Early Intervention for the Hearing Impaired

Early Intervention for the Hearing Impaired

How much does early childhood hearing loss impact linguistic abilities into adulthood? In a study conducted by Elahe Shojaei, Zahra Jafari and Maryam Gholami on Persian children ages six to seven years old, they set out to determine the impact severe sensorineural hearing loss has on the language development and communicative abilities. Sensorineural hearing loss, or SNHL, affects the  inner ear. Damage to the nerve pathways from your inner ear to your brain can also cause SNHL. The authors pursued this study to assess the gravity of the negative effect of hearing loss on language development, and if this language gap could be lessened with early intervention services. Assessing two different age groups of children with congenital hearing loss using the Persian TOLD-P3 test to evaluate language at an early age made this study possible. The subjects were chosen based on age group, similar socioeconomic backgrounds, and bilateral behind-the-ear hearing aids for severe sensorineural hearing loss.

            The data was retrieved using a medical family history questionnaire, the same audiologic evaluation of immittance and pure tone audiometry, and followed by a linguistic assessment using the Persian TOLD-P3 test. The Persian TOLD-P3 test is comprised of 11 subtests testing different aspects of linguistic comprehension in semantics, syntax, and vocabulary. The results of this test are used to determine the visual vocabulary, grammatical completion, word differentiation, phoneme analysis, and word production scores of each subject. The study showed significant difference in the results of the Persian TOLD-P3 test performed on the different age groups. The results support the negative effect late identification of hearing loss has on the syntactical comprehension and phonological skills of language. However, using the advanced technology to identify hearing loss at an earlier age, early intervention can promote normal lingual development and sensory growth for children with sensorineural hearing loss.

            This study was done well, as it shows the importance early intervention has on a child’s language development and the importance of identifying language concerns early on. I think this study is most beneficial and influential for audiologists and ENT providers concerned by the benefits of intervening early on in a child’s life with hearing aids and surgery. This study shows that the sooner a child is diagnosed with a hearing loss and receives reparative measures, the more likely the child will develop normal linguistic skills. In addition, as a future speech pathologist, knowing this information serves as a reminder to parents and myself that a child can progress and develop language skills following hearing loss. In the future, however, this study should follow the students post-intervention and to determine the growth of linguistic skills and its application into reading and writing skills in school environments. This way the study does not only determine the benefits of early hearing loss intervention on language, but that there is not a disconnect in verbal abilities with other areas of language comprehension. Overall this study confirmed the impact hearing loss has on linguistic development and the importance of identifying hearing impairments in order to introduce intervention methods to close the linguistic gap and promote emotional, academic, social and sensory growth.

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Cooperative Learning

Cooperative Learning

I am currently observing speech clinicians provide therapy sessions for individuals diagnosed with aphasia, dysphagia, early language delays, and disfluencies. I was surprised to realize how common group therapy sessions were and the learned strategies to make these sessions more effective. Today, we will be discussing cooperative learning, a strategy most effective in school-age settings.

What is cooperative learning?

Cooperative Learning, sometimes called small-group learning, is an instructional strategy in which small groups of students work together on a common task.

What are the benefits of cooperative learning? 

Some of the benefits that could come of cooperative learning instruction are:
– increase in social skills
– cultural awareness and respect
– peer guidance (beneficial for classroom differentiation)
– teamwork skills
– formative assessments and evaluation
– insight on different perspectives

Are there any issues with this type of classroom learning? 

Like any other instruction, there are some issues that can arise with this classroom instruction, especially because this offers a very social approach. With group learning a significant concern would be behavioral issues. From simply maintaining classroom order and discipline to more extreme issues like racism, disrespect, or physical contact, it is important for instructors to monitor students in groups and be alert to their environment for any student tension or conflict.

What can you do in this instructional model to meet individual needs in a session of diverse learners? 

Cooperative learning models offer the benefit of already being set up to meet the needs of diverse learners. Students can be organized into groups based on their readiness levels to share their insights and gain understanding from one another. In addition, with cooperative learning, students can be arranged based on their learning styles and preferences, and learn with personalized assignments for their group, ie. visual learners have a film to learn about the solar system, whereas kinesthetic learners can explore with telescopes.

How can you assess student learning using this model?

With this model you can assess student learning and understanding by informally assessing groups by asking varied open-ended questions to spark conversation, creativity, and further analysis of the unit.

Which tasks should use a cooperative learning model?

Not all school tasks should be completed cooperatively. Cooperative learning should be used in lesson plans where students can learn from one another by working together and/or expressing their thoughts or ideas. One task in which this model could work is a science unit on mass. Students are able to make predictions, work together to establish different lab experiments, and discuss with one another their thoughts, ideas, and any areas of confusion. Another task could be a language arts unit. Students are responsible for analyzing different forms of writing, ie analytical, creative, persuasion, etc. Students then present their findings to one another and then switch tables to learn with a different group. This method allows students to become “experts” in their subject matter to teach and learn from one another. Finally, it will also improve students’ public speaking skills and prepare them for classroom presentations in the future.

Impact of Concussions on Students

Impact of Concussions on Students

A concussion is a mild traumatic brain injury in which the brain is rattled within the skull, releasing chemicals that cause the symptoms of a concussion. As a result, concussions are known as the invisible injury, with less than ten percent of all concussions associated with a recognizable loss of consciousness, but demonstrated with symptoms that affect an individual’s physical, cognitive, and emotional states. These symptoms can affect an individual for as little as a week, or months at a time, with the possibility of further damage to the brain without proper rest and recovery, or re-injury.

Symptoms of concussion are dizziness, nausea, headache, sensitivity to noise, blurred or tunnel vision, and difficulty concentrating. Further signs that suggest the severity of the head injury include unresponsive pupils, seizure, slurred speech, vomiting, deteriorating consciousness or neurological function, and inability to recognize people or places. After experiencing a concussion, the brain begins to tire more easily as cognitive processing becomes a physical activity that requires more energy than before. Skills and tasks such as listening, following directions, concentrating, solving problems, reading, and writing become difficult for students after injury. In order to create a seamless transition post injury, students need a support system of parents, teachers, medical providers, and coaches willing to offer adaptations that best suit the child’s needs. These may include returning to school in a part time status, allowance of breaks throughout the day, or placing students in the front of the classroom and away from windows and doors to avoid distraction. Apart from cognitive changes, students may also experience behavioral or emotional symptoms. A student’s support system should offer structure, consistency, and reinforcement for positive behaviors and accomplishments, while also supplying empathy when a child is frustrated by failure.

It is also important to keep in mind that learning or mental health issues, such as ADHD, anxiety, depression, sleep disorder, or a learning disability, may become more of a challenge following a brain injury. This is why Dr. Mike Evans recommends that before a child returns to school, the step-by-step program called the Four P’s be used. The Four P’s focuses on prioritizing, planning, pacing, and positioning oneself for success when taking on the processing stress of their daily functions. Dr. Evans recommends thirty minutes blocks without any symptoms as a key determiner to whether or not a student should start adding school activities back into their daily schedule.

The intervention to build cognitive-communication skills following a brain injury is known as cognitive rehabilitation. This treatment focuses on the ability to process the information of every day tasks by using restorative and compensatory approaches. Restorative approaches attempt to improve the neural circuitry of the brain with the use of repetitive activities, such as classification tasks and word associations. On the other hand, the compensatory process improves memory and develops alternative approaches for functional abilities that have failed with the restorative process.

Students in elementary school and in college should care for a concussion in similar ways. However, compared to the older students, children are more likely to complain and demonstrate their cognitive and behavioral symptoms. In this age group, the need for a support system is crucial in assisting the student as they continue to learn how to manage their post-concussion symptoms and academic difficulties. While older students are still facing similar cognitive and behavioral symptoms, concern for this age group falls heavily on prioritizing and managing the processing load on the brain taken on by the level of academic, extracurricular, and social activities in a student’s schedule. In addition, older students are more likely to prolong their symptoms due to alcohol consumption and lack of a support system to assist in managing of their health and workload.

More than a million Americans sustain a concussion each year, but with early intervention and proper rest from cognitive and physical activities, these symptoms can be treated and result in complete recovery.

Evidence Based Study of VNeST

Evidence Based Study of VNeST

This semester I had the opportunity to observe clinicians in the Aphasia Clinic. Aphasia is an impairment of language, affecting the production or comprehension of speech, and the ability to read or write. Aphasia is always due to injury to the brain: most commonly from a stroke, but brain injuries resulting in aphasia may also arise from head trauma, brain tumors, or infections.

One of the treatment strategies used for aphasia therapy is VNeST. The academic article Effect of Verb Network Strengthening Treatment in Moderate-to-Severe Aphasia by Lisa A. Edmonds and Michelle Babb, published in May 2011, is a study conducted for the purpose of examining the correlation between the usage of Verb Network Strengthening Treatment (VNeST) on individuals with moderate-to-severe aphasia. Topics addressed were pre- to posttreatment changes in phase changes in action verbs, lexical retrieval changes in single-word naming, and error evolution. The purpose of the study is for the participants to generate thematic roles to the provided verbs, which indicates the semantic structure of a sentence.

Two patients participated in this study. They both are described to be monolingual speakers of the English language, with non-fluent aphasia and considerable lexical retrieval deficits, scoring less than 50%, on the Object, Naming Battery as stated on page 134. Both clients are diagnosed with Broca’s aphasia with utterance lengths of one (P2) to one-to-two (P1) words, with relatively good comprehension and poor repetition. VNeST was administered two times per week for 2-hr sessions. During VNeST, participant 1 and participant 2 were asked to generate appropriate noun pairs for a single verb such as “chef-sugar, seamstress-fabric” for “measure”. After 3 to 4 pairs were established, participants answered wh-questions (where, when, and why) about one pair of words. Increasing the use of the verb and related thematic roles, facilitates sentence production. P2 had difficulty producing the statements orally and was allowed to write them down. Also, P2 completed the study after P1 did and it was noticed that reading the verb along with the nouns made a significant difference. Therefore P2 was asked to read the entire sentence aloud when working on producing a noun.

Posttreatment results show P1 achieved criterion of producing 24 minimum pairs on Week 9, the treatment continued up to 15 weeks. P2 did not achieve criterion for treatment termination solely in her oral phrases, instead, the combination of her spoken and written responses enabled her to meet the criterion on Week 12. Results show VNeST improved P1’s connected speech and decreased her production of neologisms. Both patient 1 and 2 also made clinical improvements on their Western Aphasia Battery (WAB) score. In conclusion, P1 made more attempts at production and increased her utterances. P2 demonstrated fewer verb errors overall, including written. VNeST is proven to be an impactful technique during speech therapy. This study helped both moderate-to-severe aphasia patients improve their semantic skills, which is a key criteria in almost all aphasia cases. VNeST offers repetition, while encouraging personal responses from the clients. It would have been extremely helpful to see a larger number of participants, rather than the limited amount of 2, as well as VNeST being extended into writing as well. Writing was only taken into consideration when in placement of oral speech (specifically for P2). In future academic articles, VNeST should be researched as a tool for oral and written language.

Traveling SLP

Traveling SLP

I have found myself becoming more and more intrigued by the idea of building a tiny home and traveling across the country after graduation. Realistically, the best way to continue enhancing the clinical skills obtained in graduate school and complete my fellowship year while traveling, not to mention pay my bills, would be to become a traveling speech language pathologist. I searched through my podcast library and found The Traveling Traveler’s in-depth review of being a traveling SLP on Conversations in Speech Pathology.

What types of agencies could you work for?

As a traveling SLP you are required to make connections with recruiters, who will in turn work with agencies on your behalf. While recruiters are able to find agencies with assignments across any specialty in speech pathology, some agencies are becoming more specialized to ease the job hunting experience. In addition, larger recruiting agencies are able to pay more for the job placements that are advertised in frequently sought after cities and specialty clinics, versus smaller agencies. Some agencies are:
Advanced Travel Therapy
MedTravelers
Allied Travel Careers

What type of assignments are available?

Job assignments are temporary fillings that company’s are requesting SLPs for. This could be due to maternity leave, medical leave, or simply a transitional period between full time employees. That being said, job placements can be found anywhere in the United States, even in Hawaii. These placements range across the board from nursing facilities, acute care, inpatient rehab, home health, schools, and outpatient clinics. Schools are among the most popular assignments available to choose from. California is often looking for traveling SLPs, while states like Florida have a high influx of SLPs and are generally only offering positions in schools. Some states have ethical concerns that you may want to research further, such as Texas and Massachusetts.

How much do you get paid?

Assignment pay ranges by city and facility in which the job is located. In addition, the take home pay is impacted by the benefits that the agency is offering, such as health care, student loan reimbursement, and paid time off. Lastly, the agency may also receive a portion of the company’s designated salary for the position, reducing your take home pay.

Pros

-Assignments are about 13 weeks long, allowing you to travel to new places and change your work flow as often as you’d like.
-Time off between assignments is completely up to you, giving you the freedom and flexibility to continue your travels
-Some agencies offer incentives, such as a free Caribbean vacation

Cons

-While cost of living is somewhat considered, speech therapy sessions remain at a somewhat stabilized cost across the medical field. This affects a company’s ability to increase your salary, while rentals increase around you. This is particularly important in high cost of living locations, such as New York City or San Francisco.
-Cost of certification and licensing is most often up to the SLP. This means you could be faced with the strain of requesting licensing in multiple states, paying fees, paying renewal fees up to $200, and fees for any addition state required CEU courses. Something to consider if your take home pay isn’t what you expected after graduating.

Let’s see what the future holds for us!

How to Ace Your College Interview

How to Ace Your College Interview

I have recently been invited to participate in the interviewing process for admissions into a Speech Language Pathology graduate program. As I begin to prepare for this next step in my journey, I have been researching skills that are beneficial during the interviewing process.

Tips
Below are some general tips and suggestions to help with the “behind-the-scenes” prep, so to speak. These are the skills, behaviors, and research that will help build a strong portfolio of answers during the interview.

  1. Arrive 30 minutes early to the facility, and at least 15 minutes early to the reception area to sign in.
  2. The first impression lasts 7 seconds: have a strong handshake, good eye contact, a genuine smile, and confidence.
  3. Do your homework about the school, the mission statement, and program details.
  4. Ask a closing question that cannot be found in the school catalog/manual.
  5. Dress professionally and conservatively so as to not distract from your answers and work ethic.
  6. Have a closing statement to summarize yourself as the perfect candidate, ask about the next steps, and send a thank you note within 24-48 hours.

Common Questions
In this next section you will find some questions that are often asked, and some that have been reported by current graduate students. In addition, following the question are suggestions for how to formulate your answer. It is highly recommended that you begin practicing your answers in a mock interview, or in front of a mirror, to become comfortable saying your answers out loud.

  1. Tell me about yourself. This is the most common, and perhaps most daunting, question that could be asked in an interview (or anywhere for that matter). Learn how to talk about yourself by highlighting your personal, professional, and academic accomplishments that have impacted who you are today. You may also include some of your interests outside of academia, as long as they are appropriate.
  2. Why are you applying to this program? Answer with the program strengths that intrigue you, as well as your interest in the faculty members and their research.
  3. What are your strengths? Demonstrate at least three skills with the Show-and-Tell method: describe your skills with stories that support those claims.
  4. What are your weaknesses? Identify your weakness and the steps you are taking towards improving this weakness.
  5. What is something that excites you about the speech field? While it is not common to receive questions about the specifics of speech disorders or vocabulary, it is recommended to review some current news and research articles in the field.
  6. Where do you see yourself five years from now? Outline your career path and goals that are related to the speech field. You should also show how this school’s graduate program will be helpful in achieving those goals.
  7. What was the last book you read/movie that you watched? This question is often seen as a curveball to get to know you outside of your academics. Choose  books/movies that represent your persona, without being inappropriate. Mention a thought-provoking book/film over a horror or chick-flick.
  8. How would you respond in a situation where…? Behavioral questions have become more common in interviews. Use an example from your past to demonstrate your personal experience and accomplishments in a similar situation. Include details to set up the scene and do not forget to finish the story with results. The recommended strategy to use is the STAR method: situation, task, actions, and results.

If you have any additional tips, leave a comment below!

 

USPHS

USPHS

United States
Public Health Service

I know I said I wouldn’t discuss the military, but I am just blown away by this information, I had to share! If you have never heard of the Public Health Service, then we aren’t that different. Until last night, I had no idea that this was one of the seven uniformed services in the United States, and accounts for 6,500 medical professionals working in federal agencies across the country. It blew me away because I served five years in the medical field in the Navy and was not aware that this was another avenue to serve. So why is this all so important? Because the U.S. PHS accepts Speech Language Pathologists and Audiologists.

How is it different from the military?

The Public Health Service is still a commission corps similar to the military in that there is a base pay by rank, health insurance through Tricare, retirement after 20 years, and tax-deferred incentives such as a sustenance allowance (BAS), a housing allowance by location (BAH) and retirement savings (TSP). In addition, members must wear a uniform and are deployable. However unlike the military, deployments are short and usually driven by disaster relief or agency needs. Depending on your agency, you may only be responsible to respond to disasters during your designated time of the year. Lastly, moving is optional and you are only required to serve two years, after which you can withdraw at any time.

Do I need to be prior military?

Prior to applying to join to PHS, you do not need any military service. Upon selection and hire to an agency, you complete a 14-day Officer Basic Course training in Rockville, Maryland to review military customs and bearing, career development, and useful resources.

If you do have military service, the PHS will accept individuals with less than 8 years of service, and this time can be added towards retirement.

Benefits

As mentioned before there are many military benefits that are applicable to those in the PHS regarding pay, healthcare, and retirement. In addition some benefits include:
– Loan repayment potential
– 30 days of paid vacation per year
– 84 days of paid maternity leave and 10 days of paternity leave
– Access to military bases, flights, and shopping

Who is this a good fit for?

This avenue of service would most benefit SLPs who are looking to have a career with a medical focus and increased opportunities in the administrative sector of federal agencies. In addition this would be a good fit for individuals that want:
– Job security
– Paid relocation for new job opportunities
– To help when man-made and natural disasters occur
– Positions in federal agencies, such as the VA medical center, National Institutes of Health, Indian Health Service, Air Force bases, etc.

Here is an example of what your career could look like as an SLP in the Public Health Service: CAPT Mercedes Benitez McCrary.

Lastly, keep in mind that it takes about a year following application to have records reviewed and processed before you can begin applying to agencies for possible positions. This is a lengthy board approval process and requires Presidential Appointment. If you have the time and passion, this would be a great fit for you.