Where There Is No SLP - Language Strategies (fourth in a series)

What can you do, if your home health patient doesn't have speech therapy - but isn't communicating well with language? Problems with language skills can make a patient less competent to meet needs, share information, maintain social closesness, and observe the conversation rules of her/his community. Whether the patient is challenged for understanding and/or using language, preventing long - term effects of challenges to a patient's language status is a worthy goal of home health intervention. Where there is no SLP, what can you do help the patient to function best to meet her/his language needs?

As in the case with persons having problems hearing or with cognition, knowing the patient's hearing status will be helpful. If a patient shows you that understanding your directions requires a lot of effort, you can help by using simple language that you share by speaking clearly. Demonstrate any actions that you want the patient to initiate, by gesture and repetition. Be a patient listener to understand the patient's message. If the patient uses a communication system that depends upon skills other than oral language, confirm that you understood the patient's message.

Where There Is No SLP - Speech Strategies (Fifth in a Series)

What can you do, if your home health patient doesn't have speech therapy - but isn't using functional speech? Problems with speech skills can make a patient less effective for meeting needs, sharing information, maintaining social closesness, and observing the conversation rules of her/his community. Whether the patient is challenged for using speech communication, preventing long - term effects of challenges to a patient's speech status is a worthy goal of home health intervention. Where there is no SLP, what can you do help the patient to function best to meet her/his language needs?

Some of the strategies that are used for a patient with hearing loss or cognitive impairment, will also be helpful in working with a person having speech difficulties. Maintain eye contact; minimize background noise; keep the style of conversation simple; confirm what you have heard from the patient. Technology has made participation in daily living easier than ever for speech impaired persons. You can write, text, spell out a message on a low - tech communication board, or compose a 10 - minute speech that can be spoken electronically. Advocate for your patient as you can - not only with the family and caregivers, but also in the patient's community.

Where There Is No SLP - Cognition Strategies (third in a series)

What can you do, if your home health patient doesn't have speech therapy - but isn't thinking well? Problems with thinking (cognition) skills can make a patient less independent, and even jeopardize her/his safety. Human cognition is a complex hierarchy of skills that we depend upon for living in the modern complex world. Preventing long - term effects of challenges to a patient's cognitive status is a worthy goal of home health intervention. Where there is no SLP, what can you do help the patient to function best to meet her/his cognitive needs? Remember that hearing impairment in adults is a major risk factor for development of cognitive impairment. Suggest the patient get a hearing screening, either through self - assessment or behavioral testing.

Effective communication with your patient during the visit will make thinking through your activities easier. For example, speak clearly with the patient, maintaining consistent eye contact. Regularly ask the patient to "teach back" what you have demonstrated or explained. Use the "WRAP" strategy (write down; repeat/routine; associations; picturing) to help the patient retain your information. Supply WRITTEN illustrations of home exercises when possible. If the patient does not easily initiate an action (e.g., picking up a utensil or taking a step), give a timing cue by modeling what you wish her/him to do.

Where There Is No SLP - Swallowing Strategies (second in a series)

What can you do, if your home health patient doesn't have speech therapy - but doesn't swallow well? Swallowing breakdown not only can challenge a patient's respiratory system, but also can be a serious barrier to general health. Swallowing problems (dysphagia) are such a high - risk problem, that they are often the first reason doctors refer their patients to SLP. Preventing long - term effects of challenges to a patient's nutrition/hydration is a worthy goal of home health intervention.

Where there is no SLP, you can still have a positive effect on the patient's oral health and hydration status. How does the patient maintain oral care? The mouth can be a portal to many bad things. Encourage the best possible oral care.

Dehydration is easily achieved, but sometimes not easily corrected. The clinical signs of dehydration you can easily see. Even sharing an ounce of water with the patient during a therapy visit can be a reminder: SIP VOLUMES OF BEVERAGES EACH MORNING TIL NIGHT.

Where There Is No SLP - Hearing Strategies (first in a series)

What can you do, if your home health patient doesn't have speech therapy - but doesn't hear well? Hearing loss is one of the strongest risk factors for cognitive impairment in older persons. Preventing long - term effects of challenges to a patient's hearing is a worthy goal of home health intervention.

Where there is no SLP referral, try to observe the following. Does the patient complain of changes in how the ear feels? Those signs may require a medical referral. Can your patient understand louder sounds best? Does she/he confuse words in conversation? Use strategies that help the patient understand your directions and your teaching. Strategies may include: constant eye contact when speaking; slower speech rate; stressing key words; gesturing; or writing down what you said.

To document the patient's perception of her/his hearing, complete: REVISED HEARING HANDICAP INVENTORY - SCREENING VERSION. THe patient can use the experience of communicating with use of strategies, as well as the self-perception of hearing function, to decide about possible hearing rehabilitation.

Will You Try It Once?

Hi! If you're not lost, welcome to hearing about a new way to look at human communication, cognition - or thinking - and swallowing. I'm a speech - language pathologist, a professional who helps people keep these skills. Relax, have a seat and - and I hope you're comfortable enough to tell me if or when I get off track. We need to take this journey together, so we all get to the end feeling good about our travel. Are you comfortable? Got enough room? Good, good, that's good! All right, let's talk about where we're going on this trip. We want to talk about people; people of all kinds - all sizes, shapes, all colors, ages, beliefs, constitutions and appetites. Their appetites then lead us to talking about all the foods that this big group of people might eat. They eat what they can afford, what they can find, grow, what they can stash away for when it's the best time to eat, or when they have to because Mama tells them, "eat!". You eat because you have to, it keeps you here with all the rest of us. It keeps you here, and it keeps you happy and wanting more: more food, more time, more life. So we have lots of people to talk about, and we have to consider all the foods these people need and crave. Seems pretty natural and easy to talk about people and food, right?

There're people, and all people communicate - some better than others. We need to do it, people do. It's part of our makeup, like walking on two feet and thinking about tomorrow. I want to communicate well, because my Mama said I HAVE to do it this way. I communicate because I want to stay emotionally close to people like my loved ones, friends; the people I know from work and my neighborhood. Those communication skills help me behave as my family, friends and neighbors expected - to follow the rules. Good communication also helps me to tell people what I'm thinking, seeing and feeling, and at a more basic level, I get what I need through what I can say, hear, read and write, and think. Even though we all have differencies in how our communication sounds or reads, we all yearn to connect by thinking about and playing the communication game.

Thinking is so closely linked to communicating, isn't it? You are awake and alert; you're focusing and concentrating, reasoning and classifying, planning and executing. From the time we're sleeping in a drawer, a bassinet or crib, we're plotting how to jump out and run the world. Developing as we do throughout life, we couple our thinking and talking skills with all the physical prowess that we should have. We learn to take care of ourselves, we learn what our parents and teachers share with us, and we learn from the big world with our increasing sophistication of our thinking brain. A healthy thinking brain, well protected and well fed, keeps us independent agents to confront our world each day.

Hang on, hang on! You look a little restless over there. We've almost got through the basics of what we can do - we still need to think about chewing and swallowing. Since we use many of the same muscles and nerves to swallow that we use to speak, my colleagues and I in SLP take on the responsibility of making sure we all can eat what is good for us, as well as simply what tastes good. We chew foods in a range from mashed peas to massive steaks over time. Getting the food we chew ready for swallowing ("when food is ready to swallow, it should be like MOTOR OIL; sticky and slippery!") is critical. Most of the time, we don't have to think about it. At times we all may have a momentary slip in our eating patterns, but the majority of us can manage those slips without any harm done.

We speech - language pathologists (SLP's) have to think about it for you. Swallowing is often the SLP intervention physicians call upon, when they send a referral our way to help someone. Thinking disorders are more prevalent among our referrals, with all the public's concerns about dementia. When speech, language and other communication problems are remediated well, we hear how skilled we are. Our professions are built upon bringing people back from the brink of disability, and now we're prepared to to serve our communities even more. Let's talk about how you can help prevent the effects of cardiovascular disease by eating well.

(Continued, part Two)

I Will Try It Once

You most likely recognize the name "Jacob Marley" from the Dickens story that is played on television at Christmas. Though Scrooge saw the damned spirit of Mr. Marley in the story as a warning to himself, you can imagine that things might have been different. What if Marley, transported to the 21st century, had also had opportunities to improve his fate, just like Ebenezer Scrooge in the Dickens story? The following story tells how Marley - and you – might avoid the burden of chronic disease that hurries death, that weighs down the life we want. Everyone should have an equal chance to live the best, longest life.

Young Jacob "Jake" Marleigh didn't think much at the beginning of his life about how to stay healthy. His parents did much of the thinking and doing for him on this issue. He had gotten good nutrition, good sleep, and good activity. Young Jake was the middle kid of five, and he had things to do, after being programmed by the eons of growth and adaptation by his ancestry, and getting ready to tackle the tasks of an everyday kid. From his entry into the world, Jake had a need to hold, grasp and claim things, so before he could say the word "MINE", his strong fingers spoke "MINE" for him. Just as many strong-willed infants had done to lure his parents into being adored, Jake had gripped his father's index finger one day with pudgy little fingers. MINE. Then as a headstrong toddler, he was given a pack to carry on his back, to carry all things that he considered, his important stuff. All the things he had collected, craved, earned.

There were mementoes of his first McDonald's french fries from age 2 - a soiled paper fry basket; from his first bottle of soft drink, the cap; and from his initial box of Good and Plenty candy, a few sweet cartridges rattling within the container. Jake's parents did their best, exposing him to mass - produced industrial Western foods only sporadically, but of course what his parents offered tasted SO GOOD when he was given any of those treats, and so Jake would always want more. Meals at home were dark and heavy, in comparison. There was pot roast almost every Monday. Meatloaf with (ICK) onions and English peas. When Jake had his first plate of spaghetti with meat sauce placed before him and he got a mouthful of the sweet, beefy viscosity, he thought - yeah! Something nice here....and then his older sister had to tell him the pasta beneath was "worms"! AUGHHHHHHHHHHHHHHHHHHH. Four years had passed before Jake once again put a forkful of spaghetti in his mouth.

Jake was a shy boy, though he was very assertive in the grade school classroom and on the playground at recess. He was so assertive that he got mixed up in a playground scrum, the weight of all those boys causing his wrist to snap beneath him as he crashed down on a sewer cover. But as soon as the cast was dry on Jake's forearm, he was blasting out of the classroom as soon as the recess bell rang. Back inside, he was soon labeled "teacher's pet". Our hero took to both battlegrounds with energy, especially since his cast alloweed him to stash some energy sources - Hydrox cookies, Jordan almonds he had stashed inside the plaster when at the movies, and even some bits of hamburger from last night's dinner. Boy, that cast really stank! But the stash kept him going, kept his neurons firing and kept that hand raised to answer EVERY QUESTION! Books and TV became Jake's life, even though he had plenty of encouragement from his parents and his few friends to play ball after school, or go to a Scouts meeting or to church. NO, was the boy's answer. Another potato chip from inside the backpack, before he went back to his books.

Jake was dusting himself off one day at the end of recess, and wanted to be on time because he had to read aloud to the class....but a tall, imposing adult beckoned him to come closer, at one corner of the school playground. The boy was certainly no dummy and looked around for support - no other adults were on the grounds, and he had to go! The adult prevailed though, and Jake was held tight to listen to the adult's entreaty: Young man, you work hard. I've been watching you. You play hard and I know you study hard.

The large man, who was dressed like a gym teacher but whom Jake had never seen IN HIS SHORT LIFE, went on: I have noticed that you don't have much energy as the day goes on, unless you have a little, er, pick-me-up? And then, the teacher guy leaned down and ACTUALLY PATTED DOWN the boy until he found in the shorts pockets: a pack of Clove gum, fresh from his granny's hand not two hours ago, and a peppermint wheel still within its plastic wrap....then as if he was hit by an electric shock, Jake glared angrily at the strange man, hissing in the scariest voice he could: STOP IT OR I'LL SCREAM. The man reared to upright himself, smiling as if to calm Jake's anxiety. Jake - you've got to stop this living to eat! Then, quickly lifting and blowing his gym teacher whistle - POOF!