Preventing the scourge

The new patient had been in her chair about ten minutes, when I entered the waiting room near the end of the clinic day. Just above her chair, there was a banner sign that read "PREVENT the Scourge: Get Tested". She was about 60, dressed well and appeared poised, even when she was forced to wait a few minutes. Cleaning up an exploded Twinkie cake had taken more time than I thought. Oh well, I'm glad she did not leave - and when she had heard her name and we exchanged introductions at the door of our exam room, she came in and started telling her story. There was a chance we could head off a big problem for her, if I had read her case history closely.

Like most of us over 50, she had noticed that she was not understanding what people were saying to her. She had obtained a master's degree in education when in her 20's, and had retired two years ago after 25 years of teaching. At times through her tenure, she said, working conditions in her schools may have taken a toll on her hearing. High ceilings, cavernous classrooms and smooth building surfaces in older school buildings forced her to struggle to be understood by her students. Not only was she fatigued daily near her retirement time from listening, but she also found her voice was becoming strained and dogged her continually. Her circuits were getting fried, it seemed.

The testing was routine and went smoothly, and it felt easy to empathize with her during the evaluation; - to acknowledge her responses to the procedures, keep her energy up for participating actively through all the exams, and to help find some reserves to digest their meaning: what next?
We took a good break before reviewing the information, and planning any interventions. We each get a cup of tea, and a Fig Newton or two. Then the review and the counseling started: I hope we were not too late.

"Thanks for coming today, and letting us serve you. I think you understand well what has happened, and  we'll need to decide together what the best course is for you. Your audiogram says - "

"You've lost some significant ability for understanding conversations. You see, we use the high frequencies to understand speech in daily situations, and those frequencies are often the most sensitive to the stresses our ears take. Noisy and echoing listening conditions, and the changes in our general health that feed the health of the ear, can cause those sensitive frequencies to be lost for processing sound. When you lose those frequencies for fast processing of sound, the brain can step in and 'fill in the blank', so you understand the message. BUT, that loss of processing power in the ear may and often does continue, so that the brain has to compensate more and MORE for your conversations. Tell me this - do you ever feel exhausted from the effort you give to listen to conversations??"

"Because we're trying to prevent these problems from becoming a chronic communication problem that affects most daily function, we do the hearing and cognitive, or thinking, tests - and then help you estimate what effect your hearing changes might have on your daily living. Once again, do you ever feel exhausted from listening?"

(Blogger's note: Thanks to Jennifer Jones Lister and Jerri Edwards, for their July 2017 article in Access Audiology titled "Lose Your Hearing, Lose Your Mind?: The Relationship between Hearing and Cognition".)

Communication fitness: the stuff

{Blogger's note: the 4/23/17 post titled "Communication Fitness" drew a lot of response, so - there's more to be done. In light of my discovering a real - world equivalent of this clinical idea in use @ Northwestern University, we need to keep pushing the envelope}

It shouldn't be a surprise to us in the professions, that getting adults onto video game platforms would be touted as critical for boosting their cognitive fitness. When there is a chance to publicize our clinical advances, news organizations like to see people hooked up to, in circuits with, or dependent upon technology!! It's cutting edge. It's SEXY...and in some training scenarios, it has been shown that computerized "brain training" can raise scores on cognitive assessments, e.g. those for attention. The effects of this computerized training being transferred to everyday life? The jury is still out. Yet customers (to distinguish them from  persons served  in clinical treatment) for communication fitness programs, will gravitate to computer-based cognitive games as easily as 'gym rats' ramble to a treadmill.

[PROBLEM: customer wants to improve her concentration for things she hears. SOLUTION: customer presses a button whenever she can name a popular song played aloud, given four possible answers on the computer screen]. 

Yet Wii, XBox, and other game, tablet, laptop and smartphone - accessible cognition - canoodling formats are here in our bag of tricks for the foreseeable future. They encourage buy - in with adults for the "brain fitness" enterprise. They are portable and often intuitive to use. Fun is contagious, and using computer-based games as part of a cognitive fitness program fuels the social need to communicate and to think. Yet, playing games is not what most adults do all day. When I ask persons served who enroll in clinical programs with me, "How will you know when you're better? What do you want to gain from working with me?", they mention their abilities for cleaning the house, or staying focused and efficient on the job, or not being surprised by their family members appearing - even though the customer had communicated with family re a visit, earlier that day.

In this role, the speech-language pathologist is not the game master but instead, a take on the interior designer. The SLP immerses the cognitive fitness customer in real environments, tailored to the customer's needs - so that the skills that need support are exercised; that real-time feedback is available, and that it is a supportive environment that yields specific learning opportunities. The customer is then prepared to re-engage in real life, with her skill set bolstered. The context - dependent learning available, helps ensure the customer can apply what is learned, back in her real world.

[PROBLEM: customer wants to improve her concentration for activities done in the kitchen. SOLUTION: customer makes a meal for herself and cognitive fitness staff in the training kitchen]

What does each cognitive fitness approach have in common?

* An SLP constructs and supervises the activities.
* Regardless, this is not skilled treatment that requires the intervention of an SLP. A cognitive fitness customer may interact with a volunteer or a paraprofessional to complete a fitness program.
* A successful outcome of fitness training = customer returns to her everyday activity at previous level of independence.
* Cognitive fitness training is NOT paid for through insurance.
* The SLP should initiate cognitive fitness programming for adult customers, to extend the influence of the professions.
* Cognitive fitness can be seen as a preventative intervention, supporting adult wellness programs to help keep adult customers viable and safe in all their customary (residential, occupational, social) environments.

Structuring the successful cognitive fitness program: that will require patience and fortitude.

Cherry Cherry

"Cherry pick": to select the best or most desirable from  -
Example: Francois cherry-picked the art collection - 
{https://www.merriam-webster.com/dictionary/cherry%20picking} accessed 7/9/2017

"To get freshest fruit in the summer
You don't have to flail with a stick;
This FRUITERER known just as Richard
Need not be a poor stupid....

CHORUS: 

Don't cherry pick 
Look all around
You don't get the best flavors from
The first fruit you've found!

Our government has some smart people
They'll solve the huge problems, and quick;
But those governing with wispy factoids
Must just have their brains in their....

CHORUS: 

Don't cherry pick
Take sage advice 
Press the button on good facts
So you won't need it twice!!

An SLP's clinical judgement
Should be drawn up the evidence wick;
If you don't know the pros and cons prior
You look like a poor - prepared....

Don't cherry pick;
Your literature, scour;
Know why your plan works
Or it'll be a long hour!!!

Don't cherry pick;
It's supposed to be hard - !
Finding the best stuff
Will be the best RE - WARD!"

 
 

Oh the places I've been and the things I've seen

Steven Hayes is a psychologist from Reno, Nevada, who has developed a treatment program for psychological disorders called Acceptance and Commitment Therapy (ACT). There is woefully insufficient space here to properly butterfly ACT, and to allow the reader to sample its flavors; - yet, attractive to this blogger after a review of Hayes and Smith (2005), _Get Out of Your Mind and Into Your Life_, was their notion of cognitive flexibility as a requisite for psychological health. Ergo, one of the oldest of my heroes is pictured above. Bugs was and is an epitome of not being trapped in your thoughts; of acceptance, and of living your values. Bugs and his moxie have inspired countless pushes to quality in my professional career, when I was not sure which way lead to quality.

This post marks the 100th time that I've been on the road to, as an SLP, fight evil and find quality. Since that road is rarely known but to all who have heeded the call to travel it, let's look at some of the mileposts this blog has encountered.

 

SPEECH - LANGUAGE PATHOLOGISTS have and do -

* celebrate their profession in all its forms (11/20/12)
* reach across the aisle to our closely allied professions to say, "Nice job. Can I use that?" (9/22/13)
* enjoy the gathering of the clan of fellow professionals (12/14/14)
* try to bolster the state of clinical science with new ideas for the good of who needs us (6/29/14)
* see the world of CSD from the perspective of the person served (11/8/14)
* know that sharing who we are is critical to forging a healthy therapeutic alliance (12/19/15)
* love explaining what we do, to dispel rumors of our being a 'best kept secret' (3/29/15)
* relish the growth of new kinds of clinical practice (5/7/16)
* feel peace that these innovations are not solely for us, but for the next generation of clinical scientists to determine DOES IT WORK? (10/26/16)
* experience real-life, human scale stresses and need to care for ourselves (3/19/17)

Where to go next? I hope you'll continue to come along.

Be a Real American - Communicate

Happy Independence Day! We're 241 years old this year, but we only look 24 (those infrastructure patches, and the glint of glass and glow of microprocessors), and we seem to act no older than 2. We're barely on our feet, whopping each other with anything within reach, and babbling out the barest resemblance to rich adult oral communication. Though the means and methods for communication are in more hands than ever in the US, and we who have benefited from the communications technology revolution can share more communication 'product' than ever before; - what is this quintessence of flat phonemes? We can share and share it abounding; but what we are sharing: disgust, rhetorical pig bladders, and the stiffening of social-cultural camp boundaries - just because we can, should we??

It is no accident that modern political campaigns, like the 1968 presidential campaign in the US, resemble ad campaigns for mass market products. One of Richard Nixon's inner circle had been an executive with a large US ad agency, prior to his role in the political campaign - then as White House Chief of Staff. It's no more than a hop and skip from packaging an issue like a product, to the Internet meme that can be dropped into your consciousness over and over - like the fabled "Chinese water torture". Given our appetite for politics that are quick, flashy and sometimes accurate - and since this has been going on since the time of the Founders, at least 241 years old - how can we even agree on core components of being an American, such as PATRIOTISM?

https://www.wbez.org/shows/morning-shift/the-many-meanings-of-patriotism/174e7d25-5c80-4f3c-9c06-e2f2eeadb28d


Since 'communication' also means to 'connect' people, technology or ideas, it seems that connection might be tenuous in this era, when the cultural camps differ on what they're talking about. What is our national message now? Does the American brand, using the current parlance, survive our search for meaning? Because there is such an conflict among opposing sides, or opposing tribes in our national civic discourse, I think speech- language pathologists might be among the Americans who can help make communication great again. It is these professionals, US, who might be among the best qualified to CONNECT camp to camp through clear communication. If you've read this blog post to this point - hey, I may have proven my point already! But let's present the argument for your consideration:

* SLP's are expert in analyzing and decoding messages, and in helping partners in communication learn strategies for identifying and repairing conversational breakdown. We function in these roles similar to anthropologists, sociologists, psychologists, counselors, clerics and mediators. When we are on our game, we keep the scientific jargon to a minimum but have our data and sources at the ready.

* SLP's are skilled at communicating dynamically - not only within the confines of the controlled 'therapy room' environment, but they also interact with real people they serve in everyday settings everywhere. There is a lot to be said for training everyday people in the healthy use of a "crud detector", so that the crud might be replaced by - gold? Naw, too heavy. Let's replace it with silicon.

* SLP's are trained to change behavior. Every communication occurrence is different; different relationships among the parties, different motivations, different skill sets. In the clinical outcome selected, whether impairment, activity or participation-based, there is the possibility for growth and healing of relationships.

* SLP's are coached to be clinical, think clinical. Det. Meldrick Lewis (HOMICIDE: Life on the Street) reminded us of that skill set when reminding his Baltimore PD colleague: "You keep everyone at a distance". Personal opinions, relationships with participants, and the emotional smoke that can obscure the information are filtered out - so that the parties might reach their goal.

Sing, America, for better communication! https://www.youtube.com/watch?v=--XA2OtAPnk

Kazoo feel the love tonight?

I hope Sir Elton would approve of, for this post, the mangling of his music and Tim Rice's words. They're in the interest of art, science, and of - Wisconsin!

The chairman of my CSD department gave up the chair, when I was beginning the second year of my master's program. My classmates and I had debated his effectiveness, and had even held a forum with faculty re: the direction of the department. We were polite radicals. When the decision about the chair change had come down, we nevertheless decided to do something for department morale.

We were prepared along the first floor staircase of old George Hall, so that when the former chair came to work the day following the announcement....an impromptu KAZOO band formed of master's students serenaded him with a rousing "On, Wisconsin!" (his post prior to coming to our University). The guy was characteristically nonplussed at the reception - like he had heard an impromptu kazoo band at Ole Miss every week! But that is the indomitable will of this instrument; - it is sassy and it makes a lasting impression with very little effort. That is why I have kazoo love.

The use of the kazoo in speech therapy? Besides serenading the illustrious people in our field, I have found the kazoo to be an uncomplicated, off-the-shelf, easily trained and fun method to help persons served train their expiratory airflow. Having the ability to increase your airflow when exhaling may pay off, in your ability to voluntarily cough during PO intake, and in your ability to sustain a functional speaking voice for most daily settings. What does kazoo playing contribute to that process? 

Through my own clinical trials, I have found that the ideal candidate for kazoo use in treatment:
* speaks with insufficient loudness and quality in every day settings*
* may have weak reflexive and volitional cough during eating and drinking*
* has so little fun in her/his life*

You would expect then, goals for this most unconventional treatment method might include:
* produce a tone, by HUMMING with lips closed about the larger opening of the kazoo*
* demonstrate a single tone (pitch) of various durations with stable quality*
* demonstrate productions of multiple tones (pitches) by adjusting lip tension during kazoo play*
* demonstrate mastery of a simple song ("Happy Birthday", "Twinkle, Twinkle), that is understood by a listener without need for repeating

Those SLP clinicians who were not fortunate enough to play musical instruments in school (trumpet and french horn here), can easily learn the basics from reading:
https://kazoos.com/pages/how-to-play-kazoo.

Those persons served who have found success with kazoo playing, as part of their SLP clinical programs, may demonstrate improved diaphragmatic/abdominal breathing; increased cough strength in the reflexive and volitional conditions; and increased conversational voice endurance for all daily settings. How to be sure? Try it and see.