Wide World of Speech

It's time now for a broad - spectrum, quick but clear look at the world of communication sciences and disorders (CSD), in a post I wili call (obscure sports television reference) "PWC Wide World of Speech". It's both the thrill of a good therapy outcome, and the agony of forgetting to pack that new tool you were counting on for today!

Here are some recent clinical and research notes on events in the field, that many CSD professionals may have seen and noted.

COGNITION: Retired actor Bruce Willis appears "stable" to his ex - wife Demi Moore, as she commented recently about Willis' life with frontotemporal dementia for entertainment media. Moore stressed that not only does Willis enjoy moments of attention with family and friends, but he also benefits from all his supports living mindfully, or being in the moment when they're with him. Want to know more about frontotemporal dementia? See https://www.alzheimers.gov/alzheimers-dementias/frontotemporal-dementia, or Rene Utianski's PRIMARY PROGRESSIVE APHASIA AND OTHER FRONTOTEMPORAL DEMENTIAS (Plural, 2020).

FLUENCY: A July 2022 edition of the podcast "ASHA Voices" featured a discussion on how stuttering treatment might not focus upon achieving the highest level of fluency, but instead how the stuttering individual can learn to function in a chaotic world. To learn how stuttering might connect with neurodiversity, click https://leader.pubs.asha.org/do/10.1044/2022-0707-podcast-constantino-stuttering-neurodiversity/full/.

HEARING: Apple has received FDA approval for its software package that, when loaded onto their Air Pods Pro 2 listening devices will allow the wearer with diagnosed mild to moderate hearing loss to use them as hearing aids. It's been hinted at, that the vibrant market of "hearable" wearers might make wearing a visible device in your ears, free of stigma. If your consumer, family member, friend or neighbor has a mild degree of difficulty understanding speech, recommend they get tested and their doctor rule out a medical problem. For more information, see https://www.apple.com/airpods-pro/hearing-health/

LANGUAGE: What is the R.A.I.S.E. framework? An acronym for principles recommended in the evaluation of consumers with primary progressive aphasia: read it as client-clinician Relationship, Assessment choices, Including the client and care partners, providing Support, and Evolving procedures. These components should exist for any clinical assessment, right? Read about it in the paper by Jean Gallee' and colleagues, at https://pubs.asha.org/doi/10.1044/2024_AJSLP-24-00085

SPEECH: Virginia Member of Congress Jennifer Wexton is not on the ballot this November, choosing to soon spend time with her family as she lives with Progressive Supranuclear Palsy, called by some clinicians a "Parkinson Plus" impairment. She is closing out her term in the House, meeting her responsibilities, through use of AI - mediated synthetic speech she composes on a handheld computer. Her resilience can be seen at: https://youtu.be/UDwamEdbZk8?si=-AlANYcrpNP54aTX

SWALLOWING: Joanne Yee and colleagues report in the September 2024 issue of the AMERICAN JOURNAL OF SPEECH - LANGUAGE PATHOLOGY, on how standardizing exercise - based swallowing treatment might improve the swallowing therapist's ability to achieve the best outcomes. The paper is one of a series titled "Forum: Proposed Considerations for Fostering Rigor and Transparency in Dysphagia Research" in this journal issue. For more information, look at https://pubs.asha.org/doi/10.1044/2024_AJSLP-22-00179

VOICE: Harper Steele commiserated with another trans woman about her voice, in the recent Netflix film "Will and Harper". Harper's acquaintance commented on her own thoughts following a trial of voice therapy, by saying - but this is my voice. See the forum "exploring Culturally Responsive Voice Care", prefaced at https://pubs.asha.org/doi/10.1044/2024_PERSP-23-00126, for more information.

OTHER: Speech - language pathology (SLP) is challenged to assume responsibilities for a level of professional practice, above that for a individually - oriented, impairment - based discipline. "Communication Public Health", by Sarah Warren and colleagues, offers a road map for how the field might grow into a population - level science. In the tutorial, SLP clinicians are given directions to add prevention modalities and to labor for increased equity for serving the entire population. Remarkable in this paper, were citations of earlier papers which advocated a similar approach for their professions: "Occupational Therapy in the Promotion of Health and Well - Being" (AJOT, 2020), and "Promoting Health and Wellness: Implications for Physical Therapy Practice" (Physical Therapy, 2015). The Warren et al. paper can be found at https://pubs.asha.org/doi/10.1044/2024_JSLHR-23-00491.

Come explore the Wide World of Speech again sometime!

Peeling Off the Caul

I'm working the weekend for the Cognitive Division. Welcome back! The Summer was certainly a welcome transition, even the broiling hot days when I felt I was being prepared for some hungry young person's $5 meal deal. I wanted that summer vibe - that attitude that says, vibrations must only be good. In my part of the world, the cicada fest made me feel like a first - time kid at Disneyland. NOY - ZEE! The politicians were almost as noisy, and more discordant, too. "Communist"? That word is tossed around as mindlessly as "invasion", "skyrocketing inflation" and "life". Oops, I almost forgot - "deplorables", "MAGA crazies" and "convicted felon". Political campaign stresses we can largely avoid, with all the experience gained from years of our being bombarded by emails, texts, posts, pop - ups, voicemails, and vexations. The progression of this year's Presidential campaign cycle shows us, so far, how much we're exhausted from stress. It's noxious, counter - intuitive to seek it out, and we want something else. My summer was very stressful as well, and it feels good now to peel off that caul of protective muck to re-enter the world. The world is stressful enough.

The world of CSD (communicative sciences and disorders)? Very stressed at ground zero. We are primed to get paid less for our services, as federal cost - containment interventions shock the market. Our employers set staffing guidelines for SLP's (speech - language pathologists), that are required to have patient contact for at least 90% of the work day. In some work settings, SLP's are given minimal budgets for professional materials, supplies and equipment to serve our consumers. In some work settings, SLP's are not offered full - time employment but paid per visit. There's still, the relatively limited field of vision that referral sources have when considering referrals to SLP. And, as one of the more fundamental treatises of this blog argues, the public's understanding of the fields of CSD approaches its understanding of U.S. geography. A little Vince Guaraldi traveling music, please (obscure classic TV reference)? Let's follow the lines on the current map of our fields to examine why work in CSD, with emphasis on SLP, can be stressful - and why most of us love it, anyway.

The headlines spur us on to advocate against a reduction in SLP reimbursement of as much 6.3% for 2025. The cuts are a point on the trend line of recent budget decisions of Congress and the Center for Medicare and Medicaid Services (CMS), and that co - occur with plans for CMS to augment the reimbursement rates of primary care physicians. We do need to advocate for how we're paid and supported in all employment settings, because our University training is expensive; we often use our salaries are often used to finance therapy materials, and our ability to serve increasing numbers of potential consumers is limited by the pragmatics of keeping the lights on. Making an adovcacy decision based solely on our fiscal needs, seems an extremely easy decision. Yet, offseting the reimbursement cuts to SLP's, at the expense of giving primmary care physicians less support - is that a wholly acceptable decision for our healthcare system? Primary care docs are trained to look at the holistic needs of their patients, including those now trendy "social determinants of health". These physicians should appreciate the help that CSD professionals, especially SLP's, can give in addressing the functional needs of the persons they serve. Though it's inevitable that the Feds will cut our reimbursement rates, CSD folks can advocate for a strategic middle ground that benefits not only oursselves, but also primary care physicians as a bedrock referral source.

SLP's who work as a 1.0 FTE (full - time equivalent) position often carry a caseload of 6 - 7 patients during the eight - hour day. Depending upon your work setting and the procedures set by your facility, scheduling and completing all your appointments, can be a high - wire act. Variables for scheduling the workday that often make you dizzy can include: how you commute to work; the demands on each patient's time by other professional or family demands; any change in medical status, real or imagined; MEETINGS?; the endurance a patient has for keeping focus on the program's goals, etc., etc. How you pace your clinical day, as last nighht's sleep may or may not have prepared you; if you got out the door at the right time; if you're flexible about getting your lunch, so you can assist a patient at mealtime; if you're physically/mentally at your best; if the outside world doesn't intrude with news of a sick kid at school, or some car hit yours in the parking lot, - they're all constant tests of your endurance and flexibility for meeting demands of your daily productivity and your professional stature. When your schedule for a certain patient is locked in by a plan of care, a missed appointment should be made up - often during that same week. We SLP's find ourselves often selling and re-selling to consumers our products when schedules get shuffled, unless the professional has the confidence to think on their feet, and lift up your therapeutic alliance - so your consumer takes the lead to insist that your work is important, and that time can be found for the make - up. In a busy facility, a busy practice and a busy team of many professionals, meeting your schedule demands is a daily adventure. Make your day a challenge to be overcome, and an adventure to be met: plan, be mindful, stay positive, you're the expert; and make your world the best it can be every day.

Think about the well - resourced SLP clinic. Have pictures of it in your mind. What is the best equipment you would put there? What supplies, what materials? What shiny new therapy products that have garnered critical praise in the literature, are on your wish list? Keep wishing. Outside of a dedicated clinic with a large consumer base, an SLP must be relentless and creative in acquiring new inventory to do the job. A cognitive test? Find something free on the Web. Tools for swallowing treatment? Borrow, steal, beg or make your own supplies. For example, when a voice patient will benefit from an Acapella respiratory trainer but the MD will not write an order, visit your nearby department store and pick up a plastic water bottle with indwelling straw. Tell the consumer when two inches of water are added to the sealed bottle: BLOW BUBBLES! for as long as you can. Increased durration of the continuous bubble blowing stream, should translate to increased strength of the expiratory muscles. Even though you may not have had to "McGyver" your therapy materials during your career, please stay abreast of the latest publications, research achievements, as well as the trends among your colleagues in using therapy tools. There may come a time when your administrator announces that your clinical budget has been cut, and your need for the newest edition of a clinical treatment package you've relied upon won't be so accessible. Know the constructs and strengths of all your tools. Your ability to construct personalized tools may not only solve the problem of a disappearing clinical budget, but may better assist your consumers feel that their "real life" goal is within reach.

My SLP job classification for my current work is neither full - time nor part - time, but "casual"; perhaps not the most frequently used job name, yet it places the SLP in the role of consultant. You're called in to serve consumers that require specialized care after an onset of neurological impairment, or impairments of the upper aerodigestive tract, that impact the individual's function for communication, cognition or swallowing. If you're part of a multidisciplinary team, you are often the last professional to receive a referral - if you receive one at all - and often, the time allotted for you to help your consumer achieve the goals identified leaves you barely the time to assess and develop a care plan. In the home health care world, SLP's are called in for a relatively small percentage of your agency's total caseload, thereby limiting the total amount of cases a professional might carry each week and the total income an SLP might earn. These clinicians often must carry more than one job to earn income equivalent to full - time enjoyment, because their lives outside work occur on a 24 - hour schedule, and their bills arrive to be paid on that same schedule.

What do SLP's actually do? That question has lingered in the air of every work setting in which I've been employed, from the beginning of my career. The answer to that question is easier than ever now: look at the "ASHA Practice Portal", https://www.asha.org/practice-portal/. ASHA, our national accrediting and professional standards organization, has numerous additional resources to help spread the word about our professional activities. Yet, how does the public know about what we do if, in many cases, the public has no knowledge that we exist? Frequent blog readers have seen my rants on how the SLP is so rarely represented in the arts (movies and television). The six - season run of an American television series THE RESIDENT, where titanic medical issues were largely solved by - surgeons, is my most recent example. The few references to any rehabilitative service in the series were made by the CEO of the fictional hospital, who also practiced orthopedic surgery, so her preferred modality was physical therapy. The most frequent response to a PT referral by a series character was "it takes so long". I'm continuing to watch a new TV series, BRILLIANT MINDS, whose main character is an eccentric neurologist modeled loosely on the career of Oliver Sacks. How long will it take to make the SLP as familiar to patrons of the arts, as detectives or lawyers or even English midwives?

Yet, we do love our jobs. You need only see the SLP's in all our work settings to note: regardless of all the economic struggles, and the often "Modern Times", M.C. Escher landscape of bureaucracies that confine your day; in spite of the shrinking pocketbooks that help you get the tools you need, and even with all the hills you still have to climb before you are seen - like John Prine and iris DeMent might sing, we're never gonna let our mission go. In this day and age, when it's so easy to just attack, attack, attack your adversaries and never admit defeat - real communication is still, pretty wonderful. Take care of you through the stress: talk to others. Eat, sleep, move well. Give up severe pressures to a power above you. Look forward to tomorrow. See that goal of yours. See yourself, achieving it. Celebrate!