Speech Therapy + Pinterest= Great Things

All Great Things Come From Pinterest!

One morning, while chatting in the driveway, my neighbor, Kristen, told me about Pinterest. I was intrigued, and I had a few minutes before I had to leave for work, so I thought I would check it out. 

Talk about mind blowing!  I was an hour late for work that day. My life will never be the same.

Ever since then, I use Pinterest browsing as a source of entertainment. I can position myself on the sofa and appear to be watching Monday Night Football with the guys, but really I'm searching for recipes, thinking about wardrobe ideas, and learning new techniques for makeup application. I thought they had no idea I wasn't paying attention, but eventually, my husband caught on.

At first, he complained about the time I was spending on Pinterest. He thought of this type of browsing as a "waste of time,"  but it wasn't long before he began to enjoy the results of my searches: a pretty wreath for the front door, a delicious recipe, a yummy dessert, a home improvement project, a cute haircut and well styled outfits...just to name a few.

Before long, he was telling his friends, "Make sure your wife is on Pinterest!" 

With his nod of approval, I continued to search Pinterest for new pins. It's been about four years (I think) since I first discovered this amazing thing, and, at last count, my personal Pinterest account had 25 different boards with 3.9K pins. 

When my friends and family ask, "Where did you get this recipe/idea/hairdo/etc.?", it's almost certain you'll hear me say, "Everything good comes from Pinterest!"

Flash forward to this spring...I realized Pintest is a great source of inspiration for SLPs! Let me tell you about it.

For years, I've used a two page printed information sheet when discussing diet textures with patients and their families, but one day, I found myself without it. I reached for my iPad and tapped to open the Pinterest app. I wanted to show this granddaughter that there were many more options for a mechanical soft breakfast than oatmeal. I remembered seeing a pin that featured a recipe for bacon covered in pancake batter. I encouraged her to get creative, and she was interested in hearing more.

Remembering my written list of foods, I did one search after the other and was able to show a wonderful variety of colorful photos depicting soft, easy to chew food options. The granddaughter loved it! I promised I would look for more pins and assured her I would keep her up to date on my latest finds.

That night, I opened a new Pinterest account for the professional me and added new boards:  soft mech breakfast, soft mech lunch and dinner, soft mech snacks and, since grandma was having trouble manipulating utensils, I added a board for finger foods.  I realized, I'm really on to something here!  Before long, I was suggesting patients and families follow me on Pinterest, letting them know that I had many pertinent and informative boards available for viewing. 

Over the summer, I ran into a little snafu with my professional account when it was renamed...all my pins were left behind. Ugh! Very slowly, I have begun to create similar boards with new pins, and all is good again.

Just a few weeks ago, I got a wild hair and decided to taking pinning to the next level:  I added the Pinterest browser button to my desktop computer. Whoa!  Following just a few simple steps, I'm not just re pinning, I am able to make my own pins!

I've included the link to the directions for adding the browser button if you're interested...just click here.

These days, when I'm doing research on a topic or looking for suggestions for family members on how to solve a particular problem, I can pin an article to one of my boards. This allows me to save the information for my future reference. Then, during a session, we can discuss the main points, and patients and caregivers are able to dig deeper by reading the article in entirety from my Pinterest board: Articles of Interest.

Here is a link to my Spontaneous Speech Pinterest account. Feel free to follow along as I add interesting new tid bits, and as always...happy pinning!


Pinterest...because I would rather learn how to crochet a flower than spy on somebody I barely know.
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Questioning Techniques: Four Ways to Find the Answer You're Looking For

Making Choices and Answering Questions

When it comes to making choices, I need help!

Just today I was shopping for cloth napkins at Pier One. The napkin display spread from one wall to the next and featured three shelves full of perfectly folded, perfectly stacked napkins. There were so many choices, I could hardly believe my eyes: solids, stripes, prints, fringes, beads. Oh my!

I was overwhelmed. 

Actually, all of Pier One is overwhelming to me, but today, all I needed to do was pick out 10 napkins appropriate for Thanksgiving dinner. That should be easy, but there were too many options. I decided it would be much easier if there weren't so many choices. 

I took a deep breath and began choosing what I thought were the prettiest napkins. Whew! That was more difficult than you might imagine.  I had narrowed it down from 150 to 5.  My decision making should be easier from here. I again narrowed the choices down from 5 to 2. It was at that point that I called my husband over. "Which one do you like best?"

He pointed to the left, and that was that. The great Thanksgiving napkin search was over....and it only took 20 minutes. I'm sure he was wondering, "Why does it take so long for her to do something so simple?" Instead, he just smiled and paid for the napkins. 

I think I'll nominate him for Husband of the Year.

Driving home, my mind drifted back to a conversation I had with a family member earlier that same morning. She complained to me about her husband with dementia saying, "He can't remember how to feed the dog."

I asked, "What's involved with feeding the dog?' She began to describe the process. I will spare you the details, but it was 7 part process that included the precise measurement of 4 different ingredients: dry dog food, wet dog food, pumpkin and ham. It would be difficult for nearly anyone to follow all of those steps with the type of precision that is required. It's no wonder he doesn't want to feed the dog anymore. 

Without stopping, she continued to gripe, saying "He's getting worse every day. Yesterday, he couldn't even tell me what he wanted to eat!" Even though I wasn't immediately sure how I was going to approach the dog feeding situation , I knew I could easily explain why it can be so difficult to express a preference or make a choice. I began explaining the different types of questioning techniques. Here were the highlights from the discussion...

1.  Open ended questions:  What do you want to eat?

• usually begin with a wh- question word such as who, what, where, when or why

• possibilities for responding are almost endless

• full cognitive function is necessary as formulating a response requires processing, recalling, categorizing, sorting, eliminating, choosing, reasoning, decision making, etc.

• responding appropriately requires strong communication skills since sentence length productions are typically expected

• the most broad type of question to answer, making it the most difficult type of question to answer

2.  Multiple choice questions: Which one sounds best to you- Mexican, Chinese or Italian?

• typically begin with a wh- question word such as which

• possibilities for responding have been narrowed to 3 or more

• acceptable choices are provided by the speaker so that a possible answer to the question is provided

• moderate cognitive  function is needed as the listener must be able to process and recall the choices provided in the question asked in order to respond appropriately

• fair communication skills are needed in that mostly word or phrase length productions are used when responding

3.  Binary choice questions:  Do you want enchiladas or tacos?

• also known as forced choice questions

• possibilities for responding have been narrowed to only 2

• acceptable choices are given by the speaker so  that the answer to the question is already provided

• minimal cognitive skills are required for processing and responding to questions asked

• minimal communication skills are needed since responses usually have only words or simple phrases

• nonverbal responses may be possible if using gestures/ pointing

4. Yes/ No questions:  Tacos?

• questions include few words, maybe only a single word

• possibilities for responding are limited to yes or no

• minimal cognitive skills are required since most of the decision making steps have already been taken care of

• minimal communication skills are needed because a response requires only a single word 

• nonverbal responses such as nodding are acceptable 

With just a little bit of explaining, this woman had a change of perspective. She quickly realized that her questioning techniques were preventing her husband from being able to do something as simple as think of what he wanted to eat. This wife understood that she could eliminate most of the difficulties her husband was experiencing when making choices and answering questions just by asking the right kind of questions.

As a therapist, wife, mom and friend, I ask a lot of questions throughout the course of the day. Perhaps you do too? Learning to ask the right kinds of questions can make it easier to get good quality responses that spark conversation. However, not everyone understands that questions may need to be modified as the result of communication or cognitive deficits.

Be sure to educate spouses and caregivers on the importance of asking the right types of questions. Whether a person has dementia or is recovering from a stroke, methods for asking questions may need to be modified. Please share this information with someone you know who may benefit.


Successful people ask better questions, and as a result, get better answers.
Anthony Robbins

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