Tuesday, February 24, 2009
Thursday, February 12, 2009
What is Devic's Disease?
What is Devic's disease? In what manner might it lead to speech and language difficulties?
"Certificates... Do We Really Need 'Em?"
You do not need to pay for a certification course to become competent to perform FEES, MBS’s or other techniques. As I stated in my earlier post, you do need “Training, yes (does it need to be training by a specific entity, I would argue “not necessarily”). Sound and evidence based decision making capabilities, yes. The ability to produce an objective and defensible rationale for the proposed treatment, yes.”
Holding a piece of paper only means that the certificate holder attended a meeting. It does not convey competence or evidence based decision making. You state that you are not trained to perform FEES or MBS’s, but that training is possible without paying for a “certificate”.
True SLP’s pay to receive a certificate for certain kinds of training such as FEES (as you have cited). However many facilities “certify” clinician competence of SLP’s to perform FEES after they have performed 25 (or a specific number of) exams under supervision or other clinicians with more than that level of experience/competence. They do not have to pay for a piece of paper. Similarly, physicians that perform many surgical procedures do not necessarily receive a certificate stating they have attended a meeting to train them to perform the procedure. They learn from each other, in much the same way that we train and educate our students and supervisees.
Isn’t a clinician who is “certified” in lsvt qualified to train others to perform lsvt? If not, what would qualify him or her to train others? I attended a Jeri Logemann conference in 1987 and received a piece of paper, but was completely unqualified to perform the MBS procedure until I had received mentoring, experience and extensive training after the conference.
Cheers,
James L. Coyle, Ph.D., CCC-SLP, BRS-S
Assistant Professor, Communication Science and Disorders
University of Pittsburgh
Holding a piece of paper only means that the certificate holder attended a meeting. It does not convey competence or evidence based decision making. You state that you are not trained to perform FEES or MBS’s, but that training is possible without paying for a “certificate”.
True SLP’s pay to receive a certificate for certain kinds of training such as FEES (as you have cited). However many facilities “certify” clinician competence of SLP’s to perform FEES after they have performed 25 (or a specific number of) exams under supervision or other clinicians with more than that level of experience/competence. They do not have to pay for a piece of paper. Similarly, physicians that perform many surgical procedures do not necessarily receive a certificate stating they have attended a meeting to train them to perform the procedure. They learn from each other, in much the same way that we train and educate our students and supervisees.
Isn’t a clinician who is “certified” in lsvt qualified to train others to perform lsvt? If not, what would qualify him or her to train others? I attended a Jeri Logemann conference in 1987 and received a piece of paper, but was completely unqualified to perform the MBS procedure until I had received mentoring, experience and extensive training after the conference.
Cheers,
James L. Coyle, Ph.D., CCC-SLP, BRS-S
Assistant Professor, Communication Science and Disorders
University of Pittsburgh
Wednesday, February 11, 2009
Parkinson's Disease
"I don’t see anything in the description suspicious for a CN V3 (mandibular nerve) injury (was there a sensory impairment on the right side? V3 carries sensory fibers to the lower 1/3 of the face) except the jaw droop at rest which may just be his posture. Tongue to right would be right XII and palate paresis with hypernasality would be X. Also you would have to figure out what type of lesion would selectively affect these nerves/brainstem nuclei on both sides of the patient.
The most likely explanation for your observations is the rigidity associated with parkinsonism. The inability to initiate motion is one property of rigidity in which both agonist muscles (those that perform the intended movement) and their antagonists (those that resist the intended movement) are activated at the same time the patient wants to move (antagonist inhibition is disrupted in parkinsonism). Of course a MRI of his brain would help you to sort this out because certainly, apraxia after an undiagnosed stroke could cause motor planning problems (but the same stroke should not cause the bilateral cranial nerve lower motor neuron pattern observations.
If rigidity it might help to ask the patient whether he notes any improvement in the inability to initiate movement shortly after taking his Parkinson medications. Some patients (probably about 25%) notice a distinct “on” phase after medications in which they move much more easily for a short time. In those cases we ask the attending or neurologist to consider whether trying timing the medication to precede the intended activity (eating) by one-half hour or so is not contraindicated.
This article is an interesting as it relates to treatment of Parkinsons patients by using a motor pre-cue.
Johnson, A. M., Vernon, P. A., Almeida, Q. J., Grantier, L. L., & Jog, M. S. (2003). A role of the basal ganglia in movement: the effect of precues on discrete bi-directional movements in Parkinson's disease. Motor Control., 7, 71-81."
The most likely explanation for your observations is the rigidity associated with parkinsonism. The inability to initiate motion is one property of rigidity in which both agonist muscles (those that perform the intended movement) and their antagonists (those that resist the intended movement) are activated at the same time the patient wants to move (antagonist inhibition is disrupted in parkinsonism). Of course a MRI of his brain would help you to sort this out because certainly, apraxia after an undiagnosed stroke could cause motor planning problems (but the same stroke should not cause the bilateral cranial nerve lower motor neuron pattern observations.
If rigidity it might help to ask the patient whether he notes any improvement in the inability to initiate movement shortly after taking his Parkinson medications. Some patients (probably about 25%) notice a distinct “on” phase after medications in which they move much more easily for a short time. In those cases we ask the attending or neurologist to consider whether trying timing the medication to precede the intended activity (eating) by one-half hour or so is not contraindicated.
This article is an interesting as it relates to treatment of Parkinsons patients by using a motor pre-cue.
Johnson, A. M., Vernon, P. A., Almeida, Q. J., Grantier, L. L., & Jog, M. S. (2003). A role of the basal ganglia in movement: the effect of precues on discrete bi-directional movements in Parkinson's disease. Motor Control., 7, 71-81."
Friday, February 6, 2009
Measuring Attention: Digit Span Forward
Please check out post dated October 23rd, 2008 on digit span and attention in testing.
MBS Protocol
One of the issues in performing a modified barium swallow study with a radiologist is time-constraints.
The radiologist is generally attempting to perform the study as quickly and efficiently as possible. This, of course, should be our goal as well.
Arranging your presentation items is key to improving efficiency.
Sometimes, the radiologist will begin to "take over" your study if you are not fully in control. Try not to allow this to make you nervous.
As you (as a student) perform more and more MBSes, you will gain confidence and all will fall into place.
The radiologist is generally attempting to perform the study as quickly and efficiently as possible. This, of course, should be our goal as well.
Arranging your presentation items is key to improving efficiency.
Sometimes, the radiologist will begin to "take over" your study if you are not fully in control. Try not to allow this to make you nervous.
As you (as a student) perform more and more MBSes, you will gain confidence and all will fall into place.
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