Tuesday, November 03, 2009

NSSLHA Meeting November 3rd, 2009

Speaker: Adam Weiss from Zygo Industries
- his company produces voice output systems, alternative access, environmental control system
- AAC = augmentative alternative communication
- Why do you need voice output?
- Must prove that it is medically necessary to provide a voice output device
- SLP is the one who has to recommend a product for their client, need to document the need for it and choose which device or devices are necessary
- Provided handout about various devices and contact information
- Communication device can provide voice output through digital or synthezed speech.
- Macaw: digital recording device, vocabulary is recorded speech and use overlay to represent vocabulary that is stored on the machines. Symbols can be pictures, letters, graphics, words. Press on a cell and get recorded message that speaks out. Most of the overlays are pictures with text prompts. Can start off with overlay being just message, then increase the number of symbols until client can use many symbols on one overlay. All of the overlays don’t have to be the same layout (i.e. the same number of symbols). Macaw can sequence/combine two symbols to create additional messages. Can sequence up to 80 characters in a row.
- Windows XP tablet computer: dynamic display device. Make choices by touching the screen. Has a 22 GB hard-drive. Can fit more voice recordings and pictures on this device than the Macaw. Don’t have to physically change the overlay. It is cognitively more difficult than the Macaw and may not be appropriate for people who have cognitive impairments. Can plug in a tracking mouse or eye-gaze system if client can’t physically touch icons on the screen.
- PECS: can take pecs symbol and place it on the macaw overlay symbol that it matches and it makes the Macaw do voice output.
- can record various languages on the Macaw. Can use a single overlay but record two different languages for each symbol.
- Pollyanna (text to speech): person is cognitively intact but cannot be understood. Uses deck talk to transfer typed text into voice output. Had word prediction for word you are typing and for the proceeding word. ‘
- Medicare will pay for a dedicated communication device- means that all it is used for is the communication that the SLP recommends.

Wednesday, October 07, 2009

NSSLHA Meeting October 6th, 2009



- tote bags for sale $10 --> contact Bailey Duemmel to purchase.

- pay for dues for the quarter ($5) or the entire year ($20) ---> Pay dues to May Wu.

- First year graduate students apply for NSSLHA positions. Email Claire at CWbrownie84@yahoo.com

Speaker: Laurie Campbell

- speech language pathologist in hospital setting

- born in Panama, had an active childhood

- currently has Parkinson’s Disease

- her early symptoms were similar to the flu, felt achy

- had bad headaches, neck strain

- she started fainting

- first diagnosed with migraines, put on migraine medication and had a stroke from it

- she had a lot of difficulty getting doctors to take her seriously and properly diagnose her.

- Parkinson’s is a brain disorder that affects the substantia negra

- Caused by a lack of dopamine in the body

- Dopamine doesn’t cross the blood/brain barrier and the body can’t absorb dopamine

- Signs and symptoms: rigidity, slowness of movements, visible shaking/tremors, difficulty with balance, cramping, stiff facial expressions, muffled or slurred speech, depression, dystonia is a symptom for young onset of PD.

- Seeing more of young-onset cases because there is more awareness and research being done.

- PD usually affects people over 65 y/o, 10% of people with PD start having symptoms before 40 y/o.

- There is no test to diagnose PD, it’s a process of elimination

- Those with parkinsonism or the symptoms and signs of PD without the disease itself can be due to medications, drugs, or other disorders or injuries.

- 3 types of PD: young-onset, idiopathic parkinson’s, and secondary parkinson’s

- people with PD become depressed because serotonin levels are also lacking

- because the disorder is progressive, constantly need to change medication as the symptoms change and progress

- as an SLP, should ask at every session if patient with PD has had any falls, if they are taking their medication, what they are taking

- There are no cure for PD, can treat with medications and surgery.

- Exercise slows progression of the disease ---> shown by recent studies, a new phenomenon.

- Treatments don’t slow the progression of the disease, but improve motor function and quality of life.

- However, the benefits gained by these treatments decline as the disease progresses.

- Levadopa helps produce dopamine in the brain and it reduces slowness, tremors, and stiffness.

- Sinemet is an older medication

- Selegiline inhibits the enzyme MAO-B, which breaks down dopamine. Carries some anti-depressant effect.

- There are two types of surgery: Pallidotomy and deep brain procedures. Patients who receive the most benefit from surgery are people with good general health, normal intellectual/memory function for their age, and continue to have benefit from levadopa.

- Pallidotomy destroys a section of the brain and helps with tremors, rigidity, bradykinesia, and levadtop-induced dyskinesia.

- Lee Silverman voice treatment is used for people with PD ---> patient does treatment (talking really loudly) five days a week for an hour plus an hour of homework, 2 hours of homework on the weekends.

- Need to always be aware of what the goals are of the patient

Wednesday, May 27, 2009

NSSLHA Meeting Minutes May 4th, 2009

NSSLHA Meeting 5/4/2009
Speaker: Debbie Schram
- Announcement: Work for Hallmark Rehabiliation for one year after you graduate, and they will pay for your tuition or student loan. You can visit their website for more information at http://www.hallmarkrehabinc.com/

- She has been in recovery since July of 2007
- She progressed into state where she couldn’t communicate with anyone. She didn’t know what was going on.
- She struggled to find the words to use to say “I had a stroke.”
- Has left hemisphere brain tumor
- Gave her 4 months to live.
- She was given signs on paper so she could point to yes, no, right left.
- She had speech therapist that came to her house. She had worksheets for filling out phrases, prepositional phrases, sequencing steps.
- The speech therapy was helpful.
- Her and the speech therapist would have conversations.
- At 18th month, there was a period of spontaneous recovery- she was able to communicate much better.
- She would use content words and leave out all of the function words. At 18 months, she could use more function words so people could understand what she meant.
- Her comprehension is good.
- She participated in a cancer retreat. She was overwhelmed. She was aware of everything that was going on, but she couldn’t understand what was wrong with her and why she couldn’t communicate.
- She could write, but she couldn’t speak.
- She thinks others perceived her to be retarded, incompetent.
- Using gestures, the computer, facial expressions, yes or no questions work well for her.
- She has trouble finding specific words.
- Pictures work well, flashcards that have a picture on one side and word on the other are also helpful.
- DMV, police don’t understand what aphasia is. Using a card that explains her situation helps.
- One thing SLPs can do to help people with aphasia is help the families understand what the impairments are and what they aren’t, what the patient’s strengths and weaknesses are.
- Debbie is in a rehabiliation program at Coastline College for people with brain injuries. Debbie is in the language class. All of her classmates have good comprehension, but poor speaking abilities.
- Her sister, Marilyn, uses various strategies to communicate with Debbie – she can point to an option of 2 things, waiting for a response, not talking too much, not guessing/anticipating what Debbie is going to say, and to not push Debbie to talk.
- Writing is easier for her than speaking. Sometimes the same mistake comes out in the writing as it does in speaking.
- She is good at reading out loud. It is a little hard to pronounce some words.

NSSLHA Meeting Minutes April 13th, 2009

NSSLHA Meeting 4/13/2009
Register at walknowforautism.org, click on register, create a team or join our team WHEELS ON THE BUS
For more information, email baileyslea@yahoo.com

Topic: AUTISM Speaker: Gwendolyn Meier
- Autism is a spectrum disorder (classic autism -→ high functioning autism -→ Asperger Syndrome)
- A behaviorally defined condition
- Neurological disorder
- Severe impairments in: socialization, communication, behavior and interests
- Need 6 symptoms from 3 categories in the Diagnostic Criteria (DSM-IV): Social interaction (2 symptoms), Communication (1), Restricted, Repetitive, & Stereotyped Behavior & Interests (1)
- Diagnosis usually happens at Regional Centers
- Kids with autism don’t play with toys in the way typical children do: they focus on a specific part of a toy, employ self-stimulatory behaviors
- Idiosyncratic use of language
- Need very structured, concrete activities
- If something unexpected happens in their schedule, they may have a tantrum
- Many will self-stimulate: touch, visual
- Core deficits in Autism: what areas you think are core deficits will determine what you treat in therapy
1.) Joint Attention – poor response to name, lack of showing and sharing; if child doesn’t follow where his/her parent is pointing to, child won’t learn what the referent is.
2.) Symbolic Skills- coming up with the concept for the language referent; symbolic skills are apparent in language and play
- Estimates of incidence of Autism has changed a lot in recent years → could be due to population growth, data collection, investigators, change of diagnostic criteria, migration to CA, change in categorization
- Estimates of incidence of Autism are: 1 in 150 (Autism Speaks, 2009)
4-5/10,000 (prior to 1985)
- Etiology and Suspect Factors: genetic link, comorbid medical issues (GI concerns, sleep problems, allergies/infections), NOT caused by parenting, multifactorial cause
- Possible Triggers: Exposure (in utero, after birth, toxins), immunologic, metabolic, MMR vaccine debate (jury is still out)
- Evolution of Treatment: 40’s and 50’s: removal from home, 60’s and 70’s: behavioral teaching/operant conditioning, controlled settings (food deprivation, aversives, poor generalization), 80’s 90’s and 00’s: “naturalistic” behavioral approaches, natural reinforcers, daily settings, motivation, self-initiation, connection between communication and problem behavior, amount and type of stimulation (debate)
- No definitive evidence for any one treatment approach over another
- SLP Assessment: standardized measures look at language FORM and elicited responses, primary deficits lie in pragmatic USE of language/FUNCTIONS, initiation, and rate of communication, few resources aid us in evaluating pre-intentional, pre-verbal, and nonverbal communication
- Visual schedules: organizes the child’s day, establish routines, predictability, expectations
- Aided language stimulation/visually cued instruction: make language input visual and intransient, provides language model
- PECS: provides means to make requests
- For more information, visit autismspeaks.org

Tuesday, March 03, 2009

NSSLHA Meeting Minutes March 3rd, 2009

NSSLHA Meeting 3/2/09
Anne Preddy
- Works at the VA Hospital in Long Beach → doing CFY
- Sees in-patients and out-patients
- Cognitive evaluation and treatment – see many veterans with mild TBI. Does cognitive therapy and compensatory strategies training
- Swallowing evaluation and treatment – bed side swallowing evaluation, modified barium swallowing test, and FEES (flourscopic endoscopic evaluation of swallowing)
- Speech evaluation and treatment – do standardized and informal assessment, compensatory strategy training, recommends oral prosthesis, electro-larynx
- Voice evaluation and treatment – functional and organic voice disorders, standardized testing and informal assessment, compensatory speech strategies
- Language evaluation and treatment – aphasia from stroke, brain tumors
- AAC and cognitive prosthetic devices- help with speech, memory, organization
- A perk of working at the VA is that there aren’t the funding issues that you normally have to deal with at other hospitals → can get expensive devices easily
- Train families and collaborate with them
- Why work in a hospital?
- great variety
- can work with children and adults, depending on the setting
- colloboration → team of SLPs, interdisciplinary tea, VA hospital system
- have flexibility of patients you would like to work with
- learning opportunities and continuing education
- challenging, never boring
- rewarding
- Why not work in the hospital? Long hours, not as much vacation, “yuck” factor
- Email: Anne.Preddy@va.gov → for questions and/or if you want to shadow
- What is the paperwork like? Taking her a while now because she is new at it. Everything is computerized. It’s a lot of paperwork.
How much individual vs. group therapy do you do? 80% individual, 20% group. Have stroke group, teaching how to use palm pilots for patients with cognitive deficits.

Blanca Hatim
- works at a highschool in Alhambra
- she likes working at a highschool because the kids can stay still, can have a conversation with them
- can work in public or private school
- district or agency paid
- not hard to find a job → when you do your externship, you will be offered a job
- find jobs at edjoin.org → helpful to start looking now so you get the hang of it
- sign up for Advance magazine → have job postings
Why School?
- kids, competitive salary, 10- month contract, extra pay for summer work, decent work schedule (7 or 8 hour day)
- all student holidays off, full health and medical benefits, retirement benefits, union support, peer support
- school budget cuts → conference and supplies, caseloads (state avg. 55), paperwork, reports (about the same as CSULA clinic)
- paperwork isn’t that bad for her since her caseload is 37 students
- variety of needs → MR, down syndrome, autism, Aspergers, specific learning disability, etc..
Variety of Needs
- work on semantics (vocabulary building), syntax (grammar, sentence structure), morphology (internal structure of words), pragmatics (social skills), voice, articulation, fluency (stuttering)
1st Year Requirement
- called CFY or RPE year
- requires supervision by licensed SLP

Monday, February 02, 2009

February 2nd, 2009 NSSLHA Meeting Minutes

Speaker: Rebekah Taylor (SLP at a private practice)
- announcement about paying dues, signing up for email, registration
- announcement about free magazine called “Advanced for Speech Therapist” – sign up online or on phone
- Walk for Autism on April 25th →sign up on walknowforautism.org
- look on ASHA website for skills you need to obtain during CFY, gives focus on what you want from the experience
- pay attention to change in supervisor rules →supervisors need to take a class to become a supervisor
- must do everything in BLUE ink for forms for California State Board
- she did CFY in private practice
- environment completely different than what she expected
- works with 2 year old kids
- she felt like she suffered through it
- impossible to get all the information you need in a 2 year program → don’t go into your first year feeling like you have to know everything
- observe as many people as possible to get ideas for therapy
- don’t forget your sense of self, have confidence in yourself
- professionalism isn’t knowing all the answers, but knowing how to find them
1.) What should we look for in a CFY? Figure out what you want first, where you want to work, which age group. Ask classmates about the hospitals or schools they work in. Garner relationships with SLPs, network.
2.) How much supervision did you receive? She didn’t get that much. Definitely talk about it with your supervisor beforehand. She had weekly meetings with supervisor, but didn’t have much actual observation. Don’t be afraid to ask for help.
Private Practice
- works at Briggsan Associates.
- Assessment, recommendation, treatment
- Parents are in the room during therapy
- Teach parents how to do therapy/strategies at home
- Work with the family, community in a team
- Initial assessments done as a team →2 people (one person records and interviews and one examines)
- Don’t give formal assessments, very play-based
- Best way to figure out a child is to figure out how they interact
- Giving a test doesn’t really give you an idea of what is going on with a child
- Sometimes give formal tests if school district requires it
- see kids birth-5 years old
1.) Can you choose the population you want to work with? Can’t get so specific with a specific disorder you want to work with; can choose age range you want to work with. Once you get into a CFY, you can request to your supervisor that you want clients with a specific disorder.
2.) What are the differences in load of paperwork, hours between private practice and school? She works 33 hours. She has 1 on 1 50 minute sessions with the parents. Out of the 33 hours, she has 27 booked with clients. Need to write notes at end of every session. Progress report every 6 months. All private pay; work with regional center, so don’t have to deal with insurance companies.
3.) How much vacation do you get? Vacation is based on hours worked. Get about 2 weeks off. Medical benefits not as great as working in a school.
4.) What is reverse swallowing? Babies stick out tongue to swallow. Can be a problem when you do this after infancy. In same category as tongue thrust.
5.) What problems do 18 months old have? Looking at where they are developmentally. Can work on getting their mouth moving, saying any sounds. Think about what they can do and start from there.
6.) What kind of diagnoses do the kids have? Developmental delay, dyspraxia
7.) What are the symptoms of developmentally delayed kids? Delayed in milestones for speech and language. Ask if they are receptively and/or expressively delayed?