Specific information regarding the Communication Sciences and Disorders' Acute Care Speech Language Pathology practicum led by Carley Evans MS CCC SLP. Carley is a medical speech pathologist at the Evelyn Trammell Institute for Voice and Swallowing of the Medical University of South Carolina in Charleston. If you are new to this practicum, start with the oldest post listed in Archive.

Friday, June 27, 2008

Student Presentations: Summer, 2008

Student presentations will be Wed, July 9th in ENT conference room on 11th floor of Rutledge Tower.

Thursday, June 26, 2008

Doing An Awesome Chart Review

To get the most for the time you spend perusing a chart (i.e. medical record), try:

1) Reading over the entire discharge summary from the previous admission first, then take notes the second time around. Note major events whether or not they appear directly related to our field.

2) Note primary diagnosis (es) , date of onset, admission date, attending and referring physicians.

3) Note any previous speech pathology evaluations, treatments, notes, etc.

4) Review radiology reports on CT scans, MRI scans, etc.

5) Take a quick glance at labs.

6) Put the information all together in a succinct paragraph. Avoid abbreviations.

What is Aerophagia? How Come I Don't Have It?

Asked a great question. Now, look it up and give us the lowdown.

Monday, June 16, 2008

Tonic Bite Reflex

Tonic bite reflex - This is jaw closure accomplished by forceful, sustained upward movement of the mandible. It occurs following stimulation of the teeth or gums. It is accompanied by increased abnormal tone in the jaw muscles. It is difficult to release. Damage to the teeth or to the object placed in the mouth may occur. The tonic bite increases if the item is pulled on.

Do not confuse this pattern with a bite reflex which results in closing or approximation of closing following stimulation to the lips, gums or teeth. This normal reflex becomes integrated before age two, and is not associated with abnormally increased muscle tone.

Friday, June 13, 2008

NIH: Guillain Barre

What is Guillain-Barre Syndrome?

Guillain-Barré syndrome is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances, the weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until the muscles cannot be used at all and the patient is almost totally paralyzed. In these cases, the disorder is life-threatening and is considered a medical emergency. The patient is often put on a respirator to assist with breathing. Most patients, however, recover from even the most severe cases of Guillain-Barré syndrome, although some continue to have some degree of weakness. Guillain-Barré syndrome is rare. Usually Guillain-Barré occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally, surgery or vaccinations will trigger the syndrome. The disorder can develop over the course of hours or days, or it may take up to 3 to 4 weeks. No one yet knows why Guillain-Barré strikes some people and not others or what sets the disease in motion. What scientists do know is that the body's immune system begins to attack the body itself, causing what is known as an autoimmune disease. Guillain-Barré is called a syndrome rather than a disease because it is not clear that a specific disease-causing agent is involved. Reflexes such as knee jerks are usually lost. Because the signals traveling along the nerve are slower, a nerve conduction velocity (NCV) test can give a doctor clues to aid the diagnosis. The cerebrospinal fluid that bathes the spinal cord and brain contains more protein than usual, so a physician may decide to perform a spinal tap.

Is there any treatment?

There is no known cure for Guillain-Barre syndrome, but therapies can lessen the severity of the illness and accelerate the recovery in most patients. There are also a number of ways to treat the complications of the disease. Currently, plasmapheresis and high-dose immunoglobulin therapy are used. Plasmapheresis seems to reduce the severity and duration of the Guillain-Barré episode. In high-dose immunoglobulin therapy, doctors give intravenous injections of the proteins that in small quantities, the immune system uses naturally to attack invading organism. Investigators have found that giving high doses of these immunoglobulins, derived from a pool of thousands of normal donors, to Guillain-Barré patients can lessen the immune attack on the nervous system. The most critical part of the treatment for this syndrome consists of keeping the patient's body functioning during recovery of the nervous system. This can sometimes require placing the patient on a respirator, a heart monitor, or other machines that assist body function.

What is the prognosis?

Guillain-Barré syndrome can be a devastating disorder because of its sudden and unexpected onset. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest. The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of those with Guillain-Barré still have a residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack.

What research is being done?

Scientists are concentrating on finding new treatments and refining existing ones. Scientists are also looking at the workings of the immune system to find which cells are responsible for beginning and carrying out the attack on the nervous system. The fact that so many cases of Guillain-Barré begin after a viral or bacterial infection suggests that certain characteristics of some viruses and bacteria may activate the immune system inappropriately. Investigators are searching for those characteristics. Neurological scientists, immunologists, virologists, and pharmacologists are all working collaboratively to learn how to prevent this disorder and to make better therapies available when it strikes.

Questions and Answers Regarding Apraxia of Speech

What is integral stimulation?
An imitative treatment approach using multi-modal stimulation, including visual and auditory input. The instructions to the patient are key:
“Watch me, listen to me, do what I do.”

What are the four salient characteristics of apraxia of speech?

(1. Effortful, trial and error, groping articulatory movements with attempts at self-correction. 2. Prosodic disturbances or dysprosody 3. Inconsistency in articulation on repetitions of the same utterance. 4. Obvious initiation difficulties.)

What is the key diagnostic tool or step within the Mayo Clinic Evaluation of Apraxia of Speech for differential diagnosis of apraxia of speech from phonemic paraphasia or dysarthria?
What speech characterisitcs would be seen using this key diagnostic tool if the person has apraxia of speech?

1. Diadochokinetic rate – repetition of pa ta ka over time
2. Difficulty with initiation (stopping and restarting)
Difficulty with rate (slow) with equal and excess stress
Lots of substitutions or omissions

Oral Hygiene Information

Cut and paste this link into your browser as I couldn't get it to go live. Thanks.


Thursday, June 5, 2008

Therapy: Verbal Feedback, Cueing, Etc.

Verbal feedback in therapy: Telling the patient "that's right," "you got it," or "that's correct" is great verbal feedback. Perfect feedback is: "That's right; it is a zebra!"

Rewording the stimulus is a helpful cue: Asking "if wood burns, what melts?" assists a patient to complete the verbal analogy "Burn is to wood as melt is to _________."

During a verbal fluency task, remain quiet while the patient is listing exemplars unless they pause, or deny ability to think of any more items.

During word retrieval tasks such as confrontational naming, should give a letter cue or phonemic cue prior to giving model.

Wednesday, June 4, 2008

June 6th ALS Clinic

Schedule for Friday, June 6th: We will be in the Amyotrophic Lateral Sclerosis clinic on the 9th floor of Rutledge Tower beginning at 8 a.m. You can page me Friday morning and ask me for directions, if you'd like.

Monday, June 2, 2008

Sample Practicum Goals

1. Administer treatment without constant use of aids.
2. Predict patient's abilities given information in medical chart.
3. Use accurate terminology when writing progress notes.
4. Perform Modified Barium Swallow Studies precisely.
5. Learn and use critical clinical skills, such as verbal feedback techniques and efficient data collection.