The Wide-Angle Professional Perspective Interprofessional collaboration is a focus in research, health care and education. What does this “big picture” issue looks like in communication sciences and disorders? Features
Features  |   August 01, 2017
The Wide-Angle Professional Perspective
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Hearing Disorders / Swallowing, Dysphagia & Feeding Disorders / School-Based Settings / Professional Issues & Training / Attention, Memory & Executive Functions / Features
Features   |   August 01, 2017
The Wide-Angle Professional Perspective
The ASHA Leader, August 2017, Vol. 22, 58-66. doi:10.1044/leader.FTR3.22082017.58
The ASHA Leader, August 2017, Vol. 22, 58-66. doi:10.1044/leader.FTR3.22082017.58
The “big picture” has many meanings for audiologists and speech-language pathologists—but professionally, it often means stepping out of silos and working with other disciplines and settings to achieve the best outcomes for clients and patients.
Three convention sessions specifically address ways in which SLPs and audiologists can work with one another: educational audiologists helping SLPs treat students with hearing loss; SLPs helping audiologists modify hearing testing for people with language or cognitive difficulties; and clinician-researcher collaborations to propel evidence-based practice.
In addition, three “grand rounds” sessions take a wide-angle look at specific conditions—cochlear implantation, dysphagia, and vestibular/balance issues—that often require the expertise and input of health professionals from other disciplines, especially as technology improves, techniques evolve, and patients’ needs and desires drive treatment.
Check the convention Program Planner for the date, time and location of each of these sessions.
Get Schooled in Collaboration
A session for school-based SLPs offers insights on collaborating with educational audiologists in treating children with hearing loss.
Who better to offer insights for treating a student with hearing loss than someone with 18 years of experience as an educational audiologist—on top of 13 years personally navigating mainstream classrooms with bilateral hearing aids? Carrie Spangler will share her expertise to help speech-language pathologists collaborate with educational audiologists to advocate for these students during her session, “Educational Audiology 101 for SLPs: Maximizing Services for Children With Hearing Loss.”
“Open dialogues and strong relationships with SLPs are so critical for me as an educational audiologist, especially because I cover a wide range of school districts,” Spangler says.
Practical coordination tactics
Collaboration is a natural fit between educational audiologists and school-based SLPs, Spangler says. During her presentation, she will give SLPs practical tactics for coordinating services with educational audiologists. She will also advise attendees on how they can encourage school administrations to include an educational audiologist on a student’s team. She believes collaboration between these professions gives students with hearing loss their best chance at academic and social success.
A portion of Spangler’s session will go in depth into the specific role of educational audiologists: What do they provide for students and how does their input differ from what SLPs offer? An SLP usually finds out first when a student with hearing loss enters the school, Spangler explains, so it’s important for them to understand exactly what an educational audiologist contributes, which includes roles in performing educationally relevant hearing and listening evaluations, as well as selecting, fitting and maintaining hearing assistive technology.
One method for educational audiologists and SLPs to work together involves technology. Spangler will share how to collaboratively create listening maps for each student. Hearing assistive technology has advanced significantly in recent years, and so has the way classroom teachers teach. Small groups and peer-to-peer instruction are more common, for example. Even in elementary school, students might change classrooms multiple times a day, and those changes can vary daily. An SLP who knows the school building and faculty can join forces with an audiologist who understands the equipment to ensure hearing assistive devices meet each student’s specific listening environment.

“Open dialogues and strong relationships with SLPs are so critical for me as an educational audiologist, especially because I cover a wide range of school districts.”

Solutions from case studies
To give SLPs tools they can use immediately, Spangler will present case studies that offer solutions for prevalent and low-incidence scenarios. She’ll also create situations featuring students with various levels and types of communication skills. How can SLPs and educational audiologists work together to improve auditory communication skills for students who primarily use listening and spoken language, for example? How about those who are visual learners and use sign language? Both types of students benefit from auditory skill development, according to Spangler, so SLPs and audiologists can collaborate to improve those skills for all students with hearing loss.
Spangler herself experienced many of the challenges students with hearing loss face throughout their academic careers. She will relate her own stories to help SLPs understand those feelings and needs.
“I work in schools, because I needed to give back to these kids—and their families and teachers—based on my personal perspective,” Spangler says.
Spangler will also review the legislative foundations of providing services to students with hearing loss—especially students in middle and high school who still need accommodations, but might not receive them. The session will review relevant aspects of laws—including the Individuals With Disabilities Education Act, Section 504 and the Americans With Disabilities Act.
“The school-based SLP is the natural person for the student to ask to advocate for them or help them self-advocate,” Spangler says. “And an educational audiologist can contribute to the SLP knowing how to do that.”
Shelley D. Hutchins
Cognitive Impairment and Hearing Assessment
Two SLPs offer tips on adapting hearing testing for people with cognitive and language difficulties.
You’re testing the hearing of a 76-year-old woman, and results from all tools indicate severe bilateral hearing loss. When you consult with the patient and her daughter, the daughter is puzzled—she has noticed some minor hearing issues, but nothing like the tests indicate.
What’s going on?
Perhaps the patient doesn’t remember the directions. Or maybe she has a hard time carrying out sequences (“Raise your hand when you hear the tone”). Or perhaps she has attention difficulties.
“There are interactions between hearing, language and cognition, and all of them can influence how a patient performs on a hearing test,” says Pamela Smith, professor of speech-language pathology at Bloomsburg University.
Smith and Jamila P. Harley, former rehabilitation director for a large provider in Charlotte, North Carolina, will explore these interactions in “The Big Picture for Audiologists: Language and Cognition Considerations in Adult Clients.”

“There are interactions between hearing, language and cognition, and all of them can influence how a patient would perform during a hearing test.”

Subtle differences
Smith and Harley acknowledge that cognitive screening is already part of adult audiologic assessment. “But to fail a screening, you have to be pretty cognitively impaired,” Smith explains. “And, even in normal aging, working memory and processing speed slow down, differences that won’t be picked up on a cognitive screening. These subtle differences can impact performance, especially in something like speech recognition in noise, which has a big attention component.”
Just as audiologists can help speech-language pathologists assess language and cognition in people with hearing loss, SLPs can help audiologists assess the hearing of people with language and cognitive deficits, Harley emphasizes.
Harley often helps occupational and physical therapists work with residents in skilled nursing facilities who have cognitive and language deficits. A therapist will ask a patient to do three different steps, she explains, or uses only a verbal cue. An SLP can participate in the session to help the patient follow what the therapist wants them to do.
The same intervention could help in hearing assessments, and the presenters will share strategies for working with patients who may have language or cognitive difficulties.
“Audiologists are aware of aphasia, of course, but may not be familiar with the different types, and how it might impact the ability to understand or express the language portion of a hearing test,” Harley says. “We’re dealing with listening—the ability to interpret information—not just hearing a particular sound.”
Adapting testing
The presenters hope the session will alert audiologists to the cognitive and language components of their assessment tools and the difficulties they pose to people with even mild cognitive and language challenges. They will give concrete information on adapting testing for people with cognitive or language impairment.
“So, your patient’s not cooperating,” Smith says. “What might be some of the reasons? You start thinking that maybe it’s not just a hearing loss. What does the patient’s history tell you? What might you want to try instead?”
Strategies might include using a different modality—perhaps written directions—to provide instructions. Or perhaps a different test—one that doesn’t require a verbal response—would help. Directing questions to family members, rather than the patient, may be more instructive.
Harley adds that using gestures or eye blinks—rather than words—to respond could be helpful, or using tactile rather than visual or auditory cues. Other things to consider include the time of day—especially for people with dementia who may experience increased agitation in the evening—or administering the tests in two shorter sessions rather than in one long one.
Smith recalls a hearing test for a patient with severe receptive aphasia, and his only vocal response was a perseverative nonsense syllable.
“The audiologist was great,” she says. “He plopped headphones on this man and cranked up the volume on the pure tone, and the patient’s eyes got real wide and his jargon got higher pitched. He did the test and got reliable results by monitoring the patient’s eye opening and the intensity of his jargon. Here’s a patient who couldn’t have followed a single verbal direction—like raise your hand when you hear the tone—he just worked with the patient’s reaction to the change in sound. That was great flexibility.”
Carol Polovoy
Pillars of a Researcher-Practitioner Partnership
A session on collaboration to close the research-practice gap will explore how to start and sustain a partnership.
In the traditional research model, the researcher works in a largely different world from the practitioner. The setting is typically an academic or institutional laboratory. And their primary means of communicating findings to practitioners is often a journal or workshop.
But as the clamor for evidence-based practice mounts, more researchers and practitioners see this model falling short, says Lesley Olswang, professor emerita in the University of Washington Department of Speech and Hearing Sciences. The journey from research initiation to publication and ultimately implementation can be long. And, without practitioner input, the research itself can lack real-world considerations and application.
That’s why there’s a growing movement to bolster collaboration between researchers and practitioners—and why Olswang is coordinating a “big picture” session on the topic at the ASHA Convention. Collaboration is one of the best ways to close the research/practice gap and propel more evidence-based practice, she says.
“Researchers are saying, ‘If our research is meant to improve practice, we have to work more directly with practitioners—not pushing our research onto them but rather working with them to generate evidence,’” Olswang says. “We want to capitalize on this interest and encourage more researchers and practitioners to collaborate.”
The session will showcase a collaboration between language and literacy researcher Laura Justice and speech-language pathologist Jennifer Peach on Read It Again!—a research program seeking to bolster children’s development of language and literacy. The book-based program exposes children to oral and written language simultaneously, so that they see and hear the words, and focuses on four key areas of language and literacy: vocabulary, narrative, phonological awareness and print knowledge.

“Researchers are saying, ‘If our research is meant to improve practice, we have to work more directly with practitioners—not pushing our research onto them but rather working with them to generate evidence.’”

Needed ingredients
Why does the session spotlight Justice, a professor at Ohio State University who developed Read It Again!, and Peach, who’s using it in her native Queensland, Australia? Because they exemplify what it takes to make this sort of collaboration successful, Olswang says. The critical ingredients, she says, include:
Clear definition of respective roles. Justice, the researcher, tests the intervention in various contexts and improves the core elements. Peach, the practitioner (she is senior advisor of speech-language therapy in the Queensland Department of Education and Training), trains other professionals to use it and tries it in various settings, such as telepractice.
Mutual respect and open communication. Justice and Peach admire what each brings to the collaboration, and they regularly check in with each other to monitor progress.
A bidirectional, iterative relationship. The duo recognizes that the intervention is constantly evolving based on their work. “You test something in the applied environment, and then you refine it,” Olswang explains. “And then you test and refine again, back and forth, back and forth. That’s the research rigor that makes a stronger tool.”
Needed seeds
Olswang hopes that seeing the success of this type of collaboration will spur session attendees to start similar ones. She notes that clinicians she talks with are highly motivated to provide evidence-based practice, but it’s not always easy.
Olswang explains: “What I hear sometimes is, ‘When we read research articles, the pressure’s totally on us to interpret and figure out how to implement the evidence-based protocol. And we don’t really have time to do that.’”
Meanwhile, researchers want to—and feel the need to—make their results more immediately applicable. But it can be tough to find funding for research-practice collaborations to speed the process, Olswang says. Enter the American Speech-Language Hearing Foundation, which plans to launch a new initiative to fund researcher-practitioner collaborative research (see “ASHFoundation Board Approves Funding for New Grant,” July 2017) in 2018. This was, in fact, what propelled Olswang—who serves on the ASHFoundation Board of Trustees—to organize a convention session on the topic.
“It’s going to offer a new funding mechanism to support collaborative research—a way to encourage researchers and practitioners who’ve formed a team and share an interest in a problem, and a plan they agree on to solve the problem,” says Olswang. “So let’s get this ball rolling!”
Bridget Murray Law
‘Grand Rounds’ Sessions
Multidisciplinary discussions address dysphagia, balance disorders and cochlear implants.
In medicine, complex, unusual or interesting medical cases are presented in grand rounds—“big picture” multidisciplinary discussions that help health care professionals keep current in evolving areas that may be outside their core practice.
Given this wide-angle perspective, grand rounds for communication sciences and disorders professionals are perfectly suited to a convention focused on the “big picture.” Three grand rounds sessions look at the widening use of cochlear implants, dysphagia treatment for patients of different ages and diagnoses, and management of balance disorders.

Grand rounds for communication sciences and disorders professionals are perfectly suited to a convention focused on the “big picture.”

Cochlear Implants: No Longer Just for the Profoundly Deaf
In the early years of cochlear implants (CIs), only people with bilateral profound sensorineural hearing loss who had little or no speech recognition qualified for a CI. Today, those parameters are obsolete.
This session will explore technical advances and improved safety and efficacy that make CIs an option for more children and adults. It will also look at:
  • Changes in CI candidacy for children and adults.

  • Candidate testing protocols that reflect the real listening challenges patients face in their daily lives.

  • Advances in hybrid and bimodal hearing.

  • Off-label use of CIs: earlier rather than later in children with progressive hearing loss, for example, or for people with single-sided deafness.

  • Changes in surgical procedures and electrodes that may preserve residual hearing.

Presenters include Camille Dunn, director of the cochlear implant program at the University of Iowa; Daniel Zeitler, a neurotologist at the Virginia Mason Medical Center in Seattle; and Teresa Zwolan, director of the cochlear implant program at the University of Michigan.
Dysphagia Grand Rounds: Big Picture Thinking
The approach to dysphagia management can be very different, depending on the patient’s needs and the practice setting. A child in elementary school, for example, needs different considerations than a skilled nursing facility resident or an adult with amyotrophic lateral sclerosis.
This session will look at each of these three clinical scenarios: the impact of the dysphagia, the unique considerations in each case—cultural/ethical, reimbursement, education, or policy, for example—and the clinician’s approach.
Presenters include Mary Casper, corporate rehabilitation consultant for speech-language pathology at HCR ManorCare; Marnie Kershner, acute care clinician at University of Pittsburgh Medical Center; Paula Leslie, director of the clinical doctorate program in medical speech-language pathology at the University of Pittsburgh; Lisa Rai Mabry-Price, ASHA associate director of school services; Lissa Power-deFur, Longwood University professor; and Laurie Sterling, senior SLP at Houston Methodist Hospital.
Vestibular and Balance Clinical Grand Rounds
Even experienced audiologists can be confounded by patients with dizziness or balance issues. This growing area of practice often requires a multidisciplinary approach, with audiologists playing a key role.
Updated techniques—including new tests of central and peripheral vestibular function—and patient data help audiologists diagnose and manage patients. Presenters from different clinical settings who specialize in assessment of dizzy patients will present several complex cases, emphasizing clinical decision-making and best practices, the importance of a directed case history and outcome measures, and the use of vestibular evoked myogenic potentials in diagnosis.
Presenters include Margot Beckerman, assistant director of the vestibular testing center at the University of Michigan Health System; A. Tucker Gleason, director of audiology at the University of Virginia; and Neil Shepard, director of the dizziness and balance disorders program at Mayo Clinic.
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August 2017
Volume 22, Issue 8