Speech-Language Pathology

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Speech-Language Pathology. Courtney Jones MS CCC-SLP. Speech-Language Pathology. What do we do? Promote recovery of function (rehabilitation) Promote development (habilitation). Objectives. Scope of practice Points of care Resources for patients. Scope of Practice. - PowerPoint PPT Presentation

Text of Speech-Language Pathology

Speech-Language Pathology

Speech-Language PathologyCourtney Jones MS CCC-SLPPath to SLP

1Speech-Language PathologyWhat do we do?Promote recovery of function (rehabilitation)Promote development (habilitation)

ObjectivesScope of practicePoints of careResources for patients

Scope of PracticeSpeech Sound ProductionArticulationDevelopmentally appropriatePlacement for soundsSocial and academic impact

ArticulationApraxia of speechAcquiredDevelopmental or Childhood apraxia of speechMotor planning speech production

The brain is telling the mouth to say cat, but motor plans a

ArticulationDysarthriaSlurred" speechSpeaking softly or barely able to whisperAtaxia-failure of muscular coordination; irregularity of muscular actionDyskinesiadistortion or impairment of voluntary movement, as in tic or spasm

ResonanceHyper/hyponasalityCul-de-sac resonanceMixed resonance

ResonanceCleft palateHardSoftSubmucousVelopharyngeal insufficiencyshort palateweaknessPhoneme specific errors

ResonanceCorrect tongue placement for soundsBio feedback with a nasometerCompensatory articulationsENT

No research to demonstrate oral motor exercises improve soft palate movements.

Nasometer

Nasometer

VoicePhonation quality (nodules)Respiration (words per breath)Pitch Loudness

FluencyStuttering Cluttering

Martina Costello, SLP

Language (comprehension and expression)phonologymorphologysyntaxsemantics

Languagepragmatics (language use, social aspects of communication)literacy (reading, writing, spelling)

Language (comprehension and expression)prelinguistic communication (e.g., joint attention, intentionality, communicative signaling)paralinguistic communication (tone of voice, inflection)90% of what we say is with our body

Speech-Language Milestones6-12 months6 months-laughs, gurgles, coos, reacts, babbles for attention8 months- responds to name, produces syllables, tries to imitate10 months- plays peek-a-boo, may say mama dada12 months-recognizes name, says 2-3 words besides mama dadaOne year oldRecognizes nameUnderstands noImitates familiar wordsGives toys on requestWaves good-byeMakes sounds of animals

18 monthsUses 10-20 wordsRecognizes pictures of familiar persons objectsCombines two words all gone, bye-byeUses more and up, requesting wordsPoints to toes, ears and noseFollows simple commandsImitates familiar actions, vacuuming, wipingPoints and gestures to call attention to event or objectTwo year oldIdentifies body partsCarries on conversation with self or dollsAsks whats this?Sentence length 2-3 wordsCalls themselves by name300 words in speaking vocabularyAttends to an activity for 6-7 minutes2 year old450 word vocabGives first nameUses past tense and pluralsUnderstands time concepts TomorrowRefers to self as meGets attention verbally watch meTalks to children and adultsLikes to hear same story repeatedKnows big and littleThree year old1000 word vocab3-4 word sentencesUses language to express ideas80% intelligibleAsks what, frequently Attends to activity for 8-9 minutesPractices language by talking to themselves

Four year old1500 vocabAttention for 11-12 minutesAsks who? and why?4-5 word sentencesPoints to colorsIdentifies shapesEasily understood by unfamiliar listeners

Five years old2200 vocabAt least 5 word sentencesDefines objects by their use (you eat with a fork)Knows spatial relationships (on top, behind)Uses future, present and past tenseAttends for 12-13 minutesCognitionattentionmemorysequencingproblem solvingexecutive functioning

CognitionAdapted from Brain TreeAttentionAttention -Attention skills underlie all other cognitive processes. Sohlberg and Mateer (1989) describe the following aspects of attention;

Types of attentionFocused-momentary Attention Sustained Attention Selective/Elective AttentionJoint AttentionAlternating AttentionDivided Attention

AttentionProcess trainingCircling all the Cs on a page full of lettersStrategiesLimiting distractionsCuesFunctional taskCompleting a homework assignment Completing an activity with familyFollowing a 1-step direction

MemoryThe ability to keep things in the mind and recall them in the future. Errorless learning- the more accurate the response the better the retention of the information; therefore, setting up the patient for success by give the correct answer immediately before the question (e.g., My name is John. What is my name?)80/20 ruleSelf-awareness

MemoryMemoryProcess TrainingLearning about memoryStrategiesInternalExternalFunctional tasksComing to therapy on time

Information Processing The processes that organize and access information at a given rate. Visual processingAuditory processing Speed of thinkingCapacity of thinkingControl

Visual processing - the ability to fully utilize what is seen, Speed of thinking - Processing speed- amount of information a person can attend to within a given time.Capacity of thinking- amount of information a person can attend to at any given timeControl - a persons ability to be selective and organized with thought process regarding reception of the information.

34Information processingProcess TrainingVisual scanningAuditory tasksStrategiesCuesEnvironmentFunctional TasksFinding the cafeteriaExecutive Functionthe capacities that enable a person to engage successfully in independent, purposive, self-serving behavior and allow us skills to accomplish goal-directed activities in the following areas: Self-InitiationSelf-InhibitionGoal SettingPlanning and organizationSelf-MonitoringProblem solvingFlexible problem solvingSelf-awareness

Executive functioningProcess TrainingLearning about EFPatients strengths/weaknessesStrategiesSpecific to strengths/weaknessFunctional tasksAsking for directionsProblem solving unexpected eventFeeding and SwallowingFeeding and Swallowingoral, pharyngeal, laryngeal, esophagealorofacial myology (including tongue thrust)oral-motor functions

Clinical signs and symptoms of aspirationCoughing ChokingWatery eyesRed eyesRefusalFrequent respiratory infectionsUnexplained feversOxygen needDesaturation/Bradycardia with eatingUpper Right lobe infiltrates (atelectisis)Weight lossSilent aspirationWatery eyesMild rednessIncreased congestion with eatingCourse breathing via cervical auscultation

Clinical Feeding EvaluationHistoryObservationTrial therapyInterventionRecommendationsCoordination with Primary Care NP or PhysicianFormal Swallow StudiesModified Barium Swallow studyFlexible Endoscope Evaluation of SwallowRadiologyBariumX-ray exposureAspirationOutline structureENTReal food dyed blueFiberoptic scopePenetrationAnatomy/SensationFEES

FEES

MBSS

Feeding interventionsThickeningPositioningRate of flowSupplementationTreatment of causeGut comfortOral motorTherapiesBehavioral feeding programsCued feedingPositive feeding practice

Learned Patterns/behaviorsHow a child learned the behavior of eating.How our children trained us to feed them.What we practice becomes a learned behavior (Brackett)Appropriate response to an inappropriate request (Eicher)Eating is a learned behavior.

Maladaptive behaviorsTantrumingGaggingRetchingRefusalVomitingPoor acceptance of utensilStuffing mouth

Rotating headRubbing legs/bellyHolding faceSpiting outPushing food awayCovering mouthGrimacing Feeding TherapyMedical, Motor and Behavior approachSensory Oral SensationPeggy Eicher, MD, Krisi Brackett, SLPPaul Hyman, MDStructured Safe Feeding PracticeKay Toomey, PhD.Developmental researchSteps to EatingMedical motor behavior approachPeggy Eicher, MDDevelopmentally, a feeding problem exists when a child is stuck in their feeding pattern and cannot progress (Eicher)Skill acquisition = positive practice x rate of maturation (Eicher)Potential etiologiesneonatal problems (e.g., prematurity, low birth weight, substance exposure);developmental disabilities (e.g., specific language impairment, autism spectrum disorder, dyslexia, learning disabilities, attention deficit disorder);

Potential etiologiesauditory problems (e.g., hearing loss or deafness);oral anomalies (e.g., cleft lip/palate, dental malocclusion, macroglossia, oral-motor dysfunction);

Potential etiologiesrespiratory compromise (e.g., bronchopulmonary dysplasia, chronic obstructive pulmonary disease);pharyngeal anomalies (e.g., upper airway obstruction, velopharyngeal insufficiency/incompetence);laryngeal anomalies (e.g., vocal fold pathology, tracheal stenosis, tracheostomy);

Potential etiologiesneurological disease/dysfunction (e.g., traumatic brain injury, cerebral palsy, cerebral vascular accident, tumor resection, anoxic injury);psychiatric disorder (e.g., psychosis, schizophrenia);

Potential etiologiesgenetic disorders (e.g., Down syndrome, fragile X syndrome, Rett syndrome, velocardiofacial syndrome).Feeding Tube, Trach

RoleThe professional roles and activities in speech-language pathology include: clinical/educational services (diagnosis, assessment, planning, and treatment), prevention and advocacy, and education, administration, and research.

Practice Settings Speech-language pathologists provide services in a wide variety of settings, which may include but are not exclusive to:public and private schools;early intervention settings, preschools, and day care centers;

Practice Settings private practice settings;universities and university clinics;individuals' homes and community residences;community, state, and federal agencies and institutions;correctional institutions;research facilities;corporate and industrial settings.

HandoutsEarly interventionTherapy Prescription padsHome Health