Are you for real?: Twitter credibility and #SLPeeps

This chat is officially completed. To read the archived tweets you can go to chat #1 at 4:30 pm Sydney, Australia time and you can go to chat #2 at 2 pm New York, US time. They are slightly different as different people participated and bring up different points or end up focusing on slightly different areas.

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#slpchat is proud to announce that we are officially 1 year old! For our first chat of 2012, we are trying something new; we will be hosting the same chat twice.  Shareka and I have joined forces with the Aussies, meaning that #slpchat will run on February 5th at 4:30 pm Sydney (Australia) time (hosted by @SpeechieLO and @bronwynah as @SLPChat) and AGAIN at 2:00 pm Toronto/New York time also on February 5th (hosted by your usual @SLPChat moderators you know and, we hope, love).

Both chats will be ‘chirpified’ and posted here on the blog for your reading pleasure after the fact. If you are wondering which chat is best for you to attend, you can check out everytimezone.com and put the yellow line to either 4 pm Sydney time or 2 pm New York time to figure out when the chat will occur in your own time zone. So, without further ado, I bring you our topic blog post to get you thinking before the chat (written by @bronwynah). Take it away, Bronwyn!
How do we judge one another as real, credible, speech language pathologists? How do consumers see our handles – what is in our name, bio, and tweet repertoire – that might ‘ring true’ as being a qualified speech language pathologist? From those (#SLPeeps) who tweet anonymously for various reasons, but align themselves with the #SLPeeps community, and those who tweet ‘as themselves’ but without authentication – the ‘blue tick’ of Twitter- there is a huge
variation in how #SLPeeps present themselves to the ‘online public’ and to one another.

Tweeting anonymously, or identifying oneself by authentic name and biographical information, there are many variations upon the theme. However, it is interesting to discuss what might motivate some people to presenting themselves a certain way on Twitter, and how that impacts upon us, our service employers, our consumers, and potentially our own families. Seemingly too much to discuss in one twitter chat, we will simply keep ourselves to this:

•  How do we judge plausibility and veracity of ‘twitter profiles’ presenting themselves as #SLPeeps?
•  How do we present ourselves, and why? What leads us to tweet anonymously, or as identifying ourselves, and what do both of these positions allow?
• Does it really matter, that the bulk of the #SLPeeps profiles, aligned as SLPs in the ‘twitter community, are not verified or verifiable?  Does it really matter if a person you are tweeting with about SLP issues, is not reallyan SLP? What legal issues arise? What interpersonal or professional issues might arise?
•  How do consumers, families, parents, and people who seek the services of an SLP, discriminate all of this andmake some critical judgements about twitter handles and the information being tweeted by presumed ‘experts’?

Please join us on Sunday, February 5th at 4:30 pm Sydney time and/or at 2:00 pm New York time to discuss these issues and the potential further reaching issues surrounding online presence and professionals.

If you have never participated in #slpchat, but want to, you can go to our various tabs at the top of this page such as “What is SLPChat?“, “How to Participate“, and “SLPChat Tips“. We hope to see you there!

Ask An(other) SLP

The #SLPeeps have been a great resource for random questions and getting answers fast from a broad range of perspectives. Have you ever had big questions you didn’t ask? Or do you get questions from clients and families that you are never sure you’re answering in the best possible way?  Have you ever wondered what other people are doing to get around the sorts of problems and roadblocks you come up against in your practice?

Conversely, non-SLPs may not feel they are ‘allowed’ to ask questions using the #SLPeeps hashtag (but they are welcome to! Of course, they may not even know the #SLPeeps tag exists?) Students, soon to be students, and/or anyone who is not a SLP may have burning speech or language related questions too!

This time, for our last #slpchat of 2011, we want to do something very different. We want YOU to generate the questions and steer the discussion. But in order to do that, we need your questions!!

So, please, DM @SLPChat with any question or concern you have come up against in your practice as an SLP or as a non-SLP who would relish the opportunity to ask SLPs open questions. You can also email your questions to slpchat@hotmail.com if @SLPChat is not following you (although we make every effort to follow back anyone who is following us).

The #slpchat will be held live on Twitter Sunday, November 20th at 7 pm EST. If you are unsure when that time and date is for you, please consult this handy visual time zone: http://everytimezone.com/ -> 7 pm EST is New York time – slide the green line until it lines up with 7 pm in New York and your corresponding time will be displayed at the top.

We look forward to fielding your questions and seeing you next week.

EBP and the SLP: What informs our practice?

**** click here for the chirpstory of this chat.

 

The emergence of numerous intervention techniques in the field of speech &
language pathology requires the professional to make sound clinical judgements to
ensure best practice in service delivery. In recent years Speech pathologists have
been called on to critically evaluate the literature and choose the best scientific
evidence to justify treatment decisions. This connection between best research
evidence and high quality clinical practice forms part of a term with which we as
professionals are now very well acquainted: “Evidence-Based Practice (EBP).

ASHA proposes a three pronged model of EBP that includes current best practice (published research and position statements by regulatory bodies and professional associations), clinical experience, and patient/client values. None of these three prongs is sufficient on its own, and all three prongs are important contributors to EBP in a clinical setting.

The position statement of the American Speech & Hearing Association (ASHA) on
EBP highlights that in making clinical practice evidence-based clinicians should:

• recognize the needs, abilities, values, preferences, and interests of individuals and families to whom they provide clinical services, and integrate those factors along with best current research evidence and their clinical expertise in making clinical decisions;

• acquire and maintain the knowledge and skills that are necessary to provide high quality professional services, including knowledge and skills related to evidence-based practice;

• evaluate prevention, screening, and diagnostic procedures, protocols, and measures to identify maximally informative and cost-effective diagnostic and screening tools, using recognized appraisal criteria described in the evidence-based practice literature;

• evaluate the efficacy, effectiveness, and efficiency of clinical protocols for prevention, treatment, and enhancement using criteria recognized in the evidence-based practice literature;

• evaluate the quality of evidence appearing in any source or format, including journal articles, textbooks, continuing education offerings, newsletters, advertising, and Web-based products, prior to incorporating such evidence into clinical decision making; and

• monitor and incorporate new and high quality research evidence having implications for clinical practice.

Does this sound like what you are doing in your practice? Tell us more!

Evidenced Based Practice and these ASHA guidelines will be the hot topics for
our next #slpchat, scheduled for Sunday, October 2nd at 6 pm Eastern Time. Join
us and let us know how you are using EBP in your practice and how it influences
treatment decisions and outcomes.

Some of the questions we will be discussing include:

Is any one prong of EBP more important than the others?

Is any one prong used more than the others?

Is any one prong stressed more than the others?

How big and what kind of role do you think patient/client values play ins EBP? Is there a time when you’ve considered it more carefully than other times? Why?

What influences your choice of intervention technique?

Do you thoroughly research new therapy techniques?

How applicable are these guidelines to speech pathologists working in the field?

Are we as clinicians consistently using these guidelines when making treatment
decisions?

Is this really practical for the wide range of communication and swallowing
disorders which we encounter?

What challenges do you face that may hinder your ability to successfully engage in
EBP?

Would you use intervention techniques that didn’t have the sound research base
behind them?

How can we attempt to incorporate EBP into our practice when there isn’t formal research on a given therapy technique?

We look forward to hearing your views and experiences. See you there!

 

Literacy and the SLP: August 14 at 2pm EDT

*** click here for a chirpstory of this chat.

 

After a few months of vacation and hiatus, we are beginning our 2nd year of #slpchats! And what better topic than literacy and the role of SLP/SLTs, especially as many are about to begin a new school year.

SLPs are becoming increasingly involved in literacy assessment and intervention. There was a time when reading skills were left only to the daycare and classroom teachers but we find ourselves in a position to provide more support in reading and writing intervention than ever before.

There are many aspects of literacy where a speech pathologist could lend support or intervention. Listed below are several of the areas of reading that people require to be successful readers:

Print Concepts: Learning how to hold a book, which way to turn the pages or track print, that meaning is derived from print and not the pictures, and literacy-specific vocabulary (e.g. cover, author, pages, title, etc) are generally considered a part of emergent literacy skills.

Alphabet Concepts: Learning the letter names, the sounds letters make including diagraphs (e.g. ‘sh’, ‘ch’, ‘th’), as well as upper and lower case symbols for each letter are aspects of alphabet concepts and are required before a person can read or write words.

Phonological Awareness: Understanding how sounds create words and how words are separate from each other as well as the ability to manipulate these sounds with and without visuals are important to later decoding and spelling skills.

Language skills: Understanding the meaning of words (i.e. semantics) and the grammatical organization of language (i.e. syntax) is crucial to listening and reading comprehension. Decoding is of no use to anyone if they cannot make sense of what they are reading. Oral language has generally been accepted as foundational to reading and writing success.  It is also important to understand social interactions and uses of language to understand interactions and thought processes of characters in books.

Narrative Development: Being able to understand and produce narrative stories is important to reading and writing success, especially as people develop their literacy skills and apply them to academic situations. (Kaderavek & Sulzby, 2000). This also applies to understanding and use of story grammar and structure.

Research has supported that children with speech sound disorders have difficulty with later reading skills, and even more difficulty if they also have specific language impairment (Boada, Pennington, Peterson & Shriberg, 2009).

It becomes clear that a speech-language pathologist could potentially have a tremendous role to play in literacy intervention and prevention of future reading and writing difficulty. However, this continues to be ‘tricky’ sometimes given multiple people who have a role in literacy. There is a need to work together with many other professionals in order to not duplicate services but utilize everyone’s various skills and develop roles in literacy assessment and intervention. The SLP role is often not clearly defined and is different everywhere, depending on the facility, SLP confidence, others working on literacy, caseload need, availability of resources, and so on. The ASHA website has an entire section devoted to literacy, called the Literacy Gateway. It contains links to articles, position statements, and other information on literacy available to SLPs. We encourage you to browse this site. Also, CASLPA has a great section on “The 3 Ls: Language, Literacy, and Learning” in their most recent issue of Communiqué. We also encourage you to read those articles to learn more about what SLPs are doing to improve literacy skills.

Beyond children, literacy skills are also important for adults when reading labels on medications, following health care instructions, signing consent documents, driving, and other everyday living situations with friends and family. In a rehabilitative situation, SLPs can also provide support and intervention to adults learning to read whether they have lost this skill due to a neurological incident, are ESL, or never had the skill in the first place.

On August 14^th at 2 pm Eastern Time (Toronto time) we will be discussing the role of SLPs with regard to literacy. We will be asking questions about the role various SLPs have taken to support the literacy skills of their clients, what assessment and therapy tools are being used, and how we feel our role may continue to change over time. We hope you will join us!

References

Broada, R., Pennington, B., Peterson, R., & Shriberg, L. (2009). What influences literacy outcome in children with speech sound disorder? Journal of Speech, Language, and Hearing Research, 52(5), 1175.

Kaderavek, J., & Sulzby, E. (2000). Narrative production by children with and without specific language impairment: oral narratives and emergent readings. Journal of Speech, Language, and Hearing Research, 43(1), 34.

Fluency chat archive now available

If you want to read an archive of the #slpchat from May 14, 2011 on Fluency, you can read it here: http://chirpstory.com/li/1447.  Please note that while the questions posed by @SLPChat, the discussion moderator, are highlighted throughout the chat, the responses do not neatly fit under each question. This is due to the fluidity of a chat and the significant lag time we were experiencing yesterday during the chat.

Treatment of Fluency Disorders

This week is National Stuttering Awareness Week and what better way for the #slpeeps to contribute, than to make it the topic of discussion for our upcoming #slpchat! Yes we are aware!

Dysfluency/stuttering and its treatment have been making the rounds across conversations all over the world with the release of the popular Academy Award winner “The King’s Speech.” We watched the more unorthodox techniques of  Lionel Logue, which poses the question “What has changed since those early days of stuttering treatment?” “What techniques are being used now to treat stuttering in preschoolers, school aged children, adolescents and adults?”

Treatment options for the various age groups vary across countries. For preschoolers indirect therapy may be used to create a fluency enhancing environment, by teaching parents to slow their rate of speech, avoid interrupting, reframe responses, and modify questions to reduce demands on the child. Other therapists may use a behavioural approach such as the Lidcombe program , which uses verbal contingencies to praise “smooth speech” and to acknowledge or correct unambiguous stuttering.

Treatment options become a bit more difficult in the school aged to adult years due to decreased neural plasticity, amongst other factors.  ASHA notes  that techniques that have the greatest efficacy for reducing the frequency of stuttering in adults and older children includes those that change the timing of speech (e.g. slowing down, stretching out sounds), or reduce physical tension during speaking (e.g. gentle onsets of speech movement).  Some other strategies that have come up in the literature are:

•  Self-Imposed Time Outs: where a person pauses after a moment of stuttering.
• Syllable-Timed Speech : involves speaking with minimal differentiation in linguistic stress across syllables and is achieved by saying each syllable in time to a rhythmic beat.
• Pull outs: During the moment of stuttering, staying in the tension and sliding out by breaking down the tension in the speech mechanism, before continuing with the production of the word. Discussed here
• Voluntary Stuttering . Discussed here

Another speech restructuring program for adolescents and adults which I (Shareka) learned about and practiced in grad school was the Camperdown program out of Australia, which presents a new way of teaching prolonged speech.

New Medical Technology has also introduced delayed auditory feedback, rate control and masking devices for stuttering treatment.

In our upcoming #slpchat on Saturday May 14th at 7pm ET, We’d like to talk about what types of treatment you use in your practice for stuttering at each age level, and what you view as effective/ineffective. Areas we also wish to look at during this time are:

• Assessment tools in Fluency Disorders
• When to start treatment in Preschoolers
• The SLP role in counselling in fluency Disorders: Dealing with avoidance, anxiety and negative perspectives on stuttering.
• Bullying and the school-aged child who stutters
• The Acquired Neurogenic Stutter

Don’t forget to follow @Slpchat this week for some useful links to pages and articles on stuttering treatment.

We look forward to your participation this weekend! See you there!

April 10 chat archived for your reading pleasure

There is an archive of the April 10th slpchat that you can view here.  Our next chat is on fluency and will be May 14th at 7 pm ET to allow SLTs from Australia and New Zealand to join in.  If you are unsure when this will be in your time zone, please go here and select 7 pm April 10, 2011  in America/Toronto time and then choose your time zone to make the conversion.

Hope to see you at the next #slpchat!

All About Words: Developing first words in Children with Language Delay

You have just assessed 2 year old “Tommy” at your clinic. He presents with severe expressive and receptive delays and has little to no single words.

Does this scenario sound familiar?  If you’re a practicing paediatric speech therapist/pathologist you most likely have met this child at some point during your profession.  If not, be prepared; he/she is coming.  The question is where do you go from that point? What type of intervention approach do you use? What words do you teach him to use first? Many of us immediately start banging our knuckles together saying “moooore.”  However do we have a basis for choosing this word as part of our “first faithfuls”?  Some therapists have argued that “more” actually isn’t a very functional word to learn, whereas others believe it is the most functional for children’s everyday interactions. Our next #slpchat, therefore, will discuss some of the considerations in choosing the first words to teach to children with expressive language delay.

Owens(2004), notes that an important consideration in choosing words for a first lexicon  is that words are functional and fulfill a broad range of communicative purposes. We want to teach children words that they can use often to accomplish their social goals. Lederer (2002) expands this to include not only functionality, but also developmental norms, motivation, lexical variety and phonological information.

Many researchers have compiled their lists of vocab targets for children with language delay. Some contain familiar items within a child’s environment such as names of family members, body parts, preferred foods or toys, while others expand to substantive and relational words as is shown in the table below by Bloom & Lahey (1977).



A good list of early words can also be found in Banajee, Dicarlo, & Stricklin, (2003). Core vocabulary determination for toddlers. Augmentative and Alternative Communication, 19, 67-73. Accessed:  http://www.minspeak.com/documents/1-BanajeeList.pdf

We’d like to hear from you! What are you using in therapy? Are you following any particular research/ hierarchy?

Join us for the #slpchat on April 10^th, 2011 at 2pm ET, where we will be discussing these vocab choices, as well as your own considerations for early vocabulary, whether it be through verbalization, sign language or any form of AAC. We also wish to look at the types of intervention techniques you use to target this vocabulary.

It would be useful to read the following articles in preparation for our discussion:

Lederer, S.H. (2002). Selecting and facilitating the first vocabulary for children with developmental language delays: A focused stimulation approach. Young Exceptional Children, 6(1), 10-17.

First Words: From Theory to Intervention
Susan Hendler Lederer, Ph.D., Adelphi University, Garden City, NY  http://www.speechpathology.com/articles/article_detail.asp?article_id=329

First Words, First Books, & Focused Language Stimulation
Susan Hendler Lederer, Ph.D. http://www.speechpathology.com/articles/article_detail.asp?article_id=374

We look forward to hearing from you!

Other References:

Lahey, M., & Bloom, L. (1977). Planning a first lexicon: Which words to teach first. Journal of Speech and Hearing Disorders, 42, 340-350.

Owens, R. (2004).  Language Disorders, (4th ed.).  Boston, MA: Allyn & Bacon.

Paul, R. (2006). Language disorders from infancy to adolescence (pp. 301-305). St. Louis, MO: Mosby.

Oral Motor Chat Update

Well, I dropped the ball and didn’t make a Chirpstory out of the tweets from last week’s chat in time.  Now the tagged tweets are gone.  I apologize in the biggest way.  Also, the “I” in this blog is Tanya. Shareka would have never dropped the ball like I did!  However, I’ve learned a new lesson and discovered how to make the Chirpstories much more quickly so that it will never happen again and we’ll always have a record of the chats.

It was an interesting chat, and was the best attended ever.  We learned a few things from having the chat be so large – you cannot possibly keep up with all chats and conversations, especially if it was the first time someone tried to participate in the chat.  In future, we suggest that you monitor @SLPChat closely for the questions during the chat and then allow yourself to be immersed in a specific smaller group conversation within the chat.  You can always go back and read the other comments later that day or over the next few days.  And (live and learn) I won’t allow myself to make the same Chirpstory mistake again so you will have the chat completely saved for later reading and discussion.  We encourage people to discuss these topics and follow up with participants at their leisure long after the chat is officially finished.

We do have the results of our poll on use of non-speech oral motor exercises.  We were surprised to see how many people are using them, although there remains a great deal of unclarity over what different people consider to be an NSOME.  This topic will almost surely be revisited in the future with more specific content and careful planning on our part to attempt to keep discussion focussed.  You can see the results of our poll here: http://twtpoll.com/r/n0at0a

See you on May 8th at 2 pm ET for our chat on building an early lexicon in language delayed children.

UPDATE: Thanks to @kateoregon, we now have a google doc with the entire #slpchat  hurray.  You can read the chat here. Please note that you must go to the bottom of the doc and read up to see the chat in chronological order. Supreme thanks to Kate Cross for making it possible

Getting the oral motors running in therapy

Oral-motor therapy is possibly one of the oldest therapeutic perspectives in our field (Marshalla, 2008), but has recently raised some controversy. The controversy may stem from a lack of clear definition of oral-motor therapy (Bahr, 2008).  So, what is the definition of oral-motor therapy?  Pam Marshalla has a definition of oral-motor therapy on her website:  “the process of facilitating improved jaw, lip, and tongue movement for speech” (Marshalla, 2008). Many SLPs consider oral-motor therapy as using specific motor speech techniques to accomplish this task. For example, backward or forward chaining and successive approximations such as those that Nancy Kaufman has produced. Controversy does not appear to stem from oral motor therapy from that perspective, but from the use of non-speech oral motor exercises (NSOMEs).

Many clinicians have become famous for their approaches to oral-motor therapy. Nancy Kaufman, Pam Marshalla, Debra Beckman and Sara Rosenfeld-Johnson have various oral-motor therapy suggestions and programs that many S-LPs use and love. Not all clinicians consider all aspects of their programs equal, however, as a result of perceived use of non-speech oral motor exercises (NSOMEs) as part of some programs. It should be noted that not all oral motor therapy programs incorporate NS-OMEs and that oral motor therapy in a speech context can be discreet from NS-OMEs. You can read about Pam Marshalla’s view on OMT and NS-OMEs here.  You can read about Sara Rosenfeld Johnson’s view on OMT and NS-OMEs here (PDF).

So, what are NSOMEs? Greg Lof defines it as: “any techniques that do not require the child to produce a speech sound but are used to influence the development of speaking abilities” (Lof, 2007 in interview).  In 2009, Lof and Watson reported that 85% of US SLPs are using NS-OMEs in the attempt to change speech sounds. Dr. Hodge and colleagues (2009) independently found out that 85% of Canadian SLPs were doing likewise.

During the #slpchat on March 13^th, 2011 at 2 pm EST, we will be discussing oral motor therapy. We will discuss: how and when you decide to use oral-motor techniques and therapy vs. typical articulation or phonological approaches; approaches and techniques that you like or dislike and why; and we will touch on the use of non-speech oral motor exercises: the controversy and evidence that surrounds it.

For more information on oral motor therapy please see (list not exhaustive):

Mass, E., Robin, D., Austermann-Hula, S., Freedman, S., Wulf, G., Ballard, K., & Schmidt, R. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology. Vol. 17,  277–298.

What is oral-motor therapy? By Pam Marshalla: http://bit.ly/hv7yHc

What does oral motor therapy have to do with speech? By Pam Marshalla: http://bit.ly/fM3oZH

For more information on NS-OMEs please see (list not exhaustive):

Ruscello, D. (2008). Nonspeech oral motor treatment issues related to children with developmental speech sound disorders. Language, Speech and Hearing Services in Schools, 39, 380-391. Retrieved from http://bit.ly/dJGc8S

An interview with Greg Lof about NS-OMEs: http://bit.ly/hHoCaM

Oral Motor Treatment and NS-OME by Pam Marrshalla: http://bit.ly/ijykqG

Caroline Bowen and NS-OMT: http://bit.ly/eqfOsN

References

Bahr, D. (2008). The oral motor debate: where do we go from here?. Proceedings of the 2008 ASHA convention (pp. 1-23). Chicago: Poster session 2054.

Hodge, M. (2009). What can we learn about clinical practice from SLPs’ experiences using nonspeech oral motor exercises in children’s speech therapy? In C. Bowen,Children’s speech sound disorders. Oxford: Wiley-Blackwell.

Lof, G. L., & Watson, M. M. (2008). A nationwide survey of non-speech oral motor exercise use: Implications for evidence-based practice. Language, Speech, and Hearing Services in Schools, 39(3), 392-407.

Marshalla, P. (2008, April 9). Oral motor treatment vs. non-speech oral motor exercises. Oral Motor Institute Monograph, 2, Retrieved from http://www.oralmotorinstitute.org/mons/v2n2_marshalla.htmlo

Marshalla, P. (2008, July 10). Oral motor treatment and ns-ome. Retrieved from http://www.pammarshalla.com/