Methods Final

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Methods Final
2013-05-06 16:08:05
Methods Final

Methods Final
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  1. What are the multicultural constructs?
    • Language
    • Culture
    • Ethnicity/race
    • Geography
    • Degree of acculturation
    • Background
    • Family type
    • Values 
    • Belief Systems
  2. What are terms used to describe language?
    • Acquiring a second language
    • Dual Language learners
    • English Language Learners (ELL)
    • Bilingual (speak two or more languages)
    • L1-Native language
    • L2- second language
    • Dialects
  3. What is code switching
    ALternating use of each language/dialect depending on context or listener needs
  4. What are the statistics of CLD
    • Population in US = 25%
    • CLD in schools = 14%
    • Projected to increase over 30% by 2015
    • Pevalence rate of com dis = 6.2 million
    • International adopetees
    • -China and eastern europe inadequate nutrition, lack of stimulation = signiicant developmental impairments
  5. Describe socioeconomic status
    • SES
    • Ranking by position in society on class, status, power, financial resources, level of education, and occupation. 
    • Described as high, middle, or low
    • Predictor of school performance, crime
    • SES may be a better predictor of cognitive-communicative behaviors than other factors such as racial-ethnic background
  6. SES is ___ predictor than cultural/ethnic
    • low educational progres
    • high unemployment
    • more behavior probs
    • More crime
  7. What are clinical considerations for children
    • Proficiency, Dominance 
    • Acquisition of LD
    • BICS
    • CALPS
    • L1 influences L2 (language interference transfer, language loss.
  8. What is BICS and CLAPS
    • Basic Interpersonal Communication Skills- Social 2-3 years to develop
    • Cognitive Academic Language Proficiency Skills- academic learning 5-7 years to develop
  9. What are the 2 patterns of 2nd language acquisition.
    • Simultaneous- exposed to and acquires L1 and L2 from birth.
    • Sequential/ Successive - L2 is introduced later in childhood, usually after 3 y/o
  10. What are the Educational models
    • immersion
    • transitional 
    • maintenance
    • dual immersion
  11. what are the clinical considerations for adults with CLD
    • The same type and severity of aphasia may be present in both languages OR severity may be greater in one language for bilingual speakers.
    • Emphasize a cross-linguistic approach to enhance recovery
    • Use similar words from both languages for word retrieval practice.
    • Conduct tx in language common to clinician and client, but home practice in other language.
  12. Discuss the initiation of any assesment
    • Initiated for a reason
    • Chief complain or presenting issue or problem
    • Assessments are initiated in different ways (self referral, teacher, parent, physician, another professional.
  13. What are initial questions to ask for assessment
    • Are the clients speech, language, and hearing within normal limits
    • Is the client at risk for developing a disorder
    • What are the characteristics of impairment, disability, and handicap
    • What is the cause of the behaviors constituting the communication disorder
    • Is there any reason why the clinician cannot or should not provide treatment?
  14. If the referral is medical it comes from who? if it is clinic it comes from who?
    • Doctor
    • Self, parent, friend, other professional
  15. What is the process of referral for educational setting?
    • Referral by teacher or parent
    • Process starts may be changed due to RTI tears
    • 1st step : BIT/SAT team suggests other interventions. May include screening.
  16. If regular ed interventions are not successful...
    • Refer to specialist for dx
    • SLP
    • OT, PT
    • Others
    • Get a CMAP as and ORDER to start evaluation process
    • IEP process dictates the timeline by which all work is completed.
  17. When an SLP gets a referral they need to...
    • informed constent: permission papers must be signed, IDEA, HIPAA
    • Read records: permanent/confidential file; medical chart- do before you see client or patient.
  18. Discuss the process of making a dx plan
    • Interview teacher, parent, client, significant others (case history)
    • Standardized, norm-referenced assessment instruments
    • Criterion-referenced assessment. 
    • Informal assessments
    • Observation of typical behavior in functional environment (know normal behavior and development)
    • Screen other disorders or differences if not the "chief complaint"
  19. What are informal assessments
    • incldue dynamic assessment
    • language samples
    • expository
    • narrative
    • conversation
    • written
  20. what other disorders may you screen?
    • fluency
    • artic
    • voice, pragmatics, language
    • oral mechanism screening
    • hearing screening
  21. After the Dx plan, what is the next step in schools
    • MDT, multidisciplinary team or MDET
    • Minimally:SLP, reg ed teacher, parent
    • Maybe: Special ed teacher OT, PT, Social worker case manager, nurse
    • Looks at results of textsing
    • determines whether student is eligible for school-based tx
  22. Describe the evaluation report.
    • Should stand on its own
    • State what was assessed and how
    • Interpret what the scores mean in functional terms
    • integrate data
    • use clinical judgment to state the significance of the findings
    • use language non-professionals will understand
  23. Describe the IEP
    • Individual education plan
    • decides upon the goals and objectives to be addressed in tx
    • goals must be related to regular or general education curriculum
    • states time allotted for tx and where
    • referrals 
    • Accommodations in regular ed classroom
  24. Articulation Disorder=
    Phonological disorder=
    Accent Reduction=
    • Speech 
    • Language
    • Cultural and not a disorder
  25. What are the two approaches for choosing treatment targets for children with articulation or phonological disorders. Describe each
    • 1. developmental approach: Identify targets based on normal ages of acquisition os speech sounds, typically present error sounds in order that normal children learn sounds. 
    • 2. non-developmental approach: Client specific, degree of perceived deviance associated with child's errors, phonological
  26. Describe the client specific appraoch
    • targets relevant to child
    • targets most stimulable, regardless of typical development
    • Targets most visible when produced.
  27. Describe the degree of perceived deviance associated with childs errors.
    • Articulatory (omission, substitutions, distortions, initial position errors, medial position errors, final position errors. Errors on most frequent sounds
    • Phonological (most unintellibillity, initial consonant deletion, gloattal replacement of medial consonants.)
  28. Describe the verticle goal strategy
    • Intense practive on limited number of targets
    • Target /l/ first until mastered then move on to /r/
    • good if client only has few errors
    • traditional artic treatment
    • Van Riper 
    • Isolation, syllables, words, sentences, conversation
  29. Describe the horizontal goal strategy
    • Simultaneous exposure to a wide variety of targets will facilitate a client's ability to produce phonemes or sound patterns
    • Less intense practice to a large number of targets, even in same seesion.
    • Appropriate for clients with multiple errors.
  30. Describe the Cyclical goal strategy
    • Combine vertical and horizontal approaches 
    • Practice intensely on target for given amount of time, then move to another target
    • Cycle is repeated until targets emerge into spontaneous speech. 
    • Change targets regardless of progress and keep repeating cycle.
  31. there is no significant evidance or connection between _____ and speech sound production.only recomended for _____
    • Oral motor exercises
    • awareness of oral mechanism
  32. Describe an articulation disorder and the 2 kinds.
    • Phonemes produced incorrectly. This is a motor component of speech
    • Functional (without cause) and Organic (cause)
  33. Describe a functional articulation disorder
    • Speech production errors in the absence of identifiable etiology (normal hearing, no significant structural anormalities, No neurological dysfunction. 
    • Selection of tx targets from either developmental or non-developmental approach
  34. What are the speech characteristics of a functional articulation disorder
    • Substituations
    • Omissions
    • Distortions
  35. What are helpful hints for treating a functional articulation disorder.
    • Don't include more than one error sound in a stimulus word in initial stages of tx.
    • Pay attention to phonetic context of words--some consonant-vowel sequences are more difficult
    • Motor skill- so more practice is needed
    • Counsel parents about responses to errors to avoid
  36. Describe phonological disorders
    • The phonological system governs the ways in which sounds in a language can be combined to form words
    • Difficulty in acquiring a phonological system, not necessarily in production of the sounds.
  37. Describe the phonological disorder treatment approaches
    • 1. phonological processes strategy used by 1..5 - 4 y/o children to simplify production of classes of speech sounds- persistance using this is disorder and treat by teaching rule. 
    • 2. distinctive features -artic and acoustic properites- teach place manner and voicing.
  38. What are three organic articulation disorders.
    • Cleft palate
    • hearing impairment
    • Childhood apraxia of speech (CAS)
  39. Describe Cleft Palate
    • Congenital malformation of palate and/or lip
    • bilateral or unilateral
    • Interdisciplinary team
    • Surgical repair of lip, palate and pharyngeal flap
    • Speech treatment begins both before and after surgery
  40. What are the speech characteristics of Cleft palate
    Velopharyngeal incompetence (VPI): Audible emission of air, hypernasal resonance, articulation errors. Most freqent errors on fricatives, affricates and plosives distortions and omissions.
  41. Describe a hearing impairment
    • Significant loss in auditory acuity
    • Sensorineural, mixed, conductive
    • the more severe the less articulation
    • midl to moderate patients tolerate tx best
    • Speech intelligiibility affected by profound HL
  42. What are the speech charicteristics of a hearing impairment
    • Omission of initial and/or final consonants, blends
    • substitution of voiced consonants for voiceless
    • Substitution of stops for nasals, fricatives, and affricates
    • Substitution and insertion of schwa 
    • nasalization of vowels.
  43. What are the treatment approaches for hearing impairment
    • oral-emphasizes spoken language
    • manual emphasizes ASL
    • Total communication combination
    • Cochlear implants with speech therapy.
  44. Define CAS
    • Speech motor planning disorder with reduced ability to volitionally sequence movements of articulators for speech perhaps from neuologic diysfunctions.
    • Receptive language aboilites are better than expressive 
    • Can be unintelligible to not verbal
  45. what are the speech characteristics associated with CAS
    • Repertoir of phenemes is extremely restriceted
    • Reduced ability to imitate sound- especiall muliti syllables
    • Most omission, substitution, distortion (inluding vowels) addition prolongation
    • Errors on sounds requiring complex artic movements.
    • Prosodic errors
    • struggling or grouping movements
    • Errors increase with length and complexity
    • Ability to sequence phonemes is reduced.
  46. CAS treatment approaches
    • Progress is slow
    • Repeated practice --systeatic drill necessary
    • shorter, more frequent session
    • must use visual, tactile and auditory cues, 
    • work on melody and rhythm
    • Consider AAC system temporarily.
  47. How is accent reduction the same, and how is it different
    place manner and voicing

    • Includes cultural education: idioms, humor, 
    • Syntax, stress intonation
    • Adults, generally as clients
  48. What are accent reduction treatment approaches.
    • Careful analysis of differences
    • Often vowels and prosody are different
    • Determine what differences contribute most to intelligibility problems and target these first
  49. Define a language disorder
    • The abnormal acquistion, comprehension, or use of spoken or written language
    • Includes receptive and expressive language skills. 
    • May involve any aspect of the form, content or use of linguistic system
    • Primary vs Secondary disorder  (autism and language)
    • Developmental vs acquired
    • Delayed vs deviant acquisition
    • Range of severity
  50. Look at p151
  51. Define
    1. semantics
    2. morphology
    3. syntax
    4. pragmatics
    5. phonology
    • 1. vocabulary
    • 2. parts of words that go togehter
    • 3. how words are ordered and combined for sentences
    • 4. social skills
    • 5. systems and rules of how sounds are put together in words.
  52. Describe emergent literacy and metalignuistic awareness
    • Awarenss of world of print and understanding of functions of literacy.
    • Metalinguistic awareness: awareness of and ability to manipulate aspects of the linguistic system (eg: phonological awareness)
    • Vocabulary and word retrieval (rapid naming for decoding)
    • Deficits in vocab and word retrieval most common characteristics of language impairment.
  53. What is literacy, reading, writing.
    • Literacy: development of reading and writing skills
    • Reading: decoding, comprehension, vocabulary, fluency, phonemic awareness
    • Writing: spelling, conventions, compose text at sentence level and beyond.
  54. What is the basis of development for literacy?
    oral language
  55. Tx approaches vary according to theoretical orientations which are
    • cognitive-developmental
    • linguistic developmental
    • behavioral developmental
  56. what is the intervetion for birth to 3 years with a language disorder
    • Go to home
    • provide intervetion indirectly (monitoring, stimulation and prevention
    • Family centered approach: Services delivered at home or center based, interdisciplinary model, repeated exposures and stimulation.
  57. Early intervention critical for childre at risk for language due to:
    prematurity, low birth weight, family history, medical complications, hearing
  58. What are the treatment targets for birth - 3 years
    • localization
    • joint attention
    • mutual gaze
    • joint action and routines
    • vocalizations
    • communicative intentions
    • non-symbolic play and symbolic play
    • initial vocabulary
  59. What is the intervention for 3-5 years
    • Most development of linguistic system
    • Rapid growth in vocabulary
    • MLU increases
    • Syntax acquisition
    • Morphological forms emerge
    • Can understand and produce sentence forms
    • Emergent literacy continues
  60. What are examples of emergent literacy
    • shared book reading and sense of story
    • alphabetic letter knowledge
    • adult modeling of literacy activities
    • experience with writing materials.
  61. What do we know about language development of elementary school.
    • Mostly intelligable
    • MLU is increasing until about 9 years old
    • More complex sentences, relative clauses, passive voice
    • Learning to decode, comp. should be developing.
  62. What are the treatment targets for school age with language disorder
    • semantics
    • morphology
    • syntax 
    • pragmatics
    • phonology
    • exression and comprehension(narrative/expository)
  63. k-3 you ___ to ____
    3rd to 12th you ____ to _____
    • learn to read
    • read to learn
  64. Goals are programmed to addess....
    the demands and expectations of educational curriculum
  65. Describe treatment activities
    Activities need to be functional --related to educational curriculum.  (drills, memory card game)
  66. What are classroom like activities
    Books, reading, writing.
  67. What are treatment targets for adolescents?
    • Semantics 
    • morphology
    • syntax 
    • pragmatics
    • phonology
    • expression and comprehension.
  68. What are treatment targets for adolescents 10-14?
    What are treatment targets for adolescents 14-16?
    What are treatment targets for adolescents 16-20?
    • Communication skills for academic and personal-scocial
    • Communication skills for academic and personal social and career.
    • Communication skills for personal social and career.
  69. Goals for adolescents are
    Programmed to address the demands and expectations of academic, social, and career
  70. What are treatment activities for adolescents.
    • textbooks, magazines, newspapers, interest area
    • Motivation is key, adolescents must feel that they have choices and must take ownership for achieving those goals.
  71. What are the stages of swallowing?
    • Anticipatory phase
    • Oral phase
    • pharyngeal phase
    • esophageal phase
  72. Describe the Anticipatory phase?
    • Occurs before any food reaches the mouth
    • Decisions made regarding type, rate, and quantity of oral intake
  73. Describe the Oral Preparatory phase
    • Food manipulation in mouth, forming bolus
    • sufficient saliva production
    • Mastication (chewing)
    • Labial (lip) seal maintained
    • Buccal (cheek) musculature
  74. Describe the Oral Transport phase?
    • Tongue begins posterior (back of mouth) movement of the bolus
    • Labial (lip) and Buccal (cheek) muscles contract
    • Tongue elevates from front to back and bolus is propelled toward oropharynx (through the oral cavity and pharynx)
  75. Describe the Pharyngeal phase
    • Triggered when bolus approaches the anterior faucial arches and tongue base
    • closure of velopharyngeal port 
    • Contraction of pharyngeal walls and posterior tongue base movement
    • Laryngeal closure (airway closure)
    • Opening of upper esophageal sphincter.
  76. Describe the Laryngeal closure (Airway closure).
    • True and False vocal folds contract
    • Larynx and Hyoid Elevate and move Anteriorly 
    • Arytenoid cartilages approximate base of epiglottis
    • Top third of epiglottis folds down horizontally.
  77. Describe the Esophageal Stage.
    • Long, flaccid muscular tube with tonically contracted muscle at both ends
    • Esophageal transit times vary from 8-20 sec
    • Peristallic wave pushes bolus through esophagus until the LES opens to allow bolus to enter stomach.
  78. Define aspiration, penetration, residue
    • Aspiration = entry of food or liquid into the airway below the true vocal folds.
    • Penetration = entry of food or liquid into the larynx at some level down to but not below the true vocal folds
    • Residue = food or liquid that is left behind in the mouth or pharynx after the swallow.
  79. What are the etiologies associated with Dysphagia?
    • CVA stroke
    • TBI
    • Brain Tumor
    • Progressive Disorders
    • Other
  80. What are the Clinical implications of Aspiration
    • Pneumonia or poor lung condition
    • low grade fevers
    • abnormal pulse oximetry
    • increased oxygen requirement
    • decreased overall respiratory status
  81. What are the signs and symptoms associated with dysphagia and aspiration risk
    • Dysarthria
    • Wet voice/poor vocal quality
    • Decreased oral motor function
    • coughing/choking
    • Throat clearing
    • Multiple swallows
    • Patient complaints (weight loss, lengthy meals)
  82. Describe the Bedside exam
    • Patient History/ Chart Review (medical status, respiratory status, current feeding methods)
    • Interview/ Observation (Level of responsiveness, behavioral characteristics, positioning)
    • Oral Mechanism Exam (Lips, tongue, soft palate, cheeks, mandible, and larynx, strength, coordination, range of motion)
    • Non Instrumental Clinical Evaluation (dry swallows, trials swallows, oral motor function, observations after swallow)
  83. Describe the modified barium swallow
    • study of anatomy and physiology
    • Oral, pharyngeal, and cervical esophageal stage s of the swallow
    • Define management and treatment strategies that will improve swallowing safety and efficiency.
  84. Compare Bedside and Modified evaluation
    • Bedside
    • *non-instrumental
    • *Typically complete prior to MBSS
    • *Purpose is to identify aspiration risk and determine need for further evaluation
    • *Provides subjective signs.
    • Modified
    • *Instrumental
    • *Requires barium
    • *Purpose is to identify impairments and determine appropriate mgt and treatment
    • *Trial postures/ maneuvers 
    • *Provides obective evidence
    • *Silent Aspiration
  85. What are the Compensatory Strategies and describe them.
    • Diet Modifications: liquid (thin, nectar thick, honey thick) Solid (blenderized, puree, mechanical soft)
    • Postural techniques: Chin down, tilting head backward, rotating head, head tilt to side, lying on side or back.
    • Increased Sensory Input: Modifiny presentation of bolus, thermal tactile stimulation
    • Voluntary Maneuvers: supraglottic swallow, super supraglottic swallow, effortful swallow, mendelsohn maneuver, masako maneuver
  86. What are the Therapy techniques and describe them.
    • Oral Motor Exercises: range of motion tongue exercises, resistance exercises, bolus control exercises.
    • Pharyngeal Exercises: Vocal fold adduction exercises, tongue base exercises, laryngeal elevation
  87. Describe Neuromuscular Electrical Stim
    Combined with OM and Pharyngeal Exercises, swallowing trials
  88. Define Aphasia
    • Language Disorder
    • due to brain damage  (usually a hemorage or blockage)
    • results in impairment in comprehension and/ or formulation of language. 
    • can affect oral and written language
  89. What is the etiology of Aphasia
    • Cerebrovascular accident (CVA)- stroke 
    • Tumors 
    • Head trauma (TBI)
    • Disease- ex: encephalitis
  90. What are the deficits of aphasia?
    • Damage to language area of brain (usually left hemisphere)
    • Motor and sensory deficits (hemiplegia, hemiparesis, hemianopsia
  91. What are the two categories of aphasia
    • Fluent: poor comprehension with relatively spared speech, impaired word-retrieval, paraphasisas, neologisms, perseveration (wernicke's)
    • NonFluent: poor output with relatively spared comprehension, reduced vocab, agrammatism, impairments in artic rate and prosody speech is labored and effortful
  92. What is the tx efficacy of aphasia
    • may have spontaneous recovery (2-3 months or 1 yr)
    • Need frequent treatment of 2 or more hours per week)
    • More improvement in receptive, then speech production, then expression
  93. What are the goals for tx of aphasia?
    • goal is to improve communicationskills within constraints of neurological damage 
    • Focus is on care not cure
    • Establish compensatory/maintenance strategies for functional language skills
    • Consider pre-morbid status.
  94. What are the two theoretical orientations of aphasia tx
    • Restorative/Linguistic: intensive and repeated sensory stimulation. direct instruction , gain as much as possible
    • Sustititive/compensatory: use whatever modalities available to communicate. used when there is more damage.
  95. Describe group tx and self curing for word retrieval
    • Group tx: social setting, family members
    • Self-cuing for word retrieval: Automatic sequences (days of week) Paired verbal associates (salt and pepper) sentance completion (use a broom to sweep the ____)
  96. Describe constraint induced language therapy and stimulation facilitation.
    • Constraint induced language therapy: massed practice (30 hrs in 2 weeks), shapig, constrain-no non verbal (tie hands down)
    • Stimulation Facilitation: Focus on semantics and syntax, intensive auditory stimulation, high number of responses. 
    • *Both are Restorative linguistic
  97. Describe the Melodic intonation therapy and the amer-ind approaches.
    • Melodic intonation therapy: restorative linguistic, recuits participation of right hemisphere to improve verbal production in left hemisphere, rythm and unision
    • Amer-Ind: sutitutive/compensatory, gestural system based on american indian hand talk, telegraphic, no grammar
  98. Describe visual Action therapy and promoting aphasics communicative effectiveness (PACE)
    • Visual Action Therapy: substitutive/compensatory, non-vocal, single gesture level to communicate.
    • Promoting Aphasics communicative effectiveness (PACE): Substitutive compensatory, convey message by whatever means 
    • Life Participation Apprach to Aphasia: Functional compensatory, maximize clients reengagement in life based on clients and families decisions of what is important.
  99. Define Dysarthria
    • imaired muscular control over speech mechanism
    • Result of central or peripheral nervous system damage
    • Etiology: stroke, brain tumor, tbi, toxins, chemo.
  100. Describe dysarthria
    • inaccurate and/or labored performance in rapid, repetitive movement of articulators (slurred)
    • can affect respiration, phonation, resonance, articulation, prosody
    • speech musculature: paralysis, weakness, decreased tone, incoordination
    • Can be reduced range of motion or invlountary and unihibited movement.
  101. What is the prognosis of dysarthria?
    • No spontaneous recovery with some
    • Remission can occur for some neuromuscular diseases
    • Degenerative disease-prognosis is pore.
    • Co-occuring with aphasia
    • TX is generally effective.
  102. Describe the behavioral prosthetic and medical procedures for approaches to dysarthria>
    • Behavioral: verbal reinforcemtn, metronome pacing, biofeedback, delated auditory feedback, pacing boards
    • Prosthetic devices: palatal lift to decrease hypernasal resonance
    • Medical/surgical procedures: Medicaitons, pharyngeal flap, phonosurgery, pallidotomy
    • Deep brain stimulation: Surgically implanted device to electrically stimulate targeted area of brain.
    • AAC: for worst cases
  103. Define Apraxia of speech
    • Inability to plan and sequence volitional motor movements
    • Due to CNS damage despite intact muscle strength and coordination
    • can affect limbs or articulation
    • difficulty positioning speech muscles, sequencing muscle movements for voluntary production of speech but no muscle weakness.
  104. What is the etiology of Apraxia
    • Lesion in left frontal lobe near broca's area
    • CVA, TBI, tumors, disease processes
    • Frequently co-occurs with aphasia
  105. Describe apraxia
    • unpredictable and inconsistent errors
    • substitutions and transpositions are more frequent errors
    • complex consonant blends often substituted for simpler phonemes
    • difficulty initiating speech 
    • Accuracy deteriorates as word length increases
    • groping
    • automatic speech better
    • speech rate slowed
    • incorrect prosody
  106. What is the prognosis of apraxia and the tx efficacy.
    • spontaneous recovery follows initial neurological insult 
    • No good evidence at this point
  107. What is the goal of apraxia treatment>
    • increase voluntary control over articulatory movements for speech
    • severe/profound- intelligible speech not realistic, try alternative communication
  108. Structure of tx
    • drill, repeated practice
    • 8 step task continuum-integral stimulation
    • clinician provides model then fades prompting
  109. content of tx
    • initiate phonation: work from cough to prolonged phonation
    • Increase smoothness and length of speech: automatic speech
    • phonemic drill
    • nnnn to na to nana to new to nine