What Is Your Communication Quotient? (CQ)

If you have been newly diagnosed with Parkinson's Disease or a related diagnosis, you are undoubtedly trying to wrap your head around the diagnosis, understand new medication regimens and follow your physician's recommendations to exercise. Your physician may have also recommended that you consult with a speech-language pathologist/therapist for management of speech and swallowing symptoms that may be associated with your medical diagnosis. This may seem like a reasonable recommendation or an unnecessary one depending on your own perception of your speech and voice.

 

Below is a quick questionnaire that may help you determine if you might benefit from some speech and voice therapy or coaching.

 

Circle the response that best matches your experience.
0= never  1= almost never 2= sometimes  3= almost always  4= always                        

1. I breathe from my abdomen/diaphragm 01234
2. I can speak without worrying about drooling or coughing 01234
3. I use the appropriate volume for the situation 01234
4. I speak clearly and others comment on this 01234
5. I project my voice without effort 01234   
6. I use my voice and body language to express energy 01234
7. I open my mouth sufficiently when I speak 01234
8. I feel confident speaking on the phone 01234  
9. I am confident speaking in groups and in new situations 01234 
10. I speak for myself and rarely let others do my talking 01234       

How did you do? If you got mostly 3's and 4's, you may be communicating fine without much disease impact on your speech and voice. If you got mostly 0's, 1's, and 2's, speech and voice therapy might be a worthwhile investment in the New Year.



Twelve Days of Speech Therapy...will Medicare pay for this?

On the first day of therapy my patient said to me: will Medicare pay for my speech therapy?

On the second day of therapy my patient said to me: I know I need to practice, but, will Medicare pay for my speech therapy?

On the third day of therapy my patient said to me: I think I've stopped choking, I have been practicing, but, will Medicare pay for my speech therapy?

On the fourth day of therapy my patient said to me: I am talking louder, I have stopped choking, but will Medicare pay for my speech therapy?

On the fifth day of therapy my patient said to me:  no more thickened liquids, I have stopped choking, and I practice every day, did you get my Medicare EOB?

On the sixth day of therapy, my patient said to me: I am talking better, no more thickened liquids, I have no more choking,every day I practice, but I worry they will not fund my speech therapy?

On the seventh day of therapy my patient said to me: I'm so grateful for speech therapy...I am talking better, and no choking do I see, can you tell me if they paid for my speech therapy?                             
                                              
On the eighth day of therapy my spouse didn't say:"REPEAT".
 I am feeling grateful, I am talking better, no more  thickened liquids, no choking when I'm eating, can't they  see I need this? Please don't take away my speech therapy.

On the ninth day of therapy my patient said to me: Why can't congress understand the need?

I am one of millions who can't talk or swallow with ease, that is why we need  our speech therapy.

On the tenth day of therapy my patient said to me: my doctor, friends and family all agree...

I am talking better , eating with less impact of disease, I am living proof in the value of speech therapy.

On the eleventh day of therapy my patient said to me:  finally I feel free...

No more tubes or thickeners , I can eat much more safely, note to Congress don't slash my speech therapy.

On the twelfth day of therapy my patient said to me: I will pray for others who are in need...

Medicare assisted me in my efforts to succeed,
Santa  don't let Congress ruin this, pretty please.



Happy Holidays, Peace on Earth, and Good Health
      

Mary Spremulli,MA,CCC-SLP 

Why Not Try Some Weight Lifting For The Breathing Muscles?

Respiratory muscle training may not have been a part of your training program in the past, but that may change as you read on.  

What is RRMST? Resistive Respiratory muscle trainers are hand held devices designed to strengthen the muscles of inspiration and expiration. These portable devices are easy to use and beneficial for anyone interested in developing power and endurance of their breathing muscles.

How Does it Differ From Incentive Spirometry? Following surgery or hospitalization for an upper respiratory infection, patients are often given an incentive spirometer. These devices are designed to help you to take a deep breath, but you are not working the muscles against resistance, and they are designed for inspiration only. You might find it useful to use your spirometer to measure the progress of your respiratory muscle training.

Why Add Respiratory Muscle Strength Training To Your Workout? The respiratory system was built for exercise, and yet, the respiratory muscles are often taken for granted. Respiratory muscles are the muscles responsible for filling and emptying your lungs, and like the skeletal muscles, the respiratory muscles can be strengthened with exercise. In a 1998 study looking at the effect of  respiratory muscle exercise using a resistive device called a BREATHER®, [1]investigators found that respiratory training increased breathing efficiency and exercise performance.

 

Who Could Benefit From Respiratory Muscle Strength Training? Healthy individuals and athletes could benefit from exercising the respiratory muscles, as well as elderly persons and individuals with pulmonary and neuromuscular  diseases. With age, physical function declines, which influences the respiratory muscles, and just as other muscle groups within our body can become weaker  the respiratory muscles also lose strength.  Recent research has begun to examine the benefit of respiratory muscle training  for persons with neuromuscular and neurogenic diseases such as Parkinson’s Disease and Multiple Sclerosis. [2],[3]

                                 

How Can Strengthening The Breathing Muscles Help Voice And Swallowing? Patients are sometimes surprised when I suggest that resistive respiratory muscle training be added to their voice or swallowing exercise regimen. Respiration, phonation (voice), and swallowing are all interrelated functions and highly dependent on muscle strength, coordination, and accurate timing of breathing and swallowing. Since we are always using the breath out (exhalation) for speaking, interrupting exhalation to swallow, and using the muscles of exhalation for cough  effort and airway protection, it makes sense that strengthening the muscles of inhalation and exhalation  may help one to: swallow at higher lung volumes, better time breathing and swallowing, improve cough effort, and use better diaphragmatic breath support for voice.

[1] Medicine and Science in Sports and Exercise, 1998, Vol. 30, No 7, pp -1169-1172.

[2] Archives of Physical Medicine and Rehabilitation 2003. Jul;84 (7): 994-9. Effects of inspiratory muscle training in persons with Multiple Sclerosis.

[3] Can J Neurol Sci. 2005 May;32(2):213-7 Inspiratory muscle training and the perception of dyspnea in Parkinson's disease

View video: http://www.youtube.com/user/voiceaerobics#p/u/0/ie2a2cYFrb0                                       

 

                                                    

Can I Help My Patients By Just Listening ?

I have adopted a new personal mantra: "I am minding my own business". Mantras are said to create thought energy waves, and also to free the mind, directing our intentions. Why these particular words, you might be wondering?

I recently realized how often I am advising, offering opinions, gossiping by joining into a conversation about another person or situation, or chattering in my own brain about someone or something. All of these activities, I realize distract me from my own life and my own personal and business goals. Simply put, when I am engaged in someone else's drama, I am squandering the few precious minutes I have in any given day to tend to my own business.

This tendency to counsel and advise, of course is an occupational hazard, as I spend much of my working day doing just that. Patients, after all, are looking to me for help, and often that help involves teaching, training, and instructing. But, as I am trying to embrace the intent of this new mantra, I wonder if even with patients, I need to listen more and talk less. Now, this would be quite a change for me. Silently listening as someone tells me their problems makes me feels uncomfortable. " I should be responding", I think, offering solutions, re-assuring that I can help. But, perhaps, I need to just be listening.

What a patient understands about their particular problem,  the impact their communication impairment is having on them or their family, and what they hope to gain from treatment, may all be revealed, if I listen. Using probing words, like: "say more about that," "tell me more," "what did you mean when you said,"...and so on, may help to uncover the patient's own strengths and weaknesses that will impact success in therapy.

One of the frequent dynamics I often observe when an individual has a communication impairment, is that others will begin to speak on their behalf. Usually this is a spouse, adult child, or well intentioned caregiver. While at first glance, this might appear to ease the communication frustration of the individual, in reality, it begins to obscure the reason the person has sought out therapy, and limits their opportunity to take ownership of their problem and solutions. So, at times, even the most well intentioned spouse or caregiver must also learn to mind their own business, and allow the individual to fully engage actively in their own treatment.

In learning to be a better listener, I have identified 5 action steps:

1. Not to interrupt
2. Not to finish another person's thought
3. Not to personalize a situation to me
4. Not to participate in gossip
5. Not to offer unsolicited advise

If you are a professional, spouse, friend, or caregiver who also talks more than you listen, perhaps you would like to join me on this challenge.