22 Ways to Clear Pocking Without Using A Toothette Brush

The Trouble With Toothettes

Toothette Oral Swabs, or as I call them, Toothette brushes, are an important part of daily patient care in facilities from coast to coast. Easy to come by, Toothettes can be found all over the place: in central supply departments, nurses' stations, bedside tables, bathrooms, therapy gyms, rehab offices and on top of nightstands. 

I keep a bunch of them stashed in my desk drawer, I almost always have one in my pocket, and it wouldn't be unusual to find a Toothette in my purse. Abundantly available, I grab these brushes by the handful and pass them out to my patients up and down the halls.  

I think I'm being clear... there's no shortage of Toothette brushes in healthcare facilities.

In case you've never used a Toothette, they're just a little pink sponge on a stick. The thing that makes them extra special is a light coating of a pleasant, minty dentifrice.  (Now there's a word you don't use very often!)

These swabs are perfect for moistening a chronically dry mouth, they're good for scrubbing teeth and most importantly, they can gently remove tiny little food particles from hard to reach places in the back corners of the mouth. With such great versatility, you just have to love the Toothette swab.

With that in mind, fast forward to....


Today, I overheard a phone conversation between my patient's wife and her insurance company. They were discussing Toothettes.  I only heard half of the conversation, of course (because she was on the phone), but I'm pretty sure I know what the insurance company representative was saying. 

Here's what I actually heard and what I imagined was being said:

     You won't pay for them?
     No, we won't pay for them.

     It's medical equipment my husband needs.
     Uh huh, but we won't pay for them.

     What if I call the doctor and get a prescription?
     It won't matter, because we won't pay for them.

     He had a stroke and he pockets food in his mouth.
     Yes, but we don't pay for them.

     It's so important to keep his mouth clean. 
     Right, but we don't pay for them.

     What am I supposed to do?
      You'll have to pay for them yourself.

     Those things are really expensive.
     Uh huh, that's why we don't pay for them.

     I guess I'll have to ask the speech therapist what to do.
     Yeah, because... we won't pay for them.

She hung up the phone and immediately called my name. Looking like she was ready to pull out her hair, she asked:

     Can you believe my insurance company won't pay for those pink sponges?
     Yes, I can believe it. Insurance usually doesn't pay for Toothette brushes. 
     Once you're home, a Toothette is a luxury item.

     Those little things are hard to find and when you do, they are expensive.
     What am I supposed to do? 


Oh boy, I love it when people ask me that question! 

I did some super sonic brainstorming as I sat at her kitchen table and came up with a list of suggestions on how to handle oral pocketing when your supply of Toothettes is scarce. 

How To Clear Pocketing:

22 Toothette Alternatives

 Before Eating

1. eat softer foods
2. add extra gravy or sauces to meats and veggies
3. chop meats, fruits and veggies into small/ smaller pieces
4. make sure veggies are tender cooked
5. adjust seating
6. position head and body to midline

While Eating

1. take smaller bites
2. chew thoroughly
3. use a liquid wash
4. perform a lingual sweep
5. alternate solids and liquids
6. aim utensil to the strong side of mouth/ away from the weak side of mouth
7. chew on the stronger side
8. reduce the rate of intake
9. adjust seating as needed
10. maintain head and body at midline position

After Eating

1. use a gloved finger (yours or theirs) to sweep out particles
2. use an infant finger brush to gently remove foods
3. use a soft, small head toothbrush (infant, toddler or adult) to pull out particles 
4. swish and spit using water or mouthwash

Improve Oral Motor Function

1. perform therapeutic cheek exercises to increase strength and range of motion 
2. perform therapeutic lingual exercises to increase strength and range of motion

I'm a speech pathologist first but I'm also a darn good creative problem solver.  As a result, this family has 22 effective ways to resolve oral pocketing without spending a penny. Give that SLP some bonus points!

This isn't an all inclusive list, but I hope it reminds you that we have lots of options when it comes to alleviating oral pocketing. Please comment below if you know of any other methods not mentioned above. 

By the way, a few of these terms are considered professional jargon, so if you're not sure what, when, why or how, be sure to consult a speech pathologist for additional information. 

Be true to your teeth or they will be false to you.
Soupy Sales

Language Based Activities for Valentine's Day

Love is in the Air

Valentine's Day is approaching and love is in the air! Sweeten your speech therapy session by incorporating any or all of these heart related activities.

Have your patients explain these heartfelt expressions. They are a great way to get people talking and can be a nice compliment to your normal therapy activities. 

Write the sayings on construction paper hearts and glue them together to make a wreath (your occupational therapy friends may like this idea, too). Encourage family, friends and caregivers to use the wreath to elicit conversation...it makes a wonderful carryover activity. 

• have a big heart
• eat your heart out
• have your heart set on it
• a heart of gold
• cold-hearted
• pour out your heart
• wear your heart on your sleeve
• cross your heart
• with all your heart
• from the bottom of your heart
• heart and soul
• heart skipped a beat
• change of heart
• heavy heart
• whole-hearted
• half-hearted
• in my heart of hearts

Another way to stimulate speech is with thought provoking questions.  

• What would be a great gift to give a woman/ man on Valentine's Day?
• What is the best/ worst Valentine's Day gift you ever received?
• What happens to people when they fall in love?
• What are some Valentine's Day traditions you enjoy?
• How have dating traditions changed over the years?
• What's your opinion about on line dating?
• What's your idea of a perfect date?

Print copies of this heart shaped word search to address scanning, reading, attention and/or concentration. For extra fun, use a pink highlighter to complete the task.

For patients that need to improve oral motor strength or range of motion, assign homework: ask that they give or blow 10 kisses before your next session. No one has ever refused this assignment! 

Have a conversation using conversation hearts.  Take turns reading  and discussing the sayings printed on the tiny candies.  Feel free to eat as you go! Brainstorm your own list of two or three word expressions that would be appropriate for printing on a heart. To target writing, cut out construction paper hearts and have your patient write a few of these new sayings on the heart shaped candy. Use them for door or window decorations when you're through.

Finally, share these fascinating facts about the heart, providing education and discussing the importance of making heart health decisions now.  To address memory, challenge your patient to recall a few of the facts or recommendations provided in this infographic.

In a conflict between the heart and the brain, follow your heart.

Swami Vivekananda

5 Foods to Avoid: Reduce Your Risk of Developing Alzheimer's Disease

Eat This, Not That

Over 5 million individuals in the United States are living with Alzheimer’s disease, and as the population ages, the number is expected to grow. While the disease can strike as early as the 30s, most who are diagnosed are over the age of 65, and the risk increases with age. Nearly two thirds of those with Alzheimer’s are women. 

While there is no known cure for the disease, researchers have identified several lifestyle factors, including diet and exercise, which appear to affect not only the risk of developing Alzheimer’s, but also the progression of the disease.

Last week, I told you about a recently published study involving the MIND (Mediterranean- DASH Intervention for Neurodegenerative Delay) diet. Researchers have determined that following an eating pattern that has components of the DASH and Mediterranean diets will not only decrease the risk of hypertension, heart attack and stroke, but could reduce the risk of developing Alzheimer's disease by 53%. 

Also encouraging is their finding that even for those with just moderate adherence to the diet, the reduction in risk is still 35%.

While both the DASH and Mediterranean diets are rich in plant foods such as fruits, vegetables, and whole grains, as well as healthy fats, the MIND study identified ten food groups that appear to be beneficial to brain health, and five others that are harmful to the brain. In other words, the food groups in the MIND diet are deemed either "brain-healthy" or "brain-unhealthy." 

To recap, the brain-healthy MIND diet recommends:

• Every day, you eat at least three servings of whole grains, a salad and another vegetable and you drink a glass of red wine
• On most days you snack on nuts
• Every other day you eat half a cup of beans
• At least twice a week you have poultry and a half-cup serving of berries (blueberries are best)
• Dine on fish at least once a week
• Olive oil is what you primarily use at home

Here are the five brain-unhealthy food groups 

researchers tell us to limit to reduce the risk of developing dementia:

Red Meat 

Red meat isn't banned in the MIND diet, but the researchers say you should limit consumption to no more than four servings a week to help protect brain health. That's more generous than the Mediterranean diet, which restricts red meat to just one serving a week.

Butter and stick margarine

Butter and stick margarine should be limited to less than a tablespoon per day on the MIND diet. Brain-healthy olive oil can often be used instead.

Cheese  

Cheese may be delicious but it doesn't do your brain any favors, according to the MIND diet study. Eat cheese no more than once a week if you want to reduce your risk of Alzheimer's.

Pastries and Sweets

You already know they're not so good for your waistline, and it turns out pastries and other sweets could have a negative effect on brain health as well. The MIND diet recommends limiting yourself to no more than five of these treats per week.

Fried and Fast Foods

 Fried foods and fast food round out the MIND diet's list of unhealthy food groups. Limit your indulgence in fried food to no more than once a week for optimal brain health.

Even if you don’t have a family history of Alzheimer’s disease or other risk factors, you may still want to try this eating plan. Because the MIND diet focuses on nutritious whole foods, “It’s not just good for your brain. It’s good your heart and overall health, too,” says Majid Fotuhi, MD, PhD- chairman and CEO of the Memosyn Neurology Institute.

One of the best things about the MIND diet is that you don’t have to stick to it perfectly to see benefits.  “That makes it more likely you’ll follow it for a long time,” says Dr. Fotuhi. What's more, "The longer people eat the MIND way, the lower their risk of getting Alzheimer’s disease."

Considering this, it's no wonder that the MIND diet was featured by U.S. New & World Report as one of the Best Diets of 2016.  Their panel of health experts included nutritionists and physicians specializing in diabetes, heart health and weight loss.  In all, the experts scored 38 diets on short term weight loss, long term weight loss, ease of compliance, safety and nutrition. Their assessment of the MIND diet is impressive...

#1 Easiest Diet to Follow 

#2  Best Diet Overall 

#3  Best Diet for Healthy Eating 

#4  Best Diabetes Diet 

#4  Best Heart Healthy Diet 

Even though diet plays a big role, it's only one aspect of preventing Alzheimer's Disease. If you do decide to make your diet more MIND-like, experts recommend you take a few extra steps to lower your risk even more:  

• keep your portions in check
• be careful about how food is prepared (avoiding extra sugar, salt, fats and calories)
• make a point to drink several glasses of water each day
• get regular exercise
• manage your stress 

Make good choices today so you don't have regrets tomorrow.

Unknown

Fight Alzheimer's with Memory Boosting Super Foods

You Are What You Eat

For years, doctors have been saying that what you eat can affect the health of your heart, but now there is new evidence that the same is true for your brain. Here's the latest...

CBS News recently reported the results of a new study conducted by researchers at Rush University Medical Center in Chicago. It shows that a thoughtfully planned MIND diet may reduce the risk of developing Alzheimer's Disease as much as 53 percent!

The MIND diet combines many elements of two other popular nutrition plans which have been proven to benefit heart health:  The Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet.  The result is what's known as the MIND diet: Mediterranean-DASH Intervention for Neurogenerative Delay. 

Martha Clare Morris, PhD, was the lead author of this MIND diet study. She stated that "diet is just one of the many factors that play into who gets the disease." While genetics and other factors like smoking, exercise and education also play a role, diet helped slow the rate of cognitive decline and protect against Alzheimer's regardless of the risk factors present. 

Hip, hip hooray!

Because a picture is worth a thousand words, I like to use this infographic from alzheimers.net when talking to patients and family members about the best brain superfoods.

Here are some of the specific recommendations that have come from the MIND diet study:

Vegetables and Leafy Greens

• researchers recommend eating a salad and at least one other vegetable every day 
• at least two servings of greens a week can help
• six or more servings of veggies a week provide the greatest brain benefits

Omega- 3 Fatty Acids, Beans and Nuts

• eating fish at least once a week helps protect brain function
• eating beans three times a week keeps the mind sharp
• eating nuts at least five times a week helps lower bad cholesterol and reduces the risk of heart disease

Coffee, Chocolate and Spices

• drinking 1-2 cups of coffee each day is related to an 18% reduced risk of cognitive disorders
• regular intake of dark chocolate is associated with better cognitive performance in the elderly
• tumeric destroys plaques that are associated with  neurological damage related to Alzheimer's disease

Berries and Dark Skinned Fruits

• dark skinned fruits are some of the more potent foods in terms of protecting the brain
• blueberries are  known to increase memory and motor skills
• researchers recommend eating berries at least twice a week

Oils

• Olive oil beat out other forms of cooking oil and fats 
• researchers found people who used olive oil as their primary oil at home saw greater protection against cognitive decline

Whole Grains

• researchers recommend at least three servings of whole grains each day

Poultry

• poultry is an important part of a brain-healthy eating plan
• scientist recommend eating two or more servings of poultry each week

Wine

• a glass of red wine every day is recommended...but just one

Even if you slip up on the diet from time to time, the researchers say it can still have benefits. According to lead author Dr. Morris, "Modest adherence to the MIND diet measurably reduced a person's chances of developing Alzheimer's disease, and the longer you stick with it, the greater the benefits."

"People who eat this diet consistently over the years get the best protection," said Dr. Morris. "You'll be healthier if you've been doing the right thing for a long time."

This week, as you go about your work, consider providing education to your patients, friends and family regarding the importance of wise choices and the benefits of consuming brain super foods. 

Every time you eat or drink, you are feeding disease or you are fighting it.
Heather Morgan MS, NLC

Dysphagia Therapy And Thermogustatory Stimulation

Lemon Ice:

Before, During and After

Not too long ago, I was hunting for a recipe for lemon ice when I ran upon this video created by my friends at Rehab Synergies. It's awesome!

I love it because it not only gives step by step instructions for  making lemon ice, it reviews the rationale for its use and the methods for its administration.  It's a great educational video to share with patients, caregivers and family members. Have a look...

In the video, you saw this adorable SLP suggest administering lemon ice prior to a meal or in alternation with other tastes, textures and temperatures.  Recently, I decided to try something a little different...I administered lemon ice before, during and after a therapeutic meal. 

• Lemon ice before the meal primes the pump and readies the patient for swallowing and eating. It assists with the clearing of secretions before eating.

• Lemon ice during the meal slows the rate of intake,  allows a break from chewing and promotes clearing of particles. 

• Lemon ice after the meal allows provides a final opportunity for clearing the mouth, pharynx and larynx of residuals...it doubles as dessert, too!

The results were great: the patient loved the novelty of it, the wife felt like I was "doing something" to treat the dysphagia and I was happy because, all along the way, my patient was clearing the boluses and there were no gurgly residuals to worry about.

Win! Win! Win!

As happy as I was to reunite with lemon ice, I wasn't actually using a homemade lemon ice recipe. First of all, ain't nobody got time for that, and more importantly, ain't nobody got a freezer in their car (I'm a home health therapist, you know). 

Instead, I stopped by the grocery store on the way to the patient's home and picked up a container of Minute Maid Frozen Lemonade. This version of lemon ice seemed to work perfectly. It has a smooth, creamy texture, an icy cold temperature and an intensely sour flavor. It's also available in a variety of other creamy, cold, sour flavors. How neat!

Whether you choose old school, DIY lemon ice, or 5 for $5.00 soft frozen lemonade, consider incorporating thermogustatory stimulation in your next dysphagia session. I think you will be happy with the results all the way around.


When fate hands you a lemon, make lemonade.
Dale Carnegie 

Detecting Dehydration in Two Quick Steps

Dehydration is the Enemy

As SLPs, we are continuously watching for problems...after all, that's what we're trained to do. Some signs are easy to see, such as the crooked smile of a drooping mouth or a tongue that deviates to the side. Some troubles are easy to hear, such as coughing while eating or slurring while speaking. Other times, the problems an adult patient experiences are subtle and leave only small, telltale signs of trouble ahead. This is the case with dehydration.

Dehydration

Dehydration occurs when more fluids are lost than are taken in. It's just that simple. Next to oxygen, water is the substance most needed for life. While a person can live without food for approximately 30 days, most people can survive only three or four days with out water. Why is that?

Many important structures are made of water and require proper hydration for proper function. Specifically, water makes up 70% of muscles, 75% of the brain and 85% of the blood.  Additionally, water is present in and around each and every one of our cells. Therefore, when water content is deficient, there are serious consequences throughout the body.

Come to find out, it's no wonder that our older adult patients are dehydrated- the  thirst response decreases with age. In fact, researchers say that adults over 50 are more likely not to experience thirst as intensely as younger people. Additionally, stress and fatigue may also contribute to a diminished thirst response.

Dehydration is a serious problem for the elderly. According to Provider magazine, as many as 75% of older adults are not getting the minimum amount of daily fluids recommended. Yikes! To complicate things, dehydration can be tricky to recognize in the elderly.

Common signs and symptoms of dehydration:

• confusion
• difficulty walking
• dizziness
• headaches
• dry lips
• dry mouth
• low blood pressure
• low urine output
• constipation
• joint pain

Because so many elderly adults have many of the complaints listed above, it is easy to see why dehydration is often overlooked by caregivers as a contributing factor to a variety of health problems.  Luckily, our bodies signal dehydration is other ways.

Teach patients, family members and/or caregivers to recognize dehydration using two very simple methods.

Two Simple Ways to Detect Dehydration

1.  Urine Color Assessment

Urine color says a lot about our hydration status. Generally, the lighter the color, the more hydrated you are. Conversely, the darker the urine, the more dehydrated you are. Let me explain.

Dehydration is caused when the volume of water in the body is depleted. Our kidneys, which filter out waste, tell the body to retain water. As a result, we have less water in our urine, and it comes more concentrated and darker.

A urine color chart makes dehydration easy to see.

2.  Skin Turgor Test

Assessment of skin turgor can also give clues about a person's hydration status.  A skin turgor test, or a pinch test, can be quickly and easily performed. It's super simple.

Pinch the skin on the back of the hand. If it snaps back to normal in one second or less, it's a good sign that hydration is adequate. If the skin slowly returns,  does not go right back, or remains up in a tent like fashion, it's a sign of dehydration.

Because water comes out in sweat, urine, poop and even breath, it is estimated that the average person loses between 10 and 15 cups of fluid each day. Knowing that water is critical for digestion, healthy weight, body temperature regulation and even mood, encourage your patients to make sure they are getting enough to drink each and every day. If you're not sure they are following your advice, you can use either of these simple tests to help you assess for dehydration.

We never know the worth of water until the well is dry.

Thomas Fuller

photo from US Library of Medicine

Get Focused in 2016: Three Easy Options For Accomplishing More

Hello, 2016!

I love the New Year's season. It's a good time to reflect upon past things and make plans for the future. Even if those plans become thwarted by events outside of your control, a plan means you are intending to go somewhere or do something. As Mark Twain said, Plan for the future because that's where you're going to spend the rest of your life. 

As SLPs, we write goals and objectives on a daily basis. We carefully chose words, percentages and criteria to measure the functional progress of our patients, but, I'm curious...do you have a goal for your life? Let's look at three easy ways to get clear and accomplish more in 2016.

Make Resolutions

Some people begin the new year by making resolutions. These are simple promises to do an act of self-improvement or something nice for others. Common resolutions include: eat healthy, exercise more, stress less, volunteer, get organized and be happy. 

As simple as they can be, resolutions are likely to be abandoned within a few months, and people who make resolutions experience an 88% failure rate. Nonetheless, making a resolution can be the baby step you need to take before you can set realistic goals for yourself.

Set Goals

Goals are what take us forward in life: they give us focus, allow us to measure progress and give us motivation.  Goal setting involves envisioning, planning, committing to and achieving a desired end point.  If you ask me, setting goals will keep you performing at your best and should be a consistent part of your personal and professional routine. 

Experts (and my dad) agree that there are 7 keys areas to consider when setting goals:  career, financial, spiritual, physical, intellectual, family and social. It may sound like a lot, but researchers tell us that people who set goals have more success, earn more money and are generally happier people than those who don't. Sounds good to me!

If you need help  writing goals, the internet, as always, is an excellent source of information and inspiration.  Maybe you need to start from the beginning? Read this article:  The Beginner's Guide to Goal Setting. Looking for a worksheet to actually hash out your goals? Try this SMART goal setting worksheet. 

Create a Vision Board

Creating a vision board is another great way to prepare for a prosperous new year. If you have already defined your plans, a vision board allows you to illustrate them visually. This powerful tool serves as your image of the future- it represents your dreams, your goals and your ideal life. Because your mind responds strongly to visual stimulation, by representing your goals with pictures and images, you can actually increase your success.

To do this, find pictures that represent or symbolize the experiences, feelings and possessions you want in your life, and place them on your board. Position your board in an open area place where it is easy to see and regularly spend time visualizing, affirming, believing and internalizing your goals. 

Need help? Use this link to learn how to create a vision board to make your ideal life your reality. Give it a try....it's really fun AND it works!


No matter which method you choose for achieving your dreams, it all boils down to this:

1. Have a plan
2. Know the plan
3. Work the plan

It's just that simple!


As you go about your work this week, contemplate the dream, the direction and the plans you have for your life.  I encourage you to make a resolution, write down your goals or create a vision board, but more than anything, I hope you enjoy a super 2016!


Setting goals is the first step in turning the invisible into the visible.
Tony Robbins