A humorous and educational look at speech pathology.

Archive for May, 2012

Board Games and Speech Therapy: The Chain Game

This weekend, my wife and I will be attending the Origins Game Fair in Columbus, Ohio, and as I look for new games to play and blog about at the convention (if you know of one I should check out, let me know) I’m leaving readers with a review of a game that I found at the convention a few years ago: The Chain Game by Out of the Box Games. Also, this game, as well as some other games that are cycling out of print, are super-cheap at the Out of the Box website right now – go here and use the discount code DEALS.

The Chain Game by Out of the Box Publishing

Variants/Expansions: None.

General Overview: The Chain Game is a phrase-naming party game for 3-10 players. The first player starts by reading a two-word phrase or compound word, like “chalkboard” or “traffic light”. The next player must name a two-word phrase or compound word using one of the words in the previous phrase/word. For example, “chalkboard” can become “boardwalk”, “sidewalk chalk”, or “game board” (among others). A word combination may only be used once. When a player can’t think of something for more than five seconds, one of the other players honks the horn included in the game, and that player loses one of the plastic chain links they received at the start of the game. When a player runs out of links, the game is over and whoever has the most links left wins.

Skill Support:

  • Literacy – This game features a significant amount of reading at the word level.
  • Vocabulary Naming – The core mechanic of this game is thinking of vocabulary terms.
  • Figurative Language – This game rewards players who are able to think out of the box (pun intended) and use idiomatic expressions. A player who can think of and use terms like “toss-up”  or “about face” are more likely to do well than players who can’t.


  • The game is simple: Like other Out of the Box games, this game is easily played out of the box with less than five minutes of setup and rules explanation. Modeling game play is easy.
  • The game is quick: At a manufacturer-recommended time of 20 minutes, this game can easily fit into a 30-minute group treatment session.
  • The game works with vocabulary at an abstract level: There aren’t many games and activities that can quickly deal with vocabulary at an abstract level. That by itself makes this game worthwhile.


  • Literacy is required, and at a relatively high level: All the cards have words, and the vocabulary is too complex for younger students. I wouldn’t use this game earlier than 5th grade.
  • Narrow scope: The Chain Game doesn’t address many of Gardner’s multiple intelligences. It engages linguistic intelligence well, but that’s about it. Students who learn best through other methods – and not many speech and language students learn best using linguistic intelligence – may need some reinforcement to enjoy the game or find it effective.
  • Negative scoring/Player elimination: Negative scoring, demonstrated by the removal of links, and player elimination can be demotivating for many students. The first time I used this game in therapy (during my clinical fellowship year), my 5th graders more or less universally rejected the game for no reason other than the negative scoring.
  • Perseveration – I’ve had many games where the students just repeated two-word phrases starting with “red” for three times around the group before I told them they had to pick something else.


  • Keep it concrete: By taking out many of the word combinations that are abstract – whether figurative or referring to a movie or book title – you can lower the entry age of the game a bit, but significant modeling is still going to be needed with younger students.
  • Kinesthetic engagement: For students who aren’t visual learners, providing some form of kinesthetic reinforcement can get these students more interested in the game. This is going to require creativity on the part of the therapist, though, because substituting picture cards is going to be difficult (unless you have a really extensive set of cards that includes a wide variety of adjectives). My best suggestion on this end would be something like those flipbooks where you make crazy aliens or animals by mixing up parts, but that’s almost to the level of creating another activity.
  • Collaborative input: This game really works well as a group activity if you take each group, read off a card, and give the groups five minutes to think of as many phrases as possible. Each group gets one point for each answer no other group thought of (similar to Boggle), and mixing the groups up throughout the session means that each student has an equal opportunity to excel (and provides a great opportunity to work on pragmatic and social skills).
  • Positive scoring: By adding links for each correct answer instead of subtracting links for not thinking of an answer, this game can maintain positive reinforcement strategies and remove player elimination while still being a competitive game.

Alternate Uses: I haven’t really used this game outside its specific context. For anything else I’d want to use the game’s prompts for (storytelling, etc), I’ve had much better luck using materials from other games. The links could make good kinesthetic scoring tools in other games, but I’ve not had success with alternate uses otherwise.

This game is a good game for middle school students – it handles language on a more complex level, and there aren’t many games that do that without modifications. However, if you’re working with students that are younger than 6th grade or so, you may find this game to be a bit too much for them (although I’d welcome suggestions as to how to do so).

Has anyone else had experience using this game in therapy? How useful has it been? What other uses and modifications have you used?



Follow-up on Critical Reasoning Post re: CNN Article About AAC and iOS

Hey all,
I promised that I’d post an update if I heard back from AssistiveWare about the figures cited in the CNN article, and I heard back this afternoon. Short version: AssistiveWare’s white paper was misquoted, and their survey was deliberately designed to be a self-selecting report from those interested in AAC on the iOS (and clearly reported by AssistiveWare as such. David at AssistiveWare also was very helpful in providing a reference to their actual survey, which, from my reading, describes its methods well and reflects figures that seem far more reasonable with my expertise and other consultations.

I hope this provides a fair picture of what was reported by CNN and what AssistiveWare actually found and emphasizes the importance of critical thinking when reading news reports on AAC and speech pathology (or topics in general).


Better Speech and Hearing Month: Speech Pathology and Critical Reasoning

Update: I heard back from AssistiveWare about a day after I e-mailed them. In brief, CNN misquoted their report, and the accurate report (which presents a survey with methods clearly described and results that make sense) can be found here.

As speech pathologists, we hear about the need for good evidence and data tracking on a consistent, if not constant basis. As we review data, we develop a sense for when the data is inconsistent and/or unreliable. For example, if a student taking a standardized language test scores 40 points higher on the expressive portion of the assessment than on the receptive language portion, something is likely off, because the student is supposedly expressing language they’re unable to understand (my experience indicates that this frequently indicates either a culturally biased assessment, environmental interference with testing, or the presence of an attention disorder, although I always get the latter verified through other disciplines). Ideally, we should also be applying these same principles of “that doesn’t follow” to research and other presented data that we encounter related to our profession and others. I recently came across such a case reading this article about iPads and autism. The article makes a number of vague and questionable implications about the “revolution” in AAC the iPad created (to be fair, the iPad innovated access and interface significantly, but the media sometimes seems to present the iPad as inventing AAC or mentions the existence of previous devices in paragraph 10), but I found the following statement particularly interesting:

“David Niemeijer, founder and CEO of Amsterdam-based AssistiveWare, creator of Proloquo2Go, said that 90% of AAC users use an iPad for communication, and more than 25% use an iPhone or iPod Touch, according to the company’s surveys.”

These numbers, coming from the CEO of a prominent company in speech-generating AAC software, seemed inflated, especially since Medicaid (at least in Michigan) isn’t paying for iPads, iPhones, or iPod Touches. In my five years working in schools and home care, I’ve encountered two clients who use either – I’ve personally (with my admittedly limited sample size) seen more kids using GoTalks than iPads.

Thinking about the issue a little more deeply (and only a little – I’m blogging, not doing peer-reviewed research), the following questions about the figures emerged:

1. Did this get reported accurately? Reporters mishear (or “mishear”) executives all the time, especially when a certain figure would look impressive in an article, and verifying that the figures were accurately reported is the first step when analyzing the information.

2. Assuming that all of the people using AAC who do not use iPads use an iPhone or iPod Touch for communication (so minimizing overlap between the figures), more than 15% of AAC users use both an iPad and an iPod Touch/iPhone for communication. That’s also a pretty extraordinary figure.

3. What’s the definition of terms – in particular, what’s meant by “AAC” and what’s meant by “for communication”? Does the AAC definition include low-tech solutions like communication boards or a pen and paper? Does “for communication” specifically refer to using the iOS device as a speech-generating device, or would it also count if, say, someone used a communication board or GoTalk to generate the message but used FaceTime to send that message to its recipient?

4. What populations were included in these surveys? With the article being about children, did the surveys include populations that have different communication needs and different levels of technological familiarity (thinking in particular of adults with aphasia or cerebral palsy, who may not be appropriate for any high-tech AAC solution)?

5. How was data collected for this survey? There are a few critical variables with regard to this: who was asked (a parent and an SLP may have different definitions of what AAC is and have different response rates), how they were selected (public health enrollment lists? AssistiveWare’s mailing list? Names out of a hat?), and the manner of contact and response (physical mail-in surveys will be responded to at a different rate and by different demographics than a phone survey or a web survey) play a significant role in shaping the data collected.

I don’t know the answer to any of these questions. I contacted AssistiveWare asking them, but since that was about fifteen minutes before writing this post, I’m unsurprised that I haven’t yet gotten a response (although if I get one, I’ll be sure to discuss it here). And in the end, this isn’t about AssistiveWare or the CNN article in specific; Mr. Niemeijer may have well-collected data to support the extraordinary figure that was presented, and more power to him if he does. What this is about is the speech language pathologist’s role and responsibility as a trained specialist in the field to first identify information and claims that don’t fit well with our experience, and then apply critical reasoning skills to determine reasons that our data doesn’t mesh with the claims and, if appropriate, how to modify either the data-collection methods leading to the claim or our own practices to improve outcomes for our patients and students. The cycle of data collection, analysis, and modification is central to providing evidence-based practice (which, as others have recently pointed out, is not the same as research-based practice). Further, in a culture where the media reports the information that sells best rather than the information that informs best – or, to be fair, in a field where analysis and outcomes can change with new research or new investigations of old research (I’m looking at Mr. Wakefield and his “groundbreaking” research linking autism and vaccines as an example) – identifying popular news within our scope of practice, critically analyzing its claims, and educating those we serve is a critical service. If we don’t take the lead in this, who else will?

As always, the comments field is open. I’d love to hear what others think.


Board Games and Speech Therapy: Uno

Most of the games discussed in this series have been games with a clear language application. Today, I’m departing a bit from that and talking about how to use Uno by Mattel as a “stealth” therapeutic tool in speech therapy.

Variants/Expansions: Uno is a huge franchise with many, many variants, including Uno Attack, Uno Stacko, Uno Spin, Uno Dice, and Uno Dominos – not to mention all the themed Uno decks (Harry Potter, Star Trek, Hello Kitty)…

General Overview: For those of you who are unfamiliar with one of the world’s most popular family games, Uno is a card game in which 2-10 players try to play all the cards in their hand by matching the color or number of a card in their hand with the card most recently played (so a player could play any blue card or any 4 on a Blue 4). If you can’t play, you must draw a card, and if you forget to yell “Uno!” when you get down to one card in your hand, you must also draw cards. The first player to zero cards wins.

Skill Support:

  • Color Identification – You need to be able to identify (or at least match) red, yellow, blue, and green to play the game successfully.
  • Number Identification – As above but with numbers zero through nine.
  • Following/Remembering Directions – If you ever want to get down to zero cards, you need to remember to say “Uno” when you get down to one.
  • Divided Attention – This game is probably the simplest game for supporting divided attention out there – while you’re trying to determine your next move, you’re also trying to catch your opponents forgetting to say “Uno” when they’re down to one card.


  • Simple Directions: Play a card that matches or draw a card. If you have one card left, say “Uno”. Teachable in less than a minute.
  • Literacy free: Sure, the numbers are technically literacy, but there are no words that need to be read. Even Wild and Draw Two cards are identifiable via icons rather than text.
  • Engaging: This game is a game that most of my students would play every day if I let them (and with some of them, I do – see below).
  • Familiar: Most of my students have already played this game at least once before I introduce it, making it an easy transition game for new speech students.
  • Therapist Participation: This is an easy enough game that the therapist can play with the students at their level, engaging them more directly.


  • Unforgiving Rules: A student who has a hard time remembering the “Uno” rule will never win this game unmodified. Ever. This can get very frustrating unless the rules are modified.
  • Lengthy Endgame: Uno ends when you’re able to match the one card in your hand with the color or number of the last card played. That gives you slightly more than a 25% chance of being able to win on your turn. It’s amazing how long it can take for that 25% chance to work out sometimes.
  • Hidden Information: Because you keep your cards secret from the other players, it’s possible for a student who misses a card or can’t match a number to draw many cards before realizing they can play what’s already in their hand. Worse, a student who wants to be silly and sabotage the game by claiming they don’t have a matching card when they do can extend the game nearly indefinitely.


  • Verbal Output: This is one of my favorite casual articulation games – if you require your students to say the color and number of each card they’re playing, every student is producing at least one /r/ or /l/ every time he or she plays a card, and usually more than one. Even better, it’s in a context that is spontaneous and allows for easy correction without disruption.
  • “Uno” Reminder: Allowing one or more reminders for each player to say “Uno” can help reinforce the rule and stop a student who can’t remember the rule from getting stuck drawing every time they’re about to win.
  • Therapist Observer: Uno’s a great game because the therapist can play with the students, but if you suspect that students are missing cards that match or saying they can’t match the card in play when they can, it’s easy to take an observatory role, making sure students are following the rules and even giving them some ideas about strategy.

Alternate Uses:

  • Using Uno as a reward during other games or drilling activities works well as a reinforcement or engagement tool, especially if your students are working on generalizing a learned skill.

All in all, I find Uno to be a good tool on an “off” day (assemblies, dress-down, standardized testing), and it can be creatively applied directly to speech and language skills as well.

Has anyone else had experience using this game in therapy? How useful has it been? What other uses and modifications have you used?