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Why integrate the use of computers into therapy programmes? Setting up impairment based therapy programs on the PC not only provides more intensity of therapy but allows us in individual therapy sessions to concentrate more on other aspects of intervention, such as facilitating effective communication skills, and training carers and other conversation partners in strategies to assist people with communication difficulties Clients can take responsibility for some of their therapy by using the computer independently and choosing a time which is convenient for them Computers are increasingly being viewed as part of everyday life, therefore patients often feel they are getting back into an activity they did previously or, alternatively, learning a new, high tech skill which often increases their self-esteem and confidence

Sarah Woodward and Alex Davies are members of the Stroke Team across North Bristol NHS Trust# They have a patient accessible computer on two stroke rehabilitation wards% and computer equipment available for use in the community and in group settings# Recreational and leisure options are explored% as well as traditional speech and language therapy software#
During a course we ran in June% many delegates expressed an interest in forming a Computer Technology SIG to provide a useful forum for the exchange and brainstorming of ideas and equipment# If you would be interested% contact SarahWoodward (e$mail comptraining@lineone#net% tel# "''* -*" '!'! x !!+') or Alex Davies (e$mail alex#davies@north$bristol#swest#nhs#uk% tel# "''* -*( +,&+)#

Clients can discover new activities to replace some of the hobbies they now find difficult due to language or physical limitations Computer software resources enable us to adapt information to make it more accessible to people with language difficulties; we can quickly print out customised pictographic supported information in minutes for patient inclusion in meetings, issues of consent or communication charts/books. Getting started... 1. Following a stroke, many clients have to use their non-preferred hand to operate the computer. This can make using a mouse very difficult. Trackball devices, particularly those with the roller ball located in the middle, provide an easier means of mouse control. Given that the roller ball is central, they can be used by both left and right-handed users. We are using the Kensington Orbit which is usually available from Dixons or PC World for 19.99. 2. Some people find the characters on a standard keyboard difficult to see. Others find the array of different function keys somewhat scary - what if they press the wrong key? The QWERTY layout can take time to get familiar with and, for some people, the keys on the standard keyboard are just too small. Enlarged keyboards are simply plugged into the normal keyboard socket at the back of the PC. We particularly like the BigKeys keyboard range (100-130). They come with a choice of black and white or coloured keys, ABC or QWERTY layout, and there is also the option to purchase a keyguard (55). From Keytools Ltd, 023 8058 4314. Getting familiar with the PC 3. People who have never used a computer, or who are a bit rusty, need to familiarise themselves with the keyboard layout. They can do this in their own time, at their own pace, using the WAPS letter program (level 1). It presents each character of the keyboard on the screen in random order. The user must then find and type the letter on the keyboard. It keeps a running score of the time taken to find each letter, the number of errors and the location of the errors, useful for identifying visual field deficits or inattentions. FREE! from Northwick Park, tel. 4. Leisure tasks are often a good confidence-builder and show the person how they can use the computer to have fun. They can also be useful for building important skills such as opening a program or practising mouse control. In Jigsaw the person practises the click and drag functions of the mouse in a fun way. Given that it is possible to use scanned material or digital photos, the jigsaws are also easy to customise for each individual to make them as interesting and meaningful as possible. From Crick Software, 01604 671692, for 30 - a price most departments can afford. Moving onto speech and language exercises... 5. For those with dyspraxia who would like to work on their speech, a program is available which replaces the audio cassettes many therapists record for patients. Speech Sounds on Cue is an easy to use package which clients are quickly able to use independently. It provides multimedia cues for 531 CV and CVC words covering 19 consonant sounds in the initial position. One disadvantage is that the client does not have the opportunity to record their own speech attempts, although to some extent this could be overcome by setting up a tape recorder next to the PC. There are also 20 colour photos of consonant articulatory positions which can be printed out. Clients tend to find this package very motivating. From Propeller Multimedia, 0131 446 0820, 90. 6. A good set of tasks intended for people with severe to moderate aphasia is REACT. This is an easy to use language program providing interactive tasks with verbal instructions. Visual and auditory rewards are given for each task. There is also a record keeping facility to monitor improvements made over time. There are eight main sections: auditory processing, reading comprehension, semantics, sentence processing, spelling, time, money and visual matching. It is good as both therapy and assessment material. From Propeller Multimedia, 0131 446 0820, 425 (full version). 7. We have recently discovered ColorCards (Semerc, 0161 827 2927, 69) which we have installed on the ward computer. The program provides a series of activities based around picture cards presented on the computer for visual matching, semantic and categorization, and problem solving tasks. It is thus similar to the picture cards often used as resources in therapy but high tech, and therefore may feel more age appropriate for some people. Useful extras 8. For work on sentence building, and for clients with limited literacy who want to write cards/letters/emails, we find the Clicker program a handy adjunct to therapy. It can be used as a supportive writing tool. It enables the user to write with whole words without the need to generate phrases and is entirely customiseable to users vocabulary needs. It opens up within a simplified word processing window with a grid at the bottom of the screen. The grid is individually configured with as few or as many squares as is required. Each square on the grid contains a word/phrase which has been pre-stored and which takes only seconds to modify. The user can listen to the contents of each square before selecting it. The text chosen from the grid is then transferred into the word processing window to build phrases. From Crick Software, 01604 671692, 90. 9. For those clients with higher level language difficulties EFL packages can be very useful. They provide all sorts of tasks: naming, reading comprehension, spelling, following written/auditory instructions. With careful selection of exercises and flexible use of several different packages, a set of relevant and appropriate therapy tasks can be put together. The advantage of these packages is their price - they are mainstream software packages and therefore a lot cheaper than specialised speech and language therapy programs. Ones we have found useful include Smart Start English (from AVP, 01291 625439, 39.95) and Clarity Author Plus (from Wida, 020 8567 6941, 49.95). 10. For those clients who were previously crossword enthusiasts but who now find them too difficult, other puzzle programs can provide a useful alternative to fill the gap. Wordsearch (from GAMZ, 01684 562158, 49+VAT) is easily customised to enable you to change the grid size, font size and the word lists. It also allows you to make up your own wordsearch worksheet resources with your own vocabulary ideas.

Sarah Woodward

Alex Davies