I Won't Know What You Do

The day was almost over for me. I had successfully seen two people in my area, and had successfully led them through some activities. I was running now on very little energy. There was a saving grace in this being my last visit of the day, because this consumer had some different needs than the rest of my caseload. She had had a cardiac episode that took her to the hospital, where she underwent a cardiac bypass graft (CABG, or by those in the know, "cabbage"). Your question might be now, how do problems with your heart affect your speech? Answering that question required more than a few minutes, but I felt it was critical for our first visit to establish with the consumer - why I was the expert. I needed her buy - in for the evaluation procedures I had planned for her. If she didn't know what I was doing, why would she want to burn energy and do the work to get better!

She soon did say she understood that the major nerve, called the vagus ("wandering") or tenth cranial nerve, feeds both her heart and her larynx, or voice box. This connection often shows up in the videofluoroscopy suite, when a consumer presents for the swallowing x - ray with the complaint of a dry cough - and the sensation that something is lodged in his throat. Often, the person has a history of cardiac problems. Not only can the primary medical concern affect the larynx's function, but the support the consumer received to breathe during the surgery, would show up as a dry cough. Hmmmm....my listening to her voice told me that there was intermittently, less power in her sound with pitch "breaks", like a sputtering short - circuit in the stream of conversation.

I was thrilled to see last week the new Netflix comedy special by Vir Das; not for the misfortune he had to overcome, but that he had a treatment technique suggested for him that this lady used as well. He cut great comedic hay from this, but it is simple, it's real-world, and it often helps! You'll have to see the special to learn the technique. I told my patient, who had a quizzical face on when I handed her the specialized equipment, "OK, I've shown you how to do this. You gave it a try, and you showed me that YOU know how to do it. When I'm not here, I've asked you to practice using it in your exercise, but - I won't know what you do! I can only hope that you'll try it and notice if it gets easier - that might tell you, speaking longer is getting easier!".

At the end of the special, Vir Das showed what he had learned. My patient did as well - the credit not due to me, but in the faith she had shown, that she would get better.

Do You Have Primary Prevention Products? w/ M. Elwer

Not long ago, I walked through what could be considered a speech clinic of the near future.

You might imagine sleek exam rooms outfitted with high-powered flexible endoscopes capable of visualizing oral, laryngeal, and pharyngeal structures in stunning detail. Perhaps you picture the latest tablets and smartphones paired with high-fidelity digital audio systems, ready to reproduce speech output with crystal clarity. And yes, today’s communication sciences and disorders (CSD) professionals are rapidly updating practice models, with major shifts in third-party reimbursement policies unfolding even as this post is written. But instead of being packed with cutting-edge tech, the clinic I visited had changed in a different — yet equally profound — way. On its shelves were not just diagnostic tools or therapy devices, but something often overlooked in our field: primary prevention products. The inclusion of prevention activities in clinical practice represents both something new and something deeply rooted. But what does prevention really mean for a CSD professional? How futuristic is it to position prevention as a product line? And can most practices absorb prevention into their existing business models?

A Slow-Building Revolution In 1987, the American Speech-Language-Hearing Association (ASHA) released a position paper advocating for the prevention of disorders related to communication, cognition, and swallowing. This wasn’t an immediate call to action — more like the birth of a slow-rolling snowball, steadily gaining size and momentum. To many clinicians, prevention may feel like a radical departure from traditional models. The reaction often goes something like: “Wait — not only do I help people improve after a disorder develops, now I have to work to prevent them from needing me at all?” The answer, in short, is: yes. But paradoxically, incorporating prevention can actually drive more people to your door. In the short term, yes, it may reduce some individuals’ need for intensive treatment. In the long term, however, it increases your community visibility, builds trust, and ultimately expands your reach.

Understanding Primary Prevention Primary prevention aims to reduce or eliminate the conditions that can lead to a communication disorder before any symptoms arise. This can be done in two main ways: • Altering a person’s susceptibility (e.g., improving vocal stamina so someone is less affected by noisy work environments) • Reducing exposure to risk (e.g., modifying a work schedule to give the voice time to rest) For many CSD professionals, this concept feels the most foreign — perhaps because primary prevention isn’t reimbursed like diagnostic testing or treatment. And it doesn’t always look like “therapy.” It often looks like selling or teaching tools, activities, or techniques to individuals who don’t yet have impairments. Can we teach healthy people how to stay that way? Can we stock and sell low-cost wellness products? Can we handle the sales tax? Yes, we can. But we must step out of our comfort zones as clinicians to do so. The return on investment? A stronger community presence, a broader impact, and a more sustainable professional model. ⸻ So What Is the Stuff of Primary Prevention? In this future-forward clinic, here’s what I saw on the prevention shelves: I. Oral-Motor / Motor Speech • Kazoobie Kazoo – $2 • Hohner Beginner Harmonica – $8.50 II. Fluency • Mouth Sounds by Fred Newman – $10 • The Speech Choir by Marjorie Gullan – $1 (used) III. Voice • C.D. Bigelow Elixir White/Green Hair & Body Wash – $10 • 1 gallon distilled water – $1 IV. Swallowing • Ziploc kit with Life Savers & mint waxed dental floss – $5 • Ziploc kit with 12 sterile tongue depressors – $5 V. Cognition • Radius ergonomic garden trowel – $10 • GAMES magazine, single issue – $5 VI. Speech & Language • The New Moosewood Cookbook by Mollie Katzen – $10 • Walk Off Weight with Your Pedometer by Jan Small – $10 Note: Product mentions are coincidental and non-sponsored. These items were selected for their low cost, broad community availability, and potential to support wellness through primary prevention. ⸻ The Clinic Experience In this imagined clinic, the prevention section has its own street-level entrance, keeping the flow of wellness consumers distinct from tertiary care patients. Adjacent to the retail area is a video viewing room with several devices for product demonstrations. Nearby racks offer literature from local wellness resources — classes, community events, and support networks. The aim? To immerse the customer in a holistic health-promoting environment. ⸻ Back to the Questions Let’s revisit the original prompts: • How do we do primary prevention in CSD? • What is the stuff of it? • What are the outcomes we want? We do primary prevention by teaching, training, referring, marketing, selling, cooperating, and participating. We bring healthy individuals into our sphere not just to diagnose, but to keep them healthy enough that diagnosis never becomes necessary. We collaborate across community sectors — with educators, fitness instructors, faith leaders, performers, and health coaches — to support our prevention mission. Outcome measurement may be simple: improvements in health literacy and patient activation, such as those measured by the Patient Activation Measure (PAM) developed by Hibbard and colleagues. The ultimate outcome? Lower long-term healthcare costs, higher function, and more empowered communities. The story of primary prevention in our field is still being written. As we walk through this near-future clinic, we must ask ourselves: What do we see on the shelves? What kind of professionals are we becoming? Next stop: the secondary prevention wing.

Launching Lifesavers w/ M. Elwer

Let’s be honest: as candies go, Lifesavers seem innocuous enough. A sugary halo of nostalgia, lightweight in both texture and guilt. Five calories apiece, maybe. Small enough to forget—unless you’re a speech-language pathologist trying to teach a man how to cough again. This was no ordinary coughing session. This was Mr. H., a retired jazz pianist with bulbar-onset ALS and the wry humor of someone who’s played too many smoke-filled clubs to take much seriously anymore—including me. And yet, there we were, him eyeing me suspiciously as I held out a single cherry Lifesaver and said, “Put this in your mouth. Don’t chew it. Now blow it across the room.” “Blow it?” he croaked, eyebrows rising so high they almost met his hairline. “Lady, are you trying to kill me or save me?”

Honestly, I didn’t know the answer to that in the moment. It was absurd on the surface: giving hard candy to a person with a compromised swallow? In most clinical scenarios, this would have been malpractice, if not suicide. But desperation and science often meet in strange places—and this was one of them. Research had emerged—Plowman and colleagues again—suggesting that expiratory muscle strength training (EMST) could preserve, and in some cases even improve, cough and swallow function in early-stage ALS. The concept wasn’t new, but its application was still uncharted territory. We weren’t chasing miracles—we were chasing milliseconds of preserved function. And sometimes, milliseconds matter. So yes, we launched Lifesavers. I set up a towel runway on the tile floor, marked by neon tape. I positioned Mr. H. comfortably in his recliner—spine neutral, head resting back, feet planted wide like he was bracing to play a power chord. The goal wasn’t candy ejection, per se—it was abdominal engagement. Diaphragm activation. The art of a well-supported cough disguised as something playful, even ridiculous.

“Take a breath into your belly,” I said, miming the expansion with my own hands. “Now—BLOW HARD. Send it flying. You can’t let this candy beat you.” He rolled his eyes. Then he blew. It went about six inches. We laughed. He cursed. We tried again. By the sixth attempt, the Lifesaver hit the tape. By the ninth, it cleared it. On the tenth? It ricocheted off the coffee table leg like a tiny red puck, earning a fist pump and a raspy cheer from Mr. H. And then—something extraordinary. As I leaned down to retrieve the candy, I heard him say, almost clearly: “Don’t waste a good one. That was cherry.” It was the first spontaneous, intelligible sentence his wife had heard in weeks. You can’t always measure success in meters or milliliters. Sometimes, it’s measured in shared laughter, a candy skimming across the floor, or a whispered flavor preference breaking through the fog of disease. Sometimes, what looks like nonsense is the deepest kind of therapy. And sometimes—just sometimes—spitting candy can help someone reclaim their voice.

A Day in the Clinical Life

The time: it could be an hour from now, or it could have occurred twenty years ago. The place: Just outside my patient's space. She might be in a clinic treatment room, or it might be her apartment or home. I enter - "Good morning!"

"Thank you for letting me visit with you today. Your doctor asked me to visit with you, after you returned home from the hospital. Who is the doctor that ordered my visit? It was Dr. _____! You remember her, good! Did you work with a speech therapist in the hospital? OK - what I want to do is to help track your recovery from your condition. May we do that? Thank you. Do you think your ability for _____ has changed, since this all started? Tell me what you can".

"Thank you for the compliment. My mother used to say I was a nice person. I kidded with her in return, now I'll never get a date! But I think it helps me help others. Did your parents or your teachers, or other adults want you to be that way?....OK. I've enjoyed our conversation, all of it, and our conversation has given me some clues as to what you're dealing with - Can we now do something now, that's a specialized way of observing how people communicate? WE CAN? Oh, thank you. I'll explain each part of this, but please ask any questions if they come up".... ....and so it goes. After all the assessment is done, and I explain what I see, and get feedback from her, I work to "close the sale". That's a component of what we do, speech - language pathologists. Improved skills are our widgets, our EV's, and our commodity futures. Our product, when it is sold with clarity, honesty, compassion and commitment; - it's the best. We only want to help you connect.

Time Out: The Importance of the Handoff (revised from 2/5/2017) w/ M. Elwer

The whistle is blowing today—not just on the football field, but on our current blog series about becoming a better SLP. Time out! We’re stepping off the sideline to examine something that happens every day in speech-language pathology practices: the handoff. Just like in football, a good handoff can keep the momentum going. A bad one? It can result in a fumble. In our field, a handoff happens when another clinician steps in to cover your caseload—maybe because you’re out sick or on vacation. And just like a quarterback handing off the ball, the success of that session depends heavily on how well you’ve prepared your substitute to carry the play forward.

Of course, the treatment plan is already in place. It outlines the goals and objectives, both short- and long-term. But treatment plans don’t carry the full picture. As the SLP of record, you’ve likely built a therapeutic relationship, developed trust, and discovered which activities truly click with the person you’re serving. You’ve gathered a set of materials and approaches tailored to that individual. The covering clinician doesn’t have that advantage—and shouldn’t be expected to start from scratch. Why not? Because they haven’t had time to build that same rapport.

The covering SLP might ask questions like, “How do you feel about your speech therapy progress?” or “Which activities have helped you the most?” But if the client doesn’t remember or can’t communicate that effectively—and you haven’t left clear guidance—then the clinician is left guessing. At that point, it’s tempting to reach for a generic activity that’s worked with others who share the same diagnosis. But here’s the problem: a diagnosis doesn’t tell the whole story. What works for someone with aphasia might not work for this person with aphasia. Predictability drops sharply when we remove the individual from the equation. That’s why a good handoff includes just a little extra effort. A note like this can go a long way:

“Reminisce with her about family days. Use the photo album by her bed. Point out family members and ask about what’s happening in the pictures. When she talks about her family, her fluency improves dramatically.” Sharing that kind of detail takes maybe sixty seconds—but it could make the difference between a forgettable session and a meaningful, goal-driven one. So the next time you’re handing off a caseload, remember: it’s not just a plan of care—it’s a play in progress. Make the pass count.

My Swallowing Is My Business (revised from 11/6/14) with the good taste of M. Elwer

This post offers a glimpse into what I call “organic SLP” — speech-language pathology that grows from real human experience and education. The goal? Empowering patients to understand their own bodies and take action to prevent disability whenever possible. One of the most effective ways to do that is by teaching the basics of normal function. This handout, originally created for an actual patient, is just one example. As always, your feedback is welcome!

⸻ Most of us don’t think about swallowing — and why would we? I certainly didn’t, at least not until it became part of my clinical focus. The truth is, I started swallowing long before I ever had a conscious thought. Scientists have found that human fetuses begin swallowing around 15–16 weeks of gestation. I developed my first taste preferences in the womb. After birth, I was fed by others and eventually learned to feed myself, developing the skills to get food into my mouth and down the hatch.

As a child, swallowing was something I could do in just about any position. I ate sitting upright, of course — but also lying flat on the couch, hanging upside down, and even mid-spin on a carnival ride. I did it because I could. I didn’t think much about posture or process. As I got older, however, I began to notice that swallowing worked more easily — more efficiently — when I was upright. Gravity helped, coordination improved, and things just felt smoother. Swallowing is both voluntary and involuntary. Some muscles I control intentionally — like those involved in chewing and moving food with my tongue. Others work automatically, governed by brain regions that don’t require conscious effort. These two systems — voluntary and automatic — work in seamless cooperation, allowing me to swallow thousands of times a day without giving it a second thought. Over the course of my life, swallowing has become a set of deeply ingrained habits — a finely tuned sequence of motor memory. Here’s what it looks like for me:

I pick up food with my fingers or a utensil. For liquids, I use a spoon, cup, or straw to bring the fluid to my lips. I hold the food or liquid on my tongue, shape it into something manageable, and either chew or compress it until it forms a cohesive, slippery mass (known as a bolus). I then use my tongue to squeeze the bolus to the back of my mouth. That’s the point where control starts to shift — when my swallow is “triggered” and the automatic part takes over. The bolus is propelled into my throat. My larynx (voice box) lifts, the airway is protected, and a valve to the esophagus opens. Once the material enters the esophagus, it’s carried to the stomach by rhythmic waves of muscle contractions. That, in short, is my swallow. And yes — my swallowing is my business. It matters to me because eating is about more than nutrition. I eat to live. I eat for comfort. I eat to connect with others. That’s why I teach patients to care about their swallowing, too. Because when we understand what our bodies are doing — and how to support those processes — we can protect our quality of life. My body. My business. My swallow.

A Quiet Kind of Suffering, by M. Elwer

There’s a quiet kind of suffering that comes when something as basic as eating and swallowing becomes a challenge. It crept into my life slowly — first as a sore throat that wouldn’t go away, then as a growing fear every time I tried to eat or drink. At first, I thought I had just caught a cold or had a mild infection. But as days passed, the sore throat stayed. It became painful to swallow even my own saliva. Food didn’t go down smoothly anymore. I started avoiding meals, choosing soft foods that were easier to manage but still hurt going down. Eventually, I wasn’t eating enough, and I could feel my energy fading. The worst part? The anxiety. Every bite felt like a gamble — would I cough? Would I choke? Would someone notice? Eating, something that used to bring me joy and connection, now brought only dread.

People around me didn’t understand. “Just eat slower,” they’d say. “Try soup.” I did. It didn’t help. Soon, I started eating alone. I didn’t want anyone to see the way I had to chew things over and over, or how I’d wince with every swallow. I was embarrassed. I felt weak. And more than anything, I felt invisible — like no one really understood what I was going through. Eventually, my doctor referred me to a speech-language pathologist. Honestly, I was confused. I didn’t need help with talking — I needed help with swallowing. But I soon learned that SLPs are trained in more than just speech — they’re also experts in the muscles and mechanics of eating, drinking, and swallowing safely.

Still, I was nervous. I didn’t want to be another chart, another diagnosis. I wanted someone to actually hear me — and see the pain behind my problem. I want more than just therapy. I want compassion. Please don’t rush me through a checklist or hand me a stack of exercises without getting to know me. I’m not just a disordered swallow. I’m a person who misses sitting at the table without fear. I miss laughing mid-bite. I miss enjoying food without overthinking every single movement in my mouth.(this what I told the therapist)

BUT THIS WAS WHAT I ACTUALLY NEEDED FROM THE THERAPIST : Understand that I’m scared. Not just of the pain — but of something going wrong. Choking. Getting worse. Never getting better. • Acknowledge my frustration. It’s exhausting to plan every meal like a strategy session. It’s tiring to explain over and over what I can and can’t eat. • Help me feel safe. Teach me techniques, yes — but also tell me why they help. Show me how my body works, and help me believe that it can work better. • Celebrate the small wins. A spoonful of yogurt with no coughing. A full glass of water finished. A pain-free meal. These are victories. Treat them like that. • See the whole me. I’m more than this swallowing problem. I’m a person with goals, habits, fears, and a life that I want to I’m not just coming to you for therapy. I’m coming to you for hope. I want to feel normal again — to enjoy food, to nourish my body, to live without anxiety at every meal. If you can meet me with empathy, if you can treat me as a person first and a patient second, then I’ll walk this road with you. I’ll do the hard work. I’ll practice, I’ll push, I’ll persevere. But please — help me feel like I’m not alone in this.

Cherry Cherry (revised from 7/9/17) from M. Elwer Farms

🍒 Cherry Cherry: A Rhyme About Evidence, Judgment, and Juicy Decisions 🍒 Let’s take a poetic pause today to reflect on something deceptively simple: how we choose what we act on—clinically, politically, or even when picking fruit. Whether you’re selecting research for therapy decisions or watching policymakers spin partial truths, cherry picking happens everywhere. And while it might sound sweet, it often leaves out the ripest, most important information. Enjoy this playful reminder not to cherry pick—whether you’re an SLP, a citizen, or just someone searching for the best summer fruit.

⸻ “Cherry pick”: to select the best or most desirable from a group, often in a way that leaves out important context or less favorable data. Merriam-Webster, accessed 7/9/2017 ⸻ 🍒 Cherry Cherry 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 judgment Should be drawn up the evidence wick; If you don’t know the pros and cons prior You look like a poor-prepared… 🎶 CHORUS: Don’t cherry pick; Your literature, scour; Know why your plan works, Or it’ll be a long hour!!! ⸻ 🎶 FINAL REFRAIN: Don’t cherry pick; It’s supposed to be hard—! Finding the best stuff Will be the best RE—WARD! 🍒 Final Thoughts Cherry picking may be tempting—it’s quick, easy, and sometimes looks good on the surface. But whether in therapy, research, or public policy, the real flavor comes from doing the deeper work. So next time you’re making a decision? Look all around. Don’t just grab what’s convenient. Seek what’s complete.

My Ethnography (revised from 11/4/16) M. Elwer, your guide

This is not the culture and heritage for most of us.

After a long and divisive political campaign in the U.S., culminating in the November 8 [2016] election, we've been pushed to choose sides on complex social and policy issues. Around the world people are watching, and what they see is often disconcerting. Lines are drawn quickly. We retreat into our own camps even faster. We tend to duck down when cultural confrontation arises. We want to watch, to understand, but not necessarily to engage. Like watching a car crash-we can't look away, but we fear getting pulled in. Because involvement might change us. That's how it is living in a culture: loosely defined as a system of shared beliefs and behaviors. Whether you're a leader or simply trying to find your way, it's essential to understand how a culture works. Who holds power? What are the rules? How do you begin to participate?

Speech-language pathologists (SLPs), no matter the setting, often find themselves in a culture but not of it. We must understand its workings-not to fit in, but to serve effectively. To help someone reach their communication goals, we need to understand the cultural context that shapes their experience. That's where ethnography comes in. What is an Ethnography? An ethnography is a close observation of a culture

How it's structured- How it functions- How it influences people It's a practice rooted in anthropology, but it can be powerful in speech-language pathology. SLPs are already trained to observe behavior and analyze outcomes. Ethnography simply brings those skills into a new frame. It helps us see the cultural "baseline"-how things are before therapy begins. We gather data through interviews, surveys, media, products, even social media posts. These details tell the story of the culture. Then, when therapy begins, we can track how those cultural factors impact the success or challenges of intervention.

Why Does It Matter? You might wonder: why add this extra task for the SLP? Because culture shapes everything. Motivation, priorities, access to care, family involvement, and even the definition of success-all are influenced by cultural context. When we understand this, we don't just treat speech or language. We treat the whole person, in their environment. Maybe we aren't part of the culture. Maybe we're just visiting. But visitors can learn. Visitors can listen. Visitors can show respect. Ethnography isn't just a tool. It's a mindset-and one we need now more than ever.

Shuffling in Orlando Again - (after 12/15/2014) w/ tourist advice from M. Elwer

The Orlando Shuffle: Reflections from ASHA 2014

Here I am again—at the 2014 ASHA Convention in Orlando. And like every year, I asked myself the same questions before stepping into the chaos: Why am I here? What do I hope to gain? After more than three decades in the field of speech-language pathology, what could another convention possibly offer? Turns out, quite a lot.

Convention Logistics: A Florida Adventure Let’s talk logistics. The Orange County Convention Center is massive and rooted firmly in Florida’s car culture. Unless you had the luxury of a hotel connected by footbridge or shuttle, you were commuting through messy morning traffic. Luckily, I wasn’t driving. As the Convention Center rose from the swampy landscape, I reached into my canvas bag for the essentials: 🪪 Badge, 📝 legal pad, 📘 program guide, 🍫 high-energy snacks. The car screeched to a stop, and I launched out like a Navy SEAL, dodging badge-laden attendees and coffee-toting colleagues.

Dodging the Herd: A Sport Unto Itself Every hallway was a stream of SLPs hustling to their next session, like some professional obstacle course. I credit my Chicago Loop speed-walking days for helping me weave through the crowd without collision. “Whoops—sorry!” became my unofficial mantra. But along with the near-misses came friendly faces and spontaneous reunions. The buzz was electric.

Why Still Go? What’s Left to Learn? My first ASHA Convention was back in 1974 in Las Vegas. ASHA hasn’t returned to that city since, but I’ve kept returning to the Convention. Why? Because no matter how long you’ve practiced, the learning never stops. Clinical Highlights: What Caught My Eye ✅ Life Participation for Aphasia Clients with aphasia can and should participate fully in life—book clubs, tech classes, community activities. We’re no longer just treating deficits; we’re supporting life engagement. ✅ Surface EMG for Dysphagia This biofeedback tool provides real-time data during swallow therapy. Both clinician and client can see immediate progress, making treatment more efficient and motivating. ✅ Medicare Changes for SGDs New policies may prevent users from accessing unlocked speech-generating devices. That’s not just a technical issue—it’s a major threat to quality of life for many.

Why This Isn’t a Data Dump This is a blog, not a lecture summary. I’m here to share impressions, not statistics. The Convention is more than CEUs—it’s about connection, reflection, and passion for our profession. The energy in those rooms is something you can’t quite quantify—but it fuels your work for the rest of the year. The People, the Parties, the Pulse of the Profession ASHA is our annual reunion—a gathering of the SLP “clan.” Over time, some traditions have shifted: • 📢 The keynote now opens the conference with no competing sessions. • 🥪 Boxed lunches are now an option. • 🎓 University open houses have shrunk. • 💃 The beloved Convention dance? Gone. But even with the changes, the sense of purpose and community remains stronger than ever.

Why I’ll Keep Coming Back ASHA isn’t just work—it’s my annual vacation, recharge, and professional growth window. Over the years, I’ve presented on topics ranging from aphasia pharmacotherapy to swallow screenings and even horticulture therapy. Every November, that same canvas bag gets packed. And I show up.

Communication Fitness - Redux (revised from April 23, 2017) w/ M. Elwer

Communication Fitness: A Fun Guide to Staying Sharp Good morning, and thank you for joining us today! Each month, we offer community talks on staying healthy—and this time, we're diving into something you might not think about often: keeping your communication and swallowing skills strong. Before we go further—quick show of hands: Can everyone hear and understand me okay? Great! That check-in is actually a perfect example of what we’re talking about today—being mindful of how we connect and communicate.

Why Prevention Matters Just like you hit the gym or eat healthier to stay fit, you can also take steps to prevent problems with speaking, understanding, and swallowing. No doctor’s prescription needed—just smart, simple habits you can work into daily life. Simple Daily Habits That Help Primary prevention is about reducing your risk before a problem starts. Here are some fun ways to keep your voice and swallowing muscles strong: - Sing your favorite songs—yes, even in the shower! - Blow bubbles through a straw into a glass of water.

- Spit watermelon seeds for distance (just for fun!). - Try to blow a tissue across the table using only your breath. Who Helps with Prevention? Speech-language pathologists (SLPs) don’t just help after problems show up—we’re also here to help you stay well. Sometimes we work directly with you; other times, we consult with singing teachers, doctors, or even wellness coaches to help support your voice and swallowing strength. The Bigger Picture We need more tools, teamwork, and awareness around prevention in our profession. SLPs should be paid for this valuable work—because helping people stay well can mean fewer problems later. Prevention is proactive, empowering, and effective. So next time you breathe deeply, sing a tune, or enjoy a meal—know that you're doing something good for your future self. Let’s keep communication fun, fit, and full of life! Can I get a show of hands—who’s ready to give prevention a try?

Surveillance

I've enjoyed watching people most of my life. Whether it's sitting in the stands of a sports event, walking through the corridors of a state or national CSD (communication sciences and disorders) convention hall; if it's not playing tourist during my occasional playing hookey days in the "Windy City", then it's enjoying a new route between stops on my home health schedule - seeing what people are doing, how they're dressed, what are the secrets they're sharing, but that I can't hear - !! People - watching, it's my jam, my marmalade and my preserves, too. Years ago, I had figured out that watching and listening to others was my primary learning style. Shyness plus my stuttering and my endomorph body type, made it an easy decision to watch and learn, over diving in and getting involved. It could have led to stalking people, or worse? I was too afraid to do more. "I like to watch", says Jerzy Kosinski's character Chance. That fit me.

Of course, years of hindsight would tell you: that's too bad; it was regrettable that this kid didn't find the strength, or didn't get the push from behind, to step up and make more acquaintances and friendships. It wasn't my style, how I saw the world, what greased my gears to make it through my life. My style had made it easier to analyze, break down and rebuild my batting style as a leisure baseballer. Watching how other gardeners design and manage their garden plots, helped streamline my own plant care. My parents each showed signs of hearing loss, from the time I had gone off to college, so their communication struggles gave me insights on how I might help others with similar problems when I became a professional. I was getting experience in surveillance. Through watching and listening, I learned to identify problems and head off any problems becoming worse. Surveillance I learned - I could do for both fun and profit.

Surveillance, commonly known as "screening", isn't a reimbursable service for most clinical professionals. Yet it is one of the more powerful tools CSD clinicians might pull from their toolboxes. A screening clinic that opens its doors for free, to all members of the community, has a magnificent opportunity to provide service to persons who might never know about what CSD professionals do. The opportunities to teach and counsel the people who volunteer to meet with you can germinate into increased clinical caseloads, increased exposure to the entire healthcare system, and increased hope by communities for their needs being addressed. New fiscal support systems need to be developed, so that surveillance - properly known as secondary prevention - can make the CSD professions as well - known as labubus, and more fun to use. I like to watch. I like to help.

There's not enough room

A local healthcare system, the flagship of which is a tertiary care hospital that trains physicians, ancillary healthcare clinicians and biomedical basic scientists, is running a television commercial. Of course, the patient featured in the commercial has had a terrific outcome. She's training to be a trapeeze artist; can you believe it!? And it's her surviving a massive brain tumor that makes the TV promotion memorable. Brain tumors are so scary. I got my first exposure to the mystery and the horror of brain tumors when I watched as a kid, the series "Ben Casey". It was a sterile portrayal of hospital life - no disinfect stink, not much of the clamor of carts, and doc's, of course, don't show the pressure of time on their faces. Miracles, of course, were achieved, in less than 60 minutes each week. That's productivity.

The pressure of time is always there, once you find out there is a brain tumor in your head. The tumor victim might be heard saying: I wasn't born with it, was I? I didn't know it was there until my eyesight started to glitch up, or I found myself losing my train of thought, or - that I vomited all over my prom tuxedo, when I was picking up my date! Why couldn't I have known about this earlier? My head hurts almost all the time now. Is it growing? I'm afraid! I'm afraid it will get so big that I won't know, I won't know what is happening. Please get it out. Take it out, please. PLEASE!!

When there's something found inside you, something that threatens to take over your control of your body, mind and your spirit. panicking is natural. It's natural to want autonomy over ourselves. Pro athletes asserted autonomy, thereby declining vaccines during the COVID pandemic. Everyone who advocates for reproductive health, including the right to abortion services, feel they need to be in control of their bodies as well. Vegans, members of religious sects, owners of semiautomatic weapons, proud owners of old Samsung Galaxy phones and brave Cybertruck owners - they all want to survive and be left alone. Can't the person who finds out there is an invading mass inside her head - isn't she deserving of that same kind of control? Doesn't she deserve to be free of the threats to her identity?

I hope everyone everywhere, who is living or even just discovering that there is a rogue element inside their heads, can find calm and hope that we in the CSD community want their identities to be kept whole. Given that all our identities evolve with development and experience, we'd still want amy person living with a brain tumor to draw on their powers for self - care, the resources of the medical community that are available to them, and the nurturing and uplifting support circles who help every tumor victim tap their deep history, for growing a post - tumor future.

I just couldn't resist. I've been fuming for decades that with all the promotions, all the campaigns and all the zeal of our mentors and leaders in the fields of communicative sciences and disorders (CSD), we're still a poorly understood group. Even with our getting a foot in the door with our National Speech - Language - Hearing Month: where is the speech - language pathologist (SLP) on "America's Got Talent"? Do an audiologist and an SLP capture the Kiss Cam at Yankee Stadium? And if you get caught spreading a rope of ketchup on a Vienna Beef hot dog, are you punished for your Chicago meat heresy, or because you're an SLP making a diet recommendation?

I thought there had to be a more concise, powerful and memorable method to "sell" our fields to celebrated men and women on the street. i found these public relations tools I had craved, in actual slogans and posters from wartime propaganda. You notice that some posters ask you to do your part in the fight.

For those who felt they had to do something for the war effort, but didn't have the constitution to go into battle, there were posters and slogans to motivate those at the homefront.

Then there's the allure of what you look forward to again, after the fighting is over.

Are there lessons for my peers in CSD, from the punchy presentation of wartime propaganda? Let's see if an SLP or an audiologist can be captured.

For example, the Sherlock poster might read beneath: "Have you lost your voice? Call SPEECH THERAPY, so people in your world can hear you again!" What other messages do you hear, seeing this gumshoe? Here's another idea for a CSD hard sell - "You talkin' to me? Yes, I hear you now. Let me take you where you wanna go!" Are there any better slogans for this one?

A third persona for the CSD professional; not cabbie, and not private eye, but - a COACH. What does a coach do? "You've almost got it. Let's try again - take a deep breath and shoot for the goal!" Is there still another great slogan to give the coach?

Let's have a caption contest! What do the SLP or Audiologist do as a coach, taxi driver or detective??