Tuesday, June 13, 2017

I Can Do That! Can You?

Learning how to use an augmentative and alternative communication (AAC) device can take a lot of time and effort to figure out and use functionally in daily life.  Whether you have an iPad with apps like LAMP Words for Life or dedicated devices like the Accent 1000, learning the vocabulary shouldn't just be drill and practice.  It should be fun, age-appropriate, and motivating.  In therapy, we might read stories or play games, but sometimes it's fun to add in some of the person's talents as well as yours.  A little known fact about me is that I'm about 3/4 of a clown.  I can juggle.  I can make balloon animals.  I can ride a unicycle.  I can't dress like a clown.  Not yet.  I do have a clown nose.  Somehow my procrastination in graduate school turned into some fun talents.  I knew that learning how to juggle would pay off.  Anyways, I work with a young man who is very talented at spinning things.  He can spin basketballs.  He can spin books.  He can spin records.  Actually, he can spin just about anything.  He is quite talented.  He reminds me of one of those plate spinner people that keep multiple plates spinning at the same time on top of poles consecutively.  
Charlie Callas, an entertainer, is spinning plates for a crowd.

How does this equate to using AAC and speech therapy?  Well, it's fun and engaging to show others your talents.  People love to see amazing things.  People love to talk about amazing things.  My kids love watching Dude Perfect on YouTube.  These guys make videos about amazing feats.  We love talking about seeing amazing things.  I thought that it would be fun to talk about things that we can do (and can't do).  Speech therapy brain, turn on!  Bring on core vocabulary!  

Here's how to do this activity:
  • Make a list of things some people can do and some that people cannot do.  Whistle.  Use a hula hoop.  Tie your shoes.  Juggle balls.  Jump high.  Dance fast.  Do a push up.  Make a pizza.  Walk a dog.  Make your bed.  (Okay, some are amazing to parents.)
  • Make a slideshow using Google Slides or Powerpoint showing pictures of your activities.  I either project these onto a SMARTBoard or I print them out and use them as prompts.  
    girl using three hula hoops at once around her waist
  • Create a Smart Chart (cheat sheet for core vocabulary) for all of your words (both core vocabulary and fringe vocabulary).
    Table with words and Unity symbols that represent those words.  The words included are I, can, do, that along with their corresponding symbols.
  • Gather some real objects and materials.  Basketball, hula hoop, music, and etc.
  • Brainstorm some phrases that you might say during this activity.  I can do that.  I can't do that. Not me.  Can you do that?  Awesome!  Amazing!  Cool!  How do you do that? Can I try? You try.  Do you want to try?  Make comments.  Ask questions.  Say expressions.  Describe it.  Tell how you do it.
  • Practice some phrases.  I can do that.  I can't do that.  Can you do that?  How do you do that?  I want to do that.  Do you want to do that.
  • Have one person ask the question either using the actual activity/object or using a pronoun (that).  Can you dance fast?  Can you do that?  
  • Have fun!  That's always the key.  Have fun and laugh.  And, learn something new.
a man juggling three juggling clubs outside at a park

To learn more about AAC therapy ideas, visit www.aaclanguagelab.com.

Sunday, March 26, 2017

Stuttering Assessment for School Age Children

Here's a topic that I haven't blogged about before--stuttering.  If you're a speech language pathologist, how often have you attended stuttering workshops?  I can honestly say that I hadn't been to any stuttering conferences since I've been a speech language pathologist (nearly 15 years) until I attended the Northwest Ohio Speech Language Hearing Association's Fall Conference this past November.  I then had the privilege of attending a local Friends Who Stutter One-Day Conference this past weekend to further my knowledge. With that said, I thought I would give you a glimpse of what I learned from Dr. Rodney Gabel of The Northwest Ohio Stuttering Clinic at The University of Toledo and Dr. Charles Hughes from Bowling Green State University.  For the sake of this blog post, I'll reiterate the stuttering assessment process.  Stay tuned for a post on stuttering treatment.

Assessment of Stuttering
Before assessing stuttering, you must understand that it is a multidimensional problem.  It's not just the stuttering.  You also need to look at the person (and his/her environment) as a whole.  Assessment should look at basic behaviors noted in speech, behavioral and cognitive reactions to stuttering, and the impact of stuttering in the child's life.  The information can then be used to develop a treatment plan.  Dr. Gabel noted that (school-age) children must want to make a change and become dedicated to making a change.

When completing a stuttering assessment, it is imperative to establish a rapport.  Much of the information collected will be qualitative to help understand the impact of the client's feelings, thoughts, and speech.   You can attain this information using one of the attitudinal measures listed below. Use open ended interview questions such as "Tell me about your speech." and fill in the blank statements such as "My views on school..." Stuttering moments might not always occur during the assessment, so it's a good idea to have the client/family tape stuttering outside of clinical setting (maybe with a cell phone) if possible.  It's also a good moment to begin some trial therapy to learn what works best for the child.  Explore stimulability.  Have the child identify some of your stutters for practice.  See if they can identify stuttering moments by tallying your stutters.  This might be a good moment to also teach some strategies such as slow rate, easy phonation, and holding on/freezing moments of stuttering.

Assessment Tools

The OASES is an assessment that looks at how stuttering affects the person who stutters. It measures the impact of stuttering in multiple life situations.  The information can be used throughout the treatment to provide general information about the child's stuttering, reactions (feelings, thoughts, actions) to stuttering, functional communication difficulties (at home, school, other environments), and the impact on the quality of life.

The Behavioral Assessment Battery is used provides a picture through the eyes of a child whose fluency is problematic.  The results help drive the treatment plan and helps shape the child's speech strengths and weaknesses along with his or her needs.

This A-19 Scale is used to assess the attitudes of kindergarten through fourth grade students.  The assessment was created by Susan Andre and Barry Guitar at the University of Vermont.
The SSI-4 is a normed referenced assessment that helps identify stuttering severity in children and adults.  It measures frequency, duration, physical concomitants, and the naturalness of the individual's speech.

Goals for Stuttering
Once the assessment is complete, it is time to set goals for the student.  The goals and outcome of treatment vary upon age groups.  

  • Students age 6-11 years can explore how stuttering impacts a child's experience at school.  They might work on dealing with teasing and bullying at school.  
  • Students ages 12-17 years work more on independence.  The focus may be more on having the power of a group and friends.  This is a time of identity development, motivation, and responsibility.  Goals can address talking about talking (larynx, breathing).  This is a good moment to talk about previous speech therapy (what they liked and didn't like).  Begin talking about how others can help the student with stuttering.
  • Students ages 18+ can focus on how has stuttering changed over time.  At this time, the focus of therapy is not so much on if they stutter, but looking at the impact on quality of life.  Talk about ways they've coped/managed stuttering.  Discuss what they  want to get out of treatment (student-centered).
Overall, when assessing stuttering, you need look at what the child does want to change, how the child approaches his/her stuttering, and how the child deals with his/her stuttering.   That should always guide the direction of therapy.

 If you live near Northwest Ohio and would like a stuttering assessment, please visit www.rkspeech.com for more information.

For more information on stuttering, visit the following: