March 1, 2013 Departments

Inbox: March 2013

Inspiring Example

I love the article "Finding the Voices of Her Tribe" (January 2013)! Sarah Ross is a fabulous example of what being a speech-language pathologist is or should be all about. She is a positive and bright shining star for her people. By "her people," I am referring to the Confederated Tribes of Grand Ronde and the speech-language pathologists of this world. Thank you for the example you set, Sarah!! You are an inspiration!!

P.S. Love the new Leader look!

Penny Walker
Rapid City, S.D.

Love the New Format

As perhaps a youngster may write ... OMG! I simply love the new format. This is truly an amazing accomplishment of design, functionality and usefulness. All of the people who were involved should be darn proud of this new ASHA Leader. I was so excited to read through the magazine that I did so the day I received it in the mail. I already easily copied several articles and posted them at work!! Great job and thank you!

Erin E. Aafedt
Prescott Valley, Ariz.

Wow! What a delight! I have been a member of ASHA since forever (I think 1962). I felt required to write to say that I am so pleased and proud of the new Leader. The downside of it is that I cannot just scan it and throw it away, but I have to keep it handy to read each engaging article on meaningful topics. The layout is also a joy. Now I have two magazines that I look forward to devouring: the Leader and the Smithsonian.

Best wishes for continued success,

Margaret (Peg) Jerger
Cary, N.C.

Reach Out Across Settings

I am writing in response to "Think Outside Your Setting" (Inbox, January 2013). As an SLP practicing in hospitals for 24 years, I understand the frustration expressed by SLPs in communication regarding shared patients or clients. I strongly feel communication is a two-way street.

As a medical SLP working with children in the pediatric ICU and the hematologic/oncology unit, I am involved as early as emergence from coma or just after extubation. Truthfully, many times we are just grateful that the child is alive. I write goals that support the work of the medical team and that are accepted by insurance. I write goals that nursing and child life specialists can support and in which parents can participate. These considerations frequently preclude what is appropriate for a school setting, even though transition back to home and school is foremost in all of our minds.

I have worked with teachers who come in [to the hospital] at night to visit and see what activities to leave, but I cannot remember a school-based SLP doing the same. And frankly, sometimes children are discharged and I am not given time to update goals for home and school.

As a clinical assistant professor, I teach my graduate students to contact their clients' school SLPs to initiate that essential collaboration. But, in the years that I have been practicing, I can count on one hand the number of IEPs that I have been invited to attend by the school or the school clinician. Funding for services is tight, so we must all support the needed services we provide in all settings. The medical home model is becoming more prevalent, and physicians more and more are treating the whole child. I ask all school-based SLPs to invite the medical or private-practice SLP, as well as the pediatrician or family physician, to IEPs as a starting point for collaboration. You will be pleasantly surprised by the results.

Jennifer Casteix
Tucson, Ariz.

This is in response to Corrina Zimmerman-Riggs' letter "Think Outside Your Setting" (January 2013). I empathize and sympathize with her feelings, but I also understand the responsibilities of the nonpublic-school SLPs. Each school setting has mandated guidelines that allow parents to seek second opinions, a situation—that has existed since the 1960s—that puts the local education agency and the outside evaluators into a defensive position. The outside voluminous report reads like a letter to Santa Claus and contradicts that of the LEA [local education agency]. A conflict arises.

There is no simple solution to these predicaments. Each setting has competent ASHA-approved SLPs. Parents who appeal findings naturally lean toward "the hospital said" opinion. In this process the SLPs transgress their role and become a parent advocate, wittingly or unwittingly. The conflicts take on a life of their own!

To reduce the conflict it helps to seek professional unity and to try to see the world through the eyes of the other professionals. An e-mail, tweet, text or old-fashioned phone call before the report is written might improve communication and minimize conflict.

Robert J. Ferullo
Boston, Mass.

Questions About Future Technologies

I read the article "Future Present" in the January issue of The ASHA Leader with frustrated disappointment. I thought of Christopher Reeve, whose virtual ambulation across a stage expressed his wish to walk. It was heartbreaking. Reeve ought to have informed his audience more about nerve repair and cortical reorganization if he wanted to be helpful. The "11 Up-and-Coming Technologies" was a lot like a Reevian virtual moment.

Improved videostroboscopy, high-speed video and depth kymography may aid in laryngeal disorder diagnosis, but will they—much like acoustic analysis in its day—have clinical relevance? Where is discussion of a technique for laryngeal MRI or how airflow hydrodynamics relates to dysphonia? Where is an NIH-type mechanism underlying this research? Until physiology is part of our understanding of human sound production, diagnosis—much less synthesis—is not achievable.

Uses of brain implants, transcranial stimulation and direct current stimulation read too much like a Vitalstim brochure. Where is the underlying mechanism being addressed in what was offered? The brain isn't a melon. Where is mention of stimulation specificity (Penfield-type [antiquated], Merznich-type [unrefined], or Birthe Rubehn at the University of Freiburg)? Of interest, however, was discussion of neuroimaging in areas of TBI and CVA, where medical neurology is well advanced. Would neurogenics benefit from neuroimaging if we offered curriculum preparing students to participate in this burgeoning field? The Leader isn't Advance. It ought to be more than glossy "blue sky" if it truly desires to inform professionals.

George Charpied
Pittsford, N.Y.

Invasive vs. Noninvasive Brain Interface

In "Unchained Mind" (January 2013), Guenther and Brumberg make inappropriate claims that invasive brain-computer interface technologies, requiring surgical implantation of an electrode array, have greater potential to meet the expressive communication needs of patients than noninvasive BCI technologies (electrode array worn on the scalp).

By definition, BCI electrode arrays are nothing more than control interfaces, or secondary device features used to access the language content of a full, high-performance augmentative and alternative communication system. They serve the same purpose as switches. Although invasive BCI technology may eventually increase selection rate and accuracy, both methods can be used to investigate interface components experimentally and provide evidence to support the design of primary language components of a full AAC system.

The authors demonstrate use of invasive BCI technologies to produce isolated phonemes with a speech synthesizer. Extensive work is needed before "the technologies needed for restoring near-conversational speech" are truly in place.

In our ongoing VA study, veterans with late-stage amyotrophic lateral sclerosis are independently using noninvasive BCI2000 systems with P300 spellers in their home environments for communication, e-mail and Internet access. Several participants consistently generate spontaneous novel utterances using noninvasive BCI systems. Comparable data on the language performance of people using invasive BCI technologies do not exist to justify the authors' claims. We believe that the BCI2000 being implemented by the Wadsworth Center and Huggins (University of Michigan) are the only BCI systems with a built-in language activity monitor for collecting language samples to measure the communication performance of BCI users.

Katya Hill
Thomas Kovacs
Sangeun Shin

The writers are associated with the AAC Performance and Testing Teaching Lab at the University of Pittsburgh.


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