Tinnitus: In the Brain of the Beholder

Marc_Fagelson    Baguley_PTINN    David_Baguley

 

By: Marc Fagelson, BA, MS, PhD and David M. Baguley, BSc, MSc, MBA, PhD

Co-editors of Tinnitus: Clinical and Research Perspectives

Most audiologists and patients understand tinnitus to be the perception of a sound that is not connected in any way to an environmental event. For some patients, the sound produces minimal discomfort and is noticeable only a fraction of the time. Other patients are not so fortunate, and their tinnitus may persist and prove distracting when they are in the presence of other sounds or when they try to communicate. A relatively small proportion of patients with tinnitus, still probably more than 10 million people worldwide, have bothersome tinnitus that consistently reduces their quality of life and affects most routine activities. Such patients often respond to tinnitus as though its presence merits the attention and concern consistent with that demanded by a sound that is recognized as a threat. These patients illustrate some of the more confounding elements of tinnitus: it is a sound experience that may produce, or be associated with, powerful emotions and physiologic responses consistent with those demonstrated in fear-avoidance research.

A person’s experience with tinnitus may be complex and multi-faceted. Some patients link tinnitus to traumatic events, perhaps those that triggered the tinnitus onset. Other patients report psychological conditions such as anxiety and depression appear to exacerbate tinnitus and may be reinforced by tinnitus-related negative associations. Often, tinnitus severity is dictated not by the sound, but by the patient’s interpretation of and response to the sound. In this regard, the power of tinnitus to exert influence over a person’s life is in the eye, or ear, of the beholder.

Tinnitus interventions, then, may be viewed as proceeding along parallel tracks: abolishing or attenuating the sound may be the target of a treatment strategy, or the patient’s response to tinnitus may be the target of a management strategy. Both approaches are considered in detail, and with many examples, in Tinnitus: Clinical and Research Perspectives. Continue reading

The Ineffectiveness of Checklists in Diagnosing Childhood Apraxia of Speech (CAS)

Margaret_Fish  Fish_HHTCASE2E_low res

By Margaret Fish, MS, CCC-SLP, author of Here’s How to Treat Childhood Apraxia of Speech, Second Edition

Sorting through evaluation findings for young children with complex speech sound disorders can be confusing and challenging. As SLPs we strive to complete thorough evaluations and make sense of our evaluation findings to achieve an accurate diagnosis; however, many of the characteristics of CAS overlap with other types of speech sound disorders. Certain key characteristics from a CAS checklist such as inconsistency, atypical prosody, groping, or vowel errors may raise red flags for a diagnosis of CAS, but these characteristics alone should not predetermine the diagnosis until a thorough analysis of the child’s speech productions is completed.

Following are case studies of two children recently seen for consultations. Both children had an incoming diagnosis of CAS, but only one child was given a definitive diagnosis of CAS at the conclusion of the consultation. The other child demonstrated a number of characteristics commonly associated with CAS, but after careful examination of the child’s speech, the underlying nature of the challenges was not consistent with the core impairment of CAS that ASHA (2007) describes as the “planning and/or programming (of) spatiotemporal parameters of movement sequences.”

Case Study 1.

Mark, age 3 years, 7 months, had recently received a diagnosis of CAS by a diagnostic team at a local hospital. The diagnosis was based primarily on the following factors:

  • Reduced speech intelligibility (judged to be 50% intelligible)
  • A nearly complete repertoire of consonants and vowels
  • Inconsistent productions of the same word
  • Occasional vowel errors
  • Atypical speech prosody

Because of Mark’s limited speech intelligibility, inconsistency, vowel errors, and prosody differences, it was understandable how a diagnosis of CAS was made, as these characteristics often are associated with a positive diagnosis of CAS. Indeed, the use of a checklist of CAS characteristics alone could lead a clinician to conclude that Mark had CAS.

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Twenty Years of Advances in the Assessment and Management of Balance Disorders

By Gary P. Jacobson, PhD
Coeditor of Balance Function Assessment and Management, Second Edition

Balance Function Assessment and Management, Second Edition

Balance Function Assessment and Management, Second Edition

The first edition of Balance Function Assessment and Management (BFAAM) represented our attempt to coalesce for the clinician the available information pertinent to the assessment and management of vertigo, dizziness, and unsteadiness. Fortunately for the profession, there have been updates and discoveries since the publication of the first edition—as a result, a need for a second edition. The second edition of BFAAM includes several new chapters: the ontogeny of the vestibular system, mechanisms of central vestibular compensation, effects of old age on the vestibular system, the biomechanics of balance, electrocochleography, and testing the pediatric patient. Also addressed are new diagnostic techniques that have been developed during the past decade, including the ocular vestibular evoked myogenic potential (oVEMP) and the video Head Impulse Test (vHIT).   Continue reading

Meeting Industry Demands of the 21st-Century Vocal Athlete

By Wendy D. LeBorgne, PhD, CCC-SLP and Marci Rosenberg, MS, CCC-SLP

hy•brid sing•er- (n). Refers to the vocal athlete who is highly skilled performing in multiple vocal styles possessing a solid vocal technique that is responsive, adaptable, and agile in order to meet demands of current and ever-evolving vocal music industry genres.

Through our years of professional singing, training, and performance (resulting in an evolution to become voice pathologists and singing voice specialists), we have encountered a transition in the industry demands and injuries of the 21st-century vocal athlete. Today’s commercial music industry demands versatility of vocal athletes who are now expected to be skilled in multiple styles of singing. Not only are these singers asked to perform vocal gymnastics on an eight-show per week schedule, these vocal athletes must also possess excellent acting skills and strong dancing ability to be competitive. These demands on the voice, body, and psyche necessitate a physically, vocally, and mentally fit singer who is agile and adaptable. Continue reading

Alphabet Soup: The SLP, CP, and NDT

Fran Redstone, Ph.D., CCC-SLP, C/NDT
Editor of Effective SLP Interventions for Children with Cerebral Palsy: NDT/Traditional/Eclectic

Effective SLP Interventions for Children with Cerebral Palsy

Effective SLP Interventions for Children with Cerebral Palsy by Fran Redstone, PhD, CCC-SLP, C/NDT

Is it reasonable to expect a child with shallow breathing, open-mouth posture, and a tongue thrust, whose body is fixed in extension, to manipulate toys or interact with peers in a stimulating home or school environment? Of course the answer is “no.” It is an exercise in frustration for the child and in futility for the child’s unprepared speech-language pathologist (SLP). I know this because I’ve been there.

When I am asked why I, as a speech pathologist (SLP), should “handle” the child’s body, I am reminded of a second grade class observation I conducted recently of a child with spastic diplegia. This child was ambulatory and cognitively intact but was in a small class for children with language disorders. He was helped to function within the classroom with a one-to-one aide. The youngster began to demonstrate some negative behaviors stemming from the frustration of not being understood. This had resulted from a loss of stability, which led to poor trunk support, leading to poor oral control. I quietly asked the aide if I could intervene and adjusted the foot support and pelvic positioning. The child sat upright and communicated better immediately. Continue reading

2014 Awards and Honors

We are thrilled to announce the winners of the 2014 Plural Publishing Research Awards given in honor of the late Dr. Sadanand Singh. These two scholarships are awarded by the Council of Academic Programs in Communication Sciences and Disorders and honorees and their faculty sponsors are acknowledged at the annual CAPCSD meeting, taking place this year in Orlando, FL, April 10-12. Congratulations to Doreen Hansmann, the master’s level winner and to Meg Simione, the doctoral level winner.

Doreen Hansmann, Master’s level Research Award recipient

Doreen Hansmann, Master’s level Research Award recipient

Meg Simione, Doctoral level Research Award recipient

Meg Simione, Doctoral level Research Award recipient

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Featured Article: An Unconventional Childhood by author Jerry Northern

Jerry_Northern

Jerry L. Northern, PhD
Professor Emeritus, Dept. of Otolaryngology (Audiology)
University of Colorado School of Medicine
Denver, Colorado USA

This is a personal story about an unconventional childhood.  Maybe “unusual” childhood is a better description.   It begins way back in 1942 when I was 2 years old and my parents were in the midst of an unpleasant divorce.  While my parents were engaged in drawn-out skirmishes over custody for my older brother and me, we were sent to live with my grandparents in Denver, Colorado.  The unusual part of the story is that my grandparents were totally deaf.  And I mean rock-stone deaf – no measureable hearing and no hearing aids in those early days.  The communication between them was solely by American Sign Language (ASL).   My brother and I arrived at their home to meet them for the first time and realized that we no means of talking with them. Continue reading

Featured Article: One New Year’s Resolution to Keep

One New Year’s resolution to keep – learn more about being an effective speech-language pathology assistant (SLPA) supervisor

by Plural author Jennifer Ostergren

If you are like me, as 2014 swings into full gear, you look to your newly inked New Year’s resolutions. One resolution on my list this year is to expand my knowledge and skills as an educator and supervisor of speech-language pathology assistants (SLPAs). Those of you with similar aspirations know that serving as an SLPA supervisor can be highly rewarding, but also challenging, especially given a lack of resources and tools specific to SLPAs. This year, however, the American Speech-Language-Hearing Association (ASHA) continues to expand its efforts in this area, with new programs, policies, and resources specific to SLPAs and their supervisors. In particular, ASHA’s new Practice Portal on the topic of SLPAs, located at http://www.asha.org/Practice-Portal/Professional-Issues/Speech-Language-Pathology-Assistants/, is an excellent source of current information and resources on this topic. The sections that follow also highlight several key resources from ASHA that may be of help as well. Continue reading

Guest Blog Post – What’s in a CEU?

by Mary Huston, MS, CCC-SLP

One of the fabulous things about the profession of speech-language pathology is that we are expected to constantly learn. There is always new research being discussed, new ideas to practice, new breakthroughs for therapy, and sadly, new paperwork requirements. Most state licensures require a certain amount of continuing education hours every year or two and ASHA requires a certain amount over three years. Thankfully, we can usually double-dip and count the same CEUs for both state licensure and ASHA. However, in today’s busy schedule of high caseloads and insane paperwork, no one has time to sit through yet another conference that doesn’t pertain to our work.

bored_meetingAfter discussions on social media, it has come to my attention that not everyone realizes there are alternatives to sitting in a conference room just to get the CEUs. Don’t misunderstand me – I’m all for conferences. There is a lot to be said about the camaraderie of sitting in a room of similar professionals. However, as wonderful as that camaraderie is, if the subject matter doesn’t pertain to your job, or interest you, is it truly time well-spent? Thankfully there are many alternative ways to gain professional development and continuing education credits. Thankfully there are many alternative ways to gain professional development and continuing education credits. Continue reading

Featured Article: The Challenge of Clinical Education in Speech-Language Pathology

By James M. Mancinelli, MS CCC-SLP and Evelyn Klein, PhD. CCC-SLP

This article provides an overview of important issues facing clinical training of graduate students today. In light of current training models, budget constraints, staffing shortages, and productivity demands, it is time to take a hard look at the requirements and demands set by our profession in the hopes of making needed changes

The 2005 and 2014 ASHA Standards require that the student enrolled in a Master’s degree program in Communication Sciences and Disorders (CSD) obtain 400 clinical hours “across the lifespan with varied disorders”: 375 hours in direct contact with the patient/client and 25 observation hours.  This is a broad guideline and superficially seems reasonable and achievable. After all, the requirement that the student obtain a specified number of contact hours in each of the disorders, with adults and children, in assessment and treatment have been removed. Unfortunately, the current service delivery contexts in which speech-language pathologists practice are all impacted by fiscal constraints, staffing shortages, and productivity requirements.  Although these three factors may not necessarily affect the quality of care, they are seriously impacting the ability to clinically train graduate students in CSD.  It is imperative that other models be developed for clinical education and training and that the discipline reviews the evidence that supports maintaining the status quo.  This is especially critical as some programs are being asked to admit more students into the graduate program, creating the need for even more external clinical practicum experiences. Continue reading