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Blog Out in Healthcare

Out in Healthcare: Ryan Ellenbaum, MA CCC-SLP

Name: Ryan Ellenbaum 

Pronouns: She/Her/Hers

Identity: Cisgender Woman, Queer/Lesbian 

Background: I was born and raised in Philly, PA. I live with my wife and our two dogs. I love anything creative – lately I’ve been obsessed with weaving but I’ve dabbled in just about every textile craft. I also enjoy powerlifting and Olympic weightlifting. I studied Russian in undergrad which sparked my interest in communication sciences. Now I work with Russian-speaking families in early intervention and I’m co-owner of a private practice that specializes in gender affirming voice modification for the trans and non-binary community.

Profession: Speech-language Pathologist

Area(s) of Practice or Interest: Gender affirming voice modification, pediatrics, stroke rehabilitation.

What does being ‘Out in Healthcare’ mean to you?: The SLP field is full of compassionate and good hearted people but it can be a pretty homogeneous crowd in terms of race, gender, and sexual orientation. I’m proud to be a queer provider who is in tune with the issues that impact queer people seeking healthcare, especially working in trans voice. It’s important to me to make the services I provide a safe space that helps queer people access care that they might otherwise not feel comfortable seeking. 

What is one thing everyone should know about your identity?: I am generally “assumed straight” based on how I look and dress, which has been both a form of privilege and source of frustration since I came out when I was in high school. In my early intervention work, I am often subjected to unsolicited political opinions and people’s views on the LGBTQ community (while treating in families’ homes). This often forces me to make the split-second decision between being an advocate for my community and feeling safe at work. The message I would spread is not specific to me, but it is to never assume someone’s identity based on how they look. Challenge yourself to be inclusive and to provide space for people you meet to identify themselves as uniquely them, whatever the context.

How do you feel when your identity is included?: Safe and validated.

What does “taking up space” mean to you?:  Taking up space and being visible as a queer person is a form of advocacy. Queer people are everywhere, in every setting, in every town. The more visible we are, the more included we are in the conversation. The more included we are as healthcare providers, the more we can educate and guide our fellow providers to be more compassionate caregivers to patients. 

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Take the time to thoughtfully educate yourself. Seek out positive, affirming resources – especially ones that amplify real voices and experiences of the population you are seeking to learn about. Don’t make assumptions about your patients, give them the opportunity to identify themselves by using inclusive language and questioning.

Has your identity influenced healthcare that you’ve received?: I’ve been fortunate enough to not experience any healthcare nightmares directly related to my sexual orientation, but I always consider queer-friendliness or referrals from queer friends who have had good experiences when seeking healthcare providers. 

Where can people find you?: You can find me on Instagram at @authenticvoicesllc, my website www.authenticvoicesllc.com, or reach out by email to authenticvoicesllc@gmail.com!

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Blog Travel OT

LSVT and Me

Picture property of https://www.lsvtglobal.com/
Citation

What is LSVT/ LSVT LOUD?: “LSVT LOUD is an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions.  Named for Mrs. Lee Silverman (Lee Silverman Voice Treatment [LSVT]), a woman living with PD, it was developed by Dr. Lorraine Ramig and has been scientifically studied for over 25 years with support from the National Institute for Deafness and other Communication Disorders within the National Institutes of Health (NIH) and other funding organizations. LSVT LOUD trains people with PD to use their voice at a more normal loudness level while speaking at home, work, or in the community. Key to the treatment is helping people “recalibrate” their perceptions so they know how loud or soft they sound to other people and can feel comfortable using a stronger voice at a normal loudness level.” (LSVT GLOBAL)

While LSVT LOUD treatment has helped people in all stages of PD, the majority of research has been on those in moderate stages of the disease. LSVT LOUD has also helped people with atypical parkinsonisms, such as progressive supranuclear palsy (PSP), and has recently shown promise for adults with speech issues arising from stroke or multiple sclerosis and children with cerebral palsy or Down syndrome. Beginning your work with LSVT LOUD before you’ve noticed significant problems with voice, speech and communication will often lead to the best results, but it’s never too late to start. LSVT LOUD has the potential to produce significant improvements even for people facing considerable communication difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

What is LSVT BIG?: “LSVT BIG trains people with Parkinson disease (PD) to use their body more normally.  People living with PD or other neurological conditions often move differently, with gestures and actions that become smaller and slower. They may have trouble with getting around, getting dressed and with other activities of daily living. LSVT BIG effectively trains improved movements for any activity, whether “small motor” tasks like buttoning a shirt or “large motor” tasks like getting up from sofa or chair or maintaining balance while walking. The treatment improves walking, self-care and other tasks by helping people “recalibrate” how they perceive their movements with what others actually see. It also teaches them how and when to apply extra effort to produce bigger motions – more like the movements of everyone around them.” (LSVT GLOBAL)

Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in early or middle stages of your condition, when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

Method: Completed the online certification program (also an in-person program with same materials) I would personally would have done the in-class program if it were available to take around me and with the changes associated with COVID I was limited to the online course. I am a hands-on learner but still feel prepared to implement a LSVT program via the online certification course. Certification acquired by completion of LSVT Global’s LSVT BIG Online Course Modules (40) while achieving an 85% or higher on the final examination.

Time: 12.5 hours of course material with average of 16 hours of completion for clinicians, over 90 day period. If you need extra time, you can purchase extensions in 30 day increments. I used almost all of the 90 days (83 days total) to complete the course. Some barriers were working full time, traveling between multiple areas (travel therapy), and lack of motivation to start. Once I completed the first 5 or so modules, I was able to speed through multiple modules at a time. 

Cost: $580.00, $50.00 every two years for renewal. Fortunately, with a bonus from extending my travel placement, I was able to cover the cost of the certification.

Program: At least 4 1-hour sessions per week for 4 weeks, with daily exercises and tasks to completed outside of clinic time. If a patient requires additional time then you continue the program, with supportive documentation and assessment. Consists of 7 daily exercises, functional component tasks, carryover tasks, and hierarchy tasks. Facilitation of the program includes specific and simple cues from the clinician, with the use of modeling and tactile cuing techniques. There is daily homework for the patients that must be completed for the best outcome. 

Why I chose to pursue the LSVT BIG certification as an Occupational Therapist: I have always loved all thing neuro/neuro rehab! I have started the quest to enhance my knowledge in neuro-focused areas through continuing education unit courses (CEUs), certification programs, books, journal articles, podcasts, and research articles. In my year and a half long career thus far as an OT, I have worked with many individuals who live with a diagnosis of Parkinson’s Disease (PD). I briefly learned about the certification course (LSVT BIG) in college and also know friends/colleagues that had already obtained the certification. I have always heard positive reports about the LSVT program and decided to look into in further. An online course was the best option for me and I was in a financial position to purchase the course so I decided to go for it. I am also looking into the Impact OT (ITOT) certification and the Certified Brain Injury Specialist (CBIS) certification for the near future to continue on my neuro-focused journey!

Pros of LSVT Certification/Program: Set protocol to follow, but also individualized based on client’s goals and functional needs. Can be completed in multiple settings, and initiated by a LSVT certified OT in SNF and completed by LSVT OT in HH. The program is evidence-based. The exercises and task are modifiable to patient performance level, with multiple options on grading the activities up/down as absolutely needed. When the certification program is purchased, one receives an LSVT resource book with the modules, exercises, and handouts inside (also available online). I started with re-writing all of the notes from the modules by hand because I didn’t want to wait for the resource book to arrive, as I usually start with this method for studying. I would recommend just waiting for the book or taking online notes if that’s more your style, because re-writing by hand definitely slowed down my completion of the modules. The program has a ton of built in repetition so if you have to complete it in chunks like I did then this is really helpful. There is also a quiz at the end of each module to check for learning of objectives and course material. The repetition and quizzes made it so I had minimal final exam prep to do. The LSVT BIG program is able to be generalized to other neuro populations as long as they meet certain criteria. 

Cons of LSVT Certification/Program: A patient must complete at least 4 weeks, with 4 1-hr session per week, as the evidence only supports a program of this length or more. Program is more affordable than a lot of certifications, but cost is still a barrier to obtaining certification. Program not yet available via telehealth.

Overall, I think the LSVT BIG certification program for Occupational Therapists is worth it!