Spring Break Road Trip

Looking Back

Just one year ago, I spent my Spring Break vacation creating, designing and developing Pictures for Progress.  Every day, with the help and support of my mom, I worked  long hours collecting photos and writing questions for what I dreamed would be a fantastic new therapy tool for SLPs working with adults.

Twelve months later, not only have I realized my dream, I have taken my business and my products further than I could have ever imagined.   In fact, Spontaneous Speech has exhibited at state and national conventions in Phoenix, Arizona, Denver, Colorado and Fort Worth, Texas. We've covered thousands of miles spreading the word

Every day, the development of this product has taught me something new. I've learned about design, manufacturing and importing. My decision making skills have been sharpened.  With opportunities and challenges along the way, I've maintained my commitment to providing top quality tools and therapy materials to the world. 

This year, as Spring Break rolls around again, I'm spending the week enjoying a road trip to New Mexico with my kids- Jay, Mike, Meredith and Coby. 

I can't wait to see what tomorrow brings!

Wherever you go, go with all your heart. 

Confucius

TSHA 2016: Fort Worth, Texas

Texas Speech Language Hearing Association

Annual Convention:

March 10-12, 2016

After a treacherous drive in the pouring rain, we arrived in Fort Worth for TSHA's annual convention. This being our third conference in the last nine months, we're beginning to consider ourselves pros at setting up a vendor's booth. Using a beach theme, we decorated with a Spring Break vibe:  beach balls, flip flops, sunglasses and palm trees. Things at the booth came together quickly and we were headed to the hotel in less than an hour...our fastest time yet! 

Thursday, Friday and Saturday, visitors that stopped by were able to get a close look at the Pictures for Progress flashcards and the new Spanish translation booklets. We received lots of positive feedback on both of the products and delighted with each and every purchase made. Because we didn't want anyone to leave empty handed, we passed out pencils, magnetic bookmarks, business cards, brochures and mini versions of flashcards tucked inside a business card holder...there was something for everyone that stopped by. 

Thousands were in attendance and hundreds visited the booth to learn more about Spontaneous Speech Therapy Tools. In three days, we met some of the greatest people:  students, professors, marketers, business owners, recruiters, and of course, pediatric and medical SLPs. I was particularly happy to run into a former LSU professor, Dr. Jack Damico and my TCU clinical coordinator, Lynn Flahive.

We celebrated our success (and survival) at the end of each day with happy hour. Later, when we retreated to our room, we took turns using the tens unit to treat our sore legs and feet. It was just the recharge we needed!

Less than a year away, we are already looking forward to TSHA 2017 in Austin. Maybe we'll see you there?

Pictures for Progress- Spanish Translation

While I was in graduate school, I remember the pain I felt when I realized there just weren't any great therapy materials available for SLPs working with Spanish speaking adults.  My friend Normie and I agreed that we would pay any amount of money necessary to have something like this. Search as we might, the tools weren't available. So, like most students, we did the best we could with what we had. 

In the Spring of 2015, when I set out to create my first line of therapy materials, I had specific ideas about what I wanted. There was a short list of requirements:  a sturdy box, bright, contemporary photos, durable, wipeable cards, thought provoking questions and an available Spanish translation. 

Finally, 22 years later, (but who's counting) I proudly present....

Imagenes Para El Progreso: Espanol.

This 8 1/2 x 5 1/2 inch booklet is designed to accompany the Pictures for Progress flashcards. A spiral binding allows the book to lie flat and holds the pages neatly together. Made of thick card stock, the sturdy pages are designed to withstand daily wear and tear. 

With large print, and numbered, full color thumbnail pictures, users can easily locate the translations that correspond to the flashcards.  Containing two translations on each page, users can see the translated questions for up to four cards at a time- this prevents excessive page turning or the perception of disorganization that can be distracting during a therapy session. 

Knowing that there are numerous regional Spanish dialects, extra time and attention went into the translation process. While there is no such thing as one size fits all, this translation offers language that is appropriate for use in a great variety of geographical regions where Spanish is spoken. 

You can find this new Spanish edition in the Spontaneous Speech Store at SpontaneousSpeech.com.

To have a second language is to posses a second soul. 

Charlemagne 

Making Requests: A 3 Step Process

When You Need A Helping Hand:
Communicating Your Wants and Needs

Whether it's neurological impairment or cognitive decline, language deficits can make it difficult, if not impossible, to ask for help. When you can't get the help you need, the consequences range from being uncomfortable to being unsafe, and everything in between. As a result, making requests or expressing wants and needs is of utmost importance for patients and caregivers, but it's not as simple as it might sound. 

To retrain this skill, I recommend practice that is based on a 3 step process: get your caregiver's attention, say what's wrong, and then ask for help. Here's a little more detail about each of the components for making an effective request...

1.  Get Their Attention

Using a loud, strong voice, it's easy to get help once you have your caregiver's attention. Practice achieving good volume during therapy sessions, using the visual feedback of a sound level meter. In most quiet home environments, a vocal intensity of 75-85 dB will be sufficient for gaining the attention of others...even if they're in another room.

As much as possible, call caregivers by name.  If a caregiver's name isn't able to recalled quickly or accurately, incorporate photos and written cues as needed, or rehearse names using Spaced Retrieval Technique. 

In a healthcare facility, gaining the attention of caregivers may be as simple as pressing a call button. Therapeutic training with use of the call button may be in order.

2.  Say what's wrong 

In simple terms, tell what's on you mind by identifying your problem.  Be clear! While a gesture is great for clarifying or supplementing a message, its meaning can be incorrectly interpreted. 

For instance, it may not be apparent to someone else that you're thirsty if you just tap your cup on the table. The cup may be removed without the chance for a refill unless you speak up by saying, "I'm thirsty."

Squinting your eyes doesn't necessarily mean the blinds need to be adjusted to prevent the sun from shining in your face. A caregiver may see a contorted facial expression as an indication of pain. To really get your point across, say, "The sun is in my eyes."

3.  Make a request

Caregivers aren't mind readers, so now that you've got their attention and they understand the problem, make a specific request. 

Would you bring me some apple juice?

Can you close the blinds?

Now, let's put it into practice!  I created a list of scenarios to help patients with aphasia and dementia practice their requesting skills.  I've had good success using this approach and these questions.  

As usual, not every question applies to every person, so pick and choose your favorites. If there's a question that should be on the list but isn't, please leave a comment at the end of the post and I will be sure to add it. 

PS:  Double click the pop-out button (upper right corner) to print or download the document. 

Using a hierarchical approach based on your patient's language skills, start low and work your way up. This it how it might sound during practice. :


What would you say if you were in pain?

Good:  My head hurts.
Better:  Laura, my head hurts.
Best:  Laura!  My head hurts. Can you please bring me some Tylenol?


What would you say if you didn't like the clothes that were picked for you?

Good:   I don't like this sweater.
Better: Angie, I don't like this sweater. 
Best:  Angie, I don't like this sweater. Can you find another one?


The next time you need a functional speech, language or  problem solving activity, give this list of questions a try...your patients and their caregivers will be glad you did!


Refusing to ask for help when you need it, is refusing someone the chance to be helpful.
Ric Okasec

Dementia and Communication: 5 Easy Ways to Start a Conversation

What To Do When Your Mom Sleeps 

All Day Long

So often, I hear the same complaint  from family members and caregivers:

My mom sleeps all day long.
My dad just sits here watching TV.
She never has anything to say.
He's stopped talking to us.

My typical response:

Give her a reason to stay awake.
Offer him something else to do.
Ask the right questions, talk about the right things.
Provide opportunities for conversation.


Yesterday, I was talking with a daughter of a patient about the importance of creating opportunities to communicate, socialize, interact and connect. The patient has dementia but is still able to function on a conversational level when the subject is simple and concrete...here and now.  I gave a few examples of ways to initiate conversation and promote exchange. I emphasized the importance of providing chances for engagement and socialization. 

This daughter appeared to be listening attentively. She nodded to agree and then said the one thing that makes me cringe every time:

I'll  buy some flashcards at the dollar store. We can talk about those.

 UGH....I HATE FLASHCARDS FROM THE DOLLAR STORE!

These cartoon cards are perfect if you want to teach a toddler the ABCs but they are juvenile and irrelevant to the daily lives older adults. No matter how hard you might try, there's just no way you can have a meaningful conversation with flashcards like these. Instead...

Here is a list of things a speech pathologist recommends for striking up great conversation with a spouse, parent, friend, neighbor or patient.

Dementia and Communication:

5 Super Easy Ways to Start a Conversation

1.  Use the newspaper:

• read and discuss the headlines
• go shopping using the sales circulars 
• read the life stories of the people in the obituaries
• work together to complete the crossword puzzle
• skim over the police blotter- usually good for a laugh
• read and discuss the Dear Abby letters 
• find great coupons then make a shopping list
• browse the want ads

2.  Use what's on hand:

• look a photo album together
• thumb through the pages of a catalog
• talk about recipes in cookbooks
• look at magazines
• sort through the mail together
• spend some time enjoying beautiful photography in a picture book
• talk about the family photos, decor and art around the house
• plan out your television viewing using the TV Guide
• sing along with the radio
• read aloud from a book or magazine then discuss 
• read or retell stories from the Bible
• reminisce- it's always fun to walk down memory lane

3.  Use an electronic device: 

• browse Pinterest- personally, I could do that for hours
• Google search a topic or place of interest 
• play a simple game- I have apps for tic tac toe, Farkle and Connect Four
• scroll through posts on Facebook and Instagram
• create a new post for Facebook or Instagram
• watch You Tube videos- gotta love those amazing cat videos!
• see what's available on Craig's List- it can be more fun than you might think
• use Face Time or Skype to visit with friends and family

4.  Use the television: 

• talk about current events after watching the news
• watch a game show and play along -Family Feud, The Price is Right, Wheel of Fortune
• talk about the characters or the plot of  a TV show during a commercial break
• watch a cooking show
• watch a DIY or home improvement show
• Watch and learn together, then discuss- fabulous programs on:
• History Channel
• PBS
• AMC 
• Western Channel
• QVC or HSN
• Weather Channel- but only as a last resort

5.  Use others:

• chat with friends and family member over  the phone
• invite a neighbor for a brief visit
• invite a pastor or friend from church to stop by
• get out and about- talk with neighbors, other shoppers, wait staff, cashiers, etc.
• visit with home healthcare workers- they've always got a good story to tell

These fun and easy conversation starters are sure to get people talking. Browse through the list and see which ones you might be able to include the next time you want to engage a person with dementia. Pick and choose the ones you like best. As always, modify as needed.

Good luck and have fun!


Oh yeah, if you just have to have flashcards, skip the trip to the dollar store and invest in a set of good quality picture cards. I recommend Pictures for Progress.  As an SLP, I use them every single day to elicit meaningful conversation about real life topics. Try them...I know you will like them!


Think in the morning. Act in the noon. Eat in the evening. Sleep in the night. 
William Blake

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