Nov. Meeting Notes!

CSULA NSSLHA Meeting Notes
Guest Speakers: Caroline Lee & Amanda Tyree
Date: November 7, 2011

Announcements:

• elections
• tshirts on sale now at the meeting for $15 (after meeting, $17)
• CSULA COMD bags for sale for $1

Guest Speaker- Caroline

• works at Pasadena Child Developmental Associates- non profit interdisciplinary clinic
• works at a charter school

Guest Speaker- Amanda Tyree

• did CFY at a children’s hospital
• works at a private practice.

Both Guest Speakers

• both participated in the LEND (Leadership Education in Neurodevelopmental and Related Disabilities Training Program) Program
• focus is working in an interdisciplinary team
• 32 weeks long, each Wednesday
• has 7 modules (each month a different module)
• people from various professionals (RNs, psychologists, social workers, etc) from all over the country
• get a holistic view of children that is beyond speech-language
• at Pasadena Child Developmental Associates Caroline uses the DIR Floor Time Model:
• Developmental: look at a child at all levels (e.g., emotional, cognitive, gross motor skills, etc)
• Individual Differences: look at each child individually (e.g., proprioception, sensory issues, etc)
• Relationship: investing on your relationship with a child can make a difference in clinic
• PROMPT:
• method that is for people with apraxia, but this can be used with people with various disorders.
• use proprioception, kinesthetic, and tactile prompts
• Tips
• As students, take advantage of your discounts!
• For CASHA, membership is $35/year for students. You can participate in several workshops to give you more knowledge about the speech-language field.
• Balance! Maintain your work and recreation life.
• Foster your relationships with your peers. Make connections!
• Q&A
• Have any of you worked with adults?
• Yes. In the grad program you get to do a hospital internship to work with adults.
• (Amanda) I have also worked with adults in the private practice I work at. For me, I want to see it all because I work with adults and children right now
• (Caroline) I do some home health. I also worked with adults at USC when I was a graduate student.
• Where can I get more information about going to workshops?
• CASHA has different presentations at their annual CASHA convention.
• Several workshops occur throughout the year.
• PROMPT is a workshop in itself. You can look this up online.
• Both Caroline and Amanda are part of District 7 of CASHA
• We have one course on Dysphagia. How much should we look up on our own (regarding the material)?
• It’s up to each person individually to do that on his/her own.
• Be proactive with your externships. Ask questions. Request for certain clients. Ask to take notes for certain things. Build that relationship with your supervisor there! Take advantage and devour as much information as you can.
• With the LEND program, how do you apply?
• There’s an intervie.
• Program lasts from September to May
• Fill out an application.
• 32-39 programs across the country
• It’s a year long program
• How difficult is it to get into pediatrics at a hospital?
• Positions do not open up as often.
• If you are really interested, you should create an externship of this yourself because many hospitals don’t do that.
• Do you have to do LEND during your CFY?
• No, but it’s easier to do this in your CFY.
• You get paid a small stipend to cover your gas.
• DIR program, what ages is this for?
• Any age.
• What resources are there about DIR?
• ICDL with Greenspan
• Circle Stretch (can find this on the ICDL website)
• PCDA also does workshops. Look at www.pasadenachilddevelopment.org
• On Wednesday November 9th at 7pm, there will be an autism workshop about iPads at PCDA.
• How has the iPad helped in therapy?
• It’s good for a tool and productivity.
• Children are getting more involved. Can you talk about that?
• Some children need services from multiple disciplines.
• Not sure if there is an increase with children like this, but you may run into children who need several services.
• Did any of you work with cleft palate children?
• No. But St. John’s hospital has a cleft palate team and so does Cedar Sinai.
• How prepared did you feel about graduation compared to now?
• Amanda: I feel a lot different. It might have to do with my temperament. But everything gets better with time.
• Caroline: The more kids you come across, you get more of a swagger. Confidence is key. You will always be a student. The key is to seek knowledge.
• How big is your caseload?
• Caroline: You should know what you’re worth. In my work setting, I negotiated what I wanted. I work with a charter school through an agency. I work three days a week and have 35 students.
• Can you tell me about volunteering with PCDA?
• they have a volunteer program. Look at www.pasadenachilddevelopment.org
• In my session (Caroline), parents are very involved.
• Agencies. Can you tell me how or what agencies to work for?
• Talk to a person in an agency. If you don’t know the agency, call the agency and ask to talk to someone that works in one.
• Make a list of questions to ask during the workshop (for second years). To discuss paper work, negotiating, etc.

Meeting Recap from Dr. Biel

Thank you to everyone who made to our last meeting of the school year with Dr. Biel.

Here are the notes from the meeting:

Michael Biel CScD, CCC-SLP
05/10/11
Intensive Aphasia Treatment: Case of Non-Lexical Recurrent Utterances

• This is a case about a gentleman in a program called Pirate (Pittsburgh Intensive Registration Aphasia and Treatment Evaluation) in Pittsburgh.
• Why did this program become established? Aphasia is a complex disorder to treat and several veterans at the time had Aphasia.
• History: 61 y/o male, with left MCA (Middle Cerebral Artery) CVA (Cerebrovascular Accident) in 2005, global aphasia and severe AOS (Apraxia of Speech)
• He had nonlexical speech where he only said, “Ba ma ma ma, huh, ba bum bum ma ma.”
• treatment Hx:
• had 1-year inpatient rehab
• 2 years outpatient treatment (tx)
• group treatment
• various experimental txs
• despite tx, his speech did not improve; he was unable to repeat sounds.

• In PIRATE:
• tx for 6 hours a day for 6 days a week for 4 weeks.
• 4 hours of treatment were individual tx and the other two hours were in a group setting.
• COGNITION:
• he scored WNL on the Raven’s colored Progressive Matrices (assesses problem solving) and scored WNL on the pyramids and Palm Trees Test (assesses semantics)
• MOTOR SPEECH
• no cranial nerve signs
• motor speech testing was difficult- did show signs of nonverbal oral apraxia (NVOA)
• could imitate a “Uh” and /h/ via a PROMPT
• could manipulate rate and prosody of recurrent utterance when given a model
• AUDITORY COMPREHENSION
• Comprehensive Aphasia Test (CAT)
• he scored 21%ile for single word
• VERBAL OUTPUT
• all tasks resulted in production of the recurrent utterance
• chance level performance on a pictured rhyme judgement task from the PALPA; the PALPA is used supplemental to other Aphasia tests.
• a picture rhyme subtest is used: a picture of a fan and van are showed and the person has to indicate whether or not the words rhymed or not (yes or no)

• On PALPA’s picture-rhyme test he scored in the low percentile level; this means that his apraxia of speech could be and issue of something else.
• READING
• he had good visual lexical decision making (58/60); this means that for reading, he has some comprehension. He had poor with written rhyme judgment (31/60)
• perhaps he had impaired phonological processing?
• or impaired subvocalization or verbal working memory

• WRITING
• he was able to write 6/40 written items on PALPA; this suggests something that we can work with; he was also abel for write by dictation 5/6 3 letter words.
• WHY CAN’T SJ (client) REPEAT?
• Apraxia of Speech?
• He did show non-lexical recurrent utterances; he had some Nonverbal Oral Apraxia; in tx, he demonstrated overgeneralization during articulatory tx.

• TX GOALS

• 1) improve ability to repeat 2) use social greetings 3) improve ability to use writing to communicate
• TX PLANNING
• Dr. Biel looked up research articles that focused on treatment for individuals with recurrent utterances and studies with individuals with global aphasia and significant AOS. Most of the articles he found were antedotal. One article he found dealt with PROMPT.
• Dr. Biel used PROMPT since it was likely that SJ had AOL.
• INITIAL GOALS with PROMPT
• 1) control voicing during production of /h/ and “uh” contrasts
• 2) control jaw opening in /m/ and “uh” contrasts

• PROMPT RESULTS
• both goals were not met; he overgeneralized /h/ for “uh”
• NOW WHAT?
• Do we abandon goal to work on speech?
• Try antedotal txs like VCIU or MIPT (multiple input phoneme tx)?
• Try melodic intonation therapy?
• Dr. Biel tried MIPT after several attempts to contact the author of the research paper about MIPT.
• MIPT:
• How does this work?
• Step 1: gain control of involuntary utterance
• Step 2: use sounds in the recurrent utterance to generate new words to practice/probe (if the person says “ma ma” get them to say “ma mom”
• CONTROL
• Multiple inputs of the target phrase before production attempt.
• Integral stimulation (look, listen)
• Rhythmic tapping on the ipsilesional arm
• Choral repetition with the clinician being louder.

• EARLY MIPT RESULTS
• SJ controlled production of his recurrent utterances, BUT was unable to produce words generated from the recurrent utterance.
• MIPT MODIFICATIONS
• Include PROMPT cuing
• Try and create unique errors, i.e. errors that contained new sounds or sound combinations; this helped diversify SJ’s phonetic inventory.
• After a word was taught, SJ was immediately taught to generalize these words, such as “Hi.”
• RESULTS
• By the end of tx, he could produce 60 words, mostly one syllable with anterior, visible consonants.
• 50/60 repeated on post-testing with integral stimulation
• On the Syllable Length Repetition subtest (PALPA), he scored he got 6/24 by the end of treatment; initially he scored 0/24. By the end of treatment, he did not use “Ma bum bum.”
• By the 4th week of treatment, he was able to produce, “Hi,” “Fine,” and “Bye,” for social greetings.
• By the 4th week of treatment, he made improvement with writing but only with specific items which did not generalize.
• WHAT CAUSES NON-LEXICAL RECURRENT UTTERANCES?
• There is a damaged phonological system that is cut off from other systems in a loop.

April 2011 Meeting Notes!

Thanks to everyone who made it to our meeting about working with children who are deaf, especially Jane Freutel and Jen De La Paz. If you missed anything, here are the notes from the meeting!

April 11, 2011 Meeting Notes

Announcements:

1. Walk for Autism- Saturday April 23^rd

How to Sign up: http://www.walknowforautismspeaks.org/faf/search/searchTeamPart.asp?ievent=442586&lis=1&kntae442586=6A9703936DEA4476A71068660C84A096&team=4014439&tlteam=0

Meet: us at the check-in section at the Rose Bowl; find our CSULA sign! Walk starts at: 10am

Registration starts at: 8am

Opening Ceremony starts at 9:30am

2. Survivor Symposium at Chapman University- Saturday April 16^th

Includes a panel of patient with ASL, TBI, Strokes and more!

Deadline to sign up is TONIGHT! $10 to sign up (includes refreshments and snacks)

3. T-shirts: will be a black, American Apparel shirt with white writing. See our Facebook page for the design: http://www.facebook.com/event.php?eid=183709131671679#!/pages/Nsslha-at-Csula/188094447878024

4.

Guest Speaker: Jane Freutel, Assistant Director of Teacher Education at John Tracy Clinic

www.jtc.org

History of JTC

· In 1942, Louise Tracy found the John Tracy Clinic (JTC.) She has a child who is deaf. JTC has programs for parents and children who are aged 0 to 6-years-old.

· These programs are free for the children and their families. This includes educational meetings and support groups and counselors that work with families.

What is JTC all about?

· JTC is parent focused. JTC provides parents with hope; parents who go to JTC experience distress and loss about finding out their child has a hearing loss. JTC offers parents guidance in a form of “What do you want to know?” JTC doesn’t preach. If parents do not find a means to meet their needs at JTC, JTC provides resources of where to get help. Lastly, JTC provides empowerment to help parents find resources for their children.

· At JTC, there is an auditory approach where all kids wear hearing aides or cochlear implants.

· The teachers at JTC are expected to know more about teaching speech and the development of speech for children who are profoundly deaf, more than speech and language pathologists.

· If you are interested to see how the teachers in JTC teach children who are deaf, you can look on Youtube and search John Tracy Clinic or go to the website www.jtc.org

· All of the classrooms at JTC have Sound Field FM systems.

The Masters Program for Special Education

· The program is a Masters degree in Special education with an emphasis in deaf deduction at the University of San Diego.

· All of the course work is at Los Angeles. Students start in August and finish the first week of June. There is a total of 44 units.

· 10 month program

· They finish with a master’s degree and after apply for the credential to work with children who are deaf and hard of hearing. The most difficult thing to get finished is the portfolio required (about the state standards for working with people who are deaf.)

· All of the graduate students get jobs for having a background in auditory skill development, auditory focus on speech development, and developmental speech.

· There is a $10,000 fee for tuition.

· There are resources that include scholarships and low-interest loans that provide for survival for a year; it’s not recommended for graduate students to work while in the program.

· Classes start in August. During this time, students observe practicing students work with children who are deaf and hard of hearing.

· There is a Friday Family School with children who are 0-3 years-old. Teachers play with the children; and parents are separated in a different room where they are educated on how to work with their children to encourage speech development.

· Courses also include Audiology courses such as Diagnostics and Amplification. Audiology classes taken at CSULA will be very helpful to do well in these classes.

· Students graduate on May 20^th at the JTC clinic and another graduation at USD.

· The cohort has up to 8 students.

· There is also a distance cohort with students who work across the country with children who are deaf and hard of hearing.

· Students in the master’s program are taught to teach children from 0 to 6-years-old. The credential however is to work with people who are hard of hearing and deaf that are 0 to 22-years-old.

· When students graduate, the options are:

o early intervention (work with children from 0-3 years old)

o work in a special day class

o work with children who are mainstreamed into classrooms

o work with school districts

o work in regional programs

JTC and Speech-Language Pathology

· both share information with oral motor therapy

· both share interest in language development

· at JTC, there is a lot of vocal play

Powerpoint notes from Jane Freutel

· JTC provides hope, guidance, and encouragement to families without a charge, worldwide.

· JTC provides audiological testing, which includes non-sedated ABR (0-60-months-old)

· Screening services are provided at JTC.

· JTC provides Parent-Infant Services

· JTC provide

o parent education classes

o international summer sessions & Latin American summer sessions for parents with children with hearing loss/deaf

o distance learning courses for parents about babies, preschoolers and children with vision and hearing loss.

· New possibilities for people who are deaf: newborn hearing screening, advanced technologies, digital hearing aids, cochlear implants

· Impact of hearing loss: careers, daily living, psychological issues, academic, reading, behavior, emotional, social, speech, language, communication

· Mainstreaming issues: preparation, implementation, support, environment, social

· Information to get involved:

o Tours can be provided

o www.jtc.org/teachered

o prerequisites

§ a 3.0 GPA

§ GRE

§ a bachelor’s degree

§ taken an ASL class

§ experience with children

o call 213-745-8391

o Mary McGinnis, Director

o Jane Freutel, Assistant Director