Speech Therapy in Children with Snyder-Robinson Syndrome Angela M. - - PowerPoint PPT Presentation

Speech Therapy in Children with Snyder-Robinson Syndrome

Angela M. Fox, Ph.D., CCC-SLP

 Role of the Speech-Language Pathologist

(SLP)

 Assessment  Intervention  Augmentative and alternative communication

(AAC)

 Provide: prevention, screening,

consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up.

 For: speech, language (morphology,

semantics, syntax, pragmatics, phonology), cognitive-communication, voice, swallowing and feeding, and fluency disorders throughout the lifespan.

(ASHA, 2001b)

Collect and then integrate information about individuals' speech, language, cognitive- communication, voice, swallowing, fluency, reading/literacy, and writing capabilities (Beukelman & Mirenda, 1998c).

Can include:

• standardized tests
• criterion-referenced measures
• parent report formats
• play-based observations
• assessment of daily routines
• dynamic methods

ASHA, 2008

Federal regulations governing infant and toddler services under IDEA 2004 states that assessment should include:

a)

identification of the child's unique strengths and needs

b)

a family-directed assessment of the concerns, priorities, and resources of the family related to the development of the child

c)

identification of the nature and extent of the early intervention services needed by the child and family

d)

the identification of supports necessary to enhance the family's capacity to meet the developmental needs of the infant or toddler(§636(a)(2))

 Tied directly to instructional

planning

• standardized tests
• qualitative analysis of student work samples
• observations
• self-report measures

ASHA, 2008

 The World Health Organization (2001)

definitions underscore the need for assessment to address involvement in daily life activities and social aspects of communication.

 Assesses the patient in the context of the

patient's education, life experience, effort, personal goals, and values (ASHA, 2003).

 Involves gathering structured and

systematic observations within functional context-bound activities in multiple settings (Notari-Syverson & Losardo, 1996; Olswang & Bain, 1996; Pena, 1996).

 Assessment materials or strategies are

selected that support observation-based assessment in natural environments within the areas found to be most challenging.

 Language samples can be collected to

determine the range of forms, meanings, and functions (Goldstein et al., 1996).

 Needed to assess changes associated with

intervention efforts and to assess changes in the individual's communication needs.

 Furthermore, it is essential to determine whether

intervention efforts are having the desired effect on communication skills.

• Need to monitor communication function closely

when adding or changing therapy of AEDs.

Environmental arrangement (Demchak & Downing, 1996; Kaiser, Yoder, & Keetz, 1992)

1.

Set up the opportunity to encourage the child to communicate.

2.

Wait until the child communicates ( with sounds, gestures or words)

3.

Expand child’ s communication form by modeling a target.

Milieu approach (Kaiser & Roberts, 2013)

 Responsive interaction strategies

• language modeling
• expansions of child utterances

 Behavioral teaching strategies

• environmental arrangement
• selecting and teaching specific language targets

appropriate to the child’s skill level

• responding to the child’s initiations with

prompts for elaborated language consistent with the child’s targeted skills

Parent-implemented interventions (Arthur, Butterfield, & McKinnon, 1998; Roberts & Kaiser, 2011).



Interaction between the child and the parent occurs during play, routines, and everyday activities.



Provide opportunities for turn-taking



Use specific language through models and expansions



Prompting target production

These techniques typically include basic features of:

 following the child's lead  embedding techniques throughout the child's

daily routines and activities

 providing caregiver support/training in

multiple settings and contexts

Bricker et al., 1998; McWilliam, 1996

 Increases children’s receptive and expressive

language skills (Tsybina & Eriks-Brophy, 2010; van Kleeck et al., 2006).

 The adult and the child switch roles so that

the child learns to become the storyteller with the assistance of the adult.

 The adult becomes an active listener, asks

questions, adds information, and prompts the child to use more and more sophisticated responses to questions.

PEER sequence:

 P= Prompt the child to say something about

the book

 E= Evaluate the child's response  E= Expand the child's response by rephrasing

and adding information to it

 R= Repeat the prompt to ensure the child has

learned from the expansion

Zevenbergen & Whitehurst, 2003

 Pragmatics – social language  Figurative language - nonliteral language

uses such as idioms and metaphores.

 Inferences - integration of meaning within

text and verbal problem solving.

 Written language  Polysemous vocabulary - words that have

multiple meanings.

ASHA, 2001

Different disorders may result in changes in

• ropharyngeal muscular strength and

coordination over time.

• Compensatory techniques are designed to help the

individual swallow safely, not to alter physiology.

 Position – chin tuck

• Habilitative techniques are designed to change

swallowing physiology and can also be used as compensation.

 effortful swallow  thermal-tactile stimulation

ASHA, 2001

• Augmentative and alternative communication

(AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas.

• Intended primarily to maximize individuals'

abilities to communicate as effectively and efficiently as possible.

• A primary purpose of AAC is often viewed as

supplementing or au augm gmen enting ting the effectiveness with which individuals communicate through their existing methods of communication (Romski & Sevcik, 1996).

• For other individuals, the AAC system may serve

an al alte terna nativ tive function in that it becomes the primary and perhaps only means of

• communication. The role of AAC may vary for an

individual depending on the course of the disorder (Beukelman & Mirenda, 1998b; Mathy, Yorkston, & Gutmann, 2000).

 Numerous studies have demonstrated that

the use of AAC does not interfere with speech development (Romski, Sevcik, & Hyatt, 2003) and actually has been shown to support such development (Charlop-Christy et al., 2002; Marckel, Neef, & Ferreri, 2006; Millar, Light, & Schlosser, 2006; Romski & Sevcik, 1996).

• Un

Unaide ded d co communicati unication

• n sy

syst stem ems – rely on the user's body to convey messages. Examples include gestures, body language, and/or sign language.

• Ai

Aide ded d co communicati unication

• n sy

syst stem ems s – require the use of tools or equipment in addition to the user's body. Aided communication methods can range from paper and pencil to communication books or boards to devices that produce voice output (SGD's)and/or written output. Electronic communication aids allow the user to use picture symbols, letters, and/or words and phrases to create messages. Some devices can be programmed to produce different spoken languages.

• Speech generating devices (SGDs), whether

electronic or nonelectronic, is used to transmit or receive messages.

• Range from simple devices, such as a choice

selection between two photographs affixed to a sheet of paper, or a single message recorded on a single switch-activated device, to relatively complex technologic presentations of numerous symbols that can be combined to convey an infinite variety of meanings.

 Direct selection techniques tend to be faster

(depending on the individual's motor control), and easier to learn and use, but have greater motor requirements than scanning techniques (Cook & Hussey, 1995; Dowden & Cook, 2002).

 Consider alternatives to hand movements:

• Motor limitations – use eye-gaze

• Dowden and Cook (2002) proposed a

hierarchy of control sites (i.e., locations on the body where an individual demonstrates purposeful movements that may be used to access a switch)

 Fingers and hands should be considered before head and feet.  They indicated decisions must be based on actual trials with each individual.

• Naturalistic, client- and family-centered

approaches are strongly recommended when introducing AAC systems (Blacksone & Dowden, 2000; Romski & Sevcik, 1996; Sigafoos, 1999).

• Individuals should be taught to use their

systems functionally with different communication partners in different settings.

 Communication

Cause and effect Choice making Requesting Greetings Commenting Initiate

 It is important to base intervention decisions

• n what is occurring “today” as well as what is

anticipated for “tomorrow.”

 ChoiceBoard Creator – make a personalized

grid

 Yes/no – allows you to edit pages to make

choices

 TouchChat - Symbol-supported communication  Proloquo2Go - Symbol-supported

communication

 TapSpeak Choice - Symbol-supported

communication



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

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

American Speech-Language-Hearing Association. (2001b). Roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents (position statement). Rockville, MD: Author.



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

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

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

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

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

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

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

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

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

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

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

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