Therapeutic Methods

- List and explain the 5 components of language.

Speech vs. Language

• Speech: How we say sounds and words, including articulation, phonology, voice, and fluency.

• Language: The words we use to share ideas, encompassing receptive and expressive language. Can be verbal, nonverbal, or written.

Components of Speech

• Articulation: How we make speech sounds using the mouth, lips, tongue and cheeks.

• Voice: Vary in intensity pitch and quality. Can be affected by overuse, yelling, or conditions like viruses or COVID.

• Fluency: Rhythm and flow of speech. Variations can result in stuttering or cluttering, influenced by stress or brain injury.

Receptive and Expressive Language

• Receptive Language: Understanding verbal, nonverbal, and written language.

• Expressive Language: Using verbal, nonverbal, and written methods to share ideas.

  • Verbal: Spoken words.

  • Nonverbal: Body language, tone of voice, gestures, facial expressions.

  • Written: Text.

• Semantics

  • Governs the meaning of words and relationships between them.

    • Receptive Semantics: Understanding vocabulary.

    • Expressive Semantics: Choosing vocabulary to communicate.

  • Example: Describing a dog (Ellie) by category (pet, animal), description (soft, little, adorable), parts (paws, ears, tail), location, antonym, actions, and associations.

  Phonology

  • Receptive: Hearing and deciphering differences between phonemes.

  • Expressive: Ability to produce correct phonological patterns.

  • Systematic impairments result in phonological processes. For example:

    • Changing "dog" to "dot" is fronting.

    • Changing "frog" to "dog" is stopping.

    • Cluster reduction in words like "truck"

  Morphology

  • Understanding how word prefixes and endings impact meaning.

  • Expressive morphology involves using prefixes and endings to change word meaning.

  • Example: Using morphology to indicate number: one \space coffee versus three \space coffees.

  • Morphemes are the smallest units of meaning.

  Syntax

  • Refers to overall grammar and sentence structure.

  • Receptive syntax: Understanding different sentence structures.

  • Expressive syntax: Using various sentence structures.

  • Example: Yoda's inverted syntax.

  Pragmatics

  • Focuses on overall communication and context.

  • Involves understanding the intent and social cues in communication.

  • Example asking, "Can you get it" versus, "May I get it."

  Acquired Brain Injury

  • Disorder resulting from injury to the brain since birth, either traumatic or non-traumatic.

  Types of Brain Injury

  • Traumatic Brain Injury (TBI): External force to the head (e.g., motor vehicle accidents, falls).

  • Non-Traumatic Brain Injury: No external force; caused by tumors, stroke, encephalitis, infections, or anoxia.

  Signs and Symptoms

  • Include physical, sensory, behavioral, cognitive, speech-language, pragmatic, and swallowing impairments.

  Aphasia

  • Language disorder caused by stroke, TBI, tumor, or infection.

  • Two main types discussed:

    • Broca's Aphasia: Non-fluent language, difficulty verbalizing responses.

    • Wernicke's Aphasia: Fluent but meaningless utterances, decreased comprehension.

  • Classified by fluency (fluent vs. non-fluent) and the area of challenge (receptive vs. expressive).

  Apraxia

  • Neurogenic disorder affecting neural pathways between the brain and oral structures.

  • Results in decreased ability to plan and sequence movements for speech.

  • Can be caused by stroke, TBI, tumor, infection, or can be congenital.

  Childhood Apraxia of Speech

  • Difficulty connecting the motor part of the brain to the mouth to produce sounds.

  • Signs and symptoms include halting speech, articulatory groping, inconsistency, and sound distortions.

- List the 7 characteristics of FBI.

    7 Characteristics of Family Based Intervention (ASHA, 2020)

• Developmentally/Socially supportive

• Services are evidence based

• Alignment with family situation

• Family determines involvement

• Honors family values

• Culturally and Linguistically responsive

• Comprehensive, coordinated services

-List and explain how to write a PICO question.

    PICO Process

• PICO helps frame clinical questions.

  • P: Population: Characteristics or conditions of the group (e.g., diagnoses, ages, severity levels).

  • I: Intervention: Screening, assessment, treatment, or service delivery model (e.g., high-intensity treatment, hearing aids, instrumental swallowing assessment).

  • C: Comparison: Main alternative to the intervention, assessment, or screening approach (e.g., placebo, different technique, different amount of treatment).

  • O: Outcome: What you want to accomplish, measure, or improve (e.g., more intelligible speech, better hearing, upgraded diet levels).

• A well-constructed PICO question includes elements specific to the client's circumstances and values.

Examples of PICO Questions

1. Population: Children with severe to profound hearing loss.

   • Intervention: Cochlear implants.

   • Comparison: Hearing aids.

   • Outcome: Speech and language development.

   • PICO Question: For children with severe to profound hearing loss, what is the effect of cochlear implants compared with hearing aids on speech and language development?

2. Population: Young adult with a stroke.

   • Intervention: Cognitive rehab.

   • Comparison: Not specified in the transcript.

Important Considerations for PICO Questions

• Clinical questions should include family values.

• It should be specific but not too specific.

• A situation may have more than one question and each should be tackled sequentially.

-List the 3 components of EBP

      External evidence: Scientific literature.

• Internal evidence: Data from observations on the client.

• Client perspectives: Personal and cultural factors, values, priorities, and expectations.

1. Framing a clinical question.

2. Gathering evidence that supports the question.

3. Assessing the evidence: Determining what the evidence concludes.

4. Making a decision.

-Explain the 5 steps of the evidence-based process.

Four Steps of the EVP Process

1. Framing a clinical question.

2. Gathering evidence that supports the question.

3. Assessing the evidence: Determining what the evidence concludes.

4. Making a decision.

Service Delivery Models

• Provider: The person administering the treatment.

  • SLP (Speech-Language Pathologist).

  • SLPA (Speech-Language Pathology Assistant).

  • Trained support personnel.

  • Intern

  • Caregiver

  • Others?

• Format: Type of session.

  • Individual (1-1).

  • Group.

  • Concurrent Group

  • Consultation

  • Coaching/Training

  • Others?

• Dosage: Frequency, intensity, and episode of care.

  • Frequency: Number of treatment sessions.

  • Intensity: Length of each treatment session.

  • Episode of Care: Length of treatment period.

• Setting: Location of treatment.

  • Home.

  • Outpatient Clinic.

  • Classroom vs. Separate Room.

  • Hospital.

  • Community-Based.

  • Others?

Service delivery is a dynamic process where changes are made to the above components.

Format and Service Delivery Models

• Direct Service

• Indirect Service

Dosage and Service Delivery Models

Dosage: The amount of services described as the combination of frequency, the length of a therapy session, and the length of an episode of care.

• Episode of Care: The length of time needed to address a specific problem.

• Frequency: The total number of sessions of intervention that occur over the course of a specified time period.

• Intensity: Time each session

Example Dosage in Educational Setting:

• Episode of Care: The length of the annual IEP (individualized education plan), semester/trimester.

• Frequency: Times per week, month, or year. Ex. 1x/week; 4x/month; 30x/year

• Intensity: Written in minutes (15, 30, 45)

  • Example: Services are recommended for 30-minute sessions, 3 times monthly (30 x 3/month) from 9/11/2025 - 9/10/2026, totaling 810 minutes annually.

Example Dosage in Biola Clinic Setting:

• Episode of Care: The length of the semester.

• Frequency: Times per week. Ex. 1x / week

• Intensity: Written in minutes (45 minutes)

  • Example: Amelia is recommended to attend speech therapy for one 45-minute session per week from 9/9/2024 - 12/16/2024.

Dosage Terminology

• Intensive: A highly concentrated dosage of therapy intervention provided over an episode of care.

  • Example: weekly sessions lasting 45 minutes or more in length or a frequency of 2x or more/week.

• Frequent: A moderate dosage of therapy intervention provided at consistent intervals over an episode of care.

  • Example: weekly or bimonthly sessions lasting less than 45 minutes in length.

• Periodic: A lower dosage of therapy intervention provided at regularly scheduled intervals for a specified number of minutes over an episode of care.

  • Example: 2 to 5x/year for a total of 60 minutes

• Intermittent: A low dosage of therapy intervention provided irregularly or when needed over an episode of care. Length of therapy session may vary.

  • Example: 1 to 2x/quarter for 20 minutes per session.

Setting and Service Delivery Model: The role of the Speech-Language Pathologist (SLP)

• Schools: SLPs diagnose and treat children through special education and consult with administrators and educational staff.

• Skilled Nursing Facilities: SLPs diagnose and treat adult and geriatric populations to ensure quality of life, including patients with progressive diseases like ALS, Parkinson's, and Dementia.

• Private Practices: SLPs work directly with clients and families to treat adults and children with chronic disorders or developmental delays, often in familiar environments (home or school) or a clinic space.

• Hospitals: SLPs diagnose and treat children and adults following an acquired or congenital neurological disruption, in both inpatient and outpatient settings.

• NICU (Neonatal Intensive Care Unit): SLPs diagnose and treat dysphagia in premature babies to ensure swallow safety in the first few days of life.

• Acute Care: SLPs facilitate functional communication and ensure safe swallow while patients are still in the acute phases of injury.