ETSU 2017 Comps everything

Prioritizing goals based on baseline achievement

1. 10-50% accuracy 2. 1-10% accuracy 3. 50-90% accuracy

prelinguistic- communicative act

Gaze, gesture or vocalization Was it directed? Did it have communicative function

ICF- body function

Includes: Speech, language, literacy ASsessment: Standardized assessment Tx: Modes and modalities

browns stage 3

On doggy on car Possessive Mommy's shoe

Prelinguistic tx approaches

Prelinguistic milieu tx (PMT) Hanen Milieu Tx

accessory (XI)

o Supplemental role- stabilization and movement of shoulders etc

criterion referenced

o Zone of proximal development- difference btwn baseline and target, influence of max cue and moderate cue, should shrink through intervention o Used to analyze language samples- SALT

Trigeminal (V)

o sensory- tongue, teeth, lips, palate and chin o motor- muscles of mastication, tensor veli palatine, mylohyoid, anterior belly of digastric

Medical Treatment and Speech Therapy for Spasmodic Dysphonia: A Literature Review (Fabron, Marino, Nobile, Sebastiao, & Onofri, 2013)

• studies that looked at speech therapy speech therapy showed positive results from this treatment when combined with [botulinum toxin] injection

primary cortical areas for speech

1. Primary Auditory Cortex 2. Primary Visual Cortex 3. Wernicke's Area 4. Broca's Area 5. Primary Motor Cortex

how many communicative acts per min before words

2

Enhanced milieu teaching: effects of parent-implemented (Hemmeter & Kaiser, 1994)

4 parents with preschool aged kids with developmental delay, positive effects for 3 of 4 kids EMT

Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities (Kaiser & Roberts, 2012)

77 preschool aged kids with ID-autism and downs, children with EMT gained more language

SYSTEMATIC REVIEW OF THE TREATMENT OF FUNCTIONAL DYSPHONIA AND PREVENTION OF VOICE DISORDERS (Ruotsalainen, Sellman, Lic, Lehto, Verbeek, 2008)

A combination of a direct and an indirect voice therapy should be considered the best available intervention for treating functional dysphonia. Screening and subsequently treating teachers and student teachers are feasible and yield positive results. The speech and language therapist must always assess the patient, and then choose the aims and the specific techniques of voice therapy accordingly. We have not found high-quality evidence to support the current practice of giving training to at-risk populations to prevent development of voice disorders.

arcuate fasciculus

A white matter tract that connects Broca's Area and Wernicke's Area through the Temporal, Parietal and Frontal Lobes. Allows for coordinated, comprehensible speech.

Wetherby and Prizant communicative acts

Behavioral regulation- request and protest (protoimperatives) Social interaction- attract or maintain on self (mix of protoimperative and protodeclarative) • Call or greet • Request comfort • Request a social routine • Show off • Request permission Joint attention (protodeclaratives) • Attract attention to any object, event or topic • Comment on action or object • Request info

standardized tests and scoring

Con: decontextualized Norms- adequate size, representative of target population Normal is usually standard score of 85-115 (1 SD from mean) bell curve Percentiles: 15-85?? 1-1.5 SD below- mild to moderate 1.5-2 SD below- moderate Below 2SD severe

browns stage 5

Contractible aux be (they're playing) Uncontractible aux be (Is she swimming? She is) Uncontractible copula be (Is he here? He is) Irregular 3rd person singular (She has)

pyramidal system

Direct Activation Pathway. o All of the motor impulses that originate at the cortical level travel through this tract. o This pathway supplies the voluntary muscles of the head, neck, and limbs. o Neurons of this tract originate in the post-central gyrus or primary motor cortex and descends to the spinal cord (the corticospinal tract) passes through the pyramids of the medulla

general intervention techniques

Expansion- response to child's utterance that adds semantic content Extension- repeat back what was said and add more information Recast- maintains child's central meaning, can be corrective (fixes grammar, inserts missing words) or non-corrective (alternate form) Mands (commands)- require direct response from child o Questions o Mands for imitation Wait time

Complex sentence level approaches

Fast ForWord Dialogic reading Conversational recast Direct instruction Drill play Story Grammar

Simple sentence level approaches

Focused stimulation EMT Fast ForWord Dialogic reading Conversational recast Direct instruction Drill play

developing language- assessment

General measure of language ◦ TOLD-P:3; CELF-P, PLS5 Measure of morphology Language samples: TTR-type token ration, number of different words/number of total words MLU-mean length of utterance, average number of morphemes in utterance Analyze presence of morphemes Rice/Wexler Test of Grammatical Impairment Exclusionary History (sensory deficits; neurological impairment) Nonverbal/Performance IQ; Leiter, Kaufman; WPPSI-R, TONI-3

Fey's multidimensional model

Goals: Basic-long term Child will increase frequency of functional communication acts, i.e. gestures, vocalizations and eye gaze Intermediate (semester goals) Increase frequency and spontaneity of vocalizations Increase frequency and spontaneity of eye gaze Use two or more modes of communication together Specific (session goals) Child will increase CV vocalizations in response to clinician modeling Child will use pointing to request more snack Context: clinic, daycare, home, natural play, structured play etc. Agents: parents, SLP, teacher Dosage: 2 types: frequency and length of sessions, time assigned to each goal Goal Attack strategy: horizontal, vertical, cyclical Activities:

1st word tx approaches

Hanen Milieu tx Focused stimulation Enhanced mileu tx (EMT)

ICF- Contextual factors

Includes: Attitudes, products and technology, environment, support Assessment :Caregiver interview, questionnaires, policies and procedures tx: Collaborative intervention, modify caregiver's communication, environmental accommodations

ICF- activities and participation

Includes: Communication, social interactions, relationships, learning Assessment: Direct observation in different contexts, interview Tx: Functional communication, education to others

emerging language- semantic functions 1 word utterance

Labeling: that; car; mommy; uhoh; fall Answering: uhhuh; no; car Requesting Action: swing; open; car Requesting Answer: whazzat?; car? Calling: mommy; hey; car Greeting: hey; hi; bye Protesting: no; stop; car Imitating: A: That's a car. C: car. Practicing: car, car, car, car

brain arteries

Posterior cerebral arteries Cerebellar arteries External carotid artery Internal carotid artery Middle cerebral artery Anterior cerebral artery

stages of language devt

Prelinguistic: development of gestures, making adequate eye contact, sound repartee between infant and caregiver, cooing, babbling and crying Emerging Language: 1st words Developing language criteria: o More than 50 words o Beginning to combine words into sentences o They haven't acquired all basic sentence structures of the language

Yoder and Warren categories of communicative acts

Protoimperatives (commands) vs protodeclarative (comments)

browns stage 4

Regular past (He jumped) Irregular past (she fell) Regular 3rd person singular (He jumps) Articles (the dog, a book) Contractible copula be (He's eating)

prelinguistic stages

Stage 1 (0-2mos) reflexive: crying, fussing, grunts, sighs, vowel like sounds Stage 2 (2-4 mos) cooing: back sounds and vowel, isolated vowels, nasal pleasure sounds Stage 3 (4-6 mos) vocal exploration: laugh, squals, growls, more vowels, CV, front sounds-stops, lip smacks, raspberries, pitch play, reciprocal play Stage 4(6-10 mo)- babbling: nasals, stops, glides, reduplicated, early variegated (gabuba). Exclamations, first word possible Stage 5 (10-12 mos) jargon babble: true variegated, add sentence-like prosody, protowords, word approximations, actual words

anterior cerebral artery

Supplies middle portion of parietal and frontal o Also supplies corpus callosum and basal ganglia o Joins with PCA in back of brain o Can cause cognitive deficits such as impaired judgment, concentration, paralysis of feet and legs

4 parts of a goal

Target- behavior you want to change Mode- manner in which you want child to demonstrate behavior Criterion- level of success- accuracy or frequency Context- environment or activity in which response takes place

cranial nerves for speech or swallowing

Trigeminal (V) Facial (VII) Glossopharyngeal (IX) Vagus (X) Accessory (XI) Hypoglossal (XII)

significant deficit (KPW criteria)

below 10th percentile 1.25 standard deviations below the mean standard score of 80

ICF

body structure and functions activities and participation contextual factors- environmental and personal

continuum of naturalness

child centered, hybrid, clinician directed Who selects the focus? Who directs the topic? Who chooses the activity? e.g. clinician directed-drill, hybrid-games, child centered-typical daily activities

norms for emerging language stage

communicative acts- Rapid increase in rate: 2/min at 18 mos to 5/min at 24 mos. Syntax At 24 mos. MLU 1.5 - 2.4 with approximately equal numbers of 1- and 2-word utterances Vocabulary (lots of variability 18 to 30 mos) Rapid increase in expressive vocabulary: 1st word at 12 mos, 110 wds at 18 mos, 168 wds at 20 mos, 312 at 24 mos, and 546 at 30 mos

collateral factors that can affect communication

hearing, Oral motor abnormalities, Nonverbal cognition and Social functioning (pragmatics, shy)

ICF- body structure

includes: CNS, sensory, oral mech assessment: Hearing, vision, oral motor tx: Aids, devices, medical intervention

brown stage 2

ing (Me playing.) in (cookie in) plural (that books)

dynamic assessment

measure of learning, see If different cues change results, can go back on standardized and try ones missed with cueing to gain info Used to establish goals Measure progress

extrapyramidal system

o Basal ganglia o Thalamus o Cerebellum o Form complex circuits composing extrapyramidal system o Connected to direct motor pathway of pyramidal tract

circle of willis

o Base of brain, joining of 2 vertebral and 2 carotid arteries o Cerebral arteries branch off from here o Protective mechanism- limits damage if artery issue is below it

middle cerebral artery

o Biggest branch of internal carotid o Supplies entire lateral surface of cortex o Damage may result in aphasia, reading and writing deficits, contralateral hemiplegia, impaired sensation

Descriptive developmental model

o Detailed description of current level of functioning: Semantics, syntax, morphology, phonology and pragmatics, comprehension and expression o Research in normal language development guides intervention o Direct connection btwn assessment intervention o Creation of a profile and strengths and weaknesses

emerging language- semantic relations 2 word utterance

o Existence: that car; this ball o Nonexistence/Disappearance: all gone car o Rejection: no car; don't push. o Denial: no car; not ball o Recurrence: more car; ball again o Attribution: fast car; heavy ball o Possession: my car; mommy ball o Locative-Action: sit down; push high; in go o Locative-Entity: car out; in box; baby swing o Agent-Action: mommy push, baby swing o Action-Object: push swing; ball throw o Agent-Object: baby swing; mommy throw

Posterior cerebral arteries

o Formed from basilar artery o Supple lateral and lower portion of temporal lobe o Supply lateral and middle of occipital lobe

external carotid artery

o Goes towards face o Small branches supply different parts of the face Internal carotid artery

internal carotid artery

o Major supplier to brain o Branches into parts that supply different parts of brain o Includes middle cerebral and anterior cerebral

hypoglossal

o NOT sensory o Motor- intrinsic and extrinsic tongue muscles except palatoglossus, infrahyoid muscles, geniohyoid

cerebellum- role and damage

o Primary role - Synergy of muscles o Cooperative action of the muscles by providing feedback to other structures in the CNS motor system o In the case of gross motor movements, it helps maintain proper posture and balance in walking and execution of sequential motor movements such as eating, dressing and writing. o In the case of speech, it guides the production of rapid, alternating, repetitive movements. o Damage to the cerebellum or its tracts results in Asynergy o Lack of coordination of agonistic and antagonistic muscles (ex, biceps and triceps) o Deficits resulting in disorders in fine movement, equilibrium, posture, and motor learning.

facial (VII)

o Sensory- anterior 2/3 of tongue o Motor- sublingual and submandibular glands, buccinators, posterior belly of digastric, stylohyoid

vagus (X)

o Sensory- mucosa or pharynx, epiglottis, larynx and esophagus o Motor- palatoglossus, muscles of palate NOT tensor veli palatini, muscles of pharynx NOT stylopharyngeus, intrinsic muscles of larynx

glossopharyngeal (IX)

o Sensory- mucus membranes, tonsils, faucial pillars, posterior 1/3 of tongue o Motor- parotid gland, stylopharyngeus Vagus (X)

cerebellar arteries

o Stem from basilar o Anterior, posterior, superior and inferior o Supply inner ear, cerebellum and pons External carotid artery

frontal lobe- functions and important parts

o cognitive functioning, motoric functioning, and in speech and language. o Area 4 corresponds to the precentral gyrus or primary motor area (or cortex). o Area 6 is the premotor or secondary motor area (or cortex). o Area 8 is anterior of the premotor cortex. It facilitates eye movements and is involved in visual reflexes as well as pupil dilation and constriction. o Areas 9, 10, and 11 are anterior to area 8. They are involved in cognitive processes like reasoning and judgment which may be collectively called biological intelligence. o Area 44 is Broca's area. o Inferior frontal gyrus - has the Broca's area - Important for speech production. o Is in front of the area of the Primary motor cortex that controls jaw, lip, tongue, and vocal fold movements. o Damage to this area results in "motor aphasia," in which patients can understand language but cannot produce meaningful or appropriate sounds.

temporal lobe- function and parts

o involved in the processing of auditory information and semantics, as well as the appreciation of smell. o Area 41 is the primary auditory area or cortex or Heschl's gyrus . o Also a part of the primary auditory cortex, Area 42 immediately inferior to area 41 and is also involved in the detection and recognition of speech. More detailed processing and analysis is done in this area. o Areas 21 and 22 are the auditory association areas. o Area 22 is also known as Wernicke's area or association language cortex

parietal lobe- function and parts

o somatosensory processing. o Areas 3, 2, and 1 are located on the primary sensory strip, with area 3 being superior to the other two. These are the primary somatosensory areas or cortex for touch and kinesthesia. o Areas 5, 7, 39 and 40 are found posterior to the primary sensory strip and correspond to the presensory or secondary or somatosensory association areas. o Area 39 is the angular gyrus. o it is involved in a number of processes related to language and cognition & is believed to be responsible for understanding metaphors.

Using the picture exchange communication system (PECS) with children with autism: assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. (Charlop-Christy, Carpenter, Le, LeBlanc, & Kellet, 2002)

results indicated all 3 in study increased verbal speech, and small gains in social behaviors and decrease in problem behaviors

Emerging language- following directions

use # of salient items vs # of steps Get the red cow (2 salient items)

Voice Training and Therapy With a Semi-Occluded Vocal Tract: Rationale and Scientific Underpinnings (Titze, 2006)

• A semi-occlusion in the front of the vocal tract (at the lips) heightens source-tract interaction by raising the mean supraglottal and intraglottal pressures. • Impedance matching by vocal fold adduction and epilarynx tube narrowing can then make the voice more efficient and more economic (in terms of tissue collision). •

OUTCOME OF RESONANT VOICE THERAPY FOR FEMALE TEACHERS WITH VOICE DISORDERS: PERCEPTUAL, PHYSIOLOGICAL, ACOUSTIC, AERODYNAMIC, AND FUNCTIONAL MEASUREMENTS (Chen, Hsiao, Hsiao, Chung, & Chiang, 2007)

• After therapy the severity of roughness, strain, monotone, resonance, hard attack, and glottal fry in auditory perceptual judgments, the severity of vocal fold pathology, mucosal wave, amplitude, and vocal fold closure in videostroboscopic examinations, phonation threshold pressure, and the score of physical scale in the Voice Handicap Index were significantly reduced • The speaking Fo, maximum range of speaking Fo, and maximum range of speaking intensity were significantly increased after therapy • No significant change was found in perturbation and breathiness measurements after therapy • Resonant voice therapy is effective for school teachers and is suggested as one of the therapy approaches in clinics for this population

Consensus Auditory-Perceptual Evaluation of Voice: Development of a standardized clinical protocol (Kempster, Gerratt, Abbott, Barkmeier-Kraemer, & Hillman, 2009)

• Although there is no known ideal method for obtaining reliable and valid judgments of auditory-perceptual features, the CAPE-V derives its protocol and measurement scales from a state-of-the-art understanding of the multidimensional factors that underlie psychophysical measurement and human perception.

Systematic review dialogic reading (U.S. Department of Education, Institute of Education Sciences, What Works Clearinghouse, 2010)

• Based on the two studies, the [What Works Clearinghouse] found potentially positive effects of dialogic reading on communication and language competencies for children with disabilities

Vocal tract and glottal function during and after vocal exercising with resonance tube and straw. (Guzman, et al., 2013)

• During and after phonation into the tube or straw, the velum closed the nasal passage better, the larynx position lowered, and hypopharynx area widened • the ratio between the inlet of the lower pharynx and the outlet of the epilaryngeal tube became larger during and after tube/straw phonation • Acoustic results revealed a stronger spectral prominence in the singer/speaker's formant cluster region after exercising • Listening test demonstrated better voice quality after straw/tube than before • Vocal tract and glottal modifications were more prominent during and after straw exercising compared with tube phonation.

Treatment of laryngeal hyperfunction with flow phonation: A pilot study (McCullough, et al., 2012)

• Flow phonation Participants received five treatment sessions and were evaluated prior to treatment and after each session using a Phonatory Aerodynamic System to measure airflow during voicing tasks. Noise-to-harmonic ratio and perceptual voice measures were also obtained, as was self-perception of voice handicap • All increased airflow and decreased laryngeal airway resistance over five sessions

Interactive Focused Stimulation for Toddlers With Expressive Vocabulary Delays (Girolametto, Pierce, & Weitzman, 1996)

• Following treatment, mothers' language input was slower, less complex, and more focused than mothers in the control group. • children used more target words in naturalistic probes, used more words in free-play interaction, and were reported to have larger vocabularies overall as measured by parent report • children in the experimental group used more multiword combinations and early morphemes than children in the control group

IMPROVING THE SOCIAL-CONVERSATIONAL SKILLS OF DEVELOPMENTALLY DELAYED CHILDREN: AN INTERVENTION STUDY. (Girolametto, 1988)

• Following treatment, the mothers in the experimental group were more responsive to and less controlling of their children's behavior than the mothers in the comparison group • The children initiated more topics, were more responsive to their mother's preceding turns, and used more verbal turns and a more diverse vocabulary than the control group children

language modalities

• Form: syntax, morphology and phonology • Content: semantics • Use: pragmatics

LANGUAGE INTERVENTION WITH CHILDREN WHO HAVE DEVELOPMENTAL DELAYS: EFFECTS OF AN INTERACTIVE APPROACH. (Tannock, Girolametto, & Siegel, 1992)

• HANEN Consistent with the interactive model, mothers in the treatment group became more responsive, less directive, and provided clearer linguistic models • these changes were maintained for at least 4 months after intervention, and involvement in the parent-centered intervention program did not increase maternal stress. • these changes were accompanied by concomitant increases in children's use of vocal turns • an interactive model may afford a useful adjunct to other intervention approaches by instructing parents on how to promote children's use of existing abilities, but an interactive model may have no effect on language acquisition of at least some children with developmental delays.

An Evaluation of the Effects of Two Treatment Approaches for Teachers With Voice Disorders (Roy, et al., 2001)

• Only the group who adhered to the VFE regimen reported a significant reduction in mean VHI scores • when compared to the VH group, the exercise group reported more overall voice improvement (p<.05) and greater ease (p<.02) and clarity (p<.01) in their speaking and singing voice after treatment • These findings suggest that the VFE should be considered as a useful alternative or adjunct to vocal hygiene programs in the treatment of voice problems in teachers

The effects of stretch-and-flow voice therapy on measures of vocal function and handicap (Watts, et al., 2014)

• Outcome variables consisted of two physiologic measures (s/z ratio and maximum phonation time), an acoustic measure (cepstral peak prominence [CPP]), and a measure of vocal handicap (voice handicap index [VHI]) • The s/z ratio, maximum phonation time, sentence CPP, and VHI showed statistically significant (P < 0.05) improvement through therapy. • This study provides supporting evidence for preliminary efficacy of stretch-and-flow voice therapy in a small sample of patients. Treatment effect was moderate to large

Enhancing linguistic performance: Parents and teachers as book reading partners for children with language delays (Crain-Thoreson & Dale, 1999)

• Parents and staff showed changes in their shared book reading style consistent with the instruction they had received • children in all three groups spoke more, made longer utterances, produced more different words, and participated more in shared book reading • The magnitude of change in the children's linguistic performance from pre- to posttest was positively correlated with the magnitude of change in adult behavior • no statistically significant changes in children's vocabulary test scores • findings as consistent with a Vygotskian model in which children's linguistic performance can be enhanced by a supportive social context

The behavioral voice-lift: Learn how SLPs can help restore the youthful voice of an aging population (Zieglar & Hapner, 2013)

• Preliminary data indicate that the use of PhoRTE for the treatment of presbyphonia demonstrates improved vocal outcomes and improved voice-related quality of life • However, the PhoRTE group demonstrated an increased reduction in vocal effort and increased treatment satisfaction with the process and the outcome of therapy. • Although the PhoRTE voice therapy program aims to decrease the phonatory glottal gap, the vocal folds approximate one another but not past the point of a barely adducted/abducted vocal fold configuration • This configuration maximizes vocal economy by minimizing impact stress and thus, the risk of phonotrauma, while at the same time increasing vocal loudness

Evidence-based clinical voice assessment: A systematic review (Roy, et al., 2013)

• Results provide evidence for selected acoustic, laryngeal imaging-based, auditory-perceptual, functional, and aerodynamic measures to be used as effective components in a clinical voice evaluation

Maternal Responsivity Predicts the Prelinguistic Communication Intervention That Facilitates Generalized Intentional Communication (Yoder & Warren, 1998)

• Showed an increase in generalized intentional communication but it did vary based on caregiver responsivity • In families with mothers who responded to a high percentage of the children's communication acts at the pretreatment period, the children in the PMT group used more frequent intentional communication in post-treatment generalization sessions • PMT facilitates intentional communication in children whose parents are relatively responsive.

Randomized Comparison of Augmented and Nonaugmented Language Interventions for Toddlers With Developmental Delays and Their Parents (Romski, et al., 2010)

• Sixty-eight toddlers with fewer than 10 spoken words • assigned to augmented communication input (AC-I), augmented communication output (AC-O), or spoken communication (SC) interventions • ll children in the AC-O and AC-I intervention groups used augmented and spoken words for the target vocabulary items, whereas children in the SC intervention produced a very small number of spoken words • Vocabulary size was substantially larger for AC-O and AC-I than for SC groups • Clinical implications suggest that augmented communication does not hinder, and actually aids, speech production abilities in young children with developmental delays.

SMART goals

• Specific - Based on strengths and weaknesses; what sort of supports? • Measurable - When will the goal be met? • Attainable - Can lead to frustration/burnout • Relevant - Does it work toward the patients' end goals? • Timely - Want to see progression

Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up (Ramig, et al., 2001)

• The LSVT® was significantly more effective than the RET in improving (increasing) SPL and STSD immediately post-treatment and maintaining those improvements at 2 year follow up • The findings provide evidence for the efficacy of the LSVT® as well as the long term maintenance of these effects in the treatment of voice and speech disorders in patients with idiopathic Parkinson's disease.

THE RELATIVE EFFECTIVENESS OF VOCAL HYGIENE TRAINING AND VOCAL FUNCTION EXERCISES IN PREVENTING VOICE DISORDERS IN PRIMARY SCHOOL TEACHERS (Pasa & Oates, 2006)

• The VH and VFE participants reported improved vocal characteristics and voice knowledge after training while the control group showed deterioration on most variables • The VH participants showed greater improvements than the VFE participants

EFFICACY OF VOCAL FUNCTION EXERCISES AS A METHOD OF IMPROVING VOICE PRODUCTION (Stemple, Lee, Amico, & Pickup, 1994)

• The experimental group engaged in vocal function exercises • Objective measures taken after 4 weeks of exercise demonstrated significant changes in phonation volume, flow rate, maximum phonation time, and frequency range for the experimental group

Respiratory retraining therapy in long-term treatment of paradoxical vocal fold dysfunction (Nacci et al., 2010)

• The results show that long-term respiratory retraining is particularly efficacious if the cycles of treatment are repeated, no matter what clinical conditions are present. • In fact, when only one cycle of retraining treatment is given a year, there is initial improvement that slowly disappears throughout the year until the next treatment • .Long-term respiratory rehabilitation is effective, especially if the treatment is given at least once every 3 months

LARYNGOPHARYNGEAL REFLUX: POSITION STATEMENT OF THE COMMITTEE ON SPEECH, VOICE, AND SWALLOWING DISORDERS OF THE AMERICAN ACADEMY OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY (Koufman, Aviv, Casiano, & Shaw, 2002)

• The symptoms of LPR are protean; however, the most common are hoarseness, globus pharyngeus, dysphagia, cough, chronic throat clearing, and sore throat • Symptoms are often intermittent or chronic intermittent • The most common manifestation of LPR is re- flux laryngitis with or without granulation or granuloma formation

The treatment of muscle tension dysphonia: A comparison of two treatment techniques by means of an objective multiparameter approach (Van Lierde, De Bodt, Dhaseleer, Wuyts, & Claeys, 2010)

• The vocal quality before and after the two treatment techniques was measured by means of the dysphonia severity index (DSI), which is designed to establish an objective and quantitative correlate of the perceived vocal quality. • The DSI is based on the weighted combination of the following set of voice measurements: maximum phonation time (MPT), highest frequency, lowest intensity, and jitter. • This study showed evidence that MCT is an effective treatment technique for patients with elevated laryngeal position, increased laryngeal muscle tension, and MTD CLM=MCT

The effectiveness of a voice treatment approach for teachers with self-reported voice problems (Gillivan-Murphy, Drinnan, O'Dwyer, Ridha, & Carding, 2006)

• This study suggests that a voice treatment approach of VFEs and VH education improved self-reported voice symptoms and voice care knowledge in a group of teachers

Systematic review of the literature on the treatment of children with late language emergence (Cable & Domsch, 2010)

• Treatment for children with late language emergence improved performance on formal measures of language, mean length of utterance, and target word use as indicated by medium to large effect sizes in these good-quality studies • focused stimulation and modelling of single words can lead to improvements in the language of children with late language emergence.

Preliminary data on two voice therapy interventions in the treatment of presbyphonia (Ziegler, Verdolini, Johns, Klein, & Hapner, 2014)

• VFE registered slightly greater adherence to home practice recommendations than did PhoRTE, but PhoRTE perceived greater treatment satisfaction than VFE • Findings provide new evidence regarding the efficacy of voice therapy exercises in the treatment of age-related dysphonia and suggest PhoRTE therapy as another treatment method for improved voice-related quality of life and reduced perceived vocal effort in this population.

Parental Recasts and Production of Copulas and Articles by Children With Specific Language Impairment and Typical Language (Proctor-Williams, Fey, Loeb, 2001)

• We examined target-specific copula and article recast usage by 10 parents of children with SLI and 10 parents of younger language-matched children with TL, and we examined their children's productions of these same forms at three points across an 8-month period. • conclude that children with SLI can benefit substantially from the grammar-facilitating properties of recasts, but only when the recasts are presented at rates that are much greater than those available in typical conversations with young children. • Sentence recasts are adult responses to child utterances that repeat some of the child's words and correct or otherwise modify the morphologic or syntactic form of the child's sentence while maintaining the central meaning of the child's production

A Systematic Review of Resonant Voice Therapy (Yiu, Lo, & Barrett, 2017)

• available data showed that resonant voice therapy has a moderate level of evidence to support its use in clinical practice • Consistently found positive results in perceptual voice quality and efficiency of voice production.

Embedding language therapy in dialogic reading to teach morphologic structures to children with language disorders (Maul & Ambler, 2014)

• participants were read to using principles of DR intended to evoke their production of specific bound morphemes • multiple-baselines-across-subjects research design was employed • all three participants improved production of their respective target morphemes, although to varying degrees, and exhibited some generalization to unfamiliar stimuli and in conversation

Three treatments for teachers with voice disorders: A randomized clinical trial (Roy, et al., 2003)

• results from a posttreatment questionnaire regarding the perceived benefits of treatment showed that compared to RT and RMT, teachers in the VA group reported significantly more overall voice improvement, greater vocal clarity, and greater ease of speaking and singing voice following treatment • These findings replicate previous results from an earlier clinical trial confirming the efficacy of VA and provide new evidence to support RT as an effective treatment alternative for voice problems in teachers

PECS Systematic review (Sulzer-Azaroff, Hoffman, Horton, Bondy & Frost, 2009)

• supports the conclusion that PECS is an especially promising system for enabling nonspeaking individuals to communicate functionally across a wide audience of 'listeners' • Several investigators provided evidence that learning to use PECS was associated with some of their participants increasing their speaking and social approaching esults indicated all 3 in study increased verbal speech, and small gains in social behaviors and decrease in problem behaviors

Early Effects of Responsivity Education/Prelinguistic Milieu Teaching for Children With Developmental Delays and Their Parents (Fey et al., 2006)

• the RE/PMT group exhibited superior gains in communication compared with the no-treatment group. • RE/PMT may be applied clinically with the expectation of medium-size effects on the child's rate of intentional communication acts after 6 months of intervention

Investigation of the immediate effects of two semi-ocluded vocal tract exercises (Sampaio, Oliveira, & Behlau, 2008)

• the finger kazoo and phonation with straw exercises produced positive and similar reports in the vocal self-assessment, and similar reports in the acoustic analysis, whereas the auditory-perceptive evaluation indicated positive effects only in the phonation with straw.

children with specific language impairment (Camarata, Nelson, & Camarata, 1994)

• the results indicated that although both kinds of treatments were effective in triggering acquisition of most targets, consistently fewer presentations to first spontaneous use were required in the conversational procedure • In addition, the transition from elicited production to generalized spontaneous production was more rapid under conversation-interactive treatment • although imitation treatment was more effective in generating elicited production, a significantly greater number of spontaneous productions occurred under the conversational training procedures

Systematic review conversational recasting (Cleave, Becker, Curran, Owen Van Horne & Fey, 2015)

• vast majority of studies provided support for the use of recasts • A conversational recast is a response to a child's utterance in which the adult repeats some or all of the child's words and adds new information while maintaining the basic meaning expressed by the child