Revolutionary Learning Meets Evolutionary Practice Here’s a sampling of just a few stimulating sessions coming up at convention. Features
Features  |   September 01, 2018
Revolutionary Learning Meets Evolutionary Practice
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Language Disorders / Aphasia / Attention, Memory & Executive Functions / Features
Features   |   September 01, 2018
Revolutionary Learning Meets Evolutionary Practice
The ASHA Leader, September 2018, Vol. 23, 48-53. doi:10.1044/leader.FTR2.23092018.48
The ASHA Leader, September 2018, Vol. 23, 48-53. doi:10.1044/leader.FTR2.23092018.48
Can low electrical-current brain stimulation help people with aphasia? What is the role of laughter in communication? When do voice disorders benefit from medical versus speech-language treatment? And what can clinicians on end-of-life teams learn from a car company?
The hundreds of “revolutionary learning” convention sessions—presentations, poster sessions, technical sessions, demo labs, master classes, short courses and lab tours—will answer these and other questions, helping audiologists and speech-language pathologists bring evolving trends and practices to their daily work.
Overwhelmed by the choices? Here are a couple of suggestions:
  • The online Program Planner lets you search for sessions by format, time, date, presenter, topic or keyword. You can download handouts for the sessions you plan to attend. Take your schedule and materials with you in the convention app.

  • Stop at the Concierge Learning Center at the convention, located by the registration area. ASHA staff will help you identify sessions and create a personal schedule that focuses on the topics or issues that interest you.

The four session previews on the following pages offer a glimpse into the variety of revolutionary learning opportunities for all learning levels. Check the program planner for session dates, times and locations.
Stimulating the Brain to Boost Aphasia Recovery
Low-current electrical brain stimulation may bolster outcomes in aphasia rehabilitation. Hear directly from the lead researcher at the ASHA Convention.
Why do some patients recover from aphasia more quickly than others? This question is the focus of Julius Fridriksson and his co-investigators—and of his presentation at the convention research symposium, “Advances in Neuroplasticity Research: Language Recovery in Aphasia.”
In 2016, Fridriksson and colleagues at the Center for the Study of Aphasia Recovery (C-STAR) at the University of South Carolina (USC) received an $11.1 million grant from the National Institute on Deafness and Other Communication Disorders (NIDCD) to study aphasia and help develop clinical tools to better predict patient outcomes. Fridriksson, a speech-language pathologist and director of C-STAR, quickly became interested in studying and better understanding aphasia after noticing a dearth of research in the area.
Despite the high prevalence of aphasia, Fridriksson—who is also co-director of the McCausland Center for Brain Imaging at USC—believes aphasia has not received the focus it needs over the past couple of decades. “There are a lot of patients with aphasia, probably around two million people in North America,” he says. “I think that for many different reasons, those patients are very much underserved. I think that the biggest reason is that ‘treated recovery’ from aphasia is a very long process and we tend to focus our efforts on more immediate results, such as diet modifications in patients with dysphagia or prescribing communication devices for persons with aphasia.”
C-STAR is a collaborative research effort involving four sites: USC, the Medical University of South Carolina, Johns Hopkins University and the University of California, Irvine. Researchers rely on volunteer participants, who, according to Fridriksson, are plentiful in South Carolina. There’s a very large stroke population in South Carolina, he says, with the interesting and dubious distinction that half of all stroke patients are younger than 60.
Fridriksson and his team want to understand the baseline factors that predict the long-term response to aphasia rehabilitation for acute, sub-acute and chronic patients. Volunteers at the center participate in a thorough neuropsychological assessment and neuro-imaging work up.

“If you can couple aphasia therapy with this low electrical-current brain stimulation, the outcome is very much improved.”

It’s electric
During the presentation, “Outcomes and Predictors of Language Recovery Following Transcranial Direct Stimulation,” attendees will learn about the results of Fridriksson’s recently completed randomized controlled trial. In it, all participants (74 total) received aphasia rehabilitation, but some also received low electrical-current brain stimulation and some were placed in the placebo group.
The study found that at six months post-treatment, the treatment outcome (picture naming) was doubled in the experimental group compared to the control group. “What we found was very promising,” Fridriksson says. “If you can couple aphasia therapy with this low electrical-current brain stimulation, the outcome is very much improved.”
Although clinicians would need training to perform this type of treatment, Fridriksson is confident it could make its way into clinical practice very soon, based on the cost-effectiveness (about $500 worth of equipment), and it could be used in a variety of health care settings. “This is something portable that you can use in pretty much any setting, all the way from acute to home health,” he says.
Fridriksson hopes his team’s findings will help SLPs work with aphasia patients. “For the next person that comes in on your caseload, is there something about their baseline that will tell you: A, how are they going to benefit from treatment? B, what is the best therapy for them? And C, if they don’t have a good outcome potential, what else can we do for them?” he says.
Jillian Kornak
Why Take Laughter Seriously?
Neuroscientist Sophie Scott shares the importance of laughter as a social tool and form of nonverbal communication.
Have you ever giggled at an awkward moment? Or worried about laughing during a somber occasion? You’re not alone, says Sophie Scott, senior research fellow in basic biomedical science and professor of cognitive neuroscience for University College London’s Division of Psychology and Language Sciences.
“Laughter has much more to do with social processing than humor,” Scott says. “We often use it to reframe tense or threatening situations, hide anger or sadness, to get someone to like us, or show we already know somebody.”
Scott will explain how, because of this important social role, laughter ought to be taken more seriously in her convention presentation, “Joking Apart—The Science of Laughter.”
People use laughter in varied ways and the skill of using laughter appropriately takes a long time to acquire, Scott says. Her research (still in progress) indicates that we only begin to fully comprehend how to use laughter when we’re young adults.
“It’s a very interesting behavior, but also highly ambiguous,” Scott says. “There are a lot of reasons why someone might be laughing, which is why it takes us so long to understand it.”
Universal emotion
Though complex, laughter is also ubiquitous. All humans laugh across all cultures. Other mammals also use laughter to communicate. In fact, the roots of laughter are seen in play vocalizations produced by apes. In her convention presentation, Scott plans to cover ways humans use laughter as a tool, the evolution and complexities of using laughter, and the neuroscience involved.
Speech-language pathologists can use laughter to help nonverbal clients socialize and engage with family or friends, explains Scott. The ability to laugh often remains intact even after an incident—such as a stroke or traumatic brain injury—that causes a speech or language impairment.
She suggests using laughter as a gauge to understand the level of social-emotional processing that’s been preserved when language is impaired. Laughter and reactions to laughter span a huge range of experiences, from joy to fear, which Scott believes can provide significant insight into a person’s socialization ability.
“As a form of nonverbal communication,” Scott says, “laughter does heavy lifting in social situations. It’s a social-emotional tool used in nuanced ways by people to engage in social interaction without verbal cues.”

“Historically, we study negative emotions, but laughter is important because we use it in such a nuanced ways to make situations better.”

Contagious reaction
Scott’s presentation will include new data on differences in processing and using laughter between people with autism and neurotypical people. A doctoral student working with her is conducting a study on this topic. One trend has already come through from this research: “Neurotypical people rate a joke higher when they hear laughter after it, regardless of the joke’s quality,” Scott says.
That’s not surprising given the contagiousness of laughing. Most people are 40 times more likely to laugh when around other people, and often just because others are laughing. Scott uses this statistic to highlight how important laughter is to social interactions and communication.
“Laughter is worth looking at in more detail because it lives entirely in social worlds,” Scott says. “Historically, we study negative emotions, but laughter is important because we use it in such nuanced ways to make situations better.”
Shelley D. Hutchins
Stopping the ‘Conveyor Belt’ of Overly Mechanized Dying
A palliative care doctor emphasizes the role of SLPs in end-of-life, patient-centered care.
Jessica Zitter wants medical teams caring for critically ill patients to learn from Toyota: At the company’s car manufacturing plants, anyone who works on the assembly line can stop the conveyor belt if they sense something is amiss.
A pulmonary and critical care physician at Highland Hospital in Oakland, California, Zitter thinks that any member of a medical team should be able to stop the “end-of-life conveyor belt,” in which mechanization and protocol override patient and family preferences and collaborative decision-making.
And in her convention session, “A New Kind of Heroism,” Zitter wants to help providers bring patient-centered end-of-life care—characterized by eliciting and following the patient’s wishes—to their facilities.
The author of “Extreme Measures: Finding a Better Path to the End of Life,” Zitter is also featured in the Oscar- and Emmy-nominated short documentary “Extremis”. The documentary tells the stories of patients and health care providers caught in a saving-life-at-all-costs culture that, because it does not easily acknowledge the reality of death, pushes patients into overly mechanized dying.
‘Flattening’ decision-making
Zitter wants medical providers to question the use of ventilators and feeding tubes to keep critically ill people alive. “People are dying these mechanized deaths,” Zitter says, “when, in fact, surveys show us that people really want to die at home, in peace and comfort.”
In caring for people at end of life, Zitter emphasizes three points. “Number one is redefining success,” she says. “It doesn’t always mean just fighting the disease and winning.”
Number two is being honest with patients and families. “Data show a tremendous discrepancy in the medical team’s expectations and the patient’s and loved ones’ expectations about how the patient’s going to be doing in a year,” Zitter says. “Particularly with the decision to trach somebody—once you’ve done it, it’s hard to ever come back from that. Families don’t always realize this.”
The third point is to “flatten” hierarchical medical teams, so that everyone’s voice counts—as in the Toyota plants. “On most teams, no one can say ‘Hey, wait a minute—you’re traching this patient? Does the family understand what this means?’ Instead, we’ve got to elicit the opinions and experiences and knowledge of every member of the team to really do the best we can for that patient.”

“People are dying these mechanized deaths when, in fact, surveys show us that people really want to die at home, in peace and comfort.”

SLPs’ role
Speech-language pathologists, Zitter says, can be critical to this change in approach to end-of-life-care in several ways. They can help elicit the patient’s—and family’s—wishes, especially for patients with aphasia, dementia and other conditions. “Clinicians who can help figure out ways to help people communicate and create communicative access for patients and families play an integral part.”
SLPs can also help to bring this paradigm to hospitals. “It’s rare, but some hospitals are truly working to develop a culture where it’s not just the doctor driving the ship,” Zitter says. “I don’t have a magic button here for you, but I do know that this is where we need to go, and we all need to be a part of advocating for that change.”
Zitter encourages SLPs to “start to say something. Take personal responsibility to, if you see something, say something. You may be lucky enough to be in an environment where people are more receptive. There’s change coming. A better path is out there, but it will require a new kind of heroism from everyone involved.”
Carol Polovoy
Surgery? Meds? Or Behavioral Therapy?
At a convention short course, SLPs and ENTs will debate using behavioral versus medical/surgical treatments for voice and laryngeal disorders.
Who’s getting ready for a rumble at convention? Speech language-pathologists and otolaryngologists, that’s who.
Correction. It’s not really a rumble—it’s a debate for the three-hour short course, “Debate the Doctors, Oxford Style! Management of Vocal Fold Bumps, Bowing and Chronic Cough.” And its goal is to get ENTs and SLPs thinking about the spectrum of treatments for voice and laryngeal disorders, says session chair Nancy Pearl Solomon.
“Obviously people from different specialties are going to come at treating these disorders with different biases,” says Solomon, a research SLP at Walter Reed National Military Medical Center. The Oxford debate format will exaggerate those biases, pushing SLPs and ENTs to argue—perhaps somewhat theatrically—for extreme positions on either side.
“Normally, none of the ENTs are going to say you always do surgery. And none of the SLPs are going to say you never do surgery,” Solomon says. “But we’re going force them to do that for the purpose of debate, so that they can provide evidence on either side.”
Polarized, then integrated
In each of three debates held during the short course, debaters will start with seven-minute opening statements: ENTs will argue for medical/surgical interventions as the gold standard, and SLPs for behavioral interventions as the gold standard. After the statements, moderators will collect questions from the audience. The debaters will address these—and each other’s arguments—during the 35-minute debates that follow.
Before the opening statements, audience members will indicate which point of view they favor by choosing seating on either side of the room. During the debates, they may switch sides, if so swayed, as they consider the various arguments and supporting evidence posed.
“We’ll be constantly asking our audience members to actively evaluate which side they agree with,” says Solomon. “I think this learning format will be effective for really understanding the topic.”
Following each debate, the two debaters will deliver a 15-minute joint presentation, in which they integrate their disparate positions. “This will help the audience bring all the information together for that ideal interprofessional practice approach,” says Solomon.

“If you were more extreme coming in, maybe now you’ll think, ‘Oh. Maybe there’s some benefit there. That’s something I didn’t think of.’”

Controversial trio
Solomon and her co-organizers, Aaron Johnson and Douglas Roth, on the Voice and Alaryngeal Communication Convention Program Committee chose to focus the debates on three areas involving pros, cons, gray areas and tough decisions. These include:
  • Vocal fold lesions: Excise or exercise? The treatment options for vocal nodules are surgery (ENTs) versus voice treatment (SLPs).

  • Vocal fold bowing: Inject or instruct? The treatment options for atrophied vocal fold muscle are an augmentation injection (ENTs) versus voice treatment and exercises (SLPs) to bulk it up.

  • Chronic cough: Medical intervention or behavioral modification? The treatment options are neuromodulating agents, such as amitriptyline, gabapentin, pregabalin, and baclofen (ENTs), versus behavioral modification, such as breathing therapy (SLPs).

Participating in the debates will be SLPs Amanda Gillespie of the Pittsburgh Voice Center, Edie Hapner of the University of California Voice Center and Adriana Shembel of the New York University Voice Center. Participating on the ENTs’ side will be Paul Kwak and Milan Amin of the NYU Voice Center and Tom Carroll of Brigham and Women’s Voice Program.
After the debates, Solomon expects audience members to leave with a deeper understanding of the various options in these treatment areas. “And whoever changes the most minds wins the debates,” she jokes.
But, in all seriousness, Solomon hopes the course produces shifts in attendees’ thinking. “If you were more extreme coming in, maybe now you’ll think, ‘Oh. Maybe there’s some benefit there. That’s something I didn’t think of.’”
Watch a clip from a debate at the American Physical Therapy Association’s annual meeting that, at least in part, inspired this debate format (the debater plays the role of Tevye from “Fiddler on the Roof”).
Bridget Murray Law
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September 2018
Volume 23, Issue 9