Megan Berg 0:03
Welcome everybody to episode two of the adult SLP edition of the resource roadmap show. This is brought to you by Therapy Insights. This is where we’re going to spend the next hour talking all about the new releases that we’ve added to the Access Pass library. If you’re an Access Pass member, and you have the printables feature included in your membership, you have instant access to everything that we’re talking about today. And if you’re not a member, you can sign up anytime at therapyinsights.com. And we are also offering ASHA CEUs, for learning how to use these resources and watching this either via YouTube, or listening to it via podcast. And to get the CEU credit, you can just go onto our website and add the CEU feature onto your access pass. And then go to CEUs and find this episode number and answer a couple questions and you’ll get a certificate of completion for your ASHA CEUs. And I think we should just dive in. I’m excited for the resources we’re going to talk about today, I think the one I’m most excited about, and maybe I don’t know if I requested this or maybe I just sent like the brainwaves out to the universe, but the Apple Watch resource because the Apple Watch is something that I’ve been recommending, or at least discussing more with patients before they go home. So I’m glad to have a resource that I can share with them that they can look at later.
Stephanie Henigin 1:25
That was requested a lot.
Megan Berg 1:27
Okay, all right, we’re all on the same wavelength. And then we have kind of a fresh take on an older aphasia therapy. Another resource I’m excited about is the handout about the esophagram versus a modified barium swallow study. I think that’s great for patients and for colleagues. And I learned a lot from it too. And we’ve got lots of other resources to talk about. So we’re gonna dive in, I’m gonna go ahead and share my screen.
Megan Berg 1:54
And we will start off with this first resource, the one that everybody was wanting, the Apple Watch safety features.
Stephanie Henigin 2:04
So this is Stephanie. I’m one of the medical SLP writers, I work inpatient, outpatient. So this is a feature Well, this was a request for many, many months. And people really wanted it. So we made one. So this is the Apple Watch safety feature handout. And I know I talk a lot about the Apple Watch, too, with my patients, I do have an Apple watch myself. And I get really excited when a patient does come for an evaluation. And I see they have an Apple Watch. And I’ll say, How are you liking your watch. So like, I just use it to tell time. And so there’s just so much potential there for memory strategies, but also for safety.
Stephanie Henigin 2:45
A lot of times, families and are nervous about their loved one either living alone, or they also live with like their spouse or significant other, but falls are a big concern. And so if a person is cognitively able to, you know, you have to charge this guy every day, you have to put it on unlock it. But if they’re able to do those things and learn pretty quickly, they are going to be pretty successful with an Apple Watch. So it’s just it’s come we’re kind of comparing it to the one where you wear around your your maybe your neck or your a button you wear those cost a significant amount of money per month, that those are attached to 24/7 monitoring company, which the Apple Watch isn’t but this is just kind of that nice, middle ground for people who need kind of that extra alert. If they maybe fall this will go off. I don’t know if any of you guys ever had it go off on you know, and they turned down because I know that they say you know, it can react to you know different things like if you’re more active.
Stephanie Henigin 4:00
Yeah. So mine accidentally did go off, but I hit it on something as I was working out in the yard. And so what happens is there’s like this alarm that goes off and it says hey, are you like, it doesn’t say it but there’s a little screen that pops up like, like you fall was detected, are you okay, you can dismiss it. If the person doesn’t respond, it’s gonna keep getting louder over 30 seconds. And then at 90 seconds, it’s going to call emergency services and send emergency contacts, text messages with the GPS location for that person. I know there’s been a lot of news articles about how Apple watches have saved people’s lives when they’re out hiking and things. So I am just so excited for this handout to just kind of really engage in a conversation about is this a tool that’s appropriate for the person who may need it? Going through those pros and cons, there’s a whole list of pros and cons. One big benefit is people like that there’s no monitoring fee every week, every month, like the other, you know, Life Alert, whatnot.
Stephanie Henigin 5:15
But it’s just really an opportunity for the speech pathologist or OT or PT to have a conversation with the patient, about if this is an appropriate idea. But at the bottom, I do really kind of explain, it’s probably best to go talk to an Apple employee, because they know the most up to date information about these products.
Megan Berg 5:36
Yeah, I already want to be using this this week with my patients. So that’ll be good. Great. And I forgot to describe it for those of you listening, which I am working on, but it’s a one page handout, it lists the basic features, and then it has a pro con list in two different boxes. So easy to read. And I think it lays out some of the pros and cons very clearly. So people can make an informed choice if it’s going to work for them. And I know, some patients like they don’t, they can’t afford a cell phone, or they don’t have a cell phone that the watch can connect to. So those are all things to consider too.
Stephanie Henigin 6:16
I also really like the graphic that the graphic designer chose, it has a picture of a person wearing an Apple Watch. And it says it looks like you’ve taken a hard fall and there’s that SOS you slide and then there’s I fell, but I’m okay. So it really shows a patient what that screen is going to look like or a family member what that screen is going to look like. Because not easy to show that screen in a session.
Megan Berg 6:40
Yeah, and not everyone’s gonna have the cognitive capacity to either slide or tap the right button. Yeah. Important visual. Great. Thank you, Stephanie.
Stephanie Henigin 6:50
You got it. Just like everything else. They always come up with that date. So I’m sure within the next year, we’ll have even more safety features.
Megan Berg 6:57
All right. Next up is Jennifer talking about the resource information processing speed following brain injury. This is a one page resource mostly designed for speech therapists as a clinical reference. So Jennifer, tell us a little bit more about this.
Jennifer Leger 7:18
Yeah, so this resource was created for the SLP. Like he just mentioned, it’s related to the most recent INCOG, 2.0 guidelines for cognitive rehabilitation, specifically following traumatic brain injury. So for those of you that don’t know what INCOG is, is an international group of cognitive researchers and clinicians, and the recommendations are supported by published research. And they specifically said that they’ve had 160 new studies that have been published since the last guidelines were put out in 2014. And so they’re constantly looking at the new research and providing updated recommendations, you know, every so often, based on that research. So, at my you know, Inpatient Rehabilitation Hospital, I’m the Lead SLP of our traumatic brain injury team. The majority of my patients, whether they’ve sustained a mild traumatic brain injury, or you know, more of a severe severe traumatic brain injury, they often demonstrate or report some awareness of sled processing.
Jennifer Leger 8:22
This is likely due to the frequency of injury to the frontal temporal parts of the brain. And if you think about those coup contrecoup injuries, oftentimes that part of the brain is affected. And so you know, I’ve always kind of wondered myself, what’s the best way to target you know, information processing speed, trying to help somebody, you know, be able to process information a little bit quicker and INCOG kind of recommended one nonpharmacological option, and also one pharmacological option. So first talking about the non pharmacological option, this talks about developing and practicing metacognitive strategies to compensate for attention problems. So your information processing speed is underneath attention. And, you know, if you think about metacognitive, it’s thinking about thinking, and it’s really important for our patients to come up with these strategies that, you know, best work for them. We can go over, you know, a lot of different attention strategies with them, but, you know, they have to figure out what best works for them. And so, after a person figures out what strategies do best work for them. They’re supposed to apply these in real world activities using time pressure management. I’m not gonna go into you know, a lot of detail with time pressure management right now, because I think in the future, we might come up with another resource related to this, but really, the goal of it is to increase a person’s awareness of slowed processing speed, and implementing the strategies before and during tasks to make them feel less pressured related to time.
Jennifer Leger 10:00
And so that’s kind of that non former pharmacological option. And then they do talk about a medication. And what this medication they recommend it’s called methylphenidate. And really, they specifically recommend it related to a person who may have, and this is going to be maybe a mouthful, but it says low called a dopamine transporter binding. So really, that’s something obviously, that we do not, you know, assess or look into. But I think it’s always important for us to be knowledgeable about medications that are out there, that, you know, the physicians may be recommending, or that our patients may be taking to know what that is, or how it could affect their cognition.
Jennifer Leger 10:46
I know, you know, my hospital are physiatrist all the time, get consulted by internist to, you know, ask about medication recommendations after a traumatic brain injury. So, again, I think it’s just really important for us to be aware of those medications that can affect cognition. And for this, you know, specifically that processing speed.
Megan Berg 11:09
Thank you. Yeah. And when I think about, like, the way that I was trained to treat processing speed is usually with something like a cognitive task, like a deck of cards, where you’re sorting them, and you’re trying to help the person get faster and faster at it. And so what I read from this resource is that maybe a more valid intervention would be training those metacognitive strategies, we’re not necessarily trying to get faster and faster at it, we’re trying to get better and better at understanding that it’s taking us longer, and that’s okay. But that can involve all kinds of self advocacy.
Jennifer Leger 11:47
And it may be that you just have to provide yourself you know, extra time when you know that you’re going to be maybe more anxious, just more nervous situation, or just anything that might make a task more difficult. Just giving yourself the extra time even.
Megan Berg 12:04
Great. And then we always like to include information about the research behind the resources that we create. And so Stephanie, you created an article snapshot about these guidelines. Can you tell us more?
Stephanie Henigin 12:15
Yeah, absolutely. So Jennifer did a great explanation of that, what the INCOG guidelines are, it’s that group of international individuals, and there is a speech language pathologist on the team. So I love that. And I would really encourage you all to go out and read these, they’re open to the public. There’s quite a few of them, because each one covers a different topic of cognition related to moderate to severe brain injury. So the part two is the one Jennifer and I read, and she used it for her piece. And then I dug a little deeper in for the article snapshot. So there were a couple of highlights, there’s a lot of really good examples and information in these handouts, I mean articles, it’s not dry to read, it’s very relevant for any kind of clinician working with someone with a brain injury. But one thing they really talked about is just in general, the medical team should really screen for impairments and hearing, central and auditory processing, vision, anxiety, fatigue, and the sleep weakness disturbances. Because all of these can influence attention, as we know. Another really big one that they talked about is computer based, those de-contextualized programs that are not supported by the research to generalize attention abilities for everyday tasks. So I don’t know about you, ladies, but oftentimes, patients and their families will come into the session, and they’ll be like, Well, what games can I play? What what games can I play at home to work on my attention. And really, what the research is saying is the games on the iPads or the phones, you’re only going to get better at that game, it’s not going to help you generalize your attention or processing speed for everyday activities. So I really just kind of pop that bubble of like, it’s okay for you to play them. But just know that that’s not going to help with that long term recovery goal. Like if you just, you know, sometimes I just need to get out and play a game for five minutes or so and then redirect, that’s fine. People can do that. I’m not saying not play games, but just know that it’s not going to help your long term attention and processing goals and the recovery after a moderate moderate to severe brain injury.
Stephanie Henigin 12:46
The research does not show attention or cognitive improvements after mindful based meditation techniques. So that’s if you do the guided meditation for a couple of minutes, it might help that person kind of calm down and focus but in general, it’s not going to help them improve their every day attention and processing speed. And I know mindfulness has been a big one for kind of speech pathologist, and it definitely has its place, just kind of knowing its purpose and realizing it’s just going to help maybe with that moment of attention, but it’s not going to help maybe generalize.
Stephanie Henigin 15:17
Another one that my patients asked me about, is that transcranial magnetic stimulation where they put that magnetic magnet over the brain. We don’t do that where I work on. And really what the research is showing is, it really should only be in research protocols and not in treatment sessions, there really isn’t enough information to say that it’s helpful. So I know that’s always a question because people go on to Google and trying to find all these answers. As we all do, right?
Stephanie Henigin 15:52
The research does support use of metacognitive, cognitive and dual tasks with everyday function to improve attention abilities. So for example, when I’m in the clinic, I might have my patient with a brain injury come up with in the big gym area with me, we have nice tables, but it’s a very big gym, so it’s busy. And so he or she and I might be working on a cognitive task, but then I might have a timer and try to have them switch between tasks to kind of make it more simulating a busy work environment. Unfortunately, I can’t go to work with them, but it’s the best I can do in my environment at work. So anything you can do kind of real life practical, and then having that conversation like, “How do you think you’re going to do?” and then having the conversation afterwards will how do you really think it went for you? So that’s kind of that magnetic cognitive piece.
Stephanie Henigin 16:46
And then also, just learning about modifying the home and work environments to reduce distractions is supported by the research. So yeah, I highly recommend people go read this one.
Stephanie Henigin 17:00
So as you’re talking,
Megan Berg 17:00
I’m thinking about neurofeedback, do you guys know a lot about neurofeedback?
Stephanie Henigin 17:08
I don’t, I don’t know that term as well.
Megan Berg 17:12
And the only reason I know about it is because when I live in Colorado, I rented the house from a neuro psychologist. And she was like, yeah, come on over. Like, I’ll give you a free neurofeedback session. And I was just super curious, like, what that was about, I think I was in grad school at the time. And like, I go in, and like she puts these headphones on me, and I think they’re playing some music. And then there’s like brainwaves going on. And then she leaves and eats her lunch. And then like 30 minutes or 40 minutes later, she comes back and she’s like, okay, that’s the session. And I kept asking, like, like, what is this doing? Can you explain to me the mechanism behind this or like, what is happening to my brain and she said a lot of like gobbly gook. And there’s a big argument right now going on in the neuro psych community about neurofeedback, especially as it relates to ADHD is what it’s most commonly used to treat. So you’ve got, like, you can bill for it. And it’s like the easiest neuro psych therapy session ever. And like anybody listening to this, who’s like, oh my god, Megan doesn’t know what she’s talking about- there is some truth to neurofeedback. Just please email me at support@therapyinsights.com because I would love to learn more. But I do think that that’s out there in the world. And that’s a lot of times where people are going to get help with brain injuries or dementia. And so they’re getting this information they’re like, yeah, we can just hook you up and like do this Neurofeedback and your attention will improve. And I just don’t think the research is there. In I think what I love about this INCOG group, this international cognitive group is there is a speech pathologist. There’s a pharmacist, I believe, a medical doctor, so it’s a very interdisciplinary group. Yeah. So I think they’re really trying to raise the bar and really question some of the tactics that are going on in speech pathology and neuropsych. And so yeah, definitely agree that these are must read articles.
Stephanie Henigin 19:09
They also did say that that attention processing training, I don’t know if it’s like a workbook or something– that was not supported by the research either. So I don’t know if people have that in their closets at work, but it’s just, I think it’s related. They talked a lot about the attention process training, which is a computer based training that are outpatient therapy, as that as a resource, butyeah, they talked a lot about that, because that was kind of their last research that related to that.
Megan Berg 19:42
Is that the really old one, like are there cassette tapes involved
Stephanie Henigin 19:46
There could be cassette tapes, when it’s like a digit span like 4367 And then you have to say, like in ascending order, or descending order, we have it in our closet too, but I don’t touch it because I read this research and well, I never touched it anyways. But.
Megan Berg 20:06
Yeah, I’m looking forward to future attention resources that we come up with based on this material.
Megan Berg 20:14
All right, moving on to dysphagia and Parkinson’s disease. Stephanie wrote this one, and it is a one page handout that has a nice graphic of anatomy physiology with some labels about what people with Parkinson’s disease might be dealing with. And then it breaks it down between the oral pharyngeal and esophageal phase.
Stephanie Henigin 20:35
So I am a part of our Parkinson multidisciplinary clinic team where I work. And so a patient will come in for a team evaluation. So they’ll see OT, PT, speech and the neurologist. And sometimes this is right after the person is learning about that they have the diagnosis of Parkinson’s, and they really just don’t know what to expect. So I was very excited that the subscribers wanted this handout to be created. Because I think it does a really good job of just laying that solid foundation of Parkinson’s, and how does swallowing disorders play into that some people with Parkinson’s might notice some swallowing changes early on, but generally, it’s more in the middle to later stages of the disease. But oftentimes, people with Parkinson’s have a limited self awareness, and don’t always realize or report that they have a swallowing problem. Oftentimes, it’s family members or friends, or maybe what we observe in the clinic with that bedside swallow, there might be something else going on here. So I really like how it has the oral phase, and you know, kind of those characteristics of the tongue pumping, or the tongue might kind of rock in a roll back and forth, or speed up really fast. And it kind of goes into detail about different things and how in the pharyngeal phase, you might have reduced tongue and throat movements for swallowing food, I know people talk about it feels like it’s getting stuck in their throat. So this is just opening that door for a conversation about what maybe to look out for and what to maybe evaluate further with, like a modified barium swallow study or a FEES, perhaps, to really just get a better idea of what that person might be experiencing. But I kind of the big takeaway for me is, in the research, it just really emphasized that people with Parkinson’s may not always be the best self reporters for dysphasia. And so you can’t really take it at face value.
Megan Berg 23:05
Great. Thank you.
Megan Berg 23:08
And you also wrote an article snapshot related to this. Can you tell us about this one?
Stephanie Henigin 23:14
Yeah, so this one is characterizing quality of life and caregivers of people with Parkinson’s disease and dysphasia. And this one just really highlights how caregivers of people with Parkinson’s often have a reduced quality of life, because they’re taking on those extra responsibilities to maintain that safe living environment. But also, they might be losing a second income or they have to work more but then feel that pressure of I need to take care of my loved one, but also work and do everything else. And often, informal caregivers, such as spouses and partners and family members, are the people caring for those people with Parkinson’s, it’s usually not a paid person coming into the house helping. So that just adds extra stress to the family or the friends. But that relationship with that person, SLPs during the evaluations can use informal questions to kind of learn about how the caregivers and patients understand Parkinson’s and how the swallowing might be involved. Like we said, maybe the caregivers noticing more of the swallowing changes versus the person with Parkinson’s.
Stephanie Henigin 24:28
As Parkinson’s progresses, the caregivers quality of life does also decline with some additional concerns about finances and transportation and work and that person has reduced leisure time or cooking can be stressful because the person may elect to have a modification to their diet, and now that caregiver has to be the one making that food that’s appropriate for the person. So just really, the big thing is just consider the caregiver in the evaluations too, because if the caregiver has a decent quality of life, then our patients with Parkinson’s will have a better chance of you know, that better care and it that they’re going to have reduced negative impacts, too. So the caregiver is a vital person in the Team Park caring for people with Parkinson’s.
Megan Berg 25:25
Yeah, and I think with any of these diagnoses, that are degenerative in nature, it’s just a very isolating experience. And I hope that our society like evolves to value caretakers in care in general, and aging, and we have systems in place that are able to take some of the financial and emotional burden off of these individuals and families. But I don’t think we’re quite there.
Stephanie Henigin 25:57
I don’t think we’re quite there yet, either. But also, it’s just I think we unfortunately live in a society where it’s not okay, always to ask for help. And so just maybe that could be the first step of just asking for help. And then just seeing what’s available. It’s not maybe a financial fix, but at least it’s something.
Megan Berg 26:21
one thing that
Megan Berg 26:22
I worked with a doula for my pregnancy and birth. And one thing that she had me do, which I thought was really, really helpful, is, she’s like, You need to go out and ask someone for help, even when you don’t need it, like, just practice asking for help. And it can be something really little like, you need your neighbor to go run, get something from the store, or whatever it is, but just taking the time to do it before you actually have to do it was really helpful for me. So that might be some advice or an idea that you can pass on to family members.
Jennifer Leger 26:57
Yeah, I like that. Thank you. And now, before COVID happened, I was in the process of trying to get a caregiver support group started at my hospital, kind of got all the supplies ready to get that going. But then COVID happened. But that’s something that I’m really hopeful to get started in the future, because I do feel like it would be really helpful. And it’s really important, you know, it, these life changing events. So it just happened to our patients, they happen to family members, and you know, their close friends and things like that, too. And we just have to remember, you know, we do have to support that caregiver just as much as the patient.
Megan Berg 27:34
Yeah, and what an especially hard time to get that diagnosis, like during COVID, where there’s so many other things going on the health care system was in such disarray, like as far as being able to go in and have somebody come with you for a visit. And then to be dealing with that, and even further isolation, I can’t imagine. So I think yeah, now more than ever, we need support groups to talk about that time.
Stephanie Henigin 28:00
And this is just kind of a side spin off of the pandemic. But I don’t know if you have all realized or notice, but I’ve been getting a lot more referrals for people with like primary progressive aphasia and Parkinson’s and dementia. And I have no data to backup this thought, but it was just curious of how that social isolation really impacted a lot of people. And I know we’re gonna be studying this for decades, but my colleagues and I were just talking about how we couldn’t believe how many people were seeing with primary progressive aphasia, just a couple of years outside of the pandemic. So I’m just wondering how that social isolation might have accelerated things.
Stephanie Henigin 28:44
And delayed the diagnosis, because I think there’s a lot of like, yeah, oh, it’s because of ice, you know, it’s we haven’t been able to get out, or things are just new. And then that’s why it’s harder for this person. Or, I mean, a lot of people didn’t do their just physicals or go see their doctors, because they didn’t feel safe, because we just didn’t know. So yeah, it’s probably a delay of a lot of things that played into it. It’s not just isolation.
Megan Berg 29:14
All right. So we will move on to the next resource called Visual action therapy for global aphasia. And to give you a visual reference, this is it’s got some pages that have step by step instructions for how to use visual action therapy. And then we modernized the materials that go along with it. And so it’s not the exact same words that are in the protocols that was originally written. But there are words that we thought might be more relevant to people today. And so Jennifer is going to kind of show us I think, how this all works. I’ll pass it off to you.
Jennifer Leger 29:52
Yes. So this is that aphasia treatment approach that Megan was talking about that is kind of old, older. So this was research from back in 1982. And it’s for individuals that have aphasia, but really global impairments of all language modalities. So, you know, severe verbal expression, severe auditory comprehension, severe, you know, reading comprehension and severe written expression. And so these are these patients where you’re just feeling a little bit stuck as to, you know what to work on with them, because, you know, it’s really difficult to find a strength that they have, because their impairment is so severe. So what visual action therapy does is it trains the person who has aphasia to use symbolic gestures for items that are not present to be able to communicate their basic wants and needs non verbally. So for example, you know, you might think of somebody kind of tipping their hand to request a drink. And so this is what this treatment approach is.
Jennifer Leger 30:55
The goal of it is to be able to teach our patients some sort of symbolic communication. And so research has shown that using visual action therapy can improve panting, mimic ability, as well as improved auditory and reading comprehension skills. It talks about some barriers that you want to think of when choosing patients to complete visual action therapy with so that includes, you know, a lot of these patients may also have severe limb apraxia. And that’s obviously going to prevent them from spontaneously or demanded use of gestures. And so this would be a more challenging treatment approach to use with these patients. And also, you know, as I mentioned, already, the severe auditory and reading comprehension is going to be a barrier. And so these patients may have difficulty understanding the task. And so you may actually have to kind of tweak the steps, tweak the instructions to our patient’s ability. So I know, with a patient that I’ve used this with more recently, we had to start out with hand over hand, and then kind of start to fade those cues. And that was able to get him to understand the task a little bit better. So this is kind of hierarchically structured. There’s three level programs that uses a objects, there’s large color pictures, there’s small drawings that are outlined in black. And there’s also some drawing showing a figure manipulating the object. So the target items, when this research was done, they use the porch index of communicative ability, the PICA to kind of assess progress with using symbolic gestures. So I’m going to just show you how to do one of the steps of visual action therapy.
Jennifer Leger 32:50
To be honest with you, I’ve never gotten past level one myself. Just I feel like it takes you know, these patients a long time to kind of catch on to what they’re doing. And at least at my levels of care that I work on, you know, I, the average length of stay, you know, is two weeks, four weeks, so we don’t have a lot of time to work on this. So I’m going to demonstrate how to use how to do level one, step three, and this is spot small picture matching. So I’m going to try to set up my computer to where you can see it.
Jennifer Leger 33:27
So I have it set up on this here. And so as you can see, there’s eight different small pictures that go along with the objects that we have. And so I’m going to read the directions for this one. So I’m supposed to arrange the eight object picture cards randomly in a straight line in front of the patient. And you want to also think about, you know, a lot of these patients may have right in attention as well. And so just making sure that you’re bringing their attention all the way to that right side, and making sure that they are able to see all of the pictures in front of them before you start this task.
Jennifer Leger 34:11
So in random order as just to hand the object to the patient to be placed on the matching picture. And you do not remove each object before presenting the next one. So for example here, I have some scissors. And so if the patient was here in front of me, I would hand that to the patient. And then their goal would be to place it on the picture that matches it. So as you can see here, it’s a picture of scissors, and then they would place it on top and you would leave that there as you hand them more items. And here. You have a pen. Again, trying to find it on here with that picture.This is a black and white picture of a pen. And so they’re supposed to place it on top of that.
Jennifer Leger 35:03
Again, we’re always tweaking treatments at times for our patients’ needs. And so I had mentioned already, you know, starting with hand over hand with some of my more severe patients, but also, even starting with a smaller field of them that before a smaller field of picture. So rather than having all eight in front of the patient, you know, starting with just two, and building on that, again, you’re just trying to improve their understanding of what you’re wanting them to do with this task. Just kind of, you know, with this resource, we did give you some pictures that you can use. Just for example, things that I’ve used in the past even are like the lark items, because you know, you have the pictures, and also you have the manipulatives with that.
Megan Berg 35:53
Jennifer, say that, again, that what you were using, the LARK?
Jennifer Leger 35:57
This was actually so my colleague had a student create this for a project at the end of their semester. So they created a whole box full of like larger pictures, all the items, the smaller ones. So it was a really cool project, because we really needed it, we had lost our other boxes of items.
Jennifer Leger 36:29
I was going to mention to just kind of a little bit of a case study of a patient that I recently had and use this with. So I had a male that was in his 40s, he had sustained a traumatic brain injury after a tree had fell on his head and a logging accident. The left hemisphere of his brain was greatly affected, he had exposed sprain, they had to have a craniotomy due to swelling. And so he definitely had global language impairments, he kind of had a lower education at baseline, he did not read at baseline. So that kind of made our treatment options more limited. One thing that, you know, was the strength of his was being able to copy letters, but because he didn’t read, you know, that wasn’t really a functional task for him. And so it made me think, you know, he’s able to copy some sort of symbol that maybe we could use this treatment to help him communicate a little bit better. And so we actually took pictures of his personal items in his room. So his toothbrush, the remote that we have in our hospital rooms, our water bottles, you know, the exact water bottle that we use, and we use those pictures to match the items to just to make it again more functional for him and try to help him communicate better in his environment. And by the time he left us, he definitely was using gestures better to me to communicate his basic wants and needs.
Megan Berg 38:03
Thanks. And I as I remember, the original protocol for this that was published in 1982 had a picture of a pistol. I’m like, I don’t know why we need a pistol for functional communication. So that is why we made different ones. And I think the more that you can personalize it, the better, obviously, if you have the ability to make those graphics, but yeah. Great, thank you.
Megan Berg 38:32
All right. And next resource is a two page resource written by Stephanie comparing a videofluoroscopic swallow study to an esophageam. So the first page has some image examples comparing what you’re going to see in the flouro suite. And then the second page has kind of compare and contrast chart as well. So Stephanie, tell us more about this resource.
Stephanie Henigin 38:56
Yeah, absolutely. So I’m fortunate enough to do soil studies every Tuesday afternoon at my clinic and an outpatient, we see a lot more patients who are referred to us who really have more esophageal dysphasia. I mean, it’s not that I can’t do it. Luckily, I have some great radiologists who will let us kind of do an AP view and pan down, but sometimes it’s really just valuable to just take a moment and kind of talk with the the doctors who are referring these patients to us and just explain like, did you want a swallow study or are you really thinking more of an esophagram? I actually had a conversation with a doctor about this today. So this this would have been helpful. But um, what I like about this is it has some side by side pictures are actually like on the top are some modified lateral views of a swallow study down the oral and pharyngeal freight phase. And then the bottom part is an AP view looking more panning down the esophagus. And I really like kind of the the table that we ended up creating because there’s similarities and differences. And then clinical indications for both of them comparing and contrasting them.
Stephanie Henigin 40:15
So just kind of going over some things. Sometimes people don’t realize that a Zenker’s diverticulum can be assessed by both, sometimes doctors only think it can be done maybe with an esophagram. They don’t necessarily think it can be as high up as it is. But I’ve definitely seen my fair share of them in outpatient.
Stephanie Henigin 40:37
It’s confusing, because barium used for both of them. But what I really like about the modified barium swallow study is there’s food involved. And so within an esophagram, there isn’t any food involved. So that’s why I do find a lot of value in doing that AP view and looking at that upper esophagus part, because usually it’s the foods that people are talking about getting stuck, or they feel that pressure there. And so I have been seeing that a lot with my patients, that the food is getting stuck. And then we can give that information to their doctor to kind of figure out the next steps for them. I do explain that as a speech therapist, I’m not really able to do anything structurally with the esophagus. We can’t do exercises to make it stronger or whatnot. We do talk about maybe some modifications with taking smaller bites and alternating bites and sips. But really, it’s kind of just giving more information to the doctor or the gastroenterology team. And then maybe we’ll we’ll talk about doing an esophagram after a modified barium swallow study to learn more about the esophagus. But sometimes it’s just a starting point, doctors just like to rule out that maybe the throat phase is okay. And really it is further down the patients concerned about.
Stephanie Henigin 42:01
So I think this is a great kind of conversation piece to have with maybe radiologists or other doctors or other speech pathologists. Because I know I took a course on a modified barium swallow and like the esophagus, like esophageal phases of swallowing, and it really kind of encouraged us to get the courage to just say no, this is really important to the radiologist maybe who’s put giving you some pushback of like, Nope, that’s not what this study is. We can’t look down. But then when I have that conversation on the side with them, like, but this has the food element, the esophagram doesn’t, and it’s really going to give us some good information. I’m not diagnosing anything, I’m just relaying more information to a doctor. And so just kind of get that courage to kind of stand up and advocate for your patients. Because so often patients have done an esophagram first. And they’re kind of frustrated that nothing was seen, but I’m still feeling nervous. And then we do this swallow study. And it’s like, oh, yeah, that’s what you’re experiencing. So I hope this is helpful for people.
Stephanie Henigin 43:12
This is kind of what I talk about everyday. So it’s very familiar to me, but maybe it will be new to others. Or do you guys have any questions? I know Megan’s been asking me some questions about this kind of this.
Megan Berg 43:25
So this is super helpful. And I just want to clarify for other people who are new to this, like me, when you talk about food getting stuck, you’re talking about that retrograde flow creating that sensation, is that correct?
Stephanie Henigin 43:37
No, actually, sometimes there is stasis in that upper esophagus and that food just won’t move. And so like maybe it will, it’s like slowly empty, but it’s not always regurgitation. It’s really just like it’s, it’s very tight there. And maybe they need to talk to their doctor about maybe stretching or some other options for them. Because oftentimes, it’s very, it can be acid reflux or GERD related. And so that’s why it’s just information to pass along to the team to evaluate further.
Megan Berg 44:14
Okay, those are all of our new resources, we’re going to move on to our case study. So this is a chance for us to talk about different clinical perspectives and also resources from the library that we would use for this case study. And I’ll just read it out loud. Jim is a 24 year old male who sustained a TBI during a motor vehicle accident in which he was a bicycle bicyclist riding his bike alone at night with no lights or visibility stripes. He was not wearing a helmet. He was in a coma for three weeks and then began inpatient rehab. It has been two years since his injury and he is frustrated with his progress in therapy. He is physically fit and has mostly reached his PT goals. However, he finds it difficult to focus at work frequently getting distracted and losing his train of thought. He’s thinking about becoming a respiratory therapist because he’s good with machines and with people. But he doesn’t know if he can focus enough to study for the tests. His physiatrist is recommending speech therapy, but he is skeptical because he doesn’t see how speech therapy relates to being able to study because we have the most non descriptive label for our profession ever. I keep saying we need to change the name to neuro lingual therapists.
Stephanie Henigin 45:31
Yeah, I agree. That’s even harder to say. But
Megan Berg 45:36
I’m guilty. But that’s all sounds like BLT? I don’t know.
Jennifer Leger 45:40
Hey, make it easier to remember.
Stephanie Henigin 45:43
Yeah, I guess that’s true. Sometimes I even have trouble saying speech language pathologist and they’re like, and you’re the speech therapist? But it’s, it’s a mouthful sometimes.
Megan Berg 45:54
It’s just confusing, because it’s like, we do so many other things. Speech is just a very, very small part. So like, it just kind of discredits us from the beginning. And then people are making up different names, which is fine. I do that to like your primary therapist. I’m your swallow therapist. But then that gets confusing, like, Who is this person?
Stephanie Henigin 46:12
Or Sure.
Stephanie Henigin 46:14
So this is an oldie but a goodie. This handout is returning to work after a traumatic brain injury. And it’s just talking about how oftentimes this is the big goal for people after a brain injury is getting back to work. And there’s a couple like ideas of how a person could get back to work. I don’t have a vocational rerehabilitation person at my site. And I know it’s really hard to find one. So sometimes checking in with the State Department, and seeing if there’s a vocational rehab department is a great resource to us.
Megan Berg 46:56
Those are run by state governments?
Stephanie Henigin 46:59
Yeah, sometimes they have like a state entity that will help people kind of return to work.
Jennifer Leger 47:06
Yeah, now in our outpatient facility, we serve voc rehab on site that would help with returning to work.
Stephanie Henigin 47:13
Yeah, I wish we needed we definitely need some more vocational rehab therapists in outpatient.
Stephanie Henigin 47:21
But there’s two kind of approaches that a vocational rehab my person might use. So there’s the train then place, or there’s the place then train. So with this patient, what’s his name? Jim, I think? I don’t know. Okay. Anyways, the patient, Jim, I kind of just talk about how Yes, speech therapy is definitely confusing. I know, you can talk just fine. But we do focus on a lot of thinking skills. And I know your big goal is to get back to work. And so speech therapy really can help you work towards that, that goal of yours. And we since you’re already at work, maybe we could talk about some strategies or interventions that we can use at work to help you to stay more focused. And so sometimes, including the patient’s like supervisor, or sometimes if it’s like a work comp and injury, you might have a QRC, I don’t remember what that stands for. But it’s a person who is assigned to kind of be the in between between the patient, and HR, and kind of work on getting accommodations, so they can return to work safely. I’ll have to remember what off to look that up and let you know, I QRC person, but they can kind of help with those placements of transitional supports. And just really talking to Jim about how maybe we can modify the environment and maybe having some metacognitive challenge of thinking about is learning a whole new job as a respiratory therapist. Is that feasible? Is that something we can do? Could we get you accommodations in school to help with testing time, and just really explaining that speech therapy is really the area that’s going to help you ask all these questions you might not realize, and then try to set up supports to help you be successful with accommodations or strategies.
Megan Berg 49:21
Great. QRC is is qualified rehabilitation consultant.
Stephanie Henigin 49:30
Sure, there you go. So maybe the same kind of ideas of vocational rehab therapists but they’re not the exact same because those are usually for work comp.
Megan Berg 49:41
Great. Thank you. And then Jennifer selected a resource called speech or sorry, yeah, speech therapy in the brain speech therapy as more than about this resource.
Jennifer Leger 49:54
Yeah, so this is definitely a more basic resource, but this is something that I have printed and laminated my office that I like to just kind of pull out the first time that I’m meeting a patient before an evaluation. You know, a lot of times when they’re coming to inpatient rehabilitation, that’s the first moment they’re remembering more of who or what speech therapy is working with a speech therapist. And so, as we’ve already mentioned, you know, a lot of people say, Why do I need speech therapy, I talk just fine. And so I think this is a good resource to pull out and just go over, you know, the different cognitive skills that we work on in speech therapy, more than just talking more than just swallowing. But just some of the skills that Jim may be having trouble with, or worry that he may may be a barrier to him being successful with going to school to become a respiratory therapist. Just explain to him that these are different, you know, skills that we can target, to try to reach his goals, and just help him understand speech therapy in our role a little bit better.
Megan Berg 50:59
Yeah, nice. Yeah, I hope someday, the streets are lined with as many physical therapy clinics as there are neuro linguistic therapy. And people know where to go to get this kind of help, because I think that there’s this huge opportunity in this gap in services. And people try to get help from different places. And sometimes they find the right person, sometimes they don’t. And I think speech therapists are just so well positioned to be able to help people.
Megan Berg 51:37
In this kind of situation, and our approach is so unique, I feel like we’re some of the best advocates and biggest leaders when it comes to person centered care, and functional, like meaningful approaches to what we’re doing, rather than just plugging headphones in and playing music. Um, I chose the resource called strategies for executive function dysfunction. And this has kind of a listing of strategies that might be helpful for gym. And so this would be something I would use during a session to be like, Okay, let’s think about what it’s going to feel like to study. And let’s figure out some ideas and approaches that are going to work well for you. And so going through different ideas, like reducing distractions, writing to do lists, doing one thing at a time working in small chunks of time, slowing down, all of those things, I think can help set Jim up for success to be able to study in a way that works for him and his brain. And allows him to find success with his first classes. So he feels like he can going. But I think you know, what, a what a perfect scenario to have a patient come in with a very, very great personal goal that he wants to achieve, and come alongside him and help him get there.
Megan Berg 53:06
Okay, so we’re gonna wrap up, I always just mention other resources that were just released by the PT and OT team, because there’s so much overlap in what we do across speech, occupational physical therapy. And as a member, you have access to all of the resources, including the ones created by PTs and OTs. So the OT team just came out with an abdominal precaution handout. So this would be useful for any patients you’re working with, who have been prescribed abdominal precautions, but maybe have a hard time remembering what those precautions are. So it’s just a very simple one page visual that shows a log roll with four basic steps to using the log roll method. So it’s something you could put up in their room, something you could hand to a caregiver if they have one that’s around most of the time.
Megan Berg 53:59
And then the OT team also came out with a financial management task called wants versus needs. So it’s basically a discussion of looking at your budget and looking at your money management, what are the needs that you have, so what is essential to live and survive things that don’t change over time? Versus wants, so things that are desired that you would like to have been that are not essential for survival. So this is a great resource if your patient has a functional goal of wanting to be able to live within their means, and for whatever reason needs some cognitive support, to differentiate wants versus needs.
Megan Berg 54:43
And that’s our show for today. So like I said, you can get instant access to these resources and hundreds more with new content added monthly, go to therapyinsights.com. All of the links are available in the show notes so you can quickly find the resources that we’re talking about, if you have any questions for us, and that can include any kind of case study question, or wanting to know if there are resources for a particular patient that you’re working with, you can reach us at support at therapyinsights.com. And as always, be sure to vote for what we create next and tell us any ideas that you would like us to see create because those are things that we read every month and we definitely listen to your requests. And we’ll have a new episode dropping on May 1, so we will see you then. Thanks, everybody.
Megan Berg 55:34
Bye