Knowledge Is Power!

Last week, I wrote about the warning signs of Alzheimer's and shared a link which detailed the latest facts and figures about the disease. I'm a firm believer that knowledge is power.  As professionals, we must stay informed- our patients and their families are counting on us.

This week, I wanted to continue the dementia discussion by sharing information about dementia staging and the Global Deterioration Scale.

The Global Deterioration Scale (GDS), was developed by Dr. Barry Reisberg and was first made available in 1982. It provides caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer's disease. It is broken down into 7 different stages.

Stages 1-3 are the pre-dementia stages and include:

1. No cognitive decline
2. Very mild cognitive decline- age related difficulties
3. Mild cognitive decline- Mild Cognitive Impairment (MCI)

Stages 4-7 are the dementia stages and are described as follows:

     4.  Moderate cognitive decline- mild dementia

     5.  Moderately severe decline- moderate dementia

     6.  Severe cognitive decline- moderately severe dementia

     7.  Very severe cognitive decline- severe dementia

Patients, caregivers and family members can get a rough idea of where an individual is at in the disease process by observing that individual's behavioral characteristics and comparing them to the GDS. Using this 7 point scale, I have helped family members better understand dementia and its progression. It has also been my experience that staging using the GDS enables families and caregivers to recognize cognitive deficits and set realistic goals for living situations and therapy. It can be a real eye-opener.

There are several  versions of the GDS available on the Internet.  The link to my favorite printable version is here.   I have kept it within reach  on my work desk for the last 8 years.

Our practice standards expect evidence-based approaches to the care we deliver. More and more, health insurance plans, including Medicare, are requesting standardization and outcomes to measure the value of the services we provide. Incorporating standardized test is an easy way to show evidence-based data to support our intervention. 

A highly recognized measure of function, the GDS is considered a standardized assessment tool. It enables the identification of dysfunction and deficits, it removes subjective factors, and provides results that can be generalized and repeated. 

If you're a healthcare provider reading this blog, print out a copy of the scale, and take it with you to work. Use it to complete assessments, plan therapy and provide education. I believe you will find it a very valuable tool. 

If you're a friend or family member reading, you may think this information is very technical and irrelevant to your daily life. I invite you to recall the statistics from last week:  1 in 3 seniors dies with a dementia diagnosis.  Dementia is likely to affect someone you know, and if you have a brain, you, too, are at risk.

Have a great week...thanks for reading!

Knowledge is power. Information is liberating. Education is the premise of progress.                Kofi Annan

If You Have a Brain, Then You're at Risk!

Have you ever misplaced something...maybe your sunglasses, your wallet, or your car keys? Then maybe you can relate to the lady in this video:  Have you seen my keys? 

As the video mentions, the signs of Alzheimer's may be right in front of you. So, before anyone panics, take a look at the entire list:

10 warning signs of Alzheimer's

1. Memory loss that disrupts daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks at home, at work or at leisure
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words when speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgement
9. Withdrawal from work or social activities
10. Changes in mood or personality

Now, consider this: everyone with a brain is at risk for developing Alzheimer's.

Yikes! 

Just  last month (March, 2015), the Alzheimer's Association published the latest statistics on Alzheimer's Disease. The information in this video will blow your mind! Please take the time to watch it.

2015 Alzheimer's Facts and Figures

As a Speech Language Pathologist, I work with geriatric patients every day. As a group of professionals, I believe we play an important role in working with an aging population. 

• SLPs  assist in differentiating between normal aging and disordered communication.

• SLPs  provide vital treatments for people who have cognitive communicative impairments. 

• SLPs have a role in preventing communication disorders by promoting a healthy lifestyle and educating patients and family members about how to prevent disorders that may lead to impairment. 

Whether you are a therapist, friend or the family member of a person with dementia, I believe knowledge is power. To get more information about Alzheimer's Disease and its related dementias, I recommend you go to alz.org. The information and resources there are priceless! 

Thanks for reading...have a fantastic week!


You will know the truth and the truth will set you free.  
John 8:32

Breaking Up is Hard to Do

Last week, my 85 year old patient, Mr. W, came back from the dentist singing the blues.  

Cavity?

No.

Extraction? 

No.

Well then, what?

Plaque...and the dentist told him he needs a new toothbrush. 

What's so bad about that?

Well, my patient has an affection for his toothbrush and here's why: he has a  Kiss toothbrush that plays "Rock and Roll All Night" as he brushes. 

Well, no wonder he's sad!

If you're like most people, toothbrushes come and go without event as there is no real attachment. Take me, for instance,  all I can tell you about my toothbrush is that is has a green stripe. Pretty soon, I'll be trading it in for a newer model- I'm thinking purple. Anyway, it'll be no big deal when I toss it for a new one, but not for this patient! His wife told me he nearly fell to pieces when his Bruno Mars toothbrush died. Everyone involved here recognizes, for Mr. W,  breaking up is hard to do.

So, flash forward to today- I was asked to break the news to Mr. W that is was going to be out with the old and in the with new. Me? Why me? 

I took a deep breath. Here goes nothing...

Mr. W frowned and narrowed his eyes when the topic of a new toothbrush came up.  After some explaining, a little sweet talking, lots of reassurance and a little bit of eyelash batting, his caregiver brought out the new toothbrush. Mr. W, I would like to introduce you to your new toothbrush:  the mighty plaque blaster...Sonicare!

(Quick, someone cue the applause)

His face said it all- he was not happy. There were no rock stars, there was no music, there was no happiness.

Reluctantly, Mr. W squeezed the toothpaste from the tube and began brushing. He moaned,  he groaned, he even rolled his eyes, but he was brushing. I knew I needed to keep this going for as long as possible, so I reached way back into my memory bank and started talking about the correlation between plaque on your teeth and plaque in you blood vessels. His eyes got wide and he brushed a little longer. 

Over the next few minutes, he heard the condensed version of a study researchers completed in 2003. (You can find the entire article on the Internet.) In case you're pressed for time, and don't have time to read the entire thing,  here's the gist of it:

• hardening of the arteries is caused by plaque built up on inside of  blood vessels
• gum disease is caused by plaque built up on the teeth
• when gum disease is advanced, teeth are lost
• the more teeth lost,  the more likely you are to have  carotid artery plaque
• conclusion:  plaque on your teeth is related to plaque in your blood vessels

Well, in the end, Mr. W was sold! He realized that thorough elimination of plaque on the teeth could limit the amount of plaque in the arteries which could reduce his risk for having a stroke. He understood that the old toothbrush was just not as effective at removing plaque as the new one. So, pretty soon, it was bye-bye Kiss, hello Sonicare. Once again, the speech therapist saves the day!

This week, as you are busy performing oral mechanism exams and promoting the importance of good oral hygiene, keep your eyes peeled for plaque. Who do you know that needs a new toothbrush? 

 Thanks for reading...I hope it's a great week for you!

"A smile is a curve that sets everything straight."  Phyllis Diller

No Straws?

Maybe you've seen a sign like this somewhere along the way? No matter where you saw it, I can almost guarantee that a speech therapist made it. How would I know that? Because I know that speech therapists hate straws!

But not me!  I love straws and, apparently, I'm not alone.  According to Eco-Cycle International, 500 MILLION straws are used every day in the United States! Wow, that's a lot of straws!

So, as an SLP, I'm going to ask you to consider giving straws a second chance.

Of course, I know straws aren't right for every single person in every single circumstance. (Good clinical judgement must always be used when recommending the use of straw.) However, there are many good reasons for using straws and week after week I encourage my patients to do so! Let's take a look...

Dentists and orthodontists regularly recommend straw drinking to:

• reduce enamel erosion
• provide stain protection
• reduce cavities
• reduce exposure to temperatures for sensitive teeth

Some people like straws because:

• they're convenient
• they're clean
• they're fun

Sipping from a straw is said to increase the overall amount of liquids you consume. Healthcare professionals routinely promote the benefits of drinking more liquids each day. That's because adequate hydration can:

• improve kidney function
• maintain normal bowel function
• boost immunity
• prevent dehydration
• improve skin
• aid digestion
• regulate body temperature
• lubricate joints
• eliminate wastes and toxins

Straw drinking helps to increase tongue and lip control and coordinated breathing, all of which support our ability to speak with good articulation. Additionally, researchers tell us that as we suck, many of our cranial nerves are stimulated. That's a good thing. To take it even further, scientist have proven that straw drinking enhances inter-hemispheric brain integration. Wow- straws do that?


I'm making a case for straws today because just last week, I sat across from a patient sipping water from a tall glass. He tilted his head back to drink and a tidal wave of liquid entered his mouth.  Guess what?  He began coughing! If only he had a straw, he could have avoided neck hyperextension, he could have better controlled the amount of water he was getting and his lungs would not have been at risk for aspiration or penetration. Because of his good cognition and oral motor function, I say give this man a straw!


Now, having said all of that, there is such thing as a bad straw. Maybe you know the ones I'm talking about? Bad straws are typically extra wide and usually hang out at places like convenience stores and fast food restaurants...stay away from them!

Bad -vs- Good

Good straws, on the other hand, are all over the place...believe me, I'm looking for them everywhere I go. He are a few straws I found this weekend at Target:

A Manon Jar style- how trendy! Bonus points for the no-spill top and wide grip handle.

A straw with stripes, what's not to love? Easy to grip and no-spill too!

             

             

These cups are my awesome because the straws are held steady by the cup itself. These may be too juvenile for some, so take that into consideration. 

My daughter loves silly straws...another good option.

This week, take notice of the straws you see and try to categorize them as good or bad- it's a pretty fun game. More than anything though, think of the people you know and ask...

Hope it's a great week for you. Cheers!

Through the lips and over the gums, look out stomach, here it comes!

Windshield Time

Yesterday, I spent nearly 10 hours on the road with my two sons, Coby and Mike. We  traveled from the top to the bottom of the state of Texas, eventually making our way home from a great Spring Break trip. While they were enjoying uninterrupted screen time with their iPod and Nook, I was faced with a windshield and an empty passenger seat.

Ahh, windshield time...I couldn't have been happier!

I've heard some people hate driving, especially where there is no one to talk to, but if you ask me, windshield time is some of the best time in the world! I can get a lot accomplished while I'm driving. I can solve problems, make a plan, revise my strategies, map out my goals, learn all of the words to my favorite songs, go to church, secure my financial future, learn something new, finish a book, complete continuing education credits and even practice my Spanish . The long and short of it is, if I'm driving, I'm becoming a better person!

What to hear more? Here are some of my personal all-time favorites:

Audible: I'm contemplating a subscription, but in the mean time, there are...


Books on CD:  check them out from your local public library (they give you two weeks to finish your book)

• Suzi Orman- The Laws of Money, Women and Money
• Jack Canfield- The Success Principles
• Robert Kiyosaki- Rich Dad, Poor Dad, Conspiracy of the Rich
• Dr. Phil- Life Strategies

Podcasts: so many wonderful (and free) options, depending on your mood or area of interest

• Get Busy Living- Benny Hsu
• Tim Ferriss Show- Tim Ferriss
• Entrepreneur on Fire- John Lee Dumas
• Lakewood Church- Joel Osteen
• Church Unlimited- Bil Cornelius

Downloads: have fun and listen to MP3 downloads you've stored on your iPod or get serious and listen to a continuing education course from speechpathology.com,


Pandora: stream it from your phone (if you have an unlimited data plan)

• Jack Johnson
• John Mayer
• Jimmy Buffett

My car  is exactly 2 years old and just turned over 47,000 miles. Not only do I enjoy long road trips with my family  but I drive an average of 75 miles each day for work. If you ask me, I spend a lot of time behind the wheel, staring at the windshield.  There are some who do more... like my dad, who averages 1,200  miles each week, and some who do far less...maybe you?  If you ask me, you don't have to be a professional driver or road warrior to benefit from windshield time. This week, put down your cell phone and consider making the most of your time in the car by trying something new.


The road goes on forever and the party never ends. 
Robert Earl Keen

Spring Break Recharge!

Ahhh! Spring Break- that glorious time of year when life gives you one week to slow down, refocus and recharge.  There are so many options available, how do you decide what to do with yourself? I'm going to recommend you consider your options and make a list- this will help you stay focused and make the most of your time off. For the sake of diversity, I am presenting a variety of lists for your consideration.


Hit the beach:

• Get a pedicure- then wiggle those beautiful toes in the sand
• Work on your tan- make them wonder if it's real or fake
• Feed the seagulls an entire loaf of bread, maybe two- have someone take pictures, you will be smiling 
• Practice people watching- you will see things at the beach you can see nowhere else
• Perfect your picnic packing skills- variety is the spice of life
• Build a bonfire- watch and enjoy until the last embers fade to black
• Roast a hot dog on a coat hanger- but why eat a weinner when you can...
• Eat s'mores- use a peanut butter cup instead of a plain old chocolate bar
• Create new techniques for removing sand from wet bodies- let me know if you discover one
• Pretend you're a lifeguard- don't forget your whistle!
• Learn the words to Jack Johnson's song "Bubbly Toes"
• Wash, rinse, repeat!

Spring Cleaning:

I thought I should consult the professionals on this one so have a look at this terrific checklist I found on Pinterest.  She promises there will be no dust bunnies left behind!

Spring Cleaning Checklist


Refresh:

• Restock your files- make copies of often used handouts, test forms, calendars, etc. and have them ready to go
• Tidy up your car- your family, especially your kids, will thank you for clearing your therapy materials from the backseat
• Straighten up your desk, office, workspace- add a new photo or inspirational quote to your bulletin board
• Go through that stack of magazines and professional journals you've been collecting- file articles of interest of scan them to your computer for future reference
• Clean out and/or organize your toy closet- then select a fresh batch of toys to tote around with you
• Catch up on your CEUs- my favorite way to do this speechpathology.com
• Get caught up on your paperwork- ugh!
• Collect receipts from the previous year for any relevant, work related tax deductions- you've got until April 15th (tick tock)

So, pick your favorite list and get to work!  What will you do during this Spring Break?


Out of clutter, find simplicity. From discord, find harmony. In the middle of difficulty lies opportunity.      Albert Einstein

A New Acronym to Add to Your Collection

Acronyms...I love em!  When I was a little girl, my dad would write me notes that almost always included a cryptic little message at the bottom left hand side of the page:  SWAK- Sealed with a Kiss, KOS-  Keep on Smiling, DLYML-  Don't Let Your Meat Loaf .  What? I never really understood that last one, but I still use it when I write notes to my kids. (Dad, if you're reading this, give me a call- you've got some explaining to do!)

In elementary school, I learned the colors of the rainbow using the acronym:  Roy G Biv. My first band instructor, Mr. Wood, taught use to use FACE to remember the notes on the spaces on the treble clef . He also taught us that Every Good Boy Does Fine so that we could learn the notes on the lines on the treble clef.

When I got to junior high, our PE teacher, Coach Herlosky,  was just doing his job when he taught us that CPR stood for Cardiopulmonary Resuscitation. He totally blew my mind when he went on to teach us that SCUBA was an acronym for Self-Contained Underwater Breathing Apparatus. Only a real intellectual giant would know that! I felt like the smartest girl in the world.

As I got older and school got tougher, acronyms became an easy way to remember stuff. My mom was a teacher and she was a big fan of this creative memory technique. She and her kooky letter combinations helped me memorize more stuff than can be listed here.  Flash forward to graduate school. My study partner, Normie Rodriguez, taught me an acronym to top all acronyms- the one for remembering the 12 cranial nerves.  Did you learn it too?   I won't list it here because this is a family show, but maybe you recall:  Oh, Oh, Oh To Touch And Feel...  (A quick Google search will help you find the rest if you're not familiar.)

These days, acronyms are everywhere! You can't send a text message to your BFF without an LOL, JK or TTYL. When thumbing through fashion mags, it's not unusual to read about the latest trends for the LBD.  At work, you may request an order from the PCP for an MBSS, pending HMO approval. See what I mean, they're everywhere!

Earlier this week, I was thrilled when I read about CHOKES. It is an absolutely brilliant acronym that was created to standardize aspiration precautions at a community hospital. Of course, you should read the entire article so I added a link below. Until then, here's the good stuff:

Complete oral care after every meal, minimum of every shift
Have suction set up in the room
Observe swallow and monitor PO intake
Keep patient at 90 degrees while eating
Elevate head of bed to a minimum of 30 degrees at all times
Sign posted at door: Aspiration Precautions

I have committed CHOKES to memory and have started using it when teaching family members and caregivers. Maybe you want to try it out too?  Once again, here is the link: Reducing Aspiration: A Group Effort.


Before you speak, THINK: 

T- it is true?
H- is it helpful?
I- is it inspiring?
N- is it necessary?
K- is it kind?