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.

Tuesday, January 12, 2016

Book Review: Children with Cleft Lip and Palate

It has been some time since I posted about a review, but I am back today with a great resource for both families and professionals working with children born with cleft lip and palate.  This book is a parents' guide to early speech-language development and treatment, but speech pathologists and other cleft palate team professionals could benefit from having this on their resource shelves too.  The authors are three speech pathologists: Mary A. Hardin-Jones, Ph.D., CCC-SLP; Kathy L. Chapman, Ph.D., CCC-SLP; and Nancy J. Scherer, Ph.D., CCC-SLP and it is clear that a great deal of thought and time was spent in compiling this book.  I only wish that it was available when I started out as a speech pathologist 20 years ago!

The first couple chapters define cleft lip and palate and associated syndromes, and identify the treatment team.  I can imagine that the details about the team members are most important for families that may be overwhelmed with unfamiliar medical care.  Chapter two does a wonderful job describing each professional and his or her role on a cleft palate team.

By the third chapter, both families and speech pathologists will benefit from a detailed review about feeding an infant with cleft lip and palate.  Despite having some experience working with this population, I gained knowledge about developments in bottles and feeding post surgery.  I especially liked the charts on troubleshooting common feeding problems and potential feeding issues as a result of problems such as airway compromise.  Speech pathologists just starting out in this field will appreciate this feeding chapter, especially those working in early intervention.

Moving right along, chapter four brings a wealth of knowledge on a child's ears and hearing.  There are so many points applicable for all children with hearing concerns that this chapter is worth the read for any specialist working with young children.  There are several visuals including anatomical components for hearing and an audiogram that displays sounds according to pitch and loudness.  I found the description about the two most common types of ear infections:  acute otitis media (AOM) and otitis media with effusion (OME) especially helpful. The latter is the result of a  build-up of sticky fluid in the middle ear that is not accompanied by pain, fever, or other symptoms as it is not an infection.  This condition can be easily missed, but impact hearing nonetheless.  I am glad that the authors detailed this condition and I will use this description in my practice when advocating for tympanometry.

Surgery and dental care are outlined in chapter five with the authors again providing great visuals of anatomy and actual photos of various conditions.  Readers will gain insight as to when surgical procedures occur, considerations prior to surgery, a child's needs before and after surgical intervention, success rates, and the types of procedures required to repair cleft lip and palate.

Communication and suggestions for boosting speech and language development are the topics detailed in chapters six and seven of this book.  Typical speech and language milestones are discussed with comparisons and expectations reviewed for children with cleft lip and palate.  The following details are also found in these two, fabulous chapters:

  • parental behaviors thought to facilitate language learning
  • stages of early vocal development
  • comprehension milestones
  • common production patterns and age of disappearance
  • grammatical morphemes by age 3 and beyond
  • emergent literacy skills
  • details on stimulating vocalizations and first words
  •  early developing sounds and words
  • prompting words during routines
  • recommended book titles
  • prompting and question strategies for shared readings
  • increasing oral airflow
  • activities to stimulate vocalizations, consonants, and early words
The final three chapters highlight velopharyngeal inadequacy (VPI), special concerns for children internationally adopted, and expectations for development beyond the infant/toddler years.  As you may have already noticed, this guidebook covers every, possible topic as it pertains to children with cleft lip and palate.  Following the informative chapters are a glossary, resources, references, an index, and detailed biographies for each author.  I would highly recommend this book even if you are not currently working with a child who has a cleft lip and palate, especially if you are working in early intervention, a hospital-based setting, and/or private practice because you will want this resource handy for your next client with this condition.  You can purchase your copy at this link through Woodbine House.

I am grateful to have been given an opportunity to read and review this book.  While Woodbine House, the publisher, provided me a copy of Children with Cleft Lip and Palate, no other compensation was received in exchange for my review.  Opinions and thoughts expressed in this post are unbiased and solely mine.  

Monday, January 11, 2016

My 3 Favorite Organization Tips for SLPs

In my next life, I'm either going to come back as one of three options:

1) An SLP/OT/PT all in one
2) A Solid Gold Dancer (dare to dream)
3) A professional organizer

The most realistic of the above is obviously number three, which would delight me to no end!   I sometimes toy with trying to figure out how to run a private speech practice by day AND freelance as a professional organizer by night, but that wouldn't leave much time for my treasured sleep.  So, to fill the void, I write blog posts on how I keep organized in my home office. In fact, two of the most frequently viewed posts on my blog are SLP Organization and Organizing my Organization.  Today, I'm linking up with The Frenzied SLPs to share my three favorite organization tips for a private practice SLP.

FIRST:  The BEST thing I ever did was invest some money in giant binders and page protectors and then organize my paper and flashcard materials into seasonal units.  I did this a few years ago when I worked with a small caseload in a private school setting and each year since, I go through the binder while planning my weekly sessions and recycle anything that I haven't used much or no longer need with my caseload.  I have even taken those binders that are overflowing and broken them into more binders.  For example, my winter binder was divided into the following: Christmas, Black History, and Valentine's Day with the Winter one retaining New Year, Snowmen, and Hot Chocolate.

SECOND:  After sorting materials into binders, I quickly saw that I couldn't store my literacy units in this manner, as the card decks are thicker and most contain object manipulatives.  Luckily, I found a storage solution for my home office in the form of a corner cabinet with a hanging rod, hangers, and over-sized Ziploc bags for bulky units and file folder containers for lesson plans and books that can fit in a file folder.

THIRD:  This tip is my personal favorite for anyone working with a small, private practice caseload. When I begin services with a new client, I create a SOAP note that lists my goals, a blank chart for tallying data, and lines for writing homework plans.  While I use an electronic scheduling and billing system, I cannot convert to digital notes.  Personally, I find it easier to mark down data during the activity and then calculate the percentage at the end of the session.  Using my iPad for data collection can be a fairly big distraction too!  Every Sunday afternoon, I spend a couple hours planning and printing my SOAP notes for the coming week's session.  Finally, I stack the notes in order of occurrence and place them out of sight but within reach for sessions.

Printing weekly SOAP notes

Laying out materials for a new theme
during weekly planning

BONUS TIP:  As a bonus, I'm attaching a "cheat sheet" that I created for calling insurance companies to verify coverage for clients.  Make sure that you have both your NPI and tax ID number handy when calling to obtain information.  You can grab your copy here.

Now go ahead and take a peek at more SLP organization tips at the next blogs.  You'll be glad you did!!  Thanks to Speech Sprouts, Speech2U, and Old School Speech for hosting on my favorite topic.  Please take a moment to follow the above Facebook links to show these hard-working ladies some love.

Thursday, December 3, 2015

Giving Back- A Peek Through the Keyhole Edition

'Tis the season of giving.  No matter how small, every good deed counts.  This year, I came up with an idea for Naperville Therapediatrics: my private speech and language practice, that would benefit children in my community.  First, I sought crayon donations from neighbors and clients.  Then, I purchased 48 mini Christmas activity pads from Oriental Trading Company, ordered Christmas silicone trays on Walmart and Amazon, and bought containers and holiday treat bags at the Dollar Tree.  As soon as Thanksgiving was over, I pulled out all of these materials and got to work during my private speech and language sessions.

The mission: recycle broken crayons into Christmas shaped ones and package these new treasures with a coloring book to be donated to a children's unit at a local hospital.  Before we got started, I explained to all participants that these crayons would be going to sick kids in the hospital during the holiday season. 

The participants: elves as young as 3 years old to high school-aged helpers, all of whom receive services at my practice.  

The results: creative, festive, thoughtful crayon designs beautifully packaged to spread some cheer. 

Step 1:  Peel paper off all crayons.  Initially, we were doing this during our sessions until I stumbled upon a You Tube video on how to do this using a bowl with warm water.

Step 2:  Break crayons into smaller pieces for both small and large silicone trays.  All clients could complete this task and it lent for opportunities to request "help" if needed.  Clients working on articulation of target sounds earned crayons after completing speech drills.  Those needing to build sentence lengths practiced requesting crayons by color and/or size.

Step 3:  Fill both large and small trays.  I could address following directions ranging from a simple "Put in" to "Put some red crayons in the big stocking."  One client had some trouble following a two step command to break crayons, then put in, so I broke the crayons while he sorted them by color.  I couldn't trick him with varying shades of green or blue either!  He got the sort correct every time.

Step 4: Place silicone trays on a cookie sheet and put them in a preheated 275 degree oven and cook for 10-25 minutes depending on thickness.  Once cooled, you can push the crayons out of the trays and get them into decorative bags.

I made some labels that read: Made with love and healing thoughts by clients at Naperville Therapediatrics and then I put a label on the back of a business card for each bag.  I just love it when a project comes together this well!!  Clients really enjoyed seeing finished projects and some creators went home with a sample crayon to enjoy.  One middle school client even discovered comprehension for a concept that we have been working on for some time.  No matter what I tried, she just couldn't grasp the concept of "thick" until she held a thick crayon in her hand.  There's nothing better than sharing in the joy of progress.  My heart smiled when she exclaimed, "This is what you've been telling me about!"  "We made some thick crayons!"  YES!!

In the end, I was so moved by both the response from my community for crayon donations and the smiles on the faces of clients and caregivers when I explained the project we would be working on during our sessions.  I will leave you with one of my favorite quotes by Mother Teresa as a means of inspiration to spread some acts of kindness in your community.  Wishing you all a blessed holiday season!!


Sunday, November 22, 2015

Gobble up Holiday Goodies

Gobble Gobble!  The Frenzied SLPs are back with a round up of Turkey Day activities.  Be sure to check in and "like" our Facebook page so you won't miss out on our linky parties, twice monthly!!

I'm sure many of you are working somewhere right up until Thanksgiving Day.  My private practice is open through the day before Turkey Day and I have some fun, festive, and functional activities planned for the short week.

First up is my Play dough tray.  Remember that post way back in October when I talked about making orange Play dough?  Well, we are still going strong using the same dough this month to make turkeys.  I've seen so many fabulous pins on Pinterest of Play dough trays, so I grabbed a tray at the Dollar Tree and put my own spin on the contents.  I used what I had in my arts and craft bin and spent a little money on some fancy leaves and alphabet letters.  We have been working on requesting, commenting, and following directions while making unique turkeys.  Some have used the Popsicle sticks to make legs, while others took pipe cleaners and those fancy leaves to make feathers.  The Popsicle sticks have also come in handy for cutting the dough.  Hands down, this activity has been highly preferred among many (including caregivers.)

Next, is my brand new, sorting pie from Learning Resources What better way to prepare for Thanksgiving than to sort some fruit into a pie?  I love that the game came with two sets of tongs for choice making and several choice boards for matching colors, objects, or numbers.  My clients aged 2 though 7 enjoyed requesting more, naming colors, commenting, and matching objects to pictures using this super, cute pie.

Another new hit this holiday season has been my paper tablecloth.  I scored this find while looking for Halloween clearance items at Target.  My younger clients have been coloring while listening to auditory bombardment lists containing target speech sounds while my older clients have been playing tic tac toe or earning a chance to color as a reward for completing work.

What's a speech and language session without some pretend play time?  I paired my farm house with Fisher Price Thanksgiving pieces to talk about sitting at the table, eating, and bringing food from the farm to the dinner table by wagon.

Last year, I purchased a collection of interactive Thanksgiving books from Jenna at Speech Room News and once again, I have found so many great opportunities to incorporate literacy into my sessions.  This collection contains books that target action words, commenting about likes and dislikes, and other thematic vocabulary.  I have used these colorful books to engage busy toddlers, assist in sentence completion tasks, and promote answering questions about action words using speech generating devices.

Finally, I purchased a 
turkey comprehension and vocabulary bundle from my frenzied colleague Mia at Putting Words in Your Mouth.  This item is brand new in her store and my middle school clients have loved them!  The readings are short and sweet and each packet contains comprehension questions, defining vocabulary words in context, and comparing and contrasting.  

These are a few of our favorite activities at Naperville Therapediatrics!  Don't forget to follow these links for more fresh, creative ideas.  Wishing all of you a wonderful, blessed Thanksgiving.

Sunday, November 8, 2015

Thankful and Grateful

Thanksgiving for our family marks the beginning of the holiday season, so I want to begin by wishing all of you a happy, blessed gathering with friends and loved ones.  May your heart be full and your soul be light! 

Now, onto the tricky part: what am I thankful for?  It's not that I cannot come up with anything; I just cannot narrow it down to fit in one post!  As all the thoughts circle in my head, I keep coming back to one in particular. Without this one blessing, I would not be able to enjoy my time with family and friends, be an active part of my son's life, or feel the gratitude of being a speech pathologist.  I have seen so many friends, loved ones, and a few family members suffer and battle health challenges, but at the ripe old age of 43, I count my blessings for my good health.  Sure, I could stand to lose a few pounds, 10 pounds, 15 pounds, and I don't move as quickly as I used to in the morning as I head down the stairs to let the dog out, but I'm healthy. I stay on top of my annual check-ups and encourage friends to get their mammograms, and then I say a little prayer of gratitude when I get the all clear phone call.

I'm thankful for my health and I do what I can to help those who are fighting the good fight against breast cancer by taking active roles in the Avon Walks in Chicago over the last four years.  I have walked and worked alongside survivors, people who have lost loved ones to cancer, and women and men like me who just want to help because we can make a difference.  The holidays are a good reminder for me not to take my good fortune for granted and to show my gratitude by giving to those in need.  So, as we prepare for the holiday season, I will do what I love, spend quality time with family and friends, and give thanks for each day, each step, and each hour.   

My first year as a walker, I dedicated miles to specific people
and saved this dedication for the finish line.

A very rainy end to my second year participating
 in the Avon Walk Chicago.

Thanks for visiting my blog!  I am extremely grateful to be part of The Frenzied SLPs and appreciate your support too!  I am the 11th blog in the hop.  Please write this letter down and venture over to the next posts to continue collecting more letters for your chance to win in the drawings!

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