(photo credit: sound waves via Bigstock)
Ah, the familiar sounds of rustling papers, fast paced walks from meeting to meeting room, and that all too common groan, a mixture of frustration and exhaustion in equal parts, remind me that it is that time of year in the schools. It is “IEP season”.
In honor of the countless hours of reassessment, data collection, and paperwork completion you will be doing over the next few months, I thought I’d write a post to help out those of you who are once again, hitting the keyboards and staring at that blank section on your IEP. You know the one I’m talking about. You spend a lot of time thinking about it only after all the data and classroom observations are compiled. You know it needs to be completed but after writing your student’s present level of performance, his goals and objects and of course his service time, who has the energy left to even think about classroom accommodations and modifications. Well that is where I step in, at least for those of you who have students with hearing loss on your caseloads.
Last year at this time I had a few students with hearing loss managed with both hearing aids and cochlear implant (CI) on my caseload. As a multidisciplinary team, we had to do some research to find appropriate accommodations and modifications for those students. However, I recently read the book Children with Hearing Loss: Developing Listening and Talking Birth to Six, by Elizabeth Cole and Carol Flexer which provided some clinically useful information on the specific deficits a child with hearing loss might have in the classroom setting. I wish I had read this last year while I was struggling with the multidisciplinary team to write an appropriate IEP. But now that I found this information, I thought I would adapt parts of it and compile that information into a table for quick reference in the future.
The accommodations and modifications in the graphic below are suggestions of possibilities you may attempt to provide for your students. This is by no means an exhaustive list nor would every student benefit from each suggestion. Therefore, I recommend you use this list as a guide only while working collaboratively with your multidisciplinary team to determine appropriate accommodations and modifications for each student on an individual basis.
You will notice that the first accommodation for any hearing loss is the use of an FM system alone or in conjunction with auditory management (e.g. hearing aids, cochlear implant, other technology). Research has shown the use of individual FM systems positively impact students with hearing loss of any severity level AND that classroom or sound field FM systems benefit ALL students. One can’t help but wonder how different a student’s behavior would be in a classroom where the speech to noise ratio was in fact the recommended +15-20 dB rather than the typical +4 dB (Cole, Flexer 2007). That is why the recommendation of an FM system is first as it is not only practical but very beneficial even for a child with very mild hearing loss.
Here are the levels of severity, classroom difficulties and possible accommodations and modifications for children with hearing loss.
You can download your copy of the above materials here.
I hope these materials help guide you and your multidisciplinary team when writing IEPs for your students with hearing loss. Do you have additional modifications or accommodations you would add to this list? Let us know by commenting below.
Thanks for stopping by and reading our second installment of Kid Confidential. If you have any topics you would like us to discuss here, feel free to share. You just might see your topic suggestion in one of the upcoming columns. I’ll meet you back here on the second Thursday of next month.
Until then, remember, knowledge is power, so let’s keep learning!
- Cole, Elizabeth, and Carol Flexer. Classroom Accommodations for Students with Hearing Impairment. San Diego, CA: Plural Publishing, Inc., 2007. Print
- Program, Deaf-Blind. Classroom Accommodations for Students with Hearing Impairment. N.d. PDF. usd.edu, Sioux City, SD. Web. 22 Feb 2013. <>.
- Hall, Heather. Accommodations and Modifications for Students with Hearing Loss. N.d. PowerPoint Presentation. wikispaces.com. Web. 22 Feb 2013.
Maria Del Duca, MS, CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona. She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name. Maria received her master’s degree from Bloomsburg University of Pennsylvania. She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues. She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ. Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech. For more information, visit her blog or find her on Facebook.
Recently I walked through a speech clinic of the near future. You might expect that the examination rooms of this clinic would be stocked with high-powered flexible endoscopes, that would allow one to see with stunning detail oral, laryngeal and pharyngeal structures. You might also look around for powerful tablets and smartphones and high-fidelity digital audio speakers, to provide crystal clear reproductions of a person’s speech output. Today’s communication sciences and disorders (CSD) professional is rapidly reformatting current practice models, with wholesale changes for third party reimbursement occurring as this blog is written. But instead of the high technology fittings of a large scale speech clinic, this speech clinic of the near future has barely changed, but for shelves that contain a number of prevention products. The CSD professional encounters something new but also something old, when introducing prevention activities into a clinical practice. What is prevention to a CSD professional? How futuristic is the push to include prevention as a CSD product line? Can most CSD practices absorb prevention into their business models?
When the American Speech-Language-Hearing Association (ASHA) advocated for prevention of disorders of communication, cognition and swallowing in its 1987 position paper, a slow-rolling but persistently accelerating snowball had been born. Prevention of communication* disorders, on the one hand, seems a radically divergent activity from traditional clinical practice for many speech-language pathologists and audiologists. “You mean I have to not only work with my patients to help them improve, but I also have to help change the world so I have fewer patients?” Exactly. That’s it. On the other hand, prevention is set firmly within the foundation of ASHA practice patterns. Prevention may in the short term help some in your community forestall the need for treatment. It will also in the long term bring more persons in need to the CSD professional’s door.
With primary prevention, the CSD professional attempts to reduce or eliminate conditions that may bring about a communication disorder. You do this through either altering a person’s susceptibility to a condition (if I am exposed, what are the odds I will stay healthy?), or reducing the degree of exposure (should I simply avoid the risk in order to stay healthy?) that makes you susceptible. An example of altering your susceptibility might be improving your speech breathing, to speak over noise you encounter while working at a busy restaurant. The same restaurant worker may, in turn, reduce exposure by changing her or his work schedule to rest the voice.
Primary prevention appears the most alien of the prevention concepts to CSD professionals. After all, most of us stop considering a new product line when there is no reimbursement for it! And it’s not testing or treatment, but – but – it’s selling or teaching stuff, to people who may not have impairments. Can I teach healthy people things that may head off their becoming disabled? Can I sell things, and keep track of sales taxes? Yes, we can. If we are willing to lurch out of our comfort zones as clinicians, there may be tremendous return on investment with the increased community visibility we gain as health promotion professionals. So, how do we do primary prevention in CSD? What is the stuff of it? What are the outcomes we want?
On the primary prevention shelves of this near future clinic, I saw tools that included:
I. Oral-motor/motor speech:
- Mouth Sounds, by Fred Newman @ $10
- The Speech Choir: With American Ballads and English Poetry for Choral Reading by Marjorie Gullan@ $1 (used)
- C.O. Bigelow Elixir White/Green hair and body wash @ $10
- 1 gallon of distilled water @ $1
- 1-qt Ziploc bag, containing a roll of Life Savers and a dispenser of mint waxed dental floss @ $5
- 1–qt. Ziploc bag, containing a bound supply of 1 doz. sterile tongue depressors @ $5
- Radius model ergonomic garden trowel @ $10
- GAMES magazine: single issue @ $5
VI. Speech and language:
- The New Moosewood Cookbook, by Mollie Katzen @ $10
- Walk Off Weight with Your Pedometer: A Simple 28-Day Pedometer Walking Program, by Jan Small @ $10
Readers should note that the selection of brand name products is purely coincidental by the blogger. Products have neither been trialed prior to this writing, nor are there financial or non-financial relationships between the blogger and any product company. Primary prevention products are chosen for stocking in this clinic of the near future for their relatively low price; their ready availability in the community, and their applicability to the needs of the prevention consumer. Price points are strictly ad hoc at this writing; experienced CSD practitioners will adjust the price point and product selection to a level that their customers will bear.
The sales area for primary prevention has its own entrance from street level, thereby controlling the mixing of regular clinic patients (tertiary prevention consumers) with those shopping for their CSD wellness needs. Adjacent to the sales area is a video viewing room, with four computing devices available to consumers to view demonstrations of each primary prevention product. Reading racks mounted at eye level near the viewing stations, contain fliers and magazines from community services that support and announce wellness activities on community calendars.
Let’s make sure the original questions posed are answered. To wit:
- How do we do primary prevention in CSD?
- What is the stuff of it?
- What are the outcomes we want?
Ideally, primary prevention products and activities bring your customer into your marketplace. You help them stay healthy to function in their communities, so that the probability of their entering the healthcare system to identify and treat impairments is lowered. You do primary prevention through teaching, training, referring, marketing, selling, cooperating and participating in a large network of community and supports and services for your customer. Your collaborators in primary prevention may include office managers; health educators; fitness center trainers; bodyworkers; priests, rabbis, imams and healers; drama and singing and cooking teachers; and all those who work in wellness and health promotion. Outcome measurement may be as simple a function as that of measuring the customer’s changes in both health literacy and patient “activation”, as in the Patient Activation Measure of Hibbard and colleagues. The long-term outcome desired is that community healthcare costs are ratcheted downward. The story of primary prevention in CSD is, again, being written as we walk through this near future clinic. What do you see in the clinic of the future? Time to move into the secondary prevention wing now….
*communication, cognition and swallowing.
Carey Payne, MCD, CCC-SLP, is an SLP in Elmhurst, IL. He knew nothing about speech-language pathology as a profession until he needed it as a client. He was helped at his university’s speech clinic to improve his fluency. He has helped persons of all ages in numerous work settings, for almost thirty years hence. Carey Payne is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders and 13, Swallowing and Swallowing Disorders (Dysphagia).
With daylight savings time fast approaching, I am reminded that spring is nearly upon us. For the current graduate student, spring often means comps season. It always seems to be the time that never ends, until the next thing you know, it’s three years later and you look back and marvel about the relativity of time.
One of the hardest things about any new endeavor is getting started. Everyone has to start somewhere, and much as we would prefer to think otherwise, the best place to start is at the beginning. Much as I don’t want to admit it, I hated starting at the beginning. But I did it (and I’m glad I did it), and here’s a handful of things I’ve learned so far.
You’re going to make mistakes. Embrace them, learn from them, and use them for good.
I, like many I suspect, envisioned all sorts of things going smoothly when I first started. This daydream was quickly put to rest as I realized that getting the hang of things takes time.
What’s more, sometimes the only way to really learn something is to make certain mistakes along the way. The key is to realize that you can harness a lot of knowledge from mistakes. Try to think of your clinical fellowship not as a place where you need to be perfect, but a place where it can be safe to make mistakes. Keep an open line of communication with your clinical supervisor, and be realistic about what you feel comfortable doing. Think big, but don’t be afraid about starting small.
Try a little bit of everything. You never know what might end up capturing your attention.
I spent much of graduate school being grossed out by anything related to swallowing. Still, I resigned myself to trying it out because I wanted to have some experience in every aspect of the field. While at first I was wary of what I termed the ick factor, I found that I loved working with the patients. It certainly took some time to acclimate to things I found uncomfortable, but I find myself wanting to do more so I could keep working with those patients.
Think of graduate school not as the last chance to learn everything. Think of it as the place where you’re finally given the tools you need to really learn, both in terms of actual resources as well as the capacity to make sense of them.
Half of what I learned in graduate school didn’t make sense to me until the very end. Even three years out, I’m still marveling at how pieces are slowly starting to fall into place. I find myself frequently poring over text books, reading and re-reading things and making connections for what seems like the very first time.
One thing I cherish about this field, and its practitioners, is a passion for life-long learning. I talk to colleagues about things I see with patients that challenge how I had, up until that moment, thought about things. I debate things with the #SLPeeps on Twitter. I ask questions of doctors and nurses that seem at first unrelated to speech and swallowing, but which ultimately deepen my understanding of what a patient might be experiencing.
Try not to think in cliches. That said, practice makes perfect. (Or rather, perfect-ish.)
I generally shy away from the word ‘perfect’, but find this saying apt in many ways. I started playing the guitar when I was in first grade, and the violin in fourth grade. In undergrad, I did theater for two years. In every creative avenue, I found myself in awe of what others could do, of how amazing their words or their music flowed.
I used to think of those I admired while I practiced. I wanted to be able to simply pick up my instrument, or say my lines, with as much ease and grace as them. “How nice it must be not to have to practice much,” I thought, “and to have such ease of talent.”
But I was wrong on one point. They did have talent, absolutely, but they, like me, had to practice to get there. The best way to get good at something is to do it, over and over and over again, until you become just a little bit better at it each time.
It is a journey. One filled with frustration, joy, and emotion, but one worth taking. I no longer strive for perfection, not because I don’t think it’s possible, but because I never want to stop trying to learn and grow. I always want to keep aiming to get just a little bit better every step of the way.
Phillip Guillory, MS, CCC-SLP, NIC is an SLP and certified sign language interpreter. As an SLP, he specializes in acute care and especially critical care issues. As an interpreter, he specializes in post-secondary settings as well as community and, increasingly, medical settings. Phil can frequently be found on Twitter @ProjectSLP and on his website www.ProjectSLP.com. He is an affiliate of ASHA’s Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders and Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia).
For a while there, I had no idea what “IDEA” was and “504″ could have been a building for all I knew. And then there were the word associations; “FERPA” made me think of a Sherpa, “HIPAA” of hippos and an “IEP” of the movie ET. Moving from Australia and launching a speech-language pathology career in the American school system was a completely different field to wrap my head around and I had a dilemma.
I had never worked in a school before. Apart from the acronyms, numerous vocabulary challenges and having to change my naturally accented schwa to the vowel controlled “r” to be understood, everything fell into place except for one thing: the curriculum. The ASHA website for speech pathologists working in the School Setting gave me much needed direction, so I started looking for speech-language curriculum related materials on the Internet.
Then I looked a little more.
And more again… until I gave up.
I couldn’t understand that with Pinterest, TpT stores and school-based SLP blogs inspiring many of us to don our creative hats, that there was not more school based resources out there. I couldn’t help but think “Pirates are pretty cool…. but where do pirates fit into the curriculum?” Why do speech pathology materials constantly revolving around seasons and holidays such as Valentine’s Day, winter and St Patrick’s Day? We know that our students need repetition after repetition after repetition to cement their learning, so why are we introducing our own themes and topics with new vocabulary if it will not help our student’s succeed with the language and knowledge that they are learning in their classroom?
So I want to set a challenge: Really think about the following ASHA guideline, broken into two parts for clarity:
- Individualized programs always relate to the schoolwork.
- Therefore, materials for treatment are taken from or are directly related to content from classes.
Are you doing this in your school-based practice? If the answer is “no,” then why not set yourself a challenge to be more curriculum focused? Just think that every year you could recycle and add to your language materials like our teachers do! It may be some work in the beginning but you could set yourself up for years of minimal planning and support language in the curriculum at the same time.
Here are some ideas to get you started on how you can add some more curriculum to your therapy practice:
- Ask to borrow your grade level teacher’s curriculum handbooks and get acquainted with their themes.
- Get a grasp on the Common Core Standards and investigate what skills your students should have in the areas of speaking and listening, language, writing and reading.
- Borrow your student’s grade level books from the librarian or classroom teacher and use them in therapy.
- Find the website on which your curriculum is based for online games and glossaries.
- Ask the grade level teachers for tips on where to find resources or look up their teacher site on the school website. Many teachers provide a list of related and helpful links for parents, so start searching through there.
- Contact your favorite speech pathology blogger and ask them to start making materials that are curriculum related.
So take the challenge! Change your practice and connect with your student’s curriculum.
Rebecca Visintin is an Australian trained speech-language pathologist. She is currently working in elementary and middle schools in Washington state after experience in the Australian outback and as the sole speech-language pathologist in Samoa. She provides information for SLPs working abroad and free therapy resources on her site Adventures in Speech Pathology.
My Baby Can Read…Play: How Productive Play Promotes Literacy
If you pay attention to the current toys, television shows, and materials for children like Your Baby Can Read! you should notice a cultural shift to the promotion of literacy, especially early literacy skills. From older shows such as Sesame Street and Between the Lions to newer shows such as WordGirl, WordWorld, and Super Why! we see the push for phonological awareness skills and reading skills, which encompass rhyming, letter/sound naming and identification, sound segmenting and blending, and so on.
The available research clearly shows the importance of promoting literacy skills early, and the overall consensus is that oral language provides the building blocks for literacy. So if oral language is the foundation, and if we achieve language through quality language input, how is that input provided for infants and toddlers? Through play!
Besides daily care-taking routines that parents and children engage in (feeding, grooming, sleeping), the next most important activity they engage in (where crucial language input is provided) is play.
So, if appropriate play skills predict appropriate language skills, and if strong language skills predict literacy skills, then I see a clear link between play and reading.
I’m not suggesting reading to infants and toddlers is not valid and necessary; I am suggesting that perhaps there should be a greater, or at least equal, push for promoting quality play. My meaning of play, however, is where the play partner of the child is engaging the child and providing quality language input naturally but purposefully.
In a nutshell, let’s not bypass the building block of play because we’re so concerned that children be able to read.
As a personal example, both of my toddlers love books. From the time my four-year-old daughter was one, she would quietly sit on the floor going through baskets I had set around the house full of little books, and she would flip through the pages “reading” one book after another. I often find my two-year-old son sitting in a rocking chair in his room surrounded by books “reading.” He spontaneously points out characters and talks about the pictures. His big sister also helps him out, making up stories for him based on the pictures as though she is reading…and he believes every word!
As parents, my husband and I have read to them consistently, have made sure books are readily available and accessible to them, and have encouraged them to talk about the pictures and relate what they’re seeing to experiences they’ve had, but I firmly believe their enjoyment of books would not have been fostered without purposeful play in our home.
Purposeful play is crucial in order to develop what I call the 4 C’s: Concentration (attention), Curiosity, Creativity (imagination), and family Connection (through a shared activity). These four components are extremely important for promoting reading ability.
So as professionals, educators, and parents, let’s evaluate where we’re investing our time and resources and make sure the push for early literacy doesn’t overshadow or do away with the need for consistent and quality play, not through the latest electronics or gadgets, but using good ol’ blocks, dolls, cars, toy farms, puzzles, toy kitchens, playdough…and the list goes on and on.
For purposeful play suggestions, check out free tip sheets (known as P.O.P. sheets) entitled Purposeful Ongoing Play: Enhancing Language Skills Through Play.
(This post originally appeared on The Speech Stop)
Ana Paula G. Mumy, MS, CCC-SLP, is a multilingual speech-language pathologist and the author of various continuing education courses, leveled storybooks, and instructional therapy materials for speech/language intervention. She has provided school-based services, home health care, and private services for more than 12 years and thoroughly enjoys providing resources for SLPs, educators, and parents on her website The Speech Stop.
Given our knowledge of the plasticity of the brain, are we as clinicians or caregivers, able to help to develop new links with a behavioral model, by using gradated cueing hierarchies? Could this low-tech and pharmaceutical-free form of treatment have neurologically based implications for rehabilitation and adaptation in communicatively challenging settings?
Perhaps more testing with fMRI scans may be necessary to really prove the theory. Therapy approaches using cueing models have been well documented in the literature in speech therapy treatment for aphasia. However, the way we use clinician originated cues can help create new links and expedite a broad area of cognitive and linguistic improvement, or maintain the functional status quo, unless we analyze the kinds of cues we are using and the amount of independence we are carefully eliciting from the client.
By looking at each task and cue needed on a continuum from simple to complex, concrete to abstract, you can construct a grid of where on the continuum the client functions and how you can provide a cue or help them provide their own cues for success.
The idea that the damaged axons and dendrites in the brain are looking for connections and stay active when the brain is activated, prompted me to want to create a cueing continuum (see http://carmichaellab.neurology.ucla.edu/integrated-view-neural-repair-after-stroke.) On the theory that the client can develop new pathways , if we always fill in the missing word or provide the first phoneme, then the client will never have to learn where to get it, via their own written word, for example. But how do we get from writing the word for the client to having the client write the word in the air and say it? It all depends on the residual abilities, but the concept can be applied to everyone.
We have a 60 year old gentleman with TBI who is learning how to semantically cue himself to find a word. Initially, he had severe speech and cognitive impairments. Now, in conversation, he often uses circumlocution to get his point across. However, sometimes specific words are warranted, and this is difficult for him. He can sometimes spell the word aloud even though he cannot speak it. We had him do this several times with great success. Our next task was to remind him that he could do this to help himself. Later we only asked him what he would like to do. We are helping him build those dendritic links ( and learn to use a skill) by carefully reducing the amount of clinician prompting or cueing during the sessions and writing down the strategies for him to practice at home. Although there are many approaches to cueing, none of them seem to describe cueing in a continuum from most invasive to most independent. Many clinicians describe the cues as semantic or phonemic. I found that there were nuances in cueing that I had learned over the years to allow the client to gradually become independent. When I had difficulty transmitting these ideas to my students, I created a loose continuum to mark where our clients fell given specific objectives, and how we could get their neurons to get closer together behaviorally if not actually by breaking the cues down.
Along with the goals we establish for our clients, no matter their abilities, we must always be evaluating their behavior and trying new materials and varied activities to facilitate language.
As we converse with others, we derive cues from the environment and from the people with whom we are speaking (that is part of the reason why conversation amongst the adult neurologically language-impaired looks better than when we test them by looking for specific words and longer utterances).
Our goal with cueing is to develop self-cues and elicit more language. A self-cue can be as basic as a gesture or a drawing, but if the client is doing it and communicating to me what he did for the weekend, then he has been successful. Often when the stress is lower or the focus is away from speaking, the words and incidental phrases flow more freely. The best reward is to see the expression on our client’s face when he says a few words effortlessly because he was engaged in the activity. But this is not we what we are trying to do. We are trying to give him real tools for those times he cannot utter a word.
When the client leaves the therapy room, we want him or her to be able to use their own skills, rather than rely on others. Since they may not be able to develop their own means of self-cueing, we include self-cue skill development as part of the therapy plan. The client may or may not have the ability to provide his or her own cues, yet. But throughout the therapy and rehabilitation process, we work toward the skills of self-cuing no matter the level, such as writing, gesturing, drawing pictures, and talking about the item or activity with words that are available.
The Cueing Hierarchy Continuum is by no means linear, but will generally go from simple and most dependent to complex and independent. They follow the behavioral branches that may be used in clinic therapy logs. They are separated on my behavior grid in 3 categories: Clinician Assisted Cues, Clinician prompting (or reminding the client to use a strategy) and Self Correcting. This approach requires that the client learn about his strengths and how to implement them to improve what we would consider weaknesses. By identifying which cues are more dependent, we can be cognizant of allowing the client to work at a documented realistic level achieve the objective.
It is well documented that there is enough plasticity in almost any brain to stimulate, heal and renew brain function after a stroke or TBI. For cognitive loss during normal aging, the dementias and the progressive dementias, there is less clear documentation for which approaches are the most effective and pragmatic for our clients. However, similar principles can be used to establish functional objectives along with the family and caregivers.
How to develop skills? How to develop strategies for short and long-term functional success? Sometimes, we spend the therapy session working on comprehension, word finding, writing and reading using a variety of materials. But, if we don’t address what they are learning outside the therapy room, which they may visit one or two times a week, how will compensatory skills, adaptive skills and new connections be utilized? That will be the topic for next month’s post.
Betsy C. Schreiber, MMS, CCC-SLP, received a BA in Psychology and MMS Master of Medical Science in Speech Pathology from Emory University in Atlanta, Georgia. Her CCC was earned during the 3 years she worked at Hitchcock Rehabilitation Center in Aiken, South Carolina where she had the opportunity to learn about NDT and Sensory Integration with the original, Jane Ayres, working with LD and CP children and neurologically impaired adults. She is currently a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She has also served as an ASHA Mentor and hopes to participate in ASHA’s Political Action Committee in the coming year. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders, and 18, Telepractice.
According to ASHA (2006), 1 in 10 public school speech-language pathologists have a student with dysphagia. I have to be honest; this is a struggle for me. Here’s why: while I have extensive dysphagia experience in medical and private home-based settings, I have difficulty defining my role as an SLP who provides dysphagia therapy in school.
Identifying the obstacles
ASHA has a fairly clear document describing the role of the school-based SLP in schools. However, the perceived obstacles can be daunting (Miller, 2008). The top 4 obstacles consistently come across are: Scheduling and environment, training staff, keeping the lines of communication open between family, staff and outside therapists, and getting student buy-in.
Removing the obstacles
Miller (2008) urges collaboration in treating students with dysphagia. I have the good fortune to work with many talented special educators, nurses, behavior specialists. While I bring the knowledge of dysphagia to the table (bad pun), recognizing the daily demands upon the child requires team-based attention. The following strategies may help balance your student’s dysphagia issues within the context of the school day:
Examine/modify the child’s schedule. Students have very little time to eat. Snack is usually 15 minutes (if at all) and lunch is about the same with recess either before or after. This means students risk missing academic time, social time, recess. Suddenly speech is the no fun allowed zone; staff/students become worried that therapy cuts into these activities.
To help with this let the child start eating in the cafeteria before everyone else arrives, use calming strategies such as music with headphones, or a favorite book for the child to read while he/she is eating. Bring a lunch buddy if it helps. Gradually set limits around how much music she/he can listen to. If a child is too overstimulated during lunch time (elementary cafeterias are quite an experience), have the student eat early and let them read a book or chat with friends. This allows mealtimes to be associated with positive feelings.
Training staff. Many students have a paraprofessional, who also needs to eat their lunch, but guess when their student may need the most support? During lunch, of course. Keep clear instructions and provide hands-on training for staff, give a copy to the school nurse. If there is a change in staffing, make sure the change is with a familiar person who also has training. I have staff sit in on times that are not during their break or lunch. I also encourage the student’s paraprofessional to eat with the student as to “normalize” the experience and to provide role-modeling around food. We have Fun Friday where everyone eats together and we do a fun food play activity. Again, create positive associations with eating (for staff and students!). Staff need consistent access to strategies that will keep the student calm, like this cue card, created by my colleague and co-author of The Behavior Code:
Communicate closely with families. Eating is a cultural and emotional experience. Ongoing communication with family members provides insight as to when everyone is ready to move to the next step. Clearly communicate that safety is the most important factor in the decisions related to their child’s eating. Encourage parents to come in, or take pictures and video. Use a home-communication journal so notes can go between school and home, highlighting what they ate, how much they ate, and any events that may have affected their eating.
Communicating with outside SLPs. OK, so here’s the deal. Expertise exists across settings. If I don’t do VFSS on a daily basis, I recognize that I am not an expert in that assessment tool. But if I have a background in dysphagia, have worked in schools for 11 years, have seen this student 3 times a week in their school setting for three years, guess what? I have expertise as well. I can (and should) make a referral for a VFSS by an SLP who has the skill and equipment. Likewise, private SLPs should confer with the school-based SLPs perspectives on eating. Speech-language pathologists need to reach out to one another and value these differences. These differences are a good thing (stepping off of my soapbox now….).
Make the child a part of the process. Keep it low pressure, and rewarding. Take picture of their successes and make a book about it together. Have them review the book before they eat, so they remember their successes and eating strategies. Here’s a rather crude (but effective) example of a page I wrote with my student:
Last but not least, set aside your own assumptions of what tastes/feels/smells good….these kids experience food much differently than you do. Remember, eating involves developing trust; it is not a forced process. The end goal is to make eating pleasurable and safe so that mealtime becomes enjoyable for everyone.
Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.
It is no secret; I have never been a crafty person. During my days in graduate school I struggled a lot with the fact that many of my peers were able to spend hours creating these amazing therapy activities with glue and various types of paper. Yes, I did question my ability to become a speech therapist when I saw one of my colleagues bring the cupcakes she had baked at home along with all these amazing cupcakes decorations for the session. I clearly was not capable of such a thing! Oh, and of course there are the scrap-booking SLPs! Clearly, I had no idea that SLPs had to dedicate hours preparing meals, buying scrap-booking materials and other tools for various “crafty therapy sessions”. In graduate school, I appealed to my technophile side to create my sessions around my computer. I know what you are thinking… ”What about the iPad?”. I didn’t even own an iPhone while in graduate school (and the iPad was still years from being invented). Today’s post is dedicated to all my fellow speech therapists and teachers who lack “craftiness” and want to be crafty on the iPad! Blessed be the iPad!
Here are some of my favorite apps for fun, creative, and open language based therapy sessions:
1. Art Maker by ABC’s Play School ( $0.99) – Prepositions, vocabulary and more.
This application allows you to create scenes by selecting from various background options and pieces of craft that go with the theme. You can also pick from your own photos and add various pieces of provided objects and crafting materials to your photo (see how non-crafty I am based on the photo below). The images are added to your photos. For those of you feeling a little adventurous you can even make a movie as you move the items around the screen. You can use this app for promoting language skills and vocabulary. Prepositions (put the star on her shirt, put the tree next to the dog, etc.) is also a great target to use this app for.
2. Martha Stewart Craft Studio ($4.99) – Story re-telling and sequencing in one place.
This app is worth every penny I spent on it, I just wish I had it 6 years ago! The Martha Stewart app is very easy to use and offers so many possibilities. It allowed a non-crafty person like me to create a scrapbook page! The app comes loaded with possibilities. You can take photos of the students during the session or send a letter to the parents to send some family photos with the kids for the upcoming session. It is an amazing way for working on retelling a story and it is perfect for those sessions with adults! After you create each page you can print and send it home with the child. This is by far a much more cost efficient way to do a crafting session.
3. ScrapPad- Scrapbook for iPad ( Free + buy in app) – Vocabulary & following directions at no cost.
This app is very similar to the Martha Stewart application. It has several background, stickers, borders and embellishments you can add to each page you create. Using this app can be great for vocabulary as well as for following directions. Just like the previous app, you can also save the final work onto your photos and print them when you are done.
4. Hello Cupcakes (Free + buy in app) – Great app for following directions with amazing visual support.
This fourth app is truly a helping hand for those who want to do a real life cupcake but are not as talented as most of my former co-workers. The app comes with a baking tray which gives you information on which materials you will need to create the cupcakes. This app is just phenomenal; it includes step by step photos you can use for creating each cupcake. The cupcakes can be quite elaborate but this app has so many amazing visuals and it will guide you and your students to create quite the cupcake project. This is the perfect app to guide students, especially students who can benefit from visual support, for working on following directions. The app has amazing visual details. The buy in app options offer a variety of themed cupcake options too.
It turns out that not only I can be crafty, but I love being crafty on the iPad! Should I call myself technocrafty?
Barbara Fernandes, M.S; CCC-SLP is a trilingual Speech- Language pathologist, a geek and an app developer. She is the founder and CEO of Smarty Ears Apps , a company that creates apps for speech therapy. Barbara is also the face behind GeekSLP TV, a blog and video podcast focusing on the use of technology in speech therapy. Barbara has also been a practicing speech therapist both in Brazil and in the United States. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues, 12, Augmentative and Alternative Communication, and 1, Language Learning and Education. Barbara has created over 21 applications for the mobile devices for speech therapists. Find her at GeekSLP.com or on Twitter at @geekslp.
Welcome to the first installment of Kid Confidential, a monthly column where Maria Del Duca, M.S. CCC-SLP will be discussing all topics related to speech, language and child development.
First off, let me say that I am not a researcher, I’m an observer. I’m just a clinician like you using Evidence Based Practice (EBP) and trial and error to make my way in the world of language development. I do not claim to be an expert, but I have had a hodge-podge of experiences and have worked with amazing clinicians and educators who have taught me along the way.
Through my years of experience and my constant need for information I have exhausted the minds of those with whom I have worked. I have badgered them with a barrage of questions about why and how they were doing what they were doing. Most of the time, I have found teachers and therapists willing to share their knowledge with me. So today, I’m paying it forward. Let’s talk play skills!
I don’t know about you, but upon completing graduate school I knew a whole lot about normal language acquisition, how to read, understand and review a research article, and how to administer and interpret numerous standardized tests, but I knew nothing about play skills. Of course looking back at it now, this seems a bit ridiculous when we think of the number of children on our caseloads that are younger than five years of age. But at the time, I didn’t know what I didn’t know.
Research shows us that play really is the work of a child. We understand that play skills affect cognition, pragmatics and language development. According to Pretend Play: The Magical Benefits of Role Play, by One Step Ahead:
Pretend play facilitates growth in more than just the areas mentioned above. Encouraging a child to participate in pretend play positively affects:
- Imaginative thinking and exploration
- Abstract thinking
- Problem Solving
- Life skills
- Leadership skills
- Communication development
- Social Skills development
- Use of “Theory of Mind” (understanding/taking another’s perspective)
- Understanding of safety
- Self-confidence and a high self-esteem
We know we should assess play skills in young children. But do we know what developmental play skills look like when we see them? According to the Developmentally Appropriate Curriculum: Best Practices in Early Childhood Education, otherwise known as “the EC bible” in the world of early childhood educators, there are three distinct types and five social stages of play children typically exhibit between birth and age five (Kostelnik, Soderman, and Phipps Whiren). Do you know what they are? Read all about them in the tables below.
I would be remiss if I did not share a word of caution when assessing play skills. There are many cultures that do not value the child-centered, independent play of our western culture. In order to differentially diagnose deficit versus difference we must keep in mind any cultural differences of the child’s family. For more information on this topic, read Multicultural Considerations in Assessment of Play by Tatyana Elleseff MA CCC-SLP.
So now we know what typical play skills look like. How do you assess play skills? What are your favorite materials to use? What topics do you want to see discussed here on Kid Confidential?
Don’t be afraid to share your ideas by commenting below. And remember…“Knowledge is power” (Sir Francis Bacon)!
Kostelnik, Marjorie, Anne Soderman, and Alice Phipps Whiren. Developmentally Appropriate Curriculum: Best Practices in Early Childhood Education. 5. Upper Saddle River, NJ: Pearson, 2011. Print
Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona. She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name. Maria received her master’s degree from Bloomsburg University of Pennsylvania. She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues. She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ. Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech. For more information, visit her blog or find her on Facebook.
Over the years, Speech Pathology Group: Children’s Services International (SPG: CSI) and the government of Bosnia-Herzegovina have combined their efforts to establish and implement a ground-breaking program, The Bosnia Autism Project. Our mission has been to “teach the teachers” and provide sustainable aid to children with communication impairments. Lisa Cameron has recently extended the SPG: CSI efforts to the Himalayan country of Bhutan, and Marci VonBroembsen remains active in South Africa. SPG: CSI is truly expanding and going international!
From 2009-2012, SPG: CSI sent specialized teams of professional volunteers to provide evidence-based assessment and treatment education to professionals, university students and parents in Bosnia- Herzegovina. This past summer, SPG:CSI worked with a four-year old who was hidden in his house because his family was ashamed of his disability. We met a 12-year-old who had never been to school and whose parents would lock him in his empty “bedroom” (merely a concrete room and a bucket) because he was nonverbal and had become so aggressive that they did not know how to control his behaviors.
Because of the tireless efforts from professionals in Bosnia-Herzegovina, and SPG: CSI’s dedication, together we have achieved amazing results! We are ecstatic to tell you that in October 2012 both our four-year old and the 12-year old started attending school and are doing well. For the first time students with autism and other disabilities are receiving treatment, a home-based intervention program has been established, parents are being educated, and the numbers of treatment centers continue to grow. But our mission is far from complete.
We are now in phase three of the Bosnia Autism Project, which is providing advanced training to the community leaders and medical and educational specialists. In an effort to maximize our efforts, we have invited seven key professionals and medical specialists to train with us in California for three weeks in the summer of 2013. These trail-blazing pioneers will receive advanced training in communication assessment and treatment strategies for children of all ages and stages, and go back to Bosnia to train other professional peers, leading them through a professional transformation.
For those of you who have wanted to participate with the non-profit but were unsure how, we invite you to get involved. Now is the time—and you don’t have to make the trek overseas!
- Visit our website and learn more about the Bosnia Autism Project. Any and all help is welcomed, without long-term commitments. Contact us at email@example.com or firstname.lastname@example.org if you have any questions or want to get involved.
- Friend us on facebook at to follow the most up to date information, see pics and follow the progress of our Bosnian colleagues.
- Join us at California Speech Hearing Association Convention for a 90-minute informational seminar (Thursday, March 8th) and Happy Hour at the Hyatt Long Beach on Friday March 9th. Check out our website for more information.
Larisa Petersen, MS, CCC-SLP is in her third year as a Speech-Language Pathologist. Currently, she works for The Speech Language Pathology Group in Walnut Creek, California. She provides speech-language services to students in Kindergarten through sixth grade. She updates the blog for The Bosnia Autism Project and you can visit her at http://spgcsi.wordpress.com. Also written by Anna Taggart, Leah Huang, and Raquel Narain.
I’ve found a danger to blogging a lot—someone might like what I’ve chatted about casually and then want me to turn it into an APA style manuscript. Yep! That’s happened! My little ramblings about Google forms have been converted to a formal paper, and are about ready to be submitted electronically to the scholarly folds of ASHA for a peer review and heavy edit.
I’ve learned quite a bit from this:
1. What is APA style? The last time I wrote a research paper, I used a typewriter—it was at least an electric typewriter. (Hey, I’m not that old!) Regardless, writing a paper and submitting it so it looks similar to what I see in my professional journals is a bit of a learning curve. Fonts didn’t really exist in my world back then. I’ve never written an ‘abstract’ or worried about including ‘table titles’ or website references. I’ve spent more than a few hours over the holidays learning about fonts, double spacing, and citations. (I feel I’m a more than competent speech pathologist—but my job descriptions since graduation in 1984 haven’t really included this.)
2. What is a SIG (otherwise known as Special Interest Group) in the ASHA world? I’ve never fronted the money but apparently each SIG has scholarly publications that the members (who pay $35 a year) can read and get CEUs. I’m hopefully going to be published in one of the SIG publications, although I may not be able to read my own published article since I’m not yet a member of the SIG. Maybe I’m not as poor as I think I am. Perhaps, I’ll turn over a new leaf now, and join a SIG—the one focusing on school-based issues now has me intrigued! I’ll keep you posted about this.
3. What is peer review? I actually already knew about this, but it’s a bit intimidating to submit something I’ve written to be edited and reviewed by people I don’t know. Right now, I’m using my 22-year-old daughter as my editor, but we think alike and readily critique each other all time about lots of things. The part about complete strangers reviewing my paper (that I don’t know how to write) is daunting to even consider. I’m sure that the reality is there will only be a couple of people on a computer that will edit my masterpiece, but my fantasy is that a large group will be earnestly talking about what I wrote. Ha Ha!
So, writing a formal paper is outside of my comfort zone. Why did I agree to this? Possibly, I was flattered that anyone even asked. Possibly, I never say “no” to anything. I need a ready-made script or a social story in this area.
I hope all of you are having a good start to the year! What’s done is done—I said “yes” and this has been great, albeit painful practice, and I’m sure that I’ll have a bit more editing to do. I’ll let you know how this challenge turns out.
This post is based on a post that originally appeared at Chapel Hill Snippets.
Ruth Morgan is a speech-language pathologist who works for the Chapel Hill-Carrboro City Schools at Ephesus Elementary School. She loves her job and enjoys writing about innovative ways to use the iPad in therapy, gluten-free cooking, and geocaching adventures. Visit her blog at:
Google is pretty much synonymous with search. Though in the earlier days of the web, people went different places like Lycos, Yahoo, and Altavista, it’s second nature for most of us to turn to Google nowadays when we have a question or need a resource. Bing? Sorry, no.
The thing about web search, when you think of it…it’s language. We ask a question and get an answer. The results can be a list, a description, a fact, a picture to describe.
Often, a search can be very helpful when we discover those pesky gaps in our students’ world knowledge or vocabulary.
Most of us, including myself, probably turn most readily to the little Google field in the upper right corner of the Safari iPad app, which indeed does the job pretty handily. However, Google has been steadily improving its free (of course) Google Search app, and it now includes speech-to-text (Voice Search), regardless of the version of the iPad you are using. Additionally, depending on the type of search you are making, the app will read aloud the results (so, text-to-speech), a feature related to what Google calls its Knowledge Graph, which helps zoom in on the most important facts about real-world items. Google gives us some ideas for the types of questions that work well with Voice Search.
To see how the Google Search app can be useful in your interventions, check out this terrific contextual demo centering around one of my favorite places: Cape Cod. I need to go to there right now. *Sigh* I hate January.
This post originally appeared on SpeechTechie.com.
Sean Sweeney, MS, MEd, CCC-SLP, is an SLP and technology specialist working in private practice at the Ely Center in Newton, MA, and consults to local and national organizations on technology integration in speech and language interventions. His blog, SpeechTechie (www.speechtechie.com), looks at technology “through a language lens.” Contact him at email@example.com.
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Tom Jelen is the Director of Online Communications for ASHA.
Internet scams targeting Physical, Speech, Behavior, and Occupational Therapists are on the rise. Last year, I received 3 different scams via email. Initially, I was shocked that I, along with other Therapists across the United States and Canada, were being targeted for our specific services. After the shock subsided, I realized that it made perfect sense. We, as Therapists, are ideal targets. We have big hearts, want to see people improve, and we can be …well, there is no easy way to put this, a little on the verbose side. We do fit the perfect profile for a viral scamming nightmare. Typically these scams tug on our emotional heartstrings and appeal to our sense of altruism.
Shirley Kunkel, M.A., CCC-SLP, a Private Practice Owner in Escondido, CA and Speech Pathologist for 33 years, recalls a recent encounter with a scam artist.
I became mildly suspicious when they asked if I worked on receptive and expressive language, reading disorders and fluency disorders. I felt like their request was not specific enough. So I tried to ferret out what specifically they were trying re-mediate. Sounded like all the disorders I work on in listed in an Ad. Also, the person signed off as Mitchell one time and Michelle the next. I couldn’t understand why the mother who had used Dr. in her title would be coming to my town for 4 months. It is not a scientific research community at the local hospital where I live. They said they presently lived in London and sometimes visited Egypt. I did not lose any money, but I regret that I invested my time and energies into responding to this thief.
Unfortunately, many Therapists are being targeted and are unknowingly engaging in these traps. As a result, some Therapists are losing their hard-earned money by the thousands. Tom Jelen, Director of Online Communication with American Speech-Language-Hearing Association (ASHA), has also noticed this growing problem within the Private Practice Community.
ASHA has received several reports from our members about a scam that is being attempted on members in private practice. The scammer is requesting to have his or her child visit a private practitioner while visiting the United States. The scammer requests to pre-pay for an evaluation and then sends a cashier’s check that is in an amount well above the evaluation charge. At this point, the scammer requests that the practitioner deposit the money in his or her bank and send back the overage (minus some money for the inconvenience). This scam has been reported to the Federal Trade Commission.
In the article, Fake Checks, the Federal Trade Commission describes normal banking activity.
Under federal law, banks generally must make funds available to you from U.S. Treasury checks, most other governmental checks, and official bank checks (cashier’s checks, certified checks, and teller’s checks), a business day after you deposit the check. For other checks, banks must make the first $200 available the day after you deposit the check, and the remaining funds must be made available on the second business day after the deposit.
However, just because funds are available on a check you’ve deposited doesn’t mean the check is good. It’s best not to rely on money from any type of check (cashier, business or personal check, or money order) unless you know and trust the person you’re dealing with or, better yet — until the bank confirms that the check has cleared. Forgeries can take weeks to be discovered and untangled. The bottom line is that until the bank confirms that the funds from the check have been deposited into your account, you are responsible for any funds you withdraw against that check.You Can Protect Yourself
The Federal Trade Commission offers some helpful ways to avoid being the latest victim of online scams in the article, “Giving the Bounce to Counterfeit Check Scams.”
- Know who you’re dealing with, and never wire money to strangers.
- If you’re selling something, don’t accept a check for more than the selling price, no matter how tempting the offer or how convincing the story. Ask the buyer to write the check for the correct amount. If the buyer refuses to send the correct amount, return the check. Don’t send the merchandise.
- If you accept payment by check, ask for a check drawn on a local bank, or a bank with a local branch. That way, you can make a personal visit to make sure the check is valid. If that’s not possible, call the bank where the check was purchased, and ask if it is valid. Get the bank’s phone number from directory assistance or an Internet site that you know and trust, not from the check or from the person who gave you the check.
- If the buyer insists that you wire back funds, end the transaction immediately. Legitimate buyers don’t pressure you to send money by wire transfer services. In addition, you have little recourse if there’s a problem with a wire transaction.
- Resist any pressure to “act now.” If the buyer’s offer is good now, it should be good after the check clears.
Remember, if you think you’ve been targeted by a counterfeit check scam there is something you can do. Simply report it to the following agencies:
- The Federal Trade Commission
- The U.S. Postal Inspection Service
- Your State Attorney General (visit NAAG.org for a list of state Attorneys General)
- Fake Checks, http://www.consumer.ftc.gov/articles/0159-fake-checks
- The Nigerian Email Scam, http://www.onguardonline.gov/articles/0002l-nigerian-email-scam
- Giving the Bounce to Counterfeit Check Scams, http://www.ftc.gov/bcp/edu/pubs/articles/naps29.pdf
A version of this post was originally published on The Independent Clinician.
Pamela Rowe, MA, CCC-SLP, is the Clinical Director of Pamela Rowe, MA, CCC-SLP, LLC in Longwood, FL. As a Speech Pathologist, Community Partner, Wife, and Mother of 3, Pamela enjoys mentoring the next generation of Speech Pathologists and hosting various community health events within Central Florida.
I was talking recently to another SLP and of course we were exchanging ideas about how to get organized at the beginning of the year. So I thought I’d share my tried-and-true system with you. It has taken me several years to get to this point, and it will likely continue to evolve.
I have a crazy system, but I find that it has worked well, especially since I revamped it last year. I group my students, and each group gets a two-pocket slash folder like these:
Once upon a time, I put the folders into binders, but the binders grow too large throughout the year, and become more cumbersome. So I ditched the binder, and opted for an accordion file with a handle to keep them in.
It is similar to this one from Walmart. They’re easy to grab and put back as I need them. I just put them in the order that I will see my groups, and voila!
Ok, so what’s in the folders?
First, the front pocket: For each individual student, I have a data page. This includes the student’s name and date of birth, and 5 sections of notes. Each section is identical and includes: the objective targeted, room for data and notes, an indication of group or individual therapy, start/stop time for group, and selections for student or clinician absence/meetings/special activities (assemblies and field trips).
In the back pocket is a copy of each individual student’s IEP goals and any other pertinent info I might need at a moment’s notice. I had a student with a seizure plan one year, so I kept that handy in his folder in case he had one during speech. Thankfully, I never had to refer to it.
I find it easiest to nab one of those beautiful teacher gradebooks to use for attendance. I photocopy the pages so I have a set for each quarter. The pages look similar to this:
I have come to love this system. I can easily know who I saw on what day and for how long with a code system I have developed. For each student, I denote G= group, I= individual, A= student absent, CA= clinician absent, CM= clinician in meeting, S=special activity (such as fire drill, field trip, or whatever). Most of my groups are the same duration, so I don’t denote that unless it’s different for some reason. So, I may denote “I” for individual therapy with my standard time frame, or “I45″ to indicate individual therapy for 45 minutes. For clarification, I can refer back to the daily data sheets (from above). At the end of the day, I just zip down the list, and presto, I’m done wth attendance!
From this attendance roster, I highlight students that I must bill Medicaid and can zip through my list pretty quick. And bonus, I can tell at a moment’s notice how long it is until I have the daunting task of quarterly IEP updates. I start those puppies two weeks out so I can chip away at them and finish in time.
I try to use the same activity for most of my groups all day, although sometimes, depending on what I need to target, I may have something different up my sleeve for a few groups. Then, I just gather the other materials I may need, such as articulation or vocabulary cards, books or other visuals, or any manipulatives necessary. I keep all of that within an arm’s reach of where I sit in my room. This year, I share my office, and don’t have the luxury of my nice big assessment cabinet by my side like I did last year, so I’ll have to use some real estate on my desk.
OK, that was a TON! Thanks for hanging in there till the end! If you have any questions, please comment below. Did I leave something out? Just ask! I’m also interested in your system. What do you do? Do you think it’s the best system ever? Let me know! I’m always looking for a way to make the day-to-day operations easier.
This post originally appeared on Adaptable, Flexible, & Versatile Speech-Language Therapy.
Karen Dickson, MA, CCC-SLP/L is in her fifth year as a Speech-Language Pathologist. Currently, she works for Valley View School District in Bolingbrook, Illinois. She provides speech-language services to students in pre-school through fifth grade. She has recently been inspired to start her own blog and invites you to visit her site at http://afvslp.blogspot.com.
This post is the beginning of a monthly series by Betty Schreiber, M.M.S. CCC-SLP, on Aging, Communication, Cognition, and Speech Therapy.
Thank you for allowing me to be a new blogger on ASHASphere. I currently supervise Graduate Students at the Ladge Speech and Hearing Clinic at LIU/Post in Brookville, New York. Along with my wonderful business partner, Gail Weissman MA. CCC-SLP, and amazing programmers at Objectgraph LLC, I am also creating Apps designed specifically for our older clients.
As I am at the younger end of what would be considered the “baby boomer” generation, and currently working with adults who have begun to age and suffer communication disorders, I am particularly sensitive to the effect of aging and the social impact of communication disorders amongst this population.
As people get older, it is a fact that health and physical mobility are crucial elements in their ability to function in daily life, interact, and participate normally in society. Even older people who have simply aged with no other issues experience increasing isolation. Their spouses and friends move or pass away, leaving fewer opportunities for social interaction.
The baby boomers are aging and will become a large part of the population in the next 20 years. The Center for Disease Control in collaboration with the Merke Company Foundation has developed information on aging in America with a state by state assessment.
They listed 15 key indicators of older adult health:
- Physically Unhealthy Days
- Frequent Mental Distress
- Oral Health: Complete Tooth Loss
- No Leisure-Time Physical Activity
- Eating ≥ 5 Fruits and Vegetables Daily
- Current Smoking
- Flu Vaccine in Past Year
- Ever Had Pneumonia Vaccine
- Mammogram Within Past 2 Years
- Colorectal Cancer Screening
- Up-to-date on Select Preventive Services
- Cholesterol Checked in Past 5 Years
- Hip Fracture Hospitalizations
These factors have an impact on our aging family members ability to attend the therapies they need, maintain cognitive function, communicate and be self-sufficient. The majority of our elderly prefer to stay in a familiar environment even if it means living alone or with some outside help.
According to the United States Department of Health and Human Services Profile of Older Americans 2011, about 29% (11.3 million) of noninstitutionalized older persons live alone (8.1 million women, 3.2 million men), almost half of older women (47%) age 75+ live alone. The number of Americans aged 45-64, (I’m in that batch) who will reach 65 over the next two decades increased by 31% during this decade. Over one in every eight, or 13.1%, of the population is an older American. This demographic information along with changes in the federal budget and insurance reimbursement should be of concern to us, as professionals. Not only in terms of how we will make a living, but how will we be able to provide needed support and efficient services so that treatment approaches do not have to cost more money. Therapy can be more effective if we address communication and interaction within the framework of the aging living situation as a whole.
In one of the blogs on our website, I told a story of my own family experience. My grandmother, who was about 83 at the time, was placed in the middle of the livingroom while family and friends spoke to each other around her. (I was about 26 and a SLP for 3 years) She was able to hear well enough, and speak well enough, but the attitudes of the younger people were such that unless she made a ruckus, no one felt it was necessary to include her in the conversation! This isolation while surrounded by a bustling family, negatively affected her attention to her surroundings.
Part of my therapy approach with adult clients is to educate and include the families and caregivers in the therapeutic process as much as possible. Our family questionnaire includes questions such as: How many times do you talk to (our client) during the day. We also ask about the client’s speaking interactions at home or in a group of people. I have found that some family members want us to “fix” their husband or wife and want no additional responsibility. But we can talk to them to help them slowly understand that their situation will be better if they are aware of how they can help and use the adaptive tools we are giving them. We are not asking them to do the therapy or practice. We help them with resources in our community and teach them about paired communication and listening. The families, caregivers, even SNF staff should be encouraged to develop a communication routine that allows interaction not mere reaction.
There will be more on this topic in subsequent postings. Any of the Indicators of Older Adult Health frequency may impact our therapy attendance and reimbursement. What does this mean in terms of available services, advocacy, health care coverage, families and caregivers education/training? How can we, as Speech Language Pathologists recognize and support individuals and families in distress and facilitate communication awareness, not only with our clients who are coming for therapy, but for our aging population as a whole?
Betsy C. Schreiber, MMS, CCC-SLP, received a BA in Psychology and MMS Master of Medical Science in Speech Pathology from Emory University in Atlanta, Georgia. Her CCC was earned during the 3 years she worked at Hitchcock Rehabilitation Center in Aiken, South Carolina where she had the opportunity to learn about NDT and Sensory Integration with the original, Jane Ayres, working with LD and CP children and neurologically impaired adults. She is currently a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She has also served as an ASHA Mentor and hopes to participate in ASHA’s Political Action Committee in the coming year.
2012 was full of a lot of new experiences for me. I was approached at the beginning of the year to begin speaking on dysphagia for PESI. My first speaking engagements were in North Carolina in December. I absolutely loved it! Granted, I still have some kinks to iron out in the professional speaking world, but all in all, I thought it went pretty well. I can’t wait for my next speaking engagement in January down south again, then in Illinois in June. I continued work on my BRS-S and finally was accepted! Not only accepted, I passed my test! I can now officially put BRS-S after my name. Such long-sought and hard-earned letters!
Soon after I earned my BRS-S, I was promoted to Rehab Director of our department. I’m still learning the ropes and working on improving our department. I love the new job duties though.
I went to ASHA and had the opportunity to visit old friends and meet new friends. As always, I had such a fun time! I again had the opportunity to present a poster session. It had a great turnout. I worked in the SmartyEars booth, which is so much fun. It’s always great to meet people and show off SmartyEars apps. I always feel a lot of pride when people want to see a demonstration of Dysphagia2Go. I would love to say that I attend the ASHA convention for the CEU’s, but I attend for the socialization. That is one week of the year I feel like I am in “SLP heaven”.
I decided to end this post with a list. Everyone always wants to know my recommendations. Here are my top CEU courses, books and apps related to dysphagia.
Top CEU courses:
The VitalStim course by CIAO seminars is invaluable. It’s absolutely great information, with such a huge emphasis on anatomy and physiology. It is definitely worth the price whether you use the device or not.
MBSImP course by Bonnie Martin-Harris, provided by Northern Speech Services is another outstanding course. Again, this course is based on the anatomy and physiology of the swallow and using it in interpretation of Modified Barium Swallow Studies.
Of course, my Dysphagia course. I like to think that it is full of invaluable information. :)
Top Books on Dysphagia:
Dysphagia Following Stroke by Stephanie K. Daniels and Maggie Lee Huckabee is absolutely excellent. I’m in the process of re-reading it. It is a book I will keep.
Drugs and Dysphagia. Great reference.
The Source for Dysphagia by Nancy Swigert is my bible. I love that book.
Clinical Anatomy and Physiology of the Swallowing Mechanism. Absolutely must-read!!
My Top Apps for Dysphagia
Of course my top vote goes to Dysphagia2Go. I use this app all the time when I do a clinical evaluation of swallowing. It lets me input all my data and then allows me to print a report of my findings. This app is available for $39.99 on iTunes.
Dysphagia by Northern Speech Services costs $9.99 and offers amazing pictures of swallowing and swallowing deficits to share with your patients.
Lab Tests is a $2.99 app that allows you to look up lab values, their meanings and why the tests are performed. This app does not require wi-fi to run.
Micromedex is a free drug app that is amazing and gives you not only information about the drug, but possible side effects, warnings, etc. You can look up virtually any drug.
Cranial nerves is a $2.99 app that gives you information on all 12 cranial apps. Not only does it give you the in-app information, but also allows you to, with the push of a button, access further information on the app on Wikipedia and Google.
I hope everyone has an amazing 2013. I so look forward to all the new and great things to come!
This post is based on a post that originally appeared on Dysphagia Ramblings.
Tiffani Wallace, CCC-SLP, has been an SLP specializing in Dysphagia for over 11 years. Tiffani has been very active in the social media world, creating 2 Facebook groups, Dysphagia Therapy Group and Dysphagia Therapy Group-Professional Edition. Tiffani is also the co-author of the app Dysphagia2Go, available on iTunes. She is preparing to travel nationally and speak on the topic of Dysphagia. Tiffani writes a blog called Dysphagia Ramblings and is the author of www.dysphagiaramblings.com. She is a 5 time ACE awardee and recently obtained her BRS-S.
Collaboration Corner is a new monthly column written for ASHAsphere by Kerry J. Davis, E.d.D, CCC/SLP. Kerry will focus on different themes that involve collaborating with colleagues and other disciplines. Thank you Kerry for sharing your ideas with the ASHA community!
We welcome guest bloggers and columnists; if you’d like to write for ASHAsphere, please fill out a blogger application here.
I work in a totally inclusive school district as an inclusion speech-language pathologist. My caseload consists of the neediest students in the district. Those kids are simply fascinating to me. I work with the soup-to-nuts kids; kids with severe learning challenges, kids with social-emotional disabilities, kids who are nonverbal. You know the kids where you try and crawl inside their neurology and figure out how they perceive the world? These students push me to be a better clinician. More importantly, they make me want to think creatively on how to make public school and inclusion work for them.
All of my students participate in a general education classroom. Students attend their neighborhood schools and access their day with a host of academic supports. All of my students have goals that allow meaningful access to math, language arts, science and social studies. And here’s the funny part, while all of my students have communication disorders, I am working to eliminate the designated “speech and language” section of many students’ IEPs.
Imagine taking the speech and language section off of the IEP! I can sense the collective raising of eyebrows….
But here’s the deal. I believe that one of the best parts of being a speech-language pathologist is that opportunities for learning are never-ending. Language is everywhere. Bruner (1996) discussed the need to connect learning through meaningful interaction. People learn when they can relate new information with old information. Semantic-connections allow for learning. Language is the vehicle for that connection.
So let’s back up to the IEP. Why do we tend to compartmentalize language and communication to a single goal area? It is unnecessary, and dare I say…inappropriate.
So perhaps we should rethink our approach. A student’s IEP is based upon the team’s recommendations.
Integrating language-based goals throughout the IEP also encourages team ownership. Distributing language-based objectives throughout the IEP underscores the connection between language and academics. For students who need extra repetition and meaningful practice across contexts, these collaborative efforts foster skill generalization. So how does that look in an IEP? Here are some ideas my school-based teams have used (as a part of measurable objectives of course):
- Develop the concepts of less, more, some
- Answering wh-questions related to quantity
- Following directions in a recipe, including gathering appropriate tools and materials
- Provide similarities and differences(feature/function/class) between target vocabulary words
- simple machines
- animals and habitats
- states of matter
- Using temporal markers, will demonstrate understanding of a plant/animal life cycle
- Answering wh-questions related to non-fiction text and picture books
- Matching clothing with seasons
- Using attributes to describe the weather
- Identifying and answering personal and biographical information (town, street, school)
- From a book or activity, answer who, where, what doing, and when questions related to other countries and communities
English Language Arts:
- Answering wh-questions related to character, setting and supporting events
- Using temporal markers to create a personal narrative from a photograph
- Use a home journal template to retell a two activities of the day
- From a photo, use adjectives to describe an event or activity
- Sequence pictures representing events from a picture book
- Communicating self-advocacy,
- Asking clarifying questions,
- Following checklists related to daily routines,
- Following 2-step group directions
Some words of advice
I’ve used these ideas with children who have a variety of skill abilities. I use these ideas with children who have moderate to severe cognitive and communication challenges. Many use high-tech assistive technology tools, to accomplish these goals. Others use fill-in-the-blank cut and paste activities. The key is to scaffold the concepts in a way that will be meaningful. This does not mean lowering the bar for learning, these means thinking about how to embed naturalistically these ideas throughout the school day. Checklists can be used as part of getting ready in the morning. Narrative writing may include templates and photographs, or writing a letter home at the end of the day. Sequencing can be used in “how-to” books, or describing the life cycle of a frog. Comparisons can be drawn between a student’s home, and the Native American Wetu. All of these examples connect language concepts and learning in a meaningful way.
Gather the expertise in your team members and make the IEP work for those students that challenge you; you will be better practitioner for it. Not every team will be ready for this change. Through thoughtful discussion, creative planning and patience, the shift may not be as hard as you think.
Bruner, J. (1996). The culture of education. Cambridge, MA: Harvard University Press.
Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her area of interest includes augmentative alternative communication, and working with children with multiple disabilities and learning challenges. I welcome various perspectives and lively dialogue. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.
(photo credit - Aphasia Community Group)
In 2000 I produced a program called “Faces of Aphasia,” which was held at Boston University. It aimed a spotlight on aphasia and the Aphasia Community Group of Boston. Now beginning its 24th year, the Group is one of the oldest support groups of its kind.
“Faces of Aphasia” introduced aphasia to the community through the performing arts. It featured the first public performance by acclaimed mezzo soprano Jan Curtis following her stroke. Actor/playwright Joseph Chaikin performed “Struck Dumb,” a monologue on the inner thoughts of an aphasic individual. “The Other Voices of Aphasia,” an original piece by group co-founder Judy Blatt, was performed by family members. A staged reading of “Night Sky” by Susan Yankowitz, a play about aphasia, was performed by individuals living with aphasia. It was filmed and used as a teaching tool in communication disorders graduate programs.
Inspired by “Faces of Aphasia,” Emmy Award winning filmmaker Vincent Straggas and I created the documentary “after words 2003,” which premiered in Boston in June, 2003. It featured vivid portraits of members of the Aphasia Community Group as well as internationally acclaimed celebrities such as Tony Award winner Julie Harris, Academy Award winner Patricia Neal, Grammy Award winner Bobby McFerrin, Robert McFerrin, and Annie Glenn Award winner Jan Curtis, all of whose lives were touched by aphasia and related disorders. “after words 2003” opened to wide acclaim and was embraced by the public and in academic, rehabilitation, community, and medical settings.
A new documentary, based on the original film, and comprised of new portraits and interviews has been produced and is currently airing on public television stations around the country. Co-produced by me, Vincent Straggas, ASHA fellow and executive director of the National Aphasia Association Ellayne Ganzfried, the new “after words” features neurologists, authors and clinicians including Nancy Helm Estabrooks, Ellayne Ganzfried, Jerome Kaplan, Howard Kirshner, Marjorie Nicholas, Oliver Sacks, Martha Sarno, and Gottfried Schlaug. It profiles individuals living successfully with aphasia, presents different types and severities of aphasia, including primary progressive aphasia, explores aphasia’s impact on families, discusses legal implications of aphasia, and explores the life participation approach to aphasia.
“After Words” is currently being distributed to public television stations nationwide. However, it is up to each individual station to include it in their schedule. While it has already aired in a number of cities, it has not yet aired on the majority of public television stations. Therefore, the producers of “After Words” encourage the aphasia community—speech-language pathologists, state and local speech-language hearing associations, aphasia support groups, rehabilitation centers, individuals touched by aphasia—to contact their local public television stations and urge them to air “After Words.” We anticipate a new wave of airings to occur in the months to come, following the program’s re-distribution to public television in mid-January. Thus, contacting local stations, and in particular, program managers at these stations, when the film is re-distributed, would be especially timely.
We hope to bring this important program to the widest possible audience. Take a look at the trailer:
Jerome Kaplan is an SLP and founder of the Aphasia Community Group of Boston. Working with artists, actors, musicians, filmmakers, and members of the aphasia community, he has developed projects to raise aphasia awareness and understanding by illuminating the world of aphasia and promoting the life participation approach to aphasia. His latest project, “after words,” a documentary about aphasia, is currently airing on public television.