Telespeech Practice: Reaching the Underserved

Rebbecca is a 4 year-old with a severe language learning disorder. She lives in a remote area where she has access to speech services twice in six months. In another part of the country or the world, an SLP looks for opportunities with flexible hours, avoid traveling costs and tremendous amounts of paper work. How can both their needs be met? This is where ‘Telespeech Practice’ (TSP) comes in. In ASHA's recent position statements (2005), telepractice is defined as "the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation."
Speech-Language Pathologists are increasingly applying tele-health technology to provide training, education, assessment, and intervention. Here is an example of an existing system for a school environment: the student at the school (with the help of teacher’s aide) will connect to the SLP at her online office with a secure login. The SLP will work on goal-directed activities established in her lesson plan via the webcam and conclude the ses-sion by assigning homework and video messages for later viewing in a Virtual Backpack. The child can login at home or at school and do the assigned homework with a caregiver. Progress notes and reports are generated during and after each session so that the special education team including parents have access to the child’s goals, progress, and related activities.
Benefits and Challenges
Increasing need for services, shortage of personnel in rural areas, and the benefit of receiving services in clients’ home community makes telepractice critical (Kully, 2008). Besides being cost effective and environment-friendly, all documentation can be stored, completed and sent securely online. Students can also avoid missing school days by not travelling to a distant hospital or practice. A good clinical relationship can easily be achieved with the client (Brick, 2008) and active involvement of teachers and parents also helps with generalization of goals beyond the clinical sessions. School administrators welcome the idea of helping a child whose clinical needs might not be met otherwise. The biggest drawback of telespeech practice is the unavailability of hands-on treatment for clients with issues such as articulatory placement. Technical problems can also pose a glitch at any time. Despite these, telespeech therapy for stuttering, articulation, dysphagia, and stroke have shown reliable results in various programs of telespeech practice across the United States (Mashima, Birkmire-Peters, & Holtel,1999; O'Brien, Packman, & Onslow, 2008).
The children I work with are excited each time they see me on the computer and often have others students vying for this online attention! They achieve goals via fun interactive games and often have to be forced to end the session. I have found that telepractice is a wonderful service deliv-ery model that has the potential to fill the gap in speech-language treatment services.


References:
American Speech-Language-Hearing Association. (2005). Speech-Language Pathologists Providing Clinical Services via Telepractice: Position State-ment [Position Statement]. Available from www.asha.org/policy.
Brick, M. (2008). Addressing Rural populations and the Speech language Pathologist shortage with Telepractice. Presented for ASHA 2008, Chicago.
Mashima, P., Birkmire-Peters, D., & Holtel, M. (1999). Telehealth applications in speech-language pathology. Journal of Healthcare Information Man-agement, 13(6), 71–78.
O'Brien, S., Packman, A., & Onslow, M. (2008). Telehealth Delivery of the Camperdown Program for Adults Who Stutter: A Phase I Trial. Journal of Speech, Language, and Hearing Research, 51(1), 184-195.

Narrative Skills

Check out this SlideShare Presentation:

Narrative Skills

View more presentations from William Breitsprecher.

Baby Einsteins: Not So Smart After All

Here is an article that a friend forwarded.

http://www.time.com/time/health/article/0,8599,1650352,00.html?cnn=yes

Digg

The claim always seemed too good to be true: park your infant in front of a video and, in no time, he or she will be talking and getting smarter than the neighbor's kid. In the latest study on the effects of popular videos such as the "Baby Einstein" and "Brainy Baby" series, researchers find that these products may be doing more harm than good. And they may actually delay language development in toddlers.

It's not the first blow to baby videos, and likely won't be the last. Mounting evidence suggests that passive screen sucking not only doesn't help children learn, but could also set back their development. Last spring, Christakis and his colleagues found that by three months, 40% of babies are regular viewers of DVDs, videos or television; by the time they are two years old, almost 90% are spending two to three hours each day in front of a screen. Three studies have shown that watching television, even if it includes educational programming such as Sesame Street, delays language development. "Babies require face-to-face interaction to learn," says Dr. Vic Strasburger, professor of pediatrics at the University of New Mexico School of Medicine and a spokesperson for the American Academy of Pediatrics. "They don't get that interaction from watching TV or videos. In fact, the watching probably interferes with the crucial wiring being laid down in their brains during early development." Previous studies have shown, for example, that babies learn faster and better from a native speaker of a language when they are interacting with that speaker instead of watching the same speaker talk on a video screen. "Even watching a live person speak to you via television is not the same thing as having that person in front of you," says Christakis.Led by Frederick Zimmerman and Dr. Dimitri Christakis, both at the University of Washington, the research team found that with every hour per day spent watching baby DVDs and videos, infants learned six to eight fewer new vocabulary words than babies who never watched the videos. These products had the strongest detrimental effect on babies 8 to 16 months old, the age at which language skills are starting to form. "The more videos they watched, the fewer words they knew," says Christakis. "These babies scored about 10% lower on language skills than infants who had not watched these videos."

This growing evidence led the Academy to issue its recommendation in 1999 that no child under two years old watch any television. The authors of the new study might suggest reading instead: children who got daily reading or storytelling time with their parents showed a slight increase in language skills.

Though the popular baby videos and DVDs in the Washington study were designed to stimulate infants' brains, not necessarily to promote language development, parents generally assume that the products' promises to make their babies smarter include improvement of speaking skills. But, says Christakis, "the majority of the videos don't try to promote language; they have rapid scene changes and quick edits, and no appearance of the 'parent-ese' type of speaking that parents use when talking to their babies."

As far as Christakis and his colleagues can determine, the only thing that baby videos are doing is producing a generation of overstimulated kids. "There is an assumption that stimulation is good, so more is better," he says. "But that's not true; there is such a thing as overstimulation." His group has found that the more television children watch, the shorter their attention spans later in life. "Their minds come to expect a high level of stimulation, and view that as normal," says Christakis, "and by comparison, reality is boring."

He and other experts worry that the proliferation of these products will continue to displace the one thing that babies need in the first months of life — face time with human beings. "Every interaction with your child is meaningful," says Christakis. "Time is precious in those early years, and the newborn is watching you, and learning from everything you do." So just talk to them; they're listening.

Nursery Rhymes And Language Development

My son, who is 2.5 years old has been learning a few nursery rhymes over the past 6 months. He has been hearing it since he was a baby. Recently , I bought a second hand book of common nursery rhymes which had a CD in it too. He was just too captivated , listening to the CD and also following the song in the book. It's only been a few weeks and he has learnt 3 rhymes and 2 rhymes (earlier heard and learnt)have become clear, speech vice.

Some observations:

• He pays more attention to the words and music. Consequently, I have seen he plays more by himself (giving me some time to do things)(Increased attention ans concentration span with creative play)
• Tries to follow the words in the book for each individual rhyme, thus building awareness of print and sounds heard( building up Phonological awareness). Exploring the illustrations and talking about them.
• Sings along with the music and has improved catching up with the words.

Some researchers have found that children’s early knowledge of nursery rhymes is related to their development of emergent reading abilities, specifically phonemic awareness skills (i.e. the awareness of sounds and their association with letters within words). Reading skills are the not the only skills they develop. Listening and thinking skills are developed along with singing rhymes.

What you can do:

1. Expose your child to a rhyme either through you singing or through a CD repeatedly. So they will become familiar to it.
2. Associate actions along with those that you know. Encourage them to participate but don't force them.
3. If you have a book with the rhymes , show them and read along with them pointing your finger to each word. Explain the illustration and talk about the rhyme.Stimulating discussions are a great way to build oral language and comprehension skills.
4. Repeat , Repeat and repeat. Is the key to your child learning and enjoying the rhymes.

Have fun singing and dancing with your children!

Listening to the Whole Sentence

Listening to the Whole Sentence

How to deal with listening and comprehension difficulties caused by complex sentences.

By Susan Zimmerman, MA, CCC-SLP

Many of the students we work with have difficulties with listening and comprehension, especially when they encounter sentences that are longer than five to seven words. They usually can interpret simple declarative and interrogative sentences, but they may need to have them repeated.

What happens to children's ability to listen and comprehend when sentences are longer and more complex and express gradations in meaning? How can they "listen their way" through these sentences and interpret the meaning? We can express great thoughts with simple sentences, such as "Love is kind" or "It hurts to be hungry." But what if we want to talk about relative values or conditional truths? We have to use more complex language, like "Because love is kind, I will show I love you by being kind to you," or "It hurts to be hungry, but it's worse to be hungry and alone."

One of the great rewards of practicing speech therapy is taking complex skills and breaking them down into parts. Not only does this help students learn how to manage the parts of speech and language, it helps them put everything together.

There are many ways to create complex sentences. We typically use coordinating or subordinating conjunctions and adverbs to combine phrases and clauses. I present the main part of a complex sentence and help students understand how to manipulate it to refine meaning.

The first step is to get some sentence strips big enough so all students at the therapy table can see them easily. Write adverbs and conjunctions on individual slips of construction paper or index cards, and give each student a small pile. Each child should have identical stacks of words. I suggest using the following words or phrases: "because," "since," "or," "when," "although," "however," "but," "except" and "even though." I would not put "and" in the stack because it doesn't help with auditory complexity.

Present a simple sentence on the sentence strip. Leave an underscore at the beginning and end of the sentence to allow room for the adverb or conjunction. Read the written sentence, such as "I like apples," to the group, then alter the sentence by saying something like, "Although I like apples, I like oranges better." You then can perform the following steps in any order:

• Students repeat the expanded sentence.
• They find the adverb or conjunction in their pile.
• They identify whether it came at the beginning or end of the original sentence.
• Question students about the meaning of the sentence. Does this person like apples? Do they like oranges? How do you know? If they had a choice, which one would they pick?
• Do they agree with the expanded sentence? How would they change it if they could? Would they turn it around? Would they add another fruit?

Depending on the needs of your group, you can stay with this one sentence for the entire session or move on to another sentence, such as "Basketball is fun to watch." You can expand this sentence in the same way depending on the needs of your group. For example, you can say, "Although basketball is fun to watch, I like football better," or you can expand it to say, "Basketball is fun to watch, although it gets very noisy!"

Go through the steps each time you expand a sentence. I do not recommend writing down the expanded sentence because the main point of the lesson is to improve auditory processing. We are working on helping students understand what they hear the first time they hear it, and we want to give them as many trials as possible in the time we have with them. Writing down sentences can come a little later when they are sure of what they have heard.

One reason I like this therapy activity is that all preparation can be done ahead of time and saved for many sessions. Since only the basic sentence is written on the sentence strip, you can expand it differently the next time without the need for more preparation.

You can use this lesson at any age, depending on the needs of your students. They don't have to be able to read. As long as one student in the group can find the written adverb or conjunction, he or she can show the others. Students also can guess until they find it.

After completing a sufficient number of lessons, students will become comfortable with the process and demonstrate an increased understanding of complex sentences. You then can let them make up their own sentences. Either you or the students can suggest a core sentence, and they can take turns expanding it in different ways. Make sure they are listening to and understanding each other. It's important to check for comprehension frequently by asking questions.

I do not use this as a grammar lesson about parts of speech. I don't even use the words "adverb" or "conjunction." I just call them words to help us tell more.

Susan Zimmerman is on staff at Madison Elementary School in Madison, ME. She can be contacted at szimmerman@mes.sad59.k12.me.us.

Summer is over!

Summer is over!

After a great relaxed summer, things must get back to how it used to. Work, New clients, new learning, new discussions.
Look out for new developments, articles and discussions in this blog. I will be posting once a week on Wednesday.
Have a great week!

Unraveling how children become bilingual so easily

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer Tue Jul 21, 3:08 am ET

WASHINGTON – The best time to learn a foreign language: Between birth and age 7. Missed that window?

New research is showing just how children's brains can become bilingual so easily, findings that scientists hope eventually could help the rest of us learn a new language a bit easier.

"We think the magic that kids apply to this learning situation, some of the principles, can be imported into learning programs for adults," says Dr. Patricia Kuhl of the University of Washington, who is part of an international team now trying to turn those lessons into more teachable technology.

Each language uses a unique set of sounds. Scientists now know babies are born with the ability to distinguish all of them, but that ability starts weakening even before they start talking, by the first birthday.

Kuhl offers an example: Japanese doesn't distinguish between the "L" and "R" sounds of English — "rake" and "lake" would sound the same. Her team proved that a 7-month-old in Tokyo and a 7-month-old in Seattle respond equally well to those different sounds. But by 11 months, the Japanese infant had lost a lot of that ability.

Time out — how do you test a baby? By tracking eye gaze. Make a fun toy appear on one side or the other whenever there's a particular sound. The baby quickly learns to look on that side whenever he or she hears a brand-new but similar sound. Noninvasive brain scans document how the brain is processing and imprinting language.

Mastering your dominant language gets in the way of learning a second, less familiar one, Kuhl's research suggests. The brain tunes out sounds that don't fit.

"You're building a brain architecture that's a perfect fit for Japanese or English or French," whatever is native, Kuhl explains — or, if you're a lucky baby, a brain with two sets of neural circuits dedicated to two languages.

It's remarkable that babies being raised bilingual — by simply speaking to them in two languages — can learn both in the time it takes most babies to learn one. On average, monolingual and bilingual babies start talking around age 1 and can say about 50 words by 18 months.

Italian researchers wondered why there wasn't a delay, and reported this month in the journal Science that being bilingual seems to make the brain more flexible.

The researchers tested 44 12-month-olds to see how they recognized three-syllable patterns — nonsense words, just to test sound learning. Sure enough, gaze-tracking showed the bilingual babies learned two kinds of patterns at the same time — like lo-ba-lo or lo-lo-ba — while the one-language babies learned only one, concluded Agnes Melinda Kovacs of Italy's International School for Advanced Studies.

While new language learning is easiest by age 7, the ability markedly declines after puberty.

"We're seeing the brain as more plastic and ready to create new circuits before than after puberty," Kuhl says. As an adult, "it's a totally different process. You won't learn it in the same way. You won't become (as good as) a native speaker."

Yet a soon-to-be-released survey from the Center for Applied Linguistics, a nonprofit organization that researches language issues, shows U.S. elementary schools cut back on foreign language instruction over the last decade. About a quarter of public elementary schools were teaching foreign languages in 1997, but just 15 percent last year, say preliminary results posted on the center's Web site.

What might help people who missed their childhood window? Baby brains need personal interaction to soak in a new language — TV or CDs alone don't work. So researchers are improving the technology that adults tend to use for language learning, to make it more social and possibly tap brain circuitry that tots would use.

Recall that Japanese "L" and "R" difficulty? Kuhl and scientists at Tokyo Denki University and the University of Minnesota helped develop a computer language program that pictures people speaking in "motherese," the slow exaggeration of sounds that parents use with babies.

Japanese college students who'd had little exposure to spoken English underwent 12 sessions listening to exaggerated "Ls" and "Rs" while watching the computerized instructor's face pronounce English words. Brain scans — a hair dryer-looking device called MEG, for magnetoencephalography — that measure millisecond-by-millisecond activity showed the students could better distinguish between those alien English sounds. And they pronounced them better, too, the team reported in the journal NeuroImage.

"It's our very first, preliminary crude attempt but the gains were phenomenal," says Kuhl.

But she'd rather see parents follow biology and expose youngsters early. If you speak a second language, speak it at home. Or find a play group or caregiver where your child can hear another language regularly.

"You'll be surprised," Kuhl says. "They do seem to pick it up like sponges."

___

EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Strategies for Summer Reading for Children with Dyslexia Dale S. Brown (2007)

Here are some summer strategies to help your child with dyslexia remember what they learned in school and see that reading can be useful and enjoyable:(picked up from the website for reading rockets)

• Give them material that motivates them to read, even though they might find it hard to do. Try comic books, directions for interesting projects, and mystery stories. Have them read information on possible activities as you plan your summer vacation. Let them decide what they want to read.
• Support them as they read. Read their book aloud to them, help them decode, and make it easy for them to get the meaning. Even if a question is asked again and again or if you feel irritated, act happy that they asked. Show them that reading is a way to find out what they need to know, or even to entertain themselves.
• Give them easy reading. Summer is supposed to be relaxed. Let them succeed and get absorbed in the book.
• When you read with them, make it your goal to enjoy the book together. You don't have to make them read perfectly! Avoid too much correction. In school next year, the teacher will help them improve their skills.
• Let younger children "pretend" to read. Read the story aloud together. Let them follow your voice. Have them look at the words as you point to them, even if they aren't actually reading. When they say the wrong word, say the word correctly and cheerfully while pointing to the word.
• Read aloud to them as you do daily chores, sightsee, or sit on the beach. Read an instruction manual with them as you try to fix something. While visiting a museum, read the interpretive materials. If you see the slightest sign they want to read aloud to you, let them!
• Model and teach persistence. When you are working on something that is hard, model the discipline and patience that you want them to show while learning to read. Teach them explicitly the value of working hard to do something challenging. Tell them inspirational stories about famous people -- or members of your own family -- who have overcome obstacles.
• Accommodate their dyslexia. For example, if they have to read aloud in public, have them memorize their passage ahead of time. Ask the teacher or camp counselor to request volunteers to read rather than pass the book from one person to another. If you give them a recipe for cooking (or any project involving written directions), be sure that it is at their reading level and that the print is large enough for them.
• Be a model of reading. Bring books to the beach and read them. If you are traveling, find a book for the whole family to read and discuss. If you are dyslexic, "read" your taped books on vacation, letting your child see you or give them their own tapes. Show and tell them how you overcome your own difficulties.
• Have reading matter conveniently available. You might carry small children's books and magazines with you and have them ready when you must wait in line for those crowded amusement park rides and popular sightseeing destinations.

The summer months are important to your child's academic development in two ways. First, they need to be reminded of what they learned during the school year so that they remember it when they return in the fall. Second, and perhaps more important, children with dyslexia can discover the joys of reading and other academic skills in the relaxed summer season. If nobody tells them they have to read to get good grades, they might just pick up a book and enjoy it.

Reaping the rewards of reading to your child

Nothing can be more satisfying and rewarding than reading to our children. My son is 2 years old now. And after reading to him these past two years, he has started to say bits of a story. The other day after reading the story of Jonah and the whale many times over the months, Benjamin sat narrating the story to me.
Jonah said no. Big fish AAA UM(expression for ate him). Jonah said yes God. Big Fish toop(spat him out).
As simple as that.
He is learning to construct short phrases.
He is learning to fit together the connection in the story.
He is learning to narrate out the story to me with sound effects and gestures.
He is having a conversation with me.

Continue reading... reap the benefits.....

The hardships and blessings of raising a special needs child

Here is an interview with a mom, with a special needs child. Read and find hope and peace in any situation you are in.

Up Close & Personal with Maura Weis

The hardships and blessings of raising a special needs child.

by Mary Darr

Friday, November 28, 2008

Maura Weis co-authored Miles from the Sidelines: A Mother's Journey with Her Special Needs Daughter (Sorin Books, 2008). This heartfelt book describes the emotional and spiritual journey the Weis family has experienced with Hannah (13), whose name means grace of God. Maura has been married to Charlie, the football coach for the University of Notre Dame in South Bend, Indiana, for 16 years, and also has a son Charlie, Jr. (15).

In 2003, they started Hannah and Friends (hannahandfriends.org) to give out grants of up to $500 to people with low to moderate income who have kids with special needs and need a special bike, or therapeutic horseback riding lessons or music therapy. A year ago they purchased 30 acres in South Bend to build 16 residential homes for adults with special needs.

MomSense Editor Mary Darr talked with Maura about the challenges and blessings of raising a special needs child. Editorial assistance was provided by MOPS Area Coordinator Peggy Brinkmann from Wisconsin.

Describe your daughter's developmental delays

Although Hannah was diagnosed with autism when she was 2½ years old, that diagnosis never sat right with me. My maternal instinct told me that something wasn't right with Hannah, but it wasn't autism. I'd tell the physicians, "She's really not talking." And they'd say, "That's OK, but does she understand?" I wasn't sure what she understood. But I knew something was wrong with her diagnosis.

Ten years later we discovered Hannah has a rare seizure disorder called Landau Kleffner Syndrome, which starts around age 15 to 18 months. That's when Hannah's developmental complications emerged. We didn't see the seizures happening because they occurred at night. But they caused her mental retardation and developmental delays.

How is Hannah doing today?

She's 13, and the doctors told us her seizures will end in her mid-teens. But we did an EEG back in April, and found out she's seizure-free!

Every night when I put Hannah to bed, she asks me, "Are you happy?" She's so sweet! Other people have 13-year-old daughters with whom they're struggling with so many issues, and we have the sweetest teenager ever. Hannah is like a 4- or 5-year-old who has a limited vocabulary of about 50 words. She perceives much more than what she verbalizes. She's a smart girl, though, and knows how to get her point across. And she's very independent. You can sit with her for awhile, and when she's had enough of you being around, she'll escort you to the door and say, "See you later."

We take care of all her daily hygiene—we have to brush her teeth and bathe her. But she's really great about it; a lot of kids with special needs are not. I look at our life with Hannah as something God wants us to do. We love her no matter what—that's unconditional love.

Did you struggle with how and why this happened to your daughter?

I don't know how this happened to my daughter. Maybe it was from the extensive kidney surgery she had at two months old. The doctors can't answer those questions. I do struggle knowing none of the seven specialists I took her to over the years thought to give her an overnight EEG to determine if she was having seizures. Why did it take until she was 10 to discover she was having seizures, and then to age 12 to learn there was a name for it? I try not to think about it much because I want to remain positive. At least we found out what was happening to Hannah. If we'd found out earlier, I'm sure she'd still have delays, but they may not have been as severe.

Did you blame yourself?

I asked myself, What had I done wrong while I was pregnant with her? I thought of everything I'd eaten during my pregnancy. I didn't drink. I've never done drugs. I knew I'd had a virus and was sick for two days. But I cannot blame myself. And I don't blame my husband. We both know this is the child God wanted us to have. She was supposed to be in our lives no matter what. We were meant to be together.

How has Hannah impacted your family?

My husband and I are super close, and one of the reasons is because of Hannah. Our whole family is closer because of Hannah. We're a team; together we figure things out. Hannah has taught me every day is a blessing. She wakes up with a smile on her face even when she hasn't gotten much sleep. And she never complains about all the things she has to deal with: limited vocabulary, fine motor and major motor skill problems, poor eyesight.

Where have you found support as a parent of a special needs child?

I'm a happy person by nature, but after Hannah was diagnosed with autism, I felt sad and depressed. Having a child with special needs is so devastating early on. I knew my kids deserved a happy mom, so I went to counseling one hour a day, once a week for nine months. I was able to talk through my grief.

Some people with special needs kids like to join groups. But those groups didn't work for me. I found help on the Internet. I also found help at Hannah's school from other moms who had older children with special needs. They thought positively about their situation and embraced it. And my husband, Charlie, has been a tremendous support. Both parents of a special needs child experience separate times of mourning and then of moving forward to embrace their child for who she is. Kids with special needs are God's special children. That's why I say in my book that parents who receive them are special, too. But God has helped me the most. And I feel closer to him now more than ever. My trust in him leads me along the path I follow.

How can someone sensitively ask about your child's special needs?

I've felt a lot of prejudice toward Hannah from other people. But there also were some adults and children who would say to me, "Can I ask what's wrong?" I embraced them because I'd rather a person be honest. Sometimes Hannah would have a meltdown in the store. But if only someone would have just said, "Could I give you a hand?" It doesn't cost anything to offer help instead of looking at someone as though their child's a brat. It's been difficult because Hannah looks normal and then will have a complete meltdown. I understand people are scared, but it's time for us to step out of the box and be kind. And people who've extended their hand to us have been happy they've gotten to know Hannah.

How can moms offer support to a mother with a special needs child?

Offer her an hour to go to the gym, to read a book, to go for a walk or even to go to the store without her child. That hour is like gold! It doesn't cost any money. Yes, it's going to be a difficult hour. But once you get to know that child, you'll look forward to your time together. And your friend will be so grateful.

Or help a mom attend church. For instance, we can't bring Hannah to church because she can't sit for an hour.

It's also like gold to a parent when you say, "I know you're going through a really hard time. If you ever need me, I'm here to listen to you." Moms of normal children may feel uncomfortable reaching out. I've lost friends because they couldn't accept my daughter. But when you can reach out, your friendship will be deepened for life.

How do you create a "normal" life for the sibling who doesn't have special needs?

Parents of special needs kids should never forget they have another child. Our son has had a good childhood because we've made sure he's gotten the attention he deserved. We've taken him on vacations with us by himself. That's important, especially since he's a teenager. Hannah doesn't travel well, and he needs his alone time with us. When he was younger he'd say to me, "Mommy, that's enough Hannah time; time for me now." And the normal children will be the ones to help your special needs adult when you're gone. You want to make growing up a good experience for them so they don't resent their sibling for getting all the attention.

What would you say to a mom who's struggling to accept her special needs child or who's angry at God for "allowing her child to suffer"?

There is always so much guilt surrounding parents of a special needs kid. I tell people, "Don't feel guilty because that's another negative emotion you're going to put on top of the ones you feel already."

I don't think God points his finger at us and says, "This is what's going to happen to you!" Some things just happen in life. It's difficult to realize your child is never going to do the things normal children do. And being angry at God can be a very natural response. But God can take it if we're angry at him for a period of time. He's there for us no matter what. He understands.

Copyright © 2008 by the author or Christianity Today International/MomSense magazine.

This article first appeared in November/December 2008 issue of MomSense. Used by permission of MOPS International, Denver, Colorado 80231. You can find this article at:

http://www.christianitytoday.com/momsense/2008/novdec/10.8.html

www.ChristianityToday.com

Copyright © 2009 Christianity Today International

Playing,Reading and Talking to your 2 year old(Part 1)

Regular play times together build up a bank of shared experiences which provide wonderful conversational topics.He is at a stage when adult suggestions sensitively given can do much to help him make imaginative leaps in his pretend play and also to find out many wonderful ways in which play material can be used.

1. Make sure that the setting is quiet. Switch of T.V or radios. Sit at his level.
   
2. Make sure the toys are intact and are kept in the same place so that your child knows exactly where they are and doesn't need to be distracted by searching for them.
3. Have a clear area of floor or table top so that he has plenty of room to play.
4. During play, for e.g. fixing Lego blocks ;you are creating an imaginative space for him and later, him wanting to try his hand in creating different things.
   
5. Give a running commentary of what you are doing with funny sounds and play words. Wait for responses from him, ask questions(Do you want this red block?Is it hard to fix? Do you want help? Is that a car you are making?).
6. If he walks away or takes something else , don't stop him and force him to play that activity. Their attention and concentration is only so much. Insist on putting away that toy and then take the new one.
7. Wanting the best for our child , we buy a lot of toys. Electronic, plastic,talking, interactive, educational..... A simple set of stacking cups and a cardboard box is one of the many simple inexpensive toys you can provide for your child and his imagination. So chill out! Don't feel bad that you cant afford to buy these expensive toys.
   
8. Do not display all his toys in his toy box or play room. He is more likely to play and mess with everything and naturally loose value for these toys and not to mention their various parts and pieces. Put a few of them away and bring out after a few months. When you bring out some new ones , put away some old ones. This helps you a lot , when they easily get bored with their toys. Old ones seem to look so new again!
9. Teaching them to put away their toys in the respective place is very important. Or you end up always putting them away a million times. Make strict rules. Tell them,'You don't put them in their boxes, you don't get to play with them'. Enforcing this can take time and effort. But once established , its worth all the time and effort. They also develop respect and value for their things.
   
10. Do not direct the play and conversation during play so much. Give way for them to develop their own pace and their own optimum learning situation. Giving streams of directions like ' Come and look at this', 'Now do this jigsaw', Finish this', put it this way' is not what your child wants to hear. It can now, however be enormously helpful to make some suggestions in order to help her extend her pretend play.
    
11. It is also very important to show her the various ways in which different play materials can be used. It's best, when showing her a new activity, to start it and then to withdraw and let her try it out for herself. She will let you know as soon as she wants your further involvement. A Canadian study , found that a group of children whose mothers showed a high level of intrusiveness into their children's play had significantly lower language attainments than did a group whose mothers followed their children's lead.

I hope these tips prove useful when you play with your little one. More to follow soon on reading and talking to your 2 year old.
Any comments or more ideas on playing with your children are appreciated.

Marnee Brick at ASHA

Here is a link to watch Marnee at an interview at ASHA. Marnee Brick is an experienced Speech-Language Pathologist and business owner. Marnee has worked in many management capacities including the elected position of Director of Human Resources for the Board at a multidisciplinary therapy firm. In addition to partnering in private practice, Marnee worked as a speech-language consultant and supervisor for school boards, public health units, and medical centers in Canada and the United States. At TinyEYE, Marnee is lead contributor to software development and Director of Speech Therapy Services. Marnee believes in giving children a better tomorrow than they had yesterday and is an advocate for Speech Therapy Telepractice.

http://www.youtube.com/watch?v=5xVJ13ZwRrk&feature=channel

Choosing Books for your Toddlers

By now your toddlers may or may not be past the book nibbling,tearing stage. If they are you can move on gloss paper books. Here are some tips to remember while looking out for new books for your toddler:

1. Simple subjects that are related to your toddlers world
   
2. Make sure there are only a 2 to 3 lines in every page and the illustration as the background.
3. Include in your search , books containing Rhymes, repeated words, Noisy words(wow! hey! crash! boom! croack!bow wow!) .
4. Simple and bold graphics.
   
5. Have several basic concepts embedded in the book such as colors, numbers, shapes etc...
6. You don't always have to buy new books. Look out for School fairs where they sell second hand books, keep your eyes and ears open to friends selling their now grown children's books. Use your imagination on where you may get books!
7. Publishers sometimes indicate on the cover of the book the age level or grade level for which they think that book is most suitable. Don't hesitate to choose a book that may be suggested for someone older than your child.
   

As someone once quoated,"A book is an unlimited investment in the human mind and spirit. Its selection deserves thoughtful attention".

Early TV Viewing No benefit in cognitive development.

Here is an article from ADVANCE. Even as a SLP I am often tempted to put my son infront of Bob the builder or Little Einstein,or Postman Pat so I can just go on with my work or do some household chores. Sadly,I have overcome my temptation fewer times. We tend to convince ourselves its educational. What I believe and end up practicing are worlds apart. And I know this holds true for many of you. Nevertheless, I hope to reduce my son's TV viewing time to 30 minutes a day. Start early or otherwise they whine and put up a fit when they want to watch something. This can begin from as early as 1.5 years.

Early TV Viewing
No benefit in cognitive development.


TV viewing before age 2 does not improve language and visual motor skills, according to a longitudinal study of infants, ages 0-3, at Children's Hospital Boston and Harvard Medical School. The findings reaffirm guidelines from the American Academy of Pediatrics (AAP) that recommend no television under the age of 2 and suggest that maternal, child and household characteristics are more influential in cognitive development [Pediatrics, 123 (3): e370-75].

"Contrary to marketing claims and some parents' perception that television viewing is beneficial to children's brain development, no evidence of such benefit was found," said lead author Marie Evans Schmidt, PhD, of the Center on Media and Child Health at Children's Hospital.

The study analyzed data of 872 children from Project Viva, a prospective cohort study of mothers and children. Researchers visited mothers and their infants immediately after birth, at 6 months, and at 3 years of age. The mothers completed questionnaires regarding their child's TV viewing habits at ages 1 and 2.

The study is the first to investigate the long-term associations between infant TV viewing from birth to age 2 and both language and visual-motor skills at age 3. Researchers used the Peabody Picture Vocabulary Test III (PPVT III) and the Wide-Range Assessment of Visual Motor Abilities (WRAVMA) test. The former measures receptive vocabulary and is correlated with IQ, while the latter assesses for visual motor, visual spatial and fine motor skills.

The researchers controlled for sociodemographic and environmental factors known to contribute to an infants' cognitive development, including household income and the mother's age, education, marital status, parity and postpartum depression, as well as the child's gender, race, birth weight, body mass index and sleep habits. They used linear regression models to equalize the influences of these factors and calculated the independent effects of TV viewing on cognitive development. Once these influences were factored out, associations in the raw data between increased infant TV viewing and poorer cognitive outcomes disappeared.

"TV viewing in itself did not have measurable effects on cognition," noted Dr. Schmidt. "TV viewing is perhaps best viewed as a marker for a host of other environmental and familial influences, which may be detrimental to cognitive development."

While increased TV exposure was found to have no benefit to cognitive development in infants, it was not found to be a detriment either. The overall effects of increased TV viewing time were neutral. However, TV and video content was not measured, only the amount of time children were exposed to it.

While follow-up studies need to be done, the researchers warned parents and pediatricians that the body of research evidence suggests TV viewing for children under age 2 does more harm than good.

"TV exposure in infants has been associated with increased risk of obesity, attention problems and decreased sleep quality," stated pediatrician Michael Rich, MD, MPH, director of the Center on Media and Child Health and contributing author of the study and the current AAP Guidelines. "Parents need to understand that infants and toddlers do not learn or benefit in any way from viewing TV at an early age."

Diploma in Special Education (Autistic Spectrum Disorder)

Here is some information about 'Admission Notification for
Diploma in Special Education - Autism Spectrum Disorder 2009-10'

Diploma in Special Education (Autistic Spectrum Disorder)

Training Course 2009-2010

Admissions are open for Action for Autism (AFA)'s RCI(Rehabilitation Council of India) recognized course in Autism starting July 2009. A premier organization training therapists and teachers to work with individuals with autism and communication handicaps, AFA offers training in one of the most challenging and exciting areas of Special Education. AFA has pioneered teaching strategies based on extensive practical experience and internationally used sound behavioral principles, adapted to Indian condition. As in past years successful candidates receive placements in leading organizations in India.

Eligibility

Energetic and enthusiastic candidates who are creative, logical, intelligent, open to learning and willing to work hard are invited to apply. Graduates in Psychology, Education, Child Development, and Social Work preferred, though others including10+ 2 pass with 50% may also apply. Seats limited. Last date for submission of application is 29 May 2009.

For prospectus, application forms, or further queries contact:

Shikha Bhardwaj, Training Coordinator
National Centre for Autism

Pocket 7 & 8 Jasola Vihar
New Delhi 110025

Tel: 91 11 65347422, 40540991/92

Email: shikha.afa@gmail. com
Website: http://www.autism- india.org

Please mark envelopes 'DSE (ASD) 2009-10'

Twin Language .....Talking the Same Talk

I was researching my new virtual collegue Mindy Hudon. I haven't met her (virtually) or had spoken to her yet. I was amazed at her achievements and am proud to say...''Hey, I work with her!''. These are yet one of the many advantages of working with Telepractice. Bless TinyEYE's Greg Sutton and Marnee Brick (with whom I work with) for making Telepractice happen. I am enjoying the new games the tech guys have introduced and enjoying figuring its possibilities with my speech therapy kids.

Coming back to Mindy Hudon, I found this article she wrote and not stress more than she has about the importance of language enrichment and importance of reading to toddlers (not to forget and stress more.. during pregnancy and to new borns as well). Enjoy reading her article and benefiting from her insights and experience!

Twin Language: Talking the Same Talk

By Mindy Hudon, M.S., CCC-SLP

When I visit a shopping or grocery store with my twin boys, well-intentioned people often ask, "Do they have their own language?"

"Yes," I say. "English!"

Idioglossia or "twin language" has been the focus of many research studies and has interested the public for years. It was once believed that twins could develop their own language unrecognizable by others. Today, research indicates that twin language is actually one twin modeling the immature or disordered speech pattern of their co-twin, which results in the incorrect use of speech sounds and grammar by both twins. If you've ever heard two children talking with delayed speech and language, you too may think they're talking in a foreign language.

Why do twins have trouble developing sounds and words? Well, research has suggested that twins are at greater risk for speech and language delays because of higher incidence of prematurity, low birth weight or limited individual communication with their parents.

If your twins are demonstrating delayed speech and language skills, then you know what I'm talking about. It's hard enough trying to communicate with twins, but when one or both are experiencing speech delays, your job gets even harder. "We knew at 18 months old that one of our twins' speech wasn't developing like his brother," says Maria Revell of Dallas, Texas, mother of twin boys. "His brother was talking in words and a few sentences. He was still putting words together and labeling things."

What's a Parent to Do?

As parents of twins, it is our role to help reduce their risk by providing a language-rich environment. Parents have a critical role in their twins' speech and language development. "We do everything we can. We let our son lead, find out what he is interested in and try to initiate language that way," says Revell. "These are the most important years, and we are trying to take advantage of that."

There are many things that you can do on a daily basis to encourage your twins' language development. First, you are in the best situation to help your twins. Because there are two children involved, you have a ready-made language group, and your twins always have a great communication partner! Also, they have an invested speech coach you! "Almost everything we do is play," says Revell. "Anything that we use (to encourage language) with one, we use with the other."

As a parent, you're the most important guide to language enrichment. What you say and how you say it will directly impact your twins' development of speech sounds and sentence length. Here are some suggestions:

• You can never talk enough when you are with your twins. Talk about what you're doing and why you're doing it. Also, talk about everything your twins are doing. If you're pouring a glass of milk say, "Mommy is pouring some milk for you. You are thirsty. Here is your milk." When your twins are drinking the milk say, "Mmm, that milk tastes good. The milk is cold. Oh, you are drinking the cold milk." When you're talking to two children like this all day, you may find yourself sounding like a broken record. Rest assured, your efforts will pay off in the long run. Talking to each of your twins is one of the best ways to encourage language.
  
  
• Avoid using "baby talk." If your twins say a word that is pronounced incorrectly, repeat it back to them the correct way, emphasizing the sounds in the words. Don't expect them to repeat it correcty back to you at that moment. However, praise any attempts they make to say the word. Your job is to provide them with the correct pronunciation of words. If you repeat baby talk, that's what your twins will use. Remember, even though baby talk may sound cute now, it won't when they're 3 or 4 years old.
  
  
• Encourage your twins to talk! If your twins shake an empty cup at you and grunt, hold back the urge to take the cup and fill it. Instead, ask questions to encourage words, "What do you want? Tell Mommy, use your words." In the early stages of language development, it is important to praise any verbal attempts. If your twins say "oo," reinforce their attempt and say "juice." Expand on the word and say "I want juice." If your twins are using words and short sentences, then it is important they use words rather than gestures or grunts to communicate their needs. "Tell Mommy, 'I want juice.'" In the busy life of a parent of multiples, grabbing the cup and filling it is much easier than encouraging language. However, by taking the extra time to encourage language, you're helping your twins learn to be effective communicators and to learn that words are often more important than actions.
  
  
• Take time to sit down on the floor with your twins and play with their toys. Children love to play, and it's a great way to build vocabulary, expand language and teach social communication skills like turn-taking, facial expressions, emotions and greetings. Make the toys come alive! For example, a stuffed teddy bear can walk, sleep, eat, ask for help, feel sad or happy and say "hi" and "bye." It is amazing what a teddy can do! Your twins will love the interaction time with you, and you can encourage so much wonderful language by just using puzzles, stuffed animals or even a ball.

Read, Read, Read

It's never too early to start reading to your twins. Research has indicated that even infants can benefit from being read to. As your twins grow, make reading a daily part of their routine. Finding the time to sit down and read a book after a long day can be difficult. Sometimes it feels easier to tuck them in bed than to take the time to read. I encourage you to spend a few minutes reading a book because the benefits will last your twins a lifetime. Reading to your twins will improve their language, vocabulary, attention and future reading success.

Here are some helpful tips when reading to your twins:

• When you read to your twins, try to limit distractions with other books or toys.
• Reading time should be "together time" with Mommy or Daddy and books.
• Read with animation in your voice to gain their attention.
• Talk about other pictures in the books that may be unrelated to the actual story.
• Once your twins are familiar with the books, encourage their participation.
• Allow them to finish a line in the story or point and name pictures in the book.
• Ask them to find pictures in the book, and ask questions about the book as you read.

Reading tips for Preschoolers

The importance of reading as early as possible has many benefits and only benefits. I read to my son often pointing to the print and the pictures and making it animated. He aboslutely loves it. Also, when my husband and I read a book separately he also pulls out a book and pretends to read it. He also pulls out some of my books and looks at the script and pretends to be reading aloud.(most of which is baby language). The importance of reading cannot be stressed more and that passion in me to not only let everyone know but do something about it runs high. Start a reading group with parents you know having small children. Read to a group of kids in schools or churches. Get passionate about reading. Read the following tips for preschoolers. More will follow for higher grades.

Read early and read often. The early years are critical to developing a lifelong love of reading. You can't start reading to a child too soon!

• Read together every day.
  Read to your child every day. Make this a warm and loving time when the two of you can cuddle close together. Bedtime is an especially great time for reading together.
  
  
• Give everything a name.
  You can build comprehension skills early, even with the littlest child. Play games that involve naming or pointing to objects. Say things like, "Where's your nose?" and then, "Where's Mommy's nose?" Or touch your child's nose and say, "What's this?"
  
  
• Say how much you enjoy reading together.
  Tell your child how much you enjoy reading with him or her. Look forward to this time you spend together. Talk about "story time" as the favorite part of your day.
  
  
• Read with fun in your voice.
  Read to your child with humor and expression. Use different voices for different characters. Ham it up!
  
  
• Know when to stop.
  If your child loses interest or has trouble paying attention, just put the book away for a while. Don't continue reading if your child is not enjoying it.
  
  
• Be interactive.
  Engage your child so he or she will actively listen to a story. Discuss what's happening, point out things on the page, and answer your child's questions. Ask questions of your own and listen to your child's responses.
  
  
• Read it again and again and again.
  Your child will probably want to hear a favorite story over and over. Go ahead and read the same book for the 100th time! Research suggests that repeated readings help children develop language skills.
  
  
• Talk about writing, too.
  Draw your child's attention to the way writing works. When looking at a book together, point out how we read from left to right and how words are separated by spaces.
  
  
• Point out print everywhere.
  Talk about the written words you see in the world around you and respond with interest to your child's questions about words. Ask him or her to find a new word every time you go on an outing.
  
  
• Get your child evaluated if you suspect a problem.
  Please be sure to see your child's pediatrician or teacher as soon as possible if you have concerns about his or her language development, hearing, or sight.
  

Reading to Toddlers

How to Read :
For 2-4 year-olds

• give your child time to look at the pictures before you read
• ask, 'Where's the...?' 'What's that called?' 'What's she doing?'
• always follow text with your finger as you read
• with familiar stories, see if your child can join in or finish phrases
• ask questions like: 'Why did he do that?' 'What happens next?'
• discuss things you both liked/didn't like and why

Choosing Books - For Babies, Toddlers and Nursery Children


For children who understand most of what they hear, you need different books. Let your child choose, though some 'guidance' is often necessary.

You need these sorts of books:

• a variety of different types of language to read to your child (including poetry, traditional stories and mystery as well as everyday stories)
• a range of easier books with very few words, so that your child can begin to 'read' independently, by remembering a story which he has heard often
• books which your child really likes for whatever reason

Don't forget: the written word is all around us. We don't only read books - we read shop names, road signs, shopping lists, advertisements, birthday cards.... All are a chance to show your child how reading works. There is even a bit of jargon to describe this writing: ENVIRONMENTAL PRINT.

Reading strategies in upper grades

Here is a great presentation on various strategies for reading in upper grades. This is a great resource for those professionals involved in teaching dyslexics.
Uploaded on authorSTREAM by aSGuest4830

Picture Communication System:Points to Consider

Stephanie Bruno Dowling, MS, CCC-SLP is a Speech Therapist currently working in Early Intervention in Delaware County, PA. Her blog serves as an open forum for Early Intervention in the ADVANCE newsletter.

Here is a line from her recent blog entry talking about how she shares her motto for an efficient communication system:

"The Four S's ? Simple, Sturdy and Supportive so that the child will be Successful! :I currently use a mix of several different methods to help the children I work with communicate at home. One technique incorporates the use of Mayer-Johnson Boardmaker® pictures."

To read the full article click on the link below:
The Four S's of a Good Communication System

Fun with '' R ''

R MOVEMENT GAME

RACING FOR R Have your child act out some R words with you. Row Run Roll Race Rake Rope R ANIMALS Have your child pretend to be these R animals Robins Road Runners Rats Rabbits Reindeers Roosters

R LANGUAGE

RIDDLES & RHYMES Here is a riddle, it’s also a rhyme. The word starts with “R”, every time It’s long and coils and is often rough. Can you guess it, it’s kind of tough? A: A rope It’s round and red and grows on a tree. What do you think my riddle could be? A: A red apple It’s long and pointed and shoots through the sky. This riddle is hard and that’s no lie. A: A rocket

RAINBOW RABBIT
Have your child make up a story about Rainbow Rabbit.
Include things in the story that start with the letter R.

Rural Speech Therapy Telepractice

Check out this SlideShare Presentation:

Rural Speech Therapy Telepractice

View more presentations from Marnee Brick. (tags: pathology telepractice)

More recess time ,better behavior& increased learning

Unstructured , more than 15 minutes recess time in school contributes to better social and cognitive skills, and they learn better. Now isn't that what we want in our children? The overall picture on the child's well being will always be important. These small changes contribute so much to their development.

Here is a part from the article that sums it up: The study suggests that a daily break of 15 minutes or more in the school day may play a role in improving learning, social development, and health in elementary school children. The study's principal investigator is Romina M. Barros, MD, assistant clinical professor of pediatrics at Einstein.

Read the article to know more on the current research:
http://speech-language-pathology-audiology.advanceweb.com/Editorial/Content/Editorial.aspx?CC=194190

On our toes with creativity

Being a speech therapist, you need to constantly upgrade yourself on creativity. You need to have it in your gut too. When you see the child getting bored with one way of teaching, e.g. how to say a sound, you know its time to change strategy.

Here are two that I just discovered in between sessions:

1.When working on a target sound in the word level, instead of repetition and exaggerated production, you could sing the words to a familiar music to the child. We sang the other day (working on clusters st-) to Bob the Builder: story story,sto o o ry.its a new way of saying boring words. it teaches them to split words at different place depending on the music, working on intonation also.

2. We were learning to make short sentences with target words for articulation. Instead of making plain simple sentences like, "Spiders are scary" we made funny non sense sentences. For e.g.: "Spider: I saw a pink spider wearing a dress".

We have a great time laughing over it and child doesn't even feel its an exercise.

Come down to their level , when you teach them. It's a different view from where they are.

Who is using Telespeech Practice now?

Among the various professionals using TSP(Telespeech Practice) here is an article in the website of LinguaCare who have taken steps to put this into practice. A special look at a few lines from the article:

The children loved the program and were disappointed if Vickie made an on-site visit and did therapy on-site instead of via Telespeech. At the end of the semester, questionnaires were distributed to students, teachers and parents in regards to the program with favorable comments made by all. Children were found to progress in their treatment program much as if they were seen directly by a therapist on-site.

Read more on the link below:
http://www.linguacare.com/professional-development/?page_id=2

What is Telepractice?

What is Telepractice?

In ASHA's recent position statements, telepractice is defined as "the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation."

ASHA's position is that "telepractice is an appropriate model of service delivery for the professions of speech-language pathology [and audiology]. Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of specialists and/or sub-specialists, and impaired mobility."

Telepractice offers "the potential to extend clinical services to remote, rural, and undeserved populations, and to culturally and linguistically diverse populations."


How Telepractice Is Being Used...

...By Audiologists:

* Infant hearing screening
* Hearing screening
* Hearing aid programming and counseling
* Auditory brain-stem response (ABR)
* Otoacoustic emissions (OAEs)
* Audiologic rehabilitation

...By Speech-Language Pathologists:

* To provide speech and language services to schools in remote or undeserved areas
* To provide voice, aphasia, or cognitive-communication treatment to satellite clinics from hospitals
* In clients' homes as an adjunct to home health visits
* For specialized services such as laryngectomy rehabilitation and augmentative and alternative communication


Client Selection for Telepractice

To select clients who are appropriate for assessment/intervention services via telepractice.

Knowledge and skills:

3.a. Understand the potential impact of physical and sensory characteristics on the client's ability to benefit from telepractice, and provide modifications or accommodations (as appropriate) for factors such as:

• hearing ability,
• visual ability (e.g., ability to see material on a computer monitor),
• manual dexterity (e.g., ability to operate a keyboard if needed), and
• physical endurance (e.g., sitting tolerance).
  

3.b. Understand the potential impact of cognitive, behavioral, and/or motivational characteristics on the client's ability to benefit from telepractice, and provide modifications or accommodations (as appropriate) for factors such as:

• level of cognitive functioning,
• ability to maintain attention (e.g., to a video monitor),
• ability to sit in front of a camera and minimize extraneous movements to avoid compromising the image resolution, and
• willingness of the client and family/caregiver (as appropriate) to receive services via telepractice.
  

3.c. Understand the potential impact of communication characteristics on the client's ability to benefit from telepractice, and provide modifications or accommodations (as appropriate) for factors such as:

• auditory comprehension,literacy,
• speech intelligibility, and
• cultural/linguistic variables (e.g., availability of an interpreter).
  

3.d. Understand the potential impact of the client's support resources on his or her ability to benefit from telepractice, and provide modifications or accommodations (as appropriate) for factors such as:

• availability of technology,
• access to and availability of resources (e.g., telecommunications network, facilitator),
• appropriate environment for telepractice (e.g., quiet room with minimal distractions), and
• client's and/or family/caregiver's ability to follow directions to operate and troubleshoot telepractice technology and transmission.
  

Selection of Assessments and Interventions

To use technology to deliver appropriate assessments and interventions.

Knowledge:

4.a. Knowledge of the potential benefit of providing assessment/intervention in the patient's natural environment

4.b. Knowledge of the appropriateness of commercially available computerized clinical tools

4.c. Awareness of the potential impact on standardized tests, diagnostic procedures, and intervention strategies when administered via telepractice

Skills:

4.1. Selection and administration of formal and informal diagnostic tools at a distance

4.2. Identify supplemental tools/technology (e.g., fax machines, telephones) for clients to receive optimal services at a distance


Cultural/Linguistic Variables

To be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of communication disorders/differences in individuals.

Knowledge and skills :

5.a. The influence of one's own beliefs and biases in providing effective services


5.b. The need to respect an individual's race, ethnic background, lifestyle, physical/mental ability, religious beliefs/practices, and heritage


5.c The influence of the client's traditions, customs, values, and beliefs related to providing effective services via telepractice


5.d. The impact of assimilation and/or acculturation processes on the identification, assessment, treatment, and management of communication disorders/differences when delivered via telepractice


5.e. The clinician's own limitations in education/training in providing services to a client from a particular cultural and/or linguistic community


5.f. Appropriate intervention and assessment strategies and materials, such as food, objects, and/or activities that do not violate the client's values


5.g. The need to refer to or consult with other service providers with appropriate cultural and linguistic proficiency, including a cultural informant/broker, as it pertains to a specific client


5.g. Ethical responsibilities of the clinician concerning the provision of culturally and linguistically appropriate services


Use of Support Personnel

To train and use support personnel appropriately when delivering services via telepractice.

Knowledge:

6.a. Guidelines for training, credentialing, use, and supervision of support personnel as described in the ASHA Code of Ethics (ASHA, 2003) and ASHA practice policy documents (ASHA, 1996)


6.b. State regulations regarding credentialing and supervision of support personnel


6.c. Information needed by support personnel about the technology and delivery of services via telepractice

Skills:

6.a. Selecting clients, clinical activity, and technology that are appropriate for support personnel during telepractice service delivery


6.b. Providing appropriate training to support personnel in the delivery of services via telepractice (e.g., patient and family/caregiver instruction, equipment check and maintenance, clinical task performance, record keeping, universal precautions)

• appropriate training for privacy and electronic data interchange consistent with state and federal regulations

6.c. Providing appropriate supervision to support personnel (e.g., developing an effective relationship, providing feedback, and modeling appropriate communication and ethical professional conduct)

A new world of Telespeech Therapy

I am proud to be part of a telespeech therapy practice.Being a team member in a pioneering work is fabulous. Its been 6 months since I have been giving children speech therapy through the internet to the opposite part of the world, sitting in the comforts of my home in my pajamas!!! How cooler can that get. Moving away from my comforts, its sheer joy to know that I and my team mates are helping out these kids(mostly in remote areas) where no speech therapists are available. We are making a difference!!!

In the next few weeks, I will be putting up posts introducing you to Telespeech Practice and what its all about.

Parents,your child can receive speech therapy (after looking into if he/she satisfies a few criterion).It has remarkable results. The kids love it and so will you.

And to you Speech therapists, it may be a questionable area,totally taking you out of your comfort zone, questioning your ethics, but it is a possibility. It is not just in its research stage, or scary territory. It has become an accepted part in the delivery of Speech and language services.

Selective Mutism

My experience with Selective Mutism is quite limited and having a patient now, I haven't seen much of a breakthrough yet. Searching through the internet, I stumbled upon this paper presented at the ASHA 2008 by Jan Middendorf and Jessica Burungrud. It truly gave me a new perspective to treat and an encouragement, when I was running out of ideas. There are other fabulous handouts from this years ASHA convention that you can access.

Click on the link : http://convention.asha.org/handouts.cfm

Selective Mutism: Strategies for Intervention
ASHA 2008
Jan Middendorf, M.A,CCC
Jessica Buringrud, M.A.,CCC
Shaping Nonverbal to Vocal to Verbal Skills
Warm up activity

• Non vocal act, such as stick out tongue, close teeth and smile, place upper teeth on lower lip. These acts were repeated with air flow, creating an approximation of the speech sounds /th, s, f/ respectively.
• Non vocal blowing act and then stopping of the air stream at the level of the lips, then tongue tip at teeth, then at soft plate, creating an approximation of the speech sounds /p, t, k/ respectively.
• Repeat above task with voicing (cue, make it noisy) to produce speech sounds /th, z, v, b, d, g/.
• Introduce vowels by opening mouth after production of consonant. Shape vowel by describing mouth positions (fish mouth - /u/, cave mouth - /ah,/ smile mouth - /e/).
• Slowly introduce true words with in content of consonant vowel repetitions (say, see, so, Sue, day, do, may, my bye, boo, key, etc.
• Transfer repeated words to functional words. For example, say word “go” in order to get picture to appear on screen.
• Continued to generalize us of true words, for example, name word in order to “win” it in card game.