Nasal Emission Terminology Should be Evidence Based and Consistent with Physiology and Perceptual-Acoustic Characteristics

Nasal Emission Terminology Should be Evidence Based and Consistent with Physiology and Perceptual-Acoustic Characteristics (1)David J. Zajac, PhD, CCC-SLP, ASHA Fellow

Coauthor of Evaluation and Management of Cleft Lip and Palate: A Developmental Perspective

The term “cleft palate speech” has often been used to refer to hypernasality, nasal air emission, reduced oral air pressure, and compensatory articulations of speakers who exhibit velopharyngeal inadequacy (VPI). Hypernasality is defined as excessive resonance of the nasal cavity during production of vowels and voiced consonants. Nasal air emission refers to the audible escape of air during the production of high-pressure oral consonants, especially voiceless consonants. Reduced oral air pressure is the flip side of nasal air emission. When air escapes through the nose, some oral air pressure is lost. Thus, oral pressure consonantsespecially voiceless ones—may be produced with reduced oral air pressure and perceived as weak or reduced in intensity. Compensatory articulations are maladaptive gestures that are produced at the glottis or in the pharynx as a way to circumvent a faulty velopharyngeal valve. The use of glottal stops to replace oral stops is a classic example of a compensatory articulation. Hypernasality, nasal air emission, and reduced oral air pressure are passive (or obligatory) symptoms of VPI. This means that the symptoms occur as a direct consequence of incomplete velopharyngeal closure. Compensatory articulations, however, are active (or learned) behaviors and may not occur in every individual.

Although obligatory nasal air emission is a core characteristic of VPI, many confusing, overlapping, and inaccurate terms have been used to describe its perceptual manifestation. The literature is replete with terms such as audible nasal air emission, nasal turbulence, nasal rustle, and passive nasal frication. Because the velopharynx and nasal passage are complex anatomical structures— which may be significantly altered due to both congenital defects and surgical interventions associated with cleft lip and palate—the variety of terms used to describe nasal air emission should not be too surprising. Numerous other terms have been used to describe nasal air emission that is part of active (or learned) nasal fricatives and will not be discussed here. The reader is referred to Zajac (2015) for a discussion of active nasal fricatives as an articulatory error. Rather, this article will focus on terminology used to describe passive or obligatory nasal air escape.

A Brief History of Current Terminology

McWilliams, Morris, and Shelton in the first and second editions of Cleft Palate Speech (1984, 1990) described nasal air emission as occurring along a continuum. First, it could be visible but inaudible, detectable only by holding a mirror under the nostrils of a speaker to see fogging as a result of the air emission. In such a case, the nasal airflow is laminar, moving in relatively smooth fashion, and does not become turbulent, or noise producing. Clinically, visible nasal air emission typically occurs in speakers who have adequate but not complete velopharyngeal closure and normal resonance. Although visible nasal air emission should be noted when it occurs in a speaker, there are no treatment implications. Continue reading

Healing Voices

Healing Voices (1)By Leda Scearce, MM, MS, CCC-SLP author of Manual of Singing Voice Rehabilitation: A Practical Approach to Vocal Health and Wellness

Singing is a part of virtually every culture and is fundamental to our human experience. In the United States, singing is enormously popular, as evidenced by the vast number of people engaged in all kinds of singing activities. Over 30 million Americans participate in choral singing alone (Chorus America, 2009). Shows such as The Voice, America’s Got Talent, and American Idol illustrate how passionate we are about singing. From the amateur recreational singer to the elite celebrity, we sing as soloists and in ensembles, with instruments and a cappella, in classical and contemporary styles, on stage, in concert, and in the shower.

Every person’s voice is unique and identifiable, and our voices can be a big part of our identity and how we see ourselves in the world. This is especially true for singers, for whom the voice is not only intricately tied to self-image and self-esteem but also may be a source of income and livelihood, creative expression, spiritual engagement, and quality of life. For a singer, a voice injury represents a crisis. Because of the specialized needs of singers, it takes a team—including a laryngologist, speech-language pathologist, and singing voice rehabilitation specialist—to get a singer back on track following an injury or voice disorder. Singing voice rehabilitation is a hybrid profession, requiring in-depth clinical and scientific knowledge married with excellence in teaching singing.

Voice problems are rarely isolated in etiology—usually multiple factors converge to create an injury. These factors may include poor vocal hygiene, inadequate vocal technique, an imbalance in vocal load and medical problems (allergies and reflux are common in singers, but thyroid, pulmonary, neurologic, and rheumatologic conditions are among the illnesses that may affect the voice). The singing voice rehabilitation process must encompass all elements that may be contributing to the problem: medical factors, vocal hygiene, vocal coordination and conditioning, vocal pacing, and emotional factors. 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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How to Work with Interpreters and Translators

Henriette_Langdon  Langdon_WWIT  Terry_Saenz

By Henriette W. Langdon, Ed.D., FCCC-SLP and Terry I. Saenz, Ph.D., CCC-SLP, authors of Working with Interpreters and Translators: A Guide for Speech-Language Pathologists and Audiologists

Our world is increasingly heterogeneous. English is no longer the only language spoken in the United States, England, or Australia. French is not the only main language spoken in France and neither is German the only language spoken in Germany. Immigration caused by political and economical changes has dispersed many people to other countries in the world in search of better opportunities. Consequently, communication between these individuals and residents of the different countries is often disrupted due to the lack of a common language. This challenge has existed throughout humankind, but it seems that it has increased in the last century or so. There have always been people who knew two languages that needed bridging, but now this urgency is more pronounced. The need for professionally trained interpreters was first noted following the end of WWI when the Unites States was first involved in world peace talks alongside many nations with representatives who all spoke a variety of languages. This historical event eventually led the League of Nations to the foundation of the École d’Intèrpretes in Geneva, Switzerland in 1924. Since that time, many other schools that train bilingual interpreters to participate in international conferences have been established. The AIIC [Association Internationale des Interprètes de Conférence (International Association of Conference Interpreters)] Interpreting Schools directory lists a total of 87 schools worldwide: http://aiic.net/directories/schools/georegions. The reader can gather information on which specific language pairs are emphasized in the various training schools; for example, Arabic-English; French-Spanish, Chinese-English, and so forth. Thus, interpreting for international conferences is a well-established profession today, offering specific training and certificates. However, interpreting is necessary not only for international conferences, but also to assist in bridging the communication in everyday contexts such as medical or health, judicial, educational (schools) and the community at large. Training and certification in areas such as medical and judicial have slowly emerged and are available to those who need them in various states throughout the United States. Legislation has been the primary force in the establishment of certificates in the areas of medical and legal interpreting. However, training in other areas where interpreting is needed such as education, and our professions, speech pathology and audiology, are notoriously lacking. There are some situations where medical interpreters can assist speech-language pathologists (SLPs) and audiologists in a hospital or rehabilitation center, but even those interpreters may not have the specific terminology and practice or procedures to work effectively with our professionals. Working with Interpreters and Translators: A Guide for Speech-Language Pathologists and Audiologists is a second revised and expanded edition on this topic that provides SLPs, audiologists, and interpreters who collaborate with them some concrete tools and strategies on how best to conduct interviews, conferences, and assessments when the client and/or family does not speak English fluently.  The proposed process is based on information gathered from other interpreting professions. The research, and some personal interviews with audiologists in particular that were conducted to assemble this information, indicate that the process is conducted haphazardly at best.  The literature available on the collaboration between SLPs and interpreters indicates that both parties are not secure about procedure and must learn how to work together by trial and error. Often the SLP does not trust the interpreter and the interpreter does not follow suggested procedures, such as failing to interpret all that is being said, conducting a side conversation with a parent during a meeting, and giving the child unnecessary cuing during testing (if tests are available in the child’s language, which is primarily Spanish). Literature on working effectively with audiologists is almost nonexistent; therefore, the first author resorted to several personal interviews with audiologists, a specialist of the deaf and hard of hearing, and professors of audiology throughout the country. Often individuals who perform the duties and responsibilities of the interpreter and who are hired to do this job are not fully bilingual; they may speak the two languages, but may not be able to read or write the language they are using to interpret. These interpreters are often not respected, are not treated as professionals, and their pay is very low.

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Managing the Expectations of the Common Core State Standards

Lissa_Power-deFur      PowerdeFur_CCSS

By Lissa A. Power-deFur, author of Common Core State Standards and the Speech-Language Pathologist: Standards-Based Intervention for Special Population

Speech-language pathologists (SLPs) in school districts across the country have returned to school, often with the new (or renewed) obligation of addressing the “Common Core” (or the “Career and College Readiness Standards” as the Common Core State Standards [CCSS] is referred to in some states.) The SLPs’ reactions are likely to include the following:

  • With all the students on my caseload, how can I possibly do something else?
  • This is just another education fad; it’ll pass in a couple of years.
  • From what I hear about these standards, they aren’t applicable to the students on my caseload.
  • I’m focusing on the IEP goals, they are most important for my students.

These are common reactions, reflecting the current challenges and pressures of working as an SLP in the schools. However, it is important that all SLPs working with children, whether in schools or other settings, understand that the CCSS is now the lens through which educators must view the achievement of all students, including students with speech-language impairments. The education standards movement has been in place for over two decades, with states first adopting their own standards and developing assessments to measure student achievement of those standards. More recently, the National Governors’ Association (NGA) and the Council of Chief State School Officers (CCSSO), with funding from the Bill and Melinda Gates Foundation, used teams of educators, business professionals, and policy-makers to develop the Common Core State Standards. Released in 2010, 43 states have adopted the CCSS. The Standards serve as the basis for state assessments developed by two consortiums, the Partnership for Assessment of Readiness for College and Careers (PARCC), and the Smarter Balanced Assessment Consortium.

As SLPs study the CCSS, they will find that the Standards encompass a hierarchy of language skills from phonological awareness to the ability to understanding diverse perspectives, from comprehension of discipline-specific vocabulary to syntactic complexity in speech and text. The CCSS emphasize oral language and phonological awareness in the primary grades, as kindergarteners must demonstrate skills in counting, pronouncing, blending, and segmenting syllables in spoken words. The CCSS expect secondary students to use oral communication effectively to present findings and support their evidence clearly and concisely using a style appropriate to the audience and task. In the vocabulary area, students must demonstrate such diverse skills as mastery of morphology for understanding meaning to becoming adept at understanding euphemisms, hyperbole, and paradox. Students’ skills in the conventions of Standard English develop from early skills in using nouns, verbs, adjectives, and adverbs to secondary level skills in using parallel structure in their oral and written communication.

The CCSS provide an excellent vehicle for SLPs to use to support collaboration with their education partners. As SLPs communicate with teachers, the CCSS provides a common vocabulary to describe student expectations and performance, thereby facilitating the education team’s focus on needed language and communication skills. A typical child on the SLP’s caseload will have difficulty acquiring standards from prior grade levels. The CCSS can serve as a resource SLPs can use in explaining the effect of children’s speech-language impairments on their ability to master specific standards. By using the language of the CCSS in describing students’ performance, the SLP’s ability to communicate with teachers and administrators about the challenges the child is and will be facing is enhanced.

SLPs will find that an analysis model facilitates their ability to integrate the standards into their intervention planning. A 5-step model builds upon SLPs’ extensive knowledge of the language and metalinguistic skills and leads to development of collaborative direct and classroom-based intervention activities. In step 1, SLPs work collaboratively to identify the standards needed for success. SLPs will analyze the CCSS, identifying the specific expectations that will rely on the student’s language and communication skills. Due to the magnitude of the CCSS, this task quickly becomes overwhelming. Therefore, SLPs are urged to follow the practice of their education partners—creating teams to review the standards. By working with colleagues, SLPs can focus on the areas that relate to their expertise. For example, SLPs with specialization in fluency can review the standards for expectations for oral communication and presentations. SLPs with a passion for literacy can focus on these standards. Another approach would be for SLPs to focus on all standards or the grade levels they serve (or the grade levels their students have just left and will be moving into). Not only does teamwork minimize the workload, it enables the creative generation ideas that flow from a collaborative group of professionals. The Plural book, Common Core State Standards and the Speech-Language Pathologist:  Standards-based Interventions for Special Populations, provides SLPs with examples of the language and communication expectations of the standards.

The model’s second step focuses on detailed identification of the language and communication skills needed for success. This analysis addresses phonology, morpho-syntactic, semantic, and pragmatic and metalinguistic skills. The SLPs will find standards that require competency in speech sound production and fluency as well. This is another task completed well by a team of SLPs, reducing the workload and facilitating the brainstorming and analysis. The result will be a comprehensive understanding of the standards.

Step 3 shifts the attention from the standards to individual students. The SLP will complete a thorough analysis of a student’s current skills and needs. Data sources include standardized assessments, observations of the child in the classroom, classroom work samples (e.g., narratives, spelling tests), and probes of specific skills. Many of these items will be found in the Present Level of Academic Achievement and Functional Performance (PLAAFP) of the child’s Individualized Education Program (IEP). However, SLPs will find that they will want to generate skill-specific probes to understand the nuances of the child’s needs as they plan for intervention.

At this point, the SLP’s focus shifts to consideration of the expectations in the child’s classroom. The SLP will use information from observations to identify the language of the classroom communications, especially directions, texts, and instructional activities. A specific focus on morphological-syntactic constructions and vocabulary will enable the SLP to focus on specific skills the child will need for success. If multiple SLPs have children in this same classroom, this can be a joint activity.

The final step is to design intervention. Children’s academic success relies on their ability to apply the language and communication skills developed under the guidance of the SLP into real-world settings (i.e., the classroom). Therefore, the intervention should be a combination of direct intervention and collaborative classroom-based intervention. This combination of approaches allows for a specific focus on skill attainment, followed by application of that skill. The SLP may find it particularly valuable to participate in classroom center activities, working with specific children and facilitating their mastery of skills through collaboration with other students. This step relies on a collegial working relationship with the child’s classroom teacher(s), with time for planning to enable both professionals to identify which skills they will focus on and the nature of interventions.

The use of a stepwise model for analyzing the standards and applying this information to the strengths and needs of a specific child enables the SLP to tailor intervention to what matters for children—academic success. It is only through the SLP’s comprehensive knowledge of the academic standards and analysis of the specific linguistic expectations of the standards that students with language and communication difficulties can successfully meet the academic demands of 21st century schools.

About the Author 

Lissa A. Power-deFur, PhD, CCC-SLP, ASHA-F, is a professor in the communication sciences and disorders program at Longwood University in Virginia. Among the courses she teaches is public school methods, which focuses on supporting children’s mastery of the language expectations of the Common Core State Standards. In her clinical role at Longwood, she has collaborated with local school districts for service delivery. She received her bachelor’s, master’s, and doctoral degrees in speech-language pathology at the University of Virginia. She is a Fellow of the American Speech-Language-Hearing Association (ASHA) and the Speech-Language-Hearing Association of Virginia, and regularly volunteers for the profession. Dr. Power-deFur has served as a state education advocacy leader and as a member of numerous education-related committees at ASHA. She is the ASHA 2014–2016 vice president of standards and ethics in speech-language pathology. Additionally, she received The ASHA Leader Outstanding Service Award for her 2011 article on special education eligibility.

 

 

7 Tips for Landing Your First SLP Job

Guest post by Erica L. Fener, PhD, vice president, strategic growth, at Progressus Therapy

There has never been a better time to be a speech-language pathologist (SLP). According to the U.S. Department of Labor (2014), SLP jobs will grow at a rate of 19% between 2012 and 2022, which translates to an additional 26,000 jobs over the course of the decade. The median pay in 2012 was $69,870 per year, and the current number of jobs—more than 134,000—indicates plenty of opportunity, even before projected growth.

If you just finished graduate school in this field, congratulations! Now all you have to do is ensure you find the right job to begin building your long-term career. Consider these seven tips to help you land your first SLP job:

1. Apply for Your Temporary State License
Every state is different, but most require you to hold a temporary license before becoming an SLP clinical fellow—the first step to being a full-time SLP. Depending on your state, you may be able to apply for the license during your degree program. Your professors can help you figure out how.

2. Land a Professional Clinical Fellowship
Your clinical fellowship year (CFY) is a crucial step on the path to working as a full-time SLP. The purpose of the CFY is to transition from theoretical knowledge to practical application. The experience you gain will be invaluable, if it is the right kind.

The American Speech-Language-Hearing Association (2015a) recommends choosing a setting that provides a full range of speech pathology services, rather than one that solely performs screenings, and treats you as a member of the staff. Also, aim to do your CFY in a setting that you would eventually like to work in, such as a school or a nursing home, so that you will get the training you need to be successful in your future career.

3. Complete Your Fellowship
Successful completion of the clinical fellow requires you to work at least 35 hours a week for 36 weeks, totaling 1,260 hours. You may also work part time, at least five hours a week, until you hit the total. Note that your mentor must be a verified SLP, which you can check through the ASHA Certification Verification page (ASHA, 2015b).

4. Reflect on Your Experience
After you complete your hours, it is time to move forward and look for a real job, which requires reflection. This step might seem a little overwhelming, but thinking through your experience can make a world of difference in your professional career. What did you like? What would you prefer to avoid? How did the setting suit your nature? The answers to these questions will help you determine where you apply.

5. Start Searching for a Job
In rare cases, the setting where you completed your fellowship may choose to hire you. Typically, however, you should not expect your mentoring facility to offer you a job. If it does, wonderful, but you must be prepared to look for work elsewhere, so it is time to start the job search. Check out career fairs and job boards, look online, and utilize your network for prospects.

6. Look Outside the Box
Not all SLP jobs will be specifically labeled as such. Some might be called “speech therapist” or “speech-language pathologist and children’s therapist.” If you are working with older people, your duties might be split between speech-language pathology and physical therapy. The specific job you land depends on your setting and your skills. To get a better idea, do your research and review job boards to see what types of jobs are available.

7. Nail the Interview
In your interview, be personable and honest about your experience and your desires. If you are worried about it, read a few articles detailing some tricks for performing well in the interview. According to Business Insider (2014), these can be as simple as warming up your hands, mirroring your interviewer’s body language, and reading facial cues. Your expert knowledge, good humor, and attention to detail will eventually land you the job you are looking for.

Now that you have that job offer, it is time to take a little break and celebrate—but not for too long, of course. Soon enough it will be time to pack your supplies and start your new career as a professional SLP, helping improve the lives of others.

References

American Speech-Language-Hearing Association. (2015a). ASHA certification verification. Retrieved from http://www.asha.org/eweb/ashadynamicpage.aspx?site=ashacms&webcode=ccchome

American Speech-Language-Hearing Association. (2015b). Selecting a clinical fellowship (CF) setting. Retrieved from http://www.asha.org/certification/SelectingCFSetting/

Business Insider. (2014). Retrieved from http://www.businessinsider.com/psychological-interviewing-tricks-2014-9

U.S. Department of Labor. (2014). Speech-language pathologists. Retrieved from http://www.bls.gov/ooh/healthcare/speech-language-pathologists.htm

About the Author

Erica L. Fener, PhD, is vice president, strategic growth, at Progressus Therapy, a leading provider of therapy employment, including school-based therapy and early intervention services. Progressus Therapy connects speech-language pathologists with schools across the United States.

Effective Communication: A New Health Care Obligation

Beukelman Effective Communication Image

By: Sarah W. Blackstone, David R. Beukelman, and Kathryn M. Yorkston
Editors of the new Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professionals

Prior to his accident, Frank was a 26-year-old energetic, physically active young adult with a wide range of interests and a full social life. A C3–C4 cervical spine injury left him unable to move his limbs. When medically stabilized, he was transferred to the surgical intensive care unit, where he was ventilator dependent and in halo traction. He was unable to speak and his only intentional gesture was a gaze shift. The hospital communication team helped Frank establish a reliable yes/no response (looking up to indicate “yes” and down for “no”). They encouraged his nurses and family to offer other choices as well (“maybe” or “later” or “I don’t know”). A speech-language pathologist showed him a speech-generating device (SGD), but when initially asked if he wanted to use it to “talk,” he responded by looking down, “No.” Later that same day, the team demonstrated the SGD again, showing him how he could use it to control the TV and a fan. When asked if he would be willing to give it a try, he replied, “Yes!” by looking up. Within 24 hours, Frank was using a template on the SGD to call a nurse, ask for medication, control a fan, and turn the TV off and on, all with a simple serial scan method and a switch. Over time, he became an active participant in his recovery process, asking doctors questions and participating in decisions about his treatment plan.

Effective communication between patients and providers is a core component of patient-centered and value-based health care. According to the Joint Commission (2010, p.1), effective patient provider communication is the successful joint establishment of meaning in which patients and health care providers exchange information, enabling patients to participate actively in their care from admission through discharge, and ensuring that the responsibilities of both patients and providers are understood. To be truly effective, communication requires a two-way process (expressive and receptive) in which messages are negotiated until the information is correctly understood by both parties.

The medical encounters that occur across the continuum of health care are usually time constrained and many are stressful, high-stake interactions. When communication breakdowns occur, the impacts can be devastating for patients, family members, providers, and the health care system. Research shows that communication difficulties are among the major causes of sentinel events and can negatively affect patient outcomes, safety, and satisfaction, as well as result in increased readmission rates, length of stay, and additional health care costs. Because of the diversity of patients and families served in our health care systems, successful communication can be very difficult to achieve. In fact, many patients present with multiple communication vulnerabilities.

At age 4 years, 6 months, Guillermo was in the ICU, intubated and awake following a series of surgeries for tracheoesophageal reconstruction. Guillermo and his family were from Honduras and spoke Spanish only. Guillermo was most relaxed when his mother or eldest brother were sitting next to his bed and rubbing his arm. Although hospital policy supported his family remaining at bedside throughout the day and night, there were moments when they needed to step away for personal care, to attend team meetings along with a translator, or for other reasons. The speech-language pathologist provided Guillermo with a simple voice output aid (Ablenet Little Mack) with messages that included, “Where is my family,” recorded in both Spanish and English, so hospital staff could understand him. The speech-language pathologists also made a 20-target Go Talk+ device (Attainment Company) available to him. It featured 15 target photos of family members with messages such as, “I want mom,” “You’re my best friend, Frederico,” “I love you,” and “Hold my hand,” as well as some medical messages. All messages were recorded in both languages.

We define “communication vulnerability” as the diminished capacity of an individual to speak, hear, understand, read, remember, or write due to factors that are inherent to the individual (e.g., disabilities related to receptive and expressive language skills, hearing, vision, speech, cognition, and memory, as well as language spoken, lifestyle, belief system, and limited health literacy), or related to the context or situation (e.g., a noisy environment, being intubated in an intensive care unit after surgery, suffering injury while traveling in a foreign country, having cultural practices, lifestyles, or religious beliefs that are not understood or accepted by providers).

Eleven-year-old Joshua had a bone marrow transplant. He was acutely aware of his suppressed immune system and created and used several communication tools during the time he required the use of a Bi-PAP noninvasive ventilator. Using a simple voice output communication tool, Joshua insisted on having the following message available at all times: “If anything falls on the floor, use the Sani-wipe to clean it before you let it touch me. Also, if your gloves touch the floor when you pick it up, change your gloves before coming near me.”

In the book, Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professions, we describe how health care facilities and the providers who work within them can begin to assume a more active role in supporting patients who are communication vulnerable. Speech-language pathologists, nurses, administrators, and physicians are key to improving the “culture of communication” within their facilities, spearheading interprofessional practices that benefit all patients and ultimately providers and the facility’s bottom line. Currently, the role of communication intermediary is assumed by a few providers or family members with a personal commitment; although a rising number of health care organizations are beginning to specify policies and role assignments regarding the coordination of communication support services, communication facilitation for all patients with communication difficulties (not just those who are deaf or have second language issues), or a legal or medical intermediary designated to ensure that communication vulnerable patients accurately participate in legal and medical decisions.

Examples of promising practices and strategies across health care settings are highlighted in individual chapters that focus on doctor visits, emergency services, Intensive and acute care settings for children and adults, inpatient and outpatient rehabilitation, long-term residential care, and end-of-life care. In this book, we have invited authors who have considerable expertise in patient provider communication services across the range of health care settings to share information about the policies, intervention strategies, communication materials, and technologies that are being implemented within their medical settings to support the needs of communication vulnerable patients.

The wife of a person with ALS described his end-of-life experience: He was having a great deal of difficulty breathing and simply could not get comfortable in his hospital bed or wheelchair. We decided to go with in-hospital hospice since his pain management was not well controlled. In hospice, he regularly used his (eye gaze-accessible) SGD to tell us what he did and did not want. I am so grateful that he was able to use it extensively during the last few days of his life. I do not know what we would have done without it.

The authors recognize that there continues to be a considerable gap between clinical research evidence, what is mandated by health care policy, and what is experienced every day by patients, their families, and providers during medical encounters because of the ways in which many health care organizations currently deliver care. In other words, we recognize that implementation, or the process of putting effective patient-provider communication policies into practice, continues to be a challenge within many health care organizations; however, in the final chapter of Patient-Provider Communication we discuss a number of implementation strategies.

References
The Joint Commission. (2010). Advancing effective communication, cultural competence, and patient and family centered care: A roadmap for hospitals. Oakbrook Terrace, IL: Author.

About the Authors
Sarah W. Blackstone, PhD, CCC-SLP, is president of Augmentative Communication, Inc. She has authored multiple texts in the augmentative and alternative communication field as well as articles in Augmentative Communication News and other publications. David R. Beukelman, PhD, CCC-SLP, is the Barkley Professor of Communication Disorders at the University of Nebraska-Lincoln. He has served as director of research and education for the Communication Disorders Division, Munroe-Meyer Institute for Genetics and Rehabilitation at the University of Nebraska Medical Center. Kathryn M. Yorkston, PhD, BC-ANCDS, is a professor of rehabilitation medicine and head of the speech pathology division within the Department of Rehabilitation Medicine at the University of Washington Medical Center.

Are Your Services Educationally Relevant?

Jean BlosserSchool Programs in Speech-Language Pathology 5th Edition

Jean L. Blosser, EdD, CCC-SLP
President, Creative Strategies for Special Education
Author, School Programs in Speech-Language Pathology: Organization and Service Delivery, Fifth Edition, Plural Publishing, 2012

Educational Relevance—What an Important Concept!
Does a child’s disability impact his or her performance in the classroom? If yes, would services such as speech-language intervention, occupational therapy, or physical therapy make a difference? Should those services be intensive, provided face-to-face or via technology, or integrated into the classroom? The primary question is, if therapy services are offered, will the intervention provided make a difference in the student’s classroom performance, ability to access the curriculum, and/or ability to reach his or her potential?

These are huge questions that administrators, educators, clinicians, and parents ponder every day. When school teams evaluate a student, they seek to determine how the disability may be interfering with the student’s learning. Key educational areas that may be affected are academic, social-emotional, and vocational performance. If everyone agrees there is an adverse effect on educational performance, the student’s eligibility for services is confirmed.

How Do We Guarantee Educational Relevance? Continue reading

Augmentative and Alternative Communication: From Novice to Expert Clinician

By John McCarthy, PhD, CCC-SLP and Aimee Dietz, PhD, CCC-SLP

Augmentative and Alternative Communication

Augmentative and Alternative Communication by John McCarthy and Aimee Dietz

Understanding the personal story of an individual who uses augmentative and alternative communication (AAC) can have a positive impact on the attitudes of people without disabilities toward that individual (McCarthy, Donofrio-Horwitz, & Smucker, 2010). Almost any AAC specialist has story after story of moments when they have helped reveal the true abilities of an individual through AAC:

• The eight-year-old boy with cerebral palsy who everyone assumed had below average intellectual ability and presymbolic language skills, was in fact bilingual.
• The forty-year-old woman with bulbar onset amyotrophic lateral sclerosis who cannot dress or feed herself, but still manages her finances, parents her children, and makes end-of-life decisions.
• The eighteen-year-old girl with autism spectrum disorder whose potential to contribute to society was doubted, yet planned for employment after high school and managed a new mobile device-based communication system.
• The fifty-two-year-old man with stroke-induced aphasia who medical staff assumed was “incompetent”; however, still made informed decisions about medical care and enjoyed friendly banter on the golf course with his adult sons.  Continue reading

Bollywood comes to San Diego to raise money for the ASHFoundation

Angie making dinner at ASHFoundation fundraiser

Angie making dinner at ASHFoundation fundraiser

This past Saturday, June 7th, Plural President and CEO Angie Singh hosted a “Bollywood”-themed fundraiser at her home in La Jolla, CA, with proceeds benefiting the ASHFoundation. Created in 1946 by a visionary leader in the field of communication sciences, Wendell Johnson, the ASHFoundation is a charitable organization that supports the advancement of knowledge in this field and seeks to improve the lives of people with speech, language, or hearing disorders. Continue reading