Monday, May 16, 2016

Summer Speech and Language "Work"

Across the US, many SLPs are braving the end of the school year madness with final progress reports, IEP meetings, and sessions with children ready to start summer vacation!!  I say to you, "Hang in there, you've got this people!!  

While I am thankful to have those manic school days of 75 plus students behind me, I have not dodged all of the end of the school year bullets in my private practice world!  I need to first navigate the waters of my family life and son's busy, summer schedule (oh to be 10 years old again and have summers off!!)  Then, I have to steer clear of summer school schedules as I plot a summer work schedule.  Next, all of my paperwork, planning, insurance calls, and new patient consultations need to be done by early May in preparation for my summer speech and language pool group sessions.  Finally, I have to plan for holiday closings and vacations by preparing carryover work for my families.  Little by little, I'm getting there though and I wanted to share some freebies and ideas with you that will hopefully make my life and transitions easier this summer!  

Before I show you my activities and plans for summer sessions, I want to give you a sense of my mindset.  I believe that every child deserves some down time and the opportunity to participate in some summer fun, which is why I have decided to offer 6-week summer speech and language pool groups through Naperville Therapediatrics.  I also firmly believe that taking too much time off from practicing communication skills can lead to regression.  So how do I find a balance between these two worlds of taking a break and continuing practice?  It isn't easy, but I strive to offer some fun, thematic sessions that don't feel like "work." This year, I'm taking my plan one step further and providing families "work" for home use in the form of sand/water play buckets, bright and colorful flashcards, and pencil boxes filled with all kinds of goodies.  Luckily, my practice is small with under 20 clients, so I can spend a little on materials, but I understand that this may not be the case for all practitioners. If you can't afford gifting supplies, then please feel free to share the lesson plans that I have included in this post.  You can also find all sorts of summer carryover work on Teachers Pay Teachers.  Let's take a look at what I have prepared. 

Years ago, I found pencil cases at Walmart on clearance for 25 cents each, so naturally, I bought 20 of them.  I completely forgot that I had these boxes until I was Spring cleaning this year.  I decided to finally put these to good use, so I packaged several of them for individual clients.  There are three types of boxes.
  1. This one is for my youngest client who is working on increasing vocalizations and single word utterances.  I found the beginning words deck and ocean-themed lacing cards at the Dollar Tree.  You will also notice a pile of stickers on the bottom and a bingo dabber because this client loves creating artwork and can sit for hours to play with stickers and dabbers! This little one will also receive some dabber pages for expressive language practice so the dabber marker can be put to good use!
     
  2. The next box has a collection of items for one of my early elementary, speech only clients who typically comes to sessions with an older sibling, so I included an I Spy Snap card game for the two of them to enjoy.  I also updated my flair pen supply recently, so I am donating my older flairs and some crayola thin markers for articulation writing work. I cleaned out my arts and crafts bin and found some decorative tape and stickers, so I added these for some crafting fun.
  3. This final box is for my oldest client who is in middle school. We have been working on memory drills so I included a sticky note pad and mini writing notebook as a way to encourage using the strategy of writing things down in order to improve recall.  My hope is that this client can use the flair pens, pencils, and paper to work on carryover tasks. Finally, I will be adding the free, summer idioms deck that my Frenzied colleague from Old School Speech recently had featured in the TpT newsletter.   I added fish and seashell stickers to these cards to designate the idiom cards from the definition ones.  
While the pencil boxes worked well for some clients, I found something better suited for my young clients with autism.  Last summer, I purchased some colorful, blue bins at the Dollar Tree to store some materials, but have since re-arranged my office and no loner have room for these on my shelf. Rather than recycle them, I am going to gift them to some families to use as a sand/water play bin.  As luck would have it, one of my neighbors just offered me a large bag of blue, Crayola sand that she no longer needed, so I divided the lot and used a Ziploc bag to store the sand in each bin.  Next, I picked up some sand toys and summer die cuts at the Dollar Tree.  Some of my clients have been working on answering "WH" questions so I used three different objects for "WHO", "WHAT" and "WHERE" with my Smarty Ears Custom Boards app to create a matching deck for each question type.  All of the questions pertain to the summer and seasonal activities to keep things functional.


Each pencil box and bin will have an instructional sheet included with it. I wrote a few different handouts to meet the needs of three, different clientele groups. First, I created this sheet appropriate for toddlers needing to build expressive speech skills and early elementary clients working on improving articulation of target sounds. 

Next, I wrote this handout for my young clients using either PECS or speech generating devices to communicate.  Many of my tasks are carryover ones that we have worked on during speech sessions over the last six months.

Finally, I have monthly homework sheets for June, July, and August that suite my upper elementary and middle school clients working on language skills.

I am really pleased with how these collections turned out and cannot wait to share them with my clients!  The best part is that I didn't spend a fortune on materials, but rather used supplies that I already had in my practice and purchased some great items at the local Dollar Tree.  I hope that you all enjoy a wonderful, relaxing summer and that you can use some of my materials from this post to make your speech lives easier!!  




Sunday, April 17, 2016

Implementing Therapy Outside of your Speech Therapy Room~ A Frenzied SLPs Link-up


Happy Spring!!  Here's hoping that you are seeing some spring-like temperatures in your neck of the woods!  We are finally enjoying warmer days as we pack away our winter coats in the Midwest. The Frenzied SLPs want to help you celebrate new beginnings this Spring by hosting this linky party about taking therapy outside.  Be sure to check out the links below for more inspiration!  We also welcome you to join us by linking your post at the 'Add Your Link' tab on the bottom, left-hand corner of this post.

As you may already know, I have been in private practice for a couple years now in my home office: Naperville Therapediatrics. Life is good as my days are filled with a nice balance of work, home management, play time with my puppy, and quality time with our ten year old, sweet son.  At first, I struggled with coming up with ideas for this topic of taking therapy outside because I do not have the luxury of a fenced-in yard or safe space to play outdoors with my active clients.  Then, it dawned on me that I could put my own spin on working "outside" of the four walls in my therapy room.  In fact, I have been doing this for quite some time.  Here's what a typical entry looks like at my practice:

No matter how old you are or what you are working on to enhance communication, everyone can benefit from practicing using eye contact, gestures, words, or sentences when greeting each other at the front door.  Next, it's time to follow directions to remove shoes and place them either under a bench in the entryway or in a hallway closet.  Sometimes, clients need to use the bathroom, so there may be an opportunity to make a request using speech or even a speech generating device. Otherwise, we head down the hallway to the closed speech room door with the child safety lock and wait until the client initiates a request for help to open the door.  If we look at this scenario that typically takes place in the five minutes before we walk into the actual therapy room, then you can count up to four communicative opportunities (greeting, responding to directions, requesting, asking for assistance.)

Then there's this guy...,
Gryffindor the Vizsla at 15 months old



Most of my clients enjoy seeing my overly friendly puppy.  Some even head from the door straight to the treat cabinet in the kitchen to reward Gryffindor for following commands such as, "Go to your bed", "Sit", "High-Five", and "Down."  Even the shyest of all my clients lights up with a big smile when she hears Gryff barking and she also tends to be more vocal around him than she is when it's just me at the door greeting her on arrival. The best part about my pseudo clinical dog is that he helps me with transitioning clients from the therapy room to the entryway door at the end of our sessions.  I don't mean to brag, but many little ones protest when our session is over.  Guess that's a good sign that they are having fun while learning!  I have found it to be rather effective to say, even in the mist of a tantrum, "Do you want to see Gryff and give him one more treat?"  Works.  Every. Time.  Before we can say, "Speech is over", kids are heading to the coat rack and getting jackets on so they can see that crazy puppy again!  As luck would have it, Gryff is happy to comply with more attention.  It is pretty handy having him around to break the ice, practice speech skills, and make for smooth transitions!!







Sunday, April 3, 2016

Water Play: Pool Group Style


Happy Spring Everyone!!  I hope that the temps are rising and the sun is shining in your neck of the woods!  Here in the Midwest, I am enjoying seeing buds on our trees and flowers peeking through the dirt.  

This week, The Frenzied SLPs are posting about water play in speech and language therapy since April Showers bring May flowers.  Please take a moment to peek at all of the posts by following the links at the bottom of this one.

This theme seemed like an appropriate time for me to write a follow-up post about my mission to offer pool speech and language lessons.  I first wrote about my experience here and then was honored to have been featured in the Limelight section of the December 2015 ASHA Leader.  Months later, I am still getting emails filled with excitement and questions about how I researched and orchestrated pool groups.  Some of these messages have come from SLPs from as far as Germany and as close as my home state of Illinois.  In true SLP fashion, many professionals asked poignant questions, so I thought it would be a good idea to blog a FAQ post about speech and language pool groups.  


FREQUENTLY ASKED QUESTIONS ABOUT SPEECH
AND LANGUAGE POOL GROUPS
Coursework and Training:
  1. How did you got started in doing treatment sessions in the pool? Initially, I observed a pool group offered through an Early Intervention at a Jewish Community Center in 2003 in Rhode Island.  Shortly after, I submitted a request to the department that handled insurance and liability coverage at the hospital-based Early Intervention that I worked for in Rhode Island.  It took a couple months before my job site hosted speech and language pool groups at the Jewish Community Center.  There were fees involved for pool rental, but I never handled that part of the program. My only responsibilities were to promote the pool group with clients on my caseload, collaborate with a PT for planning, and write weekly service notes to submit with my billing to our office.
  2. Do you have any special certifications to help with your sessions in the pool?  All of my training was acquired from experience.  I was VERY fortunate to host my first pool group with an exceptional physical therapist who taught me so much about positioning and working with resistance in the water to help improve stability and attention.  
  3. Is there coursework or training for providing aquatic speech therapy services?  One of the emails that I received following the ASHA Leader article was from Susan Nachimson who shared that she has been teaching a course titled: Speech Therapy in an Aquatic Setting  since 1/2002 [California Board of Speech Pathology (PDP#129)].
Securing a Facility:
  1. How would I go about looking for other facilities that offer aquatic speech therapy services? If you are not interested in starting your own group and would rather observe pool group therapy, then I would start by calling rehabilitation facilities.  Many of these locations have heated pools that they use for physical therapy with clients.
  2. How did you secure the pool? I started researching for the pool group session that I wanted to offer through my private practice six months before the services were slated to begin.  First, I called three facilities and ask to speak with the aquatics directors.  Next, I followed-up with meeting those in person that were most receptive to my plan and/or were already renting their pool to other rehabilitative agencies.  In the end, I selected Rush Copley Healthplex because the director returned my calls and had availability that suited my scheduling needs.  
  3. Do you think a neighbor's pool with an outside shower and bathroom work?  Personally, I would not feel comfortable using a neighbor's pool as I am not a strong swimmer and I would not want to take on the liability and responsibility that comes with offering this type of group.  I also like being in the community and being able to offer pool group services to up to 10 families.  Having the ability to invite several participants also increases opportunities for peer modeling and expands socialization.
Billing, Insurance, and Liability Coverage:
  1. Do you bill for it like a normal group speech therapy session?  Yes, I bill my speech and language services using the speech group CPT code 92508.  This code is an "un-timed" one, meaning that you can expect the same reimbursement whether you spend ten minutes in the water or sixty. 
  2. Did you bill to insurance companies or do the group sessions private pay? If you did private pay, what were your rates?  I do a little bit of both depending on the insurance carrier and my network participation.  Some families have a required co-payment that is close to the full reimbursement allowed by the 92508 CPT, so I typically advise these families not to use their coverage, especially if they are also allowed a certain number of speech services per calendar year.  I would rather not take six individual sessions away if the family has a 25 session cap for a 30 minute group session and my clients concur.  Part of my research time was also spent requesting updated reimbursements from each of my in-network insurance companies so I could get a sense of what I should charge for my services. Every state is different, so I would suggest researching your reimbursements and deciding on your charges once you gathered that information.  You can expect to make significantly less for group services than for individual sessions.
  3. How did you go about getting liability coverage to work with clients in the pool?  I asked the pool facility what they required and in my circumstance, I only needed to add the location name to my existing liability policy. This addition did not require any additional fees.  You should ask this question while researching pool facilities as this may vary depending on your state.
  4. Do you pay pool rental fees?  There are non-refundable pool rental fees at the facility that I use for group services; however, I ask families to cover these costs.  Families are expected to pay a designated amount per group for each of the six weeks of my program prior to the start date and this fee is not prorated should they miss a session.  I can not afford the risk of paying for weekly services for each family without being able to bill for a session if the family misses or decides not to continue for whatever reason.  
Goals and Session Outline:
  1. Do you have specific goals for each child or is it more a general group therapy targeting various aspects of language (engagement, imitation, vocalizing, following directions, etc)? Years ago, when I worked alongside an Early Intervention PT during pool group instruction, we created a service rendered form with the most frequently reoccurring tasks in our sessions (i.e., managing steps on a slide, using noodles for belly time, vocalizing to make needs known.)  I edited that note to meet the needs of the pool group that I now offer in my private practice for children aged 2-7 years old.  Many of my private practice clients attend my pool groups in the summer, so I prompt them according to the goals that we are working on in our individual sessions.  If I have a brand new student start the group, then I offer the family a free, 30 minute consultation at my home office before the group initiates to observe, collaborate, and manage paperwork.  I ask families to bring their child's current IEP for my records and review to that consultation meeting.  You can find a copy of my SOAP note at this link.  I designed this note to allow me an opportunity to comment and expand on tasks and I used a local printing store to make carbons of the note so I can quickly provide families with feedback about the session.  I also wrote an outline of all the developmental goals that you can address with children aged two through seven years old during pool group therapy.  
  2. Have you ever used pool therapy for middle school and high school students with autism?  And if, what kind of activities did you do?  No, I have only worked with children aged 2-7 in the pool.
  3. Would you mind sharing more details about a typical pool therapy session? For more details about my group agenda, you can follow this link.
  4. What songs do you use in pool groups?  The most popular songs are: The Wheels on the Bus, If you're Happy and You Know it (I use this tune for a directions game to sing, "Put the duck on your head, on your head"), Head, Shoulders, Knees, and Toes, Five Green and Speckled Frogs, Hello and Goodbye songs, All the Little Fish were Swimming in the Water, One Little, Two Little, Three Little Bubbles.
Other:
  1. Did you have an ongoing day/time for a number of weeks?  Yes, my summer groups are weekly at the same day and time for six weeks total.
  2. Did you have the parents in the pool too?  A caregiver at least 18 years of age is required to remain with each child before, during, and after pool group sessions.
  3. Were your classes 30 min or one hour?  My water sessions are 30 minutes long, but "therapy" begins in the changing room both before and after water play.  We talk about our sessions, what we wear in the water, and temperatures that day just to name a few.
  4. Did you co treat with a PT?  I currently work as a solo facilitator for my pool group sessions, but highly recommend working with a motor specialist when possible, especially if you are just getting started with pool group therapy.  
  5. How do you advertise (word of mouth, flyers at your clinic, etc.)?  I bought some ad space in local, neighborhood newsletters, but did not obtain a single client from those ads.  Last summer, four of my participants were seeing me at my private practice, one found me through social media on my speech2me Facebook/Instagram accounts, and another signed up for the session at a parent night meeting that I spoke at regarding summer programs at an ABA home base.  This year, I have already signed up five of my private clients and found another when my district special needs PTA (I was recording secretary in 2014/15) emailed members my pool group flyer.  I also personally emailed the school speech pathologists that I network with for my private clients in an effort to have these school professionals help me spread the word about my summer services.   




Wednesday, March 23, 2016

Visual Supports for People with Autism by Cohen and Gerhardt {Book Review}

The generous publishers at Woodbine House offered me an updated copy of the book: Visual Supports for People with Autism by Marlene J. Cohen, Ed.D., BCBA and Peter F. Gerhardt, Ed.D. Other than the complimentary book, no other compensation was received in exchange for this review. Opinions and reference to other materials expressed in this post are solely mine and unbiased.  

Visual supports are not only essential when working with children diagnosed with autism, but also beneficial for those with language and cognitive delays.  Even if you have worked in a special education for decades, there are always new developments pertaining to visual supports and opportunities for continuing education with regards to enhancing comprehension and improving behaviors using visuals.  In fact, the opening line in the Preface of the book: Visual Supports for People with Autism states, "Since the first edition of this book was published in 2007, much progress has occurred related to the use of visual supports for people with autism spectrum disorders.  This is an exciting time, since technology has changed quite extensively and costs are more affordable." Having worked in the field of speech pathology for over two decades and provided app reviews on this blog and for Teachers with Apps, I wrongfully assumed that this book about using visual supports would be a good review for me and I would likely learn a couple new techniques.  As it turns out, there were a multitude of strategies and techniques that I acquired while reading this tremendous resource.  I'm excited to both apply what I learned in my private practice work and share my top ten findings with you in this post.  I hope that this review will leave you wanting even more details and looking to add this book on your resource shelf.  If so, you can purchase it from Woodbine House at this link.


  1. In alignment to it's title, the book: Visual Supports for People with Autism contains a comprehensive assortment of visual support examples from graphic organizers to work/daily schedules.  
  2. Power Cards were developed by Elisa Gagnon for use with students who have autism.  These cards incorporate a student's strong interest as a way of motivating behavior changes.  You can find more details about this technique in the Visual Supports for People with Autism book and at this You Tube link.
  3. A visual approach can be used to teach English word order by creating a flip book with the parts of speech in the proper sequence.  This book will yield a meaningful sentence no matter the choice and can be adapted for non-readers.
  4. Color coding matching outfits using a permanent marker in an inconspicuous location can increase independence with dressing skills. 
  5. Video modeling can be used to demonstrate a wide variety of expected behaviors.
  6. Turn photographs of reinforcements into puzzles with the student earning a puzzle piece for each completed task and receiving the award when the puzzle is complete.
  7. Visually represent time remaining until a special event by removing a token, such as a marble, from a glass jar.  When the jar is empty, it is time for the event.
  8. Create a "Key Words" chart to enhance comprehension for mathematical word problems.  For example, list all the terms that relate to addition (i.e., together, total of, more than) in the addition column of the chart.
  9. Point to color coded cue cards on a student's desk to increase attention without verbal prompting.  For example, point to the green light on a traffic light image to communicate that the student is doing a nice job attending to the lesson.
  10. Apps such as iReward, iReward Chart, and Behavior Boost integrate a timer and reinforcement visuals for more discreet and natural supports in the community.
Thank you to Woodbine House for allowing me to review this great resource! 







Thursday, March 3, 2016

{GUEST POST} Effective Writing for Students with Disabilities: There is a Solution

I am honored to have Dr. Karen Dudek-Brannan, Ed.D. CCC-SLP, posting on the blog today!  She has been a practicing speech language pathologist over 10 years, and has worked in the schools and medical settings with adults and children, has supervised clinical students, and has taught college courses in Special Education and Communication Sciences and Disorders. Dr. Karen currently works in the school systems and runs a website with innovative resources for treating language disorders with an emphasis on metacognition.  This post will focus on effective writing strategies for upper elementary students with speech and language disabilities.


We need to write for communication, academic purposes, and professional advancement, yet many adolescents and young adults fail to develop sufficient writing skills when they are in school (Graham & Perin, 2007).

This is often the case for students with disabilities that impact language. Students with language delays tend to have poor metalinguistic and metacognitive awareness. They have a poor understanding of how their brains work, which makes planning, writing, and revising difficult (Graham, Schwartz, & MacArthur, 1995).  Students with language and learning problems struggle to plan and generate ideas during the planning/brainstorming phase of writing (Chalk, Hagan-Burke, & Burke, 2005).  Many educators end up asking students probing questions to provide support, but doing this may make students become prompt-dependent.

To help students become independent, we need to show them how to self-regulate and self-question.  Self-regulation strategies may involve mnemonics or memory tools to help students remember the steps of the writing process.  Tools which guide students through protocol steps or self-questioning techniques can improve word-retrieval and executive functioning, which positively impacts idea generation.  Use of these tools can improve organization, fluency, transitions, as well as conventions of writing for students with and without disabilities (Graham, & Perin, 2007; Little, Lane, Harris, Graham, Story, Sandmel, 2010). When used effectively, self-monitoring and self-questioning tools can provide the structure necessary to help students complete steps of the writing process independently.

One specific tool for self-questioning is the Expanding Expression Tool (EET; Smith, 2011).
The EET incorporates a mnemonic device to help students to recall semantic information about nouns.  The mnemonic for the EET is twofold; as students can use a chant or a visual aide to recall questions they should ask themselves when generating ideas to write.  The visual aid is a strand of color-coded beads. 


Each EET bead stands for a specific question.  Here is a graphic to help illustrate how the beads correspond with the questions and EET cues, as well as an example of how you would use the EET to describe the word “apple.”


The second aspect of the EET mnemonic is the chant. Students can say a chant aloud or internally to help remember the questions with or without the EET strand present.  To say the chant, the students simply say or sing the beads in order: “Green group, blue do, what does it look like, what is it made of, pink parts, white where, what else do I know?” (Smith, 2011).
In order to effectively utilize a metacognitive strategy such as this, we need to show students how to use it. This often involves explaining the purpose of the strategy, modelling, and providing opportunities for both guided and independent practice (Chalk et al., 2005; Ukrainetz, 2007).
I’ve developed protocol you can use to teach students self-questioning strategies that incorporates all necessary components (e.g., rationale, modeling, guided practice, independent practice) to assist in the planning phase of the writing process (Dudek, 2014).  This protocol would be appropriate for students ranging from early elementary through high school; however you will be able to modify the level of difficulty by the content you describe.
Here is a graphic illustrating what to do in each step. This can be completed in one session, or over several consecutive sessions.


Now that you have seen the steps in the process, here is another example of the type of information that would correspond with each question on the EET strand. This sample shows how a student’s notes may look after the brainstorming process.  As you can see, there are two pieces of information per EET question; however one could use this process to provide more detail if needed. This content would be appropriate for students in middle school writing an expository piece about the Midwestern region of the United States.


The purpose of metacognitive strategies during the writing process is to improve the quality of writing and autonomy. By teaching students to use strategies, we can help our students become more aware of how they learn and process, so they can become independent writers.

For more information on the EET you can visit www.expandingexpression.com.
For additional resources on metacognition and language visit www.drkarenspeech.com.

References
Chalk, J.C., Hagan-Burke, S., & Burke, M.D. (2005). The effects of self-regulated strategy development on the writing process of high school students with learning disabilities. Learning Disability Quarterly, 28, 75-87. doi: 10.2307/4126974
Dudek, K. (2014). The effect of metalinguistic strategy instruction on the oral and written expression of school-aged children.  (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. (Accession Order No. 3623397).
Graham, S. & Perin, D. (2007). A meta-analysis of writing instruction for adolescent students. Journal of Educational Psychology, 99, 445-476. doi: 10.1037/0022-0663.99.3.445
Graham, S. Schwartz, S., & MacArthur, C. (1995). Effects of goal setting and procedural facilitation on the revising behavior and writing performance of students with writing and learning problems. Journal of Educational Psychology, 87, 230-240.
Little, M.A., Lane, K. L., Harris, K. R., Graham, S., Story, M., & Sandmel, K. (2010). Self-regulated strategies development for persuasive writing in tandem with schoolwide positive behavioral support: Effects for second-grade students with behavioral and writing difficulties. Behavioral Disorders, 35, 157-179.
MidWest. (2016, February 20). Retrieved from http://www.encyclopedia.com/topic/Midwest.aspx
Smith, S. L. (2011). Expanding expression: A multisensory approach for improved oral and written language (2nd Ed.).  Bay City, MI: Expanding Expression.

Ukrainetz, T. A. (2007). Contextualized Language Intervention: Scaffolding PreK-12 Literacy Achievement. Austin, TX: Pro-Ed. 


Monday, February 8, 2016

Tongue Tie and the SLP

Mild tongue tie restriction with a
client working on /r/ targets.

Small notch at tongue tip

Over the last year, I have learned more about tongue tie (ankyloglossia) thanks to social networking. Having spent much of my speech career in the early intervention and school settings, I was never the first to identify a tongue tie, but things are very different in the private practice world.  This past year, I referred a toddler and high school-aged client to ENTs for suspected tongue ties and both were later diagnosed with this condition.  While the toddler had an immediate release performed, the high school client is pending medical intervention at this time as a release may be completed along with another procedure in the near future.  The toddler had immediate, notable improvements in both speech sound productions and feeding.  We continue working on oral motor skills and sequencing sounds. Caregivers commented that just days after a laser procedure, this youngster began chewing and eating chicken, which she had not done while she had a tongue tie.

Please note that I used the word, "identify" in the previous paragraph, not "diagnose."  As SLPs, we can relay our suspicions about tongue tie, but only a physician can diagnose this condition.  For those of you in private practice, you cannot code on insurance claims for tongue tie under the new guidelines of ICD-10 without a physician's diagnosis, even if you are 110% certain that your client has a tongue tie.

Recently, I stumbled upon a closed Facebook group about the SLP and tongue tie and I am so relieved that I joined this network of experienced professionals!  Like most social networks, you can collaborate and consult with people from around the world.  In order to protect patient privacy, we refrain from using names and other identifying information in our discussions.  I also obtain signed consent from my private practice families prior to taking pictures, even if the photos are for my own records.  Being part of this Facebook group allows you access to files and documents pertaining to tongue tie that can help us become better at identifying it.  While exploring one document about experienced experts that perform tongue tie surgeries, it occurred to me that I should google someone near my location in Naperville, Illinois.  The first name that appeared at the top of the list was Dr. Robert Pick.  When I clicked the link for Frenectomy I was delighted to read this:


"Dr. Pick helped pioneer the use of lasers in dental surgery and his team at Northwestern in 1983 were the first ever in the world to do the carbon dioxide Laser Frenectomy technique and publish on it. Dr. Pick co-wrote the first textbook on the subject Lasers In Dentistry."

As it turns out, Dr Pick has been practicing this procedure with pediatrics for over 30 years at his office that is a mere eight minute drive from my home office.  I called the office as soon as I finished exploring his website, which incidentally is a fabulous resource for tongue tie with great visuals, and within a few weeks, I was invited to observe a procedure.

In order to protect confidentiality, I cannot use the patient's name or any identifying information, but I can provide some details about the procedure itself.  From start to finish, the frenectomy took about 30 minutes with much of that time spent waiting to ensure that the numbing agent had taken full effect.  The patient was wide awake throughout, relatively calm, and well informed about every step of the procedure.  Dr Pick had forewarned us that he told terrible jokes and he did not disappoint at all!  His bedside manner was delightful and one could clearly and immediately recognize that Dr Pick has a calling and he has made and continues making a tremendous difference in his work.  Within seconds of the laser surgery, the patient could exclaim, "I can finally stick my tongue out of my mouth!"  The muscle vanished before my eyes and the tongue found freedom.  Five minutes later, the procedure was complete and the patient was heading out the door to a lunch date with mom.

The surgery was exactly as it is described on Progressive Periodontics website: 

"Dr. Pick uses the carbon dioxide laser to remove frenum attachments.  The laser is fabulous for this as with the laser there is no bleeding during and/or after the procedure, no suturing needed, minimal to absent swelling and scarring, almost no chance for recurrence and a decreased to complete absence of pain post-surgically! In addition due to the use of the laser surgical time is dramatically reduced."

Whether you are in private practice like me or working in another setting, I highly recommend taking an opportunity to find a specialist in your area who performs tongue tie release surgery.  According to Dr Pick, he has not had to perform a second release on any patient that he has seen over the last few decades; however, he does refer post operative patients to their speech pathologists and/or myofunctional therapists to teach the tongue new placements at rest and during speech productions.  Below are some links and resources that you may find helpful in identifying red flags and performing post operative exercises.

Frenectomy exercises with an infant

Diagnosing and Understanding the Maxillary Lip Tie

The Significance of Tongue and Lip Tie and Why You Should Consider Correcting Them

List of Published Articles Concerning Tongue and Lip Tie

Frenectomy and After Care

Treatments forAnkyloglossiaand AnkyloglossiaWith ConcomitantLip-Tie

International Association of Orofacial Myology

I found many of these resources through collaborating with other professionals in my area and through discussions on Facebook.  If you have a resource that you use that isn't listed above, then please provide details in the comments section below.  I'm so appreciative that Dr Pick allowed me an opportunity to tour his office and observe a tongue tie release and feel even more knowledgeable on this subject following that visit.




Monday, January 25, 2016

Quick and easy meals for the Frenzied SLP


Who needs some new recipes to make meal planning less painstaking? If you shouted, "ME", then you are in luck because this week, the Frenzied SLPs are bringing you some quick and easy meal plans to make your busy lives a little more stress free!  Before I share my secrets, I would like to thank Speech2U and Speech Sprouts for putting together this linky party and Laura from All Y'all Need for creating the graphic.  Every day, I learn new tricks from this talented group and I am so appreciative to be part of an amazing population of professionals.

For a few years now, Pinterest has been my best friend.  Not only can I sneak a peek at creative therapy plans, but I also find many, new and delicious recipes while pinning in my PJs.  Don't get me wrong, I have had many a #pinterestfail, so I delete those pins and move on.  Here are three of my FAVORITE, EASY PEASY LEMON SQUEEZY recipes for breakfast, lunch, and dinner.  Simply follow the links for all the details.

Breakfast:  Prep this easy, no cook refrigerator oatmeal at night and you will spring out of bed in the morning to grab it.  I have been making 3-5 at a time in mason jars so I can have a healthy breakfast each day of the week.  If you want, you can even substitute some ingredients to put your own spin on it.  I love using coconut Greek yogurt with diced pineapples, shredded coconut, chia seeds, and coconut milk for a Pina Colada themed oatmeal.

Lunch:  Make a batch of this southwestern chopped salad with cilantro dressing on the weekend and you will have a healthy lunch for the week ahead.  I advise to chop and keep the lettuce separate as it tends to get soggy after a day and just add it before you eat.  It is SO good, especially with the cilantro dressing.  I used to make it to take with me for lunch at school, but now that I work from my home office, I just keep most of it in a big bowl and scoop out the portion I want for lunch that day.




Dinner:  Ironically, I was prepping this meal for dinner last night because I wanted something easy after a long and busy Sunday.  It only took me 10 minutes to cut and wash the beans and potatoes and a little over an hour for dinner to be served.  The dry Italian seasoning makes this chicken, green beans, and potatoes bake so tasty.

I hope that you find a recipe or two to try in this linky party!  Don't forget to take a peek at the other meals by following the links below.