Gestalt, or a whole that is more than the sum of its parts, is the big picture and all its implications. We are working on the gestalt because, in order to store episodic memory effectively, we first need to be able to perceive the gestalt. During the day, we practice using. For example, Pamela wanted to don her swimsuit and play with the water hose. Since the weather has been chillier than expected, I remarked, "It might be too cold." She got upset because she did not understand I was referring to my episodic memory of this time last year being much warmer than temperatures for the last week. I explained, "The mornings are usually cooler than the afternoons." Then, she realized that I knew it was going to warm up and not stay too cool for water play.
According to Lindamood-Bell, children with language comprehension disorders have difficulty interpreting incoming language, making connections, and creating gestalt inferences with connections to the interpretation of incoming language. To tie it into episodic memory, we summarize little happenings during the day:
David woke up earlier today than yesterday.
Dad is going to work late.
Mom is getting ready for the conference.
You are still wearing pajamas!
Every day, I give Pamela a pile of pictures I cut out three weeks ago so I never know exactly what I am to draw. She picks one and starts off summarizing it. Typically, she forgets the verb and we work on including that. Her role is to describe to me what she sees, monitor what I am drawing, and let me know when I misunderstand. My role is to draw and ask questions when I need clarification. Whenever possible, I provide opportunities for her to work on nonverbal communication. When I first started doing this, I printed out this list of descriptive words to seek: what, size, color, number, shape, where, movement, mood, background, perspective, when, and sound. After we finish, we study the picture together and point out any differences. In the video clip below, Pamela is telling me how to draw a glass butterfly.
I also want to spotlight how we handle Pamela's aphasia. Even though she struggles with word retrieval, she does very well at communicating her thoughts until the word comes to mine. She is quite persistent in appraising my understanding (or lack thereof) and giving more information. She is even patient when I misunderstand her. We use specific strategies to help her when she is stuck and you can see how this works in the final video clip:
- I give her first sound "p" for pin.
- After she gets it once, I write it down on a paper near her so she can see and refer to it for next time.
- I encourage her to use gestures and point.
- I try to talk less, wait more, and give her good feedback with your face and gestures.