Tales From Apraxia Boot Camp

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In August of this year, I was selected to be a part of The Childhood Apraxia of Speech Association of North America’s 2014 Intensive Training Institute, otherwise known as “Apraxia Boot Camp.” Twenty-four speech-language pathologists, including myself, trained with three mentors–Ruth Stoeckel, Kathy Jakielski, and Dave Hammer–at Duquesne University over four days. In its third year, the goal of the boot camp is to spread a high level of knowledge about Childhood Apraxia of Speech (CAS) assessment and treatment throughout the United States and Canada. This conference accomplished that and so much more.

This experience was different than any other continuing education seminars that I have attended. We did not listen to speakers discuss CAS. Instead, Ruth, Kathy and Dave became our mentors. This was powerful. They moderated discussions on evaluation and treatment approaches. We reviewed research papers and had long debates on the principles of motor learning. We highlighted and critiqued therapy methods for those brave enough to show videos of themselves. We problem solved and brought up more questions than we knew were possible.

In smaller groups, our mentors provided insights and personal perspectives on how they work. In this intimate setting, we felt comfortable asking questions and sharing our experiences. The mentors shared constructive criticism along with thoughtful suggestions. In all, they made me think, reflect and question everything I do. Why do I give that test? Why do I treat that way? What is the research behind it? They encouraged us to become critical thinkers.

As therapists, we often get used to using the same materials and therapy techniques we learned in graduate school or during our early experiences. Those methods are not always effective with every child we treat nor are they all proven effective with evidence based-research. Specifically, children with CAS require different therapy techniques than other children with articulation or phonological delays.

Ruth, Kathy and Dave provided valuable information in a small, engaging setting. Their mentoring and passion for CAS has inspired me and I hope to pass along this valuable information to others through mentoring, improving my competency in treatment and diagnosis of CAS, and, in the end, helping children to communicate.

Based on my experience, I’d recommend asking yourself a few questions when selecting your next continuing education event:

  • What am I passionate about? Is there a child or an area of speech pathology that truly inspires me?
  • How will it improve my skill set?
  • How will it help me better serve my clients?
  • Who is doing the most current, researched-based evaluation or therapy techniques?
  • How will it further our profession?

 

Amanda Zimmerman, MA, CCC-SLP, is a pediatric speech-language pathologist in Columbus, OH. She can be reached at azimmerman@columbusspeech.org.

ASHA 2014, Here I Come! It’s GO Time!

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Usually, the word scheduling elicits shivers down my spine. Usually that means scheduling 60 kids into speech therapy slots without interrupting ELA, math, lunch, recess, music, PE, art, intervention, OT or PT. It’s an astronomical feat when SLPs complete schedules every year. In contrast, scheduling for ASHA 2014 in Orlando has been a breeze. I’m scheduling lunch dates, meet ups, pool time, and my favorite CEU opportunities! Scheduling for #ASHA14 in Orlando is very different from scheduling therapy clients.

 

I’ve booked my flight. I’ve texted friends and worked out transportation. I’ve got a place to stay! I’ve joined up with some of my blogging buddies and reserved a booth for the exhibitor hall. Most importantly, I’ve started picking out a schedule for the courses I will take in November. I am so looking forward to downloading the mobile app this year. Since most SLPs don’t have time to wait in line for three days for the new iPhone 6, I’m hoping my dinosaur 4s phone will make it until November. The app should make managing my conference schedule a snap.

 

The Program Planner has been an easy way to browse for courses. It’s more user-friendly than my IEP writing program and my Medicaid billing programs. You can browse through courses by keyword, author, title, etc. So far I’ve searched for topics that apply directly to my caseload. My search terms were “school,” “autism,” “evaluation,” “preschool,” “apraxia” and “AAC.” Here are seven sessions that I’ve chosen so far:

 

  1. I really think research is valuable and there is just so much to choose from. I am trying to pick courses that relate directly to me or courses that really excite and interest me. In my current job I’m doing two preschool evaluations per week. I’m having the ‘articulation, phonology, and apraxia’ conversation with parents every week as I explain characteristics of each and their differences. The presentation “Differential Diagnosis of Severe Phonological Disorder & Childhood Apraxia of Speech” by Matthews and Rvachew sounds like a great refresher. I’m hoping to find some more evaluation-specific courses before November.
  2. I’m thinking the Phillips, Soto, & Sullivan presentation called “Strategies for SLPs Working with Students with AAC Needs in Schools” sounds perfect for a lot of my caseload. I need strategies for AAC students so this should be a big help.
  3. I can’t wait to see “iPad to iPlay 2: Teaching Play to preschoolers through Apps” from Tara Roehl. I love my iPad so I can’t wait to see how she is using it to teach play in preschoolers. This is really a skill I’d love to pass on to my teachers and parents.
  4. On the other hand I’m always careful to limit screen time with my students. There is a presentation called “The Impact of Technology on Play Behaviors in Early Childhood“ from Hagstrom, Smith, Witherspoon. Hopefully once I listen to both presentations I’ll feel good about balance and not leave feeling conflicted!
  5. Michelle Garica Winner is presenting four times. I’m hoping to catch “ASD Treatment: Cognitive Behavioral Therapy & Mental Health Problems Associated With Social Learning Challenges” and “Implementation Science & Social Thinking®: Discovering Evidence in Our Own Backyard”. I love her work and just can’t wait to finally see her present in person.
  6. Barbara Fernandez from Smarty Ears is presenting about one of her apps for data collection and caseloads. I can’t wait to talk to her about all the new Smarty Ears apps coming out in the future so I’ll be hitting up the Smarty Ears booth.
  7. Lastly, I decided to search my schools to check out what the faculty at Ohio University and The Ohio State University are presenting. “Skiing, Horseback Riding, & Communication With Individuals With Complex Communication Needs: Experiences From Community Volunteers” sounds really interesting from McCarthy, Benigno, and Hajjar at Ohio University. They are presenting information on recreational activities for individuals with complex communication needs. Interviews were conducted with volunteers in adaptive sport programs in New England.

 

I don’t think we will have any typical celebrities at ASHA. At least not the kind you see on entertainment television every night. There will however be some #SLPcelebrities to be found! I searched two of my favorites to check when they will be presenting. Hopefully you’ll see me posting a #slpselfie with some of my favorites SLPs over the weekend in Orlando.

That initial scheduling took about 30 minutes and I didn’t have to email 20 different teachers. Scheduling for ASHA is way more fun than making a therapy schedule. Now the countdown begins!

 

 

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 Facebook, Twitter, Instagram, and Pinterest. Jenna is one of four guest bloggers for ASHA’s convention in Orlando.

How to Prepare to Speak at ASHA Convention for the First Time

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This year I will be presenting at the ASHA Convention for the first time. The first time I attended an ASHA convention was last year in 2013. I enjoyed the sessions I attended and set a goal to speak at an ASHA convention sometime during my career. Thanks to partnering with amazing SLPs across the country I was able to  propose five sessions for the 2014 convention. Even though I felt that each proposal was an exciting topic, I did not expect all five to be accepted as talks (or get accepted at all). But that is exactly what happened. My first time speaking at the ASHA convention, I will be involved in five sessions. Due to scheduling conflicts, I will be speaking at only four of the sessions (see below for details). So how am I going to prepare for this? Here are three things:

 

1. Stay organized. Juggling the preparation for five sessions is not easy, so organization is key. I am reducing repetitive and inefficient work by only working on presentations at specific times. To respect my fellow presenters, I am communicating when I will be able to complete individual tasks. I schedule my presentation work sessions based on established deadlines.

Working with many co-presenters (all across the country) means many emails about our presentations. I created a file folder in my email for each presentation. I file each email in the presentation’s folder. This keeps everything together in case I need to refer back to details such as deadlines, ideas, to-do lists, and plans.

I have coordinating file folders in Google Drive for document storage (e.g. proposals, slide deck drafts, my presentation notes, etc). All the documents for each presentation are kept together. Since it’s all in the cloud, I won’t leave it behind.

 

2. Reduce inconveniences. The worst part about conventions and traveling for training for me is food. I have Celiac disease and other food allergies. Convention halls aren’t the best venue for finding gluten free, healthy food. Last year I spent $20+ on lunch, when I bought a sandwich with no bread or fries (because they were fried in the same fryer as gluten) and put the meat on top of a salad. I essentially bought 2 lunches to create one lunch (and I was still hungry).

So this time, I am doing myself a favor and anticipating a busy schedule and poor food options. I found a company that will make premade meals and deliver them to my hotel (for a lot less than $20). My hotel room has a fridge, so I will keep the premade meals in the fridge and bring lunch with me. I will not waste time on long lines or risk  getting sick.

 

3. Prepare for fun. The ASHA convention isn’t my first speaking engagement as an SLP. I have been speaking about dementia and ethics in healthcare to my fellow SLPs, other healthcare professionals, students, and family members via webinars, courses, video conferences, etc. I keep doing it because it’s fun! I thoroughly enjoy creating a presentation for a specific audience to help them reach their goals. My career has evolved into spending the majority of my time in an education role. For a former teacher, this is a very welcome evolution.

 

The pre-presentation nervousness comes, but reminding myself that each speaking opportunity is an opportunity for fun and to inspire better dementia treatment and elder care relieves my jitters quickly. I am thankful for each and every opportunity, including the several at ASHA’s convention this year. See you there!

 

Rachel Wynn is one of four guest bloggers for ASHA’s convention in Orlando and will be speaking at the following sessions:

 

Friday, November 21, 2014

  • Clients at risk for suicide: Our experiences and responsibilities (Session Code 1310) 8:00-10:00 a.m.
  • Get out of that box! Four creative mold-breaking models of private practice (Session Code 1441) 3:30-4:30 p.m.

 

Saturday, November 22, 2014

  • Social media for SLPs: Leveraging online platforms to connect and advance your practice (Session Code 1704) 1:00-2:00 p.m. (Not presenting due to scheduling)
  • Dementia 101 for students and new clinicians: Changing lives through a functional approach (Session Code 1720) 1:00-2:00 p.m.
  • Productivity pressures in SNFs: Bottom up and top down advocacy (Session Code 1755) 2:30-3:30pm

 

Rachel Wynn, MS, CCC-SLP, specializes in eldercare, and, as the owner of Gray Matter Therapy, provides education to therapists, healthcare professionals, and families regarding dementia and elder care. She is an affiliate of ASHA Special Interest Group 15 (Gerontology) and an advocate for ethical elder care and improving workplace environments, including clinical autonomy, for clinicians.

Using Comic Strips in Speech Intervention

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For the past couple of years, I have used Carol Gray’s materials extensively during my work with adults with developmental disabilities. Creating comic strip conversations has been extremely helpful in facilitating conversation, resolving social issues between peers, taking turns in conversation and providing different social scenarios within various contexts.

Since I have worked in creating my own comic strip conversations with my clients for some time now, I decided to experiment using the comics section in the newspaper. My clients are motivated by the local newspaper for many reasons. They enjoy browsing through current events, looking at the pictures in the sports section and reading the comics.

The comics within a local paper are inexpensive (in my area it is just $1.00 for the local newspaper), easily accessible and age appropriate for older children, teenagers and adults. Therapy using comic strips has been surprisingly motivating and beneficial to my clients. I never realized how effective using the comics section could be!

I like to keep my favorite comics and laminate them for future use. I have also created a game around using the comics section. My clients take turns choosing from a pile of comic cards and then have a discussion about each particular card. When one client doesn’t understand a particular comic and why it’s funny, I have him ask his peer for assistance. As a group, we have had many extensive and interesting conversations related to the comics. Here are some speech and language goals that can be facilitated with the comics:

1. Expanding vocabulary: The comics are full of language, which make it an ideal time to discuss and define new vocabulary. It will be difficult for a client to understand a particular comic without understanding the actual definition of some of the words. For example in a recent Garfield comic, Garfield thinks “This is a perfect day to stay in bed and contemplate life’s truths.” Discuss what “life’s truths” means with your client. Defining the “contemplate” can help build vocabulary and build in conversation. Ask your client, “What do you contemplate about?”

2. Abstract Language/Humor: The comics are excellent in discussing abstract language and humor. In many comic strips, there are often multiple meanings of words. In a recent comic, the discussion between the characters was about “trail mix.” To one character trail mix was the snack, to the other character trail mix was a bunch of items that you picked up along a trail in the woods (e.g. dirt, sand, rocks). This comic began a conversation about the multiple meanings of words and how they had a miscommunication. Discuss the humor in the comic and why it may be funny to the reader. This can be a tricky exercise for many clients especially with autism, but it can be extremely useful as well. Helping a client recognize humor can help build friendships and improve conversational skills.

3. Taking Turns in Conversation: Between characters, there are natural turns in conversation. This can be a great model for conversation. As a carry-over activity continue the comic with an extra blank comic strips. This can help your clients create their own conversations.

4. Improving Literacy/Punctuation: Having your client read the comics can help improve literacy and reading comprehension. Point out different punctuation markers within the comic such as exclamation marks, periods, question marks, etc. Also, discuss the difference between the characters thinking a particular thought versus actually speaking it.

5. Interpreting Facial Expressions and Feelings/Emotions: In many comic strips the characters have extreme emotions. In other comics, the feeling and emotions of a character can be a little tricky due to the high levels of sarcasm. Read the specific comic strip together, discuss the language and then ask your client how the character is most likely feeling.

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience . She discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

 

Three Easy Ways to Collaborate with Teachers

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Like many of you, as a school speech-language pathologist, I left graduate school ready and excited to jump into classrooms. I realized the benefits of reaching my students in their own environment and so I set out to reach them there by “educating” teachers on speech and language. And then… reality hit. With all the added responsibilities, how do I go about adding one more task to my ever-growing list and collaborate with teachers?

Are you like me? Often, school SLPs feel lost when it comes to reaching their students in the classroom. Typically, we fall into one of two camps. Either we feel the need to completely take over the classroom lesson to “teach” the teacher something about language or we become too afraid of looking like a “know-it-all” and so do not offer any suggestions. Neither of these offers a solution. Here are three easy ways to collaborate with teachers that provide a balance between the two:

1. Provide a monthly newsletter. This is one of the easiest ways to stay in touch with teachers. If you have monthly themes, give them an idea of what you’re working on. Provide a “vocabulary word of the month,” a tip on how to serve students in their classrooms, a good resource or website, or even a practice sheet stapled to your newsletter for teachers to provide to students. Teachers will appreciate the time you took to reach out to them and will also gain information on both their students and how we service them.

2. Give a student snapshot to your teachers. This is most beneficial at the start of the school year. Unfortunately, with all of our responsibilities, important information is often not communicated and students’ services often suffer as a result. Relay any accommodations on students’ Individual Education Program (IEP) that the teacher is responsible for providing in the classroom and make sure they understand what each one means. It is also helpful to provide an overview of the goals you are working on with their students. For example, a simple statement such as “During Johnny’s speech and language session, he is working on increasing his vocabulary and reading comprehension,” would give the teacher an idea of what he works on with you.

3. Hop into the classroom during independent reading. Many classrooms now schedule a chunk of time devoted to practicing independent reading and writing skills. My district uses a structure for this called “The Daily 5” created by Gail Boushey and Joan Moser. When I walk into a classroom during Daily 5, I can immediately sit with students and listen to reading, ask questions about what they are reading, teach vocabulary and assess and monitor articulation skills while reading. What does this type of intervention mean for us as SLPs? We can easily monitor and work on skills within the classroom setting all while requiring minimal if any planning time. This type of intervention also sets the tone for easily working with the teacher on their turf without taking over the entire classroom.

I hope this next school year finds you rested and ready to try new ideas. Reaching out to teachers often feels like one more to-do, and can fall to the bottom of our priorities. By making a goal each year of trying just one new idea, it can seem less overwhelming. I guarantee it: by reaching out to our students in their environment, we will be making a huge impact on their lives.

Nicole Allison, MA, CCC-SLP, has a passion for creating materials that benefit the school SLP, especially when it comes to data collection and the Common Core State Standards. She currently works in a public school as the only SLP (yes, that’s right, all 13 grades and loving them) and is the author of the blog Allison’s Speech Peeps (speechpeeps.com). She also serves on The Ohio School Speech Pathology Educational Audiology Coalition as secretary. Her and her husband recently had a baby and are loving parenthood. She can be reached at nrallison@gmail.com.

What School SLPs Want to Know

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If you want to know what the real talk is at an ASHA Schools Conference, you need to pull up a chair at the lunch tables. That’s where you’ll hear chatter about the most top-of-mind topics for the speech-language pathologists and audiologists who attend.

So it was that this roving blogger sat down to share a sandwich and some conversation with this year’s attendees. Here’s what a sampling of them report are the most burning issues that brought them to Schools 2014 in Steel City: Pittsburgh.

Brianne Young, SLP, Renfrew, Pennsylvania
I want to know how we’ll use the Common Core State Standards. We’re switching to the Common Core totally but we haven’t yet transitioned the speech-language piece of it 100 percent. We started adapting the reading and language standards last year, and nobody’s sure how this will all work. I also want to know more about incorporating Common Core with RTI.

Amy Shaver, SLP, Hamden, Connecticut
As a former stay-at-home mom just getting back into it—I just got hired fulltime by a school for next year—I want to learn more about iPad apps for speech. The technology has changed so dramatically and rapidly in eight years. It’s kind of an odd place to be because as a mom, technology can seem like a big negative. I’m always limiting my kids’ screen time. So it’s an interesting shift to think of it as an educational tool.

Sabrina Hosmer, SLP, Manchester Public Schools, Connecticut
As a bilingual evaluator, I’m here to find out how other SLPs have made systemic changes to their school districts. In our district we have problems of overidentification of speech-language disorders among bilingual children. The children are tested in English, and they’re not supposed to be, but we don’t have enough bilingual SLPs to do appropriate assessments or to serve the bilingual kids who really do have speech-language disorders.

India Parson, SLP, Prince Georges County, Maryland
What’s on my mind? The Common Core—how do we use the literacy standards with children with severe disabilities? And what’s going to happen with tying them to performance evaluations of SLPs, which they’re doing with teachers and are talking about doing with us? The other issue is the shortage of bilingual therapists. We have a big problem of overidentification of disabilities in the bilingual population. We need folks making better diagnostic decisions up front.

Christine Bainbridge, SLP, Ithaca, New York
What’s burning for me is wanting to learn more about central auditory processing disorder—what is the research evidence base on CAPD, how does it truly change children’s functioning in the classroom, and how do we intervene with it in an evidence-based way?

Audrey Webb, SLP, Charlotte, North Carolina
I’m just coming into the K-12 schools this year after working as a preschool SLP for many years, so what’s going on with the Common Core will be big. Of course, a lot of that’s up in the air now because our state legislature just repealed it, but we’ll still be using it for the time being. I’m also big on RTI. I’m a fan of it, and always interested in ways to get teachers on board with it.

Mary Pat McCarthy, SLP, Clarion, Pennsylvania
My reason for going to Schools every year is always to see what the current buzz is. It’s no one thing I want to know. It’s everything, really. I know if I go, I’ll get what I need for the coming school year. This year I’m especially interested in hearing about working with teachers on improving our work on phonology and articulation with kids. But this conference is always a great professional recharge during the summer.

 

Bridget Murray Law is managing editor of  The ASHA Leader.

SLPs in the Home: What’s Pot Got to Do with It?

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I never thought I’d be writing an article for ASHA about marijuana, but because I live in Colorado, I’ve got the latest news on weed to pass along to my fellow SLPs. In fact, if you were sitting here with me in the privacy of my own home (and you were over 21), we could chat about it while lawfully smoking a joint, munching on an edible cannabis-laced cookie, sucking on a marijuana lollipop or even, inhaling the vapors from an e-cigarette packed with marijuana oil. That’s just a sampling of the options we have to get high in the “mile high city.” Before you shout “I’m coming over!” I should probably disclose that I’m not a marijuana user, medical or recreational. If your next thought is “But I DON’T live in Colorado (or Washington) so this doesn’t apply to me – at least professionally” please read this entire article. Colorado law is considered a “springboard for other states” to legalize marijuana soon. Plus, illegal shipping to other states, often discovered during a routine traffic violation committed by the average Joe next door, has increased significantly. According to the El Paso Intelligence Center & National Seizure System, the mini-vans and SUVs bringing home “souvenirs” from Colorado aren’t just from the states bordering the Rocky Mountains. New York, Florida, Illinois and Wisconsin were some of the most popular destinations and consequently, you may experience some unexpected safety issues if you are providing home-based care for children and adults.

In an effort to educate therapists on the new laws and our responsibility to inform our families of issues that may arise with recreational marijuana use, Jane Woodard, the executive director of Colorado Drug Endangered Children, is traveling the state providing health care professionals the necessary information to keep ourselves and the families we serve safe. SLPs are required by law to report suspected conditions that would result in neglect/safety issues or abuse of children and adults. However, many of our families are simply not aware of the safety concerns and home based therapists are often the first resource for educating those families who choose to partake in using, growing or processing recreational marijuana.

Given the various populations that we serve, here is an overview of some of the safety issues:

Infants: As a pediatric feeding therapist, just one of the populations in my care are babies who require support for breast and bottle feeding. In this Colorado culture of embracing our new freedom, mothers are commenting to me without restraint that they’re using marijuana to combat nausea during pregnancy or enjoy “a little pot now and then” while breastfeeding.Studies indicate that by age four alarming changes occur in children that have had prenatal exposure. It’s noteworthy that the studies focused on a much lower amounts of delta-9-tetrhydrocannibinol (THC: the chemical that produces the psychoactive effect) than what is present in today’s super-charged marijuana products. The children demonstrated “increased behavioral problems and decreased performance on visual perceptual tasks, language comprehension, sustained attention and memory.” Marijuana use while breastfeeding is contraindicated because the THC is excreted into breast milk and stored in fat and is suspected to impact a baby’s motor development. There are no established “pump and dump” guidelines for THC and it stays in the bloodstream for much longer than other drugs. Consider the increased risks from both second-hand smoke and third-hand smoke or the “contamination that lingers” after smoking, including an increased risk for SIDS and more. For the home-based SLP, exposure to second and third-hand smoke or residue means that I will likely carry that aroma with me to the next home. I am responsible for the safety of all of the children I treat, and many are medically fragile and/or have sensory challenges and would be impacted by these odors. Today, I am faced with difficult conversations with parents that I never imagined I would have.

Children: In four short months, from January to April 2014, Colorado’s Poison Control Center has reported 11 children who ingested edibles, one as young as five months old. Over half of those children had to be hospitalized and two were admitted to the ICU. Consider that those are the reported cases – and what goes unreported is difficult to ascertain. While the law requires that the packaging cannot be designed to appeal to kids, current practices are questionable. Some argue that edibles are packaged too much like junk food, with boxes of “Pot-tarts” similar to the popular toaster pastry, bottles of fizzy “soda-pot” and candy bars with labels that rival Mars® and Hershey’s®.  In April 2014, Karma-Candy was the marijuana candy that a father in Denver consumed just before hallucinating and killing his wife, who was on the phone with 911 dispatchers at the time. She could be heard yelling to her kids to go downstairs as she desperately tried to get help for her family.

Packaging of certain products must also be in an opaque and re-sealable container, but that law only applies to the time of purchase. Plus, most edibles contain multiple servings and it’s not unusual for one cookie to serve six people. Even adults are mistakenly eating whole cookies and in April 2014, one visiting college student consequently jumped to his death from a hotel balcony after eating too much of an edible. A New York Times columnist visiting Colorado ate a whole candy bar labeled as 16 servings, and “laid in a hallucinatory state for 8 hours.” Home baked marijuana options are equally confusing. As a feeding therapist, I used to be comfortable offering foods to a child from a family’s pantry. But now, a tempting plate of brownies may be more than just a plate of brownies. By law, edibles, like any marijuana product (even plants), must be in an “enclosed, locked space.” However, it is not unusual for Colorado therapists to arrive for their home visit and find a bong, topical lotions or a half-eaten edible on the living room coffee table. Early intervention and home health care agencies are considering how to educate families on the first day of contact, during the intake process. Susan Elling, MA, CCC-SLP, who treats both children and adults in the home, notes that “It will be very important to have an open and honest conversation with a patient (and their family) regarding marijuana use as part of taking the medical history – just as we do for alcohol and smoking.”

Adults: Ms. Elling reported that “the population in need of homecare services may be more likely to use marijuana to control pain and nausea” because family members are more likely to suggest it and there will no longer be a need to obtain a medical marijuana card. Ms. Elling also notes that marijuana “affects sleep, balance, coordination, and cognition.  This may be amplifying the conditions a patient is already dealing with related to medical issues.  It can also significantly raise anxiety.  These are all factors that increase fall risk, confusion, lead to poor judgment, and can setback a patient’s recovery. It may be very difficult to determine what issues are related to the patient’s medical condition and which are related to the marijuana use.  Interventions, progress and prognosis may be affected.” Edibles in particular are a safety hazard for this population, because of the inability to self-regulate. There is no predicting how an edible will effect one person or another.

“It’s not your grandmother’s marijuana,” reported Dr. Richard Zane, who is the head of the Department of Emergency Medicine at the University of Colorado Hospital. Well-meaning family members, hoping to control their loved one’s discomfort, may not realize that the strength of today’s marijuana is significantly higher than the pot your cool grandma smoked in the 60’s. In fact, THC levels represent a 121% increase just from 1999 to 2010. Family members may not understand that the strength and effect of the drug varies from product to product. For example, compare two hits on today’s joint and an individual will ingest approximately five mg of the chemicals that produce the psychoactive and/or sedative effects compared to up to 100 mg in one packaged edible. Plus, even using the exact same method of ingestion does not guarantee the exact same dosage every time. Zane reported in this interview with Colorado Public Radio that the “drug isn’t always spread evenly through food or candy, so several people eating the same amounts can be ingesting different quantities of marijuana.”

The uncertainty of dosage and effects has Elling on guard: “I am concerned that the high potency, unpredictable effect, easy availability, and unclear dosage information of edibles may have serious consequences for homecare patients with already fragile health. It is also misleadingly considered quite “benign” and safe compared to alcohol consumption and smoking.  I feel the need to know the signs and symptoms of a marijuana overdose and know the contraindications with any other prescription or OTC drugs they may be taking and be able to educate my patients and their caregivers regarding this issue.”

Additional Safety Concerns: In the course of this short article, it’s impossible to cover all of the safety issues, including those related to growing and processing marijuana in the home. These concerns include electrical hazards from impromptu wiring (not to code); cultivation hazards such a mold and poor air quality for medically fragile patients;  increased carbon dioxide and carbon monoxide necessary for growing; chemical exposures and improper storage of pesticides and poisonous fertilizers; THC on household surfaces and airborne exposure; and exploding hash oil labs. From January to April 2014, hash oil explosions occurred on a weekly basis in Colorado, some triggered just by turning on a nearby light switch.

Consider Family Functioning: The impact on safety is the tip of the iceberg. Woodard explained that home health professionals must consider a parent’s behavior when using marijuana, the impact on a child’s behavior and family functioning overall. Difficult but often necessary questions to ask include: What steps have you taken to protect your children and family members? How do you store your marijuana and paraphernalia? What are you like when you use? Most importantly, she recommended asking yourself “Do I believe that the conditions in this home could reasonably result in harm” to anyone in this household? If so, educate the family and be mindful of mandatory reporting laws.

 

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.

10 Trillion Microorganisms versus Your Toothbrush

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“The mouth is dirty,” Dr Kenneth Shay stated frankly; AND, it is “the biggest hole in your body!”

Warning: You may want to finish eating, brush your teeth, floss, use mouthwash, and then come back…

OR

If it is early morning, and you haven’t brushed your teeth yet: then scrape the gunk off your teeth with your fingernail. You may have found 10 billion microorganisms in that cubic millimeter.

There are 1 trillion to 10 trillion microorganisms in your mouth. Simply brushing your teeth can get rid of that nasty bacteria film in your mouth. It can also prevent “some of that schmutz” from getting into your lungs. If you are having trace aspiration (saliva, food, and/or liquids getting into your lungs), try to make what gets into your lungs less nasty. You can prevent pneumonia. Pneumonia due to poor oral care is a major avoidable infection, per Shay.

Ross & Crumpler (2006) noted that despite strong evidence in the literature on the role of brushing the teeth in preventing pneumonia, medical staff continue to view oral care as a comfort measure and only use foam swabs.

“Toothette sponges are wimpy,” stressed Shay. They don’t get the gunk (plaque) off the teeth. Plaque is sticky. If not removed, it hardens into tarter (also known as calculus). Then a visit to the dentist is needed to get it off (debridement).

Why is the mouth forgotten in healthcare? We help the dependent elder go to the bathroom many times a day. So why don’t we help brush his teeth?I’ve heard some nurses say they are squeamish about the mouth! It makes them gag! Well, we should be gagging over the costs of neglecting the mouth.

This simple prevention technique of brushing costs pennies a day against the cost of a pneumonia. Based on CDC numbers from 2011, there were 157,500 Hospital Acquired Pneumonia infections that year. CDC states the average extra cost of that hospital acquired infection is $22,875. This equals over 3 billion dollars!

Why are we not protecting this wide open gateway to the body? Imagine your gingival space between the tooth and gum as a huge parking lot. Germs love these 1-3 millimeter deep parking spaces. If germs park in the gingival space for more than 24 hours, they become calcified into plaques. Bacterial loves to stick to plaque. Only brushing removes it. No brushing leads to a build-up of plaque in the gingival space and inflammation (gingivitis).

It only takes 48 hours of hospitalization in a critically ill patient to change this bacteria from the usual gram-positive streptococci to gram-negative microorganisms (the nasty pathogenic bacteria that cause pneumonia).
Maybe we don’t brush our patients teeth because the gums bleed? Blood is okay, per Shay, even if you are on a blood thinner. Shay stated that bleeding is a sign that you need to brush more. It is due to the inflammation, and regular brushing will prevent bleeding. Shay warned that bleeding is only risky if the patient has a blood disorder or disease that causes excessive bleeding.

Most cases of gingivitis do not progress to the more serious periodontitis, but…Immune-compromising events can cause an autoimmune response that can lead to periodontitis, per Shay. Examples of immunocompromising events are not only hospitalization and critical illness; they could also be the following:

• life stressors
• flu
• depression, and
• pregnancy

Periodontitis is inflammation caused by bacteria that affects the attachment between the tooth and the bone. It is an irreversible destruction of the supporting tissues (i.e., the periodontal ligament to alveolar bone). Then bone-absorbing cells eat away at the bone. The bone will not be regenerated. Additionally, with the gums receding, “there is more surface area to collect gunk,” said Shay. The periodontal pocket that is formed creates a larger “parking garage” of 6-8 millimeters deep. Lots of gram-negative anaerobic bacteria can park there! Pathogenic microorganisms. “These are the same things that cause aspiration pneumonia,” stated Shay.

See the full blog post at www.swallowstudy.com.

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.

Kid Confidential: Parent Education and Training, Part 1

parents

 

This is part 1 of a three part blog series on the topic of parent education and training.  Look for part 2 and part 3 coming up over the next two months.

Parent education and training is not only an important part of our job as SLPs it is an essential part of our job.  Still, I’ve spoken to many SLPs over social media who still feel like they are lacking this particular skill for a number of reasons. For SLPs in the schools, their caseloads are so high and paperwork demands so daunting, they are left with little time to collaborate with school staff let alone contact parents on a regular basis. For private practitioners, speaking from experience, I think we are so focused on targeting the necessary skills and making gains with our clients, that we forget how important parent education can really be.

We know that parent involvement in general education is certainly beneficial. Children whose parents are involved in their school tend to have better academic performance and fewer behavior problems. It makes sense that parental involvement in speech services also would result in positive effects such as increased home practice of target skills and generalization of learned skills to the home environment.  In fact, there are whole therapy models (i.e. DIR/Floortime, Hanen, etc.) that incorporate parent education and involvement as key factors in their models and have the research to back it up.  The DIR/Floortime model’s portion of parent education and training has been tested and retested among various populations all resulting in positive effects, faster progress and improved generalization of social skills for children with ASD (see list of additional resources below).

So the question we need to ask ourselves is why we aren’t tapping into this wonderful resource and effectively educating and training parents of our clients?  For myself, I can tell you that it took some time to become effective in this manner. Initially it seemed as if I was more of a teacher explaining the rationale for various techniques however I was missing some very important steps. Over time, I have improved upon my ability to educate and train parents and I will share with you my tips for effective parent training:

  1.  Trial techniques:  The first thing I usually do is trial various techniques to determine which techniques the child responds successfully.
  2. Explain rationale:  Once I determine the most effect speech therapy techniques for the child (which we have to accept will change over time, maybe even at each session depending on the child’s ability and behavior), I will explain the rationale behind the techniques to the parent(s) present (either in my therapy room or in their homes when providing therapy).
  3. Model technique(s):  Modeling the technique(s) immediately after explaining the rationale will demonstrate the effectiveness of the technique(s) and make more sense to the parent(s).
  4. Parent’s turn: Allowing the parent(s) to take turns trying to eliciting the communication skill via the use of determined techniques will give them much needed practice in the safety of the therapy session.
  5. Give Feedback: Giving feedback is necessary to training.  It allows parents to feel successful with the skills they currently exhibit and provides additional ideas for the areas in which they are weaker.
  6. Follow up: I think it is so important to follow up with parents session to session to determine how well the techniques are working at home, how comfortable they feel using the techniques and if there are adjustments that need to be made for more effective use.

These are my basic tips for effective parent education and training.  Next time I’ll be talking about how I realistically incorporate parent education and training in my speech therapy sessions.

DIR/Floortime Resources:

  • Casenhiser, D., Shanker, S., & Stieben, J. (2011). Learning Through Interaction in Children with Autism: Preliminary Data from a Social-Communication-Based Intervention. Autism, 17 (2), 220-241.
  • Pajareya, K., & Nopmaneejumruslers, K. (2011). A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism15 (5), 563-577. doi: DOI: 10.1177/1362361310386502
  • Solomon, R., J. Necheles, C. Ferch, and D. Bruckman. “Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program.” Autism, 2007, Vol 11 ( 3) 205-224.

 

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

Collaboration Corner: 10 Easy Tips for Parents to Support Language

ice cream

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.