HAWAII SPEECH-LANGUAGE-HEARING ASSOCIATION
38TH ANNUAL CONVENTION
April 16-17, 2015
Save the Date!
At the 2014 Convention, we were able to have 6 posters which shared the results from various studies performed by students in the Communication Disorders and Sciences Master’s program at the University of Hawaii. The posters are now available for viewing for HSHA members (log in required) in the continuing education section of our website.
The following are letters from student scholars who attended the 2014 HSHA convention
The following are some of the main points that I believe sill help our Hawaii SLPs work in diagnostics and/or therapy when considering the mild TBI population. I am choosing to send what I thought was the most helpful, based on the treatment that I have done in my externship at Hilo Medical Center. These points are from Don MacLennan’s talk “The Process of Cognitive Rehabilitation.”
Don MacLennan described six approaches to cognitive rehabilitation, and emphasized that there is NO single “right” way to go.
One approach that he emphasized was the notion of personalization, and suggested specific ways as clinicians that we can personalize.
PERSONALIZED EDUCATION AND UNDERSTANDING:
1. Consider how to increase the client’s awareness of their condition.
2. Validate their symptoms (when you don’t validate symptoms, they’ll just magnify).
3. Personalize ALL therapy activities and home programs, too (“education is not just a handout, personalize it). The following are examples of activities that Don MacLennan suggested during his talk. They target awareness, meaningful processing, and the principles of neuroplasticity:
-Have a verbal discussion with the client about expectation for home program.
-Give the client a highlighter and let them highlight text that they feel relates to them, etc. This way, the client is processing information in a more complex way.
-Instruct the client to write the next paragraph/edit the material based on his or her own personal experience- with this task, they’re projecting the ways in which their cognitive deficits impact their experiences.
-Encourage clients to keep a log of cognitive challenges,
(e.g., how many times do you check out when you’re spouse is talking to you?)
-Encourage clients to ask people that you trust for real feedback about how they’re doing.
-Conduct experiments in before, during, and after sessions! Design these experiments with the client. How can we test your memory?
-Transition from memory book to awareness book (list strengths and weaknesses; but nothing should go on that list that they don’t voice).
- Have clients schedule their own therapy sessions, generate a work resume, or call family members.
- Suggest the client watch a fifteen minute lecture (e.g., www.thegreatcourses.com) and have them mark down every time they get distracted during the lecture.
MacLennan truly presented cognitive rehabilitation as a dynamic process, and emphasized a few other key points:
OTHER KEY POINTS:
1. Cognitive rehabilitation is about strategies. As SLPs, we are responsible to be aware of the strategies, their level of specificity, and when/how to teach them to clients. This is key for skilled documentation of progress in therapy.
2. It is important to establish a theraputic alliance with clients right off of the bat. Clients should be made aware that they are going to have to put work into the therapy process, and they have to have a real say in the planning an dimplementation of therapy. As the SLP, you make suggestions and dynamically coach. The client is truly driving the bus.
3. When assessing a client, consider their own perception of wants and needs. Consider how you will assess whether they have used certain strategies.
4. The Principles of Neuroplasticity most certainly apply to brain injury rehab. They have specific implications for treatment targets, practice specifications, and maintenance. They are described in full in the following (very well written) article:
Kleim, JA and Jones, TA (2008). Principles of experience-dependent neuroplasticity: Implications for rehabilitation after brain damage. Journal of Speech-Language and Hearing Research, 51, 225-239.
5. There is a literature review that is the Gold Standard for practice guidelines in cognitive rehabilitation, and it is endorsed by the ANCDS. This literature provided a framework for the duration of MacLennan’s second talk:
Cicerone, K, Langenbahn, D., Braden, C., Malec J., Kalmar, K., Fraas, M., (2011). Evidence-based cognitive rehabilitation: Updated review of the literature from 2003-2008. Archives of Physical Medicine and Rehabilitation, 92, 519-530.
Please let me know if you need anything else.
I enjoyed HSHA very much this year, and plan on continuing to be an active HSHA member. I got a lot out of the conference, and am very grateful.
My name is Megan Elkin and I have just graduated from the University of Hawaii’s Communication Sciences and Disorders program and received my M.S. My classmates and I were fortunate to be sponsored by HSHA to attend this year’s conference and also share our research posters. It is always an incredible opportunity as students to be able to attend such an informative conference and meet SLP’s that we all hope to someday work with and continually learn from.
This year I was only able to attend the conference on Friday April 25th, and was able to see the presentation by Mr. Don MacLennan, MA CCC-SLP, on The Process of Cognitive Rehabilitation. Mr. MacLennan had very interesting information to share about different approaches to cognitive rehabilitation. Most of this information was a review of specific skills and techniques we have learned throughout the past couple of years, so it was nice to be able to go over some of this information again and pick out some helpful take home points. In terms of Training Cognitive Strategies, it was nice to review the TEACH-M instructional method. Mr. MacLennan shared with us various strategies to use when working with clients/patients on their long and short term memory (i.e. people with severe declarative memory deficits learn well from implicit learning strategy).
Mr. MacLennan is a man who keeps up with the times and considering Ipads and other forms of assistive technology are the “latest and greatest” tools to hit the SLP and cognitive rehabilitation realm it was very beneficial to learn about several different Ipad apps that he finds helpful and uses during therapy. I have a terrible memory myself, so some of his strategies and apps are things that I can use along with my clients/patients! Overall, I found his presentation useful to keep us enlightened about current techniques.
Andrew Shadock was the key note speaker for day one of the 2014 HSHA convention this year. He presented on ways that school psychologists and speech-language pathologist can effectively work together as a team to efficiently test a child and determine if he or she is eligible for services at a particular school. He made salient points regarding way testing is often conducted and how teams may inadvertently test the same things multiple times. He also gave suggestions and provided ideas as how to better collaborate during testing by choosing one main testing battery and supplemental subtests for individual areas.
From Kelly Smith
I had the wonderful opportunity of attending one day at the 37th annual HSHA Convention! We were privileged to have Don MacLennan as the speaker who shared about the use of assistive technology in cognitive rehabilitation. Being a soon to be graduate entering my professional career, I was introduced to new assistive technology applications and how to apply those applications to target specific cognitive deficits. This information will help SLPs identify who would be a candidate for assistive technology and with carry over of learned skills into the patient’s natural environment in treatment. I appreciated all of the recent research he provided to support the material he shared with us. I look forward to applying these new innovative applications to my treatment sessions!
From Katie Yoshida
Collaboration between disciplines in any client setting has always been emphasized within the profession. During Dr. Andrew Shanock’s lecture at the 2014 HSHA convention, he again stressed the importance of collaboration between professionals especially between SLPs and school psychologists within the school setting. It was interesting that he pointed out that both SLPs and psychologists might be “wasting time” during assessments. Sometimes both professionals administer the same test or similar supplemental tests without even knowing, which causes duplicated work and less reliable information about the student. In order to avoid this mistake it is important to discuss with the school psychologist on what protocols each person will be using. Additionally, after one administers a core battery, supplemental batteries should be given to focus on areas that were not tested. This information helps remind SLPs and psychologists that in order to gain the most accurate assessment of our students, it may be beneficial to collaborate with each other and use the most appropriate testing batteries or tools.
From Joni Shimomura
At the 2014 HSHA conference, I had the privilege of listening to Don MacLennan, MA, CCC-SLP. He presented on the process of cognitive rehabilitation, which was interesting to me as a new graduate entering the work field. The portion of his presentation that I found the most valuable was his six approaches to cognitive rehabilitation. I liked that he emphasized the importance of personalizing therapy to be specific to each patient. People learn in different ways and have various strengths and weaknesses. I understand that in order to treat our patients to the best of our ability, we need to focus on what works best for that individual.
Another important point I took away from Mr. MacLennan’s presentation was the various strategies to train cognition. For example, he discussed the importance of errorless learning. One thing he said that stuck with me was that errors interfere with the learning process. The more errors a person makes the less he or she is able to efficiently learn new information. I thoroughly enjoyed his tactic for demonstrating effortful learning vs. errorless learning. It kept me engaged with his presentation.
The remaining strategies that Mr. MacLennan presented on discussed the inclusion of assistive technology, direct training, specific skills training, and environmental modification. Assistive technology will most likely be needed with older patients and it’s vital that as SLPs we make sure our patients have access to any extra technologies needed to benefit their rehabilitation. It’s also important that we train the specific skill and provide sufficient repetitions so that the skill can be learned and retained. When training patients specific skills they should be given the opportunity to practice in the most natural environments. This will help to promote carryover. Lastly, modifying the patient’s environment to support his or her cognitive skills is vital for success.
From Jen Bruce
At the 2014 HSHA convention, Don MacLennan noted many barriers that people who are beginning or returning to college may experience following suffering a TBI. Those barriers include many skills that we as SLPs understand as necessary for success in an educational environment. For example, Kennedy & Krause’s 2010 study indicated that people with TBI experienced the following:
-Forget what was said in class
-Difficulty paying attention in class
-Feeling overwhelmed when studying
-Don’t understand assignments
-Nervous before tests
-Need to review more
Many of these issues stem from difficulty to self-regulate. SLPs must then assist our patients to realize what they can actively do in order to be more independent. One of these techniques is a concept of self-talk, which we frequently refer to as a broad treatment technique. Below I summarize some of the important facets of self-talk which Don MacLennan presented during the HSHA conference.
1) Self Talk Definition: from Dawson & Guare, 2012
“Coaching is fundamentally a process that helps students establish a link between long term goals which may be described as hopes and dreams and the daily behavior they need to perform in order to achieve those long term goals”
I had a clinical supervisor during graduate school who always told our patients that they “are the ones doing the hard work”. This quote helps me remember that patients may have difficulty seeing the link between what we do in therapy in the context of goals.
A flow chart MacLennon used during his presentation depicted the relationship between prediction of performance (the patient describes ideal outcome) -> use of strategies -> initiation/problem/self-monitoring -> concurrent self-monitoring during the task -> comparison between predicted and actual performance, in order to increase learning. (Kennedy & Coelho, 2005).
This construct may allow us to understand the use of a chart, following columns 1-3.
(1) (2) (3)
Plan: Do: Review:
3) Traditional Treatment vs Self-Coaching
Traditional treatment involves having the SLP direct treatment – with limited options for the patients – in a contextualized environment (e.g. workbooks rather than real world problems, “cookbook therapy”).
Use of Self-coaching, in contrast, allows the patient to direct goals in collaboration with SLP, as well as to identify relevant treatment strategies. When possible, this view allows the patient to self-direct in real-life activities, and increases independence and ownership of therapy.
4) Process of Self-Coaching
Focus will be on self-management and self-regulation. Goals direct behavior, focus energy towards goal, encourage persistence, and motivate the use of strategies.
5) Accounting for a “Planning Fallacy”
Students without TBI may have difficulty planning their time, an issue exacerbated by brain injury. By using the evidence based practice of Mental simulations of the process of their task, they are more likely to study earlier, study more, have less anxiety, and plan study time better. Mental stimulations may be the patient visualizing themselves sitting with their book, pens, and paper – reading and taking notes as part of their routine.
Using this process simulation increases motivation, and increases initiation – which are crucial skills for the successful college
From Emily Mohr
Information presented at convention for Newsletter:
Joining Forces: Collaborative Assessments and Interventions thru CHC
Andrew Shanock, Ph.D., NCSP
The focus of Dr. Shanock’s presentation was the overlap of Speech Pathologists and School Psychologists roles in assessment and intervention. His main point was that we do the same tests without knowing it (i.e., both of our tests given are assessing the same areas). He pointed out ways in which workload may be reduced if we can collaborate with each other through the use of the Cattell-Horn-Carroll: Cross-Battery Approach. This approach measures a wider range of cognitive abilities and there is no overlap, which makes for more time efficient testing. With the use of a more in-depth range of assessment we can therefore better individualize treatment.
The Process of Cognitive Rehabilitation
Don MacLennan, MA CCC-SLP
The focus of Don MacLennan’s presentation was the use of a variety of approaches and appropriate strategies for cognitive rehabilitation. He provided a wide range of examples on how to personalize treatment in order to make it meaningful for the patient across different conditions. He also provided examples of assessment strategies, as well as information on adjusting plans in order to meet goals. The overarching theme being, we provide guidance and it is up to the patient to decide what to do.
From Cierra Reed
I had the privilege of not only attending, but also presenting my research project/poster at the 2014 HSHA Convention. I was able to hear presentations by Andrew Shanock, Ph.D., NCSP and Don Maclennan, MA, CCC-SLP. While I found both speaker’s presentations enlightening, I found myself particularly interested in the information Mr. Shanock presented on regarding SLPs and school counselors working together to be more efficient with both time and quality. He went in depth in providing techniques counselors and SLPs can use to lessen the time for evaluating a child if they work TOGETHER. Many of the domains that are assessed by a school counselor are also tested by an SLP using a different testing instrument. If they work together, domains and subdomains that need further testing (due to low scores from an evaluation done by either the SLP or counselor) can be conducted instead of testing the same domains/subdomains twice. This also led to another topic that he presented about, knowing EXACTLY what the testing instrument you are using is actually assessing. For instance, one may think a particular domain is assessing short term memory, but is actually assessing working memory. Those are two big take away points that I found useful for not only school SLPs, but SLPs of different settings: 1) Working as a TEAM is a win/win situation for you, your coworker(s), and the client, and 2) Inform yourself and do research on the test instrument you are using to ensure that you are in fact evaluating the domains that you intend to assess on your client.
From Ashley Inferrera
Andrew Shanock, Ph.D., NSCP presented on the first day of the HSHA convention regarding the importance of collaborating with school psychologists for service delivery within the school setting. Typically, school psychologists and SLPs work individually during the evaluation process, sometimes even administering the same tests without even knowing it. Evaluations should be comprehensive in order to obtain a picture of the student as a whole and in order to accomplish this, ASHA, as well as Dr. Shanock, emphasize that assessments should involve the consultation of a student’s treatment team and the importance of working as a “team” when providing services. Assessment data should reflect multiple perspectives and Dr. Shanock suggested collaborating with school psychologists in order to provide a different perspective, in turn, increasing the accuracy of diagnosis and intervention development. Working as a team and collaborating is time effective, as it can reduce the amount of subtests administered during an evaluation and reduce the amount of report writing. Collaborating allows the treatment team to both agree with the direction of intervention, as well as provide support for every discipline and area of treatment.
From Primrose Buenaluz