The Power Of Goal Setting

Even if you’re on the right track, you’ll get run over if you just sit there.”
– Will Rogers

The Power of Beliefs

What do you believe about your diagnosis of Parkinson’s? Do you believe that medications will cure the symptoms, and you’ll be fine? Do you believe that exercise might help, but that you’re too old, too tired, or too embarrassed to participate in a class or program? Do you believe that your symptoms are mild, and you can wait until you begin to have problems to enroll in therapy or do exercise? Are you a pessimist, who thinks: “why bother, what good can therapy or exercise do anyway?”

Take a moment to think about your beliefs. Our feelings are oftentimes a clue to our beliefs. How did you feel when you received a diagnosis of Parkinson’s or other neurological problem? How do you feel about changes you have already experienced in your voice? Does your speech and voice match your personality?

If you decide to begin a therapy treatment program or an exercise program at home or with others, it may be helpful to:

Develop A Plan Of Action

• Write down a goal
• How will you feel when you reach this goal?
• What are some obstacles or beliefs that might sabotage this goal?
  
• What is an affirmation to support this goal? (eg: “people are drawn to my energetic voice and want to hear what I have to say”)
  

Associate with people who support your goals: your spouse, your therapist, your children, friends. Most goals that are worthwhile in life take a great deal of commitment to achieve. Talking about other accomplishments in your life, and goals you have committed to may help you discover what motivates you.

Voice Aerobics™ DVD is a home exercise program designed for individuals not yet sure if they are ready for formal therapy, and for those who have completed formal Speech , Physical Therapy, and/or Occupational Therapy, but who want to continue to practice on their own at home.

These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .
(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Are You Ready For Therapy?

Following a diagnosis of Parkinson’s or other neurological disorder, your doctor may recommend you undergo speech, physical or occupational therapy. Your response to that suggestion may be:

Enthusiastic: “where do I sign up?

Skeptical but willing: “my wife/husband wants me to be here”

Disinterested: “I don’t think my speech is that bad”

Who do you think is likely to gain the most benefit from a speech therapy treatment program? If you guessed the enthusiastic person, you are right.
When entering into a therapy program, one of the most important predictors of your success will be your goals. I often tell patients, that it really doesn’t matter too much what I think, or what your spouse or children think about the benefits of therapy. Your goals, and what you desire from therapy, however, is exceedingly important.

Why Goals?

“Nothing great was ever achieved without enthusiasm” – Ralph Waldo Emerson”

If your reason for enrolling in a speech therapy program is to improve or eliminate some aspect of your speech or voice behavior ,than the first task will be to identify that behavior. For example, if you say: “I want to talk better”. I will likely ask: “what does that mean?” If you further clarify your goal/s, by saying: “I want to speak louder. I don’t want to have to repeat all the time. I don’t want my voice to sound hoarse, or weak or sick,” than we can begin to evaluate if you are physiologically capable of achieving those goals, and discuss what kind of treatment program will get you there. Once we determine that the goals you have set are achievable, we also need to discuss how you will retain the improvements you make in therapy, especially, when a disease, such as Parkinson’s, is lurking in the background, changing the way your body performs. Therapy is not magic, it’s hard work on your part, and requires a commitment to continue a home program once your short term goals are achieved.

In the next article, we will explore further the Power of Goal Setting, the role of your beliefs , and how to develop a Plan of Action.

Voice Aerobics™ DVD is a home exercise program designed for individuals not yet sure if they are ready for formal therapy, and for those who have completed formal Speech , Physical Therapy, and/or Occupational Therapy, but who want to continue to practice on their own at home.

These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .
(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Voice Aerobics ™ and Principles of Vocal Development: Relaxation

In order for the vocal mechanism to produce a free and natural tone, there must be a feeling of relaxation in the muscles of the head and neck, otherwise, the presence of tension might impede correct use of the voice. Normal voice tension is not complete relaxation of all of the muscles, but rather, a balance between tension and relaxation. Often in establishing voice treatment goals, we discuss achieving “the best voice with the least amount of effort.”
Many voice problems result from an exaggeration of muscle activity or tension. People who have to speak louder than conversational speech for extended periods of time, or who sing recreationally, without proper training or warm-ups, may tend to squeeze the muscles surrounding the larynx, in an effort to be louder. The persistent use of this increased muscle tension may cause pain or fatigue in the muscles of the neck, jaw, throat, or tongue. People who have muscle weakness resulting from neurological conditions such as stroke, Parkinson’s, or post-polio, may also strain throat muscles in an attempt to be louder. In addition to proper breathing technique (diaphragmatic breathing), and adequate hydration (water intake), relaxation and stretching techniques may also help to maximize your use of the vocal mechanism.

Relaxation techniques may include:

• Stretching of all of the muscles, but particularly those of the upper body, head, and neck.
• Massage, which can include self massage or massage therapy or body work.
• Guided imagery, which can be done alone or by using audio tapes
• Warm - up and Cool-down exercises for the voice, which are essential for anyone who is singing regularly, whether on their own, or as a part of a choral group or church choir. Part 1 of Voice Aerobics™ provides an overall warm-up for the voice and upper body.

Is Your Voice Telling On You? Your Voice Is Like A Fingerprint, Amazingly Distinct.
See Your Physician If You Experience:

• Hoarseness lasting 2 or more weeks
• An achy throat after speaking
• Talking tires you
  

These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .
(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Voice Aerobics ™ and Principles of Vocal Development: A Hard Pill to Swallow

Some individuals because of or certain medical conditions find it hard to swallow food or liquids. For many individuals, a pill is nearly impossible…if that’s you..what can you do?

In the past, it was often customary to advise patients to crush medication to ease swallowing. Unfortunately, this practice can be dangerous, since crushing or cutting many drugs alters the delivery system. It’s important to know if medications you are taking can be cut, crushed, or chewed.

When prescribed medications, it’s important to ask your physician or pharmacist if pills must be taken whole. Additionally, it is important to take pills sitting upright, with at least 15ml. (½ cup) of water, and never immediately before or while lying down. Coating pills or capsules in yogurt or honey may make them easier to swallow.

A common scenario in the hospital, may be giving a patient nighttime sedation while the patient is lying down in bed. The pt. may appear to have no effect from the medication. Eventually, the pt. will fall asleep and remain lethargic through the next morning. It is often not recognized by the medical personnel that the drug did not reach the intended destination for hours.

In addition to complaints of swallowing food or pills, many patients with Central Nervous System (CNS) disorders, such as Parknson’s, ALS, or myopathy, may also have esophageal dysmotility and delayed gastric emptying, which will contribute to episodes of acid reflux (GER), and even aspiration pneumonia. In frail or elderly individuals, swallowing problems may actually be a side effect of certain medications.

Any persistent swallowing problem should be reported to your physician. He or she may request a consult with a speech pathologist who can conduct a thorough swallowing assessment, often including
x ‘ray images to assist with identifying the cause of your problem, as well as possible treatments.

To Summarize: Take your medications on time, even when in the hospital; take your medications sitting as upright as possible; take your medications with at least ½ cup of water; Report changes in your swallowing to your physician.

These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .
(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Voice Aerobics ™ and Principles of Vocal Development: Posture

Posture forms the basis for vocal development. For an “instrument” to be used efficiently, it must be held correctly. Sitting up straight, shoulders relaxed and back, balancing a basketball on your head, are all ways of focusing on good posture.

Maintaining good posture also requires muscles which are toned and stretched. Upper body stretching exercises, including the neck muscles may improve your posture. Stretches should be done slowly and without bouncing.
While letting your arms hang at your side, feel the weight of your hands and arms helping to lower your shoulders. Stretches overhead should be done slowly, elongating the muscles along the sides of your rib cage. Give yourself a hug to stretch the back muscles, and clasp hands behind you and lift, to raise the pectoralis (chest) muscles.

Shoulder rolls will help to reduce tension in the neck and shoulder muscles. Neck stretches to the side will help to relax and release tension around the larynx (voice box). During all stretches, Release the Breath. Be sure you are not holding your breath, but instead, exhale and release any tension as you hold the stretch. The exhaled breath is the breath you will speak on, so trust that it will support your voice.

Part 1 , BREATHWORK, on the Voice Aerobics™ dvd contains easy to follow exercises which will help you focus on posture, relaxation, and diaphragmatic breathing, all key elements to having a healthy voice.

These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .
(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Voice Aerobics ™ and Principles of Vocal Development

The vocal mechanism, like other systems in the body, operates by muscle power. An understanding of the basic principles of vocal development used with professional speakers and singers can also benefit you. Usually, a progression of muscle development is targeted as follows:

Posture
Breath Management
Relaxation
Phonation (vocalizing)
Registration (vocal range)
Resonance (focus of voice, also noted as hyper/hypo nasality)
Articulation
Almost any neuromuscular problem or disease can result in changes in how the respiratory system is used, with the end result being dissatisfaction with voice production. Changes you may notices in your voice, may include: too soft, hoarse, breathy, scratchy, or changes and loss of pitch range.
Vocal Abuse can occur with any muscle that is overextended or strained. Eventually, hyper function (too much tension), will lead to hypo function (weak muscle performance). The opposite may also happen, when, weak vocal folds lead to straining to produce voice, and eventually problems related to increased muscle tension and vocal fatigue.
Vocal Behaviors To Avoid Include:

• using the voice for an extended period of time at a level which is too loud (such as yelling at a sporting event).
• Using the voice outside the comfortable pitch range (speaking or singing at an inappropriate pitch)
• Throat clearing ( very prevalent bad habit), excessive coughing, allergies, acid reflux, side effect of medications, some oxygen delivery systems which are drying to the mucosa, and, of course, the worse of all, cigarette smoking or exposure to second hand smoke!

What Can You Do To Protect Your Voice?
Monitor and eliminate any or all of the above harmful behaviors. Engage in some form of aerobic exercise to strengthen respiratory muscles, and perform vocal function exercises which can strengthen and improve the way you use your vocal mechanism.
Voice Aerobics™ is a fun and easy exercise program that may help you achieve your goals of a healthier and stronger voice.
These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .

(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)
About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Making A Good Voice Impression When Communicating With Your Doctor

Marcus Welby,MD, the popular TV doctor (for those of us old enough to remember), epitomized the physician with a “good bedside manner.”
But, what Dr. Welby really possessed, that resonated with his patients and television viewers, was empathy and good listening skills, the hallmark of a good communicator.

While not all doctors have good communication skills, they can be learned and mastered, and generally include:

• Careful listening while the patient describes specific complaints and concerns
• Empathy, which means trying to see the world of the patient through his or her eyes
• Education, providing the patient with information in a way that they can understand, remember, and apply. (source: Bayer Institute on Healthcare Communication)

You and your doctor are forming an opinion of one another from the moment you meet. Your voice is one of the first thing that your doctor will “see” about you. From the way you sound, he or she will begin making an initial opinion about your general state of health and well being.
Do you think your voice makes a good impression on other people?
You Might Be A Candidate For Voice Therapy If You:

• Clear your throat a lot when you speak.
• Experience throat aches at the end of the day.
• Find that talking tires you, and people frequently ask you to repeat.
• Become hoarse after talking for awhile or at the end of the day.
• Have a feeling of tightness or tension in your throat.
• Feel you have lost power or volume in your voice.
• Have a medical diagnosis of Parkinson’s or other neurological disorder that is causing changes in your voice.

Voice treatment from a qualified speech pathologist may help you improve the quality and use of your voice. Voice Aerobics™DVD may help you retain those improvements.
These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .

(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)
About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Communicating With Your Doctor

As a healthcare provider for over 25 years, I have witnessed numerous changes in the healthcare delivery system, many of them not for the better. Prescription drug costs, reduced insurance coverage for services, and lack of available time to talk with physicians, are among just a few of the complaints and concerns I hear from patients. But, when my own father was hospitalized out of state a few years ago, the inadequacies of the health care system really hit home. In daily phone conversations with my mother and brothers, I saw how ill-equipped they were to ask the right questions or anticipate the best course for my father. My personal experiences as well as hearing the experiences of others has fueled my passion for educating health care consumers on how to communicate with their physicians.
Communication is said to be the “art” in the art and science of medicine, yet, not every physician is a good communicator. A poor communicator may leave a patient and/or their family members feeling intimidated, confused, or dissatisfied with the level of service. However, for communication to be truly effective, it must be viewed as a two way street. It is not enough to focus on the communication skills of the physician, but the patient must also evaluate how effectively they are communicating and how prepared they are when showing up for a hospital visit.
The physician is a sort of investigative reporter, who must interview the patient and gather the relevant facts. The patient, in contrast, must accurately tell their story, provide an adequate and truthful history of the problem and follow-thru with recommendations from the doctor that they have agreed upon.

The following are some specific suggestions for communicating with your physician:
* Your responsibility is to provide your physician with an accurate account of the problem (when it began, symptoms, medications,etc), as well as beliefs you have about this problem.
* Be aware of the fact that your doctor is going to pay the most attention to what you say in the first five minutes of your visit. Prioritize your concerns, and don’t allow your spouse to speak for you.
* Request that your doctor speak to you, directly and slowly. Request they repeat information you may not have heard or understood, particularly instructions.
* If you are discussing important decisions like surgery, specialized treatments like feeding tubes, take time ot think it over. Request another appointment to go over your questions, and if you think it’s needed, request a second opinion.
* Be sure to have a current list of medication you are taking, including over the counter drugs and vitamins and supplements which may interract with any new medications prescribed.
* If you feel overwhelmed by the amount of information you have been given, don’t be afraid to say: “I don’t understand.” Write down specific things the doctor tells you I fyou need to, and you may want to add: “I think I understand what we are talking about, but, if I have questions what might be a good time to call you?”
* Whenever possible try to have a spouse, other family member or friend accompany you to your physician’s office.
* If you are admitted to the hospital, be sure that you let staff know if you are hard of hearing or have any other difficulty understanding what is being said to you. You have the right to a translator if your primary language is not English, and an interpreter if you are deaf.
* As a competent adult, you have the right to accept or refuse any medical procedures. You should never make a decision with a feeling of coercion or pressure. If you feel that you absolutely cannot communicate with your physician, and feel that they are unresponsive to your needs, begin to look for another physician.
While there are many negative changes occurring in health care that we cannot directly impact, both physicians and consumers can learn to be better communicators. A good relationship between a physician and patient can go a long way towards improving patient satisfaction, reducing the risk of medical malpractice lawsuits, and improve medical outcomes.
These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .

(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Voice Aerobics ™ and Principles of Vocal Development: Relaxation Excuses, Excuses, Excuses, And Other Reasons We Fail To Reach Our Goals

When I was in my 30’s I decided to begin piano lessons. I hoped that I was going to discover some unrevealed talent, but, the truth of the matter is, I had no exceptional musical aptitude, and the only thing that improved my performance, was practice, practice, practice. On a good week, I would practice at least once a day. On a busy week, I would practice once or not at all, and on the day of my lesson, while climbing the three flights of stairs to my instructors apartment, I would think of excuses. The truth , however, was quickly revealed when my fingers hit the piano keys. There was really no way to cheat about practice. When I did, it showed in my performance, when I didn’t, well, I struggled thru the lesson, felt guilt and shame, and failed to achieve my goals, which included moving on to a piece of music I longed to play.

So, what kinds of excuses do I hear from patients when they fail to perform an exercise program? “I was too busy,” “we had company,” “ my wife/husband had too many doctor’s appointments,” “I was too tired,” etc… I think the only one I haven’t heard, is : “the dog ate it!” While I realize that we all have busy lives, and it’s a challenge for all of us to remain committed to an exercise program, for individuals with Parkinson’s or other neurogenic conditions, you simply can’t afford not to exercise. You see, Parkinson’s takes no holiday. It’s always present, lurking in the background of your life, changing the way muscles perform. I have patients who tell me that they could once command the attention of a classroom of students, and now can barely be heard by their spouse.
Patients who spent their careers working in sales, who tell me they have stopped answering the phone, because people are always asking them to repeat. And, patients who tell me they used to love taking their wives out for dinner, but have stopped eating out, because they are embarrassed about how much choking and coughing they are doing during a meal..

If you have benn diagnosed with a neurological condition such as Parkinson’s you are definitely going to face some challenges and adjustments. But, once the physicians have prescribed and adjusted your medications, the rest is up to you. Make a decision to do everything you can, to preserve muscle function, and to live well, despite the disease. Make a decision to do some form of meaningful exercise everyday for as long as you can.
As the Nike ad so wisely states: Just Do It!! No Excuses

VoiceAerobics™DVD is a 3-part exercise program, that can be done at home, on your own. rgular use of this program and others may help you to maintain speech and voice abilities for longer.

These monthly articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .
(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Principles of Vocal Development: Power Up Your Voice and Body

Interview with Kate Kelsall, blog: Shake Rattle and Roll (please go to Kate’s website to read the entire interview, and for other great information and insights about living with Parkinson’s.
http://katekelsall.typepad.com/my_weblog/
“Voice Aerobics™ was created by speech and language pathologist, Mary Spremulli, MA, CCC-SLP. It is an exercise program focusing on breath support, posture and vocal function exercises for improved vocal performance.
I was fortunate to conduct the following email interview with Mary”:
Kate: What attracted you to working with Parkinson’s patients in the area of speech/voice treatment?
Mary: I have always enjoyed working with children and adults with motor and speech disorders. More than 20 years ago when working in pediatrics, I became certified in Neurodevelopmental Treatment, also referred to as NDT. One of the underlying principles of that treatment is that "normal and abnormal cannot co-exist." Based on that understanding, I would incorporate treatment approaches that included techniques to minimize or extinguish the abnormal patterns that were interfering with the more normal expression of movement, voice, speech or swallowing.
When I relocated to Florida in 1989, I began to work with primarily an adult population, including individuals with voice, motor and speech problems from Parkinson's, stroke, and other neurological events. That theory from NDT still applied, and I realized that if someone's goal was "better" or more "normal" speech, then we needed to work together to minimize the interference from the abnormal. Using Parkinson's speech as an example, there may be a number of things that are interfering, such as tremor, too fast of rate, weak voice or hoarseness. We attempted to identify the feature that was causing the most interference and minimize that by strengthening some other aspect of the speech, voice, or respiratory system.
I became certified in the Lee Silverman Voice Treatment® (LSVT) technique in 1997. Dr Lorraine Ramig and her colleagues associated with this program have published an impressive body of research describing its benefit. In my opinion, if someone has been newly diagnosed with Parkinson’s, this is the ideal time to consider the LSVT.
I realize that I may not have answered your actual question. I find that I am attracted to working with individuals with Parkinson’s, in particular, because over the last 15 years or so, I have met so many interesting patients, whose voice and speech changes from Parkinson's really misrepresent the person behind the voice. I can think of many individuals who on first meeting have weak, monotone voices. As we begin to work together, I discover that they are often intelligent, witty individuals, who were teachers, CEO's of companies, athletes, yet their true personalities are beginning to be lost inside their bodies. So, if I can help them to strengthen their system to minimize further physiological changes and to re-capture the spirit of who they are, then, that's fun and rewarding for me. I have audiotapes of patient's first and last sessions, and you can hardly believe that they are the same person talking.
Kate: What are the biggest speech and voice challenges faced by those with Parkinson’s?
Mary: Oh, wow, well, you know that answer better than me, Kate.
I would have to say that one of the biggest challenges is the insidious or sneaky nature of the speech and voice changes. Unlike someone who has had a stroke where the changes in speech are quite sudden, the changes that come about with Parkinson's are slow and gradual. For the persons with Parkinson’s they don't really seem to realize how bad their speech may have actually become.
The LSVT people talk about the need for those with Parkinson’s to become "re-calibrated," and I do think that this is at the heart of the program, but, also the greatest challenge. Even when Parkinson’s patients hear themselves producing better and louder voices, it doesn't feel natural to them. We humans seem quite drawn to the familiar, and even when we don't like some aspect of our behavior, it can be difficult to change.
The other challenge is that the individual with Parkinson’s must realize that even when a formal program of therapy of any sort has been completed, that is not really the end. Parkinson's is still in the background of their lives, sneaking around, and changing the way muscles behave, and so individuals have to make a LIFETIME commitment to exercise. In that regard, with or without Parkinson’s, if a commitment to exercise was easy, our gyms would be overflowing with members, and of course, that is not the case.
Kate: Do you have any advice about voice and speech for those newly diagnosed with PD?
Mary: The best advice I can give, in addition to taking your medications as prescribed, is to begin a voice exercise program. Frequently, I receive a request from a local neurologist to contact a person for therapy, and in doing so, the person will say: "I don't think my speech is that bad, yet." GRRRRR!!!!! If they wait until the day of the "yet," they will already be in trouble.
interview cont’d at: http://katekelsall.typepad.com/my_weblog/

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Practice, Practice, Practice

A current voice therapy patient of mine, is a 57 yo. man with Parkinson’s. He is also a licensed pilot, so we talk a lot about flying. Recently, I asked him what specific skills were required to be a good pilot, and he said: “eye - hand co-ordination.” When using instruments, however, he said the challenge is different, because you needed to fly the plane according to what the instrumentation is showing you, and ignore the information your brain and body is giving you. “How, I asked, do you ever accomplish that?” “Practice”, he said, ”practice, practice, practice.”
“So, “ I said, “flying a plane is a little bit like doing voice therapy. You need to ignore some of the faulty information that you body or mind is giving you, and use some other, external measures of how you are using your voice.” And you need to practice.
I tell patients that it takes about 750 repetitions of a behavior to establish a new habit. Now, if that seems like an unattainable number of repetitions, add up how many times your spouse asks you to repeat yourself in any given day. Hmmm…I guess now you can see how over time you have solidified your current voice habit.
If you are currently enrolled in formal therapy, attending an exercise class, or using the Voice Aerobics™ dvd, you have an opportunity, thru practice, to establish some new habits. Pick a skill that you want to improve in the next 30 days, it could be using a louder voice, more upright posture, or getting out of a chair without tipping it or you over. Choose one and than make a commitment to practice. Post notes around the house, in the car, on the bathroom mirror, use an alarm clock, anything to remind you to practice the new habit you are trying to create. You might also want to write down how you will feel when you accomplish your goal. Choose just one word, it might be something like: happy, proud, successful, strong. Post that word in as many places as you can.. And at the end of your 30 days, celebrate the success of achieving your goal.

“whether you think you can or you think you can’t, you are right”
Henry Ford

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.

Does Medicare Pay For This??? and... What Are YOU Willing To Pay For?

In my twenty years of practicing as a speech-language pathologist in Florida, the first question usually posed to me by prospective patients is the Medicare question. Hence, it has led me to include a few comments about the Medicare payment system in my Voice Aerobics seminars. I provide a few definitions of what Medicare considers as “medically necessary” treatment, and than I caution participants to not make health care decisions based solely on whether private insurance or Medicare will pay.

Now, don’t misunderstand, as a self-employed and self-insured person, I am as concerned as you are about health care costs. But, I also know that I am willing to pay for certain non covered services, like my bi-annual dental exam, my vision exam, my monthly massage, and others, because I have witnessed the benefit of prevention and self-care. Blindly accepting a physician’s prescription for any sort of therapy, just because you are told Medicare or insurance will pay, is not likely to yield a result you hope for.

Last week I saw a woman for voice treatment for a functional voice disorder. That is, a voice problem that has come about mostly from misuse of her vocal mechanism, and not because of something anatomically wrong. She spent the first 20 minutes of the visit, telling me how stressed she was because she was about to lose some health care benefits associated with her deceased husband’s employment with Chrysler. I reminded her that voice treatment was likely to be short term (6-8 visits) and self-directed ( voice exercises that she would need to perform on her own outside of treatment). In response, she elaborated further telling me, that because she was “so busy”, and “so stressed,” she did not find time to perform any of her home voice exercises, practice recommended vocal hygiene techniques, or various other suggestions provided to her the previous week.

This example is layered with many of the challenges associated with successful outcomes from voice treatment, including: Is the patient ready? Do they understand the nature of their problem, and are they sufficiently motivated to independently perform a home program? And, will they continue to self-monitor their vocal behavior once formal treatment has ended?

Whether Medicare is paying for treatment, or a patient is taking their check book out at the end of a session, my obligation is the same: to educate you about your disease/symptoms and best treatment; to instruct you in exercises, strategies, and techniques that reduce your symptoms or improve function; and to establish a home program that you can independently and safely perform on your own or with assistance from a caregiver. So, as you consider any type of medical therapy or treatment, I would encourage you to do a self-check, and answer the question: what am I willing to pay for?

 

Articles are intended to: educate, enlist your participation in your own care, and empower you to advocate for your self or others .
(Re-printable with permission from the author: Mary Spremulli,MA,CCC-SLP. Send correspondence to: info@voiceaerobicsdvd.com)

About the author: Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist and licensed nurse. A national lecturer, with publications on the topic of Patient Education and Ethics, and with a special interest in physician-patient communication.