Communication Partner

During our 2nd (& final!) year we have allocated a placement that is NOT a clinical SLT placement.  It is there for the purpose of developing our communication skills only, not our partners.  It is an opportunity to give another individual social conversation that is an enjoyable experience whilst we students get an opportunity to learn how to adapt our own communication to suit the other, and become aware of how we communicate.

 

We select one individual over the year to work with 1:1 and I have been placed in an Adult LD setting.  I am working with a man in his 20s who is such a laugh.  He is non-verbal but he just laughs and laughs and laughs whilst I continue to entertain.  I have taken this to mean he is having an enjoyable experience so at least I can say I have fulfilled that role!

 

Initially I was unsure of why this placement was in the curriculum, and how this would really benefit me.  But I have found a way to work with someone without being a SLT but still being able to analyse and be aware of my own communication in order to suit the other.  It is a fantastic tool of reflection where I have developed skills within the LD setting, with adults that are non-verbal, with staff and carers and within my own communication.  Though I am now unable to turn my "SLT Brain" off when I am in a communicative environment, I am forever informally assessing the others receptive and expressive skills and non-verbal cues, however I have now found a way to internally analyse this and use this to adapt my communication to suit the clients needs, rather than thinking of interventions or strategies to give to others to engage in.

 

It has also made me realise that training another person to be a Communication Partner (as SLTs may need to in adult carers) and to develop their skills may take time, not only because it takes reflective skills and awareness of communication, but also because the prior education as to WHY it is important is one of the most essential parts to this process.

 

I am now curious how many other SLTs get an opportunity like this to be able to reflect so effectively on their own communication, before having to begin a job where they are reflecting on others communication. Please comment if you do have a similar experience to this as I would love to hear your views :)

 

Twitter Advocate: How to Promote Twitter?

Recently I have become some what of an advocate for Twitter and the benefits of Twitter for SLTs.

This month I wrote a Letter to the Editor of the RCSLTs Bulletin in order to raise awareness of Twitter in the field of SLTs and detail exactly how it has helped me as a Student to be connected to SLT students, SLTAs and Qualified SLTs.

When I told my Tutors at my University that this was to be published they were excited (and apologised for not joining Twitter sooner!) and even asked me to write a piece in the very first edition of the University's SLT Newsletters that will be sent to Practice Educators. 

So during this I have come to realise that many of my Twitter followers that I am connected to come from America, Canada, and Australia.  Now this makes me curious as to how Twitter is promoted over there, is the best way to tackle this lack of UK SLTs on Twitter to be writing in the Bulletin and Newsletters? Or is there a better more technology based way to reach people?

If anyone has any thoughts about this, please do comment - I would love to hear any ideas!

But overall what I have realised through taking on this "advocate" type role, is that Twitter really has supported me through the good times and the bad.  I get to have someone I can proclaim my excitement with, someone that will actually understand why it is exciting (I think I've gone past the point of boring my family with the excitment of swallow assessments!) but I also get to have someone to support me when I am confused, eagerly searching more information on a topic, or worried about how to do something!

So if you are reading this blog (and you haven't come here via my Twitter!) and you are not on Twitter, go & sign up now! Blogs are as beneficial to CPD as Twitter is, but on Blogs you do not get that community sense that you can build with Twitter, so go and join, and "meet" people you never thought you would!

And most importantly don't forget to use hashtags #slpeeps #slp2b and #slt2b to find us SLTs with :)

Dysphagia Study Week #2

So us lucky students at the University of Essex get a 2 week intensive study on Dysphagia and as a SLT that adores Paed's, and hates anatomy, I went into these 2 weeks thinking "right lets get this over and done with and we can forget about it by 2013" - but I have to admit I have become some what of an A&P Geek! I am buying books, watching youtube videos, tweeting Dysphagia specialists & playing with as many larynx/pharynx/epiglottis models as possible to get my head around it all!

 

Here is a picture with me and todays model - who was dubbed Eddie as he has a workable Epiglottis & in the true sense of SLT alliteration was essential!

Me & Eddie the Epiglottis!

 

 

So over the past 5 days out of the 6 study days we get, we have learned about the stages of the normal swallow & then practiced eating and drinking thinking of how the swallow occured, what stage each occured at, and how difficulty or easy each different food/drink was to swallow. & boy oh boy does this exercise not only make you more aware about how much goes on during a "simple" swallow - but also makes you TIRED! Imagine if you had dysphagia and had to think about each bite.. I think I'd be tired after a couple, as without dysphagia it was tiring to think of how I brought a biscuit to my lips, made lip seal whilst chewing the biscuit, formed a bolus on to centre of tongue, pushed the bolus to the back of my tongue and triggered a swallow and passed this down my oro-pharynx whilst ensuring my larynx-elevation occured and epiglottis folded and carried the bolus down my esophogeus. See, just the thought of the swallowing process is tiring enough!

 

Here's a Videofluroscopy (Instrumental Ax) of a Normal Swallow - incase all that jargon nonesense was too much for you!

 

 

Then following this exercise we had a visit from a COPD Specialist where we taught about the impact of respiration on the swallow - Including highlighting that those with a typical swallow will swallow on an out breathe in a process of:

 

Breathe Out - Swallow - Breathe Out

 

However those with respiratory problems will:

 

Breathe In - Swallow - Breathe In.

 

Thereby breathing in is pulling bolus down to lungs through the larynx passed vocal cords! So aspiration may occur and this leads to worsening of the respiratory problem!

 

Now doesn't this just add to the tiredness - Thinking of how to breathe on top of all those other muscle co-ordinations above!

 

There were many other fascinating things from the COPD day, and I have tweeted a few so head to my Twitter account at @GemSLT or search #dysphagia #slp2b or #slpeeps :)

 

Then we had a dietician visit - & that was interesting to hear that poor fluid or food intake can be as a result of lack of knowledge of nutrition, environment a person is in, medical &/or physical conditions, oral hygeine or most importantly in our field of SLT - Swallowing! 

 

One of the drinks we got to try from the dietician!

 

We were then able to taste some drinks that whilst tasted like strawberry milkshake on initial taste, left a rather unpleasant texture sensation in the mouth! But these were nutritionally complete drinks that are for gaining weight or nutrients in a speedy way for those that may have had a long term dysphagia and had poor nutrition as a result.

 

And finally we get to today; feeling our own swallows, feeling others dry swallows, swallows after drinking normal water, and after feeding others thickened fluids! Now we were only meant to feel our partners swallow, but if I refer you back to my initial comments of becoming a A&P Geek - I preceeded to use my fellow peers as "guinea pigs" and felt so many different swallows - It was so fascinating - You can really feel the larynx elevation during pharyngeal stage and the muscles in the tongue during oral stage!

 

(& although the thickened fluids were a shock to the palate at first, I didn't find the thickened fluids too bad after having 6 different people feed me them in order to feel my swallow!)

 

 

An #SLP2B desk during Swallow Ax!

 

 

So overall I've had a very exciting last 2 weeks of term, where I have discovered a new love in a job that I adore, I have surprised myself with my ability to become "sciency" as I like to now think & think it has been a fun practical way to end this first term of being a (scary but excitable) final year post-grad student!

 

I now have 1 day left of dysphagia - Then 3 weeks leave to work on my research dissertation (await a blog about that!) & then come back in January for a most exciting 8 Day Placement in a Adult LD Setting that I just cannot wait to begin!

Blog-Neglect & Being a Tweeter

I have somewhat neglected my blog for what feels like a very long time! (Since June apparently!) Which is surprising to me, as I've found that blogging is a great tool for reflection!  However, the reason for this "blog-neglect" is because I have found an equally fantastic reflective and CPD tool..read on to find out what it is!

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So, over the past few months of this academic term, I have become a great "Tweeter" and feel this is the reason why I have "accidently" engaged in severe blog-neglect! But I would say, to any bloggers that are not on Twitter.. WHY? It is so fabulous. 

 

I am now an avid Tweeter with SLT/SLP's from around the world in so many different locations, who range from Assistants to Students to "want-to-be" students to Qualified SLTs, and it is just so great to get so many different perceptions, opinions, knowledge from the comfort of your home/university/workplace. 

 

I recently wrote a Letter to the Editor of the RCSLT Bulletin on the impact Twitter has had on my CPD as a student and I am very pleased to announce it is being published in the February 2013 edition! So all you UK SLTs keep an eye out for it, and any overseas SLT/SLPs I shall most definitely be updating my Blog & my Twitter account so you can all see my piece as I am very excited about it.

So, though this blog is a short one, it is mainly just to say apologies from me to my blog for its neglect - I do not love Twitter more than it, I would hate for my blog to think that - but I would say, that all your SLT/SLPs, no matter whether assistant/student/qualified/wanna-be student, get on to Twitter! And don't forget the hashtags #SLPeeps and #SLP2B (or #SLT2B in the uk!).

(& hopefully I'll be back again this week to blog about my first term as a final year post-grad SLT student!)

SLT Jokes: A Humorous Photo for the Day

Consulation as a model for SLT

The Bercow Report (DCSF 2008) states that in the UK more commonly than not in Mainstream Primary school teams a consultative model of management is used. This sees SLTs writing a programme of therapy and providing the school with the relevant resources to engage in the therapy activities, thereby reducing the level of SLT direct input.

I am currently writing an essay that is based on a child that is on my hypothetical caseload. He is 5;06, attends a mainstream, and has a diagnosis of limb dyspraxia, severe verbal dyspraxia, and moderate learning disabilities. Though he is able to communicate via Makaton and can express 2-3 word phrases and understands Makaton supported 3-4 word phrases, his speech is unintelligible.   We have been given information regarding our job, in that we work for 1 and a half days per week, and currently have a caseload of 45 children in a 50x50 mile geographical span.   Now, we are given 3 options of management strategies to select ONE from. They include: regular direct therapy, SLT programme and review or parent and teaching staff training including a programme and review.

My gut instinct is indirect therapy of some kind.  He is able to communicate his needs through the mean of Makaton, and is able to understand WHEN supported with Makaton. So my thinking is that we need to promote the use of Makaton within the school and support the teachers with curriculum alterations and Makaton integration.

This means I have just fallen into the very same scenario that the Bercow Report refers to. The trap of the consultative model.

Now I also happen to be currently working on a presentation based on the McCartney et al. (2011) paper that researches the benefits between direct and indirect therapy. There I have come to unearth that expressive language improvements have been significant when direct therapy with a SLT occurs.  When indirect therapy is used, the interventions are rarely followed  and complied with as the SLT suggests that should be, and intervention is often subjected to issues of time available in a school day, finance of relevant teaching support and the issue of child and staff absences.

I find it intriguing that the Evidence Base suggests how strongly results can be seen when working directly with an SLT and yet the common practice, and even my own judgements are to work consultatively.

One thing that the McCartney et al. (2011) paper suggests is that IF the common practice in the UK is that of the consultative model, then a newly developed and improved model of consultative practice is required to be developed in order to produce similiar (if not the same) results as SLT direct therapy. So I think 2012 is the time to start working toward better consultative practice! We need to reduce risk factors and put in better scaffolding for working together - the gap between Health and Education is closing, but we need to continually work to ensure that the best duty of care is given to both the children and the teaching staff we work with!

References

McCartney, E. , Boyle, J., Ellis, S., Bannatyne, S. and Turnbull, M. (2011) Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention International Journal of Language and Communication Disorders 46 (1) 74-82

Department for Children, Schools and Families (DCSF) 2008, The Bercow Report: A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Needs (London DCSF) <available at: http://www.dcsf.gov.uk/bercowreview> [accessed on 17^th June 2012]

Dysphagia, AAC and Autism (The Autism Show!)

Yesterday, both myself and some fellow MScSLT peers attended The Autism Show in London's Excel.  It was both inspiring and eye-opening! I was able to attend several talks from a range of professionals, parents and individuals with autism and was exposed to new insights into communication and sensory issues as related to autism. I also saw 2 SLTs from the Hesley Group talk on the topic "Dysphagia and Autism" - As we have yet to cover dysphagia or anatomy in the course (yes, I bet you are shocked that 10 months in we have yet to cover this!) I found this a wonderful insight into the "normal" swallow and also some red flag indicators that are commonly seen in individuals with autism at eating and feeding times.  The sensory issues that accompany foods are essential to take note of - many individuals with autism have heightened or reduced sensory impacts compared with "typical" individuals and as such new tastes and textures will be unpleasant to them.  This can cause negative associations with mealtimes and can lead to poor nutrition.  Another factor that may be cause for concern that is often common in autism is Pica.  This is the eating of non-food substances and can affect both nutrition and diet but can have an impact on internal systems such as the oesophagous and stomach.  So, a very interesting talk to attend and fascinating to meet new SLTs and discuss ASD with them. 

The highlight of my day has to be the wide variety of AAC devices available to both experience hands-on but also to purchase.  Both low and high tech devices were on show and a range of different companies promoting both symbol, written and picture based devices.  As I have seen a range both working in playschemes with children with autism, but also as an SLT Student in placement it was fascinating to talk to the creators and directors of these companies to get their view on AAC.  One sales rep (for the AAC company Dynavox) even remarked that he was not there as a sales rep and was not concerned with how many sales he made, his goal was to make sure people had the opportunity to experience different AAC types hands on.  He stated that it is more important to be aware and familiar with the AAC devices that we may one day be recommending.  He even offered to do a one day talk at University! So I look forward to him demonstrating and allowing us to experience a range of low and high tec devices that his company recommends.

I was then able to get my hands (or should I say eyes?!) on trialing a piece of eye gaze software.  Now, before this opportunity I had heard of eye gaze AAC devices and seen pictures of these, but never had I seen a service user with one nor attempted to use one myself.  So straight away I burst up to an unsuspecting rep and said "please can I try it?" whilst trying to explain I was a SLT student currently with a BIG interest in ASD.  He agreed and set me up with a programme that made pretty dots dance around the screen as a result of where your eyes pointed.  Now I strongly recommend that anyone who is from an SLT, to an OT to a health care professional, to a carer, anyone working with a client with an AAC device, should try out the device and experience it for themselves.  There is no better way to learn how another person copes with life than by stepping into their shoes. So this is what I did. And my gosh was it hard! We may take for granted sometimes that if a client has access to a AAC device that that must mean its working for them.  This may not be true at all! I found that using the eye gaze softward took a lot of concentration, a lot of patience and a lot of staring very still for a long time. And I'd be as bold as to say I have good eye co-ordination! So you can imagine for many AAC users out there that a co-morbity of diagnosis' may occur and eye co-ordination may not be a strength of theirs, or even those with fantastic eye co-ordination but have un-patient personalities. 

So what this really taught me was that AAC devices can talk the talk and claim to be the best, but the only way a particular device can be the best is individually and unless a certain individual works well with an AAC device and states a preference for one over another, the companies cannot claim that one is more beneficial than another! We, as SLTs, need to ensure that the AAC device that is given to a client is one that is well suited to both their speech, language and communication needs, but also their personalities!

 

Though it is stated frequently that Autism is a spectrum, therefore the nature of each diagnosis is individual and just like snowflakes no two people with autism will present the same - it takes a day like this to prove just how true that statement is!

The Autism Show was definitely a thoroughly interesting and eye opening (and eye gazing!) day out that I recommend to anyone with an interest in the field of Autism! I am only disappointed that I could only attend one day out of the two days that this show was held for!