Tag: ccc-slp

Empathy and the End of Life

Empathy and the End of Life

Sometimes in our line of work, our patients do not get better.  Sometimes, despite our best efforts, they get worse.  And sometimes they die.  This month  has been a difficult one, as the majority of my hospital caseload has included patients at the end of life.  I have also had a graduate student working with me. Needless to say, we have experienced many “teachable moments” together this month and my twitter feed has been surprisingly supportive (see posts/retweets @CCCSLPNET).

What  I have learned/tried to teach is:

The  importance of  understanding the patient’s goals and perspective.

The importance of withholding  my personal feelings/judgements while providing the most accurate information I can to explain the patient’s deficits.

The importance of alternatives, knowing that if ‘Plan A’ does not meet the patient’s goals, there needs to be a ‘Plan B’, and possibly a ‘Plan C’.

The importance of teamwork

I am fortunate to work with a wonderful team of physicians, nurses, dietitians, case managers and a great Palliative Nurse Practitioner.  Through these collaborations I have learned that the Palliative Care conversation, that “first conversation” can happen early, before the end of life, to help clarify the patient’s goals for care in  order to mitigate unnecessary care and  avoid unwanted returns  to the hospital. I have learned to avoid blaming the patient for their informed choices by endeavoring to eliminate the  term “non-compliant” from my documentation.  If after education, the patient decides not to follow my recommendations, that is their choice.  They are not non-compliant.  They are choosing a different course of care based on their goals/values.  I need to respect that.

My biggest contribution to my team has been in providing education regarding what alternative nutrition (G tubes) can and cannot do for chronically ill patients at the end of life. Knowing that G tubes are contraindicated in patients over 75, with advanced dementia, advanced/chronic illness, low BMI, previous aspiration and UTI and that there is no evidence that tube feeding in patients with advanced dementia prolongs survival, prevents aspiration pneumonia, reduces the risk of pressures sores or infections, improves function or provides comfort has helped our team in its quest for compassionate care.

It is always an on-going process.  Each patient is different and it is never easy, but we strive. I remind myself that it is an honor and a privilege to  assist in the care of these patients at this stage of their life…. That helps.

For more information regarding Palliative Care and PEG tubes see:
Plonk Jr., WM. To PEG or Not to PEG. Practical Gastroenterology. July, 2005.  pp 18-31.  Great summary with multiple additional references.

About the Author

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com.
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Support the Supporters: Helping Caregivers of People with Aphasia

Support the Supporters: Helping Caregivers of People with Aphasia

By Lisa Haynes, MS, CCC-SLP, Clinical Consultant, Lingraphica

In our experience working with those with acquired language disorders, we have found that one of the most challenging issues is assuring carryover and functional use of an AAC/SGD once a device has been determined to be appropriate and purchased. How many times have we set up/trained a patient with a device only to find that once the patient is discharged from treatment, the device ends up collecting dust in a closet? Luckily for us, we met Lisa Haynes of Lingraphica at ASHA 2012 and she agreed to guest blog for us about this very issue. It seems that Lingraphica has some systems in place to support users, caregivers and therapists that may keep those devices out of the closet. Welcome Lisa!

November was National Caregiver Awareness Month and many took the opportunity to express their gratitude, thanks, and appreciation for caregivers who devote themselves to helping someone else. November has ended, but at Lingraphica, we make it a point to support caregivers year-round.

Lingraphica’s mission is simple: Help adults with aphasia re-establish communication with family, friends, and community. We do so by offering speech-generating devices (SGDs) communication apps (SmallTalk tm), and our recently released speech therapy apps (TalkPath sm). We know from our years of experience that when it comes to re-establishing communication or reacquiring speech, this lengthy process is more manageable when the patient has the dedicated assistance of a caregiver — whether it’s a spouse, child, friend, or paid assistant. This is why Lingraphica offers unlimited, free support and training for all of our SGDs — for as long as the patient owns the device.

When the goal is to help those with aphasia better communicate, training on their devices is an essential component to success. As such, we extend our complimentary support to everyone involved with the care and treatment of the patient, including:

• Caregivers: Our technical support team is available to answer any questions a caregiver may have regarding the use of the SGD. Caregivers can contact us via phone or email. There is no charge for the extra service and our technician will spend the necessary time to resolve the issue and ensure satisfaction.

• Speech-language pathologists (SLPs): We offer free device trails and training for any SLP who thinks a Lingraphica device is a good fit for a patient. We can help them make that determination and set up one-on-one, remote training to ensure the SLP has the training to help the patient use the device effectively.

• Patients: Everyone involved has a role in the process, but at the end of the day it’s about how well the patient is able to use the device to communicate. This is why we offer online, remote training and telephone assistance for patients, as well.

Those caring for someone with aphasia have a difficult job and communication can be a challenge. It can be even more frustrating if they are unable to assist their loved one with the learning curve involved with any SGD. Lingraphica makes every effort to arm caregivers with the support, training, and information needed to be a helpful resource at home.

So, if you haven’t yet offered your appreciation to the caregiver of someone with aphasia, now is the perfect time. National Caregiver Awareness month may have ended, but it is never too late to support their efforts.

In your case, Lingraphica makes it easy to offer that assistance — simply start a free device trial and we’ll take care of the rest.

About the Author

Lisa Haynes, MS, CCC-SLP, is a Clinical Consultant at Lingraphica applying her expertise as an AAC specialist to clinicians and caregivers using Lingraphica speech-generating devices or beginning a free device trial.  Contact Lisa at lhaynes@lingraphica.com

Information contained herein does not necessarily reflect endorsement by the web host.

Do you have expertise or a product we should know about?  Contact us at media@cccslp.net to inquire about guest blogging.  We’d love to here from you.

 …

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ASHA 2012

ASHA 2012

Opening Ceremony ASHA 2012

We are minutes from the start of something big.  #ASHA12 begins.  And,CCCslp.net returns to  ASHAConvfor the first time since 2010.  We have a new site that is easier to navigate and with more content.  But we continue to offer a SLP/AuD a place to gather and share or vent or laugh and cry or do all the above.

We are communication specialist.  Self expression is the most fundamental needs of humans.  It defines us.  It makes us happy.  It keeps us sane.  It is the single common human trait.  Our professional life is the care, nurturing and promotion of good communication. Yet we neglect our own needs to be heard.

 

CCCslp.net is here for you to express yourself.  Come Talk to Us!…

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10’s by Lori Yauch

10’s by Lori Yauch

For our inaugeral column, we have selected Lori Yauch, a Speech Language Pathologist of over 20 years, practicing as an independent Consultant/Clinician in the Tampa Bay Area. Lori has a unique product that she would like to share with her colleagues, but in order to do that, she must first answer the 10 ‘no ifs ands or buts’. We hope you enjoy her responses as much as we did.

1. Cookie of choice for bedside swallow exams:

Lorna Doone

2. Preference for language testing BDAE or WAB:

BDAE

3. +/- or PICA for scoring:

Modified PICA (10 down to 1, but I forget what 2 is. I think it’s the same as 6, so why use it? You get more credit with 6, or maybe you just get egg roll. I can’t remember)

4. Muppets or dwarves for entertainment purposes only:

Muppets

4a. Favorite individual muppet or dwarf:

Elmo

5. Worst treatment moment of your career:

Any moment during my first job. I was a new grad and had to move away from home, living truly on my own for the first time. I lived in one state and crossed the border daily to work. My CFY Supervisor was selfish, unsupportive and certainly, ineffective as a teacher. I think it was her mission to find fault in every move I made, both in the clinical arena and in the building environment. I used a scooter to assist in my mobility and was written up for, among other things, the way in which I moved about the facility. By the end of 6 months I resigned. I heard later, she fell and was in a wheelchair for a time. You know what they say about paybacks! I moved on to greater and greener pastures. Years later I am a respected clinician, having supervised many students and CF’s and am here offering insights into our field Things really do have a way of working out.

6. Best advice you ever ignored:

I don’t typically ignore advice. However, there was a time when I was looking for bigger and better things. A friend suggested I come to her company, I considered it carefully and just as I was about to make the decision to move on, the company called and rescinded the offer. As it turned out, better offers came and when the time was right, I moved on.

7. Favorite, most reliable, and practical treatment strategy:

Masko Maneuver

8. Why SLP and not world domination?

SLP is world domination. One patient at a time.

9. Would you do it all over again exactly the same way?

Yes. If I hadn’t, I would not be where I am today. I learned from every experience. What I want and what I don’t. I have a good career balanced with a good life.

10. What one thing do you still want to do before your career goals are completely achieved?

Publish my manuscript. Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity (which segues very nicely into the next question)

SHAMELESS SELF PROMOTION IN 30 WORDS (there actually is no word limit really so say whatever you want):

As clinicians in long-term care or adult rehab settings, we have all been faced with the necessity of providing group activities to our residents/patients. In an effort to come up with a new and innovative group idea, I decided to bring my passion for classic movie musicals and my job together. In conjunction with the Activity Dept. at the skilled nursing facility in Florida, where I was one of 3 speech pathologists, Movies and Music was established. In running this group I began to realize with the right material and right level of function, watching a movie which was once a sedentary activity, could be quite interactive. The interaction fostered increased communication, use of language, pragmatic skills, conversation and long term memory.

With this in mind, together with further observation that no group like this existed in any of the facilities I visited as a consultant, Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity was born.

The guide is divided into 12 sections according to the calendar year and centers on a specific movie for a given holiday in the month (New Year’s Day, President’s Day, St. Patrick’s Day, etc). The films were chosen specifically for their ability to promote interaction.

The group size is generally 4 -10 patients with mild – moderate cognitive impairment. Diagnoses may include: Right/Left Hemisphere CVA, TBI, Dementia, Parkinson’s Disease or any other diagnosis at the Group Leader’s discretion.

Field testing completed during 2008-2009, yielded positive results with clinicians stating:

“ I highly recommend Movies and Music to any clinician working with individuals with mild to severe communication deficits….I look forward to being able to include this in my future plan of care at my facility.” Jane Fitzgerald House, M.S., CCC-SLP

“Assessment of the group dynamics indicated increased motivation, interest and curiosity which resulted in increased expressive language skills. … Group participants stated it was fun and interesting.” Lisa Mathers, M.S., CCC-SLP

Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity is available for purchase. Please contact Lori Yauch at moviemaven1@verizon.net.

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Reflections on a Career in SLP

Reflections on a Career in SLP

By Therese M. O’Neil-Pirozzi, ScD, CCC-SLP

I doubt that there’s anyone who hasn’t been impacted by the January earthquake in Haiti –  maybe you lost someone who lived there…  maybe you spent some time volunteering there…  maybe you were touched by photos that you’ve seen or by articles that you’ve read…

I’ve been following the news about medical teams that have traveled to Haiti, and I’ve read about the minimal technology available to assist them in their provision of care to those in need.  Reasons for this include the limited technology in place before the earthquake because of the country’s economy and the fact that much of the technology that was previously available was destroyed by the earthquake.  Nonetheless, the injured are benefiting from quality care, and the health care providers ministering to them are expressing great pride and satisfaction with the work that they are doing

You don’t have to be providing care in a country that’s just experienced an earthquake to be challenged by limited resources trying to do so-  maybe you’re employed in a school system with no monies to purchase assessments…  maybe you work in a medical setting that doesn’t have easy access to videofluoroscopy or endoscopy…  maybe you volunteer at a homeless shelter where there’s no quiet space to empower parents to stimulate their children’s language literacy development…  Nonetheless, you minister to your students, clients, patients, and “new friends” effectively, with these people demonstrating positive outcomes as a result.

As part of Speech-Language Pathology coursework, many of us completed assignments in which we created our own articulation tests, our own auditory discrimination tests, and our own language intervention kits.  I remember painstakingly trying to draw pictures of common objects and 3-step activities and then showing them to young nieces and nephews to see if they could tell what they were supposed to be.  One of my undergraduate final exams was as follows:  “You and a 7-year old boy are in a room with a table, two chairs, and a window.  You have a pencil, a paper, and a piece of string.  Do a complete speech-language evaluation on this child.”  Although I was sure that that final was going to mark the end of my future as a speech-language pathologist, I passed the exam and continued on…

Since then, I have had to conduct countless diagnostic and therapeutic sessions without the benefit of valuable technology and other equipment and materials that I find useful.  And, in spite of the obvious challenges that this presents, I feel that these experiences have made me a better clinician.  With my eyes, ears, a deck of cards, a free newspaper, and some continually evolving critical thinking skills, I have figured out ways to do what needs to be done to benefit those with whom I am working.  Is it challenging doing this?  Yes!  Is it my preference to do things this way?  No!!  But, I think that the fundamental key to our effectiveness as clinicians is not the tools that are available for us to use with our students, clients, patients, and “new friends,” but, rather, our ability to learn how to problem solve evidence-supported ways to do what we need to do with whatever we do or do not have.

…You have a lollipop, a cup, and a phone bill.  Do a complete diagnostic evaluation on a 57-year old female with suspected cognitive-communication impairments…

Therese M. O’Neil-Pirozzi, ScD, CCC-SLP
t.oneil-pirozzi@neu.edu

About the author

Therese O’Neil-Pirozzi, ScD, CCC-SLP is the SLP Graduate Program Director and Associate Professor at Northeastern University in Boston, MA. She is also a Clinical Researcher and Clinician for Spaulding Rehabilitation Hospital. Author of many research articles, she is a frequent presenter at ASHA’s annual conventions. Her areas of interest crisscross from adults to children, from voice to aphasia, from dysphagia to literacy. If Speech Language Pathology ever had a renaissance clinician, then it would surely be Therese. In addition to her body of work, Therese continues to find time to be a resource to practicing clinicians, an advisor to graduate students, a good friend for those of us lucky enough to know her, and a devoted Red Sox fan. Her email address is: t.oneil-pirozzi@neu.edu

If you would like to reflect on your career in Speech Language Pathology/Audiology, please submit your article for consideration to mullaneycccslp@comcast.net.…

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