‘Trailblazer’ Sessions Lead the Way In keeping with the convention’s theme of changing lives and forging new paths, ‘Trailblazer’ sessions will spotlight pioneering work in the professions. Features
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Features  |   August 01, 2015
‘Trailblazer’ Sessions Lead the Way
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Hearing Aids, Cochlear Implants & Assistive Technology / Professional Issues & Training / Attention, Memory & Executive Functions / Features
Features   |   August 01, 2015
‘Trailblazer’ Sessions Lead the Way
The ASHA Leader, August 2015, Vol. 20, 58-64. doi:10.1044/leader.FTR4.20082015.58
The ASHA Leader, August 2015, Vol. 20, 58-64. doi:10.1044/leader.FTR4.20082015.58
How early can we identify infants at risk for autism spectrum disorder, and how might parents react to the information? What role does a geneticist play on a cochlear implant team? What does aerospace medicine tell us about audiology? What are the therapeutic potentials of cannabis in cognitive and motor disorders?
These diverse topics share a common feature—they are the focus of “Trailblazer” sessions at the convention. A trailblazer leads the way, and these 26 sessions, chosen by the Convention Planning Committee, look at issues that have changed—or are changing—audiology or speech-language pathology, or that are poised to take center stage in communication sciences and disorders.
Audiologists and SLPs in all settings will discover a trailblazer session or two that will pique their interest. Check out four that we previewed below:
  • Team CI

  • Aphasia Rehab: Words and Deeds

  • Find the Message Behind the Behavior

  • Building a Memory

Assessment
  • “Criteria for Evaluating Assessment Tools: Time for a Reboot,” Christine Dollaghan, University of Texas-Dallas, Callier Center.

Audiology
  • “Innovations and Clinical Implications From Aerospace Medicine and Vestibular Research,” Michael Cevette, Mayo Clinic Arizona

  • “Assessment of the Vestibular System in the Pediatric Population,” Devlin McCaslin, Vanderbilt University Medical Center

  • “Hair Cell Regeneration: Recent Progress and Future Opportunities,” Jeffrey Corwin, University of Virginia School of Medicine

  • “A New Era in CAPD Service Delivery: Changes in IDEA Eligibility, ICD-10, Coverage and Payment,” Janet McCarty, ASHA; Georgina Lynch, Washington State University; Cynthia Richburg, Indiana University of Pennsylvania

  • “TED Talks (and Hears) Neuroanatomy,” Gregory Mannarelli and Paul Kileny, University of Michigan Medical Center; Soo-Eun Chang and Karen Kluin, University of Michigan

Autism
  • “Outcomes of Young Adults on the Autism Spectrum: Situating the Role of the SLP,” Anne Roux, A. J. Drexel Autism Institute, Drexel University; Heidi Ham, Autism & Language Intervention-WA

  • “At-Risk ASD Infants: How Early Can We Identify Them and How May Caregivers React?” Linda Watson, University of North Carolina at Chapel Hill; Rebecca Landa, Kennedy Krieger; Juliann Woods, Florida State University

Health Care and Private Practice
  • “Prepare for IMPACT!” (Improving Medicare Post-Acute Care Transformation Act of 2014), Joanne Wisely, Genesis Health Care

  • “Supporting the Modification of Voice and Resonance With Speakers Who Are Transgender,” Richard Adler, Minnesota State University Moorhead; John Pickering, College of St. Rose

  • “A Health Care Executive’s View of Speech and Hearing Futurism,” Gene Balzer, American NeuroMonitoring Association

  • “Concussion Reconsidered in Children, Adolescents and Young Adults: New Science, New Roles for SLPs,” Kathryn Hardin, University of Colorado Boulder

Higher Education
  • “Launching a Funded Research Program in Clinical Education and Supervision: Theory, Tips, and Tricks,” Stella Ng, University of Toronto

  • “International Partnerships: Preparing Professionals for Practicing in a Changing World,” Ana Harten, Eastern Michigan University; Alejandro Brice, University of South Florida; Nancy Colodny, St. John’s University; Lauren Mupanomunda, New York City Department of Education; Mary Faralli, private practice

International and Cultural Competence Issues
  • “Transnational Research in Communication Sciences and Disorders: Strategies for Effective and Sustainable Collaboration,” Brooke Hallowell, Ohio University; Stephanie Stokes, University of Canterbury

  • “Increasing Cultural Competence: Asking the Right Questions Without Trivializing Culture,” Li Hsieh, Wayne State University; Mona Griffer, Marywood University; Nathan Cornish, VocoVision/Bilingual Therapies; William Gillispie, University of Kansas; Priya Sudarsanam, Priya Sudarsanam, MS, CCC-SLP, Ltd.; Yumi Sumida, Harborview Medical Center; Twhanna Green, Calvert County, Maryland Public Schools; Rosa Abreu, Newark Beth Israel; Lisa Moore, University of Ottawa; Katandria Johnson, Children’s Health; Archie Harmon, Washington University School of Medicine; Esther Gerrard, Veterans Affairs

Interprofessional Practice
  • “Interprofessional Practice: Managing Emotions and Interpersonal Communications,” Juan-Jose Beunza, Universidad de Navarra

  • “There IS an ‘I’ in TEAM: Best Practices for Cochlear Implants,” Jordan King, Arkansas Children’s Hospital

Language and Literacy
  • “Bye-Bye Roger: Rethinking Dr. Brown’s Language Sample Collection and Analysis,” Robert Owens and Zhaleh Lavasani, College of Saint Rose; Stacey Pavelko, James Madison University

  • “Genetic Contributions to Language, Reading and ADHD: Areas of Etiologic Overlap,” Shelley Smith, University of Nebraska Medical Center

Motor Speech disorders
  • “Changing Lives, Changing Minds, Leading the Way! Treatment of Motor Speech Disorders Across the Lifespan,” Nancy Potter, Washington State University; Edythe Strand, Mayo Clinic; Julie Wambaugh, University of Utah; Kathryn Yorkston, University of Washington

  • “Overview of Cannabanoid System and Its Therapeutic Potential in Cognitive and Motor Disorders,” Ken Mackie, Indiana University

Pediatrics
  • “Designing 21st Century Therapy Programs for Young Children: Integrating Evidence-Based Practices, Apps, and Multimedia Sources,” Willow Sauermilch, Texas Tech University

  • “Brain Function and Anatomy in Children Who Stutter: Insights From Pediatric Neuroimaging Studies,” Soo-Eun Chang, University of Michigan; Deryk Beal, ISTAR/U of Alberta; Bridget Walsh, Purdue University; Jason Tourville, Boston University

  • “Introduction to Addressing Swallowing and Feeding in the Schools: What You Need to Know,” Emily Homer and Kim Priola, St. Tammany Parish Schools

SLPAs
  • “The Speech-Language Pathology Assistant (SLPA): Past, Present and Future,” Rachel Miller, Robert Mayo, Denise Tucker and Celia Hooper, University of North Carolina-Greensboro; Jill McManigal, Veteran Affairs Puget Sound Health Care System

The convention offers hundreds of sessions that will catch your attention and enrich you professionally.
Team CI
Audiologist Jordan King will illustrate the benefits of an interprofessional approach to cochlear implantation—for both patients and providers.
Jordan King is an audiologist, but sometimes, “I feel like a marriage counselor,” she laughs.
It’s one effect of working on an interprofessional-practice team at the Little Rock–based Arkansas Children’s Hospital (ACH), where King and a large group of other medical professionals serve adult and pediatric cochlear-implant (CI) recipients and their families. When the team works together—paying attention to deeper, often-overlooked issues that can arise when a person deals with hearing loss, including psychological and social effects in marital and family relationships—she says, “We are doing a better job of treating the whole patient.”
King will illustrate how in a series of CI case studies she’ll present at convention. In her presentation, “There IS an ‘I’ in TEAM: Best Practices for Cochlear Implants,” she will show how collaboration across varied disciplines can improve patient treatment and general-population health, and decrease health care costs.
“Some cases are more straightforward and require less collaboration from multiple disciplines,” King says, “and some are very complex and require consulting with every one of the disciplines that we have access to.”
At her hospital, King is one of four audiologists working with people with CIs—but the list of expertise on her available team is extensive: hearing-focused speech-language pathology, otolaryngology, social work, psychology, genetics and child life (helping young children understand their surgery to ease any anxiety). In especially complex cases, the team often solicits input from immunology, gastroenterology, cardiology or other disciplines.
ACH’s focus also extends beyond the effects of hearing loss on patients to its effects on caregivers and families. The hospital offers parent-to-parent support to assist families who have newly diagnosed children. “We have an individual on staff who has three daughters, two of whom have bilateral cochlear implants,” King explains. “She helps families process things from a parent’s perspective, which, even as an audiologist who has children, is something that I can never truly get at with my [patients’] parents.”
The team’s psychological and social work is key to its holistic treatment, she says. “Hearing impairment affects everything … It affects you emotionally, socially—your ability to be bonded with your family.”
And King’s “marriage counselor” role isn’t a joke or exaggeration. The team helps spouses understand what their CI-using partner is going through—and how to deal with it to sustain healthy relationships.
“We try to have all of these services here in one place with easy access,” King says. “All of these things go a long way to helping a family mend their grief, and get to a point where they’re not paralyzed by it anymore and feel empowered to move forward.”

“We try to have all of these cochlear-implant services here in one place with easy access. … All of these things go a long way to helping a family mend their grief.”

ACH uses a tiered monthly meeting system to keep all professions involved and up-to-date on current cases, an approach that goes a long way in reducing costs, says King. For one thing, families and patients avoid making unnecessary, costly duplicate trips to the hospital—which is located in the center of Arkansas and pulls people from all four corners of the state. For another, different departments don’t have to order repetitive procedures.
“It really all comes down to efficiently planning orders and procedures,” King says. “Maybe the neurologist needs an MRI to look at one part of the brain, and we [the CI team] need an MRI to look at another part of the brain. But if we’re not communicating, then that child ends up needing two MRIs.” Avoiding that scenario translates to less of a cost burden on the health care system and on insurance, Medicaid and Medicare, she says.
Contrasted with the hospital’s team-based approach, some surgery clinics that perform cochlear implantation lack access to psychological help and tools from other disciplines—in some cases, even speech-language pathology, she says.
“There are other centers and hospitals that do what we do and do it very well, but I feel like those of us that do [interprofessional practice for cochlear implant cases] are not the norm,” King says.
But with increased national attention to the benefits of interprofessional practice, King hopes, that could be changing.
Aphasia Rehab: Words and Deeds
Involving people with aphasia in community activities should be the first—not the last—goal of treatment.
When social integration and community participation are the first priority in rehabilitation, people with aphasia are better prepared for life when rehabilitation ends.
So says Guylaine Le Dorze, professor in the University of Montreal School of Speech Therapy and Audiology, who notes that most rehab patients view socializing as the last step in their journey. And that’s a mistake.
“One of the dangers is that people interpret rehab as, ‘Well, I need to get better at talking before I get my life back together,’” Le Dorze says.
“I’d like to suggest that if we emphasize life, then language will follow. It’s a dangerous position for clients to think that they’re going to have to wait to recover before they’re able to go out to parties, barbecues, seeing their friends and going back to the activities they did before.”

“One of the dangers is that people interpret rehab as, ‘Well, I need to get better at talking before I get my life back together.’ I’d like to suggest that if we emphasize life, then language will follow.”

Le Dorze will share her ideas about rehab in a two-hour ASHA convention session, “Aphasia and Social Participation: How SLPs Can Better Prepare Clients for Life After Rehabilitation.”
Le Dorze’s philosophy is straightforward: Get people with aphasia involved in their usual activities. Provide support to them—and their friends and family—to help make this happen. The person’s participation will then lead to more opportunities for social engagement and communication.
“This is nothing new,” she explains. “It’s just the way I think about it and the way I put the pieces together, that’s maybe different from what’s been written before. We think of rehab in terms of community participation and helping family members and friends to communicate right from the start.”
This approach is critical in the face of payer limitations on the quantity of rehabilitation. “In all likelihood, we’re not going to have enough therapy time to go into the full details of the language issues,” Le Dorze notes.
“So we need to put community participation first. Get people back into their lives as much as they can to continue to develop and recover language as much as they can, through these activities.”
Le Dorze developed her theories in her early clinical years as a clinician. “We were always wondering what was going to happen to our patients with aphasia and what their lives were going to be like in the long term,” she says. “I realized we need to find ways to help people have better lives after rehab. How can we prepare people to be resilient, to be active and independent, in spite of aphasia?”
In her convention session, Le Dorze will offer guidance for SLPs on doing just that. Strategies include communication partner training, script training, alternative forms of communication—everything that can maximize communication.
Family training is key. “A very simple thing, but a vital one, is to keep on talking to one another,” she explains. “Keep on communicating, keep on enriching the relationship. One of the very frequent reactions to aphasia is, ‘Oh my God, he can’t talk, so I’m not going to talk either.’ But people with aphasia need to gain some confidence that they can have a small conversation. We need to help the family and friends be comfortable in a conversation with someone with aphasia, no matter the degree of severity.”
And the approach works. “We have looked a bit at how people in rehab have been prepared to return to shopping,” Le Dorze says. “And one very interesting outcome was that the people with aphasia and their family members whose therapy included support or activities that helped them become more confident were the people who were doing the best. And it wasn’t necessarily related to aphasia severity or to the degree of physical impairment. It had really more to do with the confidence that the people had in their ability to do things on their own.”
Find the Message Behind the Behavior
Through disruptive behavior, a child is trying to tell you something, says Jason Travers. At convention, he’ll share ways to determine what that is, and how to help the child say it more effectively.
As an undergraduate, Jason Travers discovered his knack for working with children with autism spectrum disorder (ASD). But while helping preschoolers with the disorder, he also found that even widely used ASD interventions came with limitations.
“I didn’t understand why sometimes clients did or didn’t respond well,” Travers says. “I wanted to know more about how, why and what methods worked for these kids.”
Travers pursued those question with a master’s and then doctorate in special education with a focus on autism and behavior. To continue gaining hands-on experience, he taught students with special needs in public schools while earning the degrees. At the same time, he also completed coursework, field experience and an exam to earn his certification as a behavior analyst. Throughout his studies and work experiences, he focused on learning the best ways to teach communication skills.
“I wanted to know if one method was superior to another and what qualities of the method were responsible for the improvements,” Travers says. He realized how much surroundings influence a child and learned ways to arrange environments to produce better communication. He also learned that behavior stems from a purpose and that attempting to communicate something motivates most behaviors.
He also quickly figured out that the same behavior might convey two completely different messages from one day—or one hour—to the next.
“The way a behavior looks may not really be what’s happening,” Travers says. “Hand flapping looks like self-stimulation, but it could be a way to get access to a preferred activity, get someone’s attention or avoid an unpleasant demand. I tried to understand behaviors in relation to communicative intent.”
Now teaching at the University of Kansas as he continues his research, Travers hopes to pass along those lessons. He worries that most behavioral analysts working in schools don’t understand special education, and he wants to instill the importance of learning both skills. “What can we bring as educators into the schools,” he wonders, “to get the most from behavioral science?”
In his convention presentation, “Get the Message? The Communicative Nature of Inappropriate Behavior in Learners With ASD,” Travers will share his insights on identifying the communicative intent of a seemingly unrelated behavior. The science of behavioral analysis connects a behavior to its motivating message rather than just controlling or stopping it.
For a child with ASD, acting out might mean the child is hungry, bored, overstimulated, wants a certain toy or doesn’t want to perform a demanding activity, Travers says. Using contextual clues to figure out that message allows speech-language pathologists and special education professionals to teach students a more effective way to communicate their needs.
“Understanding the communication behind the behavior allows us to help students replace inappropriate behavior—like tantrums that use a lot of energy—with one that takes little effort and gets better results, such as using a speech device,” Travers says.

“Understanding the communication behind the behavior allows us to help students replace inappropriate behavior—like tantrums that use a lot of energy—with one that takes little effort and gets better results, such as using a speech device.”

Attendees will learn strategies for managing common behavioral challenges. For example, a child flopping onto the floor might mean something completely different during lunch than at dismissal. Travers’ advice: “Understand that there is a message motivating the behavior, determine that message or purpose, and replace the ‘bad’ behavior with one that better communicates the message.”
Building a Memory
SLP Jeanette Benigas will describe how clinicians can use the spaced retrieval method to help people learn new behaviors during voice treatment.
The man with Parkinson’s disease and dementia spoke so softly that Jeanette Benigas strained to hear every word. The low volume was causing communication problems with his care team, so she decided to deploy spaced retrieval, a cognitive training method that helps people learn and remember small pieces of functional information.
Benigas first started using spaced retrieval in her dysphagia treatment, typically to help people with dementia learn compensatory swallowing strategies. Her research indicates spaced retrieval can help people avoid a modified diet of thickened liquids and pureed food. Based on this success, she uses it with voice treatment, too—the focus of her invited talk, “Using Spaced Retrieval as a Treatment Tool for Older Adults With Voice and Memory Impairments,” at the convention.
“Voice treatment sometimes goes by the wayside in our work with older populations because we focus so much on cognitive treatment and dysphagia,” says Benigas, an assistant professor in the Department of Communication Sciences and Disorders at West Chester University. “But treating voice in this population is something we shouldn’t overlook, because voice capability is strongly tied to quality of life. People rely on their voices to communicate basic wants and needs and to socialize with their peers, care partners and families.”
And low volume isn’t the only voice concern. Others speak too loudly (possibly damaging the vocal cords) or fail to stay hydrated. Spaced retrieval is a workable treatment for such problems because it’s simple to use and easily integrated into other treatments, says Benigas, who delves into the method with co-authors Jennifer Brush and Gale Elliot in their new book, “Spaced Retrieval Step by Step: An Evidence-Based Memory Intervention,” scheduled to be released at the convention.

Part of what makes spaced retrieval work is “errorless learning,” or setting up the person for success. Hence the supportive approach through use of visual aids and elimination of any struggle or opportunity to learn the incorrect response or behavior.

They note that the method can be used by a range of health care professionals and is typically covered by insurance carriers. What does the protocol look like? Here’s how Benigas used it to treat the man with Parkinson’s:
Identify the need. In this case, it was to increase the volume of the man’s voice.
Create a lead question to focus on the behavior. The simpler and more targeted the question, the better: “How should you talk so people can hear you?”
Determine the person’s response. In this case, the man says something like, “I speak louder,” and, in subsequent motor exercises, behaves accordingly by raising his voice. The clinician can also show the person a “continuous visual cue”—basically a written version of this response to help reinforce learning.
Present the lead question over increasing time intervals. The goal here is for the person to generalize the learning and display the behavior without prompting.
If the person gets the answer right, advance the time. You say, “Good. We’ll do it again in [fill-in-the-blank time],” and then set a timer for that time. The increments for setting the time are 5 seconds, 10 seconds, 20 seconds, 30 seconds, 1 minute, 2 minutes, 4 minutes, 8 minutes and 16 minutes. Generally, at 16 minutes, the behavior starts transferring to long-term memory—which is what happened with the case example.
If the person gets the answer wrong, go back to the last interval at which he or she responded correctly. If at 30 seconds, the person answers incorrectly, the clinician may say, “Actually, it’s [insert right answer],” but don’t point out the person answered incorrectly. Then work backward (20 seconds, 10 seconds) until the person gets it right. If that doesn’t work, don’t push, says Benigas. “You would just say, ‘This isn’t happening today,’ and move on to another activity. If a person is struggling for the answer, we eliminate the struggle and make it a positive interaction.”
Part of what makes spaced retrieval work, explains Benigas, is “errorless learning,” or setting up the person for success. Hence the supportive approach through use of visual aids and elimination of any struggle or opportunity to learn the incorrect response or behavior.
“Everyone is different, so we don’t want clinicians giving up if people don’t learn it in just a few sessions,” Benigas says. “Clinicians can modify the protocol in several ways if someone is not learning the behavior with the recommended one.”
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FROM THIS ISSUE
August 2015
Volume 20, Issue 8