Re: Article from Advance -Interview With An Aquatic The...

[Guest guest]

Where is in practice?

Bek

In a message dated 1/16/2009 10:06:48 P.M. Eastern Standard Time,

kiddietalk@... writes:

Thank you so much for reading the first half of my interview with the

dynamic aquatic speech therapist, B. Nachimson

**************Inauguration '09: Get complete coverage from the nation's

capital.(http://www.aol.com?ncid=emlcntaolcom00000027)

[Guest guest]

Bek -PA -her contact info is below (in part 2 of her article!) And for

those that don't know -Becky is our " homeschool expert " for the new

CHERAB Facebook page!

Part 2: Aquatic Therapist B. Nachimson, MA, CCC-SLP, CMT

Published January 20, 2009 12:09 PM by Bruno

Last Friday's post, highlighted the first part of my interview with

speech therapist, B. Nachimson where we learned about her

professional education, training and the experiences that brought her

to the water.

Today's post is a continuation of our interview. In our discussion,

describes her experiences with aquatic therapy, the benefits she

has seen and her recommendations for the conditions that need to be in

place for a successful therapeutic session.

: , tell us how you have seen therapy in the water work

for your clients.

: I have seen aquatic treatment help children and adult speech in

a variety of ways. Those with CP [cerebral palsy] have an opportunity

to use more muscles while in warm water, as the water provides

sustained compression to support diaphragmatic movement, ribcage and

lung expansion with more midline control as the extremities can move

easier with the voice projecting louder with more forceful voicing and

clearer articulation. The water also serves to support the head for

better positioning to provide trunk, neck, jaw, tongue support for

more intelligible articulation. I have seen adult post-stroke

patients attain an audible voice while practicing in warm water so

that they have the experience of attaining a goal in water with

information to then take onto land to imitate the success in water.

In addition, more SLPs are now working in rehabilitation centers with

aquatic facilities. Physical therapists report to SLPs that their

clients are using more vocalizations while they are doing their

exercises in water and want to know what to do to facilitate the

speech therapy portion of a patient's program. Many private practices

are starting to contract with local pools to provide services in water.

Also one of my course participants reported that he brought an adult

patient with Parkinson's from total g-tube feeds to soft foods and

thickened liquids by utilizing WATSU [water shiatsu] strategies taught

in the class with a very large patient to provide chin to chest

exercises to increase laryngeal strength and function. When the

patient was able to complete 30 consecutive repetitions, he was able

to swallow more efficiently.

: One of the criticisms I have heard, from a speech

perspective, is that helping children be successful in the water,

doesn't necessarily help them on land. Do you agree with that statement?

: No, in fact one of the main benefits of aquatic therapy is

having a successful experience in water that can then be referred to

land for carryover. With very young children who are not able to

reference one setting to another, the SLP has information gained in

water to try to mimic on land. Having had a successful attempt

provides motivation to facilitate that response into functional use.

One of the main problems is a lack of education. There are many

aquatic therapy courses offered for therapists to learn how to handle

patients in water to develop gross motor activities. There are very

few speech pathology courses that teach directly to speech pathology

issues. It is an area that can use a lot of exploration and

development. For my professional needs, I have learned to use WATSU

strategies and adaptations of those strategies to treat clients who

are non-ambulatory and need full body support. Many small children

need to be held unless there is shallow water for them to sit, crawl,

stand and walk in.

: Can you tell us what education courses/trainings currently

exist for speech therapists interested in learning how to implement

aquatic therapy as a method to stimulate communication?

: As far as I know, there have been very few presentations

regarding using an aquatic setting for speech therapy practice. There

were a few articles in ADVANCE for Speech-Language Pathologists &

Audiologists several years ago. I developed a course that began as a

16 hour course and is now 18 hours. I presented introductions at an

ADVANCE Job Fair in San Francisco with Jerry McCue and at APT

(Association of Pediatric Therapists) in Marin County with Dori Maxon,

PT.

Before I taught my class, I had attended many aquatic therapy courses,

one with NDT focus for pediatrics taught by pediatric PT, Jane

Styer-Acevedo. The others were courses within the aquatic therapy

emphasis including WATSU, Jahara and Aquatic Integration techniques.

Jane addressed increasing overall functions, specifically upper and

lower extremity work with children with speech addressed as something

that increases with the movement. It was clear that a speech

pathologist was needed to teach an aquatic course to address speech

pathology issues. I invited Jerry McCue, WATSU Instructor to assist

in developing the course. We held our first class in 2002 and

proceeded to teach a total of eight classes through August 2007.

It might be a good idea to mention why I began to teach this course.

It was after I wrote a note in a quarterly review for an under two

year old client that he exhibited louder voicing and stronger

swallowing following therapy in an aquatic setting. The parent was

requesting more sessions than I could provide using MediCal (Medicaid)

funding. The " can of worms " had been opened and I was told that

aquatic therapy was Standard of Practice for PTs and OTs but not SLPs.

It took me two years to figure out a way to appease the organization

that pays for therapies by agreeing to teach a course to colleagues

for continuing professional development. It was a challenge to

develop the course. I treat it as a basic speech therapy class that

addresses assessment and treatment from a traditional base that

branches out into using NDT and other treatment approaches in the

water using a diagnostic therapy approach. Emphasis is on using

problem solving techniques from information gathered about a client

from initial clinical assessment and translating it from clinic to pool.

Two participants in my course have presented informal and formal land

lectures about the use of therapeutic water for speech therapy

practice. I am unaware of any other specific classes.

: I have learned recently that our colleagues in Israel often

use and support doing speech therapy in the water. Have you had any

experience with this?

: The participant mentioned above, who did a formal presentation,

was from Israel. She attended the course in August, 2007 and returned

to Israel with information to share with SLPs there. She works at a

non-denominational children's hospital in Jerusalem where they treat

children with qualifying characteristics-a medical issue and a motor

issue.

There is a certification course for Aquatic Therapists that all

therapists who work in the pool with patients are required to take.

It is an overview of various aquatic therapy techniques. Here, in the

US there are a few of these courses available that can provide a

framework for working within an aquatic setting. None address speech

pathology, specifically.

: So, with all this experience, what is your hope/vision for

our field in this country with regards to aquatic therapy?

: I have asked each of the participants of my course to open up

to the possibilities of how they want to use an aquatic setting for

speech pathology issues for our clients. It is expected that someone

will develop another course that evolves from their needs as an SLP.

I will continue teaching my course as long as anyone is interested in

taking it.

It would be great to collect anecdotal information from any SLPs who

provide therapy in water and compile a manual to motivate others to try.

Mostly, however, my hope and vision is that SLPs will feel comfortable

looking at a client and thinking, " this child or adult would benefit

from a warm water environment because... " , and then arrange to use

the aquatic setting in which to provide options without it being

something that is an amazement, but, rather, an acceptable strategy.

Just another tool in the SLP's " Box of Tools " !

: Please outline for us the ideal conditions for treatment.

: Here is a point-by-point outline of the ideal conditions:

* Water is best 93-96F for best results so the body does not get

cold or hot. For some conditions water temperatures need to be lower.

* Depth for therapist should be to breast level if one is using

strategies to float a client, as the therapist would need to bend

knees to acquire appropriate positioning (for WATSU and other aquatic

therapy techniques)

* Shallow steps or a gradual ramp are good to start to work with

children who can sit, pull to stand, crawl, etc. Sometimes children

need to be held in the water.

* Pool ledges are good to use for giving instruction, taking a

break, working on following adult directions and learning to jump into

water if appropriate.

* Materials are as varied and creative as the therapist and the

clients' needs. There are many blowing, squeezing, floating toys.

Goals for clients determine what a therapist will need for equipment.

Do not overlook laminating pictures for identifying words and

concepts. They float and children can point to show what picture they

want.

: I have used laminated pictures in the water as well and it

has been very helpful for many of my kids. So, tell us, what are you

doing currently now as an SLP professional?

: In my practice, right now, I work at a few rural public schools

with students with a variety of needs including, but not limited to:

severe oral apraxia, feeding issues, seizure disorder, language

disability and articulation some with neurological issues, autism

spectrum disorder, CP, etc. I also go to another distant rural town

providing assessment and treatment to an under 3 population with one

school aged child with feeding needs just recently added. I have cut

back to once a month at the schools and the distant town providing

training to instructional aides and a SLPA to provide follow through

practice. I have also been providing some aquatic therapy sessions to

adults who do not have speech pathology needs in a small indoor pool

that I recently had installed at my home office. I am always

available to schedule all aged clients with speech pathology needs in

the pool or spa for therapy.

In addition, as I had mentioned, I am teaching, " Aquatic Therapy for

Speech-Language Pathologists-An Introduction " as a 3 day, 18 unit

class since January 2002. It is a course that addresses traditional

speech and language therapy issues and the adaptation for

identification, assessment and therapy within an aquatic setting

utilizing NDT and aquatic therapy (WATSU, etc) approaches. SLPs, PTs,

OTs, Aquatic Therapists, Special Education Teachers and parents of

children with special needs have all been participants. Jerry McCue,

CMT, WATSU Instructor, was my partner through August 2007, when

leukemia suddenly took his life. He created a few WATSU/Orthobionomy

moves that enhance increasing respiration that are valuable in

facilitating better breathing and vocalizing for our patients.

: Thank you so much for sharing all of this wonderful

information about what you do and how aquatic therapy can be useful as

an alternative to traditional service delivery models. How can our

readers reach you and learn more about the work you have done and

continue to do for our field?

: Please explore my website: http://www.aquaslp.com/ for digital

pictures and class information.

Feel free to send an email or call my office phone at 707-923-1625;

sbnslp@...

Bruno Dowling, M.S. CCC-SLP

Occupation: Speech-Language Pathologist

Setting: Early Intervention in Delaware County, PA

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rapist-susan-b-nachimson-ma-ccc-slp-cmt.aspx

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