Good News - FDA Approved Cochlear Implantation at 9 Months

Cochlear receives FDA approval to lower the age of pediatric cochlear implantation to 9 months.

https://www.cochlear.com/us/en/corporate/media-center/media-releases/2020/fda-ped-9-months#:~:text=Centennial%2C%20Colo.,bilateral%2C%20profound%20sensorineural%20hearing%20loss.

Cochlear received FDA approval to lower the age of implantation at the beginning of COVID-19 crisis; earlier access to cochlear implantation for children provides opportunity for better hearing, speech and language outcomes in children born deaf.

https://www.prnewswire.com/news-releases/as-surgeries-resume-pediatric-cochlear-implantation-can-now-be-done-as-young-as-9-months-301060328.html

Nucleus 24 Cochlear Implant System - P970051/S172

https://www.fda.gov/medical-devices/recently-approved-devices/nucleus-24-cochlear-implant-system-p970051s172

Check “Cochlear Implant in Children” to learn about Cochlear Implant

http://slpzone.blogspot.com/2013/06/cochlear-implant-in-children.html

Emotional eating – Obesity and COVID-19 mortality

Eating disorders - In clinical terms, the American Psychiatric Association's http://glossary.feast-ed.org/home      current diagnostic manual, identifies three categories of eating disorders: 

Anorexia Nervosa, 

Bulimia Nervosa and 

Eating Disorder Not Otherwise Specified (EDNOS).

https://youtu.be/lsxnG2dBrr4

Video - Stress Eating

EMOTIONAL EATING

Definition

Emotional eating is defined as the "propensity to eat in response to positive and negative emotions” https://en.wikipedia.org/wiki/Emotional_eating, as a means of suppressing, numbing and/or soothing emotions such as Stress, Anger, Frustration, Fear, Anxiety, Depression, Boredom, Loneliness, Insecurity, Resentment, Fatigue or Happiness.

http://glossary.feast-ed.org/5-psychology-and-therapies/emotional-eating 

Common signs of emotional eating are:

https://www.uofmhealth.org/health-library/aa145852

• Changing your eating habits when you have more stress in your life.
• Eating when you are not hungry or when you are full.
• Eating to avoid dealing with a stressful situation.
• Eating to soothe your feelings.
• Using food as a reward. (For example, "That was really a tough job/ assignment/ argument. I need some ice cream/candy/popcorn!")

Long-term effects of an emotional eating include:

https://www.psychguides.com/eating-disorder/symptoms-causes-and-effects/

• All of the many health risks associated with obesity, such as heart disease, hypertension and stroke
• Rickets, scurvy and other diseases caused by chronic vitamin deficiency
• Tooth decay
• Depression, either caused or exacerbated by the underlying eating disorder

"Comfort" Foods

We all have our own comfort foods. Interestingly, they may vary according to moods and gender. One study found that:

• happy people seem to want to eat things like pizza,
• sad people prefer ice cream and cookies, while
• bored people crave salty, crunchy things, like chips,
• guys seem to prefer hot, homemade comfort meals, like steaks and casseroles, while
• girls go for chocolate and ice cream.

Why does no one take comfort in carrots and celery sticks?

High-fat foods, like ice cream, may activate chemicals in the body that create a sense of contentment and fulfillment. This almost addictive quality may actually make you reach for these foods again when feeling upset. https://kidshealth.org/en/teens/emotional-eating.html

Physical Hunger vs. Emotional Hunger

The trouble with emotional eating is that once the pleasure of eating is gone, the feelings that

cause it remain. And you often may feel worse about eating the amount or type of food you did.

The differences between physical hunger and emotional hunger.

Physical hunger:

• comes on gradually and can be postponed
• can be satisfied with any number of foods
• means you're likely to stop eating when full
• doesn't cause feelings of guilt

Emotional hunger:

• feels sudden and urgent
• causes very specific cravings (e.g., for pizza or ice cream)
• you tend to eat more than you normally would
• can cause guilt afterward

https://youtu.be/CSHO9VdVRfg

Treatment 

First step

Break the Cycle and get emotional eating under control.

https://www.helpguide.org/articles/diets/emotional-eating.htm

Tips to Try https://kidshealth.org/en/teens/emotional-eating.html

1. Explore why you're eating and find a replacement activity. For example:

• If you're bored or lonely, call or text a friend or family member.
• If you're stressed out, try a yoga routine, listen to some feel-good tunes and let off some stress by jogging in place, doing jumping jacks, or dancing around your room until the urge to eat passes.
• If you're tired, rethink your bedtime routine. Tiredness can feel a lot like hunger, and food won't help if sleepless nights are causing daytime fatigue.
• If you're eating to procrastinate, open those books and get that homework over with. You'll feel better afterwards.

2. Write down the emotions that trigger your eating in journal.

• Write down what you ate, how much, and how you felt as you ate (e.g., bored, happy, worried, sad, mad) and whether you were really hungry or just eating for comfort.
• You'll be able to use this information to make better choices (like choosing to clear your head with a walk around the block instead of a bag of chips).

3. Pause and "take 5" before you reach for food. Just tell yourself to wait and take time to reflect.

• Can you put off eating for five minutes? Or just start with one minute. Don’t tell yourself you can’t give in to the craving; remember, the forbidden is extremely tempting. 

Second step

Eat balance and healthy food. Stop snacking between meals. Practice mindful eating, at the table, without distractions (TV, phone…)

Third step

Exercise regularly. Physical activity does wonders for your mood and energy levels, and it’s also a powerful stress reducer.

Support yourself with healthy lifestyle habits!

Childhood Apraxia of Speech (CAS) - Therapy Tools

Basia

To refresh my knowledge about Apraxia I took “Building and Expanding Your CAS Toolkit” ASHA web presented by Ruth Stoeckel

What is Childhood apraxia of speech (CAS)?

CAS is a neurological pediatric speech sound disorder (SSD) that impairs speech motor planning/programming. CAS can delay acquisition of skills including the control of vocal pitch, intensity, and duration of speech sounds [ASHA Ad Hoc Committee on Apraxia of Speech in Children 2007].

It also impairs the child’s ability to correctly pronounce sounds, syllables, and words. CAS can thus render the child unable to start articulating the first sounds, and can lead to a serious communicative disability.

CAS can be difficult to diagnose and monitor due to a high comorbidity with other speech and language disorders and a lack of specific tools [Newbury and Monaco 2010].

By working intensely with a trained speech language pathologist (SLP), those with CAS can overcome their motor planning and motor programming difficulties (articulation capabilities) [ASHA Ad Hoc Committee on Apraxia of Speech in Children 2007].

Basia

Read my other posts about CAS

Childhood Apraxia of Speech (CAS)

http://slpzone.blogspot.com/2013/03/childhood-apraxia-of-speech-casis-also.html

Apraxia Treatment

http://slpzone.blogspot.com/2013/03/apraxia-treatment.html

Apraxia Tests

Kaufman Speech PraxisTest for Children (KSPT)

Screening Test forDevelopmental Apraxia of Speech  

11 Videos with Kaufman Treatment Materials

Apraxia:Kaufman Treatment Materials

https://www.youtube.com/playlist?list=PL3St3Pv3sqw2MuNr8y22M7kdPj6_A1DHX

Kaufman (K-SLP) Treatment Kit 1 Demo

https://youtu.be/KSH-XUDfhRY

Teach children with apraxia to produce and combine the oral-motor movements necessary for functional and intelligible speech. Kit 1 trains children to combine consonants and vowels to form words while controlling for oral-motor difficulty. Published by Northern Speech Services.

Kaufman (K-SLP) Treatment Kit 2 Demo

https://youtu.be/sAsPZGt-5NU

Once a child has mastered the sounds in Kit 1, Treatment Kit 2 helps to refine intelligibility by addressing more complicated motor-speech movements and synthesis into initial and final word positions. Published by Northern Speech Services. Learn more at www.northernspeech.com.

“Architecture of an automated therapy tool for childhood apraxia of speech”

https://dl.acm.org/doi/pdf/10.1145/2513383.2513450

“Development of a Remote Therapy Tool for Childhood Apraxia of Speech”

https://dl.acm.org/doi/pdf/10.1145/2776895

Apraxia: Speech Therapy and Treatment for Toddlers and Young Children written by Sharon Gretz, M.Ed., revised and updated by Megan Overby, PhD, CCC-SLP

Practicing Speech Sounds, Syllables, or Words Multiple Times with Preschoolers By Robin Strode, M.A., CCC-SLP

A Dozen Tips for Supporting Early Speech Development in Children with Severe CAS By Margaret Fish, M.S., CCC-SLP

https://www.apraxia-kids.org/apraxia_kids_library/speech-therapy-for-younger-children/

Apraxia Kids

https://www.apraxia-kids.org/about-apraxia-kids/ 

Child Apraxia Therapy Ideas

http://www.mnsu.edu/comdis/kuster2/therapy/apraxiarx.html

Talk Tools – Apraxia Program

https://talktools.com/products/apraxia-program?variant=28452057033

Apraxia Program was developed by TalkTools Instructor and apraxia expert, ReneeRoy Hill, MS, CCC-SLP.

There are three sets of tools that provide tactile cueing for specific sounds: /m/, /p/, /b/, /oo/, /oh/, /ee/, /ih/, /eh/, /uh/ and /ah/, so clients can feel where the articulators should be during speech production. When the tools are combined with verbal and visual cues, they provide a multisensory approach to facilitating speech.

Program includes 1 set each:

• bilabial shapes
• tactile tubes
• speech blocks
• instruction manual and demo videos

You can also take live or online course "A Sensory-motorApproach to Apraxia of Speech" to learn how to use them.

“The best practice for swallowing is swallowing” – Dysphagia in Children and Adults

Basia

Swallowing Evaluation and Rehabilitation

Check my other post:
Dysphagia - Feeding & Swallowing Disorders in Infants & Children

http://slpzone.blogspot.com/2012/05/feeding-and-swallowing-disorders-in.html    

Dysphagia and Swallowing Therapy and Treatment, Diet and Liquid Consistency

http://slpzone.blogspot.com/2012/04/dysphagia-and-swallowing-therapy-and.html

 

Basia

I refreshed my knowledge about Dysphagia by viewing ASHA webinars:

“Elements of a Comprehensive Clinical Dysphagia Evaluation presented” by Joseph Murray, PhD, CCC-SLP

“Impact of Impaired Antomy and Physiology on Treatment of Dysphagia in Adults” presented by Nancy B. Swigeret, MA CCC-SLP, BCS-S

“Dysphagia Intervention: Planning and Implementation” presented by Nancy B. Swigeret, MA CCC-SLP, BCS-S

“Theoretical Basis of Exercise and Treatment of Dysphagia” Nancy B. Swigeret, MA CCC-SLP, BCS-S

 

Basia

What is normal swallowing?

Normal swallowing consists of a set of physiologic behaviors which result in food, liquid or other substances moving from the mouth to the pharynx and esophagus while protecting and closing the airway to the stomach. Swallowing is an important part of eating and drinking.

What is swallowing dysfunction?

When the process fails and the bolus is aspirated, this is called swallowing dysfunction or dysphagia. Dysphagic patients may have difficulty with any one or more of the anatomic or physiologic components of the oral, pharyngeal or esophageal stages of the swallow.

Basia

What is a role of swallowing evaluation?

Evaluation of the patient with dysphagia should identify the anatomic or physiologic abnormalities characterizing the patient's swallow and include introduction and assessment of the efficacy of treatment strategies.

Basia

What is the primary goal in the management of swallowing disorders?

The primary goal in the management of swallowing disorders is to ensure safe swallowing. For determination of the appropriate rehabilitative approaches, clinicians should consider the assessment of all symptoms and problems causing dysphagia.

What are tree types of management?

The management of swallowing disorders:

• medical management
• surgical approaches
• rehabilitative approaches.

What are the types of treatment?

Treatment may involve:

• compensatory management, such as postural changes or enhancing sensory input
• rehabilitative management, such as active muscle exercise with or without the introduction of food.

Parkinson's Disease

Shaking Palsy

“Parkinson's disease is a degenerative neurological disease causing functional disturbance, causes certain brain cells to die. They are the cells that help control movement and coordination. The disease leads to shaking (tremors) and troublewalking and moving”. To learn more go to

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001762/ 

Parkinson's: Latest From the Experts

http://www.youtube.com/watch?v=aYRCexa5FCk

Cutaneous T-Cell Lymphoma

CT-CL Overview

http://www.youtube.com/watch?v=GjxhFDlyhLc

Cutaneous T-Cell Lymphoma Treatment: The Old and the New

http://www.youtube.com/watch?v=tvXa915DR-8

http://www.youtube.com/watch?v=dvZKi1TfAMk

http://www.youtube.com/watch?v=47G87CMcS0o

The lymphatic system removes excess fluid from the body's tissues and returns it to the circulatory system. It also helps the body fight infections. It consists of lymphatic vessels, lymph nodes, and associated organs such as the spleen and tonsils. Lymph vessels form a network of tubes that reach all over the body.

Lymph capillaries are tiny thin-walled vessels that are located in the spaces between cells throughout the body. They collect excess fluid from cells and recycle it for use in the circulatory system.

A lymph node is a small organ of the immune system. They link lymph vessels together and are found throughout the body. Their main function is to filter lymph and to remove foreign particles that might cause infections.

Our immune system protects the body against disease by killing infectious particles and tumor cells. The most common response is to send antigens to fight the cells that might cause disease.

Damaged skin is defined by extensive cracking of skin surface. It can leave the skin open to infection.

The body responds to skin damage by using white blood cells to destroy any particles that might cause infection.

Pituitary Gland and Tumor

What is the Pituitary Gland?

https://www.youtube.com/watch?v=ZfDXSKhNS4I

What is the Pituitary Gland?

https://www.youtube.com/watch?v=qJj_-3dZ4ZQ

Check the side belaw to learn all you need to know about surgery and what’s after

http://www.entandallergy.com/physician-resource/b-todd-schaeffer-md/pituitary-tumors

May - Stroke Awareness Month

What Is A Stroke?

A stroke is a brain attack!

For our brain to function, we need a constant blood supply, which provides vital nutrients and oxygen to the brain cells. A stroke happens when the blood supply to part of the brain is cut off and brain cells are damaged or die.

About a third of people who have a stroke make a significant recovery within a month. But most stroke survivors have long-term problems. It may take a year or longer for them to make the best possible recovery. Sadly, in the most severe cases, strokes can be fatal or cause long-term disability.

Strokes are sudden and have an immediate effect!

After stroke a person may become numb, weak or paralyzed on one side of the body. The speech may become slur. The person may find difficult to find words or understand speech. Some people lose their sight or have blurred vision, and others become confused or unsteady.

A stroke can damage mind and body.

Strokes affect people in different ways, depending on the part of the brain that was affected, how widespread the damage was and how healthy the person was before the stroke. But strokes can damage: 

• bodily functions 
• thought processes  
• ability to learn
• and how we feel and communicate.

A stroke is always a medical emergency!

It is important to be able to recognize the symptoms of a stroke and to get an immediate help.

Visual Stroke Symptoms and The FAST Test 

FACE, ARMS, SPEECH, and TIME - identifies the most common symptoms of a stroke.

Facial Weakness: Can the person smile? Has their face fallen on one side?

Arm Weakness: Can the person raise both arms and keep them there?

Speech Problems: Can the person speak clearly and understand what you say? Is their speech slurred?

If you see any one of these three signs, it’s TIME to call 911. 

The quicker a patient arrives at a specialist stroke unit, the quicker he/she receives appropriate treatment and the more likely he/she is to make a better recovery.

What Is A Stroke? - Narration and Animation by Cal Shipley, M.D.

http://www.youtube.com/watch?v=uLJewzJcCZ0

Types of Strokes

There are two main types of strokes.

Ischaemic strokes - happen when something blocks an artery that carries blood to the brain.

There are several possible causes: 

• a blood clot forms in a main artery to the brain 
• a blood clot, air bubble or fat globule forms in a blood vessel and is carried to the brain 
• a blockage in the tiny bloody vessels deep inside the brain.

Haemorrhagic strokes - happen when a blood vessel bursts and bleeds into the brain (a haemorrhage).

The haemorrhage may be due to: 

• a vessel bursting within the brain itself, or 
• a blood vessel on the surface of the brain bleeding into the area between the brain and the skull. 

Temporary symptoms may indicate a mini-stroke - Transient Ischaemic Attack (TIA). It is the same as a stroke, except that the symptoms last for a short amount of time and no longer than 24 hours. This is because the blockage in patient’s artery is temporary - it either dissolves on its own or moves, so that the blood supply returns to normal and patient’s symptoms disappear.

Although the symptoms may not last long, a TIA is still very serious. It is a sign that there is a problem and patients are at risk of going on to have a stroke. Because of this it is often called a 'warning stroke' it must be taken in a serious consideration and treated immediately.

Types of Strokes

https://www.youtube.com/watch?v=fz1sgTke_0U

Speech And Language Therapy After Stroke

It is estimated that around a third of people will have some level of communication difficulties (called aphasia or sometimes dysphasia) after a stroke. At least 40 % of stroke survivors will initially experience some difficulty swallowing, though many people recover their swallow quite quickly.

• Difficulties with communication can affect patient’s social relationships, independence and self-confidence.
• Swallowing problems can put a patient at risk of infection and affect his/her enjoyment of food.

Speech and language therapy may be helpful if a patient has the following difficulties: 

• swallowing - including problems with coughing or choking when eating or drinking 
• understanding language (called receptive aphasia) 
• speaking, including speaking any words or saying the correct word (called expressive aphasia)
• forming words and speech sounds due to weak muscles in your mouth (dysarthria) 
• moving the muscles needed for speech in the correct order and sequence (dyspraxia), 
• reading (dyslexia) or writing (dysgraphia).

Speech-Language Therapy: 

Working with a Patient with Fluent Aphasia

https://www.youtube.com/watch?v=B1SBFUgluK0 

A survivor of an Ischaemic Stroke

Young People can have Aphasia ( Broca's) - Jack Hurley

https://www.youtube.com/watch?v=LrAM1wk1_c0

Aphasia ( Broca's) - Jack Hurley Update 2011

https://www.youtube.com/watch?v=zBicgY3vbUc 

Jack Hurley - Broca's Aphasia 2013 Update

https://www.youtube.com/watch?v=7s6-bqtgkhk 

Wernicke's aphasia

https://www.youtube.com/watch?v=dKTdMV6cOZw 

Wernicke's Aphasia

https://www.youtube.com/watch?v=aVhYN7NTIKU 

A stroke should be followed by a formal language assessment, like for instance, patient’s understanding of yes/no questions, e.g. Do you put your shoes on before your socks? The patient may be asked to describe the surroundings as a test patient’s spontaneous speech or asked to repeat simple phrases or sounds.

A stroke may also cause new problems, including loss of vision or memory, which can make communication more difficult.

There is some overlap between the tasks a patient will be asked to do for assessment and therapy. A therapist should keep checking patient’s progress.

The techniques a speech and language therapist uses to help with communication difficulties will depend on the particular problems a patient has.

Therapies that target the specific area of communication a patient finds difficult are most effective.

For example: 

• If there is a difficulty understanding the meanings of words (receptive aphasia) a patient may be asked to match words to pictures, sort words according to their meaning and judge whether words have the same meaning. These activities aim to strengthen patient’s ability to remember word meanings and link them to the spoken and written forms of words.
• If a patient presents difficulty finding the words he/she want to say (expressive aphasia) a therapy might include practicing naming pictures, judging whether words rhyme or not or repeating words a therapist says. A therapist may provide prompts, for example, making the first sound of a word or writing the first letter. A therapist may also show objects that patient can touch and see while speaking their names.
• If a patient presents weak muscles in his/her mouth, he may initially need to do exercises to help improve the muscle strength. A speech and language therapist may also give an advice on body positioning and where the tongue, lips and jaw should go when producing particular sounds.
• Difficulty controlling breathing muscles can force a patient to take a breath in the middle of a sentence. A speech and language therapist may teach a patient breathing exercises and how to plan pauses within sentences to help with this.
• One approach to help dyspraxia is to use natural melodic patterns for everyday phrases. For example, the phrase ‘Good morning!’, when said very cheerfully, has an almost musical melody. A therapist can teach a patient to use this in an exaggerated way to co-ordinate a speech. As the patient’s speech improves, the melody and rhythm cues can be gradually dropped.
• If a patient has difficulty making the right sounds in the right order to form words, a therapy should include tasks such as listening to differences between spoken words, repeating words of increasing length and developing the ability to monitor your speech.
• Some people who can do tasks involving single words, such as naming pictures, have difficulty constructing sentences. A therapy should also work on patient’s ability to understand and produce simple and complicated sentences.

An important part of the speech and language therapist’s role involves finding alternative or additional ways of communicating, which may include: 

• gestures 
• writing 
• communication charts 
• a letter board, or 
• drawing.

For some people an electronic communication aid may be beneficial so a speech and language therapist can advise on what would be helpful; may also help to family members on adapting communication to make it easier to understand.

Reading and writing

If a patient has problems with speech, it is quite likely that he/she will have problems with writing (dysgraphia), spelling and reading (dyslexia). The areas of the brain which are important for these tasks are quite close together. Therefor a speech and language therapist may also help with reading and writing. This is because all ways of communicating use similar abilities; for example, finding the right words and constructing them into a sentence. However, if a patient has difficulty with one particular way of communicating, a therapy should focus on this.

How can my family help?

Communication problems can be frustrating and lonely for family and caregivers as well as for a person who has these difficulties. 
When therapy starts, a therapist will usually give written instructions so that a patient and his/her family can practice specific exercises between sessions. It may be helpful if a family member can attend some therapy sessions to observe the exercises, and help a patient to practice them.

The family should try to resist the temptation to do all the talking for the patient. Many people who have had a stroke are capable of understanding and producing speech but their speech may be slow at first. It is easy to overwhelm someone by asking more questions before they have had a chance to process the first one. For some people it can help to wait as long as half a minute. To begin with, family members can try asking questions that only need a ‘yes’ or ‘no’ answer. Later, they can increase the complexity, just like learning a foreign language. Repetition and hard work are important.