I.M. is doing fantastic in therapy. His accuracy rates have been improving throughout the semester. Therefore, I have been able to increase his goals mostly to the sentence and conversational level. Besides being such a hard little worker, I.M’s parents are very involved. On the days the I.M. doesn’t receive speech therapy his parents work with him on his homework assignments.
Looking back on the semester, I am really proud of how far I.M has come. However, producing the /sh/ phoneme is still a great challenge not only for I.M. but for me. I started by occluding the nostrils. However, this technique is not working due to the placement of tubes into his ears. I.M. could feel the tubes rolling in his ears which caused him to be scared. (Note: I freaked out as well, but Mrs. Haines said there was nothing to be concerned about).
In Dr. Ruscello’s cleft lip and palate class he provided us with a handout discussing treatments of various types of errors such as developmental, obligatory, or compensatory errors. I.M. displays compensatory errors like glottal stops, and nasal snorts. The article suggests the use of a mirror to provide feedback to see whether air is coming out of the mouth or nose. Another feedback technique is the listening tube. I.M. and I are working on the listening tube right now. The listening tube is actually in the shape of a phone where he can hear if he is displaying nasal omission on the /sh/ phoneme.
We only have used the listening tube once in clinic, but I feel this will be more beneficial to do with I.M. to provide feedback as to whether air comes out of his nose or mouth. I.M. got very frustrated with the nasal occlusion, and this type of technique is more like a game for him. We will see how it goes!
References:
Kummer, A. W., Strife,J L., Grau, W. H., Greaghead, N.A. & Lee, L. (1989). The effects of Le Fort I osteotomy with maxillary advancement on articulation, resonance, and velopharyngeal function, Cleft Palate Journal, 26, 193-199.
Trost-Cardamone, J.E. (1990) Speech: Anatomy, physiology, and pathology. In D.A. Kerhnahan & S.W. Rosenstein (Eds), Cleft Lip and Palate (pp. 91-103). Baltimore, MD: Williams & Wilkins.
Monday, April 14, 2008
Friday, February 29, 2008
~New Blog for 2008~
I.M. is a five year old boy who has been coming to Allen Hall Speech Clinic for approximately the past two years. In 2005, I.M. had cleft palate surgery and has been receiving speech therapy ever since.
I.M. displays compensatory errors. Also, I.M. makes a lot of glottal stops whenever he speaks, which can make his speech difficult to understand at times even to familiar listeners. Also, he displays apraxia characteristics.
Since I.M. will be going to kindergarten in the fall, we have been working on a lot of goals with him this semester. These goals include the following:
Working with the /k/ phoneme in the initial position of words
Producing /d/ in isolation
Producing /p/ in the medial and final position of words and /f/ in the medial position of words at the sentence level
Voiceless /th/ in the medial position of words
Establishing air flow for /sh/
I.M. has been progressing really well with his goals. However, the /sh/ phoneme and the /k/ phoneme are giving him some problems. Despite being absolutely adorable, he is also very smart; which makes working on his difficult sounds hard for him because he doesn’t do it perfectly.
Throughout the session, I give a lot of visual and auditory feedback. For example, when producing the voiceless /th/ sound we play Bingo. I make sure the /th/ sound is in front of him and the /th/ sounds are highlighted on the cards. After every production, I give him feedback. On the sounds that he doesn’t get right, reminding him to close the end of the sound or pointing out where the sound is highlighted in the words seems to really help.
During production of the /sh/ phoneme I.M. display a lot of nasal emission and also lateralizes the sound. So, we have just started working with placement and nasal occlusion this past week. I start off by having him just correctly place his lips into the right position then gradually we work up to sound. Whenever he makes the sound we do nasal occlusion with him. When doing this, I.M. says he can tell the difference when it comes out of his mouth compared to when the air comes out of his nose.
The approach of providing visual and auditory feedback is talked about in the article cited below. The article also talks about tactile feedback which I haven’t used.
Reference:
Kummer, Ann. (2002). Speech Therapy for Characteristics of Velopharyngeal Dysfunction. Retrieved online from www.asha.org.
I.M. displays compensatory errors. Also, I.M. makes a lot of glottal stops whenever he speaks, which can make his speech difficult to understand at times even to familiar listeners. Also, he displays apraxia characteristics.
Since I.M. will be going to kindergarten in the fall, we have been working on a lot of goals with him this semester. These goals include the following:
Working with the /k/ phoneme in the initial position of words
Producing /d/ in isolation
Producing /p/ in the medial and final position of words and /f/ in the medial position of words at the sentence level
Voiceless /th/ in the medial position of words
Establishing air flow for /sh/
I.M. has been progressing really well with his goals. However, the /sh/ phoneme and the /k/ phoneme are giving him some problems. Despite being absolutely adorable, he is also very smart; which makes working on his difficult sounds hard for him because he doesn’t do it perfectly.
Throughout the session, I give a lot of visual and auditory feedback. For example, when producing the voiceless /th/ sound we play Bingo. I make sure the /th/ sound is in front of him and the /th/ sounds are highlighted on the cards. After every production, I give him feedback. On the sounds that he doesn’t get right, reminding him to close the end of the sound or pointing out where the sound is highlighted in the words seems to really help.
During production of the /sh/ phoneme I.M. display a lot of nasal emission and also lateralizes the sound. So, we have just started working with placement and nasal occlusion this past week. I start off by having him just correctly place his lips into the right position then gradually we work up to sound. Whenever he makes the sound we do nasal occlusion with him. When doing this, I.M. says he can tell the difference when it comes out of his mouth compared to when the air comes out of his nose.
The approach of providing visual and auditory feedback is talked about in the article cited below. The article also talks about tactile feedback which I haven’t used.
Reference:
Kummer, Ann. (2002). Speech Therapy for Characteristics of Velopharyngeal Dysfunction. Retrieved online from www.asha.org.
Monday, November 26, 2007
New Client, Mr. "J"
Blog #2
Background:
Mid-semester I was assigned a 5 year old boy, (J), who was initially referred by his school to the WVU Speech and Hearing Center for a diagnostic evaluation. After the diagnostic was administered, speech therapy was recommended to work on articulation and to evaluate language.
During the first few sessions with J, I administered the Goldman Fristoe Test of Articulation, Khan-Lewis Phonological Analysis, and the Preschool Language Scale 4. Test results revealed J’s language to be within normal limits. However, his articulation score put him in the moderate to severe category making his speech unintelligible to an unfamiliar listener. At first, I did have trouble understanding what J was telling me. Now I can understand what J says most of the time.
Technique:
I have been using the phonetic approach with J and we practice, practice, and practice! The main thing I use in therapy is articulation cards. (stimulus) However, since J is only 5 cards get boring real fast. Therefore, I plan camping trips, scavenger hunts, and variety of games using these articulation cards to make therapy more enjoyable.
Also, I always make sure to give a lot of reinforcement (knowledge of response). For example, whenever J can put an ending on a word I say enthusiastically “good job” or when he does not get something quite right I might say “Good try, remember to close to word.”
J has made quite a bit of progress in a short amount of time. Now whenever you remind him to put endings on words he usually gets it for that sessions. J still displays problems with transferring to spontaneous speech.
Goals:
The main goal for therapy has been working on final consonant deletion. Starting out, I tested auditory discrimination and he displayed 90% accuracy in three consecutive sessions which allowed us to move forward to another goal. Recently, initial consonant deletion was added.
Clinicial Expertise:
Since I am still new at being a clinician, my supervisor, Mrs. Graebe directed me as to where to begin. Mrs. Graebe has given me a lot of ideas and I have taken those ideas and have tried different things with each session. J also likes to spontaneity.
Patient Values:
J’s mother has been very supportive. While, J and I go on our scavenger hunt in the hallway, J’s mother comes along as well to see what we are doing. She also participates. For example, J finds the card “soap” and he doesn’t close the word she says “J close it”. She sometimes appears frustrated whenever J was not closing to word with the right sound, so I had to reassure her he was doing a great job and right now we just want him to add any type of closing to words.
Effectiveness:
I feel this technique has been effective. Data collected in therapy supports J is definitely improving.
Supporting Evidence / Reference:
Williams,A.L. (2003). Speech disorders resource guide for preschool children. Singular Resource Guide Series. Thomson: Delmar Learning.
I was very excited when I found this article. It supported what I have been doing with J. The techniques talked about in this article were the same strategies in which I have been doing with J. Listed below are the strategies in which I am talking about.
1. Treatment occurs 2x/week.
2. Analyze child’s errors
3. Select Treatment Targets
4. Begin with imitation until 90% accuracy is reached in three consecutive therapy sessions
5. Progress to spontaneous speech
Background:
Mid-semester I was assigned a 5 year old boy, (J), who was initially referred by his school to the WVU Speech and Hearing Center for a diagnostic evaluation. After the diagnostic was administered, speech therapy was recommended to work on articulation and to evaluate language.
During the first few sessions with J, I administered the Goldman Fristoe Test of Articulation, Khan-Lewis Phonological Analysis, and the Preschool Language Scale 4. Test results revealed J’s language to be within normal limits. However, his articulation score put him in the moderate to severe category making his speech unintelligible to an unfamiliar listener. At first, I did have trouble understanding what J was telling me. Now I can understand what J says most of the time.
Technique:
I have been using the phonetic approach with J and we practice, practice, and practice! The main thing I use in therapy is articulation cards. (stimulus) However, since J is only 5 cards get boring real fast. Therefore, I plan camping trips, scavenger hunts, and variety of games using these articulation cards to make therapy more enjoyable.
Also, I always make sure to give a lot of reinforcement (knowledge of response). For example, whenever J can put an ending on a word I say enthusiastically “good job” or when he does not get something quite right I might say “Good try, remember to close to word.”
J has made quite a bit of progress in a short amount of time. Now whenever you remind him to put endings on words he usually gets it for that sessions. J still displays problems with transferring to spontaneous speech.
Goals:
The main goal for therapy has been working on final consonant deletion. Starting out, I tested auditory discrimination and he displayed 90% accuracy in three consecutive sessions which allowed us to move forward to another goal. Recently, initial consonant deletion was added.
Clinicial Expertise:
Since I am still new at being a clinician, my supervisor, Mrs. Graebe directed me as to where to begin. Mrs. Graebe has given me a lot of ideas and I have taken those ideas and have tried different things with each session. J also likes to spontaneity.
Patient Values:
J’s mother has been very supportive. While, J and I go on our scavenger hunt in the hallway, J’s mother comes along as well to see what we are doing. She also participates. For example, J finds the card “soap” and he doesn’t close the word she says “J close it”. She sometimes appears frustrated whenever J was not closing to word with the right sound, so I had to reassure her he was doing a great job and right now we just want him to add any type of closing to words.
Effectiveness:
I feel this technique has been effective. Data collected in therapy supports J is definitely improving.
Supporting Evidence / Reference:
Williams,A.L. (2003). Speech disorders resource guide for preschool children. Singular Resource Guide Series. Thomson: Delmar Learning.
I was very excited when I found this article. It supported what I have been doing with J. The techniques talked about in this article were the same strategies in which I have been doing with J. Listed below are the strategies in which I am talking about.
1. Treatment occurs 2x/week.
2. Analyze child’s errors
3. Select Treatment Targets
4. Begin with imitation until 90% accuracy is reached in three consecutive therapy sessions
5. Progress to spontaneous speech
Monday, October 22, 2007
Technique
Meet Miss “J”
My first client in speech therapy has not only been interesting but has also been a great experience. My client is a twenty-two year old female, who was diagnosed as a child with a syndrome called Cavun Setum Pellicidum. J. has received therapy at West Virginia University Speech and Hearing Center from 1989-1996 and then returned in 2001 to the present.
To communicate, my client uses a variety of alternative communication devices (AAC) as well as nontraditional sign language. My client’s alternative communicate devices included the following: a laminated poster board which contains words used in her daily environment; a small personal notebook which includes one and two word phrases; and a larger personal communication notebook which includes one and two word phrases.
Past Treatment:
J. has been coming to therapy twice a week for fifty minute sessions. Two goals from previous therapy have been to enhance J’s receptive and expressive languages with both her small and large notebook. Recently, the Vantage, which is an AAC device, has been introduced to J.
Goals for this semester:
In therapy, I have had three main goals I have been focusing on. These goals work to enhance my client’s receptive and expressive languages. The first two goals have been working with my client’s personal forms of communication by using her small and large personal communication notebook. The last goal has been to familiarize my client with an actual AAC device and to present a new lesson each day to work on spelling and saying words out loud.
The Vantage, AAC device, has been the main focus of therapy this fall. The Vantage is comparable to the Picture Exchange Communication System (PECS), but, instead of using just cards it was also on the computer so every word has been digital.
Technique:
My technique when teaching on the Vantage is to provide visual cues with everything I do. For example, whenever I teach my client the word family, I present the actual letters of family, a picture of a family, and say family in a sentence before I ask my client to find the icon for family on the Vantage.
Supporting Evidence:
- Research Literature-
According to the Autism Society my technique is one I can continue with. The Autism Society stated that this technique is “clear, intentional, and helpful to get language started as well as to provide a way of communication for those who are not able to talk.”
A survey was done in Africa, comparing teacher’s attitudes on AAC devices. This survey was published in the South African Journal of Education and it’s sole purpose was to determine and compare attitudes between a digital device and a communication board. Results revealed that teachers were generally positive towards both devices, but there was a consistent tendency to view the digital AAC device more positively.
- Clinical Expertise-
Augmentative Communication News, (ACN), also supports the use of AAC devices. ACN came up with four points speech-language pathologists need to do when working with clients who have AAC devices.
SUPPORT to use of client’s who use AAC devices
Advocate to other professionals, families, friends, etc. on what AAC devices, the purpose of these devices, and the importance of the usage
Expect your client’s to use his/her devices in not only therapy but in the outside world
Expect to see your client continually improve and increase his/her independence when communication
- Patient Values & Preferences-
ACN talked about what common things people have wanted to experience before getting an AAC device. The basic thing everyone wanted was to have functional communication. Another point that was mentioned, was the want of having something to enable the client to choose what they wanted to say, specific activities and food that they wanted.
Effectiveness:
I feel during this semester of therapy my technique has been beneficial in increasing both J’s receptive and expressive languages. Whenever I would present a visual of each word I wanted to teach J, she would automatically point first to the word on the table; then J would try to match what she saw in front of her to the icon on the Vantage screen. Being able to listen to the word in a sentence, and then applying the concept by touching the icon on the Vantage screen makes me strongly believe this technique has been working effectively.
References:
Augmentative Communication News, 8. Retrieved on October 20, 2007 from http://augcominc.com
Autism Society of America: The Voice of Autism. Retrieved on October 19, 2007 from http://www.autism-society.org
1999. South African Journal of Education, 21. Retrieved October 20, 2007.
My first client in speech therapy has not only been interesting but has also been a great experience. My client is a twenty-two year old female, who was diagnosed as a child with a syndrome called Cavun Setum Pellicidum. J. has received therapy at West Virginia University Speech and Hearing Center from 1989-1996 and then returned in 2001 to the present.
To communicate, my client uses a variety of alternative communication devices (AAC) as well as nontraditional sign language. My client’s alternative communicate devices included the following: a laminated poster board which contains words used in her daily environment; a small personal notebook which includes one and two word phrases; and a larger personal communication notebook which includes one and two word phrases.
Past Treatment:
J. has been coming to therapy twice a week for fifty minute sessions. Two goals from previous therapy have been to enhance J’s receptive and expressive languages with both her small and large notebook. Recently, the Vantage, which is an AAC device, has been introduced to J.
Goals for this semester:
In therapy, I have had three main goals I have been focusing on. These goals work to enhance my client’s receptive and expressive languages. The first two goals have been working with my client’s personal forms of communication by using her small and large personal communication notebook. The last goal has been to familiarize my client with an actual AAC device and to present a new lesson each day to work on spelling and saying words out loud.
The Vantage, AAC device, has been the main focus of therapy this fall. The Vantage is comparable to the Picture Exchange Communication System (PECS), but, instead of using just cards it was also on the computer so every word has been digital.
Technique:
My technique when teaching on the Vantage is to provide visual cues with everything I do. For example, whenever I teach my client the word family, I present the actual letters of family, a picture of a family, and say family in a sentence before I ask my client to find the icon for family on the Vantage.
Supporting Evidence:
- Research Literature-
According to the Autism Society my technique is one I can continue with. The Autism Society stated that this technique is “clear, intentional, and helpful to get language started as well as to provide a way of communication for those who are not able to talk.”
A survey was done in Africa, comparing teacher’s attitudes on AAC devices. This survey was published in the South African Journal of Education and it’s sole purpose was to determine and compare attitudes between a digital device and a communication board. Results revealed that teachers were generally positive towards both devices, but there was a consistent tendency to view the digital AAC device more positively.
- Clinical Expertise-
Augmentative Communication News, (ACN), also supports the use of AAC devices. ACN came up with four points speech-language pathologists need to do when working with clients who have AAC devices.
SUPPORT to use of client’s who use AAC devices
Advocate to other professionals, families, friends, etc. on what AAC devices, the purpose of these devices, and the importance of the usage
Expect your client’s to use his/her devices in not only therapy but in the outside world
Expect to see your client continually improve and increase his/her independence when communication
- Patient Values & Preferences-
ACN talked about what common things people have wanted to experience before getting an AAC device. The basic thing everyone wanted was to have functional communication. Another point that was mentioned, was the want of having something to enable the client to choose what they wanted to say, specific activities and food that they wanted.
Effectiveness:
I feel during this semester of therapy my technique has been beneficial in increasing both J’s receptive and expressive languages. Whenever I would present a visual of each word I wanted to teach J, she would automatically point first to the word on the table; then J would try to match what she saw in front of her to the icon on the Vantage screen. Being able to listen to the word in a sentence, and then applying the concept by touching the icon on the Vantage screen makes me strongly believe this technique has been working effectively.
References:
Augmentative Communication News, 8. Retrieved on October 20, 2007 from http://augcominc.com
Autism Society of America: The Voice of Autism. Retrieved on October 19, 2007 from http://www.autism-society.org
1999. South African Journal of Education, 21. Retrieved October 20, 2007.
Friday, August 17, 2007
Let's talk.
Hello everyone! I must say this is the first experience I have with blogging - so I'm learning as I go. I graduated in May 2007 from WVU with a B.S. degree in speech pathology and audiology.
I am very excited to start graduate school and get hands on experience. I feel hands-on experience is how I learn the best. As of right now, I'm torn between which setting I feel would make me the happiest. I have always loved little kids. However, I volunteered in a nursing home and ended up loving the experience. I found out that adults need us just as much -sometimes if not more- than children do. Also, TBI's, feeding and swallowing issues, and autism really interest me. Keeping my options open is the best thing for me to do right now.
I am very excited to start graduate school and get hands on experience. I feel hands-on experience is how I learn the best. As of right now, I'm torn between which setting I feel would make me the happiest. I have always loved little kids. However, I volunteered in a nursing home and ended up loving the experience. I found out that adults need us just as much -sometimes if not more- than children do. Also, TBI's, feeding and swallowing issues, and autism really interest me. Keeping my options open is the best thing for me to do right now.
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