Should Old Arytenoids Be Subglot

Should Old Arytenoids Be Subglot
Like Pecs that Drape One's Knees; -
Then Let's Lift a Flagon of Stimulant
And demonstrate some physiologies!

For all the synapse'd parts of speech
For all the fricatives;
We'll bridge that communication gap
Avoid the ablatives.

If there's a deity above
S/He directs the cosmic cinema;
S/He wired the inner Dolby units;
They're called the cochlea

For all the full valleculae,
For pyriform plugged tight;
We'll drink a cup of lavage, YAY!
This frosty NYE night.

So - will you thus communicate
And swallow at your best?
Please make them such a '17 goal:
The gifts of cosmic largesse.

For old arytenoids, my dear;
For old arytenoidsssssss
We'll fix that diplophonia;
For old arytenoids!

Gotta Eat at Christmas

Most of my colleagues at the hospital are younger and have families, or are just barely out of college....so I volunteered to work Christmas. Man, is it ever dreary out there today!  Not horribly cold as I drove into the wet parking lot - about freezing - but the chill I feel to the bone. Mississippi Winter. Wicked! I've had - 20F Christmases, but they don't affect me like that winter on the cusp of phase change. It's warm on the floors anyway....

(Usually I am here before the rest of the rehab staff, but today - Xmas - it is even more important to get to my patients early. Seems like most of the PT's and OT's focus on getting through their list of patients, and whooshing home to the holiday festivities. Some even have to do the cooking! I try to avoid that feeling - opening the door "knock knock knock" of my first patient now - of being a human pinball, by "may I come in? Thank you...."  - by good time management, by staying in the moment and by assuring my patients that our therapy will be a good time!)

"Hello! It's Christmas morning, isn't it? My present was getting to see you early; and yes, I showered and shaved! And - what good timing, here comes the staff with breakfast now. Yay!....OK, here it is; may I help set it up for you?.....There we go; but before you start, let's make sure you are doing all the things you can always do to help yourself eat without a struggle..."

(She is here for treatment of her congestive heart failure and chronic obstructive pulmonary disease, with aspiration of food and liquid being a recurring challenge for her. Her videofluoroscopic swallowing evaluation was just yesterday, and showed she had a mild trend towards leaking things she swallowed from her throat, into her windpipe. Being here with her at breakfast is one component of helping her improve her skills. Swallowing treatment is today thought of as predominantly muscle retraining, but in the case of this Christmas breakfast, it is also a social cognitive act.)

"Those eggs look good, don't they? They are nice and warm....yes, you're swallowing well. Let's keep the good swallowing going. Remember what we practiced? After you've chewed each bite, swallow HARD! That's right! Swallow so you can feel your voice box bobbing UP and DOWN for each swallow. I can show you if you're doing it well, by resting my fingertip very lightly on the protruding part of your voice box - if you swallow hard enough, that part of your neck will rise above, then fall below the spot I mark with my fingertip. And, yes, there you go! You're moving that well when you swallow your breakfast!".

There were quite a few strong swallows after that sequence, but that was enough to illustrate what worked for this lady. I found the woman's nurse on the floor and reviewed the patient's progress, then wrote my note to describe the visit. Given the patient's chronic disease, and her tendency towards lying in bed when not exercising, teaching caregivers to grade the validity of the procedure seemed our best bet to help this woman meet her goals. Only ten more patients on this Christmas! Ho ho ho -and we steal into the mechanized Christmas morning, like Boxing Day Ninja shoppers off on a trial run.

It's a small virtual world after all; or, Deck the Lecture Halls!

(According to the weekly statistics of this blog's host, more views are coming from two areas outside the United States - France and Russia - than from around the great USA. No actionable intelligence here, folks!)

We wish you communication/
So free of tribulation/
No errs of articulation/
And no food in your teeth!//
Will you read any Luria?/
Or practice your Shaker? Ha!/
This time's a break from academia/
Park your endoscope by the wreath!//
Bonne voix à toi/ (Good voice to you)
Wherever you speak/
 n слышать разговоры (and hear conversations)/
For eight days a week!/
EVERY BODY SING!!
(Repeat chorus)











I have been gifted beyond measure by the response to this blog this year. May everyone, everywhere, soak up the au jus of the season in the bread of your choice - and keep communication pretty wonderful!

Walking and saying "gum"

This came to me while on a recent mall walk. The subfreezing weather in this area has made it wickedly tortuous to get outdoor exercise, so walking a few circuits of the local mall helps heat up the muscles, tendons and ligaments; it will stir the blood and unleash the peace. I doubt the majority of people who use physical therapy departments, colloquially termed the home of "physical torture", agree that what they do unleashes their peace. I feel it for myself during these walks.

The multiple engagements I must manage during the exercise period - dodging the shoppers and staff; avoiding the displays and distractions; maintaining the pace I want (only stop if you are going to hit someone/thing); foot plant begun with heel strike and step through, and great upright posture; all that - help me hear my inner voice. A lot of soul work gets done during those walks. It does help me unlock, feed and flex my mind. Gee, those PT's and I have a lot in common.

Even though our two professions are born of different mothers - APTA out of the wartime vocation of "Reconstruction Aides", originally all women; ASHA, largely male university clinicians serving disabled children; -  we each and together moved to meet acute needs of our consumers, in both the medical and educational spheres. Clinical discoveries and evolved standards of practice yielded programs of clinical and then, basic research; concurrently, educational standards for clinicians great and changed to meet the needs of consumers and the marketplace.

Above and beyond all the distinctions of the professions' growth, are the intertwining of movement and communication, of the motor act and the cognitive interaction. Our colleagues in physical therapy are cognizant of the contributions of play, of stress and of  daily need when moving and communicating. Stress is a distinctive quality of both the gym and the therapy room: I joke often that  some of my patients often begin to talk, when their bodies are stretched and contorted (OW! NO! =! $#%=£×_€=÷!!!).

I do admire our mutual interests and approaches; particularly, how movement and instrumental acts can engage the mind. I am still silently fretting when others assume I am a PT; that PT'S lead rehab departments predominantly; that PT took the lead at making the doctorate the terminal degree; or that we are joined at the hip for the Medicare B "therapy cap". Those dilemmas need not be owned by APTA. Time to just keep walking - and thinking.

The rest of the media story

You've seen in the previous post, that there are contemporary examples of persons with problems communicating, thinking or swallowing, portrayed in today's media and stirred into today's popular culture. With the current emphasis upon a "brand" and a "social media platform" being essential for the professional, one has to ask the questions, "Why aren't SLP'S featured more often in media and culture? How could  an SLP be a major character, or even THE main character in a play, film, novel or TV series?".

Then of course, I hear the blowback - as if it weren't all in my own mind: "Why would I want to be the star? Let me do my job and treat my students and patients, finish my documentation and go home". Real life tells us that our typical days are often not that heroic, and - we're not that sexy, not that charismatic, not that influential. Can an SLP be the hero?

Back in March 2016, this blog asked and answered the question "Who Exactly Are We?". It so happens that multiple sources affirm, an SLP is smart, industrious, courageous; that s/he takes the long view as well as the short; and that s/he listens and tends well the heart as well as the mind. Even though SLP's may influence most persons we encounter in the private, 1 to 1 world of the conversation, - the clinical encounter can often yield big, heroic outcomes! A person's striving to come fully into human existence, with communication, thinking and swallowing skills they need, is a journey that is often paved with tears, trauma, anxiety, sacrifice, ingenuity, humor and dogged, deliberate eyes-on-the-prize determination.

If you were to dramatize the clinical encounter, or any other events that surround a day in the life of the clincal encounter - would it be good TV? Good theatre or film drama?  It would be character driven, helping you know the principals involved as real, even flawed individuals who nonetheless are bound by a goal. Look at Henriette, Bauby's SLP in "The Diving Bell and the Butterfly". Look at Logue, King George's therapist and friend in "The King's Speech". They embody their mission - Logue is even fuller a character than Roi, as we get to know him more than just a professional. Building a story about the SLP, and how s/he can do things pivotal for helping people live fully, will not be fiction or fantasy or fluff.

One of my favorite canvas bags, out of all the canvas tote bags I have accumulated from meetings, etc., asks of the reader "I help people communicate. What's YOUR super power?".

I'm ready for my close-up, Dr. Van Riper

Through the years as an SLP, I have endured stark encounters with family and friends where they ask questions of what I do, often by saying " What do you do?" then they follow up after I describe a typical day, by saying, "REALLY! I never knew that speech therapists do this!". After that, I often make an observation that there have been very few opportunities for SLP's to toot the horn of this profession. After all, how often do you see an SLP represented in pop culture or by "the mainstream media"? And, if you have, could you believe your eyes and ears?!

For example, who can name a popular film in which SLP was prominently portrayed, apart than these films (attribution to the fine site "Speech Buddies" (speechbuddy.com) for this list)?

* The King's Speech
* Regarding Henry
* The Diving Bell and the Butterfly
* The Wild Child
* Sound and Fury
* Children of a Lesser God

There have also been TV series in variable formats (broadcast/cable/web), that portrayed persons with communication and cognition disorders, and the persons who interact with them. What programs can the reader recall other than the following?

* "Speechless" (the nonspeaking teenager has family and an aide translating his eyegaze communication)
* "Standardized" (fix my accent, please!)
* "MASH" (Winchester's affinity for helping persons who stutter)
*  "ER" (Cynthia Nixon cured of a severe aphasia in less than an hour)
* "Beavis and Butthead" (the boys talk about what they know, to learn more about articulation)

When it comes to the printed word, there are more options. You can consult the site GOODREADS, for lists of popular books on subjects related to communication and cognition disorders <https://www.goodreads.com/shelf/show/communication-disorders>.

Why is this important? There is so much competition for our eyes and ears, in learning about the world and making decisions about the meaning of life. I want the story of my profession told extremely well, and the day to day perceptions of a life that lights me up made so clear to the world, that the reader can see glimpses of how life's biggest questions may be answered. Maybe.

Welcome to SPEECH THERAPY! Example of an inservice outline on speech-language pathology for facility staff

I. Introduction (I am ST)

A. Name
B. Location
C. Education
D. Experience
E. Role @ my workplace

(Activity #1: introduce yourself to the person next to you....brief comments on the 'communication' required)

II. ST is a health professional that practices an "applied interdisciplinary behavioral science"

A. Applied -  benefiting everyday people
B. Interdisciplinary - coming out of the work of all these professions, and melded
C. Behavioral - people doing real things
D. Science - a systematic way of explaining the world

III. ST referrals are made to help persons with problems -

A. Swallowing (case example follows each alphanumeric item)
B. Thinking
1. Attention
2. Memory
3. Problem Solving
4. "Being An Adult" - Executive Function
C. Communicating
1. Speaking - Speech, Voice, Articulation
2. Listening - Receptive Language
3. Understanding - Speech Perception (hearing)

IV. What ST does, in summary:

A. Breakdown function to component parts - skilled activity
B. Train improvement of components in clinical (unnatural) settings
C. Retrain the whole activities in natural settings

V. What YOU can do to help persons having problems with these skills

A. Offer assistance to the persons through use of compensations
(Activity #2: Demonstrate compensations used for persons having problems swallowing)
B. Identify for ST those persons for whom compensations are used; determine the need for additional evaluation.
C. Assist ST in helping the person improve skills as needed, through use of compensations and a home exercise program (as needed)
(Activity #3: Home Exercise program example - kazoo blowing for increased exhalation strength)

VI. Questions?

VII. Thank you!

Help Them Meet their Goals

Now it was Friday at the 2016 ASHA Convention, and after an early morning meeting and my quick shopping trip through the Exhibit Hall, - the meetings continued. So far, this Convention has shown the attendee that, there's value added to therapy that asks you to do natural things; that the diversity of the membership need be nurtured; that the ability to map interactions help you interact for a desired future; and that persons can be successful at interrupting reflex pathways to modulate cough. What worlds were there to conquer still, today?? After topping the Rocky Steps last night, what? Me, worry?

Malnutrition - we have known it to be the riddle in clinical settings that is not easily solved by dysphagia protocols. Not everything the person served needs, is solved by the traditional eval and treat approach. Shune and Morano - Villhauer showed how the twain of malnutrition and dysphagia may meet, and gave participants tools for working with these complex cases as real people - so that the age-related phenomena of malnutrition might be modulated by an interdisciplinary team.

Weinstock-Guttman, Chiaravalloti and Tjaden provided insights into the 2013 revised diagnostic criteria for multiple sclerosis, the more effective treatments for cognitive impairment, and recent developments for treatment of motor speech impairment. The complications of MS are numerous, and the challenge of bringing successful outcomes to these persons served - is a challenge of getting to know one person at a time, very well. A resource for doing so is illustrated in the following:

I was very pleased to hear the paper by Devanga and Hengst, from further on down the road at UI/ Urbana - Champaign - where "collaborative referencing" after aphasia was targeted by an experimental treatment. With the person with aphasia being both the person directing, and then one following directions, data emerging suggests that the procedure may significantly improve expressive communication in these persons served.

My 2016 Convention closed with "Conversations on Death and Dying", Carrico Mann. Her perspective on end of life issues, and how professionals in speech-language pathology may engage with these persons served, in the stages of preactive and active dying, and with considerations for different cultures, and the skill set for comforting a person served and their circles of support; the handout provided gives a good beginning list of print and web-based resources in palliative and hospice care.

There was a last swim at the motel after sessions ended, with an early flight home on Saturday. Given the weight of the sessions I attended, it could be said that the sun was coming down on a world view by speech-language pathology - alternatively, the sun may be coming up on another.