We would go from someone who has spasmodic dysphonia associated with the Parkinson’s disease to being able to communicate their wants and needs without the tremors, with good volume. That kind of really got me. It got me fired up I was really excited and I was like I want to be able to do that.
Jimmy McKay, PT, DPT: Welcome to FOXcast SLP, a podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org. Welcome to FOXcast SLP, I’m your host Jimmy McKay. On the program we are talking with one my colleagues here at FOX rehabilitation, Chelsea DeStefano. Chelsea welcome to the program.
Chelsea Destefano, MS, CCC-SLP: Hi. Thanks for having me on.
Jimmy: Did I say that right. Destefano?
Chelsea: Yes. Actually you’re one of the very few people who get it right. on the furst shot.
Jimmy: Well, it’s important to say things right when you’re talking to someone who is a speech-language pathologist.
Chelsea: I always like to say I can help you with how to prounice my name it’s part of my job.
Jimmy: Where are you calling in from since Fox rehabilitation we have clinicians in 16 states right now and growing. Where are you when you located?
Chelsea: Right now I’m in Westchester County in New York northern Westchester County. So that’s kind of my my area I cover a bunch of different places there.
Jimmy: What we want to be able to help the audience with today is voice disorders and SLPs is treating individuals who have voice disorders who wanted to throw some takeaways at them and see if we can give them some insight. Maybe just tell them something they already knew in a different way so they can help the people they’re working with a little bit better. Why is this something you’re so passionate about?
Chelsea: I honestly I got passionate about it when I was in graduate school and one of my professors the way he just talked about it and I got to do a rotation with him and follow him around. And the improvements that I saw in people that he was working with were just huge you know we would go from someone who had spasmodic dysphonia associated with the Parkinson’s disease to being able to communicate their wants and needs without the tremors, with good volume. That kind of really got me it got me fired up. I was really excited. I wanted to be able to do that voice disorders has always been a really big interest of mine.
Jimmy: I love how you put that. Whenever people are passionate about anything and you know I’m a Physical Therapist by trade but I love to hear it when clinicians of all the cousin disciplines as I call a PT, OT, SLP. When you get excited about things I’m just hearing you how you phrase that makes it really important. You know someone like me who really bases my livelihood on being able to communicate not having that well that would be cripple.
Chelsea: Yeah. And that’s what I get from a lot of my patients you know.
Jimmy: So where do we want to go first always get an ENT evail before starting that’s Tip 1. Why would you do that?
Chelsea: Yes. The reason we do that and this is recommended by ASHA. So the speech pathology governing body. You know we get all of our evidence based practice from them. They recommend before starting getting an ENT evaluation. And this is crucial because we don’t have X-ray vision as ethnologist. I wish we did. But the reason we do this is because there may be something structurally wrong with the vocal folds or the larynx that we can’t see. We can do a great bedside of eval and say Oh yeah it’s this this and this. But we might be missing something so we always always always recommend getting an instrumental done. So going to the ENT and having a scope. I had one person actually this was in grad school. They had spasmodic dysphonia. So lots of tremors and shaking in their voice low volume. And I was like you know why don’t we go to the ENT. Get an appointment set it up do a scope. And they ended up finding cancer. And I never ever would have been able to diagnose that. I mean that’s one of the reasons why it’s huge and they needed to stop treatment with me and you know take care of the cancer first and then come back. So that’s a huge huge thing that we need to really advocate for is doing the instrumentals getting that in.
Jimmy: That’s a great first step. Where do you want to go next? We’re keeping it functional. We love that word in therapy. Functional why we keep it functional with individuals with voice disorders keeping it functional.
Chelsea: What I mean by that is when we’re working on voice we tend to try to get them to repeat phrases or words or something like that. Getting them to say phrases that they use on a daily basis is much more motivational. Most of my patients have grandchildren or great grandchildren. So they might say something like oh come here baby. So that might be something to work on so that their grandchild can hear them. Or saying things like did the mailman come today? Things like that. I could easily have them say the unicorn jumped over the rainbow and found the pot of gold. They’re never going to say that. So why would they want to practice that?
Jimmy: And if they are a I would like to hang out more with them because it sounds like they lead an interesting life. Yeah but I see what you mean instead of having something prewritten or you know off of a script. Yes. You know build that script off of them and their life.
Chelsea: Yes and it keeps them involved in therapy to where it’s more client centered rather than clinician centered where you know we’re going and saying you’re going to do this this this and this that’s more us getting them involved and saying what do you like to do? What are some things you say? Who do you talk to throughout the day? You know and it gets them involved and they really enjoy it because they feel like they’re also helping themselves because they’re helping create those goals and objectives with us.
Jimmy: Big difference in motivation I bet.
Chelsea: Yes Absolutely.
Jimmy: In your big seven list of working within the force disorders we’re on number three. You say keep family or caregivers always involved. I love love to hear that.
Chelsea: And I mean this is pretty important for all disorders but especially with voice disorders. A lot of times you know we have family members who are hard of hearing. So they’re going to be great judges of whether or not my patient is improving. You know so I might say oh Susan can you say this and have Harry hear it? And having them be a judge because it’s all about perception too. I might be able to hear them really well but we need the family who’s going to be there with them on a daily basis to also be judgment and be like oh OK maybe we will work on getting you up one more decibel. Things like that and then having caregivers being on it too so they can do the home exercise programs that we’re going to leave for the patients to improve generalization and carry over which is the main goal of all therapies.
Jimmy: Absolutely. Moving on to number four on your list. Hygiene is key and you even put that in bold letters.
Chelsea: I did. I did. And when I talked to my non clinician friends about voice they always asked me what that is. I talk about hygiene and I’m like Oh so you shower the throat? What is that? So hygiene for voice is monitoring your diet, watching spicy foods. Milk actually it helps with heartburn but it can actually create more. And that can create voice disorders. Getting enough sleep, getting enough water. Brushing your teeth is a huge thing too because it prevents bacteria from getting down into the larynx and getting into the lungs or the vocal folds. So hygiene is just key. Another form of hygiene too is not abusing or overusing your voice. So I always like to think of teachers. And with the start of the school year it’s an important thing for them to know too projection is key and not screaming or being shrill using your voice in the right way is going to be a huge help too because that’ll prevent any vocal nodules or polyps from developing too.
Jimmy: Wow. I don’t think I knew a lot of those points you just brought up there.
Chelsea: It’s definitely something that gets missed often if you don’t have a speech pathologist there. Or someone even who just knows about voice. It definitely gets missed.
Jimmy: Up next on the list number five. No one is the same. We’re all individual snowflakes.
Chelsea: Yes we are. And my point with that is, because I’m also I’m LSVT certified which is a very very rigorous treatment. Four days a week for an hour. That’s a lot for speech. And it’s set out its schedule. Everything has to be done for a set amount of time. But not everyone can handle that. Voice can actually be very tiring you’re using very small muscles in the throat that you don’t even know existed. Modifying therapy to be good enough for everyone and just being aware of what your patient is able to do. You know be cognizant. Maybe they can’t handle the 60 minutes so you might drop it down to 30 minutes. That wouldn’t be LSVT anymore but it might be what’s necessary for that specific person. Maybe they can only do 20 minutes or they can only do 45. You know you just have to be aware and also tailor the exercises to them too. But still give a little push so there’s progress.
Jimmy: Making sure it’s dosed appropriately, I mean we see this in all the therapies PT OT and SLP. Make sure to dose properly so you don’t want to making things worse. That’s where the skilled with right therapy comes in is you being able to recognize those things.
Chelsea: Exactly. I had one person complain of pain in their voice and there should never ever be pain when you’re doing voice therapy and that’s where point number one always get an ENT evaluation before starting comes into play. They had an ENT evaluation and there was nothing wrong and then they were treating pain I’m like you need to go back. And they had a polyp. So they had to take care of that. Voice therapy does help with that but I never would have known.
Jimmy: All right. Up next some of us number six. EBP. He we love that phrase evidence based practice. Where Does that come in here?
Chelsea: Evidence based practice. I mean that comes into play with pretty much everything that has to do with therapies. But with voice the biggest one that comes to my mind is LSVT. There is a ton of research to back it up for voice therapy. There’s a lot of research to back resonant voice therapy. You know you really want that evidence to back you up. You don’t want to just go into a session and be like oh we’re just going to do this this and this and then there’s no research behind it. You know because sometimes you get those patients and they google everything you do. And then they might be like oh why are you doing this? I don’t see anything about it helping anyone with my specific diagnosis. Evidence Based Practice is there for a reason. It’s there to guide you in therapy. It’s proven to work. So why wouldn’t we use it?
Jimmy: Stick to what has been proven this is science not guess work. I love that.
Chelsea: Exactly.
Jimmy: Up last on your list. Number seven. You’re saying go back to the basics.
Chelsea: Yes. Diaphragmatic breathing. Diaphragmatic breathing is when you use your stomach and your diaphragm to really breathe and that helps stretch the lungs out so you can fill them with enough air. So you have adequate breath support for voice. I find a lot of times with my patients if I say take a deep breath their stomach goes in and their chest puffs up instead. And that’s not really using your lungs to their full capacity. So I usually I have them put their hands on their stomach and I say OK we’re going to do a full breath. And you’re going to try and push your hands out when you’re breathing in. Then they’re able to hold their ahhhs or eeehs for much longer and with louder volume just by changing that one little thing. And a lot of sessions I try to start with maybe 30 seconds of diaphragmatic breathing. Just to kind of set them and kind of reset their mind so you know everything kind of falls in place like dominoes.
Jimmy: Chelsea’s big seven. We’ll call it the Big Seven for working with individuals with voice disorders. We’ll review always get and ENT eval before starting. Keeping it functional and making it about that individual sitting in front of you. Bringing in that family, bring in those caregivers and get them involved. Hygiene is key. Number five. No one’s the same when it comes to treatment. So it’s going to be varied. EBP follow that evidence based practice. And number seven go back to the basics and bring in that diaphragm. Chelsea love that list.
Chelsea: Thank you. It’s really easy, I love it.
Jimmy: The last part of the show. We we bring in your FOXtale. Are you ready for that?
Chelsea: Sure.
Jimmy: Why did you decide to work with older adults?
Chelsea: So I think I kind of fell into the geriatric population. I was looking for something new and I was working with pediatrics and I wasn’t really feeling fulfilled. You know the kids they’re adorable they’re cute they’re fun to play with. You could do bubbles. But when I switched over and I was talking to some friends who were in skilled nursing facilities. They were just telling me they go you know it’s a lot of fun. You get incredible stories from these populations. So I did. I applied and then I was like all right. We’ll see how this goes. And within the first month I was sold. I was like this is the population for me. The progress I see, the words of encouragement from the family and they’re saying this is like my mom again this is the old mom that I used to see and that we knew. That really kind of sends it home for me. OK. I really am making a difference I can see it. Other people are seeing it. I feel it. I call it getting the quote unquote paycheck. Not getting paid to do it. But getting that paycheck in return knowing that he made a difference.
Jimmy: Chelsea Destefano one of our SLP colleagues from Westchester New York. Appreciate you giving us this list. I think it will be definitely helpful for the other SLPs out there as well as the OTs and PTs to get some insight into the things that you with individuals with disorders.
Chelsea: Absolutely. Thanks for having me on. A lot of fun. Thanks for listening to FOXcast SLP. It’s brought to you by Fox rehabilitation. Fox clinician’s work hard, love their work and get the respect they deserve. Sound good? Then you’ll love the autonomy to work in your own style and the support you get to achieve excellence. Plus freedom and flexibility to have a personal life. Whether it’s your first day or you’ve been around for a while. Your contribution is acknowledged and rewarded. That’s what makes FOX a success. Happy well-trained clinicians make great health care. Are you a fit for FOX? Find out now at foxrehab.org.
