News

Congratulations to our newest SPARC Award winner, Brindy Klym, OT, Florida Gulf Coast University, Grad Date: May 2019. Read her winning essay below:

Daily, I do my best to live by Mahatma Gandhi’s words, “Be the change you wish to see in the world.” I envision a world of greater creativity, compassion, and empathy, and strive to embody these traits in order to help others live happier, healthier lives.

My career began as an elementary education teacher. I taught for five years, inspiring children with special needs and those learning English to embrace the world and make a positive impact on others. I strived every day to show up in utmost presence, enthusiasm, and love for my students. I taught over one hundred kindergarteners and first graders, guiding with a sense of adventure and commitment to life-long learning. Each day I was committed to bringing a “spark” to my classroom, a spark that ignited a sense of optimism, confidence, and love for learning in the children that I taught. This spark was evident in my students when they came back to visit me years later, and their families still express gratitude for it to this day as the young children grow into middle schoolers.

While working with students’ with special needs, I discovered occupational therapy (OT) and felt I had discovered my purpose. With my spirit of adventure, sincere care for others, and commitment to personal improvement, I began my pursuit of a career in OT at Florida Gulf Coast University. My commitment to helping others evolved into teaching in a new way: guiding individuals to maximize their functional potential in all aspects of life. OT delights and inspires me because I am able to help others find purpose and independence in their lives. OT is more than a profession; it is an opportunity to teach others holistically and facilitate change at the individual, group, and community level. I feel empowered by my decision to break out of my comfort zone and follow my heart into a new profession, despite the financial and academic challenges it brings. I will never stop learning and will hold strong to my commitment to helping spark a confidence in others that ignites opportunities, happiness, and independence. My purpose is to change the world by inspiring others and teaching a diverse range of individuals to make life better for themselves through occupational therapy.

I appreciate any and all support received and am committed to paying it forward through my commitment to learning so that I may better serve others through OT.

Congratulations to Cody Lemmons, DPT, of Austin, TX, and Runner-up Brent M Giacchetti, COTA, of Pueblo, CO on winning our SPARC Awards! Read their winning essays below!

Essay by Cody Lemmons, DPT, University of St. Augustine, Austin, TX, Grad Date: 8/23/19

A spark can be defined physically as transferal of energy or symbolically as “a new beginning” or “hope”. Therefore, it is crucial that every physical therapist embed themselves with a spark to change each of our patient’s lives. In a world infiltrated with pessimism, deceit, poverty and carelessness, we very well maybe the only ignition to provide meaning and purpose to our patients. Patients come from many walks of life, various generations and cultures with a multitude of diagnoses who desperately need the hope, faith and spark that therapists can provide. While I come from the lens of a physical therapist and athletic trainer specifically, every patient can benefit from a multidisciplinary team of professionals in order to produce physiological and psychological change.

This past Spring, I was blessed to be given the opportunity to travel abroad to underdeveloped regions of Guatemala City, Guatemala in order to provide physical therapy and general medical services. I remain humble while writing about this heartwarming and rewarding experience to share my spark with many individuals that have lived their entire lives without hope or motivation. The primary goals and mission were to teach others about general health conditions, educate the community with exercise prescription/benefits, train other medical professionals and provide medical advice/treatment daily to those with no access to healthcare. My experience in Guatemala was to say the least the most humbling and enlightening adventure of my life. I aspire to return that same experience to my patients wherever I practice in the future. My goal is to restore hope, faith, life, meaning and spark to patients that otherwise wandered from their path by providing education, training, treatment and habitual change to carry on long past discharge.

Clinically, my journey has taken me around the states and abroad to learn from mentors and professionals, share my knowledge and skills, and gain experience with patient care. My journey began about 10 years ago when my undergraduate assignment prior to graduation was held at an inpatient rehabilitation hospital. Then, it was uncertain where my career path would take me; however, at the end of that rotation, I knew that I enjoyed patient care and improved their lives and “human experience”. While attending this rotation, I also had the privilege of working with sports medicine professionals at the local college in which I developed much of my patient and hands-on skills with emergency medicine and orthopedics. To this point, I was involved with the medical management, treatment and physical therapy to one of my classmates and football athlete that suffered a severe SCI. I was fortunate to work with him for the duration of his inpatient rehabilitation and witnessed the power of therapy and “spark” that allowed him to walk and enjoy life with his family again. He now travels to give motivational speeches and involved with the Fellowship of Christian Athletes to share his story and provide that spark.

I continued my education to become an athletic trainer and assisted with physicians in office treating a myriad of patient populations. In many ways my duties included patient care and education but did not feel that was my purpose. Patients were effectively treated but often returned for recurrent treatment in order to improve their quality of life short term. In some cases, these recurrent in-office treatments were warranted as options were limited; however, a majority of patients could have simply required the self-management education for their injuries. I decided that further education was warranted to be able to share my knowledge and skills to improve my patients’ quality of life.

I am currently beginning my final year of physical therapy school and had the privilege to attend a skilled nursing facility for my initial rotation. I had the pleasure of seeing patients admitted in our facility with severe functional decline and discharged with modified independence with all ADLs. Many of our patients often felt hopeless, helpless and without direction. My mentor and I not only provided essential physical therapy with enthusiasm but also education/training that could be used long after discharge. Patients often discharged with new life goals, new skills and friends/support that could provide a path to better quality of life and return to share their knowledge one day.

I have been blessed with so many opportunities, experiences, knowledge, mentors, students, peers, family and support in order to become a strong future clinician. These experiences have provided a strong foundation and will create opportunities to grow as a professional and person. Although my schooling is nearing its end, my learning is ceaseless. I hope that I can provide the same knowledge, skills, opportunities, foundation and “spark” that so many have given me and change every patient’s life one step at a time.

Essay by Brent M Giacchetti, COTA, Pueblo Community College, Pueblo, CO, Grad Date: 5/1/19

I am writing to you to apply for the Spark Scholarship. It has taken me many years of my life in and out of college, traveling the world, volunteering, and working many different seasonal jobs to realize my calling is where I am currently at in the Occupational Therapy Assistant Program. I look forward to doing so many things as a Certified Occupational Therapy Assistant (COTA) to give back to the community here in Pueblo or Colorado Springs, CO.

After passing my National Exam I will work part-time and plan to return to Pueblo Community College for their Nursing or Radiology Tech program. With these Associates degrees I will have the means to work abroad and improve health conditions of under privileged communities with disabilities. I would love to go back to India, return to the Himalaya’s and live there for a few years, and network through my Catholic Priest friends to be of assistance in small mountain towns where a COTA/RT/RN is needed. Using this experience from being in the mountains it will be enriching and humbling to bring those experiences back to Colorado and integrate more yoga and meditation into therapies with children and adults so they have behavioral coping mechanisms through Heavy Work yoga motions and breathing. I think it would be extremely beneficial to those in the school systems so as a whole, these holistic approaches with evidence based research and practice could bring more peace to the kids and faculty as a whole. With the success of this kind of program, it would be implemented into the routine of the teachers to do this for children, since many are sitting all day for hours in a chair, would decrease joint and ligament stress from repetitive motion fatigue and make school increasingly fun through movements that are silly, fun, and relaxing.

As I have lived my adult life in poverty and continually struggle in school due to a learning disability, it is increasingly challenging to make ends meet. I have taken to being a homeless student out of my Subaru Forester. It would be nice to lift myself out of this homelessness to afford some comforts, pay off school loans and credit card debt that have accumulated trying to complete my formal education over the past many years. Working part-time for Pikes Peak Community College as a Pre-Nursing tutor helps me manage my finances some, though the real financial support is from loans, grants and scholarships to make car payments, pay for insurance, and food. Starting Spring 2019 in January, I will have to let go of working due to the intensity and long hours of school and with clinical field work. With your generous support it will help me stay afloat from the concerns of financial instability. I appreciate your time, and I thank you for reading this.

Warm Regards!

Congratulations to our newest SPARC Award Winner, Jane Song! She is an Occupational Therapy student at Dominican University of California, and plans to graduate in May 2019.

Read her winning essay below:

In late 2012, I watched my father be nursed back to health after a serious automobile collision left him barely able to move on his own. Though the accident was difficult to deal with, the positive experience with his medical team thereafter led me to believe in the value of occupational therapy. Watching him regain the ability to engage in the functional activities that were important to him was an emotional experience. I still remember the proud look on my father’s face after he used the bathroom independently for the first time since the accident. I, too, felt extremely proud of his accomplishments. This experience led me to pursue a career in occupational therapy. The experiences I’ve had since then continue to validate my decision and reinforce my passion for this profession.

Initially, I had a desire to work in pediatrics. I first-handedly witnessed the benefits of early intervention when I worked as a volunteer with a young girl who was born with an orthopedic disorder that disallowed for fluid movements of her extremities. After several months of therapy, she was able to independently perform various functional tasks such as taking off her jacket. Her progress was remarkable to watch, but seeing her become more confident in herself was what left a lasting impression of this entire experience. This was the first time I had played a role in facilitating progress as a healthcare provider, and I felt the same, incredibly proud feeling I had felt with my father for this young girl and her accomplishments.

As my clinical knowledge and skills continued to develop throughout graduate school, the want to help individuals discover their potentials and feel more confident remained the same. This desire was especially strong during my recent level two fieldwork experience in an inpatient acute mental health setting. An experience I had with a patient not only reinforced this passion but also enabled me to gain real-life experience of the importance of engagement in functional activities. This patient spent all day in his room and refused to speak with the staff for the first three days of his stay. On the fourth day, I briefly made his acquaintance in the hallway when he momentarily stepped out of his room. I introduced myself and welcomed him to find me in the occupational therapy office if he needed anything. The next day, I invited him to group therapy. A full week nearly passed before he took his first steps into the occupational therapy room to join us for art group. With much encouragement, he picked up a paintbrush and painted his first picture. He, then, painted everyday until he was discharged. Not only did he start coming out of his room more often, but he also began to open up to the staff, making jokes and laughing. The positive changes in his behavior when he discovered this leisure activity was an eye-opening experience that demonstrated the effectiveness of occupational therapy. I, again, found myself feeling proud of this individual and the progress he had made.

Throughout the pursuit of my professional career, I am constantly reminded of the incredible potential that people have to achieve their goals. My experiences continue to solidify the notion that I am undoubtedly in a field that not only enables me to meet my professional goals but also incorporates values that I hold most dear: serving others and making a difference.

By Brian del Poso, Associate Compliance Partner

With just about three-fourths of the year completed, it’s a good time to provide an update on where we stand compliance-wise and what’s on the horizon for the rest of the year. Therapy documentation and technical accuracy has come a long way, so kudos to all of you. There are still a few areas, however, that we can pay closer attention to. These items will sound familiar as they have been identified in years past and have improved, but we definitely still need to consistently get better at:

1. Physical agent modalities documentation
2. Co-tx documentation
3. Personalized clinical assessment in Progress Reports
4. Documentation and justification for billing patient education, especially when residents are difficult and/or refusing treatment

Again, there has been improvement in these areas, but there’s definitely a high ceiling for growth. I encourage you all to seek further education and training in these documentation areas. The easy way out would be to look at some of these things and just say, “Well, we just won’t do co-tx anymore,” or “We don’t use physical agent modalities often, so…,” but the easy way out isn’t who we are. Let’s invest in each other and in the spirit of our core value of PASSION FOR LEARNING, and utilize the therapy resources, POSTettes, and compliance partners we have at our disposal to move ourselves forward.

Part A MSCAs were on a bit of a hiatus as the IRO summer season began, but they are starting up again as we speak. With that said, here’s a YTD look at some of our top-performing facilities from the MSCAs. Congrats and keep it up!

If you’d like to know where you rank within your company, please reach out to your local compliance partner, and we will get that information out to you.

Coming up in Q4, we’ll be wrapping up any leftover MSCAs, and similar to recent years, we will also be starting up Part B MSCAs. As a reminder, not all facilities will receive a Part B audit this year. Facilities chosen for Part B audits will be dependent on the size of your Part B program. Essentially, if your YTD Part B revenue hits a certain threshold, you’ll be in the pool for a Part B audit. We’re currently working on the threshold to see how much revenue makes sense for a cutoff point, so more to come from your local compliance partners.

Lastly, I’m sure you all have heard or seen the emails about our Independent Review Organization (IRO) audits. We’re not out of the woods yet and still have the remote portion coming up, but we wanted to give a shoutout to this year’s on-site facilities (Legend Oaks Kyle, Golden Acres, Rehab Center of Des Moines, Grand Oak, Redmond, HCR CO Springs, Heritage Park, Brookfield) for doing such an awesome job in our very last CIA and IRO year!

Congratulations to our newest SPARC Award Winner, Hannah Ruth Downing, SLP Student at Sacramento State University, Grad Date 5/19/2019

Read her Winning Essay Here:

“What do you want to be when you grow up?” is the question I was continually asked as a child. Being raised in the Filipino culture, one is expected to become a nurse, doctor, or have almost any job relating to the medical field, but this did not seem like something I wanted to do. From a young age I enjoyed the idea of becoming a teacher. As I grew older I tutored elementary students at a local middle school, and there my ardor for helping kids increased. The thought of becoming a teacher continued to linger in my mind, but the voices of others encouraged me to choose otherwise. Going into college, I chose to pursue occupational therapy due to the fact that it was in the medical field, and I could specialize in pediatrics. However, I quickly realized that occupational therapy was not the career choice that suited me best. I then stumbled upon speech pathology. This career field had both aspects that I was looking for, teaching kids while being in the medical field. The classes I began to take and the volunteer work that coincided, sparked my interest.

Having finished my first two semesters in the communication sciences and disorders major, I was taught the basics such as the anatomy that is used for speech and swallow, language disorders in children, how effects to the brain can disrupt the language process, and various other topics. I soaked up the majority of the information given to me by my professors and I enjoyed learning everything, but by putting the knowledge I had obtained, over the two semesters into practice, I was enabled to truly comprehend the things that were taught to me.

During the first two years in college I was a childcare attendant at California Fitness. I was able to observe and interact with typically developing children, and with the knowledge I held at the time, I was able to distinguish kids that incorrectly produce sounds that were typical for their age and others who could not. This was the first encounter where I was able to practice what I had learned. This aroused my desire to learn more in order to implement the information I was attaining, so I decided that I needed more exposure to the field that I was working towards. During my third year, I got hired at Genesis Behavior Center as a behavioral therapist working with children with autism. This job has allowed me to apply a lot of the information about autism that was taught by my professors because a lot of the clients on an SLPs case load are on the spectrum. The most impactful thing that I have obtained, as well as what has driven me to learn more from being a behavioral therapist, is the struggle of communication that someone with autism faces. As a behavioral therapist, I have to train my clients how to communicate their emotions in the most effective way. In training a child with autism, how to do this can be complicated and it can take weeks, months, or even years to accomplish. However, when the child finally understands that when they are mad the inappropriate thing to do is throw a chair across the room, and instead they can simply state that they are mad and take some deep breaths to calm down, this is the moment that brings me so much joy. I have learned that communication is extremely important, and when communication is hindered, by a developmental disorder like autism or aphasia from a stroke, it can cause a copious amount of stress on the person with a disability as well as the people around them.

Working at Genesis reaffirmed my love for working with children, and although my passion for helping kids had increased, I still needed to gain experience by working with adults. I began getting involved with several organizations such as Elk Grove Adult Community Training (EGACT) and Training Toward Self Reliance (TTSR) where they both work with adults with developmental disabilities such as Down’s Syndrome, cerebral palsy, or autism, Head Trauma Support Program (HTSP) where they work with clients who have had a traumatic brain injury, and lastly stroke support group. Volunteering at these organizations was an immense revelation that left me heartbroken. There were two paramount concepts that I gained from my experience, first was the fact that kids grow up. I knew that kids obviously grow up, but I forgot that even though they get older their disabilities do not disappear. There is so much focus on early intervention, which is not a bad thing, but people often forget that adults with disabilities still need guidance and assistance. I was so happy to see day centers like EGACT and TTSR assist adults with disabilities go to and interact with each other as well as guide them so that they can continue to be a part of society regardless of their condition.

The second concept was the fact that before the patients had a stroke or TBI, they lived functionally. When going to HTSP meetings I noticed that a lot of the clients had tattoos. In order to get those tattoos they had to have the ability to make the executive decision to get something that would be permanently on their body, however, when you see them now they cannot even form a sentence, let alone a word. I realized that a lot people that encounter patients with TBIs or strokes were treating them as a person with a disability, and not just as a person. We often forget they used to have normal lives and were capable of accomplishing daily tasks themselves, and that they are just working to get back to what they remember as normal. One of the patients at the stroke support group meeting stated that, “It was like tracing out your ABC on the wide rule paper like you were in kindergarten again, but in kindergarten I probably did it better. I have to learn everything over like I’m a child.” This statement impacted the way I saw patients that had gone through a stroke or TBI. It made me realize how frustrating ever day must be for them, and going to school to potentially become someone that could help them try to get back to living functionally really encouraged me. Even though my passion is working with children, volunteering at these organizations has not only opened my eyes to many misunderstood concepts, but it has also driven me to want to understand and learn more about working with adults.

Overall, the classes I have taken for communication sciences and disorders, have aided me when I am volunteering. It allowed me to understand the absence of pragmatic skills in kids with autism, and the many different aphasias one can experience after enduring a stroke. I can easily see and pinpoint things I am learning in class to what I experience as I work and volunteer. I am aware that I still have so much to learn because even though with all the knowledge I have obtained, I continuously ask myself questions when I encounter certain situations. These questions can only be answered as I learn more, which has driven me to want to continue in my education. This scholarship money will allow me to further this desire of learning in order to gain more experience, enabling me to treat my future clients with the utmost excellent care they deserve.

By Deb Bielek, Therapy Education Resource

SUMMER!! It’s the season of the year when we celebrate sunny days, spending time at the beach or outdoors boating, camping, barbecuing with family and friends and we plan family vacations, while the kids are on break from school. For those of us who serve as therapy and nursing providers in skilled nursing, summer also carries with it another meaning. Each year and usually on the last Friday in April, the SNF Notice of Proposed Rule Making (NPRM) is made public by the Federal Government. While we often have ideas about some of the proposed regulations we may find in the NPRM, we also eagerly await the public notice so we can dive in to see if it contains any surprises. We then spend time processing, analyzing and putting together thoughtful comments for the Federal Government to consider before releasing the SNF Final Rule, which is typically published sometime in August. The Final Rule directs our next season of reimbursement and regulatory requirements.

The proposed rule Fiscal Year 2019 has been considered by many to be the most anticipated rule proposal since the introduction of the Medicare Prospective Payment System in 1998. The NPRM was released to the public on Friday, April 27, 2018, and introduced us to a new payment model entitled, the Patient Driven Payment Model (PDPM), which is suggested in the rule to become effective in October 2019.

CMS Administrator, Seema Verma, describes the proposed rule in this way:

“We envision all elements of CMS’ healthcare delivery system working to reward value over volume and decisively focus on patients receiving quality care from their Medicare benefits. For skilled nursing facilities, we are taking important steps through proposed payment improvements that will reduce administrative burden, and foster innovation to improve care and quality for patients.”

CMS further describes PDPM as an innovative new system for SNF payment that ties payment to patients’ conditions and care needs rather than volume of services provided. PDPM is proposed to simplify complicated paperwork requirements for performing patient assessments by significantly reducing the MDS reporting burden. The proposed new PDPM is designed to improve the incentives to treat the needs of the whole patient, instead of focusing on the volume of services the patient receives. This approach advances CMS’ efforts to build a patient-driven healthcare system beginning with innovation throughout Medicare’s payment systems.

We recognize that under the newly proposed SNF case-mix model, skilled nursing facilities which offer services tailored to individual patient conditions rather than the specific individual services provided by the SNF will become most important. You will want to think more about the outcomes you achieve when treating a patient who has had an acute neurological condition, for example. Do your patients go home more often? Do they improve more significantly? Do they stay free from readmission to the hospital longer after discharge from the SNF? If this model becomes the final rule, data such as this will be more accessible to your patients, allowing them to be more informed as they evaluate their options for post-acute care.

As an industry, we have opportunities to be the setting of choice under a value-based model, but we MUST continue our focus on providing interdisciplinary, patient-centered care, while measuring and analyzing our results, and making adjustments where needed. Standardized Tests, interdisciplinary communication, CARE & NOMS data (Section GG), evidence-based practice, reducing re-hospitalization through predictive assessments such as the LACE Tool, better discharge planning and enhanced patient engagement are all the keys to success as the Improving Medicare Post-Acute Care Transformations Act of 2014 continues to make its IMPACT through rules refinement. How will you and your program continue to be the provider of choice in the Healthcare Communities where you operate this summer and all year long—Best in the World!

By Billye J. Lee, PT, GCS, RAC-CT, Therapy Compliance Partner — Keystone

My family recently went to see the new “Avengers” movie, being Marvel comic fans and all. Action flicks are a rare treat for our busy family, and the latest in the series did not disappoint. In one intense scene where young Spiderman decides he will stay and fight alongside his team, he states, “You can’t be a friendly neighborhood Spiderman if there’s no neighborhood!” Now, I’m not saying Compliance is nearly as cool as Spiderman, but I would agree with his premise: We are nothing without those we serve.

This statement is so true throughout our Ensign family and is a common thread within our CAPLICO culture. Without our employees, there would be no “who,” no bus to drive. Without our residents, there would be no purpose or “what,” no mission. And for Compliance, without our facilities and markets, there would be no team, no momentum.

As much as I would love to get high-fives, slow clapping and gasps of relief when I enter a building (Yay, Spiderman is here!), I know in reality, Compliance visits are not always joyous events. However, we would love to challenge that perception! Yes, it can be uncomfortable “turning over rocks and looking at the squiggly things,” but identifying our risks keeps us tethered to our process toward greatness. You see, we are on the same team! We love our markets, buildings, resources and staff members. We want to help you achieve your goals and add value to your systems. Being sustainable in a competitive industry means we have more time together to do what we are most passionate about.

Although Audits, IRO support and Investigations are critical to our role, Compliance can also provide education, in-services, clarification, observe meetings, answers to questions, and assistance with goals — dare I say, it can be the web that pulls it all together. As service providers, please reach out to your Compliance Partners if you need us or have questions. Even if you don’t have questions, but would like more information about a Compliance topic, please don’t hesitate to contact us. If you’re not sure who your Compliance Partners are, you can locate us on the Portal, under Compliance, at the very bottom of the page, at “Compliance Contacts.”

-“Greatness is not a matter of circumstance. Greatness is a matter of conscious choice and discipline.” — Jim Collins ..OR, “Remember, with great power, comes great responsibility.” — Uncle Ben

Essay By Sarah Gromko, SLP Student, Southeastern Louisiana University, Grad Date: 7/2018

Music and language both are universal and innately human, develop at the same time, and are culturally dependent. Speech, in particular, utilizes pitch, rhythm, and timbre—all elements of music (Smith, 2011). Because of these significant areas of overlap, music and speech carry a natural relationship. But most obviously, music moves people. The right song can bring back the fondest of memories. Hearing the sweet sounds of the right melody can turn a hopeless situation into hopeful. Singing in particular, reverberates the music inside one’s body. In these ways, I hope to use music to spark energy, motivation, and happiness into the lives of my patients.

Throughout my life, I had cited music as my primary motivation. To declare allegiance to such an amorphous concept may seem frivolous to some, but without it, I may have lacked the basic skills needed for language reception or expression. Music was my childhood method for learning to read, speak, listen, and understand prosody. That knowledge of music’s importance was what spurred me to embark on my journey to pursue a master’s in communication sciences and disorders. Only now, however, am I being shown how my lifelong endeavors in music, specifically my vocal training, can benefit a much larger population through clinical application of evidence-based research and expanding on that research in my own clinical studies.

Much of my early comprehension of vocal therapy was limited to my formal training as a singer. When I began working as a choral conductor, I started to discover my passion for teaching those skills to others. Training others then piqued my interest in the field of speech-language pathology but, with an almost exclusively music background, I had little exposure to its other applications. As I enthusiastically explore the vast field, I am becoming enlightened to how vocal therapy (and many other music-based therapies) can positively affect the lives of patients with neurological disorders, cancer patients going through radiation, children with language delays and disorders, and so many more. This exploration took a turn when one of my professors pulled me aside one day. She was well aware of my eagerness for a research project and suggested that I investigate music use in speech-language pathology interventions. “On my own?” I asked. I felt I had been thrown into deep waters. “Yes,” she said, “there is a conference in our city this summer. Why don’t you submit a proposal to present a poster?” I somewhat bemusedly took her suggestion and submitted a proposal for a systematic review of all therapies in the vast field of speech-language pathology that use music. Much to my surprise, my poster was accepted to be presented at ASHA Connect in New Orleans. “Oh no! Now I have to do the research!”

Over the spring and early summer, as I pored over hundreds of articles, I learned just how many aspects of our field are benefitting from music. Pandora’s box was opened and my view of therapy expanded. The more research I read, the more I wanted to know. Yet the more I wanted to know, the more I realized how many different etiologies and service delivery areas were not being studied with music interventions. I decided that my mission going forward was not only to often incorporate music therapies I read about as appropriate for my clients, but to further the research in the therapy room. In fact, when I presented my research again, in a flash presentation at ASHA 2017, that was my call to action.

My education and training will be a spark in the lives of my patients both directly and indirectly: in the therapy room;and by turning the spark into a fire with research that can be used by others to spark lives of their patients. My first opportunity to try some research-based therapies came in my first field-based clinical placement: The Bright School, a pre-school for deaf children and children with hearing impairment and language delay. I began to use a general music therapy program that Kaplan originated in 1955 with children with hearing impairment and speech delay. By listening, singing, and playing songs, one of the children in particular has responded well by demonstrating expanded utterances and improved intelligibility.

Another early, yet effective study was done by Deutsch and Parks in 1978. It used contingent music to set routine. Two of my autistic clients are especially enamored by music, and it has served as a calming effect and incentive to focus on specific therapy goals. I hope before the semester is over to use some research by Katongo and Ndhlovu (2015). These researchers used singing simple songs to increase speech intelligibility in 60 children with post-lingual hearing impairment. They found that not only did it improve speech intelligibility, but also motivated the children during speech drills.

Next semester, I will be placed at Ochsner’s Voice Center in New Orleans. This is the placement I have been waiting for since starting the program. It is what most directly brought me to speech-pathology and hopefully the area in which I will continue. Nine of the studies in my systematic reviews covered voice interventions with music, and I hope to try them while there with willing patients. One of them in particular (Vatanasapt, Vatanasapt, Laohasiriwong, & Prathanee, 2014) is for patients with laryngectomies to increase utterances using esophageal speech. It incorporates music with movements and breathing and had a 75% success rate with 16 patients.

Neurogenics is another area that interests me greatly, specifically aphasia. Music Intonation Therapy was developed by Albert, Sparks, & Helm (1973) and utilizes music skills in the complementary right hemisphere to compensate for damage to the language center of the left hemisphere. It melodizes speech in order to elicit utterances and gradually is faded out until speech has returned. To witness this much-researched and tear-jerking therapy, let alone practice it, would be a life changer for the clients and myself. Another therapy I hope to do if I am placed with adults with aphasia is to start an aphasia choir. I would be able to use the techniques outlined in the literature (Tamplin, Baker, Jones, Way, & Lee, 2013) and marry it with my choral background in order to bring purpose, challenge, joy, and semantics to the lives of those I would serve. Of course, there are many other therapies (89 total, to be exact) that showed positive effects of music in speech-language pathology interventions. I hope to use many of them as I embark on my career and gain experience.

Though there are many therapies to choose from the research, there were several aspects of speech-language pathology that did not exist in the literature. My goal is to fill in some of the gaps and educate others on what to research in order for our clients to be served with spark-inducing music. When using ASHA’s list of realms of service delivery (http://www.asha.org/policy/SP2016-00343/#Domains), the areas of feeding and swallowing, fluency, resonance, and elective therapies all could benefit from more research. Language was a domain that was generally well-represented in the literature, but morphology and paralinguistic communication were each only studied once in the early 1980s. I have several thoughts on how to fill these gaps.

It may seem counter-intuitive to facilitate feeding and swallowing with music, since mature humans cannot sing and swallow simultaneously. But the use of background music has been used as early as 1969 by Carol Traub. Outside of speech-language pathology, in 2008, an article was published entitled “Sound Level of Environmental Music and Drinking Behavior: A Field Experiment with Beer Drinkers” (Guéguen, Jacob, Le Guellec, Morineau, & Laurel). It determined that the louder the music in a bar, the faster and more quantity was drunk by an individual. It could be implied from this study that calming music may have a more controlled effect on the swallowing of dysphagia patients, but only more research could solidify that hypothesis.

Only one therapy involved music for intervention of fluency. Chenausky, Kernbach, Norton, and Schlaug (2106, 2017) recently published two studies using Auditory Motor-Mapping Therapy, which is an intonation-based treatment originally intended to improve fluency in spoken output. The recet studies on that particular therapy (although only one covered fluency) gives hope that more studies are forthcoming, but there should be more therapy options to investigate for fluency clients. Even the use of video games similar to Guitar Hero could motivate clients while regulating their fluency.

Thirdly, there were many studies done using vocal therapy, but few covered resonance explicitly. Besides focusing on resonance issues in normal repertoire of the singer, instrumental and vocal music may be considered as models for mimickry. For instance, a comparison between the perceived nasality of a clarinet sound versus that of a violin could serve as qualitative tools for singers and non-singing voice clients, alike to model, since speaking and singing output is so heavily dependent on perception. Based on the list of ASHA’s specified elective therapies (transgender communication, preventative vocal hygeine, business communication, accent/dialect modification, and professional voice use), only transgender communication has been studied (once) with music. Business communication and professional voice use may benefit from using musical soundtracks in preparation for negotiations or speeches, and accent/dialect modification may benefit from a common choral technique of vowel modification used in singing.

Finally, as discussed earlier, language and music go hand-in-hand. It can be broken down into elements in much the same way. For instance, a morpheme may coincide with a musical note, semantics may pair with a musical measure (a series of notes separated by bar lines), and semantics may be seen as a musical phrase or sentence. For this reason, a study on morphology may benefit from assigning each morpheme a note when teaching language. Furthermore, since paralinguistic communication (signs, gestures, and body language) is not only used by the deaf and those with hearing impairments, musical phrases may be used in conjunction with a series of gestures, for instance.

In the words of the old hymn, “it only takes a spark to get a fire going.” I hope that one spark instilled in a patient from any of these techniques will set afire the souls of my patients and spread like wildfire to their loved ones and the others around them. Mahatma Gandhi exposes my selfishness in his words, “The best way to find yourself is to lose yourself in the service of others.” My choices for service are both metaphorically and literally to give voice to the voiceless. There is nothing else I have ever sought with such longevity. I will continue to light the industry through using evidence-based research and adding to the literature for others.

References:

Albert, M. L., Sparks, R. W., & Helm, N. A. (1973). Melodic intonation therapy for aphasia. Archives Of Neurology, 29(2), 130-131. doi:10.1001/archneur.1973.00490260074018

Chenausky, K., Norton, A., Tager-Flusberg, H., & Schlaug, G. (2016). Auditory-Motor Mapping Training: Comparing the Effects of a Novel Speech Treatment to a Control Treatment for Minimally Verbal Children with Autism. Plos ONE, 11(11), 1-22. doi:10.1371/journal.pone.0164930

Chenausky, K., Kernbach, J., Norton, A., & Schlaug, G. (2017). White Matter Integrity and Treatment-Based Change in Speech Performance in Minimally Verbal Children with Autism Spectrum Disorder. Frontiers In Human Neuroscience, 111-13. doi:10.3389/fnhum.2017.00175

Deutsch, M., & Parks, A. L. (1978). The use of contingent music to increase appropriate conversational speech. Mental Retardation, 16(1), 33-36.

Guéguen, N., Jacob, C., Le Guellec, H., Morineau, T. and Lourel, M. (2008), Sound Level of Environmental Music and Drinking Behavior: A Field Experiment With Beer Drinkers. Alcoholism: Clinical and Experimental Research, 32: 1795–1798. doi:10.1111/j.1530-0277.2008.00764.x

Kaplan, M. (1955). Music therapy in the speech program. Exceptional Children, 22112-117.

Katongo, E. M., & Ndhlovu, D. (2015). The Role of Music in Speech Intelligibility of Learners with Post Lingual Hearing Impairment in Selected Units in Lusaka District. Universal Journal Of Educational Research, 3(5), 328-335.

Smith, R. S. (2011, October 4)). Speech-Language therapy and music therapy collaboration: The dos, the don’ts, and the “why nots?” log post] Retrieved from

http://blog.asha.org/2011/10/04/speech-language-therapy-and-music-therapy-collaboration-the-dos-the-donts-and-thewhy-nots/

Tamplin, J., Baker, F. A., Jones, B., Way, A., & Lee, S. (2013). ‘Stroke a Chord’: The effect of singing in a community choir on mood and social engagement for people living with aphasia following a stroke. Neurorehabilitation, 32(4), 929-941.

Traub, C. (1969). The relation of music to speech of low verbalizing subjects in a music listening activity. Journal Of Music Therapy, 6(4), 105-107.

Vatanasapt, P., Vatanasapt, N., Laohasiriwong, S., & Prathanee, B. (2014). Music Speaks the Words: An Integrated Program for Rehabilitation of Post Laryngectomy Patients in Khon Kaen, Thailand. Music & Medicine, 6(1), 7-10.