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How Constant Therapy revolutionized one SLP’s practice: Interview with Janet Gruber MS, CCC-SLP

Constant Therapy | Clinician

“Since using Constant Therapy in my practice, I can see significant gains in skillsets… most often it facilitates a quickness in processing speed and sparks memory gains that are evident not only to me but also to a patient’s family.”

As part of our mission to reimagine brain therapy, we want to bring you stories of how Constant Therapy has helped clinicians and patients improve real-world outcomes. To that end, we recently interviewed Janet Gruber MS, CCC-SLP, who has dedicated over 40 years of her life to helping patients as a speech-language pathologist (SLP). In this interview, Janet discusses her career trajectory and how Constant Therapy has been a key discovery for revolutionizing her practice and improving her patients’ lives

The following interview has been edited for concision and clarity. 

  • What types of clinical settings have you worked in?

I have been practicing SLP since 1979, and I have focused on adult neurogenic work in a variety of clinical settings since then, from acute care and inpatient rehab to home health therapy with a short time in skilled nursing facilities. For the past 13 years, I have focused on providing speech and language therapy services in an outpatient setting serving adults with cognitive retraining needs.   

  • Which neurological injuries or disorders do you treat?

In my early years, I primarily worked in the area of stroke rehab. However, that early emphasis expanded to cognitive retraining in various diagnoses that now form the majority of my caseload. Those diagnoses include multiple sclerosis (MS), Parkinson’s Disease, mild cognitive impairment, traumatic brain injury (TBI), and concussion. 

  • What are your favorite and least favorite aspects of being an SLP?

Like most SLPs, my favorite aspect is treating and teaching patients. By incorporating family members into each session, I can appreciate how strategies that the patient and I work on take hold in their day-to-day lives to help improve communicative and cognitive functioning. My least favorite part is charting and dealing with denials from third-party payers, such as insurance companies. 

  • How did you hear about Constant Therapy?

I learned about Constant Therapy from a colleague, and I have been using it as a supplement to my outpatient visits for over 5 years now. I wanted to see how technology might help my patients, and I first introduced Constant Therapy to some of my younger patients experiencing mild cognitive decline. Then I introduced the program to my older patients. Once I showed them the ease in which to operate an iPad or tablet,  I found that the format of CT was easy for them to pick up—you just push a button and the therapy starts. At times a family member will need to assist for the first few sessions, but generally, I found the majority of my caseload to be independent with the program after the first few weeks. 

Now, I encourage my patients to do Constant Therapy every day or 3 to 5 days a week as an add-on to outpatient speech/cognitive retraining therapy. 

  • How does Constant Therapy help you optimize your SLP practice?

In a busy practice with high demand for productivity, I have little time for prep work and even less time to create individualized homework, so Constant Therapy serves as a great home program that is very convenient for both myself and my patients. CT saves me so much time in gathering “pages” looking through workbooks for supplemental support, that I can then spend my time on developing patient strategies. After all, we are being referred to and getting paid for our unique expertise in problem-solving and implementing techniques, unlike that of other disciplines or interested parties

After assessing and working with my patients for a few sessions, I can quickly determine which cognitive or communicative modules and at which level within the Constant Therapy program are suitable for that patient’s needs/skills. I can also take a quick glance at a patient’s past homework in the app prior to starting a speech/cognitive retraining therapy session, as well as set up or adjust their new homework modules with a few clicks.  I can see progress beyond accuracy levels, by looking at latency and processing speed. These are crucial markers of gain of function that are easily acquired by CT’s tracking data and are valuable to my charting dynamic changes or progress for a patient on a weekly or monthly basis. Gains in processing speed, in my professional opinion, demonstrate the most beneficial improvement for a patient, yet are very difficult to capture or chart on in a typical  cognitive retraining session, 

Therefore, latency scores should always be included in charting gains. 

The adjustability of Constant Therapy is particularly useful: if a patient reports that their program or a specific module is too easy or too difficult during our session, I can address the issue right then and there with only a few taps. 

  • Which features of Constant Therapy do you find particularly beneficial as an SLP?

One great feature of CT is the wealth of stimulus items per module that it offers. As most SLPs know, we might find the perfect task for our patient in a traditional workbook, but there will be at best 10 or 15 examples for that task. That’s not ideal, because in learning theory we know that repetition is the hallmark of learning. However, with Constant Therapy, I can have my patient stay on a single task with multiple examples and practice provided for as long as it takes him/her to master the skill. 

Another aspect of CT that has been very beneficial for almost all of my cognitive patients is its ability to pair well with in-person therapy. I use this combination to adapt my selection of speech therapy strategies to individual patients’ strengths. During a session, I might want a patient to try out a specific technique/strategy to see if it is helpful. Using a module in CT with multiple samples available, I can compare a patient’s baseline score, for example, from the first 10 trials completed without using the technique, to the score the patient achieved while implementing the technique. This allows me to keep all other confounding variables to a minimum to evaluate the efficacy of a given strategy in a cleaner psychometric effort. This supports my charting efforts while introducing strategies with ease in collecting that data. 

Constant Therapy also provides a great variety of communicative/cognitive exercises in the key treatment areas for each patient’s cognitive retraining program. Because of this, I can offer my patients homework simultaneously targeting attention, memory, and problem solving, all within a 20 to 30 minute time frame each day.

  • Why is Constant Therapy an effective tool for your patients? 

The fact that the Constant Therapy app provides positive feedback in real-time is very helpful for keeping my patients optimistic and encouraged. And, from my perspective as an SLP, the great thing about CT is that it helps keep patients accountable. Clinicians can see how much homework patients did in the app between visits, and my patients know that I can see their scores and how many times they engaged in the program that week. Since I stress their “buy-in” into their time with me and subsequent homework time for maximum gains, this eliminates any guesswork about whether the assigned work was completed. 

Constant Therapy is also helpful because it’s enabled by technology and can therefore achieve continuity across modules that old-fashioned workbooks lack.  

  • What do your patients like most about using Constant Therapy?

The immediate, positive feedback is very motivating for my patients. Most of my patients are encouraged that they can instantly see their scores, and that stimulates long-term commitment. 

Constant Therapy also helps facilitate independence. The app’s self-guided mode, along with its instant feedback, allows patients to do their homework with the minimum amount of assistance from others. Because Constant Therapy is driven by technology, almost all of my patients are motivated, entertained, and willing to complete daily independent homework sessions. 

  • How often do you encourage your patients to use Constant Therapy?

I generally abide by the CT research that suggests doing 4 to 5 hours of Constant Therapy per week maximizes gains in a troubled area. I typically design a program that will cover a 30-minute set to minimize fatigue and then encourage my patients to do this twice daily. For some patients who might find that too challenging, I instead create 15-minute programs within the app and suggest doing 3 to 4 sets per day. 

  • If you were to offer one takeaway about Constant Therapy to prospective users, what would it be? 

After using Constant Therapy in my practice for the past 5+ years, I can honestly see significant gains in skillsets when a patient commits to the program as assigned. Most often it facilitates a quickness in processing speed and sparks memory gains that are evident not only to me but also to a patient’s family.  Its ease in setup, patient use, and daily/weekly adjusting is paramount for the busy SLP.

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