Exam 2 Clinical Methods

Habilitation

helping a person learn or develop new skills they have not yet acquire

Communication treatment procedures are behavioral

True

• Practice + Feedback = Effective Communication among client

Different types of Treatment

• Intervention

• Teaching

• Habilitation

• Rehabilitation

Example of Habilitation

teaching a toddler with a developmental delay how to talk

Rehabilitation

helping a person regain or restore skills that were previously mastered but later lost or impaired due to illness, injury, or medical events

Example of Rehabilitation

helping an adult recover language or swallowing abilities after a stroke

Myth

There are endless varieties of procedures for treatment of communication disorders.

• There are many treatment options, but they are not endless, and not every treatment works for every client.

target equals

skills to be taught

procedures

methods of establishing the treatment targets

Core Procedure 1

Gather, present, and manipulate stimulus items to evoke specific target behaviors

Core Procedure 2

Shape and strengthen the target behavior by positive reinforcement of various sorts

Core Procedure 3

Decrease undesirable verbal and nonverbal behaviors by specific response consquences

Core Procedure 4

Train family members and others

Target differs across disorders

True

Selection of Target Behaviors

• If client has been assessed or treated at your clinic

• If client has received serives at another facility

Multiple targets should be sequenced

True

2 approaches to target behavior selection

• Normative approach

• Client- Specifc Approach

Normative Approach

Selection is appropriate for the client’s age and the age-based norms

Client- Specific Approach

Selection is based on if target makes an immediate & significant different in the client’s communication

Guidelines on Selecting Target Behaviors

► Behaviors that make immediate difference

► Behaviors that expand communication skills

► Behaviors linguistically and culturally appropriate

► Complex or difficult behaviors for initial teaching (client is learning a new communication skills and may be complicated or difficult to learn)

What targets should you select for speech sound disorders

• indivual sounds

• sound patterns

What are the five language targets for children with language disorders?

• Basic vocabulary

• Phrases

• Morphologic and Syntactic Elements

• Functional Units and Social Communication

• Literacy Skills

What are the four target behaviors addressed in the treatment of voice disorders?

• Aphonia

• Dysphonia

• Disorders of loudness and pitch

• Disorders of resoance

What are the 4 Fluency target behaviors

• Fluency shaping

• Direct stuttering reduction

• Fluency reinforcement

• Cluttering

Cluttering

a syndrome featuring an abnormally fast, irregular, or erratic speech delivery rate

Fluency Shaping

techniques to replace stuttered speech

• Easy onset/ Breathy /h/

• Cursive Speaking

• Light Articulation Contacts

Direct Stuttering Reduction

Reduce or change stuttering moments

Fluency Reinforcement

Rewarding or encouraging a person when they speak fluently to help them use fluent speech more often.

Dementia

progressive cognitive and functional decline that interferes with independent living

Target Behaviors in Dementia

Impaired skills are selected for intervention

Target Behaviors in Hearing Loss

Oral communication skills are targeted ONLY when it is requested by the parents of the child/adult with HL

Target Behaviors for Minimally Verbal and Nonverbal Persons

• Unaided AAC (gestures, signs, mime, facial expressions)

• Aided AAC (external devices and objects)

Final treatment target

effective communication in natural settings

What is the problem with using a standarized assessemtn for a culturally diverse student?

may be culturally biased and may not account for differences in language, dialect, or cultural experiences, which can lead to inaccurate results or misdiagnosis.

What is one way you can appropriately assess a culturally diverse student?

Using dynamic assessment to reduce cultural bias and distinguish a language disorder from a language difference.

Stuttering

communication disorder characterized by disruptions or disfluencies in the flow of speech, such as part word/ whole word repetitions, prolongations, or blocks.

Aphasia

an acquired language disorder caused by damage to the brain's left hemisphere from a stroke, traumatic brain injury, tumor, or neurodegenerative disease

Baseline

are clinician designed measures that offer the client multiple opportunities to demonstrate the communicative behavior in the absence of planned intervention.

Initial steps in treating all clients is

establishing baselines for the target behavior

What is the accepted number of stimuli for baseline data

20 on each pretreatment baseline

Types of Basline Data

• Conversational

• Discrete Trials

Conversational Baseline

Measures the target behavior in conversational speech before treatment begins

How to collect baseline data from conversational

◦Play-based activities

◦Topic of interest with adults or teens

◦Client Interview

How to measure baseline data from conversational

• measure incorrect/correct behavior in the speech sample

• Calculate a percent correct of the behavior in the baseline sample

What are 2 subcategoires of Discrete Trial Baseline

Evoked

Modeled

How to measure evoked trials in discrete trials

By measuring if the client attempts to produce the target across trials without a model.

How to collect data from evoke trials in discrete basline

◦Select the target behavior to measure

◦Specify the target behavior in measurable terms (/ʃ/ in the initial position of words)

◦Prepare stimulus items to evoke the target response (20 picture words to evoke  /ʃ/ in the initial position of words)

◦Prepare questions to help you evoke the response (What is this?  What is happening?  What is the boy doing?)

how to measure evoke trials?

• Calculate a percent correct of the behavior in the sample

• Compare with the conversational sample

Discrete Trial Baseline: ModeledTrials

Measures the target behavior in discrete trials in which the client attempts to produce the target with a provided model for imitation.

How to collect data from modeled trials

• Select the target behavior to measure

• Specify the target behavior in measurable term (/ʃ/ in the initial position of words)

• Prepare stimulus items to elicit the target response (20 picture words to elicit  /ʃ/ in the initial position of words)

• Prepare questions to help you evoke the response and your models for modeled trials (Jane, what is this?  Say shoe)

How to measure modeled trials

◦Calculate a percent correct of the behavior in the sample

◦Compare with the conversational sample

How does baseline data help establish accuracy criteria for goals and objectives?

Helps determine the client's starting performance (baseline data) to decide how accurately they should be able to perform a skill in their therapy goals.

Ex: An SLP tests a child who correctly produces the /r/ sound in only 2 out of 10 attempts (20%). The SLP uses this baseline to set a realistic goal, such as producing /r/ correctly in 8 out of 10 attempts (80%).

/ʃ/ in the initial positon of words = 20% accuracy: Would this be a good objective for treatment?

No; It describes the client's baseline performance rather than the expected outcome.

Where should training begin if baseline accuracy is below 50%?

Start at an easier level than the one the client struggled with.

• Ex: /ʃ/ (“sh”) in words = 30% accuracy.

• The SLP may start with an easier task, such as practicing the sound by itself, before moving to words.)

Where should training begin if baseline accuracy is between 50–75%?

training can begin at the same level of accuracy as the baseline.

• /ʃ/ in words = 65% → Start training at the word level.

• /ʃ/ in phrases = 40% → This is below 50%, so consider starting at an easier level than phrases.

• /ʃ/ in sentences = 20% → Start at an easier level than sentences.

How do long-term goals differ from short-term objectives in accuracy?

Long-term goals usually have higher accuracy criteria, but the percentage can vary based on the client's needs and progress.

• Short-term objective: The client will produce /ʃ/ in words with 60% accuracy.

• Long-term goal: The client will produce /ʃ/ in sentences with 90% accuracy.

Why are treatment plans needed?

► To keep therapy consistent during the course of

treatment.

► To give clients a clear picture of what you believe

they can accomplish in the course of therapy

Why are objectives important

• They guide treatment, clarify expectations, track progress, and show when a goal is met.

Goals

• Long term

• Big 9 should be included

Objectives

• Short-Term

• Consistent with the LTG

• Must be met before the LTG can be achieved

Components of Behavioral Objectives

• Perfomance

• Condition

• Criterion

Performance

States the specific action the client is expected to do or perform

Examples of Acceptable Verb for Performance

► Build

► List

► count

► Label

► repeat

► name

Examples of Verbs to Avoid when describing performance

• Communicate

• Demonstrate

• Learn

Why? Too vague and are hard to measure and collect data

Condition

Specify what you as the clinician will provide to the individual in order to help the client do the task.

► Where the behavior will be performed

► When it will be performed

► In whose presence it will be performe

Examples of Conditions

►In all word positions

► During reading tasks

► Without a model

► While describing picture

Criterion

States how well the target behavior must be performed for the objective to be achieve

Without a criterion, it is impossible to determine whether an objective as been accomplished

True

Examples of criterion

► In 90% of his attempts

► For 20 of 25 pictures

► With fewer than 5 dysfluencies

► Twice during a 10-minute time segment

► 3 consecutive session

SMART Objectives

S: Specific

M:Measurable

A: Attainable

R: Relevant

T: Timely

How do you determine appropriate targets for therapy

consider development norms & perfomance on standarized tesitng

What are the four elements of a treatment plan?

• Client identification: Basic client imformation

• Beginning status: Clients current skills and abilites before treatment

• Semester-long goals: Main skills client should improve during the semester

• Individual objectives: Smaller, measurable steps that help client reach goals

Status At Beginning Of Treatment Period Information

► Short synopsis of background

► Evaluation history (Where and when was client evaluated? With what results?)

► Statement and description of speech/language impairment

► If client is not new to the SLHC, give short explanation of progress from last semester

► Any other information relevant to therapy

What should you consider when writing goals and objectives?

• Make them measurable

• Plan how to track progress

• Encourage carryover and self-awareness

Behavior

Something that a person does that can be observed, measured, and repeated.

Behaviors describes:

actions

Ex: troubled child, ran, read, interrupted

Function that behavior serves

• Attention

• Escape/ Avoidance

• Access

• Sensory Input/ Self- stimulation/ Actualization

Attention

a means to get attention (positive, negative, peer, adult)

Escape/Avoidance

allows us to escape an activity, situation, person

Access

acquisition of tangible items or activities

Ex: A child throws a tantrum at the grocery store, and the mother gives the child candy to stop the behavior.

Sensory Input/ Self-stimulation/Actualization

• provides stimulation to the pleasure zones in the brain.

• Ex: Engaging in the behavior either feels good or relieves something that feels bad.

Ex: spinners, rockers, thumb sucking

Many clients escape behaviors because

• difficult task

• prolonged work

• social demands

• therapy environment

• the professionalist

How to change the behavior?

operationally define the target behavior and the desired behavior

What types of data can be collected to measure behavior

• frequency

• rate

• duration

• latency

• magnitude

ABCs of Behavior

A: Antecedent

B: Behavior

C: Consequence

Covert Triggers

hidden, slow-building background condtions that causes behaviors

• Trauma, Abuse

• Upcoming court date

Immediate Triggers

Observable events that happen right before a behavior.

• Being told “No” or Being told to begin/stop a task

Observations to make when analyzing behavior

• Collecting data on frequency, rate, duration, latency, and magnitude of the measured behavior

• Collecting information about when the behavior occurs (Think ABCs of Behavior)

• Focus on the interaction between the environment and the person

• Developing an intervention for the target behavior and replacement behavior

Consequence

an action or response that follows the behavior (punishment or form of discipline)

• Could also be reinforcement

What are some behavioral strategies for preventing problem behaviors?

•Arrange the therapy room to decrease the likelihood of problem behavior

•Communicate your expectations (Visual Schedules, Verbal Instructions, Classroom Rooms)

•Structure your session (If a child needs predictability, make sure to follow a schedule)

•Provide transitions between tasks/activities/locations.

•Provide choices (activities, order, etc.).

•Consider your reinforcement schedule and reinforcers (Reflect and observe on what is reinforcing for your client; Use those reinforcers to support behavior.)

Factors influencing behaviors

• Site and severity of damage

• Pre-injury characteristics of the personality

• Intelligence and learning style

• The current environment

Shaping

Breaking things down into smaller or simpler components

1st step in core treatment techniques

Evoke target verbal behaviors

2nd step in core treatment techniques

Create nonexistent verbal behaviors

3rd step in core treatment techniques

Increase exisitng target behaviors

4th step in core treatment techniques

Strengthen and sustain target behaviors

5th step in core treatment techniques

Control undesirable behaviors

Core treatment techniques vs. core treatment procedures.

• Techniques are the methods used to teach a skill

• Procedures are the steps and activities used to carry out treatment.

List 4 ways that could be used to evoke target behaviors during treatment

Instructions, Modeling, Prompts, Physical Stimuli

Fading

progressively withdraw parts of a model