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.

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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!

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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.

 

 

 

What SLPs Need to Know About the Medical Side of Pediatric Feeding

no food

Pediatric feeding problems come in all shapes and sizes. They tend to be complicated and often result from a combination of factors. This can make effective treatment challenging for the feeding therapist. A feeding problem is defined as “The failure to progress with feeding skills. Developmentally, a feeding problem exists when a child is ‘stuck’ in their feeding pattern and cannot progress.”

So where should the speech-language pathologist start? We should always begin by trying to figure out why the child is stuck and not progressing with eating and oral motor skills. Whether the child is dependent on tube feedings, not moving to textured foods, grazing on snack foods throughout the day, failing to thrive, pocketing foods, or spitting foods out, using medical management strategies can greatly improve a child’s success in feeding therapy.

A significant number of children with feeding difficulty also have a history of gastrointestinal problems such as gastroesophageal reflux, constipation, poor appetite, poor weight gain, and sometimes food intolerance. These issues can cause eating to be painful for the child which can lead to food refusal and avoidance and subsequent oral motor delay due to decreased practice eating the needed volumes for growth and poor acceptance of age appropriate foods. Research has shown the relationship between feeding difficulty and gastroesophageal reflux.

Most of the children we work with can’t tell us what is wrong. Their eating behavior tells us a lot about their digestive tract. These children often graze, volume limit, or avoid food because filling up their stomachs hurts. Some children complain that they have stomach pain while others vomit, spit up or cry with eating. We know that if these problems persist for any length of time, they become learned patterns of behavior.

Medical strategies that promote “gut” comfort and encourage appetite will help the child be receptive to eating and can improve response to feeding therapy. These strategies typically involve the following:

 

  • Addressing weight gain and growth as the priority of a feeding program.
  • Treating constipation and establishing a routine of daily soft stooling.
  • Treating gastroesophageal reflux and hypersensitivity in the GI tract.
  • Using hydrolyzed formulas that are easier to digest and promote gastric emptying and stooling.
  • Adjusting tube feeding rates and schedules to promote comfort.
  • Using appetite stimulants to boost hunger.

Some children’s feeding skills improve dramatically with medical management alone. Other children will need feeding therapy using techniques to improve acceptance of volume and variety of foods as well as oral motor therapy to progress to age appropriate oral motor patterns. No matter what type of feeding therapy approach you are using, the child will respond better if they feel better.

Many therapists have been taught to start with the mouth. That means addressing the oral motor hypersensitivity or oral motor delay first. Many clinicians feel that the doctor or medical specialists are addressing the reflux and constipation issues. However, it really is a team effort. Most physicians do not watch the child eat or see a child as often as we do as therapists. Therefore, it is important to work closely with the referring physicians to assist with proper diagnosis and treatment in order to assure the best outcomes for our patients.

Depending on the child, using medical management strategies can take multiple visits over time with the physician. If the child’s symptoms persist despite using medicines for reflux and constipation, a pediatrician may decide to refer the child to a gastroenterologist or feeding team for specialized care. A child also may undergo further testing to rule out medical diagnoses that can negatively effect eating such as anemia, food allergy, eosinophillic esophagitis, malrotation, and motility disorders.

The most important reason to recognize and treat the underlying medical issues of children with pediatric feeding problems is to help them progress. As SLPs, we need to recognize and identify GI issues prior to starting therapy so that we are not reinforcing pain or discomfort for the child. Our goals for most clients involve weight gain and growth, age appropriate oral motor patterns, and acceptance of a variety of foods from all food groups for healthy eating. These are attainable goals for many of our clients. Using medical strategies to help the child feel better will improve response to feeding therapy and eventually outcomes.

Krisi Brackett MS, CCC-SLP, is a feeding specialist with over 20 years of experience working with children with feeding difficulties. Krisi is co-director of the pediatric feeding team at the NC Children’s Hospital, UNC Hospitals, Chapel Hill, N.CFollow her at www.pediatricfeedingnews.com. The blog is dedicated to up to date pediatric feeding information. Krisi teaches a two-day workshop on using a medical/motor/behavior approach, is an adjunct instructor teaching a pediatric dysphagia seminar at UNC-Chapel Hill, and has co-authored a chapter in Pediatric Feeding Disorders: Evaluation and Treatment, Therapro, 2013.

Why Growing a Healthy Green School is Golden

green school

Remember dioramas from first and second grade? Last fall I was invited to attend the opening of the U.S. Environmental Protection Agency’s “Lessons for a Green and Healthy School” exhibit, a giant, life-sized, walk through diorama on how to create a green environment in schools. Located at the Public Information Center of US EPA’s Region 3 offices in Philadelphia, what I learned there about sustaining a healthy school for students, teachers, and community was exciting…and I heard it from the students themselves. [How to Build A Healthy School]

The Green Ribbon Schools Program is a joint endeavor between the U.S. EPA and U.S. Department of Education. The program honors schools and districts across the nation that are exemplary in reducing environmental impact and costs; improves the health and wellness of students and staff; and provides effective environmental and sustainability education, which incorporates STEM (science, technology, engineering, mathematics), civic skills and green career pathways.

A healthy green school is toxic free, uses sustainable resources, creates green healthy spaces for students and faculty, and engages students through a “teach-learn-engage” model. Examples of greening techniques include the using building materials for improved acoustics; installing utility meters inside the classroom as a concrete aid for teaching abstract concepts in math; and incorporating storm water drainage systems within a school’s landscape design to teach and practice water conservation. What are some environmental concerns to address when you are growing a healthy school?

  • Asthma and asthma triggers (indoor air quality)
  • Asbestos and lead (especially in older buildings)
  • Carbon monoxide (from old furnaces, auto exhaust)
  • Water fountains
  • Chemicals in the science lab (think mercury)
  • Art and educational supplies
  • Managing extreme heat
  • Upkeep of athletic grounds
  • Mold, lighting fixtures
  • Waste and recycling

Now more than ever, we must educate new generations of citizens with the skills to solve the global environmental problems we face. How can we have a green future or a green economy without green schools?

Benefits of green schools

1. Cost/Energy Savings:Daylighting” or daylit schools achieve energy cost reductions from 22 percent to 64 percent over typical schools. For example in North Carolina, a 125,000 square foot middle school that incorporates a well-integrated daylighting scheme is likely to save $40,000 per year compared to other schools not using daylighting. Studies on daylighting conclude that even excluding all of the productivity and health benefits, this makes sense from a financial investment standpoint. Daylighting also has a positive impact on student performance. One study of 2000 school buildings demonstrated a 20 percent faster learning rate in math and 25 percent faster learning rate in reading for students who attended school with increased daylight in the classroom.

2. Effects on Students: Students who attended the diorama presentation in Philadelphia expressed a number of ways how their green school changed personal behavior and attitudes. One young lady spoke of how a green classroom helped her focus and stay awake. Another student said being in a green school made them happier. There was more interest in keeping their school environment cleaner by monitoring trash disposal, saving water by not allowing faucets to run unnecessarily, picking up street trash outside the school, sorting paper for recycling, and turning off lights when room were no longer in use. Some students went so far as to carry out their green behaviors at home. Small changes in behavior and attitude such as these are the foundation for a future citizenry who will be better stewards of the environment.

3. Faculty Retention: Who wouldn’t want to be a speech-language pathologist in a green school? Besides, there would be so many opportunities for a therapist to embed environmental concepts in to their session activities. Think how a quieter environment would foster increased student attention. How about having the choice of conducting a small group session in the pest-free landscape of the school yard? Research supports improved quality of a school environment as an important predictor of the decision of staff to leave their current position, even after controlling for other contributing factors.

How to make your school green

  • Have a vision for your school environment. You can start small at the classroom level or go district wide. Focus on one area or many (healthier cafeteria choices, integrated pest management, purchase ordering options, safer chemistry lab) Maybe you already know what environmental hazards affect your school – if you do then start there.
  • Get a committee going. It helps to have friends. Is there someone you can partner with? School nurse, building facilities manager, classroom teacher, PTA, students?
  • Conduct a school environmental survey. This doesn’t have to be complicated, you can poll your colleagues, or discuss at the next department meeting, or over lunch. If you like, check out EPA’s “Healthy SEAT – Healthy School Environments Assessment Tool” for ideas.
  • Have a plan. Select a time frame, short term first and use it as a pilot to evaluate whether a green school is possible. Pick something small to work on.
  • Monitor and evaluation your progress. It’s always a good idea to collect data but it doesn’t have to be too sophisticated. Use “before and after “ photos or video student testimonials.
  • Embed the green environment into the student curriculum and activities. Create speech lesson plans with green materials or photos of your green school project. Growing Up Wild is an excellent curriculum for early childhood educators.

Anastasia Antoniadis is with the Tuscarora (PA) Intermediate Unit and works as a state consultant for Early Intervention Technical Assistance through the Pennsylvania Training and Technical Assistance Network. She earned a Master of Arts degree in speech pathology from City College of the City University of New York and a Master’s degree in public health from Temple University. She was a practicing pediatric SLP for 14 years before becoming an early childhood consultant for Pennsylvania’s early intervention system. Her public health studies have been in the area of environmental health and data mapping using geographic information system technology.  You can follow her on Twitter @SLPS4HlthySchools.