EPISODE 267

[INTRODUCTION]

 [0:00:14] MD: Hi, folks, and welcome to First Bite: Fed, Fun, and Functional. A speech therapy podcast sponsored by speechtherapypd.com. I am your host on this nerd venture, Michelle Dawson, MS, CCC-SLP, CLC, the All-Things Peds SLP. I am a colleague in the trenches of home health, early intervention right there with you. I run my own private practice, Heartwood Speech Therapy here in Cola Town, South Carolina. I guest lecture nationwide on best practices for early intervention for the medically complex children. First BiteÕs mission is short and sweet, to bring the light, hope, knowledge, and joy to the pediatric clinician, parent, or advocate.

[0:01:01] EF: By way of a nerdy conversation, so there's plenty of laughter, too.

[0:01:05] MD: In this podcast, we cover everything from AAC to breastfeeding.

[0:01:10] EF: Ethics on how to run a private practice.

[0:01:12] MD: Pediatric dysphagia to clinical supervision.

[0:01:15] EF: And all other topics in the world of pediatric speech pathology. Our goal is to bring evidence-based practice straight to you by interviewing subject matter experts.

[0:01:25] MD: To break down the communication barriers, so that we can access the knowledge of their fields.

[0:01:30] EF: Or, as a close friend says, ÒTo build the bridge.Ó

[0:01:34] MD: By bringing other professionals and experts in our field together, we hope to spark advocacy, joy, and passion for continuing to grow and advance care for our little ones.

[0:01:45] EF: Every fourth episode, I join them. I'm Erin Forward, MSP, CCC-SLP, the Yankee by way of Rochester New York transplant who actually inspired this journey. I bring a different perspective, that of a new-ish clinician with experience in early intervention, pediatric acute care, and non-profit pediatric outpatient settings.

[0:02:06] MD: Sit back, relax, and watch out for all hearthÕs growth and enjoy this geeky gig brought to you by speechtherapypd.com.

[DISCLOSURE]

[0:02:22] MD: Hey, this is Michelle Dawson, and I need to update my disclosure statements. My non-financial disclosures. I actively volunteer with Feeding Matters, National Foundation of Swallowing Disorders, NFOSD, Dysphagia Outreach Project, DOP. I am a former treasurer with the Council of State Association Presidents, CSAP, a past president of the South Carolina Speech Language and Hearing Association, SCSHA, a current Board of Trustees member with the Communication Disorders Foundation of Virginia, and I am a current member of ASHA, ASHA SIG13, SCSHA, the Speech-Language-Hearing Association of Virginia, SHAV, a member of the National Black Speech Language Hearing Association in NBASLH, and Dysphagia Research Society, DRS. Additionally, I volunteer with ASHA as the topic chair for the Pediatric Feeding Disorder Planning Committee for the ASHA 2023 Convention in Boston, and I hope you make it out there.

My financial disclosures include receiving compensation for First Bite Podcast from speechtherapypd.com as well as from additional webinars and for webinars associated with Understanding Dysphagia, which is also a podcast with speechtherapypd.com. I currently receive a salary from the University of South Carolina in my work as adjunct professor and student services coordinator, and I receive royalties from the sale of my book; Chasing the Swallow: Truth, Science, and Hope for Pediatric Feeding and Swallowing Disorders as well as compensation for the CEUs associated with it from speechtherapypd.com. Those are my current disclosure statements. Thanks, guys.

[0:04:18] EF: The views and opinions expressed in today's podcast do not reflect the organizations associated with the speakers and are their views and opinions solely.
[INTERVIEW]

[0:04:26] MD: Okay, everybody. I am so excited about today's guest. Because honestly, Jenn didn't know me from Adam. Then I reached out, and she came and she showed up at the AAC Palooza at James Madison, and my students raved about her. They loved her. She brought in all these devices. Then she let me bow out, not so gracefully on a recording, because we got a new Internet, and the new Internet isn't as good as the old Internet, which I don't understand the purpose of having now fiber optics when the old box upstairs works just as well. But here we are, here I sit.

Anywho, she said yes, and she came back. Y'all, this is absolutely a crucial conversation, because we are going to talk about Eyegaze, but also talk about the eye. Let's be honest, very few of us had an in-depth AAC class, much less one that actually talked about the eye. I am so excited, also when I told Erin, Erin geeked out, and then Erin was like, ÒOoh, I'm coming to that one.Ó We are tag teaming this together because we're that nerdy and excited. Jenn, hi. Thank you for coming on.

[0:05:37] JR: Thank you so much for having me. That's awesome. I am also a nerd about this kind of stuff, so it sounds like that will be a fun conversation.

[0:05:45] MD: Okay. I've literally met you cold calling, trying to get devices for James Madison. Jenn Rubenstein, you're with Eyegaze, which is actually the company is called Eyegaze.

[0:06:00] JR: You got it.

[0:06:02] MD: That tripped me out, I'll be honest because I was like, but where's the rest of the name? I assumed there was going to be another name, and it was short and sweet to the point. Erin and I like to start with the backstory. Can you take us from the beginning, like how did you find this field of speech pathology?

[0:06:19] JR: Yeah, absolutely. I will tell you a little bit more about the name because that's actually fun as well. I am a speech-language pathologist. I actually did have the great privilege of having a fantastic AAC course, and I also had one of my placements in grad school, did a lot of AAC. All of that said, did I know anything about the eye, or about eye tracking at all? The answer is still no.

I mean, it could be an entire course in itself. It could probably be an entire semester worth of classes. After I finished grad school, I went to grad school up in Boston, and I'm actually originally from the DC area, so I grew up in Northern Virginia. Ended up back in this area for my CF. I did my CF in a large, sub-acute rehab facility in Washington, DC. Then stayed on as a staff clinician after I got my Cs. Ended up being there for 11 and a half years. Those final two and a half years were as the director of rehab. I tell people sometimes, is that I started there for my CF, and then just never left.

[0:07:25] MD: Also, wait, director of rehab. Did you oversee OT and PT as well?

[0:07:30] JR: Yeah, the whole department for a 259-bed facility. Yeah.

[0:07:33] MD: That's refreshing, because to have a DOR that's actually an SLP, and they get it because the productivity codes are so different for speech than they are.

[0:07:46] JR: We could do a whole podcast on that. I can honestly say, I don't miss it. I feel for everyone who is out there working in the SNF world. I actually left right when the big Medicare change happened. When I was there, it was PPS, it's now PDPM. If folks work in that realm, they know what those letters mean. If not, don't worry about it. It tremendously changed the way the reimbursement structure works. I'm not as familiar with the way it is currently, but I know that that is pretty exclusively Medicare, so there are still some folks who are working, I think, some state Medicaids are still using the PPS system.

It's tough. On the one hand, you want to give the best possible treatment to your patients. But on the other hand, how do you keep the lights on? If everything closes down and no one has a job, then no one gets therapy, so it's tough. It's very tough. I am out of that realm now. It actually happened completely coincidentally. I had been looking elsewhere. I was there for over a decade. If you think of the decade from basically, 2008 to 2018, just thinking about what technology was in that time, from the time I started more talking about a nursing home, you're talking about a lot of geriatric patients, so older folks.
When I first started, if I put something with a touch screen in front of someone, a lot of times, there would be, ÒI don't want to break it. If I touch it, what's going to happen?Ó By the time I left, everyone was coming in with their own iPhones, they put Wi-Fi in the facility, people were coming in with laptops and still working while they were there. That decade was just a huge shift. I do not know off the top of my head when the first iPhone came out, but I think that was really Ð there have been touchscreen communication devices for a long time, but it really became accessible to, you could say, the masses when it wasn't necessarily a dedicated device. You could actually pull up a memory game on an iPad that you got as a free trial app. Things AAC-wise, in that setting, I think changed very, very dramatically while I was there.

I didn't get the opportunity to do too much of it while I was there, but I took it upon myself to do some CEU courses outside of my job that were AAC focused, because it was just something that I personally had an interest in. I could, again, do an entire hour just talking about how I landed here, but I actually just celebrated my fourth anniversary. I started three months exactly to the day before everything shut down in March of 2020. I started in December of 2019. Had about three months to start to get my feet under me in this brand-new position before everything changed.

[0:10:49] MD: I joke, I take full credit for causing the pandemic because I got my husband to take me to a ballet on Friday, March 13th. If you knew Christian, and you knew Ð and he had thrown his back out. But it was my birthday. He powered through on pain pills in the ballet. We made it to, essentially, intermission, and he was like, ÒBaby, I can't sit up.Ó I was like, hell froze over because you went to the ballet. That's why the universe broke. Okay. Well, then how did you find out about the field of speech therapy?

[0:11:22] JR: Oh, so my entrance into speech was different than I think every single one of my classmates in grad school. When I first went to college, I did not graduate with this degree, but initially, I started off college as a voice major. I had done all kinds of choir, show choir, musical theater, things like that, all through high school. Then went to college, I thought to do vocal performance. It did not take. That lasted about a semester. I changed majors. I changed schools, but I did keep singing.

I did symphonic choir and acapella groups, things like that. In addition to that, I had a lot of friends in the local music scene. In the very early, I guess, we're calling them the aughts, the early aughts in the DC, Baltimore area. There were a lot of rock, hard rock, metal, melodic metal. When you're going to see a band, this is not necessarily a big concert in a stadium. This is small bars, two or three bands, everyone knows each other. If you go to a concert, if the guitar player breaks a string, they either switch out a guitar with someone else, or they take some time to change the string while the drummer plays a little something, or the singer tells some jokes. If it's the singer and something happened to their voice, your show is done, your tour is done, there goes your livelihood.

That was actually my path. I went to grad school specifically, thinking that I was going to specialize in voice disorders. I did not. I think the Internet is a bit more now than it was when I was looking for grad schools. I did not know what I was walking into and what the field of speech looked like. I was very surprised when I got there. Also, I had been out of college. I had already graduated. I was working as a professional proofreader at a marketing company. Did the scenic route when I got there. Did not even know that dysphagia was in our scope of practice. Discovered the medical piece and really, really loved that. I really focused on Ð my plan had always been to work with adults. I actually fought to not have a school placement. I was able to do two medical placements and forgo a school placement.

Then one of those Ð not one of my medical placements, but actually, one of my very first clinical placements was a specialty school working with students from early elementary age through age 20. Most of them used some type of AAC. That happened by accident. I did a placement in an acute care hospital that was almost exclusively swallowing. I did a placement at a specialty hospital in their voice clinic. That was 100% voice. Primarily adults. A lot of professional voice users, so singers, but also, clergy people, teachers, lawyers, people who you are speaking as your job.

If something goes wrong there, there's going to be a big problem. Are you going to be able to continue to do this job, or to live this life? Not only that. You would have people who were not necessarily using their voice as their primary job earning their living, but you might have someone who sang on the side doing something. Like, I worked with a young woman who was a soloist at her church choir. That was a huge part of her life. Then, what happens if you're not able to perform? Yeah. That's how I ended up in grad school in the first place. We did that story a little bit backwards. Then you know what happened after I finished grad school. Just stumbled into the medical.

[0:15:24] EF: Yeah. I went in to grad school for AAC. I worked at a school in Pittsburgh in undergrad, that they were primarily AAC users. They had multi-disability classrooms and then autism classrooms. I would help out at lunch and I would sit with some of the autism classrooms and they tell me what they want on their device. They had a lot of Eyegaze users. Kids would come in and use their device to ask other kids to prom. It was just like, it was the best environment. I went in, I was like, okay, I'm going to do AAC. I'm going to do medically complex. It's like, I don't want to touch swallowing. Then I went with Michelle and I was like, I actually really love this, too. The school I was at was very into literacy. I was like, I didn't know that we Ð there's so many things that we do, I had no idea.

[0:16:14] JR: It's wild how broad the umbrella is. If you do burn out, which happens in our field for sure, there are so many things you can do still within that umbrella. Or you can do something like what I did, which is, yes, I am not Ð I have my Cs. I have my license in a few states. I am not practicing directly under those and billings for services but I think of what I'm doing now as SLP adjacent.

[0:16:40] MD: Okay. You and I haven't worked together for a patient. The folks back in South Carolina, Wyatt Franken, he has his bachelor's degree in speech pathology and heÕs with Talk to Me. Then Kelsey Peterson, she's with Talk to Me, but she has her Cs. I could go to them on cases that I needed help for. Dr. Carol Page, she was the Director of the South Carolina Assistive Technology Program for years. South Carolina is so small, they only have the one. It's housed with the University of South Carolina School of Medicine, which is interesting that it was in that.

Being able to go to you and say, ÒHey, I have a case. I need guidance. I need help.Ó YouÕre SLP adjacent, but you're subject matter expert. Folks, it is okay to go to the subject matter expert and say, help. We don't have to know it all because we need our SLP adjacents to come in and say, ÒOkay, but have you considered this?Ó Because this is the thing that it is that they do all the time and they know it like that. Wyatt wants taught me how to connect an Eyegaze onto the stand because I couldn't figure out how to work the hooks. Also, I don't do well with a basic screwdriver some days. Those are really complicated. Yeah.

[0:18:04] JR: I mean, we talk to people all the time to troubleshoot and throw around ideas. Obviously, I work for this company. But first and foremost, I'm an SLP. I have my Cs. Those are the ethics that I am bound by. It's not necessarily, well, I'm only going to talk to you if it is specific to this device. Sometimes I get to take off vendor hat and put on SLP hat and say, have we tried switch access? Can we call in the OT to see if maybe there's something with a head array that might make sense? Will a sip and puff make sense? Will some kind of foot pedal? IÕm not an expert in that, but neither is the SLP.

It's a lot of times going to be PT, OT, respiratory. We're calling in a team. I'm working with a patient right now up in Pennsylvania, who we did the initial trial. We went in, knowing we were going to have some questions. Ended up with questions. At least, we knew what questions to ask. Sometimes that's the biggest difficulty. We went back in last week and brought the OT. We had all three of us in the room, had multiple things to try, had some switches, had a joystick.

Our company's name is Eyegaze. I am going to come back and talk about that in a second. That is what we really specialize in. But we recognize, that's not going to be appropriate for every person. That doesn't mean, okay, well, you don't get anything. That means, all right, this might not be the right path. What other path can we go down that might make the most sense for you in terms of access?

Yeah, let me pick up that thread, so I don't lose it again. Yeah, you mentioned you were curious about the name. For folks who are listening, if you are familiar with eye tracking as an access method and if you've been around for a little while, you might be familiar with the company and just not recognize it by the name Eyegaze. We've actually been around since the late 1980s. We are one of the oldest eye tracking communication companies. We're actually based in Fairfax, Virginia.

Prior to the end of 2019, the company official name was LC Technologies. That might be a name that folks have been familiar with. Over the years, the device has always been the Eyegaze Edge. The website has always been eyegaze.com. The phone number has always been 1-800-Eyegaze. There was a rebrand that happened, actually, right before I started with the company, just to clarify that across all of the different areas, because you already have Eyegaze at all these different places. But would you know that LC Technologies was eyegaze.com? It made sense to just make everything. That little piece.

[0:20:44] MD: You've been around since the 80s. I have been around since the 80s. I am 40 and fabulous, and coming in on the home stretch on 41. I got to be honest, we were talking with the boys yesterday. What were your favorite video games? My favorite video game as a kid was the duck. Remember the Duck Hunt? Then my dad would yell at me, because I would put the gun, the little Nintendo gun on the screen and try to Ð because that's how I could keep track of it and my dad was [inaudible 0:21:08]. Right? You shot the duck. Yay. I don't think of Eyegaze technology as being from the 80s because we had plastic guns for Nintendos. That's crazy to me.

[0:21:28] JR: Yeah. It was a bit before my time. I have seen the pictures. But think about what a computer looked like at that time. Now we're using these very slim, touch screen, slip it in a sleeve and throw it in your backpack. At the time, it was basically, the entire table. You would have this monitor and it was this big heavy tube monitor. You would have your tower that was the actual computer. Then even the camera was just this enormous piece of equipment.

A lot of people who were trying this for the first time, they'd never used a computer before. Things have definitely changed since then. The display on the screen, I mean, I am also a product of the 80s. It sounds like I'm a tad bit older than you. Just a tad.

[0:22:18] MD: Fabulous. Erin, say nothing.

[0:22:25] JR: But I'm young at heart. That's fine. There were video games there that had very basic dot, kind of, graphics. I remember in elementary school, we had a, I believe it was an Apple 2GS and the screen was black with green text. That was, I think my maybe second or third grade, we got to take a little trips down the hall to the computer lab. When you're thinking about what the display looked like, the display was very simple, very plain, text only.

It's been updated, but we still have the communication program that was being used at that point in time. Like I said, it has been updated a bit. At the time, it was a very basic keyboard and then very simple phrase pages, that you're just thinking of a grid. I have one next to me. I want so badly to show you. This is a podcast that is not the right medium to be here. Let me show this off.

[0:23:25] MD: Send us a picture. We need that.

[0:23:28] JR: Yes. I will definitely do that. I can send you all kinds of screenshots. The thing is, if you have someone today who is not particularly familiar with technology, not comfortable with technology, a lot of people in their day-to-day work, even if they're not big into computers and tablets at home, they might have a computer they have to use for work. There are plenty of people who either, for whatever reason, are not using a computer at work, or they're already retired and hadn't made that transition yet. There's no prerequisite to be tech savvy to need some type of AAC.

We do have that very plain, very basic communication program available for folks that would really just rather not have bells and whistles. They're not looking for word prediction. They just want Ð I look at the letter T and it types a T, the end. Many of the kids that we're working with, the complete opposite. They've been used to screens from the get-go, but you don't have to choose between them, but it always comes with both. But it's always there if someone wants something that's just stripped down, very plain, dark background, a couple of lines on the screen, and that's it.

Yeah. I mean, I've seen pictures from what our original medical director had done. She would print out pictures and just tape them to the screen for using with kids who weren't literate yet, because that's what you did. In the very, very early, we're talking about 1989, 1991, that's what they were doing with kiddos.

[0:25:07] MD: The boys and I have started watching Young Sheldon, and it staged at the late 80s. As you're describing this, I'm imagining the characters from Young Sheldon putting together an Eyegaze board on a computer. It turned out quite well in Michelle Land, as you were describing these little variations. Yes, love this.
Okay, so limited experience with Eyegaze in general. I remember very, very long time ago, probably close to 11 years ago, I was up visiting Carol at the assistive tech office, and it was one of my first couple visits. I was talking to her about the patient and she was the first person to talk to me about Eyegaze. She was like, ÒHave you considered this?Ó I was like, ÒWell, no. The patient has a cortical vision impairment.Ó She was like, ÒThat doesn't prohibit them from accessing an Eyegaze as an option.Ó But my limited experience is filtered through the lens of my husband's brother has a cortical vision impairment.

I'm used to thinking of it in the terms of uncle Matthew, right? Then over the years, I've had other patients. Can you just talk to a sum about the eye and the power of the eye and how the eye interfaces with the Eyegaze?

[0:26:32] JR: Yeah. It's interesting that you started the question talking about CVI. I feel like that's Ð thatÕs not just a whole podcast for itself. That's an entire semester-long grad school course that I really wish that we had had. All of the names are escaping me, but I do have some folks that I can point you towards. There is one person that I have been directed to to find more information from the person who literally wrote the book and they're based in Pittsburgh and I apologize that the name is not one that is at the forefront of my brain.

Yeah, CVI is fascinating, in that it is not necessarily one thing. You've seen one student with CVI, you've seen one student with CVI. The next student might have the same diagnosis and a diagnosis of CVI and what that actually means for them is very different. But in in general, so eye tracking, how eye tracking works, right? Eye tracking is in general, a method of determining where someone is looking. When I'm talking about a Òcamera and eye tracking,Ó how that works. I'm doing air quotes. I know that's not a thing that people in podcast land can see.

When I'm saying things like that, that is not specific to the device that is manufactured by the company I work for. This is true across the board for any eye tracker, whether it's being used for gaming, being used for accessibility, being used Ð I know some cars have it built into the dashboard now. This is just how eye tracking works. You have a camera, or multiple cameras that take pictures of either one, or both eyes and those images are digitized and analyzed to determine the gaze location, where you are looking.

That gaze data can be passively collected, so that can be used for analysis and research, or can be used immediately as an access method. Every single eye tracker on the market today uses some amount of infrared light to illuminate the pupil and pictures are taken to track the reflection of that light.

Picture an eye. Now, I am used to doing this with a screen that I can use to illustrate. In the absence of a diagram, you can look in a mirror, or I can share the documents from our recent ASHA presentation if you're interested. The anatomy I want to think about are the pupil, the iris, the cornea, and the eyelid. The cornea is the clear dome-shaped surface that covers the front of the eye. The pupil is the opening that allows light to pass through. The iris, which is the colored area, so mine are hazel, can make the pupil opening, or the aperture of the eye larger, or smaller.

Inside the eye is the lens, which is a transparent structure that focuses light onto the retina. The retina is the light-sensitive nerve layer that lines the back of the eye. This is inside the back of the eye. That allows the optic nerve to carry signals to the visual cortex in the brain to assemble into images that we can see and understand. No, that's an awful lot in a very short time without pictures.

[0:29:50] MD: Okay. One Cleveland Clinic has a fantastic Ð if you Google eye anatomy, Cleveland Clinic's image is perfect. Two, I know for a fact that Jenn carries eyeball gummies, that according to Goose and Bear are delicious. Also, I had about my tray on my desk because yes, I'm a 100-years-old and I have a platter of where there's originals and candies and I had eyeballs. None of the grad students wanted the eyeballs, but my boys were like, ÒMom, we went all the eyeballs.Ó The eyeballs are pretty. The eyeball gummies are also pretty accurate, according to her description and Cleveland Clinic. There's that.

[0:30:32] JR: Maybe when I do in-person in-services, I just start just slicing open the eyeball gummy and you see that.

[0:30:41] MD: For those us that are neurodiverse in the back, that will help pay attention. Yes.

[0:30:48] JR: All right. Those are just the initial eye structures that we are thinking about. There's also three types of muscles. There are ocular muscles. Those are the muscles that actually rotate the eyes within the head. If you're looking up, looking down, looking all around, the muscles that actually move your eye to point the different directions. There are pupillary muscles that controls the pupil size, and there are eyelid muscles. The eyelid muscles open and close your eyes for protection, for sleeping, for lubrication.

Eye trackers use infrared light to shine into the eye through the pupil, which passes through the lens inside the eye and reflects off the retina at the back of the eye. This reflection illuminates the pupil and allows the eye tracker to find the eye. Every eye tracker will need some type of calibration. Every eye is shaped differently and calibration takes images of the eye pointed at different directions to map the shape of the eye in order to determine where the user is looking.

[0:31:55] MD: Okay, so when I've done that previously with some of my patients, and some of them Ð I mean, they've had microcephaly, we've had strokes in utero, lots of different etiologies. I can't think of the term. It's on the grid and then we do the tracking program. Sorry, the sun just came in through the very large windows in my office and now I can't see you speaking of taking an infrared light to the eye. That has allowed us to track where the individual is looking at the screen or the grid. It was on grid box. I can't remember the name.

[0:32:44] EF: Are you talking about a game, Michelle?

[0:32:47] MD: Yes, but it was also the Ð

[0:32:48] EF: Sometimes I'll do like, yeah. TheyÕll have like Ð there's calibration that they'll do a lot with dots on the screen, or with kids will do like.

[0:33:00] MD: Yes. Then we can see where their eyes naturally go to on to help us figure out where we need to position. Because if we've had little ones that track up to the upper left and they have a harder time because of whatever's going on with them physically, they can't get to the lower right. Then if we move the full screen up, that might help them have a better overall access to the complete screen. Does that make sense? I should have had a second cup of coffee. I've been at it for a little while today. Yeah.
[0:33:33] JR: Yeah, there are some people that will be able to, with calibration, be able to access all areas of the screen, but not necessarily everyone. Sometimes that means moving things on the screen, like having the most important buttons located in a certain place on the screen. Sometimes that means moving the entire screen somewhere. We will have initial, basic positioning recommendations. But if we find that for one particular individual, it makes sense to have it in a slightly different place. There's not a right and wrong across the board for everyone.

A lot of this is going to be specifically tailored to the individual. When you have complex vision and complex eye and complex positioning, things going on, that is especially true. Also, think about, the eye tracker does not actually know what an eye looks like. We know, we look at you, I can look at you on the tiny little thumbnail that I have on my laptop screen right now. I can see your eye. Even though you're very small, I can actually tell where you're looking, just because we are Ð it is programmed into our brains that you can tell at just a glance what direction someone's eye is pointing.

For a computer, they don't actually know what an eye even is. They are programmed to find landmarks that indicate a pupil. Most pupils are circular and most retinas reflect light. It's important for us to keep in mind that many people of all ages who may need alternate means of access, that the patients and students we're working with who will be using eye tracking as an access method, they often have complex eyes and complex bodies.

You might have a pupil that's so small that light has trouble passing through, or at least sufficient light to successfully track. The pupil can also be extremely large, or dilated. This can be as a result of medications. This is something we see a lot with Baclofen, which is a common medication for people with CP, but also, with spinal cord injuries, ALS. Then we Ð

[0:35:41] MD: I had no idea.

[0:35:42] JR: Oh, yeah.

[0:35:44] MD: What does that do to its ability to track?

[0:35:48] JR: It depends. It really depends. Baclofen is one of the medications that a lot of times makes eyes dilate. We see the opposite a lot of times with narcotic painkillers. It'll be a pinpoint pupil and very little light passing through. Thinking about light needs to pass through the eye in order for eye trackers to work. Anything that impedes that light can make eye-tracking more difficult, if not impossible.

That can include cataracts. Cataracts is clouding of the lens inside the eye. A lot of times, people think of cataracts as something that older people get, but they can also be congenital. They're both congenital, or acquired. They may or may not impact someone's vision, at least to the point that they notice it. You might talk to someone and they say, ÒOh, yeah. I have cataracts in my right eye.Ó Or they might not even know, especially if it has not impacted their vision. If you have someone who does not have vision difficulties that need something like glasses, they might not have been to an eye doctor to even know that there was a cataract there. They can form very, very slowly over time. If you're not noticing that there's something impeding vision, you might not have had an appointment to take a look at that.

[0:37:15] EF: I have an eye disease that I learned about.

[0:37:17] JR: Oh, yeah?

[0:37:20] EF: Well, Michelle, I got anxious about it. Well, I have optic nerve drusen, which haven't really Ð I mean, I have stigmatism. That's what's affected my vision. Then when I went down a rabbit hole, and my one eye doctor was like, ÒYou could eventually lose your peripheral vision, but I've rarely seen ÐÓ and all the research is like, it doesn't actually Ð most the majority of the time, you don't tend to see too many deficits. Yeah, when I have my eye exam, my optic nerve lit up like a Christmas tree, because it was like, all the calcium filled up in it. I panicked a little bit.

[0:38:01] MD: As you should. But I mean, you saw the specialist. You've got the right doctor. I mean Ð

[0:38:07] EF: No, I don't.

[0:38:09] MD: You're going to get the right person. We're claiming joy here.

[0:38:14] EF: We'll be all right. I can't do anything about it. You can't hear it. There's no Ð

[0:38:18] JR: Have you seen a neuro-ophthalmologist? A lot of times that Ð

[0:38:23] EF: ThereÕs some good ones in Cincinnati.

[0:38:24] JR: Yeah. That's a lot of times weÕll Ð I'm jumping ahead of myself a little bit. But a lot of times when questions come up, I think I said earlier in a different context, sometimes it's about knowing what questions to ask. Sometimes, we'll have someone who's had a lot of difficulty and just didn't know why and will come in. We still know it's not working but at least we have Ð we know where to direct the questions and neural ophthalmology, they're not necessarily readily available.

Sometimes their offices are not fully equipped to accommodate things, like power wheelchairs. That makes specialist visits extra difficult sometimes. There's a lot that we do know about the eye. I say, we, meaning myself, my colleagues. I am not an eye doctor of any flavor. A lot of times, at least we'll know, okay, we have a question, we might take a screenshot and say, okay, let's take this to a physician who is an eye doctor. Ophthalmology is great. Neural ophthalmology, if possible because they're the ones that will actually be able to address some of these things. Just the one more thing about Ð oh, yeah. Let me Ð

[0:39:47] MD: No. I was just going to say, but these are the things that aren't covered in AAC class. I distinctly remember taking this amazing AAC class from an AAC user. She taught adjunct down at Old Dominion University because that's where I did my undergrad down in Norfolk, Virginia. It was phenomenal, but it didn't take into account all of the medical stuff. It's that interprofessional practice predicated upon interprofessional education. That's how we serve these individuals with complex bodies that, yes, be Ð

[0:40:25] EF: Well, and Michelle, where I get frustrated is like Ð and this is not a knock to OTs at all. OTs have a lot of understanding about vision and they have a lot of understanding about access. What I do find is because they don't have courses on AAC specifically, it scares them a little bit, but they have this knowledge to help with the access. But it's translating that like, how is this relating to access to the device? Because I have a lot of OTs who are like, ÒI don't do AAC.Ó But they do, they just don't always know how they do, if that makes sense. That's where, I think, some of that disconnect can happen if it's not an OT that's in an environment that that's what they're constantly doing.

[0:41:16] JR: Yeah. There is, even when it's not explicitly AAC, there's so much of what OT does and PT as well. Depending on where you're located, what your clinic is, sometimes seating in positioning falls under OT, sometimes PT, and sometimes both. If you have someone who is not in a good seating situation Ð it's not always possible, but if that can be rectified first, that makes a lot of things, everything else can fall into place. If you have someone who is, just as an example, I was speaking with an SLP in, I think it might have actually been Holly from the TTAC at Virginia Tech, and talking about Ð she's amazing. But we're talking about, if you have someone who, you have a student who doesn't necessarily have a lot of access to specialists, a lot of access to medical care, you might not have the option of going to someone for seating and positioning, getting a specialized custom chair built, especially with very young kids. It's expensive enough if you're a full-grown adult, but with kids, kids are growing so fast.

I know, just thinking about shoes. I was a figure skater, and that is ridiculously expensive. When you're a kid and your feet are growing fast, every few months you're out growing it, how do you get a chair that's going to be comfortable and supportive and can also continue to be all of those things for multiple years? It's tough. But a lot of times, you'll have someone who they don't have that kind of chair. Maybe they're in something that's closer to a stroller, or a very basic transport wheelchair that's way too big, so you don't have the torso support, you don't have the neck support, you're flopping all over the place. How do you do eye tracking when you're not stable and you're not comfortable? Yeah, there are a lot of pieces.

We try to do some thorough pre-screening before even scheduling a demo. If someone were to reach out to us and say, ÒWe think this might work. Can we try it?Ó Usually, we want to start by saying, ÒIt's great to talk with you. Let me ask you some questions.Ó Before we even schedule an appointment to meet up, we're going to say, ÒOkay. First off, how are you currently communicating?Ó Is this someone who has been in the situation they're in Ð was this a recent disease process change? Was this a recent accident, or injury? Was this something that you've been dealing with for multiple years? Are you currently speaking? If you're not speaking, do you have something that you do to communicate with the people around you, whether that is with low-tech AAC? Whether that is using sign, whether that's something like ASL, or even makeshift signs.

Sometimes people come up with gestures, just within a family. Is this just grimacing? They're not speaking, but you can tell by a facial expression if something is making them unhappy, or very excited. Are they very still when they're not excited about something? But when they are excited about something, maybe they'll kick out a leg. There's a lot of times, especially if you're talking with parents, sometimes the response will be like, ÒOh, they don't communicate, but I know what they want, or what they need.Ó A lot of times, we need to dig deeper, and this is SLPs in particular are generally pretty good at this. What the parent, or whoever we're talking to, caregiver, is thinking of as Òcommunication.Ó Again, I'm doing air quotes. We know that all of the things Ð

[0:45:31] MD: I love that you say that. ThatÕs amazing. Thank you.

[0:45:37] JR: Well, we know those facial expressions, those flailing out an arm when you're trying to get someone's attention, or if you're just happy, or excited, or interested, or angry. We recognize that all of that is communication. You don't have to be speaking, or writing, or typing, or signing to be communicating. Sometimes it's not just Ð we're not just asking a yes/no question, where we want to dig a little bit more, just to know when we're going in.

The next big one is how is their vision? We want to know, is there any history of eye surgery? Sometimes I don't use the word surgery anymore. I'll say, procedure. I had someone who told me they had never, ever had eye surgery. Then we had our appointment and I'm looking at the eye image that you have on our particular device, and I'm seeing something that is looking curious to me. I said, ÒHave you ever had cataract smudge?Ó She was, ÒOh, yeah.Ó

Cataract removal is just such a common procedure now. It is very likely that the doctor that did the procedure never called its surgery. It's done outpatient. It's very quick. It's very routine. Tons of people get it. She didn't think of it as surgery, but she had had a Òprocedure,Ó and she had had lens replacement surgery.
[0:47:01] MD: If you go a little bit farther into the mountains and you say, do you have the diabetes? They're not going to know it. But if you say, ÒYou got the sugars? Honey, how are your sugars doing?Ó Everybody has the sugars. But diabetes, it's just not a term that everybody knows. It's just, yeah, code-switching.

[0:47:17] JR: Yeah. Technical jargon versus what are the words that folks are actually using and how are they describing in their own words. Then also, do they wear glasses or contacts? There are a lot of folks who have what you might consider a normal eye history, but they've worn glasses for years. Or maybe they just started wearing readers. I wear glasses. I've been wearing glasses since fifth grade. I didn't really know how glasses worked, until I started doing this job and learned, oh, that's what the lens is doing to make it so I can see.

[0:47:54] MD: Now, when you ask these questions, who are you meeting with? When the folks call in to do the screen, are they meeting? Is it the caregiver, the patient, the clinician? Who can call in? Sorry, we got so excited. Then I was like, wait, back up. I need to know that part of it. Yeah.

[0:48:14] JR: No, the answer to your question is yes. It was not a yes or no question, but the answer is yes. We have folks who find us online and reach out through our website. We have clinicians that reach out because we've worked with them before, or we've worked with one of their colleagues before. When we are having these very initial conversations, sometimes it's with the clinician, sometimes it's with the patient themselves, depending on what their diagnosis is, what their situation is. Sometimes it's a family member. It might be the direct caregiver. It might be, ÒMy cousin is going through this right now and they seem really overwhelmed, so I figured that I would help out by reaching out.Ó I've had emails from a neighbor, or a family friend. That very initial outreach.

Sometimes it's just, ÒI found you. I'm curious how this works.Ó They might not even tell us upfront, because I have a person in mind, I think the benefit. They're just like, ÒWhat is this? I've never heard of this. How does this work? How does one go about getting it?Ó Like a lot of things, obviously, you could just, ÒHere is my credit card number. Thank you for this purchase.Ó For the most part, we have folks who are using insurance. There is a whole process that that goes through.
With school systems, sometimes that's even more different because sometimes students who are in public schools will be using health insurance. Sometimes the school system will have other procedures in place. It really depends on the person. It depends on the state. Sometimes it depends on the county, or something even smaller. Yeah, there's a lot of questions we ask. I'm usually asking the clinical questions, but we have funding questions as well. Again, that is its own podcast.

[0:50:11] EF: I do have an eye question.

[0:50:13] JR: Yeah.

[0:50:16] EF: In regards to fatigue, it feels like, based on how you're describing it, it feels very passive in the way that the camera is looking at the eye. I worked with a lot of girls with Rett syndrome. I worked at the Rett syndrome clinic in Shriners when I was in South Carolina. A lot of them, I mean, a lot of them had Eyegaze. I know the caregivers, a lot of their questions would be like, how much effort? I know it's different with every child, but what do you notice in regards to someone that's using an Eyegaze most of the time with how much effort their eyes are using, if that makes sense as a question?

[0:51:00] JR: Absolutely. That's a big concern that I think a lot of people have is how fatiguing, how tiring it would be. I'm going to go back to, I was talking about the types of muscles in the eye. Those ocular muscles, the actual muscles that rotate the eye within the head, those muscles do not fatigue. That is the same type of muscle as the heart muscle. If you think of when we are asleep, our eyes are moving. You might have pictures or videos, I guess, of someone who's dreaming, who's in REM sleep and their eye is moving, even though it is closed. Those muscles do not fatigue.

Eyelid muscles, so the muscles we use to blink can fatigue. We have a couple things at play here. We have, first off, where is your device positioned? There is a way to optimally position a device to minimize fatigue. We like to have it, so you do not have to look up, because that can be Ð Just right now, again, I know that folks out there in podcast land cannot see us, but keep your head on straight, but with just your eyes, look up at the ceiling for about two seconds. Can you feel that Ð you can feel that roll. That that was a very short period of time.
Obviously, we're not going to have the device on the ceiling, but just the act of looking up causes that pull. If you're doing that for more time, that's going to be more tiring. Also, infrared light is warm light. Warm light will potentially dry the eye faster. When eyes are dry, you need to blink. When you're blinking more, that's using those eyelid muscles. All of the devices, exactly. All the devices out there use infrared light. They do not all use the same amount of infrared light. Some devices use one single infrared LED. Others use a whole array of lights.

At the same time, devices that use a whole array of lights might have a wider head box. Not more accuracy, but just a bigger area. Someone who has more movement might benefit from a larger area, what we call a head box, the entire area that a camera can see. It's not that, oh, more light is better. Oh, less light is better. It really depends on the individual. That's one of the big pieces that the gold standard, the recommendation is to try at least three different devices from different manufacturers. That's the asterisk there. From different manufacturers, because different cameras function in a different way.

It's like test-driving a car. If you have never tried it, you don't know what the difference is. You want to find what is going to be the most comfortable, what is going to feel the most accurate. It does not matter what I think. What matters is when the device is being used by the person, what it feels like for that person.

[0:54:17] EF: I like what you said, too. I think that, unfortunately, and I don't view it this way, but it feels like, in a lot of places, the child almost has to earn the device, if that makes any sense. Which is so unfortunate, because you shouldn't have to earn communication. It's like, if one thing doesn't work Ð my focus is very individualized, very trauma-informed care. With that, involves a lot of time and effort to understand that client patient, wherever they're coming from.

I learned this from Michelle. I'll introduce high-tech super early, especially if I know a patient's diagnosis. Sometimes, I'll have to go to Eyegaze first, because of their motor differences, knowing that there might be a point in time where direct access is an option. Or like, I think that's where it can be difficult, too. It's like, they deserve communication now. It might change with how they want to access a device and finding that balance of, is it going to stick with them? But how is it best for them to communicate in this moment when their communication is just as valid too, as opposed to, oh, they're not ready for it yet. Which really bothers me.
[0:55:43] JR: With AAC, I feel like, we spend all this time talking about feature matching, which is fantastic when you know what features you're matching. For a lot of the people that we're working with, whether these are pediatric patients, or students, or these are adults, have you been able to complete a comprehensive language and cognition assessment? That's an important question.

[0:56:10] MD: WhatÕs the bias in the test that you selected? Can we go back to that one? But okay.

[0:56:16] JR: I mean, can, can I do basic orientation questions with you? Can I get a yes/no response from you? Do I know if you are understanding the things that I am saying to you? If we don't have the ability, if this person does not have the ability to either speak, or make some gesture that we know what it means, that means that Ð what features are being matched?

[0:56:46] EF: Most of Michelle and IÕs patients. The ones that we're really trying to give them an opportunity to communicate, we use the communication matrix a lot, which I love, because it allows you to really pick up those very subtle cues of communication. I vividly remember having this patient with a Rett syndrome come in. She was older, maybe almost 10. I mean, she was so engaged with mom, had so many things to say, was non-speaking, and her device was overwhelming to caregiver.

Did I know fully from the patient that it was overwhelming to her? No, but her cues were telling me it was, because she wasn't using it. I remember mom was like, ÒI just want her to hear ÔI love youÕ, or to hear something like that.Ó I had to advocate for what she wanted to say on the device, like she loved poop jokes, so we put fart jokes on there. Also, had to advocate to mom that every time she reached back and touched her, she was saying, ÒI trust you, and I love you.Ó It's such a balance of not Ð and we know this, I mean, we all do it, but such a balance of helping caregiver.

I don't know if you get this. I mean, we could talk forever, so I will shut up in a second, I promise. I have a lot of families that will be like, they don't really use a device at home. Sometimes I go, ÒWhen you go home from work, and you're exhausted, and you worked so hard all day, sometimes you just want to sit on the couch and put your hand on the other person's lap.Ó Some of that is just, you get me and I don't feel the need to use it. I just went down a rabbit hole. I'm really sorry. I don't know what my point was. I just really, I'm appreciative of your advocacy for working with that family, working with that client, taking the time to understand them, to provide what they want. Even though it's going to take a lot of work, if like you said, we don't have as much data from them.

[0:58:54] JR: Yeah. Sometimes what that means is, first off, making sure we're on the same page before we start, so that we don't have unrealistic expectations. Coming in with the device, with the understanding, this is not a device trial that's going to determine if you are going to be successful using this device. This is me bringing this device that we can use as an assessment tool. What does that mean for, just sticking with this example with a pediatric patient, what does that language assessment look like?

What I was taught in school and what all of the literature tells us is that for a child language assessment, this is accomplished with play. You're not going to sit a three-year-old at a table, expect them to sit quietly, while you just show them pictures and demand that they name them. Just because Ð

[0:59:51] MD: Can you put that on repeat, because this is the dynamic assessment? A standardized assessment alone does not capture what our children are capable of doing. If we learn through play and truly seek to understand what gets them excited, that's where Ð

[1:00:08] EF: Yeah, it doesn't capture what they want to communicate.

[1:00:11] MD: Yes.

[1:00:12] EF: If we don't let them play.

[1:00:15] JR: That's just putting so many demands. It does not matter if you're talking about a typically developing child, which is not any special education scenario. You are just talking about a kid in preschool who is going about a task. That's not expectation that is being put on this child. Why should this be different because we have this high-tech device? There are ways to incorporate play. That might mean, you know what? We know that we need calibration in order to be accurate with the tracking for you to access this device. But that's not what we're trying to do right now.

What we're trying to do is, is this something that is of interest to you? If I'm working with an adult with ALS, I put a device in front of them and say, ÒLook at the yellow ball and it'll take a measurement of your eye and move on to the next one. Okay, here's a keyboard. Spell your name.Ó I'm not doing that with a child. I'm also not doing that with adults who have potentially, cognitive communication deficits and we're not exactly sure what they are. This is more, okay, I have a young child. It's very possible, especially now that it is 2024, that they have had screen time. They know what that is. They've had an iPad in front of them and it's playing Coco Mellon and that is not an unusual occurrence.

I can't just say to this child, ÒHey, this is an interactive screen. If you look at a thing, it'll do a thing.Ó That's not how this works. They have to experience that and make that connection. They have to have that little light bulb moment. I cannot lecture this young child until they get that. It is up to them to get the opportunity to explore, until they realize, ÒWait a second. Every time I looked at that button, it played that song and showed me that thing. Hmm.Ó That very likely means, I'm going to put it in front of them and I'm going to walk away.

Depending on the age of this child and their safety, we're not going far. We're not necessarily leaving the room. We're going to be over here chatting and we're just going to put this in front of them and just see what happens. They are exploring. They are the child who is sitting on the play mat and they are picking up the toy and they're turning it around and they're poking it with their finger and they may be putting it in their mouth. That's what their classmates are doing. They are getting the same opportunity. They're just using their eyes.

We have just a very simple cause and effect type of page that all that it does, if you look at something, something happens. The software that's on the device that our company has, so the Eyegaze Edge has a software called Mind Express. There's one of the cause and effect pages is a pile of leaves. It's fall and you've been raking, there's a pile of leaves. As you look around, the leaf will disappear. At the bottom of the pile of leaves, there's a ladybug, or some little cute thing, but you have to lift all the leaves in order to see the thing at the bottom. Just a very, very basic. There is no right and wrong. There's no expectation of any kind. This is just exploration. Is it going to immediately click? Not necessarily. But it's just exploring.

You know what? I don't think so, and that I feel like, for a lot of folks, and this is not just children, I feel that would be Ð There is one. It is not farts. I do apologize, but there is one that's there's an opera singer and a tomato appears on the screen. If you look at it, it'll throw it at the opera singer. The first time I saw that, I was like, ÒWait, that's mean.Ó You know what? There's going to be kids and that is the one that is going to be effective, so there you go.

[1:04:25] MD: I've seen the pie spot one and the fart ones with Ð 

[1:04:30] JR: Maybe there is one and I'm just not familiar with it.

[1:04:34] MD: Okay, that's my request. I like the fart one. I mean, also boy mom life, but farts are fabulous. Unless it happens on your foot when you're cuddling up next to your child. ThatÕs not Ð Oh, God. You have no idea. Yeah.

[1:04:48] JR: There are certain things that can unite everyone. Sometimes everyone just needs a little giggle. I don't think there's any age limit on the fart jokes.

[1:05:02] MD: Okay. All right. I am bearer of the bad news, that we have to wrap up, because I have to go to a practicum planning meeting in five minutes. But Jenn, this is amazing. Can we please schedule for a part two?

[1:05:22] JR: Yeah, absolutely. I feel like, we could go on for Ð we have a lot of things we could talk about for sure.

[1:05:27] MD: I know, because we barely got through Ð I mean, we got through some anatomy, but we teased into the CVI stuff and we just got into the components of the email. But I want to know what it looks like when you're going through the process into intervention and what the program systems are, or what are the alternatives if the Eyegaze doesn't work. Or, say their disease progression is not deterioration, but the prognosis is optimal. Then how do we teach how to use direct access? You suit all the things.
[1:06:05] JR: Yeah. Agree. All of those things.

[1:06:08] MD: All of those things. I'm very excited. I got so excited, I had to move. I was like, I need this one in my back. I have to be able to see because this is fantastic. Okay. All right. Then on that note, one, what are your final thoughts for now? Because I feel like, we cut you off midstream, but I have to go see Jerilyn.

[1:06:29] JR: Yeah. No, that's okay. I think, the biggest pieces to keep in mind, that pre-screening. How do you know if this person is Ð if this is a potential access method for the person that you're working with? It might be very obvious to you and it might be Ð I'm not sure if this is going to be the right path for this person. For that question, I would recommend reaching out Ð you're welcome to reach out to me, whether it is specifically for this company, or just about eye tracking in general. We welcome those questions.

We get questions from folks who have devices from other manufacturers a lot of the time. We're happy to bounce ideas around there. Because it might be that it's not a no, but it's a, let's get another specialist visit first, so that we have more information going in if that is even a possibility. Yeah, I think that's really the biggest takeaway, at least of this.

We like to be curious about the eye. One thing that I did not mention, the last and really important question about that pre-screening is, do they have volitional eye movement? Can they not track something across the screen, but volitionally, can you just ask them, look up, down, left, right. Can their eyes move in those directions? If the answer is no, that does not necessarily mean this is not the right access method for them, but it gives us a lot of important information going in.

There are some people who have had brainstem stroke, or other brain injuries and their eyes may be only move up and down and they don't move left to right. That might be something that is obvious, just by saying, look up, look down, looked left, look right. That said, we might not see it until you put a device in front of them and say, ÒHuh, that's interesting. Let's explore that further.Ó

[1:08:39] MD: Wait. We didn't even get into Nystagmus, because that makes me think about Nystagmus when there's Ð Okay, so we'll have to pick up with Nystagmus.

[1:08:45] JR: Yup. Always a part two.

[1:08:49] MD: Yes. Okay. The part two, we can start with Ð

[1:08:51] JR: Yeah. We can talk about Nystagmus, we can talk about strabismus. Yeah, we've got all kinds of things. I don't think I talked about ptosis. That's when the eyelid blocks part of the pupil. Yeah, we've got all kinds of things that can potentially interact with eye tracking.

[1:09:07] MD: Yes, okay. We'll do, uh-huh, uh-huh. Do round two. Okay. Then on that note, if somebody's listening right now and they have a question, how can they reach you?

[1:09:17] JR: Yeah. I will make sure that you have this information to put in your show notes as well. But our company phone number is 1-800-Eyegaze, E-Y-E-G-A-Z-E. That reaches us in Fairfax, Virginia. That's East Coast U.S. time. My email, it might be easiest for me to just give you my email to put in there, because my name is long. But my name is Jenn Rubenstein. It's jennrubenstein@eyegaze.com. 

[1:09:52] MD: Beautiful. Folks, they have a Instagram account as well. It's simply called @Eyegaze. That's the handle name. E-Y-E, gaze, G-A-Z-E. Be sure to check them out on the land of Instagram. Then the question that I love to ask, if somebody has any love money lying around, do you have an organization, an entity, a non-profit that they could donate to, something that means a lot to your heart? It can be SLP-related or not SLP related. Where would we sprinkle joy to?

[1:10:26] JR: Oh, goodness. I did not do a good job of preparing for this in advance. I think, for part two, I'll have another one. I'll think for this one. IÕll start by throwing out, there are local chapters of the ALS Association all over the country. They provide a lot of services, including support with assistive technology. That is a pretty, pretty great one. I guess, while I'm on that note, speaking of ALS, there's an organization based in New Orleans called Team Gleason, that was started by Steve Gleason, who is a former NFL player for the New Orleans Saints, who has ALS. The support that they provide to folks with ALS all over the country is just incredible.

[1:11:14] MD: I hadn't heard about either one of those. Yes. I love doing this and finding out where people want to send joy, because it's always so impactful and personal and it's just lovely. Yes. Okay. You are freaking amazing. Erin and I are so grateful that you came on. Folks, be sure to check out First Bite Podcast on Instagram, as well as the land of the Facebooks. We will get you scheduled for part two, maybe part three. Yay.

[END OF INTERVIEW]

[1:11:48] ANNOUNCER: Thank you for joining us for today's course. To complete the course, you must log into your account and complete the quiz and the survey. If you have indicated that you are part of the ASHA registry and entered both your ASHA number and a complete mailing address in your account profile prior to course completion, we will submit earned CEUs to ASHA. Please allow one to two months from the completion date for your CEUs to reflect on your ASHA transcript. Please note that if this information is missing, we cannot submit to ASHA on your behalf. Thanks again for joining us. We hope to see you next time.

[1:12:29] MD: Feeding Matters guides system-wide changes by uniting caregivers, professionals and community partners under the Pediatric Feeding Disorder Alliance. What is this alliance? The alliance is an open access collaborative community, focused on achieving strategic goals within three focus areas; education, advocacy and research.

Who is the Alliance? It's you. The Alliance is open to any person passionate about improving care for children with a pediatric feeding disorder. To date, a 187 professionals, caregivers and partners have joined the alliance. You can join today by visiting the Feeding Matters website at www.feedingmatters.org. Click on PFD Alliance tab and sign up today. Change is possible when we work together.

[OUTRO]

[1:13:21] MD: That's a wrap folks. Once again, thank you for listening to First Bite: Fed, Fun and Functional. I'm your humble, but yet, sassy host, Michelle Dawson, the All-Things PFDs SLP.

This podcast is part of a course offered for continuing education through speechtherapypd.com. Please check out the website if you'd like to learn more about CEU opportunities for this episode, as well as the ones that are archived. As always, remember, feed your mind, feed your soul, be kind and feed those babies.

[END]
FBP 267		Transcript

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