In this episode you will discover:

• Math IS Language - It's in Our Wheelhouse Math has syntax (order of operations), semantics (number meanings), and involves memory and executive function - all areas SLPs already assess and treat. If you can help with language, you have transferable skills for math therapy.
• Start Simple with What You Have You don't need special materials or extensive math training. Use a deck of cards, dice, and real-life examples like restaurant receipts. Make numbers "friendly" (round $18.72 to $20) and let clients show you multiple ways to solve problems.
• Address Your Own Math Anxiety First Most SLPs feel uncomfortable with math, but clients need this support for life participation (paying bills, calculating tips, telling time). Acknowledge your discomfort, start with basics you DO know, and remember - if you avoid it, you can't help your clients who want to work on it.

If you've ever felt your palms get sweaty when a client asks for help with numbers, this conversation is for you. Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong, a faculty member at Central Michigan University where I lead the Strong Story Lab.

I'm today's host for an episode that might just change how you think about math anxiety - both your own and your clients'. We're featuring Tami Brancamp and Dave Brancamp, who are doing pioneering work at the intersection of aphasia and mathematics. Before you hit pause because you're having flashbacks to algebra class, stay with me! This research shows us that the language of math is exactly that - language - which puts it squarely in our wheelhouse as SLPs.

We'll explore how to support our clients with aphasia who are struggling with everyday math tasks like counting change, telling time, or balancing a checkbook. And yes, we'll tackle the elephant in the room: addressing our own math insecurities so we can show up confidently for our clients.

Let me tell you about our guests. Tami Brancamp is an associate professor at the University of Nevada, Reno School of Medicine and founder of the Aphasia Center of Nevada. Her research focuses on identity in aphasia and rehabilitating everyday math skills. Dave Brancamp spent over 15 years as a junior high math teacher and later became Director of Standards at the Nevada Department of Education. Together, they co-founded Aphasia + Math, where they're exploring how language and mathematics intersect for people with aphasia.

Okay now let's get this Aphasia + Math conversation started!

Katie Strong: Tami and Dave, welcome to the podcast. I'm so excited for you to be here today.

 

Dave Brancamp: Thank you.

 

Tami Brancamp: We are both super excited to have a chance to talk about things that are different, right?

 

Katie Strong: Right. I do have to say, I don't know if it was a rash, but I did get a little bit nervous coming into the conversation, because I think I may be one of those SLPs that feel a little bit uncomfortable with math.

 

Tami Brancamp: Well, this SLP also is uncomfortable with math, so we can be uncomfortable together. And we'll let the math dude guide us through some of the things.

 

Dave Brancamp: And it will be fun. By the time you're done, I want to see that smile that you have on your face.

 

Katie Strong: Well, let's jump in and have you share a little bit about how you came to researching aphasia and math.

 

Tami Brancamp: Well, I have loved working with people who have aphasia since the beginning of my graduate studies. And then probably, like most of us, there's a few clients who've really hit your heart. One of them, I don't recall her name, and that's okay, but she had a stroke, had aphasia. She had had great recover physically, and her language was quite good, some anomia. But she's a banker, and she could not process numbers, and she was angry. I'm a newbie, I didn't understand the emotional piece of stroke survivor, aphasia. can't do my job well. But she was angry, and I felt so helpless. I didn't know what to do to help her. You know, I could pull a workbook off the shelf or something, but it didn't feel right. You know, she could do calculations, but couldn't do her job. And I always felt so very, very helpless over the years.

 

And the other part that came to start looking at this was teaching in a speech pathology program, undergrad and grad. And in class, maybe we're doing an averaging or something to get a score. I'm not sure if we start talking math, and I would see these students, and their eyes would just like, pop up, like, “Oh my gosh, she's asking me to do math.” And like, deer in the headlights. So I'm like, “What is this?” Every semester, I would do kind of an informal survey when we would do a little bit of math, and I say, “Okay, so how many of you don't do math? Raise your hand or are afraid of math?” And it would be at least two thirds to three quarters of the class every single semester, and I'm like, “Okay, there's something here.” Like, if I'm afraid of math, how am I going to help my clients remediate that in an efficient way? Right? I'm going to avoid it. If I can, I'll go do other things that are important.

 

So those were, like, the two big things, and then happened to be married to a math dude. And I wondered why are we not combining our skill sets? Because I would come home and I would share with Dave. I'm like “Dave, the majority of my students are afraid to do math or uncomfortable doing math.” And it's not complicated math. We're not talking quadratic equations or things I don't even know what they mean anymore. And we would talk about it a little bit, and we talk about math attitudes and perceptions and how we develop our math skills. And I'm like, “There's something here.”But I was never taught, how do you remediate number processing? Calculations? right? But yet, I would have multiple clients say, “Hey, Tammy, I can't do numbers.” “Yeah, how do I do this?” And there really wasn't anything the literature that told me how to do it. So, I would talk to Dave, and then, just over the years, I'm like, “Okay, we need to do something with this. We really do.” And I don't know what that means, because I'm not most comfortable with math, it is not my passion. We're very opposite. I think I shared like, Dave has math and fun in the same language, and then in the same sentence, I'm like, “they don't go together in my brain.” So we're very, very opposite. But you know, you can speak for yourself how you grew up and you had to learn how to embrace math, and having good teachers helped when we were younger, and having poor teachers or teachers with different attitudes also left a lasting impression. But when you think about it, whether it's, you know, cooking, driving, banking, living, going to grocery store, restaurants, everything we do all the time, it all involves numbers to some impact, you know, to some effect. And our folks with aphasia, again, not everybody, but the majority of them, will still have an impact with acalculia, difficulty processing numbers and calculating and transcoding, you know, saying, saying the numbers. So, we started to look at it.

 

I did have a had a gift of time with Audrey Holland. So that was my beautiful, like, for many of us, a mentor, you know, she had her three-pronged stool, like the different parts of aphasia. And Dave and I started dividing it up, like, what were the parts we thought involve, you know, aphasia and numbers. And we did think about the math and language math skills, making it fun, but also those influencing elements, like attitudes and perceptions. So, we started just like, “How do we look at this?” Because it's really overwhelming just from the beginning, you know, and just pulling that workbook off the shelf didn't do it for me. You're allowed to speak on that. (Laughter)

 

Dave Brancamp That's one of my passions, obviously, the whole math side. But pulling a workbook is an unfortunate because if someone starts to practice something wrong, they'll repeat that practice, and now it's very difficult to get them to correct a habit, basically that you've formed. And sometimes it's like that nails on a chalkboard? That's what it feels like to me when I hear it. I'm like, “Oh, don't do that.” Because if they're doing it wrong, like, 20 times, 10 times, even then it performs a habit that's real hard for them to go, “Well, but I thought I got them all right.”

 

Katie Strong: Yeah.

 

Dave Brancamp: Because I think we can all go back to math and you come up unless it was something really, really difficult in at least in our early years of math. We all came up with an answer. And that's how it feels on a worksheet that might have like just adding single digit numbers, if you make an error, you won't know until someone either corrects it or asks you, “How did you get there?” And to me, that's where it became more important. And then I had to learn how to do what do you call it? aphasia friendly language, you know? So, math folks usually speak in short sentences, so that helps. But we'll run a whole bunch of sentences together. If I give you the best example. I know we're going to talk a little bit about that math perception quiz, the difference between us on that question, I think it says “I would prefer to do an assignment in math rather than write an essay.” I'm the person to give me that math assignment. 100%. Tammy is like, give me the essay!

 

Katie Strong: And I have to say I'm right there with Tammy.

 

Tami Brancamp I think so, as speech pathologists, we learned about the pedagogy of language and language development. We can analyze it. We can treat it. We can assess it. And then I talked to Dave, and he goes, “Well, there's this whole math I know there's a math pedagogy, and there's this whole developmental progression of how we learn math.” But “Really, okay, well, I've never learned that, right?” “No, you learn this before you learn that.” We lived it, we just weren't overtly taught it. Or how you know, if there's an error in a calculation, that means that there's some challenges in this part of your developmental math abilities. Like, “Huh, okay, well, that kind of sounds like language to me, a little bit.” They do go together.

 

Katie Strong: Yeah, yeah. So, I love to maybe ask a little bit about this. As we've pretty clearly stated, many SLPs feel uncomfortable with math and their own math skills.

 

Tami Brancamp: Yeah.

 

Katie Strong: And we, probably many of us, have avoided it in our own education.

 

Tami Brancamp: Yeah.

 

Katie Strong: So I love this idea that there's the language of math, and I was wondering if you could talk a little bit about that and why it should fit right within our scope of practice as SLPs.

 

Tami Brancamp: A long time ago, I remember how many years ago I came across an article by Seron 2001 in Aphasiology. And he or she, I actually don't know, stated that math should be part of the SLPs practice. I started looking at 20 years later, and it still wasn't (a part of our practice). So, something's really amiss. What are we missing? When we talk about the language, there is a syntax in math. Dave calls it order of operations. And I don't even know what the PEMDAS.

 

Dave Brancamp: PEMDAS.

 

Tami Brancamp: PEMDAS, right?

 

Dave Brancamp: You what scares most people about that? Parentheses, exponents, multiplication, division, addition, subtraction. The left to right. I mean, that's the part people left off.

 

Tami Brancamp: But, ah, yeah, that kind of sounds familiar, doesn't it?

 

Katie Strong It does. It's ringing a very faint bell.

 

Dave Brancamp: It's like, oh no, we're not going to do that.

 

Tami Brancamp So there is a syntax. There's an order of operations, how we put mathematical equations together. Just like how we put sentences together. There's semantics, right? There's word meaning. We have a little sign for you. It won't translate audio, but we'll talk about it. So, in math, and you use the word or the number, the orthographic representation 2, right? Yes. And then we spell it TWO. We also spell it TO and TOO. And then, if you say, “Okay, we also have a two in the number 12, right?” They have to be able to transcode that and a two in the number 20, the two zero. The two in all those locations has different meaning, right? So, it does have semantics.

 

The other parts, I think, were important, was memory and executive function. Executive function permeates mathematics in so many ways. So, when we think about our stroke survivors, those are areas that are and can be impacted. Information processing. How much can they hold in memory of being presented with language, and in this case, language and numbers.

 

So, I think for me, it just, it really is integrated. I also thought, too, when we were looking, I was looking at the neuroscience of it, and there's some shared neuro space that works for math and language. They're not fully disassociated, so I found that really fascinating as well.

 

Katie Strong Yeah, it really is, as I've been thinking about our conversation and just looking into things a little bit, it really makes sense. And even just thinking about just thinking about a word problem in math, certainly, there's that language component that may be a little less intimidating for SLP clinicians that aren't typically working in practice. But I so appreciate you both bringing this conversation out into the light and doing this work, because I can think of a significant number of clients that I've worked with that have also expressed challenges in all sorts of different ways of math. And sometimes I've been able to maybe support it a little bit, and other times I haven't. And I, you know, whether it's me just avoiding it and saying, “Oh, we could work on all of these other things or we can work on this math thing”  or, you know, it's just frustrating, I think, to not have really the tools to be able to know how to support it.

 

Our podcast, really focuses on the Life Participation Approach to Aphasia, which really emphasizes a person-centered approach. Like I'm the client I want to choose what I want in my life and what I want to work on. And so, I'm just wondering if you might be able to talk through a little bit about how math skills fit into LPAA framework.

 

Tami Brancamp: Yeah, we were talking about that, and there's one particular client who has multiple PhDs before his stroke. He has family, adult children. And he's like, “Tammy.” And we were Dave and I were piloting some work together. And he's like, “Guys, I want to take my family to dinner. I want to pay the bill and the tip.” I'm like, “Okay, dude, I got an app for that.” And he's like, “No, I want to do it myself.” So that, to me, is life participation. If a person is fine with an app, let's make it so and work on something else.

 

Katie Strong: Yeah.

Tami Brancamp: But his case, it was so important to him. I'm like, “Okay, here we go.” How do we how do we work on figuring out the tip? Now, does it have to be an exact percent? No, Dave likes to teach it more like there's some more strategies to get to the tip.

 

Another client I wanted to share, and sometimes too, when we think about assumptions. So, the data on how many people with aphasia also have math difficulties, numeracy difficulties is wide ranging. It's so big. So you can't even really say what percent. But I also had an assumption. I have a gentleman who I've worked with off and on for a very long time. He's nonfluent aphasia and also has apraxia of speech, and so we're working a lot on his language and his speech. And I said, “So how's your math?” “It's fine. You know, I own my own business and I have somebody help, but it's fine.” I'm like, in my head, hmm, I don't think so. I wonder, because the severity of his aphasia and his ability to transcode so like, see a number and then say the name or say the numbers he wants to say, was really impacted. So, we were doing a pilot study during the pandemic online, and so Dave and I were working with this one gentleman. And I think you why don't you do the story because I don't remember you gave him homework or something. A home program.

 

Dave Brancamp: There's a math game called Krypto.

 

Tami Brancamp: Oh, Krypto.

 

Dave Brancamp: So you put five cards down. And each one has its value, you know. And so your listeners just so they know, like when the Jack would fall, that would be 11, and so the Ace automatically took a one, the Queen would be, you know, 12, and the King 13. So five cards different values, or they could be the same value didn't matter, and then one more card became like a target. You had to figure out an equation. So, some big, nice math term there to that you'd add, subtract, multiply, divide to equal this last card.

 

Now they could do with just two cards, three cards, four cards or five would be ideal. So, they had some room for success. And this gentleman, we had some hard numbers that were there. And, you know, he had done a couple, and was rolling right through. And I kept looking over at Tami and I am like, "He's got his math. His math is really good.”

 

Tami Brancamp: His ability to calculate.

 

Dave Brancamp: And then we hit one that was really hard, and we're both looking (each other). And the next thing, you know, this gentleman, not to scare anybody, but makes a complex fraction, making a fraction over another fraction to solve. And you can see right now, right Tammy. Tammy is like, “What are you doing?” I'm like, “Yeah, yeah, no, let's go for it. Let's go for it.” And next thing you know, we were able to solve it by doing two complex fraction with another number. And he solved the problem. And I looked at Tammy said, “This man has no math problems.”

Tami Brancamp:  And I said, “Boys, I'm out. I'm out. You all just continue playing with your numbers. Have a good time.” That's not a comfort zone for me. It's also not the focus we're doing with aphasia in math. But it was something he was capable to do, and I also could see within him, he was super excited that he could do this.

 

Katie Strong: Yeah

 

Dave Brancamp: And he wanted to show his wife. He wanted to show other people, he was like, “Look at this. Look at this.” You know, I was like, “Yeah, there's a lot happening.”

 

Tami Brancamp: But he could not read the equation. Okay, so there's the aphasia language issue.

 

Katie Strong: Right.

 

Tami Brancamp: Transcoding. He could do the calculations without difficulty.

 

Katie Strong: Amazing.

 

Tami Brancamp: But those are the those are really fascinating. And while we were piloting, we had a group of, I don't know, five or six people with aphasia, and each one had their own. They're all on the non-fluent side, but everybody had their own combination of language difficulty and number processing difficulty. We did notice what one client we worked with who had more cognitive impairment along with language and hers, her processing was much more different than pure aphasia and the acalculia issues. So, it's really interesting to see. It's definitely not cookie cutter, right? Just like aphasia therapy.

 

Katie Strong: Right.

 

Tami Brancamp: Every person's got their unique strengths and challenges. And I'm going to say similarly, I think with the math. Where in the brain was the injury? What is their background? What are their interests and passions? All of that plays in just like in aphasia.

 

Katie Strong: I love bringing up though their prior experience with math too is so important. We think about that from a language standpoint, but we really don't consider that. Or I will speak for myself, I don't typically consider that when I'm learning about somebody and their strengths.

 

Tami Brancamp: Yeah.

 

Dave Brancamp: You think like to go back to your language, like the word “sum” S-U-M, is what we'd use in math for adding, but it has the same sounding as “some” S-O-M-E and so right there, there's some language difficulty that could come out. So often we will have flash cards with the plus symbol so that they and can associate words and just so that you feel better on it, too.

 

Most of us, when we'd heard subtraction probably used an unfortunate phrase of what's called “takeaway”.  Well, that's not what happens from a mathematical point. So, us in the math side, cringe and are like, “Oh well, the numbers don't get taken away. They're still there.” They got, you know, replaced is what we would call them. And so the word of difference, you know, where you live in a different town than we do, so that's what we associate but difference is how we do subtraction. So those little, simple nuances that I had to also remember too because I taught junior high, which most of them were fairly comfortable with their, you know, at least their basic skills. And I'd heard those terms where suddenly, you know, Tammy would bring up to me, “You're gonna have to help us out with that” because that it's easy for you to say that it's causing a problem and that makes us then, you know, have those moments of pause that you're like, “Oh yeah, you're right. I've got to do that.”

 

Tami Brancamp: Just a little aside on that with we just finished a pilot study with two groups of people doing online intervention. So that background of knowledge, you know, say you got 10 people in a group, and you could see the people who go, “Oh yeah, I remember that. I remember that math language.” You're getting, the nodding like, “Oh yeah, that's right.” And then there's others who have like, “I don't understand what he's saying.” The look. So, it's really fascinating to make sure that we pay as much attention to that background as we do in language.

 

Katie Strong: Yeah. Interesting, interesting.

 

Dave Brancamp: I don't know if you want to go down that path, but like when we hit time, you know, which is an element that folks aphasia really want to work with, right? And yet, it's a whole different concept mathematically, because we are used to in almost all the countries we work with of things from, you know, basically what we call base 10 or zero to 100 zero to 10, we can play time is in elements of 12. And so, like you might say it's a quarter past, you know, like one, that's not a 25 it's written as 1:15. And you know, what does that mean? And, oh, I don't know. I don't know how I'm supposed to be at the bus stop or the doctor appointment or whatever they may be going to.

 

Katie Strong: Right, right.

 

Dave Brancamp: And a lot of our groups found that to be a huge help, you know. And as much as we all laugh, you probably at least most of us remember when we were in elementary school having little clocks that we might play with.

 

Katie Strong: Right

 

Dave Brancamp:  We call them our Judy clocks from when we were as teachers. But it's like, as simple as those are, those are what you need to bring back and go, “Let's take a look at what you know, because it's a quarter of the circle, and that's where it got its name from.”

 

Tami Brancamp: But it's one over four, like 1/4 one quarter.

 

Dave Brancamp: But that's not how we'd write it in time. It's actually whatever the hour is and the 15, and you're like, “Where'd that come from?” So, it was very fascinating to watch,

and especially when we did some work with some of the clinicians, are just like, “Oh, you're kidding. I didn't even think about that.” It's because we knew it. we transition it naturally and not thinking, “Oh my gosh, my brain now has to re-picture this”. So.

 

Katie Strong: It is fascinating.

 

Tami Brancamp: And that you can see how much language is involved.

 

Tami Brancamp: Huge. Huge.

 

Katie Strong: Yeah, well, I'm excited to talk about the projects and research that you've been doing. You gave us kind of a teaser about these online groups. Should we start there?

 

Tami Brancamp: Maybe, we aren't there. We haven't analyzed all the data…

 

Katie Strong: I'm curious.

 

Tami Brancamp: Yeah, that'll be a teaser. We are working with our partner, Carolyn Newton. She's in London, and she is at University College London. She's done some work in mathematics and aphasia, and also her doc students, so we're working with them. They did all the assessment with my students. And then Dave and I did intervention. We had two groups. We had, like, a Level 1 and a Level 2. Everybody had aphasia. And we did group intervention primarily because Dave and I have been working with Lingraphica and Aphasia Recovery Connections Virtual Connections.

 

Katie Strong: Yep.

 

Tami Brancamp: Since March of 22, we've been doing it every single month.

 

Katie Strong: Amazing.

 

Tami Brancamp: We had some time off. Yeah, but you know, what's so crazy is that we average about 38 people who come on to do the session.

 

Katie Strong: Wow!

 

Tami Brancamp: Oh, I know, with a range like 19 to 50 people.

 

Katie Strong: That is amazing, but such a testament that people are interested in this topic.

 

Tami Brancamp: That's what made us keep pushing forward. Because if that many people show up, there's an interest and there's a need.

 

Katie Strong: Right.

 

Tami Brancamp: You know? But how do we how do we help is the challenge. We are in the process of analyzing, did we could that group in the way that we did it, like twice a month over three months? Would that impact change? They could hold it at the end of the treatment. And then we also did 30 days later, so we'll see. And then we also did some we did the math, attitudes and perceptions.

 

Katie Strong: I took it so maybe give people a little bit of background on what this is.

 

Tami Brancamp: Yeah. So this is a we looked at a lot of different tools, and this one is called, what is it called Attitudes Toward Mathematics Inventory. And it was designed for adults, college age, students and adults. There's a lot for children. But this is like, really, you know, what do you think about math in terms of you like it, you don't like it. Is it important? Not important. And so there is a lower number means that you are less confident, less familiar.

 

Dave Brancamp: You might not like it. You might not like it as much.

 

Katie Strong: And it might give you a rash.

 

Tami Brancamp: (Laughs) It might give you a rash!

 

Dave Brancamp: I'm sorry.

 

Tami Brancamp:  Right, all the things that it does. It's up to a point of 200 Do you want to share what your score was?

 

Katie Strong: Well, I didn't calculate it. I just did the ABCDE, but I'm gonna guess it's in the lower like 25th.

Tami Brancamp: Yeah.

 

Dave Brancamp: So let me ask you, what was your last math class?

 

Katie Strong: It was a statistics class in my PhD program.

 

Dave Brancamp: And how did that class make you feel? Were you like, “Oh, I'm so excited to go!” or like, “Oh my gosh, I just got to get this done.”

 

Katie Strong: I wanted to get out of there as quickly as I could. I tried hard, and I just kept, I think I kept telling myself it was hard and I couldn't do it, and it just and it was.

 

Dave Brancamp: So, if you think about that, for us as adults, right? Or anybody, even kids. Take our kids. Whatever your last class is, it sits with us. It's a memory we carry. And then math has its unique way of, kind of building on itself. And then it can bridge to a couple different areas and what have you, but it builds. And if your last class wasn't the most pleasant. You didn't score well, or you didn't have a teacher that you could relate with, or whatever it was, you probably don't have a real fun feeling of math. So that leads to our perceptions, right? And it's and you know, using this we've done this with some of your students as they go through soon to be clinicians, and as soon as they took it and then had us talk, they you almost want to say, “Let's take it again”, because our feeling is of that last class. But when you find out, what we'll probably do is adding, subtracting, multiplying, maybe division, not likely. But what we call basic life skills, it may change how you took the test or take the inventory, because, you know, like for me, it's still, it will never change the fact of giving a math problem over an essay. I'll give you guys the essay. I'll take the math problem. But it's just, you know, is it important your everyday life? Well, how often do you do your statistics on an everyday life? That was your last class right? Not a lot, maybe some. But it's, you know, it's becomes an interesting whatever sitting with us probably has a feeling. If we come in with a bad attitude toward what we're going to teach or share with you, no matter whether they have aphasia or if it's just us in a general setting, they're going to know you don't like this, then why should I spend time with it so we that's the My purpose is make it so that they enjoy even if it's difficult, we're going to enjoy it so that otherwise, you know, I'm already behind because you don't like it. So why should I like it?

 

Katie Strong: And I love that because, I mean, I know that, like hard work

can be fun. I mean, in a therapy situation, hard work can be fun, but thinking about this from a math standpoint really is kind of a game changer for me.

 

Tami Brancamp:  One of the things, and I think we'll come back to the research a little bit. But Dave likes gamification. I don't really like to play games, right?

 

Dave Brancamp: You're getting better!

Tami Brancamp: But you have to, you know.

 

Dave Brancamp: I will pick up like dice. We try to do things that we figure our folks could find rather easily. You know whether you have dice from a Yahtzee game where you can go pick them up and a deck of cards. Almost everything I do with them are one of those two. It might take a little more looking, but I'll we often use what are called foam dice so they don't make all that noise, because sometimes too much noise can be very bothersome. And then using, like, the whiteboard or something to write with helps so they can see, because sometimes you'll be playing a game and they'll have no idea of the math that's involved and why there might have been, like, a strategy or so on.

 

Tami Brancamp: When we do work with people using cards and dice to generate the numbers, we have activities we do and we make it aphasia friendly, but we'll also discuss, maybe after the fact, “All right, so how did you do? Where was it difficult? I want you to recognize that you were working on executive function here. You were giving it strategies and thinking and multiple steps ahead.” So that they can recognize it isn't a kid game.

 

Katie Strong: Yeah, just a game.” Yeah.

 

Tami Brancamp: It’s not just a game. It's making it fun and a little bit more lighthearted. If we can lighten it, but still make it skilled intervention, I'm not in there to play games and win. But having a give and take, a little competition, some laughter, some humor, while we're doing the intervention. To me, that's a lovely session.

 

Dave Brancamp: One of the things Katie, we found, too, is there's not a lot of good tests out there for math to diagnose the problem. You can find out by taking the different tests, and you and Tammy know the exact names, but they'll say, “Well, Dave has a problem doing math.” But now where do I start? Is a whole different game, because they build, as we said earlier, and if I don't start at the right spot the building block, I get a sense of failure immediately, because I can't do it, whereas you need to just keep backing up, just like you do in language, you keep backing up till you find my starting point. And that's one of the areas we'll maybe talk about later, is those things we're trying to figure do we work on finding a better way to assess the math, to truly know what's Dave or your client or whoever, whatever they're doing, because sometimes it could be simply the language, like we had with the one gentleman who has great math skills.

 

Katie Strong: Right.

 

Dave Brancamp: And others could be I can't even tell the difference between these two numbers, which is larger or smaller. And so now we have to start back at what we call basic number sense. It can be anywhere in that game, and it's like, well, they can't add. Well, do we know they can't add? Or do they just not recognize that six is smaller than eight.

 

Tami Brancamp:  Or how did you let them tell you the answer. If you only get a verbal response versus writing response, or, you know, selecting from four choices, you know. All of those give us different information when you're when you're having to blend a language disorder and a numeracy disorder.

 

Dave Brancamp: Because that one gentleman, he struggles immensely with anything with a two in it, so 20s, just…so you could easily say, “Wow, there's no way this man has math skills.” I mean he's doing complex fractions. He just couldn't tell you it’s one over two. It was be like, I don't know what that is called.

 

Katie Strong: Fascinating.

 

Dave Brancamp: We enjoy the game part. And one of the pieces in this last research we did that was a new thing, right? We didn't even think of it prior was what we call a home program. Taking the game we did, putting it in friend aphasia friendly language with pictures so they could practice them.

 

Katie Strong: Okay.

 

Dave Brancamp:  Because we would not see them for like a two they was every two weeks. So, some could practice. I would say our Level 1 -  our folks working on foundational sets practiced more than are more advanced. Which was very fascinating.

 

Tami Brancamp: What we were doing in this research, the most recent one, we would encourage people to, you know, take a photo, take a screenshot of the work we're doing. But we also did it too, and then we put it into a page with an explanation, and then we would send it so that they could, ideally practice with a family member or a friend, or by themselves. You know, that's also a variable for people, right?

 

Dave Brancamp: And what we found in it, they needed more pictures. In our first attempt, we didn't put as many. So we would ask them, “since you wanted this, did that help?” “Not really.” They're honest.

 

Katie Strong: Yeah.

 

Dave Brancamp: We appreciate that. And they're like, Well, what? Why didn't it like, well, it, even though we tried to make it as aphasia friendly language, it was just too much word

 

Tami Brancamp:  Too many words.

 

Dave Brancamp: Too many words. So then we started asking, “well would more pictures help?” “Yes.” So we did that. So they helped us. It was amazing to watch.

 

Tami Brancamp: So that research project will we can get to down the road once we figure out what was going on. What we did share with you was the survey that we did with speech language pathologists from the United States and the United Kingdom. So we thought, well, Carolyn's there, and we kind of look at math a little bit similarly. So we had 60 participants who completed the study. We want to know, like, do you treat people with aphasia who also have math difficulties? If so, what are you doing? Dave and I still wanted to look at the attitudes and perception, because I still believe that's an influencing factor. But we also wanted to get a good sense, like when you are working with people with aphasia, who have number difficulties, what difficulties are you seeing? And then what are you doing? What do you use to assess?  And what are some of the barriers? So it gave us a nice overview, and that one's out for review currently. Anywhere from like, how many of you work on numeracy difficulties? About 35% responded with rarely, and 40% responded with occasionally, and 17 said frequently. And also, there was no difference between the countries.

 

Katie Strong: Oh, interesting.

 

Tami Brancamp: Yeah, I thought so too.

 

Katie Strong: But I also think too, you know, I mean, there really isn't a lot out there instructing SLPs on how to do this work in an evidence-based manner. So that makes a little bit of sense.

 

Tami Brancamp: It did, because I still felt the same way for myself, like, “Where do I go to learn how to do this?” Okay. I'm married to a math teacher, so I'm learning right? It's a lot of give and take. And Carolyn, our partner, she's very good about when we're talking about this she's like, “But not everybody has a Dave on their shoulder.” Like, “No, they do not.” Because even today, I'm still a little cautious, like if I had to go do all this solo, I have some holes that I want, and those are the things I want to help us create for future training opportunities and education continuing ed that would help clinicians who really want to do this and they have a client who wants to work with it, right?

 

Katie Strong: I hope that's a large number of people, because I think, you know, I think that this is really a significant challenge that I hear so often from support group members or people that I work with who have aphasia.

 

Tami Brancamp: I really think that's why we keep going, because we hear it from our we hear it from our clients.

 

Katie Strong: Yeah.

 

Tami Brancamp: We're not hitting it as much in acute care, for sure, rehab, you might get a little sample that is going on, but it's usually that outpatient. And then the longer term, like the they have some of the big needs met. And then we've got time to maybe look at math. But for some people, math should have been math and language together could have been hit earlier. But who's to say, you know?

 

Dave Brancamp: Well, you would know it best because I've asked when we first started this there would be like one, Tammy would give me one of her classes, and I would talk to them about math and absolutely deer in the headlight looks, “Oh my gosh, what are you going to do?” to by the end realizing “We're going to make this as fun as we can. We're going to use dice and cards, and we're going to do pretty much what we call foundational adding subtracting skills that they were welcome”, but you already have so much in your course to do that we just don't even have time. So that becomes this very interesting, because, you know, one of the big questions Tammy always asked me is, “Well, how can I know this pedagogical, or the reason behind?” I know they'll be able to hear but, I mean, I've done this now for 30 plus years, so there's a lot in my head that I have to figure out, how do we do this? So I can see this is the problem by how they addressed it without them having to take a whole other set of courses.

 

Tami Brancamp: Yeah, we can’t. There is surely not room for whole courses. So it's got to be embedded in existing coursework, or continuing ed opportunities after training.

 

Katie Strong: Or both, right?

 

Tami Brancamp: Yeah, I think both. Some of those barriers that we found people saying was, you know, there's not training on it, which I agree.

 

Dave Brancamp: There’s not the resources.

 

Tami Brancamp: Yes, there’s not the resources. And are the tests that people use. They have some sampling of math. But my question always is, “Okay, so I give this little bit of math in my aphasia test or something else like and now, what? Well, I know what they can't do, but what does that mean? And how might I support them for relearning?” I found it more helpful to look at it from a developmental perspective. I'm going to learn a, b, c, d, and I'm going to learn x, y, z, and then it helps me understand, like, “Where might I start?” Because I don't have to go down to counting dots, right? That number sense larger, less than visually. If that's not where the client needs to be. But learning where they need to be, we need better assessments for that. I don't know if that's something we're going to be able to tackle or not. I mean, Dave spent quite a big part of his professional career, developing assessments. So, it would be logical. But there's so many pieces to do.

 

Katie Strong: Right? It's a big it's a big undertaking.

Dave Brancamp: Well, there's so much that you gain by finding out from the client how you did the problem. It could be four plus six is what? and they write two. Well, I need to know why you think it's two. So did you think that was subtraction? Because they just didn't see the plus symbol. Well, you know? Well, then they have some good math. There's some good math there. They did the math correctly if they subtracted it. It's not the answer I'm looking for. And so could they say, you know, when you asked it if you were a person and he’s like, “Katie, so if I gave you six things and gave you four more, how many your total?” Do you know what that even meant to do? These things that just gives us clues to where your math might be and for unfortunately, for a lot of us, which makes it hard for me, I feel bad that they didn't have the experience is ones and zeros have some very powerful meanings in math that unfortunately, scare a lot of folks.

 

Katie Strong: Yeah, right.

 

Tami Brancamp: I never learned the fun stuff of math, you know. There's some tricks and some knowledge and some skills that I, you know, good math teachers will teach you, and I just didn't really learn those. So, Dave's teaching me just because I were doing this together? I don't know. I kind of was thinking like what we talked a little bit about, what does the intervention look like?

 

Katie Strong: Yeah.

 

Tami Brancamp: Gamification, making it fun, not using workbooks. We're hoping that we could utilize some of the home programs that we've created, and share those as part of the teaching.

 

Dave Brancamp: And like the game. I think I told you that we did with that one gentleman with Krypto. It could simply be like a target number or something of that nature, but it's fun to have when we did with our both groups with Virtual Connections, or our research groups,

other people could find out, like, you could solve it one way, Katie. Tammy could do it a different way, and I could do it a completely different way. And it was fascinating to watch the groups, like, I had no idea you could do it there. And that's what we need to hear So that people go, “Oh, you don't have to do it just one way.” Because I, unfortunately, and some are my colleagues, they forced, “I need you to do it x way.” It's like, “Well, okay, maybe to start. But now let's open the door to all these other ways you can, like, add a number or whatever.” And because it always fascinates me when we do, is it multiplication or subtraction? Now I forget, but one way Tammy is, like, “I never learned it that way. I always…” and, you know, it was just how she grew up. It was what you were taught.

 

Tami Brancamp: Well, like multiplication. When I'm multiplying multiple numbers, it's like, I'm kind of just adding multiples of things. So, how I get to the answer is very different than how Dave does, yeah, and we've had experiences with care partners, who we were doing some of the pilot work, who felt very strong that their way was the only way. Is this some generational differences? I suspect there's some of that, but it's also just, it's personality. This is how I know how to do it, and this is how it should be done. Well, not necessarily.

 

Katie Strong: It really mind blowing for me to be thinking about. I mean, I know that, like, you can teach things in different ways, but I just didn't really think about it from a math standpoint, because, probably because I know how to do things one way. If I know how to do it, it's probably one way, versus having more versatility in “If this doesn't work, try something else.”

 

Dave Brancamp: But like on a deck of cards at least the ones we use, they'll have, like a seven of diamonds. There's seven little diamonds on that card. Well, nothing else. Put your finger to them. There's nothing wrong with counting 1 2 3 4 5 6 7. Now, when you move over to the three, go 8 9 10, and there's your answer. They're like, “I can do that?” “I'm like, sure you can!” I can use my fingers? You know, it's, it's those, it's those little things that, unfortunately, probably for a lot of us and a lot of our clients, went through, at least in my experience, in math as we went through school, we took away those, what we call manipulatives in math, that you learn it right, bringing them back now, so that they're like, “Oh, I can do this”” So they can see it, or they can write it in a different way, or, you know, whatever it takes to help them. That's one of the pieces that's so amazing.

 

Tami Brancamp: We definitely support a multi modal approach. Not just one way.

 

Katie Strong: Which, I think the clinicians who are listening to this conversation will feel like, “Oh, I do a multi modal approach in all of the other things that I do in my interventions.” And so, you know, that makes sense.

 

Dave Brancamp: And that's where we saw that piece of saying that we're trying to unite math and language. The two of those do play together. You know, it's like because you just said you spend weeks and weeks with all your future clinicians training them on all these skills and language, so many of those will play out just as well in math, except to do it in a different way.

 

Katie Strong: Mmm. So we've talked about what the intervention might look like, and we'll be excited to see what comes out from your projects that you're in the process of analyzing but looking ahead, what excites you most about where this field could go?

 

Dave Brancamp: Oh my, that's the question!

 

Tami Brancamp: There's a lot of work to be done. It actually is…it's fun. We are wondering, you know, how might it be if it's on a one on one, a more traditional model, right for our outpatient settings, versus small groups.

Katie Strong: I'll say this. I should have said it earlier, but for those of you listening, I'll put in a link to Virtual Connections and if you're interested in seeing Tammy and Dave's math Aphasia + Math.

 

Dave Brancamp: Yeah, it's aphasia plus math. It would be Level 1 or 2. They can come watch the whole thing. It’s fascinating to watch them how they work.

 

Tami Brancamp: They are best teachers, yep, without a doubt.

 

Dave Brancamp: To your last question, “So that's with the clients?” But you know, there's been and we've talked on and we've touched on, like, “how do we help our clinicians?” And then the unfortunate side of that stool that sometimes gets forgotten is, what could we do for our caregivers? Does this help? Because we've all been taught differently. so sometimes you might look at one of the gamifications we did and went, “Oh, I can't do that. That's not how I add.” We have a very set format, or do they understand the language? Do we make it clear enough. So, you know, we're I think that's a great question, because then we get torn to just time in the day to say, “But I want to still work with my clients, but we need to help clinicians so they can help us, and don't forget the caregiver in there.” I know it's not an easy answer. It's not the it's nothing nice and smooth, but it's kind of the one that we've been really what is to what are we doing.

 

Katie Strong: And probably also why it this hasn't, there aren't tons of resources already developed, right? That it is complex.

 

Dave Brancamp: Well, and I will tie back to our attitudes. What we found, we were fortunate enough to do….

 

 

Tami Brancamp: IARC. The International Aphasia Rehab Conference. we presented there.

 

Dave Brancamp: So some of our beginning there's an awful lot of interest out of Australia and Europe. But Australia and Europe, and I'm not trying to sound bad or negative, but they take look at math very differently than like England and the United States for sure does. That's a natural like thought, we don't accept the term. “I don't do math well.” They don't like to say that. There's an increased interest, at least in those two areas of the world, to when we but we gotta strengthen this, this is important. So, we've found that very fascinating, that some of our folks who've drawn an interest and set out of this come out of the main countries of Europe, or from Australia, because they don't mind talking about a subject that we often go, “I’m good at this, right? Let Dave solve it.” And it's like, well, but I don't have the skill set that all of you SLPs have.

 

Tami Brancamp: In our earlier conversations, we touch on the fact that United States, it's okay for me to say, you know, “I don't do math, right?” It's okay, and it's sort of accepted in some cases, it's kind of a badge of honor in some ways. But if I were to say, “Oh, I can't read” you know, that's we one. We want to help if somebody admits it. But there's a personal sense of shame attached. So, in our country, I believe the perceptions are different. You have the person who's had the stroke, has survived the stroke, has the aphasia, and now also has the math difficulties. That's a lot to navigate, and I respect in our in our world, as a clinician, I can't address all of it. So following that Life Participation Approach, we're going to let our clients be our guide. Support, train, and look at where their priorities are. And it's never enough. There's never enough therapy, never enough opportunity to be in a group environment, because not everybody has access to that, you know, but I think, “Where can I make a difference?” Like, that's probably my question. Like, I can't fix the world, so let me keep backing it down, backing it down, backing it down. And if I can make a difference with 5, 10, 15, 20, people, Hey, and then let those ripples go as they go out and make a difference and learn. I think that, in itself, is powerful.

 

Katie Strong: Beautiful, and certainly is conjuring up Audrey here. Well, I've got one last question for you as we wrap it up. But you know, what would you say to an SLP, who's listening right now and thinking, I want to help my clients with math, but I don't know where to start.

 

Tami Brancamp:  So one of, I think one thing for me is you do know basic math. You know everyday math. You do know how to do this.  So one just start. You can get a little assessment. You can use the existing ones that are out there with our aphasia batteries or the Numerical Activities for Daily Living.

 

Dave Brancamp: I would say, a deck of cards are not hard, you know, hopefully they have or some dice, yeah, and use those to generate the numbers. Or bring in, like, when they want to do tips, we would often just bring in receipts of anything and just say, “Let's say something cost $18.72. Round it up to 20 and make it a friendly number.” So it's around 20, So it's a little bit easier for them to grab onto and hold, and it's okay to say, because we've done it in our own sets going through, “Oh, wait a minute, six plus six is not 13. Look at what I did here. I let me, let's check this and add it.” Because sometimes you'll hear just even, you know, like when any of us are doing something, you look and go, oops, I made a mistake.

 

Tami Brancamp: Okay, right?

 

Dave Brancamp: It's all right, hey, to make mistakes and say, that's what we all do. And then, you know, but I mean to me, it's if we can get, like, if you want to use one or two problems off a worksheet, use it as a driver to start discussion and say, “So what can we do?” And see if they can do anything. Because sometimes it's amazing what we'll find out is just knowing that 16 is a bigger number than just 12 is let them and then what's the difference between right there, you could figure out subtraction if they know it or not. And we often will in if they have a chance to look on the website or any of this stuff, we'll take out, like all the face cards, we'll take out the 10. Keep moving it down to numbers that they're comfortable with, like dice will only be the numbers one to six, yeah, but if I use two dice, I could make some interesting two digit numbers, right, that are in that range. So it's just things that make it so they can grab on. And then you can start adding and changing rules and some of the math games they may have seen, they just adjust them so that they have access points. The true rules of Krypto is, you must use all five cards in order to get a point. Well, we just change it usually is two, right?

 

Tami Brancamp: Like we do for everything we can modify.

 

Katie Strong: I love this. And I mean, I'm thinking, most clinics have a deck of cards and dice.

 

Tami Brancamp: In most households in general, not but in general, you're going to have access to those tools. We didn't want people to have to go buy crazy stuff. I think there's one challenge I do want to think about and put out there. So, our new clinicians who are graduating, let's say they're in their mid-20s, and I know there's a range they are doing online banking. How are they going to support an older adult?

 

Katie Strong: Oh, right.

 

Tami Brancamp: Very structured and rigid in their checking account. I think we have to think about some again, different ways. None of the students that I teach today, and even our own son, they don't have a checkbook. Yeah, they don't write checks. So that's gonna introduce another variable down the road, but in the meantime, cards, dice, numbers, gamification, simplifying, watching language, thinking about executive function, number of steps, how we how we speak, the instructions. Give the directions. It's language.

 

Dave Brancamp: And ask the client what they think or what they might have heard, because it's interesting what they would have, what we've learned from them as well.

 

Katie Strong: Thank you so much for being a part of our conversation today, and for the listeners, I'll have some links in the show notes for you to check out for some info on Aphasia + Math. Thank you.

 

Tami Brancamp: Thanks for having us.

 

Dave Brancamp: And thanks for playing with us too. Thank you.

Katie Strong: On behalf of Aphasia Access, thank you for listening. For references and resources mentioned in today's show please see our show notes. They're available on our website, www.aphasiaaccess.org.There you can also become a member of our organization, browse our growing library of materials and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at [email protected]. For Aphasia Access Conversations, here at Central Michigan University in the Strong Story Lab, I'm Katie Strong.

 

Resources

Aphasia + Math focuses on strategies for the rehabilitation of everyday mathematics in people with aphasia. Tami and Dave focus on four pillars to support this work: Influencing Elements (math literacy, learning environment, aphasia severity); Math and Language (receptive & expressive language, cognition including executive function and  memory); Foundational Math Skills (use of linguistic and numerical symbols, lexicon, syntax, semantics); and Aphasia Friendly Math Activities (gamification in learning,  understanding math language, opportunities for communication). Their goal is to unite math and language.

Contact Tami [email protected]

 

Join the Aphasia + Math Facebook Community

Join an Aphasia + Math session on Virtual Connections

 

Brancamp, T. & Brancamp, D. (2022). Exploring Aphasia + Math. Aphasia Access 24-Hour Virtual Teach-In. https://www.youtube.com/watch?v=2mGSOJzmBJI

 

Girelli, L. & Seron, X. (2001). ) Rehabilitation of number processing and calculation skills. Aphasiology, 15(7), 695-71. https://doi.org/10.1080/02687040143000131 https://www.researchgate.net/publication/32888331_Rehabilitation_of_number_processing_and_calculation_skills#fullTextFileContent

 

Tapia, M. (1996). Attitudes toward mathematics inventory.

https://www.academia.edu/29981919/ATTITUDES_TOWARD_MATHEMATICS_INVENTORY