In Appreciation: Jeri Logemann

In Appreciation II

Jerilyn (Jeri) Logemann, ASHA 1994 and 2000 president and a world-renowned researcher in speech-language pathology, died at age 72 on June 19, 2014, in her home surrounded by friends.
Logemann_web

After obtaining her bachelor’s, master’s and doctoral degrees from Northwestern University, Logemann joined the faculty and became one of the most influential leaders in her field. A prolific scholar, she contributed groundbreaking books, journal articles, workshops, conference presentations and seminars on the management of voice disorders, normal swallowing physiology, and the assessment and treatment of speech and swallowing in patients with head and neck cancer and those with neurological impairments.

Logemann was the Ralph and Jean Sundin professor of communication sciences and disorders at Northwestern University, and professor of otolaryngology and neurology at Northwestern University Feinberg School of Medicine, where she directed the Voice, Speech and Language Service and Swallowing Center.

A pioneer in the development of techniques for effective assessment and treatment of speech and swallowing disorders, she—with Hilda Fisher—developed the Fisher-Logemann Test of Articulation Competence, and she developed the modified barium swallow test. Regarded as the leading authority in swallowing disorders, her research was continuously funded by the National Institutes of Health and other agencies for more than 30 years. Always concerned with improving speech-language pathology clinical service, Logemann formed the Clinical Sciences and Disorders Clinical Trials Research Group in 1995 to assist in the design and conduct of large-scale treatment studies of speech, language, learning, voice, swallowing, hearing and balance disorders.

Logemann was a Fellow of ASHA and the Chicago Medical Society, and received ASHA Honors, the association’s highest award. She served the university as chair of the department, and twice as chair of the Northwestern University Faculty.

Logemann’s relentless passion and commitment to her work; skilled leadership; inventive, indomitable and optimistic spirit despite relentless physical challenges; and her loyalty and generosity will be sorely missed by her patients, students, friends and colleagues.

She is survived by her cousin, Ruth Fruland, of Sheridan, Ill.

Gifts in her memory can be made to the Communication Sciences and Disorders Clinical Trials Research Group:

David Lilienfeld, Treasurer
CSDRG
13412 Pantera Road
San Diego, CA 92130-1022

Checks should be made payable to CSDRG. Should you wish to receive a tax deductible receipt, please indicate your return address.

Tanya M. Gallagher, PhD, is a professor in the Department of Speech and Hearing Science at the University of Illinois at Urbana-Champaign.

“In Appreciation” is an occasional ASHASphere feature highlighting the lives and accomplishments of leaders in communication sciences and disorders.

In Appreciation: Glenda J. Ochsner

In Appreciation II

Glenda J. Ochsner, 2003 ASHA president, died May 29, 2014, at age 72.

Ochsner_web

An Oklahoma native, Glenda earned her bachelor’s, master’s and doctoral degrees at the University of Oklahoma. A speech-language pathologist, she started her long career in academics at the University of North Texas (Denton) in 1968.

Glenda returned to Oklahoma in 1969 to accept a position in the Department of Communication Sciences and Disorders at the John W. Keys Speech and Hearing Center at the University of Oklahoma Health Science Center, where she taught for the next 25 years and served asdepartment chair from 1987 to 1994. She then served as dean of health, social sciences and human behavior at Oklahoma City Community College (1994–1998). She began teaching in the Honors College in 1996 and the College of Liberal Studies in 2001 at the University of Oklahoma Norman Campus, and continued to serve both programs until her death.

Glenda received numerous teaching awards, including the prestigious David Ross Boyd Professorship, given to recognize teaching excellence at the University of Oklahoma. Her classes were widely sought by students on both the Norman and Health Sciences Center campuses.

Her teaching skills were not limited to the formal classroom. She served for more than a decade as coordinator of interdisciplinary diagnostic and treatment planning teams dealing with orofacial anomalies and language development on the Health Sciences Center campus, which have served as models for similar teams.

Despite demanding teaching and clinical service commitments, Glenda was active in research and in the training of student researchers. During her tenure at the university, she directed doctoral dissertations, numerous master’s theses and senior papers, and served on many planning and examining committees. In addition, she has mentored doctoral students who have participated with her in ongoing research projects, many of which have been grant-supported.

A consummate professional, Glenda served on major committees and boards relating to training and provision of services to people with communication disorders at both the federal and state levels. She was a leader in the profession, serving as president of the Oklahoma Speech-Language-Hearing Association and as president of the American Speech-Language-Hearing Association in 2003. Her dedication to high standards is shown in her service as chair of the Oklahoma Board of Examiners for Speech-Language Pathology and Audiology.

Glenda’s ability to attract federal and private support for the department programs in communication sciences and disorders contributed materially to their rise in national standing, enabling the university to compete with other programs for high-quality students and provide access to emerging technology.

Throughout her long career, Glenda had a strong commitment to quality patient care. She gave her support to the first licensing law in speech-language pathology and audiology in Oklahoma. She was appointed to chair that board and was regarded as highly effective in her term. Glenda Ochsner’s expertise and dedication is a testament to the high quality of leadership she gave to the profession.

Glenda also was a strong supporter of the arts, so much so that she earned a second master’s degree in 2005 in theatre and museum management to become better equipped to serve her community. She expended much time and energy working with and providing financial backing to various fine arts and performing arts groups in Yukon, Okla.

Survivors include her mother, Mary Jane Ochsner; life partner, James G. Schmaelzle of Yukon, Okla.; adopted son, Ryan B. Tigner of Yukon, Okla.; cousins; and a host of colleagues and friends.

James G. Schmaelzle, MCD, CCC-A is an audiologist in Yukon, Okla.

jims@flash.net

 

“In Appreciation” is an occasional ASHASphere feature highlighting the lives and accomplishments of leaders in communication sciences and disorders.

Robot Turtles: A Fun Way to Target Social Communication and Coding Skills

maxresdefault

If you are looking for a fun way to target social communication skills, as well as beginning computer programming, Robot Turtles is a great new board game you can play with your students (with or without autism). Robot Turtles requires players to use simple commands to move their turtles to capture a jewel on the game board. When students give commands, they are replicating the process computer programmers use to give instructions for a computer to execute. Games, in general, provide opportunities for social communication; Robot Turtles in particular involves specific interactions between the game players that enable more opportunities for social communication. For students who show an interest in games and computers, playing Robot Turtles can be a highly engaging way to practice social communication. Check out this video.

During game play, it is easy to provide students with opportunities to practice five different social communication skills:

1) Perspective taking: As turtle masters, students take the perspective of their turtles on the game board in order to decide which way to move. If they were to take their own perspectives, players may not move in the intended direction; success in the game depends on the ability to make decisions based on a different perspective.
2) Turn taking: Students also actively take turns throughout the game. Not only do they have to wait for the other turtle masters to complete their turns, but students do not actually move their own game pieces. The adult overseeing the game, otherwise known as the turtle mover, is in charge of executing the moves on the game board based on student commands.
3) Eye contact and body language: Since turtle masters don’t move their own pieces, they must clearly communicate their commands to the turtle mover. This offers a good opportunity to practice politely giving directions, as well as utilizing eye contact and body language to effectively communicate and acknowledge the turtle mover.
4) Following directions: In return, the turtle mover may communicate directions for the turtle masters to follow. The turtle mover also ensure players are aware of and adhere to the rules of the game.
5) Making comments: Throughout game play, students can be encouraged to make positive comments directed specifically to other turtle masters. For example, a student could say, “Nice move. I like how you did that!” when another player makes a good move in the game. In Robot Turtles, the goal is not to have one winner; all students keep playing until they achieve the goal for that specific level. Establishing a positive atmosphere where everyone is encouraged to be successful creates a great opportunity for modeling and practicing comments.

Robot Turtles can be played with children as young as four, all the way up to middle or high school. The game has several levels so it is easy to adapt game play based on student age and experience with the game. The upper levels of the game require sophisticated logic and analytical skills to complete the challenges, while the simple levels introduce children to basic logic. Either way, social communication skills can be targeted in various ways throughout the game.

Eric Sailers, MA, CCC-SLP, is a speech-language pathologist with eight years of experience who currently works with high school students. He has an assistive technology certificate and a mobile programming certificate specializing in iOS. When he is not providing speech-language services in schools, he is creating iOS apps and delivering presentations.

7 Clues in the Medical Record to Discover Dysphagia

7 clues

Medical speech pathology has its uncertainties.This may cause the speech-language pathologist to be very conservative, possibly over-treating or overcompensating, per James Coyle, PhD, CCC-SLP, BCS-S at his talk on April 11, 2014, at the ASHA Healthcare & Business Institute.

“When the cause of dysphagia is not obvious: Sorting through treasure and surprises in the medical record.”

Coyle advised clinicians to value the medical record just as much as our direct examination of the patient. The “medical record is a messy place,” per Coyle. It is our job to dig for clues to distinguish which came first: the illness or the dysphagia. Some conditions can mimic dysphagia-related aspiration pneumonia. Some community acquired infections can create weakness and delirium, which then cause an acute dysphagia.

Let’s start with a story: An active-independent elderly female develops a urinary tract infection (UTI). She feels sleepy and stops eating/drinking regularly. This worsens the UTI and causes dehydration. She gets to the hospital four days after the onset of symptoms. Dehydration causes electrolyte imbalances, leading to delirium. Delirium + infection = more lethargy and a global cognitive decline. Being out of her usual environment causes more confusion and agitation. Antipsychotic medications are used to control the acute agitation. The patient becomes septic, as the infectious process spreads. Her urosepsis spreads to a pneumonia. The SLP notes a high aspiration risk, as the patient looks severely impaired. Unfortunately, without a thorough medical record review, the patient is labeled with dysphagia-related aspiration pneumonia. She stays on thickened liquids and pureed foods until hospital discharge. Will the patient fall through the cracks and never eat regular food again? Will the “Big-A-word” (ASPIRATION) follow her the rest of her life? Or will an SLP re-evaluate her in two weeks and discover that her dysphagia has disappeared?

I have summarized Coyle’s talk into these seven clues (more details and references in my full post).

1)    Is it pneumonia?

  • New infiltrate on CXR. Dependent lobes? Not necessarily only the lower lobes if the patient is bedridden or aspirating while laying down on the couch.
  • Leukocytosis (WBC count of >11.5-12.0). Warning: immune-compromised patients cannot make white blood cells.
  • Fever (>38 Celsius for >24 hours)

 

2)    What type of pneumonia is it?

  • Ventilator Acquired Pneumonia (VAP): May be widespread infiltrates. Strong correlation with oral pathogens.
  • Dysphagia-Related Aspiration Pneumonia (DAP): A recurrent pneumonia may be one big infection from ongoing aspiration. Perform a swallow study to determine if dysphagia is present and why. This is so important. If we label them with DAP, that patient’s past medical history will forever say “Aspiration Pneumonia.” Then medical personnel may be overly conservative in the future.
  • Non-Dysphagia-Related Aspiration Pneumonia (NDAP) and/or Aspiration Pneumonitis: if no dysphagia present before infection, check history for chemical irritants, allergens, reflux, a vomiting event, or use of acid-suppression therapy (i.e., Proton-Pump Inhibitors).
  • Hospital Acquired Pneumonia (HAP) or Health Care Acquired Pneumonia (HCAP): pathogens from the institution getting into the lung. Aspiration?
  • Community Acquired Pneumonia (CAP): may be diffuse infiltrates and not in dependent lobes.

 

3)    What was the patient’s baseline? “You got to have dysphagia to have dysphagia,” joked Coyle. “But seriously,” he added, “I can’t underscore this enough.” Dysphagia-Related Aspiration Pneumonia (DAP) requires the finding of difficulty swallowing prior to getting sick. Be a detective.

 

4)    Is there a systemic spread of infection (e.g., septicemia or sepsis)?

  • Sources: The lung is not the sole source for the primary infection. Wound, oral cavity, urinary tract?
  • Problem: The patient may not develop sudden signs, but it can unfold rapidly. Coyle urged SLPs to be careful when predicting goals for the future, as “sick people look pretty darn sick.” Good communication is needed at discharge to ensure re-evaluations.
  • Ask the medical team questions: Is this a short-term reversible problem? Could this be an acute dysphagia due to the illness?

 

5)    Was there a surgical procedure that could have caused the dysphagia? For examples: cardiothoracic surgery, lung transplant, lung resection, esophagectomy, head/neck cancer resection. Coyle recommended Atkins, et al (2007). See references on my full post.

 

6)    Was there a medical procedure that could have caused the dysphagia or an aspiration? For examples: feeding tubes, prolonged intubation, traumatic intubation, peri-operative aspiration event, chemotherapy/radiation.

 

7)    Are there medications that could be causing the aspiration, dysphagia, or pneumonia?

  • Polypharmacy increases a patient’s pneumonia risk.
  • Coyle recommended reading Knol, et al (2008). This was a case controlled study of elderly patients with age-matched controls. Patients who received antipsychotics where 60% more likely to have pneumonia.
  • Read more possibilities on my full post.

 

Our answers to these questions have a great impact on all we do: from our initial examination and instrumental evaluations through our discharge plan and beyond. SLPs do not diagnose pneumonia, but our communication with the medical team is an extremely valuable contribution to their differential diagnosis.

 

Karen Sheffler, MS, CCC-SLP, BCS-S, graduated from the University of Wisconsin-Madison in 1995 with her master’s degree. There, she was under the influence of the great mentors in the field of dysphagia like Dr. John (Jay) Rosenbek, Dr. JoAnne Robbins, and Dr. James L. Coyle. Once the “dysphagia bug” bit, she has never looked back. Karen has always enjoyed medical speech pathology, working in skilled nursing facilities and rehabilitation centers in the 1990s, and now in acute care in the Boston area for more than 14 years. She has trained graduate student clinicians during their acute care internships for more than 10 years. Special interests include neurological conditions, esophageal dysphagia, geriatrics, end-of-life considerations, and patient safety/risk management. She has lectured on various topics in dysphagia in the hospital setting, to dental students at the Tufts University Dental School, and on Lateral Medullary Syndrome at the 2011 ASHA convention. She is a member of the Dysphagia Research Society and the Special Interest Group 13: Swallowing and Swallowing Disorders. Karen obtained her BCS-S (Board Certified Specialist in Swallowing and Swallowing Disorders) in August of 2012. You can follow her blog, www.swallowstudy.com.

 

Learning to Hear: Finally, the Technology

tech

Hearing aids have improved by leaps and bounds over the past decade. The advanced signal processing and wireless connectivity options absolutely boggle the mind. As an audiologist, I’m constantly amazed at what today’s hearing aids are capable of doing for patients. I’m equally amazed at what my patients expect the hearing aids to be capable of doing for them; yet can we blame them? They are bombarded by newspaper advertisements and mailers boasting the incredible benefits of modern hearing aids. They don’t understand what all is (or should be) included in bundled pricing, so they figure that a $X,000 pair of hearing aids should fix their hearing problems and more. I believe these inflated expectations, coupled with a lack of comprehensive patient education during the rehabilitative process, explain why patient satisfaction and market penetration are not increasing at the same rate as the technological advancements in amplification.

So how do we address these issues? The answer always goes back to the root of our profession. As audiologic rehabilitation specialists, our job is to equip our patients with tools and strategies necessary to function successfully in the world, despite their hearing loss. Patients must understand that hearing aids are only one piece of the puzzle when it comes to successful communication. In fact, there are five essential keys to communication success:

dusty graphic

In previous blogs we’ve discussed listener strategies, speaker strategies, and environmental modifications as critical parts of the communication puzzle. During the aural rehabilitation process, I deliberately present those pieces before I discuss technology options. Listener strategies empower the patient to take responsibility for their hearing loss. Speaker strategies engage the communication partners to be involved. Environmental modifications make the patient and their communication partners aware of their surroundings and empower them to actively create the best possible listening situations.

When we’re finally ready to present technology options, there are two important points to keep in mind. First, we need to be sure we are presenting options. I don’t mean options in terms of different hearing aid manufacturers. I mean options in terms of ALL the technology options appropriate for the patient, based on his or her specific listening challenges. I present the options as a continuum, with inexpensive assistive listening devices and personal sound amplifiers on one end, and high end hearing aids with wireless accessories on the other end. Obviously there are many technological options in between. Second, it is critical that the technology options are presented in conjunction with the other strategies discussed. Patients must understand that technology must be combined with speaker and listener strategies and environmental modifications. The speaker, listener, environment, and technology keys are equally important when it comes to ensuring a successful communication exchange.

The fifth key to communication success is practice. Patients can learn all the communication strategies in the world, but they won’t help a bit if they don’t actually use them. The same goes for technology. Patients can buy the most advanced digital hearing aids available, but they are just a waste of money if they refuse to wear them in all of their challenging listening situations. As rehabilitation specialists, we are responsible for motivating our patients to practice and use all that they’ve learned. We must find ways to hold them accountable and create a follow-up plan that ensures long-term success.

Patients with hearing loss have many options when it comes to pursuing technology. As audiologists, it is our responsibility to make them see the “big picture” and implement a comprehensive plan that addresses all pieces of the communication puzzle. I truly believe that patient satisfaction and market penetration rates will only increase when we return to our roots and make patient education the focus of our rehabilitation efforts.

 

Dr. Dusty Ann Jessen, AuDis a practicing audiologist in a busy ENT clinic in Littleton, Colo. She is the founder of Cut to the Chase Communication, LLC, a company dedicated to providing “fun, easy, and effective” counseling tools for busy hearing care professionals. She is also the author of Frustrated by Hearing Loss? 5 Keys to Communication Success. Dr. Jessen can be contacted at info@CutToTheChaseCommunication.com.