McGyvering Therapy

You sometimes get a chance, in your work as a CSD professional, to make a singular difference for someone you serve. It's the responsibility of the mindful clinician, fully focused in the moment of the clinical encounter,  to marshall all possible resources, techniques and training and enhance this person's outcome  with perhaps one simple decision. It is a testament to the primacy of communication in everyday life, that the mindful clinician can find a key to a successful outcome in everyday life.

Do you remember the ABC television series, “McGyver”? The hero stands atop a very tall dais in the pantheon of series TV, for his ability to solve fantastic and seemingly overwhelming problems with simple solutions. Is it possible that the speech-language pathologist has at her/his disposal such simple solutions to clinical problems? In this EBP day and age, “McGyver” solutions to clinical questions are not the solutions often sought. Yet, even though the solution chosen may not be strictly based upon experimentally-tested methods, the persons served often learn from these procedures and make positive change towards their desired outcomes. What are examples of “McGyvering” in speech-language therapy?

1. Take a “Life Savers” sugarless candy. Tie a strand of waxed dental floss to the candy, then instruct the person served to take it on the middle third of her/his tongue. The person sucking the candy receives discrete sensory feedback for isometric exercise. Concerns about salivary production and salivary control are easily addressed. The person wishing to practice the Mendelsohn maneuver (assigned to persons to improve laryngeal elevation and upper esophageal sphincter function) has a hard target for pressing the tongue dorsum into the soft palate.
2. Inspired by Netsell’s work with the U-tube manometer, the clinician may give a person served a glass that contains approximately 2 inches of water and a drinking straw. The person is asked to blow a continuous stream of bubbles for at least 5 seconds. Expiratory strength training such as that achieved by this activity, benefits persons with all variety of needs: voice, swallowing, speech and cognition.
3. Horticulture to go? In a long-term care setting, there are often persons served who do not want to leave their rooms – therefore wishing to decline your scheduled treatment – due to pain, depression, fatigue, cognitive impairment, etc. The speech-language pathologist may then take to the patient’s room, on a cart, a variety of horticultural materials for the patient to cultivate while sitting, or even while lying in bed. The mindful clinician can map onto the horticultural activity, a large number of cognitive, linguistic and communicative goals.

If there are general rules for “McGyvering” a treatment activity, they might include -using materials most people will have; replicating an activity most people perform in everyday life; giving the persons served copies of the treatment materials to use in their natural environments as soon as possible; and the person served can describe what is happening when they do the activity. I hope readers of this piece discover for themselves how to “McGyver” treatment.

Originally published 9/11/2012 in different form in ASHAsphere, the blog of the American Speech-Language-Hearing Association.