Speech Therapy and Aging: Implications for Our Approach to Communication Disorders

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This post is the beginning of a monthly series by Betty Schreiber, M.M.S. CCC-SLP, on Aging, Communication, Cognition, and Speech Therapy.

Thank you for allowing me to be a new blogger on ASHASphere. I currently supervise Graduate Students at the Ladge Speech and Hearing Clinic at LIU/Post in Brookville, New York. Along with my wonderful business partner, Gail Weissman MA. CCC-SLP, and amazing programmers at Objectgraph LLC, I am also creating Apps designed specifically for our older clients.

As I am at the younger end of what would be considered the “baby boomer” generation, and currently working with adults who have begun to age and suffer communication disorders, I am particularly sensitive to the effect of aging and the social impact of communication disorders amongst this population.

As people get older, it is a fact that health and physical mobility are crucial elements in their ability to function in daily life, interact, and participate normally in society. Even older people who have simply aged with no other issues experience increasing isolation. Their spouses and friends move or pass away, leaving fewer opportunities for social interaction.

The baby boomers are aging and will become a large part of the population in the next 20 years. The Center for Disease Control in collaboration with the Merke Company Foundation has developed information on aging in America with a state by state assessment.

They listed 15 key indicators of older adult health:

  • Physically Unhealthy Days
  • Frequent Mental Distress
  • Oral Health: Complete Tooth Loss
  • Disability
  • No Leisure-Time Physical Activity
  • Eating ≥ 5 Fruits and Vegetables Daily
  • Obesity
  • Current Smoking
  • Flu Vaccine in Past Year
  • Ever Had Pneumonia Vaccine
  • Mammogram Within Past 2 Years
  • Colorectal Cancer Screening
  • Up-to-date on Select Preventive Services
  • Cholesterol Checked in Past 5 Years
  • Hip Fracture Hospitalizations

These factors have an impact on our aging family members ability to attend the therapies they need, maintain cognitive function, communicate and be self-sufficient. The majority of our elderly prefer to stay in a familiar environment even if it means living alone or with some outside help.

According to the United States Department of Health and Human Services Profile of Older Americans 2011, about 29% (11.3 million) of noninstitutionalized older persons live alone (8.1 million women, 3.2 million men), almost half of older women (47%) age 75+ live alone. The number of Americans aged 45-64, (I’m in that batch) who will reach 65 over the next two decades increased by 31% during this decade. Over one in every eight, or 13.1%, of the population is an older American. This demographic information along with changes in the federal budget and insurance reimbursement should be of concern to us, as professionals. Not only in terms of how we will make a living, but how will we be able to provide needed support and efficient services so that treatment approaches do not have to cost more money. Therapy can be more effective if we address communication and interaction within the framework of the aging living situation as a whole.

In one of the blogs on our website, I told a story of my own family experience. My grandmother, who was about 83 at the time, was placed in the middle of the livingroom while family and friends spoke to each other around her. (I was about 26 and a SLP for 3 years) She was able to hear well enough, and speak well enough, but the attitudes of the younger people were such that unless she made a ruckus, no one felt it was necessary to include her in the conversation! This isolation while surrounded by a bustling family, negatively affected her attention to her surroundings.

Part of my therapy approach with adult clients is to educate and include the families and caregivers in the therapeutic process as much as possible. Our family questionnaire includes questions such as: How many times do you talk to (our client) during the day. We also ask about the client’s speaking interactions at home or in a group of people. I have found that some family members want us to “fix” their husband or wife and want no additional responsibility. But we can talk to them to help them slowly understand that their situation will be better if they are aware of how they can help and use the adaptive tools we are giving them. We are not asking them to do the therapy or practice. We help them with resources in our community and teach them about paired communication and listening. The families, caregivers, even SNF staff should be encouraged to develop a communication routine that allows interaction not mere reaction.

There will be more on this topic in subsequent postings. Any of the Indicators of Older Adult Health frequency may impact our therapy attendance and reimbursement. What does this mean in terms of available services, advocacy, health care coverage, families and caregivers education/training? How can we, as Speech Language Pathologists recognize and support individuals and families in distress and facilitate communication awareness, not only with our clients who are coming for therapy, but for our aging population as a whole?

Betsy C. Schreiber, MMS, CCC-SLP, received a BA  in Psychology and MMS Master of Medical Science in Speech Pathology from Emory University in Atlanta, Georgia. Her CCC was earned during the 3 years she worked at Hitchcock Rehabilitation Center in Aiken, South Carolina where she had the opportunity to learn about NDT and Sensory Integration with the original, Jane Ayres, working with LD and CP children and neurologically impaired adults. She is currently a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She has also served as an ASHA Mentor and hopes to participate in ASHA’s  Political Action Committee in the coming year.

Winter Literacy

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I love following bloggers and using their lesson plans that are paired with children’s books!  They have inspired me to create some of my own plans for my elementary aged clients.  Over the winter break, I pulled out some of my seasonal books and created simple, functional lessons to pair with the stories.  I also purchased and printed some great winter literacy plans from a couple other sites.

The first book, Tracks in the Snow by Wong Herbert Yee, is a nice read for my 1st and 2nd grade clients.  This year, much of my caseload is working on irregular past tense verbs, so I decided to use this short and sweet winter story to target verbs.  I decided to create a list using sentences with present tense verbs from the story.  Children will take turns changing the target verb into the past tense and earn an animal track card or tokens for correct responses.  The person with the most tracks or tokens wins! You can grab your list here for Tracks in the Snow.

My next book, The Missing Mitten Mystery by Steven Kellogg is a funny story about a little girl who retraces her steps outside in search of a missing mitten.  I found this book by Scholastic for a quarter at my local library sale!  I needed a lesson for some 3rd graders that focused on simple comprehension questions following a short reading and this book fit the bill!  If you can find this book at your local library or bookstore, then you can use these comprehension questions!

Another score at the library sale was, In the Snow: Who’s Been Here? by Lindsay Barrett George.  I highly recommend borrowing or purchasing this book because each page gives clues about a winter animal that has crossed the trail in the woods just prior to the children’s walk.  Great for vocabulary building and answering who/what questions!!

If you have not seen the FREE templates at www.makelearningfun.com that go along with the stories, The Mitten and The Hat both by Jan Brett, then you should follow this link to take a look!

Finally, I recently found some great worksheets for the award winning story,Owl Moon by Jane Yolen at this blogger’s TpT site.

I hope that you have found these resources to be helpful!  If you have, then please take a moment to follow [my] blog and/or like my Facebook page, speech2me.  I would LOVE to hear about some of your favorite winter literacy units, so feel free to comment below!  Happy New Year!!

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This post originally appeared on The Next Chapter in my Speech World.

Nanette Cote, MA, CCC-SLP works contractually for Staffing Options and Solutions and has her own practice, Naperville Therapediatrics.  She is a pediatric Speech-Language Pathologist in Naperville, Illinois who was recently certified in Interactive Metronome Therapy.   Her blog, speech2me, was named one of the top Speech-Language blogs for 2012.  For more information about this practitioner, please visit the blog at www.speech2me.blogspot.com or the Facebook page.

Embracing The Potential Benefits Of Using New Technologies In Children’s Speech And Language Therapy

(This post originally appeared on PediaStaff.com)

Communication is so much more than speech, now more than ever, and the gap between the technological literacy of parents and the Speech Language Pathologists (SLPs) assisting children with communication disorders has never been greater – and it is accelerating at a dizzying pace. Speech language pathologists are communication disorder specialists, not computer experts. Many SLPs are from a different, older generation, or just coming out of a newly digitally-connected generation. The communication disorder and sciences profession is rapidly changing at such a fast pace that we must adapt to new tools that were never really intended for speech language pathologists. We must find modern means to keep children’s attention and motivate them to be good communicators.

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Photo by Kodomut

Since facial expressions and simple gestures, humans have attempted to figure out all kinds of messages one person is trying to get across to another person, or, in a sense, what a sender is trying to convey across to a receiver. The Sender (A) has a message of information (X) for the Receiver (B). The question now is, what is the most effective, efficient, understandable way to get that informational message across from person A to person B and then back to A (and so on)? That is every pediatric SLP’s dilemma to figure out in order to provide the best possible therapy. Part of that dilemma is finding and keeping up with the exponentially changing, newest additions to the communication disorder ‘tool bag’.

All new technology is a tool; one tool of many to aid in the communication between a parent and a child. They are not gadgets to replace interaction or placeholders in important social connections between two emotional human beings. New technology is just one tool to help bring people together and aid in understanding basic, functional needs and wants for quality daily living. A new technology can motivate and facilitate a connection and exchange of ideas or emotions with another person. More tools include animals, blankets, crayons, puppets, games, music, bubbles and puzzles. Therapy tools are meant to motivate and open up opportunities for speech and language development in children. If an iPad helps a child share a smile with their parent, a shared moment of attention, attachment and engagement – that is a good thing. The tech device is just a therapy tool of gaining a child’s attention. It is only with joint attention that more opportunities for interaction can occur.

Finding that attention-grabber takes work, work on the parent’s end and work on the therapist’s end of intervention. We must engage with children and their ‘tech toys’ in order to stay connected to them to some degree. That does not mean that an app or a gadget is a replacement for interacting with a child. Interpersonal interaction will never be replaced – humans are social beings; we need each other to survive and blossom. The tool means nothing and is rather useless without the person using it to facilitate human bonding. We must find what keeps a child’s attention to maintain the level of attention required for communication opportunities. We have evolved from early interaction and attachment, to pragmatics, to gestures, to play, to language comprehension, to language expression – each one an important step in communication and engagement with one another. Each step is a huge communication milestone and it all starts with attachment, attention and interaction. We must get on the floor, be face-to-face and give our full attention to children on their level in order to begin to foster positive shared experiences.

SLPs need to learn how to use new tools and help teach parents, teachers and children how to share these modern communication opportunities. We must learn how to effectively and efficiently embrace children’s new digital language knowledge. We all use Augmentative Alternative Communication (AAC) devices every day. People with or without communication disorders, whether we call them AAC or not: cell phones, cameras, daily planners and computers – we are all users of AAC devices. We should not be overwhelmed by new technologies it is just that we have to take the time to learn more about them. It is like learning a new language – and if children are trying so hard to communicate – why can’t we the caregivers and therapists put in effort to understand what is available to children today? Technology is part of our new job requirement. We as SLPs have to stay one step ahead to give these children the best opportunities for communication possibilities. Our new challenge as speech language pathologists and parents is to keep up with the new ways children are learning to communicate.

It is our job as SLPs to understand and to integrate that digital language into therapy to aid children by taking technology from other fields never intended for SLPs. If children are going to engage in this type of online socialization, help them (and us) learn how to navigate this new digital world together. We cannot be perfect therapists, perfect parents, grandparents, or even perfect aunties or siblings, but we can get on the level of a child and really want to find ways to connect with them. Children want to share experiences with us strange and intriguing adults, but they need us to understand and follow their lead sometimes. Children need us to understand their world. Adults, yes, this means homework and taking the extra time to learn about areas in science and technology that may be unfamiliar to us. We must be active participants in order to connect and receive the full, active attention of the children of today.

Connection between people is the most important part of being human. Communication is always evolving. Just like our language dictionaries that require constant updates, speech language pathologists have to keep our tool bags updated and current. We have to keep up with the children of 2010, but keep therapy grounded in human connection to focus on the basics of daily living, wants and needs facilitated by real people. All technologies are just tools of getting a message, information or code (X) from person, Sender (A) to person, Receiver (B) and vice versa. New technology can seem complicated but all these methods have only one purpose- they are methods of connecting people to other people. Speech language pathologists must see all technological tools as just part of the SLP tool bag to effectively use these current and those ancient technologies in therapy. It is no longer necessarily augmentative, alternative communication, but rather, typical digital communication that we must adapt to in order to help children. That does not mean we cannot communicate with children if we do not understand this digital language. Basic, face-to-face communication will always be based on body language and gestures of nonverbal, behavioral communication which speech language pathologists are educated to understand, translate, decode and decipher as a model to the caregiver. SLPs are conduits to pass on skills to others – we are decoders and resources to children. We are resources to parents who desire to achieve attention then engagement with their child; but just need some guidance and support to get there.

SLPs will have to adapt at a faster rate to the exponential increase in therapy tools available for our tool bags and what speaks to children. What keeps their attention? There are many resources available to all of us to be better educated in an increasingly fast paced, digital world. Let us keep up with the children of today and share what we learn to stay as connected to the people we love as humanly possible. So, how do we all stay informed about the exponentially changing, newest additions in communication facilitating technology tools? As a start, we can begin by learning and sharing information from the resources right in front of us. The Internet is full of wonderful educational and therapeutic tools including information on apps and website links for children with communication disorders. Let us therapists and parents listen to children, and to what they can teach us. All anyone needs is a place to start. The following list of highly recommended links is one place to start in helping adults understand children’s digital language of 2010.

Highly recommended links to learn more about children’s digital communication:

Megan (Panatier) Bratti, MS, CCC-SLP, lives in Los Angeles, California with her husband.  She graduated from California State University Northridge with her Master’s degree in Communicative Disorders and Sciences, Speech Language Pathology in 2006.  Megan explores technology and its potential in the communication disorder and sciences field with, Avocado Technologies, co-founded with her husband, Bruno Bratti, an Integrated Circuit Engineer.  Avocado Technologies is a forum on a Facebook page and on Twitter @avocadotech to engage others with the latest stories and news about communicative disorders, language, speech therapy, education, science, linguistics, literacy and technology found on the web.

Patient-Provider Communication

How well do you communicate with your clients? We are, after all, experts in human communication. Shouldn’t that mean that we are good at communicating with the people we serve?

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Photo by Chrissy Johnson1

Unfortunately, this may not always be the case. Like many other health care providers, SLPs and audiologists often have trouble communicating clearly so that clients fully understand and can use the information we share. We tend to use jargon and talk in medical or technical terms that are not easily understood by the average person. We use words like “dysarthria” or “sensorineural.” We talk about a person’s “standard scores,” “functional abilities,” and degree of hearing loss in terms of “decibels.” We also tend to share written information that is very dense and complex and do so without spending time explaining the information we’ve given out. This has been demonstrated in studies of the readability of communication disorder-related brochures as well as reflected in responses to ASHA surveys about how consumer materials are used.

Patient-provider communication is a hot topic these days. Do an Internet search of the term “patient provider communication” and you’ll find resources from the Institute for Healthcare Improvement, the American Medical Association, scholarly journals, and more. Go to the Joint Commission website and you’ll find new standards regarding effective, culturally competent patient communication. Closer to home, a group interested parties, including a number of ASHA members, have joined together and formed the Patient-Provider Communication Forum in an attempt to further patient-provider communication across the continuum of care. Patient-provider communication, including issues related to health literacy, is fast becoming as serious an issue in health care as universal precautions. In fact, the Agency for Healthcare Research and Quality (AHRQ) has branded its information about health literacy as a universal precaution. Makes sense if you consider that poor communication can result in very harmful consequences and poor outcomes if medical advice is not understood and followed.

So, how do you think you do in regards to communicating with your clients? Do you think they understand what you are telling them? Do they appear to read brochures and other information you give them? And, more importantly, do you think they understand that information well enough to follow through on any recommendations in it? What do you do to try to improve your communication with clients and families? As experts in human communication, we can lead the charge on effective patient-provider communication. But first we need to be good at it ourselves.

Amy Hasselkus, M.A., CCC-SLP, is associate director of health care services in speech-language pathology at ASHA. She is also currently enrolled in a Masters degree program in communication at George Mason University, with an emphasis on health communication.