Velopharyngeal Dysfunction (VPD)

What is VPD?

Velopharyngeal Dysfunction (VPD) is a condition where the velopharyngeal valve does not close consistently and completely during speech sound production.

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Three Types of VPD

1. Velopharyngeal insufficiency (VPI): a structural defect that prevents adequate velopharyngeal closure. This is the most common type of VPD, as it includes a short or abnormal velum. This occurs in children with a submucous cleft or cleft palate.
2. Velopharyngeal incompetence (VPI): a neurophysical disorder which results in poor movement of the velopharyngeal structures. This is common in individuals with dysarthria due to cortical damage or velar paresis due to cranial nerve damage.

• Children with VPI may demonstrate hypernasality(too much soundin the nasal cavity), nasal air emission (leakage of airduring consonant production) and compensatory articulation productions (abnormal articulation productions in the pharynx to compensate for a lack of oral air pressure due to VPI).

3. Velopharyngeal mislearning: lack of velopharyngeal closure on certain sounds due to the use of sounds in the pharynx as a substitution for certain oral sounds.

• Children with velopharyngeal mislearning may produce pharyngeal sounds as a substitute for oral sounds. This causes nasal emission due to the placement of production.

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When is Speech Therapy Necessary?

1. Speech therapy cannot change abnormal structure and therefore, cannot correct hypernasality or nasal emission due to VPI— even if there is only a small gap! VPI requires physical management such as surgery, or a prosthetic device.
2. Speech therapy is beneficial when nasal emission or hypernasality is caused by placement errors.

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What is done in Speech Therapy

• Use a “listening tube” (even a bending straw), have the child put one end of the tube in the entrance of a nostril and the other end near his ear. When nasality occurs, it is heard loudly through the tube. Ask the child to try to reduce or eliminate the sound coming through the tube as he produces oral sounds and then words.
• Bring awareness to the abnormal production versus the target sound. Give as many clues as possible using visual, tactile and auditory feedback.
• Have the child produce the phoneme /p/ and then a vowel preceded by an /h/. For example, /p…hɑ/ for /pɑ/ and /p…ho/ for /po/. This keeps the vocal folds open during transition to the vowel and prevents the production of the glottal stop.

Ashley E. MA, CF-SLP

Ten Principles of Grammar Facilitation for Children with Specific Language Impairments

Introduction

• This article focuses on grammatical morphology (i.e. omission of copulas, auxiliaries, articles, regular tense inflections) because it is heavily researched in the field and is a consistent deficit in children with Specific Language Impairment (SLI).
• SLI is a language disorder that delays the mastery of language skills in children who have no hearing loss or other developmental delays.
• Because of its pervasiveness, SLPs are often asked to develop intervention plans targeting grammatical morphology however, they have difficulty developing intervention plans that consider other areas of weakness the child has or potential areas of weakness the child may develop.
• Ten principles were developed to facilitate “state of the art” grammatical interventions.

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Principles

1. The basic goal of all grammatical interventions should be to help the child achieve greater facility in the comprehension and use of syntax and morphology in the service of conversation, narration, exposition, and other textual genres in both written and oral modalities.
2. Grammatical form should rarely, if ever, be the only aspect of language and communication that is targeted in a language intervention program.
3. Select intermediate goals in an effort to stimulate the child’s language acquisition processes rather than to teach specific language forms.
4. The specific goals of grammatical intervention must be based on the child’s “functional readiness” and need for the targeted forms.
5. Manipulate the social, physical, and linguistic context to create more frequent opportunities for grammatical targets.
6. Exploit different textual genres and the written modality to develop appropriate contexts for specific intervention targets.
7. Manipulate the discourse so that targeted features are rendered more salient in pragmatically felicitous contexts.
8. Systematically contrast forms used by the child with more mature forms from the adult grammar, using sentence recasts.
9. Avoid telegraphic speech, always presenting grammatical models in well-formed phrases and sentences.
10. Use elicited imitation to make target forms more salient and to give the child practice with phonological patterns that are difficult to access or produce.

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Summary

• The purpose of these ten principles is to assist in the of development of interventions that foster grammatical development.
• These intervention methods should be broad enough to note improvement in the child’s overall communicative, behavioral, social and academic performance.
• While these principles are meant to guide intervention, the SLP should still consider each child’s individual strengths and weaknesses when administering therapy.

Ashley E. M.A., CF-SLP

Reference:

Fey, M. E., Long, S. H., & Finestack, L. H. (2003). Ten principles of grammar facilitation for      children with specific language impairments. American Journal of Speech-Language          Pathology, 12(1), 3-15.

Hearing Loss in Children with Down Syndrome

Hearing loss is prevalent in the Down syndrome population for a variety of reasons. Primarily, there are abnormalities present in the Eustachian tube, ossicular anomalies and remnant tissue in the middle ear cavity that contribute to the presence of conductive, sensorineural or mixed hearing loss in this population (Tedeshi, Roizen, Taylor, Murray, Curtis & Parikh, 2015). A common disease accompanied with middle ear infection is otitis media, which causes conductive hearing loss. Conductive hearing loss occurs when there is a disruption in the flow of sound waves in the outer and/or middle ear. In addition, it is hard to examine the tympanic membrane due to the narrowing of the external auditory canal (Tedeschi et al., 2015).

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If hearing loss is a recurring problem in children with Down syndrome, there are various intervention strategies that can be implemented over the span of their life. These intervention strategies include both medical and surgical, such as cochlear implantation and the insertion of pressure equalization tubes. Amplification, such as hearing aids may be an option if medical or surgical intervention is not ideal. Both approaches have led to a decrease in hearing loss in this population. Although hearing loss can never be reversed, research has found the earlier intervention occurs, the more effective it is likely to be.  Early intervention is fundamental for children with Down syndrome accompanied with hearing loss. They are already at a cognitive disadvantage, so receiving therapeutic services from a young age is beneficial in multiple ways. According to the American Speech-Language Hearing Association, early intervention helps children stay on schedule with their speech and language development. If there is a hearing loss, speech may suffer, as there is a disruption in receptive language comprehension. Early intervention can also enhance the child’s awareness of their hearing loss and special communication services. In addition, early intervention allows for the documentation of the child’s progress, which can guide further intervention approaches, such as medical or surgical options. With a knowledgeable clinician, there are an abundance of benefits that children with Down syndrome can receive from early intervention services. (Shott et al., 2001).

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In some scenarios, medical and surgical intervention, such as providing medication and the insertion of pressure equalization tubes are not adequate enough to subside the affects of hearing loss in children with Down syndrome. In severe cases, cochlear implantation may be suitable in order to diminish the affects of hearing loss. Cochlear implantation is implemented for severe to profound sensorineural hearing loss. Those implanted at a young age, as early as three months, receive greater benefits because language is developing at a similar rate as their peers. Since children with Down syndrome are prone to several disabilities, it is encouraged to have consistent audiology appointments and to possibly discuss cochlear implantation as early as six months.

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References:

Shott, S. R., Joseph, A., & Heithaus, D. (2001). Hearing loss in children with                                 Down syndrome. International Journal of Pediatric Otorhinolaryngology 61(3), 199-205. Retrieved March 20, 2016

Tedeschi, A. S., Roizen, N. J., Taylor, H. G., Murray, G., Curtis, C. A., & Parikh, A. S. (2015). The Prevalence of Congenital Hearing Loss in Neonates with Down Syndrome. The Journal of Pediatrics,166(1). Retrieved March 21, 2016.

-Ashley E., M.A, CF-SLP

Traumatic Brain Injury

According to ASHA (2017), Traumatic brain injury is a form of brain injury that is caused by sudden damage to the brain. Depending on the location and source of the trauma, the TBI can be a closed head injury, a penetrating head injury, or a deceleration injury.

Type of injury	Definition	Example
Open Head Injury	When the skill is penetrated with direct injury to the brain	Wound to the head
Closed Head Injury	No penetration to the skill but indirect force to the head caused by rotation and deceleration of the brain	Motor vehicle accident, fall
Penetrating Head Injury	When the brain continues to move inside the brain as it moves at a different rate than the skill	Head-on motor vehicle accident

 

The most common causes of TBI are motor vehicle accidents, recreational accidents that typically occur during sports and acts of violence. The risk of TBI is greater in males between the ages of 15 and 19 and for children of either gender between 0 to 4 years of age. It is recommended that the individual is observed for any abnormalities for 12 to 24 hours. When a TBI occurs, it is typical for individuals to experience either retrograde amnesia or anterograde amnesia. Retrograde amnesia refers to the loss of memory for the events directly before the injury. In contrast, anterograde amnesia refers to the loss of memory for events directly after the injury. TBI is diagnosed by clinician presentation, signs and symptoms, and brain imaging studies.

Some clinical signs that medical personnel utilize to determine the occurrence of TBI are:

• Headaches
• Dizziness
• Vomiting
• short term memory loss
• physical signs of trauma
• seizures
• depression
• fatigue

Communicative Deficits Associated with TBI

• Sensory
• Physical deficits
• Swallowing difficulties
• Behavioral issues
• Confused language
• Articulatory or phonological disorders
• Auditory comprehension difficulties
• Naming difficulties
• Pragmatic language difficulty
• Repetitive verbal responses
• Reading and writing difficulties

Assessment

First the speech-language pathologist (SLP) will assess the patients cognitive-communication skills, such as attention and orientation. The SLP will then assess recent memory skills and the patient’s ability to plan, organize, and attend to details.

Treatment

A treatment plan will be developed depending on the stage of recovery. The treatment plan will always focus on increasing independence in everyday life and functional communication skills. According to ASHA (2017):

• In the early stages of recovery (e.g., during coma), treatment focuses on:
  • getting general responses to sensory stimulation,
  • teaching family members how to interact with the loved one.
• As an individual becomes more aware, treatment focuses on:
  • maintaining attention for basic activities,
  • reducing confusion,
  • orienting the person to the date, where he or she is, and what has happened.
• Later on in recovery, treatment focuses on:
• finding ways to improve memory (e.g., using a memory log);
• learning strategies to help problem solving, reasoning, and organizational skills;
• working on social skills in small groups;
• improving self-monitoring in the hospital, home, and community.
• Eventually, treatment may include:
  • going on community outings to help the person plan, organize, and carry out trips using memory logs, organizers, checklists, and other helpful aids;
  • working with a vocational rehabilitation specialist to help the person get back to work or school.

 

Source: ASHA.org

-Lauren LaGreca, M.A, CF-SLP

What are the benefits of practicing at home?

Have you ever been thought to your-self that “life gets in the way?” Well, you are not alone. It is normal for parents who work full time jobs to feel like the day just flies by. However, most parents do not realize the importance of making practicing speech and language at home. Practicing speech and language therapy can mean all the difference in your child’s progress. Practicing at home does not need to be a major time commitment, however, practicing for five or ten minutes every day will benefit your child more than practicing only one per week.

Benefits

• Therapy becomes more effective- higher outcome
• Family feels that they are involved in their child’s success
• Family increases their knowledge about child’s development
• Family feels more confident with child’s communication abilities
• Client has a better long term support system
• Promotes carry over

Why is it important

Why is practice important? Well, the more your child is exposed to the skill, the faster he/she will catch on. When the SLP sends practice work home for the child, the parent can work together to complete work that may be challenging. This will allow the parent to understand what the child is working on and how to work on it differently at home. Homework activities provide opportunities for the child to practice his/her goals in a more natural environment with the encouragement and support from family. It is important for the parent to collaborate with the Speech-Language Pathologist that is working with the child to ensure the same cues and prompts are given at home, as they are in therapy.

Some parents may decrease the amount of home practice due to positive feedback from his/her therapist. However, even if your child has met his/her goals, the last goal of speech therapy should be carrying over that skill to other settings. It is important for parents to maintain practicing at to ensure that the child’s skill is not only mastered in the therapy room. The patient may be showing improvement in the therapy room without carrying that improvement over to other settings during everyday life such as home, school, and socializing with friends.

*The good news: home practice can be fun!

Practicing at home does not have to be a set of drills before play time. Parents can incorporate home practice while participating in activities in daily life. For an example, the parent can incorporate language, articulation, and fluency at a food store, restaurant, playground, or the pool. The main key to is to have fun!!

What can help motivate child at home:

• Providing a model: Models will help child visualize and understand the task they are being asked to do.
• Feedback: Feedback is beneficial for children to help them understand what they are doing wrong, and how to fix it.
• Reinforcement: Providing reinforcement will increase the child’s motivation and self-confidence.
• Sticker chart: A sticker chart can be used as a reward system. The parent can tell the child that he/she will receive a sticker for every time he/she practices. The parent will then set a goal for the child to have 4 stickers on the chart before the end of the week. If the child has 4 stickers, he/she will get a reward.
• Schedule: Making a schedule will allow the child to fit practice speech and language into his/her schedule. This will help them stay consistent and ensure they are practicing.
• Incorporating speech and language in daily routines: Children tend to feel most comfortable in their homes because there is less pressure. By incorporating speech and language in daily routines, parents can feel involved in their child’s progress and see faster results.

Source: ASHA.org

-Lauren LaGreca, M.A, CF-SLP

 

Apraxia of Speech Vs. Dysarthria

Apraxia

            Apraxia of speech (AOS) refers to a neurogenic speech disorder that is caused by central nervous system (CNS) damage. AOS is associated with impairment to motor planning and/or programming. Although there is no weakness of paralysis of the muscles, the CNS damage makes it difficult to program and precise movements necessary for smooth articulated speech.

Childhood Apraxia of Speech is pediatric speech sound disorder associated with impaired accuracy and consistency of movements underlying speech. These individuals demonstrate sensorimotor difficulties in positioning and sequentially moving muscles for the volitional production of speech. It is hard for these individuals to plan and program the movement sequences and they frequently show groping behaviors and poor intelligibility due to inconsistent and multiple articulation errors.

• Children with CAS usually show:
  • Slow, effortful speech
  • Prolonged speech sounds
  • Repetition of sounds and syllables
  • Most difficulty with consonant clusters followed by fricatives, affricates, stops and nasals
  • More frequently occurrence of omissions and substitutions
  • Voicing and devoicing errors
  • Vowel errors
  • Groping and silent posturing of articulation
  • Problems with hypernasality and nasal emission
  • History of feeding problems
  • Limited sound inventory
  • Inconsistency in sound productions

Treatment:

Treatment for CAS and adults with apraxia involve extensive drills that stress sequences of movement involved in speech production, imitation, decreased rate of speech, normal prosody and increased accuracy in the production of individual consonants, vowels, and consonant clusters. The overall goal for treatment is to have the individual spontaneously produce words naturally, effectively, and efficiently with a focus on articulation and prosody. It is important to master this goal both inside and outside the clinic. Most recently, a system called PROMPT (prompts for restructuring oral muscular phonetic targets) has been used to treat children with CAS. This approach uses tactile kinesthetic proprioceptive cues to support and shape movements of the articulators.

Dysarthria 

The term dysarthria refers to a group of speech disorders associated with an impairment to motor speech control and execution resulting from damage to the central nervous system (CNS) and/or the peripheral nervous system (PNS). The area of damage categorizes the type of dysarthria, the associated characteristics, and treatment goals. This damage typically leads to weakness, or incoordination of the muscles of speech. Dysarthria can be caused by cerebral palsy, head injury, degenerative disease, tumor, and stroke. This disorder impacts all of the speech systems, therefore, all of the speech systems must be incorporated in assessment and treatment. Individuals with dysarthria typically show:

• Breathy or harsh voice
• Monopitch or monoloudness
• Hypernasality or hyponasality
• Nasal emission
• Distorted vowels
• Imprecise consonants
• Prolonged phonemes
• Reduced or excess stress

Treatment:

Dysarthria treatment is very repetitive and structured. It involves increasing muscle tone and strength, increasing range of motion, rate of speech and treating other parameters that affect intelligibility. It involves systematic drill, modeling, phonetic placement and emphasis on accuracy of sound production. The focus of treatment for each individual with dysarthria is based on the severity of the disorder.

What is the difference between Apraxia and Dysarthria?

• Predominant lesion for AOS occurs in frontal lobe
• Speakers with apraxia do not exhibit neuromuscular conditions, as seen in dysarthria
• Speakers with apraxia do not exhibit swallowing deficits, as seen in dysarthria
• Typically, only articulation and prosody are impaired with AOS, meanwhile, all subsystems are impaired with dysarthria
• Speakers with AOS demonstrate inconsistent speech sound errors
• Volitional phonation can be impaired at times with apraxia, however both volitional and reflective behaviors are impaired with dysarthria
• Well practiced tasks will be easier for AOS than less familiar task

Source: ASHA.org

-Lauren LaGreca, M.A, CF-SLP

 

 

 

Normal Language Development for Young Children

Language can be defined as a form of social behavior that is shaped and maintained by a verbal community. It is described as a code in which specific symbols that convey meaning. Language is broken down into five major components, morphology, syntax, phonology, semantics, and pragmatics.

• Morphology is the study of word structure and the construction of word forms.
• Syntax refers to the study of sentence structure which involves the arrangements of words to form meaningful sentences, the overall word order, and a collection of rules that specify the way and order in which words may be combined to create a sentence.
• Phonology is the study of the underlying knowledge of rules of a sound system in language. This component of language describes the rules of sounds and sound systems. Meaning, how sounds come together to form meaningful words (phoneme) and the rules of which sounds do not form meaningful words. For an example, p-l-a-y becomes play, z-w-e-d would not be a word due to the rule that /z/ and /w/ are not two sounds that come together to form a meaningful word.
• Semantics is the meaning conveyed by words, phrases and sentences. This component includes areas such as word knowledge and world knowledge, and vocabulary.
• Pragmatics is the understanding and use of language in a social context. This includes the ability to use appropriate language in a communicative and social setting and understanding the social rules. Examples of pragmatics are turn taking, eye contact, topic maintenance, and sequencing sentences logically.

Normal language development relies on the child’s ability to bring innate characteristics to the situation, the child’s environment, and cultural expectations. The language that is spoken at home and cultural forms may influence the way we communicate. caregiver plays a very important role that contributes to

*REMEMBER: every child is unique, and no individual that will develop the in the same ways and at the same times. Use this information as a guide to understand what you should expect your child’s language to be.

Birth – 3 months

• Displays startle response to loud sound
• Visually tracks, or moves eyes, to source of sound
• Attends to and turns head toward voice; turns toward sound source
• Smiles reflexively
• Cries for assistance
• Quiets when picked up
• Ceases activity or coos back when person talks (by 2 months)
• Produces predominantly vowels

4 – 6 months

• responds by raising arms when mother says ‘come here’, and reaches toward child (by 6 months)
• moves or looks toward family members when they are named (‘where’s daddy’)
• explores the vocal mechanism through vocal play such as growling, squealing, yelling, making ‘raspberries’
• begins to produce adult-like vowels
• beings marginal babbling; produces double syllables (‘baba’), puts lips together for /m/
• varies pitch of vocalizations
• responds to name (5 months)
• vocalizes pleasure and displeasure
• varies volume, pitch, and rate of vocalizations

7 – 9 months

• looks at come common objects when the object’s names are spoken
• comprehends ‘no’
• begins to use some gestural language; plays pat-a-cake, peek-a-boo, shakes head for ‘no’
• uses a wide variety of sound combinations
• uses inflected vocal play, intonation patterns
• imitates intonation and speech sound of others (by 9 months)
• uses variegated babbling (‘mabamaba’ – at approximately 9 months)
• uncovers hidden toy (beginning of object permanence)

10 – 12 months

• understands up to 10 words, such as, no, bye-bye, pat-a-cake, hot; understands on simple direction like ‘sit down’, especially when command is accompanied by gesture.
• Begins to relate symbol and object; uses first true word
• Gives block, toy, or object upon request
• Obeys some commands
• Understands and follows simple directions regarding body action
• Looks in correct place for hidden toys (object permanence)
• Turns head instantly to own name
• Gestures or vocalizes to indicate wants and needs
• Jabbers loudly; uses wide variety of sounds and intonations; varies pitch when vocalizing
• Uses all consonant and vowel sounds in vocal play
• Establishes joint reference – the ability to focus attention on an even or object as directed by another person.

1 – 2 Years

• Syntax:
  • The child uses one-word sentences
  • Average MLU = 1.0 – 2.0
  • The child uses sentence-like words; communicates relationships by using one word plus vocal and bodily cues. The sentence-like word can serve several functions:
  • Between approximately 18-24 months of age, children begin to put two words together.
  • The child may use 3- or 4-word responses at two years
  • A child combines 3- and 4-word utterances about 50% of the time; the other 50% of the time, the child uses 2-word utterances (at 24 months)
  • Near 24 months of age, the child uses ‘and’ to form a conjoined sentence.
  • Approximately 51% of the child’s utterances consist of nouns.
• Semantics:
  • The child uses 3-20 words and uses gestures; around 18 months, the child produces 10-50 words.
  • The child shows understanding of some words and simple commands; understand ‘no’; around 18 months, child understands about 200 words.
  • The child uses cause-effect relationships
  • The child also exhibits the following during this period:
    • Uses overextension
    • Answers the question “what is this?”; responds to yes/no questions by nodding or shaking head
    • Says “all gone” (emerging negation)
    • Follows one-step commands or simple directions accompanied by gestures (give mommy the spoon)
    • Follows directions using one or two spatial concepts such as in or on (19-24 months)
    • Points to one to five body parts on command; points to recognized objects (emerging nomination)
  • Pragmatics
    • The child uses verbal and nonverbal communication to control the behaviors of others, satisfy needs and wants, interact with others, express emotions or interest, imagine, inform, and explore and categorize.
    • Presuppositions emerge; between 1 and 2 years of age, the child uses expressions that have shared meaning for the listener and speaker.
    • The child begins to understand some rules of dialogue, ‘when someone talks, you need to listen’ – the child is able to take the role of both speaker and listener.
    • The child uses nonverbal as well as verbal communication to signal intent.
    • Dore (1975) focused on the 12-24 month period in which children use early words to signal communicative intent, focusing more on the children’s intentions and less on listeners’ reactions:
      • Practicing (language)
      • Protesting (‘no’ and resisting)
      • Greeting (‘hi grandma!’ as grandma comes in the door)
      • Calling/addressing (‘mommy’)
      • Requesting actions (says ‘juice’ to get juice)
      • Requesting an answer (‘Cow?’)
      • Labeling
      • Repeating/imitating
      • Answering (adult: ‘what is this?’ child: ‘bottle’)

2-3 years

• Syntax
  • Uses word combinations; has beginning phrase and sentence structure
  • Has an average MLU of 2.0 – 4.0; at 36 months, sentences often average 3-4 words.
  • Combines 3-4 words in subject-verb-object format (‘daddy throw ball’)
  • Uses incomplete sentences; word order is often object-verb (‘doggy sit’), verb-object (‘push Barbie’), subject-verb.
  • Asks wh-questions and yes/no questions
  • Expresses negation by adding ‘no’ or ‘not’ in front of verbs (me not do it; he no bite)
• Semantics
  • Comprehension usually precedes production – at 30 months the child comprehends up to 2,400 words
  • At 36 months, the child comprehends up to 3,600 words
  • Expressive vocabulary is 200-600 words; average is 425 words at 30 months.
  • Meanings seem to be learned in sequence: objects, events, actions, adjectives, adverbs, spatial concepts, temporal (time) concepts.
  • First pronouns used are self-referents such as I and me.
  • Answers simple wh-questions; understands questions; begins asking wh-questions of adults (30 months)
  • Can identify simple body parts
  • Understands plurals
• Morphology
  • Develops inflections such as –ing, spatial prepositions in and on, plurals, possessives, articles, and pronouns.
  • Develops simple, irregular past tense (went)
  • Develops is plus adjective (that is pretty)
  • Develops regular past tense verbs (walked)
  • Over-regularizes past tense inflections (goed, throwed, falled)
  • Over-regularizes plural morphemes (feets, mouses)
  • Uses some memorized contractions such as don’t, can’t, it’s, that’s
• Pragmatics
  • The child’s utterances, although occasionally egocentric, generally have a communicative intent.
  • The child demonstrates rapid topic shifts; a 3-year-old can sustain a topic of conversation only about 20% of the time.
  • Communication includes criticism, commands, requests, threats, questions, and answers
  • Interpersonal communication expands; the child learns to adopt a role to express his own opinions and personality.

3-4 years

• Syntax
  • Learns set of clause-connecting devices, including coordination (‘and’) and subordination (‘because’), and uses then in sentences.
  • Begins using tag questions (‘you want to go, don’t you?’)
  • Begins using passive voice (‘she’s been bitten by a dog’)
  • Uses mostly complete sentences; at 48 months (4 years), sentences average 5 – 5.5 words per utterance; MLU is approximately 3.0 – 5.0
  • Uses mostly nouns, verbs, and personal pronouns
  • Acquires do insertions and ability to make transformations (‘does the kitty run around?’)
  • Uses negation in speech (‘Timmy can’t swim.’)
  • Begins using complex and compound sentences (‘I can sing and dance.’)
    • 7% of sentences are compound or complex
  • Semantics
    • Comprehends up to 4,200 words by 42 months (3.5 years); at 48 months, comprehends up to 5,600 words.
    • Uses 900-1000 words expressively
    • Asks how, why, and when questions
    • Understands some common opposites (day, night; little, big; fast, slow)
    • Labels most things in the environment
    • Relates experiences and tells about activities in sequential order
    • Can recite a poem from memory or sing a song (48 months)
    • Uses pronouns you, they, us, and them, as well as others such as I and me.
    • Understands concepts such as heavy, light; empty, full; more, less; around, in front of
    • Supplies last word of sentence (the apple is on the ____) (closure)
    • Appropriately answers ‘what if’ questions (by 43-48 months) (what would you do if you fell down?)
  • Morphology
    • Uses irregular plural forms (children, mice, feet)
    • Uses third person singular, present tense (he runs)
    • Consistently uses simple (regular) past and present progressives (is running) and negatives (not)
    • Uses simple (regular) plural forms correctly (boys, houses, lights)
    • Begins to use is at the beginning of questions
    • Uses and as a conjunction
    • Uses is, are, and am in sentences
    • Uses possessive markers consistently (by 43-48 months)
    • Begins to use reflexive pronoun myself (by 43-48 months)
    • Begins to use conjunction because (by 43-48 months)
  • Pragmatics
    • Can maintain conversation without losing track of topic
    • Begins to modify speech to age of listener
    • Uses requesting (yes/no questions, wh-questions)
    • Responds with structures such as yes, no, because; expresses agreement or denial (‘that’s not really her dress’), compliance or refusal (“I won’t take a bath’)
    • Uses conversational devices
      • Boundary markers such as hi, bye – indicate beginning, end of communication
      • Calls such as “Hey mommy!”
      • Accompaniments such as “here you are”
      • Politeness markers such as please, thanks
    • Uses communicative functions
      • Role playing, fantasies
      • Protests/objections such as ‘Don’t touch that!’
      • Jokes such as ‘I threw the juice in the ceiling!’
      • Game markers such as ‘You have to catch me!’
      • Claims such as ‘I’m first!’
      • Warnings such as ‘look out or you’ll fall!’
      • Teases such as ‘You can’t have this!’

 

Source: Roseberry-McKibbin, C., & Hegde, M. (2016). An Advanced Review of Speech-Language Pathology. Austin, TX: Pro-ed.

Source: ASHA.org

-Lauren LaGreca, M.A, CF-SLP

 

 

 

 

 

 

Read Aloud 15 MINUTES

Read Aloud 15 MINUTES is a non-profit organization that is working to make reading aloud every day for at least 15 minutes the new standard in child care. This organization makes direct connections between reading aloud to a child from birth to the level of readiness to learn in kindergarten, the necessary literacy skills to succeed in school and the ability to have a productive and meaningful life after school.

Quick Facts:

• More than 1 in 3 children arrive at kindergarten without the skills necessary for lifetime learning.
• More than 15% of young children, 3.1 million, are read to by family members fewer than 3 times a week.
• Only 48% of young children in this country are read to each day.
• Reading 15 minutes every day for 5 years is equivalent to 27,375 minutes and 456.25 hours.

Reading aloud has a direct impact on language development, instilling a love of reading, knowledge gained and shared, literacy skill building, brain development and bonding. The number of words within a child’s lexicon upon entering kindergarten is a key predictor of their future success. When a parent or loved one reads to their child, it demonstrates the importance and value of reading as well as the enjoyment. Books can be enjoyable as well as informative in which children can learn something new each time they are read to. Reading aloud builds several literacy skills, including vocabulary, phonics, familiarity with the printed word, storytelling and comprehension. Furthermore, the critical years in the development of language skills are from birth until age 3. Lastly, reading aloud provides a great opportunity for bonding between the child and the loved one as it can be their own special routine.

Takeaway:

If you are treating a client under the age of 5, begin to tell their parents and caregivers the importance of reading aloud to their child for at least 15 minutes each day. It can make a world of difference!

 

SOURCE:  https://www.asha.org/News/2017/ASHA-and-Read-Aloud-15-MINUTES-Announce-New-Go-To-Resource-for-Parents-of-Young-Children/

-Rebecca Hipp M.A., CF-SLP, TSSLD

Better Speech and Hearing Month!

The American Speech-Language-Hearing Association (ASHA) designates the month of May as “Better Speech and Hearing Month!” Usually during this time of year Speech-Language Pathologists (SLPs) and Audiologists come together for workshops and conferences. It is also the time of the year to increase awareness of the field of Speech-Language Pathology within the community.

History of the Profession:

The need for specialists to work with individuals who presented with disorders of speech was identified in the 1920’s. “Speech correctionists”, as they were formerly referenced, were not introduced into the school system until the 1950’s. The beginning of the field revolved around articulation but as the years past the field has grown to include voice, fluency, language, dysphagia, accent reduction, acquisition and oral-motor evaluations and treatments. Speech-Language Pathologists are now amply present in not only schools but also hospitals, rehabilitation facilities and private practices.

Education and Certification:

There are four professional terms associated with individuals who work in the field of speech therapy, “Speech Correctionist”, “Speech Therapist”, “Speech-Language Pathologist” or “Speech Pathologist” and “Speech-Language Specialist”. Although these terms are often used interchangeably, they actually mean different things. In the 1950’s, a person would receive a Bachelor of Arts (B.A.) in Speech Correction. The requirements for the teaching certificate then changed in the 1980’s to what they are now. In order to work in most schools, an SLP must obtain a “Speech-Language Specialist” or “Speech-Language Pathologist” certificate. This requires a master’s degree (M.A. or M.S.) and approximately 300 clinical hours in diagnostics and interventions. The masters program for Speech-Language Pathology combines science, education, medicine, and psychology. Most graduate programs require 40-60 graduate credits, in addition to several clinical internships. SLPs may also be registered to obtain two additional certificates: The Certificate of Clinical Competence (CCC) and a state license. The CCCs are issued when the SLP completes a masters degree, 375 hours of supervised clinical hours in communication disorders and therapy, a passing score on the ASHA exam, and completion of a Clinical Fellowship Year (CFY). However, state license requirements vary.

Scope of Practice:

If an SLP is in a school-based program they are most likely going to focus on articulation therapy, voice therapy, stuttering therapy, language therapy, group language lessons, sign language programs, speech reading programs, speech and language evaluations and hearing screenings. If an SLP is in a rehabilitative program they are most likely going to focus on dysphagia therapy, videofloroscopy studies, laryngectomy patients, closed head injury, stroke and trauma, Alzheimer’s patients, cleft palate, speech and language testing and hearing screenings.

SOURCE: Super Duper Handy Handout #19

Click to access 19_Celebrate_Better_Speech.pdf

-Rebecca Hipp M.A. CF-SLP, TSSLD

Talking To Loved Ones With Dementia

Communicating with loved ones who have Alzheimer’s disease, another dementia or memory loss can be challenging if not frustrating for both communicative partners. However, there are three common tips to remember when presented with speech and communication issues.

• Ensure that the attention of your loved one is not only on you but on the current topic. Some of the frustration and confusion can be reduced simply by ensuring that you have your loved ones attention before communicating with them. This can be done by sitting in close proximity, preferably directly in front of them, exuding proper body language by facing them and not only making eye contact but maintaining it as well. Alzheimer’s disease impacts an individual’s peripheral vision, so standing slightly to the side can be significantly detrimental to their focus or attention as they may no longer see you. Additionally, don’t assume that even if you are in their field of vision that they are actually looking at you, eye contact is still imperative.
• Continue to maintain the attention of your loved one as people living with Alzheimer’s disease present with difficulty concentrating. This can be done by continuously stating your loved ones name and waiting for them to respond before continuing with the conversation. Another helpful tip is to use simpler sentences along with a slower rate of speech. Additionally, try to decrease the amount of questions and/or options presented to them within one conversational exchange and if a decision needs to be made try to limit the choices to two or else communication may be hindered.
• Another way to decrease the demands placed on your loved one is by not putting them on the spot which a memory, which can unwittingly create anxiety for individual’s with Alzheimer’s disease. To someone who presents with dementia, it can feel as though they are being tested on something they do not know the answers to, which could potentially be setting them up to feel embarrassed or ashamed. Although Alzheimer’s disease and other forms of dementia impact several speech and language areas, it does not cause individuals to forget how to feel emotions. Although these may be well-meaning questions, try to reword them in a way that is much less likely to create anxiety or confusion, which significantly increases the likelihood of a positive experience for the person with dementia.

SOURCE: http://www.alzheimersweekly.com/2016/10/3-ways-to-talk-to-dementia.html

-Rebecca Hipp M.A., CF-SLP, TSSLD