1. Courtney Jones MS CCC-SLP

2. Speech-Language Pathology What do we do? Promote recovery of function (rehabilitation) Promote development (habilitation)

3. Objectives Scope of practice Points of care Resources for patients

4. Scope of Practice Speech Sound Production Articulation Developmentally appropriate Placement for sounds Social and academic impact

5. Articulation Apraxia of speech Acquired Developmental or Childhood apraxia of speech Motor planning speech production The brain is telling the mouth to say “cat”, but motor plans “a”

6. Articulation Dysarthria Slurred" speech Speaking softly or barely able to whisper Ataxia- failure of muscular coordination; irregularity of muscular action Dyskinesia distortion or impairment of voluntary movement, as in tic or spasm

7. Resonance Hyper/hyponasality Cul-de-sac resonance Mixed resonance

8. Resonance Cleft palate Hard Soft Submucous Velopharyngeal insufficiency short palate weakness Phoneme specific errors

9. Resonance Correct tongue placement for sounds Bio feedback with a nasometer Compensatory articulations ENT No research to demonstrate oral motor exercises improve soft palate movements.

10. Nasometer

12. Voice Phonation quality (nodules) Respiration (words per breath) Pitch Loudness

13. Fluency Stuttering Cluttering Martina Costello, SLP

14. Language (comprehension and expression) phonology morphology syntax semantics

15. Language pragmatics (language use, social aspects of communication) literacy (reading, writing, spelling)

16. Language (comprehension and expression) prelinguistic communication (e.g., joint attention, intentionality, communicative signaling) paralinguistic communication (tone of voice, inflection) 90% of what we say is with our body

18. Speech-Language Milestones 6-12 months 6 months-laughs, gurgles, coos, reacts, babbles for attention 8 months- responds to name, produces syllables, tries to imitate 10 months- plays peek-a-boo, may say “mama” “dada” 12 months-recognizes name, says 2-3 words besides “mama” “dada”

19. One year old Recognizes name Understands “no” Imitates familiar words Gives toys on request Waves good-bye Makes sounds of animals

20. 18 months Uses 10-20 words Recognizes pictures of familiar person’s objects Combines two words “all gone”, “bye-bye” Uses “more” and “up”, requesting words Points to toes, ears and nose Follows simple commands Imitates familiar actions, vacuuming, wiping Points and gestures to call attention to event or object

21. Two year old Identifies body parts Carries on “conversation” with self or dolls Asks “what’s this?” Sentence length 2-3 words Calls themselves by name 300 words in speaking vocabulary Attends to an activity for 6-7 minutes

22. 2 ½ year old 450 word vocab Gives first name Uses past tense and plurals Understands time concepts “Tomorrow” Refers to self as “me” Gets attention verbally “watch me” Talks to children and adults Likes to hear same story repeated Knows big and little

23. Three year old 1000 word vocab 3-4 word sentences Uses language to express ideas 80% intelligible Asks “what”, frequently Attends to activity for 8-9 minutes Practices language by talking to themselves

24. Four year old 1500 vocab Attention for 11-12 minutes Asks “who?” and “why?” 4-5 word sentences Points to colors Identifies shapes Easily understood by unfamiliar listeners

25. Five years old 2200 vocab At least 5 word sentences Defines objects by their use (you eat with a fork) Knows spatial relationships (on top, behind) Uses future, present and past tense Attends for 12-13 minutes

26. Cognition attention memory sequencing problem solving executive functioning

27. Cognition Adapted from Brain Tree Functional tasks Strategies Process training

28. Attention Attention -Attention skills underlie all other cognitive processes. Sohlberg and Mateer (1989) describe the following aspects of attention;

29. Types of attention Focused-momentary Attention Sustained Attention Selective/Elective Attention Joint Attention Alternating Attention Divided Attention

30. Attention Process training Circling all the C’s on a page full of letters Strategies Limiting distractions Cues Functional task Completing a homework assignment Completing an activity with family Following a 1-step direction

31. Memory The ability to keep things in the mind and recall them in the future. Errorless learning- the more accurate the response the better the retention of the information; therefore, setting up the patient for success by give the correct answer immediately before the question (e.g., My name is John. What is my name?) 80/20 rule Self-awareness

32. Memory Recall Store Short or Long-term Encode Understand it and use it Attention To what is important

33. Memory Process Training Learning about memory Strategies Internal External Functional tasks Coming to therapy on time

34. Information Processing The processes that organize and access information at a given rate. Visual processing Auditory processing Speed of thinking Capacity of thinking Control

35. Information processing Process Training Visual scanning Auditory tasks Strategies Cues Environment Functional Tasks Finding the cafeteria

36. Executive Function the capacities that enable a person to engage successfully in independent, purposive, self-serving behavior and allow us skills to accomplish goal-directed activities in the following areas: Self-Initiation Self-Inhibition Goal Setting Planning and organization Self-Monitoring Problem solving Flexible problem solving Self-awareness

37. Executive functioning Process Training Learning about EF Patient’s strengths/weaknesses Strategies Specific to strengths/weakness Functional tasks Asking for directions Problem solving unexpected event

38. Feeding and Swallowing oral, pharyngeal, laryngeal, esophageal orofacial myology (including tongue thrust) oral-motor functions

40. Clinical signs and symptoms of aspiration Coughing Choking Watery eyes Red eyes Refusal Frequent respiratory infections Unexplained fevers Oxygen need Desaturation/Bradycardia with eating Upper Right lobe infiltrates (atelectisis) Weight loss

41. Silent aspiration Watery eyes Mild redness Increased congestion with eating Course breathing via cervical auscultation

42. Clinical Feeding Evaluation History Observation Trial therapy Intervention Recommendations Coordination with Primary Care NP or Physician

43. Formal Swallow Studies Modified Barium Swallow study Flexible Endoscope Evaluation of Swallow Radiology Barium X-ray exposure Aspiration Outline structure ENT Real food dyed blue Fiberoptic scope Penetration Anatomy/Sensation

44. FEES

46. MBSS

47. Feeding interventions Thickening Positioning Rate of flow Supplementation Treatment of cause Gut comfort Oral motor Therapies Behavioral feeding programs Cued feeding Positive feeding practice

48. Learned Patterns/behaviors How a child learned the behavior of eating. How our children trained us to feed them. What we practice becomes a learned behavior (Brackett) Appropriate response to an inappropriate request (Eicher) Eating is a learned behavior.

49. Maladaptive behaviors Tantruming Gagging Retching Refusal Vomiting Poor acceptance of utensil Stuffing mouth Rotating head Rubbing legs/belly Holding face Spiting out Pushing food away Covering mouth Grimacing

50. Feeding Therapy Medical, Motor and Behavior approach Sensory Oral Sensation Peggy Eicher, MD, Krisi Brackett, SLP Paul Hyman, MD Structured Safe Feeding Practice Kay Toomey, PhD. Developmental research Steps to Eating

51. Medical motor behavior approach Learned Behaviors MotorMedical Peggy Eicher, MD Developmentally, a feeding problem exists when a child is “stuck” in their feeding pattern and cannot progress (Eicher) Skill acquisition = positive practice x rate of maturation (Eicher)

53. Potential etiologies neonatal problems (e.g., prematurity, low birth weight, substance exposure); developmental disabilities (e.g., specific language impairment, autism spectrum disorder, dyslexia, learning disabilities, attention deficit disorder);

54. Potential etiologies auditory problems (e.g., hearing loss or deafness); oral anomalies (e.g., cleft lip/palate, dental malocclusion, macroglossia, oral-motor dysfunction);

55. Potential etiologies respiratory compromise (e.g., bronchopulmonary dysplasia, chronic obstructive pulmonary disease); pharyngeal anomalies (e.g., upper airway obstruction, velopharyngeal insufficiency/incompetence); laryngeal anomalies (e.g., vocal fold pathology, tracheal stenosis, tracheostomy);

56. Potential etiologies neurological disease/dysfunction (e.g., traumatic brain injury, cerebral palsy, cerebral vascular accident, tumor resection, anoxic injury); psychiatric disorder (e.g., psychosis, schizophrenia);

57. Potential etiologies genetic disorders (e.g., Down syndrome, fragile X syndrome, Rett syndrome, velocardiofacial syndrome). Feeding Tube, Trach

58. Role The professional roles and activities in speech- language pathology include: clinical/educational services (diagnosis, assessment, planning, and treatment), prevention and advocacy, and education, administration, and research.

59. Practice Settings Speech-language pathologists provide services in a wide variety of settings, which may include but are not exclusive to: public and private schools; early intervention settings, preschools, and day care centers;

60. Practice Settings private practice settings; universities and university clinics; individuals' homes and community residences; community, state, and federal agencies and institutions; correctional institutions; research facilities; corporate and industrial settings.

61. Handouts Early intervention Therapy Prescription pads Home Health