What's in a Name?

I earned my M.A. from Louisiana State University, then received my "C's" from ASHA. Like most of you out there in the USA, my job title is "speech-language pathologist" (SLP) or "speech therapist" (ST). I have always preferred SLP over ST because I felt that it more accurately described our areas of expertise, and to me, it encompassed our role in evaluating as well as treating communication disorders. My credentials read: Jennifer Kay-Williams, MA, CCC-SLP.

Once I ventured into the world of adult services, I found that 80% or more of my caseload consisted of dysphagia patients. Not surprisingly, I found myself explaining to many families (and even some nurses and CNA's) that I was there to evaluate swallowing function and/or oromotor skills for deglutition, rather than speech skills.

I can't count how many times I've heard "Oh, but he can talk just fine" or even "Are you here because grandma has an accent? She's talked that way her whole life!"

In the interest of clarity, I began to introduce my self as a "communication and swallowing therapist". Sometimes I just said "swallowing therapist," leaving off the communication aspect if the potential patient quite clearly had no communication impairment. It was just less confusing for patients and families, and as I gained experience with swallowing and swallowing disorders, I also became more comfortable with referring to myself as a swallowing therapist as well as a speech-language therapist. After all, that's what I am.

I went to school to treat communication disorders, not fully realizing until I began my graduate course work what a large percentage of our professional career is spent on swallowing disorders. I was fortunate to have a superb professor at LSU in the field of swallowing and swallowing disorders, but I had no hands-on experience with dysphagia patients for four years after graduating because I chose to begin my career in the public schools. Once I decided to switch my career focus to adults, I quickly began to search out all of the current best practice standards and dysphagia treatment techniques that I could find. After four years, I feel comfortable in the treatment of most dysphagia patients and able to converse knowledgeably on the topic with patients, caregivers, staff and co-workers. But as long as I call myself a "swallowing therapist", I'll have to continue to hone my skills and learn about the latest research and treatments.

Descriptions of Frequency and Intensity of Cueing

I find this information from ASHA very helpful, as I have sometimes debated the severity of a patient's communication disorder and/ or level of dependency with co-workers. Of course, different SLPs will maintain their own professional opinions based on their experience.

From ASHA:
www.asha.org

Frequency of Cueing

Consistent	Required 80-100% of the time.
Usually	50-79% of the time.
Occasionally	20-49% of the time.
Rarely	Less than 20% of the time.

Intensity of Cueing

Maximal	Multiple cues that are obvious to nonclinicians. Any combination of auditory, visual, pictorial, tactile, or written cues.
Moderate	Combination of cueing types, some of which may be intrusive.
Minimal	Subtle and only one type of cueing.

Better Speech and Hearing Month Activities for Adults?

May was Better Speech and Hearing Month. I say "was" because, well, May is just about over. I was in the process of a move to GA from VA, so I did not get to plan any BSHM activities or events this year. In 2008 I was fortunate to have a terrific intern at the SNF where I worked. As part of her internship, she developed and presented a family/ caregiver presentation for BSHM entitled "Communicating With Your Elderly Loved One." We presented basic communication tips for caregivers and families (although 99% of our audience were CNAs and nurses from the facility) and offered candy during a Q&A session at the end.

When I Google "BSHM", I get tons of hits for child-centered and school-based activities, but not so many for adults. Understandable, since so many BSHM activities we think up lend themselves to pediatric therapy more than to adult therapy. School-based SLPs can use BSHM coloring activities within speech-language tx group activities and can share presentations about speech-language and hearing with parent and teachers. ASHA has coloring activities, bookmarks, and "The Buds" as well as activity booklets from companies like Progressus. When I worked in the schools, we had classrooms color posters and banners and we had contests. One year, the classroom that came up with the most types of communication, verbal or non-verbal, got a popsicle party. I really did look forward to BSHM activities in the schools!

For the adult-centered therapist, we can of course order pens and notepads and share the news about BSHM with co-workers. We can provide in-services to SNFs, ALFs, home health offices, etc. I know I always like to bring candy or goodies in to the rehab department, to say "thanks" to my colleagues for the work they do in collaborating with me throughout the year. But, sometimes bringing in goodies or passing out pens feels like preaching to the choir. I mean, the OTs, PTs, OTAs and PTAs usually had a pretty good handle on what I did, especially since I had the chance to collaborate and share info about speech-language and swallowing tx with them almost daily.

The ability to order BSHM materials from ASHA varies greatly from facility to facility. One company I worked for let us order pens & notepads from the company site, with the company logo on them; that was nice, but our recipients were of people who already worked for that company! Why "market" company materials to company employees, when BSHM is about promoting speech-language pathology as a discipline? For many of us, ordering ASHA's brochures and supplies just isn't feasible, unless we are willing and able to dig into our own bank accounts.

I also tried to use BSHM as a way to thank the hardworking CNAs and nurses. They are the ones I count on to use the safe swallowing strategies I recommend, to check for correct diet texture and liquid consistency, to try communication strategies with patients. Without them buying in to speech-language and swallowing therapy, our job is so much more difficult.

Basic Tips: Alzheimers and Dementia

Repeating a question quickly does not help people find the answer. They need time to process information and formulate a response.

If a person cannot remember a fact or direction, simply repeat it to them. Don't "quiz" them because this does not help with memory.

People learn best when they are interested and engaged in the activity.

Activities should be useful and meaningful, not just "busy work."

Demonstrate without long explanations.

Break down activities into smaller parts.

Slow down. Match your speed to the participants' speed.

People with dementia need more activities to keep them engaged throughout the day.

Don't repeat an activity because a person is successful at it (example: unfolding laundry just to fold it again). This becomes meaningless.

Give people a choice of activities whenever possible.

Explain/ demonstrate the obvious. Materials are not edible, how to use tools/ materials, etc.

Avoid extraneous materials and clutter. Only have out what is needed for the activity.

All activities should have an end result (example: planting herbs to cook with later).

Try other activities with a similar level of difficulty, using a similar procedure, or a similar ability.

You can also us easier or more challenging tasks that follow an original task, depending on your loved one's success.

Invite people to participate; don't insist that they join in. Tell them that you need their help.

Basic Word Finding Tips for Adults

Word Finding Tips

1. Give her plenty of time to speak. When people feel rushed, they are more likely to experience word-finding problems.

2. If you know the word she is trying to say, give her a hint such as the first sound of the word.

3. If she still cannot get the word, you can ask her “Are you trying to say ‘train’?

4. If she says a word that sounds almost like the one she meant to say, try asking her “Did you mean ‘telephone’ or ‘television’?"

5. She may not find it helpful if you ask her “What did you say?” more than once. She may appreciate conversational partners giving her some hints. Many times, the word is “right on the tip of her tongue.”

6. If you understand what she is saying, try to ignore small errors.

7. Encourage her to take part in conversations as much as possible by asking her questions, slowing down your rate of speech, and allowing her extra time to reply.