Management of Facial Paralysis

By Mark K. Wax, MD

Editor of Facial Paralysis: A Comprehensive Rehabilitative Approach

Facial Paralysis: A Comprehensive Rehabilitative Approach

Facial Paralysis: A Comprehensive Rehabilitative Approach

Facial paralysis is a devastating process. Normal facial function is of paramount importance in both cosmesis and how individuals are perceived by others. It also plays a role in natural physiological processes. When the facial nerve—which provides animation to the muscles of the face—is paralyzed, there are severe cosmetic, psychological, as well as physiologic sequelae. The facial plastic surgeon has the ability to play a unique role in both the reconstruction and the rehabilitation of the adverse effects of facial paralysis. Management paradigms for the multitude of issues that face these patients involve a team approach—not only facial plastic surgeons, but also speech pathologists, physiotherapists, social workers, family, and so forth. The facial plastic surgeon stands at the epicenter, able to direct the care of the patient to these different specialists. Continue reading

Augmentative and Alternative Communication: From Novice to Expert Clinician

By John McCarthy, PhD, CCC-SLP and Aimee Dietz, PhD, CCC-SLP

Augmentative and Alternative Communication

Augmentative and Alternative Communication by John McCarthy and Aimee Dietz

Understanding the personal story of an individual who uses augmentative and alternative communication (AAC) can have a positive impact on the attitudes of people without disabilities toward that individual (McCarthy, Donofrio-Horwitz, & Smucker, 2010). Almost any AAC specialist has story after story of moments when they have helped reveal the true abilities of an individual through AAC:

• The eight-year-old boy with cerebral palsy who everyone assumed had below average intellectual ability and presymbolic language skills, was in fact bilingual.
• The forty-year-old woman with bulbar onset amyotrophic lateral sclerosis who cannot dress or feed herself, but still manages her finances, parents her children, and makes end-of-life decisions.
• The eighteen-year-old girl with autism spectrum disorder whose potential to contribute to society was doubted, yet planned for employment after high school and managed a new mobile device-based communication system.
• The fifty-two-year-old man with stroke-induced aphasia who medical staff assumed was “incompetent”; however, still made informed decisions about medical care and enjoyed friendly banter on the golf course with his adult sons.  Continue reading

Ten Advances in Cochlear Implant Technology and Services

By: Jace Wolfe, PhD

Over the past several years, there have been numerous advances in cochlear implant technology and services. As recent as a decade ago, there were little to no technological solutions available to assist a cochlear implant candidate/recipient, who presented with severe to profound hearing loss, with speech recognition in difficult listening situations—understanding speech in noisy and reverberant settings, over the telephone or television, and when spoken from a distance. Today, cochlear implant manufacturers offer a wide variety of solutions to meet the needs of patients with hearing aids or cochlear implant processors who struggle to communicate. This article identifies ten ways in which cochlear implant technology and services have evolved and improved in the past few years.

10. Automatic scene classification: Hearing aids have featured acoustic scene classifiers for almost a decade. Through these systems, hearing aids classify an environment as one that possesses background noise, speech in quiet or in noise, music, wind, and so forth. Once the listening situation is classified into one of these environments, the hearing aid selects the appropriate form of signal processing that will theoretically optimize performance in the given environment. This technology can be quite valuable as many users are unlikely to manually switch to programs designed for specific, challenging situations. Furthermore, this system will likely be well-received by cochlear implant users as it makes its way to implant sound processors.

9. The development of new speech recognition materials that provide a more realistic assessment of how hearing aid and implant users perform in real-life listening situations: Cochlear implant technology has improved so much that many users score near 100% correct on sentence recognition tests in a quiet environment with a single talker who is male and speaks at a slow to moderate rate. Additionally, many hearing aid users who struggle substantially in realistic situations also often score too well on these tests to meet the indications for cochlear implant candidacy. This fact makes it difficult to distinguish between excellent implant and hearing aid users and good users who may benefit from additional services.

Continue reading

Reflections on 10 years at Plural

An interview with Plural President, Angie Singh

Angie Singh

Angie Singh, Plural Publishing’s President

What is your favorite moment in Plural’s history?

“My favorite moment occurred before Plural was incorporated. Some of the things we had most valued and had come to miss most in the ten years after the sale of Singular [the Singh's previous publishing house] were the close relationships, daily interactions and sense of purpose and commitment that we had shared with our authors.

One day, I received a call from longtime friend and Singular author Dr. Robert Sataloff, who suggested that we should start a new company. The idea intrigued my beloved husband and me but it also presented us with many challenges and concerns that included financial investment and the extraordinary time commitments that would alter and affect our lifestyle, especially with our eight year old twins.

We managed to overcome the most serious of concerns and embarked on a journey that became Plural Publishing. We were immediately pleased to learn that many of our past authors were eager to join us in the new venture. Ten years after founding Plural, I couldn’t be more gratified.” Continue reading

Featured Article: One New Year’s Resolution to Keep

One New Year’s resolution to keep – learn more about being an effective speech-language pathology assistant (SLPA) supervisor

by Plural author Jennifer Ostergren

If you are like me, as 2014 swings into full gear, you look to your newly inked New Year’s resolutions. One resolution on my list this year is to expand my knowledge and skills as an educator and supervisor of speech-language pathology assistants (SLPAs). Those of you with similar aspirations know that serving as an SLPA supervisor can be highly rewarding, but also challenging, especially given a lack of resources and tools specific to SLPAs. This year, however, the American Speech-Language-Hearing Association (ASHA) continues to expand its efforts in this area, with new programs, policies, and resources specific to SLPAs and their supervisors. In particular, ASHA’s new Practice Portal on the topic of SLPAs, located at http://www.asha.org/Practice-Portal/Professional-Issues/Speech-Language-Pathology-Assistants/, is an excellent source of current information and resources on this topic. The sections that follow also highlight several key resources from ASHA that may be of help as well. Continue reading

Featured Article: The Challenge of Clinical Education in Speech-Language Pathology

By James M. Mancinelli, MS CCC-SLP and Evelyn Klein, PhD. CCC-SLP

This article provides an overview of important issues facing clinical training of graduate students today. In light of current training models, budget constraints, staffing shortages, and productivity demands, it is time to take a hard look at the requirements and demands set by our profession in the hopes of making needed changes

The 2005 and 2014 ASHA Standards require that the student enrolled in a Master’s degree program in Communication Sciences and Disorders (CSD) obtain 400 clinical hours “across the lifespan with varied disorders”: 375 hours in direct contact with the patient/client and 25 observation hours.  This is a broad guideline and superficially seems reasonable and achievable. After all, the requirement that the student obtain a specified number of contact hours in each of the disorders, with adults and children, in assessment and treatment have been removed. Unfortunately, the current service delivery contexts in which speech-language pathologists practice are all impacted by fiscal constraints, staffing shortages, and productivity requirements.  Although these three factors may not necessarily affect the quality of care, they are seriously impacting the ability to clinically train graduate students in CSD.  It is imperative that other models be developed for clinical education and training and that the discipline reviews the evidence that supports maintaining the status quo.  This is especially critical as some programs are being asked to admit more students into the graduate program, creating the need for even more external clinical practicum experiences. Continue reading

Feature Article: Toward a More Effective Collaboration

Toward a More Effective Collaboration by Aaron Fletcher, MD

2doctorsAs a discipline Otolaryngology has long recognized the benefits and virtues of a collaborative model of healthcare delivery. In fact, I believe that few other medical specialties collaborate as frequently and as effectively as Otolaryngologists—it is an integral part of our culture. On a daily basis, we are called to collaborate with specialists of diverse expertise (Audiologists, Speech and Language Pathologists, Neurosurgeons, Radiologists, Radiation Oncologist, Medical Oncologists and so on). In consulting these experts, we recognize the knowledge of these specialists as complimentary to our own and no less valuable. In fact, we frequently congregate in multi-disciplinary conferences where everyone has a say, and everyone’s opinion counts.

As our specialty embarks upon a changing healthcare landscape, we are constantly challenged to evolve our collaborative process in order to keep pace with the expanding application of technology across healthcare.This collaborative spirit is one of the major reasons that I enjoy this specialty. One of the things I appreciate most about Otolaryngology is the opportunity to learn the subtle nuances of a diagnostic finding, condition or technique that are afforded by colleagues and other members of the treatment team.  Throughout my very young career, I’ve found that better collaboration invariably leads to better care and that to be successful; collaboration requires shared vision, values, risks, resources, and rewards regardless of function, occupation or level of training. This is truly what collaborative care is all about.

communicationThe ubiquity of internet access via mobile devices and smartphones, along with the rise of social media has changed the way in which health care information is distributed and consumed. This factor has allowed patients ample access to information about their health conditions and associated treatment options. A recent Pew Internet research study found that one in three adults have turned to online sources to figure out a medical condition that they or someone else they know might have1. Combining these internet resources with expanded mobile network technology means that patients are increasingly capable of seeking answers to their healthcare questions instantaneously. This means that patients are now empowered to become more active participants in their care, and this is certainly a good thing.

On the other hand, these factors also exert pressure upon caregivers to keep pace with these changes in health related information consumption by increasing technological sophistication and improving their own access to medical knowledge. By doing so, we are better suited to meet the demands of a patient population that is better equipped to make important healthcare

As the application of technology across the healthcare landscape has led to a greater sense of empowerment among patients, advancements in health IT, (including electronic health records, cloud computing and health information exchange platforms), also hold great promise for clinicians. The advent of these tools has empowered clinicians to mobilize and share clinical information with members of the treatment team at any time and from any location with internet access. Given the intrinsic collaborative nature of our field, it makes perfect sense that we leverage these technologies to expand our approach to coordinating collaborative care. HIPPA compliant hosting and file sharing networks are now working to mitigate the risk of exchanging protected health information (PHI) via the web and mobile devices. These networks work to encrypt PHI both in storage and in-transit, thereby providing a layer of protection against breaches in security. While these platforms should be used with caution to ensure compliance with HIPPA regulations, as these tools continue to evolve, they will create new opportunities for collaboration and partnership across traditional institutional and geographic boundaries.

Naturally, I believe that Otolaryngologists should be at the forefront of integrating these tools into clinical practice, as we continue to seek new ways of perfecting collaborative care.  I believe ubiquitous data accessibility and sharing (cloud computing) coupled with HIPPA-compliant hosting platforms have the ability not only to facilitate, but to enhance the way we collaborate. Using these tools we can share best practices and treatment protocols, coordinate video conferences with colleagues outside our geographic area, and obtain outside expertise about challenging cases. These tools also allow us to interface with patients about their care, and to provide them a portal to share relevant updates on their condition from the comfort of their home. All of these efforts are critical to the long-term success of our collaborative efforts as a specialty, and familiarity with the tools by which we accomplish these aims is imperative.

So as we embark upon a continually evolving paradigm of healthcare consumption and delivery, we must continue in the spirit of collaboration, and seek out the new tools of our trade.  By doing so, we can continue to demonstrate that better collaboration leads to better care.

References:

1.            Fox, Susannah, Duggan, Maeve: Health Online 2013. Accessed online via http://  pewinternet.org/Reports/2013/Health-online.aspx

 

Dr. Fletcher is the author of the just-published Comprehensive Otolaryngology Review: A Case-Based Approach Fletcher_COR