Clinical Aphorisms: Thoughts While Shaving

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  1. Evidence-based practice must consider the clinical intangibles: Performance does not guarantee competency.
  1. Do not be afraid of silence—it is your best friend!
  1. The most potent clinical interventions are those that empower the family.
  1. Family-centered is just that: seeing the family as our client.
  1. Not doing is doing: More often than not, it is the most powerful doing.
  1. The most important clinical tool is the clinician: Every so often the “tool” needs a checkup and re-calibration.
  1. Having dependent clients benefits no one.
  1. Covert help is the best help: Miracle workers need not apply.
  1. The clinician’s need to be needed—in conjunction with perceived client helplessness—is a clinical death dance.
  1. Clinical success can best be measured by the degree that the client takes ownership of the disorder.
  1. Operate on the fringes of your competency: If you aren’t a bit scared, you aren’t learning anything.
  1. Communication is best accomplished when we engage both feeling and cognition.
  1. View the client through the eyes of compassion; when you do so, there is no blame.
  1. Listening to the client is often the only thing needed.
  1. Embracing our pain—by expressing it—is often the first step in healing.
  1. The greatest gift we can give our clients is a support group: It’s a powerful healing vehicle.
  1. The difficult client is often our best teacher.
  1. It’s only a mistake if you do it twice—competency is born of mistakes.
  1. Always remember what the Dali Lama said: “Everybody is seeking happiness.” It helps to get through the day.

 

David M. Luterman, AuD, EdD, is professor emeritus at Emerson College, author of many books on counseling people with hearing impairment and other communication disorders, and director of the Thayer Lindsley Program for Deaf and Hard of hearing Infants and Toddlers at Emerson College. dmluterman@aol.com

 

 

Five Things to Know if Your Client Has Food Allergies

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For pediatric feeding therapists, whether working in the home, school/community or hospital/clinic setting, understanding safety precautions for kids with food allergies is essential. Here are five things every SLP should know when treating a child with food allergies:

  1. Know the symptoms of the reaction. They often occur suddenly, but a slight delay after exposure is also possible. They might vary from client to client, so ask parents to describe their child’s unique symptoms. According to physician Kirstin Carel of Children’s Hospital Colorado, symptoms may include:
  • Respiratory: wheezing, coughing, shortness of breath, hoarseness, throat swelling.
  • Skin: hives, redness, itching, swelling, eczema.
  • Gastrointestinal: mouth or throat itching, lip or tongue swelling, vomiting, diarrhea, cramping.
  • Cardiovascular: low blood pressure, abnormal heart rhythm, pale or blue skin, fainting.
  • Neurological: fainting.
  • Behavioral: sudden irritability (in combination with other symptoms).
  1. Know how your client communicates his or her symptoms. A child might perceive bodily changes before any of the signs noted above become apparent to you. According to Food Allergy Research & Education (FARE), children can communicate their symptoms by saying:
  • “This food is too spicy.”
  • “My tongue is hot [or burning].”
  • “It feels like something’s poking my tongue.”
  • “My tongue [or mouth] is tingling [or burning].”
  • “My tongue [or mouth] itches.”
  • “It [my tongue] feels like there is hair on it.”
  • “My mouth feels funny.”
  • “There’s a frog in my throat.”
  • “There’s something stuck in my throat.”
  • “My tongue feels full [or heavy].”
  • “My lips feel tight.”
  • “It feels like there are bugs in there” (to describe itchy ears).
  • “It [my throat] feels thick.”
  • “It feels like a bump is on the back of my tongue [throat].”

Ask parents if their children describe their feelings or symptoms with specific language or how they respond to the body changes after being exposed to the allergen. Learn more about various symptoms here.

  1. The epinephrine auto-injector stays with the child. Severe allergic reactions can happen suddenly. A caregiver sitting in a waiting room or away from the treatment setting might run out of time to locate this life-saving device. Know your agency’s policies on using an auto-injector when the parent is not nearby. Ask the parent to walk you through the steps on how to use it, should it be needed.
  2. Avoid cross-contact. Whether treating a child individually or in a group setting, everyone in the room should wash hands thoroughly with soap and water before beginning the session and dry with their own paper towel. Hand sanitizers are not adequate for getting rid of food proteins. Equipment used in food preparation is another factor, including knives, cutting boards, blenders and more. One common mistake is using a community toaster when toasting gluten-free bread for a child with celiac disease. Crumbs in the toaster contaminate the gluten-free food. Likewise, scrub tables, countertops or other surfaces where another child many have played with or eaten the allergen. Toys or equipment that you take from home to home, or even your clothes, may spread an allergen. Being cautious about cross-contact is essential, especially in the realm of feeding treatments where each client is exploring new foods throughout your work day.
  1. Know how to read a label. According to FARE’s website, food manufacturers must note major allergens in ingredients on conventional foods, dietary supplements, infant formula and medical foods containing milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat and soy. Manufacturers might add the phrase “contains _____” or list it in parenthesis. For example: “albumin (egg).” Read the label every time before serving the food. Ingredients and manufacturing processes can change without warning. Advisory labeling such as “Processed in a facility that also processes ____” and “Processed on equipment shared with ___” is voluntary on the part of the product’s manufacturer. Be cautious after reading both statements, especially the second, because the risk of exposure is much greater for products processed on shared equipment,.

What strategies do you use to keep your clients safe when they have food allergies? Or do you have allergies yourself that require special precautions? Share your ideas in the comments below.

 

Melanie Potock, MA, CCC-SLP, treats children, birth to teens, who have difficulty eating. She is the co-author of “Raising a Healthy, Happy Eater: A Parent’s Handbook—A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating” (Oct. 2015), 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!

Six Steps to Improve Communications—Listening and Talking—with Parents

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This year’s Better Hearing and Speech Month theme—”Early Intervention Counts”—made me wonder what more I could do to connect with moms and offer families early intervention services. I asked myself a key question:

Am I getting inside the mind of moms whose children I could help?

Throughout May, I communicated with moms everywhere I possibly could. I mean everywhere!

I spoke with moms I knew personally or professionally. I visited online speech-language groups, I peeked at comments on speech-language blogs popular with moms, and I learned what questions moms ask on forums and social media groups.

I noticed a strong trend that moms tend to ask other moms for advice about their children’s communication skills before going to a speech-language pathologist. I asked numerous moms: “Why would you reach out to other moms to share your concerns and/or ask questions about your child’s speech-language development over seeing a speech-language pathologist?”

Let’s look at the most common responses:

  • It’s faster and convenient to ask other moms their opinion or a question, especially online and during evenings.
  • It takes commitment to make a potentially unnecessary appointment with an SLP plus extra commitment for follow-up appointments.
  • I know and trust moms but I don’t know any SLPs.
  • Other trustworthy moms have a wealth of knowledge, especially if they have been through the process with an SLP. These moms give you an idea of what warrants a visit to a professional.
  • Fellow moms share my perspective. They show compassion and understand what I’m going through with my child.
  • I’m not intimidated by “parent friendly” messages that don’t use confusing or technical jargon.
  • Advice from other moms comes free.
  • I’m nervous an SLP will tell me my child needs help or diagnose my child with a disorder.

Based on responses, I’m taking six steps to improve my communication approach, the language I use and how I connect with parents:

  • I’m communicating with moms on my own social media sites and within online groups and forums.
  • I’m being vulnerable by sharing relatable facts about myself personally and my core values for my business.
  • I’m using parent-friendly language and avoiding acronyms and negative terms, such as “disorder,” during our conversations.
  • I’m asking moms more questions about their perceived needs and concerns for their child so I have more opportunities to listen actively and empathize about what they are going through.
  • I’m focusing on and talking about children’s strengths as a way to build a rapport with parents.
  • I’m also acknowledging my appreciation to parents for taking the time and effort to access my services.

If you wonder what types of questions parents ask, here are three valuable online resources:

  1. www.circleofmoms.com
  2. www.mamapedia.com
  3. Search for speech-language support groups for moms and moms on Facebook

Boost the value you get from online communities by reading through the group descriptions, rules, policies and other posts before posting in the group. Contact the group administrator(s) before posting for their best tips on joining.

What have you learned from listening to parents? Please share in the comments!

 

 

Keri Vandongen, aka “Speech Keri,” provides speech-language services for families with young children through her private practice in Alberta, Canada. She also offers online video training and techniques to enhance speech-language practice and carryover. Keri@myspeechparty.com

Hey, I’ve Got a Voice Box and This is Crazy…Singing—Speaking—Similar Maybe?

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If you see clients who complain of voice problems, it’s important to know if they sing in any context. Patients don’t have to be professional singers to be “rockstars” in the car or shower, so make sure you investigate all ways or places voice damage might occur.

We don’t switch out our speaking vocal folds for singing ones, but some folks speak much differently than they sing. Billy Corgan, for example, speaks in a low vocal fry and sings in a high-pitched nasal way. Here are a few pointers to aid in helping speakers who are also singers get the most out of each session.

1) Treat your diaphragm like a well-oiled machine. Whether you’re singing or speaking, you must have air flow through the vocal folds to achieve oscillations. If you force too much air out at one time, you sound breathy. If air is extremely rationed, you sound strained and strangled. If you treat a classically trained singer, chances are he/she knows proper breath technique for singing, but there’s always a chance that breath for speaking was never addressed in any teaching. Knowing your vocal dynamic science helps your treatment approach. We all breathe with the same organs, and voice disorders caused by poor breath support can be easily corrected with proper breath training. Remind your clients and yourself that the best breathing for both speaking and singing is with the powerhouse muscle that is your diaphragm.

2) Speaking or singing both cause tension in muscles surrounding your vocal folds. The larynx/voice-box hangs in muscles and ligaments from one bone: the hyoid. It does not have a strict skeletal frame to keep it in place, so tension can very easily impact the vocal fold movements during sound production. If singing or speaking fatigues your patient, laryngeal tension can reduce that sore, tired feeling. For singers, try singing through a straw to facilitate proper production and throat alignment, then immediately sing a line of a song to practice maintaining that decrease in vocal fold collision forces. For speakers, use straw phonation to speak a sentence or paragraph then immediately speak the same thing normally with no straw. The patient will feel the freedom of decreased glottal impact and can learn to recognize this and aim for it in normal speech.

3) Hone Your Cavity!! Resonance modifications to the oral cavity during singing and speaking, instead of recruiting excess muscular effort, can increase intensity. Opera singers have a distinct, but loud sound. Megaphones help cheerleaders project over the roar of the crowd. Each uses time and space to amplify sound to keep from overworking the delicate vocal systems. With the operatic style of singing, the soft palate and oral cavity raise and open in the back, similar to a yawn. Vowels are modified to sound similar to the word being sung, and volume’s achieved with this mouth position. Megaphones and wide-mouthed singing (belting) use very little muscular effort, but singers and speakers must also create the right space with their mouth. With each type of oral cavity construction, the larger amount of space created equals high volume as the sound bounces off the walls before leaving the mouth. (Source-Filter Theory anyone?) Use the diaphragm for this in speaking and singing to avoid strain in the throat.

The vocal subsystems of breath control, vocal fold vibrations and resonance work simultaneously in a delicate balance for us to speak and to sing efficiently. We are communicating when we do both, so let’s learn to speak the language of coordination.

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech-language treatment in her private practice, a tempo Voice Center, LLC, and lectures on the singing voice to area choirs and students. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders. Knickerbocker blogs on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

Am I an SLP With a Social Communication Problem?

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Have you ever pondered your social relevance, like an iPhone 5 right after the iPhone 6 comes out? Sure, you still look pretty good and have barely been used, so why is everyone already lining up to trade you in for a newer model? As a 28-year-old SLP working with junior high kids, I think about this a lot. I’m not that old and, therefore, relatively “cool” and in tune with what kids like … right?

The other day, during one of my many social skills groups, it hit me. I just might be an SLP with a social communication problem. My second realization was that I hadn’t been using the same advice I give my students. Like a broken record, I instruct my students on the rules of making and keeping friends. Week after week I serve up the same social strategies, such as find common topics of interest, initiate small talk and add relevant information.

However, the awkward social elephant in the room was me! I knew relatively little about the topics my students enjoyed.

Kids communicate in ways that we, as SLPs, and most adults don’t even understand. Surely it’s not for us to keep up with the five-second attention spans of adolescents and their never-ending pop culture nonsense. But, on the other hand, how can we teach social communication skills if we don’t know how kids are communicating or what’s important to them?

If a student asks me for help on inviting other kids over for a party, I advise to shoot a quick text. Email is considered far too formal and they’d laugh at the idea of a thoughtful handwritten note on engraved cardstock. So I do need to keep up with the times. I help kids talk and socialize for a living. But I need to do that using things from their world, not mine. Also, many of my students already struggle to know what’s socially important or appropriate, so it’s up to me to fill in the blanks.

I had some homework to do. That evening, I spent a hot second on Google and ended up learning way more about One Direction, Ariana Grande and CW series than I ever cared to. Talk about an unnecessary wake-up call!

As an SLP, however, I use the socially relevant information to relate to my students. The difference between good and great treatment comes down to preparation and knowledge. The more I learned, the better my sessions and conversations with my kids became. It will for you as well.

On a side note, did you know that there’s a Wikipedia knockoff site called Wookieepedia? As the name might imply, the information covers all things Star Wars. Trust me, your kids with autism spectrum disorder sure know about it.

Since making it a priority to spend a few minutes here and there searching celebrity gossip or other trends, my social groups changed for the better. My kids find it incredibly cool that I actively participate in conversations about the newest apps, superhero movies and hot video games.

I’m not suggesting anyone run out to buy the newest gaming system. I’m just saying that as we teach students to communicate in the world, let’s participate in the conversation ourselves.

#foodforthought #pragmatics #speechtherapy

 

Ken Anderson, MS, CCC-SLP, is a school-based SLP in Los Angeles. Follow him on Instagram @slpken or email kenwanderson87@gmail.com.