Collaboration Corner: 10 Easy Tips for Parents to Support Language

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As we make our way through the lazy days of summer, schedules change, and things relax. My usual theme is collaboration; parents can be one of our biggest assets in promoting language development. Parents of young children usually want to know what they can do to support their child’s language development in the absence of a structured day. Though I teach children with disabilities, I find I continually revisit the following tips with parents of young children regardless of whether a child is typically developing or needs a little more support. Here they are in no particular order of importance:

  1. Pay attention to body language, when a child is looking toward or reaching for something, they are communicating. Talk about what they are reaching for, “Oh, you want the bubbles!”
  2. Avoid the “say this” tendency. Don’t pressure the child to speak; keeping the experience positive is important. Instead, model what the child might say when he/she is ready.
  3. Take time to sit and read with your child every day. Label everything you see, and encourage them to point to the words and pictures as you talk about them. Books with repetitive lines are great.
  4. Be playful. Sing songs. Use lots of inflection. With familiar songs, leave some of the words out and see if your child will hum or sing the words.
  5. Provide limited choices when you aren’t sure what your child wants. Holding out 2 items, lessens the stress of having too many choices.
  6. Talk with your child about what you are doing, then provide the opportunity for your child to reciprocate. “I’m making some cookies, do you want to help?”
  7. Use first/then language to guide behavior, and then be consistent, “First you need to eat, then you can read.” Use this language even when moving between activities that are preferred or less preferred.
  8. Use pictures: Take pictures of your child’s day and talk about what is coming up next, or make a photo album of fun activities (vacation, going out for ice cream) to talk about.
  9. Remember language is everywhere, even if you child doesn’t understand everything you are saying, he or she needs the exposure. Car rides, walks outside, blowing bubbles are just a few examples. Describe what you see, and ask questions, e.g, “I see a cow. What does a cow say?”
  10. Simplify your props. Sometimes the simplest toys can bring out the best language. Summer is full of such opportunities: A spinning toy, taking a turn kicking a ball, bubbles…all can support your child’s development, simply by talking to them.

Kerry Davis Ed.D., CCC-SLP,is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer speech pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this blog are her own, and not those of her employer.

CFY (Coming For You)!

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I’m a big fan of musical theater (I was so excited Jessie Mueller won a Tony this year.  She was wonderful.). I’m in awe of the performers who seem to sing, dance and act with equal aplomb.  And then they go out and do it in front of a live audience.  Every day.  Twice on Wednesday and Saturday. Where do they find the endurance?

Well, baby, I’ve got news for you.  You’re about to star in your own show.

There is no denying the difficulty of grad school. You’re taking classes in everything, even the stuff that might not be your cup of tea.  Ideally, your clinical fellowship year is in an area you particularly enjoy and the everyday implementation of book learned skills will certainly give you many ah-ha moments. What can be difficult is the frequent observation, knowing, or maybe not knowing, that someone is on the other side of that two way mirror.  There is a feeling of being constantly “on.”  Even paperwork remains a performance. I would drop into bed at night, completely spent.

I actually had two CFY experiences.  The first was my dream job. I was a preschool therapist in a local school system and my job included home visits/evaluations, lessons within the preschool handicap classroom, individual pull-out therapy for many of those same kids, other children that came only for speech, and screenings–lots and lots of screenings.  I’d been working at my school practicum the previous spring in the same location so I knew the staff, some of the kids and had a relationship with my supervisor.

Then life intervened.  My husband and I married in early August which gave us time to honeymoon before the first day of school.  But as the saying goes, “the best laid plans of mice and men….”  Within the first month my husband was transferred to Atlanta, a five to six hour drive from where we were living, and needed to move immediately.  I gave notice that I would leave at the Christmas holiday, started packing our wedding gifts and began to look for a new placement.  (Yes, my husband left a couple months before I did.  Not an auspicious start to married life, but we made it work.)

My second placement was equally as dreamy–out-patient rehab for a large children’s hospital with lots of experienced therapists, including OT and PT, to learn from and watch. The experience I gained there truly shaped the clinician I am today.  So much so, that if I were to give one bit of advice to a new therapist starting out it would be to work where you have lots of interaction with more experienced clinicians. I know you’re sick of being watched, guided, and yearn to start doing your own thing, but…for me, it was the best possible thing that could have happened. (This is where I spent two years exhausted.  I was finally starting to get my feet under me, doing some mentoring myself, and feeling less stressed by the whole process when, guess what, transferred again.)

I share this because I think we get so close to a situation we aren’t seeing it anymore. My situation was unique, but these things come up for lots of reasons.  Sometimes CFYs take place in more than one location or setting.  There might be a short “pause” right in the middle. It’s ok.  Show close and new ones open.  Break a leg!

 

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

 

Favorite Resources: Fiction and Non-Fiction Texts

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School based SLPs often look to align their intervention goals with academic content standards to increase student success in the classroom. Many of these goals align with English Language Arts standards. Goals for vocabulary, comprehension, and articulation can be targeted easily using fiction and non-fiction texts. Using reading passages is a perfect way to support reading skills and curriculum. It’s also an easy way to incorporate current events or seasonal information as well. I wanted to share four different resources I used for my caseload this year.

The

1. Newsela.com
Newsela is a site that takes regular news articles and changes the lexile level for a variety of readers. You can select the article, then pull it up on your screen. On the right side of the screen you can select a variety of lexile levels from 3rd grade up to the regular adult version.This is perfect for mixed groups.
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I love to use it for middle schoolers reading at lower lexile levels.
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We also use these in my articulation groups. This 7th grade student went through and highlighted each /r/ word.
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As he reads the page, I marked each sound with a +/-. Then we go back and work on the words he missed. This resource is free.
2. ReadWorks.org
ReadWorks is another fantastic free resource. I love their units for seasonal reading. Sign up for a free membership. You can search using the calendar at the bottom of the home page. There are resources for Kindergarten and up.
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They even have whole units for free for common books you already have on the shelf! Take time to search through and find units that are made to teach specific skills.
3. ReadingA-Z.com 
Many  districts pay for teachers and SLPs to have access to ReadingA-Z.com. I use it a lot and would recommend it to any SLP working with school aged students. I also have access to VocabularyA-Z. Let me show you some favorite resources within it.
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Leveled books used to be the meat of ReadingAZ. Lately they have added a whole lot more, but these are still my Go-To!
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Once you open a leveled book, you have many options. Print the book, share on a Smartboard, or print additional worksheets.
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I love the vocabulary connections most of all.  Since we have a subscription to VocabularyA-Z there are sets of  vocabulary lessons for EVERY BOOK!
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This is such a huge time saver for me. It takes the planning out of vocabulary practice!
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There are special lessons for ELL/ESL. These are great for language learners and for daily living skills units.  There are printable books that focus on feelings, vocabulary (vegetables, money, etc.), and places (neighborhood, school).
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The website also includes decodable books.  They are divided by sounds and even blends. These are  great for articulation practice.
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One section of ReadingAZ features comic books. Lots of my reluctant readers /language delayed  kids love comic books.
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The last feature I frequently use is the write your own story books. Most of the lower leveled books are available in the ‘write your own’ format. You can either print the regular book or print the wordless book. This is an easy way to progress monitor a variety of grammar and narrative skills. Of course it’s great for direct instruction, too! If you’re working on retell you can read the story with the words first and then use the ‘write your own’ version to support retell.
ReadingAZ is a paid subscription. Look into the free trial if you haven’t used it before.
4. N2Y.com
News-2-You is a symbol based weekly newspaper. It’s my ‘go-to’ for daily living skills classes and autism classrooms. I love the predictability and the symbol support. You can also download many levels of  instruction.
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This is the ‘regular version.
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The simplified version has less text.
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This is the ‘higher’ version (but still not the highest offered.)
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Did you know they have a spanish edition?
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I love the pre-made communication boards and the recipes included. I use the app frequently with my students.N2Y is a subscription based program. You would not be disappointed if you purchased it. I promise!
Those four resources are websites I use every week to support my instruction.  SLPs can use them as part of their instruction or as a way to provide homework, align their intervention goals with academic content standards in order to increase student success in the classroom.

Jenna Rayburn, MA, CCC-SLP. is a school based speech-language pathologist from Columbus, Ohio. She writes at her blog, Speech Room News. You can follow her on facebooktwitter, instragram and pinterest.

Three Reasons Why Kids Get Hooked on “Kids’ Meals”… and How to Change That

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Let me say this up front: I’m not condemning the American Kids’ Meal that is so common in fast food chains and family restaurants, but clearly I’m not keen on eating that type of food when there are other choices.   My own kids have certainly had their fair share of chicken nuggets, mac n’cheese and French fries, just to name a few of the comfort kid foods that predictably reappear on kids’ menus day after day.   This is not a blog about good vs. healthy nutrition, because most parents (including me) know that the traditional fast food fare is not healthy…and that’s exactly why parents want to change the statistics that 15 percent of preschoolers ask to go to McDonald’s  “at least once a day.”    The millions of dollars spent on advertising and toys to market kids meals certainly makes many of us frustrated when much less is spent on marketing a culture of wellness.  By hooked, I don’t mean addicted, although there is research that suggests that food addiction may be a serious component for a subset of the pediatric population Plus, the added sugars in processed foods have been found to be addictive in lab experiments.  But, for the purposes of this short article, let’s keep kids’ meals in this very small box:  Most kids love them.

Why am I writing about this for ASHA? As a pediatric SLP who focuses on feeding, one of the frequent comments I hear from parents is “As long we’ve got chicken nuggets,  then my kid will eat.”   Besides the obvious “just say no” solution, what parents truly are asking is,  “How do I expand my kid’s diet to include more than what’s on a kids’ menu?”  Whether we are considering our pediatric clients in feeding therapy or simply the garden-variety picky eater, that is an excellent question with not a very simple answer.

In feeding therapy, therapists take into account the child’s physiology (which includes the sensory system), the child’s gross motor, fine motor and oral motor skills  and also behaviors that affect feeding practices.  Therapists then create a treatment plan designed to help that specific child progress through the developmental process of eating.  While the nuances of learning to bite, chew and swallow a variety of foods are too complex to cover in a short blog post, here are just three of the reasons why kids get hooked on kids’ meals and some strategies to avoid being locked into the standard kids’ menu and begin to expand a child’s variety of preferred foods:

  1. Kids barely have to chew.  The common fast food chicken nugget is a chopped mixture of …well, if you want to know, click here.  Warning: it will ruin your appetite for chicken nuggets, so if your kids can read,  clicking might be the first solution.  However, in terms of oral motor skills, bites of chicken nuggets are a first food that even an almost toothless toddler can consume with relative ease.  Simply gum, squish and swallow.  Macaroni and cheese?  Oily French fries?  Ditto.  There’s  not a lot of chomping going on!
  • In feeding therapy, SLPs assess a child’s oral motor skills and may begin to address strengthening a child’s ability to use a rotary chew, manage the food easily and swallow safely.  Many of the families we work with eat fast food on a regular basis and we might start with those foods, but slowly over time, more variety is introduced.
  • For general picky eaters or those progressing in feeding therapy, the key is to offer small samplings of foods that DO require chewing, as long as a parent feels confident that their child is safe to do so.  Starting early with a variety of manageable solids, as described in this article for ASHA, is often the first step.   For older kids, the texture (and comfort) of “squish and swallow” foods can contribute to food jags.  Here are ten tips for preventing food jags, including how to build your child’s familiarity around something other than the drive-thru.
  1. At restaurant chains and drive-thrus, kids’ meals are readily available.  Helpful hostesses grab the crayons and the matching kids’ menus as soon as they spot a parent walking in with little children.  Kiddos quickly become conditioned to ordering mac n’ cheese or hot dogs.   Parents want a peaceful, enjoyable experience dining out, so naturally they like the kids’ menu option because it appeases everyone.  But it’s just that–an option.
  • In feeding therapy,  SLPs assess and often treat a child’s ability to be flexible with food at home and in the community.  A hierarchical approach is often utilized, where exposure to new foods occurs as a gradual process over time.
  • As a parent, if your child likes to stick to the same routine at a restaurant, begin with helping your child order from the “adult” menu, knowing that you can request adaptions to certain dishes if needed.  If the prices feel too steep, order a side for the kids, and give them samplings of everything on your plate.  Keep in mind that often the goal is simply experiencing the presence of new foods, so order a side dish that is a favorite food plus present a selection of new options from your plate if you are concerned your child will not eat anything.  Now you and your child have a new routine and the tasting piece occurs once the routine is established.   If you order a salad in the drive-thru, consider skipping the kids’ meal and creating a kid’s sampling of grilled chicken cubes, sunflower seeds, mandarin oranges or other options directly from your salad when you arrive at your destination.   Request an extra packet of dressing if your kids like to dip.
  1. Kids Meals are QUICK! Quick to buy, quick to eat and quick to raise blood sugars and thus, feel satisfied.  I get it – part of today’s hectic lifestyle is shuttling kids to and from activities and often, mealtimes happen while riding in the mini-van.  Fast food chains understand this too – that’s why it’s marketed as “fast food.”
  • In feeding therapy, this reliance on drive-thru food affects progress in therapy.  For example, it’s not uncommon for elementary school kids in feeding therapy to  have trouble eating in the chaotic school cafeteria and be “starving” when a parent picks them up from school.  The quickest, easiest solution: The drive-thru every day after school.
  • In today’s quick-fix society, our children are losing the valuable skill of waiting.  Feeling hungry and then making a snack or meal together to satisfy growling bellies is one way to practice the art of waiting.  Have some pre-cut veggies ready in the refrigerator to nibble on if waiting for the meal is too challenging.  Besides, it’s the perfect time to place them on the counter while your prepping the entrée because you’ve got hunger on your side!  Hint: Blanched veggies, patted dry and then chilled, hold more moisture and taste slightly sweeter to some kids.  The higher moisture content makes them easier to crunch, chew and swallow.  Most blanched fresh vegetables last for several days in the refrigerator.  Remember, keep presenting fresh foods so that the more common option is a healthy one, rather than the oh-so-well marketed processed foods found on many kids’ menus today.

SLPs and parents, what strategies do you use do limit traditional kid food and help kids become more adventurous eaters?  Please comment and share your tips!

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

How to Make Social Skills Stick

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At Communication Works, a private practice in Oakland, California, we’re passionate about partnering with parents and caregivers in the treatment process. When it comes to social learning, many children struggle to carry over learned skills from the therapy setting or school to their home environment. Parents are in a perfect position to help practice and facilitate those skills and help make them stick! As professionals, we can give parents the awareness and knowledge as well as the tools and strategies to help them embrace teachable moments and guide their children. Even though parents are busy and sometimes overwhelmed, we can enlist their help without making stressful demands on their time. Parents are usually eager to help as long as we offer specific, easy activities that fit within the family’s natural routines.

Whenever possible, try to support the things parents are already doing and to piggyback onto those activities, such as reading bedtime stories, doing chores, or eating dinner. As an example, if a child is working on conversational turn taking in therapy, families can pass a “talking stick” (a spoon or spatula) at the dinner table to signify whose turn it is to talk and facilitate taking turns when describing each person’s day. If the child is working on “wh” or “wonder” questions (who, what, when, where, etc.) and you are using a visual prompt to facilitate this in therapy, make a copy of that visual and send it home for parents to use with their children during meal times or when having conversations in the car..

If you’ve created a roadmap or social story for an event at school, share a copy with parents. If the child has an event coming up (a graduation, birthday party, holiday, etc.), offer examples of details the parent can share with the child about what is expected during that event. For example, if a child is planning to attend a graduation for the first time, the parent can explain about caps, gowns, and diplomas (and why students toss the caps into the air) as well as how much sitting still and listening time the child can expect. If the child hasn’t yet attended a July 4th celebration, the parent can prepare the child for a big crowd and loud noises. They can discuss the type of behavior expected in a crowd and how to make the event more enjoyable and comfortable for the child, perhaps by bringing earplugs or asking for a break when feeling overwhelmed.

Parents also appreciate simple suggestions for teachable moments that may occur during part of the family routine or in the community. For example, if you’ve worked on increasing observational skills and understanding nonverbal language, talk to the parents about setting up a time for them, to take their child out for a snack and do some “people watching.” This can not only be an excellent opportunity to generalize a skill learned in the therapy setting, but can be a great bonding experience for parents and children. Teach the parents how to play “social detective” with their child and identify how the other people in the coffee shop are related, how they are feeling, and possibly what they are talking about. If you’re teaching sequencing during a therapy session, show parents how to practice this skill by sequencing out the steps for baking cupcakes or making a birthday card. If you’re focusing on self-regulation strategies like calm breathing, show the parent how to practice by placing a teddy bear or book on the child’s belly and watching it go up and down. As you develop new lessons, think about how parents could easily adapt them for home use. Be sure to provide handouts or information for them to share with other family members, and keep activities “no fuss” for busy parents.

Therapists working in schools will have limited time with parents, but can communicate through notes, logs, or a binder that goes back and forth from home to school. If you work in a private setting, consider bringing parents into group or individual sessions for a portion of the time, and have the child(ren) show what they have learned. Take a few minutes to brainstorm with the parent about ways to practice at home. Parents appreciate knowing the why’s as well as the how-to’s. Without overwhelming them with pages of information, provide the reasoning behind a particular activity as well as specifics about how to carry it out at home.

Social learning is a 24/7 process, and kids need support to be able to bring learned skills into the home and community. If professionals don’t collaborate with parents, the child misses countless opportunities for practicing essential social skills. When we do engage parents in the process, they can serve as both coaches and cheerleaders for their children. If we give parents the right tools, knowledge, and encouragement, they can feel confident and inspired to play an essential role in bridging the gap between therapy and real life.

Elizabeth Sautter, M.A. CCC-SLP is co-director and co-owner of Communication Works, a private practice in Oakland, California, offering speech, language, social, and occupational therapy. She is the co-author of the Whole Body Listening Larry books. Her most recent book is Make Social Learning Stick! How to Guide and Nurture Social Competence Through Everyday Routines and Activities. She can be reached at makesociallearningstick@gmail.com or follow her: website; Facebook; Pinterest; Twitter.

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

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

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

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

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

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

7 Clues in the Medical Record to Discover Dysphagia

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

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

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

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

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

1)    Is it pneumonia?

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

 

2)    What type of pneumonia is it?

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

 

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

 

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

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

 

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

 

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

 

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

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

 

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

 

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

 

June is Aphasia Awareness Month—Join the Celebration!

aphasia

June is National Aphasia Awareness Month and this year’s host group is the Big Sky Aphasia Program in Missoula, Mont.. This year’s theme is “ It’s Never Too Late To Communicate” and the National Aphasia Association (NAA) is encouraging professionals, consumers, community support groups and aphasia centers nationwide to raise public awareness about aphasia in June and has a poster and resource packet available.

Thanks to Senator Tim Johnson (D-S.D.) and Senator Mark Kirk (R-Ill.) for, once again, co-sponsoring the resolution to proclaim June as National Aphasia Awareness Month! You can find the resolution here.

This year we launched a month-long social media contest to help the public understand aphasia and how to communicate with people who have aphasia. We are proud to introduce our new social media intern, Laura Cobb, whose first assignment is serving as spokesperson for the Aphasia Awareness Month contest. Laura is 27 years old and lives in St, Louis, Mo.. In September 2008 she was a student at Washington University majoring in psychology and hoping to work in the field of autism when her car was struck by a drunk driver as she returned home from studying. Laura suffered a stroke resulting in aphasia along with other injuries including a partial hearing loss for which she wears bilateral hearing aids.With intensive speech services, Laura has been able to regain a good portion of her ability to communicate. She continues to receive speech and language treatment and continues to improve. We first met Laura when she created her own video for You Tube on “How to Talk to Someone with Aphasia.” Her video has received more than 200,000 views to date and she was interviewed for an article in the Huffington Post.

“I’m excited to work with the NAA now,” says Laura in the first of her weekly video clips discussing the NAA’s contest, which encourages people to post about aphasia on Facebook, Twitter, Instagram and YouTube using the hashtag #AphasiaAwarenessMonth.  Each week, participants are tasked with a different challenge. For example, in week one, people were asked to answer the question “What is aphasia?” In week two, participants shared their tips for communicating with people with aphasia and in week three they posted pictures of themselves with the June poster. Click here to learn about this week’s challenge.

“It’s never too late to communicate. So, we want your tips. My favorite tip: speak s-l-o-w-l-y,” says Laura. At the end of each week, a winner will be selected randomly and awarded a series of aphasia-related prizes; then a new weekly challenge will be announced. At the end of the five-week contest, the top prize, an iPad Mini, will be awarded on June 27. There is no cost to participate. The more people post using #AphasiaAwarenessMonth, the more chances they have to win and the more we can raise awareness of aphasia!

But that’s not all you can do. Here are some other suggestions as to how you can celebrate National Aphasia Awareness Month in June:

  • Provide training at local hospitals, clinics, senior citizens centers, nursing homes, etc.
  • Send packets of information to doctors and other professionals and staff who work with aphasia (e.g. physical therapists, occupational therapists, social workers, nurses). Training for these groups would be very helpful in dealing with the communication difficulties.
  • Provide training workshops and support groups for family and caregivers.
  • Provide workshops for local religious groups – many of these have existing programs for helping people in the community.
  • Display posters and disseminate materials in local shopping centers, libraries and supermarkets about aphasia.
  • Set up an information table to educate employees, patients and families about aphasia.
  • Get your city/town to pass a resolution proclaiming June as National Aphasia Awareness Month- we can provide you with the template.

Remember, aphasia advocacy and increasing awareness is a year round activity so join the effort! For more information or to receive your Aphasia Awareness Month packet, contact the NAA’s Response Center at 800-922-4622 or visit the NAA website.

 

Ellayne S. Ganzfried, M.S., CCC-SLP, is a speech-language pathologist and the Executive Director of the National Aphasia Association. She is Past President of the NYS Speech Language Hearing Association (NYSSLHA), Long Island Speech Language Hearing Association (LISHA) and the Council of State Association Presidents for Speech Language Pathology and Audiology (CSAP) and remains active in these associations. Ellayne is a Fellow of the American Speech Language Hearing Association (ASHA). She was a site visitor for ASHA’s Council on Academic Accreditation (CAA) and a practitioner member of the CAA for four years. She is currently on ASHA’s Committee on Honors. Ellayne has created and managed several speech, hearing and rehabilitation programs in New York and Massachusetts. She is an adjunct instructor at Adelphi University-Garden City –NY. Ellayne has written articles and presented regionally and nationally on a variety of topics including aphasia, rehabilitation and leadership skills.

Preventing Food Jags: What’s a Parent to Do?

picky eater

 

As a pediatric feeding therapist, many kids are on my caseload because they are stuck in the chicken nugget and french fry rut…or will only eat one brand of mac-n-cheese…or appear addicted to the not-so-happy hamburger meal at a popular fast food chain. While this may often include kids with special needs such as autism, more than half my caseload consists of the traditional “picky-eaters” who spiraled down to only eating a few types of foods and now have a feeding disorder.  I  even had one child who only ate eight different crunchy vegetables, like broccoli and carrots.  Given his love for vegetables, it took his parents a long time to decide this might be a problem. The point is: These kids are stuck in food jag, eating a very limited number of foods and strongly refusing all others.  It creates havoc not only from a nutritional standpoint, but from a social aspect too. Once their parents realize the kids are stuck, the parents feel trapped as well. It’s incredibly stressful for the entire family, especially when mealtimes occur three times per day and there are only a few options on what their child will eat.

It’s impossible in a short blog post to describe how to proceed in feeding therapy once a child is deep in a food jag.  Each child is unique, as is each family. But, in general,  I can offer some tips on how to prevent this from happening in many families, again, keeping in mind that each child and each family is truly unique.

Here are my Top Ten suggestions for preventing food jags:

#10: Start Early.  Expose baby to as many flavors and safe foods as possible.   The recent post for ASHA on Baby Led Weaning: A Developmental Perspective may offer insight into that process.

#9: Rotate, Rotate, Rotate: Foods, that is.  Jot down what baby was offered and rotate foods frequently, so that new flavors reappear, regardless if your child liked (or didn’t like) them on the first few encounters.  This is true for kids of all ages.  It’s about building familiarity.  Think about the infamous green bean casserole at Thanksgiving.  It’s rare that hesitant eaters will try it, because they often see it only once or twice per year.

#8: Food Left on the Plate is NOT Wasted: Even if it ends up in the compost, the purpose of the food’s presence on a child’s plate is for him to see it, smell it, touch it, hear it crunch under his fork and  perhaps, taste it.  So if the best he can do is pick it up and chat with you about the properties of green beans, then hurray!  That’s never a waste, because he’s learning about a new food.

#7: Offer Small Portions:  Present small samples.  Underwhelming – that’s  exactly the feeling we hope to invoke.   Besides, if a tiny sample sparks some interest and your child asks for more peas, well, that’s just music to your ears, right?  Present the foods in little ramekins, small ice cube trays or even on  tiny tasting spoons used for samples at the ice cream shop.

#6: Highlight Three or Four Ingredients Over Two Weeks:  You can expose kids to the same three or four ingredients over the course of two weeks, while making many different recipes.  For example, here are nine different ways to use basil, tomatoes and garlic.  Remember get the kids involved in the recipe, so they experience the food with all of their senses.  Even toddlers can tear basil and release the fragrance, sprinkling it on cheese pizza to add a little green.   If they just want to include it as a garnish on the plate beside the pizza, that’s a good start, too!

#5 Focus on Building Relationships with FoodThat often doesn’t begin with chewing and swallowing.  Garden, grocery stop, visit the farmer’s market, create food science experiments like this fancy way of separating egg whites from the yoke.  Sounds corny (pardon the pun!), but making friends with food means getting to know food.  I often tell the kids I work with “We are introducing your brain to broccoli.  Brain, say hello to broccoli!”

#4 Don’t Wait for a Picky Eating Phase to Pass: Use these strategies now.  Keep them up, even through a phase of resistant eating.  Learning to be an adventurous eater takes time.

#3 Don’t Food Jag on FAMILY favorites.  In our fast paced life, it’s easy to grab the same thing for dinner most evenings.  Because of certain preferences, are the same few foods served too often?  Ask yourself, are you funneling down to your list of “sure things?”  It’s easy to fall into the trap: “Let’s just have pizza again – at least I know everyone will eat that.”

#2 Make Family Dinnertime Less about Dinner and More about Family.  Why?  Because the more a family focuses on the time together, sharing tidbits of their day and enjoying each other’s company,  the sweeter the atmosphere at the table.  Seems ironic, given this article is focused is on food, but, the strategies noted above all include time together.  That’s what family mealtimes are meant to be: a time to share our day.  Becoming an adventurous eater is part of that process over time.

And the #1 strategy for preventing food jags?  Seek help early.  If mealtimes become stressful or the strategies above seem especially challenging, that’s the time to ask a feeding therapist for help.  Feeding therapy is more than just the immediate assessment and treatment of feeding disorders – the long term goal is creating joyful mealtimes for the whole family.  The sooner you seek advice, the closer you are to that goal.   I hope you’ll visit me at My Munch Bug.com for articles and advice on raising adventurous eaters and solving picky eating issues.  Plus, here are just a few of my favorite resources:

Websites & Blogs

Doctor Yum.com

Spectrum Speech and Feeding.com

Picky Tots BlogSpot

Books

Getting to Yum

Fearless Feeding

Nobody Ever Told Me (or My Mother) THAT!

Facebook

Food Smart Kids

Feeding Matters

Feeding Tube Awareness

 

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

Become a (Hearing) Environmentalist

dusty4

 

Communication is a complex puzzle that requires all pieces to be properly placed. It is critical for audiologists to address all pieces of that puzzle during the aural rehabilitation process to ensure a successful outcome for the patient. A comprehensive counseling protocol should thoroughly address the following five keys to communication success:

dusty graphic

My previous blogs focused on the roles of the speaker and the listener in a communication exchange. Today we’ll address the third key to communication success: environment. No, I’m not talking about the trees and the birds! When it comes to communication, environmental modifications often have the biggest impact, yet they are often overlooked. Let’s take a look at one of the most difficult listening situations for people with hearing loss, and how environmental modifications can reduce potential communication challenges.

The hastily-educated patient:

Mr. Jones and his wife are looking forward to dinner at their favorite restaurant to celebrate their anniversary. After a busy day, they rush out of the house at 5:30 p.m., hoping they won’t have to wait too long for a table. They are both starving, so they accept the first-available table, which happens to be in the middle of the restaurant and close to the kitchen. Mr. Jones is still adapting to his new hearing aids and feels overwhelmed by all of the noise. They are surrounded by families with loud children, clanking dishes, and noises from the kitchen. He and his wife can hardly hear each other above all the noise and feel frustrated that they weren’t able to fully enjoy their anniversary dinner. They are both disappointed that his new hearing aids did not perform better in this situation.

The well-educated patient:

Mr. Jones and his wife are looking forward to dinner at their favorite restaurant to celebrate their anniversary. They make a 4:00pm reservation and request a corner booth with good lighting. When they arrive for dinner, they are pleased to find that they nearly have the restaurant to themselves. They are seated immediately, served quickly, and enjoy reminiscing about the past year over a pleasant early dinner. Mr. Jones is pleased that his new hearing aids made it easier to hear his wife’s voice.

It doesn’t take a rocket scientist to figure out which scenario will result in a more satisfied patient outcome. Determine which situations are most challenging for your patients, and help them to develop an “environmental modification” plan for those specific situations. These plans typically incorporate some version of the following two elements:

1. Reducing background noise
2. Improving visibility (ex. lighting, proximity, orientation)

It is our professional responsibility to make sure that every patient is educated and equipped with tools and strategies that address all pieces of the communication puzzle. They must understand that environmental modifications are just as important as the hearing aids. While thorough patient education may take a bit longer in the beginning, it almost always saves valuable clinic time in the end. The resulting patient success and satisfaction certainly make it time well-spent.

 

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