Are You Wearing Your Play-Based Hat Today?

Importance of play

Ever leave the house and not know what to wear? As an early intervention SLP, I wear many hats, and there are days when I’m not sure which hat (or hats) I’ll put on. As any therapist knows, the nature of our job is not just treatment related, but often much more. Of course the hat I wear most often is my speech therapy hat but when I enter the homes of my “kids” every week I sometimes encounter life that requires me to be more than just an SLP.

There is a trust that forms when you regularly enter someone’s home. Families respect you not only as their child’s SLP, but also as a resource for other parenting questions. These questions might require my community resource hat, my fellow parent hat or my support hat. Because the parents of our clients trust us to meet many needs, it is important that when they ask questions or seek guidance we are there to help.

For example, many families today experience a societal pressure to push their child well beyond what is developmentally appropriate. Parents set unrealistic expectations for their children and panic if they feel their child isn’t “keeping up.” I’m concerned when I enter homes filled with obscene piles of toys, a television constantly going and a toddler who manipulates my phone and tablet more skillfully than I do! Through my sessions I model play, in the absence of fancy toys and electronic devices, hoping the parents will realize how simply PLAYING with their child is enough. There’s no better way to achieve developmental milestones and enrich children than through play.

Sometimes my example isn’t enough…well OK, it’s often not enough. So frequently I have a conversation about age-appropriate expectations, age-appropriate toys and what children need most from their parents.

When pondering how to start this conversation, I often find myself asking: What can I do to educate families on the importance of play? What can I say to drive home age-appropriate expectations? What are some of the most important points to stress to the families I serve? Professionally, I branched into owning a business devoted to play, plus I learned about how play is changing and why it matters.

Here are some tips you may find helpful to educate parents about the importance of simple play:

• Remind families that children need unstructured playtime and give specific examples of what is learned when a child does “nothing.” A toddler’s day should consist mostly of unstructured play and opportunities to experience their world with all their senses. Tell parents that this is the best way for their child to learn.

• Share with parents the American Academy of Pediatrics’ recommendation of no screen time before age 2 and only two hours per day for children older than 2. Parents are usually shocked to hear this, but even a television in the background distracts a baby/toddler and can make it more difficult for them to focus and learn.

• Inform parents that babies and toddlers do not truly learn anything from flashcards. The powerful marketing beast can sell just about anything to an anxious parent who wants that best for her child. However, research and experience do not support their use, particularly at such an early age. Share what you know about play-based options for teaching language skills.

• Encourage parents to slow down and follow their instincts. Oftentimes parents know what’s best for their child, but are influenced by outside sources. As professionals, we can reassure parents to trust themselves.

If you are an EI SLP I hope you realize your importance not only in the life of the child you serve, but his family as well. You are appreciated and trusted, so may you guide your families so that they are able to enjoy the miracle of their child to the fullest. Choose your hats wisely and don’t keep all that knowledge about PLAY under your hat. We all have a role in supporting families and enriching children’s lives.

Lacy Morise, MS, CCC-SLP of Berryville, Virginia works for the West Virginia Birth to Three Program as an early intervention therapist. She also owns Milestones & Miracles (with her EI PT bestie, Nicole Sergent, MPT) Read her blog and like her on Facebook, follow her on Twitter @milestonesm and Pinterest

On the Road Again: ASHA Convention and Telepractice

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I admit it. I am an ASHA convention regular attendee. I am the SLP you see year after year collecting large yellow tote bags, company pens and my new favorite—nail files. This year, I even lined up to have my professional photo taken for my LinkedIn profile. I take in all that the ASHA convention offers, and my schedule allows, year after year.

One reason why the ASHA convention is so important to me is that I rarely stay in one place very long. I am the spouse of an active duty military officer. Therefore, I move a lot. With each move (eight so far), I’ve attended ASHA with a new job title: Department of Defense school SLP, hospital SLP, staff SLP, Lead SLP… This year, I attended ASHA as an SLP that works via telepractice. I deliver services and perform assessments via an online, custom built platform. I’m several states away from my students but I am licensed in the state where they reside and the state in which I reside. Using my home computer(s), a headset, webcam and high-speed internet connection with plenty of bandwidth, I treat, assess and collaborate with other SLPs, school staff and parents daily.

At this year’s convention, I encountered some surprising conversations regarding telepractice. I was met with responses ranging from: “Telepractice. I’m not so sure how I feel about that,” to “Yes, I’ve been looking into doing that. How does it work?” When embarking on a career in telepractice as a service delivery model, I was skeptical too. Was it ethical, effective and authorized? After researching ASHA’s rules and state bylaws, I put my feet in the water. That was four years ago.

During the ASHA convention, I was pleased to attend an increasing number of sessions focused on telepractice. However, these sessions highlighted the work and research still to be done to prove the effectiveness of telepractice as a service delivery model (especially with regards to culturally and linguistically diverse populations).

I still wonder, does an increase in sessions and visibility at the ASHA convention translate to increased acceptance/adoption by SLPs on the ground?

Telepractice is established and has been used in the medical field for more than 40 years. The American Telemedicine Association states that “telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a variety of applications including two-way videos, smart phones, tablets, wireless tools and other forms of technology.” According to ATA, “the use of telemedicine has spread rapidly and is now becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies and private physician offices as well as consumers’ homes and workplaces.”

I am looking forward to next year’s ASHA convention in Denver. I am already wondering about the sessions, networking opportunities and of course the pens and highlighters. Most of all, I’m looking forward to attending ASHA again as a SLP working via telepractice and the discussions that will surely follow.

Lesley Edwards-Gaither , MA, CCC-SLP, is a Speech-Language Pathologist in the Washington D.C. area.  She is a Lead SLP with PresenceLearning and an affiliate of Special Interest Group 18, Telepractice. She can be reached at legaitherslp@gmail.com

 

Why “Why Not?” Is a Worthwhile Attitude

Why Not?

November 8, 2014: eleven days before the ASHA Convention in Orlando, Florida.

After talking with my CSD professors and mentors about convention and exploring the ASHA website, I knew there was nothing more that I wanted than to attend. My chances of being able to go, however, were slim. After all, it was only a little more than a week away and I hadn’t figured out transportation or housing, much less how to pay for the actual convention.

I noticed the “Student Volunteer” link on the ASHA website, and my eyes lit up. At least until I saw the deadline to apply was two months ago. After a twinge of disappointment, I decided to email the volunteer contact anyway—I figured, “Why not?”

When I got a response back asking if I could work on November 18th from 10 am to 7 pm in exchange for complementary attendance, I practically fell out of my chair. I said yes, and after moving several pieces of the logistics puzzle around, my arrangements were set.

Now that I am fortunate enough to have attended my first ASHA convention, I can say with confidence that it was one of the most eye-opening, inspiring experiences I’ve had. Throughout the week, as I walked from session to session, I often found myself shaking my head in pure astonishment that the whole plan actually came together. The “Why Not?” mentality—grounded in drive, openness and ambition—encourages the pursuit of opportunities that seem beyond reach. Committing to this mindset will not only enable you to “shoot for the stars,” but to land among them.

When approaching your aspirations with a “Why Not?” attitude, here are a few things to keep in mind:

  • Communicate in a professional tone. Whether you are writing an email or interacting in person, be mature in your presentation to show that even as a student, you will be able to fit in seamlessly with experienced professionals.
  • Providing too much information is better than too little. This is the part where you make it easy for them to say yes. Emailing to inquire about a volunteer position? Attach a resume before they ask for one. Tell them why you are the best possible fit. Hold nothing back when pursuing an opportunity.
  • Be persistent. Professionals are busy, so don’t take lack of response personally. If you do not hear from anyone after a few days, send a polite follow-up email to ensure that they saw your previous message. Persist also in setting deadlines for yourself. If you say you will do or send something, then follow through.
  • Become comfortable with being uncomfortable. This is one of my life mottos after being an avid gymnast for 14 years and I find it applies to almost every challenge I encounter. Asking yourself “Why not?” forces you to get out of your comfort zone and pursue opportunities not easily attainable. The more you put yourself out there, the better you will become at it.

Pursuing opportunities with the “Why Not?” mentality serves me well in attaining my ultimate goal of becoming an SLP, and affords me a variety of experiences, including the writing of this article. After receiving a hand-out to write for the ASHA Leader at the convention, I chuckled at the idea. When I took out the folded piece of paper from my backpack days later, however, I opened up my laptop, started typing, and thought: “Why not?”

 

Robyn Croft is a third year undergraduate student in the Communication Sciences and Disorders Department at the University of Texas at Austin studying Speech/Language Pathology. She is a Student Clinician at the Michael and Tami Lang Stuttering Institute. She can be reached at robyncroft00@gmail.com.

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.

Collaboration Corner: 5 Take-Aways to Support AAC, Apps and Language

TEchnology and augmentative and alternative communication

This past month, my colleague Sean Sweeney (AKA @speechtechie) and I had the opportunity to join forces and write about AAC, apps and literacy development. Our article will be in the next issue of SIG 12: Perspectives in Augmentative and Alternative Communication.

This gave us a great opportunity to discuss how AAC users can benefit from apps to enhance treatment outcomes. Here are five highlights:

Feature matching is important: When choosing AAC or apps for learning, the tool must meet the needs of the user. For AAC, this includes the size, layout and physical accessibility of features to maximize independent use. For apps, this includes Sean’s FIVES criteria, which examines the context, appropriateness, accessibility and therapeutic considerations for learning. Just like any other tool in your kit, if it isn’t a good match then opportunities for communication or learning are potentially lost.

Make CORE align with the CORE: Using generative language formats, including core and fringe word vocabulary, benefits the student two-fold: building in opportunities for language growth throughout the day, while also meeting those pesky Common Core Standards. For example, a first grade ELA standard CCSS.ELA-Literacy.L.1.1.c, “Use singular and plural nouns with matching verbs in basic sentences.” Using core vocabulary allows the student to meet this standard through basic sentence construction activities. A first grader may enjoy learning this through the “Collins Big Cat” series, a free app that reads stories out loud and then has the option of the student recording his voice (or in this case, synthesized voice). The app also has a more interactive component, which allows the student to build scenes and narrate his own version of the story.

Apps and AAC are powerful together: Students love the interactive nature of apps. “Toca Hair Salon” is a highly interactive hair salon studio allowing students to describe how they are going to cut, color or otherwise coif the animal or person of choice. Another simple app, “Pogg,” is a cute alien that hops, sings and performs other actions, all at your student’s direction during a session. Beyond paper flashcards, the apps give students immediate reinforcement, so then work feels less like work.

Separate communication tools from other tools: If you are going to use apps and AAC at the same time, one practical solution is to use separate tools. Toggling between apps and AAC is cumbersome, and slow session momentum. In addition, having separate systems prevents the user from confusing a communication device with other technology, which is an important distinction. If your tools look the same, change the colors of the cases. If you have students that like to surf and press that home key, enable guided access so that only the AAC app is available.

Model, model, model through apps and AAC: Finally, apps provide the opportunity to model AAC live, and in unpredictable ways. You have more opportunities to explore and learn together. Don’t have curling iron as a fringe vocabulary item when using your “Toca Hair Salon” app (it’s not there, believe me)? Show your student how you can give clues to what you mean and talk it through using what is available on your AAC: “Let’s see, it’s a tool, it’s hot and it makes your hair curly…what is it?

There’s your abridged version and takeaways…log in to your SIG 12 portal for more info, and to get CEUs….ASHA renewal is right around the corner!

 

 

Reference

Sweeney, S. & Davis, K. (2014). In press. Reading, writing and AAC: Mobile technology strategies for literacy and language development. SIG 12: Perspectives in Augmentative and Alternative Communication. American Speech Language and Hearing Association.

 

 

Kerry J. Davis, EdD, CCC/SLP is a speech-language pathologist in the Boston area. She holds a special interest providing services to children and adolescents with complex communication profiles, including AAC. Davis is a volunteer SLP and consultant to Step by Step Guyana, a school for children with Autism in South America.

 

“Use Your Speech Tools!” Why Your Child Who Stutters May Not Be Using His Strategies

Stuttering Tools

When a child who stutters demonstrates the ability to change his speech during a treatment session, it seems obvious that he’d want to use the same strategies to improve speech outside the session as well.  Children, especially teenagers, rarely want to stand out in a way that stigmatizes them, provokes questions or increases the chances of teasing.   So the question arises, “Why aren’t they using their tools?!”

Speech and stuttering modification techniques are often learned quickly and easily within the treatment setting.  However, SLPs and parents often feel discouraged when these tools seem to disappear as soon as the client gets to his car.  Is it laziness on the part of the child?  Is it the fault of the family for not following through with home assignments?  Is the SLP not teaching the best strategies?

Instead of placing blame, consider the following three reasons a child may have difficulty generalizing his skills:

Reason # 1: These Techniques Are Too Hard! 

Making changes to one’s speech becomes exponentially harder when you introduce factors that often are not present in the session, such as interruptions, time pressure and feelings of embarrassment or shame associated with stuttering. Learned escape/avoidance behaviors and increased language demands may make it very difficult to use these tools.  Suddenly, what felt like an easy decision to use a new technique, becomes complicated by the person’s desire to be heard in a large group of chatty peers or by the need to formulate an excuse about why he doesn’t have his homework.

How Can I Help?

Children will be more likely to use speech/stuttering strategies if they are first introduced in safe and supportive environments (i.e. home, session room).  To help with this, create a hierarchy of speaking situations and use it to guide where the client practices the strategies.  If a child who stutters is not yet using speech tools in certain situations such as the classroom, it is probably because of where that situation is on his hierarchy. Work with your clients to determine where they would like to use their strategies , while also identifying those situations where they would prefer to concentrate on things other than using their tools.

Reason #2: These Techniques Make Me Sound Weird! 

There are several techniques that may be taught to a child who stutters. Some strategies involve prolonging the initial sound to ease into or out of a word with less physical tension or struggle.  Other techniques include inserting more pauses into speech.   All speech tools require a child to alter their speech in a way that is still different from how his friends sound.  Children may report that they have similar negative thoughts and feelings about using these strategies as they do about their stuttering.  This may play a role in why they are choosing not to use speech strategies outside their sessions.

How Can I Help?

Just as you might spend time trying to help reduce negative reactions to stuttering, you might also spend time desensitizing clients to hearing themselves use strategies through voluntary stuttering assignments.  Children can also benefit from improving their ability to handle listener reactions. This can be addressed by participating in role-playing activities that help the child create “scripts” for responding to curiosity/teasing.  For example: “Why do you sound like that?” “Sometimes I stretch my sounds like that to help me get out of a stutter.”  The more comfortable the child feels with his strategies and ability to respond to questions about his speech, the more prepared he will be to use these techniques outside the session.

Reason #3: These Techniques Aren’t Worth it!  

A cost-benefit analysis can be useful when trying to understand why a child may choose not to use speech/stuttering strategies.  At the surface, it may appear that there are many benefits of using strategies which include increased fluency and improved overall communication. However, SLPs and parents must be careful to consider the costs, as well.  Costs may include increased effort, difficulty concentrating on the content of message, the risk of showing more stuttering and the potential that the strategy doesn’t work.

How Can I Help?

Have discussions with clients about what they perceive as potential costs versus benefits of using strategies in a variety of different speaking situations.  As the child becomes more accepting of stuttering and is better able to tolerate both his feelings about stuttering and listener reactions, physical tension and struggles associated with speaking will decrease.  As this happens, tools become easier to use and costs may not feel so high.

The bottom line 

There are several strategies that may help reduce stuttering frequency and severity.  However, you often can’t offer these tools without first considering and incorporating goals that target how the client thinks and feels about his speech both while stuttering and while using tools.

Brooke Leiman, MA, CCC-SLP, is the Director of the Stuttering Clinic at the National Speech/Language Therapy Center in Bethesda, Md. She is an affiliate of ASHA Special Interest Group 4, Fluency and Fluency Disorders. This blog post is adapted from a post on her blog, www.stutteringsource.com, which focuses on fluency disorders and their treatment.

 

 

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.

In Appreciation: Sylvia Onesti Richardson

Richardson SylviaSylvia Onesti Richardson, president of the American Speech-Language-Hearing Association in 1973-74  and a passionate advocate for children with language and learning disorders, died in her home on Friday, October 24. A Tampa resident since 1980, she was 94 years old.

Throughout her career, Richardson strongly advocated for children with learning disabilities and speech-language disorders: In 1949 she established at Boston Children’s Medical Center the first speech-language clinic in any children’s hospital in the United States. She also created the Child Study Center and became involved in the use of Montessori educational methods for children with learning disabilities while at the University of Oklahoma. In Cincinnati, she was a founding member of the Hamilton County Diagnostic Center for Children with Learning Disabilities and the founding editor of Children’s House magazine. In 1970, she was invited to the White House Conference on Children and in 1977, was appointed to the President’s Commission on Mental Health. She was also Chair of the National Joint Committee on Learning Disabilities from 1997 to 1999, and a member for 30 years.

Richardson received her training in pediatrics from the Montreal Children’s Hospital and the Boston Children’s Medical Center and was also an ASHA-certified speech-language pathologist  and certified Montessori primary teacher. Richardson had numerous academic appointments, culminating in Emeritus Clinical Professor of Pediatrics at the University of South Florida, where she began teaching in 1981.

Richardson has contributed much to the literature of her field with more than 100 publications including the book, “Something’s Wrong With My Child: A Parent’s Book About Children with Learning Disabilities,” 1973. She also received numerous honors, including the 1964 Oklahoma Woman of the Year.

Richardson’s professional accomplishments are only a part of her remarkable life. She was an active member of the Athena Society, and especially their Young Women of Promise Award program, which has been renamed in her honor. She was a strong supporter of the arts, especially the Straz Center for the Performing Arts, and she loved to attend performances there.

She is survived by her brother, Silvio Onesti; her sons William and Christopher; and her grandchildren: Lucas, Michael, Eva, Will, Anna and Sophia. These grandchildren were Richardson’s pride and joy. She attended many graduations from high schools and colleges, and this past June saw Lucas get married.

A memorial service was held Saturday, November 8, in Tampa.

In lieu of flowers, memorial contributions may be made to the International Dyslexia Association, 40 York Road, 4th Floor, Baltimore, MD 21204.

Cooking up the Perfect ASHA 2014

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What’s the perfect recipe for ASHA 2014? Blend together science, learning and practice. Add a pinch of party and a heaping of gratitude. Watch it grow for generations.

Like many SLP swallowologists, I’m a foodie. Expand that: I’m a bilingual (Spanish-speaking)-Canadian-American-Salsa-dancing-foodie-mama-dysphagia nut, ready for a stimulating convention getaway in Florida. Good thing ASHA has cooked-up a feast for the body and mind.

Coming from Boston, I’ll feel right at home Wednesday night at Minus5º Ice Bar for the ASHA-PAC Party. Drinking a cocktail in a glass made out of ice may make you swallow faster! Watch out! The icy architecture will cool us down as we discuss the latest political action on Capitol Hill.

On Thursday, ASHA promises “hot, hot, hot” at the The ASHFoundation Latin Party at Cuba Libre Restaurant & Rum Bar. After we swallow liquids, we can test solids from the award-winning chef Guillermo Pernot. Salsa lessons anyone?

But of course we won’t just be there to party– relaxing and dancing will help us learn better.

 

Gratitude for opportunities in Science & Learning

I love seeing my heroes at conventions. This year we are deeply saddened to have lost our pioneer in dysphagia, Jerilyn Logemann.

As we remember Logemann, we also need to remember to thank all our mentors. Take time to reflect on how much they have influenced you and your career. Who would I be today without teachers like Jay Rosenbeck, Joanne Robbins, and James Coyle during my master’s studies years ago? Thank you!

And not just mentors who you know directly, but those who are influencing the profession, too. Thank you Catriona Steele, University of Toronto, for pushing us to go global. She suggests an international consensus for diet texture terminology. How many names do we have for that safe-ish dysphagia diet between puree and regular? Here are a few: mechanical soft, ground, moist ground, chopped, mechanically altered…

Thank you Tessa Goldsmith, Partners MGH, for the very important exploration of Human Papilloma Virus (HPV). SLPs are public health advocates. Michael Douglas was misdiagnosed three times, delaying his treatment by too many months. He said it started with a sore throat and sore gums behind his last molar. As rates of laryngeal cancer from smoking decline, HPV has emerged as the most common cause of oropharyngeal cancer. However, there are many differences between HPV-positive and HPV-negative cancers. Additionally, don’t miss a chance to see Katherine Hutcheson, of MD Anderson, who gave a fabulous series at the ASHA Healthcare & Business Institute this past April. Jeri Logemann co-authored a two-part series on Long-Term Dysphagia After Head & Neck Cancer. Thank you to her team for carrying the torch.

I appreciate how Dr James Coyle is like Socrates, probing with critical questions to seek the truth. His courses ask: Which side is up?; What’s wrong with my patient?; What are we doing and why?; and what can bedside swallowing examinations do and what can’t they do? Every SLP practicing in dysphagia has to take at least one of his courses. We will learn a lot of science that directly relates to our practice, while having fun! I try to capture his humor in my blogs.

Another thank you to the twilight session on Thursday, called “Eating is Not Just Swallowing.” Samantha Shune, University of Iowa, integrates “components of the broader mealtime process with our definition of swallowing.” I typically introduce my bedside swallowing evaluations with: “Your doctor wants me to evaluate your eating and swallowing.” However, I was once told at an old job to not say “eating,” because it was deemed unrelated to swallowing and swallowing impairment. I appreciate this session’s holistic perspective.

 

Generations of Discovery

ASHA conventions inspire growth. I have discovered that you can recreate your career at any age. After performing Modified Barium Swallow Studies for 15 years, I am beginning again in an extensive FEES training program.

This past April at the ASHA Healthcare & Business Institute, a group of us were sharing our dreams and goals for our careers. I realized that I love to constantly learn, synthesize, and share with others. One year ago, I never would have believed that I would start a dysphagia resource website and become an SLP blogger.

As us older generations teach the younger generations, we also need to thank the younger SLPs for inspiring us to keep it fresh. For me that meant finally embracing technology. It is technology that is helping ASHA members network and reach all corners of the globe.

Thank you, ASHA, for this feast!

 

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. Sheffler is one of four invited bloggers for ASHA’s 2014 Convention in Orlando.

Teens and Feeding Therapy:  An SLP’s Top Five Tips!

Making trying new foods fun for teens.

Making trying new foods fun for teens.

As a pediatric feeding therapist, it’s not unusual for me to get a call from a mother who says “My kid’s 14 years old and still eats only six foods. He’s so picky!  I thought he would grow out of it.”  True, with patience and consistent strategies, some kids do indeed grow out of the picky-eater stage, typically at its peak aro

und age three. But if the child had underlying motor, physiological or sensory challenges that stalled the developmental process of learning to eat a variety of foods, it’s not unusual that selective eating behaviors will prevail into the teenage years.  I approach treatment with teens in a similar manner as my younger clients while respecting one important fact: They are teenagers!

Here are my top five tips for interacting with teens while building trust and confidence, plus making feeding therapy successful (and fun!) for both of you:

#5  Use Cool Games:  I always incorporate games into feeding practice.  Learning to try new foods is HARD, at any age.  Including games in the process of biting, chewing and tasting keeps anxiety levels low and still allows learning to take place.  Using games as a means of distraction, such as eating while playing independently on an iPad, does not allow for conscious learning.  Instead, try using games that are reciprocal in nature and where each player’s turn lasts no more than ten seconds.  If your client is working on learning to drink a smoothie, perhaps he might take a drink, get a turn, etc.  Try Blockus, UNO Blast or  Connect-4 Launchers, all interactive and exciting games. Plus, they are easy to clean, which is important in feeding treatment.

#4 Create Your Own Games: To quote a bit of teenage lingo, find out what the teenager “is obsessed with” and create games around that obsession. Does she love three-toed sloths?  Pull up the best sloth videos on YouTube and create a Jeopardy game around them, hiding each video under categories like  “Kristen Bell for One Hundred Please.”   I once had a client who knew every Movie Production Logo in Hollywood.  His mother sent me pictures of ten favorite logos and I laminated two copies of each.  During feeding therapy in his home, we would spread out the laminated pictures all over the kitchen floor and after each bite, try to toss a penny onto a picture.  Get a match, and you get a point.  Another client of mine was obsessed with paintball, but I wasn’t about to do feeding therapy in a paintball bunker.  Instead, I brought my Discovery Toys Marbleworks® and with each bite we added one piece, eventually building intricate contraptions and using the paintballs as marbles.

#3 Ask WHY: Once I get to know a teen, I always ask this question: “Is there a special reason you want to learn to try new foods?” One teen told me that he wanted to ask his girlfriend to Prom, but was afraid that he couldn’t take her to a fancy restaurant for dinner.  “I don’t think they serve pizza there, and that’s all I know how to eat.” That was eye-opening for me!  Now I know his motivation and we have a timeline for success. When there is no motivation, that’s a problem.   It’s common for a teen to reply: “I don’t want to learn to eat anything new – my Mom is making me.”  This is the time to help a teen FIND motivation.  “How’s wrestling going?  Did you know you need protein to build more lean muscle? What types of protein would you like to learn to eat: nuts, hamburger or vegetable protein?”  One of my clients had been consisting on  four strawberry Pediasures mixed with whole milk every day for over three years before starting therapy. He used to eat some solid foods, but over time began to limit his intake until he was food jagging on Pediasure.  He didn’t see a problem, because he liked the way he could gulp down a Pediasure and rush outside during break time to play basketball with his friends. That worked for him because it enabled him to avoid social eating in the cafeteria, which made him very anxious.  I suspected that the high dairy content was making him constipated, thus decreasing appetite.  Let’s face it: A teen is not likely to tell ME about his constipation.  But, I called his pediatrician and requested that they have the constipation talk during the upcoming sports physical.  Once his doctor explained that he would no longer have to struggle with bathroom issues, which was a huge source of embarrassment for him, the teen was open to tasting some new foods.  Feeding therapy, especially with teens, goes best when we focus on the whole child and learning what’s important in his unique world.

#2  Teach positive self-talk: So many older kids engage in negative talk about food because it stops parents from serving it.  Over time, those negative comments become a habit that for lack of better term, is a form of self-brainwashing.  While it’s important to acknowledge a teen’s feelings if he says “I can’t – I’m scared I’ll gag,”  it’s just as important to help him talk positively about eating.  I explain it this way:

I want you to talk to your own brain the way you would talk to your best friend.  If your best friend had practiced with his soccer coach to take a goal kick in soccer but was feeling anxious when it came time to attempt it, he might turn and whisper to you, “I can’t – I’m scared that I’ll miss.” You’d probably tell  him “You’ve practiced with coach and you have the skills to do it!  It’s OK to be nervous – you can still make that goal!”  He needs to hear that from you.  Well, your brain needs to hear the same positive talk from you when you talk about food.  It’s OK to be nervous and it’s OK not to like the taste of it.  We’re just beginning to learn how to how to eat this new food and we are practicing it.”

And this SLP’s #1 Tip? Give Them the Script: Teens may not always have the most descriptive vocabulary, except to narrow taste and texture down to “gross.”   Give them the language and discuss what terms like savory, buttery, creamy truly mean.  A reference list of 345 terms to describe food can be found here.  Plus, it helpful to use comparison phrases such as “It’s similar to tiny dots of corn, but it’s called polenta” in order to build familiarity with a food they’ve experienced in some manner, such as corn.  If the most interaction they’ve had with corn is just staring at it, that’s OK!  Stare at the polenta.  Make it a kitchen science experiment and discuss all the properties of polenta if you need to.  Give them the words that build visual familiarity with polenta: “yellow cornmeal”, “hulled”, etc.  Talk about how it can be baked, fried, grilled or stirred into a porridge.  Interact with it – get to know it.  Now you’ve got a teen whose introducing his brain to polenta by saying: “Polenta is cornmeal, which is made from something I’m familiar with: corn.  I think it looks best when it’s fried, because I like fried foods.” He’s OPEN to the concept of Polenta because he has the terminology to describe it and understand the properties. As you progress from visual interaction to tactile exploration, provide terms that describe the feel of polenta such as “gritty” and “course.” Eventually, you’ll be discussing the same feel in the mouth.  As all SLPs know, language is empowering.

What other strategies do you have when helping teens interact with new foods?  Please list them in the comments section, thank you!

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.