Bilingual Speech Therapy of Houston was established in 2007 to help address the often unmet speech, language, feeding, swallowing, and cognitive-linguistic needs of the residents of Houston, Texas. Our dedication to the community as well as our...
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November is here and many of us are looking forward to the holidays. Many are fascinated with the feeling of holiday cheer. Let’s be honest, we can all use some holiday cheer as we wrap up this year. Incorporating holiday activities into my sessions helps spread holiday cheer. No matter what level or goals you're targeting, holiday themes (i.e., Thanksgiving, Christmas, Kwanza, Hannukah, New Year's eve, etc.) are easy to address in your therapy sessions. Here are some ideas to get started:
1. Sign up for an account on Boom Cards and Teacher Pay Teachers. Many creative therapists and teachers create and post activities throughout the holiday seasons that may be free or available for purchase. These are great sites if you feel creative and want to create your own activities.
2. GoGo Speech has been a wonderful resource I use for free activities. When you subscribe for GoGo Speech, the creator sends out free activities by email. Her activities can be used with green screen or as a power point download.
3. Holiday books are fantastic! Many may not have access to actual books during this time. Many therapists working via tele-therapy use digital resources like Vbooks. Additionally, sites like YouTube offer narrated books. It’s great to utilize a video or digital book because you can stop as need to incorporate goals.
4. Theme-centered pictures can easily be found online, printed, colored, and cut for pasting or for playing a game. Crayola offers a variety of holiday coloring pages that are great for coloring or painting. You can also draw a picture of a holiday item (snowman or turkey), then add in silly eyes, nose, ears, mouth, or hair.
5. Utilize theme-driven words for articulation activities. For example, if you are targeting /r/, write a list of /r/ words or print images related to your themed holiday. Google images offers a great supply of holiday-themed pictures.
6. BINGO! Who is not a fan of bingo? Utilize Microsoft Word to create bingo cards while incorporating pictures, words, phrases, or sentences to target goals. Create your cards around a holiday theme.
7. Utilize holiday theme pictures you can find through Google images to incorporate as conversation starters or description, sequencing, fluency activities.
8. Utilizing holiday movie clips are great for targeting goals to recall information, to describe, and for wh-questions as well.
9. Crafts are another fun way to include the holidays. If you are working in person, the patient's participation can be reinforced by working towards earning opportunities to cut ornaments for pasting items onto a Christmas tree or a turkey, depending on your focus. If you are working virtually, some platforms offer a white board feature you can utilize to add to a Christmas tree or to draw tail feathers onto a turkey.
As always, the focus is to provide skilled therapy while targeting patient goals in a fun way. That being said, we can definitely pair some holiday fun and cheer to our sessions. Happy Holidays!
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
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Motor speech disorders vs. Articulation disorders vs. Phonological processes: What’s the difference? Why does it matter?
MOTOR SPEECH DISORDERS
When we think of motor speech disorders, two general neurologically-based disorders come to mind, i.e., apraxia and dysarthria. Apraxia is generally characterized by a lack of coordination with the oral structures required to produce speech. The speaker may have difficulty producing speech sounds and words with consistency. For example, the same word may sound different with each production of that word. There may be difficulty with maintaining vowel sounds and with producing longer, more complex words—the major hallmark is inconsistency. Dysarthria is characterized by a general incoordination of the systems required to produce speech. This motor speech disorder is due to a weakness of one, some, or all, the speech system components. The speech systems in question include voice, respiration, resonance, or prosody. There are several different types of dysarthria. Motor speech disorder can be seen across the lifespan.
ARTICULATION DISORDERS
Articulation disorders may also be seen across the lifespan; however, they are most often seen with children. Children with typically-developing speech learn to produce speech sounds in a somewhat predictable pattern. In essence, children are expected to produce specific speech sounds by a certain age. Typically, by 7 or 8 years of age, all speech sounds should be developed—the sounds should be produced clearly nearly all the time if not all the time. When a child does not produce the expected speech sounds by the expected age then he or she may be identified as a child with an articulation disorder or a phonological disorder. One of the main threads that is key to understanding articulation disorders is that speech sounds develop as the child ages.
PHONOLOGICAL PROCESSES
Unlike articulation disorders, phonological processes are typically seen only with children or those who may have never stopped applying phonological processes to their speech. The general idea of phonological processes involves the elimination of rules that children apply to speech production. In principle, it is thought that children apply all phonological processes when they are learning to speak. For example, a child may not produce the last sound in a word or a child may not produce all syllables in a word because the child has not learned how to abandon the idea of dropping the last sound or syllable yet.
If you are having difficulty understanding your loved one, child or adult, it is important to discuss your concerns with a physician to decide if a speech and language evaluation is needed. A comprehensive, well-executed, speech and language evaluation along with the highly-skilled speech and language clinician will help you clearly chart your course and help you to decide the next, most appropriate, course of action. In some cases, intensive therapy may be indicated and as you may know, everything starts with a proper diagnosis.
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at mayoclinic.org or at asha.org. NOTE: This article is intended only as a general source of information, i.e., it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
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“When is this going to end? “
“I have had enough of this already!”
If you have spoken with anyone within the last several months you have probably heard something along these lines. Earlier this year we were all thrust into uncertainty with the onset of a pandemic for which none of us were really prepared. The repercussions have been great and many have been affected in some way. Having lived in the “new normal” for about seven months with no clear end in sight, many of us are simply getting tired of it all. We have had to make many adjustments in many areas of our lives, including wearing masks, social distancing, more frequent hand-washing, working from home, staying home to care for your loved ones...the list is endless.
Patient stress
Children have had to adapt quickly to new changes within their homes, schools, and communities. Many of these unexpected changes may contribute to anxiety and stress they feel on a daily basis. Additional stress may come from seeing their parents stressed, adapting to on-line school, or the anxiety of being back at school in-person. As we work with children, it is important to be aware of some of the areas that may be contributing to stress we see during therapy sessions. Here are some tips that may help a child feel more at ease during a therapy session:
Allow a child more time to process information and to respond
Begin the session with a positive or funny task
Let the child know sometimes we have stressful days and we understand
Provide an additional break 1-3 minute break between activities, if applicable
Parent/caregiver stress
Many of you can relate to hearing and seeing parents more stressed since the beginning of COVID-19. It helps to consider challenges and stressors they may be facing as we decide how to go about building rapport and understanding them during therapy sessions. Some parents by be facing unemployment, learning technology for the first time, worrying about in-school child safety, and dealing with daily parenting stressors. These stressors may present themselves as overwhelmed parents that may forget about their child’s scheduled session, arrive late, may seem short and frustrated, have less patience with technical troubleshooting for teletherapy, or may seem not as flexible with therapy treatment. The following tips may help with building and maintaining good rapport with parents during these uncertain and overwhelming times:
Listening to a parent express their concerns or worries for a couple of minutes goes a long way
Keep a resource list handy to provide to parents when need (local mental health number or community assistance programs)
In cases where parents possibly begin to “no show” or “cancel” sessions, set aside a time to schedule a meeting or call, to check in on them
Therapy-Life Balance
As with the optimal work-life balance many of us try to achieve, the same can be said for therapy in the context of people’s lives. Therapy is a critical component of many children’s lives; however, in the case of those that participate in online school/structured online learning, sitting at a computer for an additional 30-45 minutes with your speech and language professional may be the last thing you want to do. Some tips/ideas to help maintain a good balance may include:
Exercising for a few minutes between school and therapy
Going outside to breathe some fresh air
Playing a board game
Engaging in an electronic-free hands-on activity
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at https://mhahouston.org/covid19help/. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
REFERENCES
"COVID fatigue" is hitting hard. UC Davis. Retrieved on October 22, 2020 from https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard too-says-uc-davis-health-psychologist/2020/07
Your Mental Health During COVID-19 Outbreak. Mental Health America of Greater Houston. Retrieved on October 22, 2020 from https://mhahouston.org/covid19help/
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Back in the spring of 2020, many of us were blind-sided by the COVID-19 pandemic. Most clinicians in the field of speech-language pathology were likely providing face-to-face services or delivering services via more traditional methods, avenues, and means. Teletherapy, also referred to as telehealth, is not new to all clinicians but it is a relatively new service model for many clinicians from many disciplines—one that some of us have come to embrace. At the beginning of the pandemic, our clinic was unprepared for the transition to online services; however, we quickly learned to adjust to the service model that was new to us. The most important thing we realized was that we already possessed the needed skills to provide our services and we already possessed some of the needed skills to transition to an online environment; however, as with anything new, we also realized that there was a lot to learn. Here and in some future posts, we will discuss some of the things that have worked for us and, hopefully, work for you too.
Internet connection
The most important thing to consider is a solid, high speed internet connection. Without a good connection you may never even get to the point of seeing your patient on the screen—this can be frustrating. In addition to a solid connection, there are some other specifications that may be required for a speedy connection that will ensure a more reliable audio and video feed.
Platform(s)
There are numerous choices in where and how you host your online therapy sessions. Some have embedded therapy activities, while others offer no such thing but are much easier for your patients to access. In any case, the most important things to consider include minimum device requirements, minimum connectivity requirements (e.g., device, connection speed, etc.), HIPAA compliance, screen-sharing capabilities, and whether your patient can control your screen.
Computer(s)
A newer model, fast-starting laptop or desktop computer with a solid-state drive that can readily handle numerous open pages and a live audio/video feed, is highly recommended. In addition, a monitor 13 inches or larger will provide you with a reasonable amount of space to work with your patient, collect data, and the like. Some clinicians also opt for additional monitors that are wither used separately or in tandem. Though tablets and phones are not recommended, they can also be used but your offerings for your patient will be greatly limited.
Additional Device(s)/Considerations
Headphone(s)
A pair of good quality headphones, preferably noise cancellation headphones, will help to eliminate extraneous noise for you so that you can hear your patient as if you were in the same room with them.
Camera(s)
Needless to say, a webcam is a requirement; however, additional cameras are also very useful. For example, a document camera attached to one of your USB ports can be used to present any of your more traditional therapy items to your patients. For example, you can present a tablet, therapy cards, drawings, writing, or actual toys with the additional camera.
Digital pen
Though not an absolute necessity, a digital pen can come in handy for writing on the screen to help direct your patients to a particular word or item.
Applications/websites
Taking the time to create a go-to library or list of therapy-focused and/or kid -friendly sites and applications to use during therapy will ensure a good variety of activities.
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If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. NOTE: This article is intended only as a general source of information, i.e., it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. If you have an urgent medical need, please seek immediate medical attention.
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We need you to interpret right away! Over the years, having worked as a bilingual speech-language pathology assistant and a rehabilitation technician at a rehabilitation hospital, I can remember being asked to interpret for staff and patients that spoke Spanish—often with no warning or time for preparation. Many times, I was nervous about interpreting Spanish, even though I spoke the language fluently. Interpreters are highly-skilled professionals that deserve much respect and admiration. Having been utilized as a non-trained interpreter in situations that require a professional, trained interpreter, I have firsthand knowledge of the many misconceptions related to the skill level and wherewithal that goes into interpreting for others.
Interpreters are not required to obtain a college degree although many interpreting companies require certificates in the language(s) and settings (e.g., medical, educational, or government) in which one will interpret. Having been catapulted into situations that required professional interpreting, helped me to appreciate the beauty and fragility of the skill—one inaccurate interpretation and chaos might ensue. Each interpreting experience taught me some new things. Here are some of the things I have learned through my experiences.
Being knowledgeable of key vocabulary I was being asked to interpret
My first interpreting experiences occurred in the medical setting. After my first couple of experiences interpreting for others, I quickly learned that despite being a fluent Spanish speaker, I needed to become familiar with medical terminology quickly.
Keep an open dialogue with the professionals/patients you are interpreting for
In many languages, it is impossible to interpret word for word from English. Keep in mind it is imperative to interpret accurately, as diagnosis, interventions, decisions are based on the information being interpreted.
Awareness to different language dialects is important
Many common phrases in English do not translate into other languages. The use of the appropriate word to interpret may vary by dialect.
Sensitivity to culture
Culture mannerisms, beliefs, and traditions are good areas to acknowledge for when interpreting.
Needless to say, I am grateful for the catapulting interpreting experiences throughout my career. In the midst of some stressful situations, I was guided to see the importance of an interpreter. The skills and knowledge an interpreter possess are important to bridge communication barriers in a world full of beautiful languages.
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at stutteringhelp.org or at asha.org. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
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As a bilingual speech-language pathologist located in a major city in the United States, I can attest to the need for understanding how to work with professional interpreters. Working properly with a professional interpreter will help with better communication, improved interaction, a greater overall understanding, and eventually a more accurate diagnosis and appropriate therapy. As you know, these last two points are critical because much of our therapy is based on the initial diagnosis. With an improper diagnosis, you may be missing a real deficit, recommending therapy for one who truly may not need it at all, or you may be recommending more therapy than what is needed for your prospective patient.
In the ever-changing landscape of the United States, it is becoming increasingly likely that you will encounter others who speak a language that may be completely unfamiliar to you. You may feel unprepared or intimidated by the fact that you are the communication professional and you do not feel that you have a clear, direct line of communication with your patient. Luckily, there are professional interpreters available often in-person, by phone, and possibly even online. Now what do you do when your interpreter arrives? Here’s what we have found to be useful rules, tactics or techniques for working effectively with a professional interpreter:
· Learn about your prospective patient’s language and culture
o Access reputable sources to help you find good, reliable information
§ CHALLENGE: Not all cultures are the same
§ POSSIBLE SOLUTIONS: Before you see your patient, take the time to learn about general cultural norms, speech and language norms, and dialectal variations—you will quickly find that there is much to learn and you may find that there is not much information available about your prospective patient’s language
§ Recruit the help of others in the community or online
· Monitor the interpreter’s pauses and visual engagement with the patient while he or she is speaking--You are a communication professional—there are some universal signs of communication difficulties that you might be able to detect--pausing or stopping infrequently is one of them
§ PROBLEM:
· Prolonged pauses may be “normal” in the language being used but frequent and prolonged pauses and/or eye contact that does not appear to be culturally appropriate may also indicate that your interpreter is struggling to interpret your exact message
§ POSSIBLE SOLUTION
· Ask your core questions at different times and in different ways—this will help to improve your chances at arriving at an answer that matches your questions
· Talk to your patient and make culturally appropriate eye contact with your patient
o You should do everything in your power to help your patient feel valued
§ PROBLEM: Oftentimes, patients are somewhat left out of the conversation although everyone is present because of the patient
§ POSSIBLE SOLUTION: If you are in the same room, consider having all participants across from each other in a triangular position to help encourage equal dialogue and opportunity for a viable communication exchange
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If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at stutteringhelp.org or at asha.org. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please call 9-1-1 or speak with your physician.
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Since earlier this year, many of us have had to become tele-therapists overnight—the adjustment has been difficult for many of us. Most clinicians were probably providing speech and language services in a more traditional sense, i.e., face-to-face, and with some use of technology mostly in the form of tablets, an image on a cellphone, or a shared computer screen. With the unanticipated onset of COVID-19 we have quickly become keenly aware of the risks associated with being with or near others, especially in small environments—as a result, we were thrust into the world of therapy online. Teletherapy, or telehealth, has proven itself as a viable alternative to in-person therapy, especially when all users are proficient participants, timing is coordinated, and all of the technology is working well. However, when all is not working well or going smoothly with a therapy or an evaluation session there may be some things for us to consider. Cultural sensitivity has its place here as well. Here are some things to consider:
Literacy
Basic reading and writing skills are important for daily functioning. Some people may get by in a non-computer environment with some difficulty, they may learn to compensate, and/or have others assist them to complete tasks that require functional reading and writing skills--in an online environment, this difficulty can be magnified. As such, others' reading and writing skills should not be taken for granted. Clinicians of all types that deliver services online should be mindful of this potential obstacle and do their best to work with the patient or family member that has trouble reading or writing so that services can be accessed. A solution may involve incorporating others that are trusted by the responsible party.
Computer literacy
Computer literacy is another skill we need to recognize as critical for online service delivery. Just as we clinicians adjusted to the difficult task of online therapy, our patients have had to do the same. In some instances, our patients and or family members had little to no use of technology to access services. We have all had to learn about new applications, platforms, websites--the list continues. A helpful idea here may be to take the time to work through the basic or most important features available before you need deliver the service--this can help alleviate stress for all involved and can contribute to a much smoother session.
Technology available
It is no secret that access to technology is equal for all. Some people have multiple devices such as computers, tablets, cellphones, and the like. Others may have only a phone available. Understanding what is available to families and adjusting your services is critical to providing your patients with quality service delivery.
Internet reliability
As with technology, not all of us have a solid, reliable internet connection. However, we can make adjustments as needed to improve the signal. For example:
if you or your patient are on a mobile connection and you have a poor signal you should consider sitting closer to a window
if you or your patient are on network connection and you have a poor signal you should consider the following:
decrease the number of devices connecting to the network during therapy
move your device closer to the modem and/or router
connect your device to the modem or router
reset your modem or router
Work schedule
some parents need to shift around on your schedule because they have to work
as clinicians we need to understand and respect that parents have many responsibilities that involve more than the service we provide
Other unknown or unidentified needs
Life can be complicated and unpredictable for many--let's be flexible and understanding
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If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at stutteringhelp.org or at asha.org. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
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When targeting fluency with a child there are many points to consider. It is important to consider the level of sensitivity a child expresses towards his or her stuttering when selecting activities.
Does the child become anxious in the presence of others?
Does the child’s speech improve when in a one-to-one setting?
Has the child progressed to speaking fluently around others?
These factors can drive activity planning. As many can relate, finding super cool and fun activities that take all facets of stuttering therapy into consideration can be a challenge. I have found that scavenger hunts can transform fluency activities into adventures to help lessen the stress of speech therapy for children. Scavenger hunts are exciting adventures that children can come to anticipate (Note: Always remember HIPAA regulations and clinic/school/home safety guidelines, precautions, and measures. Here are some ideas to get you started:
Set up a scavenger hunt around your office, classroom, school, clinic, and even a home health setting.
If a safe area is available, consider having a scavenger hunt outside.
Personalize each search with a fluency, target, strategies, exercises, or opportunities to speak with others.
Simplify the activity to be one-on-one or incorporate peers or other staff.
Incorporate a few or many searches depending on the child:
Utilize puzzle pieces or potato head parts for a child to find and assemble
Search for clues to a song or riddle
Create cards that provide items they have to find by color, size, or description
Search for small prizes to build excitement for the child
Use picture cards or game cards
Become a pirate and utilize a map to find fluency treasures
Travel the world, see attractions, or become a part of a sporting event by basing each clue/search on a theme
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If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at stutteringhelp.org or at asha.org. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
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Culture, as it is widely understood, is related to one’s way of life. According to Zimmerman “Culture is the characteristics and knowledge of a particular group of people, encompassing language, religion, cuisine, social habits, music and arts.” As a result, culture permeates all facets of one’s life. In a world with ever-increasing diversity, cultural sensitivity, like linguistic sensitivity, is important to consider when working with people who may or may not share a similar background with the clinician. It is known that you do not have to be speak another language or be from another country or city to have a culture that differs from that of another person. It is crucial for clinicians to gain an understanding of differences and similarities between cultures for the purpose of forging common ground while learning to adjust to cultural differences. As clinicians, our role is to be objective while also being aware of and sensitive to subjective differences—a “one size fits all” approach does not work. So, how can we start the process of increasing our cultural sensitivity? Here are some ideas that incorporate your different senses:
This might be surprising but you should find a reputable source to learn more about your culture. You might be amazed by what you find—this may help you to understand other people’s perspectives about you
Find a reputable source to learn more about the culture of other groups
This is crucial because unreliable sources may give you inaccurate information about others—assumptions are not useful in this context
Learn to speak another language
This is a great way to connect to others that speak another language—it is very likely that many doors will be opened for you
Visit markets, shops, and restaurants where you can learn about other groups
You can learn new words, try on some different garb, and try some new foods
Go to a museum so that you can learn a bit about other cultures’ histories
Visit or live in a place that has a culture different from your own
Immersing yourself in another culture is one of the best ways to learn about others
Befriend others from cultures different from your own
Observe other groups and listen—take in all the different sights and sounds
Most importantly, disregard your assumptions, disregard your expectations of others, and have an open mind. Lastly, accept and embrace the differences. By learning about other cultures, you will learn many things that you may not have known beforehand. It's important to note that you may not need to go far to learn about other cultures. This will contribute to you becoming a well-rounded, knowledgeable clinician.
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If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at stutteringhelp.org or at asha.org. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
REFERENCES
Zimmerman, K.A. Live Science: What is Culture? Retrieved from https://www.livescience.com/21478-what-is-culture-definition-of-culture.html on September 1, 2020.
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Are you experiencing some unforeseen challenges with your online therapy sessions? As we all continue to grapple with the technology challenges associated with providing or receiving services online (see our post titled Teletherapy Success: Ideas for Those Delivering or Receiving Therapy Online for technology tips and ideas related to providing therapy online), we are learning of other unanticipated issues that may make it even more difficult to provide services effectively. Luckily, for you, we have narrowed down our list of non-technology-related issues that may need to be addressed so that you can have a smooth therapy session. We have attached a list of items, in English and in Spanish, that we include on the tip sheet we share with families when we are considering online therapy for their loved ones. As always, clear communication can yield positive results—as we have seen. Please feel free to share these with your patients and email us at [email protected] with your questions. We would love to hear your thoughts.
GENERAL RULES
All participants should be fully clothed during the teletherapy session
Patients should eat before their therapy or evaluation
All distractions (toys, food, electronics) should be removed from the patient and his or her surroundings
A responsible adult should be near the pediatric patient at all times
Only the patient and caregiver should be in the session
For younger children:
Parents should not answer for their children
Parents are encouraged to let their children answer questions for themselves
Please allow your child’s therapist help your child in the way that will best elicit a response from the child—the therapist is trained to help your child in the best way possible
PUNTOS IMPORTANTES PARA LA TERAPIA EN LINEA
REGLAS GENERALES
Todas las personas dentro de la visión de la cámara deberían estar completamente vestidas
Los pacientes deben comer antes de su tratamiento o evaluación
Todas las distracciones deben ser retiradas del paciente y del ambiente inmediato durante la sesión de terapia en línea
Si el paciente es un niño un adulto responsable debe estar cerca del paciente para la visita
Sólo el paciente y el cuidador deben estar en la sesión
Para los niños más pequeños:
Los padres no deben responder para sus hijos
Los padres deben dejar qué sus niños contesten las preguntas del terapeuta
Por favor permita a la ayuda del terapeuta—el terapeuta ha sido entrenado para ayudar a su hijo del mejor modo posible
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If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. NOTE: This article is intended only as a general source of information, i.e., it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. If you have an urgent medical need, please seek immediate medical attention.
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Finding novel, highly-motivating activities has always been a challenge. The push for creativity and out-of-the-box thinking is an ongoing reality especially with tele-therapy becoming the new normal. Recently, I started embellishing my speech sessions with free virtual visits to popular museums, zoos, special attractions, and national parks. Utilizing virtual visits allows one to address speech goals while catering to each patient’s personal interests while expanding the battery of therapy tools available at one’s disposal.
Virtual field trips offer the flexibility to utilize free tours online through your speech platform. Because patients, parents, caregivers, and others can easily access the sites as well, these virtual tools can help with generalization, or carryover, of skills that are targeted in therapy. Virtual tours can be paired with pictures, words, and sentences using a Word document, Boom cards, or Google images. For therapists providing in-person therapy, virtual field trips offer an activity that can be done on a tablet or laptop to help with utilizing materials that are easy to sanitize. If you would like to pair some target words, pictures, sentences with your virtual tour, you can consider printing out your targets and laminating them to make them easy to sanitize. Check out the following links—maybe you’ll use some of these in your next session.
ZOO
https://zoo.sandiegozoo.org/live-cams
https://www.houstonzoo.org/explore/webcams/
https://nationalzoo.si.edu/webcams
https://www.montereybayaquarium.org/animals/live-cams
WORLDWIDE ATTRACTIONS
https://www.nasa.gov/nasa-at-home-virtual-tours-and-augmented-reality
https://www.earthtv.com/en
https://www.universalorlando.com/web/en/us
https://www.visitlondon.com/things-to-do/sightseeing/london-attraction/webcams-of-london
NATIONAL PARKS
https://www.nps.gov/subjects/watchingwildlife/webcams.htm
MUSEUMS
https://www.metmuseum.org/art/online-features/met-360-project
https://www.louvre.fr/en/visites-en-ligne
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at stutteringhelp.org or at asha.org. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
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Stuttering is one of the disorders that people are most familiar with when it comes to speech-language pathology. Stuttering may develop in early childhood and persist throughout the life span. Some types of stuttering, e.g., developmental, will likely fade over time while other types of stuttering are lifelong. Stuttering may be characterized by, but not limited to, the following: frequent pauses (e.g., John...can I go...to the store...with you?), word repetition (e.g., John...John...John...can I go...go...go...go...go to the store...with you?), phrase repetition (e.g., John...can I go...can I go...can I go to the store...with you?), or prolongation of sounds (e.g., John can I go to the ssssssssstore...with you?).
It can be difficult for those who stutter to get their point across quickly and clearly. The listener(s) may not know how to react to the disfluent speech. Although there is no one clear explanation of why stuttering occurs, there are several factors that have been found to be useful to enhance the speaker’s fluency. Luckily, there are some things that listener(s)/speaking partner(s) can do to promote fluent speech.
Tips to promote fluent speech:
Turn off the television when you are having a conversation
Don't look at your phone or computer when you are listening to the person that is stuttering
Go to a quiet place that is free from other people
Maintain eye contact while speaking to the person that is stuttering—this lets the speaker know that their communication is valuable
Slow down your rate of speech
Speaking with a slower rate of speech can send the message that you are not in a rush; real, or perceived, time constraints may result in more disfluent speech
Don’t rush your child to answer/speak
Allow your child to finish what he or she is saying—don’t interrupt him or her
Don’t bring attention to the stuttering in younger children
Modeling may be a more effective means to promote increased fluency
In older children/teenager, encourage the use of the fluency strategies they have learned in speech therapy
Do not ask children to repeat themselves or to start over again
If your child becomes frustrated when speaking due to stuttering, take a break from the conversation and come back to it at a later time
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. Additional information on this topic can be found at stutteringhelp.org or at asha.org. NOTE: This article is intended only as a general source of information, i.e, it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. Lastly, if you have an urgent medical need, please seek immediate medical attention.
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Parents have expressed their concern about providing speech therapy in a language that is not their home language. The fear of their child forgetting their home language can be concerning. In America, the education system provides the majority of its teachings in English. There are some schools that offer bilingual programs. The fact that most children are surrounded by the English language most of their day at school or by older siblings at home, does assist in them learning the language. Leading to commonly hearing questions that express a parent’s concern over the language their child’s speech services will be delivered.
Q: Will my child forget his or her home language?
A: Children can experience language loss when there is a lack of exposure to that language. Some key factors for maintaining one’s language skills is daily practice and frequent exposure to the language(s).
Q: Can my child’s therapy be in our home language?
A: It depends. The language(s) used in therapy are selected after a full speech and language evaluation is completed by a speech-language pathologist. The language(s) used in therapy will be selected based on the child’s skill level in and exposure to each language.
Q: Can therapy be in English, so my child learns the language better.
A: In the benefit of your child, it is best to deliver speech therapy in the language the speech-language pathologist deems most appropriate based on results from their evaluation. Children that know more than one language have a unique ability to learn/know/understand a second or multiple languages.
Q: Is a speech therapist a language teacher?
A: No. Speech and language professionals are licensed, and often certified, clinicians that specialize in treating communication skill deficiencies. While speech and language professionals work with those who have or are suspected to have communication disorders, language teachers generally work to teach a new language.
Q: How does a speech-language pathologist decide which language to provide speech services to best target the child’s speech and language deficits?
A: A speech-language pathologist will evaluate the child’s understanding and use of all languages to which a child is exposed. The results of the evaluation form the basis for many decisions that are made for therapy--in this case, the language of delivery.
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. NOTE: This article is intended only as a general source of information, i.e., it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. If you have an urgent medical need, please seek immediate medical attention.
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One of the many resources most speech and language professionals refer to is a developmental chart. Developmental charts typically cover several developmental domains like communication skills, cognitive skills, social-emotional skills, adaptive behavior, and physical skills.
Communication--related to understanding and use of verbal and/or nonverbal means of communication
Cognitive skills--related to one's thought processes and functional problem-solving
Social-emotional skills--refers to interaction with and attachment to others
Adaptive behavior--generally refers to self-care
Physical skills--related to one's body awareness and muscle control
The information covered in developmental charts basically includes what most children are typically accomplishing at or by a particular age. Because developmental charts generally serve as guides, they are not absolute, i.e., there is a range of ages by which children should be accomplishing certain developmental tasks. For example, a child that is not walking by his or her 1st birthday should not raise any alarms in and of itself--there is an acceptable range for establishing this skill. However, when there are suspected or confirmed delays that are significant, developmental charts can be utilized as a catalyst for a meaningful, objective conversation and, more importantly, intervention. After a thorough medical evaluation is completed by the child's physician that confirms the delay, the child is referred to professionals that can help to identify and treat the areas of difficulty. Intervention may involve referral to one or several physicians or other healthcare professionals.
In some instances, the child's physician may refer the child to a speech-language pathologist for a comprehensive evaluation of the child's communication skills. Speech-language pathologists, like other professionals familiar with typical and atypical development inherently utilize information related to "ages and stages" that constitutes a developmental chart. Once a diagnosis is made by the speech-language pathologist, he or she will create an intervention plan that is at essentially based on the information found on a developmental chart. From time to time, the speech-language pathologist will update the child's intervention plan, again, oftentimes with a developmental chart in sight or at least in mind. If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. NOTE: This article is intended only as a general source of information, i.e., it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. If you have an urgent medical need, please seek immediate medical attention.
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WH- questions, unlike yes/no questions, are open-ended questions. WH- questions require responses that can easily exceed one-word in length. By implementing modeling and expansion techniques, longer utterances can be developed. Yes/no questions require only a yes or no response.
Wh-questions are a great way to help build your child’s language skills at home. How can you practice wh-questions without the worry of spending extra time with homework, after a long day of work? Utilize daily routines, topics of interest, hobbies, or family activities to implement these questions throughout your day.
As an example, we can discuss an orange.
Who grows oranges?
What do you do with an orange?
Where do oranges grow?
When do you eat oranges?
Why do you eat oranges?
How do oranges grow?
A second example, we can discuss school.
Who helps us learn?
What did you learn about at school?
Where did you go after school?
When do you eat lunch?
Why do you go to school?
How do you get to school?
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. NOTE: This article is intended only as a general source of information, i.e., it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. If you have an urgent medical need, please seek immediate medical attention.
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What is phonological awareness? What does it have to do with speech and language?
Phonological awareness is related to one's detection of differences between sounds and words. As with most areas, there is a hierarchy of skills that are developed in a set sequence. Phonological awareness includes but is not limited to skills like rhyming, counting the number of words in sentences, and counting the number of syllables in words. These skills are regularly practiced in preschool settings; however, lack of development in this area will likely be detected well beyond the preschool years.
With older children, difficulties with phonological awareness may be mistaken for an articulation disorder—difficulty with producing speech sounds. Those with limited phonological awareness may mispronounce words or produce unclear speech because of decreased detection of differences between words, sounds in words, and the like. Children with difficulty in this area may pronounce individual speech sounds without any difficulty but they may struggle when producing longer or less common words and/or when comparing words. Difficulty with phonological awareness may also show up in writing—this is because the child will write what he or she hears, exactly as he or she hears what was spoken by another.
What can I do if I suspect my child is experiencing difficulty with phonological awareness?
Talk to your child’s teacher and his or her pediatrician if your child is not yet receiving speech and language services. However, if your child is already receiving speech and language services from a qualified speech and language professional then you should talk to that person. He or she will guide you towards the best approaches for correctly diagnosing and treating this area of struggle. Oftentimes, after some solid intervention, you will notice marked improvements
Photo by Simon Matzinger from Pexels
What can I do at home to help my child improve his or phonological awareness?
Sing along with your favorite songs
Practice nursery rhymes
Play with words, e.g., have your child say a word that starts with the same initial or final sound you produce
Practice rhyming words—you can even use nonsense words, e.g., cat--mat--wat
Utilize games or apps that promote learning or producing the sounds each letter makes: Ex: A is for apple, B is for ball, C is for cat. Also, games that practice letter sound combinations: Ex: ma, me, me, mo, mu.
Practice counting out the syllables to words. Ex: Cat – 1 syllable, gator-2 syllables, celebrate-three syllables.
Beginner reading books are great to help piece together sounds and letter recognition.
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. NOTE: This article is intended only as a general source of information, i.e., it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. If you have an urgent medical need, please seek immediate medical attention.
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The rapidly increasing use of technology for speech-language pathology services via telethealth has generated many questions and challenges for many of us, parents and clinicians alike. Seemingly overnight, we transitioned to online services only and we were inherently asked to provide a level of service that meets or exceeds the quality of the services we deliver in-person. Along the way, we found some tips, tricks, and ideas that may make it easier for those that receive or deliver synchronous (i.e., in real-time) therapy in an online setting. Here are some ideas for you to give or receive higher quality therapy.
Use a reliable device
a phone, a tablet, or a computer will work
Establish a good internet connection
run a free speed test online to ensure that your electronic device and your internet connection won't lag
Work in a secure environment
Use a firewall on your computer
Work in a virtual private network (VPN)
Use a HIPAA-compliant platform
it doesn't need to be therapy-specific but your privacy and confidentiality should be respected and maintained
Use headphones
those receiving therapy can split their audio connection so another authorized person can listen--this may help to decrease the impact of competing sounds
Eliminate distractions in your environment
this includes people, other devices, e.g., TV, phone, tablets, people, animals
Let the therapist work with your loved one as he/she would in any setting, e.g., clinic, office, school setting--let your loved one engage in some problem-solving with the clinician
people receiving therapy typically struggle with what we are addressing in therapy
speech and language professionals are specially-trained to address these difficulties using a variety of techniques that may or may not be familiar to the untrained eye
Clinicians should use the internet to provide patients with a great variety of resources to keep everyone highly motivated
As you may know, those receiving therapy online must be provided with a teletherapy-specific consent form. Additionally, unauthorized observers are not allowed on either end of teletherapy. As a result, some of the aforementioned challenges, e.g., eliminating distractions, will naturally be resolved if each patient's privacy is respected and maintained.
Photo by August de Richelieu from Pexels
If you or someone you know needs the services of a licensed and certified speech-language pathologist, please be sure to discuss your concerns with a physician, a speech-language pathologist, or another qualified provider. You can also find a provider through the ASHA ProFind service or visit us at www.bilingualspeech.org for more information. NOTE: This article is intended only as a general source of information, i.e., it is not intended to replace information given to you by a qualified health professional that is familiar with your particular circumstances. If you have an urgent medical need, please seek immediate medical attention.
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