Mind-Blowing Sessions Discovery Talks are designed to encourage further exploration of thought-provoking topics important to SLPs and audiologists. Features
Features  |   August 01, 2014
Mind-Blowing Sessions
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Speech, Voice & Prosodic Disorders / Voice Disorders / Hearing Disorders / Professional Issues & Training / Social Communication & Pragmatics Disorders / Features
Features   |   August 01, 2014
Mind-Blowing Sessions
The ASHA Leader, August 2014, Vol. 19, 44-48. doi:10.1044/leader.ACC10.19082014.50
The ASHA Leader, August 2014, Vol. 19, 44-48. doi:10.1044/leader.ACC10.19082014.50
Voice banking. Positive behavioral intervention. Compassion fatigue. Suicide.
Intrigued? These and several other topics are the focus of Discovery Talks, an innovation at the 2014 convention.
Loosely modeled after TED Talks, this new series of CEU-eligible, cross-disciplinary sessions will feature dynamic speakers. Audiologists and SLPs alike will want to discover something new in at least one of these thought- and discussion-provoking conversations.
  • Social culture. More than 20,000 schools across the country are investing in a positive social culture that helps improve academic and social outcomes by implementing positive behavioral interventions and supports. In “Social Culture Matters: Using School-wide Positive Behavior Support to Achieve Academic & Behavior Outcomes,” Robert Horner of the University of Oregon will explore how PBIS can improve school effectiveness and the equitable provision of quality education.

  • Voices in AAC. Rupal Patel of Northeastern University is working to provide personalized voices for people who use alternative and augmentative communication. “Giving Voice to Augmented Communicators” will feature Patel’s TED talk and examine the role of speech-language pathologists and the importance of enlisting everyday people in building a massive voice bank. Read more about this session below.

  • Age-related hearing loss. It’s an old problem, but there may be new approaches. In “Presbycusis: Emerging Solutions to Old Problems,” Ann Clock Eddins and David Eddins of the University of South Florida examine the need to address speech in noise, temporal process, spatial hearing, loudness perception and tinnitus in treatments for age-related hearing loss. They will highlight these deficits and underlying mechanisms in the context of biomarkers of presbycusis and review established and emerging treatment approaches.

  • Influence and persuade. Regardless of what you say, it’s your nonverbal message that clients and staff read first and respond to. What nonverbal messages are you sending, and how are others reacting to them? Linda Talley of Linda Talley & Associates, in “How to Use Five Powerful (and Subtle) Nonverbal Behaviors to Influence & Persuade,” will spell out the nonverbal messages you convey with your hand gestures. The key question: Is it the meaning you want to send?

Four of the Discovery Talks are also “premier” sessions, specially organized by the convention co-chairs. These two-hour, cross-disciplinary sessions seek to raise important questions and give participants solid information to take back to their practice and research.
  • Compassion fatigue. SLPs and audiologists—like most other health care professionals—may find their own lives affected by their work with people with disorders or disabilities. “Compassion Fatigue’s Impact in Serving Individuals with Communication Disorders,” led by SLP Lesley Olswang of the University of Washington and social worker Mary Barrett of the Center for Contextual Change, examines how CSD professionals may lose sleep, feel incompetent or fail to attune to what their clients are telling them. The presenters will help you recognize symptoms in yourself and caregivers, and explore personal and professional strategies to relieve distress. Read more about this session below.

  • Suicide and depression. People with a variety of disorders—including communication disorders—may experience depression, anxiety and isolation, which may escalate into thoughts of, and attempts at, suicide. In “Clients at Risk for Suicide: Our Experiences and Responsibilities,” a five-member panel will share examples of clients contemplating and completing suicide, and discuss clinicians’ roles in preventing suicide and working with those who have attempted suicide.

  • Interprofessional education. If you know nothing—or something—about IPE, you will want to attend one of the two IPE sessions. The first, “Interprofessional Education 101: What You Need to Know,” introduces the concept, its place in the professional preparation of SLPs and audiologists, and its potential impact on quality and safety outcomes. The three panelists all have experience with IPE in their academic programs. At the second, “Interprofessional Education 102: Innovations in Health Professions Education Programs,” a seven-member panel will share models for IPE that they say engage students and faculty, are reasonable to deliver, have the potential to improve health care—and are transforming how education is delivered.

A Voice of Their Own
Rupal Patel is on a mission to build personalized voices for people who can’t speak. And she wants your help.
The electronic voices all spoke at the same time—in the same exact monotonous cadence. All were the same mid-pitch, white adult male voice, even though they belonged to men and women of different ages, sizes and races. Well, more accurately, they belonged to the augmentative and alternative communication devices of these men and women.
To Rupal Patel, who stood in the exhibit hall listening to them at the International AAC conference years ago, this uniformity of voice seemed horribly wrong. She had, after all, just given a talk explaining that prosody is preserved in people with severe speech disorders. So why were these AAC users all using generic voices?
Patel wondered if it might be possible to combine preserved aspects of one voice with that of another person matched for gender, age, race and body type—thus achieving a more natural voice that conveys the personality of the “speaker.” She resolved to find out.
Fast-forward a few years to 2006. Patel landed her first National Science Foundation grant to build these personalized voices she’d envisioned. And the initiative burgeoned from there. Results from her lab’s initial trials suggest that building a personalized voice is challenging: “You have very little speech from the client and a whole inventory from the healthy talker, so the resulting voice is ‘overpowered’ by the person who donated the voice,” explains Patel, a professor with joint appointments in the Department of Speech-Language Pathology and Audiology and the College of Computer and Information Science at Northeastern University in Boston.
What helps, Patel says, is having a massive bank of donated voices from which to select a close match. And that’s where you—the ASHA convention attendee—come in. In a convention Discovery Talk, Patel hopes to inspire you about the next phase of her project: As part of The Voicebank Initiative, coordinated by Patel’s company VocaliD and Northeastern University, she and her colleagues want to collect 1 million voice samples by 2020 to create the world’s largest spoken repository.
This respository, she says, will enable them to build the most personalized synthetic voices possible. Donation does take a time commitment of three to four voice-recording hours—the team needs about 3,000 sentences from each person to build a high-quality synthetic voice. The good news? Recording won’t require a trip to a sound booth. The team is building a website and mobile application through which donors can record and submit their samples. The site and app should be ready to launch by fall and—thanks to a big boost from a TED Talk Patel delivered in December and subsequent news coverage—18,000-plus people have already signed up to donate. You, too, can sign up at vocaliD.co or at humanvoicebank.org.
“We’ve had a huge response, which is super exciting,” Patel says. “But we’ve got a lot of collecting to do to reach a million, so we’d love for SLPs to be engaged in this—donating themselves, encouraging students and others to donate, and generally raising awareness.”
Through her enthusiasm, Patel wants to keep expectations realistic. “The new voices can’t be available overnight,” she says. “There are lots of nuances to work out: licensing, fees, logistical arrangements. My best guess is a year and half to three years out.”
She anticipates the wait will be well worth it. Three young women who’ve been testing the personalized voices have found them life-changing. “One of their moms talked about the fact that when her daughter’s new device had to go to the shop, it was so jarring to have that old generic voice back,” Patel says. “She loved hearing the new voice that really sounded like her daughter.”
Through The Human Voicebank Initiative, Patel hopes to give many more people the chance to “finally be heard in their own voice.”
When It’s More Than Stress
An SLP and social worker team up to help clinicians recognize—and prevent—compassion fatigue, which taxes providers’ emotions and clinical judgment.
Lesley Olswang knows all about compassion fatigue. As a University of Washington researcher investigating early communication intervention for children with significant disabilities, she saw firsthand the heart-wrenching struggles of her clients and their families—and how those struggles affected the clinicians working with them.
“Clinicians work continuously, hour after hour and day after day, with clients and their families who often experience frustration, depression and desperation,” says Olswang, a speech-language pathologist whose research focuses on early communication intervention for children with significant disabilities. “These symptoms of compassion fatigue appear from frequently experiencing others’ traumatic events and working to provide the best professional help.”
Olswang, professor emerita in the Department of Speech and Hearing Sciences at the University of Washington, will co-lead a convention session on recognizing and taking steps to overcome compassion fatigue. She is presenting with her sister—social worker Mary Jo Barrett, executive director and founder of The Center for Contextual Change and adjunct faculty at the University of Chicago, the Family Institute at Northwestern University and The Chicago Center for Family Health.
To be clear, compassion fatigue is more than typical work-related stress and exhaustion. “SLPs and audiologists with compassion fatigue may second-guess their clinical judgments, feel burned-out or completely depleted by their work, have a hard time focusing on what their clients are saying, lose sleep or become depressed,” Olswang explains. “One day we turn around and see that we have not been caring for ourselves in the same compassionate way that we care for our clients.”
At their session, Olswang and Barrett will talk about how to recognize compassion fatigue and how it affects personal energy.
“Professionals in caregiving disciplines need to sustain their energy, passion, curiosity and motivation so that they can maintain their ‘professional fitness’ for delivering good clinical care,” Olswang says. “They need to know how to address and manage their energy, which is necessary for good health, professional happiness and competent performance.
After receiving her master’s degree in speech-language pathology at Northwestern University, Olswang worked for the Evanston (Illinois) school district on an interdisciplinary team of nursing, physical therapy, psychology, speech-language pathology and education professionals to screen preschool children for possible special education placement.
“We were interdisciplinary before it’s time,” she says. She immediately saw the need to develop speech-language screening and assessment tools and ways to determine if treatments were helping.
Realizing that she had found her passion—treatment efficacy—she earned a PhD from the University of Washington. In addition to treatment efficacy, she also investigates language development and disorders in children, social communication disorders in school-age children, and early signals of communication in infancy.
“I’ve been in this business for 40 years, working with a wide range of patients, from children with specific language impairment to babies with severe physical disabilities,” Olswang says. “I’ve seen the tremendous efforts of SLPs and audiologists as responsible, committed professionals adhering to guidelines for good clinical care while making evidence-based decisions and attending to the emotional needs of clients and caregivers.”
SLPs and audiologists need ways to “sustain their energy and positive outlook in a field characterized by compassion and empathy as well as excellent clinical skills,” she says. “We need to recognize compassion fatigue and develop wellness plans so we don’t succumb to frustration, feeling overwhelmed, and second-guessing our own competence.”
Bringing it Back to CSD
SLP Laurie Swineford will explore how social (pragmatic) communication disorder entered the DSM-5—and why SLPs are poised to take the lead in its treatment.
When Laurie Swineford was an undergraduate student at Kean University in New Jersey, she always knew she wanted to work with young children with language delays. During her studies she had heard of “autism” but didn’t see a lot of information about what the behavioral presentation of autism symptoms looked like in very young children.
“We’ve always known that language development plays a significant role in children with autism and there’s such remarkable heterogeneity in language abilities—some children remain nonverbal while others gain language but have specific deficits,” says Swineford, now a research fellow at the National Institute of Mental Health. “I became really interested in understanding the factors that influence language development in these children.”
In “Social (Pragmatic) Communication Disorder: What is this Diagnostic Category and What are the Clinical Implications?” Swineford and co-presenter Geralyn Timler will discuss the background of the diagnostic category in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and, more important, the implications for communication sciences and disorders professionals. Swineford acknowledges there is a great deal of confusion with this new category, with some wondering if it’s really a new diagnosis or if it’s just part of the autism spectrum disorder continuum.
A first-time presenter, Swineford hopes the session will be interactive and that participants will bring up points for discussion, making the talk a “venue for group thinking.”
Swineford will review the relevant literature with participants, and discuss the level of empirical support for this new diagnostic category. Also on tap for discussion will be the overlap of diagnostic features between SCD, ASD and other language impairments as well as the challenges these present to clinicians. Timler will provide clinical expertise and advice related to assessment and intervention techniques for deficits seen in SCD.
“I want attendees to be excited because the placement of social communication disorder into the Communication Disorders section of the DSM-5 is intentional because it does share a lot of common traits with other language disorders,” Swineford says. “SLPs have the expertise and, therefore, the responsibility to help move the field forward and understand if and how this diagnostic category is a separate entity from ASD and language impairments and if there are targeted and effective interventions we can deliver.”
Swineford says she’s heard people describe SCD as “mild autism” or “autism without the repetitive behaviors,” but notes that information for the new category was drawn from both the ASD and pragmatic language impairment literature. She says, “I want attendees to understand where SCD came from and bring it back to us—the speech-language pathologists—because we are really the experts when it comes to language and pragmatic deficits.”
Hybrid Implants on the Cusp
Audiologist Jaclyn B. Spitzer will showcase FDA-approved and still-experimental innovations in cochlear implants.
Audiological innovation tends to be measured in new technologies, but Jaclyn Spitzer—director of audiology and speech-language pathology at Columbia University in New York City—is more focused on using existing technology in new ways to help more people with different types and degrees of hearing loss.
When audiologists counsel patients with very poor speech recognition, single-sided deafness, or what’s known as a “ski-slope” hearing loss—named for the audiogram’s distinctive curve— “they should put on the table that a cochlear implant may be appropriate,” Spitzer says. “Many more people should be considered for cochlear implants than ever before.”
The desire to help people isn’t new to Spitzer. “All my life I’ve known people with hearing loss,” she says, “and have seen some of their struggles, and wanted to be the kind of person who could help them.” After earning her doctorate at Columbia University, that’s exactly who she became, instructing the next generation of audiologists at Case Western Reserve and Montclair State universities. Spitzer also treated service members with hearing loss at the Veterans Administration Medical Center in Cleveland, and was chief of Audiology and Speech Pathology Service for the Connecticut Veterans Healthcare System.
Today she balances professorial duties, clinical audiology practice and a lively research docket devoted to the latest and greatest audiological advances. In her convention session “New Innovations in Cochlear Implant Technology: What Clinicians Need to Know,” she’s particularly excited to share the hybrid cochlear implant, a device recently approved by the U.S. Food and Drug Administration. What makes the hybrid different, Spitzer explains, is that candidates for the hybrid may be “people with a lot of residual hearing.”
In the past, these people were very difficult to fit with hearing aids. But the hybrid device’s processor has one component that provides electrical stimulation and another component that provides acoustic stimulation.
“This is always a team effort,” Spitzer cautions. “The surgeon has to use techniques that are designed to be as minimally traumatic as possible. If they’re successful in inserting the electrode and hearing is, in fact, preserved—which we verify after surgery—then based on whatever the performance is after surgery, we program an acoustic component as well as an electrical component. But the amount of preserved hearing can be really extraordinary.”
Spitzer also will discuss programs in the United States that are experimenting with cochlear implants for people with single-sided deafness—an “off-label” technique not yet approved by the FDA. “Everybody—the patient, the surgeon, the audiologist—has to acknowledge that this is not strictly according to the criteria,” Spitzer says. But for some patients, such as those who who also have debilitating tinnitus, a cochlear implant can have lasting benefits. “We’re accumulating evidence, and other people are doing this on research projects, to look at these people and see whether or not there are trends.”
Spitzer recalls a patient, a woman who suffered a sudden sensorinerual hearing loss in one ear and could no longer work. She had trouble localizing sounds, and severe tinnitus hampered her concentration. “She felt that her performance on the job was much poorer, because she couldn’t respond to alarms and things like that in a rapid way. And [with a cochlear implant] this person has experienced a tremendous reduction in her tinnitus.”
All of this goes to show that innovation sometimes lies in clinicians’ and researchers’ ability to find new uses for old tools. In the case of hybrid cochlear implants, it’s a new use that has allowed audiologists to improve the hearing of a whole new class of patients. “It’s tremendous,” Spitzer says. “It’s a tremendous difference from the type of people we’ve traditionally been implanting.”
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August 2014
Volume 19, Issue 8