In neurological recovery, there’s often a big gap between what someone can do now and what they’d like to be able to do.

To work toward that long-term goal, we need to set short-term goals that serve as stepping stones along the way. But often clinicians and families struggle to define what those steps might be. How do you get from here to there?

I’d like to offer you some ways to increase (or decrease) difficulty along a few different parameters. Many of these are built into the Tactus Therapy apps, but they can all be used in therapy activities or at home with just about any communication goal.

1. Make the language harder

The first thing we can change about a task or activity is the linguistic complexity.

Linguistics refers to all the parts of language: sounds (phonetics), the way sounds go together (phonology), parts of words that have meaning (morphology), the meaning of words (semantics), combining words into sentences (syntax), and using language in conversation (discourse). Each of these can be adjusted to make a task easier or harder.

For example, if a person is working on understanding words, we can make those words longer or shorter (cat vs caterpillar), more or less common (dog vs dachshund), and more concrete or abstract (prince vs principles). Words can grow in syllable length (in-di-vid-u-al) and meaningful units (dis-agree-able). If the goal is writing, there are regular (hat) and irregular (aisle) spellings to consider.

Sometimes people struggle to jump from words to sentences, but there are many steps in-between. We can have 2-word phrases that have a single meaning (hot dog) or that modify a word (brown dog). Sentences can be quite simple (Bob sings), include pronouns and other tenses (he sang), or grow in complexity (Bob sings a song to Sue every time she’s feeling blue).

Even in paragraphs, the reading level can be adjusted. There are websites and word processing tools that will tell you at which grade level the text is written. Aside from rewriting text to the right level, using materials meant for English-language learners could be a good bridge toward regular reading.

2. Adjust the cognitive demands

Another way to increase the difficulty is to consider the cognitive demands of the activity. This is considering how much thinking is required. I like to use this hierarchy when considering cognitive demands in any speech or language task:

1. Repeat after someone (easiest)
2. Read aloud from written text
3. Respond to a question
4. Generate content from existing knowledge or thoughts (hardest)

For example, reading aloud may be a good next step in therapy for a person with apraxia who can repeat words but struggles in conversation.

You can also add in physical and attentional demands to make a task harder. If everything is working well while sitting, what happens when you do the same task while standing, walking, riding a stationary bike, or bouncing a ball? Add in various levels of background noise such as music, talk radio, or a conversation nearby.

3. Alter the environment

Finally, any task can be made easier or harder by adjusting where and when it happens. While it’s often best to do therapy when you’re feeling your best, problems may be significantly worse when you’re tired. Talking to your family in your own home may be quite comfortable, but talking to strangers in the community is a different story.

Always consider who the communication partners are, how many people are around, the environment the task is happening in, and other personal and psychological factors like mood, confidence, or anxiety that may be affected by these variables.

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I hope these tips help when you're looking to step up or step down the difficulty of a task. Most of our app user guides have advice on which settings to adjust to make the activities easier or harder. It's so important to work at the right level - not too easy as to get bored, and not too hard as to be frustrated. Use these tips to help find your Goldilocks level in therapy - just right!

Until next time,

-Megan

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P.S. Did you know all of the Tactus Therapy apps are available for Android as well as Apple devices? It's true! Find all our apps on the Google Play Store for Android phones and tablets.

P.P.S. If you're using Writing Therapy on an iPad or tablet, you should now see an option in the Settings to use a QWERTY keyboard layout for the letter tiles. It's a way to increase difficulty toward the goal of typing - available in the latest free update!