1. DECEMBER 2014 OF GOD Seyede Fateme Mohammadi M.Sc Speech & language pathology Under the supervision: Atabak Vosughi

2. Speech and Language Disorders

3. Definition Speech-language pathology is the treatment for the improvement or cure of communication disorders, including speech, language, and swallowing disorders. The term used to describe professionals in this discipline is speech and language pathologist (SLP).swallowingpathologist

4. Description The discipline of speech-language pathology includes professionals that are trained in the techniques, strategies, and interventions designed to improve or correct communication disorders. Communication disorders include disorders of speech, language, and swallowing.

5. Language disorders include developmental or acquired conditions that lead to difficulties in understanding or producing language. Speech-language pathologists participate in the screening, assessment, and treatment of patients who experience one or a combination of these disorders.

6. Communication Speech= audible representation of language. Language= message that is contained in speech.

7. “Copyright© Allyn & Bacon 2006” Face-to-face.talephone.radio or television & other media Verbal Communication Gestures.how we dress or act-ever our scent.Body language Non-Verbal Communication Ietters.email.book.magazine.the internet or via other media Written Communication Charts.graphs.maps.logos & other visulizations can communicate messages. Visualizations

8. The system of symbols that individuals use for communication, based on their culture Expressive Language Receptive Language

9. 5 Components of Language Phonology Morphology Syntax Form Semantics Content Pragmatics Function (usage)

10. Structure of language(linguistic approach) Phonology = rules regarding how sounds can be used and combined. Syntax = the way sequences of words are combined into phrases and sentences. Morphology = the form and internal structure of words. Semantics = the understanding of language. Pragmatics = rules that govern the reasons for communication as well as the choice of codes to be used when communicating.

11. Definition Language process of cognitive involves: Memory. Learning. Message reception and processing. Expressive skills. Language delays= sequence of development is intact but the rate is interrupted. Language disorders= sequence of language acquisition is not systematic or sequential.

12. Language development Stages in developing skill's language. Crying, then cooing, growling and babbling by age 0-9(m). Different tones and vocal intensity. Echoing or mimicking responses. Words begin to become attached to people or objects by age 12-15(m). Strings of two and three words by age 18-24(m). Basic syntactical structures by age 4. Six word sentences by age 5. Articulate nearly all the speech sounds correctly by age 8.

13. 13 Etiology of Speech and Language Impairments Ways to Classify Speech and Language Impairments Functional vs. Organic EnvironmentalPhysical Congenital, Developmental, or Acquired Exist at birth Emerge in childhood Result from injury

14. Language Disorders (for example): Central Auditory Processing Disorder Specific language impairment Language delay Aphasia

15. Classification(According to cause):. Receptive language = difficulties in comprehending what others say. Expressive language = difficulty in formulating and using language. Aphasia = impairment of language comprehension, formulation, and use due to injury, disease, or mal- development of the brain.

16. Receptive Language Problems Encounters difficulty with understanding oral presentation of information Does not understand humor, figurative language, or abstract thought

17. Expressive Language Problems Limited use of vocabulary Searches for the right word Poor social language skills Hesitates to ask questions Jumps from topic to topic Topics chosen are concrete rather than abstract, temporal, or spatial Repetitive and unspecific

18. Dimensions of Speech Voice Pitch, intensity, quality Resonance Articulation Fluency Speech disorders can occur in all of these areas

19. Speech disorders Speech behavior that is sufficiently deviant from normal that it attracts attention. Fluency Disorders Repeated interruptions, hesitations, or repetitions that seriously interrupt the flow of communication. Cluttering = speech that is overly rapid, disorganized, and occasionally filled with unnecessary words. Stuttering = flow of speech is abnormally interrupted by repetitions, blocking, or prolongations of sounds, syllables, words, or phrases. Childhood apraxia of speech

20. Speech disorders Articulation Disorders Abnormality in the speech-sound production process resulting in inaccurate or otherwise inappropriate execution of the speaking act. Omissions. Substitutions. Additions. Distortions of certain sounds. Causation: Physical malformation, nerve injury, or brain damage. Cleft palate. Occlusion/malocclusion. Defective learning of the speaking act.

21. “” Causation

22. Speech disorders Voice Disorders Unusual or abnormal acoustical qualities in a person’s speech. Subjectivity in determining voice normalcy. Problems are persistent when not treated. Nasality, hoarseness, or breathiness.

23. Prevalence of Speech Language Disorders 11-12 % of all students receiving special education 2:1 ratio, boys to girls Does not include students who receive speech and language therapy as a related service

24. Causes of Speech and Language Disorders Biological causes Physical causes Emotional causes Brain injury Heredity Environmental causes Neglect or abuse Poverty, malnutrition

25. Speech Assessments Formal tests of articulation ( phonetic & …) Spontaneous conversation samples(TOLD & …) Developmental history Examination of mouth, teeth, palate (oral motor function)

26. Language Assessments Formal and informal assessments Samples of student’s written schoolwork Observations What child talks about How child talks about things How child functions in context of community How child uses language socially

27. Communication and Technology Augmentative and alternative communication (AAC) Unaided (low Tech): sign language Aided (high Tech): depends on equipment or materials Communication board Computer with speech processor Word prediction software

29. Overview of Services Speech therapy…. ( PROCEDURE CPT CHARGE) Swallowing Function Treatment of swallowing dysfunction and/or oral function for feeding 92526 Evaluation of oral & pharyngeal swallowing Function 92610 Motion fluoroscopic evaluation of swallowing function by cine or video recording 92611 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording 92612 physician interpretation and report only 92613 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video Recording 92614 physician interpretation and report only 92615

30. Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing 92616 physician interpretation and report only 92617 Speech and Language Evaluation of speech, language, voice, communication, and/or auditory processing 92506 Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual 92507 group, two or more individuals 92508 Development of cognitive skills to improve attention, memory, problem solving, direct one-on-one patient contact by the provider; each 15 minutes 97532 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands; each 15 minutes 97533

31. Nasopharyngoscopy w/ endoscope 92511 Laryngeal function studies 92520 Evaluation of auditory rehabilitation status, 1st hour 92626 each additional 15 minutes 92627 PROCEDURE CPT CHARGE Auditory rehabilitation; pre-lingual hearing Loss 92630 Auditory rehabilitation; post-lingual hearing loss 92633 Assessment of aphasia with interpretation and report, per hour 96105 Developmental testing; limited, w/ interpretation and report 96110 extended, with interpretation and report 96111

32. Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report 96125 Laryngoscopy; flexible fiberoptic; diagnostic 31575 Laryngoscopy; flexible or rigid fiberoptic, with stroboscopy 31579 Augmentative and Alternative Communication Evaluation for use/fitting of voice prosthetic device to supplement oral speech 92597 Evaluation for prescription of non-speech generating augmentative and alternative communication device 92605

33. Therapeutic service(s) for the use of nonspeech generating augmentative and alternative communication device, including programming and modification 92606 Evaluation for prescription for speechgenerating augmentative and alternative communication device; face-to-face with the patient; first hour 92607 each additional 30 minutes 92608 Therapeutic services for the use of speechgenerating device, including programming and modification 92609 Repair/Modification of AAC device (excluding adaptive hearing aid) V5336

34. Other Procedures Otorhinolaryngological service or procedure 92700 Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 98966 11-20 minutes of medical discussion 98967 21-30 minutes of medical discussion 98968

35. Online assessment & management service provided by a qualified nonphysician health care professional to an established patient, guardian, or health care provider not originating from a related assessment & management service provided within the previous 7 days, using the Internet or similar electronic communications network. 98969 Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by nonphysician qualified health care Professional 99366 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care Professional 99368

36. THANK YOU FOR YOUR ATTENTION Try to become not a man of success, but try rather to become a man of value.. Albert Einstein