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  1. Speech-Language Pathology Courtney Jones MS CCC-SLP

  2. Speech-Language Pathology • What do we do? • Promote recovery of function (rehabilitation) • Promote development (habilitation)

  3. Objectives • Scope of practice • Points of care • Resources for patients

  4. Scope of Practice • Speech Sound Production • Articulation • Developmentally appropriate • Placement for sounds • Social and academic impact

  5. Articulation • Apraxia of speech • Acquired • Developmental or Childhood apraxia of speech • Motor planning speech production The brain is telling the mouth to say “cat”, but motor plans “a”

  6. Articulation • Dysarthria • Slurred" speech • Speaking softly or barely able to whisper • Ataxia- • failure of muscular coordination; irregularity of muscular action • Dyskinesia • distortion or impairment of voluntary movement, as in tic or spasm

  7. Resonance • Hyper/hyponasality • Cul-de-sac resonance • Mixed resonance

  8. Resonance • Cleft palate • Hard • Soft • Submucous • Velopharyngeal insufficiency • short palate • weakness • Phoneme specific errors

  9. Resonance • Correct tongue placement for sounds • Bio feedback with a nasometer • Compensatory articulations • ENT No research to demonstrate oral motor exercises improve soft palate movements.

  10. Nasometer

  11. Nasometer

  12. Voice • Phonation quality (nodules) • Respiration (words per breath) • Pitch • Loudness

  13. Fluency • Stuttering • Cluttering Martina Costello, SLP

  14. Language (comprehension and expression) • phonology • morphology • syntax • semantics

  15. Language • pragmatics (language use, social aspects of communication) • literacy (reading, writing, spelling)

  16. Language (comprehension and expression) • prelinguistic communication (e.g., joint attention, intentionality, communicative signaling) • paralinguistic communication (tone of voice, inflection) • 90% of what we say is with our body

  17. Speech-Language Milestones • 6-12 months • 6 months-laughs, gurgles, coos, reacts, babbles for attention • 8 months- responds to name, produces syllables, tries to imitate • 10 months- plays peek-a-boo, may say “mama” “dada” • 12 months-recognizes name, says 2-3 words besides “mama” “dada”

  18. One year old • Recognizes name • Understands “no” • Imitates familiar words • Gives toys on request • Waves good-bye • Makes sounds of animals

  19. 18 months • Uses 10-20 words • Recognizes pictures of familiar person’s objects • Combines two words “all gone”, “bye-bye” • Uses “more” and “up”, requesting words • Points to toes, ears and nose • Follows simple commands • Imitates familiar actions, vacuuming, wiping • Points and gestures to call attention to event or object

  20. Two year old • Identifies body parts • Carries on “conversation” with self or dolls • Asks “what’s this?” • Sentence length 2-3 words • Calls themselves by name • 300 words in speaking vocabulary • Attends to an activity for 6-7 minutes

  21. 2 ½ year old • 450 word vocab • Gives first name • Uses past tense and plurals • Understands time concepts “Tomorrow” • Refers to self as “me” • Gets attention verbally “watch me” • Talks to children and adults • Likes to hear same story repeated • Knows big and little

  22. Three year old • 1000 word vocab • 3-4 word sentences • Uses language to express ideas • 80% intelligible • Asks “what”, frequently  • Attends to activity for 8-9 minutes • Practices language by talking to themselves

  23. Four year old • 1500 vocab • Attention for 11-12 minutes • Asks “who?” and “why?” • 4-5 word sentences • Points to colors • Identifies shapes • Easily understood by unfamiliar listeners

  24. Five years old • 2200 vocab • At least 5 word sentences • Defines objects by their use (you eat with a fork) • Knows spatial relationships (on top, behind) • Uses future, present and past tense • Attends for 12-13 minutes

  25. Cognition • attention • memory • sequencing • problem solving • executive functioning

  26. Cognition • Adapted from Brain Tree

  27. Attention • Attention -Attention skills underlie all other cognitive processes. Sohlberg and Mateer (1989) describe the following aspects of attention;

  28. Types of attention • Focused-momentary Attention • Sustained Attention • Selective/Elective Attention • Joint Attention • Alternating Attention • Divided Attention

  29. Attention • Process training • Circling all the C’s on a page full of letters • Strategies • Limiting distractions • Cues • Functional task • Completing a homework assignment • Completing an activity with family • Following a 1-step direction

  30. Memory The ability to keep things in the mind and recall them in the future. • Errorless learning- the more accurate the response the better the retention of the information; therefore, setting up the patient for success by give the correct answer immediately before the question (e.g., My name is John. What is my name?) • 80/20 rule • Self-awareness

  31. Memory

  32. Memory • Process Training • Learning about memory • Strategies • Internal • External • Functional tasks • Coming to therapy on time

  33. Information Processing The processes that organize and access information at a given rate. • Visual processing • Auditory processing • Speed of thinking • Capacity of thinking • Control

  34. Information processing • Process Training • Visual scanning • Auditory tasks • Strategies • Cues • Environment • Functional Tasks • Finding the cafeteria

  35. Executive Function the capacities that enable a person to engage successfully in independent, purposive, self-serving behavior and allow us skills to accomplish goal-directed activities in the following areas: • Self-Initiation • Self-Inhibition • Goal Setting • Planning and organization • Self-Monitoring • Problem solving • Flexible problem solving • Self-awareness

  36. Executive functioning • Process Training • Learning about EF • Patient’s strengths/weaknesses • Strategies • Specific to strengths/weakness • Functional tasks • Asking for directions • Problem solving unexpected event

  37. Feeding and Swallowing • Feeding and Swallowing • oral, pharyngeal, laryngeal, esophageal • orofacialmyology (including tongue thrust) • oral-motor functions

  38. Clinical signs and symptoms of aspiration • Coughing • Choking • Watery eyes • Red eyes • Refusal • Frequent respiratory infections • Unexplained fevers • Oxygen need • Desaturation/Bradycardia with eating • Upper Right lobe infiltrates (atelectisis) • Weight loss

  39. Silent aspiration • Watery eyes • Mild redness • Increased congestion with eating • Course breathing via cervical auscultation

  40. Clinical Feeding Evaluation • History • Observation • Trial therapy • Intervention • Recommendations • Coordination with Primary Care NP or Physician

  41. Formal Swallow Studies Modified Barium Swallow study Flexible Endoscope Evaluation of Swallow • Radiology • Barium • X-ray exposure • Aspiration • Outline structure • ENT • Real food dyed blue • Fiberoptic scope • Penetration • Anatomy/Sensation

  42. FEES

  43. FEES

  44. MBSS

  45. Feeding interventions • Thickening • Positioning • Rate of flow • Supplementation • Treatment of cause • Gut comfort • Oral motor • Therapies • Behavioral feeding programs • Cued feeding • Positive feeding practice

  46. Learned Patterns/behaviors • How a child learned the behavior of eating. • How our children trained us to feed them. • What we practice becomes a learned behavior (Brackett) • Appropriate response to an inappropriate request (Eicher) • Eating is a learned behavior.

  47. Maladaptive behaviors • Tantruming • Gagging • Retching • Refusal • Vomiting • Poor acceptance of utensil • Stuffing mouth • Rotating head • Rubbing legs/belly • Holding face • Spiting out • Pushing food away • Covering mouth • Grimacing

  48. Feeding Therapy Medical, Motor and Behavior approach Sensory Oral Sensation • Peggy Eicher, MD, Krisi Brackett, SLP • Paul Hyman, MD • Structured Safe Feeding Practice • Kay Toomey, PhD. • Developmental research • Steps to Eating