What is working memory and how does it relate to language? Working memory refers to the brain’s process of storing information, then recalling the information later on to complete tasks. It’s a storage system used for tasks of daily living, including engaging in conversation, following instructions, and solving problems. For example, if you ask your child “what’s 2+2?”  Your child uses working memory to process the question, implement a previously learned skill to execute the calculation, then respond. Working memory is often confused with short term memory. Working memory involves the process of storing, organizing, and manipulating information for use later on. Short term memory involves temporary storage of information.

Working memory allows an individual to process language that is heard or seen. When a sound, word, or sentence is heard or seen, working memory holds this information in the brain. It then retrieves corresponding information from the long term memory and processes the new and old information together. If the information heard or seen is new, the working memory will store it to long term memory. Ideally, this new information can be used to make associations with information stored in the long term memory for use later on.

What is processing speed?

Processing speed is a basic cognitive skill. It refers to the amount of time that it takes for an individual to complete a mental task. Otherwise, it is defined as the speed by which an individual can understand and react to information that is heard or seen. If an individual’s processing speed is slow, they may experience greater difficulty processing information quickly and efficiently in order to think and learn.

Ways that we use working memory and processing speed:

We use working memory in a variety of ways to participate in activities of daily living. This includes, but is not limited to:

• Responding in conversation
• Following instructions
• Verbal comprehension
• Reading comprehension
• Reading a new word
• Paraphrasing information
• Organizing activities of daily living
• Problem solving (e.g. calculating a math problem in your head)

How does working memory and processing speed impact language?

Working memory and processing speed are crucial to language learning and use. Research disagrees on whether working memory and processing speed are the cause of language impairments. However, we do know that some (but not all) children with language impairments demonstrate poor working memory and processing speed. This tells us that we need to consider these skills when working with language impairments.

Working memory and processing speed are related to overall academic success. Working memory and processing speed correlate to comprehension and vocabulary. Specifically, vocabulary/word learning, working memory, and processing speed. Research reveals that children with good working memory and processing speed are better word learners.

Addressing working memory and processing speed related to language:

Research does not suggest that training working memory or processing speed will improve language. Instead, it suggests that we support working memory and processing speed using a strategy based approach. Firstly, we need to identify the working memory and processing speed demands of the environment and task. Then, we must provide supports to decrease demands for those children with language impairments. This might include: use of repetition, decreased instruction rate, task lists, detailed instructions, or use of visual supports.  Use of supports will help provide children with strategies to manage their working memory and processing speed within the context of the environment or task. Meanwhile, intervention should remain focused on their language needs.

Strategies used to improve memory when addressing language:

Children are capable of learning memory techniques at a young age. Some positive techniques to use in therapy and at home include:

• Visualization – taking mental “pictures” of something heard or seen
• Rehearsal – repeating something aloud or to oneself over and over
• Chunking – remembering items, such as a phone number, in groups
• Visual reminders – use Post-It notes, calendars, schedules, or alarms

Memory games can also support a child’s ability to practice the strategies that they have learned in therapy. For additional information on working memory, processing speed, and language, seek support from your child’s therapist. The most appropriate supports, strategies, and memory games to use with your child will be determined by your therapist. Implement strategies and practice daily across a variety of activities and environments.

If you have concerns about your child’s working memory or processing speed, call MOSAIC to set up an evaluation with one of our speech-language pathologists.

References:

1. Abel, A. (2017). Guest post: Working memory, processing speed, and language disorder.  The Informed SLP Blog.  Retrieved online on 12/22/2020.

2. Boudreau and Costanza-Smith. (2011). Assessment and Treatment of Working Memory Deficits in School-Age Children.  Lang Speech Hear Serv Sch.2011; 42: 152-166.  Retrieved online on 12/22/2020.

3. Kid Sense Child Development Corporation Pty Ldt. (2020). Working Memory. Retrieved on 12/22/2020.

4. Speech Therapy Talk Services, LLC. (2020). Making Speech Therapy Meaningful. Working Memory.  Retrieved online on 12/22/2020.

Like any profession, you have to start somewhere. Starting out as a “new” anything is always challenging and so exhausting mentally. The transition from title of “student” to “new grad practitioner” poses many challenges related to the actual work, as well as adjusting to new changes in your personal schedule as well. Being a new graduate has had an interesting spin in 2020 with ever changing schedules and all the uncertainty surrounding COVID-19. Put that on top of a new grad, and you have a recipe for extra naps in your day. Here are some ideas, tips, and resources for new graduates that may help with the difficult transition. At the bottom of this blog, hear some bonus words of wisdom through interviews from fellow new grad pediatric and adult practitioners across Montana.

Tip 1

Give yourself grace as you figure out your footing. While striving to be the best therapist, mistakes are unavoidable and help you learn and grow as you transition to being a new grad OT. View those mistakes, learn what you need to learn, and make changes the next time. This field is ever-changing, and there is always something to learn.

Tip 2

Reach out to your co-workers for guidance. They likely have had many more years of experience and can answer so many of your questions. If they don’t know, they usually can point you in the right direction of where to find the answers. You’re not expected to know even a fraction of what your co-workers do. Learn what you can from them.

Tip 3

Channel your learning style! Remember those personality tests you took in school? The ones that placed you in a specific category and suggested you were a visual learner, hands on learner, etc.? While you learn and soak in all the new information for being a new grad, remember how you best learn and communicate that to your co-workers/boss if needed. Whether it’s by observing, asking questions, or reading research, remember to filter information through your own unique learning style.

Tip 4

Set boundaries between your personal and professional life if that’s what you need to stay sane during those first 6 months transition from school to practice. If you’re like me, once my metaphorical plate is full, it’s full. Anything else added on will cause more stress and more chances of burnout. If saying “no thank you” becomes your most used word phrase, you probably are now aware you’ve reached the expert level of setting boundaries.

Tip 5

Be flexible! While you figure out how to be your “own” practitioner, try new ways and strategies to see what fits you and your client best. Healthcare is never black and white and having to be flexible with schedule changes, filling in for someone, getting sick, etc., is  all unavoidable.

While these are some of my own tips and tricks, I interviewed fellow new graduates from around Montana. They were asked several questions about their transition from student to a new grad occupational therapist. All of the OT’s are either currently working in pediatrics or in a skilled nursing facility.

Questions and Answers from New Graduates

Q1: How do you set boundaries for yourself as a new grad?

A: I set time limits on when I answer work related emails, phone calls, and messages, as well as documentation. I don’t let myself be accessible outside of work hours to my patients.

Q2: What is the biggest adjustment you’ve had to make since transitioning from student to OT?

A: The biggest adjustment I’ve had to make is becoming a supervisor for a COTA. It requires constant communication about our caseload in order to stay up to date with the patient’s plan of care.

Q3: How does your learning style impact how you develop new skill as a new grad?

A1: I’m a hands on learner, so I tend to ask my coworkers and boss for feedback or ideas during sessions if they’re treating in the same room as me.

A2: I love to read and soak up all of the new OT information I can even if it is not directly related to my work. Learning through research and reading has been really helpful for me.

Q4: What’s your favorite thing about being a new grad?

A1: The ability to research and focus my practice into whatever area interests me the most. Having independence in a private practice is amazing.

A2: The chance to learn about development from a trauma informed focus. Also, learning a lot more about reflex integration and seeing large improvements in unexpected skill areas due to reflex integration.

FAQ 1: What are some helpful websites and resources for new graduate OT’s?

While these tips for new graduates are focused on new occupational therapists, they can be applied to almost any profession!

More Tips for New OT Graduates:

New OT Practitioners Get Real About Their First Jobs in Occupational Therapy

What New Grad OTs Need To Know About CEUs

The New Grad’s Guide To Occupational Therapy CPT Codes

Occupational Therapy Continuing Education

MOSAIC Health & Rehab Occupational Therapy

The first part in the postnatal return to running series after childbirth will address signs and symptoms of pelvic floor and/or abdominal wall dysfunction as well as risk factors. One question that frequently gets asked is, “When can I start running after giving birth?” Some women can’t fathom running soon after birth and some go in way too quickly! Running is a high impact sport that places a lot of demand on the body. High impact exercise was found to have a 4.59 fold increased risk of pelvic floor dysfunction compared to low impact exercise. After birth, women need adequate time to heal and regain strength, specifically with abdominal and pelvic floor muscles. This includes women who had vaginal births and caesarean section deliveries!

After vaginal deliveries, pelvic floor muscles stretch out and become less strong. Pelvic floor muscle recovery is generally maximized at 4-6 months postnatal. Following a caesarean section delivery, abdominal fascia has only regained 51-59% of its original strength at 6 weeks. It has regained 73-93% of strength at 6-7 months postnatal.

With all that said, for the first 3 months of the postnatal period low impact exercise is recommended. Return to running should not start until 3-6 months postnatal at the EARILEST.

Signs and Symptoms of Pelvic Floor and/or Abdominal Wall Dysfunction:

• Urinary incontinence
• Fecal incontinence
• Urinary urgency that is difficult to defer
• Fecal urgency that is difficult to defer
• Heaviness/pressure/dragging in the pelvic area
• Pain with intercourse
• Obstructive defecation
• Pendular abdomen, separated abdominal muscles, and/or decreased abdominal strength and function
• Musculoskeletal lumbopelvic pain

Be sure to keep an eye on MOSAIC’s Facebook page to watch for Part II of Postnatal Return to Running. You will learn about strength testing and pelvic assessment. And don’t forget to check out our Running Quick Tips to make sure you avoid injury when you return to running.

Reference

Voice is one aspect of communication. The sound of our voice is also something with which we identify strongly. It is uniquely us. But like the rest of our body, our voice changes with normal aging.

How does our voice change with aging?

Our voice may sound thinner, less resonant. This is the change that is most often associated with aging, and is known as vocal asthenia. Vocal asthenia occurs because our vocal folds lose muscle over time and become thinner, less pliable.

Our voice may sound rougher, have a hoarse quality to it. Again, due to normal aging, our vocal folds become stiffer and less pliable. They may bow or curve inward, and as a result, don’t vibrate tightly together. Having uncontrolled reflux (heart burn) or smoking will make this worse.

Our voice may be less loud. A decrease in loudness is a direct result of lower lung capacity or breath support. Reduced breath support occurs when our respiratory system is compromised. Common contributors to poor breath support include neurological impairment, COPD, and reduced overall fitness.

Our pitch may change. A change in pitch is common with aging. In women, pitch may drop over time, likely due to hormonal changes. In men, pitch may increase slightly. The reason is not fully understood, but is likely due to atrophy of muscle in the vocal folds.

As we age, we may also experience vocal fatigue; our voice fades later in the day. The most common cause is general muscle fatigue. A weak voice puts us a risk for isolation. When speech requires effort and causes fatigue, we decrease our social connections, our engagement with family, friends, and community.

So, what do we do to maintain our vocal quality? 

We cannot change the aging process, but we certainly can reduce its effects. One of the most important things we can do, is to practice good vocal hygiene. Good vocal hygiene seems simple, but habits developed over the years may sabotage our voice. Good vocal hygiene includes:

• Hydrate, hydrate, hydrate. Because the sense of thirst decreases with age, we need to remind ourselves to drink fluids. Fluids do not have to be just water.
• Avoid shouting.
• Avoid smoking. Seek help if you currently smoke.
• Rest your voice during cold/flu season. Do not try to whisper loudly to be heard.
• Manage heartburn/reflux. Uncontrolled reflux affects more than just your voice. Seek medical advice to achieve optimal management.

Improving our general fitness will also benefit our voice.

Doing just the following can help improve the loudness and quality of our voice.

• Increase your physical fitness. As mentioned above, reduced lung capacity affects the loudness of our voice. An overall decrease in fitness will result in decreased breath support, and, as a result, lower vocal loudness. If you have not been active for a while, consult with your physician before beginning a program, or seek physical therapy services to prevent injury while you regain fitness.
• Improve your posture. Improved posture allows your lungs to expand and fill with more air. With more air, you are able to talk louder, and in longer sentences. Again, a physical therapist can assess and guide you toward improved body alignment.

If you feel your voice change is not due to aging but a result of a compromised respiratory system due to COPD or neurological impairment (e.g., Parkinson’s disease, MS, stroke, etc.), speech therapy may benefit you. The clarity and loudness of your voice is dependent on effective use of breath. By using techniques to improve speech breathing, a speech-language therapist can improve the quality and strength of your voice.

Let’s face it, all of this time at home has left us feeling burnt out on cooking and eating from home. It’s a constant concern over what and when to cook, let alone that dreaded grocery store trip. To top it all off, we just got done with the holidays where we probably found ourselves resorting to holiday treats. Honestly, what your body might be craving the most is something simple and healthy. Something that you can prepare in advance and pay no worry later on. So, here are a couple do it yourself healthy breakfast ideas for those of us needing something different.

Healthy Breakfast Idea #1: Granola Recipe

This delicious healthy granola recipe is naturally sweetened with maple syrup (or honey). It’s made with oats, coconut oil, and your favorite nuts and fruit. Recipe yields about 8 cups granola, enough for about 16 half-cup servings.

Ingredients:

• 4 cups old-fashioned rolled oats (use certified gluten-free oats for gluten-free granola)
• 1 1/2 cups raw nuts and/or seeds (I used 1 cup pecans and ½ cup pepitas; sunflowers, almonds, cashews, or any other kind of nut will work)
• 1 teaspoon fine-grain sea salt (if you’re using standard table salt, scale back to ¾ teaspoon)
• 1/2 teaspoon ground cinnamon
• 1/2 cup melted coconut oil or olive oil
• 1 teaspoon vanilla extract
• 1/2 cup maple syrup or honey
• 2/3 cup dried fruit, chopped if large (I used dried cranberries, cherries, and candied ginger)
• Optional additions: 1/2 cup chocolate chips or coconut flakes*

Instructions:

1. Preheat oven to 350 degrees Fahrenheit and line a large, rimmed baking sheet with parchment paper.
2. In a large mixing bowl, combine the oats, nuts and/or seeds, salt, cinnamon, and coconut flakes (if using), and stir to blend.
3. Pour in the oil, maple syrup, and/or honey and vanilla. Mix well, until every oat and nut is lightly coated. Pour the granola onto your prepared pan and use a large spoon to spread it in an even layer.
4. Bake until lightly golden, about 21 to 24 minutes, stirring halfway (for extra-clumpy granola, press the stirred granola down with your spatula to create a more even layer). The granola will further crisp up as it cools.
5. Let the granola cool completely, undisturbed (at least 45 minutes). Top with the dried fruit (and optional chocolate chips, if using). Break the granola into pieces with your hands if you want to retain big chunks, or stir it around with a spoon if you don’t want extra-clumpy granola.
6. Store the granola in an airtight container at room temperature for 1 to 2 weeks or in a sealed freezer bag in the freezer for up to 3 months. The dried fruit can freeze solid, so let it warm to room temperature for 5 to 10 minutes before serving. To serve, granola is great on its own or with milk, yogurt, fresh fruit, etc.

Notes:

***Recipe adapted from Cookie & Kate.

***To make gluten free, use certified gluten-free oats. To make nut free, use seeds such as pepitas or sunflower seeds instead of nuts.

 

Healthy Breakfast Idea #2: Overnight Steel Cut Oats

Overnight oats are a simple, healthy breakfast option. You can make tons of variations by switching out the optional add-in ingredients to change it up frequently.

Base Ingredients:

• 1 3/4 cups milk (I use unsweetened oat milk, but any kind you like works)
• 1 1/2 tablespoons honey or maple syrup
• 1/2 teaspoon kosher salt
• 1 1/2 tablespoons peanut butter or other nut butter (I use cashew butter, but any kind you like works)
• 1 cup uncooked steel cut oats or quick cooking steel cut oats for a softer, less chewy texture

Optional Add-ons:

• Chia seeds, flaxseeds, or hemp seeds
• Protein powder
• Ground cinnamon
• Citrus zest (I use orange zest)
• Dried fruit
• Fresh fruit (frozen or thawed fruit works too)
• Toasted or untoasted nuts (I use almonds or pecans and put in just before serving for added crunch)
• An extra drizzle of honey, maple syrup, agave syrup, or other sweetener

Instructions

1. In a mixing bowl, whisk together the milk, honey, nut butter, and any protein powder you may be adding until smooth. Stir in the oats, salt, and any other optional additions (wait to add fresh fruit or nuts so that they stay fresh and crisp). Cover the bowl tightly with plastic (or transfer it to an airtight storage container), and refrigerate overnight or for up to 5 days.
2. When ready to serve, stir the oats and portion the desired amount into your bowl. At this point, you can also divide the oats into individual containers and refrigerate for the week. Top your oats with any desired fresh fruit, nuts, or other toppings. If storing as a single larger batch for the week, I find it is best to wait to add the fresh toppings until just before serving so that they don’t all sink to the bottom. Enjoy cold or warm in the microwave for a few minutes.

Notes:

***Recipe adapted from Well Plated by Erin.

***Oats may be stored in the refrigerator for up to 5 days before they should be consumed. The texture will continue to soften as they sit so let the oats sit longer if they are too chewy on first attempt.

***On the first day, your oats will contain more liquid, and they will continue to absorb liquid throughout the week, so you are welcome to add more liquid as desired.

In addition, learn how to have your children help make these healthy breakfast ideas, check out Part 1 and Part 2 of  Cooking with Your Kids.

Childhood bladder and bowel issues are more common than one would think. Understanding toileting accidents can help improve how you approach problems. I remember going through this experience with my own son and wondering what the heck was going on? He was 3 years old, and he would not poop. I knew he was scared. I knew he was getting stressed out. Also, I knew he was going up to 7 days without pooping!! I remember questioning if he needed more fiber, fluid, exercise. As time passed, I worried that there would never be a day when he did not need to take Miralax. I worried how much he was being mentally affected by all the stress around pooping. I think every family member weighed in at some time; all with good intentions but no real facts or practical help.

I will spare you all the various ups and downs along our journey. I will skip ahead to inform you that we did survive that stage of his development relatively unscathed. But I regret that we (my husband and I) were not aware of this topic. I regret that we didn’t get help for our son sooner. The experience led me into learning more about this therapy area. Now I am helping families talk more openly about poop and pee issues!!

Understanding Childhood Bowel and Bladder Disorders and Accidents

Elimination disorders are disorders that are typically related to body part function. They are not necessarily due to a specific condition or disease. The most common disorders include:

• Urinary incontinence
• Urinary retention
• Constipation
• Constipation leading to encopresis (poop that is backed up into colon for longer periods of time)
• Fecal incontinence
• Bedwetting

Many of these disorders appear around the time of toilet training and in preschool age. The symptoms vary by disorder and by child. The intensity and severity are also child/family specific. If the specific disorder is not addressed, the disorder and the subsequent behaviors and physical symptoms can occur indefinitely. It is important to know that most children do not “outgrow” the disorder. Therefore, they need help.

First off, it is necessary to seek medical advice (see symptom guide provided) and increase your understanding of what is happening for your child. As a parent, I wish the two following recommendations were addressed after our son was diagnosed with encopresis:

1. Medical interventions that are needed.
2. Rehabilitation treatment options are available and successful.

Understanding Treatment Options for Toileting Accidents

1. Bowel/bladder retraining – habit training, pelvic floor muscle training or re-training, biofeedback, postural training, and breathing education/training
2. Dietary/fluid education
3. Feeding therapy
4. Behavioral modification
5. Understand that potty training needs to be reviewed. A plan needs to be established that fits the child’s needs

Had I known and understood these two areas before, I would have handled our experience differently. We would have had success earlier on. If you have concerns for your child, please view the symptoms guide. Then, use the resources provided to choose your best course of action.

How do we treat here at MOSAIC?

If we recognize a disorder, it is important to look at the age and development of the child we are treating and establish realistic***goals. Occupational and physical therapists specifically trained in this area can establish comprehensive treatment plans. Firstly, we are looking to increase your child’s and family’s success and independence in the area of toileting. Secondly, we will collaborate with you in addressing the daily routines and training needs for your family. Thirdly, we will assess your child’s environment. The therapist will provide you with the best positioning for sitting on the toilet. They will also provide support to improve your child’s daily experience. Finally we will address behaviors surrounding resistance and avoidance. We will also teach you how to support improved habits and patterns.

Collaboration with your child’s primary care provider will occur. This provides continuous care for diet and medication follow through. We may design specific physical pelvic floor muscle training exercises. Exercises will improve strength and “coordination” of the muscles needed to support elimination of urine or stool. We will develop a home program with you to support the individual goals for your child. In addition, we will include toilet training support and education in our treatment approach. However, you should be aware that toilet training is more about the parent than the child.

***Realistic goals are about measuring success through reduced symptom occurrence and physical improvements. Therefore, goals are NOT about being toilet trained by a specific date. Toilet training includes a child’s ability to respond to bodily urges in a timely manner. This often does not fully occur until later in development (ages 4-5).

Resources

In conclusion, for more help understanding toileting accidents, check out bedwettingandaccidents, GIKids, The Poo in You, and the Bristol Stool Scale. Or, call MOSAIC to set up an appointment with a physical or occupational therapist trained in this area.

References

1. An Introduction to Pediatric Bladder and Bowel Disorders, Part 2 Tiffany Ellsworth Lee, MA, OTR, BCB-PMD, PRPC

2. An Introduction to Pediatric Bladder and Bowel Disorders, Part 1 Tiffany Ellsworth Lee, MA, OTR, BCB-PMD, PRPC

3. Physical Therapy Management of Pediatric Incontinence Jennifer Stone, PT, DPT, OCS, PHC