Blog 4: Prognosis

At my outplacement at Cheat Lake Elementary I am lucky enough to have a very supportive supervisor who is interested in giving me as much experience as possible. Thus, when it came time to write a new IEP and conduct an IEP meeting with a parent of a child who will begin receiving speech services, she talked me through the paperwork and the process ahead of time, then simply sat in as I ran the meeting.

During the meeting, the parent had several good questions about both the therapy itself, the process, and what kind of progress she could expect to see in her son. When she asked about his prognosis, I told her that as the sounds he had acquired were very stable, and the sounds he had in error were being produced inconsistently, this was a good prognostic indicator for his success. I told her we expected to see fast progress with his speech.

This article supports the use of a child's error consistency index as a prognostic indicator; that is, the more inconsistent the errors, the better the prognosis with intervention.

Tyler, A.A., Lewis, K.E., & Welch, C.M. (2003). Predictors of phonological change following intervention. American Journal Of Speech-Language Pathology. 12, 289-98.

Blog 3: Pragmatics Intervention

R and E are both in the second grade. In addition to being seen individually for articulation errors, they are also seen in a group of 2 twice weekly for pragmatic language intervention. They have no specifically diagnosed disorder or problem, just an observed lack of pragmatics skills both in and out of the classroom. These goals have been included on their IEP.

One of the techniques we use to review and discuss pragmatic skills is social skills stories. These are comprised of a short paragraph describing something happening to or around a child, and giving 3 choices of response, only one of which is correct, giving an appropriate interpretation of or reaction to the situation. R and E must then choose the correct response, and discuss WHY they think that was the response, using both information from the story and inference skills.

Additionally, R and E take turns reading the cards aloud to each other, to practice oral reading and listening comprehension skills. This also reinforces turn taking and other manners such as paying attention and listening.

The clients, R and E, enjoy this technique, and respond positively and enthusiastically to both the cues and discussion, and to the stories themselves. R’s regular classroom teacher reported she has been acting more “normal” with her peers on the playground. My supervisor feels that this is an appropriate intervention for R and E.

In the article “Exploring the effects of communication intervention for developmental pragmatic language impairments: a signal-generation study,” the authors Adams, Lloyd, Aldred, & Baxendale report that pragmatic skills can be accurately measured and will improve with direct treatment. This study was done with school-aged children over an 8 week period, and although focused on the ability to provide accurate measures of the increases, indeed did demonstrate that these children made gains in the area of pragmatic skills.

Adams, c., Lloyd, J., Aldred, C., & Baxendale, J. A. (2006). Exploring the effects of communication intervention for developmental pragmatic language impairments: A signal-generation study. International Journal of Language & Communication Disorders, 41, 41-65.

Blog 2: DSL/CAS/AAC Client

A is a 6 ½ year old boy who has been coming to the Allen Hall Speech Clinic since summer of 2006. He had been diagnosed with severe Childhood Apraxia of Speech, and was provided with an AAC device called the Vantage. His general diagnosis is Delayed Speech and Language. Over the summer of 2007, he was also diagnosed with Selective Mutism.

We have been working on many, many goals. Several are related to language, both expressive and receptive, also on producing function words and some pre-literacy and basic literacy skills. We are also working on using the Vantage for communication, and learning the language of Unity that the Vantage uses.

Paul (1997) suggests that if a child is using some vocalizations, then it is appropriate to shape these into words meeting a variety of social functions, such as greetings, acknowledgements, and attention getting. This reinforces my attempts to teach A to say such words as “hi” and to shape his attempts at “dad, uh-huh, huh-uh, look, more” into more standard productions. As communication is a multimodal event, this is a fitting addition to A’s communicative abilities.

It is also important that AAC users become literate, as this is the most efficient and common method of communication that may be available to them. Literacy socialization is one of the basic components to building literacy. This involves understanding words as being made up of letters and having meaning, page turning and left to right progression of words and sentences, and different types of language found in books. I am trying to foster some of these skills in A by attempting to read a story to him at least once a week, often pointing to the words as I read and having him turn the pages.

I think A has a very tough road ahead of him, and try very hard to support his attempts at and abilities for communication. We are working hard, and although progress is slow, it is occurring. A is a challenging and enjoyable boy to work with, and with the support of my supervisor, I am learning a lot from him.

Paul, R (1997).Facilitating transitions in language development for children using AAC. Augmentative and Alternative Communication. 13, 141-8.

AR client post

My client is 75 years old, and is being seen for aural rehabilitation. He has a severe, sloping progressive sensorineural hearing loss and has been seen in therapy for about 4 years. He is mainly working on developing and refining his speech reading skills, and has utilized a variety of therapy techniques including computer-generated programs and live voice practice.

In therapy, I have been using a variety of presentation techniques to practice speech reading, from live voice reading to computer programs wherein a video is played of someone saying different words/phrases, etc. One reason I have been doing this is to keep the client interested and motivated. He is an intelligent man and has already experienced many of the therapy techniques used at Allen Hall, and enjoys something new. He seems to enjoy not knowing what to expect when he comes for therapy each session. This is where I have considered patient values and preferences in choosing my variation of presentation techniques.

My supervisor has encouraged my use of a variety of presentations, both to keep my client “on his toes,” and to allow him to practice his speech reading in the same structured therapy sessions, but using different faces and presentations.

Research has shown that synthetic faces can provide valuable support to boost comprehension in speech reading tasks (Lidestam, Lyxell, & Lundeberg, 2001). Thus, although the computer programs I currently use are video clips of natural faces, and they fall in the middle in the continuum between natural and synthetic faces, I think this research plays a part to support this. Using the semi-synthetic faces on the computerized programs can help provide my client with necessary practice using speech reading techniques with different speakers while remaining in the therapy room.

I feel this is effective. Although my client has mentioned that he finds the computer program “repetitive,” he has stated that he sees the value in both its repetition and the presentation of different faces on which he can practice speech reading.

Reference: Lidestam, B, Lyxell, B, & Lundeberg, M (2001). Speech-reading of synthetic and natural faces. Scandinavian Audiology. 30, 89-94.

All Out!

This will be the beginning of Paula: ALL OUT! As I stumble through graduate school. Keep your eyes (and tires) peeled for exploits here!