Smart PHONeNATION: How My Device Revolutionized My Voice Rehabilitation Practice

timer-20-screenshot-iphone

My smartphone has literally revolutionized the way I give sessions. And I don’t mean literally Rachel Zoe style. I use my phone practically every session! Now I hear those of you who are seasoned professionals. You are unfamiliar, maybe apprehensive about technology like this. “It’s too difficult,” you say, “I’m not generation text message-thumb.” I hope this piece encourages you to give it a try.

Age knows no bounds when you apply technology, because most everyone can benefit from these innovations. I’ll echo a recent ASHA post on SLP hats and inquire the same about the many jobs of your smartphone:

  • Stop-watch. I have one less item to worry about if I use my phone for timing maximum vowel prolongations, S/Z ratios and structured session tasks. Your phone timer also tracks session length. We all have those clients who love (I mean REALLY love) to talk, which is good when you advance to structured conversational tasks, but sometimes they carry on too long. Use your phone timer if you feel it’s appropriate for signaling a wrap-up.
  • Recording device. I record my acoustic measures when I analyze cepstral peak prominence and fundamental frequency, but during therapy—where the hard work begins—I employ my voice memo app. I also teach patients how to use their own voice memo programs, which is important for home practice. Follow-through is such a different game now, because most patients have recording options on their phones. You can record session highlights for easy patient access on his or her own device, versus cassette-taping the session.
  • Biofeedback. It’s great if you have a state-of-the-art Computerized Speech Lab setup. If you don’t, your smartphone has an app for that. (Ha! You were waiting for that phrase, weren’t you?) Bla | Bla | Bla works as a visual sound meter. As you get louder, the faces change. It doesn’t replace the software that helps you stay within a target pitch range, but can provide biofeedback for intensity tasks. I use smartphone video recorders to improve self-awareness for laryngeal and upper body tension. Instant review of these videos may help your patient meet goals sooner.
  • Piano. For Joseph Stemple’s Vocal Function Exercises, I use my MiniPiano app for pitch matching on Warm-up and Power. For the small group of clients with NO musical inclination, just do you best to find a mid-range pitch for VFE’s, but for your type-A’s (you know who they are), the option to have perfect pitch right at your fingertips wastes no time.
  • Anatomy. I used to lug around literally (Ha, Rachel again!) thousands of copies of anatomy drawings for patients. The copies usually ended up in the trash. The Dysphagia app has been my most effective tool for explaining the anatomy of a swallow, vocal folds as well as reflux. It has nice color videos demonstrating disordered and normal swallows and dramatically enhances patient education. Plus, the video action makes a more lasting impression.
  • Alarm. Ever get a patient who doesn’t practice? (You can always tell.) With a smartphone, you can name each alarm and set them to go off at certain times. The patient can deliberately practice diaphragmatic breathing and single syllable target words every hour on the hour! We’re going for making new muscle memory here, so it’s key to entice the patient to practice mindfully and not just be on autopilot. It’s beneficial for whole body exercise to take place for short periods throughout the day, so why not phonation training? And it keeps patients accountable.

Embracing the technology out there doesn’t mean you need to de-humanize sessions. The relationships you build with your clients are special. Their progress depends on how comfortable they feel in the room. Don’t spend the entire session glued to your phone, but strive to find a good balance where you use it when you think it will make a difference.

We SLP’s and AuD’s are in the people business and let’s not forget we’re professional voice users ourselves. Voice therapy techniques used to be difficult to maintain out of the treatment room. Now our clients have a fighting chance to recreate that buzzy forward-focused sound every time they glance at their smartphone between Facebook updates and Yahoo news articles.

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.

Snow Day Recap

AugustSnowman

It’s a snow day here at ASHA and for many of our members on the East Coast. So whether (pun intended!) you’re snowed in or not, curl up with some of our most popular posts from 2014 in this compilation published earlier this year.

 

From stuttering to aphasia, hearing loss to hearing aids, early intervention to telepractice and more, ASHA’s blog posts are written by you—our members—sharing knowledge with peers on a variety of subjects. But there’s no doubt about it, pediatric feeding has been the topic on ASHAsphere in 2014!

Check out your five favorite posts from last year:

Step Away From the Sippy Cup!

SLP Melanie Potock specializes in pediatric feeding and explains that sippy cups were created to keep floors clean, not as a tool to be used for developing oral motor skills.

“Sippy cups were invented for parents, not for kids. The next transition from breast and/or bottle is to learn to drink from an open cup held by an adult in order to limit spills or to learn to drink from a straw cup. Once a child transitions to a cup with a straw, I suggest cutting down the straw so that the child can just get his lips around it, but can’t anchor his tongue underneath it.” – Potock

Baby Led Weaning: A Developmental Perspective

For parents interested in following the Baby Led Weaning (BLW) philosophy of pediatric feeding, which states that babies are developmentally capable of reaching for food and putting it in their mouths at about 6 months of age, SLP Melanie Potock shares some thoughts to consider.

“For children in feeding therapy, incorporating some aspects of BLW is dependent on that child’s individual delays or challenges and where they are in the developmental process, regardless of chronological age. My primary concern for any child is safety—be aware and be informed, while respecting each family’s mealtime culture.” – Potock

Collaboration Corner: 10 Easy Tips for Parents to Support Language

Paying attention to body language, reading every day and using pictures are just a few tips SLP Kerry Davis shares with parents to support their child’s language development.

“Take pictures of your child’s day and talk about what is coming up next, or make a photo album of fun activities (vacation, going out for ice cream) to talk about.” – Davis

What SLPs Need to Know About the Medical Side of Pediatric Feeding

To overcome pediatric feeding problems, SLP Krisi Brackett explains the importance of first figuring out why the child’s in a food rut.

“Whether the child is dependent on tube feedings, not moving to textured foods, grazing on snack foods throughout the day, failing to thrive, pocketing foods or spitting foods out, using medical management strategies can greatly improve a child’s success in feeding therapy.” – Brackett

Preventing Food Jags: What’s a Parent to Do?

For kids who only eat a limited number of foods, it can be difficult for parents to provide the right nutrition for their kids. SLP Melanie Potock shares her top 10 suggestions for preventing food jag.

“Food Left on the Plate is NOT Wasted: Even if it ends up in the compost, the purpose of the food’s presence on a child’s plate is for him to see it, smell it, touch it, hear it crunch under his fork and  perhaps, taste it.  So if the best he can do is pick it up and chat with you about the properties of green beans, then hurray!  That’s never a waste, because he’s learning about a new food.” – Potock

 

ASHA always welcomes new blog contributers. Interested? Apply to here become an ASHAsphere blogger.

Sara Mischo is the web producer at ASHA. She can be reached at smischo@asha.org.

Picky Eaters in the Preschool Classroom: 7 Tips for Teachers

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

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

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

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

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the co-author of Parenting in the Kitchen: How to Raise Happy and Healthy Eaters in Our Chicken Nugget World (Aug. 2015), the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs.  She can be reached at Melanie@mymunchbug.com.  

More than a Picky Eater: How to Really Know?

boy not eating

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.

 

Pediatric Feeding Tops the Charts in 2014

baby eating

From stuttering to aphasia, hearing loss to hearing aids, early intervention to telepractice and more, ASHA’s blog posts are written by you—our members—sharing knowledge with peers on a variety of subjects. But there’s no doubt about it, pediatric feeding has been the topic on ASHAsphere in 2014!

Check out your five favorite posts from last year:

Step Away From the Sippy Cup!

SLP Melanie Potock specializes in pediatric feeding and explains that sippy cups were created to keep floors clean, not as a tool to be used for developing oral motor skills.

“Sippy cups were invented for parents, not for kids. The next transition from breast and/or bottle is to learn to drink from an open cup held by an adult in order to limit spills or to learn to drink from a straw cup. Once a child transitions to a cup with a straw, I suggest cutting down the straw so that the child can just get his lips around it, but can’t anchor his tongue underneath it.” – Potock

Baby Led Weaning: A Developmental Perspective

For parents interested in following the Baby Led Weaning (BLW) philosophy of pediatric feeding, which states that babies are developmentally capable of reaching for food and putting it in their mouths at about 6 months of age, SLP Melanie Potock shares some thoughts to consider.

“For children in feeding therapy, incorporating some aspects of BLW is dependent on that child’s individual delays or challenges and where they are in the developmental process, regardless of chronological age. My primary concern for any child is safety—be aware and be informed, while respecting each family’s mealtime culture.” – Potock

Collaboration Corner: 10 Easy Tips for Parents to Support Language

Paying attention to body language, reading every day and using pictures are just a few tips SLP Kerry Davis shares with parents to support their child’s language development.

“Take pictures of your child’s day and talk about what is coming up next, or make a photo album of fun activities (vacation, going out for ice cream) to talk about.” – Davis

What SLPs Need to Know About the Medical Side of Pediatric Feeding

To overcome pediatric feeding problems, SLP Krisi Brackett explains the importance of first figuring out why the child’s in a food rut.

“Whether the child is dependent on tube feedings, not moving to textured foods, grazing on snack foods throughout the day, failing to thrive, pocketing foods or spitting foods out, using medical management strategies can greatly improve a child’s success in feeding therapy.” – Brackett

Preventing Food Jags: What’s a Parent to Do?

For kids who only eat a limited number of foods, it can be difficult for parents to provide the right nutrition for their kids. SLP Melanie Potock shares her top 10 suggestions for preventing food jag.

“Food Left on the Plate is NOT Wasted: Even if it ends up in the compost, the purpose of the food’s presence on a child’s plate is for him to see it, smell it, touch it, hear it crunch under his fork and  perhaps, taste it.  So if the best he can do is pick it up and chat with you about the properties of green beans, then hurray!  That’s never a waste, because he’s learning about a new food.” – Potock

 

ASHA always welcomes new blog contributers. Interested? Apply to here become an ASHAsphere blogger.

Sara Mischo is the web producer at ASHA. She can be reached at smischo@asha.org.

Ten Tips for Making Progress in Feeding Therapy

Dad and son at farmer's market

Parents’ Ten Tips for Making Progress in Feeding Therapy

The end of a year is a reflective time for many parents, especially those who have children in any type of therapy.  As a pediatric SLP who focuses on feeding, I asked over forty parents for their number one tip that helped their child progress through feeding therapy.  I found it interesting that typically what popped into their minds wasn’t an oral motor tool or a specific therapy modality or other tips like “practice, practice, practice!”  What struck me was that most parents focused on an emotional component.  When we consider the bond between parent and child, that makes perfect sense.  I learn so much from the parents of the children I treat and I’m grateful for their wisdom.

Here are the Parents’ Ten Tips for Making Progress in Feeding Therapy:

#10: “Meet my child where she is…show interest in what she’s interested in” and build from there.  It builds relationships and that’s the foundation for mealtimes.

#9 “Your child sets the pace.” Expectations and goals are two different things, as described in this article for ASHA.

#8: “Patience.” This was the most popular response.  One…step…at…a…time.

#7:  Pause and “be compassionate.” It’s not easy for many kids to move through the developmental process of eating.  Both physical and emotional pain may come into play.

#6: “Have FUN and PLAY daily in food!”  Join in and get the whole family involved, as noted in this ASHA article.

#5: “Expose kids to the Joy of food” – and not just at mealtimes: Farmer’s Markets were a top pick along with the produce isle at the grocery store.  Focus on sharing time together and the event, not what might or might not happen when the food makes it to the dinner plate.

#4: “Build Trust.”  When a child trusts their mealtime partner, whether it be a therapist, parent or caregiver, that builds confidence in eating skills over time.

#3: Kids get sick and sometimes that stalls progress or causes some regression.  One parent stated that: “It’s just part of being a kid, so it’s also part of the process.”

#2: “Rely on Faith,” and not just the religious kind: Faith in family and faith in your child … but also faith in yourself as a parent.

#1: “Park your own stress in the driveway.”  That’s a tip that I teach to parents – and I am pleased to see it repeated here.  Life is full of stressful moments and it’s easy to bring those into your home.  But family mealtimes are a time to focus on family and if there is one thing I am sure of,  it’s that kids mimic  their parent’s emotions.  Be sure to take care of you too – the  feeding therapy process isn’t always easy, but it’s incredibly rewarding and exciting when you witness even the smallest changes in your child’s ability to enjoy all kinds of food.  Those changes often start with your emotions: Smile when you can, laugh even more and be ready for all the good things to come.

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.

 

If You Give My Picky Eater Some Turkey…

PickyEaterGirl

An open letter to any relative who plans to invite my family to Thanksgiving dinner:

In the spirit of the season, I want to thank you and yours for inviting my family and our little picky eater to your traditional Thanksgiving celebration.  I should warn you that my sweet 3-year-old isn’t always the most adventurous eater and may turn up her nose at the traditional holiday fare, but I have a few helpful tips for you here:

If you give my picky eater some turkey, she’s going to ask for a hot dog.  When you give her the hot dog, she’ll probably ask you for ketchup.  Then, she’ll ask for more ketchup.  And then, she’ll refuse the hot dog, because it’s “cold”.  It’s a cold dog.  So she’ll just eat the ketchup.

If you give my picky eater green bean casserole, she’ll panic.  She only eats foods that are easily identified.  Green bean casserole is not easily identified.  But, if you put ketchup on it, it’s fine.  I’ve brought her favorite brand of ketchup, which you have to serve in the original plastic bottle so she can see you squirting it onto her plate. Don’t ever remove the bottle from your lavishly-set table. She’s needs to see it at all times.

If you give my picky eater cranberry sauce from a can, she’ll ask: “How did it get in the can?” along with 100 gazillion other questions.  “Why does it jiggle? What are those lumps? Cranberries? What are cranberries?  It looks like red vomit.”  Now, no one at the Thanksgiving table will eat the canned cranberry sauce…even with ketchup. I’m very sorry for that. That’s why I brought you this very expensive bottle of wine. I suggest you open it now.

If you give my picky eater the platter of candied yams and suggest she helps sprinkle on the mini-marshmallows, she’ll stick out her tongue, but then join in.  As she places the last tiny marshmallows on the layer of yams, she’ll ask why the marshmallows stick to yams.  You’ll probably tell her “It’s the sticky syrup on the yams.”  She’ll reply “Oh, I thought it was because I licked each one.”  You’ll have another glass of wine.

If you give my picky eater some mashed potatoes, she’ll gag.  “But, they taste just like French fries!” you’ll exclaim. She’ll gag again and run from the table.  While having a complete Thanksgiving meltdown, she’ll scream “I want French fries!!!” and you’ll make an immediate mental search of what fast food drive-thrus are open on Thanksgiving. You’ll send you husband out to find French fries and he’ll happily agree to leave.

If you give my picky eater some stuffing, she’ll stare at it.  You’ll tell her it’s chopped-up chicken nuggets that your husband bought while he bought her French fries at the drive-thru. She’ll pause…she’ll ponder…she’ll ask: “Where’s the toy?”  You’ll grab three mini-marshmallows, smoosh them together and tell her it came with a toy “Olaf” from Frozen.

If you give my picky eater some gravy, she’ll ask: “What is this?”  So you’ll lie and say “It’s brown ketchup.” She’ll stare at the brown ketchup and ask “If I eat it, do I get dessert?”

Upon the suggestion of dessert, you’ll give my picky eater a slice of pumpkin pie.  After all, pumpkin’s a vegetable, right?  She’ll ask for some whipped cream to go with it.  But not the homemade kind: She only eats the kind in the can.  “Not like the can that had cranberry sauce,” she’ll explain.  “Only the ‘squirty’ kind of can.”  She’ll eat all the whipped cream off the top of her pie, completely missing any remnant of “vegetable” you hoped she would consume.  That is, unless she detects any kind of lump…like those lumpy cranberries…which are red.  The red will remind her of her favorite food: ketchup.  So, she’ll ask for some ketchup.  And chances are if she asks for ketchup, she’ll want some turkey to go with it.

(Many thanks to Laura Numeroff, author of If You Give a Mouse a Cookie, which was the inspiration for this piece.)

 

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.

Cooking up the Perfect ASHA 2014

shutterstock_159814334

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.

Three Reasons Why Kids Get Hooked on “Kids’ Meals”… and How to Change That

chicken

Let me say this up front: I’m not condemning the American Kids’ Meal that is so common in fast food chains and family restaurants, but clearly I’m not keen on eating that type of food when there are other choices.   My own kids have certainly had their fair share of chicken nuggets, mac n’cheese and French fries, just to name a few of the comfort kid foods that predictably reappear on kids’ menus day after day.   This is not a blog about good vs. healthy nutrition, because most parents (including me) know that the traditional fast food fare is not healthy…and that’s exactly why parents want to change the statistics that 15 percent of preschoolers ask to go to McDonald’s  “at least once a day.”    The millions of dollars spent on advertising and toys to market kids meals certainly makes many of us frustrated when much less is spent on marketing a culture of wellness.  By hooked, I don’t mean addicted, although there is research that suggests that food addiction may be a serious component for a subset of the pediatric population Plus, the added sugars in processed foods have been found to be addictive in lab experiments.  But, for the purposes of this short article, let’s keep kids’ meals in this very small box:  Most kids love them.

Why am I writing about this for ASHA? As a pediatric SLP who focuses on feeding, one of the frequent comments I hear from parents is “As long we’ve got chicken nuggets,  then my kid will eat.”   Besides the obvious “just say no” solution, what parents truly are asking is,  “How do I expand my kid’s diet to include more than what’s on a kids’ menu?”  Whether we are considering our pediatric clients in feeding therapy or simply the garden-variety picky eater, that is an excellent question with not a very simple answer.

In feeding therapy, therapists take into account the child’s physiology (which includes the sensory system), the child’s gross motor, fine motor and oral motor skills  and also behaviors that affect feeding practices.  Therapists then create a treatment plan designed to help that specific child progress through the developmental process of eating.  While the nuances of learning to bite, chew and swallow a variety of foods are too complex to cover in a short blog post, here are just three of the reasons why kids get hooked on kids’ meals and some strategies to avoid being locked into the standard kids’ menu and begin to expand a child’s variety of preferred foods:

  1. Kids barely have to chew.  The common fast food chicken nugget is a chopped mixture of …well, if you want to know, click here.  Warning: it will ruin your appetite for chicken nuggets, so if your kids can read,  clicking might be the first solution.  However, in terms of oral motor skills, bites of chicken nuggets are a first food that even an almost toothless toddler can consume with relative ease.  Simply gum, squish and swallow.  Macaroni and cheese?  Oily French fries?  Ditto.  There’s  not a lot of chomping going on!
  • In feeding therapy, SLPs assess a child’s oral motor skills and may begin to address strengthening a child’s ability to use a rotary chew, manage the food easily and swallow safely.  Many of the families we work with eat fast food on a regular basis and we might start with those foods, but slowly over time, more variety is introduced.
  • For general picky eaters or those progressing in feeding therapy, the key is to offer small samplings of foods that DO require chewing, as long as a parent feels confident that their child is safe to do so.  Starting early with a variety of manageable solids, as described in this article for ASHA, is often the first step.   For older kids, the texture (and comfort) of “squish and swallow” foods can contribute to food jags.  Here are ten tips for preventing food jags, including how to build your child’s familiarity around something other than the drive-thru.
  1. At restaurant chains and drive-thrus, kids’ meals are readily available.  Helpful hostesses grab the crayons and the matching kids’ menus as soon as they spot a parent walking in with little children.  Kiddos quickly become conditioned to ordering mac n’ cheese or hot dogs.   Parents want a peaceful, enjoyable experience dining out, so naturally they like the kids’ menu option because it appeases everyone.  But it’s just that–an option.
  • In feeding therapy,  SLPs assess and often treat a child’s ability to be flexible with food at home and in the community.  A hierarchical approach is often utilized, where exposure to new foods occurs as a gradual process over time.
  • As a parent, if your child likes to stick to the same routine at a restaurant, begin with helping your child order from the “adult” menu, knowing that you can request adaptions to certain dishes if needed.  If the prices feel too steep, order a side for the kids, and give them samplings of everything on your plate.  Keep in mind that often the goal is simply experiencing the presence of new foods, so order a side dish that is a favorite food plus present a selection of new options from your plate if you are concerned your child will not eat anything.  Now you and your child have a new routine and the tasting piece occurs once the routine is established.   If you order a salad in the drive-thru, consider skipping the kids’ meal and creating a kid’s sampling of grilled chicken cubes, sunflower seeds, mandarin oranges or other options directly from your salad when you arrive at your destination.   Request an extra packet of dressing if your kids like to dip.
  1. Kids Meals are QUICK! Quick to buy, quick to eat and quick to raise blood sugars and thus, feel satisfied.  I get it – part of today’s hectic lifestyle is shuttling kids to and from activities and often, mealtimes happen while riding in the mini-van.  Fast food chains understand this too – that’s why it’s marketed as “fast food.”
  • In feeding therapy, this reliance on drive-thru food affects progress in therapy.  For example, it’s not uncommon for elementary school kids in feeding therapy to  have trouble eating in the chaotic school cafeteria and be “starving” when a parent picks them up from school.  The quickest, easiest solution: The drive-thru every day after school.
  • In today’s quick-fix society, our children are losing the valuable skill of waiting.  Feeling hungry and then making a snack or meal together to satisfy growling bellies is one way to practice the art of waiting.  Have some pre-cut veggies ready in the refrigerator to nibble on if waiting for the meal is too challenging.  Besides, it’s the perfect time to place them on the counter while your prepping the entrée because you’ve got hunger on your side!  Hint: Blanched veggies, patted dry and then chilled, hold more moisture and taste slightly sweeter to some kids.  The higher moisture content makes them easier to crunch, chew and swallow.  Most blanched fresh vegetables last for several days in the refrigerator.  Remember, keep presenting fresh foods so that the more common option is a healthy one, rather than the oh-so-well marketed processed foods found on many kids’ menus today.

SLPs and parents, what strategies do you use do limit traditional kid food and help kids become more adventurous eaters?  Please comment and share your tips!

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.

Tiffani Wallace’s 2012 Top CEU Courses, Books and Apps Related to Dysphagia

8335589660_b4c5eb311e_z

(Photo credit)

2012 was full of a lot of new experiences for me.  I was approached at the beginning of the year to begin speaking on dysphagia for PESI.  My first speaking engagements were in North Carolina in December.  I absolutely loved it!  Granted, I still have some kinks to iron out in the professional speaking world, but all in all, I thought it went pretty well.  I can’t wait for my next speaking engagement in January down south again, then in Illinois in June. I continued work on my BRS-S and finally was accepted!  Not only accepted, I passed my test!  I can now officially put BRS-S after my name.  Such long-sought and hard-earned letters!

Soon after I earned my BRS-S, I was promoted to Rehab Director of our department.  I’m still learning the ropes and working on improving our department.  I love the new job duties though.

I went to ASHA and had the opportunity to visit old friends and meet new friends.  As always, I had such a fun time!  I again had the opportunity to present a poster session.  It had a great turnout.  I worked in the SmartyEars booth, which is so much fun.  It’s always great to meet people and show off SmartyEars apps.  I always feel a lot of pride when people want to see a demonstration of Dysphagia2Go.  I would love to say that I attend the ASHA convention for the CEU’s, but I attend for the socialization.  That is one week of the year I feel like I am in “SLP heaven”.

I decided to end this post with a list.  Everyone always wants to know my recommendations.  Here are my top CEU courses, books and apps related to dysphagia.

Top CEU courses:

The VitalStim course by CIAO seminars is invaluable.  It’s absolutely great information, with such a huge emphasis on anatomy and physiology.  It is definitely worth the price whether you use the device or not.

MBSImP course by Bonnie Martin-Harris, provided by Northern Speech Services is another outstanding course.  Again, this course is based on the anatomy and physiology of the swallow and using it in interpretation of Modified Barium Swallow Studies.

Of course, my Dysphagia course.  I like to think that it is full of invaluable information.  :)

Top Books on Dysphagia:

Dysphagia Following Stroke by Stephanie K. Daniels and Maggie Lee Huckabee is absolutely excellent.  I’m in the process of re-reading it.  It is a book I will keep.


Drugs and Dysphagia
.  Great reference.


The Source for Dysphagia
by Nancy Swigert is my bible.  I love that book.


Clinical Anatomy and Physiology of the Swallowing Mechanism
.  Absolutely must-read!!


My Top Apps for Dysphagia

Of course my top vote goes to Dysphagia2Go.  I use this app all the time when I do a clinical evaluation of swallowing.  It lets me input all my data and then allows me to print a report of my findings.  This app is available for $39.99 on iTunes.

Dysphagia by Northern Speech Services costs $9.99 and offers amazing pictures of swallowing and swallowing deficits to share with your patients.

Lab Tests is a $2.99 app that allows you to look up lab values, their meanings and why the tests are performed.  This app does not require wi-fi to run.

Micromedex is a free drug app that is amazing and gives you not only information about the drug, but possible side effects, warnings, etc.  You can look up virtually any drug.

Cranial nerves is a $2.99 app that gives you information on all 12 cranial apps.  Not only does it give you the in-app information, but also allows you to, with the push of a button, access further information on the app on Wikipedia and Google.

 

I hope everyone has an amazing 2013.  I so look forward to all the new and great things to come!

This post is based on a post that originally appeared on Dysphagia Ramblings.

Tiffani Wallace, CCC-SLP, has been an SLP specializing in Dysphagia for over 11 years.  Tiffani has been very active in the social media world, creating 2 Facebook groups, Dysphagia Therapy Group and Dysphagia Therapy Group-Professional Edition.  Tiffani is also the co-author of the app Dysphagia2Go, available on iTunes.  She is preparing to travel nationally and speak on the topic of Dysphagia.  Tiffani writes a blog called Dysphagia Ramblings and is the author of www.dysphagiaramblings.com.  She is a 5 time ACE awardee and recently obtained her BRS-S.