"Good morning, and thanks very much for coming to this little gathering. We provide this talk each month on various health topics, for people who live in the community....and before I go on, - I want a show of hands: can everyone understand me OK? YES? NO? OK, thank you for the feedback. This little check-in, about your being able to understand me, is a good example of what we're talking about today: KEEPING FIT for good communication and swallowing. Just as people of all ages go to the gym, eat a more healthy diet, and are taking better care of their health to prevent getting disabled, - people can learn and practice skills for preventing communication and swallowing problems!"
"Another show of hands, please. Who's heard a program on 'preventing communication problems' before? YES?? NO? OK, thanks. You're right, all the 'no' votes. But speech-language pathologists like me, -we're supposed to help the public prevent becoming disabled, as part of our job. This talk is being held just prior to Better Hearing and Speech Month, in May, when we spend time teaching about communication and swallowing, and how to keep these skills strong through your life."
"Let's get down to business, now: what is prevention; how does this connect with your ideas of 'fitness', and what are ways you can prevent disabilities for talking and swallowing?"
Prevention for the purpose of this discussion, refers to the prevention of disability and handicap when the function of your body changes. What does that mean? How can that happen? Can you actually prevent having a disease, or be totally free from injury, that affects your ability to speak, or to listen and understand speech? Can you reduce your risk of having a problem with thinking, or with swallowing? You actually can do things - you can carry out some very common - sense activities in your daily routine that, when properly planned and executed, can help you maintain the quality of life you want for yourself.
Do you need a doctor's prescription for them? NO. Do you need any special training or equipment to complete these activities? NOT AT ALL. If you can do these activities successfully alone or with a friend or two, you have the chance to lessen the risk that a disability can occur, or avoid the risk altogether. How might this work for communication or swallowing skills?
An example of primary prevention (minimizing or eliminating risk), where the SLP is providing direct service is through training the use of expiratory air. We exhale with force when we cough, and when we speak loudly. To keep the respiratory tract functioning well for those normal uses of expiratory air, we need to pick an exercise activity that encourages you to exhale with near maximum capacity. A roster of these activities might include:
* singing holiday carols
* spitting watermelon seeds for distance
* blowing a continuous stream of bubbles through a straw into a glass of water
* blowing a crumpled tissue down the full length of a dining table, then off the table
Those activities, - just one example of the steps a person wanting to minimize her/his risk for disability- can happen when the person served is working with a solo practitioner. Prevention activities are, regardless of the mandate from where they emerge, more often a collaborative effort of a team of professionals. In this situation, the SLP may not offer direct service to the person served, but may instead be a consultant for specific needs the person may have while in the direct service of another professional. For example, a person served by a singing teacher, a pulmonologist, or an acupuncturist might contact an SLP for tips to sustain her/his professional voice. Examples of direct service and consultative intervention models exist in our literature, for primary prevention of communication and swallowing impairments.
So much remains to be done by our professions, before prevention - and for this discussion, primary prevention - can become a trusted and powerful tool in the toolkit of clinical SLP's. The language and the techniques need be learned and incorporated into our clinical practice. Successes in prevention should be documented and replicated. The importance of prevention, as part of the total skill set of clinicians, needs examples of successful business models that allow this largely neglected piece of your work day GET PAID. There, that got your attention.
Keeping people well, by giving them access to tools to keep them away from, or neutralize the risk of disability; keeping the model of human service evolving from a top-down model with an expert and a "patient", to a consumer-driven consultation model that helps the person meet her goals; - with the potential to actually reduce the need for direct service - ? Will that pay? "Can I have a show of hands?"
