Geriatrics, Pediatrics, and Everything In-Between...

As I serve 8th-9th graders with speech and/or language disorders, I am sometimes reminded of my work in geriatrics. The scope of practice for Speech-Language Pathologists is wide and varied. In geriatrics, the main focus seems to be Dysphagia (swallowing disorders), but also includes cognitive therapies. This is where I see the commonalities. Word finding difficulties, problem solving, and comprehension are all areas in which the two populations seem to have deficits.
As I enter a new journey into Geriatric speech/language therapy with my on-call job through Aegis Therapies, I will likely see some of the same language difficulties in both populations. However, the approach taken with the Geriatric population may be very different. For example, word finding difficulties in the Pediatric population may have a stronger focus on vocabulary comprehension and learning strategies, while the Geriatric population will focus more on naming common items in their environment. In relation to problem solving, when a nursing home resident needs help, they are to use their "call button" to summon help from a nurse or nursing assistant. What happens when the resident doesn't know what a "call button" is, or where it is? These are the functional activities that will be the focus in the nursing home setting. Also, residents are often upset by the fact that they cannot recall names of family members. In this case, a memory aid such as a photo album with name labels can be helpful.
In pediatrics, problem solving may have more focus on functional activities such as homework strategies, safety in the community, or maintaining friendships. Even though both populations have similar disabilities, the approach to treatment needs to be differentiated based on functional needs.
Over the coming months, I will continue to reflect on the commonalities and differences in evaluation and treatment strategies between the Geriatric and Pediatric populations.

Alternative and Augmentative Communication

Recently, I attended two separate workshops related to Alternative and Augmentative Communication (AAC). The first was Closing The Gap, and the second was regarding AAC goals & objectives and was held by the PACER center.
The following information was presented:

First and foremost, a student with an alternative communication device needs a Postivie Communication Environment. The student should not be made to feel that their device is a burden. Teachers, students, and paraprofessionals should use caution when talking in front of the student about the device. For example, a video was shown in which a student's teacher needed to move the device from one desk to antoher. The teacher proceeded to make negative comments, such as "this thing is so heavy!" and "what a hassle". When a student hears negative comments regarding his/her own communication, he/she is likely to shut down and reduce communicative attempts.

Secondly, the student will benefit greatly from modeling. Students are often expected to use their communication device, while never seeing or hearing others use it. Teachers and paraprofessionals need to be trained on how to use the device, in order to increase modeling and language input to the user.

Lastly, partner assisted scanning may be extremely beneficial to the new device user. Partner assisted scanning consists of the communication partner reading the choices along with the device as it scans. This pertains only to those users who require scanning, versus direct selection. Using partner assisted scanning allows another form of language input and may help the user learn to navigate his/her device more efficiently.

AAC can be a challenging, yet rewarding, experience for both the student and the communication partner. When the student makes the connection between communicative attempts and receiving feedback from their partner, true communication can begin.

Seminar

Phonemic Awareness and RTI: Change HOW You Teach as much as WHAT You Teach

On October 7th, 2010 I went to a seminar in Bloomington, MN. The presenter was Colleen E. Hill, CCC-SLP. The seminar was six hours long and information about specific phonemic awareness therapy materials and strategies were discussed, as well as research based comprehension strategies.

Six Evidence-based Comprehension Strategies that Work with RTI are...

1. COMPARE & CONTRAST

~How is a bunch of bananas like a group of students?

2. INFERENCES

~Background knowledge, discussion

3. PREDICTING

~Student invests, activates interest & memory

4. SYNTHESIS/CREATING

~How is Rush Limbaugh similar to Barack Obama?

5. DISCUSSION of TEXT MEANING and INTERPRETATION

6. ANSWERING DEEP EXPLANATORY QUESTIONS

~At all grade levels---80% of teachers' 400 daily questions are knowledge level (Bloom's Pyramid). Students not using higher order/critical thinking skills.

 

I feel as thought I already knew the "strategies" the presenter discussed towards the end of the seminar. I also felt the six she discussed were not exactly strategies of teaching, but that they were the topic areas of what to teach about under the umbrella of comprehension.

The presenter did give numerous therapy activities (mostly worksheets or handouts) on the topics of; Proverbs, Same or Different Sentence Meaning?, Compare and Contrast, Word Chains, Word Finders, Expressive Language, Verb Forms, Sentence or Fragment?, Noun or Verb?, and Word Scramblers. Personally, I enjoyed receiving activity ideas for therapy, but felt that work sheets were not the only way to go about teaching comprehension strategies and phonemic awareness. There are some great computer programs out there, which can be very fun and beneficial in keep a student motivated. I feel as though it is good to break up phonemic awareness practice with another therapy activity--besides always hearing the SLP's voice when listening to phoneme sounds produced by only the SLP. Computer games or programs often offer different voice choices and allow the students to manipulate the pictures or objects on the screen which really changes how the student is learning about phonemic awareness. When a child can manipulate pictures or objects they are using their whole body to learn, not just their mouth.

Overall, I would not recommend this seminar to Speech-Language Pathologists. I would recommend it to classroom teachers because there was a lot of great information on the importance of phonemic awareness and how it relates to phonics and RTI. I also felt the comprehension portion of the seminar could benefit classroom teachers, as well as special education teachers.

Building Rapport with Speech and Language Students

This is my third year as a Speech-Language Pathologist. Over the last few years, I have learned the importance of building good rapport with the students I serve. My first year, I dove right in to therapy and did not pay too much attention to getting to know my students likes and dislikes. My second year, I tried an interview type format with my students. I learned that the interview format did not go over well. It was very difficult for my new students to interview me--even with help. This activity seemed to also be a little too much for the first week of school. It was a too formal for building a relationship with my students. This year, I began each first session of the year with a "Tell me 3 LIKES of your summer and 1 DISLIKE." The students seemed to enjoy this very much. We had a casual conversation of our summer activities and we also discussed WHY we are in speech, WHAT we do in speech and HOW we can obtain our goals and objectives. I have used the topics we have in common to plan for other therapy sessions and to strike up conversations in the hallways at school. Building rapport with students will create a more productive learning atmosphere, give the student a good sense of a connection with the SLP and build trust.

Metacognition

In our recent Special Ed. Department meeting, we read an article pertaining to Metacognition as it relates to study strategies, motivation, and monitoring. Metacognition (thinking about thinking) also relates to Speech-Language Pathology, especially at the secondary level, as we teach students how to use educational learning strategies. Such strategies may include producing an outline, summarizing, predicting outcomes, identifying key words, and applying learned information to a real-life scenario or case.

Also at the secondary level, I often encounter the road block of motivation. As the article states, "Metacognition affects motivation because it affects attribution and self-efficacy." When a student experiences success, they tend to attribute that success to their ability and to the amount of effort put forth, which in turn promotes future success as it develops self-confidence. Conversely, students tend to attribute failure to a lack of ability, which reduces self-confidence and may contribute to the self-fulfilling prophecy of repeated failure. As a defense mechanism, students may then reduce the amount of effort put forth, in order to prevent feeling as though their failure is attributed only to lack of ability. This may be especially prevalent with students in Special Education.

As a result of processing this information, my first plan of attack will be to provide each student with ownership over his/her goals and objectives in speech therapy. Each student will be presented with the following questions: What are your goals? Why do you think these goals were chosen? How will we accomplish these goals? Will accomplishing these goals in speech therapy help you in other environments, such as in the classroom?

As students begin to see the connection between their speech/language goals and generalization into other environments, I hope to build their self-confidence and expand their knowledge of educational learning strategies, as well as their knowledge of compensation strategies when presented with a challenge. This article has shown me the ways that Metacognition is linked to study strategies, motivation, and self-monitoring.



Source: http://academic.pgcc.edu/~wpeirce/MCCCTR/metacognition.htm

SLPs

All people interested in Speech-Language Pathology WELCOME!