Service isn’t something that happens “over there”

dont just stand there

Merriam-Webster defines “service” as “the occupation or function of serving” or “the work performed by one that serves”.

By that definition, we could say speech-language pathology is a field of service. The work I do is not for me. It is for someone else.

Yet at one of the sessions I attended there were some negative comments about professors having to participate in service activities (or joy for not having to participate in service activities). It totally struck me and distracted me the rest of the session.

Before we move forward, let’s take a look at a definition of service. When people working in a university talk about service, they are usually talking about one of the following:

  • service of the profession – reviewing manuscripts, leadership in professional organizations, etc.
  • university service – committee participation, faculty senate, etc.
  • extracurricular university service – involvement in student groups

The common argument is service takes professors away from teaching and research, which I can understand. (These are general observations; not all professors are the same.) But as someone who formally worked in student affairs (which is service heavy), I can see the other side. Service is important to universities and our professions.

As a practicing SLP, I can see so many reasons to participate in service activities. For as long as I can remember, I have had involvement in multiple service activities in, around, and outside my profession. I have been in a far number of conversations with therapists who want “someone” to do “something”, but they don’t want to get involved (for various factors). We need to be involved.

So why is service important to clinical and academic SLPs?

  1. You benefit. I learn so much from my service outside of our profession. I am on the board of directors for a co-op insurance company and I am learning so much about insurance regulation and lack of medical resources in the rural areas of my state (just two examples). Participating in service is a great way to connect with people who are want to make things happen.
  2. You can influence change. This is huge. Many of us want changes to caseloads in the schools, when and if we receive referrals, physician understanding of language and swallowing disorders, or productivity pressures in healthcare. Getting involved in service can put you into a position where you have influence on an organization or association that will help you accomplish goals. Imagine the possibilities of working with other people with big ideas. Together, we’re unstoppable!
  3. Service helps resolve our public relations problem. How many of us have ever told someone we are an SLP and they immediately understand what we do? Few and far between, right? Service outside of or around (e.g. other health care professionals) our profession helps us share the wonderful world of SLP with other professionals and people of influence.

I encourage you to find a service opportunity. There are so many ways to get involved. Here are a few. You may want to look for opportunities with the following organizations:

  • ASHA – Call for nominations is currently open. There are also many ways to volunteer or participate in committees.
  • Your state association has many similar opportunities. Join and get involved.
  • Universities aren’t just for professors. Look for opportunities to get involved as an alum. Wish you had XYZ training in school, advocate for it, so the next generation does.
  • State, city, and county associations and associations (e.g. Alzheimer’s Association, County Agency on Aging, etc.) are great ways to provide service around and outside our profession. Look for ways to influence how we help underserved populations (rural, low income, etc.).
  • Look within your organization for opportunities on committees. Perhaps your building is going to be renovating soon; get involved so you can advocate for the environments that would help all patients. Join the falls committee. Make change from the inside.

Service isn’t something that happens “over there” by someone else. Service should happen wherever you are. It doesn’t have to be “big”; you just have to do it in a big way.

See other 2014 ASHA Convention related blog posts.

Ethics Sessions at the 2014 ASHA Convention

Calling all bloggers! I’m looking for 7 guest bloggers to write a blog post about one of these sessions regarding ethics at the convention. (If I missed one, let me know!) I’ll provide guest bloggers with a template for a quick and easy blog post. I can’t go to all of the sessions and most people can’t go to the convention. I’d love for the messages in these sessions to be shared with all Gray Matter Therapy readers.


Guest Blogger Title Session PDH(s) Date Time Room
Be at the Table, Not on the Menu: Advocating for Your Profession 1151 1 Thursday 4:30-5:30 CC/W320
Productivity Pressure? Using Lean Problem Solving to Do More With Less 1196 1 Thursday 6:30-7:30 CC/W205BC
Strategies for Ethics Education in Speech-Language Pathology: Clinic & Academic 1434 1 Friday 3:30-4:30 CC/W221ABC
Doing the Right Thing: Learning the Power of Ethical Decision-Marking in Practice 1488 1 Friday 5:00-6:00 CC/W221ABC
Professional Ethics: Concerns from the Workplace 1611 2 Saturday 8:00-10:00 CC/W204AB
SLPs as Change Agents: Lessons in Leading 1656 1 Saturday 10:30-11:30 CC/W110B
Productivity Pressures in SNFs: Bottom Up and Top Down Advocacy 1755 1 Saturday 2:30-3:30 CC/W415A

Networking: Social Media Vs. Face-to-Face

social media networking

When I started Research Tuesday, I stared it with the goal of increasing discussions about research in our field. Since then I have covered a number of topics, some of which were on the periphery of our field. Today’s Research Tuesday post seems unrelated to our field. It comes from the Atlantic Marketing Journal. Stay with me, because I believe research on the periphery or seemingly not in our field has great relevance and implications for our professional practice.

The Networking Project

A university in the United States conducted a project with the following details

  • Goal: through project management execute a professional networking event
  • Event details: Held at a hotel and included a reception, seated dinner, and limited program.
  • Benefits: enhance professional development and fundraising
  • End goal: support the business school’s professional development curriculum, which focused on developing soft skills such as interviewing, business etiquette, and professional attire.

During the first year, only students and their professors attended the event. In later years the project included participation of a couple dozen local professionals. Adding local professionals made the event much more successful.

As the event evolved, he business and marketing students were in charge of planning and executing the event. This allowed students to obtain real world project management experience.

Trough the event students shared the following insights:

  • Some students thought it was easier than expected to gain the attention of professionals and speak about their experiences
  • Other students wished they had bought business cards and resumes
  • Students reported learning about the importance of a firm handshake and appropriate business attire
  • Some students reported they felt they had to “compete” for the attention of attending professionals.
  • Students and professionals noted that students were often shy and hesitant to approach other participants.

Overall the event provided insights regarding the differences between face-to-face interactions versus a virtual environment. It was determined that there were distinct advantages to face-to-face networking training.

My Take

My university (a large urban state school) used to host annual etiquette luncheons. We were taught to engage in conversation, use the write utensils, whether you should reapply lipstick at the table, etc. Unlike the university program described in the article, the event was a stand-alone event without student involvement prior to attendance. It was hosted by the career center, so students did not plan it. I attended for several years and really enjoyed the experience.

If you are attending the ASHA Convention or other professional development or events increase your networking. You won’t turn from wallflower to social butterfly in overnight, but set a goal. “At this event, I’ll introduce myself to one person.” As you become more comfortable, increase how you challenge yourself at networking events.

I, participant in online networking via social media and blogging, and certainly not dismissing the value of our online communities; however, I would like to challenge you to think about getting involved in face-to-face communities as well. As we advocate for ethical care, those face-to-face interactions and discussions can help prepare us to speak up face-to-face for those tough conversations.

Also consider how you “engage” in social media. The literature review portion of the article discussed the tendency for social media participants to spend more time in “observation” on Facebook than actually engaging in conversation and exchanges at length. We spend a lot of time observing and simply “liking” or “favoriting” things rather than discussing. You can approach social media like a conversation. Rather standing on the outside and silently nodding, you can get involved and say something.

Harris, K, & Williams, J.A. (2014). “Some Experiences Cannot Be Had at a Distance: The Importance of Face-to-Face Settings for Building Professional Networking Skills,” Atlantic Marketing Journal, 3(2). Available at

The Full Story

Fear and failure

Most of my blog posts are planned (months) in advance with my audience in mind. I spend hours researching, writing, and editing. Today’s post is completely different. It is not planned. As a writer, I enjoy the creative aspect of writing challenges. Tonight, a give myself a challenge:

Take all the thoughts swirling in my head and put them on paper in one hour. Write for me, rather than my audience.

It’s 8:48 PM. Let’s go.

Part of me feels like a Scrooge. My fellow SLPs are on social media just so excited for the 2014 ASHA Convention. People have countdowns, are shopping for the occasion, and talking incessantly about it. Part of me is excited to see the people I’ve met via social media and others that I haven’t seen since last year. The other part of me is ready for the convention to be over.

Are five sessions impressive or crazy? I’m leaning toward crazy. I never imagined all five proposals would get accepted. I’ve got four of the five done with hours of practice ahead of me. I wouldn’t recommend submitting five proposals. They might all get accepted.

But is that the reason part of me wants the convention to be over? Not really. The reduction in stress will be nice. The relief from finishing a big project will be good.

It’s what I’m talking about at the convention…

  • I’m joining several wonderful SLPs and private practice owners to talk about out of the box private practice models. I feel like my model is the model that is sinking, then floating, then sinking, then floating, but mostly sinking…
  • I’m partnering with another SLP to talk about Dementia 101 for students. Over the past 18 months I have read so much about intervention for people with dementia. I have learned so much, but I hardly have the opportunity to impact people with dementia. I work minimal PRN hours. It feels like a waste.
  • And I’m talking about SNF ethics and productivity. My dedication to these issues has taken up so much unpaid time, cost me a job, and set my expectations high for ethical care. I haven’t been able to find more work. I looked at my income for 2014 today. It’s embarrassing. I never imagined finding a job would be so challenging. I talked to a recruiter this morning who told me there were ZERO jobs working with adults in the state of Colorado (listed within her staffing company).

So really, I feel like I am a failure. Who the heck would want to go to a session where such a huge failure is speaking? (Cue the tears)

I know I’m focusing on the negative aspect of the situation. I think it’s human nature, when faced with a big event (e.g. speaking at a convention) for fear to kick into high gear. (Though I only fear public speaking for the hour before I speak…)

I also know that I’m operating with general society’s definition of success. Merriam Webster’s definition of success is:

“the fact of getting or achieving wealth, respect, or fame
: the correct or desired result of an attempt
: someone or something that is successful : a person or thing that succeeds”

We tend to focus on the achieving wealth or the desired result as our definition of success. It’s a very finite concept. You are successful or you are not.

But is success finite? My inner type A personality likes to argue that success is finite. If you can’t afford to put food on your table or a roof over your head (I can’t.), you aren’t successful.

But that isn’t the full story.

But there is another part of me (less concerned with bills) that argues success is not an end point, it’s a journey. Also that journey is not a straight line. It’s wavy, broken, and all sorts of irregular.

  • So what if my business can’t take me out to dinner or pay any of my bills? It can pay its own bills. We’re getting there – slowly. And if it doesn’t work and I have to quit, I am not ashamed that I tried. Most great ideas sit in a box on a shelf.
  • While full time paid work seems like a luxury right now, I do have the opportunity to make a difference in people’s lives. When I taught a course about dementia through my local school district’s Lifelong Learning program I was peppered with comments like, “Why don’t doctors tell us information like this?”, “Any patient and family would be lucky to have you”, and “What you said made me completely change my approach with my mom. Thank you.” I am making a difference.
  • While my expectations for ethical care may have impacted my income, it has opened the door to opportunities like serving as a guest editor for a journal, being elected as a board member for a co-op health insurance company, and honored with the opportunity to hear so many of your stories and be there when you needed a sounding board.

Am I failure? Despite the popular definition, I believe I am a success. I am a “person or thing that succeeds”. I do not succeed all of the time, but I do succeed. So I am a success.

In conclusion, consider these relevant quotes from a few of my favorite books.

“Perfectionism is the voice of the oppressor, the enemy of the people. It will keep you cramped and insane your whole life, and it is the main obstacle between you and a shitty first draft. I think perfectionism is based on the obsessive belief that if you run carefully enough, hitting each stepping-stone just right, you won’t have to die. The truth is that you will die anyway and that a lot of people who aren’t even looking at their feet are going to do a whole lot better than you, and have a lot more fun while they’re doing it.”
― Anne Lamott, Bird by Bird: Some Instructions on Writing and Life

“Sufficiency isn’t two steps up from poverty or one step short of abundance. It isn’t a measure of barely enough or more than enough. Sufficiency isn’t an amount at all. It is an experience, a context we generate, a declaration, a knowing that there is enough, and that we are enough.”
― Brené Brown, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are

“Most of all, learning to fail well means overcoming our natural instincts to blame someone—maybe ourselves—whenever something goes wrong.”
― Megan McArdle, The Up Side of Down: Why Failing Well Is the Key to Success

(aside) Yes, I understand the importance of a 30-something being able to pay their bills and find sustainable income. I am not so full of hope that I have disregarded this fact. I have a plan set in place to “pull out all the stops” to make this work provide sustainable income. And I have a quit date, a date when I will have to breath in the entire experience and then let it go. I will work on a career switch. Even then, having to let something go will not make me a failure. It will just be a part of that broken line of success.

9:45 PM. That’s a wrap.

A note about the picture: That’s my husband, me, and my good friend and neighbor Kat at the top of High Dune (the nearest of the Colorado sand dunes). When climbing up a sand dune at times the only thing you feel that you are accomplishing is getting sand in your shoes.

ASHA Convention: What are poster sessions?

poster sessions

Last week I wrote about Where You’ll Find Me at the 2014 ASHA Convention. As we are talking about the convention, we often discuss what sessions we are looking forward to seeing. But what about poster sessions?

When I attended my first conference, I did not understand poster sessions. I browsed posters, but I really did not know what I was looking for. (Conventions are, in general, overwhelming as a student.) But in 2011 I had a poster session at the ASHA Convention and created my own poster.

It was an interesting experience organizing my poster, so the data told a story. I learned a lot doing the research (a case study) and even more putting into a concise poster format. I cannot speak to presenting the poster, as my research partner presented it. (I wasn’t able to attend the convention due to a new job.)

I am looking forward to checking out several posters at the 2014 ASHA Convention. Posters are an opportunity to have a discussion with researchers. Attendees can ask the sort of questions that pop in your mind as you read a research article, such as:

  • Why did you choose this assessment rather than that assessment?
  • Did people seem to enjoy the treatment or did they find it frustrating?
  • What are you working on right now to follow up this research?

Poster sessions can be very personal conversations in a much smaller group or even individually. I would encourage you to attend at least one poster session, so you can directly interact with researchers. Check the program planner for poster sessions in your area of interest. You can wander by posters, but you’ll really miss out on talking to researchers. Also, you can only obtain CEUs by attending a 90-minute poster session.

So what posters are you looking forward to seeing? If you are a reader with a poster, please list your poster session in the comments.

Where you’ll find me at the 2014 ASHA Convention

Where you'll find me

This post will be updated as more details about events are made available.


I choose sessions in several different ways including:

  • Checking out what other people are doing in my areas of strength
  • Beefing up my areas of weakness
  • Supporting friends and colleagues
  • Speaking

Checkout the sessions I’m attending here. Feel free to “Save a Copy” and use this document to help you plan. You can also check out Tara’s post on planning your schedule. Tara and I are both huge fans of Google Docs/Drive, which allows you to access documents on your laptop, tablet, or phone.

You’ll see that I give each day a different color. This is to give myself a visual cue when I pull it up on my iPad. I can totally see myself looking at the wrong day and ending up in the wrong room. The darker colors are my sessions that I’m presenting in.


I will be hanging out at the SLP Hub (in the Exhibit Hall) at lunch on Friday. If you have ethics, billing, or practice questions stop by the SLP Hub where there will be several ASHA staff members available to answer your schedule. Just to be clear, I am not an ASHA staff member, but I would love to hear your stories of SNF ethics change, impact of the consensus statement and your advocacy, etc.


The #slpeeps on Twitter are meeting up while in Orlando. Check back for updates and contact information.


I’m on Twitter, Facebook, LinkedIn, and Pinterest. I turned off push notifications for all of these platforms several months ago. However, during the convention, I’ll turn my Twitter push notifications back on, so it’s a great way to reach me. Also check Twitter as I post pictures of many of you! Hopefully we’ll get a chance to meet while in Orlando.

Why are CEUs so expensive?

Why are CEUs so expensive

Let’s talk about money. (At least we’re not at the dinner table, okay?)

There have been several posts talking about the costs of apps, which are becoming a much more popular tool to use in therapy. Since many therapists pay out of pocket for the apps we use in therapy, we’re often looking for the best deal (free if possible). However, there’s no such thing as a “free” app, because apps are complex and time intensive to create.

I noticed a similar conversation happening around CEUs. In forums I see therapists looking for the best deals on CEUs, at times having little regard to the quality of the continuing education. These comments are saddening, because I believe our code of ethics requires continuing education, so we become better therapists. Our clinical competency is an ethical dilemma we seldom discuss.

I sent out a survey through my newsletter in September to glean information about people’s thoughts on CEUs. One of the questions I asked is how much you would value a one-hour webinar with CEUs provided from our national associations. The answers I received were not surprising based on the conversations I’ve seen on social media regarding CEUs. Many respondents valued one-hour of continuing education at $20 or less with several people stating the value was zero dollars. Which really begs the questions, why are CEUs so expensive? and why/how do we form our value assessments of CEUs?

CEUs are expensive to provide

There is time and cost associated with providing CEUs. I would like to provide you with three reasons you may have not considered regarding the cost of providing CEUs.

First, becoming an approved CEU provider with the national associations is expensive.

Whenever I have spoken to a therapist and shared this information, the reaction has been the same, “Oh wow, I had no idea!”

This information has been updated based on the comment below: To become an ASHA CEU provider, the provider would have to pay several fees, including an $825 application fee and $550 annual fee. Let’s play those numbers out in an example:
If the CEU provider offers courses at $50 each, they will need 27.5 people to register in order to break even for the application fee and annual fee. In subsequent years, providers won’t need to pay the application fee (however, renewal fees may apply later).

To offer a first course as an AOTA CEU provider, the fees are similar. Application fee is $600 and annual fee varies from $425-1025 based on number of participants each year. For a new CEU provider, the fee would probably be $425. There are no additional fees per course. So in order to break even during the first year the CEU provider would need 20.5 people to register at $50 each.

APTA is structured differently, as APTA does not approve continuing education providers or courses. APTA is different in yet another way; they don’t license or certify PTs or PTAs either. State licensure boards hold the responsibility to license PTs and PTAs and manage competency/CE requirements. In my state there is not an approval process for CEU providers that charges providers money; however, there is a set of criteria CEU opportunities must meet.

It costs money to produce continuing education

Marketing is expensive. Marketing can be done via association advertisements or purchasing lists for direct mail (that’s how all those CEU fliers end up in your mailbox). Check out some of the fees associated with advertising through the associations or purchasing direct mail lists:

  • ASHA charges 21 cents per a name with a minimum of 1000 names per order. The costs for a minimum order would be $210, which means 4.2 people will need to register just to break even for this method of advertising. That doesn’t include the costs of producing and printing direct mail or postage.
  • To advertise in the ASHA Leader with a half page horizontal ad, the cost is $3,640 for one month (or $2,910 if you advertise every month for 12 months). Looking again at our example of $50 per course, 72.8 people who need to register in order to break even for one advertisement.
  • AOTA charges 12.5 cents plus $30 processing fee for mailing lists. Purchasing 1000 names would be $155, which means 3.1 would need to register at $50 each to break even.
  • AOTA’s OT Practice magazine charges $2209 for a half page horizontal ad (or $1876 monthly for 12 months). To cover the cost of advertising 44.18 participants would need to register at $50 each.
  • To order 1000 names from APTA it costs $239 plus a $25 processing fee, which means 5.28 people must register at $50 to break even.
  • To purchase a half page horizontal ad in PT in Motion is costs $3,310 (or $2,315 monthly for 12 months), which is equivalent to a break even point of 66.2 registrants at $50 each.

So why don’t CEU providers market via social media? They do, and it’s not free either. It costs money to promote ads via Facebook, Twitter, and other social media platforms. Someone’s time and energy goes is spent to create ads and determine how to effectively distribute them. Even monthly newsletters costs money. Gray Matter Therapy pays a fee each month to distribute the newsletter.

CEU providers are often big participants in continuing education themselves, whether that be through reading recent journal articles (which have their own fees associated), purchasing books on the topic, or attending conventions, conferences, and other CE events.

How much should CEU providers get paid?

Many people have spent years becoming an expert in a particular area and through continuing education events, share their expertise with you. They do it because they love the topic and have a passion for education and patients.

But they also do it for money. Education is a part of their job. If they didn’t spend time educating, they could spend time using their talents in another way that would make money.

So just how much should a CEU provider make? Is it fair for an instructor to charge $50 a person for an hour CEU event with 25 attendees? That means they are making $1259 an hour, right? Not quite. There is a lot of time, preparation, marketing, and other fees associated with providing continuing education.

Given this information, how do you think we could foster a lifestyle of continuing education that is both cost effective for participants and values the presenters’ time and expertise?

Good news about medications for dementia


Let me just state my bias up front. In my personal life, I avoid taking medications. Rather than take pain reliever for a headache, I drink water. The headache is likely due to dehydration (which is common at high altitude) or sinus distress (and water thins mucous being produced). I avoid medications, but I am not anti-medications. In fact, I take a medication every day and will likely for the rest of my life, because my body requires it. Personally, I believe medications aren’t often necessary, especially as the first intervention.

As a speech-language pathologist, it is not within my scope of practice to give recommendations regarding medications. However, it is within my scope of practice to understand how medications effect the body, especially when there may be side effects impacting cognition or swallowing.

Medications but no therapy?

One of the things I have found quite concerning is meeting a new patient admitted a skilled nursing facility and seeing the list of medications they are on. They may be on a cholinesterase inhibitor and antipsychotic medications for dementia, but they have never participated in any therapy (speech-language pathology, occupational therapy, or neuropsychology). This is concerning, because there are so many benefits to therapy throughout the course of dementia.

In the earlier stages, therapists develop individualized compensatory strategies and routines for patients to help their maintain their independence as long as possible. In the middle to late stages of dementia, therapists work on changing the environment to increase a person’s independence and quality of life. These interventions don’t cure dementia (but neither do any of the current medications on the market); however, they are individualized to help improve quality of life, independence, and safety without side effects.

Antipsychotic medication effects in the elderly

Antipsychotic medications are not without side effects. Common side effects of antipsychotics in the elderly include [1]:

  • anticholinergic reactions
  • parkinsonian events
  • tardive dyskinesia
  • orthostatic hypotension
  • cardiac conduction disturbances
  • reduced bone mineral density
  • sedation
  • cognitive slowing

We rightfully spend great time and energy on fall prevention efforts in the skilled nursing facility setting. How many of those antipsychotic side effects would contribute to an increased risk for falls? Most of them. Besides falls, in people with dementia sedation and cognitive slowing would complicate matters. Yet, these are very common side effects.

CMS sets goal to move away from antipsychotics

Given my stance on medication, especially in the treatment of dementia, I was very pleased to see the this press release from the Centers for Medicare & Medicaid Services [2]. The press release states the goal CMS set to reduce use of antipsychotic medications in nursing homes by 25% by the end of 2015 and 30% by the end of 2016. This is excellent news.

Want even better news? Patrick Conway, MD and CMS chief medical officer said, “In partnership with key stakeholders, we have set ambitious goals to reduce use of antipsychotics because there are – for many people with dementia – behavioral and other approaches to provide this care more effectively and safely.” (emphasis mine).

As an advocate for person-centered healthcare, Dr. Conway’s words make my heart happy. He said, “Ultimately, nursing homes should re-think their approach to dementia care, reconnect with the person and their families, and use a comprehensive team-based approach to provide care.”

Way to go CMS! Now let’s chat about how CMS reimburses for these therapy services that can achieve excellent results without the side effects of antipsychotic medications…


  1. Masand, P.S. (2000). Side effects of antipsychotics in the elderly. Journal of Clinical Psychiatry, 60(8), 43-49.
  2. Centers for Medicare & Medicaid Services. National Partnership to Improve Dementia Care Exceeds Goal to Reduce Use of Antipsychotic Medications in Nursing Homes: CMS Announces New Goal. Newsroom Center., 19 Sept. 2014. Web. 19 Sept. 2014.

Perceptions of SLPs & Memory Aids in the SNF setting

SLP perceptions

This blog post is a part of Research Tuesday. I read “Perceptions of Speech-Language Pathologists Linked to Evidence-Based Practice Use in Skilled Nursing Facilities”.

The article recognized several barriers to implementing evidence-based practice (EBP) such as:

  • Lack of high quality evidence
  • Insufficient time to study evidence
  • Lack of clinician training to implement EBP
  • Negative workplace cultures
  • Clinician and leadership perceptions of evidence

The article also reviews some suggestions for resolving barriers to implement EBP. (See the article for these details.)

Non-electrical external memory aids are considered one of the most effective interventions for people with dementia. The non-electrical external memory aids can improve communication while reducing behavior challenges. They include things such as visual schedules and memory wallets.

This study looked at the following questions:

  1. Do SLPs and rehab directors have different perceptions of non-electronic external memory aid use for people with dementia?
  2. Do SLPs and rehab directors perceive the SNF organizational context differently?
  3. Is the perception of non-electronic external memory aids consistent with the use of non-electronic external memory aids?
  4. How do SLPs describe the evidence related to non-external memory aid use?

To answer these questions the author created a survey that was completed by SLPs and rehab directors in the SNF setting. In addition, SLPs answered questions specific to non-electronic external memory aids and SLPs and rehab directors completed the Organizational Readiness to Change Assessment (evidence and context scales).

Answers to the research questions:

  1. No significant difference between SLPs and rehab director’s perceptions of non-electronic external memory aid use for people with dementia was identified.
  2. Rehab directors perceived the organizational context more positively than SLPs for the implementation of non-electronic external memory aids. SLPs identified the following barriers to implementation: lack of staff, physical materials, and time.
  3. 45.89% of SLPs reported using non-electronic external memory aids with patients with dementia in the last 6 months.
  4. Most SLPs reported the EBP for non-electronic external memory aids was positive and relevant.

Overall it was seen that clinician perceptions and organizational variable are important factors in whether non-electronic external memory aids are used as a tool for people with dementia.

It is interesting to read a study in which the participants of the study are of a category that you belong to (SLPs in the SNF setting). I am really interested in reading future research looking at the use of memory books in the SNF setting. It is not often that I read research that directly pertains to the SNF setting. It seems much of the research in our field is focused on outpatient therapy.

You can follow the first author of the study on Twitter.

Douglas, N.F., Hinckley, J.J., Haley, W.E., Andel, R., Chisolm, T.H., & Eddins, A.C. (2014). Perceptions of Speech-Language Pathologists Linked to Evidence-Based Practice Use in Skilled Nursing Facilities. American Journal of Speech Language Pathology, doi: 10.1044/2014_AJSLP-13-0139.

Vocal changes during the normal aging process

Mandys Voice Post
Earlier this week, I wrote about our ethical obligation to clinical competence. I mentioned that one area I lack competence is voice therapy. I am thankful to be in a situation where I refer voice patients to my colleague, Mandy Politziner who is an SLP and vocalogist. I asked her to lay some groundwork for understanding normal aging in terms of voice in the blog post today. Thanks Mandy!

Typically after the age of 60, men and women’s voices begin to change. For those of us who work with elders, we know elders’ voices do not sound like our own. Buy why? What exactly is happening to the voices of our elders? The following are examples of changes that can occur in our voices as we age.


Typically beginning in the sixth decade, laryngeal tissues begin to atrophy, or waste away. The vocal folds generally atrophy towards the lateral direction, which results in vocal fold bowing, in which a gap forms between the vocal folds. Atrophy may also cause the structure of the tissue itself to change. Parallel strands of muscle fiber may become fibrous, or criss-cross in shape. This change in shape of fibers may cause irregularities in the mucosal wave of the vocal folds.

A clinician may hear weakness, soft volume and/or breathiness with atrophy, as well as a decreased pitch range.

Neural cell changes

Another change that inevitably happens to many areas of the body with aging is that the neural cells may not function optimally like they used to. Whether through degeneration or malfunction of neural input, the result may be a change in muscle tone of the larynx, and a change in regularity of muscle contraction.

With malfunctioning of the neural cells, a clinician may hear that distinctive “wobble” in the voice that we associate with old age, as well as weakness in the voice.

Laryngeal ossification

Laryngeal ossification, in which cartilage changes to bone, typically starts at the age of 30 and slowly increases until around our 80’s. The good news is that this hardening of the structures can lead to greater stability in the voice, as the voice has somewhat of an anchor for the ever-changing movements in the larynx. The bad news is that ossification can lead to lack of agility of the voice. This is particularly stressful to our elders who sing. For those of our elders who sing in their local community or religious choirs, this lack of agility can be particularly upsetting to them.

With laryngeal ossification, a clinician may hear difficulty with a patient’s ability to change pitches quickly and freely.


Just as someone can get arthritis in their fingers or toes, the elderly can get arthritis in the joints of the larynx. Due to inflammation, these joints may become limited in their movement, affecting adduction, abduction, and cricothyroid movement.
With laryngeal arthritis, a clinician may hear limited pitch range.


Personally, I have heard more roughness in my patients’ voices than weakness. Roughness may be caused by edema, which can also manifest as we age. Edema is swelling caused by excess fluid in the vocal folds. The excess fluid can disrupt the mucosal wave pattern.

With edema, a clinician may hear vocal roughness.

Hormonal changes

Hormonal changes may be the contributing factor to change in fundamental frequency as we age. The male voice gets higher with age, and the female voice gets lower, possibly due to decreasing testosterone and estrogen levels. After men and women are well into their 80’s, their voices may be indistinguishable from each other.

Potentially due to hormonal changes with aging, the clinician may hear a low voice in a female (below 200 Hz) and a high voice in a male (above 150 Hz).

These are examples of typical changes of the aging voice. Of course, certain populations can beat the odds and maintain a healthy voice as they age, such as those who are trained singers or speakers.

It is important to note that this list contains examples of occurrences in the normal aging process, and does not rule out that your patient does not have an actual voice disorder. If you or your patient suspects a voice disorder, send your patient for an otolaryngologist evaluation

Titze, I.R. (2000). Principles of Voice Production (2nd printing). Iowa City, IA: National Center for Voice and Speech.

Guest blogger bio:
Mandy Politziner, MS, CCC-SLP, is a speech-language pathologist in Boulder, Colorado. She recently graduated from the Summer Vocology Institute at the National Center for Voice and Speech under the direction of Dr. Ingo Titze. Mandy has a BFA in musical theatre from the University of Michigan, and she enjoys combining her arts and science backgrounds as she works with her clients at her skilled nursing facility.