Clinical Practice - EXAM 1 Review

-        audiologist: diagnose and create treatment plans for hearing loss and balance disorders. Can also conduct research, provide screening and assessments, hearing conservation, educational settings to provide support to school-age children, practice via telehealth

-        audiologist assistant: work under the supervision of an audiologist and performs hearing screenings, provides assistance, and helps record data

-        SLP: diagnose and create treatment plans for speech, language, feeding, and fluency disorders. Can also do counseling, prevention, early intervention, research, and education

-        SLP-A: works under the supervision of an SLP. They assist and deliver therapy services, help with data collection,

-        Who can treat what?

o   SLPs: communication disorders (speech and language)

o   Audiologists: hearing differences

-        Who can complete assessments (and intervention)?

o   SLPs and Audiologists

-        Who can write treatment plans?

o   Slps and audiologists. That could be wrong. I think this one has something to do with the primary care provider, or it includes it.

SOAP – know what this stands for and why we need it

-        Subjective: info related to the client or behaviors you observed. Also incudes info that was reported during the session

-        Objectives: data

-        Assessment: summary of what happened during the therapy service

-        Plan: recommendation for next steps in intervention

-        SOAP notes will assist in documenting your client’s performance and information for each therapy session. Also required for billing.

CCC – what is this?

-        Certificate of Clinical Competence awarded by ASHA. Shows that they have met the standards they have set. Includes educational background, 400 hours of clinical practicum, a clinical fellowship, pass the praxis, continue their education (30 hours over 3 years)

-        Considered a gold standard

Know educational and licensing requirements of SLP & Audiologist

-        SLPs need to at least obtain a master’s degree in speech lang pathology. They must also complete a clinical fellowship that is 1,260 hours. They also need to pass the praxis. This is usually what is required but may vary by state

-        Audiologists need to at least obtain a doctorate in audiology, an externship, and pass the praxis exam. This is usually required but may vary by state.

ASHA – what is this?

-        American Speech-Language Hearing Association. It is the national professional, scientific, and credentialing organization for SLPs and audiologists

How many observation hours must you complete prior to initiating direct contact time?

-        25 hours of observation

What’s the difference between professional and personal ethics?

-        Professional ethics are rules and standards to guide behavior in the workplace. Created to ensure accountability, fairness, and integrity in a work setting.

-        Personal ethics refer to an individual’s own moral beliefs and values

How are SLPs most often paid?

-        (I couldn’t find an exact answer, so my guess is this since it is always brought up (billing)) reimbursement from insurance or government programs

-        Can also include salaried, hourly, and contact based

What organization provides the Code of Ethics for SLPs? For Audiologists?

-        ASHA for SLps

-         American Academy of Audiology (AAA)for audiologists

Why should SLPs know how to read and interpret audiograms?

-        SLPs should know how to read and interpret audiograms because they help assess a patient's hearing abilities, which is crucial for diagnosing and treating speech and language disorders effectively.

What is the auditory skills hierarchy?

-        Low difficulty ----> high difficulty

-        Detection -> discrimination -> identification -> comprehension

-        Detection is the ability to determine the presence or absence of sounds. Can be detected via behavioral response (such as turning the head) or verbal (“I heard that”)

-        Discrimination is the ability to determine whether sounds are the same or different

-        Identification is the ability to repeat what is heard, write what is heard, or point to what is heard

-        Comprehension is the ability to understand the spoken message  

What’s the difference between listening age and chronological age?

-        Chronological age: the age that is measured from the time of the child’s birth

-        Listening age refers to the length of the time the child has had clear and consistent access through hearing technology

Continuing education – what is this and why is it needed?

-        30 hours across 30 years (like professional development). It is needed to ensure professionals stay up to day on advances in their field

Diagnosis – what is this?

-        a clinical decision as to whether a disorder is present

Prognosis – what is this?                

-        a statement of how the clinician anticipates the client will do in therapy

Screening – what is this and when do we do it? Hearing? Speech? Language?

• Screening is a brief assessment to identify individuals who may have a communication or swallowing disorder and require further evaluation. SLPs conduct screenings during routine healthcare visits, in schools, or other settings to detect potential issues early and initiate appropriate intervention.

• Hearing screenings can be performed by slps, aud-a, and audiologists. Quick test to determine if further evaluation is needed

Know the difference between formal and informal tests

-        Formal tests for SLPs are standardized assessments with specific procedures and scoring criteria, while informal tests are more flexible, often involving observation and clinical judgment without standardized protocols.

What is HIPAA?

-        Health Insurance Portability and Accountability Act: Provides specific procedures regarding the protection of the client confidentiality

What is a conflict of interest?

-        A conflict of interest for SLPs occurs when their personal, financial, or professional interests interfere with their ability to act in the best interest of their clients or employers.               h

What does a language assessment include?

-         case history, parent interview, hearing screening/eval, oral mechanism exam, spontaneous language sample, parent questionnaire, and formal/standardized testing

What does a hearing screening include?

-        Typically, it is just a quick pure tune test to get an idea of where one’s hearing is. Results can help determine if one needs to get a hearing evaluation. Can also include gathering case history, a visual inspection,

What are speech samples and why are they useful?

-        Speech samples are recordings or transcripts of an individual's spoken language used by speech-language pathologists to assess communication skills, including articulation, language, fluency, and pragmatics. They provide valuable insight into a person's speech and language abilities in various contexts, helping clinicians diagnose disorders, track progress, and develop targeted interventions.

Be familiar with writing long term goals and short term objectives.

You will have case scenarios on the exam. You may need to identify appropriate goals, objectives, or tasks given the case scenario.

What is the difference between clinician directed and client directed therapy?

-        Clinician-directed speech therapy involves the therapist structuring and leading the therapy session, providing explicit instruction and feedback to the client. Client-directed therapy empowers the client to take a more active role, with the therapist facilitating natural communication and providing support as needed.

What is an IEP, IFSP, FAPE?

-        An IEP (Individualized Education Program) is a plan for school-aged children with disabilities, detailing educational goals, services, and accommodations to meet their individual needs.

-        An IFSP (Individualized Family Service Plan) is a plan for children under age 3 who have developmental delays or disabilities, outlining early intervention services and family support.

-        FAPE stands for Free Appropriate Public Education, which is a legal entitlement for students with disabilities to receive education and related services at public expense.

What types of teams might be involved? (Mulit-, Inter-, Trans-) How are these different?

- Multidisciplinary teams include each professional, evaluates clients individually and submits their findings in a report that may be later shared with members of the team for review and recommendation of services.

- Interdisciplinary teams include team members that each use their area of expertise to contribute to the shared goal of providing high-quality care. This includes consistent communication of progress, recommendations, and results with all team members.

- Transdisciplinary team will assess the client together, with each member being assigned a role during the assessment process, often with roles shared beyond the boundaries of professional development scopes of practiced

What might artic disorders be caused by?

• Structural abnormalities, motor speech disorders, sensory issues

Difference between intelligibility and stimulability

• Intelligibility is a subjective determination on how intelligible the child’s speech is to the listener.

• Used to determine the need for intervention and to evaluate progress in therapy

• Stimulability is the degree in which the child can imitate error speech sounds in different contexts and with different models and levels of cueing

• Used to determine prognosis for treatment, determine if error sounds are likely to be acquired without intervention and select appropriate therapy targets

• Is how consistent the client is with production.

• For example, if a child produces a /p/ consistently one day, if they are stimulable they should be producing the /p/ with the same high level of consistency.

An inventory of speech sounds should include…..what?

• Phonemes used by the child

• Different sound combinations

• Syllable shapes produced

• Sound articulated in different word positions

• Speech sound errors

• Phonological processes

How might transcription be different for a speech sample than a language sample?

• A speech sample emphasizes phonetic detail and articulatory precision while a language sample centers on language structure, child's language abilities and overall conversational skills.

Articulation treatment techniques:

• Use a mirror—many children find this visual feedback of placement and movement of the articulators very helpful.

• Use gestures—hand gestures that cue placement and movement of the articulators are simple yet helpful.

• Use amplification—amplifying target phonemes may improve attention, reduce distractibility, and increase sound awareness and discrimination.

• Use tactile feedback—place tools, devices, or substances within the mouth (e.g., tongue depressors, peanut butter) to provide feedback on appropriate tongue position and coordination.

• Use metaphors—compare some aspect of speech to something the child is familiar with (e.g., the [ʃ] sound is the “sleeping baby” sound, the [s] sound is the “hissing snake” sound).

Articulation treatment approaches:

• Articulation-based treatment usually follows a 3-phase sequence:

• Establishment: involves both the elicitation and stabilization of the target sounds/behaviors

• Generalization: involves facilitating the use of established sounds in progressively more complex linguistic levels

• Maintenance: involves stabilizing target sounds/behaviors by encouraging self-monitoring of speech and self-correction of sound errors to make correct productions more automatic

• Van Riper (traditional approach)  focuses on the correction of individual phonemes

• Paired-stimuli approach: highly structured approach, use a keyword where the target phoneme is articulated correctly

• Multiple phoneme approach: targets all misarticulated sounds at the same time

• Core vocabulary approach: focuses on whole-word production

• Maximal oppositions: pairs of words with one of the words containing a speech sound produced correctly by child

• Cycle approach: highly unintelligible child. Simulate the emergence of sounds and/or patterns

• Metaphon Therapy

SMART goals: used for short term goals

-        Specific, measurable, attainable, relevant, and time goals

Difference between articulation and phonological disorders:

• Articulation disorders are a type of speech sound disorders (SSD) that refer to the errors in production of phonemes which result from problems in speech motor control

• Phonological disorders is a disordered of language resulting in difficulty organizing speech sounds and using the rules that govern how speech sounds are combined and difficulties using the speech sound contrasts that aid in the discrimination of words

• In short arctic is speech and phono is is combining sounds

Syllable structure patterns:

• These error patterns occur when children alter the syllabic structures of words, such as leaving off the final consonant in a word, for example the word “coat” would be pronounced as [koʊ] instead of /koʊt/

Assimilation simplification patterns:

• these error patterns are sometimes referred to as “consonant harmony” because they describe the child’s attempt to make the target word easier to produce by making all the consonants in a word similar, for example [lɛlo] for /jɛlo/

Components of phonological processing:

• the ability to use the sounds of your language to process both spoken and written language

• There are three distinct components of phonological processing: phonological awareness, phonological working memory, and phonological retrieval

Phonological Treatment Approaches:

• Maximal oppositions - uses pairs of words with one of the words containing a speech sound produced correctly by the child. The correctly produced sound is contrasting with a maximally opposing sound that is not produced correctly by the child.

• Multiple oppositions - Several speech sound errors are targeted and contrasted during the same session for moderate to severe phonological disorders, sound errors are targeted

• Cycles approach - approach is based on the theory that normal phonological development is gradual and that easier to produce or “primary” patterns are obtained before more complex “secondary” ones.

• Metaphon therapy - the awareness of the phonological structure of language is taught by contrasting sound properties. For example, for children who consistently “stop” continuous speech sounds, the concept of “short” (stops) versus “long” (continents) sounds are presented.

Chronological vs. Developmental age, on what should treatment plans be based?

-        Chronological age: the age that is measured from the time of the child’s birth

-        Developmental age: measured based on the child’s development

-        Treatment plans should be based on developmental age.

Recommendations for caregiver coaching:

-        Families often need counselling as well

-        Develop a functional and efficient relationship with the caregivers

-        Hanan early language parent program: The interventionist helps the adult learn to respond to their child’s communication attempts in ways that best facilitate language growth

o   Caregivers are active participants in intervention

o   Easy to use

o   Caregivers learn proper responses to communication attempts

Why might EI for language skills look different than other ages for language treatment?

-        Early Intervention (EI) for language skills may look different than treatment for older ages because young children's language development occurs rapidly and is highly influenced by early experiences and environmental factors. Therefore, EI focuses on providing interventions that are developmentally appropriate, family-centered, and incorporate play-based activities to promote language skills in natural contexts.

What are modes of language?

-        Modes of language refer to the various ways in which communication occurs, including speaking, listening, reading, writing, and nonverbal communication such as gestures and facial expressions.

What are the types of AAC? When might each be appropriate?

-        No-tech: nothing internal to the individual

o   Gestures, facial expressions, manual signs

-        Low-tech: involves external support to the individual but no batteries

o   Printed photos, paper and pencil for writing

-        Mid-tech: involves batters, but no computer component

o   Talking photo albums, laser pointers to select printed material

-        High-tech: involves a computer component

o   Smartphones and tablets

-        You always want to start with the least invasive option and not over prescribe.

Who might need AAC?

-        Any individual with speech that is limited or with speech that has limited functionality

-        Can be any age across the lifespan

o   Children at risk for limited speech development

o   Adults who experience a medical condition involving deterioration in speech

What skills are needed to be able to use AAC?

-        Linguistic competence: knowledge and skills related to the language code and the language features of a particular AAC device

o   Some level of vocabulary, word association or item to word association, understand cause and effect, the foundational skills needed so it can start to build on language?

-        Social competence: knowledge and skills related to use of language and use of AAC for interaction

o   Turn taking, communicating wants and needs, understanding cause and effect to the next level

-        Operational competence: knowledge and skills related to the language code and the language features of a particular aac device

o   Understanding the basic functions of the device (for mid and high aac)

-        Strategic competence: knowledge and skills related to maximizing communicative success despite limitations to an aac device

o   Advocating on the front end, use of acronyms to speed up communication rate

What treatment ideas were discussed in class for using AAC in therapy?

-        Modeling: demonstrating how to use AAC device

o   It may be discouraging to use an aac device if it is not used with regular success

-        Using individualized content: make it meaningful to user

o   Makes it more engaging and motivating to use, increases learning

-        Training communication partners

What strategies might be used in training communication partners of individuals who use AAC?

-        Teaching communication partners how to program and use AAC device, provide guidance, train partners how to use AAC devices and how to use modeling to support individual in building language and communication using AAC

What is PBS and ABA?

• PBS is positive behavior support

• ABA is applied behavior analysis

Understand and be able to identify antecedent, behavior, consequence

• Antecedents: events taking place before unwanted behavior

• Behavior: the behavior or response itself

• Consequence: events taking place immediately after the unwanted behavior

What techniques were discussed for teaching new behaviors?

• Behavior-specific feedback

• Token economies

Why are senses important in behavior management?

• How people process sensory information can significantly affect their behavior.

• For example if someone gets irritated with the florancent lights, changing the lighting to soft lamps can help reduce unwanted behavior

What’s the difference between hypersensitive and hyposensitive?

• Hypersensitivity is an exaggerated response to sensory stimuli. Example includes a child covering his ears due to loud sound

• Hypersensitivity refers to a diminished response to sensory stimuli. Example includes a child who does not react to loud noises

What recommendations were provided for how to respond to challenging behaviors?

• Understanding sensory needs

• Teaching coping strategies

• Use positive reinforcement

• Create predictable routines

• Model and teach communication skills

• Practice patience and understanding