Assessment

Assessment

Category Archives: Assessment

Introduction to Telepractice

Telepractice (AKA telemedicine, teletherapy, telehealth, telespeech, telerehabiliation, virtual speech therapy) is the delivery of health services via a telecommunications system. This service model is becoming increasingly more popular in the fields of speech-language pathology and audiology. Large factors that have driven the use of telepractice are reducing travel time for the client and/or professional and expanding the reach of services. Telepractice is becoming a more widely used and accepted method of providing speech-language pathology and audiology services. However, many families are skeptical that the services provided through a computer could be beneficial or equally as productive as those provided face-to-face. Despite family reservations, researchers (e.g., Gorgan-Johnson and colleagues) have found that children receiving virtual speech therapy do as well as those receiving services in person.

Benefits of Telepractice

  • Decreases the rate of cancelations or no shows
    • Sessions can still occur in bad weather or when the speech-language pathologist (SLP) or client are sick.
  • Allows underserved populations to receive evaluations and treatment
    • Individuals living in rural towns may struggle to find local in-person services for their needs. Furthermore, individuals from culturally or linguistically diverse backgrounds may struggle to find appropriate services in their area. By using telepractice, these clients are able to receive the services they deserve.
  • Increases family involvement in the sessions
    • Family members can have a more active involvement by assisting clients with the session activities.
  • Increases interest or attention with clients that are motivated by and/or more comfortable in front of computers
    • Clients may be more engaged during their sessions because they enjoy being on the computer. They may also feel more comfortable asking and answering questions and performing difficult tasks with the computer screen as a safety net.
  • Allows clients to connect with professionals who specialize in their disorder or disability and/or can provide services in their native language
    • Speech-language pathology is a broad field. Although all SLPs receive some degree of training in all aspects of speech, language, and swallowing disorders, most  specialize in certain areas over areas.  For example, some SLPs may specialize in working with children with autism while others may have extensive training in treating adults who have aphasia. In addition, the majority of SLPs are monolingual and/or do not have the training to provide appropriate services to a bilingual client.
  • Makes sharing information easier
    • Clients and SLPs can share their computer screens and upload files to enhance the therapy session.
  • Helps clients and families to remember and understand what occurred during the session
    • Virtual therapy sessions can be recorded (with permission) and used for later review. By recording the sessions, clients and family members can watch what occurred. Watching the recordings assists clients with practice and carryover of skills. Moreover, watching previously recorded sessions allows everyone to observe the progress that has occurred.

How can we help?

At Liberty Speech Associates LLC, we provide telepractice sessions for the following purposes: accent modification, counseling, speech-language evaluations and treatment, speech-language screenings, and collaboration with related professionals. For more information on our telepractice services, contact us today.

References

  1. Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16(3), 134139.
  2. Grogan-Johnson, S., Gaebel, R., Taylor, J., Rowan, L. E., Alvares, R., & Schenk er, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children. International Journal of Telerehabilitation, 3(1), 3141.
  3. Grogan-Johnson, S., Schmidt, A. M., Schenker, J., Alvares, R., Rowan, L. E., & Taylor, J. (2013). A comparison of speech sound intervention delivered by telepractice and side-by-side service delivery models. Communication Disorders Quarterly, 34(4), 210220.

What to Expect During an Adult Speech and Language Evaluation

 

Adults may undergo speech and language evaluations for a variety of reasons, including, but not limited to, difficulty pronouncing sounds or words, speaking clearly, retrieving and using familiar words, understanding words they hear, speaking fluently, remembering peoples/places/events, and swallowing. Adult speech and language evaluations may be performed differently depending on the speech-language pathologist (SLP), the setting of the evaluation and/or the reason for the referral. To help you and your loved one prepare for a speech and language evaluation, below you will find detailed descriptions of what you can expect during a typical evaluation.

 

Intake Interview

The purpose of the intake interview is to gather information about you. This is the most important aspect of any speech and language evaluation as it helps the SLP understand why you are seeking the evaluation, how your current communication difficulties are impacting your daily life and what you hope to get out of the evaluation and/or therapy. During the intake interview, the SLP will ask you about your medical history, education and employment, cultural and linguistic background, and current and past evaluations and therapies.

 

Oral Mechanism Examination

The purpose of an oral mechanism examination is to assess the structure and function of your oral mechanism (e.g., lips, tongue, teeth, hard/soft palate) to support speech and/or swallowing. Examples of tasks you may be asked to do during this portion of the evaluation include moving your tongue from side-to-side, opening your mouth and saying “ah,” and raising your tongue to try and reach your nose.
Assessment of

 

Articulation/Phonology

Articulation is the manner in which sounds are produced using the oral mechanism and phonology is the manner in which we organize sounds to form words. Assessment of articulation and phonology is important if you are difficult to understand. The purpose of this assessment is to determine what sounds you have difficulty saying and if there is a pattern to your difficulties. In addition to general pronunciation concerns, this type of assessment is important if there is suspected apraxia and/or dysarthria. General assessment of articulation and phonology typically includes obtaining and analyzing a speech sample (this is exactly how it sounds – a sampling of your speech) obtained during conversation with the SLP, as well as administration of a standardized test (e.g., Goldman Fristoe Test of Articulation, Arizona Articulation Proficiency Scale, Hodson Assessment of Phonological Patterns, Apraxia Battery for Adults, Frenchay Dysarthria Assessment). During standardized testing, you will be asked to look at and name various pictures and/or objects, repeat a variety of words and phrases of varying lengths and complexities, and/or perform different actions with your mouth. The evaluator will transcribe what you say during the assessments for later analysis.

 

Assessment of Voice


Voice refers to the quality, loudness, pitch, resonance and prosody of one’s speech. A person typically undergoes a voice assessment due to vocal concerns as the result of a neurological condition (e.g., Parkinson’s Disease), a vocal pathology (e.g., nodules, cyst), or dysarthria. A thorough voice assessment cannot be completed without prior evaluation from an otolaryngologist (ENT) to determine the potential etiology of the vocal concerns. After a patient has been seen by an ENT, a voice assessment can be completed by an SLP and components of the assessment may include a discussion of how you use your voice and your feelings about the current status of your voice, use of computerized software to analyze your speech compared to other adults of similar ages, and/or use of laryngeal imaging.

 

Assessment of Fluency

Fluency refers to fluidity of one’s speech. Assessment of fluency is crucial if you have concerns that you stutter. A fluency assessment typically involves engaging in conversation with the SLP on topics of interest so she can obtain a speech sample for later analysis, as well as discussing your feelings about your stuttering administering a standardized fluency test (e.g., Stuttering Severity Instrument). During the standardized test, you will likely be asked open-ended questions, instructed to read passages and describe pictured scenes, and/or tell a story.

 

Assessment of Language and Cognition


Language refers to receptive and expressive language. Receptive language is an individual’s ability to understand language; where as expressive language is an individual’s ability to use language. Language goes beyond the spoken word and also encompasses written words, gestures, and facial expressions. Cognition describes a person’s memory, attention, problem solving, executive function, reasoning, organization, perception, and judgment. Assessment of language and cognition is typically completed when there is a suspicion of aphasia and/or a noted neurological decline, which may be the result of a traumatic brain injury, stroke, or neurological condition (e.g., Alzheimer’s, Parkinson’s). Assessment of language and cognition includes obtaining a language sample, as well as administering standardized tests (e.g., Western Aphasia Battery, Boston Diagnostic Aphasia Examination, Montreal Cognitive Assessment, Cognitive Linguistic Quick Test). The tasks you would be asked to do would depend on the test(s) administered; however, like with most standardized tests, you are likely to be asked questions about different pictures, words, objects, stories, and concepts. For example, you may be asked to find a letter or word named by the SLP.

 

Assessment of Swallowing


The purpose of a swallowing assessment is to determine what, if any, difficulties you have swallowing, at what stage the difficulties occur, and what types of food and liquid consistencies are safe for you to consume. Swallowing assessments can be done with and without instruments. Non-instrumental swallowing assessments involve the SLP watching you as you eat different foods and taking notes on what happens as you eat (e.g., do you cough after swallowing?). Instrumental swallowing assessments (e.g., videofluoroscopic swallowing study, fiberoptic endoscopic evaluation of swallowing) involve using medical equipment to watch your swallow internally.

 

Discussion of the Results

At the conclusion of the evaluation, the SLP should discuss the results with you. The discussion should include information related to her findings (diagnoses, observations) and recommendations (e.g., if additional testing by an SLP or related professional is recommended or required and/or if speech/language therapy is warranted). You should also be given the opportunity to ask any questions you may have.

What to Expect During a Pediatric Speech and Language Evaluation

Although all speech-language pathologists structure their evaluations a little differently, there are crucial components that should be expected as part of all pediatric speech and language evaluations. These components include a family interview, an oral mechanism examination, assessment of articulation/phonology, assessment of voice, assessment of fluency, assessment of receptive and expressive language, and a discussion of the results. Depending on your child’s age, his reported difficulties, and/or the location of the evaluation, additional components of the evaluation may include: a teacher interview, a hearing screening, a play assessment, a feeding/swallowing assessment, and/or a narrative assessment. Each of the crucial components will be described in detail below:

Family Interview

The purpose of the family interview is to gather information about your child’s background, such as birth and medical history, speech and language concerns, past evaluations and/or therapies, developmental milestones, languages your child speaks and/or hears.

Oral Mechanism Examination

The purpose of an oral mechanism examination is to assess the structure and function of your child’s oral mechanism (e.g., lips, tongue, teeth, hard/soft palate) to support speech and/or feeding. Examples of tasks your child may be asked to do during this portion of the evaluation include moving his tongue from side-to-side, opening his mouth and saying “ah,” and raising his tongue to try and reach his nose.

Assessment of Articulation/Phonology

Articulation refers to the way we produce sounds using our oral mechanism and phonology refers to the way we organize sounds to form words. The purpose of assessing articulation and phonology is to observe what sounds your child can say, as well as to determine if your child has any errors in his speech and if there are patterns to those errors. For young children (under the age of 3), assessment of articulation and phonology is primarily done through a speech sample obtained during various play activities. A speech sample is exactly how it sounds – it is a sample of your child’s naturally occurring speech. For older children (above 3), assessment of articulation and phonology typically includes analysis of a speech sample obtained through conversation and/or play, as well as administration of a standardized test. During the standardized test, your child will look at pictures and/or objects, which represent all of the consonants (and depending on the test, also vowels) in Standard American English, and be asked to name them. The evaluator will transcribe what your child says for analysis.

Assessment of Voice

Voice refers to the quality, loudness, pitch, resonance and prosody of one’s speech. For most pediatric evaluations, especially for young children or when vocal characteristics are not a concern, assessment is done through a speech sample. The evaluator listens to your child’s speech to see if it appears appropriate for his age or gender. However, for older children and/or for those with vocal concerns, assessment may include a discussion of how your child is using his voice and his feelings about his voice, use of computerized software to analyze your child’s speech compared to same-age children, and/or laryngeal imaging.

Assessment of Fluency

Fluency refers to fluidity of one’s speech. The purpose of a fluency assessment is to determine if your child experiences stuttering and/or cluttering. For young children, assessment of fluency focuses on obtaining a speech sample to analyze any disruptions in the flow of your child’s speech. For older children with fluency concerns, assessment involves obtaining a speech sample, as well as discussing feelings about the fluency difficulties and situations when fluency skills are better/worse and administering a standardized fluency test. During the standardized test, your child may be asked a series of conversational questions, instructed to read different passages, and/or asked to describe various picture scenes.

Assessment of Receptive/Expressive Language

The purpose of a language assessment is to determine your child’s ability to understand and use language for a variety of purposes. Assessment of language includes obtaining a language sample, as well as administering standardized tests. The tasks your child is asked to do would depending on the test(s) administered; however, like with most standardized tests, your child is likely to be asked questions about different pictures, objects, and stories. For example, he may be asked to find a picture described by the evaluator (e.g., show me the big black dog).

Discussion of the Results

At the conclusion of the evaluation, there should be a discussion of results with the evaluating speech-language pathologist. The speech-language pathologist should share her findings (diagnoses, observations), inform you if additional testing by a speech-language pathologist or related professional is recommended or required, discuss if speech/language therapy is warranted, and answer any questions you may have.

 

 

Is it Apraxia?

Apraxia, also known as childhood apraxia of speech (CAS), has become the go-to diagnosis for many children in Early Intervention (under 3 years of age). However, many of these children do not have apraxia or are too young to receive a true diagnosis. So what is apraxia?

 

Apraxia is a motor speech disorder that makes it difficult for a person to coordinate the movements of the mouth for speech. Apraxia can occur in children or adults, but for the purpose of this post, I will focus on CAS. There is some debate over the exact diagnostic features of CAS, but some commonly described symptoms are:
  • Inconsistent errors 
  • Inappropriate prosody 
  • Vowel errors 
  • Limited inventory of consonants and vowels 
  • Increased difficulty with longer, more complex words and utterances

 


Additionally, children with CAS tend to be “late talkers;” however, late talking in and of itself does not warrant a diagnosis of CAS. As can be seen by the aforementioned symptoms, the characteristics of CAS are described with regards to talking, so if a child is not yet talking or not talking much, a clear diagnosis of CAS cannot be made. In fact, the American Speech-Language-Hearing Association goes so far as to say that “diagnosis below age 3 is best categorized under a provisional diagnostic classification, such as ‘CAS cannot be ruled out,’ ‘signs are consistent with problems in planning the movements required for speech,’ or ‘suspected to have CAS.’ 

If you have concerns with any aspect of your child’s speech or language development, it is suggested that you contact a local speech-language pathologist so that a thorough evaluation can be completed.

 

Resources:

5 Questions to Ask a Provider Before Signing Up for Speech Therapy

 

Question 1 – Are you licensed?

In most states, including NJ, a speech-language pathology license is required to practice as a speech-language pathologist (SLP). Refer to the ASHA website for specifics on what licensing (if any) your state requires. Although SLPs should be the ones providing speech therapy, there are non-SLP providers out there selling their services with claims that they are doing “speech therapy.” Unfortunately, these individuals typically don’t have a licensing board/governing body to control their practices nor do they have the background to provide sound speech and language treatments. Therefore, this question should be at the top of your list when looking to begin speech therapy.

 

Question 2 – Are you ASHA-certified?

While certification is not required to practice as an SLP, ASHA-certified providers are required to complete a minimum of 30 continuing education/professional development hours every 3 years to ensure that they are providing the best practice.

 

 

Question 3 – What are your areas of expertise?

Although all SLPs have the same general background on speech and language disorders, not all SLPs have the same areas or levels of expertise. Some SLPs may specialize in working with adults, while others only work with children. Some SLPs may have an extensive background in dysphagia (swallowing disorder), while others may be stuttering specialists. Not all SLPs are the right fit for you and your family.

 

 

Question 4 – Do you keep current with the research in your field? How so?

It might seem obvious that all SLPs or healthcare professionals would keep current with the research in their field, but this, unfortunately, is not always the case. There are SLPs (and other healthcare professionals) out there who don’t take the time to read peer-reviewed research articles regarding the current status of different evaluation and treatment methods. While it can be costly and time-consuming to stay in the loop of current best and evidence-based practices, it’s crucial for SLPs to do so to provide the most appropriate services for their clients. Would you prefer an SLP who frequently reads research and is continuously trying to expand his/her knowledge or one who hasn’t opened a speech-language pathology journal since s/he graduated from school a number of years ago?

 

As SLPs, we are required to complete continuing education hours (as mentioned above for the ASHA certification question); however, in taking these courses, there is still no guarantee that the information disseminated has been thoroughly researched or vetted. That’s to say that an SLP could be doing many hours of continuing education, but on topics that have never truly been studied.

 

 

Question 5 – Have you worked with a client with _________ diagnosis recently?

This question is similar to the expertise one mentioned above and, probably goes without saying, but if you or your loved one have a specific diagnosis (e.g., Parkinson’s Disease, Autism Spectrum Disorder, Down Syndrome) for which you are seeking speech therapy services, it’s important that the SLP you select has experience with and has recently worked with this population. Selecting an SLP who has only worked with one Parkinson’s patient in the span of 10 years would probably not be your best bet if you or your loved one has Parkinson’s Disease.

Early Intervention 101

Thank you for visiting the Liberty Speech Associates LLC blog! Today I’m excited to write my first post. This post is about the New Jersey Early Intervention System (NJEIS). After presenting to families and teachers at a local daycare, it has come to my attention how much is unknown and misunderstood about the NJEIS. Therefore, I hope to shed some light on the basics of the program.

You might be asking yourself, “What is ‘Early Intervention’?” Early Intervention (EI) is a program that provides intervention to infants and toddlers. Guidelines vary state to state. In New Jersey, EI is for children from birth to the age of 3. Services address a child’s overall development in the areas of cognition, communication, self-help, social/emotional, gross motor, and fine motor.

If you have a child with a disability or that seems to be delayed, there are some important things you should know about the NJEIS.

Evaluation

If you contact the NJEIS (1-888-653-4463), you will share your concerns regarding your child’s development. Based on this information, member of a Targeted Evaluation Team will schedule an initial evaluation. These professionals will be in two separate disciplines For example, one may be a physical therapist while the other may be a speech-language pathologist. Ideally, one of the two professionals should be in the discipline that is your primary concern. That’s to say that if you’re concerned because your child is not yet speaking, one of the professionals should be a speech-language pathologist. On the day of the evaluation, the two professionals will use an instrument called the Batelle Developmental Inventory to assess your child.

Eligibility Criteria

In order for a child to qualify for EI services, he must be 33% delayed in one area of development or 25% delayed in two or more areas of development. Your child’s degree of delay will be based on his performance on the Batelle. If a child doesn’t qualify for EI, it doesn’t necessarily mean that he doesn’t need support or isn’t delayed; it just means that he doesn’t meet the eligibility criteria for this program.

Therapy

After the evaluation, a meeting will take place to create an Individualized Family Service Plan (IFSP) for your child. Family members, the evaluators, and your service coordinator (case manager) will be present during the meeting to discuss the IFSP. When making the IFSP, you will discuss the type and frequency of services that your child will be receiving.

Cost

Therapy through the NJEIS is not free. The program is based on a “cost-share.” This means that your family may be responsible for a part or all of the cost of the EI services. The cost-share is dependent upon your household income. However, there is no cost-share for evaluations and meetings. These services are always free.