When you have Asperger's and need to communicate quickly with an official

https://aspergersawareness.files.wordpress.com/2013/05/aspergerscard.jpg
from https://aspergersawareness.wordpress.com/2013/05/08/great-idea-aspergers-wallet-id-card/

Search for more with https://www.google.com/search?q=asperger%27s+wallet+card&oq

Going places in DC: Public Gardens

Planning an outing : Two of these three are Metro accessible!
http://wmata.com/   http://dcgardens.com/

www.usna.usda.go The U.S. National Arboretum is a U.S. Department of Agriculture

3501 New York Ave NE, Washington, DC 20002
(202) 245-2726

www.usbg.gov/ United States Botanic Garden

100 Maryland Ave SW, Washington, DC 20024
(202) 225-8333
The oldest continually operating botanic garden in the United States. 

www.montgomeryparks.org/brookside/  Brookside Gardens, Montgomery County, Maryland.

1800 Glenallan Ave, Silver Spring, MD 20902
(301) 962-1400

http://www.wmata.com/accessibility/metroaccess_service/customer_guide.cfm

TBI resources (brain injury) Large font

http://www.biamd.org/tbi-info-resources.html (excerpts)

National Rehabilitation Information Center (NARIC)

8201 Corporate  Drive

Suite 600

Landover, MD 20785

naricinfo@heitechservices.com 

http://www.naric.com

Tel: 301-459-5900

301-459-5984 

TTY 1-800-346-2742

Fax: 301-562-2401

Brain Injury Association of Maryland

Our Mission is to create  a better future through brain injury prevention, education, advocacy and promotion of research. We Take Action by providing leadership and support for a wide variety of projects and programs in resource coordination, prevention, education, advocacy and self determination.

2200 Kernan Drive

Baltimore, Maryland 21207

info@biamd.org

http://www.biamd.org 

Tel:410.4478.2924 

1-800-448-3541 

Fax:410.448.3

Brain Injury Association of America, Inc.Non-profit organization dedicated to people with brain injury and their families. Offers research, education, and advocacy programs through a national office, network of state affiliates, support groups, and a helpline.1608 Spring Hill RdSuite 110Vienna, VA 22182

braininjuryinfo@biausa.org

http://www.biausa.org

Tel: 703-761-0750 

800-444-6443

Fax: 703-761-0755

Having fun with figurative language

This excerpt for non-commercial use is from http://www.amazon.com/Speaking-Values-Intermediate-Conversation-Edition/dp/0130978817 by Irene Schoenberg (p. 54). Although Mrs. Schoenberg's target audience is the ESL (English as a Second Language) student, the areas of English also fit for learning with people who are recovering from aphasia or TBI and re-learning English.

Five words are in the Word Bank: 

disease             face             compliments            foot             red

1.  When his mom kissed him after the game, he turned beet-------

2.  I really wanted to laugh, but I had to be serious. It was hard to keep a straight                 _

3.  He always says embarrassing things. He suffers from foot-in-mouth

4.  When I first started my job, I said the wrong thing to my boss. We started off on the wrong -------

5.  Last night my aunt said she was surprised I could cook so well. She has a

habit of giving left-handed -------

 Match the idioms on the left with their definitions on the right. Write the letter on the line.

         1. start off on the wrong foot

         2. keep a straight face

         3. foot-in-mouth disease

         4. turn beet red

         5. a left-handed compliment

a.  get embarrassed

b.  a comment that is positive, but a little negative too

c. have a bad beginning

d.  be serious when you want to laugh

e.  a habit of saying the wrong thing

TBI

http://www.braininjurygeorgia.org/docs/brain-injury-wallet-card.pdf (has Georgia logo on it)

Kyphosis and dysphagia -- subset of cervical dysphagia

Dysphagia Associated with Cervical Spine and Postural Disorders (2013, Dysphagia )

Dysphagia in individuals with Kyphotic – Lordotic Posture 
page 5 has an anatomy diagrams for curved spine
Agnes Gradowski and Susan Graves propose (page 6):

1. Upturned head position -> elongation and stretch of anterior neck muscles 
2. Prolonged muscle stretch ->  weakness  
3. Weak anterior neck muscles -> worse dysphagia

How to do paperwork for obtaining treatment

Fair Use Excerpt of Notes on Speech-language pathology in long term care / Shelly Cordero, Enna D. Santiago, C. Cecile Fountain (1995).  Read more: http://www.copyrightencyclopedia.com/speech-language-pathology-and-audiology-issues-and/#ixzz3e2w5yA8J

Section 1, OBRA and health insurance
Section 2, Screenings

Section 3, Admission Process (pp. 15-18)

3-1 Telephone orders reflect the MD's approval for your intervention/treatment.

3-1-1 Initial Telephone Order - goes to the primary to authorize the eval and  tx.

This is a Repeat symbol for preceding text                                                  

S.T. to evaluate and treat as indicated. 

Speech-Language Pathology to

- Videofluoroscopy swallow to assess for aspiration etiology with increased emphasis upon the pharyngeal phase of swallow, and to determine therapeutic intervention feasibility. Patient is consistently coughing upon drinking liquids.
- Audiology evaluation to rule out otopathology. Patient is requesting frequent repetiions of auditory stimuli in quiet environments.

3-1-2 Clarification orders for S-L P services come after the initial evaluation is completed. Specify the Tx, freq, and duration. Describe modalities, teaching, and training.

- S.T. to treat 5X/week BID X 8 weeks, for oral and pharyngeal stage dysphagia to increase A-P transfer and increase swallow initiation with instruction in safety measures to prevent aspiration.

- ST to treat 5X/week QD X 6 weeks to increase word finding skills accompanied by semantically correct verbal output secondary to recent CVA.

- S.T. to treat 5X/week QD X 4 weeks secondary to a decline in cognitive-linguistics skills related to decreased spatial, temporal orientation and decreased short term memory.

3-1-3 Change of treatment? Document in your progress notes and get new telephone orders from Physician. 

3-1-3-1 ΔDuration Extend S.T. treatments 5X/week QD for 4 weeks as patient has not met maximum potential in ability to follow 2-step directions and answer yes/no questions.

3-1-3-2 ΔModality : Use a telephone order to add modalities or discontinue

- S.T. to change liquid level from "honey" thickened to "nectar" thickened liquids secondary to increased timeliness of swallow.

- S.T. to upgrade food texture from mechanical soft to regular diet secondary to increased ability to masticate in a rotary manner.

- S.T. to add modality of dysphagia treatment to existing cognitive-linguistic treatment, secondary to recent declines in chewing, swallowing abilities.

3-1-3-3 ΔFrequency
- S.T. to decrease treatments from 5X/week BID to 5X/week QD for pharyngeal stage dysphagia treatment.
- S.T. to decrease treatments from X to Y for 2 weeks in preparation for D/C planning. S.T. to continue to address A with emphasis on safety awareness, patient/staff education/training to continue to follow through with techniques taught.
- S.T. to increase treatments from X to Y for N weeks secondary to increased alertness and endurance for J.

3-1-3-4 Transferring from Part A to B of Medicare (after 100 days)
Get a telephone order.
- Pt to continue S.T tx 5X/week QD X4 weeks for the modality of aphasia.
- Pt to continue s.T. tx 5X/week QD X2 weeks. S.T. to increase word finding skills, accompanied by semantically correct verbal output and to provide pt/caregiver training, secondary to recent CVA.

3-1-3-5 DONE! Get telephone order auth from MD for any discontinuation of services. To prevent decline, refer residents of SNFs to "restorative nursing" and/or Activities or Social Services.
- S.T. to discharge pt from Aphasia tx. Restorative nursing to continue conversation with resident related to basic wants and needs.
- S.T. to discharge pt from services. Pt has met max potential of functioning. D/C to restorative nursing to monitor compensatory strategies for safe eating.
- Discontinue S.T. services. Restorative nursing to continue with positioning strategies for eating, and dysphagia techniques taught.
-  Discontinue S.T. services. Restorative nursing to continue with facilitating the use of basic language expression through the use of an alternative communication system.

Dysphagia Awareness Week

http://www.stroke.org/we-can-help/survivors/stroke-recovery/post-stroke-conditions/physical/dysphagia

Do you have trouble swallowing after a stroke? Up to 60% do. Here is a video by the National Stroke Association to raise awareness and offer resources: https://www.youtube.com/watch?v=41zuq7QspgM

Dehydration or not drinking enough is always a risk. Thin fluids, such as water, are harder to swallow changing the thickness with liquid thickeners can be helpful. Ask your healthcare professional for the best plan for your individual needs.
http://helpmeswallow.blogspot.com/
slide show http://www.in.gov/fssa/files/COMPREHENSIVEDYSPHAGIAMANAGEMENTCommunity.pdf

http://www.brainline.org/content/2010/08/swallow-safely_pageall.html     http://www.swallowsafely.com/

https://medicalspeechpathology.wordpress.com/student-handbook/introduction-to-dysphagia/
https://medicalspeechpathology.wordpress.com/student-handbook/treatment-of-dysphagia/

http://www.nature.com/ Medical and rehabilitative therapy of oral, pharyngeal motor disorders Jeri A. Logemann, Ph.D. (2006)   Oral, pharyngeal and esophageal motor function in aging

http://swallowingdisorderfoundation.com/breaking-news-potential-game-changer-patients-profound-oropharyngeal-dysphagia/
http://www.ucdmc.ucdavis.edu/medicalcenter/features/2010-2011/03/20110310_swallowing-device.html
http://www.ucdvoice.org/latest-news/
https://clinicaltrials.gov/ct2/show/NCT02296528
http://www.enttoday.org/article/evaluating-dysphagia-maximize-exam-and-swallow-studies-for-diagnostic-success/

Validity and reliability of the Eating Assessment Tool (EAT-10) (Belafsky, 2008)

http://www.ucdvoice.org/the-eating-assessment-tool-eat-10-goes-global/ Dysphagia is a symptom, not a disease. Patients reporting the symptom of dysphagia may lack objective evidence of swallowing dysfunction.

https://www.nestlenutrition-institute.org/Education/practical-tools/Documents/EAT-10_Swallowing_Assessment_Tool.pdf

An example of the health care financing administration Form 700-DYS Plan of Progress

accredited stroke rehabilitation centers

http://www.carf.org/advancedProviderSearch.aspx
http://www.carf.org/programdescriptions/med/
http://www.carf.org/Accreditation/QualityStandards/OnlineStandards/

http://www.jointcommission.org/certification/advanced_certification_comprehensive_stroke_centers.aspx
http://www.jointcommission.org/facts_about_primary_stroke_center_certification/

Retraining after a stroke

one-digit addition and subtraction (with audio)
https://quizlet.com/20570283/flashcards https://quizlet.com/20570283/arithmetic-flash-cards/original

https://quizlet.com/subject/subtraction-practice/
2 digit https://quizlet.com/18346886/kylas-subtraction-practice-flash-cards/
("dash" should be "minus")

https://quizlet.com/subject/accounting-statements/
https://quizlet.com/subject/accounting-practice/
https://quizlet.com/84010819/accounting-practice-quizes-flash-cards/