arollwitz, Author at West Texas Rehab - Page 2 of 2

Author: arollwitz

Oral Motor Approach to Feeding and Speech

Posted on by arollwitz

Oral Motor function and skill is something you may hear your Speech-Language Pathologist talk about in reference to your child’s speech and feeding therapy. What does Oral Motor mean anyway? Oral motor refers to the movement patterns and muscles of the mouth. So it makes sense that Oral Motor function and skill are important for speech and eating. Therefore, when we look at speech and feeding delays through the lens of oral motor functioning, we are able to more specifically identify and serve those patients whose speech and feeding skill delays are a result of an oral motor function deficit.

Oral motor function impacts five major areas:

  1. Awareness of pressure and movement – The body’s automatic response to sensory input i.e.(trigger of swallow or cough to protect the airway)
  2. Control of Secretions – swallowing saliva, adequate lip closure to prevent drooling
  3. Coordination for eating, drinking, talking, and facial expressions- just like we need coordination to walk and ride a bike, we need motor coordination to eat and drink a variety of consistencies safely and efficiently, and to coordinate speech movements along with breathe.
  4. Knowledge of the environment-sensory receptors (taste and touch) give information about objects within the environment i.e.( when babies mouth and chew to find out more about things around them)
  5. Control of movements for talking – early developing sounds require slower, larger movements for cooing (vowels) and as development progresses and muscle skills improve new sounds emerge with the vowel sounds i.e. babbling (bababa, mamama). Once coordination increases sound combinations become more complex i.e. (first words -> phrases -> sentences).

All of these areas are vital in the development of normal speech and feeding abilities. If there is significant weakness or deficit in oral motor function, feeding and speech development may be delayed or disordered for a child’s age i.e. (problems with drooling, tongue thrust, gagging, poor suck, poor eating, poor food texture grading, limited food preferences, and poor speech production).

What’s the next step? A Speech-Language Pathologist will do a comprehensive evaluation to look at all areas of speech, language, and/or feeding abilities. As a part of this evaluation, the SLP will determine if oral motor assessment is indicated. If oral motor assessment is warranted, the SLP will measure your child’s oral motor function and determine if oral motor intervention is indicated as an appropriate approach for speech or feeding therapy sessions.

Don’t we need to work on actual speech or eating tasks to improve these areas?

YES, in order to improve/develop adequate speech and/or feeding skills, the main target of therapy will be to practice speaking and/or eating. However, there is more than one way to build muscle strength, control, and coordination. Just like there are many different exercises to increase core strength i.e. (crunches, sit ups, plank). If we incorporate a variety of different ways to work and provide input to the muscles used for speech and feeding, the greater the functional strength and coordination outcome.

Will Oral motor intervention magically produce speech or increased feeding skills?

Not on it’s own. However, when paired with targeted speech or feeding intervention tasks, oral motor exercises can increase awareness and sensory input to the muscles which impact muscle activation, planning, programming, and execution. We need all of these components for everyday speech and feeding tasks.  To find out more information contact our Speech Therapy department in San Angelo or Abilene.  https://westtexasrehab.org/services/

References:

Beckman, D. A. (1986 Rev. 2007) Beckman Oral motor Assessment and Intervention.

Published by Beckman & Associates, Inc.

620 N Wymore Rd STE 230, Maitland, Florida 32751-4253.

www.beckmanoralmotor.com

Written by:

Kalee Rupe M.S. CCC-SLP

The Manufacturing Process: Employees Included

Posted on by arollwitz

KARIL REIBOLD

JUN 27, 2023 11:00:00 AM

As I tour a manufacturing facility, I am in awe at the care taken in the design of the production process flow.    Resin stored outside is piped into each machine through an elaborate web of piping, the machines have varied degrees of automation, and the floor plan is strategically designed for optimal productivity and efficiency.  My tour guide shows pride in the design and care taken, the automation, and the complexity of the manufacturing workflow.  The final steps in the manufacturing process involve humans … aka employees.  They are in repetitive motion jobs with physically demanding work and long shifts (10 -12 hours) on their feet.

After the tour, the team gathers at a board to review each machine’s current “uptime” and availability to meet today’s production needs.  The fear of lost productivity is real.  Each year in the US, manufacturers lose an estimated $50B in lost productivity due to unplanned downtime.  A team of machine maintenance employees is focused on uptime and break fixes because it is so critical to keep the machines running.  These employees are essential in the manufacturing process yet are an often-overlooked component of the “uptime” discussion.

According to Harvard Business Review (HBR), employee “downtime” due to lost productivity is estimated at $150B with presenteeism and absenteeism combined.  And the Institute of Medicine reports that workers’ compensation claims for MSK -related work injuries are between $45B -$55B annually.  Abrupt changes in available staffing in labor-intensive industries create bottlenecks, lost productivity, and an internal scrambling to juggle resources and meet deadlines.  This scenario may mean longer shifts for some employees, increasing the risk of injuries.

The key component for a strong foundation is prevention.  Creating a “well-oiled” manufacturing or distribution environment starts with ensuring production uptime of all process components- both people and machines.  
Some foundational components to address the human element are:

  • Understanding the physical demands of the job.  Performing functional job analysis (FJA) and creating Functional Job Descriptions (FJD)
  • Implement a Post Offer Employment Test (POET) utilizing FJDs to ensure the candidate is physically able to do the job.
  • Invest in a Managed MSK onsite clinic to design, deliver and manage to create a solid foundation of employee health.   Staffed with a highly trained provider (PT, OT, ATC) and managed by a team of experts, some aspects include:
    o    Catching aches and pains before they turn into injuries 
    o    Onboarding and conditioning new hires 
    o    Job coaching and workplace modifications 
    o    Trusted resource to employees on MSK and wellness 
    o    Proactive programs, warm-ups, micro-breaking, and toolbox talks that have lasting results due to the onsite presence.
    o    Small footprint and investment with a significant impact

Yes, it requires spending a little time and money but think about the long term in effectively, safely, and efficiently keeping people healthy and on the job. Investing in machines and people builds a solid foundation for a productive and safe work environment.

If you’d like more information on our WorkSteps programs, please contact our Employer Services departments in Abilene at 325.793.3443, San Angelo at 325.223.6370, or Ozona at 325.392.9872 or go to https://westtexasrehab.org/services/

Pumping for the Working Mom

Posted on by arollwitz

Pumping for the Working Mom

By: Anna Nguyen, M.S., CCC-SLP, CLC

Speech-Language Pathologist, Certified Lactation Counselor

Maternity leave coming to an end can trigger a lot of feelings: sadness to leave your baby, excitement to be back at your job, or anxiety about pumping. If you have been breastfeeding your baby for the last few weeks or months, you know the benefits of breastfeeding are worth the effort. Going back to work may mean you have to pump more than you previously did. Maybe you are an exclusive pumper who is used to pumping in the comfort of your home and have not had to worry about milk storage outside of the house. Either way, pumping and working can be a tricky transition.

A general rule of thumb for pumping when separated from your baby is to pump as often as your baby would eat. For a baby around 12 weeks old, that typically means you would need to pump 3 times during your 8:00-5:00 day. It can be easy to worry about supply, saving up, or having enough but all you need is enough for the next day’s bottles. A sample schedule may look like this:

7am: breastfeed baby at home

9/9:30am: pump

12/12:30pm: pump

3/3:30pm: pump

5/5:30pm: breastfeed

**This schedule is only a sample and may look different depending on the needs of you or your baby.

Breastmilk is safe to keep in a closed container in the work fridge. However, some parents prefer to keep their breastmilk in a more personal location or do not have access to a fridge. Other options can include a cooler bag with an ice pack or specially designed thermoses for breastmilk. Be aware that adding warm breastmilk to either a cooler with an ice pack or a thermos may change the temperature of the container as milk comes out at body temperature.

According to the Centers for Disease Control and Prevention (CDC), freshly pumped breastmilk is safe to stay at room temperature for a maximum of 4 hours, can stay in the fridge for up to 4 days, and in the freezer for up to 6 months for best retention of nutrients and 12 months for adequate retention of nutrients. Previously frozen breastmilk should be used within 1-2 hours of it being thawed, up to 24 hours in the fridge, and should NEVER be refrozen after it has been completely thawed. Once a bottle of milk has been given to a baby, the milk should be consumed within 2 hours or less due to bacterial growth that takes place when the milk touches saliva.

Breast pumps are not as efficient at removing milk as a baby and some mothers find difficulty with supply or achieving a letdown when pumping or when separated from their baby. Finding a quiet place at work away from your work to allow yourself to relax, looking at pictures or videos of your baby, or even bringing some of your baby’s clothes or blankets to smell while pumping can help with the hormonal production needed to achieve a letdown.

If you find yourself needing a more personalized schedule for pumping at work, exclusively pumping, or combination feeding your baby, contact me for an evaluation.

Anna Nguyen, M.S., CCC-SLP, CLC

Speech-Language Pathologist, Certified Lactation Counselor

anguyen@wtrc.com

Lymphedema Treatment Act passed by Congress in 2023 goes into effect January 1, 2024

Posted on by arollwitz

FOR IMMEDIATE RELEASE

Contact: Heather Ferguson

Heather@LymphedemaTreatmentAct.org

704-965-0620

 

Health Provision Passed by Congress will Help Millions Who Suffer From this Under-Recognized Chronic Disease: Cancer survivors and others with lymphedema applaud inclusion of the Lymphedema Treatment Act in the Consolidated Appropriations Act of 2023

For 12 years, the all-volunteer Lymphedema Advocacy Group led a grassroots campaign to close the unintended gap in Medicare coverage that prevented the program from covering prescribed medical compression garments that are the cornerstone of treatment for lymphedema.

“My son who was born with lymphedema was prescribed his first compression garment when he was seven months old,” said Heather Ferguson, the Founder and Executive Director of the group. “Our insurance company denied it because they aligned their coverage with Medicare.”

An estimated 3-5 million Americans suffer from lymphedema, a disease that causes painful and potentially life-threatening buildup of lymphatic fluid in the body. About two-thirds of patients acquire the condition due to damage done to their lymphatic system during cancer treatment, but there are also many other causes of lymphedema, including congenital malformations.

During each of the last three Congresses the Lymphedema Treatment Act had tremendous bipartisan support, with over 400 House and Senate cosponsors. As Congress concluded their work in 2022 the bill was included in the year-end omnibus spending package, creating a new Medicare Part B benefit category for lymphedema compression supplies.

“I am proud that the Lymphedema Treatment Act, which I have worked on for many years, was included in this package. Lymphedema is not a choice. Access to care should not be either,” said Congresswoman Jan Schakowsky (D-IL-9), who sponsored the bill in the House.

“Lymphedema patients have been denied this coverage for far too long. After battling cancer, survivors can be met with this equally debilitating diagnosis, but with far fewer resources in place to assist them,” said Congressman Buddy Carter (R-GA-1), who co-led the House bill. “As a pharmacist and a child of a cancer survivor, I’ve seen the pain that lymphedema can cause. To those patients – help is on the way.”

“Lymphedema affects more than 8,000 Medicare beneficiaries in Washington state and millions of Americans. By updating Medicare, we’re reflecting necessary and effective treatments for this condition,” said Senator Cantwell (D-WA), who sponsored the bill in the Senate. “This new law is a commonsense approach to improving care for Medicare beneficiaries living with lymphedema while reducing costly hospitalizations.”

The Senate bill was co-led by Senator Chuck Grassley (R-IA). According to multiple studies and real-world data, the use of medical compression garments has been proven to significantly reduce lymphedema-related infections and other complications, and an independent analysis by Avalere concluded that improved access to these doctor prescribed supplies would save Medicare hundreds of millions of dollars annually through avoided hospitalizations.

“As an SSDI and Medicare beneficiary I have experienced more frequent infections since being on Medicare and not having coverage for my compression garments,” said Sarah Bramblette, Board Chair of the Lymphedema Advocacy Group. “Being able to better manage this chronic disease will greatly improve my health and quality of life.”

Patient advocates and stakeholder groups will now work with the Centers for Medicare and Medicaid services as they implement the new coverage, which will go into effect January 1, 2024. The Lymphedema Advocacy Group plans to celebrate passage of the bill and announce next steps at an upcoming event in Washington, DC, which may occur in March, during Lymphedema Awareness Month. Advocates interested in more information can go to LymphedemaTreatmentAct.org.

May is Stroke Awareness Month

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May is Stroke Awareness Month, a time dedicated to increasing awareness about stroke, its causes, and its impact on individuals and families. Stroke is a leading cause of death and disability worldwide, and it is important to understand its warning signs and risk factors.

A stroke occurs when blood flow to the brain is disrupted, either due to a clot blocking a blood vessel (ischemic stroke) or due to bleeding in the brain (hemorrhagic stroke). When the brain is deprived of blood and oxygen, brain cells start to die within minutes. This can lead to permanent brain damage, disability, or even death.

According to the American Stroke Association, someone in the United States has a stroke every 40 seconds, and someone dies from a stroke every four minutes. In addition, stroke is a leading cause of serious long-term disability, with more than 6.5 million stroke survivors currently living in the U.S.

While stroke can affect anyone, certain risk factors increase the likelihood of having a stroke. These include high blood pressure, smoking, diabetes, high cholesterol, obesity, and a family history of stroke. People who have had a previous stroke or transient ischemic attack (TIA, or “mini-stroke”) are also at higher risk.

Recognizing the warning signs of stroke is crucial for getting prompt medical attention and preventing long-term damage. The acronym “FAST” is an easy way to remember the signs of stroke:

  • Face drooping: Does one side of the face droop or feel numb?
  • Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
  • Speech difficulty: Is speech slurred or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.”
  • Time to call 911: If someone shows any of these symptoms, call 911 immediately.

Getting to a hospital quickly can make a big difference in a stroke patient’s outcome. Certain treatments, like clot-busting drugs or mechanical thrombectomy, are time-sensitive and can only be given within a few hours of the onset of symptoms.

Stroke Awareness Month is an opportunity to spread the word about stroke prevention, recognition, and treatment. By raising awareness, we can help more people understand the risk factors, warning signs, and actions to take in the event of a stroke. This knowledge can ultimately save lives and improve outcomes for stroke survivors.

Source: https://thestrokefoundation.org/stroke-awareness-month/

Sensory Defensiveness and Anxiety

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Usually when you think of sensory defensiveness we do not think of anxiety as a part of “sensory issues”. However, many times when children have difficulties with sensory modulation disorders, they will also have anxiety due to either over responding to sensory input.

When sensory integration is working…

A child can attend to tasks

Change routines without stress

Can tolerate touch, sounds and can listen

Tolerate transitions in activities

Tolerate most textures with feeding and touch

Tolerate movements

Tolerates most visual input as well as auditory

Can play, and vary types and intensities of sensory experiences.

Have the ability to conceptualize, organize, and execute non-habitual motor tasks (praxis)

Children with sensory modulation disorder may demonstrate behaviors appearing “over-responsive” or have a low threshold (takes little sensory input to set them off. Winnie Donn, Ph.D.,OTR, FAOTA). “These children can be fearful of movements, defensive to touch, certain textures, have feeding problems or be sensitive to sounds.  They appear to have anxiety, and can often have behavioral outcomes.

When a child is “under-responsive” or has a high threshold, it takes a lot of sensory input to achieve the ‘just right’ threshold.  These are the children that seek out sensory input, such as running, crashing, jumping, or have lack of attending.  They have a decreased awareness of tactile or auditory input (such as calling their name). These children can also have difficulties with emotional/behavioral regulation.  Some children can fluctuate between the two extremes.  Dunn, Winnie, 1999, The Psychological Corporation.

As a therapist working with toddlers or older children, learning strategies to deal with the sensory issues as well as the anxiety is paramount. Sometimes the anxiety can manifest into sensory issues.

Toddlers:

With toddlers there can be a wide array of sensory issues that can set them off.  I usually have parents start out by filling out the “Sensory Profile”, then as a therapist I want to know their likes and dislikes and will have the parents give a list of both. Again, working closely with parents so they may be successful at home, daycare, church or any environment that was challenging for the child.

I start out with a plan of heavy work activities that is suited for the child. Heavy work  is any type of activity that pushes or pulls against the body. Heavy work activities can help kids with sensory processing issues feel centered. Heavy work engages a sense called proprioception, or body awareness.  I also encourage parents to start working on this at home.

For Older children:

Again, we get them involved with heavy work as this is generally calming to most children in a high or escalated state.

We also work on self -awareness of the level of anxiety using charts (see below).  On this particular chart the levels are 1-5 with 1 being happy and 5 being “I feel Anxious!” or “I feel like hurting myself.”  We recognize some anxiety is healthy, however when it interferes with daily activities such as school work, relationships, performance in daily tasks at home it is no longer healthy.  I have children look at the chart 5 times throughout the day and read their levels, if they are getting to a level 3, 4, they need to address the anxiety before it gets out of control by performing heavy work activities, or favorite activities to calm them down.

My child was just diagnosed with a speech/language impairment, now what?

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by Anna Nguyen, SLP

As a therapist, my day-to-day is pretty routine. Do therapy. Drink coffee. Document. Drink more coffee. Do an evaluation. As a parent, bringing your child in for an evaluation is anything but routine. I imagine there is a flood of emotions. “Is it because I put them in daycare too early?” or “Is it because I didn’t put them in daycare?” And even “Is it because 2 languages are spoken at home?”

Rest assured. None of these things are the reason. As much as I would love to think I know everything in the world, there is not always a hard and fast reason for why some children’s language develops slowly or differently than others. Sometimes it just happens.

When your child is evaluated for therapy, there will be a lot of questions we might ask. It is OK if you do not know all of the answers. Say that with me again. IT IS OK to not know all of the answers. The SLP will then make recommendations for therapy, re-evaluation, home program, or discharge.

Now let’s say your child was just recommended to receive therapy for language skills. We expect you and your family to be active partners in this process with us. We cannot fix your child. We can help your child gain new skills. But it is YOUR job to give your child experience and practice with these skills. Here are a few ways to help be a partner in your child’s road to successful communication:

1) Read with your child every day. Read interactively, do not just recite the words. Point things out in the book. Ask questions. If your child points to a picture, explain that picture to them.

2) Play with your child every day. The most important thing a child can do is play. This is where they learn vocabulary, social skills, and problem solving. You being a play partner opens up a new world full of new actions, words, and lessons.

3) Expand on what your child is saying. If you are trying to get your child to use sentences rather than just single words and your child sees a dog and says “dog” this is a perfect opportunity to fill in their gaps! “Oh look at that dog run! He is fast! Hi dog!” For older children, talk about what you know about a dog. “Our dog is brown but that dog is ____”

4) If you have a question, ask. Your SLP is your partner. Never be afraid to ask for our advice on anything. We are both working toward the same goal–increasing your child’s communication!


More about Anna…

Anna Nguyen is a speech language pathologist in San Angelo. She was born and raised in Abilene and attended Abilene Christian University for her B.S. in Communication Disorders and Psychology. She continued on to Texas Tech University Health Sciences Center to get her M.S. in Speech-Language Pathology. She has been at West Texas Rehab since 2015 and loves the patients and coworkers she sees each day. “I began to grow my knowledge with feeding disorders and feeding therapy and loved it!

I had my sweet baby boy, Oliver, in 2021 and struggled with breastfeeding. I joined different Facebook groups to get advice and, after a while, found myself trying to share my journey in order to help others be successful. It was during this

time that I realized that I had a passion for breastfeeding.” Anna explains. After completing coursework, clinical competencies, and the certification exam, she received her certification as a Certified Lactation Counselor in August 2022. “I have months of personal experience with exclusive pumping, milk storage, and weaning. I am also confident in my ability to help parents of preterm infants or infants born with differing abilities be successful in their pumping or breastfeeding journey. Breastfeeding not only allows a unique bond to form between the nursing parent and the child, but it also benefits both the nursing parent and the baby! I am excited to share my passion and expertise with parents wishing to pursue their breastfeeding journey!” Anna exclaims.

What is LSVT BIG and what does it have to do with helping Parkinson’s patients?

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LSVT BIG (Lee Silverman Voice Treatment) is a specific treatment regimen that was developed after it was shown that specific cues for patients that deal with Parkinson’s Disease helped to address their voice deficits. Some of the most commonly shared symptoms of movement with Parkinson’s Disease involve freezing or festinating gait (shuffling), smaller overall movements with upper and lower extremities, and rigidity of joints- specifically with trunk movement. With Parkinson’s Disease, the patient’s internal comparator (basal ganglia) is thrown off due to the decrease in overall dopamine, which is the neurotransmitter within the body that helps this part of the brain work properly. This leads to many symptoms, including those listed above. With LSVT BIG, the therapist helps the patient utilize EXTERNAL cues to help improve their overall movement. Since the patient’s internal system is not working properly, it is crucial that the patient understands that their movement is smaller than intended and that in order to produce normal movement, they need to move BIG. This is a very common cue that is used within LSVT BIG which signals the patient to make bigger movements with their arms, legs, and with the way they move their whole body throughout the day. With constant feedback and constant practice, patients going through this treatment are able to learn to produce better movement, which can help their quality of life and safety with improved overall gait speed and stability.

by Brady Holcomb, PT, DPT

More about Brady:

My wife Leslie Ann and I moved from Lubbock to Abilene in August of 2019 when I accepted a position at West Texas Rehab Center. I received my Bachelor’s of Science in Exercise Sports Science from Lubbock Christian University and a Doctorate of Physical Therapy from Harding University. After graduating from physical therapy school in 2018, I was provided the opportunity to practice in rural health in outpatient orthopedics before coming to Abilene. I have a passion for serving rural communities, and still see that passion being fulfilled in serving the people who live in and around the Abilene area. I have a special interest in Parkinson’s Disease after being certified in LSVT BIG and getting the chance to work with patients dealing with this disease process. I am also certified in Dry Needling and have an interest in orthopedics, specifically in treating a variety of shoulder injuries. In addition, I am currently pursuing additional certification to be an Orthopedic Clinical Specialist. My hobbies outside of work include road and mountain biking, hiking and running with my wife and my sheepadoodle Gimli, and also playing the guitar and the banjo.