The Dudes Do ASHA 2011: Day 1. On Traveling, Truth, and EBP

journey, (n). / /. A day’s travel; the distance traveled in a day or a specified number of days.

According to the English writer Oliver Goldsmith, “Life is a journey that must be traveled no matter how bad the roads and accommodations.” Well, in all honesty, when the journey is to the ASHA 2011 conference in San Diego and the accommodations are at the Hilton San Diego Bayfront, it’s hard to imagine anyone feeling any sympathy for our having to travel for hours and across thousands of miles to get here. When you’re sitting back in a swanky, high-priced bar drinking White Russians and nibbling on a $26 selection of gourmet meatballs, you keep glancing at the hotel entrance to see if the “Occupy San Diego” people are about to storm the building with flaming torches, dragging off “the rich” to a hastily constructed gibbet.

The Odysea Bar

Still, it’s not as if this is the regular lifestyle for the Speech Dudes. No sir! For every luxury hotel we stay in there are tales we can tell of others that involve insect infestations, bullet-proof check-in desks, ear-splitting air-conditioners, no air-conditioners (in a Coloradan summer), and one just on the edge of a European red-light district that rented by the hour. So rest assured the Dudes are immensely appreciative of their current locations, split as they are between the Hilton and the Marriott, also with a view of the bay.

Despite having traveled individually from the East Coast, Mid-West, and Canada, we are, after all, Speechies, and within minutes of ordering food and drinks at 10:30 pm PST, the conversation  shifted from how which is the worst airport in the US (Philadelphia  is currently in the running, says one of us) to Speech Pathology, specifically the issue of outcomes. Incredible as it may seem that a group of guys at a bar would want to get into Evidence-based Practice rather than the sad state of the NBA and the prospect of not being able to spend some quality time over Christmas secretly hoping LeBron James will twist an ankle and bruise his ego, we ploughed into the current fad for dropping iPads [2] on every kid with a pair of hands as the “miracle cure” from St. Stephen of Jobs and the Angels at Apple.

The messianic zeal of evangelical Jobbites [3] is such that the answer to life, the Universe, and everything, is quite simply “there’s an App for that.” And if there isn’t, then someone will make one and all will be well. It’s no use talking about “levels of evidence” or “controlled experiments” or even “proof” because there is, of course, lots of “proof” on YouTube, and, of course, sales of iPads outstrip the gross domestic product of several South American countries so they must be useful.

Already, Jobbites reading this are spluttering and trembling, their wobbling fingers poised to launch into a tirade of near-religious rhetoric in defense of the New World Order, where Apple will save the world by the benevolent use of the “One store to bring them all and in the darkness bind them.” But take a deep breath and hold back for just a few minutes.

Whether using technology for teaching articulation skills, sentence construction, fluency, AAC, literacy, and so on, the glamour [2] of the machine can cloud our judgment. Our pads, tablets, smart phones, and laptops are such magical totems that we really want them to be special. The trick is for us to make sure we are open-minded enough to see the benefits of new technology (or just new approaches in general) but not so open-minded that our brains fall out.

Sackett, Strauss, Richardson, Rosenberg, and Haynes (2000) [3] talked about using a foreground question to determine the quality of external evidence that can help us make informed decisions about using a new approach. The use the acronym PICO as a memory aid that helps us formulate a testable question;

  • A Patient or Problem
  • An Intervention (a treatment or evaluation)
  • A Comparison or Contrast
  • An Outcome (measurable, of course)

Thus, a good question to ask would be “If I use this app for a month (I) with my 4-year-old client with a hearing loss (P) will the improvement in selecting new images on the screen (O) be better than if I’d used simple picture books (C).”

OK, so you can fine tune this in a few ways but we’re writing a blog post not an EBP textbook. The point is that we do have the clinical tools to evaluate the use of flashy new technology if we ask the right questions. Just using an app for a month and noticing “change” tells you nothing; the client may have “changed” if you’d let them watch SpongeBob SquarePants with you because the interaction was the cause, not the app.

Healthy skepticism is not a rejection of change but a necessary perspective to evaluate the extent of change. What is dangerous about new approaches, technological or social, is when claims are made to efficacy that are based purely on anecdote and a wish to see things happen.

And who would have thought White Russians and meatballs could lead to this.

Time for bed…

Time for bed

Notes

[1] Curiously it is iPads and not tablets in general. A recent report asked schools if they were considering buying new tablet technology for the classrooms and 100% said iPads against 0% for any other device. Now, doesn’t that strike anyone else as odd if the education system is supposed to be evaluating things on merit? Or is this a triumph for Apple’s marketing department? Just a thought.

 [2] The word glamour not only means “fascination” or “allure” but also “a magical spell cast over a person to hold them in thrall.” Literary types might want to take a read, or re-read, of Tennyson’s Idylls of the King and the verses entitled The Beguiling of Merlin. This demonstrates poetically how the glamorous Vivienne enchants and defeats the Arthurian mythological wizard.

[3] A Jobbite is an individual who considers Steve Jobs and all his works as beyond criticism. Followers of Ayn Rand have a similar perspective, which ultimately can result in the emergence of cults. Although Jobs was unquestionably influential in the world of technology, it’s easy to forget that Apple succeeded because of the creativity and hard-work of its workers. Jobs himself didn’t actually sit down and build iAnythings – he facilitated it, and there was his skill.

[4] Sackett, D.L., Strauss, S.E., Richardson, W.S., Rosenberg, W. and Haynes, R.B. (2000) Evidence-based medicine: How to practice and each EBM. Edinburgh, Scotland: Churchill Livingstone.

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