Aphasia: How a Video IS Worth a Thousand Words

 

words

I have been a practicing speech-language pathologist for the past 40 years. My last position prior to my retirement in September of this year was as an out-patient SLP at Virginia Commonwealth University Health System (VCUHS) rehab clinic working primarily with stroke and head injury patients. Ours is a rewarding profession but during the past year and a half my involvement in a community aphasia support group has been one of the most gratifying experiences of my career.

Approximately two years ago, the daughter of a stroke survivor contacted VCUHS Speech/Language Pathology Department asking for volunteers to help her start an aphasia support group in Richmond, Va. She indicated that she wanted to form the support group to provide her mother and others living with aphasia the opportunity to exchange information, opinions, and feelings about this communication disorder.

The first group meeting was held in February 2012. The discussions during the monthly meetings often focused on how little the general public knew about aphasia. Other recurring topics included: loss of insurance coverage for out-patient speech treatment due to “plateau in skills” or insurance caps; false assumption that loss of language means loss of intellect; family members and others lacking appreciation of what it is like to have a head full of thoughts and ideas but not be able to communicate these thoughts to others. One of the group members, a corporate trainer prior to his stroke and subsequent aphasia, had an idea about how to address these problems/misconceptions: He proposed making a video that recorded the personal narratives of group members to educate healthcare professionals as well as their own families and friends on the daily challenges of living with aphasia and strategies for being a good communication partner. He and other group members felt that who best to advocate for aphasia patients than those living with aphasia themselves?

This past year, Marcia Robbins and Kate Schmick (two other SLPs who volunteer with the group), Jan Thomas (support group member who has taken a leadership role in the group), and I applied for and received funding through the VCUHS Speech/Language Pathology Department to produce a documentary style video on living with aphasia. Eric Futterman, a Richmond-based videographer, filmed and narrated scenes of aphasia support group members going through their daily routines and one member interacting with SLP. The 18-minute video highlighted the fact that those living with aphasia were not a homogenous group but rather individuals with unique needs and challenges as they faced the difficult road to recovery from their stroke. The video also showed support group members getting on with living and finding new talents. Our group had a community premier of the video entitled “Patience, Listening and Communicating with Aphasia Patients” during our September, 2013 monthly support group meeting. 90 people from the community attended. Attendees remarked on the powerful and informative message of the film.

In an effort to spread the word about aphasia, we have contacted the National Stroke Association and the National Aphasia Association about posting this video on their websites. NSA already has posted the video on their website.

Susan Hapala, M.Ed.,CCC-SLP, is a retired speech-language pathologist who volunteers with the Richmond, Virginia Aphasia Support Group. She can be reached at rva.aphasia@gmail.com.

Collaboration Corner: “Out of my Mind” Speaks Volumes

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This year, I worked with a fifth grade class who was reading “Out of my Mind” by Sharon Draper. The story is about a nonspeaking 11- year-old girl with cerebral palsy. Her classmates, teachers, and even  her doctors underestimate her abilities. Little do they know she has a photographic memory. One day after months of fighting with insurance, Melody (the protagonist) is given the gift of voice through an AAC device; the drama unfolds from there.

The teachers read a little of this book every day to the class, but wanted the students to get a better understanding of Melody’s struggles. They asked me to come in and show students various kinds of AAC devices.

This was the perfect launching point for a lesson on inclusion and AAC. This was one of the most effective ways I’ve worked with teachers and students regarding the challenges AAC users face everyday.

Here’s all I used:

  • A PECS book;
  • Two iPads with two different communication apps;
  • An alphabet board;
  • Low-tech battery operated voice output device;
  • A sheet with a picture of two “thought bubbles” and two hearts (see below);
  • Index cards with written scenarios; and
  • A sheet of emotion cartoons.

First, the class gathered together, and I gave them an overview of how people might communicate. Most understood body language, words, and some mentioned sign language. Then I brought out the different systems. Their eyes lit up. Then they started to make connections to other children in the building who used these systems. They were hooked.

Next, the children broke up into groups of four or five. Each table had two AAC systems. Within each group, students paired off. One student had a “speaker” card, and the other a “listener” card. Speaker cards had clues like, “you can’t speak, but you can point and read. You really want to tell your friend about the movie you saw last night.” The partner’s card (“listener”) read, “Your friend can’t speak, but she can point and read. She really wants to tell you something, find out what it is.”

I wish I had taken a video. The interactions were amazing, and the students really dove into the activity. Each group got a turn with a different kind of system. A nice, unexpected experience: Teachers went by and facilitated interactions with tips like being closer to the speaker, or waiting and not interrupting.

Finally, I collected the devices. Each group received a copy of a words related to emotions and a worksheet, which they worked on individually. This gave them a chance to reflect.

On the worksheet were only two fill-in the blanks on top:

When-I-was-the-speaker

On the bottom were two more:

When-I-was-the-listener

And then the teaching part happened! Here were some of the responses:

  • I was thinking, why can’t he understand me!!! I was outraged!
  • This is so hard! I felt like giving up.
  • I don’t have enough words. I felt like oh, well, never mind.
  • I wanted to help you, I’m sad and frustrated for you
  • I can’t understand you, I felt impatient.
  • Keep trying! I felt helpless.
  • I can’t spell, this takes too long! I felt annoyed.

I kept copies of every single sheet, I’m not exactly sure what I’m going to do with them, though I’m fighting the urge to wallpaper my office with them.

Kerry Davis, EdD, CCC-SLP, is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are her own and do not represent those of her employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

 

 

 

 

How to Provide Bilingual Services (Even When You’re Monolingual)

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Evaluation is one huge hurdle to working with English Language Learners (ELL). The second is providing therapy. Once you’ve determined there is a disorder, what do you do? Do you provide treatment in English? What goals do you target? Can you provide competent treatment in English only?
It may be easier to address some of these ideas for specific age ranges. For the children under 3 years of age, working with an interpreter in the primary language with the family on how to talk with toddlers and babies is your best friend. It is important to be mindful of possible cultural differences in how adults and children relate to each other. Not every culture values parent-child verbal interactions as the stereotypical white middle class family might. How to address these differences is like a dance. If one person is too powerful of a leader the other cannot follow, might stumble, and ultimately will quit dancing. A parent/caretaker who does not share the value we place on parent-child interactions will most likely not follow through on our recommendations. In which case it may be better to train a sibling how to model language for a younger sibling. Make sure you understand the family and/or cultural relationships as much as possible first.
For preschool age children (depending on family views of preschool) your efforts should go toward encouraging the family to enroll the child in Head Start, preschool, daycare, or even scheduling consistent “play dates” to expose the child to typical language development. If possible, encourage both languages (primary language and English). What about therapy? Targeting social language, the Basic Interpersonal Communication Skills, in English is essential. Children will need these skills to be successful in the academic world.
For school age children, research suggest that there is a strong correlation between ELL students with a language learning disorder and poor and/or inappropriate social skills and therefore, have fewer friends when compared to other students who are ELL. Social skills groups are very important for these students. Simultaneously, targeting Basic Interpersonal Communication Skills and Cognitive Academic Language Proficiency will help close the language gap these students have. One approach to do that is by teaching root words, suffixes, and prefixes (morphology). As we learn in linguistics, they are like puzzle pieces. For example, you can take the root word “view” and the prefix “re-“ and teach students that the view means “to look” and re- means “again.” When added together form “review” or “to look at again.” Then applying context, “The teacher tells you to review your work,” what does she want you to do? Helping students understand contexts for which they might hear the word and then additional contexts for when they might use the word is important. How does your work in English translate over to the primary language? Here is where parents come into play. Most parents I’ve worked with prefer you send the list of “academic” words (from curriculum and/or state standards) home in English. They can then use their personal dictionary to look up the correct correlating word in their home language, versus us guessing on a translation website. Have the parents talk with the child about these words in their home language. This builds the foundation for carryover from primary language to English. When using root words you can also can help students make educated guessed on definitions for words. Once students have a decent grasp on root words, some great games to play are Scrabble, Boggle, or Balderdash. An added benefit for teaching root words, is it’s included in the Common Core State Standards.
Here is some personal evidence. Last school year I had a 5th grade student who scored Level 1 (Beginning) on an English Language Proficiency Assessment for all of his academic years, Kindergarten through 4th grade. His 5th grade year we implemented a social skills group and taught root words from the curriculum. With the entire team’s support (student, parents, teacher, SLP) this student scored a Level 3 (Intermediate) on the same assessment. Some beliefs for such success was that our intervention targets were meaningful to him. Social skills helped his friendships and the root words helped him understand and communicate in the academic setting, which is the majority of his day Monday through Friday.
I am sure that there are other evidence-based therapy approaches to working with this population and they should all be founded on the same principals. 1) It is better to target both BICS and CALPs together that waiting for BICS to be mastered well enough to move to CALPs. Reason being, the language gap will only increase exponentially. 2) It is also better to work with the family.
I’d love to hear about other approaches. How do you address therapy for children and families who are not fluent in English?

 

Leisha Vogl, MS, CCC-SLP, is a speech-language pathologist with Sensible Speech-Language Pathology, LLC, in Salem, Oregon. She can be reached at leisha@sensiblespeech.com.

 

How to Navigate the Profession One Binder at a Time

Binders

 

My entire professional career can be summarized by what binder I was holding, and where I was while holding it. I waltzed into my interview for graduate school with a small binder, and a ton of nerves; I entered the current school I’m working in (my first job, ever!) holding my giant binder containing my portfolio. However, the most important binder in my very “speechy” timeline is the one I took to my school practicum.

Many departments offer different variations of clinical experience, whether they’re in a clinic, school, or hospital setting. Everyone gets their hours, but sadly to say, some either have poor experiences or don’t make the best use of their time. When I entered into the first day of my school practicum, I was chock-full of bulletin board ideas, and holiday-themed crafts. I almost exploded with Velcro and stickers! Then it hit me–I was going to have five faces staring at me every day as I navigated teaching them everything they needed to know. All while attempting to be as entertaining as their Xbox or iPhones. I began to panic.

That’s when I recalled the power of supervision. I had almost forgotten the wonderful woman who showed me around the building on my first day. Oh yeah–that nice lady is going to hold my hand through the first few weeks of this! Thank the Speechy Powers That Be!

Not only did my supervisor support me through my practicum, but she let me fly. Our first sessions with the students from the self-contained classroom left my head spinning. Were we shaking maracas and throwing scarves? Did I need to invest in Velcro’s stock? How many times can we sing that song? Oh, and when will this song leave my brain!? By the third week, I was singing, shaking, and velcroing with the best of them. We had an intense caseload with fantastic kids. Everything my supervisor uttered, handed me, sent me, all went in my binder. I knew I only had this window of opportunity for so long and I had to keep it all. binder1 I left my cozy clinical experience and now have embarked upon my Clinical Fellowship Year. I went to pick up one of my first students, and was met with a non-verbal child with autism spectrum disorder. He, of course, did not have his AAC device. I grabbed his hand, said a small prayer to the Speech Gods, and we went to the classroom. It was scary, sure, but I had this; I knew what to do. Not only did I have the materials from my binder, but I had the training to go with them. Skills I learned in a classroom are necessary and invaluable (especially when I pull out those technical words in a meeting to prove a very Speechy point!). However, the knowledge I gained from my supervisor, and my school practicum, is what makes me a good speech-language pathologist.

So my advice is this: Take the time to cherish, learn from, and stumble during your school practicum. Rewrite things, ask questions, and most importantly, make sure you’re in the placement where you will learn best. I’m now navigating my CF in a new building, with new students, new faculty, and a new non-graduate student version of myself. I’m surviving and, even better, also learning something every second (or so it seems). However, I always say that if I had not had the practicum experience that I did, or my handy binder that absorbed it all, I most likely would be crying in a corner hugging my Praxis book!  

Alexis Gaines, MA, CF, is a speech-language pathologist for the New York City Department of Education. She is using Instagram to document her clinical fellowship and you can follow her @practicallyspeeching and #instacfy! You also can follow her blog “Practically Speeching.” She can be reached at practicallyspeeching@gmail.com.

Kid Confidential: Using Thematic Instruction in Speech Therapy

pirate

I have seen many speech and language activities labeled as “themed” therapy activities just by the mere coincidence that they may sport graphics or clip art associated with a particular theme or holiday.  However, simply pasting an associated picture on a stimulus card while asking a student to perform a generic speech or language task is the not the same thing as participating in a themed activity.  Until I learned from my educator colleagues what it truly meant to teach via themes, I made this same mistake, too.  Regular and special educators are taught to understand the importance of themes and how they relate to child development and learning.  However, at least based on my own personal experience, newly graduated speech-language pathologists lack the instruction needed to fully understand what thematic teaching is really all about.

I see myself as an educator first and foremost.  Therefore, I learned many valuable things about education through colleagues and by reading educational research and textbooks.  This particular topic has been no exception.  Marjorie Kostelnik, Anne Soderman and Alice Phipps Whiren, spend an entire chapter explaining what thematic units really are and how they can effectively be used within the academic environment in their book titled, Best Practices in Early Childhood Education.  The following information is adapted from this source.

What is a theme and why would we use them in speech interventions?  A theme can be defined as the creation of various meaningful activities planned around a central topic or idea. The activities are then integrated into all aspects of the curriculum (i.e. language arts, reading, math, science, social studies, etc.).  Thematic instruction has been researched and observed to help children learn about concepts (i.e. ideas about objects and events in a child’s world) and facilitates in connecting various concepts together cognitively. In SLP lingo, this means thematic instruction helps to teach our children about categories. Through first-hand experience and additional learning activities, our students are improving their semantic mapping/networking skills thus improving receptive and expressive vocabulary, understanding and using synonyms and antonyms, word retrieval skills, story comprehension and story retelling skills, answering “WH” questions, as well as improving their ability to make inferences and predictions, thus resulting in improvements in overall language skills.

How do we create effective thematic lessons for our speech sessions?  According to Kostelnik, et al., there are five necessary components to creating an effective theme:

  1. Relevance: The theme must be relevant to your student’s real-life experiences and timely in that themes should be targeted based on your students’ current interests.  For example, a field trip to the pumpkin patch may be planned in the fall. Creating a theme-centered around fall harvest/fruits and vegetables, around this time would be an appropriate time to maximize your students’ interest in learning about this topic.
  2. Hands on activities: Concepts whose informational content can be accessed through hands on activities are appropriate for students 3-8 years of age.  These activities can be offered via exploratory activities, guided discovery, problem-solving activities, group discussions, cooperative learning, demonstrations or direct instruction.  I think as SLPs we tend to be very good with demonstrations and direct instruction (i.e. speech/language activities, what I like to call “drill and kill” activities) as well as guided discovery (particularly in book reading when asking student’s to infer or make predictions), however we miss opportunities for students to use self-talk to problem solve or use cooperative learning to have a discussion with peers.  These are important executive function and social skills that should be trained at an early age so as to generalize to other environments as our students mature.  If, during our group therapy sessions, we step out of the equation as facilitators, will our students educate each other on the necessary skills for continued development (e.g. teaching each other to self-monitor speech production or how to use appropriate social skills in real-time, or even help each other use correct grammar in sentence formulation)?  We must create opportunities for our students to use what they learn independently to help themselves and their peers.
  3. Diversity and balance across the curriculum:  Many of you might be reading this and think, well this doesn’t apply to me because I teach speech and language skills.  However, the truth is, you are already doing this!  Through your planning of speech therapy activities you are incorporating science (e.g. matching pictures of clothing to correct seasons, mixing red and blue paint to make purple, etc.), social studies (e.g. discussing community helpers and matching up the helpers to the objects/tools they use), math (e.g. counting and sorting animals into correct categories), and language arts (e.g. recalling details of a story or retelling a story in correct sequence).  Therefore, the use of “academic” or “curriculum-based” materials in the upper elementary grades, middle school and high school is, more than likely, what most of you have been doing for years!
  4. Primary and secondary sources of information must be available:  When planning a theme, thought must be given to the primary and secondary sources of information.  Primary sources of information are seen as what the child already knows (background knowledge) or can determine via concrete information present.  Secondary sources of information are sources that provide students with additional information they had not known nor can determine via concrete information present.  For example, when focusing on “farm animals” as a theme, a child may already know that a pig says “oink” and can see from a picture that it has four legs.  This is known as primary information.  An example of secondary information would be using books, pictures or other additional resources or materials to explain the role of pigs on a farm or the types of pigs and where they live.  So in a nutshell, a good theme uses the background knowledge your students already have and builds on that by providing additional new information.  Doesn’t this sound a lot like reading comprehension strategies (background knowledge, pre-teaching vocabulary, introducing new information, recalling information, etc.)?
  5. Potential for projects/“discovery learning”:  A good theme must lend itself to discovery learning. Discovery learning simply means you present your students with opportunities to problem solve and/or reason information not factually presented to them.  These projects are child-centered and/or child directed.  This piece is very important in planning themes because as you introduce information to your students you want to follow their lead and listen to the questions they have about the information presented.  Then you want to create a “project” that addresses the student’s questions or concerns.  For example, if when discussing farm animals a child asks have you (as the SLP) ever been to a farm? Your student is expressing the interest to learn more about others personal experiences about farms.  So you guide a “project” where your student asks the other students in your therapy group (language practice in formulating appropriate questions) or classroom if providing in class therapy, and you graph their responses.  Now you’ve just incorporated math (graphing, counting, adding, concepts of more/less) into a “project” your student directed and by the end your student has problem solved a way to survey his/her peers to find out more information about themselves.

I can hear the collective frustrated sigh from many of you out there reading this. “I have my students for 30 minutes, two days a week.  How am I supposed to use thematic units to teach them what they need to learn in that time?”  The first thing I would suggest to do is to start small.  Focus on the use of thematic teaching for a small portion of your language delayed students. Listen to what they are interested about learning and begin to create activities based around those topics. Remember you need to know what your students already know (primary source) so you can provide appropriate expansion materials/activities (secondary source).  Then compare your results.  See how the use of themes aid in learning and language development for this group as compared to the therapy groups for which you do not provide thematic lessons.

Another important key to successful themes is the stay flexible.  Follow your students’ lead.  Remain on one theme only as long as your students’ interest in the topic lasts.  This means, you don’t have to perform five or six thematic activities within your two therapy sessions a week. You can take as long or short a time as needed.  You might even take two sessions to participate in one activity.  I used to work with a colleague who used two or three sessions of repeated book reading as part of thematic teaching and it was amazing to see the improvements in numerous linguistic skills of her students after these sessions.  It just depends on your students’ current level of skills and interest.

So the next time International Pirate Day rolls around on the calendar throw out those multi-step direction cards that have nothing remotely related to learning about pirates. Rather, spend a week or two reading pirate stories while increasing the use and understanding of pirate-associated vocabulary (e.g. treasure, map, spyglass/telescope, etc.), and pirate lingo (e.g. “Shiver me timbers!” “Matey” and “Land ho!”), recalling details and or retelling the stories read (language arts), discussing famous historical pirates and from where they originated (history, geography), creating a “treasure hunt” for your students to cooperatively complete (following directions with pirate lingo, problem solving and reasoning, use of appropriate social skills), and spend time creating a pretend play scenario about pirates (hands-on, expansion activity) using all the information your students’ learned throughout your therapy sessions.  I promise you that your students will have just as much fun learning from you as you will have teaching them.

 

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

Remembering Sandy Hook: How to Live Like a First Grader

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As a speech-language pathologist who works with young children in their homes and schools, it’s impossible for me not think of the heartbreak at Sandy Hook Elementary School this time of year. Shortly after the tragedy in 2012, I made a list of some simple things I can do to honor those precious lives taken on December 14th. Every year, I plan to add to the list. This new year, I promise to embrace life more like a first grader in memory of the children and the young-at-heart adults who will always be missed by their families and communities. I plan to:

• Break into random acts of dancing in the most quiet places, like the doctor’s office.

• Use words like “sparkly.”

• SKIP. Everywhere.

• Stop in my tracks and squeal at the sight of anything furry: squirrel, neighbor’s dog, or the ring of fur on my best friend’s winter hood.

• Learn to read…new books, that is. Something happy – something meaningful, like “Oh, The Places You’ll Go,” by Dr. Seuss.

• Sing silly songs. Loudly. In public.

• Eat a peanut butter and jelly sandwich masterfully created with a dinosaur cookie cutter. This will make any co-worker at the office jealous and he will ask his mom for the same lunch.

• Gallop, because I love horses. Skipping is so over-rated when you can gallop.

• Pretend.

• Buy a Whoopee cushion and burst out laughing every single time someone sits on it. Whoopee cushions never, never get old.

• Finger paint. Do crafts. But first, let go of perfection.

• Hold it up and yell, “I made this for you!” and then give it to a stranger.

• Bring an apple to a teacher.

• Stomp in a puddle.

• Make a homemade card to brighten someone’s day.

• Eat snow.

• Open your lunch in front of co-workers and announce, “I got a juice box today!”

• State emphatically every 20 minutes “I’m hungry.” Oh wait, I already do that.

• Dress up. Wear party shoes even when there is no party.

• Take every opportunity to play… especially in the rain.

• Truly believe in the power of a found penny (head-side up, of course).

• Demand a full set of birthday candles on my cake EVERY year, and blow them out with vigor.

• Lick the spoon.

• Hold the door open for the rest of the line behind me.

• Never ever walk by a playground without stopping to swing.

• Go to the library.

• Post things that I am proud of on my refrigerator.

• Hug my mom and dad.

Never forget to be a kid! What do you plan to do in the New Year? Let us know in the comments below. Let’s keep this list growing in memory of Sandy Hook.

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.

 

Taming the Wild Editor: How to Get Published in The ASHA Leader

lion

All around the world, wherever their presence is tolerated, editors are notoriously cranky and unreasonable. Some are so ill-tempered, they’re like wild animals. Can you blame them? They would rather be writers to begin with. Instead, these stunted authors toil in bumpy office chairs, sip stale coffee, and cultivate eye strain and stooped shoulders … while they pore over a seemingly endless pageant of manuscripts. Their profession is based almost exclusively on spotting others’ errors—in short, being insufferable curmudgeons. And this wretched life stamps its mark all over a person’s demeanor.

Right about now, you may be thinking: Thank goodness I’m not an editor. Most reasonable readers would agree and share your relief.

But here’s the bad news: If you’re a prospective author for The ASHA Leader, editors not unlike the ones we described above will decide whether your carefully crafted proposal is accepted or rejected. Like hungry (and angry) lions locked in a cage too long without Starbucks coffee, these ferocious editors seek out any signs of weakness in your proposal … and pounce. Call it instinct.

On the other hand, nothing is as soothing to these savage editorial beasts—nothing shines so bright a ray of light into their cluttered lives—as a well-crafted, compelling story proposal. Editors feel satisfied when they find an error, but finding a storyteller fills them with joy. It’s like catnip for editor lions.

So how can a prospective author brighten a downtrodden editor’s life? How can you find a path to safety—and publication—through the famished, circling lions? We’re about to arm you with the chair, whip and confidence you’ll need to tame a pack of wild editors.

In the Leader’s general guidelines, we ask prospective writers to submit a proposal form before they spend time completing an entire manuscript. This is designed to save everyone some time, rather than writing an entire story that may not be suitable for the Leader, or for its upcoming content. And the proposal form includes a checkbox for authors to affirm that they’ve read the Leader’s writer’s guidelines.

The catch, however, is that reading the guidelines typically isn’t sufficient. The Leader’s editors look for proposals that exemplify the guidelines: lively, entertaining stories that provide practical advice or enlightening information about communication sciences and disorders. Every story needs a “hook” to draw the reader in, and should be conversational enough to keep them reading. Write sentences in an active voice. Avoid technical terms, jargon and overuse of acronyms. And per the Associated Press Stylebook, don’t include parenthetical citations in the text.

In short, if an author checks the box affirming he or she has read our writer’s guidelines, we expect the proposal to demonstrate the guidelines. If it doesn’t, the author’s chances of being invited to submit a manuscript are greatly diminished.

Some have wondered whether the Leader is still a science magazine. It absolutely is. But it is not a scholarly journal. As far back as April 1962, James Jerger declared in Asha Magazine his belief that scientific writing can be readable—that it can inspire and inform while appealing to a wide audience. (The full article [PDF] is worth a read.) The Leader’s editors share Jerger’s belief. Instead of presenting concepts only to fellow clinicians, using specialized language and tangled verbiage, we see the redesigned Leader as a vehicle for clinicians to show the public and other professionals (those in CSDs’ many and varied areas) what they do—in language most readers can understand.

So what are the most important things you can do to ensure your proposal’s best chance for acceptance? The first four come straight from Jerger’s article:

  • Write short sentences. Use a new sentence for each new thought.
  • Avoid artificiality and pompous embellishment. Write it the way you would say it.
  • Use active verb construction whenever possible. Avoid the passive voice.
  • Use personal pronouns when it is natural to do so.

Most important, craft your proposal so its inspiring, informative qualities jump off the page. Use a hook. Include sample content that whets the appetite for more. Make the Leader’s editors sit up, take notice and demand to know where your story is going. At the very least, take pains to follow the writer’s guidelines in your proposal.

After all, when you’re fending off wild animals it’s usually best to throw them a bone.

Matthew Cutter is a writer/editor for The ASHA Leader.

All I Want for Christmas is My G-Tube Out!

santa baby

A Parent’s Expectations and an SLP’s Goals

As a pediatric SLP who focuses on feeding, I guide families through the process of transitioning from g-tube feedings to 100% oral feeds and ultimately, removal of the g-tube.  This year, I had the unique experience of learning more about the emotional process through the eyes of one mom who happened to be an SLP, too.  In the course of nine months of feeding therapy,  her daughter Payton has taught us both that goals and expectations aren’t always met on the SLP’s or parent’s timeline and that most importantly, the child sets the pace.  Payton’s mom graciously shared her thoughts on the process:

History: Payton was born in December 2012 at 38 weeks, 4 days and weighed 4 lbs., 13 oz..  One month  later, Payton was hospitalized due to congestion, but it soon became apparent that this was a more serious matter.  On January 9th, surgeons performed a Ladd’s procedure to repair a malrotation of the stomach and intestines, a Nissen fundoplication to control reflux and secondary aspiration, removed her appendix, repaired a hernia and placed the g-tube.

Payton-Preemie2

Melanie: When I first met you in March 2013, your family and of course, Payton, had been through so much!  What did that feel like, knowing that she needed surgery and consequently, a g-tube? 

Payton’s Mom: This was my baby; my flesh and blood. I was so mad, sad, overwhelmed, devastated, in denial, and didn’t want any of this to happen. There had to be another option, another way to make her better. My child was not going to eat through a tube and I was going to do all that I could to get that thing out as soon as I could.  I was SO mad and devastated that this had to happen to MY baby.  It felt to us that when she was in the hospital, that the goal was to “fix” her and then we were sent home (feeling totally alone and shattered) to cope with all that we needed to get her to grow and thrive.  Short and long term goals were not clearly communicated to us.  In the back of my mind I knew that this would be a long journey, but I didn’t exactly know how long or what it would entail and I wanted to know NOW! Everyone in the hospital kept telling me that Payton would do this at her own pace (“Payton’s Pace”) but I didn’t want to wait. I wanted my baby better now!

Melanie: We have often talked about the difference between setting goals and setting expectations.  Your journey with Payton has helped me to have a better understanding of the difference.  Goals are targets or objectives.  Expectations feel more passionate and focus on hope, anticipation and personal beliefs.

Payton’s Mom:  As an SLP, I set goals and benchmarks all the time. There is a target behavior you want your client to meet and you set reasonable, attainable steps to get there over a specific, realistic time period.

As a parent, when you have a child with any challenge, you have expectations for them that are based on your emotions, including sadness, anger, denial and/or hope.  From the beginning of our journey, I remember having the expectation that Payton would eat a normal birthday cake and drink milk from a cup on her 1st birthday. Even though Payton just had a feeding tube placed and we were not sure when she would be eating orally again, I still had this expectation.

Melanie: I remember that so well!  I asked you what I ask every parent in feeding therapy: “Tell me what you want for your child” and you answered “I want her to eat birthday cake on her first birthday” and then, you stated it clearly to me once again, just to ensure that I understood.  “She’s GOING to eat BIRTHDAY CAKE on her FIRST birthday” and you had tears in your eyes.  That was a big lesson for me – you’ve taught me so much.  Expectations are very emotional. 

Payton’s Mom: I also had other expectations: that she would be running the hallways of the hospital on the week of her first birthday and say hello to the doctors who treated her!  When I stated these expectations, I knew in the back of my mind that it was unfair to myself and especially to Payton to expect this, because if she couldn’t do it, then would I feel guilty, disappointed, angry and upset that the therapists and doctors didn’t do their job right, or that I wasn’t doing my job.  It was all based on my hope for her to be “normal” and desperately wanting all the emotions of sadness and anger to go away after this difficult journey

Melanie: Is there anything else you feel would be helpful for parents and therapists to understand?

Payton’s Mom: Most importantly, follow your instinct as a parent. I truly believe that following my instinct saved Payton’s life.  A parent should trust that feeling inside of them and advocate for their child as they know them best. The opinions of doctors and therapists should be respected as they are knowledgeable and experienced;  however as the parent you go through life with your child all day, every day and it’s important to communicate and discuss the issues  with the doctors and therapists. Come to an agreement what is reasonable and feasible for your child and family. Sometimes when doctors and therapists are not on the same timetable as you it “gets in the way” of your expectations as a parent. A lot of time is spaced between appointments and as a family, life goes on. Another lesson is to pick your team well. When you have a child who works with many different specialists, it’s important that you work well with them as a family and that your child responds positively to them. There are many options when it comes to professionals and you don’t have to work with who was assigned to you, specifically in the hospital, if you do not communicate well with them, agree with their overall philosophy, or feel that there is mutual respect in the relationship.  Lastly, I have learned to respect my child’s pace of development and progress. Getting your child the therapy they need and following through with the  recommendations from doctors and therapists is essential, but that doesn’t necessarily mean they are going to meet the goals and expectations for them on your timeline. I have tried to remind myself when things get tough/or my expectations are not met that this is “Payton’s Pace.” She is her own being who will determine what she does and when she does it.

Melanie:  Yes, she sets the pace.  So, we don’t know if she’ll get her tube out at Christmas.  What’s  most important is what a fantastic year this has been for her and for Team Payton!   Plus,  this is her birthday month!  She’ll have cake and something delicious to drink from a cup.  Probably a purple cup … because she loves purple.  Happy Birthday, Payton!

Payton-One-Year-Old2

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.

Insights Into Effective Language Treatment for Internationally Adopted Children

Indian boy
I was recently asked to consult on a speech-language evaluation for a 12-year-old child who has lived with her adoptive parents in the United States for the last three years. English is the fourth language she has been exposed to since birth, but there is no trace of the child’s first three languages ever since her immersion in an English-speaking environment.

Though her adoptive parents knew which languages she was exposed to, they did not know the extent or quality of that exposure, and they were given very little information about her receptive and expressive language skills in those languages. The referring speech-language pathologist was very cautious in how she approached the assessment. She was careful to look at the length of time the child has been exposed to English, the quantity and quality of language input she has received up to this point, and so on. She recognized that the child had experienced significant native language loss.

The most important piece of information she needed, however, was missing. No one could affirm whether or not the child ever had appropriate language skills in any of the previous languages of exposure. No information was available on her comprehension, her vocabulary use, her ability to form sentences, and so forth, in her previous languages.

So how does one arrive at an appropriate diagnosis for children whose language backgrounds are virtually unknown? First, look for patterns of language development. Second, urge prospective parents to obtain extensive information on their child’s current native language functioning prior to leaving the birth country. For more on this topic, I recommend reading the articles of language-development researcher Sharon Glennen, including her ASHA Leader piece “Speech and Language ‘Mythbusters’ for Internationally Adopted Children.”

I would like to highlight a few things that set internationally adopted children apart:

  • They are not the typical English Language Learner in the sense that most adoptive parents do not speak the native language of the child. Thus, the likelihood of preserving the native language is very slim. We see that expressive and receptive language loss occurs rapidly with these children because their need for the native language is virtually nonexistent due to complete immersion in the adoptive language. In contrast, most ELLs whose contact with the native language continues (such as immigrant families) do experience varying levels of language loss but at a much slower and gradual pace. They retain some measure of bilingualism, whereas IA children do not and in essence become monolingual English speakers. This means the majority of IA children, particularly ones adopted at younger ages, won’t require bilingual testing (again, Glennen explains this thoroughly).
  • For children adopted at older ages, distinguishing true language disorders can be somewhat trickier, so it is imperative that parents gather and share with SLPs extensive information on their child’s communication skills in the native language. If accurate information is not obtained from the start, by the time concerns arise significant language loss will have already occurred. Knowledge of native language proficiency is only beneficial in the evaluation process if that knowledge is based on what was happening before the complete language immersion experience.  I have developed a simple screening measure specifically for parents to use in the birth country prior to bringing their child home.  My hope is that this will assist parents in asking the right questions of orphanage workers, caseworkers, or any adult familiar with the child.  Parents can then store the answers if more information is needed, whether immediately or in the future. The bottom line is, because of the inevitability of instant language loss, if the IA child’s native language skills are shown to be delayed on adoption, there is no need to postpone speech and language testing and to implement appropriate and direct intervention.
  • IA children gain conversational language skills more rapidly than most ELLs due to their full immersion experience, but some may struggle with cognitive language development as other ELLs do. Cognitive language or academic language encompasses specialized or content-specific vocabulary, complex grammatical structures, abstract concepts, discourse patterns or text structures, and reasoning. This means that parents can be proactive in how they assist their IA children to succeed in the school environment, especially children adopted at older ages. Resources available for adoptive parents include the SmartStart program by psychologists Carol Lidz and Boris Gindis, which is designed to help parents facilitate thinking and learning in their adoptive children through fun, meaningful family activities, games and experiences.

Though the number of international adoptions has declined in the United States in recent years, largely due to more stringent rules and regulations, thousands of children are adopted yearly into U.S. families from abroad. Given this, we must continue to provide guidance and resources for families walking this journey, as these children’s language development, school readiness and adjustment are often at the forefront of their parents’ minds.

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention.  She has provided school-based and pediatric home health care services for nearly 12 years and offers resources for SLPs, educators and parents on her website The Speech Stop.