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

https://www.superduperinc.com/handouts/pdf/19_Celebrate_Better_Speech.pdf

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

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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

Impacts of Seasonal Allergies on Speech and Hearing

Seasonal allergies can severely affect speech and language development. Several children who present with speech or voice disorders will also suffer from allergic rhinitis and/or asthma. Allergies interfere with the nasal passage and cause congestion, which further compromises auditory acuity and perception therefore interfering with production and intelligibility. Asthma is a condition in which an individual’s airway becomes inflamed, thus causing them to narrow and swell making it difficult to breath. It is important to note, both of these conditions result in inflammation and swelling of the airways, and when the nasal tissue becomes inflamed, the voice is affected. The impacted voice, including irritated vocal cords due to frequent clearing of the throat from increased nasal drainage, can result in improper articulation. Additionally, children who present with severe congestion often breathe through their mouth and young children who utilize this breathing pattern frequently may create a habit of a perpetually opened mouth with a protruding tongue. This posture severely impacts the quality of their speech and articulation as this behavior perpetuates lingual weakness as well as inadequate tone in other oral motor muscles. This breathing pattern is actually one of the possible causes of orofacial myofunctional disorder  (OMD), which is commonly referred to as a “tongue thrust”, resulting in the improper articulation of the sounds “t”, “d”, “n”, “s”, “z”, “l”, “sh”, “ch” and “j”.

Seasonal allergies can not only affect articulation and vocal quality, but also hearing as well. In addition to congestion, allergies can cause ear infections secondary to fluid in the middle ear space. Ear infections with concomitant fluid in the middle ear space are known to create a temporary conductive hearing loss, which can negatively impact a child’s ability to recognize, discriminate, and produce phonemes. When the Eustachian tube becomes clogged, children experience pain or pressure in the ears, along with reduced ability to hear. Hearing loss from ear infections is usually temporary and can be resolved with treatment prescribed by a medical professional. However, children with allergies may suffer from more frequent ear infections and may experience a more severe impact on hearing. Hearing is critical for speech and language development as if a child cannot hear, it interferes with their ability to understand language or discriminate sounds as they may not be able to hear softer, high-frequency sounds, causing them to mispronounce the sound.

There are certain signs and symptoms that may show that a child is presenting with seasonal allergies. These include constant runny nose, excessive sneezing or coughing, watery eyes, dark circles under the eyes and/or itchy eyes or nose. Additionally, the child may complain that their mouth or throat feels itchy when eating certain fruits or vegetables, such as bananas, cucumbers and melons, which is called oral allergy syndrome (OAS) and often occurs in those who are allergic to ragweed. It is important to have the child fully diagnosed by a medical professional to ensure these symptoms are secondary to allergies and not a cold.

Luckily, allergies are treatable and may only require an over-the-counter medication or an antihistamine nasal spray that can be used daily and improve quality of life immediately for the child. It is also important to evaluate the child’s environment to find ways to reduce possible allergens at home. This includes keeping the windows closed, acquiring an air purifier, and encouraging hand or body washing immediately after playing outside.

SOURCE: https://www.speechbuddy.com/blog/language-development/seasonal-allergies-and-speech-issues/

 – Rebecca Hipp M.A., CF-SLP, TSSLD

 

Maximizing the Effectiveness of iPad Use for All Children

iPads are growing in popularity with not only children who have Autism but with children of all ages. These can be great tools as there are different ways to utilize an iPad as well as certain activities that can be used to maximize its effectiveness with regards to the specific goal being targeted. For example, iPads should be utilized in different ways whether a parent’s goal is to encourage communication with their child, accomplish daily activities with their child and/or allow their child to receive it as a reward. It is important that these distinctions are made to eliminate any confusion the child might have with regards to the expectations they may have for the iPad. Here are some suggestions for each specified use for the iPad:

  1. Encouraging Communication
  • Look for apps that include pictures and photographs and simultaneously provide the verbal label as the image is chosen. Keep an eye out for apps that allow the number of pictures displayed to be controlled along with personalization of categories.
  • Use the iPad to make requests. Model making a request via the iPad by touching the desired object that the child is asking for, repeat the label for the item then immediately give the child the item. For example, if your child is asking for juice then press the iPad symbol for juice, say “juice” and then hand your child the juice. Additionally, any time your child tries to imitate, approximate or spontaneously say the target word reward them immediately with the requested item. Continue working with as many items as possible as this will not only help the child learn to associate pictures with objects but it will also increase their vocabulary. Try starting with a field of one to two items and as the child learns how to use the iPad appropriately begin increasing the field to more pictures on the screen at one time. Once the child is successfully requesting items via the iPad, try introducing comments about objects via the iPad as well.
  • TIP: If the main purpose for the iPad is to teach language then it is important to avoid putting games on it until the child is consistently communicating, otherwise, they may escape out of the program and instead try to open the games. It is also important that the iPad is available at all times if the primary use is communication as the child’s voice should not be taken away. Lastly, communication between the parent and the child’s therapist and/or teacher is key to increasing generalization for the iPad.
  1. Accomplishing Daily Activities
  • Several apps exist that provide support for daily activities and routines through schedules along with visual aids.
  • A schedule can be kept on the iPad with reminders that show when it is time for the next activity to decrease difficulty and/or anxiety with transitions. Additionally, visual schedules can be utilized that lay out all of the activities the child will engage in that day and in the exact order that they will occur to aid in transitions as well. Visuals also allow the child to stay focused on the task at hand as they understand that the previous activity has finished and they know what to expect next.
  • Steps for daily activities that the child may demonstrate difficulty with can be kept on the iPad, such as brushing teeth, getting dressed, cleaning room, etc. The steps can include pictures/visuals with each step for the child to follow along with the help increase independence.
  1. Rewarding with the iPad
  • iPads are a great motivational tool as there is a never ending list of fun and engaging games for children of all ages. However, apps can be chosen in a way that not only benefits the child recreationally but functionally as well.
  • When utilizing the iPad as a reward system, try choosing a behavior to be targeted that is appropriate for the child’s skill level. Some examples include sharing, being respectful to family members and independently getting ready for school or bed.
  • Instead of targeting a behavior as a whole right away, try breaking the behavioral down into smaller ones that can be rewarded. For example, if the goal behavior is to share, the behavior can be broken down by rewarding the child for every minute they have not taken a toy out of someone else’s hands. The demands can be increased to two minutes then five minutes before getting the iPad. Once this is consistent the child must also give their own toys to another individual to play with for the entirety of the activity prior to playing with the iPad. If the behavior was getting ready for school, start with one task and continue adding more over time.
  • Ensure that the reward system is consistent and that the child understands exactly what is expected of them in order to receive the iPad. The child should not only receive the iPad every time the specified behavior is accomplished, but the child should also not receive the iPad at other times for different reasons. Over time more behaviors can be targeted in which the child can earn time on the iPad.

 

SOURCE: https://www.autismspeaks.org/family-services/technology/maximizing-use-ipad

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

Signs, Symptoms, and Potential Causes of Pediatric Dysphagia

Possible Signs of a Feeding/Swallowing Disorder

  • Refusing to eat
  • Eating very little for a prolonged period of time
  • Spitting out food
  • Frequent coughing or throat clearing during or soon
    after eating
  • Excessive drooling
  • Food leaking from mouth
  • Refusing to eat certain textures or temperatures of
    food
  • A “wet” or “gurgly” sounding voice or cry after
    eating
  • Excessive spitting up or vomiting after eating

Reflux

  • Occurs when the contents of the stomach, including the stomach acid,
    return to the esophagus.
  • Can occur when eating or drinking but also when there is any kind of
    change in intra-abdominal pressure
  • Some symptoms of children with GERD may include:
    • Vomiting
    •  Coughing, gagging, or choking
    • Exhibit abnormal postures
    • Unexplained irritability
    • Failure to Thrive
    • Weight below the 3rd percentile for age
    • Organic, non-organic or mixed etiology
    •  Organic causes include endocrine deficiencies, chronic disease,
      enzyme defects or congenital/genetic anomalies or oral-motor
      dysfunction
    • Non-organic causes include poor caregiver-child interaction, psychosocial
      issues, environmental deprivation, child abuse and poor feeding
      practices
    •  Factors related to caregiver-centered FTT include lack of nutritional
      information, improper feeding techniques, unrealistic expectations
      about feeding, inability to accurately assess the child’s needs, neglect
      and isolation

Aspiration

  • Occurs when food travels into the airway instead of into the stomach
  • Often suspected by observation of coughing, wet voice, throat
    clearing, or diagnosis of pneumonia
  • Aspiration may be seen on different textures so a child could be
    perfectly safe eating purees and solids but aspirate on thin liquids
  • If you suspect aspiration, contact your pediatrician to discuss the
    possibility of a swallowing evaluation

Sensory Issues

  • Reactive Sensory Defensiveness can occur when an infant has not
    received positive sensory input to the mouth
  •  When sensory input is provided, it may be experienced as very strong
    and uncomfortable
  • Primary Sensory Defensiveness to facial and oral stimulation occur
    as a primary difficulty in some children
  • Child’s basic perception is one of danger, and the sensory stimulus is
    often perceived as an attack
  • Not based on some past, negative experience
  • May occur as a response to touch, movement, smell, taste, and texture
    in food
  •  Eating Aversion is the result of a complex interplay of sensorimotor,
    gastrointestinal, and environmental responses
  • Typically perceived as a behavioral issue
  • Many of these children have subtle sensorimotor and gastrointestinal
    issues that make eating uncomfortable
  • These children may choose a non-eating behavior to reduce or
    prevent discomfort

SOURCE: ASHA

-Sharon P. M.S. CF-SLP TSSLD

Spatial Concepts and Relationships – Early Skills with Preschoolers

Spatial concepts (a category of basic concepts) define the relationship between us and objects, as well as the relationships of objects to each other. As our language begins to develop, early spatial concepts such as in front of, behind, top, bottom, over, under, last, between, farthest, backward, in, on, etc., help us understand directions more precisely, ask detailed questions, and express our ideas to others. For preschoolers and young students, an awareness or understanding of spatial concepts and relationships usually predicts later success in math, reading, and following directions. Parents and preschool educators should begin teaching spatial concepts to children at a very early age. At age two, children are already absorbing, learning, and rapidly developing their vocabularies. They are beginning to understand the concepts of space in their environment; they are moving, touching, talking, and beginning to ask questions. This is the perfect time to immerse them in language that fosters their understanding of spatial relationships between their bodies and the objects in their environment. We ask toddlers, “Where is your nose?” They point to their nose. We follow up with different concept phrases like, “Your nose is on your face,” “Your nose is above your lips,” “Your nose is on the front of your head.” This type of response embeds concept words—expanding on and making them a regular part of language. Using concepts in “teachable moments” helps children understand, and later generalize, the concepts for further learning. I Spy and I See are examples of games that can use spatial concepts in a fun way. For example, “I see a book. Where is it?” When the child finds or points to it, an adult responds with, “The book is on the shelf…in the book bag… under the table… by the bed… above the table… beside the chair.”

In therapy I like to play “I Spy”. “I spy a big, green book! I spy a little, square pillow. I spy a red, round ornament with a crooked hook.” It is easy to include concepts while interacting with your child by talking in great detail and description. For example, a mother may tell her kindergarten child, “Take off your coat and boots. Hang your blue coat in the closet on the little hook above the doorknob. Put your red boots on the rubber mat by the door. Now lie down and rest beside your dad before we have dinner.” In just a few seconds, this child must listen to over ten concepts, make sense of them, and then follow through with the directions. Think of all of the verbal directions a teacher gives each student every day at school. Spatial concepts, along with other basic concepts, are essential for success in school and daily activities at home.

Source: Superduper Publications

 

Sharon P. M.S. CF-SLP TSSLD

Helpful Strategies for Auditory Memory

Memory impacts a person’s ability to perform almost any activity. Memory is how
“knowledge is encoded, stored, and later retrieved” (Kandell, Schwartz, and Jessell, 2000).
Even mild memory deficits can impact a student’s success. There are different kinds of
memory, including long-term memory, short-term memory, working memory, auditory
memory, and visual memory. Auditory memory is the ability to take in information that is
presented orally (out loud), process it, retain it in one’s mind, and then recall it (Bellis, 2003;
Roeser & Downs, 2004; Stredler-Brown & Johnson, 2004). Auditory memory requires
working memory.
Working memory is “the management, manipulation, and transformation of
information drawn from short-term memory and long-term memory” (Dehn, 2008). Working
memory is responsible for processing higher level linguistic information, and if the task is
more complex, working memory spends more time processing (Daneman and Carpenter,
1980). Working memory capacity has significant relationships with reading decoding,
language comprehension, spelling, following directions, vocabulary development, note
taking, and GPA (Engle, Tuholski, Laughlin, and Conway, 1999).

Auditory Memory Deficits
Auditory memory deficits include remembering multi-step directions, relating new
information to prior knowledge, oral language comprehension, taking notes while listening,
verbal fluid reasoning, written expression, and oral expression (Dehn, 2008). Individuals with
deficits and weaknesses can benefit from direct teaching of strategies which can improve
working memory performance. According to Dehn (2008), effective strategy teaching
can include:
• Engaging in one-on-one brief, focused sessions over several weeks;
• Teaching one strategy at a time;
• Explaining purpose and rationale;
• Explaining and modeling the steps of the strategy;
• Providing plenty of practice and offering feedback;
• Teaching cues to help remember the strategy;
• Providing positive reinforcement and data tracking;
• Encouraging children to monitor and evaluate strategy use;
• Encouraging generalization across sessions.

Types of Auditory Memory Strategies
Different types of auditory memory strategies include:
• Verbal Rehearsal – repeating words or numbers, either vocally or subvocally
(e.g., Try saying the numbers over and over, like this: 2, 7, 5; 2, 7, 5; 2, 7, 5.);
• Elaborative Rehearsal – associating new information with prior
knowledge, such as creating sentences of the to-be-remembered word
or creating a story, or paraphrasing [reorganizing larger amounts of
information into smaller, more personally meaningful units (Donahue
& Pidek, 1993)];
• Chunking – pairing, clustering, grouping, or association of different items into larger
units (e.g., Try putting the numbers together. So if you hear 2, 4, 8, 3—think 24, 83.);
• Relational Strategies – making the information being memorized more meaningful
through mnemonics, imagery, or elaboration (e.g., Try to make a simple sentence
using the words you hear. If you hear dog, hat, bed, make a silly sentence like, “The
dog found a hat under the bed.”).

SOURCE: SuperDuper Publications

-Sharon P. M.S. CF-SLP TSSLD