Dishing on Dysphagia from #ASHA14

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I digested my ASHA 2014 dysphagia notes from 15 hours of courses into these five themes. I appreciate both the clarity from our physical therapy partner in item #1, as well as the tension and uncertainty underlining issues in #2-5 below. Here are the highlights:

1.  Inactivity is worse than smoking, obesity, and alcohol combined per the physical therapist, Mark Richards, at Evidence-Based, Optimal Strength Exercise Parameters: Practice Considerations for Speech Therapists.

SLPs need to review exercise physiology and advocate for effective strength training:

  • Endurance exercise with many repetitions of low intensity at a constant load is NOT effective.
  • Need progression of resistance with the load increasing, otherwise it is maintenance only.
  • Quality strength training of even one set done to fatigue is better than an arbitrary 3 sets of 10.
  • Use the BORG Scale – Rate of Perceived Exertion. The patient should feel the effort is “fairly light” to “somewhat hard” for a moderate level of exercise OR “somewhat hard” to “hard” at the high level.
  • Increased muscle fiber mass and the motor neuron span of control.
  • Increased muscle force strength also increases synchronization and timing for a complex coordinated task like swallowing.

2. A thorough Clinical Swallowing Evaluation (CSE) is valuable, necessary, and should be done prior to instrumental examinations (per James Coyle at Bedside Swallow Examinations: What They Can Do & What They Can’t). Debra Suiter and Laura Sterling were co-presenters and reviewed what a CSE cannot do.

Additionally, Steven Leder, Debra Suiter and Heather Warner (at Simultaneous Clinical & Instrumental Swallow Evaluations: Findings & Consequences) reminded that the CSE should never diagnose pharyngeal dysphagia. Leder stressed the importance of the instrumental exam. For instance, CSE CANNOT evaluate:

  • Bolus flow characteristics
  • Pharyngeal/laryngeal anatomy
  • Hyolaryngeal excursion
  • Pharyngeal delay
  • Pre-swallow spillage
  • Post-swallow residue
  • Swallow physiology. Therefore, we cannot make therapy recommendations based on a CSE (i.e., Masako, Shaker, double swallow, etc.).
  • The following are NOT supported in research as predictors/signs of aspiration: absent gag, changes in oxygen saturation, wet voice, watering eyes, sneezing, and nasal drainage. Even the parameter of a cough can give you a false positive/false negative.

But here’s what the CSE CAN do:

  • Start the patient-clinician relationship. Paula Leslie advises to “shut up and listen,” and sense the feeling in the room.
  • Identify patients who may have dysphagia, may be at risk for aspiration, and may be at risk for pneumonia (i.e., Langmore’s research and oral hygiene research). We know from Leder & Suiter’s research (see references below) that patients who are not oriented, cannot follow 1-step commands, and who have decreased lingual ROM are at increased risk for aspiration. Their research also tells us that if a patient cannot continuously drink 3 ounces of water, he is at an increased risk for aspiration. “Aspiration is volume dependent,” per Leder & Suiter’s research. A patient will not silently aspirate if they are able to complete the full 3 ounces without distress or stopping. However, Stevie Marvin and Amy Baillies (at High-Risk ICU Patients: Managing their Dysphagia Care) showed a FEES exam of an ICU patient who easily consumed the 90 cc of fluid, but he had significant silent aspiration. Marvin & Baillies stressed taking in the big picture of dysphagia risk factors with ICU patients.
  • Develop a hypothesis. Narrow down possible problems. Make appropriate referrals. Let’s not waste time and money doing an oropharyngeal instrumental exam if it is clearly an esophageal issue (of course, keep in mind these frequently co-occur).
  • Share your hypothesis with the radiologist at the MBSS to ensure a thorough instrumental exam, including deploying interventions.
  • Train interventions that can be tested in the instrumental exam.
  • Indicate if instrumental testing is appropriate or not. Is the patient ready for further testing? Will it change anything? Which instrumental exam will best answer the questions? If the goal is palliation, further testing may be academic. Then the CSE’s purpose is to “help the patient aspirate more safely,” per Coyle.
  • Observe lip seal and mastication. We need to realize that we are making an inferences about bolus manipulation and control once the mouth is closed.
  • Observe coordination of respiration and swallowing. Palpating the swallow may not reliably evaluate delay or the extent of hyolaryngeal excursion, but we can note exhale versus inhale after the swallow. If the respiratory rate is >30, the patient may inhale after the swallow, placing him at a higher aspiration risk (per Coyle at What’s Wrong With My Patient?).

The bottom-line is that we need to know why we are doing the CSE and what we expect to get out of it.

3. “Understanding the patient’s disease process is one of the best tools a clinician can have,” reminded James Coyle at What’s Wrong with my Patient? 2014 Update: Pulmonary, Cardiovascular, & Digestive Systems & Conditions Affecting Swallowing. For example, if we do not perform a thorough chart review as part of our CSE, we may think the patient’s pneumonia is a dysphagia-related aspiration pneumonia when it is really a hematogenous pneumonia due to the patient’s sepsis (bacteremia).

 4.“Not everything that can be counted counts. Not everything that counts can be counted.” (William Bruce Cameron, 1963). John Rosenbek and Paula Leslie reminded us of this quote at their session: Ethics & Evidence in Practice. Leslie stated that Evidence-Based Practice (EBP) is one of the most misunderstood issues, forgetting that research is just one aspect out of three. Leslie worded EBP as: an informed clinician checks her knowledge against best available evidence and against informed patient preferences. Rosenbek warned against the “tyranny of the RCT.” In “clean” RCT studies, he asked if we tend to have difficulty finding our patients. For example, Leder noted (at Simultaneous Clinical & Instrumental Swallow Evaluations: Findings & Consequences) how his research on the 3 ounce water swallow excluded patients with tracheostomy, head and neck cancer, and dementia.We should feel a tension between data and belief, per Rosenbek.

Another example of challenges in EBP was from Catriona Steele’s lecture on Diet Texture Terminology. She noted how the Protocol 201 (which is often cited as a reason to not put patients on honey thick liquid) actually used 3000 cp for honey thick as opposed to 1750 cp. This means the research was really comparing nectar thick to pudding thick. “No clear agreed upon taxonomy causes a clear risk to our patients,” per Steele.

 5. “Safe and successful mealtimes are so much more than safe and successful swallowing,” per Samantha Shune at Eating is Not Just Swallowing: Redefining the “Swallowing” Process in the Elderly. This is the perfect example of how the CSE is much more than a screen of swallowing. The act of eating has an anticipatory phase. Shune showed that healthy elderly need more pre-oral time, using all proprioceptive and sensory feedback to prime the motor system. We can ensure that caregivers maximize the mealtime environment to ensure the patients have this compensatory advantage.

 

Bringing it home

So here’s what all this means to me and what I am taking home: Our clinical swallow evaluation is not a screen. We all agree on the limitations of the CSE. However, physicians perform clinical bedside examinations on patients and bill accordingly. They then order instrumental examinations to test their differential diagnoses. We do the same, testing our hypotheses. Per my verbal communication with Steven Leder, he does bill for an evaluation when he performs the Yale Swallow Protocol. However, he also indicated that a nurse could perform this “screening” protocol. We cannot bill for screens. What we do bedside is at a much higher cognitive level of reasoning and critical thinking than just a screen. As Rosenbek said at Ethics & Evidence in Practice: “All of this is why we have frontal lobes.”

We heard our colleagues at the sessions lament that they do not have quick access to instrumental examinations, if at all. What can we do? Some ideas for starters:

  • Document well, stating your hypotheses, as well as the limitations of a bedside CSE.
  • Find Mobile FEES/FEESST and MBS services.
  • Push for adequate staffing and equipment to be able to perform necessary instrumental exams on inpatients.
  • Push for adequate time to review the MBS studies frame-by-frame to “make darn sure of what we see…our recommendations are depending on it,” per Martin Brodsky at Paying it Forward: Training Future Experts in Swallowing Diagnostics. For example, one cannot gather adequate information in real time on 17 components of a MBSImP.
  • Stay open to changes in the field.
  • Maintain positive dialogues.
  • Teach students to expect/embrace uncertainty and realize that there are differing opinions.
  • Thank our trail blazing researchers who are pushing us to question our long-held beliefs!

Speaking of trail blazing, see you next year at ASHA 2015 in Denver, Colorado!

 

Karen Sheffler, MS, CCC-SLP, BCS-S, graduated from the University of Wisconsin-Madison in 1995. Karen has enjoyed medical speech pathology for 20 years. 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. She has lectured on dysphagia in the hospital setting, to dental students at the Tufts University Dental School, and on Lateral Medullary Syndrome at the 2011 ASHA convention. Special interests include neurological conditions, geriatrics, oral hygiene, and patient safety/risk management. Karen continues to work in acute care and is a consultant for SEC Medical. She started the website and blog www.SwallowStudy.com in May 2014. She has blog posts on ASHAsphere and www.DysphagiaCafe.com. You can also follower her on Twitter, Facebook or on PinterestSheffler was one of four invited bloggers for ASHA’s 2014 Convention in Orlando.

References:

Leder SB, Suiter DM. The Yale Swallow Protocol: An Evidenced-Based Approach to Decision Making. Springer, NY, 2014.

Suiter DB, Leder SB. Clinical utility of the 3 ounce water swallow test. Dysphagia. 23:244-250, 2008.

Leder SB, Suiter DM, Green BG. Silent aspiration risk is volume dependent. Dysphagia 26:304-309, 2011.

@speechroomnews Speaks Out on #ASHA14

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I went to my first ASHA convention unsure of what to expect. I knew CEUs, exhibit hall swag, Orlando sunshine and lines at the ladies restroom were certain. While all these were true, the most important parts of the conference for me were friendships and renewed energy.  Throughout the convention you might have seen daily hash tags used to discuss and promote daily happenings. They turned out to be a good marker of all the different parts of my trip as I reflect on the weekend.

#asha14roots: I’ve only been an SLP for five years, so my roots don’t grow very deep in this field yet. At the conference, I got to hug clinical supervisors and undergraduate friends. Lunch with a fellow Ohio University Bobcat made me thankful for all the people who have played a part in my SLP history thus far.

#asha14branches: Branching out was my favorite part of ASHA. Specialist from all over the country taught the CE courses. It’s something you just can’t get at your local courses. Listening to sessions about hands-on research happening in different parts of the country got me so excited about the growth in our field. I look forward to following the results of the various projects funded through grants or universities.  In the exhibit hall, I got to put a face to the many names I email throughout the year. Although apps are nothing new, I was really impressed with the increasing level of complexity in new apps.  It’s not much of a secret that I love speech therapy materials. I have a closet-full at work and a closet-full at home. The exhibit hall had a variety of new materials. There is something special about a speech therapist that makes a tool that works for her clients, who then turns that into a business to make materials available for other professionals.

#asha14leaves: I’m leaving ASHA with some excellent plans for my preschool caseload. I’m going to increase my use of informational text and increase multi-step play routines to develop language within one level of play. I love leaving sessions with specific ideas for next week’s therapy.  I’m leaving ASHA with new networking connections. I did some planning with Yapp Guru to talk about cataloging app reviews.  I’m leaving with new ideas about Social Thinking from Michele Garcia Winner’s sessions. Most importantly, I’m leaving with new SLP friends. Sometimes being the only SLP in your building can feel isolating. Being amongst 12,000 fellow professionals has made me remember that I have connections all over the world. Our job is a unique blend of science and arts. The convention renewed my excitement for our field and my fellow SLPs. See you next year in Denver!

 

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, Instagram, and Pinterest.

 

My First ASHA Convention: The Perspective of a Graduate Student

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How To Get There

My exposure to the ASHA convention up until this year was limited to the experiences of others: faculty members who discussed their presentations; doctoral students who presented their work at the conference; and tales of bright-eyed graduate students who had attended their first convention. But amidst the busyness of the end of the semester I wasn’t prepared for just how amazing my first ASHA convention experience was going to be.

My journey to the 2014 ASHA Convention started earlier this year, when I saw a post on ASHA’s Facebook page announcing the Student Ethics Essay Contest. Like most other graduate students, I did not have an expendable income to support my conference attendance, so I figured it was worth a shot to enter the contest! I never expected to win and am so honored. It was a rewarding and enriching experience to examine the Code of Ethics in greater detail, and I encourage graduate students to enter the contest in future years.

Why Go as a Graduate Student?

I didn’t really know what to expect of the convention and I wasn’t sure how useful it was going to be for me, but it turned out to be an incredibly valuable experience. As a second year graduate student, I now have the level of knowledge and assuredness of which areas are most interesting to me to allow me the focus necessary to be productive at the convention.

Here are some compelling reasons to attend an ASHA convention as a graduate student:

• Perhaps the most exciting part of the experience was being surrounded by thousands of other people who have the same interests, passions, and who are doing similar work. It was validating and encouraging to be sitting in a room full of students, researchers, and clinicians who have the same questions that I do, and who were there seeking answers, knowledge, and ideas from other clinicians and researchers. There is so much to learn!
• It is a great way to network. For example, while at the convention I had the opportunity to meet a professor from another university whose project I am assisting with from a distance and discuss the next steps of the project.
• Jobs, jobs, jobs! There are so many recruiters in the exhibit hall, from all kinds of settings. It is the best feeling to walk around, peruse the different opportunities and locales, and feel confident that our field is in such a need that we can find work pretty much anywhere!
• It is a great opportunity to gain experience presenting research. Submit a poster and if it is accepted there are always ways to find funding, like through your local NSSLHA Chapter or your graduate program department.

 

What It’s Like

Once at the convention, I quickly had to accept the fact that it was impossible to see every presentation that I wanted to. So instead I strategized and attended talks that are relevant to my clinical placements and other intriguing topics that I won’t get the chance to learn about in my rotations. Things that stood out:

• The days are long and the presentations are many. I was faced with the choice of attending Short Courses (CEU courses), Sessions, Poster Presentations, and Technical Sessions – all of which co-occur! So having a sense of focus was important.
• The beauty of ASHA is that there are so many presenters that you are bound to find many presentations that you’re interested in. My two greatest areas of interest are voice and bilingual (Spanish/English) speech-language pathology, so that’s primarily where I focused my time, but I also stepped out of my comfort zone and attended a talk about using Passy Muir valves in the pediatric population, as well as a really interesting talk about qualitative research using ethnographic interviewing in the Mexican immigrant population in the US. My favorite talks were the ones that ended in great conversation and a common sharing of ideas and knowledge between clinicians and researchers alike.
• I was impressed with the NSSLHA Experience program, which is geared toward current and prospective graduate students in both speech-language pathology and audiology. Experienced clinicians, current clinical fellows, and leaders in our field presented about the ins and outs of preparing for the PRAXIS exam, how to secure a quality Clinical Fellowship experience, and the important differences between a mentor and supervisor.

I wasn’t ready to leave and I am still thinking about the wonderful people I met, all of the opportunity in store for the future of our field, and the next generation of speech-language pathologists and audiologists. See you next year, in Denver!

Christine Delfino is a second year master’s student in the Speech and Hearing Sciences Department at Arizona State University studying bilingual speech-language pathology. She was the first place winner of the 2014 Student Ethics Essay Award. She can be reached at cdelfino@asu.edu.

Lessons Learned from #ASHA14

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Before the convention, I wrote a blog post about how to prepare to speak at the ASHA convention for the first time. When I wrote the post, I had spoken at another convention; however, I attended that convention as a speaker rather than the primary goal to participate in continuing education. At the ASHA Convention I planned to do both.

As I write, it is Sunday morning after the convention. I am reflecting on what went well and what didn’t go well as a speaker and attendee (not in regards to the convention in general).

 

What Went Well

I stayed organized. I used the resources I mentioned in my previous post to stay organized with my presentations. I also designated a paper folder to put information I would need paper copies of (e.g. shuttle routes, tickets, speaker’s notes, and master schedule). My master schedule was a great compensatory strategy for someone with a tired and busy brain. I will use the same system next year.

 

My food was amazing! Not only did I not get “glutened” (I have Celiac’s disease), but also my food was delicious and I didn’t stand in line waiting for food and I could eat on my schedule. The premade meals I ordered (external source) were a major success. It was relatively inexpensive to have delicious food pre-made and delivered to my hotel. I felt like I beat the system! Traveling is usually full of extra energy finding food I can eat and worrying if I’ll get sick (and dealing with it when I do).

 

I had a ton of fun! I was able to reconnect with friends and colleagues I haven’t seen since last year. I made new friends and connections. Sessions were inspiring. Several sessions had amazing speakers that couldn’t hide their excitement for being there. I love to see that excitement in a presenter. I went to a few large group events and quieter, smaller events too.

 

What I’ll Do Different Next Year

Submit fewer sessions. As I mentioned in my prior post, I didn’t anticipate all of the sessions would get accepted. I will submit fewer sessions next year. With so many sessions, it was challenging to schedule meetings and focus on relationship building at the convention. There were some conversations that I really would have liked to continue in order to form professional partnerships. (Thankfully, I can reach out to those people via email to continue the conversation.) Next year I won’t submit as many.

 

Book better flights. In Chicago, I left too early. This year I’m leaving too late. My flight doesn’t depart until 8:40pm on Sunday. The buzz from the convention has halted and I’m ready to go home to my family. Of course, next year it will be in Denver. I live in Boulder, so the convention center is a 35-minute drive from my home. No flights necessary. Travel will be much easier next year!

 

Sleep more. I was so excited to present on Friday morning (and inspired by Thursday’s sessions) that I was wide-eyed in the early hours of the morning, which meant I got about 3-hours of sleep. Just like I tell my clients all the time, adequate sleep is so important for your brain. I was processing slower, tripping on my words, and lost my place in conversations and while speaking in sessions! Anyone have suggestions for turning down excitement and wonder?

 

Overall the 2014 ASHA Convention was an excellent experience. I feel so inspired from the sessions I attended, people I met, and presenting. I have so many ideas help make the first quarter for 2015 amazing for Gray Matter Therapy.

 

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.

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.