Assessment and Intervention Final

Differentiate between nonfluent and fluent aphasia. What would a speech-language pathologist expect to see in a client with either disorder.

"Nonfluent aphasias is one with poor output with relatively spared comprehension. It generally is characterized by reduced vocabulary; agrammatism*; and impairments of articulation, rate, prosody (rhythm, stress, and intonation), resulting in labored and effortful production" (p. 298). "Fluent Aphasias consist of impairment in language comprehension with maintenance of normal melodic speech contour. The main characteristics are word-retrieval difficulties*, paraphasias* (phonemic and semantic), neologisms*, perseveration*, and the maintenance of normal melodic speech contour.

You are working with an 8 year old articulation client who has a coexisting stuttering disorder. Describe two programming methods you could use to design your treatment sessions and why you chose those two.

1) Lagged programming method: this is a modified form of the blended approach (below) that incorporates an initial time delay. A period of initial therapy focuses on attaining a predetermined level of mastery in the concomitant disorder (articulation). Once the client has reached this level of mastery, fluency therapy can begin using the recently mastered articulation forms as the basis for practice. Fluency therapy continues to be programmed at comfortable levels of articulation demand as the client progressively masters new objectives in the concomitant disorder area. I chose this because it would create the client to feel comfortable/more confident with one aspect of his or her speech (articulation). With this comfort and confidence, the client would be better able to move onto therapy activities that include both his stronger speech asset and his weaker asset (fluency). 2) Blended programming method: therapy goals for one disorder are incorporated into the therapy activities for a second disorder. For example, during articulation activities, the clinician can encourage fluency-enhancing behaviors such as slower speaking rate and increased pause time between conversational turns. I chose this because it would help the client generalize the therapy techniques for articulation with fluency as well. This would allow the client to practice the techniques together to make his overall speech stronger. This programming method would work well after the lagged method was used because the client would feel more comfortable and stronger with articulation.

While working as an SLP within a middle-school setting, you are collaborating with classroom teachers to encourage the use of effective language strategies within their classes. You've decided to hold a teacher in service for the science department at the school. What are two language learning strategies you could teach the educators that could be used to benefit all of the students within their individual classrooms?

1) Previewing: planning strategy that is used to prepare students for upcoming lessons (two types, oral and written) Oral Material: Topic identification, pertinent vocab review (tier two!!), brief synopsis of information to be presented Written Material:Identification of section headings and photo captions to provide "big picture" of structure/content of reading selection Always check at end of sections to check comprehension and restate/summarize information to help "own it" 2) Think-Aloud: strategy for improving comprehension and monitoring of oral and written material (focuses on literal and inferential comprehension). Clinician orally describes his/her own thought process while engaged in a difficult comprehension or problem-solving task to model target behavior (I do). Then encourage students to engage in their own self-talk. It teaches them to self-monitor and problem solve. E.g. student says "I am frustrated and cannot understand these instructions" → learns to use strategy "ask again and take notes"

An SLP is working with a client with global aphasia. The client struggles to produce spoken language during therapy sessions, so the SLP encourages the client to use a combination of sign language and gesturing to achieve functional communication. Based on this information, which theoretical orientation to aphasia treatment is the SLP using in therapy sessions with this client: restorative/linguistic or substitutive/compensatory? How do you know?

1) The SLP is using substitutive/compensatory because the approach is based on the premise that language function has been lost in the individual. However, the focus of therapy is on establishing functional communication. The SLP "encourages the client to use a combination of sign language and gesturing to achieve functional communication." The procedures are designed to encourage use of whatever modalities are available to the individual to convey messages across successfully to listeners. These may include: speaking, gesturing, signing, writing, facial expressions, drawing, and so on. The focus of this "consequence-oriented" model is on tasks and responsibilities of everyday living and resuming a role in society. 2) I know she is not using the restorative/linguistic approach because this model of intervention is based on the assumption that an aphasic individual's linguistic knowledge has been disrupted and these skills can be strengthened or restored through direct instruction. The main emphasis of this approach is intensive and repeated participation in therapy activities to improve compromised linguistic functions (e.g., syntax, word finding, and phonology). It cencompasses both comprhehension and production of oral and written language targets. The SLP is not using these this type of approach b/c the client is not going through intensive and repeated activities to improve compromised linguistic functions.

Annie is a 6 year old girl presenting a severe phonological disorder. She exhibits final consonant omissions and distortion of fricatives and affricates. She also misarticulates the following phonemes in her spontaneous speech and is quite unintelligible to peers and adults in the school environment (Error sounds: /f/, /v/, /g/, /k/, /l/, sh, ch, th, j, /r/, /s/, /z/, and all consonant blends). However, Annie produces all vowels accurately and her error phonemes are consistently misarticulated. Explain to the parents why you would choose targets based on the Complexity Theory Approach. Provide possible treatment phoneme targets for her intervention plan.

1) The first sounds to target would be /m,n, k,d/ because those are the sounds that develop first. All of those sounds are typically developed by 3-3.5 years old. /r/ should not be targeted first because it doesn't occur until around age 8 for males. 2) Sample activities: Draw 10 pictures on dry erase board, each containing one target sound. Give child squirt gun and tell him to hit one of the pictures. Then instruct him to produce stimulus item at appropriate level of complexity (Single word, phrase, sentence, narrative) Assemble 20 pictures/ objects that contain target sounds and place them on a table. Introduce "Shopping game" by presenting carrier phrase like "I went to the store and bought ___, ___, and ___. Have child remove corresponding pictures from table, then instruct child to take a turn at making a shopping list by producing same phrase with three new food items.

Mary has a 3 year - old boy on her caseload who exhibits word-initial syllable repetitions and hesitations. The child's parents are sensitive to the word stuttering and often finish the boy's sentences, tell him to stop and think before he speaks. Sometimes tell the boy to try again later when he is struggling with repetitions. They have told Mary that his problem is with his motor actions and he seems to be able to control the stuttering some days so they wonder if he stutters for attention. What might Mary counsel his parents on? What therapy targets should she select when working with this client and why?

1) To the parents I would say that the presence of word-initial syllable repetitions and hesitations are common behaviors for stuttering. Stuttering can be differentiated from normal disfluency on three main characteristics: 1) part-word repetitions 2) single-syllable word repetition, and 3) dysrhythmic phonation. 2) Based on the client's young age, an indirect treatment would be selected. An indirect approach focuses on the modification of the communicative environment rather than on treating the disfluencies themselves. The child's family would be taught strategies for adapting their communication behaviors in ways that create an environment conductive to the production of fluent speech. Parents would be encouraged to do the following: listen to the child;s message rather than speech pattern, avoid speaking for the child, avoid communicative stresses (time pressure), decrease demands for verbal performance, and avoid interrupting the child.

A clinician has recently started seeing a client with a psychogenic voice disorder due to PTSD. The client presents with a loss of voice loudness. What stages should the clinician work through with the client? What is the overall goal of psychogenic voice treatment?

1. Client education. The clinician discusses available medical reports with the client and emphasizes that the client's laryngeal anatomy and physiology are intact and, more im-portant, that the client is capable of producing a normal voice. 2. Symptomatic therapy. The clinician attempts to elicit normal phonation through vegetative vocal functions. The client produces a variety of these sounds (i.e., coughing, throat clearing, laughing, gargling, humming). When normal phonation occurs during one of the vegetative behaviors, it should be brought to the client's attention immediately. The client then extends this normal voice into vowels, single words, and sentences. For clients with mutational falsetto, inhalation phonation (as described in the section on hyperfunction) also may be an effective technique for eliciting normal phonation. 3. Referral. The clinician considers the possibility that voice intervention alone is insufficient to resolve a client's underlying emotional problems and may counsel the client to seek psychological or psychiatric services as needed. (p. 416) The overall purpose of treatment is to re-establish a client's access to his or her own normal voice. This purpose is generally achieved through three sequential stages of intervention

You are a supervisor of an SLP graduate student who is getting ready for her first experience in early intervention. To help her prepare for her first session, you decided it would be a good idea to refresh her memory on this area. Discuss the SLP's role in early intervention. Then discuss the primary goal of early intervention. Finally, briefly explain two therapy targets for infant intervention programs

A) The SLP's role in early intervention includes: Prevention, Screening, Evaluation and assessment, Planning, implementing, and monitoring, intervention. Consultation with and education for team members, including families and other professionals. Service coordination. Transition planning. Advocacy B) The primary goal of early intervention is to develop the basic skills thought to be critical for successful speech, language, and communication learning. C) Localization: Showing awareness of sounds by turning toward and visually searching for the source of the sound Joint/shared attention: Highlights relationship between adult's utterances and objects, actions, or concepts they present; child and adult are focused on same referent in environment. Prerequisite for all subsequent communication Mutual gaze: Characteristic of early communicative development in which infant and caregiver look at each other during social interactions. Enhanced with smiling or other facial expressions, touching, and vocalizations Joint action and routines: Joint action between an adult and infant occurs in play sequences known as sound-gesture games or routines such as peekaboo, patty-cake, or "I'm gonna get you." A routine is a prepackaged or ritualized exchange between an adult and infant. Vocalizations: When child exhibits rapid physical growth and neuromuscular maturation; child begins increasing control over speech mechanism and exhibits significant expansion in quality and variety of vocalizations Vocal behaviors: Reflexive, cooing, laughter, vocal blay, early babbling, reduplicative babbling, nonreduplicative babbling, jargon, protowords Communicative intentions: Messages to be conveyed in messages Nonsymbolic and symbolic play: Early types of play are nonsymbolic. Children use objects for their intended purposes (functional play) or engage in exploratory play; Later, symbolic forms emerge, where child substitutes objects or events for other objects/events, like using a stick for a sword or banana for telephone Initial vocabulary/first lexicon: Begin building receptive and expressive language. Receptive consists of repeated presentation of target word as well as use of gestures and exaggerated vocal intonation. Expressive fixates on the number of words and the contexts they can be used in, how important the words are to the child, and words that represent dynamic states.

Explain the main differences between apraxia and dysarthria and the differences between speech characteristics of each.

Apraxia: - Articulation is better in involuntary speech, with periods of error free speech. - Errors are unpredictable and highly inconsistent - Substitution and transposition errors are predominant - Significant difficulty with intonation of speech, evidenced by hesitations, pauses, restarts, and repetitions - Visible and audible groping Dysarthria: - Automatic and voluntary speech are impacted similarly. No periods of error free speech. - Errors are predictable and highly consistent - Distortion and omission errors predominate - Initiation is usually not affected - No groping - All speech process are involved, including respiration, phonation, articulation, prosody, and resonance

Ed is a 65 year-old male with spastic dysarthria. Name the five categories of speech that you as his SLP will need to evaluate. For this type of dysarthria, what might you expect to see in each of the categories? How can you as a clinician be sure that Ed has spastic dysarthria and not apraxia?

As his SLP, I will need to evaluate his voice quality (might see harshness/abuse) , his pitch and loudness (might see monotone), his nasality (might see hypernasality), his ability to articulate (slower and more imprecise), and his phrasing (short). As a clinician, I can be sure he has dysarthria and not apraxia because there were not evident groping postures, his ability to articulate is impaired and he has no troubles with starting his speech. These are all things that someone with a apraxia will have.

Jacob is 6 years old and demonstrates the following articulation errors: 1) Initial w/r and b/m 2) Medial w/r and j/n 3) Final -/k and -/d Based on this information and Jacob's age which sounds would you target first when using a developmental approach? Explain two sample activities you would use when targeting the sounds you chose

Based on this information and Jacob's age, the sound that are necessary to target first would be /b/ /m/ and /w/ in the initial positions. These are appropriate sounds to target because based on the 'Iowa-Nebraska Articulation Norms for Males' these sounds should be mastered by age three. When using a developmental approach for targeting these sounds, two sample activities could include creating a game with colored paper fish and using puppets to elicit the appropriate sounds.. Each fish would then have a picture on it with the desired sound in the appropriate position. A magnet would be attached to the back of each fish and the child would use a "fishing pole" to catch the fish and then produce the sound presented in the picture. Another advantage of this activity, is that the clinician can require differing difficulty levels from simple one-word responses to lengthy sentences. Another appropriate activity that could be used includes making puppets. After collecting close to 25 pictures and putting them in a pile on the table, the clinician will select a picture, the clinician models the appropriate production of the word and proceeds to glue it onto one of the bags. The client, Jacob in this case, will then select the next picture, produce the word accurately three times and glue it onto the other "puppet." This process will continue until both bags are completed.

Brian is a 56-year-old male who has come to see you for a voice assessment. After collecting background information on Brian, you learn that he is a high school PE teacher. He has been teaching for 30 years. He also coaches his son's football team. He reports that he talks a lot throughout the day at work, and yells often to motivate his students and football players. Other than his harsh and breathy voice quality, he has no other health issues. Explain if Brian most likely has an organic or functional voice disorder. Explain what voice targets you would address in the treatment plan.

Brian likely has a functional voice disorder caused by years of vocal abuse/misuse (talks a lot throughout the day at work and yells often). In our treatment plan we would target vocal hyperfunction (primarily consists of vocal dysphonias related to vocal abuse or misuse) by reducing loudness and eliminating the abusive behavior. We would determine an optimal loudness level by reading short phrases and sentences practicing different intensity levels for each. A lower intensity level is identified and practiced in drill. and eliminating the abusive behavior. Because has been yelling during practice and class for so long, we would have him tally how many times a day he is yelling, to create a visual representation of the abuse.

Compare and contrast the three types of nonfluent aphasias. Give a brief description (1-2 sentences) of a treatment idea you would implement with each type.

Brocas - Effortful articulation of phrase-length and utterance. Impaired prosody and intonation. Good comprehension. Lesion on the posterior inferior frontal lobe, as well as central and inferior parietal. Treatment: Script training: this would help a client learn to automatically produce phrases. Client chooses contexts for scripts and identifies key ideas and vocab, client starts at receptive level with listening, then moves on to producing at the phrase level, finally they practice the entire script. Transcortical Motor - Little or no initiation of speech. Output similar to broca's, but excellent imitation Intact comprehension. Lesion in medial-frontal cortex, involving supplementary motor area. Treatment: Melodic Intonation Therapy: helps the client with their intonation. I would work with the client on tapping out rhythms while listening to the clinician and slowly build them up to producing utterances spontaneously. Global - Severe deficits in all areas of language comp and production. May have limited output and stereotypic utterances. Lesion encompases pre- and postlandic speech zones. Treatment: One possible treatment is proximal or distal limb VAT. the basic sequence is to match and point to objects or pictures, demonstrate appropriate use, pickup appropriate object for indicated action, produce an appropriate gesture when shown objects, and reproducing a gesture for an object shown to them.

You have a 23-month-old client who doesn't seem to be displaying any forms of symbolic play. How would you explain to their parents the difference between symbolic play and nonsymbolic play? What are three different activities that you might incorporate into therapy to encourage this type of play?

Children learn through play and often practice their new acquisitions in play. Infants gain experience in how both receptive and expressive language function by participating in play sequences. In addition, play is the most important context for the development of social communication skills and the natural context for early language learning. In early types of play, children use objects for their intended purposes (functional play) or engage in exploratory play such as dropping, mouthing, or transferring objects) and do not require the use of symbolic agents. Additional examples of functional play include activities such as running, filling and emptying receptacles, driving toy cars, and water play. Later, symbolic forms of play emerge, where, the child substitutes objects or events for other objects/events. Examples include pretending to talk on the telephone or using a stick as a sword. Following are some suggested themes and activities for facilitating play, arranged developmentally: ■ Exploring common objects such as blocks, rattles, spoons, pots, and pans, through banging, mouthing, manipulating, and visual inspection ■ Using toys appropriately, such as a busy box or Fisher-Price See 'n Say

You determine a client's voice disorder is caused by psychogenic factors. Explain 3 ways you may assist your client in addressing these issues and give explanations for why these are helpful for a client with psychogenic causes.

Client education - discuss medical reports with client that emphasize that the client's laryngeal anatomy and physiology are intact and, more important, that the client is capable of producing a normal voice Symptomatic therapy - clinician attempts to elicit normal phonation through vegetative vocal functions (coughing, throat clearing, laughing, gargling...) When normal phonation occurs during the vegetative behaviors, it should be brought to the client's attention immediately. The client then extends this normal voice into vowels, single words, and sentences. Referral - Voice intervention alone might be insufficient to resolve the underlying emotional problems; SLP may counsel the client to seek psychological or psychiatric services as needed.

Bill is a seven year old who has verified for services in the area of fluency. He only has a couple friends and many classmates mock him at recess. You have tried to explain what happens with his speech mechanism when he is speaking. Bill seems very disengaged and uncooperative in these treatment sessions. Using the CALMS model, what other aspects should be addressed in treatment? Explain how this may improve his interest in treatment.

Cognitive: Increase knowledge and awareness of stuttering To increase Bill's knowledge, understanding, and awareness of stuttering, the clinician could develop a question of the week about stuttering, and if Bill gets the question right, he would receive a token or a prize. Affective: Decrease negative emotions, feelings and attitudes about stuttering; increase acceptance and confidence in overall communication. Have Bill play with stuttering or teach others how to stutter; can use speech toolbox for practicing positive-self talk(listed under "M") Linguistic: Improve child's capacity for increased linguistic demands (length and complexity of utterance). Create speech toolbox that consists of fun items and each item represents a strategy to utilize (pullouts, easy onset, positive-self talk, etc.)--practice these strategies when a tool is pulled Motor: Decrease in frequency, duration and severity (form) of stuttered moments; decrease presence of secondary behaviors. Create speech toolbox that consists of fun items and each item represents a strategy to utilize (pullouts, easy onset, positive-self talk, etc.)--practice these strategies when a tool is pulled Social: Decrease avoidance of words, people, and speaking situations; decrease effect of stuttering on friendships and interactions with peers. Role play in different speaking situations to help Bill be comfortable with speaking and interacting with others

As a speech - language pathologist you will treat a wide variety of clients with fluency disorders. It is important to understand that clients who stutter possess a set of very unique characteristics. These characteristics can be split into two main categories: core behaviors and secondary behaviors. Thoroughly explain the difference between the two sets of behaviors and give an example of each.

Core Behaviors - are basic manifestations that seem beyond the voluntary control of the stutterer and include the following: 1. repetitions of sounds, syllables, or whole words. 2. Prolongations of single sounds. 3. Blocks of airflow/voicing during speech. Secondary Behaviors - develop over time as learned reactions to the core behaviors and are categorized as escape or avoidance behaviors. Examples of escape behaviors are head nods, eye blinks, foot taps, and jaw tremors. Examples of avoidance behaviors are substitutions, unfilled pauses without the use of "um" or other interjections.

Your client is interested in trying delayed auditory feedback after reading about it in an online forum. How would you explain delayed auditory feedback? What are the practical benefits of this technique?

Delayed auditory feedback is a fluency shaping technique that has been widely used in stuttering treatment. The speaker's own words are returned through headphones after an imposed electronic delay of a few milliseconds. While it disrupts the speech of "normal" speakers, individuals who stutter benefit from it as it decreases their speech rate and reduces the number of notable disfluencies. It has been recommended by many authors for it tends to generate increased fluency in the early stages of therapy. It is also believed to enhance the speaker's ability to monitor oral-sensory feedback cues from his or her own speech mechanism. It facilitates a slower speaking rate by increasing a client's syllable duration and phonation time.

A family brings their four-year-old son to you, as the final consonant deletion phonological process has yet to be suppressed in his speech. As a clinician, there are two main approaches that can be used when determining a client's initial therapy targets in articulation and phonological intervention: developmental and nondevelopmental. Briefly describe each.

Developmental: Therapy targets are identified based on the order of acquisition for typically developing kids. Non-developmental: Norms not used in selection of target behaviors. Instead, target selection falls into two groups: 1) client - specific:targets sounds are most RELEVANT to a child's world (e.g., the sounds in their name), and target sounds that are most stimulable, not according to norms but according to the child's productions. 2) Target sounds selected on degree of perceived deviance, based on articulatory or phonological factors: articulatory: Omissions most damaging to intelligibility, so sounds that are omitted are targeted first. Same goes for initial sound errors and errors occurring on most frequent sounds in a language. Phonological: patterns of initial consonant deletion and glottal replacement of medial consonants most damaging to intelligibility.

Taryn is a 4 years, 8 months and has been referred to your clinic for a phonological disorder. Her parents are concerned that she will not be able to keep up with her kindergarten classroom the upcoming year. Her parents have reported delayed acquisition of speech and also say that their family has trouble understanding the child. Based on this information how will you use Evidence Based Practice to determine the therapy approach you will take?

EBP approach comprises three basic elements: scientific research, clinical expertise and client/family values. So, taking into consideration that her parents are concerned about intelligibility I would start by addressing their concerns. PICO: population, intervention, comparison, outcome. Question: Is a child with a phonological disorder more or less likely to enter Kindergarten prepared to learn using intervention A or intervention B? Steps: Find internal evidence, answer question. Find external evidence, Critically appraise external evidence, Integrate internal and external evidence, Evaluate decision by documenting outcomes

Briefly explain two of the four approaches used in early intervention: focused stimulation, incidental teaching, floortime/developmental, individual difference, relationship-based, and family-centered. Of the two you choose give an example of the approach used in therapy. (p. 181)

Family-Centered: Trains parents and other caregivers to foster the development of language and communication in naturalistic contexts such as the home setting. The SLP functions in an indirect or educational capacity with family members, helping them become the "change agents" for their child. These programs may focus on improving the child's communication skills and/or improving the adult family members' ability to engage in mutually reinforcing communicative interactions with their child. a. The parents are the main agent of therapy. This approach is important as it will promote generalization and also teach other skills, for example social skills. Focused Stimulation: Clinician provides concentrated exposure to a target form in a variety of contexts (e.g. individual words, embedded in sentences or short stories). The clinician pre-selects a linguistic target and produces it in high concentration throughout natural and meaningful adult-child interactions. Because this focus is on comprehension, the child is not required to produce the linguistic form. This approach can encompass a wide variety of targets, including vocabulary, grammatical morphemes, and syntax. a. Example (while reading)- Target words: eat, drink "This is a boy. A boy loves to EAT. Let's pretend to EAT a treat. EAT, EAT, EAT. Again. EAT. EAT. EAT. This is a girl. A girl loves to DRINK. Let's pretend to DRINK something pink. DRINK. DRINK. DRINK. Again. DRINK. DRINK. DRINK. A girl loves to DRINK. A boy loves to EAT. Let's DRINK. Let's EAT. Did you do that? Neat!!!"

A mother is concerned about her 4-year-old's speech. She says that she has a hard time understanding her daughter, Macey, and that strangers can only understand her about 75% of the time. After evaluating Macey, you find that she demonstrates the following phonological processes: Final consonant deletion -/s, -/p, -/d, and -/k, Fronting: t/k d/g, Gliding: w/r. According to the developmental approach, which patterns would you target? Explain to the parents in layman's terms what phonological processes are and then describe the processes you will be targeting with Macey.

First approach: FCD of /p,d/ because those are the earliest sounds to emerge. Next: FCD of /k/ and fronting /k,g/. When children are learning to talk it is a lot like learning to ride a bike. At first, training wheels are helpful. When your child is learning to talk, she uses her own training wheels in the form of word productions that aren't quite at the level of adult production yet. One common way they do this is by leaving off words at the end of sounds. This is a normal part of development until about age 3, so your child is holding on to her training wheels a little longer than we want her to. So, we are going to target those word endings to help her get rid of those training wheels.

A 5 year old boy exhibits part word repetitions, whole word repetitions and prolongations. The parents often finish the boy's sentences, look away when he stutters and frequently tell the boy to "just stop" when he is struggling with repetitions. The parents expressed their concern for his expressive speech and their confusion as he occasionally seems capable of controlling his stuttering when talking. How might the Speech-Language Pathologist counsel these parents about stuttering? What different aspects about treatment for stuttering should be explained.

First, you should never tell a person who stutters to "just stop." This may cause him to stutter even more. I would suggest/counsel to the parents that they should allow adequate time for their child to speak. Do not finish his sentences. Finishing his sentences will not help him become a better speaker. Also look him in the eye and allow him to work through his stutters. Let your child know you are there to support and motivate them. Looking away from them is #disrespectful. This may also cause him to think that you are annoyed by his stutters which may cause him to think negatively of himself and the way he speaks. This may cause him to not speak in social situations. I would introduce the parents to the indirect approach because it facilitates parental awareness of the child's disfluency status in the home environment. Stuttering is often unpredictable; sometimes your child can control it, and other times not. Just because your child can control it sometimes, does not mean he can control it all of the time. That is normal.

You are working with a stuttering client and part of your therapy requires that you develop fluency shaping and the different fluency enhancing techniques. You know that it is important to explain what you are doing in treatment and why. What information will your explanation include?

Firstly, fluency shaping is based on the assumption that stuttering is a learned behavior. The primary goal is to eliminate disfluencies and gradually change the speaker's habitual speaking pattern. The fluency enhancing techniques include: Easy onset/prevoice exhalation: The client will exhale slightly before beginning phonation and reach conversational loudness gradually Decreased speaking rate (prolonged speech): The client will stretch out the sounds (primarily vowels) and produce words at a slower-than-normal rate while maintaining normal stress and intonation Light articulatory contacts: The client will move articulators in a loose and relaxed manner Continuous phonation: The client will reduce all breaks between words by maintaining voicing continuously until a breath is needed These techniques are being implemented with the ultimate goal of completely changing speech behaviors. It is encouraged to generalize these techniques into all contexts, not just disfluent moments. They were designed to interfere with stuttering behaviors, thus reducing them. They can also be categorized according to which parameter of communicative interaction is the focus of change, such as phonation, speech rate, or length of utterance.

As a speech -language pathologist , a family comes to you to receive services for their 8 year old son who stutters. At this point, they are aware that there are two primary schools of thought (fluency shaping & stuttering modification/management) in regards to fluency treatment approaches. Explain to the family the similarities and differences of the two approaches. Keep in mind that you are speaking to a family, not other professionals.

Fluency shaping - believes that stuttering is a learned behavior. With this approach, our goal is to eliminate disfluencies and change your son's habitual speaking patterns to make it more fluent. Stuttering Modification/Management - believes that stuttering involves a physiological predisposition. The goal of this approach is to modify each disfluent moment and eliminate struggle and avoidance behaviors. It is often called the "stutter more fluently" approach because we want to see the client stuttering more easily.

You are working as a speech-language pathologist with Agnes, Aged 63, with a stroke history and right hemiparesis. Her speech is indistinct and articulation is labored. There is also hyper nasality and a breathy voice quality. What would you diagnose as the speech concern and what is a specific procedure to target respiration that could be implemented in her therapy?

I would diagnose Agnes with flaccid dysarthria due to the different characteristics of dysarthria. A specific procedure to target respiration that could be implemented in her therapy could be: Instructing the Agnes to inhale deeply and hold the breath as the clinician slowly counts to three. Tell Agnes to exhale slowly while producing rhythmic patterns of a voiceless fricative (e.g., /s/). Sound productions of long and short duration compromise the rhythmic patterns

Your good friend approaches you asking for your professional opinion. She is concerned that her two year old son is developing a fluency disorder. She explains he will often repeat words in sentences and will take occasional pauses while talking. She invites you over for dinner to observe him. You jot down a couple of his entices: "She said said I could play with her." "I don't [hesitation] don't want broccoli." You made sure to be aware of jaw tremors and the rhythm of his voice; you noted no concerns. What will you tell your friend?

I would tell my friend that the rule of thumb is that 50% to 80% of children who stutter will recover with or without treatment. For individuals who continue to stutter, the characteristics of the disorder may gradually change over time. In fact, research shows that 80% of children who stutter will spontaneously recover before the age of puberty. Also, hesitations and revisions/repetitions of words, phrases, or sentences are typical for children between the ages of 2 and 4.

Early intervention and academic achievement can be directly related. Emergent literacy intervention strategies are important for clinicians to understand and use with pre-school children. How would you increase a child's print knowledge? Describe a strategy you would use and why it is beneficial to the client. (pages 182, 183, 184)

I would use shared book reading. I would direct the child's attention to the printed words rather than focusing solely on the pictures. I would engage in print referencing, which is an interactive reading style in which the adults highlight specific aspects of print in storybooks verbally with comments and questions, and nonverbally through gestures and tracking print while reading. Research shows that parents who engage their children in meaningful reading activities is going to be more effective than learning literacy in the classroom settings.

A clinician is using oral-motor speech exercises in therapy with a young client. It is the clinician's belief that the exercises will help the child to appropriately articulate sounds. However, the client has made no noticeable progress in articulation as a result of the exercises. Why would it be appropriate for the clinician to discontinue use of oral-motor speech exercises in this scenario?

In order to treat speech issues you have to use speech acts. There is no research base backing the notion that NSOMEs increase ability to speak. The few controlled studies present correlational rather than causal findings and report no significant connection between nonspeech oral motor exercises and speech sound production.Sometimes they can be useful for organic disorders like cleft palate, but they are not typically useful for functional disorders.

A 4-year-old child substitutes the sounds /k/ for /t/ and /g/ for /z/ in conversational speech. However, the child is able to produce all sounds appropriately in isolation. The child also pronounces words without initial consonant sounds. Is this child exhibiting articulation errors, or phonological processing errors? If he is using phonological processes, what processes are present? Would it be appropriate for an SLP to assess this child for speech services and begin treatment? Why or why not?

It is a phonological processing error. The child has problems with language specific functions of phonemes and doesn't understand how to use them properly. Processes present include: backing, stridency deletion. It would be appropriate to start treatment because initial consonant deletion is not a developmental process so it needs to be addressed.

A school-based SLP is speaking with an elementary educator about the importance of literacy in language development. The educator is surprised to hear that the SLP is focusing on literacy with some students during therapy sessions, because he thought SLPs solely focused on speech-language intervention. How might the SLP explain to the educator why literacy falls under an SLP's scope of practice?

Language and literacy are interwoven concepts Intervention revolves around relationship between oral language and literacy Language therapy goals are programmed to address the demands and expectations of the educational curriculum Lang and lit both encompass reading, writing, speaking, and listening As many as half of all poor readers have an early history of spoken-language disorders. It is noted that language problems are both a cause and a consequence of literacy prob- lems.

If a family expresses guilty feelings and upset about their 4 year old son's fluency, what tip can you give them in understanding stuttering? What advice can you give them for how they can help and also continue treatment at home?

Listen attentively to the child's message rather than his speech pattern. Avoid speaking for the child; do not fill in or complete his message. Decrease demands for verbal performance (e.g., "Tell Aunt Suzy what you did in school today") Avoid interrupting the child or allowing siblings/friends to interrupt (emphasize the rules for turn-taking in conversation) Avoid too many questions, especially those that demand lengthy or complex responses in favor of the ones that require simple answers Maintain naturally eye contact while child is speaking, even during disfluencies Avoid correcting child's mispronunciations

When working with a child during early intervention services, a clinician should model his or her speech around motherese. Explain the main characteristics of motherese and provide examples.

Motherese is characterized by slow, exaggerated speech a. Exaggerated intonation b. Short utterance length c. Simple vocabulary and syntactic structure d. Frequent repetition of utterances e. Talk about topics in the "here and now" Also known as infant-directed speech Example- Parent: "Show me the horsie.. Yes, that's a horsie! ... You showed me the horsie! ... Now show me the doggie." (higher-pitched voice, speak slowly, distinctive and frequent pauses)

What are three approaches applicable to any voice disorder regardless of the symptoms or cause? List and describe each. You have a client who just had laryngeal surgery and you recommend vocal rest for them. What other strategies for communication might you recommend for them in order make vocal rest possible?

Listening skills: These techniques are used to increase the client's awareness of his or her vocal behaviors. The clinician demonstrates and contrasts appropriate and inappropriate vocal behaviors. The client is asked to identify and discriminate between the two in live and recorded samples. (p.411) Respiratory control: These strategies are used to optimize respiratory support for voice production. Attention is given to posture, breathing patterns, and expiratory control for phonation. The client may be asked to prolong phonation for as long as possible at a variety of different pitch and intensity levels. (p.411) Vocal rest: Reduction or elimination of phonation is sometimes recommended to limit laryngeal irritation and to permit the vocal folds to recover from surgery or misuse. A client may be asked to modify or totally refrain from talking for a specified amount of time (usually 4 days to 2 weeks). Individuals most likely to be placed on vocal rest have (1) fluid-filled lesions that may rupture (e.g., cysts), (2) vascular conditions such as hematoma, or (3) just undergone laryngeal surgery. The strategy of complete voice rest is highly controversial with regard to its value and practicality.

One of your clients displays many symptoms of Broca's Aphasia with severely restricted verbal output (your client's speech comprehension is intact) resulting from a stroke. You have been working with your client on various restorative strategies, but with little progress, and your client is beginning to become discouraged. What is a unique restorative technique that utilizes "intoning" to help motivate and facilitate verbal expression in your client? Define this therapy technique. In addition, what other characteristics determine suitable candidates for the use of this technique?

Melodic Intonation Therapy is a technique that utilizes "intoning" to facilitate verbal output for clients with severely restricted verbal output and good speech comprehension. This technique includes tapping out rhythms, imitating clinicians utterances, eventually the client will spontaneously produce speech when asked questions. Some characteristics for suitable candidates are those who have had unilateral strokes in the left frontal lobe that extend to the parietal, severely limited verbal output with poor articulation, poor imitation skills, spared comprehension of verbal input, and emotionally stable with good attention span.

Explain the difference between organic voice disorders and functional voice disorders. As a practicing clinician, you notice one of your regular clients voice seems different than usual. Informed by their parent that they recently lost a close family member, what type of functional voice disorder might they be displaying? What type of collaborative treatment might you consider?

Organic voice disorders: result from pathology or disease that affects the anatomy or physiology of the larynx and other regions of the vocal tract. Ex: vocal fold paralysis, laryngeal webs, papilloma, tumors Functional voice disorders: are dysphonias related to vocal abuse/misuse or psychogenic factors in the absence of an identifiable physical etiology. Ex: abuse/misuse, vocal nodules, contact ulcers, ventricular dysphonia The person may be experiencing soft glottal attacks. Soft glottal attacks: tight glottal closure, increased subglottal air pressure, and explosive abduction (p.409) Treatment: Yawn-sigh: The client yawns in a natural manner and phonates a gentle sigh on exhalation. Once relaxed phonation is mastered, the client produces words on the exhalation. Begin with single words that begin with /h/ or a vowel and progress to four or 5 words per exhalation. The eventual goal is for the client to induce easy phonation by imagining the relaxed oral feeling associated with the yawn-sigh approach

As an SLP, you acquire a client who shows signs of aphasia including specific language deficits. The deficits the client is exhibiting are paraphasias, neologisms, and perseverations. While communicating with the client and their family members you are asked to explain each of the deficits and how you could address these concerns. (p.299)

Paraphasia- Errors in speech output characterized by the production of unintended sounds, syllables, or words. The two main types are phonemic and semantic. Phonemic paraphasias (also known as literal paraphasias) consists of extraneous or transposed sounds and syllables or substitution of one correctly articulated phoneme for another. Example: When asked to name a hammock in a picture, the client may respond with one of the following: "hammerock," "hackamm," "pammock," respectively. Semantic paraphasias involve unintended substitution of one word for another, usually within the same semantic category. Example: When asked to name a hammock, the client responds, "It's a bed. Neologism- Invented word that has no true meaning but adheres to the phonological rules of a given language. These errors tend to occur primarily with nouns and verbs rather than function words. Example: When asked to name a hammock in a picture, the client responds, "That's a blick." Perseveration- Inappropriate continuation of a response after the presentation of a new stimulus. Example: After successfully naming a hammock in a picture, the client continues to respond "hammock" when shown the next three pictures of a chair, key and glove. Addressing these concerns: I would tell the client and family members that we can improve the deficits with practice in the clinic, as well as practice at home. For paraphasias, we can have the client work on letter, word-picture, or word-word matching, and sentence completions through matching card activities to build the production of syllables, words, and phrases when speaking. For neologisms, we can work on naming pictures of primarily nouns and verbs because neologisms are typically associated with these parts of speech. For perseverations, we can show the client a variety of pictures and include some that are similar to one another (e.g. couch, chair, hammock) and work with the client on distinguishing between them.

An SLP is working with a fifth grade student who struggles with pragmatic language skills. Specifically, the student struggles to maintain eye contact with teachers and peers, and blurts out answers when the teacher asks questions, often interrupting other students. Describe one strategy the SLP could use to address the student's behaviors.

Social Stories Strategy: main focus is to improve pragmatic language skills. Clinician develops written scripts providing explanations of appropriate communicative behaviors for social situations. Stories contain both descriptive and directive statements. Descriptive: specific words, phrases, and sentences appropriate for the context. Directive: Socially appropriate alternatives to child's current behavior. Visuals may be helpful, especially for children who cannot read

As an SLP, you have a client with a voice disorder, particularly in the area of glottal attacks. Describe the different types of techniques you can use to soften those glottal attacks.

Softening Glottal Attacks. Several techniques can be used to soften hard glottal attacks: Yawn-sigh: The client yawns in a natural manner and phonates a gentle sigh on exhalation. Once relaxed phonation is mastered, the client produces words on the exhalation. Begin with single words that begin with /h/ or a vowel and progress to four to five words per exhalation. The eventual goal is for the client to induce easy phonation by imagining the relaxed oral feeling associated with the yawn-sigh approach. Chewing: The client chews in a natural but exaggerated manner while simultaneously producing phonation (Froeschels, 1952). Start with vowels and gradually increase the length of the utterance on successive exhalations. The client practices variations in pitch and loudness levels while chewing/phonating. Relaxation of laryngeal musculature should be maintained. Easy onset: The client produces syllable combinations of /h/ + vowel to practice relaxed initiation of phonation. This phoneme sequence establishes airflow through the glottis prior to phonation. Gradually lengthen utterances to polysyllabic words and short sentences. Expand the drills to include other voiceless fricatives and other sound classes. Chant talk: The client listens to and imitates a recording of chanting, a speaking pattern characterized by the production of words in a continuous unbroken monotone, prolongation of vowels, and lack of syllable stress (e.g., Gregorian chant). Once this speaking style can be reliably produced, the client reads aloud for 20-second periods, alternating between habitual voice and chant talk.

Early intervention, for birth to 3 year olds, can be a turning point for their therapy. During these years critical brain development occurs. A part of early intervention therapy is joint or shared attention. For a 3 year old child with Autism Spectrum Disorder, how can an SLP obtain joint or shared attention during a play routine? Give examples of ways the SLP can gain joint or shared attention.

The SLP can gain joint or shared attention by paying special attention to what the infant is interested in. Depending on how severe the diagnosis of ASD is, a noisy object may not work because it could be overstimulating for the children instead, which is why the decision must be made carefully. In this case, we will say that the child does enjoy objects that make sounds. It should be placed before the child, and then the SLP may look at and comment on it. The SLP may also point to the object and shake it to encourage eye contact. In a different case, the SLP may have to wait for the child to find an object to focus on and then practice joint attention.

A clinician is providing treatment to a client who is 15 years old with a language disorder. The client does not complete the homework that the SLP assigns and is regularly combative during therapy. Why might the client be behaving in this manner and what can the SLP do to help lessen the behavior?

The client could be acting this way due to frustration (he doesn't think he/she is smart, embarrassed, etc.) or he may think intervention is boring or not helpful. SLP can reduce behavior by building greater rapport to ensure SLP truly understands client's fears, frustrations, etc. Make services as inclusive as possible to keep client in general education classroom with typically developing friends Find ways to motivate client, e.g. token reinforcement of some sort

Of the four types of treatment approaches for apraxia of speech (as presented by Wambaugh et al., 2006) you have chosen to implement the Rate and/or Rhythm approach for a 13 year-old client that has issues with her rate of speech. What types of devices can you use in therapy? What types of things to you emphasize/focus on?

The devices that I could use metronomes to help them learn how to get a good rate going, pacing boards, and computers. Each of these would help my client learn how to pace him/herself and helps them focus on modifying the pattern of their speech. I will emphasize on how to reduce their rate of speech, which will allow them more time for motor planning.

You have just begun seeing a 12-month-old client who just had her cleft palate repaired, but is still experiencing some signs of velopharyngeal incompetency. Can this articulation disorder be considered functional or organic? Explain both.

The disorder would be organic, because the accompanying speech production deficits are direct result of structural/neurological anomalies and are not developmental in nature. Organic: result from known causes such as cleft palate, neurological dysfunction or hearing impairment. Some children can have both functional and organic deficits. Functional: when no known pathology is causing the errors. SSD errors occur without any identifiable etiology. Children have adequate hearing and intellectual abilities without signs of significant structural abnormalities or neurological dysfunction. Specific errors vary greatly and are not predictable like organic disorders.

What is communicative intention and how does it relate to a child's use of language later on in life?

The meaning that a speaker wishes a message to convey is known as a communicative intention. At about 9 months of age, infants discover intentional communication and begin to express their communicative intentions through gesture and vocalization. Requests and statements are among the earliest communicative intentions to emerge. Requests represent the infant's intentional use of a listener as an agent or tool in achieving some end (e.g., a desired object). Statements are the infant's attempts to direct an adult's attention to some event or object in the environment. As children begin to acquire an initial vocabulary, they express communicative intentions through single-word utterances. Evidence suggests that the rate of preverbal communication in young children with developmental delays is a strong predictor of later vocabulary usage. The frequency of intentional communication is also predictive: Higher rates of nonverbal intentional communication during the preverbal stage are associated with better language outcomes 1 to 2 years later.

You are working with a young client who exhibits a significant language delay. Explain to the mother the importance of language development and preliteracy skills. What recommendations would you make for the mother to assist with language development and emerging reading skills in the home?

The overall goal of emergent literacy intervention is to promote oral and print-knowledge skills that are associated with the ability to successfully learn reading and writing skills. This goal addresses the significant reciprocal relationship between early intervention and academic achievement. SLPs may play a variety of direct and indirect roles in this area of intervention. Clinicians can work directly on providing emergent literacy intervention to children with identified communication disorders. Indirect roles encompass collaborative consultation with others, professional staff development, parent/community education, and curricular policy recommendations regarding the critical nature of emergent literacy skill acquisition for all children. From an RTI/multi-tiered perspective, all areas of emergent literacy skill can be integrated into Tiers 1, 2, or 3. There are several other components of emergent literacy, each of which can be used as an avenue to increase a child's print knowledge. Following are five main areas, accompanied by instructional guidelines. Recommendations: Shared Book-Reading and Sense of Story

A client of yours has aphasia, the family comes to you with concerns about the efficacy of the aphasia treatment. They ask you to help them understand why there is controversy over the treatment.

There is controversy over treatment because some studies have suggested that any objective improvement seen in a client's status is attributable to the brain's spontaneous recovery rather than a result of treatment effects. Others content that aphasia treatment results in measureable gains in communicative functioning through both traditional and group treatment models. Evidence indicates that speech and language treatment is effective in improving functional communication, as well as receptive and expressive language skills, in individuals with stroke-induced aphasia. This controversy is a result of methodological problems associated with obtaining matched subject samples and the ethical dilemma of withholding treatment from individuals assigned to control-group conditions. In 1996 Holland, Fromm, DeRuyter, & Stein published a comprehensive summary of available data on treatment efficacy for aphasia. Their conclusion was that aphasia therapy is efficacious in that treated clients make significantly more improvement than untreated clients.

Amy is a fairly new clinician and has just received her first adult stuttering client. She is unsure of which technique to utilize so she has decided she will start with one approach and move onto the next if it doesn't work. Do you think this is the best way to fit her client's needs? Why or why not? What can she do differently?

This is not the best way to address the client's needs because the clinician has not effectively established what the client's needs are. The ultimate aim of most stuttering therapy programs is spontaneous fluency. To achieve this, we must individualize treatment approaches and techniques to that individual. Doing so will allow for the client to succeed because the approach will be based on his comfort level. The clinician can get to know the client better and customize the approaches thereafter.

What are the three sources of sound production after a client has had a laryngectomy? Describe the sequence of training for esophageal speech.

Three general sources: external mechanical devices, functional use of the sphincter-like tissue at the junction of the pharynx and esophagus (PE segment) to produce esophageal speech. Sequence of training: Step 1: Establishing esophageal voice Step 2: Gaining and maintaining control over production Step 3: Increasing intelligibility of esophageal speech Step 4: Increasing length of utterance production Step 5: Mastering conversational nuances of pitch, loudness, and stress patterns

Lindsay is 10 years old and her speech is characterized by part and whole word repetitions and prolongations of initial sounds. She also demonstrates secondary behaviors such as head nod and aversion of eye gaze. A 200 syllable spontaneous speech sample indicates that 30% of the syllables uttered were dysfluent. According to a report provided by Lindsay's mother, Lindsay is extremely anxious about her fluency difficulties. Explain to Lindsey the techniques of voluntary stuttering and identification of stuttering. Explain why these techniques are beneficial.

Voluntary stuttering is a technique that requires you to stutter on purpose and then analyze your own feelings, as well as listener reactions. The goal of this technique is to reduce/minimize your feelings of fear or embarrassment associated with disfluent moments. I will first model easy repetitions and prolongations for you during a short conversation. Then, you will produce at least 5 of these voluntary stutters on nonfeared words during another 3 minute conversation. I can provide hand gesture cues to prompt your use of easy repetitions and prolongations. Afterwards, you can rank your feelings on a 5 point scale. This technique can be generalized outside of the clinic room.

A teacher at a school has questioned your involvement with Troy, a 14-year-old student who has trouble with planning and problem solving, along with other metacognitive functioning tasks. Explain to this teacher what metacognition is, and how SLPs help students who have difficulties with metacognitive functioning.

What is metacognition/executive functioning? "The brain's air traffic control system" Higher order thinking that requires mindfulness and self-awareness → "thinking about one's own thinking". Awareness of one's own problem-solving abilities and include self-regulation behaviors used to guide, monitor, and evaluate the success of one's performance. Planning, attention/focus on specific task, redirecting attention when appropriate, inhibition of behavioral impulses, goal setting, organization. How can SLPs help? SLPs know how to "teach" metacognition and how it relates to language → not typically taught in classroom, so SLP can help Think aloud/self talk is an effective strategy to build metacognitive skills. Metacognitive Stems strategy: SLP teaches steps to complete a task accurately Steps include "I'm thinking, I'm picturing, I'm noticing, I'm wondering, and I'm feeling" Visual aid is helpful with those thinking stems are beneficial

You are a clinician working with Gary, a 40-year-old male, to soften his hard glottal attacks. Describe two techniques to soften his glottal attacks (yawn-sigh, chewing, easy onset, chant talk) and explain how you would use it in therapy with Gary.

Yawn-sigh:The client yawns in a natural manner and phonates a gentle sigh on exhalation. Once relaxed phonation is mastered, the client produces words on the exhalation. Begin with single words that begin with /h/ or a vowel and progress to four to five words per exhalation. The eventual goal is for the client to induce easy phonation by imagining the relaxed oral feeling associated with the yawn-sigh approach. Chewing: The client chews in a natural but exaggerated manner while simultaneously producing phonation (Froeschels, 1952). Start with vowels and gradually increase the length of the utterance on successive exhalations. The client practices variations in pitch and loudness levels while chewing/phonating. Relaxation of laryngeal musculature should be maintained.

Your 3 year old client seems very uninterested in interacting with you during your therapy sessions. After one session consisting of your client turning away from you, getting distracted and not communicating with you, you decide it is time to use specific strategies to encourage communication. Describe two strategies (with examples) you could use with the client to encourage communication between you and the client and sustain a language rich environment during sessions.

You could use strategies such as joint/shared attention. If he is becoming easily distracted, allow the little guy to play with something that interests him and slowly join in. While you're playing with something that interests him, expand on his utterances and comment on objects, actions, and concepts. You could also utilize turnabouts, which is when the clinician responds to the child's utterances and are framed in a way that encourages the exchange to continue and keep the child in the interaction. For example, if the child asks "Dat?" then the clinician could ask "Kitty cat! What does it say?" versus just stating that it is a cat