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
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