Collaboration Corner: Knowing the Big Picture and Little Details of Autism

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As Autism Awareness month wraps up, I thought I‘d share my learning moments from working 15-plus years with my students on the spectrum, their families and my dedicated co-workers who support them:

  • Autism is a spectrum. There’s not a cure or a fix, but there are evidence-based interventions and nuances for each child that will help him or her succeed. My job (and yours) is to recognize those little details and shine a light on them.
  • I’ve developed a super appreciation for things that spin, shake, light up and squish. I also appreciate when these features suddenly become appalling and over-stimulating.
  • Sometimes the best way to get a child’s attention is to speak just above a whisper or not talk at all. Less is more and often things don’t just sound loud, they feel loud to a person with autism.
  • Sand and water play are seriously awesome.
  • Regardless of where a child is on the spectrum, you can find an activity that feels like fun and learning at the same time.
  • Candy doesn’t always taste or feel good, but hot sauce tastes delicious on French fries.
  • Take the short and long view on augmentative and alternative communication. Work on the here and now to make your clients efficient communicators, then model your expectations to bring them to the next level. Make them life-long communicators.
  • Students and families will show you when they are ready—ready to try something new, ready to accept who they are. You just have to listen, be patient and push. But not too hard.
  • Finally, having co-workers who are cued in and can step in and help at a moment’s notice is invaluable and—when in action—nothing less than a work of art.

What lessons have you learned from working with clients on the spectrum?

 

Kerry Davis EdD, 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 clinician 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. kerrydav@gmail.com

 

 

 

 

10 Early Signs and Symptoms of Childhood Apraxia of Speech

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I was a practicing speech-language pathologist for five years before my daughter was born. I worked primarily at the elementary and middle-school levels. I took professional development workshops on childhood apraxia of speech (CAS) and treated it successfully in three kiddos from my caseload. Perhaps that’s why I was bewildered, angry and utterly devastated when I missed those very signs in my own child.

I hadn’t yet worked in early intervention, so I missed what seem like obvious signs to me now that I specialize in the disorder. I urge all SLPs to learn more about CAS, because the disorder requires a specialized approach different from other commonly used treatments for speech and language delays.

In addition, ASHA denotes that the qualified professional to diagnose CAS is an SLP with specialized knowledge in motor learning theory and skills with differential diagnosis in childhood motor speech disorder, not a neurologist or other medical practitioner. It’s important to know the signs, but also to refer your client to a qualified SLP for differential diagnosis if you suspect childhood apraxia of speech.

Here are 10 early signs and symptoms of childhood apraxia of speech:

  • Limited babbling, or variation within babbling
  • Limited phonetic diversity
  • Inconsistent errors
  • Increased errors or difficulty with longer or more complex syllable and word shapes
  • Omissions, particularly in word initial syllable shapes
  • Vowel errors/distortions
  • Excessive, equal stress
  • Loss of previously produced words
  • More difficulty with volitional versus automatic speech responses
  • Predominant use of simple syllable shapes

Other non-speech “soft signs” that may be present include:

  • Impaired volitional oral movements (oral apraxia)
    • Difficulty with volitional “smiling” “kissing” “puckering”
  • Delays with fine/gross motor skills
  • Feeding difficulties that include choking and/or poor manipulation of food
  • General awkwardness or clumsiness

These are early signs, but many overlap with other phonologic and language delays, so it’s important to keep in mind that differential diagnosis is critical, as over-diagnosis of CAS remains problematic. It’s still a relatively rare disorder; however, there are resources that can help if you suspect it.

You can tap the below resources to learn more about childhood apraxia of speech.

 

Laura Smith, MA, CCC-SLP, is a school-based and private clinician in the Denver metro area specializing in childhood apraxia of speech. She’s CASANA-certified for advanced training and clinical expertise in Childhood Apraxia of Speech and often speaks at conferences and consults for school districts or other professionals. Like her on Facebook, follow her on Pinterest, or visit her website at SLPMommyofApraxia.comlauraslpmommy@gmail.com

 

 

 

 

 

Picky Eaters in the Preschool Classroom: 7 Tips for Teachers

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

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

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

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

Melanie Potock, MA, CCC-SLPtreats children birth to teens who have difficulty eating.  She is the co-author of Raising a Healthy, Happy Eater: A Parent’s Handbook – A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating (Oct. 2015), the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is offered for ASHA CEUs.  She can be reached at Melanie@mymunchbug.com

“Play It Again, Sam”: How the Use of Music is Reawakening the Minds of Many Individuals Battling Dementia.

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To say there has been a recent increase of videos on the web highlighting the power of music with individuals with dementia would be a vast understatement. From caregiver videos flooding YouTube to more carefully crafted films, such as Alive Inside, exploding on the scene, the individual stories being told are nothing short of remarkable.

But what does this mean for us as speech and language pathologists? And what does research say about the overwhelming number of anecdotal stories being touted on the internet? The answer to both questions is, A LOT! Many resources, such as the nonprofit organization MUSIC & MEMORY, now offer an extensive list of research citations that highlight the clinical benefits that listening to music can have on cognition and communication. It’s not just researchers taking notice of the mounting evidence. As the Centers for Medicare & Medicaid Services makes a push to decrease inappropriate use of antipsychotic drugs in long-term care settings, some of its efforts go toward funding personalized music programs to help address agitation and other behavioral concerns in a non-pharmacological way. Many states are also embracing this approach with great clinical outcomes to report.

So do we all switch professions and become music therapists? Of course not. The need for skilled speech therapists to directly target cognitive-linguistic deficits in long-term care settings is more important now than ever as the aging of our population and the dramatic rise in dementing illness converge, but the research and these dramatic personal stories should make us take pause and reconsider the environments in which we practice. As therapists we have a unique opportunity and perspective to be client advocates.

What information can we share, what videos can we show and whose life can we touch to be a catalyst for change in our communities? Consider your impact and take action today. Still need convincing? Let me leave you with one final image. Watch as Naomi Feil, founder of Validation Therapy, makes a power connection with Ms. Gladys Wilson. I wonder how many speech therapy screen forms were sitting in her medical chart stating she was “non-communicative” when this was filmed.

Robert Maxwell, MA, CCC-SLP is a speech-Language pathologist and clinical specialist for Genesis Rehab Services. He currently chairs the dementia special interest group for Genesis Rehab Services and has presented on the company, local, state and national level with regards to cognitive-linguistic and swallowing deficits related to the dementia population. He can be reached via email at: Robert.Maxwell1@genesishcc.com

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.