Clinical Methods and Treatment of Communication Disorders

Speech and Language Intervention is a dynamic process: Order of intervention

1. Assessment (separate assessment for adults/children)

2. Diagnosis

3. Selection of therapy goals

4. Intervention utilizing teaching strategies

5. Discharge

Universal Design Principles for Learning (UDL)

Utilize multiple means of:

• Representation → how are we going to present info to client? (oral ASL etc)

• Expression

• Engagement → give them choices (should have a say in how we are keeping them interested)

The crux of UDLs is instructional flexibility to provide the most suitable options for different learners (3 ways)

• Accomodations

• Modifications

• Assistive Technology

Accomodations

simple changes that help client overcome or compensate for their disability such as preferential seating or allowing written rather than spoken communication

Modifications

changes in informational content or expectations of an individual’s performance such as decreased amount of classwork/homework → make changes of information

Assistive Technology

Support for students and adults with disabilities

Three Kinds of Evidence

(NOT JUST TALKING ABOUT RESEARCH)

1. Client Preference→ what they like/are interested in

2. Internal Evidence→ what we as clinicians see (observing client, working on goals, etc)

3. External Evidence→ research + clinical guidelines (i.e., minimal pairs, how we can involve client in) (ASHA OR PUBMED)

USE ALL 3 TO MAKE STRONG DECISIONS

Fundamental Principles

• Programming

• Behavior Modification

• Key Teaching Strategies

• Session Design

• Data Collection

3 Steps of Programming

1. Target Selection → done assessment, gotten diagnosis, now deciding what skill to focus on

2. Sequence of therapy targets

3. Generalized skills

1st Step of Programming: Select Therapy Targets

Identify communication behaviors to be acquired over the course of the treatment program.

• Long-term goals → months/years

• Short-term goals → breaking long-term goals into smaller steps

Goals are:

1. Based on the client’s concerns, with consideration for culture and linguistic background

2. Assessment results, which include baseline measures

Use ___ or ____ needs to select targets.

Developmental Norms or Client Specific

SMART Goals:

1. Specific: The goal should be clear and specific, so you know exactly what you are aiming for.

2. Measurable: You should be able to measure progress towards the goal, so you know if you are on track

3. Achievable: The goal should be realistic and attainable, not something far out of reach

4. Relevant: The goal should be relevant to your overall objectives or priorities

5. Time-Bound: The goal should have a deadline or a specific timeframe for completion

By setting SMART goals, you can increase your chances of success by making your objectives clear, trackable, and achievable within a specific timeframe.

Selection of targets rely heavily on ____. Identify a target and provide at least ___ separate trials to perform. Minimum of ___ stimuli on each baseline. Calculate ratio of correct vs incorrect responses.

• clinical judgement

• 3 trials

• 20 stimuli

Baseline measures fall below ___% accuracy

75%

Choosing targets based on developmental norms

• Consider the developmental sequences of communicative behavior in normally achieving individuals

• Therapy targets are taught in the same general order as they emerge developmentally

5-year-old with articulation problems: rank these for how you would developmentally treat them:
1. /p/ for /f/

2. /t/ for “sh”

3. /d/ for “juh”

4. /d/ for /b/

1. /d/ for /b/

2. /p/ for /f/

3. /t/ for “sh”

4. /d/ for “juh”

4 year old with language problems: Rank these for how you would developmentally treat them:

1. Omission plurals

2. Omission present progressive “-ing”

3. Overgeneralization of regular past tense

1. Omission of the present progressive “-ing”

2. Omission plurals→ is it b/c of /s/ sound?

3. Overgeneralization of regular past tense → “stoppeded”

Choosing targets based on client specific needs

• How often does the communicative behavior occur in the client’s daily activities? → Is it frequent or occasional?

• The relative importance of the communicative behavior to the client→i.e., goal for what is most impactful for child

• The client’s potential for mastery of a given communication skill

Stimulability

a child's or patient's immediate ability to correctly imitate or produce a mispronounced or missing sound when given cues, models, or hints from a speech-language pathologist

Factors that Influence Target Selection

1. Data - Assessement and Stimulability

2. Behaviors - Developmental and Client-Specific

3. Impact - Overall communication

4. Background - Cultural and Linguistic

5. Mastery - Potential Mastery of Skill

2nd Step of Programming: Sequence of Therapy Targets - New Behaviors

• Introduce them in highly structured situations

• Use multiple prompts and maximal support

• + @beg. of therapy session

Subsequent Activities lead to…

Generalization

Subsequent activities increase level of difficulty or complexity, and decrease your support, which lead to Generalization

You know it is Generalization when they…

Demonstrate newly learned behavior in novel situations, in a variety of contexts

Progression of the Therapy Sequence

• Stimulus Type

• Task Mode

• Response Level

Stimulus Type

• Nature of input used to elicit target response (what we are using, i.e., object, picture

3 Types of Stimulus + From Most Easy to Difficult

1. Direct Physical Manipulation→ helping them by using hand-over-hand facilitating (i.e., moving block in box)

2. Concrete Symbols - Objects, Pictures, Drawings

3. Abstract Symbols - Spoken Language, Written Word

Task Mode

• Amount of clinician support

• → Helps facilitate generalization

3 Task Mode + From Most Easy to Difficult

1. Imitation

2. Cueing or prompting

3. Independently

Response Level

• Increase the length and complexity of the response

• Decrease latency between stimulus presentation and client response

3 Types of Response Level + From Most Easy to Difficult

1. Isolation → i.e., /s/ (sound on own, progress if child can isolate)

2. Syllable

3. Word

4. Phrases

5. Sentence

6. Conversation

Programming Guidelines: Baseline should be under ___% accuracy, training should begin at next “easier” level. Baseline betwee ___ % — __% accuracy, training should begin at that level

1. 50%

2. 50% —75%

EXAMPLE: Initial /s/

• Word Level: 65%

• Carrier Phrase level: 40%

• Sentence level: 30%

What level would you begin? Word Level = 65%

Generalization

• Transfer newly mastered behaviors beyond the clinical setting

• Built-in when therapy conducted in natural environment

Examples of using Generalization

• Use real objects and materials as stimuli (familiar toys, school work, items related to client’s hobbies or work)

• Use typical routines and activities (caregiving routines, play-based activities; cooking, etc)

• Use peers and family members in therapy activities

• For phonology, use high-frequency words

General Discharge Guidelines

• Attainment of communication skills that are commensurate w/ a client’s chronological or developmental age

• Attainment of functional comm skills that permit a client to operate in the daily environment without significant handicap