Phonologicaltherapy meets Twitter

This chat occurred Feb 3/4 2013 and is now archived here.

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Caroline Bowen PhD CPSP, whose Speech-Language Therapy dot com website is well known to #SLPeeps worldwide, also runs the eight thousand strong discussion group called phonologicaltherapy. The emphasis in both of these online resources is EBP in children’s speech sound disorders: articulation disorders, phonological disorders, and childhood apraxia of speech. A relative newcomer to Twitter, Caroline signed on as @speech_woman (met Speechwoman yet?) in February 2012 when she was writing about Life Online for her Webwords column in @SpeechPathAust‘s Journal of Clinical Practice in Speech-Language Pathology. One year on, she bravely steps up to the plate to take part in our first #SLPchat for 2013, “phonologicaltherapy meets Twitter”.

We think this is perfect symmetry, since our first ever #slpchat, in December 2010, was on Cycles for phonology and we’ve just passed our two year anniversary (how time flies!). We’re thrilled that Caroline has agreed to join us. We’ll also be merging the North American and Australian chats into one chat only on Sunday, February 3rd, at 6 pm EST (New York/Toronto) which is also Monday, February 4th, at 10 am AEST (Sydney). We hope you’ll join us for the chat. Here is what you can expect:

Question 1: What are your top 5 resources for child speech assessment and intervention?

What inspires your intervention sessions? Share the ‘must have’ and ‘must read’ SSD materials, equipment, sources and resources that you use or refer to all the time. These might include particular journal articles, books, manuals, games and activities, reinforcers and rewards, professional listservs, discussion groups and other social media, websites and more.

Question 2: Articulation Disorders: How do you assess articulation disorders, and which treatment approach, or approaches do you use? 
What is your assessment tool of choice? Do you implement traditional articulation therapy, a variation of it, or some other approach?

Question 3: Phonological Disorder: How do you assess phonological disorder, and which treatment approach, or approaches do you use?
What is your assessment tool of choice? In intervention, do you use any, some or all of the following, Core Vocabulary Therapy, Cycles Therapy (Patterns Intervention), Imagery Therapy, Metaphon, Minimal Pair Therapies, Parents and Children Together (PACT), or Phoneme Awareness Therapy or some other approach? Are you an eclectic practitioner who uses a mix-n-match approach – do tell!

Question 4: Target Selection: In the process of Target Selection for Phonological Intervention which of the available approaches do you employ?
How do you decide what to work on first…second…third…? Are you a fan of traditional or newer selection criteria, do you combine them, and have you implemented a complexity approach to choosing therapy targets? How was it for you?

READINGS
Explore the links above as preparation for this chat. Take the time to discover leads to interesting and useful journal articles.

REFERENCE
Bowen C. (2012). Webwords 44: Life online. Journal of Clinical Practice in Speech-Language Pathology, 14(3), 149-152.

AAC – Everyone knows something, and some people know a lot: Let’s Get Together for Solutions

This chat is completed. You can read the archive of tweets for both chats by going here for the chat at 7 pm on Sept 9 (EDT) and clicking here for the chat at 8 pm on Sept 10 (AEST).

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This chat on AAC in practice will be filled with ideas, tips and strategies for applying AAC to communicate in many settings. We all know that it takes a lot more than the tools, to get AAC in use in day-to-day situations. So what do people find helps to actually translate the strategies, techniques, and tools that have been recommended, into daily life? Let’s focus on children who are trying to move their language skills into interactions with other children. Let’s think about actual strategies during everyday and even uncommon activities and ways of using AAC in those activities, that will help children to get enjoy communicating with others.

Perhaps more than any other field in speech pathology, AAC demands not only a person-centred and family-centred, but a multi or cross-disciplinary, collaborative approach, and one that includes people with the communication disability and their families. To add to this, AAC is ‘multi-modal’ (low tech, high tech, and no-tech) with a myriad of strategies, approaches, tools, and techniques that might be employed (a) in sequence, (b) concurrently, or (c) in isolation. Sometimes, it is the tools and techniques in combination that is helpful, and other times, just one action will make a big difference. Focusing on the tools first, and the person second, leads to a lot of false starts in finding the correct combinations of strategies, techniques, approaches and tools – since all of these things influence the other.

It’s not always easy to balance doing something ‘quick’ and ‘easy’ with doing something that takes more resources – and relies on a full assessment, detailed information from a range of professionals, and waiting for funding and funding applications to come through that might provide something more tailored and complex. We need to do both – we can do quick helpful things, and we can advocate that children and adults who need it have access to a full assessment for communication supports. We would not accept any less than this if it related to mobility options, such as wheelchairs, for which we expect having a proper assessment , fitting, and alignment with the person’s body and mobility needs as to make their mobility comfortable, safe, and effective.

So, this chat will move across the continuum of ‘quick and easy’ ideas to ‘slow and steady’ with a little in-between topic on ‘full assessments’. It does not matter how much training you have had, or
how much ‘expertise’ you think you have. This is not about finding flaws in various AAC systems – it is about tips and strategies for overcoming limitations and removing barriers to successful use.

Question 1: What is ‘Quick and Easy’ to do in AAC practice? tell us your ideas for using AAC that are relatively simple, that might not rely on a full assessment before you get started : these might be general tips, do no harm measures, principles of good multimodal communication, use of picture supports for understanding, promoting emergent literacy – anything at all!

Question 2: Let’s talk about ‘Full AAC Assessment’. What do you usually find are included in a full assessment? What should be? What is sometimes left out? Are there any ways to improve this process?

Question 3: What more complicated AAC systems are you using in practice? This could be high or low tech options. Share your tips and strategies for ensuring that children with higher needs are not ‘left behind’ just because the environment does not yet support a ‘top of the range’ AAC system. What helps you to overcome the limitations of all of the devices that you are using in your practice?

Question 4: What types of devices are you using in your practice? Here we will discuss high tech vs low tech, specific devices, the use of communication books with the PCS symbols and so on. What are the limitations of these devices?

The two chats will occur at 7 pm EDT (New York/Toronto) on Sunday, September 9th, and 8 pm AEST (Sydney) on Monday, September 10th. If you need to know what time that is where you are, you can use everytimezone.com to help.

We hope to see you there!

The ‘A’ Word

This chat occurred on APril 29, 2012. You can read the Australian chat here and the N American chat here. Both were very different chats and worth a look!

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April is Autism Awareness Month, so what better way for the
#slpeeps to celebrate and highlight the growing need for concern
and awareness about ASD, than to make this the topic of our April
#slpchat.

Autism has become the new buzz word in the media and across
various social networks, with celebrities joining in the quest for a
cure, and the app market opening new doorways for children with
Autism. More recently the hot topic has been the possibility that the
new DSM-5 diagnostic criteria will ‘redefine autism,’ and exclude
many from being able to receive services.

Our next discussion will cover many of these topics, as well as
questions about assessment and intervention techniques for ASD.
We also want to cover current trends and research in this area, types
of AAC support, and generally what you as SLPs are doing in your
practice as it relates to ASD.

Once again our chat will be held across 2 different time zones,
giving you two different times to come out and participate. They
are: Sunday, April 29th at 3 pm Sydney, Australia time and again
at 2:00 pm New York, USA time. Don’t forget to check everytimezone.com, the visual timezone that will allow you to put the cursor over each time and
then see what time that will be for you.

We hope to see you out to one or both chats!

What do speech and language professionals do, anyways?

This chat ran March 18th, 2012. Here is an archive of the Australian-based chat and here is an archive of the North American-based chat.

Also, for your viewing pleasure, on top of the memes we have below, here is one created by @SpeechieLO after the chat:

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Over the past month a lot of people have been circulating memes of “what people think I do”. SLP/Ts had a lot of fun with this one, since it feels as though no one knows what we do in the first place. Here are a two examples of these memes:

Taken from www.rehabalternatives.com

Via @SLPTanya

Whether you are a speech pathologist, a speech language pathologist, a speech and language therapist, or a speech therapist, speech therapy assistant, speech language pathology assistant, communicative disorders assistant or otherwise – you have an important role in your community. During this chat we’re talking about our ‘roles’ and ‘identity’ from our own perspective, and from the perspective of people we meet, people we know, people in our own families, our employers, or anyone at all. The question is – who are we in terms of our role, and what do we do, and what do other people think we do?

The reason it might be important to think and talk about this is that ‘role clarity’ is an important factor in successful collaboration. It is only when people are clear about their own roles and those of others, that collaboration can be most effective.

Our last experiment with 2 different time zones worked well, so we’re trying it again! That means that you have two different times to come out and participate in the chat. They are: Sunday, March 18th at 4:30 pm Sydney, Australia time and again at 2:00 pm New York, USA time. If you are wondering what time each of those will be for you, here is a great visual timezone page that will allow you to put the cursor over each time and then see what time that will be for you.

We hope to see you out to one or both chats!

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.

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! 🙂

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/

SLPChat Dysphagia Summary Available Now

We had a great chat on Saturday about dysphagia and feeding.  You can read the entire chat, in chronological order, at Chirpstory. Our next chat will be on Saturday, March 13^th at 2 PM EST.  For those of you who live by daylight savings time, that’s the day the clocks “spring ahead”.  So, if you live near Toronto, New York, Virginia, etc it will be at 2 pm.  If you live along the West Coast, it will be at 11 am.  If you live in the UK, the chat will be at 6 pm (not 7 pm because Daylight Savings Time kicks in that day).  If you are in Melbourne, Australia it will be 5 am on March 14^th (sorry).  If you are still unsure about the date and time, please use the Time Zone Converter to check.

Mark it in your calendar and we’ll see you there!