January 8, 2025 • 38 mins
In this episode of Advice From Your Advocates Podcast, Attorney Bob Mannor speaks with Lenora Edwards, speech & language pathologist, and Chief Knowledge Officer at Better Speech, about the importance of speech therapy, particularly for the elderly and those experiencing cognitive decline.
Bob and Lenora discuss how online therapy can be beneficial, especially for caregivers and family members, and the role of communication strategies in managing conditions like dementia. Lenora also emphasizes the significance of nonverbal communication and the integration of neuro-linguistic programming in therapy. The conversation concludes with practical tips for families dealing with these challenges.
Listen to learn more about how:
- Better Speech offers online therapy that is accessible anywhere.
- Recording therapy sessions can help reinforce learning for patients and caregivers.
- Speech therapy can address not just speech but also swallowing and cognitive issues.
- Family involvement is crucial in the therapy process for dementia patients.
- Engaging the brain through activities can slow cognitive decline.
- Nonverbal communication is key in interactions with dementia patients.
- Adjusting tone and approach can significantly impact communication effectiveness.
- Neuro-linguistic programming can enhance communication strategies in therapy.
- Respect and dignity should be maintained in all interactions with elderly patients.
- Curiosity and open-mindedness are essential for families navigating dementia care.
More on our guest:
Lenora Edwards, Board Certified Speech-Language Pathologist and Chief Knowledge Officer at Better Speech, is a communication expert with over 15 years of experience specializing in adult communication. Integrating Neurolinguistic Programming (NLP) and evidence-based techniques, Lenora empowers professionals to master public speaking, refine interpersonal skills, and optimize nonverbal cues, guiding them towards achieving their personal and professional communication goals with clarity and confidence.
To learn more about Mannor Law Group visit: www.mannorlawgroup.com
Thanks for listening!
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ABOUT US:
Mannor Law Group helps clients in all matters of estate planning and elder law including special needs planning, veterans’ benefits, Medicaid planning, estate administration, and more. We offer guidance through all stages of life.
We also help families dealing with dementia, Alzheimer’s disease, Parkinson’s disease, and other illnesses that cause memory loss. We take a comprehensive, holistic approach, called Life Care Planning. LEARN MORE...
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who work
with the elderly and theirfamilies.
Speaker 2 (00:10):
Welcome back to Advice from your Advocates.
I'm Bob Manor.
I'm a board-certified elder lawattorney in Michigan and we
have a great guest today LenoraEdwards from Better Speech.
She's a board-certifiedspeech-language pathologist.
Make sure I said that right.
I might have gotten yourcredentials a little bit wrong.
Speaker 1 (00:27):
Hi Lenora, how are you doing?
I am great.
How are you doing?
Speaker 2 (00:30):
So tell us a little bit about your credentials.
I might have flubbed over thata little bit, but I think it's
important that you have theboard certification.
So tell us a bit about who youare and those credentials.
Speaker 1 (00:42):
You did beautiful.
Not to worry, I am aboard-certified speech-language
pathologist.
Some people might hear of us asa speech therapist and as a
board-certified clinician.
We have often four years ofundergrad and two years of a
master's program, somethingalong those lines.
There are now five-yearprograms, but I've been
certified and in the field since2009.
And I have quite a bit ofexperience working in every area
(01:05):
, especially in the elder carecommunity.
So I'm very excited to spendtime with you.
Speaker 2 (01:10):
And you are the chief knowledge officer for Better
Speech.
So tell us a little bit aboutBetter Speech and tell us about
what a chief knowledge officerdoes.
Speaker 1 (01:19):
So with Better Speech , we are an online speech
therapy company, and what I loveabout that is, especially in
our very busy world of today, alot of the time receiving speech
therapy services can feel likethis overwhelming process where,
oh my gosh, I have to pause inthe middle of the day.
I have to get in the car, driveto the clinic park, get in, get
settled, see my clinician leave, start my day again and
(01:40):
continue on.
And with Better Speech, whichis an online speech therapy
company, we are there anywhereyou are.
So if you're traveling or ifyou happen to have an older
loved one that is at home andit's quite taxing for them to
leave the house, we're rightthere with you.
So, especially when technologyhas advanced so much, it's a
(02:01):
great thing.
It's way better than dial-up,for sure, but especially with
Better Speech, we are on Zoom,so we have that HIPAA compliance
that everybody is often curiousabout, and we are also able to
record our therapy sessions andwhat I love about.
That is a lot of the time,especially when you're in an
outpatient clinic and if you'rethere for a short amount of time
(02:22):
, as those sessions can movevery quickly, you get this
torrid of information coming atyou, and if you're there for a
short amount of time, as thosesessions can move very quickly,
you get this torrid ofinformation coming at you and
you're hoping that you rememberall of it or you're trying to
take notes as to what to do andwhat strategies they're
recommending.
The great thing, now that we'reon Zoom, you can record the
entire session, and then thenice thing is is that you can
share that session with yourloved ones or with the
(02:44):
caregivers that are present withthe individual receiving
therapeutic services.
There's a lot of benefits toonline therapy.
That just happens to be one ortwo of them.
Speaker 2 (02:53):
Yeah, no, that actually makes a lot of sense.
I hadn't thought about thatadditional advantage of being
able to record the session.
I recall when I had my rotatorcuff done and I had physical
therapy, I'd get home and Icouldn't remember exactly how I
was supposed to move it orexactly what exercises I was
supposed to do.
It'd be very helpful to havethat, especially with speech
(03:14):
therapy, which can be a littlebit more nuanced and be able to
reinforce it.
Plus, you know, a lot of thisis folks that you know,
especially if we're dealing withfamily members as caregivers or
family members around theperson that is receiving the
speech therapy reinforcement.
So watching that sessionmultiple times might be really
(03:36):
useful for reinforcement,because it's hard to change old
habits, right, Right?
Speaker 1 (03:40):
Very much so, especially if it's in the area
of a loved one that'sexperiencing, let's say,
dementia or Alzheimer's orParkinson's Depending on what
area of focus you're having fortherapy is really important.
So, for example, as a clinician, as a speech pathologist, I
often say we work from the neckand up and people are often
thinking well, you're a speechtherapist, how's my speech?
(04:02):
And for the elderly population,they'll often say, well,
nothing's wrong with my speech.
And I'll often say you're right, but I hear you might have some
trouble swallowing your food ormaybe something's hard for you
to chew.
Or I'll say, well, that you'reright, your speech is great, but
I hear you're having sometrouble with your memory.
And then, oh, yeah, you'reright, my memory is terrible.
Yeah, I can't chew meat.
(04:23):
Those are details that a lot ofpeople don't realize that speech
pathology is connected to.
So that's why we say from theneck and up, because food and
swallowing are involved,especially throughout the aging
process, and especially memorysequencing, problem solving,
forgetting where you putsomething, forgetting how to
(04:44):
write a check, forgetting whattime you took your medication or
if you took your medication.
These are all areas that areour area of expertise and during
those therapy sessions whenwe're adding strategies, when
we're talking about what isgoing on at home or what else is
occurring.
Where are your strengths?
What are you noticing thatyou're concerned about?
All gets into play, so beingable to record the session and
(05:05):
then share it at home andrewatch it can be
extraordinarily helpful.
Speaker 2 (05:19):
I think it's overlooked by speech therapy
that really memory issues andcommunication are very important
when it comes to dementia orAlzheimer's or any of the memory
issues, and a lot of peopleoverlook the fact that speech
therapy can help with that.
So let's talk a little bit moreabout that particular.
(05:46):
I think sometimes what Iunderstood from you, from
talking to you before, is thatsometimes it's a matter of
actually also teaching thefamily how to communicate, the
caregivers how to communicate.
Speaker 1 (05:53):
Very, very much so.
So, especially when it comes todementia or Alzheimer's any
neurological decline there'sdifferent stages and there are
times where you might hear thatyour loved one is diagnosed with
dementia and you might think,oh my God, they're in a nursing
home and I have to put them awayright away.
That's not the case.
When somebody starts toexperience signs of memory loss
(06:13):
or signs of having cognitivedifficulty, we like to look at
it as a whole.
Is it a sudden onset, such as?
Is a medication shifting andsuddenly they're having a
different response to it?
So that's always something topay attention to.
Have you reached out to yourphysicians?
Do we know what really is goingon inside?
And being able to help peopleget a better, clear picture of
(06:35):
that individual that isexperiencing those cognitive
difficulties is so important.
So, even if we talk about theearly stages of dementia yes,
there are things like forgettingto put your keys in the right
place there are other signs,such as putting milk in the
cupboard and cereal in thefridge as you're shifting.
Things can be very, verysequential, but if you're
(06:58):
noticing a pattern of this inyour loved one, or perhaps
taking the eggs out of thefrying pan and not turning off
the burner.
Those are very small indicatorsthat something else might be
going on.
Other things that you also wantto pay attention to is is that
loved one able to consistentlytake their medication?
If they're on medication, arethey taking their vitamins?
(07:20):
Are they consistently eating?
Are they consistently takingthemselves to the bathroom?
How's their hygiene?
So all these daily activitiesand sometimes you might hear the
key phrase of ADLs, which isactivities of daily living are
very important to notice.
Make sure you have a reallygood picture of what they were
(07:42):
like, where they are now,because things can change in a
short period of time.
And if we're talking shortperiod of time, does that look
like a year, lenore?
No, that looks like possiblytwo to three months of a change,
and you're going to start tonotice things along the way, so
you definitely want to payattention.
One thing that I absolutelyencourage people to do is notice
(08:09):
their routines and write downtheir routines, and if you start
to notice that there might bemaybe a hiccup or two or hey,
that was weird make a note of itand write it.
Keep track of it in your phone,keep track of it in a notebook,
whatever you want.
Make a note of what it was andthe date that it was, because
that can be extraordinarilyhelpful.
Speaker 2 (08:24):
A little bit more about how speech therapy can
help with those things.
So that was an excellent reviewof warning signs to be looking
at to see that this might beleading in this direction.
Tell us a little bit more abouthow speech therapy can help
with these issues once it's beenidentified.
Speaker 1 (08:42):
Definitely issues, once it's been identified,
definitely With speech therapy.
If a loved one is still at homeand you're starting to notice
these cognitive indicators of adecline, working with your
neurologist or with your lovedone's neurologist, working with
the primary care and sayingthese are the things that I'm
noticing, I would like an orderto receive speech therapy
(09:02):
services.
That is truly, truly helpfulbecause you're communicating to
your physician that there's aconcern.
That being said, it's alsosomething that you will
definitely need to have speechtherapy services reimbursed
through whatever provider ofhealthcare insurance that you
have.
And when you receive speechtherapy services, you wanna work
(09:24):
with your clinician and sayhere are the things that we're
noticing, this is what theirdaily routine was like, this is
what we're starting to see, andthe reason that's so important
is because, when you're workingwith your healthcare providers
such as myself, I would be ahealthcare provider we want to
get as clear of a picture ofthat individual what's going on,
(09:45):
where are they and then that'show we set our goals, where we
want to go.
If a loved one is experiencingcognitive decline and they're
forgetting to eat regularly orthey're forgetting to write
things down or they'reforgetting names, that's okay.
What we do as a clinician, asthe speech therapy team is.
We implement strategies, weoffer tips and techniques and we
(10:08):
also help work with them toimprove their memory so that way
they're not having this massivedecline.
The reason it's so important isbecause neurons that fire
together and wire together.
That's a great thing.
We want to keep that brainhealthy, we want to keep it
strong, we want to keep itfocused, we need to give it
tasks, we need to keep itengaged.
(10:30):
If your loved one is spending 8,10, 12 hours in front of the TV
, that's not an engaged brain,that is a very passively engaged
brain.
Actively engaged brains includehaving conversations, doing
tasks, going to the grocerystore with somebody, quite
literally writing stuff down,being active, moving in your
(10:53):
body, and it's so important tobe engaged.
The more actively engaged youare, the more likely that that
individual will rememberinformation, because it's not
going by them like it's on TV.
They're a part of it, they'reengaged in it and then, after
the task, asked after the event,have a conversation about it,
(11:16):
keep it active in their memory,especially for loved ones that
are.
If your loved one isexperiencing a cognitive decline
, it's really important forfamily and friends and that
support network to do this,because it's going to keep that
individual that much moreengaged and it's going to slow
the progressive decline, whichis a great thing.
Speaker 2 (11:37):
We had a guest on the podcast a while back that
talked about how many familiesthat have a loved one with
Alzheimer's or dementia theystart to cocoon and like you say
, really not leave the house,really not expose dad or mom to
the outside world, but then whathappens with that is then
they're not accessing theresources and the things like
(11:59):
speech therapy and other thingsthat could help with this.
And one of the key points thatI think is really key on this is
for the families to understandthat well, all the things that
you just mentioned where we'reengaging the brain, those types
of things well, it might extendthe period of time that the
person is more able to interactwith people.
(12:22):
It certainly makes that timebetter than if they're just
sitting in front of a TV.
The ability to communicate withfamily is key to this, and so
these types of activities, thistype of engagement, will make
the time that you have with thisperson more fulfilling, more
(12:42):
quality of life for both thefamily and the person that needs
care.
Speaker 1 (12:46):
Absolutely.
I could not agree more, andespecially for families that are
experiencing this, especiallywhen they hear it for the first
time and they don't have ahistory of a loved one that's
already gone through it.
They're hearing very targetwords.
They're hearing very, very hotbuzzwords that you might hear on
TV or that you might've heardin a read in a magazine, and you
(13:09):
don't know a lot of information.
You just know that this issomething your loved one does
not want to have, and, oh mygosh, allow yourself to
recognize that there's a lot youdon't know, and that's okay.
You're not supposed to knowabout it.
What you can do, though, isreally start connecting with
other people and ask for theirstories, ask for their insights.
(13:33):
Go to support groups, educateyourself.
Allow yourself to recognizethat educating yourself will
take longer than a week.
Really get curious as to howpeople do live with this and
what their quality of life is.
A lot of the time that buzzwordof dementia or Alzheimer's,
(13:53):
people think, oh my God, they'regone and that's it.
That's not it at all.
To really start to notice thatthere is a community for
individuals who experiencedementia and Alzheimer's and the
caregivers of people providingthat care to those with dementia
and Alzheimer's.
It really is something that youcan recognize and say, okay,
(14:17):
this is going to be a journey,they're not in the grave.
I can keep them at home to thebest of my ability.
I can support them to the bestof my ability and I can be
supported as much as I'm willingto allow myself to be supported
.
Speaker 2 (14:32):
You and I have talked previously about this, about
how with a family member,particularly if it's a spouse
and you know it's very difficultwith this significant change in
the way that someone caninteract, if they've been, if
they have Alzheimer's or anyform of dementia, and so
sometimes it's difficult for thefamily member like I say,
(14:56):
particularly a spouse to acceptthat this is actually the
disease, as opposed to theirhusband just being grumpy or
their wife just doing the samethings, that the baggage that
comes with 50 years of marriageI suppose.
But the thing is that is one ofthose communication issues.
Not only is the communicationissue where we're trying to make
(15:19):
sure that the person is able tocommunicate, but also that the
family is able to communicate.
So if you could talk a littlebit about that, but also about
how much communication isactually not just the words that
we say, it's not just the voicethat we use or sometimes it is
the tone of the voice, but it'snot just the words that we say
(15:39):
so how it might make a bigdifference for a family member
if they can kind of adjust tothis and accept that this is
actually part of the disease andthat we might have to change
the way that we communicate,even if this is the way we've
done it for 50 years.
Speaker 1 (15:54):
You've said that so beautifully, so, so beautifully.
And when it comes to a lovedone who's experiencing dementia,
whether it's your husband oryour wife or whomever it might
be, there is such a thing aspeople becoming very short and
very what can come across asmean or nasty.
There are times where peoplehave dementia and they're
(16:18):
considered the pleasant onesthat they don't remember
anything, but they're lovely allthe time.
There are also individuals whoexperience the opposite, and
they can be very short and verynasty.
That being said, thatindividual if you can maintain
this one piece of information atall times that individual would
much rather not have thisdisease, much rather not have it
(16:40):
.
They are not.
Despite however they comeacross, they are not doing it
intentionally.
There's a shift in theirchemical, hormonal balance.
There is a shift in theirsleeping, there is a shift in
their memory loss.
There are so many things goingon that, even though part of us
might want to say they're doingit on purpose I know they're
(17:02):
being mean on purpose theyreally aren't.
They're really trying to dotheir best and, as the loved one
, as the care provider, as theperson that is a part of this
journey with them, the bestthing that I can do to support
them is allow myself to takebreaks but also change my tone
(17:24):
of voice.
When somebody is very harsh,very nasty, and you can hear it
in their voice and they justcome after you, allow yourself
to shift your voice and when youcan become softer, when you can
speak slower, it's going tohelp regulate your nervous
(17:44):
system and it's also going tohelp you recognize.
I'm going to need to exercise alot of emotional control right
now and that's okay.
I'm going to do my best to bepatient.
When we tap into our change ofa voice, when we slow our speech
, it can be very helpful and itcan also shift that person
(18:06):
because their tone is totallydifferent.
You are controlling yours withintention and it will help
regulate that other individual.
So if they're having a badperiod of time, you can say okay
, I see you need a break.
Right now, I'm going to pause,I'm going to, I'm going to stay
over here.
You tell me when you're ready.
You're telling that individualwhat's going on.
(18:29):
You're acknowledging thatthey're frustrated, you're
acknowledging where they are andyou're also allowing that space
that needs to occur for them tocalm down.
You're also allowing yourself aspace that needs to occur to
calm down because it can be verytaxing, it can be very
frustrating, it can be veryheartbreaking for you as the
(18:51):
caregiver.
And when you can notice that,when you can just recognize I
just need to pause, slow myspeech and soften my tone and
allow that space to maneuver, itwill be so much more effective
when you have those interactions, especially when you have
interactions with somebody whois not in a good mood.
Speaker 2 (19:11):
I think one of the things that you said there
that's so important that peopleoverlook is the idea that by
changing your tone, if you'reforcing yourself to sort of
change your tone, that also hasan effect on you.
It's not just you know theeffect that it has on other
people.
If you add a speak in a more,it doesn't just affect how the
(19:34):
other person interacts.
It actually is.
You know, it's aself-fulfilling prophecy.
It helps you regulate your ownemotions, which I think is
really important and somethingthat people overlook quite a bit
.
Speaker 1 (19:45):
Very much so.
Speaker 2 (19:47):
I want to get into.
I know that you've been anexpert at integrating
neurolinguistic programming, orwhat is usually called NLP, into
the you know for evidence-basedtechniques for using speech
pathology and speech therapy.
Tell us a little bit more aboutthat.
Maybe some of our listenershave heard of neuro-linguistic
(20:10):
programming.
Some of them haven't.
Tell us a little bit more aboutthat and how that helps with
the role that you do and therole in speech therapy and
speech pathology.
Speaker 1 (20:20):
Absolutely.
Being certified in NLP hastruly helped me become a better
communicator.
Also, it's more of the study oflanguage when we can understand
if somebody's saying I don'tsee what you're saying.
I don't see what you're sayingand you're saying can't you hear
me, can't you hear me when webreak it down.
(20:40):
Somebody saying I don't see,they're more of a visual.
They need that visualdemonstration for them to better
understand that other personhad said can't you hear me?
That other person is more of anauditory person.
So they're just really littlenuances that can be very helpful
along the way For me when itcomes to communication.
(21:01):
If I know my client is much moreof a visual learner, I will
make pictures.
I will not just make a cartoonpictures.
I will use pictures of theirbelongings to better help their
sequencing skills.
So if they are needing to go tothe bathroom and it has to go
in a certain sequence andthey're forgetting to do certain
(21:21):
things along the way, I willhave that caregiver take
pictures of what needs to happenso that visual can hang in the
way.
I will have that caregiver takepictures of what needs to
happen so that visual can hangin the bathroom.
And when they look at thatvisual.
They're not looking at acartoon picture of possibly a
bathroom or whatever I found onthe web.
They're looking at theirpictures.
They're looking at theirclothes, and that can be much
more effective.
(21:42):
If somebody is much better atunderstanding written words
rather than typing it out, Iwill have that caregiver and
that client write out thosesteps to better help them
understand.
We want individuals to be ableto understand information in
ways that are meaningful to them.
(22:03):
The more we can do that, themore we can engage that brain
and engage that individual, thebetter they will be able to
maintain their cognitive skills.
So those are just some littlethings that I've used along the
way, very specifically when itcomes to NLP.
Speaker 2 (22:18):
Very nice Talk to us a little bit about and I think
this goes hand in hand with whatyou've been saying but the
importance of nonverbalcommunication when communicating
with someone with dementia.
Speaker 1 (22:30):
So when it comes to nonverbal communication, a lot
of people think that nonverbalcommunication might just be
something like eye contact.
When we're talking about verbalcommunication versus nonverbal,
there's a variety of researchout there that says 70 plus
percent of what you're saying isnonverbal.
What does that look like?
That looks like your eyecontact.
That looks like your posture.
(22:51):
That looks like your facialexpressions.
It also sounds like your tone.
There's so many pieces that arecoming in, as well as your
energy.
There's so many pieces that gointo effective communication.
If I'm turned away from you andI'm not looking at you and I'm
looking down, how active of acommunication interaction are we
(23:12):
having?
Not a very strong one.
When I look at you, when we'rehaving the conversation
especially in our culture we'revery big on eye contact in the
US when we're having thisface-to-face interaction, when I
can be in the same position, onthe same eye level as you,
you're going to be much moreengaged in my interactions and
that's a great thing.
(23:32):
That is a piece of oureffective communication.
Being able to have all of these, along with words, on the same
plane allows for a much moreimpactful level of communication
, allows for a much moreimpactful level of communication
.
When we're with a loved one, orif somebody is a caregiver and
(23:55):
they're spending a lot of timetogether, they're not always
aware of this because they'redoing other things.
Maybe they're preparing a mealin the kitchen or maybe they're
doing something else and they'rehaving this flyby of a
conversation.
The person who might be sittingin a chair watching you and
kind of hearing you isn't veryengaged, even though you might
be engaged because you might bein your 50s or in your 60s and
you're firing totallydifferently.
(24:16):
Your loved one, who might be 80or 90, is not firing on the
same level as you are.
When you need that stronginteraction or when you're
having that effectivecommunication, you want to be
paying attention to each other.
Whether you're at the sametable, whether you pull up a
chair and you sit down next tothem, you want to have this
engaged interaction.
(24:36):
Being present in the room issimply being present in the room
.
Being present in theinteraction, in the
communication that's occurring.
Speaker 2 (24:45):
that's a completely different story.
I have a quick example on that.
So I had a client who was in acare setting and they were
concerned and they had talked tothe family about mom being
violent.
And I thought, boy, that justdoesn't seem consistent with
(25:06):
every meeting I've had with momon this.
And so the example that theygave was that she was in a
wheelchair, I believe, and sheappeared chilly.
So they tried to put a sweateron her, but they approached her
from behind and this was the,the caregiver.
(25:26):
And the thing is, when, withdementia, you don't have the
same understanding of yoursurroundings and your brain's
not always explaining everythingas quickly as it would with
someone without dementia, and soapproaching someone with
dementia from behind, that mayfeel like they're being attacked
(25:47):
right or even from above, youknow, and so the idea is that
she probably would not havereacted violently had the person
come around to the front, goton her level, like you say, look
her in the eye and say are youchilly, can I put a sweater on
you?
And that would have probablybeen a completely different
(26:08):
interaction.
I think, some of the times whenwe have what in the industry we
sometimes call behaviors,meaning that there is some bad
behaviors that make it difficultfor the caregivers.
Those can be addressed by someof this communication style, by
getting on somebody's level, bymaking sure we're doing our best
to communicate with them asopposed to just you know doing
(26:31):
the thing.
It's not surprising thatsomeone that doesn't have a full
understanding of theirsurroundings would react in that
way and, you know, kind of pushback on that.
Speaker 1 (26:42):
Is that a good example?
That is an excellent example.
Absolutely, especially whenthey're not, let's say they're
not at home.
They're at your home, which isthe home of the caregiver, and
they've been there for a numberof years, or, excuse me, they
visited over the years, but it'snot their home.
So now, technically, you havethem in a different environment,
(27:03):
so approaching them from behindcan be very alarming to them.
And you're completely right whenwe're having interactions, we
want to let them know what we'regoing to do before we do it,
especially when and you mightnot see this too often in the
early stages of dementia.
You might see this more in themoderate or the severe levels of
(27:24):
dementia, but letting them knowwhat you're going to do quite
literally communicates I'm not athreat, I'm not in a dangerous
situation right now.
Another one also, which can wesee often in the advanced
population, is when they'rerequiring assistance for having
(27:44):
to go to the bathroom.
There's a lot of behaviors, andthe reason that is is for what
some people may or may notconsider very obvious.
They might think I've done thisfor years with them, I'm taking
care of them, don't you knowwhat I'm doing To that
individual?
You're no longer all thatfamiliar, but it can feel a lot
to that individual that'sexperiencing dementia, like
(28:05):
sexual abuse, and we need to bevery respectful of that and help
them understand.
This is what I'm going to donext.
I'm a safe person.
You can trust me and helpingthem understand that on multiple
levels.
Again, with that nonverbalcommunication, again with the
tone we want to communicate tothem what's going on.
(28:26):
And if you even flip the tablesand think, okay, you know, I
don't remember what I ate forbreakfast, I don't always
remember the environment, andthis person that I'm looking at
is sometimes familiar to me, howwould you feel?
And trying to understand itfrom their perspective, how do
you want to be cared for?
(28:47):
We need to be, to the best ofour ability, as considerate as
possible.
The more considerate we are,the more we communicate with
them, the more we let them knowwhat's coming and what to expect
.
We quite literally have muchmore control over their
behaviors because we're sharingwith them what's coming.
(29:07):
It's not a surprise.
They're not getting caught offguard and they're not quite
literally under fight, flight orfreeze.
Speaker 2 (29:14):
Yeah, so would that also apply?
I think it would, but I want toask you would it also apply
when you know it gets to thestage which sometimes it does,
that the person is actuallynonverbal?
The person with dementia isnonverbal.
That doesn't give us an excuseto not try to communicate with
them.
Just because they can'tcommunicate verbally doesn't
mean that we still have anobligation to do all the things
(29:37):
that you just mentioned.
And they're, you know, maybe ina lesser way, but they're still
able to perceive communication,particularly from the
standpoint of, you know, liketone and movement, and you know
eye level, things like that.
Speaker 1 (29:52):
I am so glad that you mentioned that.
Absolutely, when it comes tocommunication and, very
specifically, language, languageis two parts.
We have the ability tounderstand language, which we
consider our receptive part oflanguage, such as if I give you
a direction, you'd be able tocarry it out, or if I asked you
a WH question, you're able toreceive that information and
know what to do with it.
(30:12):
Then we have the expressivepart of language, which is the
words that are quite literallycoming out my mouth as I'm
speaking.
We string them in a sentenceand we're communicating
effectively as an individualadvances.
Communicating effectively as anindividual advances.
They might not be able to findall of their words, such as hey,
can you pass the yeah, thatthing over, yeah that?
And you go oh, you want me topass the salt.
(30:34):
So we call that missing thetarget word when they can't name
something.
That being said, it progresses.
So they might not just remembera loved one's name.
They might not remember to tellsomebody I have to go to the
bathroom, as in they've now lostthe words, they're not
communicating or their wordssound, their words sound like
(30:56):
that.
They don't.
They're not what we considereffectively communicating.
They can't express their wantsand their needs.
That being said, when we go tohave an interaction with
somebody and I've worked inskilled nursing facilities and
outpatient clinics and inpatientclinics for years when we go
into that room to say hello tothat person good morning, how
(31:19):
are you?
Today is November 25th.
It's so good to see you.
My name's Lenora.
I'm going to help get you readyfor this morning and letting
them know what to do.
You can tell by my tone.
They might not understand asingle thing, but they can see
by the expression on my facethat I'm not a threat.
They can hear by the tone of myvoice that I'm not a threat as
(31:40):
I move and I don't make abruptmovements.
They can watch me and I canshow them their clothes.
Okay, we're going to wear apurple shirt today or a red
shirt, and give them choices.
These are all a part of it.
Even if they might not be fully,actively engaged and able to
say I want to wear the purpleone, we still want to give them
that respect, we want to givethem that dignity and we also
(32:03):
want to be sure that we aretreating them in the same
sincere way that, hey, we wantto be treated, but also at the
same level.
So, for example, to my95-year-old client I would not
say, oh, which one do you want?
Do you want the red one or doyou want the purple one?
I would treat them with therespect and the dignity that
they deserve at 95.
Would you like the red one orwould you like the purple one?
(32:26):
A lot of the time people willshift their tone and they'll
take their tone down to a childtone.
We want to be respectful.
Another key one is I don't callthem diapers and we don't call
them whatever other term peopleuse for that.
We call them briefs or we callthem underwear.
Give them that dignity.
(32:49):
It is so important and it istruly communicated on such a
deeper level than it's actuallygiven credit for.
Speaker 2 (32:56):
That's very nice, very nice.
Well, to shift gears just alittle bit.
I imagine, having studied thisand studied communication, that
you actually are able to seethis, that in just everybody,
that sometimes you'll noticethat people's expression perhaps
is not in congruence with whatthey're actually feeling, and
(33:19):
that's very helpful.
I think I notice occasionallywith folks if I'll make a demand
or request for them.
There's some folks that justhave this you know, deer in
headlights look because theyhave to process it.
I have a couple of consultantsthat help me with accounting
matters and when I talk to themabout ideas or things, they
(33:42):
always have this look ofskepticism on their face.
What I've learned is they'reactually intensely listening to
what I say and I probably dothat myself.
Or if I'm intensely listeningto what somebody says, I
probably have this look ofskepticism on my face.
And just recognizing this foreverybody, not just for folks
with dementia that sometimes theexpressions might not match up
(34:04):
with the actual feelings thatsomebody's had.
They just need time to focus orconcentrate or they need to
take in the new information.
So I imagine that's somethingthat you experience in daily
life, where you see wheresometimes things aren't always
congruent with people's actualfeelings about the situation.
Speaker 1 (34:22):
Very much so, and especially if you go up to
somebody and you say, hey, canyou help me with this really
quick, depending on the tonethat we approach somebody with,
that will impact their response.
That being said, depending onwhere that individual is, quite
literally, in their own thoughtsif they're thinking of a fight
(34:43):
that they had with somebodyearlier that day, or if they're
thinking of all the tasks thatthey have to get done and
they're not in a bad mood, orthat they are in a bad mood,
your response, the response thatyou're going to receive, can be
completely different and you'regoing to feed off each other's
tone.
So this really goes into a muchdeeper level of emotional
intelligence and communityeffective communication goes
(35:06):
into a much deeper level ofemotional intelligence and
effective communication.
When I go to have aninteraction with somebody, it is
different.
For example, when I go tointeract with my husband, it's
going to be very different thanwhen I go to interact with my
client.
That being said, because of thework that I do, I'm very tuned
to somebody's response and I canhear where they are emotionally
(35:26):
just by listening to theirvoice.
I also happen to be quiteempathetic.
That's another bonus.
When I can hear somebody, I willstop.
If they respond to me in a waythat doesn't feel like it was
meant for me, I'll say, oh, iseverything okay?
Yeah, everything's fine.
Are you sure, or are youthinking of something else, or
is something else on your mind?
(35:47):
A lot of the time, somethingelse is on their mind.
So when you're noticing theincongruency in somebody's
receptiveness to yourconversation, it might have
nothing to do with you.
That being said, if you'reasking a task or if you're
asking somebody to do somethingfor you hey, can you help me
with this?
(36:07):
And you're going on a list ofwhat you need help with, their
brain needs time to process.
So pausing or even asking alongthe way, does this make sense?
Are you following my thoughts?
Am I being clear?
It might be that I am beingclear.
It might be that that person'sdistracted, or it might be that
I'm not being.
It might be that that person'sdistracted or it might be that
I'm not being clear, and I wantto have that effective
(36:29):
communication.
So watching somebody's facialexpression can be very, very
helpful.
Also listening to their tone.
Speaker 2 (36:36):
Oh, that's great.
Those are great tips.
Tell us a little bit more howthe listeners can interact with
better speech.
So we have a lot of variety oflisteners, from people in the
long-term care industry tosocial workers, to just general
folks that are interested inthese topics.
And so how would?
What's the best way to interactwith your company?
(36:58):
Better Speech.
Speaker 1 (37:00):
For reaching out to us.
If you would like to schedulesome time with us, just simply
visit betterspeechcom and wewill get you scheduled to work
with a board-certifiedspeech-language pathologist
right away.
If you're curious about thethings that we do, you can also
visit betterspeechcom, and wehave loads of insights in our
blog, and we also have quite theYouTube channel and social
(37:20):
media links in there.
The best way to reach out to usis at betterspeechcom.
Speaker 2 (37:27):
I did have an opportunity to check out your
website.
It's very good.
It has a lot of great contentin it, so I do recommend people
check that out, thank you.
Any final tips for familiesthat are dealing with these
issues before we wrap up today.
Speaker 1 (37:41):
My final tip would be to be curious and to be
open-minded.
The more curious and the moreopen-minded you can be,
especially for your loved one,and you can release that
judgment of what might happen.
It will be extraordinarilyhelpful to you, you'll be able
to reach out to other people andyou'll be able to have a much
(38:03):
better experience going throughthe entire experience, because
there's so much that you don'tknow and there are many people
that are still safely living athome, with strategies, with
certain things in place thatkeep them safe at home, and not
everybody goes to a nursing homeand not everybody is a horror
story home and not everybody isa horror story, right.
Speaker 2 (38:28):
Well, thanks so much, lenore Edwards, from the Chief
Knowledge Officer at BetterSpeech.
If you've enjoyed this podcast,don't forget to subscribe.
You can find us at any placethat you can find podcasts, or
you can find us on YouTube orour website at manorlawgroupcom.
Thanks again and we'll see younext time.
Speaker 1 (38:52):
Thanks for listening.
To learn more, visitmanorlawgroupcom.
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who work
with the elderly and theirfamilies.
Speaker 2 (00:10):
Welcome back to Advice from your Advocates.
I'm Bob Manor.
I'm a board-certified elder lawattorney in Michigan and we
have a great guest today LenoraEdwards from Better Speech.
She's a board-certifiedspeech-language pathologist.
Make sure I said that right.
I might have gotten yourcredentials a little bit wrong.
Speaker 1 (00:27):
Hi Lenora, how are you doing?
I am great.
How are you doing?
Speaker 2 (00:30):
So tell us a little bit about your credentials.
I might have flubbed over thata little bit, but I think it's
important that you have theboard certification.
So tell us a bit about who youare and those credentials.
Speaker 1 (00:42):
You did beautiful.
Not to worry, I am aboard-certified speech-language
pathologist.
Some people might hear of us asa speech therapist and as a
board-certified clinician.
We have often four years ofundergrad and two years of a
master's program, somethingalong those lines.
There are now five-yearprograms, but I've been
certified and in the field since2009.
And I have quite a bit ofexperience working in every area
(01:05):
, especially in the elder carecommunity.
So I'm very excited to spendtime with you.
Speaker 2 (01:10):
And you are the chief knowledge officer for Better
Speech.
So tell us a little bit aboutBetter Speech and tell us about
what a chief knowledge officerdoes.
Speaker 1 (01:19):
So with Better Speech , we are an online speech
therapy company, and what I loveabout that is, especially in
our very busy world of today, alot of the time receiving speech
therapy services can feel likethis overwhelming process where,
oh my gosh, I have to pause inthe middle of the day.
I have to get in the car, driveto the clinic park, get in, get
settled, see my clinician leave, start my day again and
(01:40):
continue on.
And with Better Speech, whichis an online speech therapy
company, we are there anywhereyou are.
So if you're traveling or ifyou happen to have an older
loved one that is at home andit's quite taxing for them to
leave the house, we're rightthere with you.
So, especially when technologyhas advanced so much, it's a
(02:01):
great thing.
It's way better than dial-up,for sure, but especially with
Better Speech, we are on Zoom,so we have that HIPAA compliance
that everybody is often curiousabout, and we are also able to
record our therapy sessions andwhat I love about.
That is a lot of the time,especially when you're in an
outpatient clinic and if you'rethere for a short amount of time
(02:22):
, as those sessions can movevery quickly, you get this
torrid of information coming atyou, and if you're there for a
short amount of time, as thosesessions can move very quickly,
you get this torrid ofinformation coming at you and
you're hoping that you rememberall of it or you're trying to
take notes as to what to do andwhat strategies they're
recommending.
The great thing, now that we'reon Zoom, you can record the
entire session, and then thenice thing is is that you can
share that session with yourloved ones or with the
(02:44):
caregivers that are present withthe individual receiving
therapeutic services.
There's a lot of benefits toonline therapy.
That just happens to be one ortwo of them.
Speaker 2 (02:53):
Yeah, no, that actually makes a lot of sense.
I hadn't thought about thatadditional advantage of being
able to record the session.
I recall when I had my rotatorcuff done and I had physical
therapy, I'd get home and Icouldn't remember exactly how I
was supposed to move it orexactly what exercises I was
supposed to do.
It'd be very helpful to havethat, especially with speech
(03:14):
therapy, which can be a littlebit more nuanced and be able to
reinforce it.
Plus, you know, a lot of thisis folks that you know,
especially if we're dealing withfamily members as caregivers or
family members around theperson that is receiving the
speech therapy reinforcement.
So watching that sessionmultiple times might be really
(03:36):
useful for reinforcement,because it's hard to change old
habits, right, Right?
Speaker 1 (03:40):
Very much so, especially if it's in the area
of a loved one that'sexperiencing, let's say,
dementia or Alzheimer's orParkinson's Depending on what
area of focus you're having fortherapy is really important.
So, for example, as a clinician, as a speech pathologist, I
often say we work from the neckand up and people are often
thinking well, you're a speechtherapist, how's my speech?
(04:02):
And for the elderly population,they'll often say, well,
nothing's wrong with my speech.
And I'll often say you're right, but I hear you might have some
trouble swallowing your food ormaybe something's hard for you
to chew.
Or I'll say, well, that you'reright, your speech is great, but
I hear you're having sometrouble with your memory.
And then, oh, yeah, you'reright, my memory is terrible.
Yeah, I can't chew meat.
(04:23):
Those are details that a lot ofpeople don't realize that speech
pathology is connected to.
So that's why we say from theneck and up, because food and
swallowing are involved,especially throughout the aging
process, and especially memorysequencing, problem solving,
forgetting where you putsomething, forgetting how to
(04:44):
write a check, forgetting whattime you took your medication or
if you took your medication.
These are all areas that areour area of expertise and during
those therapy sessions whenwe're adding strategies, when
we're talking about what isgoing on at home or what else is
occurring.
Where are your strengths?
What are you noticing thatyou're concerned about?
All gets into play, so beingable to record the session and
(05:05):
then share it at home andrewatch it can be
extraordinarily helpful.
Speaker 2 (05:19):
I think it's overlooked by speech therapy
that really memory issues andcommunication are very important
when it comes to dementia orAlzheimer's or any of the memory
issues, and a lot of peopleoverlook the fact that speech
therapy can help with that.
So let's talk a little bit moreabout that particular.
(05:46):
I think sometimes what Iunderstood from you, from
talking to you before, is thatsometimes it's a matter of
actually also teaching thefamily how to communicate, the
caregivers how to communicate.
Speaker 1 (05:53):
Very, very much so.
So, especially when it comes todementia or Alzheimer's any
neurological decline there'sdifferent stages and there are
times where you might hear thatyour loved one is diagnosed with
dementia and you might think,oh my God, they're in a nursing
home and I have to put them awayright away.
That's not the case.
When somebody starts toexperience signs of memory loss
(06:13):
or signs of having cognitivedifficulty, we like to look at
it as a whole.
Is it a sudden onset, such as?
Is a medication shifting andsuddenly they're having a
different response to it?
So that's always something topay attention to.
Have you reached out to yourphysicians?
Do we know what really is goingon inside?
And being able to help peopleget a better, clear picture of
(06:35):
that individual that isexperiencing those cognitive
difficulties is so important.
So, even if we talk about theearly stages of dementia yes,
there are things like forgettingto put your keys in the right
place there are other signs,such as putting milk in the
cupboard and cereal in thefridge as you're shifting.
Things can be very, verysequential, but if you're
(06:58):
noticing a pattern of this inyour loved one, or perhaps
taking the eggs out of thefrying pan and not turning off
the burner.
Those are very small indicatorsthat something else might be
going on.
Other things that you also wantto pay attention to is is that
loved one able to consistentlytake their medication?
If they're on medication, arethey taking their vitamins?
(07:20):
Are they consistently eating?
Are they consistently takingthemselves to the bathroom?
How's their hygiene?
So all these daily activitiesand sometimes you might hear the
key phrase of ADLs, which isactivities of daily living are
very important to notice.
Make sure you have a reallygood picture of what they were
(07:42):
like, where they are now,because things can change in a
short period of time.
And if we're talking shortperiod of time, does that look
like a year, lenore?
No, that looks like possiblytwo to three months of a change,
and you're going to start tonotice things along the way, so
you definitely want to payattention.
One thing that I absolutelyencourage people to do is notice
(08:09):
their routines and write downtheir routines, and if you start
to notice that there might bemaybe a hiccup or two or hey,
that was weird make a note of itand write it.
Keep track of it in your phone,keep track of it in a notebook,
whatever you want.
Make a note of what it was andthe date that it was, because
that can be extraordinarilyhelpful.
Speaker 2 (08:24):
A little bit more about how speech therapy can
help with those things.
So that was an excellent reviewof warning signs to be looking
at to see that this might beleading in this direction.
Tell us a little bit more abouthow speech therapy can help
with these issues once it's beenidentified.
Speaker 1 (08:42):
Definitely issues, once it's been identified,
definitely With speech therapy.
If a loved one is still at homeand you're starting to notice
these cognitive indicators of adecline, working with your
neurologist or with your lovedone's neurologist, working with
the primary care and sayingthese are the things that I'm
noticing, I would like an orderto receive speech therapy
(09:02):
services.
That is truly, truly helpfulbecause you're communicating to
your physician that there's aconcern.
That being said, it's alsosomething that you will
definitely need to have speechtherapy services reimbursed
through whatever provider ofhealthcare insurance that you
have.
And when you receive speechtherapy services, you wanna work
(09:24):
with your clinician and sayhere are the things that we're
noticing, this is what theirdaily routine was like, this is
what we're starting to see, andthe reason that's so important
is because, when you're workingwith your healthcare providers
such as myself, I would be ahealthcare provider we want to
get as clear of a picture ofthat individual what's going on,
(09:45):
where are they and then that'show we set our goals, where we
want to go.
If a loved one is experiencingcognitive decline and they're
forgetting to eat regularly orthey're forgetting to write
things down or they'reforgetting names, that's okay.
What we do as a clinician, asthe speech therapy team is.
We implement strategies, weoffer tips and techniques and we
(10:08):
also help work with them toimprove their memory so that way
they're not having this massivedecline.
The reason it's so important isbecause neurons that fire
together and wire together.
That's a great thing.
We want to keep that brainhealthy, we want to keep it
strong, we want to keep itfocused, we need to give it
tasks, we need to keep itengaged.
(10:30):
If your loved one is spending 8,10, 12 hours in front of the TV
, that's not an engaged brain,that is a very passively engaged
brain.
Actively engaged brains includehaving conversations, doing
tasks, going to the grocerystore with somebody, quite
literally writing stuff down,being active, moving in your
(10:53):
body, and it's so important tobe engaged.
The more actively engaged youare, the more likely that that
individual will rememberinformation, because it's not
going by them like it's on TV.
They're a part of it, they'reengaged in it and then, after
the task, asked after the event,have a conversation about it,
(11:16):
keep it active in their memory,especially for loved ones that
are.
If your loved one isexperiencing a cognitive decline
, it's really important forfamily and friends and that
support network to do this,because it's going to keep that
individual that much moreengaged and it's going to slow
the progressive decline, whichis a great thing.
Speaker 2 (11:37):
We had a guest on the podcast a while back that
talked about how many familiesthat have a loved one with
Alzheimer's or dementia theystart to cocoon and like you say
, really not leave the house,really not expose dad or mom to
the outside world, but then whathappens with that is then
they're not accessing theresources and the things like
(11:59):
speech therapy and other thingsthat could help with this.
And one of the key points thatI think is really key on this is
for the families to understandthat well, all the things that
you just mentioned where we'reengaging the brain, those types
of things well, it might extendthe period of time that the
person is more able to interactwith people.
(12:22):
It certainly makes that timebetter than if they're just
sitting in front of a TV.
The ability to communicate withfamily is key to this, and so
these types of activities, thistype of engagement, will make
the time that you have with thisperson more fulfilling, more
(12:42):
quality of life for both thefamily and the person that needs
care.
Speaker 1 (12:46):
Absolutely.
I could not agree more, andespecially for families that are
experiencing this, especiallywhen they hear it for the first
time and they don't have ahistory of a loved one that's
already gone through it.
They're hearing very targetwords.
They're hearing very, very hotbuzzwords that you might hear on
TV or that you might've heardin a read in a magazine, and you
(13:09):
don't know a lot of information.
You just know that this issomething your loved one does
not want to have, and, oh mygosh, allow yourself to
recognize that there's a lot youdon't know, and that's okay.
You're not supposed to knowabout it.
What you can do, though, isreally start connecting with
other people and ask for theirstories, ask for their insights.
(13:33):
Go to support groups, educateyourself.
Allow yourself to recognizethat educating yourself will
take longer than a week.
Really get curious as to howpeople do live with this and
what their quality of life is.
A lot of the time that buzzwordof dementia or Alzheimer's,
(13:53):
people think, oh my God, they'regone and that's it.
That's not it at all.
To really start to notice thatthere is a community for
individuals who experiencedementia and Alzheimer's and the
caregivers of people providingthat care to those with dementia
and Alzheimer's.
It really is something that youcan recognize and say, okay,
(14:17):
this is going to be a journey,they're not in the grave.
I can keep them at home to thebest of my ability.
I can support them to the bestof my ability and I can be
supported as much as I'm willingto allow myself to be supported
.
Speaker 2 (14:32):
You and I have talked previously about this, about
how with a family member,particularly if it's a spouse
and you know it's very difficultwith this significant change in
the way that someone caninteract, if they've been, if
they have Alzheimer's or anyform of dementia, and so
sometimes it's difficult for thefamily member like I say,
(14:56):
particularly a spouse to acceptthat this is actually the
disease, as opposed to theirhusband just being grumpy or
their wife just doing the samethings, that the baggage that
comes with 50 years of marriageI suppose.
But the thing is that is one ofthose communication issues.
Not only is the communicationissue where we're trying to make
(15:19):
sure that the person is able tocommunicate, but also that the
family is able to communicate.
So if you could talk a littlebit about that, but also about
how much communication isactually not just the words that
we say, it's not just the voicethat we use or sometimes it is
the tone of the voice, but it'snot just the words that we say
(15:39):
so how it might make a bigdifference for a family member
if they can kind of adjust tothis and accept that this is
actually part of the disease andthat we might have to change
the way that we communicate,even if this is the way we've
done it for 50 years.
Speaker 1 (15:54):
You've said that so beautifully, so, so beautifully.
And when it comes to a lovedone who's experiencing dementia,
whether it's your husband oryour wife or whomever it might
be, there is such a thing aspeople becoming very short and
very what can come across asmean or nasty.
There are times where peoplehave dementia and they're
(16:18):
considered the pleasant onesthat they don't remember
anything, but they're lovely allthe time.
There are also individuals whoexperience the opposite, and
they can be very short and verynasty.
That being said, thatindividual if you can maintain
this one piece of information atall times that individual would
much rather not have thisdisease, much rather not have it
(16:40):
.
They are not.
Despite however they comeacross, they are not doing it
intentionally.
There's a shift in theirchemical, hormonal balance.
There is a shift in theirsleeping, there is a shift in
their memory loss.
There are so many things goingon that, even though part of us
might want to say they're doingit on purpose I know they're
(17:02):
being mean on purpose theyreally aren't.
They're really trying to dotheir best and, as the loved one
, as the care provider, as theperson that is a part of this
journey with them, the bestthing that I can do to support
them is allow myself to takebreaks but also change my tone
(17:24):
of voice.
When somebody is very harsh,very nasty, and you can hear it
in their voice and they justcome after you, allow yourself
to shift your voice and when youcan become softer, when you can
speak slower, it's going tohelp regulate your nervous
(17:44):
system and it's also going tohelp you recognize.
I'm going to need to exercise alot of emotional control right
now and that's okay.
I'm going to do my best to bepatient.
When we tap into our change ofa voice, when we slow our speech
, it can be very helpful and itcan also shift that person
(18:06):
because their tone is totallydifferent.
You are controlling yours withintention and it will help
regulate that other individual.
So if they're having a badperiod of time, you can say okay
, I see you need a break.
Right now, I'm going to pause,I'm going to, I'm going to stay
over here.
You tell me when you're ready.
You're telling that individualwhat's going on.
(18:29):
You're acknowledging thatthey're frustrated, you're
acknowledging where they are andyou're also allowing that space
that needs to occur for them tocalm down.
You're also allowing yourself aspace that needs to occur to
calm down because it can be verytaxing, it can be very
frustrating, it can be veryheartbreaking for you as the
(18:51):
caregiver.
And when you can notice that,when you can just recognize I
just need to pause, slow myspeech and soften my tone and
allow that space to maneuver, itwill be so much more effective
when you have those interactions, especially when you have
interactions with somebody whois not in a good mood.
Speaker 2 (19:11):
I think one of the things that you said there
that's so important that peopleoverlook is the idea that by
changing your tone, if you'reforcing yourself to sort of
change your tone, that also hasan effect on you.
It's not just you know theeffect that it has on other
people.
If you add a speak in a more,it doesn't just affect how the
(19:34):
other person interacts.
It actually is.
You know, it's aself-fulfilling prophecy.
It helps you regulate your ownemotions, which I think is
really important and somethingthat people overlook quite a bit
.
Speaker 1 (19:45):
Very much so.
Speaker 2 (19:47):
I want to get into.
I know that you've been anexpert at integrating
neurolinguistic programming, orwhat is usually called NLP, into
the you know for evidence-basedtechniques for using speech
pathology and speech therapy.
Tell us a little bit more aboutthat.
Maybe some of our listenershave heard of neuro-linguistic
(20:10):
programming.
Some of them haven't.
Tell us a little bit more aboutthat and how that helps with
the role that you do and therole in speech therapy and
speech pathology.
Speaker 1 (20:20):
Absolutely.
Being certified in NLP hastruly helped me become a better
communicator.
Also, it's more of the study oflanguage when we can understand
if somebody's saying I don'tsee what you're saying.
I don't see what you're sayingand you're saying can't you hear
me, can't you hear me when webreak it down.
(20:40):
Somebody saying I don't see,they're more of a visual.
They need that visualdemonstration for them to better
understand that other personhad said can't you hear me?
That other person is more of anauditory person.
So they're just really littlenuances that can be very helpful
along the way For me when itcomes to communication.
(21:01):
If I know my client is much moreof a visual learner, I will
make pictures.
I will not just make a cartoonpictures.
I will use pictures of theirbelongings to better help their
sequencing skills.
So if they are needing to go tothe bathroom and it has to go
in a certain sequence andthey're forgetting to do certain
(21:21):
things along the way, I willhave that caregiver take
pictures of what needs to happenso that visual can hang in the
way.
I will have that caregiver takepictures of what needs to
happen so that visual can hangin the bathroom.
And when they look at thatvisual.
They're not looking at acartoon picture of possibly a
bathroom or whatever I found onthe web.
They're looking at theirpictures.
They're looking at theirclothes, and that can be much
more effective.
(21:42):
If somebody is much better atunderstanding written words
rather than typing it out, Iwill have that caregiver and
that client write out thosesteps to better help them
understand.
We want individuals to be ableto understand information in
ways that are meaningful to them.
(22:03):
The more we can do that, themore we can engage that brain
and engage that individual, thebetter they will be able to
maintain their cognitive skills.
So those are just some littlethings that I've used along the
way, very specifically when itcomes to NLP.
Speaker 2 (22:18):
Very nice Talk to us a little bit about and I think
this goes hand in hand with whatyou've been saying but the
importance of nonverbalcommunication when communicating
with someone with dementia.
Speaker 1 (22:30):
So when it comes to nonverbal communication, a lot
of people think that nonverbalcommunication might just be
something like eye contact.
When we're talking about verbalcommunication versus nonverbal,
there's a variety of researchout there that says 70 plus
percent of what you're saying isnonverbal.
What does that look like?
That looks like your eyecontact.
That looks like your posture.
(22:51):
That looks like your facialexpressions.
It also sounds like your tone.
There's so many pieces that arecoming in, as well as your
energy.
There's so many pieces that gointo effective communication.
If I'm turned away from you andI'm not looking at you and I'm
looking down, how active of acommunication interaction are we
(23:12):
having?
Not a very strong one.
When I look at you, when we'rehaving the conversation
especially in our culture we'revery big on eye contact in the
US when we're having thisface-to-face interaction, when I
can be in the same position, onthe same eye level as you,
you're going to be much moreengaged in my interactions and
that's a great thing.
(23:32):
That is a piece of oureffective communication.
Being able to have all of these, along with words, on the same
plane allows for a much moreimpactful level of communication
, allows for a much moreimpactful level of communication
.
When we're with a loved one, orif somebody is a caregiver and
(23:55):
they're spending a lot of timetogether, they're not always
aware of this because they'redoing other things.
Maybe they're preparing a mealin the kitchen or maybe they're
doing something else and they'rehaving this flyby of a
conversation.
The person who might be sittingin a chair watching you and
kind of hearing you isn't veryengaged, even though you might
be engaged because you might bein your 50s or in your 60s and
you're firing totallydifferently.
(24:16):
Your loved one, who might be 80or 90, is not firing on the
same level as you are.
When you need that stronginteraction or when you're
having that effectivecommunication, you want to be
paying attention to each other.
Whether you're at the sametable, whether you pull up a
chair and you sit down next tothem, you want to have this
engaged interaction.
(24:36):
Being present in the room issimply being present in the room
.
Being present in theinteraction, in the
communication that's occurring.
Speaker 2 (24:45):
that's a completely different story.
I have a quick example on that.
So I had a client who was in acare setting and they were
concerned and they had talked tothe family about mom being
violent.
And I thought, boy, that justdoesn't seem consistent with
(25:06):
every meeting I've had with momon this.
And so the example that theygave was that she was in a
wheelchair, I believe, and sheappeared chilly.
So they tried to put a sweateron her, but they approached her
from behind and this was the,the caregiver.
(25:26):
And the thing is, when, withdementia, you don't have the
same understanding of yoursurroundings and your brain's
not always explaining everythingas quickly as it would with
someone without dementia, and soapproaching someone with
dementia from behind, that mayfeel like they're being attacked
(25:47):
right or even from above, youknow, and so the idea is that
she probably would not havereacted violently had the person
come around to the front, goton her level, like you say, look
her in the eye and say are youchilly, can I put a sweater on
you?
And that would have probablybeen a completely different
(26:08):
interaction.
I think, some of the times whenwe have what in the industry we
sometimes call behaviors,meaning that there is some bad
behaviors that make it difficultfor the caregivers.
Those can be addressed by someof this communication style, by
getting on somebody's level, bymaking sure we're doing our best
to communicate with them asopposed to just you know doing
(26:31):
the thing.
It's not surprising thatsomeone that doesn't have a full
understanding of theirsurroundings would react in that
way and, you know, kind of pushback on that.
Speaker 1 (26:42):
Is that a good example?
That is an excellent example.
Absolutely, especially whenthey're not, let's say they're
not at home.
They're at your home, which isthe home of the caregiver, and
they've been there for a numberof years, or, excuse me, they
visited over the years, but it'snot their home.
So now, technically, you havethem in a different environment,
(27:03):
so approaching them from behindcan be very alarming to them.
And you're completely right whenwe're having interactions, we
want to let them know what we'regoing to do before we do it,
especially when and you mightnot see this too often in the
early stages of dementia.
You might see this more in themoderate or the severe levels of
(27:24):
dementia, but letting them knowwhat you're going to do quite
literally communicates I'm not athreat, I'm not in a dangerous
situation right now.
Another one also, which can wesee often in the advanced
population, is when they'rerequiring assistance for having
(27:44):
to go to the bathroom.
There's a lot of behaviors, andthe reason that is is for what
some people may or may notconsider very obvious.
They might think I've done thisfor years with them, I'm taking
care of them, don't you knowwhat I'm doing To that
individual?
You're no longer all thatfamiliar, but it can feel a lot
to that individual that'sexperiencing dementia, like
(28:05):
sexual abuse, and we need to bevery respectful of that and help
them understand.
This is what I'm going to donext.
I'm a safe person.
You can trust me and helpingthem understand that on multiple
levels.
Again, with that nonverbalcommunication, again with the
tone we want to communicate tothem what's going on.
(28:26):
And if you even flip the tablesand think, okay, you know, I
don't remember what I ate forbreakfast, I don't always
remember the environment, andthis person that I'm looking at
is sometimes familiar to me, howwould you feel?
And trying to understand itfrom their perspective, how do
you want to be cared for?
(28:47):
We need to be, to the best ofour ability, as considerate as
possible.
The more considerate we are,the more we communicate with
them, the more we let them knowwhat's coming and what to expect
.
We quite literally have muchmore control over their
behaviors because we're sharingwith them what's coming.
(29:07):
It's not a surprise.
They're not getting caught offguard and they're not quite
literally under fight, flight orfreeze.
Speaker 2 (29:14):
Yeah, so would that also apply?
I think it would, but I want toask you would it also apply
when you know it gets to thestage which sometimes it does,
that the person is actuallynonverbal?
The person with dementia isnonverbal.
That doesn't give us an excuseto not try to communicate with
them.
Just because they can'tcommunicate verbally doesn't
mean that we still have anobligation to do all the things
(29:37):
that you just mentioned.
And they're, you know, maybe ina lesser way, but they're still
able to perceive communication,particularly from the
standpoint of, you know, liketone and movement, and you know
eye level, things like that.
Speaker 1 (29:52):
I am so glad that you mentioned that.
Absolutely, when it comes tocommunication and, very
specifically, language, languageis two parts.
We have the ability tounderstand language, which we
consider our receptive part oflanguage, such as if I give you
a direction, you'd be able tocarry it out, or if I asked you
a WH question, you're able toreceive that information and
know what to do with it.
(30:12):
Then we have the expressivepart of language, which is the
words that are quite literallycoming out my mouth as I'm
speaking.
We string them in a sentenceand we're communicating
effectively as an individualadvances.
Communicating effectively as anindividual advances.
They might not be able to findall of their words, such as hey,
can you pass the yeah, thatthing over, yeah that?
And you go oh, you want me topass the salt.
(30:34):
So we call that missing thetarget word when they can't name
something.
That being said, it progresses.
So they might not just remembera loved one's name.
They might not remember to tellsomebody I have to go to the
bathroom, as in they've now lostthe words, they're not
communicating or their wordssound, their words sound like
(30:56):
that.
They don't.
They're not what we considereffectively communicating.
They can't express their wantsand their needs.
That being said, when we go tohave an interaction with
somebody and I've worked inskilled nursing facilities and
outpatient clinics and inpatientclinics for years when we go
into that room to say hello tothat person good morning, how
(31:19):
are you?
Today is November 25th.
It's so good to see you.
My name's Lenora.
I'm going to help get you readyfor this morning and letting
them know what to do.
You can tell by my tone.
They might not understand asingle thing, but they can see
by the expression on my facethat I'm not a threat.
They can hear by the tone of myvoice that I'm not a threat as
(31:40):
I move and I don't make abruptmovements.
They can watch me and I canshow them their clothes.
Okay, we're going to wear apurple shirt today or a red
shirt, and give them choices.
These are all a part of it.
Even if they might not be fully,actively engaged and able to
say I want to wear the purpleone, we still want to give them
that respect, we want to givethem that dignity and we also
(32:03):
want to be sure that we aretreating them in the same
sincere way that, hey, we wantto be treated, but also at the
same level.
So, for example, to my95-year-old client I would not
say, oh, which one do you want?
Do you want the red one or doyou want the purple one?
I would treat them with therespect and the dignity that
they deserve at 95.
Would you like the red one orwould you like the purple one?
(32:26):
A lot of the time people willshift their tone and they'll
take their tone down to a childtone.
We want to be respectful.
Another key one is I don't callthem diapers and we don't call
them whatever other term peopleuse for that.
We call them briefs or we callthem underwear.
Give them that dignity.
(32:49):
It is so important and it istruly communicated on such a
deeper level than it's actuallygiven credit for.
Speaker 2 (32:56):
That's very nice, very nice.
Well, to shift gears just alittle bit.
I imagine, having studied thisand studied communication, that
you actually are able to seethis, that in just everybody,
that sometimes you'll noticethat people's expression perhaps
is not in congruence with whatthey're actually feeling, and
(33:19):
that's very helpful.
I think I notice occasionallywith folks if I'll make a demand
or request for them.
There's some folks that justhave this you know, deer in
headlights look because theyhave to process it.
I have a couple of consultantsthat help me with accounting
matters and when I talk to themabout ideas or things, they
(33:42):
always have this look ofskepticism on their face.
What I've learned is they'reactually intensely listening to
what I say and I probably dothat myself.
Or if I'm intensely listeningto what somebody says, I
probably have this look ofskepticism on my face.
And just recognizing this foreverybody, not just for folks
with dementia that sometimes theexpressions might not match up
(34:04):
with the actual feelings thatsomebody's had.
They just need time to focus orconcentrate or they need to
take in the new information.
So I imagine that's somethingthat you experience in daily
life, where you see wheresometimes things aren't always
congruent with people's actualfeelings about the situation.
Speaker 1 (34:22):
Very much so, and especially if you go up to
somebody and you say, hey, canyou help me with this really
quick, depending on the tonethat we approach somebody with,
that will impact their response.
That being said, depending onwhere that individual is, quite
literally, in their own thoughtsif they're thinking of a fight
(34:43):
that they had with somebodyearlier that day, or if they're
thinking of all the tasks thatthey have to get done and
they're not in a bad mood, orthat they are in a bad mood,
your response, the response thatyou're going to receive, can be
completely different and you'regoing to feed off each other's
tone.
So this really goes into a muchdeeper level of emotional
intelligence and communityeffective communication goes
(35:06):
into a much deeper level ofemotional intelligence and
effective communication.
When I go to have aninteraction with somebody, it is
different.
For example, when I go tointeract with my husband, it's
going to be very different thanwhen I go to interact with my
client.
That being said, because of thework that I do, I'm very tuned
to somebody's response and I canhear where they are emotionally
(35:26):
just by listening to theirvoice.
I also happen to be quiteempathetic.
That's another bonus.
When I can hear somebody, I willstop.
If they respond to me in a waythat doesn't feel like it was
meant for me, I'll say, oh, iseverything okay?
Yeah, everything's fine.
Are you sure, or are youthinking of something else, or
is something else on your mind?
(35:47):
A lot of the time, somethingelse is on their mind.
So when you're noticing theincongruency in somebody's
receptiveness to yourconversation, it might have
nothing to do with you.
That being said, if you'reasking a task or if you're
asking somebody to do somethingfor you hey, can you help me
with this?
(36:07):
And you're going on a list ofwhat you need help with, their
brain needs time to process.
So pausing or even asking alongthe way, does this make sense?
Are you following my thoughts?
Am I being clear?
It might be that I am beingclear.
It might be that that person'sdistracted, or it might be that
I'm not being.
It might be that that person'sdistracted or it might be that
I'm not being clear, and I wantto have that effective
(36:29):
communication.
So watching somebody's facialexpression can be very, very
helpful.
Also listening to their tone.
Speaker 2 (36:36):
Oh, that's great.
Those are great tips.
Tell us a little bit more howthe listeners can interact with
better speech.
So we have a lot of variety oflisteners, from people in the
long-term care industry tosocial workers, to just general
folks that are interested inthese topics.
And so how would?
What's the best way to interactwith your company?
(36:58):
Better Speech.
Speaker 1 (37:00):
For reaching out to us.
If you would like to schedulesome time with us, just simply
visit betterspeechcom and wewill get you scheduled to work
with a board-certifiedspeech-language pathologist
right away.
If you're curious about thethings that we do, you can also
visit betterspeechcom, and wehave loads of insights in our
blog, and we also have quite theYouTube channel and social
(37:20):
media links in there.
The best way to reach out to usis at betterspeechcom.
Speaker 2 (37:27):
I did have an opportunity to check out your
website.
It's very good.
It has a lot of great contentin it, so I do recommend people
check that out, thank you.
Any final tips for familiesthat are dealing with these
issues before we wrap up today.
Speaker 1 (37:41):
My final tip would be to be curious and to be
open-minded.
The more curious and the moreopen-minded you can be,
especially for your loved one,and you can release that
judgment of what might happen.
It will be extraordinarilyhelpful to you, you'll be able
to reach out to other people andyou'll be able to have a much
(38:03):
better experience going throughthe entire experience, because
there's so much that you don'tknow and there are many people
that are still safely living athome, with strategies, with
certain things in place thatkeep them safe at home, and not
everybody goes to a nursing homeand not everybody is a horror
story home and not everybody isa horror story, right.
Speaker 2 (38:28):
Well, thanks so much, lenore Edwards, from the Chief
Knowledge Officer at BetterSpeech.
If you've enjoyed this podcast,don't forget to subscribe.
You can find us at any placethat you can find podcasts, or
you can find us on YouTube orour website at manorlawgroupcom.
Thanks again and we'll see younext time.
Speaker 1 (38:52):
Thanks for listening.
To learn more, visitmanorlawgroupcom.
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