Pragmatically Blind

A few months ago I listened to an episode of a podcast called Invisibilia and the topic was expectations. They recounted how expectations can have both positive and negative results, and talked to a blind man named Daniel Kish who has a remarkable sense of his environment.

What struck me most about the discussion was not the discourse surrounding sight or the lack thereof, but on the arguments in favor of or against the use of 'clicking' for blind people to navigate their world (referred to as echolocation). Many blind people are discouraged from clicking, it seems, as they are told that it is not socially appropriate. By whose standards is it not appropriate? By sighted people.

I find it appalling that individuals out there "helping" people are limiting functional behaviors which can foster independence because people with sight may not understand it or somehow find it uncomfortable. In this case, it's not blind people who need to adjust, but everybody else.

Posted on February 7, 2016 and filed under communication, links.

◆ Looking back and moving forward.

2015 started out as a year of uncertainty for me: I was leaving my job of over three years to venture out into the unknown. I was stressed out, exhausted, and not sure how to proceed. I had tied much of my professional identity to being an acute care SLP, and the thought of changing was incredibly daunting. Would I be able to jump into the world of rehab and know what to do? Would I like it? Would I be able to make ends meet?

In the midst of this large professional shift, my family was having its own challenges. My mom was in the middle of chemo and radiation treatment for cancer, and making sure I was present for my parents was very important to me.

This blue bear served as a frequent reference point for me when trying to navigate the Denver convention center at #ASHA15.

This blue bear served as a frequent reference point for me when trying to navigate the Denver convention center at #ASHA15.

When I first wrote about this change I had no idea what all these changes would look like. As these things so often seem to go, nothing goes according to plan. Because the credentialing process for insurance takes a very long time, and because I was the very first SLP at the private practice, I had to find other work while waiting to be approved to provide services in that setting.

To sustain myself in the meantime, I picked up a PRN position in home health. This was (and is) a fascinating and challenging position, and was a wonderful way to rebuild my therapy skills. I also picked up freelance interpreting work. I was a sign language interpreter before becoming an SLP, and have long kept up a small handful of hours on the side. Picking up more hours was a helpful change of pace, and afforded me a nice variety to my work.

With all that said, here's some things I've learned in 2015 that I believe will make 2016 an even more exciting year.

The Denver convention center was an easy walk from the hotels and the sunny weather made for a very pleasant convention experience. 

The Denver convention center was an easy walk from the hotels and the sunny weather made for a very pleasant convention experience. 

Trust those instincts.

From figuring out how to proceed in therapy, to knowing what kind of work to accept, pay attention to that little voice especially if it expresses nervousness. In the process of my hiring for both the home health and the outpatient positions, I noticed a fair amount of disorganization that left me nervous, so I accepted only PRN positions to afford me more flexibility in that environment. As a result, I've been able to be flexible with my hours and make sure that my caseload is manageable.

Learn new things.

It's no secret that I enjoy conferences. They are in part a social experience for me, since it's a chance to see colleagues from around the country (and world). Meeting new colleagues is equally important. The interaction with my fellow SLPs and audiologists allows as much opportunity to learn as the workshops themselves.

This year, I stepped out of my comfort zone and attended some sessions in areas which I don't currently treat. For example, I attended a session about transgender voice therapy, and it turned out to be one of my favorite sessions of the entire convention. When thinking about why this was, I realized that it was because I got to think about therapy in a different way for a change. Also, one of the topics emphasized in the talk was principles of motor learning, which is a hot topic in the areas of dysphagia and motor speech. Hearing it discussed in new ways, by SLPs who talk about their work differently than I do, was a fantastic way to really start to get a better grasp of the concept and understand why it is so vital to therapy. On top of that, it helped me learn about an area I have interest in, but not experience or training. It may help open new doors in the future, and in the meantime has already helped make me a better clinician.

The main entryway in the Denver convention center. 

The main entryway in the Denver convention center. 

Do the right thing.

Ethical challenges come in all shapes and sizes. It may be a company that accepts more patients than they have staff to accommodate. It may be an employer with unethical billing practices. It may be pressure to see more patients than you are able to handle.

In the past year, all of these situations have presented themselves to me, in varying degrees of seriousness. It proved to be to my advantage to accept work only on a PRN basis, as it has afforded me more control over my time and my work. I do not accept new patients unless I know I can commit to providing their treatment consistently. Having become all too familiar with burnout, I recognize and honor my limits, and always remind myself that if I don't take care of myself, I'll be a less present, and therefore less effective, clinician for my patients.

I love windows that move up tall buildings, and appreciated all the light they brought to the convention.

I love windows that move up tall buildings, and appreciated all the light they brought to the convention.

Move forward.

For me, 2015 was a chance to reboot. Though I wasn't looking for it at first, change found me and reminded me I needed it. Challenges presented themselves and I found strength I didn't know I had. I re-invented myself in ways I hadn't imagined I could, and in the process of learning about myself, I found myself growing both personally and professionally. My patients were a big part of that growth, and have helped me to identify new goals for myself.I never used to set goals for myself. In my last job, we had an annual performance review, and I always had a hard time thinking about what I wanted to accomplish in the next year. "I just want to do my work and do well at it," I used to say. This year, I find myself having tangible goals I want to accomplish. Among these, I want to more readily identify ways to target and help my patients meet their goals. I want to start a business and learn to establish contract relationships so I can be more flexible and mobile with my services. In this vein, I want to write about what I learn, both so that I can hold myself accountable with my goals, have a way to look back on what I've learned, and also that others may learn from my experience (both the good and the bad).

Cheers to 2016. Let's make this year an awesome one.

◆ En Route to #ASHA15

Traveling is always an interesting way to observe both how we communicate with one another, and how stress can impact communication. It can also remind you just how bizarre it can be to interact in worlds we consider familiar.

After arriving to the airport this morning, I found myself standing in line for security in front of an unusual man wearing sunglasses. He was friendly to a fault, and started talking to me despite my not having made eye contact, or even offering a 'good morning'. He wore dark sunglasses, slicked back hair, and carried a bag containing a suit jacket. Instead of a greeting, he said "I only need to show my boarding pass, right?"

We carried on in silence for a while, in part because when I travel, I like to retreat into my thoughts more than interact. Perhaps it's a means to handle the sheer number of people, though perhaps it's also because I hadn't yet had any coffee, so I wasn't feeling terribly social.

After a few minutes, he broke the silence again. "They don't have dog sniffers in Phoneix, do they?"

Setting aside the unusual turns this conversation took, I found myself thinking about my patients. How doe they handle these situations? Do my patients with aphasia try to talk when they travel, and if so, what sort of reception do they receive? What can I do to maximize their success in such situations, even in the early stages of therapy? It's so easy to take such "simple" communciation for granted.

This is a reminder to me that communication, and indeed language, are not simpley words and turns taken. It's the setting, the body language, the mental state of the people you're trying to interact with. It's the events that lead up to your arrival, and also to everyone else's arrival. It's the lights, the sounds, the smells, the stress.

I am on my way to the annual convention to meet my friends and colleagues, and to learn new things. I always look forward to this, and am excited for the advneture ahead.

Posted on November 11, 2015 and filed under ASHA, continuing education.

◆ It's Conference Time Again!

The annual ASHA Convention is coming up in one week, so I’m gearing myself up for traveling, seeing some fantastic colleagues, and learning as much as I can. It hasn’t been long since I last attended a conference, and I’m looking forward to taking the lessons I learned there and bringing them to #ASHA15. The ASHA Convention is, by my rough estimation, just shy of ten times as large as the more intimate ASHA Healthcare and Business Institute (this estimation includes this year’s combination with ASHA Schools). While I think I prefer the intimacy of the smaller conference, I am nonetheless very excited for the convention ahead.

A little prep work can go a long way to ease the stress of such an enormous event. Here’s some things I’m doing this year differently than I have in years past, which I anticipate will make for a smoother and more productive experience.

  1. As I did for the Healthcare and Business Institute, I took the day off Wednesday so I could fly in earlier in the day. The extra time to check in to my hotel, unpack a bit, and explore the area has a huge impact on the experience as a whole. When you have three solid days of learning ahead of you, be good to yourself and don’t start the experience off with so much rushing.

  2. Though I will be tweeting throughout the convention, I will not be live-tweeting my sessions. I also won’t be typing notes on any of my various devices. I love my technology, for sure, but I found such a significant difference in what I took away from my sessions by writing my notes by hand that I will be doing so again. I may write a tweet here and there, for various powerful points during sessions. As always, you can find me tweeting @ProjectSLP.

  3. I have been planning my sessions ahead of time, and giving myself a few options for back-ups if I need. This alone reduces the stress of trying to figure out where to go, freeing up cognitive resources to better attend to what I’m trying to learn. It also has the benefit of making it easier to meet new colleagues along the way.

  4. I’m bringing a small backpack to carry around my convention program, my notebook, some pens, a water bottle, and snacks. I purposely keep the bag small to help keep me from acquiring too many things along the way. The exhibit hall is a wonderful place to visit but the number of papers and freebies really can add up. By making sure I have limited space, I only acquire things I know I will find useful, and it has the added benefit of keeping things simple. As the saying goes, less is more.

Also, if you want to come visit all the #SLPeeps from the internet, do consider joining in at the “unofficial” (non-ASHA-affiliated) tweet-up.

Posted on November 5, 2015 and filed under ASHA, continuing education.

Movement and the Brain ⇒

A very interesting case study came out recently, looking at the neurological function of a particularly active 93-year-old woman named Olga Kotelko (she died in 2014 at age 95) . She became an athlete in her sixties playing softball, then started track and field at age 77. Exercise benefits are often assumed to apply to our physical state, and it also seems to be associated more and more with good mental health. This study took things a step further and looked at her overall brain function to see if her routine exercise had any impact on both the brain itself as well as cognition.

“In general, the brain shrinks with age,” [University of Illinois Beckman Institute postdoctoral researcher Agnieszka] Burzynska said. Fluid-filled spaces appear between the brain and the skull, and the ventricles enlarge, she said.

“The cortex, the outermost layer of cells where all of our thinking takes place, that also gets thinner,” she said. White matter tracts, which carry nerve signals between brain regions, tend to lose their structural and functional integrity over time. And the hippocampus, which is important to memory, usually shrinks with age, Burzynska said.

Previous studies have shown that regular aerobic exercise can enhance cognition and boost brain function in older adults, and can even increase the volume of specific brain regions like the hippocampus, Kramer said.

Kotelko’s brain offered some intriguing first clues about the potentially beneficial effects of her active lifestyle.

Though it wasn't strongly emphasized in the article, something else really grabbed my attention:

“During dinner after the long day of testing, I asked Olga if she was tired, and she replied, ‘I rarely get tired,’” [Beckman Institute director Art] Kramer said. “The decades-younger graduate students who tested her, however, looked exhausted.”

It really does seem that our culture has a problem with sleep. I'm as guilty of not getting enough sleep as anyone. I have a bad habit of getting only around 6-7 hours of sleep per night. I blame the amount of things I have on my plate at any given time for this, but the likelier truth is that if I would get enough rest, I could probably manage all of these things with greater efficiency.

In any case, one of my goals since transitioning settings has been to both increase the amount of sleep I get and also start to exercise more. Forming new habits is hard, but watching Olga herself on video shows that it's clearly worth it.

Posted on September 12, 2015 and filed under cognition, research, links.