New year, (better and improved) me: Setting SMART goals for the new year

With the impending new year upon us, we often make grandiose resolutions,  repeating the mantra “new year, new me,” over and over again until it is ingrained in our minds. While ambitious goals are something to constantly strive for, we often set goals that are completely unreasonable. While the final goal may be ideal, the trials and tribulations we have to endure to ultimately reach this unattainable goal, may prove too cumbersome.  So is often the case with the goals we set for clients.  As altruistic health care providers, we inherently have our clients’ best interests at heart and will do whatever it takes to optimize their potential.  However, when we set goals that are unrealistic and inappropriate, we are doing a disservice to both our clients and ourselves. To improve my ability to provide services as an SLP and better myself as a human being, I will consciously attempt to employ the acronym SMART when setting goals.   For those of you unfamiliar with this handy mnemonic, SMART stands for:

S: Specific-    Your goal should be clear and specific, otherwise you won’t be able to focus your efforts or feel truly motivated to achieve it. The language should not be too verbose and should succinctly and clearly define what we want to accomplish. With our clients it is imperative that we make the goals specific, while also ensuring that they are not too ambiguous or too narrow.

M: Measurable- Goals should be measurable so that you have tangible evidence that you have accomplished the goal. When formulating goals for clients, it is important to define how much assistance is necessary (maximum support–> independent) and the percentage which you deem appropriate for proficiency for that specific client (e.g. 80% with min support). In my personal life, as someone whose weight fluctuates more than the stock market, setting measurable weight loss goals has helped me to see the light at the end of the tunnel and stay on track.  Additionally, it helps me to ignore the seemingly omnipresent cheesecake or other temptations that would otherwise serve as impasses.

A- Achievable:You can meet most any goal when you plan your steps wisely and establish a time frame that allows you to carry out those steps. As you carry out the steps, you can achieve goals that may have seemed impossible when you started. On the other hand, if a goal is impossible to achieve, you may not even try to accomplish it. Achievable goals motivate individuals. Impossible goals de-motivate them. This is where differentiated instruction comes into play.  In order to keep students motivated and determined, it is our responsibility to generate achievable goals.  If a goal is unrealistic, we will unequivocally hinder progress and deter the client from attending therapy.

R-Results-Focused: Goals should measure outcomes, not activities.  If we form our goals correctly, the end product should ensure generalization and a carryover of skills outside of the contrived therapeutic environment.  While we can make activities fun, and use every TeacherspayTeachers resource at our disposable, the true mark of success is when a client is able to employ what was taught in therapy in the outside world.
Time-bound: Goals should be linked to a timeframe that creates a practical sense of urgency, or results in tension between the current reality and the vision of the goal. Without such tension, the goal is unlikely to produce a relevant outcome.  While there are some nuggets that we would love to keep in therapy with us forever, our ultimate goal is for each and every client to reach discharge.  By making time specific goals, we are able to stay on track, and also amend goals to account for the rate of progression.  Personally, my SMART goal for this year is to squeeze into a bridesmaid’s dress by the time June rolls around.  So while that timeframe was not set by myself, but rather by the Save the Date invitation hanging on my refrigerator, it definitely creates that aforementioned sense of urgency and forces me to get my rear in gear to meet that goal!
So in all aspects of our lives for the 2018 year, let’s vow to be SMARTer individuals than we were in the past.  For success is right around the corner!
Included below is a link to help you when formulating SMART goals:
~Brianna Fonti, CF-SLP, TSSLD~
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Adaptability: An essential component for success as an SLP.

When I first embarked on my arduous, yet ultimately rewarding journey, of becoming a speech-language pathologist, I knew that I would encounter roadblocks along the way.  As an individual who falls under the classification of the hybrid Type A/B personality, I loved how this profession required a certain extent of preparation while simultaneously requiring an ability to think on one’s toes and adapt to any situation that could come your way.    When I was in graduate school, I read an article that completely altered my perceptions and changed the way in which I would approach the profession for the rest of my life.  The article discussed the importance of ensuring that therapy is student-centered.  As molders of young minds, it is imperative that we implement differentiated instruction, adapting a set plan to match the needs of the specific student and ensure that we are creating an instructional environment conducive to success.

Those who are the most efficacious speech-language pathologists, I believe, are those who are inherently altruistic, those whose greatest pleasure in life is seeing others grow and succeed. This is not something that can be taught or acquired, but rather is something that must be intrinsic. These educators are the ones who feel a sense of pride not from the acquisition of accolades, but rather from enriching the lives of those they teach. In the article I read during graduate school, the author preaches the importance of student-centered teaching. Initially as new speech-language pathologists, we will be concerned with how we are doing and how our colleagues view us. We want to present ourselves with aplomb, and avoid coming across as disheveled or overwhelmed. However, the mark of a great SLP is when the question turns from internally directed to externally directed; turning from how am I doing, to how are the children doing?

While reading the article, the image of John Keating, the exuberant and unconventional teacher from Dead Poets Society, came to mind. Although I believe those educators who believe in structure and strict adherence to rules would meet his pedagogical methods with condemnation, he was able to connect with his students on a cerebral as well as emotional level, in a way that would be unachievable had he just tediously read his students facts from a book. He exercised differentiated teaching, taking into account the individual needs of each student. He then formulated creative ways to engage them and foster learning. Of course I am a little biased, as this is one of my favorite movies; but I’m sure anyone would agree that Mr. Keating is very deserving of the reverence I have for him. As perfectly stated in the article, “While taking our hands off the steering wheel is a bad idea in a car, it isn’t always bad pedagogy.”

Each day as I progress on my CF journey, I become more and more comfortable with metaphorically taking my hands off the steering wheel, trusting my instincts, and thinking on the spot.  It believe it has immensely improved my ability to implement therapy, and will continue to benefit me as I cultivate my skills while navigating this incredible profession.

 

Included are a few articles that describe differentiated instruction, and subsequently offer ways to incorporate the strategies into classroom and therapy settings:

https://www.scholastic.com/teachers/articles/teaching-content/what-differentiated-instruction/

http://www.readingrockets.org/atoz/1123/all

Brianna Fonti, CF-SLP, TSSLD

 

 

Movies and Communication Disorders

As a self-professed movie aficionado, I am always looking for ways to incorporate my love of cinema into therapy.  While many directors have a propensity for the theatrics, often to the point of being histrionic, some directors do a laudable job of accurately depicting characters who are afflicted with communication disorders.  Enumerated below are a few movies, with brief synopses included, that I believe do an exemplary job of accurately depicting individuals who encounter communication barriers on a regular basis.

  1. Children of a Lesser God:            The movie, “Children of a Lesser God” masterfully delineates the divide between those who inhabit a hearing world and those who are part of the Deaf community. The story follows the life of a speech teacher, James Leeds, who enters a school for the Deaf and falls for a female janitor, Sarah, who is deaf. Upon arriving at the school James is told to not come in with new fancy new ideas on how to make the world a better place for the Deaf. Instead, he was expected to just focus on helping the kids in his class to better manage their lives. This kind of mentality is sometimes common when dealing with schools; the older generation admonishes against progressive methods and advocates for strict adherence to conventional ways. However, Mr. Leeds disregards this and implements his own techniques. He emphasized the importance of music, and helped his students feel the vibrations, a practice that is still utilized to this day. When asking his students why they want to learn to speak, one expressed that it will help him to flirt with hearing girls. While this student obviously had a motive for learning to speak, many people in the Deaf community vehemently oppose the emphasis placed on learning to communicate orally. This is a controversial topic in the Deaf community, and the movie accurately depicts the divide. Sarah embraces her deafness and is opposed to using her voice, embarrassed by the irregular prosodic quality of it. She is proficient and confident in her signing abilities, and her reluctance to use her voice forced James to improve his sign language in order to communicate and connect with her. She becomes irate when people speak for her, implying that she doesn’t have a voice of her own. When James offers to help her learn to speak, he is unaware of the condescension that his suggestion implies. Helping implies a relationship between two unequal partners, where one assists the other whom they regard as less able or weak. Sarah does not feel emasculated by her condition, but rather embraces it; and the unsolicited offer of help is something she won’t stand for. The end of the movie perfectly describes their relationship, with James asking if there is a space where they could meet, not in silence, and not in sound. This line portrays how imperative compromise is in order to make a relationship between a hearing person and one who is deaf work. For if they fail to find a happy medium, they will continue living in two disparate worlds.
  2. A Fish Called Wanda:            In “A Fish Called Wanda,” a man named Ken presents with a stutter. Ken is a diffident man, shying away from human contact, much preferring the company of his fish. His preference for isolation to company could erroneously lead those to consider him misanthropic. However, his aversion to interaction is not due to a hatred of mankind, but rather to a hatred of how the majority of mankind treats him once he opens his mouth to speak. In the movie, Ken is caught up in a cumbersome jewel theft scheme and surrounded by glib con artists, the most notable being the abrasive Otto.   Upon meeting Ken, Otto opens up with the remark, “Quite a stutter you got there.” This flippant and disrespectful attitude seems harsh, but those who stutter oftentimes face this kind of scrutiny.   Throughout the film, Otto continues to make offensive remarks, saying, “You have a beautiful speaking voice, when it works.” While explicitly rude, this statement delineates how a person who stutters oftentimes feels that they are not in control of their voice. Stuttering is a fluency disorder, one in which the motoric aspect of speech production is affected. It is not that Ken struggles with finding the words or has difficulties with comprehension; it is that he struggles with articulating his thoughts. The movie was accurate with regards to which phonemes are commonly compromised by stuttering. Ken would display repetition when attempting to articulate plosives and fricatives. This is most apparent in the scene where he is trying to tell George where Otto and Wanda had escaped to. He tried to enunciate “Cathcart Hotel,” but his efforts proved futile. After failing to convey the message through spoken word, he resorted to written, using a pen and paper to spell out the location. Ken also struggled with saying airport, and instead whistled and went around with his arms outspread in a charade-like manner to visually convey what he found impossible to say. His use of visual cues is an example of a type of coping mechanism for those with communication disorders known as alternative communication. Alternative communication is utilized when spoken communication proves ineffective or unsuccessful.
  3. Rain Man:            The film, “Rain Man,” depicts the relationship between a narcissistic man and his middle-aged brother who is an autistic savant. An autistic savant is a person on the autism spectrum who showcases extreme talent in one area while being deficient in others. In the case of “Rain Man,” Ray was gifted in the mathematics domain. He could readily identify the number of toothpicks in a box, and was a promising asset at the casino, able to covertly count cards. This kind of extraordinary talent is rather rare in people with autism spectrum disorders (ASD), affecting only 1-10% of the autistic population. Similar to stuttering, males are four times more likely to have ASD than females. Those who have ASD specifically struggle with establishing relationships with others, as many are averse to touch and have a deficit in social-emotional reciprocity. In one moving scene of the film, Charlie tries to affectionately embrace his brother. Ray negatively responds by tensing up and rejecting his brother’s touch. Another factor that contributes to an inability to form secure relationships is that most people with autism are very egocentric with regards to speech. They lack theory of mind, and are incapable of viewing the world from another’s point of view. Similar to most of those with ASD, Ray did not respond well when he was reprimanded; he felt barraged with criticism and would revert to childish-like behaviors, like rocking himself back and forth in an attempt to soothe himself. The way in which those with ASD see the world is so different from the way in which a “normal” person does, so frustration is bound to arise. At one point in the movie, Charlie yells at Ray to, “Stop acting like a fucking retard.” This hostile outburst was the result of an accumulation of frustration, partially from his inability to genuinely connect with his brother, and partially from his embarrassment concerning his brother’s deviant behavior in public. While this biting remark is entirely inappropriate, it does hold some verity. While ASD has been present for quite a while, it has just recently received national attention. Before criteria were established to properly diagnose this condition, those that presented with the symptoms were generally regarded as “retarded.” Even in the film, Tom Cruise’s character claims that, “Autism is a load of shit,” and implies that it is not a real diagnosis. When Charlie brings Ray to the doctor, even the nurse expresses that she is not very familiar with the diagnosis. It is important to note that this film was released in the late 1980s. Since then much more is known about ASD.

    The aforementioned movies exposed audiences to what it is like living with a communication disorder in an accurate manner. The characters may show communication deficits, but that does not mean that they do not have a story to tell.

Brianna Fonti, M.A., CF-SLP, TSSLD

Speech-Language Pathologist/Therapist/Counselor

The feeling of being conferred with a Master’s degree after navigating and ultimately completing the rigorous and challenging endeavor that is graduate school, is truly ineffable.  At the culmination of graduate school, one is finally bestowed the title of speech-language pathologist, an altruistic and rewarding profession where one can positively impact the lives of numerous individuals by giving them a means of effective communication.  However, among the masses, we are commonly referred to as “speech therapists.”  While many SLPs are quick to correct, I personally do not mind being referred to as a therapist.  Our profession is so multifaceted; we are required to understand the etiology of a myriad of diseases/disorders and to stay abreast of the most efficacious treatment approaches available to alleviate symptoms and improve quality of life.  And while our title does not explicitly state therapist, I don’t think it is erroneous to assume that therapy is a crucial component of our profession.

There are a plethora of studies and anecdotal accounts that support incorporating therapeutic/counseling techniques into our therapy sessions to optimize success.  For example, cognitive behavior therapy (CBT), a therapeutic approach directed at changing one’s negative perceptions, is postulated to help stutterers.  Additionally, I believe it behooves a therapist to understand the grieving process.  When dealing with individuals who have suffered strokes, TBIs, or have been diagnosed with a neurodenegerative disease (e.g. Parkinsons), we have to recognize that they are experiencing a loss.  A loss of confidence, a loss of prior abilities, a loss of feelings of competency, and even in some cases, a loss of self.  By having an individual assess and verbalize their feelings, a “therapist” can help mitigate any misgivings an individual may have about themselves, offering coping strategies, and ultimately help the client achieve acceptance of their newfound situation.

As SLPs, we are able to teach compensatory strategies to help individuals communicate when a previous method no longer proves effective.  We are able to help correct habitual erroneous speech patterns, by teaching correct placement and manner of speech.  And although not specifically delineated in our job description, we are able to help people, just by listening and occasionally being a shoulder to cry on.  Thus far in my profession, I have found that some of my most rewarding sessions, are when a client feels comfortable enough to open up with me and express their thoughts and feelings.  By understanding the impact that a communicative disorder can have on an individual, I am able to view the patient as a whole, rather than just define them and plan a course of treatment based solely on their diagnosis.  Breaking down walls has proved invaluable to me, as it allows me to delve into the mind of a patient, and for a brief moment in time, put myself in their shoes.  By doing this, I am able to plan a individualized treatment plan, one that will produce the most beneficial results for the client in question.

So while “therapist/counselor” isn’t explicitly listed in our credentials, I believe employing therapeutic techniques, such as listening, offering coping mechanisms, and helping an individual put things into perspective when everything appears catastrophic, is part of our duty as a health care professional and is essential with regards to improving the quality of our patients lives.

Listed below are some articles detailing how to incorporate therapeutic techniques into speech sessions.

https://www.stutteringhelp.org/introduction-cognitive-therapy

http://www.asha.org/uploadedFiles/asha/publications/cicsd/2004FACounselingTrainingModule.pdf

 

 

Brianna Fonti, M.A., CF-SLP, TSSLD

 

AAC Devices

Many times, the patients we see struggle to communicate verbally. They easily become frustrated and may demonstrate behaviors because they cannot communicate their basic wants and needs. Some of these patients may be candidates for Augmentative and Alternative Communication (AAC) devices. An AAC device gives a person a way to communicate via a machine that they control. Parents are often skeptical about implementing these devices because they believe it will deter any verbal language development. A study performed at the University of Tennessee found that using an AAC device (specifically Proloquo2Go) can enhance a child’s verbal speech skills. The children throughout this study showed improvements with manding, verbal completion, and tacting tasks during ABA therapy when using the Proloquo2Go software. The following are some things to consider when beginning to implement an AAC device:

  1. Consider the activities of daily living your patient participates in. It is important to personalize the AAC device so the patient can participate in all social and academic activities.
  2. It may be helpful to begin with manding tasks when an AAC deivce is first presented. Manding tasks will allow the patient to understand that the device acts as their own voice and can be used to answer, comment, and express.
  3. Encourage parents and patients to carry the AAC device with them at all times. This device is the voice for the child and they need to be able to communicate their wants and needs easily.
  4. Utilize other related service providers when implementing an AAC device. For example, some children who are presented with an AAC device may struggle with fine motor skills. Making proper referrals to an occupational therapist may help to alleviate some of these struggles

References:

http://trace.tennessee.edu/cgi/viewcontent.cgi?article=4573&context=utk_graddiss

https://link.springer.com/article/10.1007/s40489-014-0018-5

Johanna Sullivan MA, CF-SLP

Language and Literacy

As speech language pathologists, we often encourage parents to read to their children and engage them in joint book reading activities. Many parents may not understand the direct correlation between language and literacy. Children who have difficulties acquiring language are more likely to struggle academically, specifically with reading and writing. Books offer an opportunity for parents to engage children in conversation, ask questions, and learn new vocabulary. Even if children cannot read yet, exposing them to books will reinforce the importance of literacy skills, a basis for all academic success. According to ASHA, reading can foster the growth of spoken language. Parents can begin reading to their children at a young age and developing joint book reading skills. During joint book reading, parents should encourage children to turn the pages of a book and point to the words as they read, this will help young children become familiar with how books work. The following are books that can help foster language and are useful during speech-language therapy.

  1. Repetitive books (Brown Bear/Five Little Monkeys Jumping on the Bed)- these stories are easy for children to follow and have certain phrases that are repeated throughout the entire book. This allows for children to learn the story and understand a sequence of events.
  2. Animal books (Touch and Feel Farm/Dear Zoo)- these books can be used to when introducing animals and animal noises. Pairing the book with a toy farm and animals is often a good technique during therapy and allows children to have a tangible object to reference.
  3. Song books (The Wheels on the Bus)- any books that incorporate songs are typically engaging for children and allow for them to participate with you. Singing lines from a book allows for children to learn new vocabulary in a fun and memorable way.

Reference:

http://leader.pubs.asha.org/article.aspx?articleid=2292588

Johanna Sullivan MA, CF-SLP

Making the Holidays Less Anxious

The holidays are a time that many people look forward to each year but for a child with Autism Spectrum Disorder (ASD), they can be challenging and scary. Many times, holidays involve going to family member’s houses and interacting with people you may not see on a daily basis. Holidays may involve being exposed to new foods, which are not part of a child’s typical dietary repertoire. Many of these new experiences can cause a child with ASD to become anxious. As speech therapists, we can do different activities during therapy to help ease the anxiety of the holidays and make this special time something a child looks forward to.

  1. Holiday themed books: Choosing a holiday themed book can help a child understand what the purpose of the holiday is and the activities that usually take place on that day. Therapists can easily incorporate these books into sessions if a child has goals involving Wh- questions, object labeling or following directions etc.
  2. Talk to parents: Bring parents into your sessions and discuss the traditions that the family has and what their plans for the holidays are. This can help therapists personalize therapy sessions and role play situations that could happen on the holiday.
  3. Holiday foods: Encourage parents to bring in foods that are present on their holiday tables. This will allow therapists to use the SOS feeding hierarchy on a food that the child may be interacting with during the holiday season.
  4. Discuss behaviors: Encourage parents to talk to their children and practice behaviors that are expected when you are around family members or in someone else’s house. Therapists can role play these situations and target greetings that may be required over the holidays.