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This text-based course is a written transcript of the live event, “The PICO Template for Reviewing Speech-Language Therapy Apps: A decision-making tool for SLPs” presented by Lara Wakefield, Ph.D., CCC-SLP and Theresa Schaber, M.A., CCC-SLP on October 6, 2011.
>> Amy Hansen: We are pleased to have you join us for our Expert e‑Seminar titled, “The PICO Template for Reviewing Speech Language Therapy Apps: A Decision Making Tool for SLPs” presented by Lara Wakefield and Theresa Schaber this afternoon. Dr. Lara Wakefield has 16 years of experience as a speech‑language pathologist. She has researched the roles of the speech‑language pathologist and teachers in collaborative settings related to language and literacy for 13 years in several grant funded projects. She has presented at state and national meetings on these topics. She has a specific interest in writing development in children ages 2 to 7 years. Dr. Wakefield has worked in a variety of settings including rehabilitation, home health, schools and universities. She is now in private practice as an SLP and parent advocate at Wakefield Consultation Services.
Miss Theresa Schaber has 15 years of experience as a speech‑language pathologist. She has worked in various settings such as rehabilitation, SNF settings and early childhood intervention. For the past 3 years she has been researching therapy apps in the context of evidence‑based practice principles. She works PRN and as a CF supervisor for a post‑acute rehab facility. So welcome to both of you and thank you so much for joining us today.
>> Lara Wakefield: Hello, everyone. Thank you for joining us today. My name is Lara Wakefield. I will be giving you my side of the story first and then my friend and research partner, Theresa Schaber, is going to tell you her side of the story. This course is a companion course to our previous tutorial titled, “Selecting Apps for Therapy Using EBP for Choosing Intervention Tools”. This tutorial is available on SpeechPathology.com, as recorded course 5058 or podcast 5059. You can take our courses in any order. If you took our previous courses please know that the introduction to this course is slightly similar so that we can provide a common foundation for the participants.
The idea for today's presentation actually resulted from the requests and comments from our previous tutorial. We discovered that SLPs needed more information on a specific skill set and how to frame a clinical question in the evidence‑based practice model, and that is what we will be focus on today. I would like to give you a quick background on how the project started.
Three and a half years ago, Theresa and I began a conversation related to reviewing apps for therapy and evidence‑based practice framework also known as EBP. In 2008 when the app store opened for iPhones® we started searching the apps daily to see what we could use in our practice. We noticed the trend of the app reviews on the app store and the descriptions by developers lacking pertinent information. This prevented us from making informed decisions. This is when we thought we would start reviewing therapy apps and writing up some type of summary to share with other SLPs. We thought this was the greatest idea and then reality dawned on us that there was no way we could review all the apps out there on the market that could be used for therapy. We both have jobs and families and we knew this would take a lot of time.
Also, we discovered more importantly that we really would not be following the spirit of EBP if we were reviewing apps without authentic clinical questions, so I decided to tell Theresa our idea was a little too crazy. Theresa was fired up about the project and wanted to give it a go. That is when we decided to form the AppKickers Division in my company.
The goal of AppKickers is to kick around ideas. We are here to critically review apps. Critical meaning - using criteria or a guideline to inform our process. People may misinterpret the word ‘critical’ as meaning negative, and they think we may be giving a negative review; however, we are not concerned with the concepts of positive or negative related to our process. So we want to clarify that at the outset. That being said, we are not here to give you a feel good review or be down raters or haters of an app in any way. We always find strengths in an app and ways to adapt it so it can be improved. We attempt to use an EBP model to review the app to help other SLPs make decisions about app selection.
What SLPs Really Need
Finally, we respect app developers. We are app users and hope to see excellence in apps in the field of speech‑language pathology and we firmly believe that SLPs are the best people to be designing apps for clients with speech and language disorders. Theresa and I are typical SLPs and we love to talk and have conversations like this. This conversation thread on apps has progressed over several years, which allowed us to narrow our idea. We learned that what we needed to do was to teach other SLPs how to “fish in the ocean of apps” rather than give them the fish. So now Theresa is going to share her side of the conversation.
>> Theresa Schaber: We had our work cut out for us and we had very little to go on. But we're problem-solvers by nature and knew a solution was there in the cold, cold recesses of our prefrontal cortexes.
Here is what we knew at the time and what has recently come about. One, there was great potential for utilizing apps as a therapy tool. Two, however, our choices were severely limited 3 years ago. Three, only recently has there been an influx of SLP apps on the market with the majority of target populations aimed at toddlers through middle school. And four, there still lacked evidence for their development. Which leads us in to a discussion of what is known as Cultural Historical Activity Theory or CHAT, which is apropos for the current method of obtaining information these days - pun intended.
Lara explained to me that we are immersed in a CHAT frame of mind on how we view tools, which may be very different from how others view tools. She told me CHAT theorists like Vygotsky, Leont’ev, Rubinshtein and Engestrom contend that the activity is a unit of analysis and are goal directed. The interactions of a subject on an object are through the use of a tool. These tools are exteriorized forms of mental processes, which brings around a transformation, which is the act of learning as a result of the tool.
So I thought, “Whoa, Lara, you lost me. How does that relate to our current subject?” She responded with simply, “The SLPs are the subject when we view an app for its potential as a therapeutic intervention. Our interactions with the tool bring about a transformation that is learning in the object, with the object being the client, the patient or the student.” We respect differences in opinions, which incidentally are based on clinician expertise, the client values and what clinicians know to be true about whatever tools, methods and/or theories they're utilizing at the time.
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