Inside my head, your care in my hands

"Hello. I've been running my tail off today. I wasn't sure I had gas in the tank to be here with you....and now your meal is an hour late, so your frustration tolerance may be even more frayed than mine! No matter, I'm your man now. It's time to eat; may I help you?"

May I help you eat your meal? I see you've got (meal items). I'm going to just take a few seconds and (prepare) your plate. There; now it's time to start. I hope you're hungry! (There is your utensil) (Let me scoop up a bite for you)....what do you think? 

"Hmmmmmmmmmm....I am watching you for a bit; do you feed yourself or not? It makes a difference for how well you swallow, but - no matter. Eating is not just a survival act and a cognitive act. It's a social act, too! Let's get to know each other a bit as you eat. Whatever I can teach you to do, I will also teach the staff who work with you. Ready? (holding up the utensil, stationary, so you can see it and open your mouth - before I bring it to your mouth). You see how I place the bite of food inside, so you have to make an effort to pull it off the utensil and start swallowing?? I like how people swallow more easily, when food is not just dropped at the front of the tongue. Now, here's another bite...."

I am going to help you eat; is that OK? (about 3 seconds for person served to respond 'yes') Good, thank you. (Utensil lifted, a bite of food cut from portion served into  bite-size pieces). Ready? (utensil avoids 'clacking' teeth or scraping cheek, so the bite rests on the Middle/posterior tongue). I watch you swallow, before presenting the next bite....

"WHAT? WHAT DID YOU SAY? It's the staff; she said that I was feeding you too slowly, and you were criticizing how I fed you with your eyes.  First of all, if they were doing a thorh job about feeding you, they wouldn't have had to refer you for a speech-language pathology evaluation. If all I were doing was feeding you, second of all, - I might do no more than drop the spoonful inside your lips. I do want to give you assistance that make your more readily swallow, as well as swallow safely. We'll get up to your speed soon enough."

I like how you looked at me intently. Don't worry; I'm not stopping your meal. I wanted to see how well you were paying attention, and - YOU ARE.   Here's another bite; ready? Good, I'm glad you are enjoying that....A cough? Yes, cough it out well. A strong cough is an important skill to have. Good then; can we keep going? OK, here's another bite; another sip. Oops! That mess is my fault. Good, and another - another - you're doing quite well today. 

"I do want to do a number of these observations of your eating and drinking. A sufficient sample size of them, and each of them being not cross-sectional but longitudinal.  I want to see you consistently eat and drink, while using these skills and strategies we have tried today. What do you think? I don't want to change your diet unless absolutely necessary. Can we do this?"

Untangling tongues with things

Better Hearing and Speech Month 2018 is  over. We've bypassed National Joke Day; Workaholics Day, and even World Emoji Day. There's a lot still that can make us happy, about our potential for bringing a better quality of life to people we serve as SLP's.

In spite of decreasing program budgets, increasing controls over reimbursement, productivity targets for clinical practice that threaten making persons served, widgets; the challenges to our clinical foundations, through disciplines fighting over who will serve; even, will persons having needs, be served? - there are innovations, breakthroughs and standards upon which practitioners can stride, and see the next bright vistas for the professions. There are so many interventions that can be celebrated: I can take one in hand.

I owe thanks for inspiration to Katie Schwartz (Alt Career Options), as well as to Gayle Van Tatenhove (Core Vocabulary Classroom Kit) , Julie Tracy (Urban Autism Solutions), Beth McCauley (Animal Assisted Therapy), Rachael Baethge (Speech/Language Skills at the Zoo), Matthew Crawford (Shop Class as Soulcraft; The World Outside Your Head) and Kelly Lambert (Natural Enriched Environments)....and all those not mentioned, who have helped grow the field with instrumental, non-traditional approaches to treatment.

By instrumental, I point to instrumental activity, or what is called 'handiwork'....instead of picking up a  picture card, pick up a ball or a horse's reins. When you are bored with squeezing or pointing, substitute digging or watering. Have you done all the stimulus-response work in the clinic, you can abide? Get out into real life, and practice the skills where persons served will ultimately use them.

Why handiwork? The rich, abundant and emotive energy of everyday life is largely driven by instrumental action: we live through eating, painting, writing, driving, exercising, praying, and so many more actions that are mediated by communication. The writings and teaching of these innovators will remind us clinicians that communication:

* does not just happen in quiet spaces;
* often occurs when persons served are performing an action of daily living;
* requires the clinician to manage multiple, complex variables to help persons served to reach a functional outcome;
* provides outlets for persons served, to sustain and increase emotional health, in conjunction with cognitive communicative health;
* is how you do things;

Let's communicate where we live!