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The CF

15 Oct

Okay I was GOING to blog about AAC assessment and device trialing but I am doing my first days of device trialing this week and I figure I should wait until that actually happens to have an opinion on it. (Don’t worry though – I already have opinions.)

The Clinical Fellowship. The ol’ CF. Ye olde CFY. (It isn’t a year anymore I HATE when people call it the CFY now. IT ISN’T A CFY STOP THAT STOP IT RIGHT NOW.) (STOP IT.)

What’s the deal with the CF? According to ASHA:

The Clinical Fellowship (CF) is a transition between being a student and being an independent provider of clinical services that involves a mentored professional experience after the completion of academic course work and clinical practicum.

Purpose of the Clinical Fellowship

  • Integration and application of the theoretical knowledge from academic training
  • Evaluation of strengths and identification of limitations
  • Development and refinement of clinical skills consistent with the Scope of Practice
  • Advancement from constant supervision to independent practitioner

It is 36 weeks of full-time clinical practice. You get paid don’t panic. It isn’t a continuation of an internship. You’re expected to do real work and you’re the SLP. You just don’t have your CCCs yet because probably you’re a screw up. Don’t worry – we all are. As my mom says, “YOUR PROFESSION HAS A CF FOR A REASON.” (And I’m all, “Yeaaah Mom but like, I like being perfect at everythiiiiiing.”)

What do you have to DO for a CF? Here, read this:

Clinical Fellowship Requirements

  • 36 weeks of full-time (35 hours per week) experience (or the equivalent part-time experience), totaling a minimum of 1260 hours. Part-time work can be completed, as long as the CF works more than 5 hours per week. Working more than 35 hours per week will not shorten the minimum requirement of 36 weeks.
  • Mentoring by an individual holding ASHA certification in speech-language pathology. It is the responsibility of the Clinical Fellow to verify certification of the mentoring SLP, and can do so by contacting the ASHA Action Center to verify at 1-800-498-2071.
  • A score of “3” or better on the core skills in the final segment of the experience, as rated by SLPCF Mentor using the SLP Clinical Fellowship Skills Inventory form.
  • 80% of time must be spent in direct clinical contact (assessment/diagnosis/evaluation, screening, treatment, report writing, family/client consultation, and/or counseling) related to the management of disordered that fit within the ASHA Speech and Language Pathology Scope of Practice.
  • Submission of an approvable CF Report and Rating Form.

I actually filled out my own rating scale the other day of how I think I’m doing. I mostly gave myself 3s and 4s. November 15th is the last day of Segment 1 for me and then my supervisor and I will compare and discuss.

Something you’ll also note on the CF Rating Form is:

A full-time SLPCF consists of a minimum of 35 hours worked per week and equals 1,260 hours throughout the 36-week SLPCF. The SLPCF must consist of at least 36 mentoring activities, including 18 hours of on-site direct client contact observations and 18 other monitoring activities.

Ew.

That equals 6 hours of direct supervision and 6 hours of “mentoring” per segment. THAT’S A LOT OF BONDING TIME. Sheesh ASHA, you’re killin’ me.

Overall I think the CF is going pretty well – I love my supervisors and I have wonderful support at my facility. I think for a CF it is SO important to have support – you NEED other SLPs, you SHOULD HAVE an onsite supervisor who you see regularly. A few jobs I interviewed for would have supervisors for me in other buildings, or I’d be doing only home health and wouldn’t really have a home base. It would have been a mistake for me to take one of those positions. I have a sounding board, I have people to observe, people to bounce ideas off, people to share/commiserate with.  I do group therapy twice a week where I get to see PTs, OTs, and Early Childhood Educators in action. My supervisor and I meet every Friday. There are SIX other SLPs for me to talk to and they’re such amazing resources. If you’re considering somewhere for your CF – please consider the support system your facility will have in place for you, it’s incredibly important.

Shoot me questions! I’m happy to help.

NP: Lee Brice – Hard to Love

Aphasia therapy

26 May

APHASIA!

If you’re working with adults you’re PROBABLY working on aphasia. There are maaany types of aphasia. If you use the WAB, which there is a good case you will, then you will give your patients any one of eight aphasia diagnoses (Broca’s, Wernicke’s, Transcortical Motor, Transcortical Sensory, Global, Isolation, Conduction, Anomic). Most aphasias  be classified as fluent (receptive) or non-fluent (expressive). And there are other aphasias out there like primary progressive, alexia, agraphia etc. AND the way you classify aphasia will depend on your “theory” of aphasia.

I say all of this, but really you won’t see “pure” aphasias often – I would say many are mixed. You’ll see patients with a variety of difficulties that manifest themselves in all sorts of exciting ways.

AND QUITE FRANKLY – sometimes the diagnosis is SORTA irrelevant. To me – I’m not treating a diagnosis. I’m treating the issue. Just because someone has Broca’s aphasia doesn’t necessarily mean that the treatments typically used for Broca’s aphasia will work for this patient.

So what do you do with these patients – who may have difficulty speaking, understanding, reading, writing, spelling and a plethora of other troublesome word related tasks?

I’ll try to narrow it down a bit.

The patients I saw MOST OFTEN were having difficulty with word finding. I’ve had one patient with global aphasia and one patient with Wernicke’s. My externship had a very cool “Evidence Based Aphasia Clinic” which analyzed the aphasic characteristics of patients enrolled in the clinic, and then looked at EVIDENCE BASED protocols for treating aphasias. WHICH IS SO SMART. Everyone should do this. Not just with aphasia. With all things. One day I’d like to have at least one legit journal article printed off that explains why I do what I do with each kind of disorder that I focus on.

Back to what I was saying – What do we do with these patients? With a global aphasia you’ll likely be trying to find some kind of multi-modality communication system that will be consistently and appropriately utilized in the patient’s life. These are tough patients but you’ll find a way to communicate. One of my most favorite patients had global aphasia. She was the sassiest.

Wernicke’s? Wernicke’s aphasia is really cool. There is a Treatment for Wernicke’s Aphasia which works, but is extremely tedious and exhausting for EVERYBODY. Be sure to break up your sessions if you attempt it. The idea is you put out six photos (of 12 photos total) of everyday photos and first – hand the patient a card with a word on it. The patient matches the word to the picture. The patient then reads the word or verbally identifies the picture. The patient then repeats the word after you. Then you ask the patient to identify the picture with just a verbal cue. There is no scaffolding or cueing, but obviously for training purposes and for success purposes you’ll want to cue and prompt as necessary at the beginning. When I find the source for this I’ll share it – I’m not sure where I hid it. You can also do Response Elaboration Training, Cloze Procedures, Melodic Intonation Therapy, and I’m sure a number of other procedures.

And the biggie – word finding. This is going to change with each patient. I really enjoy category naming and teaching HOW to do this efficiently. I think often we say to a patient “Name all of the animals you can!” and then they have a hard time and we write down how many they got and then we tell them to name some other things. THIS IS NOT GOOD THERAPY.

Teach, don’t test, people.

So some ways we can deal with naming and word finding is to do semantic mapping tasks and semantic feature analysis. You can TEACH patients how to categorize by really thinking about how our brain works. How is our brain organized? Do we just have a jumble of animals in our brain all willy nilly? If someone asked YOU to name as many animals as you could what would you do? I often tell patients to subcategorize. Tell me animals, but first tell me farm animals, then zoo, pets, woodland, ocean, flying, etc. Tell me vegetables but envision yourself at the grocery store. And also consider – are you asking the patient to name CONCRETE items or ABSTRACT? Example time. Concrete: Animals. Abstract: Red things. Our brain is not organized by color.

Other tasks for word finding: synonym and antonym generation. And not just ONE word. Tell the patient to think of THREE antonyms. This gives you a good idea of where they are as far as what is difficult and what sorts of scaffolding is required. Can you give a patient a FIM score without really pushing them and figuring out what is hard? (No.)

Unscrambling tasks. Idiom defining.  Homonym explanation. Word defining. Seriously – ask a patient with a word finding disorder to define the word “tree”. Try that one. I really recommend the WALC books and Cognitive Reorganization if you work with aphasia often.

Now, I’m going to do the last edit of my thesis because I’ve been…not doing it.

NP: Anna Begins – Counting Crows

PS – if you Google just the word “WALC” you get this website. Lolz.