Solutions for Food Enjoyment When Swallowing Problems Require a Modified Diet

For most people, food is one of the most pleasurable aspects of life and many would agree that food increases our overall quality of life.  All great events in life include food.  So what happens to those adults, who have experienced this type of enjoyment and then have to shift their lives to one of a modified diet due to a difficulty swallowing?

Why Modify a person’s diet? 

Modified diets are often needed for adults that have begun aspirating (choking) on foods they are eating. This problem can happen for multiple reasons. The diets are prescribed by doctors or speech-language pathologists to reduce the chances of food or drink entering the lungs. This risk can be very serious and life threatening as it can cause pneumonia.

Modified Diets and Quality of Life

Modified diets, are stereotypically not as enticing as a regular diets since they may include soft-textured food, thickened liquids, inability to eat certain foods unless blended first etc.  The difficulty lies in balancing a modified diet with quality of life.  As SLP’s we consider quality of life when the client and their families are asking us questions about the modified diet recommendations.  We modify the diet as minimally as possible, to improve overall swallowing function, while trying to maintain pleasure of eating.  It is therefore important to let your practitioner or SLP know if there are any foods that you just can’t live without.

For example, my grandmother was put on a feeding tube, after being diagnosed with multiple mini strokes.  These strokes affected her overall functioning; she was wheelchair ridden, eating through a feeding tube and most of her day was spent on a respiratory machine.  The only joys in her life at that time were having her children, grandchildren and great-grandchildren visiting, but the family felt that wasn’t enough.  In our culture, food is everything, and what my grandmother loved was chocolate.  Although my grandmother was not supposed to be eating anything orally, her SLP said that if she couldn’t live without her chocolate, she could eat some chocolate pudding to improve her overall quality of life.  The role of the SLP was to provide our family with all of the information on swallowing risks. Since the family decided that chocolate was worth risking from time to time, and we were open and told this to our SLP, she was able to give us the information we needed to give my grandmother chocolate in the least risky format. This did not mean it was without risk, but it was a risk we were all fine with taking. At the same time, it allowed my grandmother to have one more pleasurable thing in her life, her love… of chocolate!

Melissa Oziel

M.Sc-SLP, Reg. CASLPO

Speech-Language Pathologist

 

The Speech Therapy Centres of Canada

www.speechtherapycentres.com

 

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Ho, Ho, Ho Holiday Conversations

Holiday time is an exciting time for everyone: celebrations, food, and time with loved ones. With many families and friends coming together and reuniting, often after long periods of time, come many loud group conversations. These conversations can feel quite overwhelming to some people, especially those with acquired brain injuries (ABI). Many clients with ABI find it difficult to attend to the conversations, keep up and/or add meaningful information to the conversation, or remember what has been discussed.

Some tips for keeping up in group conversation:

• Prepare. If you anticipate that it will be a long night, take a proper rest and cognitively prepare yourself. This could include deep, relaxation breathing or going for a brisk walk.
• If you are nervous that people are going to be asking you about your injury, plan a script ahead of time and try to re-direct the conversation back to the speaker. This will help you feel more comfortable and confident, knowing that you have anticipated this exchange in advance. E.g., “It’s been a long year but things are moving along, thank you. And how is Johnny enjoying college?”
• Try and eliminate background noise– if you are hosting the party, keep the noise to a minimum e.g., turn music low, turn off the television. If you are attending a party, ask the hostess if they do not mind to turn down the volume.
• Seating is important. Try and sit close to the person you feel comfortable conversing with. Try and seat yourself away from distractions e.g., away from the kitchen, or washroom.
• If you are finding it difficult to carry on a large conversation, try and create a smaller sub-group conversation. Smaller conversations are much easier to maintain and require less brain energy, than those larger, louder ones.
• If you are having trouble concentrating, ask 1-2 people if you can go in the other room to talk. It may be easier to have a productive conversation when you have decreased the amount of distractions.
• Repeat the question back to the listener. This helps you remember the information shared and also shows the listener that you are following the conversation. E.g., Q-“What do you plan on doing during the holidays?” A-“What do I plan on doing during the holidays? Well this week….”
• Summarize the information back to the listener to confirm your understanding. E.g., “So you are leaving to Mexico next week and going with the family for 7 days. What a nice time!”
• If you are stuck and are having trouble keeping the conversation going, transition to another topic. You can use the surrounding context if you are having difficulty choosing a new topic, such as commenting on the food, decorations, host or hostess, holiday plans.
• Don’t be afraid to ask for repetition! Everyone needs clarification sometimes, and your participation matters.

 Use these strategies to help communication during the holiday season! The Speech Therapy Centres of Canada hopes to make your holiday conversations enjoyable and successful. Speak with your S-LP for more social communication strategies.

 Ashleigh Wishen, M.H.Sc. S-LP (C)

Speech-Language Pathologist, Reg. CASLPO

 

The Speech Therapy Centres of Canada Ltd.

www.speechtherapycentres.com

 

Causes of speech and language disorders: Some answers to parent’s “why’s”

When parents walk through our door, they often want to know ‘WHY’ their child is not understanding and talking like other children; ‘WHY’ they aren’t pronouncing sounds like others; or ‘WHY’ they’re stuttering. Listed below are some factors that are known to predispose or precipitate speech and language disorders.

Neurological factors: Specific areas in the brain control our speech and language functions. Understanding what others say to us, expressing our thoughts and needs, remembering details of what was said, reading, and writing are all controlled by regions in the brain. There is evidence in the literature to suggest that children with language disorders may have a neurological involvement contributing to their speech and language difficulties. This means that there may be obvious or subtle differences in the brain which makes the child susceptible to a language disorder. No one pattern of brain architecture has been consistently shown in all individuals with language impairments, which makes this all still a bit of a mystery.

Motor and Sensory factors: Our senses serve as channels for us to perceive the external environment. Be it our sense of vision, hearing, touch, taste, and smell; they offer us with different ways to perceive things from the external environment. If any of these senses are not functioning optimally, it would limit the essential information that we receive from our environment. For example, children with vision or hearing problems will not be able to use those senses to see by reading, or hear someone speaking in their environment, making them more susceptible to a speech or language disorder. Having adequate motor skills is also essential to speech and language development. Early on, children move around and explore their environment. This exploration fosters early language and cognitive development as they are exposed to new ideas and vocabulary. Children who have limited motor abilities may be at a disadvantage because of not being able to actively explore their environment. Adequate motor abilities are also required for the movement of the voice and oral structures (lips, teeth, tongue etc.) required for speech. Thus, any difficulty with speaking movements may impact a child’s speech and language development.

Cognitive: Intact cognition (the ability to think, know, perceive, judge, reason etc.) is an important foundation on which we build our speech and language skills. Vice versa, developing our speech and language skills helps us improve our cognitive abilities. Hence, children with cognitive challenges may be at risk for developing speech and language disorders. These children may have trouble associating different words with their meanings, remembering words, recognizing patterns and sorting words into different categories, and learning new concepts in general.

Genetic factors: Speech and language disorders tend to run in families, suggesting a possible genetic involvement in causing these disorders. However, it is also true that many people with speech/language disorders’ children do not have any difficulties, and that children with speech/language disorders have no family history of it in the past.

Environmental factors: Environmental information is key in fostering speech and language development. Providing a language rich environment with an adequate amount of stimulation is necessary to support children in developing age-appropriate speech and language skills. Children who have a less language rich environment and stimulation may be at risk for developing speech and language disorders.

Acquired factors: Some individuals may acquire speech and language skills as per typical milestones and then lose some of these skills due to an acquired injury or illness. Some examples of these include a traumatic brain injury, infections such as meningitis, tumors, strokes, etc.

It is important to note that this list is not exhaustive, but is an overview of some of the reasons we may see speech-language disorders.

If you are concerned about  your child’s speech and language development, see a Speech-Language Pathologist to address your concerns.

Nisha Balakrishnan M.A. SLP, Reg. CASLPO

Speech-Language Pathologist

 

The Speech Therapy Centres of Canada

www.speechtherapycentres.com

 

Reference: Paul, R. (2007). Language Disorders from Infancy through Adolescence- Assessment and Intervention. (3rd ed.). St. Louis, Missouri: Mosby Inc.

Exercise Your Brain

The body undergoes many changes as we age.  As kids, humans typically grow taller, get stronger, and learn.  Our brain is made up of little things called neurons which connect and essentially “talk” to each other to make our brain function.  We start out with thousands.  At age three we have approximately 15000.  Then by the time we’re adults, we’re down to about half the neurons we were born with.  What has happened is that our brain has recognized which areas are being used the most and devoted more of its energy there, cutting back on other areas.  As humans age, our thought processes get slower which can have an effect on our language.  The words can be harder find.  We need extra time to respond to what is being said.  We are slower to respond.  The thought of losing half our brain by the time we’re adults is pretty depressing…

So how can we combat our aging brain?  Good news.  Recent research is suggesting our brains can change.  If you work hard at strengthening the connections you have, not only might they become stronger, you may even build new connections.  So put your brain to the test, and add mental exercises to your physical exercise regimen.  Build some new connections!  Here are some suggestions on how:

• Play word games: Scrabble, Boggle, Scattergories, Catchphrase, Taboo etc.  These expand the way you think about letters and words.  Notice how after you have played a few rounds, you have improved.  That’s your brain in action .
• Try to learn a new language:  Even the act of trying causes your brain to think differently than you normally would, therefore, exercising your brain.
• Read! You’ll be exposed to new words, words you may not hear often and will open your brain to new ideas.  Reading stimulates thinking.  If you usually read one type of book, try another to give your brain that extra challenge.
• Try to remember: Ever notice how we no longer remember phone numbers?  How we rely on all our gadgets to remind us of things?  Take a step back from the gadgets and focus on remembering.  Use mnemonic devices like acronyms to help you remember (for example: Never Eat Shredded Wheat…for North East South West) Challenge your brain to be your best gadget.

 Jana Zalmanowitz M.Cl.Sc

Speech-Language Pathologist (C) 

 

The Speech Therapy Centres of Canada

www.speechtherapycentres.com

 

Social Communication – What does it Really Mean?

Think back to a recent cocktail party you attended with distant relatives or unfamiliar co-workers in a new job setting…did you dread getting ready for the event? Did you feel awkward trying to start a conversation with your distant Aunt? Did you feel your heart pounding faster and harder as your new boss approached? Welcome to the world of many adolescents and adults, especially those on the Autism Spectrum or with an Acquired Brain Injury (ABI). Similar to those cocktail parties, social settings that require conversing, initiating  and keeping conversations going can lead to feelings of anxiety, anger, confusion and even depression.

At the center of all our interactions lies the foundation of communication: to flourish academically, to build successful friendships, to develop professional relationships, and to create intimate bonds with our partners. However, the fundamental requirements of successful social communication are far from basic.  One must have: the motivation to interact, be aware of their surroundings and how to modify them appropriately (eliminate distractions), recognize their own intentions, have the flexibility to shift perspectives, understand the “hidden”
social conventions appropriate to different contexts, and formulate their  response in an organized manner.

A Speech-Language Pathologist works with individuals who have difficulties with social communication using a one-on-one direct model, or through group programs. You start increasing your or your child’s communicative competence by:

• Anticipating topics and/or vocabulary that will come up during the social interaction. Predicting conversational topics allows you to prepare ahead of time and thus increase your social confidence. E.g., if you or your child is going to a sports event;
  research about the teams, rules, scores, and players or if you will be attending a work conference; read about the lectures ahead of time and familiarize yourself with the content of the day.
• Using ice breakers that you find helpful in starting conversations, such as “it’s a beautiful day today” or “how is your day going?”
• Practicing the tricky skill of making small talk. You can do this in the car on the way to an appointment, in a coffee shop or even at the dinner table.
• Using surrounding context to guide the conversation, especially when stuck on what to say next to keep the interaction going. For example, if you or your child are at a baseball game, comment on their favourite player, the uniforms, a great pitch. If you are at a wedding, comment on the bride and groom, the food, their opinion of the band.
• Shifting the conversation back to the speaker. Many clients with ABI dread answering questions about their accident or the details of their recovery. Instead of going into detail, briefly state how you are doing and then divert the conversation back to the partner, for example, “I am doing well, thank you. I heard you started a new job, and how is that going?”

These are a few tips that can help build communicative competence. If you are concerned about someone’s social communication skills, speak with a Speech-Language Pathologist for additional suggestions, recommendations and/or strategies.

Ashleigh Wishen,
M.H.Sc. S-LP (C)
Speech-Language Pathologist, Reg. CASLPO

The Speech Therapy Centres of Canada

www.speechtherapycentres.com

 

How to Help People With Communication Disorders in the Community

Last week I was in Tim Horton’s when I saw a man trying to order a coffee but he was struggling because of a communication disorder. He was having a difficult time being understood by the Tim Horton’s employee and needed help getting his money out of his wallet because of physical difficulties. Although the people around him – both the employee and bystanders – all seemed to want to help the man they were all hesitant and did not seem to know what to do or how to help this man.

One of our jobs as speech-language pathologists is to advocate for those with
communication disorders.  As part of that we try to increase awareness and knowledge on how to interact with people in the community who have various communication disorders. This may include people with disabilities (cerebral palsy, developmental disorders), people who have had a stroke or head injury, people with dementia (such as Alzheimer’s), people who communicate with assistive technology/computers, or people with speech that is difficult to understand. Here are some communication tips that you can use with almost any kind of communication difficulty:

First and foremost – always be respectful and ask the person if they would like your assistance! Remember: a communication disorder does not mean they are unintelligent!!

To help the person understand you:

• Keep your messages short and to the point (for example: say “Do you want help?” not “I noticed you’re trying to order and I thought that I could help by…)
• Wait! They may need more time to process the information
• Keep your message short but grammatically correct so they do not feel that you are insulting them (for example: do not say you….help….get….coffee??”)
• Repeat if necessary or try to say your message in a different way
• If they are still having difficulty understanding you, use gestures (pointing to objects or locations) or use objects around you (if they don’t understand “what size coffee do you want?” show them the different sized cups)
• If open ended questions are difficult (“what do you want?) give choices (“do you want a drink or something to eat?” “do you want coffee or tea?”)

To help the person express themself:

• Give them specific feedback on what you did not understand. Instead of just saying what?” try saying  “you want a coffee, what do you want in it?”
• As explained above – if they are still struggling have them gesture, use objects around the room, or give them choices
• If they are using assistive technology – wait for them to finish creating their message. Avoid reading their message over their shoulder or guessing what they might be saying.
• Most importantly – be patient, give them time, and don’t give up!

Carla Montgomery, M.H.Sc. SLP(C)
Speech-Language Pathologist, Reg. CASLPO

 

The Speech Therapy Centres of Canada

www.speechtherapycentres.com

Bullying

When I was a kid I had a pet hamster, that I adoringly named Grover. Unfortunately, I was not able to produce my /R/ sound, so Grover shortly became known as “Gwova.” By being teased and imitated at school, I quickly learned what other people heard when I spoke… and I was very embarrassed about my speech. Looking back years later, I consider myself to be incredibly fortunate that this teasing did not lead to bullying, but sadly not the case for most children.

It has been a goal of mine, since becoming a speech-language pathologist, to not only work on the communication difficulty itself, but to target self-esteem. Speech-language pathologists often find themselves faced with the bullying epidemic. They may work in schools, where most bullying typically occurs, or they may work outside of schools, but with students that are frequently susceptible to bullying, for example, children with communication, developmental, and/or social difficulties.

A professor from Pennsylvania State University, Gordon Blood, has done extensive research on bullying and feels that speech-language pathologists have a role in managing and reducing social bullying. Examples of social bullying are: a child not being allowed to join a game, to participate in conversation with peers, or becoming the subject of teasing or negative gossip, in turn causing children to experience emotional and/or academic difficulties. Blood says, “In all bullying, there’s intent to do harm, and a perceived power imbalance.” Speech-language pathologists are in a position where they can often have a strong role in restoring the balance of power that is disrupted in bullying. Instead of encouraging a child to ignore the problem, or pretend not to be bothered, it is recommended that professionals, such as speech-language pathologists, teachers, and parents do the following: 1) Listen to the child. Give them non-interrupted time to speak. 2) Praise the child for discussing the bullying – it can be incredibly hard for children to talk about. 3) Encourage the child to build his or her social network – one or two friends is all most children need to stick up to a bully.

Remember that the common goal for children that experience bullying is to develop their confidence enough to overcome bullying before it has negative effects on their learning and health.

Information obtained from Speech-language pathologists positioned to help victims of bullying, January 7, 2011, written by Gordon Blood, Ingrid Blood, Michael Boyle, and Gina Nalesnik from Pennsylvania State University.

Written by:

Michelle Cameron, M.H.Sc. S-LP(C)

Speech-Language Pathologist, Reg. CASLPO

 

The Speech Therapy Centres of Canada

www.speechtherapycentres.com

 

Children and Acquired Brain Injuries

For decades scientists believed that children with an Acquired Brain Injury (ABI) would do better than adults with ABI.  The reasoning was based on the fact that because adult brains have already been developed and children had ‘plastic’ (changing, growing) brains, children with an ABI would be better able to adapt and learn with their ABI.  However, more recent studies have shown that this is incorrect, and in fact, children with ABI do worse in the long-term than do adults.

According to recent research, young children with ABI are at a tremendous disadvantage.  The younger a child is when he/she suffers an ABI, the worse the child does.  This is because younger children have not yet fully acquired speech and language structures.  They are then faced with the task of learning language (vocabulary, grammar, sentence structure etc.) with an acquired learning disability that is caused by the ABI –namely cognitive-communication difficulties that hamper learning (such as attention, memory, comprehension and expressive language difficulties etc.).  Those children then struggle with learning in the classroom as their language skills are already behind, and the acquired learning disability further compromises new learning.

Older children who have already learned language also present with difficulties in new learning.  In some cases, these children are able to cope in school for the first year or two following their injury.  However, as the curriculum material gets more and more difficult, they also experience failure and difficulty.

How does an Speech-Language Pathologist help?

Research has shown that consistent and intensive intervention is the most helpful following a brain injury.  In my experience, repetition is the key to teaching these children language.  In order to do well, these children need to practice their speech therapy goals on a daily basis with all caregivers, teachers and therapists across all environments for learning and carryover to take place.  With the proper support and collaboration, I have seen children with ABI grow from toddlers to grade school and from single words to complex sentences.  I have witnessed these children learn to read and even correct other people’s grammar in conversation.  Although they continue to require support throughout their school years, it is reassuring to know that intensive and collaborative intervention is the key to their success.

Written by:  Claudia Correia, Speech-Language Pathologist, The Speech Therapy Centres of Canada Ltd.