Sunday, December 7, 2014


This always happens to me during the ASHA convention.  I get to a point that I am, well, maybe a bit silly and start Tweeting about crazy things.  This is the time that my following rises the most.

This year was no different.  As I was Tweeting various pictures of our friend Mary, I had a new follower called MannaQure.  Naturally, I was wondering what my Tweets had to do with my nails.

I first looked at the website.   MannaQure is a comprehensive dysphagia and dysarthria evaluation.  Not only is it an evaluation, but it is designed for Spanish speaking patients.

I was wondering about the name.  I couldn't make the connection.  On the website, it states that:  "Manna"-Found in the book of Exodus, the food that was miraculously provided for the Israelites in the wilderness during their flight from Egypt. "Manna"-Mentioned in the bible, spiritual nourishment of divine origin. MannaQure is pronounced Manna."

I found the MannaQure booth the next day in the exhibit hall.  The protocol for this evaluation has the questions/instructions written in English, in Spanish with pronunciation for those that do not speak Spanish and just in Spanish for those that are able to speak Spanish.  All on the same protocol.

It looked like a fairly comprehensive evaluation, with a few questions regarding cranial nerves.  I would love to have more time to look over this evaluation.

The complete set sells for $225.  The Examiner's Manual alone is $125, 25 Questionnaires are $45 and 25 Protocols are $55.

If you work with Spanish Speaking patients, this may be an evaluation to look at.

Friday, November 28, 2014

ASHA Convention Withdrawal

I seriously cannot believe that I have been home for almost a week following the ASHA convention this year.  I was beyond excited to leave.  How beautiful and warm Orlando Florida was going to be compared to Indiana.   Writing this post has been a little difficult.  For one, the craziness of returning home has been abundant and it just makes me sad to think about my friends that I miss SO much!

Don't let the sunshine fool you.  It was chilly!!

After a long trek to the convention center, well the correct building anyway, I was able to register and pick up my materials.

Wednesday night started with Meet the Masters and a Jeri Logemann memorial pin.  The session was great.  I tweeted as much information as I possibly could!

Thursday was crazy!  SIG 13/BCS-S breakfast was at 7:00 in the morning!  Yes, that's right, I said 7!  After that was a full day of sessions, poster and the exhibit hall, followed by 2 more days of the same!

There is always that excitement of seeing friends that I haven't seen in a year and meeting new friends that I have chatted with on Twitter and Facebook for several years!

It was the year of the selfies and the usies.  I had the pleasure of FINALLY meeting Cyndee Bowen, Jonathon Waller and Kelley Babcock.  Spending time with the SLPeeps is what makes the convention great for me!

Between poster sessions and sessions, I learned a lot of new information that I'm still trying to sort out.  I'm still trying to figure it all out to submit CEUs as well!  

The exhibit hall proved to have so much information as well with several new dysphagia products that I will be sorting through, contacting companies and blogging about to let you know about the new products available!!

One of the saddest parts of the convention for me is the Closing Party.  Not that I don't have a great time, but I know it means saying goodbye.  This year's party was probably the best I've attended, however it was also the worst.  The way it was set up, it was very difficult to spend time with your friends and there were so many I never really had to opportunity to tell goodbye.  The Wizarding World of Harry Potter was amazing all the same!

Yes, I did try a Butter Beer and I did like it!!  

Keep watching for posts looking at a new pureed brand of food, new sEMG, books I discovered, a quick thought of the FEES equipment that attaches to your iPhone.....whew!!  

Knowing I still had a long drive home to see my family, I did have quite a surprise waiting for me at the Indianapolis airport.  My friend Tara flew in to head out to Ohio and JUST HAPPENED to still be there as I waited for my suitcase to arrive!

Is it bad that I'm already so excited for ASHA 15?

Pudding and a Straw

Picture from:

Haven't you always wanted a very simple exercise that will work and strengthen the entire swallowing mechanism using resistance?  I do as well.  I have an exercise that I use all the time with my patients.  I am usually chastised by my co-workers when having patients use this exercise.  Patients give me a strange look until they try it.

This exercise has no fancy name.  I call it........Pudding with a Straw.  It is exactly as the name implies.  The patient drinks pudding through a straw.

So first, let's look at the evidence.......  I take into account that, from reading research.....I know using a straw increases labial activation.  A thicker, heavier bolus can add resistance to the swallow and can actually increase the movements both orally and pharyngeally with the swallow.   Using an effortful swallow increases sensory input to the swallowing mechanism.  Swallowing is a sub maximal event as a whole, but when the patient focuses and purposefully uses a more effortful swallow, there is an increase in the muscle contraction of the entire swallowing mechanism.

I take all of this into account and then try the method myself, to see what I feel.  When I drink pudding through a straw, not a Panera smoothie straw, not a regular drinking straw, a cocktail straw/coffee stirrer size straw, I can feel a difference.  My lips purse together with increased effort.  My tongue retracts and tightens, my jaw tightens.  I then suck enough pudding through the straw to swallow and use an effortful swallow.  At one time, I have incorporated straw use with a safe consistency bolus for most, an effortful swallow and a weighted bolus.  I have also used the entire swallowing structure.

I believe it is important and necessary that we look at the swallowing mechanism as a whole, a process, rather than 4 parts.  It's great to break the swallowing system down into phases for descriptive purposes, but every part of the swallow is connected in some manner and every part of the swallow deserves some attention.

Now, keep in mind, not every patient can start at the level of a small cocktail straw/coffee stirrer or even the pudding.  I can modify the straw by either using a larger diameter straw (Panera smoothie straws seem to be the largest I've found at this point).  Regular drinking straws also work very well.  Not only can I change the diameter of the straw, I can change the size of the straw by cutting it in half or in thirds.  The shorter the straw, the easier the task.

Now, keep in mind, the viscosity of pudding can be varied as well.  Many times I will use a thickened liquid or applesauce for patients that are not able to start with pudding.  I may work up to yogurt, without the fruit.  Then with the pudding, in my experience, I have found that sugar-free pudding seems to be the thinnest, followed by home-made, then Snack Pack pudding.  Snack Pudding, the chocolate seems to be the lesser viscous, followed by butterscotch, with vanilla having the thickest viscosity.  Room temperature vs. refrigerated also makes a difference.  Room temperature pudding is a little less tedious for the patients, while with the refrigerated, I'm also adding the temperature aspect to my sensory portion of therapy, in addition to the difficulty of the task.

I don't write a goal for the patient sucking pudding through a straw.  We may be working on lingual strengthening, pharyngeal strengthening, tongue base retraction, labial seal.  I don't write my notes as "the patient was able to drink a Snack Pack cup of refrigerated chocolate pudding."  We were working on using an effortful swallow, straw sucking for increased labial seal, weighted bolus for resistance.

Now I do time my patients and keep track of the time.  I will time the patient to see how long it takes to complete the task.  As the patient gains strength with the task, the time should decrease.  You can also use e-stim or sEMG with your patient as they are completing the task.

I don't stress if the patient needs the entire session time to complete the task.  This is what I want them to do!!  I want the patient to use an effortful swallow.  I want to apply the rules of neuroplasticity and use a specific swallowing task, applying resistance and specificity.  My patient is swallowing, using both an effortful swallow with a focus of tongue to palate contact and using a weighted bolus with the thick pudding.

I challenge you to try this exercise.  Try the vanilla with the coffee stirrer/cocktail straws and feel what the exercise does for you!

1 Clark, H.M. (2005).  Therapeutic exercise in dysphagia management: Philosophies, practices and challenges.  Perspectives in Swallowing and Swallowing Disorders, 24-27.

2 Robbins, J.A., Butler, S.G., Daniels S.K., Diez Gross, R., Langmore, S., Lazarus, C.L., et al. (2008). Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language, and Hearing Research, 51, S276-300.

3 Burkhead L.M., Sapienza C.M., Rosenbek J.C.  (2007).  Strength-training exercise in dysphagia rehabilitation:  Principles, procedures and directions for future research.  Dysphagia; 22:  251-265.

4 Clark, H.M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. 

5 Lazarus, C. Logemann, J.A., Huang, C.F., and Rademaker, A.W. (2003). Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatrica et Logopaedica, 55, 199-205.

6 Robbins, J.A., Gangnon, R.E., Theis, S.M., Kays, S.A., Hewitt, A.L., & Hind, J.A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatric Society, 53, 1483-1489.

7  Wheeler-Hegland, K.M., Rosenbek, J.C., Sapienza, C.M.  (2008).  Submental sEMG and Hyoid Movement During Mendelsohn Maneuver, Effortful Swallow, and Expiratory Muscle Strength Training.  Journal of Speech, Language and Hearing Research, 51, 1072-1087.

8  Burkhead LM.  Applications of Exercise Science in Dysphagia Rehabilitation.  Perspectives on Swallowing and Swallowing Disorders (Dysphagia) June 2009; 18: 43-48.

9 Park JW, Kim Y, Oh JC, Lee HJ.  Effortful Swallow Training combined with Electrical Stimulation in Post Stroke Dysphagia:  A Randomized Controlled Study.  Dypshagia (2012).  DOI: 10.1007/S00455-012-9403-3.

10  Bulow M, Olsson R, Ekbert O.  Videomanometric Analysis of Supraglottic Swallow, Effortful and Non Effortful Swallow and Chin Tuck in Healthy Volunteers.  Dysphagia.  (1999); 14(2):  67-72.  DOI: 10.1007/PL00009589.

Sunday, November 16, 2014

Blue Tree Publishing Apps Review

App:  Aspiration Disorders

Price:  $4.99

System:  iOS (iPhone, iPod Touch and iPad)

Version:  1.2

App:  Oral Disorders

Price:  $4.99

System:  iOS (iPhone, iPod Touch and iPad)

Version:  1.1

App:  Swallow ID

Price:  $4.99

System:  iOS (iPhone, iPod Touch and iPad)

Version:  1.1

App:  Vocal Folds ID

Price:  $2.99

System:  iOS (iPhone, iPod Touch and iPad)

Version:  1.3

App:  Larynx ID

Price:  $4.99

System:  iOS (iPhone, iPod Touch and iPad)

Version:  1.1

App: Residue Disorders

Price:  $4.99

System:  iOS (iPhone, iPod Touch and iPad)

Version:  1.1

I typically review apps individually.  These apps by Blue Tree Publishing are all very similar, so I decided to review them at once.  

If you've never heard of Blue Tree Publishing, they make incredible educational materials.  They started making educational apps which are great to share with patients, caregivers, physicians, nurses and anyone who may be interested.  The apps can be purchased individually or in a bundle.  

Each app offers a drawing that depicts each structure/function in the title.  The drawing can be viewed still or animated.

There is text that can be used to accompany the drawing or can be removed.  

With the swallowing apps, Aspiration Disorders, Oral Disorders, Swallow ID and Residue Disorders, a video of a modified barium swallow study showing the dysfunction is included on each app.  With the Aspiration Disorders app there is also a FEES video available of aspiration.

The Larynx ID does not have videos, but does have nice animations to show the muscle functions and the structures, including how they move.  Vocal Folds ID does have a video available showing the movement of the vocal cords during phonation.

These apps are definitely worth the money if you need a great educational app.

Dysphagia By Lingraphica App Review

App:  SmallTalk Dysphagia

What it is:  An app that can be used as an AAC device so that the patient can communicate about their swallowing difficulty.

Price:  Free

System:  iOS (iPhone, iPod Touch and iPad)

Version:  3.1

SmallTalk Dysphagia is an app designed for patients to use to communicate about their swallowing disorder.  
 Vertical View

SmallTalk Dysphagia offers a variety of pre-recorded phrases that relate to a patient's swallowing difficulty.  

Horizontal View

The app also offers 4 videos that will first tell the technique required to swallow and then show a video demonstrating the technique.  You find this at the main menu by selecting Videos rather than Icons.  The videos are available for the Mendelsohn, the Supraglottic Swallow, the Super-Supraglottic Swallow and the Effortful Swallow.  The videos can not only be used as a reminder of how to complete each exercise, but can serve as an instructional video for care-givers and other professionals as well.  

It's a nice app and can serve a great purpose, however it cannot be personalized to a specific patient.  The patient would have to scroll through every phrase available to find the phrase they need.

Oral Motor by Lingraphrica App Review

App:  Oral Motor

What it is:  An app full of oral motor exercises with videos to demonstrate each exercise.

Price:  Free

System:  iOS (iPhone, iPod Touch and iPad)

Version:  3.1

SmallTalk Oral Motor Exercises is an app that was created by Lingraphica.  

This app offers an extensive list of exercises with accompanying videos to demonstrate how to complete each exercise.

Horizontal View

 Vertical View

This is an app that can be used for a home exercise program, as there is a video to demonstrate each exercise. 

The downfall with this app is there is no way to personalize it for your patient to make it into a home exercise program.  

This offers a wide variety of exercises and if you are an SLP that likes oral motor exercises, this is a vast array.

Smart Oral Motor App Review

App:  Smart Oral Motor

What it is:  An app that for pediatric oral motor exercises.

Price:  $5.99

System:  iOS (iPad, iPhone and iPod Touch)

Version:  1.0

Smart Oral Motor is an oral motor app by Smarty Ears.  

Smart Oral Motor uses the Smarty Ears mascot "Clever" to demonstrate oral motor exercises.  

There is a list of 12 exercises from which to choose.

Clever will then show the child how to complete the exercise.  For each time the child completes the exercise, they earn a star.

When the child is done, they receive applause for their hard work.

I think Clever is adorable, however, there are times that I would love to skip through the intro.  I'm not much of an oral motor therapist, but do like the app when I need to do an oral motor exam on a child that just does not want to participate.  They love imitating Clever and find the app to be rather engaging.  

This can actually be a very fun app!