Know Your CAS

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When I was pregnant, I remember dreaming about my new baby. My husband and I wondered aloud if she would be a musician like him, an athlete like me, or have some individual talent all her own. We had absolutely no doubts about what strong communications skills she’d have, however. Her mother was an SLP after all.

During her first year, my daughter lagged in all developmental milestones. I went to at least five different conferences on early intervention, but I couldn’t figure out why my daughter wasn’t a chatterbox. She met her first word criteria at one saying “hi” to everyone she met.

My husband’s mother reported he was late to talk and didn’t really say much of anything until after two. I had heard of late talkers, but because I worked at the elementary level, I never treated preschool kids. I brushed aside my pediatrician’s suggestion to seek treatment because I was convinced my daughter must be like her Daddy and that I could help her.

I finally took her in for an evaluation when she was close to three and received a diagnosis of childhood apraxia of speech and global motor planning deficits. After starting therapy based on motor learning principles, she made progress immediately.

Upset that I missed this diagnosis in my own child, I went on to endlessly and obsessively research childhood apraxia of speech. I was disappointed to find maybe eight pages on the subject in my graduate school materials. I know CAS is rare, but SLPs need to know about it and need to have the tools to diagnose and treat it correctly.

That summer I attended the national conference for CAS. The next summer I applied and was accepted into the Apraxia Intensive Training Institute sponsored by CASANA, the largest nonprofit dedicated exclusively to CAS. I was trained under three leading experts: Dr. Ruth Stoeckel, David Hammer and Kathy Jakielski.

If I could get one message out to pediatric SLPs, it would be for them to research and become familiar with the principles of motor learning and change their treatments accordingly for a client with CAS or suspected CAS. I know many like me get so little training or even information on it in graduate school. I’ve met other SLPs who were told it was so rare they would probably never treat it or even that it didn’t exist.

ASHA recognized CAS as a distinctive disorder in 2007. Taking the time to learn more about how treatment for childhood apraxia of speech differs from other approaches for speech and language disorders is crucial for kids with this motor speech disorder.  The importance of a correct diagnosis leads to a successful treatment plan. To briefly summarize, sessions should focus on movement sequences rather than sound sequences taking into account the child’s phonetic repertoire and encouraging frequent repetition.

For more information visit apraxia-kids.org and become familiar with ASHA’s technical report on the subject.

 

Laura Smith MA, CCC-SLP is a speech/language pathologist in the Denver metro area specializing in childhood apraxia of speech. CASANA-recognized for advanced training and expertise in childhood apraxia of speech, she splits her time between the public schools and private practice. She speaks at conferences and consults for school districts or other professionals. Email her at lauraslpmommy@gmail.com, Like her on Facebook, follow her on Pinterest, or visit her website at SLPMommyofApraxia.com.

 

 

The Possibilities are Endless!

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Having been an SLP since 2004, I know the feeling of “burn out” as well as being comfortable. I have learned that there is far too much opportunity in this field to settle for status quo or unhappiness. Perhaps the most valuable lesson I learned was recognizing that simply venting to family, friends and fellow SLPs was only a short-term solution.  I had to learn to be a doer and motivate myself within my chosen profession.

I often see many Facebook posts about SLPs feeling tired of the profession, often citing endless paperwork, disrespectful supervisors, caseload overload, lack of resources, unreasonable expectations and unfair pay. They are often looking to change careers for a “quick fix” to these problems, but overlook the changes they can make within their profession.

I was feeling frustrated at my district job six years ago and my lack of connection with other SLPs. I did my best to reach out to others and was ultimately nominated by my colleagues to become the lead SLP. That experience empowered me to talk to administration about changing to the 3:1 service delivery model. My presentation worked!

From then on, monthly SLP meetings were built into our indirect weeks and the 15 of us worked and supported each other throughout the school year. Our motto was “we’re all in this together,” because we are the only people who knew what our jobs are like on a day-to-day basis.

Fast forward six years, I loved my position as lead but craved a change. One fateful day I happened to be talking to a friend/fellow SLP in my district who said, “Annick, why don’t we just quit and start our own private practice?” My response, “Why don’t we?” My friend laughed but I wasn’t joking.

That was the question I needed to ask myself. I hadn’t thought about that option before. Coming out of our master’s program, the questions on everyone’s mind were: Are you going to the schools? Hospital? Or private practice? We never asked each other: “Do you think you’ll ever start your own practice?” For me, that question was life altering. Although my friend was kidding, her words were far from a joke for me. Within months, I registered my business, created a website and printed business cards.

I now grow my practice while working as a part-time, school- based SLP. But it doesn’t end there. I supervised three graduate students earlier in my career and one them recommended me to a professor as a possible lecturer. I jumped at that opportunity and have made yet another discovery: I love teaching adults! I am about to begin my second semester teaching college courses.

Looking to the future, I want to continue to teach more classes, build my practice, present at conferences and perhaps look into other areas of our profession such as telepractice and corporate speech therapy. Whatever I do, it is comforting knowing the possibilities are endless within our field.

 

Annick Tumolo, MS, CCC-SLP is currently a school based SLP, lecturer at San Francisco Sate University and founder of Naturally Speaking San Francisco, a private practice specializing in home-based speech and language treatment. She is Hanen certified in It Takes Two To Talk ® and holds a Augmentative and Alternative Communication Assessment and Services Certificate awarded by the Diagnostic Center of Northern California. Like her on Facebook, follow her on Pinterest or contact her at Annick@naturallyspeakingsf.com.

Ten Speech and Language Goals to Target during Food/Drink Preparation

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Food and/or drink preparation can be an excellent way to help facilitate speech and language goals with a variety of clients that span different ages and disabilities.

Below are 10 speech and language goals that you can target during food or drink preparation:

  1. Sequencing: Because recipes follow steps, sequencing can be an ideal goal. If there are too many steps in a recipe then break them up into smaller steps. Take pictures of each step and create a sequencing activity using an app such as Making Sequences or CanPlan.
  2. Literacy: If a recipe has complex language that your client has difficulty reading and processing, modify it. I often rewrite recipes with my clients or use a symbol based writing program like the SymbolSupport app.
  3. Expanding vocabulary: Recipes often contain unfamiliar words. When beginning a recipe, target new vocabulary. If your client is an emergent reader, create visuals for the vocabulary words and use aided language stimulation as you prepare the food and/or drink with her.
  4. Articulation: Target specific sounds during food preparation. Are you targeting /r/ during sessions? Prepare foods that begin with r like raspberries, radishes and rice, or even a color like red!
  5. Describing and Commenting: Food/drink preparation can be an excellent time to describe and comment. Model language and use descriptive words such as gooey, sticky, wet, sweet, etc. Encourage your client to use all five senses during the activity (e.g. It smells like ____, It feels like ______).
  6. Actions: Actions can be an excellent goal during food and/or drink preparation. For example, when baking a simple muffin recipe, the actions such as measure, pour, fill, mix, bake, eat, can be targeted.
  7. Answering “wh” questions: As you are preparing food, ask your client open ended “wh” questions, such as “What are we baking?” or “Why are we adding this sugar to our recipe?” and more.
  8. Problem Solving: Forget the eggs? Hmm, what should we do? How about forgetting the chocolate in chocolate milk? Ask your client different ways of resolving specific problems with food preparation, such as: “What do you do if you are missing an ingredient?” or “What do you do if we add too much of one ingredient?”
  9. Turn Taking: Whether you are working with one or two people, turn taking occurs naturally during baking and/or food preparation. If you are working in a group, make assignments before beginning.
  10. Recalling Information: As you prepare the food/drink, ask your client to recall specific After you are done with the recipe, model language and then ask your client to recall the steps of the recipe.

Preparing even a simple beverage such as chocolate milk can be an excellent activity to engage in during a session. Although it’s made up of only two ingredients, you can still work on a variety of speech and language goals including sequencing, describing, problem solving (e.g. what to do if you put in too much chocolate), actions, turn taking and recalling information.

Here are some helpful apps to use during or after food/drink preparation:

I Get Cooking and Create Recipe Photo Sequence Books

Making Sequences

CanPlan

Kid In Story

SymbolSupport App

For more suggestions, check out my post here on getting a child with special needs involved in the kitchen.

 

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

Six Vocal Myths: Practical Therapy Applications

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We all have a tree of knowledge that represents the intricate experiences that make each of us different and wonderful. Our branches stretch, flower and die only to grow into a more complex labyrinth of information. Once this tree is rooted in ideals, it is difficult to pull out any of the roots, especially if they have been supporting a perfectly healthy tree for many years.

I like science. I find a certain solace in knowing that a randomized control trial was completed in order to prove that I’m not just making you hum through a straw for fun. On the other hand, I completely give merit to the occurrences you can’t explain or rationalize. Some very important moments in my life, especially in my speech-language pathology career, cannot be measured and explained scientifically.

When I was younger, I was petrified that eating before a performance would screw it all up. I can remember vividly, sitting at a Texas Music Educators Association competition as a kid near me consumed an entire slice of pepperoni pizza before disappearing into his audition room. He leaned over and smiled, “It’s always good luck for me.” I was aghast, and I hope my face did not reflect what was going on in my head. Food? I thought. Before singing? NEVER! But, why did I believe so strongly that the voice gods would shun me if I ate a bite of anything? Should superstitions be revered? Is it really all in my head?

I posed that question to a few forums I belong to, both vocal pedagogy and vocal pathology. Along with comments and emails that flooded my inbox, the University of Minnesota and Truman State University brought me a study by Julia Edgar and Deirdre Michael that surveyed almost 400 singers about their beliefs in vocal health. The only thing everyone could really agree on? A whopping 97 percent believed that warming up before performing benefits the voice. That’s it. The rest of the answers were as scattered as an Admission, Review, and Dismissal team after the final meeting before summer break.

I pulled together the most interesting beliefs and did my best to find scientific evidence to aid in proving or refuting. I have questions from the professional singers I treat about many of these subjects, so what better way to debunk the myths? What I found was that many people hold their beliefs dear and are not willing to lend an ear to anything that might refute what gets them through a gig. So, what are we as SLPs to do? Do we believe in Grandma Sue’s recipes? Do we believe in science? Do we believe in experience? Do we believe in life after love? Sorry, Cher kind of snuck in there.

  1. Smoking marijuana and vaping is not damaging to the vocal folds like cigarettes are Reinke’s Edema, tissue damage in the form of gelatinous goo just below the top layer of the vocal folds, commonly occurs from smoking.  A study here discusses the effects of cigarette smoke on the delicate tissues of the vocal folds. Even the vocal folds of rats changed after passive inhalation of smoke. So that sets you straight…right? Not quite. A student told me that an alarmingly high number of voice performance students at her school claimed smoking marijuana and vapor cigarettes will not damage the vocal folds. Although there are not yet any published studies specifically about the effects of vaping on the vocal cords, a study here found that electronic cigarettes contain less carcinogenic ingredients than their tobacco counterparts, however less does not mean none. There is also concern that propylene glycol irritates the respiratory tract. (PG is just a fancy word for stage smoke.) Despite more than 1,000 studies on electronic cigarettes, conclusions cannot be made on their safety or danger because of contradictions and inconsistencies in methodology. Get it together people…I think people are learning this and deciding ECs are safe to smoke because of the lack of evidence. Perhaps they are fishing for an excuse. Perhaps they are avid consumers of research. In my clinical opinion, you are still inhaling something that is manufactured and exposing your most delicate tissues to foreign materials that may or may not be toxic. An article in the Guardian states that those who smoke ECs think the water vapor is safe, they brush off the PG as an irritant, and smoke them anyway. As for the marijuana, aside from altering perception and most likely performance, it is heated just like cigarette smoke and any smoke will irritate your tissue.

Bottom Line: Smoke can change the composition of your tissue. If you don’t inhale foreign material, your vocal folds will likely maintain their health.

  1. Throat Coat Tea and Entertainer’s Secret are a sore throat cure-allA 2004 study on the effects of laryngeal lubricants, like Entertainer’s Secret, revealed that even if a spray affects the vocal fold vibratory pressure, after 20 minutes it is like you never used it. Throat Coat tea contains slippery elm bark, a demulcent that soothes irritated tissue, and is not FDA approved to cure anything. There are no studies on how it directly affects the voice, but the steam from a hot beverage most likely will topically hydrate your vocal folds as you inhale, so that’s a plus. A hydrating beverage will provide you with internal hydration to lubricate the vocal folds from within the body. Like any pain, though, if your throat is hurting, don’t mask the problem by using numbing spray or another band-aid.  Your body is trying to tell you something and if you silence it, you could injure yourself further. Know your body.  I’m all for throat coat tea, ginger tea, lemon water, whatever–If you say it helps you feel better. I am against using any of that to hide pain so you can perform. If you are not giving your body time to heal, you’ll end up with a bigger problem.

Bottom Line: Using any crutch will usually get you through a performance, but “getting through” something may backfire on you. Instead, try to maintain a balance by keeping your body healthy, listening to it, and caring for your vocal folds even more fervently because you can’t see them.

  1. Whispering is a good idea to save your voice when on vocal rest. I was informed when I received voice therapy myself that I was not allowed to talk or whisper for a week following my surgery. Some people say the real myth is that whispering is as bad as shouting. Is it? For her own voice issues, an SLP who received treatment like me, was told that whispering would save the voice, but she found it to increase fatigue and pain for her. Go figure. Shouting and whispering differ in placement and technique, but whispering can sometimes turn into a hyperfunctional breathy voice where vocal production is made with an incomplete vocal fold closure. Ah, there’s the danger. A study in 2006 examined 100 patients with a fiberoptic camera. Only 70 percent of the patients showed supraglottic hyperfunction while whispering, meaning some of them had no hyperfunction at all. Other muscles are involved in whispering, and people whisper differently, so some studies suggest that whispering, when low in effort, can be considered for post-op patients.

Bottom Line: Whispering could turn into a poor vocal production habit in the majority of patients, so better to avoid it or monitor it closely on a case-by-case basis. If you were to whisper with a completely relaxed larynx, it’s hard to get adequate volume anyway. Tell them to text. Don’t we all have smart phones glued to our thumbs?

  1. Dairy products thicken my mucus. Recent publications have demonstrated that dairy products do nothing to chemically increase mucus production or viscosity, but why does the myth remain? A group of investigators from New York examined 21 individuals, half with asthma and half without, to see if milk increased mucus. It suggested that airway resistance was not altered by milk consumption, so no thicker mucus here. Perhaps if there is a milk allergy, the body will have a reaction to it? That might explain the widely-held belief that mucus will “gunk up vocal cords” and should be avoided. Unfortunately, I could not find any research studies about mucus thickening after eating or drinking dairy. Another study states that some people with asthma may see an improvement after eliminating dairy from their diets, however, it does not definitively prove that mucus production increases because of dairy products.

Bottom Line: You can throw science at your patients, but they may remain convinced that milk will gunk things up. You might be fighting a losing battle, but hey, at least calcium comes from other sources.

  1. Eating or drinking certain foods (or abstaining from them) will improve your performance. Okay, here we are with pizza singing boy again. He obviously thought that the pizza was his golden ticket for the American Idol of Texas choir competitions. Some performers believe licorice before a gig helps improve vocal range. One singer would consume an entire bag of licorice prior to a performance. Is this a placebo? After discussing, he stopped and the range remained the same. Hmm…. What about those singers that tell you eating Lays potato chips will lubricate their throats? Is this only in Nashville? What you eat and drink will not touch your vocal folds, it only touches the tongue, soft palate, throat walls and esophagus. If it is touching your vocal folds, you are aspirating! A recent post on a professional voice teaching thread inquired about what teachers advised singers to drink to lubricate their cords. Home remedies included vinegar, garlic, ginger, olive oil, sugar, and even aloe vera. None of these have scientific evidence that they are harmful to the voice, so if you think it helps, then by all means. Nothing really lubricates the cords from the outside, but drinking hydrating beverages lubricates from the inside, so this is kind of true…kind of…Just make sure you don’t become a yummy snack for your speech therapist if you come in smelling like an Italian dish.

Bottom Line: Hydration, Hydration, Hydration. There is no scientific evidence that certain foods or beverages will improve or hinder your performance. Water will always benefit the friction and heat created by your vocal folds by lubricating them on a cellular level. See also, my previous blog on beta-blockers and performance if your patient is considering anti-anxiety meds along with the olive-oil rub.

  1. Cold beverages, caffeine and alcohol are bad for your voice. A student at one of my lectures saw me drinking ice cold water in my handy Tervis cup. Those things are indestructible and I have one for every day of the week. Obsessed? Maybe. There is no evidence to suggest that cold water is bad for your vocal cords, I told him. Beer actually counts toward hydration, interestingly enough. These researchers found that when you are dehydrated, drinking beer will not only get you drunk, but hydrate you as well. Caffeine was found to usually not impact vocal acoustics if consumed conservatively (100mg), and this study showed that caffeine did not adversely affect voice production at all. Also, not related to voice specifically, this study suggested that coffee even hydrated similarly to water.

Bottom Line: Cold or hot, it’s your choice. And when there’s a choice, go with water over alcohol. Caffeine consumption should be examined along with other factors when recommending cessation in the therapy room. When I look at this, I think, Starbucks? Why not.

We have to be careful when presenting new information. Try hard not to claim information already known to be erroneous. Many established teaching professionals have been molding and creating performers for years, and trying to reveal a “new” truth might be unwelcome. Can we not bridge this gap between pedagogy and therapy? Between art and science? After all, the voice is both, isn’t it? Many SLPs told me they are afraid to challenge any voice teacher because they might get brushed off. I want to change this “challenge” to “suggest.”

If we are cognizant of the training and education of others, we can present information in a way that is not patronizing. And if we are open to new ideas from different sources, (I am so guilty of this too) then we might find that it works in our studios and clinics. One contributor had the most poignant response. “People become defensive sometimes when they are confronted by their own knowledge gaps, but hopefully they’ll internalize the information and emerge the better for having heard it.”

 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech therapy in her own private practice, a tempo Voice Center, LLC. She also lectures on the singing voice to area choirs and students. She belongs to ASHA’s Special Interest Group 3-Voice and Voice Disorders. She keeps a blog on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

Happy New Year, ASHA Family!

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Happy New Year to my whole ASHA family – those dedicated to helping people achieve “human wholeness!” I am so proud to be part of this profession and believe I was predestined to be an SLP. The first movie I remember seeing in a theater was My Fair Lady. I’ve since become a modern-day Henry Higgins and even have worked with university teaching assistants on accent reduction! I was also a recipient of the care engendered by those in my as-yet-unchosen field when an amazing neurologist and SLP “asked me questions” (a child’s interpretation of diagnostics) and guided my family during my recovery from a head injury significant enough to require last rites in 1971. 

Although a practicing member for more than 25 years, I didn’t attend my first ASHA convention until 2013. I went to update my clinical and research skills, but also to visit school friends from Northwestern who still live in Chicago. I particularly enjoyed the courses presented by a then recent ASHA fellow and complimented her in our hotel elevator. I also asked a question about spring 2014 events. She not only answered my questions, but allowed my family to stay in her family’s home during our visit!

One Chicago friend (an organizational psychologist) was shocked at the friendliness and trust exemplified by even the offer of such hospitality and further astounded when I told her nearly 15,000 people attended the 2013 conference. I explained that ASHA members are friendly, helpful people. That presenter and new acquaintance was no fool, however, she did her due diligence and called my current work ‘family’ to vet my responsibility.  I, in turn, offered her the use of our Orlando lake home as she celebrated being named “Fellow” with her family.

That story shows how I, and many of my peers, view ASHA as a large extended family, which was reinforced by my encounters at the 2014 “Generations of Discovery” convention. Harry Belafonte, along with his daughter and granddaughter, highlighted how family focus has directed their lives. At the awards event, Annie Glenn explained how services such as her 1973 stuttering therapy, “save us from being solitary souls,” while father-son TV journalists the Geists received her “Annie” Award for their communication contributions. Honors of the Association recipient, Nan Bernstein-Ratner, gushed that obtaining the Glenns’ autographs on a photo and copy of  the Geists’ book, The Right Stuff, for her son were her most moving moments of the convention. Voice expert Daniel Boone shared how excited he was that his son and granddaughter were visiting from Tampa. We were saddened by Jeri Logemann’s passing, but her impact is ever present, from the pins at an exhibitor’s display to shared remembrances of a holiday party at her home.

None of us are “solitary souls” and our uniquely human abilities to enjoy conversing and sharing with our families and friends are a testament to the vital work each of us has chosen to undertake. For the new year, I wish my ASHA family wisdom (recalling John Rosenbek’s closing session’s  “Neuroplasticity” message that we “First do no harm”), a wealth of well-wishers (for our world has its woes), and work as we help heal the world in 2015!


Denise Dancull, M.A., CCC-SLP
is a pediatric SLP with more than 25 years experience specializing in cleft palate and cochlear implant services. Please feel free to contact this proud parent, bibliophile and theater fan at denise.dancull@nemours.org.

CSD Students Use Their Skills in Ethiopia This Month

   

The CSD program at Teachers College Columbia University is in Ethiopia this month visiting schools for students with autism and a center for adults with intellectual disabilities. The TC Team—nine master’s students and three ASHA-certified SLPs: Lisa Edmonds, Jayne Miranda and I—used our experiences in Ghana and Bolivia to prepare for the trip.

At a vocational center for adults with intellectual disabilities the TC Team created “Seller’s Market Cards,” so the adults can independently sell their products. These low-tech Augmentative and Alternative Communication cards, laminated with packing tape, introduce the seller and list products for sale with their prices. We worked with the sellers to create the cards and then immediately tried them out at an impromptu market at the center!

At the Nehemiah Autism School, 20 teachers and our team spent the day collaborating to identify ways to bring more communication opportunities into an otherwise excellent school. We made 70 flash cards for weather, a large calendar, practiced social stories, and talked about ways to introduce literacy and math.

Right now, we’re presenting a five-day cleft palate speech institute at Yekatit 12 Hospital. Smile Train and Transforming Faces supported 14 cleft palate team professionals who attended from East and West Africa.

Please follow our adventures on the blog.  We love to see comments and are just halfway through our trip.

 

Catherine J. Crowley, CCC-SLP, JD, PhD, Distinguished Senior Lecturer in speech-language pathology at Teachers College Columbia University, founded and directs the bilingual/multicultural program focus, the Bilingual Extension Institute, and the Bolivia and Ghana programs. An experienced attorney, Crowley is working with NYCDOE on a multi-year project to improve the accuracy of disability evaluations. 

More than a Picky Eater: How to Really Know?

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The struggles of a parent during mealtime with a picky eater can range from bad to worse. It often begins with the ever-present protest of “No!”  then ends with screaming, tantrums and food flying across the room. The question remains: is the food refusal normal of a picky eater or could the signs be more consistent with a feeding disorder?

A pediatric feeding problem is often accompanied by a developmental delay or medical disorder. These can include, but are not limited to, autism spectrum disorders, Down syndrome, gastrointestinal motility disorders, cerebral palsy, respiratory disorders or cystic fibrosis.

Children who were hospitalized for an extended time at birth or who received a tracheotomy or feeding tube may also have difficulty transitioning to an age appropriate feeding pattern. However, children who are considered typically developing can also develop a fear of food. Research shows that 25 percent of children suffer with some degree of a feeding disorder. In children who suffer from a developmental, neurological or genetic disorders, that number rises to 80 percent (Branan & Ramsey, 2010).

A feeding disorder is characterized by any difficulties eating or drinking including chewing, sucking or swallowing. Children who have not developed age appropriate feeding skills and/or have a genetic, developmental or behavioral disorders can have difficulty during mealtime.

Some signs and symptoms of a problem feeder include:

  • Trouble breathing when eating or drinking
  • Choking, gagging or excessive crying during mealtimes
  • Tantrums when presented with new foods
  • Excessive drooling or spillage of foods/liquids from the mouth
  • Difficulty chewing or swallowing food
  • Restricted variety of foods eaten—usually less than 20
  • Refusal of categories of food based on texture or basic food group
  • Refusal to eat meals with the family

In order to better treat children with feeding problems, it is important to understand those children who do not meet the criteria. Children who are picky eaters present with the following signs and symptoms (Toomey 2010; Arvedson 2008):

  • Eat a limited variety of foods; but have around 30 foods they will eat
  • Intake enough calories a day for growth and nutrition
  • Lose interest in a certain food for a period of time, but accept it again after a few weeks
  • Eat at least one food from all major food groups (protein, grains, fruits, etc.)
  • Tolerate a new food on the plate, even if they don’t eat it

Although mealtimes with either issue can be difficult for parents, distinguishing between the two helps SLPs create the best individualized treatment approach.

Once a professional diagnoses a child with a feeding disorder, there are three key concepts to remember:

  1. Contact a child’s pediatrician, nutritionist and other health care providers in order to create the best treatment plan for that child. A multidisciplinary approach provides various viewpoints that bring the whole child into consideration.
  2. Choose foods that are meaningful to the family. If no one else in the family eats broccoli, it may not be a necessary food to add to the child’s eating repertoire.
  3. Create both short term and long term goals to track progress and keep both the child and family motivated.

Treating a child with a feeding disorder is a challenging but rewarding task. The end goal of treatment should always be a safe, happy and healthy eater.

 

April Anderson, MA, CCC-SLP, is a Speech-Language Pathologist at National Speech/Language Therapy Center in Bethesda, MD.  She works with infants and toddlers, as well as school-aged children with feeding disorders. April can be reached at  april@nationalspeech.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

Be an Advocate for Your Clients

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This summer I had an interesting experience with a major insurance provider. The company initially approved treatment for a 3-year-old client, who I evaluated and diagnosed with severe apraxia of speech. This little guy had maybe five words in his lexicon, all unintelligible to an unfamiliar listener. He could not even consistently attempt to imitate monosyllabic words. His receptive language skills were at least at age level with cognition the same.

After several months of treating him with a motor-planning and sound-sequencing approach, his parents received notification from the insurance company that his treatment was denied because “it was not medically necessary” and his apraxia was deemed “developmental.” The communications stated that my client would “outgrow” his issue in time.

I have been in private practice for almost 28 years and ardently disagree with the insurance company’s reasoning. I consulted with Janet McCarty, at ASHA headquarters, and she provided me with excellent professional advice plus solid evidence to fight for my client. I organized my information then consulted with the family to get their green light to proceed. I went all in to fight this decision with the big insurance company’s medical director.

It became a step by step process to help this medical director understand that apraxia is NOT a developmental disorder, but rather a neurologically based disorder that results in disruptions to a child’s ability to sequence the necessary motor movements to produce speech sounds. My favorite part of this story is when I asked the director how much time I had to discuss my client with him during our peer-to-peer scheduled review, he informed me that “he did not want to be lectured about apraxia because he had Googled it and saw the word ‘developmental’ tossed sporadically around the literature and that was all he needed to see to be convinced that apraxia was not a medical condition with neurological basis.”

I quickly lifted my jaw off my desk, hit my reset button and proceeded to help this “medical expert” understand more about apraxia from this expert in the field of speech and language. While our exchange made some positive impact, he still felt the need to take this case to the next level by calling in a third party pediatric neurologist. I knew that this was going to be a medical professional in my corner. The neurologist and I spoke about my client and I was able to answer specific questions about his treatment and progress. Sure enough, her recommendation was absolutely in favor of this severe speech disorder being neurologically based and treatment medically necessary. She agreed that my client would not outgrow it in time or improve through weekly sessions in small groups.

My point for sharing this story is to say that while it is often frustrating to deal with insurance companies, you have to fight for your clients. When you meet, evaluate, work with a child and their family and you know a child needs treatment, you must advocate and spend the time to fight for this child, no matter how BIG these insurance companies are or how much they try to shut you down.

I need to correct my earlier statement when I referred to my “favorite” part of the story…in fact, my favorite part of this story is that my client, who is now 3.6 years old, was approved for intensive therapy to treat his motor planning disorder. He is making remarkable progress and I am quite confident he can tell Santa what he wants in a complete sentence. Maybe with Mom’s help interpreting, but still excited and able to convey his message!

 

Lorraine Salter, MS, CCC-SLP, has been in private practice in Reading MA since 1986. She studied and earned both degrees from Emerson College in Boston, after deciding that a career in performing arts was not going to pay the bills.  She enjoys the ability to create a strong team for the children she serves through interaction with her clients’ families. You may contact her at lorraine@northshorespeechandlanguageservices.com.

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