Cloned from: CD 768 Midterm

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Principle 4
1. Maintain  professional working relationships with others in the field.
2. Give credit where credit is due (e.g., avoid plagiarism.)
3. Exercise professional judgment.
4. Behave within standards and report ASHA violators.
The purpose of an assessment
  • find disorders
  • determine severity
  • goals and objectives
  • judgement regarding prognosis
What Does a Comprehensive Assessment Consists of?
  • Collection of a case history
  • The client and/or caretaker interview
  • Informal and standardized assessment of the clients: articulation, language, voice, fluency, and social/pragmatic skills; in addition, a hearing screening and an oral-peripheral examination should be completed
Preparing for a University Assessment
  • Review the clients file
  • Discuss your assessment plan with the supervisor
  • Prepare for your interview
  • Obtain case history information (using a form/questionnaire and through the client and caretaker interview)
Case History Information
  • Prenatal (e.g., complications during pregnancy); whats an example of something that could be significant in the normal development of the fetus?
  • Birth (e.g., temporary lack of oxygen to the fetus)
  • Developmental (e.g., the age at which the client first began to talk)
  • Medical (e.g., history of cleft lip and/or palate)
  • Social (e.g., child prefers to play alone, does not express an interest in toys, does not engage in pretend play, demonstrates inappropriate play)
  • Educational (e.g., attends an SDC classroom, receives support services from a reading specialist)
  • Occupational (e.g., was lead scientist, but now unemployed)
  • Previous related evaluation and treatment (e.g., has had five years of fluency treatment without success)
  • Premorbid abilities (e.g., was trilingual)
Objectives During the Client and/or Caretaker Interview
  • To clarify information on the case history questionnaire
  • To Obtain new information
  • To recommend and review the tests you would like to use
  • To involve the parents in the process of developing appropriate goals and designing an intervention plan
Strategies for a Successful Interview
  • Use a warm conversational style to establish rapport; do not write as you listen; videotape the interview instead
  • Use open-ended questions to elicit responses
  • Provide the interviewee plenty of time to respond
  • Summarize information already reported and ask for clarification
  • Listen carefully and ask follow-up questions; although it is important to have some questions prepared in advance, it is even more important to follow the parents lead
  • Be knowledgeable about the clients culture and language, but avoid stereotyping people
  • Paraphrase what the client or the caretaker report and check for understanding
  • Share your thoughts and beliefs with the client or the caretaker; be careful not to pass judgment when doing so
Procedures for Obtaining a Speech/Language Sample
  • Use conversational topics of interest to the client (e.g., favorite TV show or vacation)
  • If unsuccessful at eliciting a sample, use pictures, toys ad books (again of interest to the client) or talk about yourself first
  • Follow the clients lead in the conversation
  • Tape record the sample and transcribe it as quickly as possible following the session
  • Use phonetic transcription for unintelligible utterances and those containing errors
  • Identify the context used elicit the utterance in your transcription
  • When eliciting a sample from a highly unintelligible client, use highly structured activities
  • Video record when possible to check for nonverbal information (e.g., the clients body language, facial expression, and eye contact)
  • Collect a sample in a variety of environments and w/ a variety of people if possible; why?
  • Use materials that are culturally appropriate; how can you ensure cultural sensitivity? What are some examples of culturally sensitive materials or conversational topics?
  • Model various language structures to elicit a variety of structures
  • Slow down and give the client plenty of time to respond
  • Have fun
Speech and Language Sample Analysis
  • Articulation errors - type of error (e.g., omission, substitution, distortion), frequency of error, and impact on intelligibility
  • Semantic errors (e.g., using dad to refer to any adult males, using cat to refer to a lion and a tiger)
  • Grammatical errors (e.g., omission of the plural s, present progressive -ing, and past tense -ed)
  • Errors in syntax (e.g., throw ball boy)
  • MLU (i.e., Mean Length and Utterance)
  • Type-token ratio
  • Analysis of vocal qualities (e.g., pitch, loudness and quality)
  • Fluency
Giving Standardized Tests
  • Select a test relevant to the clients disorder
  • Review the test to familiarize yourself with administration procedures and scoring and to ensure the tests appropriateness in regards to the clients culture and language
  • Check the state laws for tests that have been banned for the African-American population
Reviewing Standardized Test Results
  • Discuss your impressions and recommendations with the client and/or the clients family
  • Use language that is clear and provide examples
  • Check for understanding, concerns, and questions
Client specific vs Normative Approaches to Target Selection
Client specific = selected based on what makes an immediate and significant difference in the client's communication

Normative = based on what are appropriate for the client according to age and age-based norms
Selection of Target Behaviors

  • A target behavior is any skill you choose to teach a client
  • Some clients may have only one target behavior (e.g., correct production of all fricative sounds affected by a lateral lisp)
  • Most client will have multiple possible targets; address only a few at a time
  • Sequence targets and begin with those that make the biggest impact on functional communication skills
  • Complete task analysis and teach prerequisite skills when necessary (e.g., before addressing increased response accuracy to ‘where’ questions, determine if the student knows prepositions and other concepts of place)
Guidelines for selecting target behaviors
  • Select behaviors that will make an immediate and socially disnificant difference in the communication skills of the client.
  • Select the most useful behaviors that may be produced and reinforced at home or in other natural settings.
  • Select behaviors that help expand communication skills (ex: words that can be easily expanded into words and phrases)
  • Select behaviors that are linguistically and culturally appropriate for the individual client.
Functional Target
Target behaviors that make a socially and personally meaningful difference in life
Additional Guidelines for Target Selection

  • Target functional skills

  • Target skills that may be reinforced in the clients home environment

  • Target behaviors that expand the clients existing communication skills (e.g., teaching verbs in preparation for expanding the clients MLU)

  • Consider the clients culture and primary language at all times

Potential Targets - Articulation Disorders
  • find out if each phoneme is produced correctly or not
  • classify errors as substitutions, distortions or omissions
  • find out the word positions in which the sounds are misarticulated
  • select the initial target sounds for training, and write your target behavior statement in objective and quantitative terms
  • in the case of a child who is bilingual or multikulti or both, select phonemes based on clear understanding of the phoneme use in the client's language
Potential Targets - Phonological Disorders
  • include simplification patterns beyond expected ages (fronting, stopping etc)
  • voice place manner analysis
  • check error consistency
  • choose 2-3 individual sounds that represent the class of sounds affected by the process
  • choose specific phonological analysis procedure (cycles, optimality etc)
Vocabulary
  • choose relevant words
  • involve parents and teachers
  • consider native language
  • target concrete words (common nouns, verbs, adj)
Phrases
  • begin teaching word combos the kid already knows
  • if speaks one-word utterances, encourage two-word
  • requests are easiest to teach
Morphology and Syntax
  • should begin when child can already produce phrases
  • browns stages to determine appropriate morph targets
  • syntax taught through targeting addtl morph constructs like questions/neg sentences
Functional Units
Aka speech acts, have different listener intentions and speaker effects.

Examples: gaining attention, seeking or givng information, requesting, greeting, responding to questions, following requests, etc.
Pragmatic Targets
  • more adv stages of lang dev
  • speech acts (getting attention, giving info, requests etc)
Behavior analysis perspective
A behavior analysis perspective suggests that communication units are a cause-effect phenomenon; this perspective emphasizes the importance of understanding the antecedent event, the communicative behavior and the consequence
Literacy Skills
  • slps care about early intervention of preliteracy skills
  • ell kids!
  • oral lang skills correlate to later lit dev
What population of children are reported to be at higher risk for developing later delays in reading and writing skills?
Preschool children with oral language disorders.

(Oral language skills are reported to have a strong correlation with later literacy development)
Parent involvement in Literacy development
  • regular book reading time
  • create literacy rich home environment
  • ask kids comprehension questions
  • modeling reading and writing
  • writing project
  • the read aloud handbook
Direct Instruction (of Reading Skills)
  • Modeling sound-letter correspondence
  • Pointing out printed words (in books or the environment)
  • Tracing the line as you read a book
  • Talking about parts of speech (e.g., the words in a sentence, the syllables in a word)
  • Using print when teaching speech and language targets
  • Teaching sight words, using names of family
  • members, high frequency words, or words of high interest
  • Helping children read a book (e.g., by taking turns or helping the child decode difficult or unfamiliar words)
Direct Instruction (of Writing Skills)
  • Manually guiding children to write the letter of the alphabet when teaching target sounds
  • Guiding children in writing target words
  • Scribing phrases and sentences and guiding children to copy the writing
  • Guiding children in writing short stories (e.g., the adult narrates while the child writes)
  • Providing practice for writing various genres independently
Voice - Disorders of Phonation
  • Can be due to disease (e.g., cancer, and infection), a physical problem (e.g., paralysis), or vocal abuse
  • Many problems require medical attention first and foremost
  • Treatment targets vary widely depending on etiology; examples include: 1) speech using an artificial larynx, 2) reduction of vocally abusive behaviors, 3) using muscular effort to achieve vocal fold adduction
disorders of RESONANCE
  • May also call for medical intervention (e.g., surgical repair of a cleft palate, surgical repair of VPI, the use of an artificial device)
  • Targets include increased use of oral resonance, increased use of nasal resonance, reduced use of the nasal resonance
Aphasia
  • Defined as an impairment in the understanding, formulating and expressing language (i.e., may affect all modalities)
  • Target selection is highly dependent on the individual patients impaired language characteristics
  • Targets include, but are not limited to the following skills: Improved auditory comprehension, naming, and writing skills, and use of alternative and augmentative
  • communication and/or compensatory strategies
Right Hemisphere Syndrome Targets
  • Counseling to address acceptance of impairment
  • Increased awareness of left neglect and compensation
  • Increased attention to task
  • Improved abstract reasoning
  • Improved pragmatic skills
  • Compensatory strategies for the care-taker (e.g., using auditory-verbal communication to compensate for a visual-perceptual deficit) ?
Verbal Apraxia
  • Automatic and accurate speech production is the ultimate goal
  • Practicing nonspeech movements (treatment efficacy?)
  • Generalization of correctly imitated sounds (i.e., of sounds with high stimulability)
  • Beginning with sounds that are visible and easier to produce
  • Treating singleton consonants before CCs

Dysarthria
Improved posture and muscle tone are usually primary targets; improved posture results in improved respiratory support, phonation, rhythm/prosody… •Respiration, phonation, articulation, resonance and prosody are all affected and addressed using various approaches (e.g., slow rate of speech to improve precision of articulatory movement) •In cases of severe dysarthria, AAC m once again be the only viable option
TBI
Targets include...
  • Increased attention
•Practice with orientation •Use of AAC devices to compensate for impaired communication skills •Use of compensatory techniques to address memory deficit (e.g., using day planners, lists, and visual reminders) •Drill and repetition to improve naming skills •Reduction of inappropriate responses and/or social/pragmatic behaviors •Improved speech production (e.g., slowed rate of speech) •Family counseling to increase support for the patient
Cerebral palsy
•One common characteristic of CP is dysarthria •Tx targets need to address respiratory, phonatory, resonance, articulation and prosodic deficits
Developmental Apraxia of Speech
- Controversial diagnosis
•Tx targets may include nonspeech movements…but only thse related to speech-related movements (e.g., elevating the tongue tip, closing the lips, rounding the lips, protruding the tongue between the teeth) •Imitation of visible, easy-to-produce sounds are often encouraged in the initial stages •Tx may begin at the syllable and word level •Reduced rate of speech may also be helpful •What are additional treatment techniques that may be helpful?  (e.g., Core Vocabulary, AAC, targeting prosodic features by using contrastive stress drills)
Treatment defined
•As SLP’s, we create new behavior(s) or alter existing ones by presenting controlled stimuli, modeling or prompting a desired behavior, and responding to the behavior in a systematic way
Basic Components of Treatment
I) Eliciting a target behavior II) Establishing a new behavior III) Increasing response frequency IV) Strengthening and maintaining behaviors V) Decreasing undesirable behaviors (which sometimes decrease naturally when appropriate communication behaviors are established)
Eliciting a Target Behavior
  • Provide Instructions
  • Model and imitation: do it often in early therapy stages, reintroduce after increasing tax complexity, request immediate imitation
  • Prompt: if model fails; choose subtle prompt; fade prompts
  • Use physical stimuli: bring from home; gradually fade to generalize
Establish a new behavior
Shaping: successive approximations
  • analyze behavior and how to simplify it
  • accept approximations in early stages
  • gradualy fade modeling and instructions
Increase response fluency
  • done through use of positive reinforcement
  • reinforcement must be motivating for client
  • may need to change from session to session
  • 2 kinds: primary (food) and social (verbal praise)
  • Token system: conditioned generalized system; work toward bigger reward later.
  • Feedback: immiediately/relevant/accurate feedback can be a powerful tool to change client's behavior
  • Biofeedback: (visipitch, etc.) gives visual info about client's production in comparison to target production through device
Strengthen and Maintain Behavior
  • Systematic changes in reinforcement schedule -----> variable/random reinforcement to increase spontaneous productions and self monitoring
  • It's important in the beginning to be consistent with reinforcement since the client may not self-monitor
Prompting Hierarchy
Hierarchy: Tactile – fade first Verbal – fade verbal second – it’s more intrusive and interruptive Visual – best, doesn’t interrupt client’s flow of communication
* Visual prompts (as compared to verbal prompts) are more subtle (less intrusive) and easier to fade
Reinforcers: 2 kinds
1) Primary = food, drink, etc. (most effective for children)

2) Social or conditoonal = verbal praise, smile, pay on back.
The number of trials you decide to teach depends on the client's..
Depends on the following factors: a)client’s age b)Motivation c)Attention d)Language skills e)Intellectual capacity f)Learning aptitude
Discrete Trials
  • Discrete trials (i.e., presenting a stimulus, asking a question to elicit a response, modeling, waiting for a response, and providing reinforcement and feedback) provide structure within clinical sessions.
  • Most clients benefit from having structure in the early stages of therapy
  • Clients with a severe speech and/or language disorder also benefit from having structure in the session
Probing for generalization
* When you point out that the client has used the target behavior in an untrained context and environment
* Do NOT use modeling when probing for generalization
Importance of data collection
  • Data is used to determine whether or not a client is making progress, to evaluate the effectiveness of a treatment program, and to make the final decision of dismissal from services
  • "Ultimate guiding principles"
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