Stop Managing Incontinence. Start Treating It! Here’s How…

By Jon Anderson, Senior Therapy Resource – Texas

If you or a loved one has bladder control issues, you’re not alone. Millions of people in senior living facilities are in the same situation. In fact, more than 70 percent of long-term care residents are not in complete control of their urinary bladder function.

Bladder control problems, such as overactive bladder (OAB), are not a normal part of aging. OAB is not something one has to accept. OAB can limit social life, making it harder to share meals, play cards and stay active in the community. There are also serious health risks associated with this condition, from urinary tract infections and poor sleep to skin problems and falls. OAB is a treatable condition and can be treated in the long-term care facility by a physical therapist.

What Is OAB? OAB is a common condition that prevents you from controlling when and how much you urinate. People living with OAB may experience any of the following:

  • Urgency — the sudden sensation of needing to use the bathroom
  • Frequency — using the bathroom more than eight times per day
  • Urge incontinence — unexpected small or large leaks

Physical therapy can treat OAB through utilization of Medtronic NURO system. How does this therapy work? Medtronic Bladder Control Therapy delivered by Medtronic NURO system restores bladder function by stimulating the tibial nerve through an acupuncture-like needle placed near the ankle.

The therapy is delivered during a 30-minute session, once a week for 12 weeks, by a licensed physical therapist and is covered by Medicare and most insurance providers. This therapy is proven to significantly improve the symptoms of OAB, reducing urgency, frequency and daily urge incontinence episodes. Several recent studies have shown the therapy to decrease OAB type symptoms by 40 percent. At Ensign Affiliates, we are currently piloting this therapy at Legend Oaks San Antonio West and are looking to expand the pilot in the coming months. The most common side effects of PTNM are temporary and include mild pain and skin inflammation at or near the stimulation site. Rest assured, the stimulation is gentle on the patient. It is not painful, although your patient may feel a slight tingling in their heel or the base of their foot. For full prescribing information, see professional.medtronic.com/NURO.

Six Simple Steps to Launch a Successful Heart Math Program

By Jen Farley, Therapy Resource & DOR, Sea Cliff Health Care Center, Huntington Beach, CA

At Sea Cliff Health Care Center, the therapy team actively incorporates Heart Math techniques into daily treatments. Heart Math is a highly effective, multifaceted program that has had a positive impact on the majority of our patient population. Self-regulation is recognized as a key factor to assist in recovering from illness and improve functional performance. Listed below are the six steps used to implement the Heart Math system.

Step One: Get Trained

Contact Mary Spaeder or your local Resource to plan for a hands-on training experience. Generally, the train

Kristi Rosales, PTA, will be the team lead for the HeartMath program at Sea Cliff

ing is completed in an hour. Invite IDT members, EDs, cluster partners and marketers to a Lunch & Learn training. IDT member education highlights the benefits of Heart Math programming. Additional training provided by Dr. Timothy P. Culbert, M.D., is available for advanced certification. Sea Cliff has identified a PTA for completing the certification program and will be recognized as the team lead.

Step Two: Identify Your Target Resident Population

An effective treatment plan includes an evaluation and four to six treatment sessions, 30 to 45 minutes each, within two to four weeks. Collaborate with the resident and the family in setting up a consistent treatment schedule. Sea Cliff has incorporated the emWave Stress relief system with Heart Math techniques. Sea Cliff’s resident population has a broad scope of medical diagnosis. Participating residents have experienced a significant reduction in hypertension, pain, poor sleep, anxiety and depression.

Step Three: Establish Your Treatment Location

A quiet environment is recommended. Sea Cliff consolidated two work offices into one, and the benefit is now a quiet treatment room. Team members collaborated on room design, color and furnishings. Therapists initiated and purchased a pre-owned, low-cost high-low mat. Extra seating is available for family members to attend the treatment sessions.

Step Four: Provide Consistent Follow-Through

Follow-through is both the greatest challenge and the greatest opportunity for therapists as they work to achieve successful treatment outcomes. Scheduling treatment times in a quiet environment enhances the resident’s experience. It is important for the DOR to review the treatment goals and progress. Residents, caregivers and family members appreciate the opportunity to participate.

Step Five: Get Reimbursement

At Sea Cliff, we include billing under Therapeutic Activities or Self Care. For example, charting may include “Heart Variability training to address SOB, fatigue and low endurance to increase activity or ADL tolerance.” Therapists will want to write a specific goal. Documentation should focus on how the use of Heart Math Variability training can increase focus and decrease anxious behaviors to increase safety and participation in self-care and therapeutic activities.

Step Six: Have Fun!

Share your success stories at the Annual Therapy Meeting, the quarterly DOR Meetings and the Monthly Cluster Meetings. Other pathways to highlight this unique program include marketing events, facility tours, IDT care plan meetings and community outreach. When Therapy has fun, everyone has fun!

Making E-Stim Bulletproof

By Lori O’Hara, MA, CCC-SLP – Therapy Resource, ADR/Appeals/Clinical Review

One of the most common reasons for denials in both the Medicare and managed care areas is removing e-stim minutes because the documentation doesn’t support a skilled service.

Reminder! No one pays the machine, so the amount of time the machine is running has nothing to do with how much time is billed. What is reimbursed are the minutes that required a skilled brain — so clearly describing the minutes when the brain was engaged is critical!

Typically, the skilled time includes: assessing and prepping the patient for treatment (including a skin check), applying the electrodes, selecting and inputting the parameters, time spent during the treatment assessing for tolerance or accommodation and making any adjustments, and the post-treatment take-down (including another skin check) and assessments.

Patients who rapidly and frequently accommodate to the current, or roll over from sensory response into a pain response, may require skilled attendance the entire duration of the delivery — but that is not common, so when it occurs it must be very well-documented.

Also remember to put billed minutes in the right place! If you’re using e-stim as an adjunct to neuromuscular re-education or therapeutic exercise, make sure you record the minutes properly. Lumping your treatment minutes into the e-stim code creates an artificially high delivery that the documentation will almost certainly not support.

And finally, the cherry on top: Conclude your narrative entry with a summary statement about the billed time for one-on-one skilled intervention, e.g., “Total number of one-on-one skilled time = 16 minutes.” This is even stronger if the run time is detailed in the description of the e-stim parameters.

Please see the Supervised Modalities POSTette on the portal for more details and examples.

Are You Uncomfortable?

By Willow Dea, Therapy Resource

Comfort is not the objective in a visionary company. Indeed, visionary companies install powerful mechanisms to create /dis/comfort — to obliterate complacency — and thereby stimulate change and improvement /before/ the external world demands it. -James C. Collins

We take tremendous care to achieve our mission every day: To dignify and transform long-term care in the eyes of the world. We do that by enacting a pledge to our core values, which foster a culture of integrity and compassion for our patients and their families.

These commitments ask everything of us. They require each of us to explore a profound, and continuously evolving understanding of leadership. Every Ensign affiliate is a leader; it’s part of the agreement we made when we accepted our respective positions. As partners in this endeavor, we are offered an opportunity to be part of something much greater than ourselves. It’s in this context that I find myself wondering how to be a better partner to each of you and a better leader, especially in practical terms. What does it actually look like, as a set of behaviors and outcomes, to be a leader?

Good to Great[1] revealed the traits of great leaders, and we’ve benefited from learning from these examples. We know that taking responsibility, being humble, getting the right people on the bus, being able to ask for help and leading with passion are essential characteristics and skills for building great organizations and realizing our mission.

Yet the question of how to develop those traits remains somewhat elusive for me, even with such clear stories. In practice, this means we get to cultivate new habits and practice new behaviors. To do that, we need to get comfortable with the uncomfortable. Easier said than done, right? Where do we start? It’s been said that habits are more powerful than fear and that “life begins at the edge of your comfort zone.”

Fortunately, many people are asking similar questions, in every industry sector. Extensive research has been done to help us grapple with these central concerns and effectively answer them. Leadership Agility is based on the rigorously researched developmental framework presented in the award-winning book Leadership Agility: Five Levels of Mastery. The three dimensions of this framework are summarized below.

The Developmental Model[2]

Agility Levels

The first aspect is a description of the “leadership agility levels” that came out of the research. As managers develop, they grow through stages or levels of agility that can be clearly defined and measured. Teams and leadership cultures have the potential to evolve through parallel levels of agility. The three levels of leadership agility most relevant to the vast majority of today’s organizations are:

  • Expert: Managers who operate at this level of agility use their technical and functional expertise to make tactical organizational improvements, supervise teams, identify and solve key problems, and sell their solutions to others. Research indicates that approximately 45 percent of today’s managers operate at this level of agility.
  • Achiever: Managers who function at this level of agility use their managerial skills to set clear organizational objectives, lead strategic change, motivate and orchestrate team performance, and engage in challenging cross-boundary conversations. About 35 percent of today’s managers operate at this level of agility.
  • Catalyst: Those rare managers who have developed this level of agility are visionaries who can lead transformative change, develop high participation teams, and collaborate with others to develop creative, high-leverage solutions to tough organizational issues. About 10 percent of today’s managers operate at this agility level.

As change accelerates and the world continues to become more complex, the need increases for more Experts to become Achievers and for more Achievers to develop the capacities and skills needed to operate at the Catalyst level. In this increasingly turbulent environment, teams and leadership cultures are challenged to undergo parallel developments.

Action Arenas

As leaders develop through the levels of agility described above, their capacity for taking leadership in all three key leadership arenas expands and becomes more effective:

  • Leading organizational change
  • Improving team performance
  • Engaging in pivotal conversations

The Agility Compass: Four Types of Agility

Joiner and Joseph’s research found that agile leaders employ four types of agility, which work together to increase the effectiveness of leadership initiatives in each of the three arenas. The four types of agility are briefly summarized below:

  • Context-settingagility determines how leaders scan their environment, select key initiatives, then scope and set objectives for these initiatives
  • Stakeholderagility determines how leaders identify and understand key stakeholders, as well as their ability to create greater alignment with different stakeholder groups
  • Creativeagility determines a leader’s ability to identify the key problems an initiative needs to solve, get to the underlying issues, and develop creative solutions that work for multiple stakeholders
  • Self-leadershipagility determines how proactive leaders are in experimenting with new leadership behaviors and in learning from their experience

If your curiosity is sparked and you’d like to learn how to reach your next level, reach out to Willow Dea at WDea@EnsignServices.net to take a self-assessment. It takes about 10 minutes, and you’ll leave with a clear understanding of exactly what you can practice to become the leader you aspire to be.

Remember, “The job isn’t to catch up to the status quo; the job is to invent the status quo.” — Seth Godin

[1] Good to Great, James C. Collins, Harper Business; 1st edition (October 16, 2001)

[2] Leadership Agility, William B. Joiner and Stephen A. Josephs, Jossey-Bass; 1 edition (October 20, 2006)

 

 

A Season of Change

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!

Compliance Corner

Your Friendly Neighborhood Compliance Partner

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

Congratulations SPARC Award Winner Sarah Gromko!

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.