Bridging the Divide Between EBP and Practice

becky blog

How well does your program integrate clinical practice and research education? It’s a question definitely worth asking. Today, clinicians are expected to use evidence-based practice in all of their clinical encounters, but does it ever seem as though research evidence is pulling clinicians in one direction while clinical experience is pulling the other way?

EBP requires you to consider current best research evidence, clinical expertise, and patient perspectives in your clinical decision-making. Clinicians who did not receive a proper balance and integration of research and clinical practice in their graduate classes may be feeling thinly stretched to meet these demands. In an ASHA survey fielded in 2011, 24 percent of respondents indicated that EBP created unrealistic demands on clinicians.  CSD programs need to provide students with the knowledge and tools to evaluate and apply research. Additionally, faculty members need to think about how well they model a fusion of research and clinical practice in their own teaching.

Some help

To help, ASHA has updated a tool, the Academic Program Self-Assessment: Quality Indicators for Integrating Research and Clinical Practice in Communication Sciences and Disorders (CSD) Programs. The Quality Indicators (QIs) were developed originally in 2007 and were updated in 2014. They can act as a tool to stimulate discussion among academic and clinical faculty members and students about the program’s strengths and needs in integrating clinical practice and research education. The QIs are divided into five sections:

1) Curriculum and Department Goals

2) Course Work

3) Faculty

4) Students

5) Clinical Practica

They are designed to be flexible in their application–some programs may choose to formally survey a broad group of faculty and students using the tool, while others may choose to use the QIs to guide discussion during a faculty meeting.

A test drive, if you will

Beginning in November of 2013, ASHA asked several academic programs to try out the updated QIs and report back on how they used the tool. Here’s what they said…

It took most responders about one hour to complete the QIs, and most programs judged the length, appropriateness, and comprehensiveness of the tool to be “good.” Most of the programs (82 percent, 9/11) had academic faculty, clinical faculty, and the program director/administrator complete the QIs individually and then discussed the results in a meeting. Alternatively, one program provided time for faculty members to complete the QIs during a faculty meeting rather than asking that the QIs be completed on their own time. A few programs (27 percent, 3/11) also included students in the process.

A handful of challenges also were reported. Some faculty members did not have time to complete the QIs, and some students and faculty were not familiar enough with certain aspects of the department to respond to all items. ASHA is currently working to address these challenges; for example, revising the QIs to include a “Don’t know” response option and providing additional online resources.

The QIs did reveal areas of need and areas of poor knowledge exchange between clinical and academic faculty for some pilot programs. Roughly half of the pilot programs used the QIs to develop department goals for further integration of research and clinical practice. Southern Connecticut State University developed and shared with us three of their goals:

  1. To provide opportunities for discussion of contemporary research and clinical topics, faculty will rotate presenting their research and related topics to faculty/staff/students each semester.
  2. The department curriculum committee (DCC) will conduct annual reviews to ensure that EBP concepts are included in syllabi in accordance with the department mission and vision.
  3. NSSLHA will host monthly meetings to discuss research topics of interest.

Jayne Brandel of Fort Hays State University stated that following completion of the QIs, “We are reviewing our curriculum at the undergraduate and graduate level. In addition, we are exploring new clinical opportunities and having clinical instructors participate in courses.”

ASHA plans to follow up with several of the participating CSD programs after 6 to8 months to gain more insight into the longer-term role of the QIs for these programs.

Whether you are a program director, faculty member, or student, the QIs are a great resource to check out to get your program thinking about and talking about the integration of research and clinical practice. It is imperative that new clinicians are adequately prepared for the changing healthcare landscape with knowledge and application of EBP as soon as they enter the workforce. Thus, Academic programs need to be focused on both providing and modeling the foundations of EBP consistently throughout CSD education. The QIs are freely available for download.

 

Rebecca Venediktov, MS, CCC-SLP, is a Clinical Research Associate for ASHA. 

 

Dynamic Assessment: How Does it Work in the Real World of Preschool Evaluations?

dynamic evaluation

 

In a disability evaluation, we ask a child to point “to the triangle” or “to the author” as part of test developed to identify disorder.  An evaluator who uses this kind of test to identify disability must assume that all children being evaluated have had similar exposure to “triangle” and “author” including similar family, cultural, and educational experiences. It follows then, that if a child cannot identify “triangle” or “author” it is because that child has some kind of learning problem. But what if a child does not have a disability but simply did not have the same exposure to “triangle” or books as the majority of children his age? Dynamic assessment offers evaluators an approach to see whether a child can acquire new linguistic information from the environment. Here are some clinicians examples of how to translate the dynamic assessment research into their own disability evaluations, including some “dynamic” approaches to increase the accuracy of our preschool disability evaluations.

First, Let us consider nonword repetition tasks, one type of dynamic assessment. Nonword repetition tasks assess whether a child can hear, retain briefly, and then repeat nonsense syllables of varying lengths. Nonword repetition tasks give us insight into why a child may have a weak vocabulary. If the child has difficulty with nonword repetition tasks it may indicate a disordered ability to learn new words from the environment and will also affect the child’s ability to understand directors and spoken stories. Here are two modules analyzing videos of several children, both with and without language impairments, doing the same nonword repetition task. By seeing how different children of different abilities perform as they acquire the new words, clinicians acquire clinical judgment. Nonword repetition tasks are not classic dynamic assessment because there is no pre and post-test. But because we watch the child learning new syllables in front of us, it is dynamic rather than static.

Another dynamic approach is fast word mapping. In fast word mapping we evaluate whether a child can learn new words. Because the words are completely made up, no child has more or less experience with these words. In these videos of 4-year-olds, one child is typically developing, one child has low average to mildly delayed skills, and one child has mild to moderate delays. What is especially helpful with more dynamic approaches to assessment, we see a much greater range of information about a child’s skills, rather than simply did he identify the “triangle” or not?

A child’s cognitive skills, including the ability of children to describe cognitively challenging tasks, can also be seen through dynamic assessment. Here is an example of how a psychologist used dynamic assessment to evaluate the nonverbal cognitive skills of a 2 year 10 month old boy with Autism Spectrum Disorder (See 8:25 to 10:50). The psychologist described in his report what he saw as: Dynamic assessment demonstrated that George is intelligent and learns quickly. The evaluator showed George how to make a rubber duck fly into the air by placing the duck on the flat end of a spoon placed on the table and hitting the round end. George smiled and laughed and searched for the duck, although he did not make eye contact with the evaluator. George tried and had difficulty the first time, but after a second demonstration George was able to make the duck fly and seemed happy he made it happen.”

David’s dynamic assessment task reminds me of one that a great trilingual SLP, Barbara Dittman, showed me. She used the disappearing egg in the cup trick. Barbara would show the trick to the student and tell him how to do it. Then she would bring another person–a parent, teacher, or peer—and have the student do the trick and then explain to the person how to do it. Barbara learned about cognition and also about the student’s ability to explain a somewhat challenging task.

Recent articles demonstrate similar effectiveness of dynamic assessment in distinguishing bilingual preschoolers with and without disabilities. These dynamic assessment tasks for bilingual preschoolers include fast word mapping and a graduated prompting task with a novel word learning, semantic, and phonological awareness component.

Based on research going back several decades, the importance of dynamic assessment in accurate identifying a language disorder is well established. New studies continue to support its value. In addition to the videos on dynamic assessment and preschool assessment in general, the LEADERSproject.org has many resources available to anyone looking to sharpen their disability evaluation skills including test reviews, discussion of current law, regulations, and policies, and model evaluations.

Catherine J. Crowley, CCC-SLP, JD, PhD, Distinguished Senior Lecturer in speech-language pathology at Teachers College Columbia University, founded and directs the bilingual/multicultural program focus, the Bilingual Extension Institute, and the Bolivia and Ghana programs. An experienced attorney, Cate is working with NYCDOE on a multi-year project to improve the accuracy of disability evaluations. The LEADERSproject.org is a website dedicated to supporting quality clinical services and is funded by the Provost’s Office and several foundations.  Cate, an ASHA fellow, received the “2012 Humanitarian Award” from the National Council of Ghanaian Associations, and ASHA’s certificates for Contributions to Multicultural Affairs and for International Achievement.

Apps with Elders

elderapps

I am a tech savvy person. Use of technology is integrated into my life, and I am always learning something new. Currently, I am learning basic coding and web design to help private practice owners with their websites. Your website should tell your story and technology can make that happen. Perhaps I was a little naive, but it never occurred to me that maybe I should not use an iPad in my work with my geriatric patients in the SNF setting.

In the SLP social media communities I saw many SLPs using iPads or other tablets with their school or pediatric clinic caseloads. I saw what they were doing and thought, “Hey, I could do that with my patients.” And so I did. A few years ago when I got my CCC’s I gifted an iPad to myself.

And then I started using my iPad in therapy. There were a few bumps along the way, but I am still using it today. The iPad will by no means do therapy for you, but it is an excellent tool.

Five Tips to make using an iPad in therapy easier

Be confident to reduce the intimidation of technology. I start by asking if a patient has used an iPad. Then I briefly explain that it is a “little computer”, and we are going to use it to have a little fun in therapy. I gloss over the technology aspect and go straight to the fun. And then I choose an easy but interesting game, so they will have success when they are learning to use the tablet.

Use a stylus. A stylus is a pen-like instrument that the tablet will recognize similar to a fingertip. I pick them up for super cheap at stores like Marshalls or Ross. Some of the ladies I work with have gorgeously lacquered long fingernails. This almost always causes a problem, since tablets respond to fingertip taps rather than fingernail taps. A stylus will solve this problem.

Make it fun. Some of the games and apps can be quite challenging (just as any other task). When frustration starts to rise, I remind my higher level patients that we are just experimenting. If the solution or answer is not correct, we just figure out why and try something else. This approach seems to ease frustration. With my lower level patients, I do not allow that point of frustration to be reached. I use errorless learning and vanishing cues to increase success rate.

Keep your client relaxed. Because it is an unfamiliar technology there can be some anxiety about using it. I watch my patient’s body language. Is their brow furrowing, are their shoulders creeping up, are they tapping the stylus with great force? Sometimes I use subtle cues to help them improve insight into how they are feeling. Other times overt. These are great moments to talk about the effect of emotions (including anxiety) on cognitive function. Then I teach the strategy of doing something less taxing during these moments and moving back to more challenging tasks when they are feeling calmer.

Get a case. Get a case that allows you to prop up the tablet at different angles. This is really helpful for reducing the glare caused by different patient positions as well as making the tablet more accessible to those with mobility impairments.

Favorite Adult SLP Apps

Memory Match: If you are looking for an app to exercise use of memory strategies (visualization, association, verbalization) then Memory Match might be an app to check out. It’s $0.99 and available for iPad and Android. This is only suitable for clients that are able to generalize memory strategies and need activities to learn strategies.

ThinkFun Apps: Rush Hour and Chocolate Fix are great problem solving brain teaser apps that require use of deductive reasoning and logic for visual tasks. First, we identify the problem. Then, we work backward to solve it.

Tactus Therapy: This company makes some great apps. I have several, but my favorite is Conversation TherAppy. It is so versatile. I seldom use the scoring function of the app. The app has picture stimuli and a variety of prompts to target specific skills. I love not having to carry around a deck of picture cards. Have you dumped a box of stimuli cards on the floor? I have, too many times to count.

Google: Access the Google search engine via Chrome or Safari for endless possibilities. Do you have a client working on word finding tasks and needs a visual cue? Google it. Need a restaurant menu or a prescription label as a stimulus for functional questions? Google it. And I’ve been known to use it as a task motivator. Do your dysphagia exercises, then we’ll look up information about moose. (True story.)

Dropbox: Scan those 3-inch binders full of worksheets, protocols, and other information. Create PDFs and put them into Dropbox and have them anywhere you go with your iPad.  If you buy digital versions of books or tests to use on your iPad you will resolve the problem of original documents getting raggedy.

If you have an iPad or another tablet at home and haven’t used it for therapy, I recommend checking out what it can do. You might be pleasantly surprised.

Rachel Wynn, MS CCC-SLP, is speech-language pathologist specializing in geriatric care. She blogs at Gray Matter Therapy, which strives to provide information about geriatric care including functional treatment ideas, recent research, and ethical care. Rachel’s projects include: Gray Matter Therapy newsletter, Research Tuesday, and Patient Education Handouts. Find her on FacebookTwitter, or hiking with her dog in Boulder, Colo.

Thirty Million Words

Jan 30

Spreading the Words: the Thirty Million Words® Initiative

It’s no secret to speech/language and hearing professionals that children’s early language environments are critical to their speech, language, and academic outcomes.  Yet millions of children fail to receive the input they need to be ready for school when they start, and they fall only farther behind as school continues.

But it doesn’t have to be that way.  Parents, caregivers, speech/language and hearing professionals, teachers, and community members can join in what we at Thirty Million Words® call ‘Spreading the Words.’  By ‘Spreading the Words’ about the power of parents talking to their children to grow their children’s brains, we can ensure every child is ready to learn when they start school.

The Thirty Million Words® Initiative is an evidence-based parent-directed program designed to encourage parents to harness the power of their words to enrich their young children’s language environments, build their brains, and shape their futures.  The Thirty Million Words® and Project ASPIRE (created specifically for children with hearing loss) curricula utilize animation and real parent-child video to teach parents about early brain and language development, along with strategies to encourage and support development.

Watch how your words build your child’s brain

The curricula are supported with LENA® technology, which works as a ‘word pedometer’ to count how much parents are talking with their children and getting their children talking with them.  This feedback from the LENA® helps parents track their progress as they advance through the Project ASPIRE and Thirty Million Words® programs.

The Thirty Million Words® and Project ASPIRE curricula offer parents strategies to enrich their interactions with their children without adding more to their already busy and often overstretched lives.  When parents are equipped with three key tools – the 3Ts – a world of rich language engagement is unlocked.

Tune In: Pay attention to what your child is focused on or communicating to you and change your words to match.  The signals your child gives will change rapidly since her attention span is short while she’s young – staying Tuned In is a dynamic activity!

Talk More: Think of your child’s brain like a piggy bank – every word you say is another penny you invest.  There’s no limit to how many words you can invest to fill your child’s bank and build his brain!  Be as descriptive as possible to build your child’s vocabulary.

Take Turns: Your child is never too young to have a conversation with you!  Respond to your child’s signals to keep the turns going.

Parent talk is the most powerful tool for building children’s brains and sending them to school ready to learn.  With a community of professionals, caregivers, and parents ‘Spreading the Words’ about the power of parent talk, every child can get on track for school.

Hear from Shurand, a Thirty Million Words® graduate.

Learn more about the Thirty Million Words® Initiative at tmw.org.

 

Kristin R. Leffel, BS, is the Director of Policy and Community Partnerships for the Thirty Million Words® Initiative at the University of Chicago.  Her primary focus is curriculum development of Thirty Million Words® and Project ASPIRE, program design and implementation, and evaluation.  Her academic interests focus on health disparities, particularly the social determinants of health and the health of socially disenfranchised populations. 

 

Dana L. Suskind, MD, is a Professor of Surgery and Pediatrics at the University of Chicago Medicine, Director of the Pediatric Cochlear Implantation Program, and Founder and Director of the Thirty Million Words® Initiative. Her research is dedicated to addressing health disparities, specifically early language disparities, through the development of novel intervention programs. She has conceptualized and initiated development and evaluation of two parent-direct, home-visiting interventions: Project ASPIRE and the Thirty Million Words®. These interventions, for parents of children with hearing loss and parents of typically developing children respectively, aim to improve child outcomes through parents’ enrichment of the early language environment.

 

 

 

Continuing Education: The Options; The Reality

conted

Kids, my own or those I work with, are often slightly astonished that I like school—genuinely like school.  They can’t believe I willingly went to school beyond college and even now happily sign up for multi-day seminars.

Apart from the fact that it’s required for us to maintain our certification (30 hrs or 3.0 CEUs/3-year maintenance period) and the ethical obligation to stay current with best practices, I truly enjoy hearing about new methods, gathering information and collaborating with others in our field.

As a result, I’ve racked up a lot of CEUs over the years and  have found not all CEUs are created equal.  There are marked differences between the types offered and unless you’re really just trying to cross off credits, you need to know which will best suit your needs.

ASHA or State Convention

ASHA provides up to 2.6 CEUs; or up to 3.15 if you register for pre-conference activities.  State conventions will vary, but .6-1.4 CEUs seems to be the standard.

Pros:

  1.  There are lots of different topics available, sometimes on very niche issues that wouldn’t make sense, or be cost effective, for an entire seminar.
  2. If you realize 10 minutes into a session that it isn’t what you expected or that the speaker is so dry you’ll be nodding off if you stick around, you can simply hop up and move to another session.  At ASHA you can follow the Twitter feed to find out where the good stuff is happening
  3. Go with a friend and you can double the amount of information you receive (though your credits stay the same).  It’s a certainty that you will find some times slots overflowing with sessions your dying to hear—split up the work.
  4. It’s also a certainty that some time slots will have no compatible sessions to your interests.  No worries, head to the exhibit hall!  The exhibit hall at ASHA requires you to set aside a decent chunk of time, but even the state vendors are worth a look.  This is an outstanding opportunity to see new products, have someone walk you through scoring on a new assessment tool, or find resources for referral in your area.  And don’t forget the giveaways—you won’t need new pens for a year!
  5. Networking is a huge opportunity, especially at ASHA when participants are staying in the area for a few days.  You can meet up at the ASHA sponsored events or join smaller groups like the #SLPeeps at dinner.  You’ll get more information, recommendations and camaraderie than you thought possible and head home reinvigorated about the profession.

Cons:

  1.  Though there is tremendous variety in topics some of them can be fairly obscure, but, hey, that means there really is something for everyone.
  2. The title and even the couple sentence description can be misleading.  You may not really know what you’re walking into until you’re in it.
  3. The sessions are short!  Unless you pony up for a short course, the sessions are 30min-2 hrs.  Sometimes I feel like we’re just getting started when they start wrapping it up!
  4. There can be, for better or worse, a lot of anonymity at a big conference.  If you want to network, you’ll need to put yourself out there otherwise you’re one person in a very large sea.  I think I saw that ASHA broke records this year with over 14,000 attendees!

Seminars

This will vary widely depending on the topic and number of attendance days.  Most will provide up to .6 per day.

Pros:

  1.  You can really delve into a topic at a seminar and the sign-up literature is usually very specific as to what will be covered.
  2. Seminars move around quite a bit and you might get to see one of the stars of our profession in a smaller setting that allows one-on-one interaction at some point (yes, I’ve asked for autographs).
  3. Seminars tend to be more clinically based, rather than strictly research, so you will usually find yourself implementing new techniques, maybe even materials, the day you get back.
  4. Seminars tend to have more participatory components.  You might get to try out techniques on other therapists, write plans/goals, or play a “patient” yourself.
  5. Keep your eyes peeled and you can attend something very close to home, even if you don’t live in a metro area.  This can cut down on costs substantially.

 

Cons:

  1.  If you’ve made a bad decision, you’re pretty much stuck.  Get a cup of caffeinated coffee, try to muddle through awake and ask a lot of questions.  Some speakers will improve with participant interaction and at least you’ll get some of the info you were looking to find.
  2. You can get quite a few hours in with a one or two day seminar, but it will likely take a few to cover your total CEU requirements.  You need to consider travel costs, but seminars themselves are usually pricier/hour.
  3. Some seminars have a bit of a cult-like feel.  If you’ve drunk the Kool-Aid yourself, that’s fine, but if you’re a dissenter and question the theory … you might find the room gets a little chilly.  Oops.

At Home Options

Again, this varies widely.  You can take on-line courses as short as an hour (.1 CEU), or sign on to a webcast and get a few hours.  An ASHA on-line conference like the one on Neurodegenerative Disorders (2/19-3/3) can earn you up to 2.6.  There are also DVD or CD courses and self-study journal article options.

Pros:

  1.  The convenience of CEUs earned at home can’t be ignored.  You can do them at your leisure, devoting just a bit of time each day or make it a marathon session and knock it all out at once.  You can do it before the kids wake up or after they go to sleep, or during a snow day.
  2. With no travel expenses, the cost can be much lower than other alternatives.  ASHA SIG members can earn very inexpensive CEUs through self-study as well as discounts on other related ASHA courses.  SpeechPathology.com offers a yearly subscription for unlimited on-line courses.  Specific organizations such as The Stuttering Foundation have very economical DVD classes.
  3. You have a lot of flexibility in terms of topic.  There are lots and lots of courses available and you don’t need to wait for it to arrive somewhere near you.

Cons:

  1.  You’ll need some discipline.  Make that quite a bit of discipline.  It’s really easy to let a stack of DVDs sit, and sit…and sit some more.  It’s even easier to start a course only to find you never finished it.  Be honest with yourself and what you are likely to accomplish.
  2. The quality of the DVDs/CDs will be fine, but in a world of surround sound and fast paced cable shows you will be astonished at how slow a lecture moves.  Speakers that are dynamic in person are often diminished on film when you lose the energy of the audience as well.  And beware if you stop a DVD and try to find your place again later!  When the “scene” never changes, it can be frustrating to try and relocate your stopping point.
  3. Interaction is often limited.  Live webinars and conferences will give you an opportunity to ask questions, but other options lack this ability.

In the examples above, I’m referring to ASHA-approved course,s which are required for the ACE award and can be tracked through the ASHA CEU Registry.  However, ASHA does permit other CEU credits to count toward your certification maintenance.  Check the guidelines for information on continuing education credits without pre-approval.

Kim Lewis is a pediatric clinician in Greensboro, NC and blogs at ActivityTailor.com.  Attendance at the ASHA convention this fall qualified her for an ACE award (7.0+ CEUs in a 36 month period).

How One Bold Adventurer Survived the Opening of Exhibit Hall at Convention (We Think)

running of bulls

At approximately 8:35 pm on the evening of Thursday, November 14, a sheath of papers and an undeveloped roll of film were recovered by a custodian working in the Posters section of the Exhibit Hall at McCormick Place in Chicago. Tucked snugly under a (still warm) seat cushion, the yellowed, tattered handwritten manuscript and frayed film were rushed to the Leader’s office in Rockville, where they were subject to the most intense scrutiny and interrogation. Satisfied with the integrity of contents, astonished at the revelations contained therein, and aflame with ardent desire to share a unique eyewitness account of a quintessential ASHA convention event, the Leader presents the discovered manuscript in its entirety. For intelligibility, we’ve translated from the original Most Distant, Really Dullest, and Certainly Deadest Tongue.

DEAREST READER: Months of arduous sojourn across twilight epochs and treacherous terrain have brought me to this place, this moment, to this gathering of likeminded intrepid explorers poised to shatter the boundaries of convention and assail terra incognita. Mine is a wandering soul consumed by curiosity and troubled by siren calls beckoning through forbidden entryways. Standing and milling with hundreds of students and professionals outside the Exhibit Hall before it opens on the first day of ASHA convention, I am at last after all these long years among my own kind, again. We all want in, through that entrance blocked by McCormick Place staff. Right now. We’re just not always sure of the reason.

Someone pray tell—why are we here, waiting?

Huddled on the carpet some 20 feet away from the others, three students rapid-fire last night’s anecdotes and today’s possibilities while flipping through convention programs. Purses, askew tote bags and half-drunk cups of coffee ring them. Hmmm…perhaps their obviously keen attention to detail lends insights into why hundreds of us are all just, well, standing here ready to spring into whoknowswhat beyond yonder guarded entranceway.

After a lengthy, cross-city quest for a men’s restroom to change from elegant breeches and ruffles into roughen jeans and a too-plain button down shirt, I approach, ever hopeful, pen poised.

“So, are you waiting to get into the Exhibit Hall?”

Two nods, one dismissive glance back to the program.

“If you don’t mind me asking, why?”

Smiles and a chorus of replies. “I hear there’s lots of cool stuff in there—giveaways.” “My friend’s in charge of a poster session.” “I want to visit the bookstore.”

The latter speaker pauses, leaning forward. “We didn’t realize,” she hiss-whispers, “that there’d be so many people here when it opens!”

“Um…” I try to reassure. “You do know it’s open for all of convention, right?”

Shrugs. Blank stares. Heads return to programs and chatter resumes.

gary1

I next squirm, dodge, and dart my way mightily to the front, hoping to converse with those possessing a vast reservoir of experience with such opening day events. One of the security staff is more than happy to chat.

(Me out of breath after crowd-tunneling extravaganza) “Why…in the world…are there so many people waiting… to get in?”

(Chuckle) “It’s always this way, sir.”

“Any reason for it?”

(Slight shake of head and sigh). “It’s just the way these things go.” (Mt. Vesuvius yell eruption) “MAKE SURE YOU ALL HAVE YOUR BADGES READY FOR INSPECTION!!!”

I scuttle-crawl away, none-the-wiser and God help me, somewhat deafened.

gary2

It’s now about 10 minutes before the opening of the Exhibit Hall, and a most fascinating ritual is occurring. The crowd without prompting or dispute is self-organizing into a single, momentously long, serpentine line that curls and stretches into the distance across the palatial hall. Sitters and standers fall into place; no disputes, just a low murmur of expectancy rippling up and down the line. Calling upon fifth-column skills well-honed for decades in His Majesty’s Most Glorious Topsy-Turvy Revolution, I slip into line, one-third back, without incident.

There’s still time to uncover the answer.  Hmm…perhaps another direction. My laborious research en route here did uncover the venerable Black Friday tradition of frenzied mob trampling while seizing limited time deals. Maybe exhibitors likewise promise opening hour deals?

“Hey, is anyone here to nab a bargain?” I call forward and back.

Universal acknowledgment of query but a stunning silence of reply. A few shakes of heads; one roll of eyes.

Dearest reader, I…still don’t understand. But, what the heck, let’s go along for the ride.

gary3

11 am, zero hour. The line begins moving into the Exhibit Hall past security staff…steady…steady…the quick-stepping of hundreds of feet…we’re a millipede slowly picking up steam…and then the hounds unleash. Back segments of the line press forward and come alongside; we’re now four—nay, eight—across and coming on strong.

Faster. Faster. Oh boy.

A backpack-toting student a few millipede steps in front turns to me, brown eyes flashing and giggling. “Hey mister, you know why we’re here?? Because…it’s FUN!” Bursts of laughter.

We’ve just zipped past security and through the entranceway…rows upon rows of exhibits (staffed by some who seem rather startled by the human torrent) flash by to the right.

Goodness—most of us are surging left, a millipede in mad pursuit of the Poster sessions. Or NSLHA. Sustenance, perhaps? Wafts of downright delicious offerings pour in from 2 o’clock.

Pant. Pant. Fasterfasterfaster.  Woops–someone’s foot. Ouch—stand back, good sir. I must confess it’s most difficult to pen this narrative and properly capture visuals while honoring the press and pace of the crowd.

Oh my God, I can’t believe it! There’s hundreds of–

The narrative unfortunately breaks off at this point. The Leader has no reason to suspect that the author came to a grim, bone-crunching, nasty little end. We suspect that the tantalizing offerings of the Exhibit Hall were enough to draw him away from his sordid tale.

Gary Dunham, PhD, is the director of publications at ASHA. He can be reached at gdunham@asha.org.

The Blame Game

July 4

 

Although researchers are gradually learning more about stuttering and its cause/s, there is still a lot that remains a mystery. With “the unknown” comes room for parents to try and fill in the gaps with their own guesses as to what caused their child to begin stuttering. One of the questions I most often hear from parents is “Is it something I did?” The answer is a resounding “No!”

What We Know

According to the Stuttering Foundation, there are four factors that most likely play a role in the development of stuttering. It is hypothesized that a combination of these factors may result in a child with a predisposition for stuttering.

1. Genetics: Approximately 60 percent of people who stutter have a close family member that stutters as well. In addition, recent research by Dr. Dennis Drayna has identified three genes as a source of stuttering in families studied.

2. Neurophysiology: Brain imaging studies have indicated that people who stutter may process language in different areas of the brain than people who do not stutter.

3. Child development: Children with developmental delays or other speech/language disorders are more likely to stutter. (Note: By no means, is this implying that all people who stutter have delays in other areas. There is simply an increased likelihood of stuttering in children with developmental delays and language disorders.)

4. Family dynamics: High expectations and fast-paced lifestyles may play a role in stuttering.

Family Dynamics?? I Thought I Wasn’t the Cause??

You’re not! There are plenty of “fast-paced” families out there that do not have children who stutter. However, there are certain environments that may exacerbate disfluencies in a child who already has the increased propensity to stutter. This does not mean that you have to lower your expectations for your child or take them out of their extra-curricular activities. However, there are some changes that may help. Although I advise parents not to tell a child to “slow down” or “relax,” I do suggest slowing your own rate of speech and inserting more pauses. This decreases time pressure and models a more relaxed way of speaking. Indicate you are listening to your child with eye contact and by trying to set aside some time during the day that they have your undivided attention. Try your best to reduce interruptions. This can be easier said than done so don’t beat yourself up over this one, especially when there are siblings involved! On days that your child is having particular difficulty, reducing questions and language demands (i.e. “Tell grandma what we did yesterday.”) is a good idea. Let them initiate when they want to talk. Keep your expectations high, but give them a break on rough days!

If I’m Not To Blame, Then Why Does My Child Stutter More at Home And Around Me?

Although this is certainly not true of all children, many of my clients have stated that their child stutters more at home. Contrary to what most parents would believe, this is usually a positive thing and not a sign that they are doing something wrong. What these parents are witnessing is “open stuttering.” Open stuttering occurs when a child (or adult) speaks freely and without hiding, avoiding or “going around” words that they worry they may stutter on. Instead of feeling accountable for this increase in disfluencies, parents should be praised for creating a supportive environment that has allowed their child to be themselves and has encouraged their child to express themselves whether or not they stutter. At school or around peers your child may not stutter as frequently, however this may be a result of avoidance behaviors such as switching words or opting to speak less. These avoidance behaviors can be exhausting and frustrating. Home should be a place for your child to take a break from “avoiding” and say exactly what they want to say, when they want to say it (even if it means taking a little longer to come out!).

But What About The Techniques My Child Is Learning In Speech?

The strategies your child is learning with their speech-language pathologist are extremely valuable in giving them a way to regain some control over their speech, especially when entering a difficult speaking situation (i.e. reading aloud, oral presentation, introducing themselves, etc.) However, when it comes down to it, it is up to them when they choose to use their speech tools. They should be praised when they practice or use their techniques but also praised for open stuttering. It may not be easy, but resist the urge to feel (or express) disappointment when your child stutters. Instead, be proud that when they begin to stutter they are choosing to continue to speak and be heard.
Brooke Leiman, MA, CCC-SLP, is the Fluency Clinic Supervisor at National Speech Language Therapy Center in Bethesda, MD. Brooke hosts a blog dedicated to informing people on stuttering and stuttering therapy at www.stutteringsource.com. She can be contacted at Brooke@nationalspeech.com.

Writing an Article for Special Interest Group Perspectives

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You’ve never contemplated writing a research article since you left college, right? Perhaps writing in your field was something someone else did? No time, interest, or motivation to pursue such a professional endeavor? If you have a passion for your work, you can write that article if you simply approach it in steps. Start with your topic and what would you like to share with colleagues. It could be a therapy approach, new information about a specific population, or facilitating your documentation. Start compiling information through your search engines such as Google Scholar and ASHA’s research databases. Start bookmarking abstracts and articles on your topic. You’ll discover there are many facets that you never considered–bookmark those too. As you gather information, you’ll learn more about your subject.

The next step is to paste your facts or paraphrase them from your abstracts and articles including your article’s bibliography into a Word document. You’ll notice there are sometimes two, three, or more authors on a specific facet to your topic. This document will be your working template and will give you a basic framework for your article. Your next step is to review and revise your template into a readable paper. As you edit your paper, you’ll find yourself moving portions of your research from beginning to end, omitting data, and going back to your search engine to pursue that one piece of information you’d like to add.

Once your paper is assembled, ask a colleague to read it to see how the paper flows in form and style. Read it again and revise it again. Now it’s ready to be sent to your Perspectives Editor (find the editor for any Perspectives publication under the heading, “Information for Authors.” Example: SIG 15’s Information for Authors.).

My first article I sent off came back with so many revisions and corrections that I felt like I was back in English 101. I felt deflated and intimidated. My issues included simple grammatical errors, citation omissions, spelling and sentence fragments. The only way I was going to get this information out was to fix my mistakes and improve my first draft. You will feel like giving up. I would recommend that you avoid working on it when you encounter a difficult section, but keep chipping away at it. You will ultimately be rewarded for your efforts, learn a great deal about your topic and professional writing, and have the satisfaction to know you’ve written your first article.

My editor taught me a lot about professional writing and surviving the process of editing and revision. I kept my first draft with revisions to document my growth as a writer and researcher.

Once your revisions are completed, read it again, and ask your colleague to read it again. You’re almost done. You now need to write your article’s abstract and submit five questions about your article’s content for continuing education credits for other SLPs. You can do this!

I want to take this opportunity to acknowledge my colleagues who encouraged me to attempt my first article: Ann Kulichik, owner at AK Speech, past SIG 15 Associate Coordinator who inspired me to write; Joanne Wisely, Vice President, Regulatory Administration & Compliance for Genesis Rehab Services, who reviewed my articles and encouraged me to keep writing; Grace Burke, Senior Director of Adult Day Services at Life Senior Services, who was the previous editor of Perspectives and guided me through my first article with patience and professionalism and Anna Feezor, Senior Clinical Specialist at Genesis Rehab Services and present Associate Editor for SIG 15 Perspectives. Thank you!

George A. Voyzey, M. Ed., CCC-SLP, is a speech pathologist for Genesis Rehab Services at Maine General Rehab and Nursing Care at Glenridge in Augusta, Maine, a 125 bed skilled long-term care facility specializing in Alzheimer’s and other dementia care. Mr. Voyzey also serves as a Master Clinician in the area of dementia, a clinical instructor and mentor. He recently had his fourth article published for ASHA’s Special Interest Division 15 (Gerontology) on-line publication, Perspectives, and serves as a coordinating committee member for SIG 15. Mr. Voyzey received his Master’s degree in Communication Disorders from Pennsylvania State University in 1983. 

Blogging is to Talking, as APA Style is to ?

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I’ve found a danger to blogging a lot—someone might like what I’ve chatted about casually and then want me to turn it into an APA style manuscript.  Yep!  That’s happened!  My little ramblings about Google forms have been converted to a formal paper, and are about ready to be submitted electronically to the scholarly folds of ASHA for a peer review and heavy edit.

I’ve learned quite a bit from this:

1.  What is APA style?  The last time I wrote a research paper, I used a typewriter—it was at least an electric typewriter. (Hey, I’m not that old!)  Regardless, writing a paper and submitting it so it looks similar to what I see in my professional journals is a bit of a learning curve.  Fonts didn’t really exist in my world back then.   I’ve never written an ‘abstract’ or worried about including ‘table titles’ or website references.  I’ve spent more than a few hours over the holidays learning about fonts, double spacing, and citations.  (I feel I’m a more than competent speech pathologist—but my job descriptions since graduation in 1984 haven’t really included this.)

2.  What is a SIG (otherwise known as Special Interest Group) in the ASHA world?   I’ve never fronted the money but apparently each SIG has scholarly publications that the members (who pay $35 a year) can read and get CEUs.   I’m hopefully going to be published in one of the SIG publications, although I may not be able to read my own published article since I’m not yet  a member of the SIG.   Maybe I’m not as poor as I think I am.  Perhaps, I’ll turn over a new leaf now, and join a SIG—the one focusing on school-based issues now has me intrigued!   I’ll keep you posted about this.

3.  What is peer review?  I actually already knew about this, but it’s a bit intimidating to submit something I’ve written to be edited and reviewed by people I don’t know.  Right now, I’m using my 22-year-old daughter as my editor, but we think alike and readily critique each other all time about lots of things.  The part about complete strangers reviewing my paper (that I don’t know how to write) is daunting to even consider.  I’m sure that the reality is there will only be a couple of people on a computer that will edit my masterpiece, but my fantasy is that a large group will be earnestly talking about what I wrote. Ha Ha!

So, writing a formal paper is outside of my comfort zone.  Why did I agree to this?  Possibly, I was flattered that anyone even asked.  Possibly, I never say “no” to anything. I need a ready-made script or a social story in this area.

I hope all of you are having a good start to the year! What’s done is done—I said “yes” and this has been great, albeit painful practice, and I’m sure that I’ll have a bit more editing to do.  I’ll let you know how this challenge turns out.

This post is based on a post that originally appeared at Chapel Hill Snippets.

Ruth Morgan is a speech-language pathologist who works for the Chapel Hill-Carrboro City Schools at Ephesus Elementary School. She loves her job and enjoys writing about innovative ways to use the iPad in therapy, gluten-free cooking, and geocaching adventures. Visit her blog at:
http://chapelhillsnippets.blogspot.com.

Got Clinical Questions? Submit Them to ASHA for Systematic Review

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Photo by WingedWolf

Are you wondering whether group treatment or individual treatment will produce better speech and language outcomes for infants with a speech or language disorder? Or whether oral sensory-motor treatment (other than e-stim) will improve functional swallowing outcomes in adults?

Well, you can find the answers to these and many more treatment questions in ASHA’s collection of evidence-based systematic reviews (EBSRs). These EBSRs, which are formal studies of the amount and quality of the published scientific evidence surrounding clinical questions of interest to ASHA members, can be used to inform your treatment decisions.

Want to get involved? ASHA’s National Center for Evidence-Based Practice in Communication Disorders is currently seeking nominations for future reviews.

  • Nominate your clinical question(s) related to intervention and to diagnosis, screening and detection.
  • Questions submitted by March 31 will be considered for next year’s EBSRs.
  • Those submitted after March 31 will be considered for reviews to be conducted in 2014.

Submit your nominations today. Your suggestion could be a topic for a future ASHA EBSR!

 

Floyd Roye is the project administrator for the treatment outcomes program at ASHA’s National Center for Evidence-Based Practice in Communication Disorders.