Chapter 2: Counseling Meeting Notes

·       How do we empower our clients? By creating a space for family to share concerns and fears about the future. (pg. 8) “to empower our clients we must develop the capacity to create nonjudgemental space for their normal human emotions , including pain, grief, fear and guilt” (pg 11). “the central idea of client empowerment is the concept of imbuing clients with an internal locus of control” (pg. 11).

·       What is empathy and how do we do it? Empathy is identification of thoughts, feelings, and attitudes of client. This is done by feeling the client’s perspective as if you are viewing the situation in their shoes (pg. 9)

·       What does it mean to be present? To be fully attuned to the immediate moment with a client or family’s pain, tears, or negative emotions. Gives the client permission to fully experience their emotions.

·       What is the locus of control?

o    Internal locus of control: client is secure in feeling that the events in his or her life are within their power or ability to manage. More likely to believe they have a choice (choose the way they react). They have the ability to notice self-critical thoughts (perhaps challenging it). When good things happen these people are more likely to attribute this to skills, attitudes, or choices they make.

o     External locus of control: events that happen in their lives happen to them and that people do things to them.

o   To facilitate shift from external to internal, we must provide space for negative emotions and help clients magnify and clarify their strengths

·       How should we give praise and feedback?

·       We should give more praise then feedback ( a 3:1 ratio). Negative feedback should be delivered with sensitivity at its core while acknowledging the client and family members’ strengths resulting in positive experiences. The 3:1 ratio provides trust and provides client with assurance that they will be given productive solutions (pg. 12).

·       Be familiar with the levels of listening:

o   level 1: internal listening: listening that is full of “mind chatter” (ongoing dialogue in a person’s head that distracts our focus and is full of judgement) and egotistical in nature because it involves interpreting what is spoken as being about oneself.

o   Level 2: focused listening: focused on listening and requires laser sharp concentration on the other party. We listen to the words as well as the meaning behind the words. Function as “giant mirrors” that reflect everything our client feels/says. Client thus hears themselves more clearly. SLP thus minimizes own mind chatter, uses silent pauses and becomes fully present. Think “becoming blank” to facilitate this state

o   Level 3: global listening: listening with all of your senses. The professional becomes more aware of shifts in client posture, energy, mood, and non-verbal cues. Actors call this “soft focus” or intuition (Daniel Goleman 1995). Be aware of gut reactions and be tactful. “how does that sound to you?” +

o

·       What is a word trap and how do you avoid those? Word traps are commonly relied on default phrases that limit possibility “I/you should”

·       Be familiar with acknowledging versus complimenting.

·       Acknowledgment “denotes to recognize as being valid or having force or power.” Highlights individual’s strengths fostering greater access to those gifts. Direct and specific and reflects tone of admiration. Three parts: statement, how it resonates with the other individual, and your observation of the other’s reaction.

·       Compliments are nonspecific and superficial.

·       On page 23 of our text there is a section called 'The interview (the clinician's tool kit)'. Be able to define and give an example of the following sections.

o   reflecting and clarifying: in reflecting we mirror what client says (giant mirror)leading client to access their own emotions and be resourceful. When you check in whether clarifying what you heard and be sure client agrees with your paraphrase.

§  Example: interviewer: is that true? Client: yes that’s exactly how I feel; very overwhelmed. Interviewer: So you feel very overwhelmed Client: Not really overwhelmed, more afraid than overwhelmed; scared.

o   summary probe: summarize in your own words what the client has told you. Allows us to steer conversation back to topic and reinforce depth.

§  example: clinician: let me just back track for a minute here to be sure I understand: you said your child of 3 years old stutters and became self conscious about it this year in kindergarten? Tell me more

o   clearing: clients need to release emotions (vent) by telling stories, releasing negative emotions. Use your intuition to determine this need

§  example: venting about being unfairly targeted, angry, sad, overwhelmed.

o   powerful questions: open-ended, curious, introspective, though-provoking. Prompt person to look inside and seek authentic response.

§  Examples: what do you truly want? What have you tried so far? What’s working? What would you like to know that you dudnt today?

o   meta-view: assists individual in gaining a perspective of their situation. “birds eye view”. Usually perspective changes to be more empowered.

§  Example: picture yourself in the sky above yourself, what do you see?

o   Reframing: helps client view problem from different perspective. Helps client redefine the problem into something positive. Reframing suggests we always have a choice. Allows them to move from being stuck (victim) to being in control.

§  Example: reframing problem so that instead of experiencing stuttering as a bad thing, it gives them an empathetic perspective for others with speech issues or disabilities.

o   Acknowledging: (see pg 22.) denotes to recognize as being valid or having force or power.”

§  Example: “I see that your son lights up when he sees you. It appears you have a special bond.”

o   using silence: silence with presence and silence with absence. Silence with presence people feel connected, silence is energized and supportive. Honor silence as a time of reflection, thinking, or learning.

·       Post evaluation tool kit.

o   Flow talk: casual conversation is soothing and humane transition in stressful situation.

o   Highlight positive attributes and strengths: acknowledge general personality or intellectual strengths of the client.

o   Clarify role: explain the role we have, relay that we are communication specialists and look at all aspects of spoken and written language.

o   Highlight communication strengths: convey the strengths of the client in terms of voice quality, fluency, articulation. Etc.

o   Enlist family diagnosis: slp should share areas of concern for patient to the client’s family. Ask family what they noticed during evaluation. Explain what they can do to support client.

o   Provide written recommendations: give client and family recommendation on whether they are going to therapy immediately. Suggestions may include book reading, phonemic awarenesses, rhymes, etc.

Chapter 3: Diagnostic Report Meeting Notes

·       Page 48 ‘use of active voice’ through end of chapter.

o   Use of active voice: the subject is doing the action reflected in the sentence. In a sentence that expresses passive voice the subject is receiving the action.

§   Passive: the client was given 10 sentences by the clinician to practice at home.

§  Active: the clinician gave the client to practice at home.

o   Use of positive form: positive form is clearer and more direct.

§  His mother said he usually turned his writing assignments late.

o   Use of specific rather than vague words: specific words provide more information and greater clarity than vague words.

§  After speaking their first word, a child typically adds more than 20 new words to their lexicon each month until roughly 50 words are included

o   Avoidance of unnecessary words: use only necessary words to convey your point

§  He said he was unaware that stuttering was treatable.

o   Parallel structure: indicates that a sentence consists of elements that are similar in grammatical form (parallel)

§  The client’s hobbies included swimming, reading, and watching movies.

o   Fragmented sentence: a fragmented sentence cannot stand by itself, as it is not a complete thought, that is there is no subject verb relationship.

§  Some clients were provided with therapy last week.

o   Run on sentences: is one in which two independent clauses are connected without punctuation to separate clauses.

§  Incorrect: he wasn’t successful in therapy he didn’t practice at home.

§  Correct: he wasn’t successful in therapy; he didn't practice at home.

o   Rambling sentences: contain many independent clauses and is too long.

§  Incorrect: the client came to therapy, and she forgot to bring her homework, so she was very upset and began to cry, but the clinician calmed her down, and the client was able to produce the sounds correctly.

§  Correct: the client came to therapy, but she had forgotten her homework, she was very upset and began to cry. Clinician calmed her down, and the client produced the sounds correctly.

o   Paragraphs: reports generally divided into headings and subheadings, one idea per paragraph. Sufficiently developed, introductory sentence, supporting sentences, concluding sentences. The development of a diagnostic report may be related to 1) logical sequence of events 2) a statement of strengths followed by weaknesses 3) a comparison of assessment results related to information from other parts of the evaluation. 4) any other clear connection between additional information and topic ideas.

o   Cohesion and coherence: clear information and do not assume content is implicit. Use pronouns and synonyms. Use transitional devices.

o   Using transition: creates clarity by creating easy to follow ties between sentences, paragraphs. An effective transition uses words or phrases that show the kind of logical relationship you want to convey.

o   Writing professional reports:

o   Sample reports and modifications:

Cultural considerations (p.
83-85, 143-145)

Assessment tools are culture bound thus reflect the culture they are from including knowledge, valuesand communication strategies.

3 things that prevent the use of norm referenced measures across cultures: content bias, linguistic bias, and disproportional representation in standardized samples.

Content bias occurs when test materials and procedures are based on the assumption that children have been exposed to similar concepts and world knowledge

Linguistic bias: most tests modeled on White middle class.

The examinees ethnic/racial group may or may not be included in normative sample.

May lead to over or under identifying speech and language issues.

(see book for 143-145)

Chapter 5: Audiological Screening Meeting Notes

·       The importance of an audiological screening within an assessment.

It is important because hearing loss is one of the most prevalent birth defects. It’s also important because hearing loss can happen at any age and impact speech and language.

·       Impacts of hearing loss on speech and language.

Depends on

·       degree of loss: greater the loss the greater the impact

·       audiometric configuration: a hearing loss greater in higher frequencies interferes more with speech understanding than one in the lower frequencies (p. 93). This is because consonants are represented in higher frequencies where spoken vowels have more energy in the low frequency.

·       age of onset: congenital and prelinguistic would have greater affects than acquired HL after language learned.

·       age of the individual: older population has decline in speed of auditory processing and cognition.

·       site of lesion: conductive loss causes sensitivity problems, SNHL affects sensitivity and clarity.

·        number of ears affected: one ear has left impact than bilateral hearing loss.

·       presence of concomitant disorders: those with typical development are less affected

·       speed and type of intervention: earlier treatment, the faster the child’s language development and academic success is salvaged.

·       family involvement: commitment and support of the family in rehabilitation efforts  has great positive effect.

·       Listening environment: intensity of sound in comparison to competing sounds and degree of reverberation (echo) affect those with hearing loss.

·       The steps of administering pure-tone testing.

o   Appropriate infection control: surfaces, equipment, earphones, all need to be cleaned and disinfected after every contact with a patient. Use of disposable insert earphones is recommended. Handwashing between patients.

o   Calibrated pure tone audiometer on quiet room: biologic check must be preformed before testing (one that has normal hearing at each frequency and intensity level)

o   Clear and simple instructions:

·       for young children: give child a block or toy to hold near ear. “you are going to wear these special earphones. After I put them on, wait and listen. You will hear a sound, like a beep. When you hear the sound drop the toy in the bucket. The sound may be soft, so listen carefully.”

·       For children and adults: “ you are going to hear a series of tones. Raise your hand when you hear the tone or think you can hear the tone.”

o   Placement of earphones: red earphone is on right ear, blue on left. Glasses or jewelry removed if they interfere with placement. (with insert headphones otoscope should be used to make sure ear canal is clear).

o   Positioning: do not have child face practitioner.

o   Choice of task:

·       Conditioned play audiometry: child is taught to provide play response upon hearing sound. Two trials of conditioning recommended.

·       By age 5, children can raise hand for task.

o   Screening under headphones: quiet room is needed. For adolescents add 6000Hz and 8000Hz due to increased noise exposure. Insert headphones recommended due to high rate of false positive with standard headphones. Two presentations at each frequency.

·       Pass/refer criteria:

o   In the absence of responses, at one or more frequencies, attempt to reinstruct/recondition or reposition earphones. Then rescreen. When the screening is not passed and referral should be made.  If there are no responses at one or more test frequencies in either ear or if the patient cant be trained reliably to perform the task a referral should be made. Children who fail should be referred for medical and/or audiological evaluation

·       Audiological Screening Powerpoint: Chapter 5

o   ASHA recommends that a hearing screening be included in every comprehensive speech-language eval.

o   Types of hearing loss:

§  Conductive: pathologies originating in the outer/middle ear

·       Impacted cerumen, otitis media, otosclerosis

§  Sensory or cochlear: pathologies originating in the inner ear

·       Meneire’s disease, HL induced by noise, bacteria/virus, genetic influence

§  Neural or retrocochlear: pathologies with the 8th nerve

§  Mixed: pathologies that affect both conductive and sensorineural parts of ear

o   Draw attention to…

o   Page 92

Pure tone Screening:

Quiet space

1,2,4 Hz

Kids 20dB and adults 25dB

Pass or refer no fail, ear specific

Chapter 6: Oral-Peripheral Speech Mechanism Assessment Meeting Notes

·       What is an OPE – define and describe carefully.

Oral-peripheral examination (oral examination or speech mechanism examination) is an assessment of the anatomical and functional integrity of the structures that support speech and swallowing, and its an essential part of a complete speech, language, and swallowing evaluation.

Performed on patients of all ages infant to adult. Obtained after obtaining case history information about client.

What do you ask the client to do to assess the ….. and what are you watching for?

o   Face: overall head size, face shape, facial symmetry, and spacing of facial  features (completed during initial conversation). For facial integrity first ask client to rest face, then clinician should note abnormalities such as flattening of nasolabial folds, drooping of corners of lips. Evaluation rate, strength, and range of motion of muscles of facial expression. Ask client to wrinkle forehead, frown, pucker, smile, bare teeth, and close eyes tightly

o   Head/Neck: clinician should note posture at rest and drooping of head or shoulder. Assess sternocleidomastoid and trapezius muscles. Test trapezius by having client shrug shoulders while clinician places light pressure on the shoulders. To test sternocleidomastoid by having client rotate head while clinician puts light pressure on client’s neck to resist the movement. Drooping, weak shoulder shrug, and reduced head turning suggests damage to CN XI.

o   Lips: clinician should look at client’s lips at rest for structure symmetry, posture (closed and open) and condition. Note presence of cleft lip and its severity (and drooling if present). Test range of motion and labial closure and seal by having clinician pushing against lips, client puckering and smiling, or producing /u/ /i/ sounds. Labial closure assessed by asking the client to purse their lips, puff out cheeks and approximate lips while clinician pushes against cheeks.

o   Mandible: clinician should examine the size of the mandible in relation to the upper jaw in relation to the face, how low in hangs at rest. Assess range, speed, accuracy, and symmetry of jaw movements. Ask client to slowly open and close jaw, noting deviations. To test strength ask client to maintain closed jaw while clinician applies light downward pressure. Ask client to move jaw to side, hold it while clinician tries to move jaw towards the center. All malmovements are associated with trigeminal nerve (CN V).

o   Dentition: examine the alignment of client’s dentition by asking client to bite down and smile. Clinician should ask client to open mouth to evaluate client’s oral hygiene and condition of teeth.

o   Tongue: examine size, surface, color, completeness, and symmetry of tongue at rest. Note extra movements while tongue is at rest. For frenum, clinician should instruct client to lift tongue tip to alveolar ridge where clinician will inspect frenulum. Evaluate range of motion by instructing client to protrude, elevate and depress tongue and have them rotate tongue clockwise and counterclockwise. Evaluate lingual strength by having client protrude tongue while clinician presses flat against the tongue in midline of tongue and lateral margins.

o   Diadochokinesis: for alternating motion rate (amr) have client repeat p, p, p, t, t, t, k, k , k as fast as possible (20 times per sound). Clinician notes how fast this is done. Sequential motion rate is how long it takes for client to produce 10 reps of ptk. Each test performed three times.

o   Hard palate: contour and width of hard palate, presence of fistulas, scars, or discoloration. Blue tinge or translucent zone should be noted. In addition, cleft palate should be noted.

o   Soft palate: ask client to open and close mouth noting configuration of soft palate and uvula. Vp integrity assessed by using mirror instructing client to produce nasals then oral consonants. If vp closure adequate foggy mirror during nasals. The second assessment is by pinching client’s nose during production of oral sounds eliminating nasal sounds. Use straw to listen to hypernasality and nasal emission during production of oral sounds.