Of Language Barriers, Culture Gaps and e-Bridges

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It certainly isn’t news that our country is becoming increasingly diverse. What may surprise us is that some of the biggest growth is happening in non-border, less-urbanized states. California, Texas and Florida continue to have the most residents who were born in another country. However, Alabama, Arkansas, Delaware, North Carolina and Tennessee all saw more than a 70% increase in foreign-born residents between 2000 and 2012.

This means that ASHA members probably find themselves with more and more English-language learners on their caseloads. These audiologists and SLPs likely also live in areas where there may not be many resources for serving ELL students. Our Code of Ethics states that we should provide culturally and linguistically appropriate services. ASHA also acknowledges that the ideal situation for ELL clients is to work with a bilingual service provider with specific language and clinical skills.

Telepractice offers an elegant solution for connecting colleagues with these competencies to our clients that need them.

The versatility of telepractice makes it useful in different settings. A school district might use several Spanish-speaking telepractitioners to manage its entire ELL caseload. A rural health clinic may create a limited agreement with a bilingual audiologist for follow-up care of a patient who communicates in a less-commonly spoken language.

Telepractice can be used for more than intervention. We can assess patients—even formally—through telepractice. Formal assessment via telepractice is getting easier because many well-known tests are now digitized. Even when a certified professional is not available through telepractice, an onsite team can use technology to connect with interpreters and cultural brokers to help provide appropriate services.

Telepractice licensing, however, remains a hurdle for taking advantage of remote services or becoming a telepractitioner. Most states don’t currently have regulations on telepractice for our professions. ASHA and local associations, however, advocate for states to formulate and adapt guidelines permitting telepractice.

In the meantime, associations advise telepractitioners to verify requirements and policies, as well as hold all appropriate credentials, both in the state where we reside and where the client receives services. This applies also to special credentialing for bilingual telepractitioners.

ASHA doesn’t certify bilingual service providers, but it provides guidelines for those who represent themselves as such. For example, we are ethically-bound to ensure that we speak or sign another language with native or near-native proficiency, and possess various clinical competencies.

To my knowledge, only Illinois and New York have a type of credential for bilingual practitioners, and these are specific to professionals working in schools. However, because policy changes frequently (and is difficult to track), SLPs and audiologists should verify any bilingual-specific requirements in states where they might practice before providing services.

Telepractice holds a lot of promise for serving clients with diverse needs. Even when there is some red tape to figure out, using technology to build bridges to communities that may not have many resources is one of my most rewarding professional experiences!

 

Nate Cornish, M.S., CCC-SLP is a bilingual (English/Spanish) SLP and clinical director for VocoVision and Bilingual Therapies.  He is the professional development manager for SIG 18: Telepractice, a member of ASHA’s Multicultural Issues Board, and a past president and vice-president of the Hispanic Caucus.  Cornish provides clinical support to monolingual and bilingual telepractitioners around the country.  He also organizes and presents at various continuing education events, including an annual symposium on bilingualism.  Contact him at nate.cornish@vocovision.com.

Noise Control: 11 Tips for Helping a Child With Autism

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Editor’s note: This is an excerpt of a blog post written by Karen Wang for Friendship Circle. Her full post can be read here

When my son was a toddler, he had a panic attack every time our washing machine clicked loudly to change cycles. He developed a phobia of all types of bells. He covered his ears and cried in crowds. But he became calm, even joyful, every single time we went for a walk in the woods, visited the library or entered any kind of religious environment: his stiff, tight muscles would relax instantly in my arms.

Creating a Plan to Deal With Sounds
All of these observations gave me food for thought as I developed a plan to help him cope with his sensitivity to sound. Over the years his ability to tolerate noise has steadily increased, and barking dogs are his only remaining noise-related phobia.

Here are eleven ways to help a highly sensitive person learn how to cope with and enjoy everyday noisy situations.

1. Know the types of sensitivity
There are several different types of noise sensitivity, and there are different treatments for each type. Consult with an audiologist to pinpoint which type of sensitivity is affecting your quality of life. There are five common types of sensitivities, but keep in mind that a person may be affected by more than one issue. For example, my son has hyperacusis in addition to phobias of specific sounds.

2. Provide relief
Headphones and earplugs offer instant comfort and relief. Noise-canceling headphones are the most effective, because they replace irritating environmental noise by producing calming white noise. However, most audiologists, physicians, therapists and educators recommend against frequent use of headphones and earplugs, because a person can quickly become dependent on them.

3. Identify safe environments
One of the first steps that I took for my son was to make a list of his “safe” places and increase his participation there.

4. Allow control over some types of noise
At its heart, anxiety is a fear of being unable to control reactions and situations. When my son had a phobia of bells, I gave him several different types of bells to handle and experiment with at home. When we saw bells at customer service desks or in other public places, I allowed him to ring the bell. He gradually became comfortable with the sounds, and he even began identifying speaker systems, alarm systems and other sources of sounds everywhere we went.

5. Allow distractions
When my husband and I took a Lamaze childbirth class many years ago, we learned about the power of distraction in pain management. By giving a person something like an iPad to focus on or an unusual privilege such as bringing along a favorite toy from home, it becomes possible to direct attention away from the offending noise.

6. Gradually increase exposure and proximity
The cure for a fear of snakes does not involve throwing a person into a snake pit. Similarly, relief from noise sensitivity requires a gradual desensitization and not a sudden exposure. Start by observing something from afar and take a step closer with each opportunity.

7. Alternate noisy and quiet
I discovered that my son’s tolerance for noise increased the most when I scheduled frequent quiet breaks. After a morning out doing errands, we enjoyed a quiet lunch at home. After a playgroup with 7 other children, we made time to snuggle on the sofa. When we felt brave enough to visit a large theme park, we booked a hotel inside the park so that we could retreat as often as necessary. We always take a break before the noise upsets him, so that he will want to return for more fun after resting.

8. Hyperacusis Retraining Therapy (Tinnitus Retraining Therapy)
Auditory Integration Therapy (AIT) is sometimes suggested to people with noise sensitivity, but there is very little peer-reviewed research published on the topic of AIT, and the existing research has generally not been favorable. However, there is plenty of medical research on Tinnitus Retraining Therapy (TRT), which involves listening to broadband pink noise to habituate a person to ringing in the ears. Pink noise contains all audible frequencies, but with more power in the lower frequencies than in the higher frequencies. Most people report that pink noise sounds “flat.” Because of this, it helps to rebuild tolerance to sound.

9. Cognitive-behavioral therapy
Physicians widely recommend cognitive-behavioral therapy for phobias and anxiety because it teaches a person to self-manage emotions and coping skills. The goal of the therapy is to reframe a person’s thought processes about the cause for anxiety in order to increase quality of life.

10.Consider supplements
Many people with tinnitus or hyperacusis are deficient in magnesium or other minerals. Consult with a physician to determine if nutritional supplements may be able to help.

11. Avoid food additives
Certain food additives, especially those in the salicylate family, are associated with noise sensitivity. In fact, medical literature refers to salicylate as a “tinnitus inducer.” Special diets, such as the Feingold Diet or a diverse whole foods diet, eliminate those additives and may help reduce sensitivity. Consult with a physician or dietitian before making any major dietary changes.

Karen Wang is a regular blogger for Friendship Circle, a nonprofit organization that supports people with special needs and their families.  Karen is also a contributing author to the anthology “My Baby Rides the Short Bus: The Unabashedly Human Experience of Raising Kids With Disabilities”

Heidi’s Top Blogs

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Editor’s Note: In her daily work at PediaStaff, Heidi is Editor-in-Chief of the popular PediaStaff Blog for pediatric and school based therapist, and also created the PediaStaff’s Pinterest Site  for therapists and parents of special needs children.  The company’s continuing work to educate, share resources with, and support the special needs community has been featured on Parents.com, and Love That Max, (an award-winning special needs blog).   In addition, PediaStaff was profiled by the well-regarded social media blog, The Realtime Report, for their innovative work.

 

In the past few years, the internet has exploded with speech-language resources, largely due to the ease of publishing one’s thoughts through a blog. When I wrote a piece on SLPs blogging back in 2012, most clinicians had no idea that this wealth of knowledge was out there. Today however, blogs are everywhere and they are widely known as a great place to get specialty information on virtually every topic.

Anyone who has ever blogged will tell you that regular blogging is a time-consuming commitment that demands ongoing diligence. A successful blogger needs to write insightful, informative posts at least two to three times per week. Blogging usually starts for most as a fun way to get your ideas out there. A year later, when the “newness” has worn off, contributing to your blog evolves from a “want-to” to a “have-to,” and then unfortunately often to a “Do I really need to?” task.

A good many of the blogs we featured in our first article no longer exist. Fantastic clinicians have just decided that the time it took to consistently share the excellence they practice was just too much of a drain on professional and personal time. Thankfully, a new crop of bloggers have recently come in to fill some of the gap left behind.

Others, have gone the route of making their blogs a way to supplement their income. If I am going to invest this much energy in blogging, why not sell some of my great ideas? After all, school speech surely doesn’t pay very well. The advent of Teacher Pay Teacher, has enabled many extremely creative school therapy clinicians to share their ideas and earn themselves a nice secondary income to boot.

In this article, I selected only blogs that are not offering their own products for sale. There are so many creative SLPs doing this now, that I would never be able to choose.

Here are some of my personal favorites (in alphabetical order) of those bloggers sharing all of their insights, opinions, tips and activities free of charge:

Almaden Valley Speech Therapy Blog – While I do not personally know the author of this blog, I find her posts, mostly on pronunciation, quite interesting.

ASHAsphere – You’re here. Need I say more?

Bilinguistics Blog – This blog focuses on bilingualism and issues facing clients with multicultural backgrounds. Highly recommended.

Chapel Hill Snippets – After years of giving away substantial resources—especially printable books and Boardmaker share activities—Ruth Morgan has finally bitten the bullet (her words) and opened a TpT store. While she is selling a few things now, I wanted to share her blog for the enormous collection of free resources she has amassed and still offers for your use.

Doyle Speech Works – A new blogger, Annie Doyle muses mostly on professional issues facing SLPs. Insightful, fresh and enjoyable.

Erik X. Raj – Erik is one of the most creative SLPs I have had the pleasure to meet. Funny and full of spot-on ideas to engage kids, this blog never fails to inspire.

Language Craft – Lucas Stueber is especially good at sharing ideas that inspire boys to enjoy speech-language treatment. In addition, he has some excellent profession insights. While he hasn’t been blogging often lately, the entries he posts are definitely worth a read.

Play on Words – Sherry Atemenko – is an expert on reviewing books and toys through a speech and language lens. A very valuable blog, indeed.

PrAACtical AAC – A perennial favorite, this blog specializes in augmentative and alternative communication and does a mighty fine job of it.

Speech Adventures – Mary Huston always has something interesting to say, even though the number of posts she writes has slowed down this past year. Whether she is reviewing apps, talking about commitment to the profession or just musing, her blog is definitely worth a subscription.

Speechie Freebies – This is the one primarily Teacher Pay Teacher oriented blog in this article. Every post offers something free and generally printable to use in the classroom or clinic. And while, each contributor does also sell their wares on TpT, the offerings on Speechie Freebies are always free and often substantial. If you are interested in bloggers that offer their ideas on TpT, Speechie Freebies is a fantastic way to explore them.

Speech Techie – If you’ve been to an ASHA convention in the last few years and are interested in how technology can be valuable in SLP practice, you have heard of Sean Sweeney. It’s a top-notch blog with the awards to prove it.

Happy reading!

 

Heidi Kay is one of the founding partners of PediaStaff and is the editor-in-chief of the PediaStaff Blog, which delivers the latest news, articles, research updates, therapy ideas, and resources from the world of pediatric and school-based therapy. PediaStaff is a nationwide, niche oriented company focused on the placement and staffing of pediatric therapists including speech-language pathologists.

Know Your CAS

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When I was pregnant, I remember dreaming about my new baby. My husband and I wondered aloud if she would be a musician like him, an athlete like me, or have some individual talent all her own. We had absolutely no doubts about what strong communications skills she’d have, however. Her mother was an SLP after all.

During her first year, my daughter lagged in all developmental milestones. I went to at least five different conferences on early intervention, but I couldn’t figure out why my daughter wasn’t a chatterbox. She met her first word criteria at one saying “hi” to everyone she met.

My husband’s mother reported he was late to talk and didn’t really say much of anything until after two. I had heard of late talkers, but because I worked at the elementary level, I never treated preschool kids. I brushed aside my pediatrician’s suggestion to seek treatment because I was convinced my daughter must be like her Daddy and that I could help her.

I finally took her in for an evaluation when she was close to three and received a diagnosis of childhood apraxia of speech and global motor planning deficits. After starting therapy based on motor learning principles, she made progress immediately.

Upset that I missed this diagnosis in my own child, I went on to endlessly and obsessively research childhood apraxia of speech. I was disappointed to find maybe eight pages on the subject in my graduate school materials. I know CAS is rare, but SLPs need to know about it and need to have the tools to diagnose and treat it correctly.

That summer I attended the national conference for CAS. The next summer I applied and was accepted into the Apraxia Intensive Training Institute sponsored by CASANA, the largest nonprofit dedicated exclusively to CAS. I was trained under three leading experts: Dr. Ruth Stoeckel, David Hammer and Kathy Jakielski.

If I could get one message out to pediatric SLPs, it would be for them to research and become familiar with the principles of motor learning and change their treatments accordingly for a client with CAS or suspected CAS. I know many like me get so little training or even information on it in graduate school. I’ve met other SLPs who were told it was so rare they would probably never treat it or even that it didn’t exist.

ASHA recognized CAS as a distinctive disorder in 2007. Taking the time to learn more about how treatment for childhood apraxia of speech differs from other approaches for speech and language disorders is crucial for kids with this motor speech disorder.  The importance of a correct diagnosis leads to a successful treatment plan. To briefly summarize, sessions should focus on movement sequences rather than sound sequences taking into account the child’s phonetic repertoire and encouraging frequent repetition.

For more information visit apraxia-kids.org and become familiar with ASHA’s technical report on the subject.

 

Laura Smith MA, CCC-SLP is a speech/language pathologist in the Denver metro area specializing in childhood apraxia of speech. CASANA-recognized for advanced training and expertise in childhood apraxia of speech, she splits her time between the public schools and private practice. She speaks at conferences and consults for school districts or other professionals. Email her at lauraslpmommy@gmail.com, Like her on Facebook, follow her on Pinterest, or visit her website at SLPMommyofApraxia.com.

 

 

The Possibilities are Endless!

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Having been an SLP since 2004, I know the feeling of “burn out” as well as being comfortable. I have learned that there is far too much opportunity in this field to settle for status quo or unhappiness. Perhaps the most valuable lesson I learned was recognizing that simply venting to family, friends and fellow SLPs was only a short-term solution.  I had to learn to be a doer and motivate myself within my chosen profession.

I often see many Facebook posts about SLPs feeling tired of the profession, often citing endless paperwork, disrespectful supervisors, caseload overload, lack of resources, unreasonable expectations and unfair pay. They are often looking to change careers for a “quick fix” to these problems, but overlook the changes they can make within their profession.

I was feeling frustrated at my district job six years ago and my lack of connection with other SLPs. I did my best to reach out to others and was ultimately nominated by my colleagues to become the lead SLP. That experience empowered me to talk to administration about changing to the 3:1 service delivery model. My presentation worked!

From then on, monthly SLP meetings were built into our indirect weeks and the 15 of us worked and supported each other throughout the school year. Our motto was “we’re all in this together,” because we are the only people who knew what our jobs are like on a day-to-day basis.

Fast forward six years, I loved my position as lead but craved a change. One fateful day I happened to be talking to a friend/fellow SLP in my district who said, “Annick, why don’t we just quit and start our own private practice?” My response, “Why don’t we?” My friend laughed but I wasn’t joking.

That was the question I needed to ask myself. I hadn’t thought about that option before. Coming out of our master’s program, the questions on everyone’s mind were: Are you going to the schools? Hospital? Or private practice? We never asked each other: “Do you think you’ll ever start your own practice?” For me, that question was life altering. Although my friend was kidding, her words were far from a joke for me. Within months, I registered my business, created a website and printed business cards.

I now grow my practice while working as a part-time, school- based SLP. But it doesn’t end there. I supervised three graduate students earlier in my career and one them recommended me to a professor as a possible lecturer. I jumped at that opportunity and have made yet another discovery: I love teaching adults! I am about to begin my second semester teaching college courses.

Looking to the future, I want to continue to teach more classes, build my practice, present at conferences and perhaps look into other areas of our profession such as telepractice and corporate speech therapy. Whatever I do, it is comforting knowing the possibilities are endless within our field.

 

Annick Tumolo, MS, CCC-SLP is currently a school based SLP, lecturer at San Francisco Sate University and founder of Naturally Speaking San Francisco, a private practice specializing in home-based speech and language treatment. She is Hanen certified in It Takes Two To Talk ® and holds a Augmentative and Alternative Communication Assessment and Services Certificate awarded by the Diagnostic Center of Northern California. Like her on Facebook, follow her on Pinterest or contact her at Annick@naturallyspeakingsf.com.

Ten Speech and Language Goals to Target during Food/Drink Preparation

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Food and/or drink preparation can be an excellent way to help facilitate speech and language goals with a variety of clients that span different ages and disabilities.

Below are 10 speech and language goals that you can target during food or drink preparation:

  1. Sequencing: Because recipes follow steps, sequencing can be an ideal goal. If there are too many steps in a recipe then break them up into smaller steps. Take pictures of each step and create a sequencing activity using an app such as Making Sequences or CanPlan.
  2. Literacy: If a recipe has complex language that your client has difficulty reading and processing, modify it. I often rewrite recipes with my clients or use a symbol based writing program like the SymbolSupport app.
  3. Expanding vocabulary: Recipes often contain unfamiliar words. When beginning a recipe, target new vocabulary. If your client is an emergent reader, create visuals for the vocabulary words and use aided language stimulation as you prepare the food and/or drink with her.
  4. Articulation: Target specific sounds during food preparation. Are you targeting /r/ during sessions? Prepare foods that begin with r like raspberries, radishes and rice, or even a color like red!
  5. Describing and Commenting: Food/drink preparation can be an excellent time to describe and comment. Model language and use descriptive words such as gooey, sticky, wet, sweet, etc. Encourage your client to use all five senses during the activity (e.g. It smells like ____, It feels like ______).
  6. Actions: Actions can be an excellent goal during food and/or drink preparation. For example, when baking a simple muffin recipe, the actions such as measure, pour, fill, mix, bake, eat, can be targeted.
  7. Answering “wh” questions: As you are preparing food, ask your client open ended “wh” questions, such as “What are we baking?” or “Why are we adding this sugar to our recipe?” and more.
  8. Problem Solving: Forget the eggs? Hmm, what should we do? How about forgetting the chocolate in chocolate milk? Ask your client different ways of resolving specific problems with food preparation, such as: “What do you do if you are missing an ingredient?” or “What do you do if we add too much of one ingredient?”
  9. Turn Taking: Whether you are working with one or two people, turn taking occurs naturally during baking and/or food preparation. If you are working in a group, make assignments before beginning.
  10. Recalling Information: As you prepare the food/drink, ask your client to recall specific After you are done with the recipe, model language and then ask your client to recall the steps of the recipe.

Preparing even a simple beverage such as chocolate milk can be an excellent activity to engage in during a session. Although it’s made up of only two ingredients, you can still work on a variety of speech and language goals including sequencing, describing, problem solving (e.g. what to do if you put in too much chocolate), actions, turn taking and recalling information.

Here are some helpful apps to use during or after food/drink preparation:

I Get Cooking and Create Recipe Photo Sequence Books

Making Sequences

CanPlan

Kid In Story

SymbolSupport App

For more suggestions, check out my post here on getting a child with special needs involved in the kitchen.

 

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

Six Vocal Myths: Practical Therapy Applications

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We all have a tree of knowledge that represents the intricate experiences that make each of us different and wonderful. Our branches stretch, flower and die only to grow into a more complex labyrinth of information. Once this tree is rooted in ideals, it is difficult to pull out any of the roots, especially if they have been supporting a perfectly healthy tree for many years.

I like science. I find a certain solace in knowing that a randomized control trial was completed in order to prove that I’m not just making you hum through a straw for fun. On the other hand, I completely give merit to the occurrences you can’t explain or rationalize. Some very important moments in my life, especially in my speech-language pathology career, cannot be measured and explained scientifically.

When I was younger, I was petrified that eating before a performance would screw it all up. I can remember vividly, sitting at a Texas Music Educators Association competition as a kid near me consumed an entire slice of pepperoni pizza before disappearing into his audition room. He leaned over and smiled, “It’s always good luck for me.” I was aghast, and I hope my face did not reflect what was going on in my head. Food? I thought. Before singing? NEVER! But, why did I believe so strongly that the voice gods would shun me if I ate a bite of anything? Should superstitions be revered? Is it really all in my head?

I posed that question to a few forums I belong to, both vocal pedagogy and vocal pathology. Along with comments and emails that flooded my inbox, the University of Minnesota and Truman State University brought me a study by Julia Edgar and Deirdre Michael that surveyed almost 400 singers about their beliefs in vocal health. The only thing everyone could really agree on? A whopping 97 percent believed that warming up before performing benefits the voice. That’s it. The rest of the answers were as scattered as an Admission, Review, and Dismissal team after the final meeting before summer break.

I pulled together the most interesting beliefs and did my best to find scientific evidence to aid in proving or refuting. I have questions from the professional singers I treat about many of these subjects, so what better way to debunk the myths? What I found was that many people hold their beliefs dear and are not willing to lend an ear to anything that might refute what gets them through a gig. So, what are we as SLPs to do? Do we believe in Grandma Sue’s recipes? Do we believe in science? Do we believe in experience? Do we believe in life after love? Sorry, Cher kind of snuck in there.

  1. Smoking marijuana and vaping is not damaging to the vocal folds like cigarettes are Reinke’s Edema, tissue damage in the form of gelatinous goo just below the top layer of the vocal folds, commonly occurs from smoking.  A study here discusses the effects of cigarette smoke on the delicate tissues of the vocal folds. Even the vocal folds of rats changed after passive inhalation of smoke. So that sets you straight…right? Not quite. A student told me that an alarmingly high number of voice performance students at her school claimed smoking marijuana and vapor cigarettes will not damage the vocal folds. Although there are not yet any published studies specifically about the effects of vaping on the vocal cords, a study here found that electronic cigarettes contain less carcinogenic ingredients than their tobacco counterparts, however less does not mean none. There is also concern that propylene glycol irritates the respiratory tract. (PG is just a fancy word for stage smoke.) Despite more than 1,000 studies on electronic cigarettes, conclusions cannot be made on their safety or danger because of contradictions and inconsistencies in methodology. Get it together people…I think people are learning this and deciding ECs are safe to smoke because of the lack of evidence. Perhaps they are fishing for an excuse. Perhaps they are avid consumers of research. In my clinical opinion, you are still inhaling something that is manufactured and exposing your most delicate tissues to foreign materials that may or may not be toxic. An article in the Guardian states that those who smoke ECs think the water vapor is safe, they brush off the PG as an irritant, and smoke them anyway. As for the marijuana, aside from altering perception and most likely performance, it is heated just like cigarette smoke and any smoke will irritate your tissue.

Bottom Line: Smoke can change the composition of your tissue. If you don’t inhale foreign material, your vocal folds will likely maintain their health.

  1. Throat Coat Tea and Entertainer’s Secret are a sore throat cure-allA 2004 study on the effects of laryngeal lubricants, like Entertainer’s Secret, revealed that even if a spray affects the vocal fold vibratory pressure, after 20 minutes it is like you never used it. Throat Coat tea contains slippery elm bark, a demulcent that soothes irritated tissue, and is not FDA approved to cure anything. There are no studies on how it directly affects the voice, but the steam from a hot beverage most likely will topically hydrate your vocal folds as you inhale, so that’s a plus. A hydrating beverage will provide you with internal hydration to lubricate the vocal folds from within the body. Like any pain, though, if your throat is hurting, don’t mask the problem by using numbing spray or another band-aid.  Your body is trying to tell you something and if you silence it, you could injure yourself further. Know your body.  I’m all for throat coat tea, ginger tea, lemon water, whatever–If you say it helps you feel better. I am against using any of that to hide pain so you can perform. If you are not giving your body time to heal, you’ll end up with a bigger problem.

Bottom Line: Using any crutch will usually get you through a performance, but “getting through” something may backfire on you. Instead, try to maintain a balance by keeping your body healthy, listening to it, and caring for your vocal folds even more fervently because you can’t see them.

  1. Whispering is a good idea to save your voice when on vocal rest. I was informed when I received voice therapy myself that I was not allowed to talk or whisper for a week following my surgery. Some people say the real myth is that whispering is as bad as shouting. Is it? For her own voice issues, an SLP who received treatment like me, was told that whispering would save the voice, but she found it to increase fatigue and pain for her. Go figure. Shouting and whispering differ in placement and technique, but whispering can sometimes turn into a hyperfunctional breathy voice where vocal production is made with an incomplete vocal fold closure. Ah, there’s the danger. A study in 2006 examined 100 patients with a fiberoptic camera. Only 70 percent of the patients showed supraglottic hyperfunction while whispering, meaning some of them had no hyperfunction at all. Other muscles are involved in whispering, and people whisper differently, so some studies suggest that whispering, when low in effort, can be considered for post-op patients.

Bottom Line: Whispering could turn into a poor vocal production habit in the majority of patients, so better to avoid it or monitor it closely on a case-by-case basis. If you were to whisper with a completely relaxed larynx, it’s hard to get adequate volume anyway. Tell them to text. Don’t we all have smart phones glued to our thumbs?

  1. Dairy products thicken my mucus. Recent publications have demonstrated that dairy products do nothing to chemically increase mucus production or viscosity, but why does the myth remain? A group of investigators from New York examined 21 individuals, half with asthma and half without, to see if milk increased mucus. It suggested that airway resistance was not altered by milk consumption, so no thicker mucus here. Perhaps if there is a milk allergy, the body will have a reaction to it? That might explain the widely-held belief that mucus will “gunk up vocal cords” and should be avoided. Unfortunately, I could not find any research studies about mucus thickening after eating or drinking dairy. Another study states that some people with asthma may see an improvement after eliminating dairy from their diets, however, it does not definitively prove that mucus production increases because of dairy products.

Bottom Line: You can throw science at your patients, but they may remain convinced that milk will gunk things up. You might be fighting a losing battle, but hey, at least calcium comes from other sources.

  1. Eating or drinking certain foods (or abstaining from them) will improve your performance. Okay, here we are with pizza singing boy again. He obviously thought that the pizza was his golden ticket for the American Idol of Texas choir competitions. Some performers believe licorice before a gig helps improve vocal range. One singer would consume an entire bag of licorice prior to a performance. Is this a placebo? After discussing, he stopped and the range remained the same. Hmm…. What about those singers that tell you eating Lays potato chips will lubricate their throats? Is this only in Nashville? What you eat and drink will not touch your vocal folds, it only touches the tongue, soft palate, throat walls and esophagus. If it is touching your vocal folds, you are aspirating! A recent post on a professional voice teaching thread inquired about what teachers advised singers to drink to lubricate their cords. Home remedies included vinegar, garlic, ginger, olive oil, sugar, and even aloe vera. None of these have scientific evidence that they are harmful to the voice, so if you think it helps, then by all means. Nothing really lubricates the cords from the outside, but drinking hydrating beverages lubricates from the inside, so this is kind of true…kind of…Just make sure you don’t become a yummy snack for your speech therapist if you come in smelling like an Italian dish.

Bottom Line: Hydration, Hydration, Hydration. There is no scientific evidence that certain foods or beverages will improve or hinder your performance. Water will always benefit the friction and heat created by your vocal folds by lubricating them on a cellular level. See also, my previous blog on beta-blockers and performance if your patient is considering anti-anxiety meds along with the olive-oil rub.

  1. Cold beverages, caffeine and alcohol are bad for your voice. A student at one of my lectures saw me drinking ice cold water in my handy Tervis cup. Those things are indestructible and I have one for every day of the week. Obsessed? Maybe. There is no evidence to suggest that cold water is bad for your vocal cords, I told him. Beer actually counts toward hydration, interestingly enough. These researchers found that when you are dehydrated, drinking beer will not only get you drunk, but hydrate you as well. Caffeine was found to usually not impact vocal acoustics if consumed conservatively (100mg), and this study showed that caffeine did not adversely affect voice production at all. Also, not related to voice specifically, this study suggested that coffee even hydrated similarly to water.

Bottom Line: Cold or hot, it’s your choice. And when there’s a choice, go with water over alcohol. Caffeine consumption should be examined along with other factors when recommending cessation in the therapy room. When I look at this, I think, Starbucks? Why not.

We have to be careful when presenting new information. Try hard not to claim information already known to be erroneous. Many established teaching professionals have been molding and creating performers for years, and trying to reveal a “new” truth might be unwelcome. Can we not bridge this gap between pedagogy and therapy? Between art and science? After all, the voice is both, isn’t it? Many SLPs told me they are afraid to challenge any voice teacher because they might get brushed off. I want to change this “challenge” to “suggest.”

If we are cognizant of the training and education of others, we can present information in a way that is not patronizing. And if we are open to new ideas from different sources, (I am so guilty of this too) then we might find that it works in our studios and clinics. One contributor had the most poignant response. “People become defensive sometimes when they are confronted by their own knowledge gaps, but hopefully they’ll internalize the information and emerge the better for having heard it.”

 

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

Happy New Year, ASHA Family!

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Happy New Year to my whole ASHA family – those dedicated to helping people achieve “human wholeness!” I am so proud to be part of this profession and believe I was predestined to be an SLP. The first movie I remember seeing in a theater was My Fair Lady. I’ve since become a modern-day Henry Higgins and even have worked with university teaching assistants on accent reduction! I was also a recipient of the care engendered by those in my as-yet-unchosen field when an amazing neurologist and SLP “asked me questions” (a child’s interpretation of diagnostics) and guided my family during my recovery from a head injury significant enough to require last rites in 1971. 

Although a practicing member for more than 25 years, I didn’t attend my first ASHA convention until 2013. I went to update my clinical and research skills, but also to visit school friends from Northwestern who still live in Chicago. I particularly enjoyed the courses presented by a then recent ASHA fellow and complimented her in our hotel elevator. I also asked a question about spring 2014 events. She not only answered my questions, but allowed my family to stay in her family’s home during our visit!

One Chicago friend (an organizational psychologist) was shocked at the friendliness and trust exemplified by even the offer of such hospitality and further astounded when I told her nearly 15,000 people attended the 2013 conference. I explained that ASHA members are friendly, helpful people. That presenter and new acquaintance was no fool, however, she did her due diligence and called my current work ‘family’ to vet my responsibility.  I, in turn, offered her the use of our Orlando lake home as she celebrated being named “Fellow” with her family.

That story shows how I, and many of my peers, view ASHA as a large extended family, which was reinforced by my encounters at the 2014 “Generations of Discovery” convention. Harry Belafonte, along with his daughter and granddaughter, highlighted how family focus has directed their lives. At the awards event, Annie Glenn explained how services such as her 1973 stuttering therapy, “save us from being solitary souls,” while father-son TV journalists the Geists received her “Annie” Award for their communication contributions. Honors of the Association recipient, Nan Bernstein-Ratner, gushed that obtaining the Glenns’ autographs on a photo and copy of  the Geists’ book, The Right Stuff, for her son were her most moving moments of the convention. Voice expert Daniel Boone shared how excited he was that his son and granddaughter were visiting from Tampa. We were saddened by Jeri Logemann’s passing, but her impact is ever present, from the pins at an exhibitor’s display to shared remembrances of a holiday party at her home.

None of us are “solitary souls” and our uniquely human abilities to enjoy conversing and sharing with our families and friends are a testament to the vital work each of us has chosen to undertake. For the new year, I wish my ASHA family wisdom (recalling John Rosenbek’s closing session’s  “Neuroplasticity” message that we “First do no harm”), a wealth of well-wishers (for our world has its woes), and work as we help heal the world in 2015!


Denise Dancull, M.A., CCC-SLP
is a pediatric SLP with more than 25 years experience specializing in cleft palate and cochlear implant services. Please feel free to contact this proud parent, bibliophile and theater fan at denise.dancull@nemours.org.

Picky Eaters in the Preschool Classroom: 7 Tips for Teachers

Two scoop sizes allow children to select a smaller portion for unfamiliar foods.

Two scoop sizes allow children to select a smaller portion of unfamiliar foods.

As a pediatric feeding therapist, part of working in the child’s natural environment is making regular preschool visits to offer teachers and staff guidance when a child is not eagerly participating in mealtimes. Whether a child is a selective eater or the more common picky-eater, here are seven tips for teachers that focus on the seven senses involved in food exploration and eating:

  1. Sight: New foods are better accepted when the sight of them is underwhelming. When serving foods family style, include TWO utensils for scooping from the main bowl or platter [see above]. Present each food with one larger scoop and a standard spoon. The kids at the table can choose which scoop/spoon they would like to use, which allows the more hesitant eater to choose a small sample instead of what might feel like an overwhelming shovel-full. If meals are served pre-plated, offer smaller portions (1 tablespoon) of new foods and allow the kids to request more after their first taste.
  2. Smell: Warm foods often have a stronger aroma and for some kids, this can be a quick turn-off before the food ventures toward their lips. In regards to the hesitant eater, begin passing the bowl of warm foods so that it ends up at his seat last, when it will be less aromatic. For meals that are pre-plated, simply dish up his first but place it in front of him last, so that the food has time to cool a bit. Straws are an excellent option for soups, because they allow the child to sample by sipping. The longer the straw, the farther away they are from the smell. The shorter the straw, the less distance the soup needs to travel to reach the tongue, but the closer the nose is to the aroma. Consider what suits each child best and adjust accordingly. Thinner straws allow for a smaller amount of soup to land on the tongue, but if the soup is thick, you may need a slightly wider straw. Keeping the portion as small as possible also keeps the aroma to a “just right” amount for little noses. Try tiny espresso cups, often under $2, for serving any new beverage, soup or sauce.
    espresso cups
  3. Taste: Experiencing food doesn’t always mean we taste it every time. If the best a hesitant eater can do that day is help dish up the plates or lick a new food, that’s a good start! But when it comes to chewing, encourage kids to taste a new food with their “dinosaur teeth.” A fun option are these inexpensive tasting spoons commonly found in ice cream shops. Keep a small container in the center of the table for kids to take tiny sample tastes direct from their plates.
    tasting spoons
  4. Touch: Like any new tactile sensation, few of us place our entire hand into a new substance with gusto. It’s more likely that we’ll interact with a new tactile sensation by first using the tip of one finger or the side of our thumb. Take it slow – and remember that touch doesn’t just involve fingers and hands. The inside of the mouth has more nerve endings than many parts of our bodies, so it may be the last place that the hesitant eater wants to experience a new texture, temperature or other type of sensation. Start with where he can interact and build from there.
  5. Sound: The preschool classroom is abuzz with activity and thus, noise. Beginning each snack or mealtime with a song or a ritual, such as gently ringing some wind chimes to signal “it’s time to be together with our food” is a routine that centers both teachers and children. Whatever the ritual, involve the most hesitant eaters in the process and encourage their parents to follow the same routine at home if possible. Kids do best with when routines are consistent across environments.
  6. Proprioceptive Input: The sense of proprioception has a lot to do with adventurous eating. One fun routine that provides the proprioceptive input to help us focus is marching! In one preschool classroom, we implemented a daily routine where the kids picked a food and marched around the table with it as a way to mark the beginning of a meal and provide that much-needed stomping that is calming and organizing for our bodies. Download the song “The Food Goes Marching” here (free till February 1, 2015) as the perfect accompaniment!
  7. Vestibular Sense: While we all know the importance of a balanced diet, you may not be aware that a child’s sense of balance has a lot to do with trying new foods! Our sense of balance and movement, originating in the inner ear and known as the vestibular system, is the foundation for allfine motor skills. In order to feel grounded and stable, kids need a solid foundation under the “feet and seat.” Many classroom chairs leave preschoolers with little support and feet dangling. Create a footrest by duct taping old text or phone books together or if you’re extra handy, create a step stool that allows the chair legs to sit inside the stool itself.
    footrest
    An inexpensive version can be made with a box of canned baked beans from COSTCO, like this one. Carefully open the box because you’ll be using it again to create the footrest. Simply remove the cans, empty just two, then rinse thoroughly and discard the lids. Now place the cans back in the box with the two empty cans facing up, so that the legs of the chair will poke through the box and into those two cans. Reinforce with duct tape. Instant footrest!

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the co-author of Parenting in the Kitchen: How to Raise Happy and Healthy Eaters in Our Chicken Nugget World (Aug. 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!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs.  She can be reached at Melanie@mymunchbug.com.  

CSD Students Use Their Skills in Ethiopia This Month

   

The CSD program at Teachers College Columbia University is in Ethiopia this month visiting schools for students with autism and a center for adults with intellectual disabilities. The TC Team—nine master’s students and three ASHA-certified SLPs: Lisa Edmonds, Jayne Miranda and I—used our experiences in Ghana and Bolivia to prepare for the trip.

At a vocational center for adults with intellectual disabilities the TC Team created “Seller’s Market Cards,” so the adults can independently sell their products. These low-tech Augmentative and Alternative Communication cards, laminated with packing tape, introduce the seller and list products for sale with their prices. We worked with the sellers to create the cards and then immediately tried them out at an impromptu market at the center!

At the Nehemiah Autism School, 20 teachers and our team spent the day collaborating to identify ways to bring more communication opportunities into an otherwise excellent school. We made 70 flash cards for weather, a large calendar, practiced social stories, and talked about ways to introduce literacy and math.

Right now, we’re presenting a five-day cleft palate speech institute at Yekatit 12 Hospital. Smile Train and Transforming Faces supported 14 cleft palate team professionals who attended from East and West Africa.

Please follow our adventures on the blog.  We love to see comments and are just halfway through our trip.

 

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, Crowley is working with NYCDOE on a multi-year project to improve the accuracy of disability evaluations.