ASHA 2015: A Journey in Photos

 Spontaneous Speech Therapy Tools: 

On The Road Again

We loaded the car and hit the road...
Denver here we come!

We saw miles and miles of Texas

A rest area for horses?
Yes, a rest area for horses.

Welcome to Colorado

The landscapes were gorgeous

The beautiful Colorado Convention Center

Peek a Boo!

Ready for Day One

14,000 people attended the conference

Technical difficulties with the cash register.
 What a nightmare! 

Pizza...the breakfast of champions!

The Spontaneous Speech Therapy Tools
Sales and Marketing team

So long Denver...
may the speech be with you

Head 'em up, move 'em out.
Another successful event!

On the way home, a pit stop in
Cripple Creek, Colorado
at Bronco Billy's Casino and Hotel

A big win on a penny slot:  $25. 65!

Colorado Springs, Colorado
Brrrrrr!

Garden of the Gods

Incredible rock formations

To be continued....

Ronda Rousey Speaks Out on Childhood Apraxia of Speech

Anything Can Be Overcome

In a recent Huffington Post article, UFC champion Ronda Rousey talked about how she overcame Childhood Apraxia of Speech (CAS), a motor speech disorder that makes it difficult for kids (1-2 in every 1000) to make sounds, syllables and words. Now, this fighter has become a vocal advocate for children who have trouble speaking just like she once did.

During a Reddit AMA (Ask Me Anything) post, she was asked how a speech therapist helped her overcome CAS while keeping her confidence high. She responded, "I love my speech therapist- I thought she was super cool and I didn't even know I was in speech therapy."

Growing up with older sisters, a father working in the aerospace industry and a mother working as a psychologist, Rousey began to struggle with feelings of inferiority at a young age. Born with the umbilical cord wrapped around her neck, her vocal folds were damaged at birth. 

During an interview with Rolling Stone, Rousey reported that nobody knew if she would ever produce an "intelligible sentence." According to the magazine, a young Rousey said, "I'm dumb Mom. Maria and Jennifer have the words. I don't have the words."

With speech therapy and encouragement, Rousey was able to overcome CAS and has become a person whose interviews are described as "confident and sharp."

Rousey has posted about CAS on her Facebook page and sent a message to all of the kids who are currently coping with the disorder. 

"I would like to tell any kid struggling with speech that anything can be overcome with hard work regardless of how insurmountable the odds seem. Shout out to all speech therapists. You're all awesome."

Thanks, Ronda! I think you're pretty awesome, too!

Rousey will face Holly Holm in a UFC Women's Bantamweight Title Fight November 14, 2015. Best of luck to you Ronda...SLPs everywhere will be rooting for you.

Give thanks for what you are now, and keep fighting for what you want to be tomorrow.

Fernanda Miramonetes-Landeroa

photos:  USA Today, Associated Press

Seven Things SLPs Want You to Know About Feeding Tubes

Talking About Tubes

A new order for an ST eval is always exciting because you never know what to expect. 
Caring for a new feeding tube can be overwhelming and confusing for patients and caregivers.

These thoughts came to mind today as I was taking a medical history from the son of my new patient. I was excited to be there. He was overwhelmed and confused.

His 88 year old mother was discharged from a skilled nursing facility two days prior to my visit. She had experienced a stroke "somewhere back there" and had a brand new feeding tube "because she failed the swallowing test."

Does this sound familiar?

He could not relate any specific information about the stroke or the feeding tube, but now, he is in charge of the daily care of a stroke victim and the daily operation of a feeding tube. That's scary!

To make matters worse, her discharge from SNF to home was poorly planned. She arrived home without any medical equipment. In fact, the son told me the feeding pump she was using had been "borrowed from the rehab place." Oh my!

I worked hard to contain myself from dropping my jaw as the son answered my questions and explained the situation. No matter the circumstances, it was obvious:  she needed equipment and he needed education.

Though I'm limited in what I can do to solve an equipment problem, I felt I could provide some helpful information about feeding tubes. Here are the 7 things I told him:

What Your SLP Wants You to Know 
About Feeding Tubes

1.  You can still aspirate!

Even though the nutrition being provided by a feeding tube bypasses the problem areas (mouth, larynx, esophagus), feeding tubes are not guaranteed to prevent aspiration. Families need to know that saliva, secretions and stomach contents can be aspirated.

2. Oral care is super important

Because saliva and secretions can be aspirated, it is important to keep the mouth as clean as possible. Routine oral care helps to reduce the amount of bacteria in the mouth, thereby reducing the risk of pneumonia in the event of an aspiration.

3. The head of the bed should always be elevated to 30 degrees

Digestion is improved and reflux is reduced by simply elevating the head.  Propping the head and shoulders on pillows or adjusting the head of the bed to a 30 degree angle reduces the risk of aspiration. Gravity is a wonderful thing. 


4. There are continuous feedings

Feeding pumps regulate and deliver continuous feedings. These feedings occur at a certain rate and are delivered over a predetermined amount of time. The flow rate and feeding schedule are ordered by a doctor. The feeling of continuous feeding can be compared to the sensation of fullness when continuously snacking- you're never really hungry. While a pump may be necessary during acute illness, it may be impractical as you become for active.



5.  There are bolus feedings


Bolus feedings involve administering a specific volume of formula at a specific time of the day. A doctor sets the feeding amount and schedule. Either a gravity drip or a large syringe is used to deliver formula, water and medications. Bolus feedings approximate the sensation of fullness you experience after consuming a complete meal. Since there are long intervals of time in between the feedings, a person may experience the sensation of being hungry. Because a large volume of liquid is quickly entering the body, some have trouble tolerating bolus feedings. 


6. Speech pathologist are permitted to work around your restrictions

Feeding tubes are often inserted due to dysphagia (swallowing difficulties) and come with an NPO (nothing by mouth) restriction. When a patient is placed on NPO status, it doesn't automatically mean that he will never, ever eat or drink anything ever again.  With MD authorization  and as judged clinically appropriate, speech pathologists are able to introduce small amounts of food or liquid into treatment sessions for the purpose of assessing swallow function and safety. While these therapeutic trials are carefully planned and are an important part of helping you reach your treatment goals, patients should continue to follow NPO restrictions outside of treatment sessions.


7.  If you cheat, we want to know

Sometimes, as patients progress, they are tempted to disregard their NPO status. They may take a few sips of water, one good slurp of coffee or a bite of birthday cake. No matter what it is that tempts them, patients are encouraged to tell their therapist if they are eating or drinking anything outside of a supervised therapy session. Reporting these cheats provides valuable information to the therapist about swallow function and safety. Depending on the circumstances and/or the outcome the patient experienced, unsupervised cheats may:  reinforce the need for NPO status, explain that mysterious new pneumonia diagnosis or lead to a therapeutic progression of oral intake. No matter what a patient chooses, it is important to emphasize that honesty is the best policy.




The use of feeding tubes is increasingly common, and due to the aging of America, their rate of placement continues to rise each year.  The most common primary diagnoses among patients receiving feeding tubes are dementia (25-50%), stroke (50-75%) and head and neck cancer (60-70%). As an SLP, if you work with patients in any of these populations, it is important to be prepared to provide education, answer questions and make recommendations regarding feeding tubes. 

If you are a patient, family member or caregiver that is just becoming familiar with the basic operations of a feeding tube, remember your SLP can be a great source of information and support.



Don't be afraid of the answers, be afraid of not asking the questions.
Jennifer Hudson

5 Simple Ways to Motivate Your Patients

What motivates you?

Motivating yourself to continue moving forward during tough times can be a challenge.  Believe me, I know! But motivating a patient requires a little more finesse.  I realized that this week as I was talking to a patient and his wife.

Until he had a stroke in September, Mr. H was working full time as a business consultant. He's 81 years old, and maybe you know his type? He's focused, driven, and no nonsense. He looked me right in the eye and asked me, "How long is this going to take?"

My first thought was to tell him, "Forty minutes." Then I realized he didn't want to know how long the treatment session would be, he was looking for something more. My next thought was, "You have 12 scheduled visits." No, that's not it. "There are 60 days in each home health certification period." I sensed that was not the answer he was looking for.

As my mind scrambled to formulate an answer, his wife chimed in, "He's really down in the dumps. He thinks he's not making any progress and can't understand why he's not getting better any faster."

Well, bring out the pom poms...we've got some motivating to do!

The question is, what motivates an 81 year old man?

Stickers, Goldfish and M&Ms might keep kids happily coming to speech therapy week after week, but Mr. H, like most adult patients, needs something more. Here is a short a list of my favorite ways to motivate adult patients.

5 Simple Ways to Motivate Your Patients

Show them:  

• Quickly calculate percentages of accuracy at the completion of a task and/or show the percentages of accuracy you have recorded at the end of a session

• Share daily notes or weekly progress reports- compare the numbers recorded from day to day or over the course of a week

• Review percentages of change upon reassessment and again upon discharge- it's a quick and easy way to assure the patient they are making positive progress

Record them:

• Snap picture to capture an image of:
• oral weakness
• facial droop
• poor posture

• Use audio recordings to capture:
• vocal quality
• volume
• intelligibility 
• fluency  

• Use video to record performance while speaking or eating

• A smart phone or iPad is all that you need to:
• increase awareness
• improve self monitoring
• judge progress as treatment continues

• Be sure to ask permission before making any sort of recording; most people will agree if they know the images/ recordings will only be used in their treatment sessions

• Save the recording for future comparisons- patients are often amazed when they see or hear themselves before and after 

Encourage them:

• During practice or upon completing a task, when they get it right, phrases like good, that's right and nice job, are appropriate from time to time

• When they come close but don't get it perfect, you can give simple encouragement by using phrases like better, good try and you're getting closer 

• At the end of a session, at the end of the week, or whenever you see fit, a short discussion about progress toward goals or functional improvements is appropriate to keep patients trying their hardest during therapy...See, you are getting better.

Teach them:

• Patients and family members like to be informed, so provide information regarding short and long term goals- it's good to know what you are working toward and it's even better to know that you are making positive progress

• Provide education to keep motivation high during treatment sessions:

• the purpose, meaning or rationale of a task
• the functional importance of a skill 
• the relevance of a therapeutic activity or exercise

• Discuss disease process(es): 

• a general understanding of their disease or disorder keeps them realistic about what to expect during the healing process
• tell about the typical progression toward recovery- it's going to take some time
• share information about promising new research and recent studies- Neuroplasticity!  

• Teach them the basics of therapeutic progression- look at it as a means for measuring progress

• levels of assist: min, mod, max, etc. 
• types of cues and/or prompts: verbal, tactile, visual, semantic, phonetic, etc.
• levels of acuity:  normal, within functional limits, mild, moderate, severe, etc.

• Therapists have a knack for observing progress so discuss the many different ways to measure improvement:  faster, slower, louder, smoother, safer, more often, less often, etc. 

Talk to them:

• Without getting too wacky, discuss the importance of positive self talk- encourage a change in mindset:

• I'm working on it
• I'm getting better
• I can do this

• Tell them success stories about other patients you have worked with

A short pep talk and a new perspective on measuring progress worked wonders for Mr. H and his wife. They now better understand the process of brain reorganization and the complexities of recovery following a stroke. Both are moving forward with anticipation of progress.

Proper motivation can be the key to getting the most out of your patients. While each patient will have their own unique needs, if you focus on keeping your patients motivated you will help them reach their highest potential.


Instruction does much, but encouragement does everything. 
Johann Wolfgang Von Goethe

The Basics on Mucus and Mucus Producing Foods

Let Me Clear My Throat!

This week, it seems as though everyone having difficulty with mucus. Whether they are throat clearing, coughing, hacking or spitting, mucus is suddenly a huge part of my day. Yuck! My patients, my husband and four out of four of my children are battling this thick, gooey, stringy substance on a daily basis. What can I do?

I am a self-proclaimed saliva expert but, admittedly, I haven't quite reached that same level of competency in the field of  mucus. Since it is the current enemy, I decided to do a little research.  Here's what I found:

• Mucus-producing tissues are everywhere! They line the mouth, nose, sinuses, throat, lungs, stomach, and gastrointestinal tract
• Mucus helps to filter out viruses, bacteria and other harmful or irritating pollutants and particles
• Mucus keeps body tissues from drying out 
• Your body produces about 2 liters of mucus each day
• Mucus mixes with saliva to assist with bolus (food)  preparation and digestion
• Most mucus trickles down your throat and you don't even notice it

You don't even notice it?  Yeah, right!  

When mucus production changes, it can cause continuous throat clearing, coughing, sore throat or changes in vocal quality. Most annoyingly, thick, sticky mucus can leave you with that feeling that there is something in your throat. That's what Mrs. S was complains about every morning I see her.

We discussed probable causes for increased mucus, including reflux, allergies and illness- she denies having any of these. I taught her strategies for loosening and clearing the mucus in her throat- she uses them consistently. She even increased her intake of water in hopes of keeping her secretions from turning into goo. So, why does she still complain about excessive, thick mucus? I was racking my brain, and then I remembered: mucus producing foods!

Finally, I asked her, "What did you eat for breakfast?" She reported that she drank a glass of orange juice.  Ah ha! That's it!  Acidic foods and drinks can increase the production of mucus...I finally figured it out. 

But why is that?

The link between orange juice and mucus can best be explained by considering things from a scientific perspective.

Mucus has a pH of about 7 and juice has pH of about 3.5.  Since the human body operates best at a pH of 7.3-7.45, the juice significantly changes the optimal pH levels. As a result, the body works to stabilize the pH inside the mouth by producing more mucus. 

The additional mucus can pool in the throat, causing a person like Mrs. S to experience the sensation of thick mucus hanging in her throat. She stopped drinking orange juice for breakfast and her early morning mucus has reduced significantly. She has declared, "Problem solved!"

Of course, I don't think mucus producing foods are the cause of all mucus problems, but being familiar with this list of foods and drinks certainly came in handy this week. Take a look at the most common mucus makers and consider their effect on the patients you are treating.

Mucus Producing Foods

Dairy Products:   While there is no clear evidence that dairy products actually increase mucus production, consuming dairy products like milk, cheese and yogurt may cause mucus to be thicker than normal.

Meats:  High fat red meats and processed meats can cause excessive mucus to be problematic, particularly with persons who have COPD.

Gluten:  Excessive mucus is also associated with the consumption of gluten found in wheat products, rye and barley. This is especially true for those with gluten allergy or intolerance.  

Fruits and Vegetables:  Bananas, cabbage, potatoes, coconut, mushrooms, olives, tomato and citrus fruits and juices are known to increase mucus production

Caffeinated Foods and Drinks:  Beverages containing caffeine, such as soft drinks, coffee and tea may increase the risk of dehydration, which can lead to thicker mucus. Chocolates and desserts containing coffee may also thicken mucus due to the dehydrating effects of the caffeine in the food. 

Other Offenders:  Spices, alcohol, mint, beans, tofu, sugar, candies, pastries, beans, cereals, a variety of processed foods and fast foods can contribute to mucus changes

Individual Considerations:  People may have allergies to foods which cause them to experience increased mucus production after they eat the offending foods. While each person is different, foods that commonly trigger allergic reactions include milk, eggs fish, tree nuts, peanuts, shellfish and products containing gluten or soy. 

Whether you use this information, or share it with someone else, I hope it gives you a new understanding of mucus and mucus producing foods. Being conscientious of these foods and drinks can help you avoid a sticky situation. 

Let your food be your medicine and your medicine be your food.

Hippocrates 

Put a Stop to Weight Loss, part two

Don't be Caught with Your Pants Down

Once upon a time, I sat at my desk and watched a  PT and OT as they struggled to walk their patient down the hallway. Sure, he had some physical limitations that were problematic, but it wasn't weakness or discoordination that were giving them trouble...it was the man's pants!

He was in our facility for rehab after faceplanting into the toilet. It sounds funny when I put it that way, but that's exactly what happened...he fell, face first, into a commode. His face was black and blue, he fractured several facial bones and unfortunately, experienced some brain damage as a result. But, again, this was not the biggest problem...it was the man's pants!

The man had been losing weight and his pants were now way too big. The therapists asked him, "At one time, did these pants actually fit you?"  He nodded. "Do you have a belt or suspenders?' they asked. He shook his head. "How much weight have you lost?" they wondered. "A lot!" the man replied.

The practical PT cinched the gait belt a little tighter but the pants sagged down. The OT ran some Theraband through the belt loops of his britches, but it was not enough. The pants fell down a little further. The three of them stood there, in the hallway, contemplating what they were going to do. 

Next thing you know, the man was standing in the middle of the hallway with his pants around his ankles!


Even though this might be a funny story, continuous weight loss is not. Excessive weight loss increases the physical demands on the body, resulting in:  headache, irritability, fatigue, dizziness, constipation, hair loss, muscle loss, and, as in this case, loss of pants. 
These demands may result in serious negative effects such as gallstones (I did not know that), dehydration, malnutrition and electrolyte imbalance. 

In my last blog post, I gave 15 things to do to stop weight loss. Then, I went back to work, gave it some thought and came up with 15 more things you can do to stop weight loss.

Picking up where I left off...

15 (More) Ways to Stop Losing Weight

16. Supplement your diet- use protein powders, protein shakes or vitamins as needed

17.  Talk to your doctor about appetite stimulants- prescription medications are available

18.  Learn to read nutrition labels- make sure you can find information about calories and fat in the foods and drinks you consume

19.  Weigh frequently- monitoring your weight helps increase awareness and provides motivation to continue with your efforts

20.  Add some variety to your diet- don't get stuck in an oatmeal rut...there are some really great breakfast options out there; don't be afraid to try something new

21.  Determine your calorie requirements-  your doctor can refer you to a dietitian

22. Set a weight goal- calculate ideal body weight and use that as a guide for determining how much weight gain is appropriate; that same dietitian can help you here too

23.  Eat as much as you can... then eat 3 more bites- on average, there are 25 calories in each bite of food you take; 75 calories each meal adds up quickly!

24.  Go to a buffet- there is something for everyone and it's all you can eat

25.  Eat with others- you are likely to eat more when you aren't eating by yourself

26.  Assist with food preparation- this helps to promote your appetite and intake at mealtime

27.  Address and correct dental issues- poor dentition or improperly fitting dentures can limit consumption

28.  Rule out swallowing difficulties- dysphagia can be the cause of weight loss

29.  Modify textures as needed- chopped or pureed foods may be necessary

30.  Keep a food diary- record all solids and liquids and their corresponding calories for a do it yourself calorie count...you may be quite surprised to see 

Of course, you know this blog always comes to you from a speech therapist's perspective. These suggestions are a collection of all of the pieces of advice I have given to my patients and their family members over the years. I am not a dietitian, a doctor, or a nurse...and I don't even own an alligator purse. So, as always, consider your specific circumstances and use good judgement when following these recommendations.

What ever you do, don't be caught with your pants down.

This week, please share this information with someone you know: a patient... your Aunt Nancy... or even the neighbor down the street. I believe these tips can be of benefit to a great number of people.  


PS:  

In case you missed last week's blog with tips 1-15,  just scroll down to the October 7th posting... you can find them there.

You can click here to get to a cool website that can help you calculate your daily caloric needs.

Or click here for a free, printable food journal- a great thing to have in your therapy bag of tricks

Put a Stop to Weight Loss, part one

Life is Funny

When you were in preschool, an afternoon nap was mandatory. 
As an adult, you dream about taking a nap in the middle of the day.

Way back when, your bedtime was 8:00 pm.
As grown ups, most of us only wish could turn out the lights and crawl under the covers at 8:00 pm. 

When you were in elementary school, you were required to read 30 minutes each day.
As an adult, there's not much time for pleasure reading, and if there is, it's certainly not happening on a daily basis. 

When  you were a kid, your parents pressured you to go outside and play with your friends.
As an adult, you wish you could go outside to enjoy sunlight and fresh air while visiting with your neighbors... but if you did, you know there would be no one to make dinner.

When you were a teenager, you wanted to get out of the house and move as far away as possible from your parents.
As an adult, you would pull out your two front teeth to have your mom or dad live nearby. 

When you are a younger adult, you count every calorie and exercise like a crazy person to maintain your ideal body weight. Desert is reserved  for special occasions.
As an older adult, weight loss is slow and steady...it happens without even trying.  People encourage you to eat as much as possible.  Deserts and snacks become mandatory. 

Does this sound familiar to you?

As a medical speech pathologist, I advise patients and family members on ways to prevent weight loss each and every week. Over the years, drawing upon both research and clinical experience, I've come up with a list of things that can be done to put a stop to weight loss. 

Considering this, I present...

15 Ways to Put a Stop to Weight Loss

1.  Keep favorite foods on hand and serve them often- avoid foods that are likely to be refused...like Brussels sprouts and lima beans

2.  Choose high calorie foods-  eat a creamy baked potato soup rather than vegetable and broth soup (that's diet food)

3.  Choose high protein foods-  meat, fish, chicken, cheese, beans, yogurt, eggs and peanut butter

4.  Add butter...to anything and everything- each pat of butter adds an additional 36 calories

5.  Use high fat dairy products- whole milk, cream, sour cream, cheese and cream cheese

6.  Add high calorie condiments- use dressings and mayonnaise generously on salads and sandwiches

7.  Add sugar or honey- ditch the pink or blue packets when sweetening your drinks, and get an extra 16 calories per teaspoon by adding the real thing

8.  Skip foods and drinks that are fat free, sugar free or diet- always go for the full fat, full sugar, full calorie options

8.  Add sauce or gravy to meats and veggies- it puts extra calories in every bite

9.  Provide sufficient serving sizes- larger portions may be necessary in some cases

10.  Eat 3 meals and 2 snacks every day- no skipping!

11.  Give high calorie drinks- juices, milk, soda and sugar sweetened tea are best... there is no nutritional value in water, I repeat, there is no nutritional value in water!

12.  Offer bedtime snacks- because it will be a long time until breakfast tomorrow morning

13.  Eat desert every chance you get- pies, cakes, cookies, brownies,  pastries and ice cream

14.  Use extra seasonings- food tastes better when the flavor is enhanced with salt, pepper, red pepper, cinnamon or vanilla

15.   Exercise- increasing your level of activity increases your natural appetite

Pass these tips along to someone you know who may benefit or put them into practice when you head off to work with your patients today. Several small changes in food and drink choices can lead to big increases in daily calorie consumption. Give them a try. What have you got to lose?




Growing up is mandatory. Growing old is optional.
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