Clinical process

Etiology

origin of problem

Rapport

relationship and dynamic you build with your client. trust is involved.

clinical reasoning

includes clinical problem solving

case history

client background

important questions

what was the referral source’s question

Does the client have a disgnosis with a communication impairment associated with it?

questions for child case history

pregnancy, birth, medical, family, educational development milestones (motor, social, self-care) current level of functioning

questions for adult case history

medical, educational, vocational, social, past therapies. Current level of functioning compared to onset of acquired problem (baseline functioning)

developmental conditions to consider

Clear cause vs. unknown, typically in infants and children

congenital conditions to consider

present at birth, (syndromes, health conditions, sensory impariments)

acquired conditions to consider

The result of some change in functioning, individual functions typically prior to the acquired disorder/event

delay vs. disorder

delay-once addressed the child will follow a typical pattern of development

disorder-there most likely will not be a typical pattern of development and intervention is needed for any significant improvement, likelihood of catching up is unlikely without treatment.

When a medical or educational diagnosis has not been made yet

case history identifies areas of difficulty dependent on communication but there is no underlying diagnosis. Examples: behavioral problems in a young child.. underlying communication difficulties; a child failing in school.. could be an undiagnosed communication impairment.

when selecting clinical assessment tools (what is unknown)

must choose the best tool to answer the questions you have created about the client based on the case hx and what you are thinking about the case

must answer questions about

what is still unknown

assessments must be

focused and purposeful

integrate information/clues to

select relevant testing materials

Release of information: permission to obtain copies of reports from other professionals to

gain further information

How to establish trust

Listen, Validate, Empathize, Clarify.

Process and procedure for an effective interview

reflecting and clarifying

summary probe

clearing

powerful questions

meta-view

reframing

acknowledging

using silence

reflecting and clarifying

reflecting- mirror what the client says back to them (restate, gives them a chance to clarify)

paraphrasing and interpret what the client says in your own words

clarifying- check in and make sure the client agrees with your words

summary probe

summarize in your own words what the client has told you once they are done sharing. “let me make sure i understand”

clearing

allow clients to tell their story and express emotions. people are often more ready to receive information after emotional release. when allowing client to tell, its human to want to comfort but be careful as youre encouraging them not to over identify. can risk sounding patronizing. “that must be really hard. I understand how that might be frustrating for you”

powerful questions

open-ended, curious, introspective, and thought provoking. e.g. “what woud you like to accomplish form todays session? What is one important think you are taking away? limit use of close ended, yes-no, or leading questions

Meta-View

Assists client in gaining a perspective on their situation

Reframing

Also helps client see their problem from a different perspective by redefining the problem into something positive or shifting their thinking

Acknowledging

Review acknowledging vs. complimenting

Using silence can be uncomfortable, consider that a person may be:

processing information, evaluating feelings, formulating a response. this is an opportunity to think, reflect and learn. dont be quick to fill the silence.

Clients and families tend to get easily overwhlemed and stressed by information given by clinicians.. They may:

Become defensive or resistant, struggle to absorb information, this is exacerbated when we present technical content and advice without regard to the individuals’ feelings

addressing emotions.. it’s important to give clients

the space mentally and emotionally absorb information. meet the client where they are. dont try to make it better. recognize emotions and allow the client to experience them so that they can move past them and fully participate in the sessions.

Developing the Therapeutic relationship

Essential to develop listening skills and a way of speaking that create confidence in our clients and families. no overconfidence/judgement

listening

the foundation of the therapeutic rship. continually developing skill. we tend to listen to others through our own filters. often instead of truly listening we jump to conclusions or misinterpret what is being said. careful of emotional triggers that cause defenses to rise. same happens to parents clients when they are listening to us.

Level 1 listening

Internal listening

Level 2 FOCUSED LISTENING

requires laser sharp concentration to the other person. listening to the words as well as the meaning behind the words. reflect back to the client, be a mirror for the client about what they are saying

Level 3 GLOBAL LISTENING

integrated listening with all your senses. become aware of shifts in client’s posture, energy and mood. listening ro what is not said. INTUITION

Sensory systems

vision

Hearing

Tactile

Motor systems

Gross

Fine

Visuomotor

medical systemic information

neurological-acquired conditions

cardiac- stamina'/fatigue

pulmonary-breathing issues

digestive-feeding issues/allergies

dermatological-eczma asthma

endocrine-hormonal functino/influences

emotional systemic

self-ability to regulate

family-history and support

peers-relational

school-promlems/successes

work

cognitive systemic information

play

hobbies

attention

memory

executive functioning

intellect

Receptive aspects of language

semantics

morphology

Syntax

Pragmatics: behaviors and functions

Expressive aspects of language

semantics

morphology

syntax

pragmatics: behaviors and functions

Voice aspects of speech production

Resonance

prosody

Breath support

Artic aspects of speech production

phonological system

Dialect (differences)

Oral mechanism: structure and mobility

Fluency aspects of speech production

secondary behaviors vs. natural disfluencies

Cultural awareness considerations

cultural and linguistic background, consideration for services. Consider Bilingualism/ESL, SLP language proficiency in client’s primary language/interpreter. consider selection of appropriate assessment toold and dialectal differences

Why do we conduct OFE/OME

Document STRUCTURAL INTEGRITY and FUNCTION of orofacial mechanism. DIagnostic information about role of structural and functional differences on speech production and swallowing

What we see during the OME may help

explain speech or swallowing characteristics we observe in our patients

Initial observations for OME

gross motor coordination, gait

physical appearance

look for asymmetry or drooling

with structures, you must remember there is a wide range of

“normal” or typical when you complete an OME

(OME) also consider whether the potential structural difference or problem

helps explain the speech production problems of the client (ankyloglossia or tongue tie)

For function we evaluate

range of movement

strength of movement

rate of movement

accuracy of movement

Range of movement in OME

how far out can tongue go on all planes

Strength of movement for OME

how strong muscle structures are

rate of movement

how quickly or slowly

accuracy of movement

precision of movement, can they hit targets

tone is

the muscle at rest

listen for vocal quality like

breathy, wet or gurgly, hoarse, strained and resonance

breath support for speech production like

prolonged “ah”(lax( for as long as possible

prolong “ee” (tense) to judge voicing

children blow bubbles through a straw

for 5 seconds

resonance is

degree of nasality

stridor

noisy breathing on inhale or exhale. indication that there is narrowing or restriction in the airway. supraglottic, glottic and subglottic.

hypernasalilty

sound of speechw ith too much air escaping through nose.

VPI

Velopharyngeal Insufficiency

hyponasality

sound of speech with too little air escaping from nose. soundsn like stuffy nose, enlarged adenoids can be the culprit

Velum assessment

assess for function and VPI

vocalized sustained AH and looking for elevation of soft palate

vocalize ah 3 times in rapid sequence and look for symmetrical elevation and retraction

nasal emission

gag reflex is not

a standard procedure in all oral facial examinations

Class I Dental alignment

normal

CLass II Dental alignment

jaw retracted (overbite)

Class III dental alignment

Jaw protruded (underbite)

Open bite

check for tongue thrust/thumbsucking

tongue will deviate to

weaker side on protrustion

reduced rate and precision of DDK are associated with

Dysarthria (weakness) and apraxia (inconsistent)

Alternate DDK productions for children

Taco Bell, Pat a Cake, Butter cup. (do not report these as DDK)

Trigeminal Nerve (V)

looking at jaw, at rest, bite, mouth opening and closing without resistance

Facial Nerve VII

Symmetry

pucker lips

smile

taste, anterior 2/3 of tongues

Glossopharyngeal (IX) and Vagus Nerve (X)

Velum at rest and elevated

gag reflex

taste posterior 1/3 of tongue

Vocal quality

Voluntary cough

Hypoglossal Nerve (XII)

examine tongue at rest, protrustion, lateralization, strength