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SESSION SUMMARY SPAA 31 9/628 CLINICAL PRACTICUM CLIENT: DATE OF SESSION: OVERALL SUMMARY OBJECTIVE DATA PROCEDURES/NoVEL STRATEGIES FOR FUTURE SESSION QUESTIONS Jl Language Screening for APD Auditory Training CELF 4 (Clinical Evaluation of Language Fundamentals fourth edition) CHAPPS (Children's Auditory Processing Performance Scale DALS II (Developmental Approach to Successful Listening II) Erber - '---- Auditory Training LACE (Listening and Communication ~ancement) Articulation GFTA-2 (Goldman Fristoe Test of Articulation 2 nd Ed.) Auditory Training Articulation and Phonology Articulation Type Auditory Attention Deficits CAAP (Clinical Assessment of Articulation & Phonology) Test ACPT (Auditory Continuous Performance Test) Arizona - - It Evaluates perceptual abilities on four different levels- Detection, Discrimination, Identification, Comprehension Provides information about a child's articulation ability by sampling both spontaneous and imitative sounds. Measures articulation of consonant sounds and determines types of misarticulation. The Sounds-in-Words section is norm-referenced. The Sounds-in-Sentences and Stimulability sections are not norm-referenced. An interactive computer program designed to improve listening skills. This program is used in the client's home in a self-directed manner. It focuses The child is taught to develop hearing as an active sense so that listening becomes automatic and the child seeks out sounds in life. Hearing and active listening become an integral part of communication, recreation, socialization, education, and work. Determines language strengths and weaknesses. Provides Receptive Language and Expressive Language scores, and additional composite scoresLanguage Structure, Language Content, Language Content and Memo~ and Working Memory. A questionnaire that is used to screen for APD by assessing a parent's and/or a teacher's judgment of a child's listening ability as compared to his or her peers. Consists of a hierarchy of listening that are worked on in brief individualized sessions. Description Determine if an attention problem is one of the underlying factors contributing to a child's learning problems. Provides a quick, reliable, and well-standardized measure of articulation proficiency in children. Adult Children 2-21 years Pre-School and School Aged Children Children 7+ 5-21 years 2:6- 8: 11 Varies I I ~I ~. 5 to 15 minus depending on age and attention span Varies Varies Depends 30-60 minutes 2-10 minutes depending on if a language screening is included 15-20 min - Children between 1.5 and 18 years - - Time to Administer 10 minutes Target Population 6-11 I I J ' L Direct Audio Processing Articulation Auditory Training Auditory Training SCAN-C (Test for Auditory Processing Disorders in ChildrenRevised) S-CA T (Second Contextual Articulation Test) SKI-HI SPICE (Speech Perception Instructional Cirriculus & Evaluation) TOLD Language Language PLS (Pragmatic Language Skills Inventory) Seven subtests: Picture Vocabulary, Oral Vocabulary, Grammatic Understanding, Sentence Imitation, Grammatical Completion, Word Discrimination, and Word Articulation on perception of degraded speech and developing Irefining certain cognitive skills. Assesses children's pragmatic language abilities in three subscales: Personal Interaction Skills, Social Interaction Skills, and Classroom Interaction Skills. Give to children who have normal peripheral hearing but who appear to have poor listening skills, short auditory attention span, or difficulty understanding speech in the presence of background noise. (Need a cd player) Part I-SPAC: Storytelling Probes of Articulation Competence Part 2-CPAC: Contextual Probes of Articulation Competence Part 3-TWCT: Target Words for Contextual Training Determines exact pretreatment status for any particular phoneme or phonological process, evaluates progress during treatment, and ensures correct treatment target. Also allows practice materials to be linked to the assessment process, and documents overall effectiveness of intervention. This program is based in the home and is a developmentally based auditory stimulation training program. A guide to clinicians in evaluating and developing auditory skills in children. Babies and children who have just received CIs 4:0-8:11 60 minutes Varies Varies 3-5 minutes to be administered as a reading task or an imitative task Preschool to adults Infants 30 minutes 5-10 minutes 5:0-11:0 5:0-12:11 'l"'I 'l"'I 0 ('1,1 1 1 1 1 'QAJ I C 1 ;: 1 Q. en What Everyone Should Know About Speech Soun isorders Jordan Amor Special points of Interest: > Articulation > Phonology Definition of Speech Sound Disorders III Speech sound disorders inhibit a person's ability Most cases of SSD are (SSD) cover a wide to communicate. either articulation variety of areas but their Included in this category disorders or common theme is they are disorders of voice, phonological disorders. 'iii arti'culation, or fluency. G) I ,c l .... 1 What is an Articulation Disorder? ~ I 0 C 1 1 An articulation disorder the age of 8. An In other cases there is a is associated with the articulation error is when physical disability inability to properly a sound is substituted involving the articulators produce speech sounds. (substitution), left off including malformations ~ I This is often associated (omission), added of the lip or palate en _ with difficulties involving (addition), or changed among others. the articulators (lips, (distorted). The cause of Neuromuscular teeth, tongue, soft and articulation disorders problems also impact hard palate). On vary. Some children speech. Finally, average children should have some form of articulations disorders 0 x: 1 ~ I .. 'iii ' ~ I - 1 C , ;:) 1 !II I - l I I ~: have mastered the hearing loss that inhibits can result from correct production of them from properly overarching 1 most speech sounds by perceiving the sounds. developmental delays. Tell Me About Phonological Disorder 1 Tell Me About Phonological Disorders Treatment 2 Inside this Issue: .- What is an Articulation Disorder Specific Errors Things To Do at Home to Help I 3 4 Phonological disorders speech sounds needed that is easier for them to involve the cognitive to communicate. It is produce. Also common processes associated common for children is cluster reduction. with the selection of with phonological Cluster reduction proper speech sounds. disorders to substitute happens when a child Clients with phonological all sounds made in a produces "poon" for disorders have difficulty particular way or place in "spoon" removing the s. learning and organizing the mouth for something 55 Page 2 Treatment for Articulation Disorders The earlier intervention Another popular method is the In this instance the for articulation disorders clinician would begin by cycles approach. This was begins the easier the training the client to developed by Hodson and Paden in rehabilitation will perceive the difference 1991. With this type of therapy progress. There are between the target sound several different articulation goals several factors that and the error sound. Then are being worked on influence therapy the clinician begins simultaneously. The rationale including, the age of the working on production of behind this approach is that client and the severity of the phoneme in isolation individuals do not learn speech the disorder. then syllables, words, concepts in isolation; they are sentences, and learned in conjunction conversation. with multiple concepts. One approach is to target Single phonemes. , ell -;; Q) .c Treatment for Phonological Disorders I .. ~ ell S .. .. I speechlsto ~ -;; persuade, to ~c convert, to Q) compel. .... ;:) III (f) When a clinician is way to produce the and other speech focusing on a desired sound. In disorders it is important to phonological goal it is addition, clinicians know take therapy outside the common to begin with the concepts behind clinic so the child can placement. One way is to language and it is their generalize what they are go through a step-by-step goal to teach the client learning and apply it to process of teaching the rules of language other situations. client to move their including past tense. With articulators in the correct phonological disorders Speech Is power: o -Ralph Waldo Emerson Intervention for Both Often articulation and non-developmental of a target makes it easier phonology are combined approach which uses other for the clinician to teach. Finally, some clinicians into one approach. There factors to determine goals. are two main methods One option is to choose the choose targets based on the that target both areas. The targets that are most apparent level of deviance first is the developmental relevant to the client. related to a specific error. approach. When using this Targets may also be chosen This option is organized to method the clinician to coincide with other errors increase the client's targets articulation or in the child's use of intelligibility as quickly as phonological errors in the language. Another option is possible by targeting the order in which they typically to choose targets because of errors that are the most develop. The their visibility. The visibility detrimental. 56 Page 3 Common Types of Phonological Processes • Alveolarization • ::::I o ~ c partial of complete Depalatalization- an syllable is repeated • o » ... • C'CI .c ~ (I) 'ii • ~ .c .. I by which a sound cate replaces a palatal a stop for a fricative or becomes more like those fricative or affricate. affricate • Diminutization- addition • of /V Doubling- insertion of a Backing- a phoneme is Cluster Reduction- when a strident or replacing it with a nonstrident • deletion Final consonant deletion Fronting- a sound being Unstressed syllable • Voicing of devoicing- a together but only one is that is produced further because of surrounding produced forward sounds Coalescence- a different sound substituted for a cluster .. • • Strident deletion- deleting substituted for something o c • new sound • two consonants are (I) , ...» 'ii Stopping- substitution of alveolar fricative or affri in the mouth ~ > L&.I • Reduplication- when a Assimilation- the process is produced further back .. • with similar placement replaced by another that fI) sounds alveolar for a labial or around it .c Denasialization- a nasal being replaced with a stop lingualdenta • • substitution of and Deaffrication - a fricative • • • replacing an affricate Gliding- a glide is changed in vOicing • Vocalization (vowelization) substituted for a liquid - a vowel takes the place Initial consonant deletion of a liquid in the final Matathesis (Spoonerism) position transposition of two 1c ;:) ..... ~ I Works Cited C'CI fI) C'CI CD , Articulation disorders: treatment. (n.d.). Retrieved from http:;/www.clas.ufl.edu/users/rahuIj4250/ artn3.htm. Bowen, Caroline. (1998). Pact: a broad-based approach. Retrieved from http://members.tripod.com/ caroline_bowen/clinphonology.html. Davidson, Tish. (2011). Phonological disorder. Retrieved from http:;/www.minddisorders.com/Ob-Ps/ Phonological-disorder.html. Roth, F, & Worthington, C. (2005). Treatment resource manual for speech-language pathology. Clifton Park: Thomas Delmar Learning. Shipley, K, & McAfee, J. (2009). Assessment in speech-language pathology. Clifton Park: Delmar Cen gage Learning. Speech sound disorders. (2011). Retrieved from http://www.brighttots.com/ Speech_and_Language_disorders/What causes an articulation disorder? (2010, June 19). Re trieved from http://superstarspeech.com/blog/2010/06/what-causes-an-articulation-disorder/. Speech sound disorders: articulation and phonological processes. (n.d.). Retrieved from http:;/ www.asha.org/public/speech/disorders/speechsounddisorders.htm. Speech sound disorders Glossary of terms. (n.d.). Retrieved from http:;/www.mtcus.com/ glossary.html. 57 Jordan Amor What Everyone Should Know About Language Special points of interest: > Expressive and Receptive Language > Symptoms of Language Disorders > Types of Language Disorders > Treatment of Language Disorders Basics of Language Disorders presented to them. This the rules that are in deal with broad based type of disorder is effect when they are communication. All typically experienced combined into phrases. disorders fall into one of when listening or writing. Morphology controls the two categories: Because of its general construction of words by expressive language or nature, receptive the combination of .. receptive language. language disorders may morphemes, the Both types of language overlap with auditory smallest level of a ~ disorders can affect one processing disorders or language that contains :::J or multiple forms of aphasia. It is also meaning. Syntax communication possible for an individual concerns sentence including oral to have a mixed structure and the communication, reading, language disorder in creation of and writing. which they experience grammatically correct Language disorders 1/1 1 Uj l Q) I ,c l 1- 1 ~ I 0 1 C I 0 1 ::E: I >. :!:: 1/1 Q) C .... ....C'CI /I) Q) C'CI In An expressive langoage disorder creates problems for an Inside this Issue: Basics of Language Disorders Recognizing a Language Disorder 0 1 2 Specific Language Disorders 2 Treatment 2 characteristics of both sentences. Pragmatics subgroups . focuses on nonverbal Another way language aspects of language individual trying to disorders are classified including turn taking and communicate a is by associating them personal space. Finally, message to another with the major linguistic there is phonology, a individual or other component they most component of language individuals. Expressive impact. There are five the most basic because disorders can present different linguistic it deals with individual themselves orally or in components: semantics, sounds, or phonemes. writing. morphology, syntax, Some language pragmatics, and disorders are present in inhibit a person's ability phonology. Semantics children and others in to understand the deals with the meanings adults. message being of individual words and Receptive disorders 59 , G) , '01) , ~ , Page 2 '01) ' c , nI , :: ' Recognizing a Language Disorder ::lI o .a Here are the most common c( ~ what others are saying expected • Clients may have a o symptoms. ::IC Expressive ph rase that is used • Sentences are not excessively-especially coherent or when unsure of what to grammatically correct say or unable to say what Sentences may be is intended c =, 'C 0 , oC , 1/) , G) I C , ~ , "~ ,I • "' I abnormally simple and ni l short. .. 1 ~ I • • • Slower than normal • Trouble following processing rate directions • Difficulty preparing thoughts Common misuse of verb • predicting tenses. Word finding issues are • Improper use of pronouns • • Q) ....oC .. III Echolalia- repetition of words or phrases apparent III c;; Trouble inferring or Vocabulary might not be Receptive as developed as • Difficulty understanding o C 0 1 :2: , >- 1 :: , ~ I Q) I ~ I C l ;:) 1 Q) ' " I ,-- Specific Language Disorders "Language shapes the way we think, ,!! I 1/) 1 and determines CD , what we can think =ni ,l Child Language Disorders Adult Language Disorders Associated Disorders • • • • • • about." -Benjamin Lee Whorf • Language Based Aphasia- can be Learning Disability- expressive or the child has difficulty receptive. This occurs with age-appropriate when there is damage reading, spelling, and to the language center or writing. of the brain. Selective Mutism- the • Dementia - an child chooses not to acquired disorder speak in particular leading to intellectual social settings decline from Traumatic Brain Injury Strokes Autism Fetal Alcohol Syndrome • • • • Mental Retardation Developmental Delays Learning Disabilities Specific Language Impairment neurogenic causes Treatment Treatment for school-age setting. For adolescent children incorporates both clients goals become more Treatment for older adults oral language and literacy. complex including the becomes more Therapy goals should be introduction of specialized. The types of oriented to the metalinguistics. It is also treatment depend on the requirements placed on expected that utterances specific disease or the child in the classroom and conversations disorder. 60 become more complex. G) 'QAI IV Page 3 :::s 'QAI ......c IV :::s o J:I C ~ o c ::.:: :E :::s o .c en G) c o ...> G) > III ... I IV .c ~ (I) -;; G) ... .c ... (I) Works Cited Aphasia. (n.d.). Retrieved from http://www.asha .orglpu bl ic/speech/d isorders/ Aphasia.htm. Expressive language disorder. (n.d.). Retrieved from http://www.kidspeech.com/ index.ph p?option=com_content&view=a rticle&id=211<emid=506. Language-based learning disabilities. (n.d.). Retrieved from http://www.asha.orgl public/speech/disorders/LBLD.htm. Language disorder - children. (2010, June 29). Retrieved from http:// www.nlm.nih.gov/medlineplus/ency/article/001545.htm. Owens, R E., Metz, 0 E., & Haas, A. (2007). Introduction to communication disor ers a lifespan perspective. Boston: Pearson. Receptive language disorders. (n.d.). Retrieved from http://http:// www.kidspeech.com/index.php? option=com_content&view=article&id=222<emid=512. o c o Selective mutism. (n.d.). Retrieved from http://www.asha.orglpublic/speech/ ...> -;; Watson, Sue. (n.d.). 10 common symptoms of language disorders/delays. Re ::I: ... c> G) :::;) ...... en G) IV disorders/SelectiveMutism.htm. trieved from http://specialed.about.com/od/learningdisabled/a/ langdelay.htm I I 61 Grammatical morphemes: are used to modify words such as "ing" in talking. Mean Length ofutterance (MLU): the average number of morphemes per sentence. Morphemes: smallest unit of meaning in language for example played has two play and the past tense ending "ed." Overregularization: an error in which children use the rules for plurals and past tenses even when they are inappropriately applied. Vocabulary to Know All ages provided in this brochure are only averages. Children reach and pass through stages at different rates and that is completely normal. In addition, what children can understand and what they are able to produce are completely different. In most cases children can understand a wider variety and more complex information then they themselves can convey. Please keep this in mind when interacting with a child who is exploring their world through language; the most important thing is to be supportive. Make sure you give your child your full attention. It is also best to have their full attention when speaking to them. Some helpful hints include playing labeling games with body Mean length of utterance is 1 2 or about 2-3 words. The child's vocabulary is between 150- 300 words. Sounds for k, g, f, t, d, and n are beginning to be used. The child's speech is now at a point where those who are frequently around them can understand most of what they are saying. When your child names something he or she is trying to draw your attention to that object. After naming the object the child might add a describing word. Also, the words that your child uses most often are those that are common in their environment. As far as your child's understanding you can tell them a string of two tasks to complete. They can also distinguish between go and stop and other similar pairs. In addition, the child is questioning their world so be prepared. As the child approaches three their vocabulary has almost tripled and three word sentences are easy. Most children should be able to identify their name, age, and sex. You will begin to notice the correct use of some plurals and past tenses. They have a good :dle on the pronouns I, youJ and Ages 2 through 3 By this point in development the child should have most consonants, vowels, and diphthongs. Some exceptions are s, Z, r, I, and h blends. Their MLU is between 3.5 - 4.5 and increases with age. The child's sentences are beginning to contain more detail. In addition, stories are staying on topic. At this stage most people should be able to understand 90% of what the child is saying. However, the child might still be over regulating during conversations. Up to this point the child has been able to ask questions but can now answer simple ones. The child has full use of at least four prepositions including over and under. Children can identify familiar animals by name. Also, the child should know at least one color. They are able to pay more attention to short stories and answer some basic comprehension questions. Make-believe play has become very popular and it is a great way for them to explore Ages 4 through 6 parts or other word groups to establish vocabulary. Also reading and singing nursery rhymes helps to establish speech patterns. Here are some additional resources for parents and caregivers seeking more information. http://www.asha.oralpublic/speech/ development/chart.hlm http://www.childdevelopmentinfo. com/development/language develo pment.shtml http://www.nidcd.nih.gov/health/v oice/speechandlanguage.asp#mych ild http://www.asha.org/public/speech/ deve lopmentlParen t-St im Activities.htm http://www.speech-Ianguage therapv.com/deveI2.htm their world. Around age five, the majority of children's speech should be grammatically correct. The child should understand common opposite pairs including hard-soft. Additionally, time has acquired a basic meaning for them, for example morning, afternoon, and night. The child is now using spatial relationships such as first, middle, and last. Furthermore, they might start to show off to by counting to ten. After six the remaining consonants should be mastered. Most children can look at a series of pictures and create a story. rce for The perfect parents with I,;hildren entering Preschool or Kindergarten. (MLU): el nlirnero promedio de morfemas por sentencia. Morfemas : unidad mas pequei'la de significado en lenguaje interpretado por ejemplo tiene dos juegos y el preterito terminando a "ed". Overregularization: un error en el que los niftos utilizan las reglas plurales y ultimos tiempos incluso cuando sean aplicados de manera inapropiada. Signijica longitud de enunciado para modificar palabras tales como "ing" al hablar. Motfemas gramaticales: se utilizan Vocabulario saber Todas las edades en este folleto son solo promedios. Niftos alcanzan y pasan por etapas a diferentes velocidades y eso es completamente normal. Ademas, 10 que los nii'los pueden entender y 10 que son capaces de producir son completamente diferentes. En la mayorfa de los casos los niftos pueden entender una variedad mas amplia y pueden transmitir informacion mas compleja, y luego ellos mismos. Por favor, tengalo en cuenta cuando interacruan con un nino que esta estudiando su mundo a traves dellenguaje; 10 mas irnportante es ser solidarios. Aseglirese de que darle a su hijo su completa atencion. Tambien es mejor tener toda su atencion al hablar con ellos. ecto El recurs para los paares con ninos en preescolar 0 Kindergarten. ~===:::!:I EI promedio de longitud de la expresion es de 1-2 0 de 2-3 palabras. EI vocabulario del nino es de entre 150 a 300 palabras. Sonidos para k, g, f, t, d, n, y estan empezando a ser utilizado. EI habla del nino se encuentra ahora en un punto donde los que son con frecuencia alrededor de ellos pueden entender la mayoria de 10 que estan diciendo. Cuando su nino los nombres de algo que el 0 ella esta tratando de lIamar su atencion sobre ese objeto. Oespues de nombrar el objeto que el nii'io podria anadir una palabra descriptiva. Ademas, las palabras que su hijo usa con mayor frecuencia son aquellos que son comunes en su entomo. En cuanto a la comprension de su hijo se les puede decir una cadena de dos tare as que realizar. Tambien se puede distinguir entre ir a parar y otros pares similares. Ademas, el nino pone en duda su mundo, as! que preparate. A medida que el nino se acerca a tres su vocabulario casi se ha triplicado y tres palabras son faciles. La mayoria de los nifios deben ser capaces de identificar su nombre, edad y sexo. Usted empezara a notar el uso correcto de algunos plurales y tiempos pasados. Ellos tienen un buen manejo de los pronombres yo, ttl y yo. Algunos consejos utiles son los juegos con el cuerpo de etiquetado I Edades de 2 a 3 En este punto del desarrollo del nino debe tener la mayoria de las consonantes, vocales y diptongos. Algunas excepciones son s, z, r, I, h, Y las mezclas. Su MLU es entre 3,5 a 4,5 y se incrementa con la edad. Las frases del nii'io estan empezando a incluir mas detalles. Ademas, las historias se quedan en el tema. En esta etapa la mayoda de la gente debe ria ser capaz de entender el 90% de 10 que el nino esta diciendo . Sin embargo, el nino todavia puede ser mas regular durante las conversaciones. Hasta este momenta el nif'io ha sido capaz de hacer preguntas, pero ahora pueden responder a los simples. EI nino tiene pleno uso de al menos cuatro preposiciones entre ellos mas 0 menos. Los nii'ios pueden identificar a los animales conocidos por su nombre . Tambien , el nino debe saber por 10 menos un color. Son capaces de prestar mas atencion a las historias cortas y responder a a lgunas preguntas basicas de comprension. Juegos de simulacion se ha conveltido en muy popular y es una gran manera para que ellos exploren su mundo. Edades de 4 a 6 partes u otros grupos de la palabra para establecer el vocabulario . Tambien leer y cantar canciones de cuna ayuda a establecer los patrones del habla. http://www.asha.org/pub Iic/speec h/developmenrfchart.htm http://www.childdevelopmentinf o.comJdevelopmentllaJ1guage de velopmenLshtml http://www.nidcd.nih .gov/hcalth/ voice/speechand Ian guage.asp#m ychild http://www.asha.orglpublic/speec h/developmentiParent-Stim Activities.htm http://www.speech-Iangua!!e therapy.com/deveI2.htm Aqui hay algunos recursos adicionales para los padres y cuidadores que buscan obtener mas informacion. Alrededor de cinco an os de edad, la mayorfa de habla de los ninos debe ser gramaticalmente correcto. EI nii'io debe comprender comunes pares de opuestos como duro-bl ando. Ademas, el tiempo ha adquirido un significado fundamental para ellos, por la manana ejemplo, tarde y noche . EI nii'io esta ahora con las relaciones espaciales, como primero, segundo y ultimo. Ademas, se podria empezar a mostrar que por con tar hasta diez. Oespues de seis consonantes restantes deben ser dominadas. La mayoria de los ninos pueden ver una serie de imagenes y crear una historia. Jordan Amor What Everyone Should Know About Hearing Special points of interest: > Classifications of Hearing Loss > Causes of Hearing Loss > Types of HearingAids What Type of Hearing Loss Is It? III III There are three types of caused by aging, diseases malformations, and wax hearing loss: conductive including but not limited to buildup. Another cause is hearing loss, mumps and meningitis, otosclerosis, a calcium sensorineural hearing ototoxic drugs, and build up on the middle ear loss, and mixed hearing heredity. Sensorineural bones. It is possible for loss. Of those three hearing loss is permanent this type of hearing loss to sensorineural is the most but in the majority of be treated medically or common. A sensorineural cases hearing aids can surgically. But if these loss occurs when hair provide some assistance. problems are left cells, sound receptors, in Next there is conductive untreated the hearing loss the inner ear become hearing loss. This is can become permanent. damaged. When this caused when sound is Mixed hearing loss has happens the sound cannot blocked from reaching a components of reach the brain. This type properly functioning inner sensorineural and of damage is often caused ear by an obstruction in conductive loss. There is by repeated exposure to the outer or middle ear. often a partial medial loud sounds without the The most common causes solution but hearing aids use of protection. This of a conductive loss are often suggested. type of loss can also be include infections, Causes of Hearing Loss People experience Inside this issue: Classifications of Hearing Loss 2 Configurations of Hearing Loss 2 Types of Hearing Aids 3 this include a buildup of damage (acoustic trauma) different degrees of wax, external and as well as pressure hearing loss from slight to middle ear infections, trauma, a fracture in the profound. All cases of dislocated ossicales (the temporal bone (head hearing loss fall into two bones in the middle ear), trauma), ototoxic drugs, diagnostic categories: and a perforated ear vascular disease, a tumor conductive hearing loss drum. in the auditory nerve, of and sensorineural hearing When the hearing many types of infections loss. When the cause in loss is sensorineural the (measles, mumps, conductive there is sound waves can not be meningitis) may also be something physically perceived. Prolonged responsible. It is also blocking the passage of exposure to loud noises quite possible that it is sound. Some examples of causes this type of simply the result of aging. 67 _I .1' 'i:: 1 Page 2 • • C Configurations of Hearing and Their Meanings 1 ii · 1 ~ I .. 1' :. -, :-I 1 ~ I The configuration of the hearing loss denotes the that the hearing loss is Progressive means that only in one ear and the hearing loss will ,. 1 shape/pattern of the bilateral designates both continue to become worse hearing loss as it appears ears are effected. Next, over time as opposed to a w , on the audiogram. there is symmetrical and sudden loss which Diagrams are presented asymmetrical. These happens quickly. Finally, below. terms refer to whether the there is the distinction degree and configuration that is made between other ways to label of loss are the same in fluctuating versus stable hearing loss. First, there both ears. Third, hearing loss. A fluctuating are unilateral and progressive and sudden loss changes sometimes bilateral types of hearing are used to specify the for the better but other loss. Unilateral signifies onset of the hearing loss. times for the worse. - I ~ . _ I ...& .1 =- 1 .III . :' 1 -lit iii There are also several ....• Flat Configuration lit ~ III if: .-•.. i! = ..• w • High Frequency (Sloping) Configuration f"Tcqucocy In Hertz C ." "When someone I I In the family has a f"Tcquency 1.0 Rc--r1:r. 1 hearing loss, the ~ entire family has a ~~ I i. ~ hearing problem." Mark Ross, PhD r'_ I~ " C ] :: I ....A "_I ." --" :T. ; .,¢; 1' } ~ 1t. $'" .iI ~c -., f'f l'~ ~~ '\.'\. '" " -~ '\.~ ~\ .. ,. S ("A"I \. ~ :: Low Frequency (Rising) Configuration f'rl!'qur. nCJ' c lr ' / _tt:" ~ • I Saucer Shaped FYeqUCDC;Y La Hcrtz I ~ .. 10.1 Conflguration -.., ,/' ~ -s- ~ I I I I ~I--~--+-~-------r--4 '(r~--~~-----r-- I ;; ~ ... ~ :n ~, 'S.3" . 1 ", > . :: ,....,, I I) "" 1ro T '........ 68 i(' ......... I.n Heru I ~ '\l r-7 l . I .s I ~ f\~ '\.'\.. ~ /1 W .._I11 -..• ...-• ";: 1 - I :1: 1 olD Page 3 Types of Hearing Aids There are five main types of is easy to handle and maintain. plastic shell that fills the outer i ll hearing aid styles: behind-the Next there are the mini BTE part of the ear. Also there is M: ear, mini behind-the-ear, in the which is also know as the on the in-the-canal. type In this 'ii ear, in the canal, completely in the-ear. It is extremely similar instance the entire hearing aid en - the canal. to the BTE except noticeably fits inside the ear canal. The smaller. Also instead of an completely-in-the-canal aid is (BTE) hearing aid is contained earmold they might have an even smaller and less .;; in a plastic case behind the ear piece similar to an ear bud. conspicuous. Smaller hearing ear. Then there is a piece of Third, is the in-the-ear hearing aids are often harder to clear tubing that is connected aid. With this style all control. to an earmold. This type of aid components fit inside a hard - • to ::• II I: The bulk of a behind-the-ear ..• III iii -- to ~ Hearing Aid Styles • -= l! -. i! iii =;•;; Comole t et", . ,f'I .. H" ' i - 5h>!11 -Win.,' (C l e) '\ '\ ~J ~ III F-lill Shell 5 eh .n d- lhe -Ear Open Ea r ti lE E nr Works Cited Configuration of hearing loss. (n.d.). Retrieved from http://www.asha.org/public/hearing/ Configu ration-of-Hearing-Loss/. Hearing aid styles. (2011). [Web]. Retrieved from http://www.thingsforoldpeople.com/page/2. Hearing loss (cont.). (n.d.). Retrieved from http://www.emedicinehealth.com/hearing..Joss/ page2_em.htm. Types and degrees of hearing loss. (n.d.). Retrieved from http://www.unitronhearing.com/unitron/ global! en/consumer/youchearing-c/hearing..Joss/types_degrees.html. Types of hearing loss. (n.d.). Retrieved from http://www.pamf.org/hearinghealth/facts/types.html. 69 Diagram of the Ear @ _ Ea dru 2. M letJ5 3. Incu fl . Vestlb la Coch ea 5. Se tclrcula canals Auditory n e 7 Fa I Ne e (5 erve O. EuSia IS tLJ e 4 Stapes http:L/jacketmagazine.com/20/pt-reev-kerr.html '> 71 .crth \lEtS In nlv mity All-in-One Resource on Noise Induced Hearing Loss (NIHL) Honors Thesis JordanAmor Ball State University Spring 2011 What is NIHL? • Approximately 15 percent of Americans between the ages of 20 and 69-0r 26 million Americans have noise induced hearing loss. Every day our ears are responsible for receiving millions of sounds. Normally, hearing these sounds at safe levels does not affect our hearing. However, when sounds are too loud or loud are prolonged the sensitive structures in the inner ear can be damaged this causes noise induced hearing loss (NlliL). These sensitive structures, called hair cells, convert sound energy into electrical signals that travel to the brain. Once damaged, the hair cells cannot grow back. Symptoms When exposed to loud noise over a long period of time, symptoms of NlliL will increase gradually. Over time, the sounds heard may become distorted or muffled, and it may be difficult to understand speech. Someone with NillL may not even be aware of the loss, but it can be detected with a hearing test. Prevention NIHL is 100% preventable so take these easy steps: • Know which noises can cause damage (those at or above 85 decibels). • Wear earplugs or other hearing protecti ve devices when involved in a loud activity (special earplugs and earmuffs are available at hardware and sporting goods stores). • Be alert to hazardous noise in the environment. • Protect the ears of children who are too young to protect their own. • Make family, fiiends,and colleagues aware of the hazards of noise. If hearing loss is suspected, have a medical examination by an otolaryngologist (a physician who specializes in diseases of the ears, nose, throat, head, and neck) and a hearing test by a licensed! certified audiologist (a health professional trained to measure and help individuals deal with hearing loss). Works Cited Bredenkamp, MD, FACS, J. (2009, July 21). Noise-induced hearing loss and its prevention. Retrieved from http://www.medicinenet.com/ noisejnduced_hearingJoss_and _itsyreventionlarticle.htm. Noise-induced hearing loss. (2011, March 01). Retrieved from http:// www.cdc.govlhealthyyouthlnoise. Noise-induced hearing loss. (2008, October). Retrieved from http:// www.nidcd.nih.gov/healthlhearinglnoise.asp. 73 AII- -n-One Resource on Otitis Media Jordan Amor Honors Thesis Ball State University Spring 2011 Signs and Symptoms Otitis Media At a Glance: Definition: An infection in the middle ear usually caused by bacteria when there is a build up of fluid behind the ear drum. Statistics: • There are 7 million cases of middle ear in fections each year. • The majority of cases are in children The majority of cases of otitis media occur in children. If several of these signs are present a doctor needs to be seen. • • • • • Tugging or pulling at ears Fussiness and crying Trouble sleeping Fever Fluid draining from the ear • Problems with balance • Trouble hearing or responding to quiet sounds Types of Otitis Media Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear become infected and swollen when fluid is trapped behind the eardrum. This causes pain in the ear commonly called an earache. The child might also have a fever. Otitis media with effusion (OME) can occur after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OIVIE may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument. Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even thoug h there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing. pain medication may be recommended. If the individual continues to have problems with otitis media it is suggested to consult an ear, nose, and throat doctor. Tubes may need to be implanted in the ear assist with drainage. Treatment For an acute case of otitis media most doctors will prescribe an antibiotic for 7-10 days. Additionally an over the counter Works Cited Ear infections in children. (2011, January 05). Retrieved from http://www. nidcd. nih.gov/health/heari ng/earinfections. Perlstein, MD FAAP, D. (2011). Otitis media (middle ear infection or inflammation). Retrieved from http:// www.medicinenet.com/.otitis_media/article.htm. 74 ~.ltrJrne Resource on Pre s bycusis g e Re lated Hearing Loss) Honors Thesis JordanAmor Ba ll State University Sprin g 2011 Causes and Risk Factors Tiny hairs in the ears detect sO\Uld waves and transmit them to the brain to be interpreted. Hearing loss occurs when these hairs are damaged or die. They are unable to regenerate. Some risk factors include: • Family History • Repeated exposure to loud noises • Smoking • Other medical conditions can increase the incidence of Presbycusis. Signs and Symptoms nerve pathways that lead from the middle ear to the brain begin to deteriorate. Statistics: • Presbycusis is present in 30 35% of those over 65 and 40 50% over 70. • About 10.6 million people in the United States alone are suffering from Presbycusis. This type of hearing loss occurs slowly over time. At the onset, it is most difficult to hear loud sounds. • Certain sounds seem overly loud • Difficulty hearing things in noisy envirorunents. • High-pitched sounds such as "s" or "th" are hard to distinguish from one another • Men's voices are easier to hear than women's • Other people's voices sO\Uld mumbled or slurred • Ringing in the ears. It is unlikely that Presbycusis will cause a complete loss of hearing. Treatment There is no cure for hearing loss because it is a permanent type of damage. However, there are things a patient, family, and friends can do to make it easier for loved one to hear. First, make an appointment with an audiologist. This hearing professional will be able to tell you if hearing aids are appropriate in your situation. There are other types of assistive devices including telephone amplifiers, or telephones that convert sound into text and fro systems. In addition try to • Reduce the amO\Ult ofbackgro\Uld noise. • Look at the individual. • Speak slowly and clearly. • There is training available is speech reading and sign language Presbycusis. (n.d.). Retrieved from http://medicalcenter.osu.edul Works Cited patientcare/healthcare_services/otolaryngology/ abouCotolaryngology/ear_nose_throaCfacts/presbycusis/Pages/ index.aspx. Presbycusis. (2010, June 07). Retrieved from http:// www.nidcd.nih.gov/healthlhearing/presbycusis.htm. 75 Coping with Hearing Loss ~ordanAmor Honors Thesis BaD State Uohersity Spring 2011 You have just found out that you or someone you love has a hearing loss. You are full ofquestions. What does this mean? What do we do now? How will our lives be different &om now on? Hopefully the information in this brochure will help you begin the process ofunderstanding and coping with the lifestyle associated with hearing loss. Steps/ StageS A.dditional ResoUJ"CeS • Alexander Graham Bell Association for the Deaf and Hard of Hearing http://nc.agbell.org! netcommunity/page.aspx? pid=348 • American Society for Deaf Children (ASDC) http:// www.deafchildren.org! • American Speech Language Hearing Association (ASHA) http://www.asha.org/ • Association of Late Deafened Adults http://www.alda.org! • Hearing Loss Association of America http:// www.hearingloss.org! • American Academy of Audiology http://www.audiology.org! Pages/default.aspx • Denying that the problem exists • Guilt for having caused the hearing loss (HL) • Depression • Anger at themselves or others • Anxiety-not knowing what to expect intensified if the hearing loss is quite rapid. To successfully cope with hearing loss, first the client should grieve. This process helps stimulate re evaluation, which can lead to acquiring positive values and atti tudes, and facilitate growth. There are individuals and facilities who are able and willing to help at any point during this process. Grieving When you find out that you or someone you love has a hearing loss it is as if you are losing a part of what you thought you knew. Hearing loss throws emotions into a turmoil. This is Get Active and Get Informed Having come to is also important to use assistive terms with the hearing loss you need technology. This comes in several to become an advocate for yourself forms such as frequency modulation and or your loved one. (FM) systems, a The first step is to amplification devise become informed. that can be used in Look into different almost any situation, types of hearing aids or voice converter for and then get fitted the telephone. with the correct ones Another option to for the hearing loss. It consider is learning to 77 speech read, the process of determining the meaning of a speaker's message using visual cues, lip movements, facial expressions and bodily gestures. This skill can help an individual acquire additional information in challenging situations. Page 2 Coping with Hearing Loss Environmental Management • Tell friends and family about the hearing loss. • Ask people to look directly at you when they speak. • Make sure the area is well lit. This helps provide visuaJ cues for those with hearing problems. • Use closed captioning when watching TV. • Arrange furniture to create a positive conversation environment where individuals are facing each other. • Reduce background noise (Turn off the TV, stereo, etc.). • Use additional alerting systems that tell occupants when the phone is ringing, a visitor is at the door, there is smoke or a fire has started, or baby is crying. Some signalers have flashing lights and others make a loud sound, or shake the bed. • Telephone jacks should be installed near electrical outlets to accommodate signalers, voice to text converters, and other devices. • Since a person with hearing loss may not be able to hear someone's voice on the other side the door, a view panel (a window or side panel) helps identify visitors. A view panel is preferable to a typical peephole because it's easier to see through. • The type of flooring used is another important consideration. If background noise is problematic, wall to wall carpeting will help absorb sound. However, if occupants depend on feeling vibrations in the horne, thin carpeting or rugs, linoleum, or hardwood floors are better. • Sit closer when speaking to the person who is hard of hearing. • Try to find a more suitable location for communication. Works Cited Five steps to successfully coping with hearing loss. (2005, December 26). Retrieved from http://hearinglosshelp.comlweblog/fIve-steps-to-successfully-coping-with-hearing loss.php. Kohnle, D. (2010). Health tip: coping with hearing loss. Retrieved from http:// www.medicinenet.comlscriptlmainlart.asp?articlekey=115995. Total resource guide. (n.d.). Retrieved from http://www.inflnitec.org/totalresource/deaf/ modhearing.htm. 78 COChlear Implant All-in-One Resource on Cochlear IlTIplants Honors Thesis Jordan Amor Ball Slatl' l JniYl'r",ity Spring 2011 Criteria for Children Memhel's of the CocWeru'lmplanl Team patient's parents must consult success of the surgery. It is 12 months of age to receive with adoctor, preferably an imporlantto know cochlea cochlear implant surgery. In otolaryngologist, to make sure implant surgery will not result • Patient addition, the patient's hearing there are no medical in perfect hearing. • Parent loss needs to be at least contraindications. The patient Finally, the patient needs to • Audiologist profound and receive lillie to and the patient's family should have access to habilitation and • Speech Pathologist no benefit from the use of have appropriate expectations hearing aids. and motivations. These • Otolaryngologist The patient must be at least rehabilitation services. criteria contribute to the Prior to surgery the • Educational Psychologist • Social Worker Criteria for Adults preferably an otolaryngologis~ porlantto know cochlea im surgery the patient's hearing to make sure there are no plant surgery will not result in loss needs to be at least sever medical contraindications. The perfect hearing. to profound and receive lillie patient and the patient's family Finally, the patient needs to to no benefit from the use of should have appropriate expec have access to habilitation and hearing aids. tations and motivations. These To receive cochlear implant Prior to surgery the patient must consult with adoctor, 79 criteria contribute to the suc cess of the surgery. It is im rehabilitation services. Page 2 Benefits of Cochlear Implants In children cochlear implants aid in tbe development of spoken language both expressive and receptive. Successful surgical outcomes also increase their environmental awareness. In adults this device increases information input and speech recognition abilities. Adults also gain increased environmental awareness. Bilateral vs Bimodal Bilateral cochlear implants are avery new concept. They are still in development and are not currenLly seen as extremely useful. In Bimodal cochlear implants the patient has a cochlear implant in one ear and a hearing aid in the other. Trouble Shooting Cochlear Implants No Sound or Intermittent Sound Speech is Unclear, Too Soft or Noisy Intermittent Buzzing Sonnd • Insert new or fuUy charged balleries • Check if headset coil is in place • • Use dry pack to remove moisture • (Radio or TV transmission towers, If the Mlight doesn't nash the speaker security systems, and some mobile might be speaking too softly from speech processor Check for electromagnetic interference phones.) • Turn on speech processor • locate and reduce background noise • Ensure headset is properly connected • Check the headset function If the Mlight stays on allemptto Battery Charger Won't Charge Sounds are Uncomfortably Loud • Check balleries for charge • • Remove and reinsert the balleries to Reduce microphone sensitivity insure they are installed properly Works Cited Cochlear implants. (2011, March). Retrieved from hllp://www.nidcd.nih.gov/health/hearing/coch.html. Coclr/ear implants. (2011). Retrieved from hllp://www.asha.org/public/hearing/Cochlear-Implanl/. Troubleshooting guide your introduction to cochlear implants. (n.d.). Retrieved from hllp://professionals.cochlearamericas.com/siles/ defaull/files/resources/TroubleShoolingFUN599GISS2.pdf. 80 AII-in-One Resource on Classroom Amplification Honors Thesis Jordan Amor Ball State University Spring 201.1 Who Benefits and Why? Teachers are the first to benefit from added amplification. In today's classrooms teachers are fighting a losing battle against background noise that forces them to raise their voices. This causes straining which can lead to permanent damage of the vocal cords. In addition, all groups of students benefit from classroom amplification systems. These systems allow those students with attention deficit disorder and attention deficit hyperactivity disorder to focus better by blocking out background noise. Classroom amplification makes it easier for those students with hearing • Be Heard School Grant http:// www.calypsosys tems.com/grant apps • Community Foundations • Psi Iota Xi disabilities to hear. Finally, students with normal hearing don't have to exert as much energy to hear the teacher. The use of a sound-field amplification system provides the teacher with a unique opportunity to maximize listening and learning opportunities in the classroom. Sound-field amplification research supports the benefits for both students and teachers. Primary research findings are: • An improvement in academic achievement, espeCially for younger students • An increase in on-task behavior • An increase in attention to verbal instruction and activities and improved understanding • A decrease in the number of requests for repetition • A decrease in the frequency of need for verbal reinforces to facilitate test performance • Psi Chi • Rotary Club • Kiwanis • A decrease in test-taking time • An increases ub sentence recognition abilities • An improvement in listening test scores • An increases in language growth • An improvement in student voicing when speaking • Lions Club • Elks Club • An increase in student length of utterance • An increase in ease of listening and teaching • A decrease in vocal strain and fatigue for teachers • Moose Club • A decrease in the special education referral rate • An increase in seating options for students with hearing loss • Sertoma Club • It is a cost-effective means of enhancing the listening and learning environment. 81 AII-in-One Resource on Classroom Amplification Page 2 Trouble Shooting CA Systems getting reception the channel lights on the receiver are red_ What's wrong? Check that the transmitter is on and is un-muted. Verify that you are not blocking either the emitters on the transmitter or the sensors on receiver or mounted around room. If reception is interrupted when facing a certain direction, install an additional sensor in that area of the room . Ifteam-teaching, verify that transmitters are not on the same channel. If low battery indicator shows recharge transmitter's batteries. Replace batteries if recharge is ineffective. Getting feedback (squealing) - how can it be minimized? Make sure the speakers are mounted as close as possible to both the ceiling and the listeners; avoid mounting speakers in the teacher's primary lecture area. Position the microphone closer to the speakers mouth. Lower the microphone volume control on the receiver. Select the low or medium OptiVoice setting. No sound coming out of the speakers (or sound output is weak). Verify that the receiver is on (green power light). Verify that the receiver is picking up a signal (green channel indication light). Increase the microphone volume or Aux Volume control on the receiver. Position the microphone closer to the speakers mouth. Verify that the speaker cables are connected properly. Verify that the transmitter is not muted. {he receiver won't turn on - the power light is off. What needs to be done? Verify that the power supply is plugged into both the receiver and a working wall outlet. Test with another power supply. If the power light turns yellow, the receiver is in standby mode. The receiver will power-down automatically when it does not detect a microphone or audio input for more than ten minutes. The receiver will turn on automatically when: the microphone is turned on and/or un-muted, or an audio source is connected to the receiver. How to eliminate 'dead spots' or microphone crackling / noise? Verify that the speaker is not blocking either the emitters on the transmitter or the sensors on receiver or that are mounted around room. If reception is interrupted when facing a certain direction, install an additional sensor in that area ofthe room . If team-teaching, verify that transmitters are not on the same channel. Recharge or replace the transmitter's batteries. Verify that the emitter/microphone is working (Test with another working emitter/microphone). Works Cited Classroom soundfield amplification: an introduction. (2008, December 15). Retrieved from http://www.extron.com/ download/files/whitepaper/ciassroomsoundfieldamp_reVl.pdf. Classroom amplification systems. (n.d.). Retrieved from http://www.esd112.org/edtech/whitepapers/ Sound_Amp_whitepaper.pdf. 'Iassroom sound-field amplification systems. (1995). Retrieved from http://www.hear-more.com/ 82 Classroom Amplification Diagram Ampifier/Receiver on back counter Speakers at a 33" height to accomrr.odate students seated at tables \. Speaker at height to accommodate students seated on floor for music and story time MAIN ALL-CLASS INSTRUCTION AREA small group table bookcase Speaker at 21" height to accommod students seated on floor • 21~) PLAY AREA door FIGURE 7-1 1. Diagrom of loudspeaker place .ent for sample kindergarten . Adopted from A School Handbook on Classroom Amplifica/ion (p . 19) by L. Allen,1991 , Permission Keystone Area Educational Agency, Division of Special Education, RR #2, Box 119, Elkader, Iowa 52043. 83 Severity of Hearing Loss Graph I~L_O __ W___________~_IT_C_H________~~ oH ) to 250 50 0 1()()O ~oo o I 400C) 8000 0 (/) 10 20 30 lfl MI l:: t1) W 40 Z o so J o ..J 60 a :> 60 ! \\ 0 (I \ ...J l \I V 90 100 Ir---=:---+------tr------'------;t~~-t__-_______+ _ - - - - ' - -_t___I HO f -- ; - - - - + - - - - i - - - - - - ; - - - - - i r - - - - r - - r - - - r - - + - - - - - - r - -- t - i 120 ~--~~--~----~----~----~----~ http://www.pedsent.com/problems/aud_audiogram.htm 84 Sound Levels Graph http://www.hearing-aid.com/h eari ng-I oss-treatment-consi d erations/ au dio Iogists-a nd-h ea ri ng-speci aIists/h earing-I oss-a ud iogram 85 Speech Audiogram , 1(100 0 0 0 x x .c.{IOl 0.><: X 0 x x 0 Normal h e-<J ri IlS Ph zv J'. mdb AI !I fsth clh Mild sh fa 0 kt g r } Mod } Moder.I.ly. 100 1 0 no htt ·www.unitronhearing.com/unitron/global/en/consumer/your_hearing-c/hearing_loss/types_degrees.html 86 Ie ",,~ ·in·One Resource on Alzheimer's JordanAmor Honors Thesis Ball State Unncrsity Sprm,r; 2011 What is Alzheimer's Alzheimer's disease is a progressive, degenerative disorder that attacks the brain's nerve cells resulting in loss of memory, thin'king and language skills, and behavioral skills. Alzheimer's disease is the most common cause ofdementia among people 65 years of age and older. Brain weight is usually reduced due to the atrophy ofbrain tissue. • It is estimated that as many as 5.1 million Americans have Alzheimer's disease. • On average 1-4 family members are needed to take on the role of caregiver. • $172 billion are spent annually on treatment. • It is the 7th leading cause of death. Symptoms ofAlzheimer's • ~emory • Trouble loss that disrupts daily life • Challenges in planning or problem solving • Difficulty completing familiar tasks • Confusion with time and or place • • understanding visual images and spatial relationships New problems with words in speech or writing ~isplacing things and losing the ability to retrace steps • Decreased or poor judgment • Withdraws from work or social activities • Changes in mood and personality Stages ofAlzheimer's Stage 1: No Impairment-no memory problems or other symptoms. Stage 2: Very ~ild Decline-maybe normal age-related changes, minor memory lapses Stage 3: ~ild Decline- early stage: people close to the client begin to notice changes. Stage 4: ~oderate Decline- forgetful of recent events and personal history, greater difficulty performing complex tasks Stage 5: ~oderately Severe Decline-get confused about where they are and what day it is. 87 Stage 6: Severe Decline- personality changes may take place and need extensive help with daily activities Stage 7: Very Severe Decline-last stage individuals need help with the most basic tasks such as eating and using the toilet. All-in-Onc Resource on Alzheimer's Page 2 ~entfor~hebners Currently there is no cue for Alzheimer's. However, researchers are trying to develop drug therapies to slow the progression and reduce the damage. The U.S. Food and Drug Administration (FDA) has approved several medications for treating Alzheimer's. Several of the drugs are only able to be used during the mild to moderate stages. One type of drug being prescribed is cholinesterase inhibitors. These medications help slow the breakdown of the parts of the brain that are in charge ofleaming and memory. EfFects on Speech The Speech Language Pathologist is an important part ofthe treatment team. Other members include doctors, nurses, and occupational therapists among others. The role of a speech pathologist can take on several forms for an Alzheimer's patient. • First there is treatment for disorders such as aphasia and apraxia. To work on aphasia clinicians target the area that is having the difficulty spoken language or written language, It also involves finding alternate communication methods. To decrease the affects of apraxia clinicians work on strengthening articulators. Also they teach the client strategies about the placement of lips, teeth, and tongue. • Secondly, they can assist in strengthening and maintaining memory. This minimizes the effects and can slow the progression of Alzheimer's disease. • In the fmal stages of Alzheimer's disease the patient may begin to have trouble with basic functions such as swallowing. The treatment of swallowing is called dysphasia. The treatment can include making diet recommendations such as thickened liquids or pureed foods. Additional Resources: Alzheimer's Disease Education and Referral (ADEAR) Center Eldercare Locator P.O. Box 8250 800-677-1116 (toll free) Www.eldercare.gov Silver Spring, MD 20907-8250 Family Caregiver Alliance www.nia.nih.gov/Alzheimers Alzheimer's Association 180 Montgomery Street, suite 1100 225 north Michigan A venue, Suite 1700 San Francisco, CA 94104 800-445-8106 (toll free) Chicago, IL 60601-7633 www.caregiver.org 800-272-3900 (toll free) www.alz.com National Institute on Aging Information Center Children of Aging Parents P.O. Box 8057 Gaithersburg, MD 20898-8057 P.O. Box 167 800-222-2225 (toll free) Richboro, PA 18954 800-227-7239 (toll free) www.nia.nih.gov www.caps4caregivers.org Works Cited: Alzheimer's Association. (20 10, November 30). Retrieved from http://www.alz.org/. Alzheimer's Association ofAmerica. (2010). Retrieved from http://www.alzfdn.org/. Hodges, l.R. (2001). Early-onset dementia. Oxford: Oxford University Press. 88 Jordan Amor Honors Thesis Basics of Cerebral Palsy wo-thirds of :hildJ~en with cerebral palsy will be mentally impaired. • About 10,000 babies per year in the U.S. will develop cerebral palsy. • An estimated 800,000 people have cerebral palsy in the U.S. • About 2-3 chil dren per 1,000 have cerebral palsy. • In 2003 , the average lifetime cost of cerebral palsy is esti mated at $921,000. This does not include hospital visits, emergency room visits, residen tial care, and other out of pocket expenses. The diagnosis of cerebral palsy (CP) refers to anyone of a number of neurological disorders that appear during infancy or early childhood before 12 years of age. The disorder is caused by permanent damage to the parts of the brain that controls body movement and muscle coordination. However, it is not a progressive disorder. The damage that causes Cerebral Palsy occurs during a period of brain development. The majority of children with cerebral palsy are born with it. Nevertheless the majority of cases aren't detected until months or years later. This is because the areas of the brain that were damaged are not used until later in development. There are three main factors that cause CPo The first is prenatal, which is before birth or during pregnancy. These causes include intrauterine infection, ingestion of drugs, chromosomal abnormalities, trauma during the first trimester, and radiation exposure. Second there are perenatal causes which include hemorrhage and anoxia (the umbilical cord being wrapped around the neck) or the use of forceps or a vacuum. Last there are postnatal causes such as infections, trauma, and convulsions. Forty percent of all CP cases have an unknown cause. Classification of Cerebral Palsy PhysiCians identify cases of CP using three criteria: place/ location, classification, and severity. There are four place classifications: monoplegia, where one extremity is effected, hemiplegia, where two extremities on the same side are effected, paraplegia, where two lower extremities, and 89 quadriplegia, where all four extremities are effected. Next is classification which describes five types of disabilities. Spasticity is the hyperactivity of the stretch reflex. Athetosis in a type of involuntary writhing movements. Ataxia is a discoordination and tremors in both fine and gross motor skills. Tremors are a rhythmic repetitive involuntary movement in the extremities. The last is rigidity which is muscular resistance to passive motion. The final classification is severity: mild, moderate, severe, and profound. PageZ Symptoms of Cerebral Palsy The early signs of cerebral palsy usually appear before a child reaches 3 years of age. The most common forms are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exag gerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a "scissored" gait; and muscle tone that is either too stiff or too floppy. Treatment of Cerebral Palsy can begin therapy for movement, learning, speech, hearing, social, and emotional development. In addition, medication, surgery, or braces can help improve muscle function. Surgery can help repair dislocated hips and scoliosis Currently there is no cure for cerebral palsy, but there are a variety of resources and therapies can to improve a patients quality of life. Different kinds of therapy can help them achieve maximum potential in growth and development. As soon as CP is diagnosed, a child (curvature of the spine)- both common problems associated with CPo Severe muscle spasticity can sometimes be helped with medication taken by mouth or administered via a pump (the baclofen pump) implanted under the skin of children with CP. Cerebral Palsy's Effects on Speech Communicating is difficult for children with cerebral palsy and speech therapy can relieve the frustration of communication problems. Speech therapy helps the patient correct speech disorders, restore speech, use communication aids, learn sign language, and improve listening skills. Some people with cerebral palsy have problems moving their mouth to form words correctly because of muscle control. Hearing loss can be evident as well in a person with cerebral palsy, and speech therapy can help with speech clarity. Speech therapists can also help clients build their language skills by learning new words, learning to speak in sentences, or improving their listening skills. To strengthen muscles used in speaking, the patient might be asked to say words, smile, close their mouth, or stick out their tongue. Picture cards Works Cited may be used to help the patient remember everyday objects and increase vocabulary. The patient might use picture boards of everyday activities or objects to communicate. Workbooks might be used to help the patient recall the names of objects, practice reading, writing, and listening. Computer programs are also available to help sharpen speech, reading, recall, and listening skills. Additional Resources 4 my child. (2010) retrieved from http:// www.cerebralpalsy.org/what-is-cerebral-palsy/statistics/. Cerebral palsy source. (2005). Retrieved from http:// www.cerebralpalsysource.comlTreatmen_and_Therapy/ speech_cp/index.html. Danilova, L.A. (1983) . 23methods of improving the cognitive and verbal development of children with cerebral palsy. New York: World Rehabilitation Fund, Inc. ""ids health- cerebral palsy. (2010). Retrieved from http:// kidshealth.org/parentlmedical/brain/cerbratpalsy.html#. 90 4MyChild offers families of children with special needs a kind of help and hope that may change lives for the better. I-BOO-4MyChild (I-BOO-469-2445) United Cerebral Palsy 1660 L Street, NW, Suite 700 Washington, DC 20036 Phone: (800) 872-5827/(202) 776-0406 Fax: (202) 776-0414 E-Mail: [email protected] Huntington'sDiseaseAffects the Brain's Basal Ganglia AII-I- n - 0 ne Re sou rce 0 n Huntington's Disease Honors Thesis Jordan Amor Basal Ganglia Ball State University Spring 2011 What is Huntington's Disease? tistics: In the United States alone, about 30,000 people have Huntington's disease. • A child who has a parent with Huntington's disease has a 50% chance of inheriting the disease. • 1-3 % of Huntington's disease cases Huntington's disease (HD) is also known as Huntington chorea. Huntington's disease is a progressive brain disease. The disease is caused by a mutation on chromosome number 4. It only takes one faulty gene for a person to inherit HD because the disorder is dominate. Signs and symptoms typically first appear in middle age. Some parents may not know they carry the gene until they've already had children and possibly passed on the trait. The disease destroys cells in the basal ganglia causing substantial brain atrophy. The basal ganglia is the part of the brain that controls movement, emotion, and cognitive abilities. Signs and symptoms usually develop in middle age. Younger people with Huntington's disease often have a more severe case, and their symptoms may Symptoms are sporadic, meaning they occur even though there is no family history. • The disease was named for Dr. George Huntington who first described it in 1872. progress more quickly. Rarely, children may develop Huntington's disease. Huntington's disease is not specific to anyone population. Also it is not more prevalent within any particular race, ethnic group, or gender. However, the highest incidence of Huntington's disease is in Western Europeans. Early signs can include: Later signs include: • Personality changes, such as irritability, anger, depression, or loss of interest • Sudden jerky, involuntary movements though out the body • Decreased cognitive abilities such as decision making and learning new information • Severe balance and coordination problems • Jerky, rapid eye movements • Mild balance problems • Hesitant, halting, or slurred speech • Involuntary facial movements • Swallowing speech 91 • Dementia AII - in-One Resource on Huntington's Disease Page 2 Treatment There is no treatment to permanently stop or reverse Huntington's. There are, however, several medications to control symptoms. The medications tend to do one of four things . One type increases the dopamine in the brain to reduce the involuntary movements. Next are tranquilizers to reduce movements. Third are anti psychotics to control hallucinations. Last are medications to help control depression and the obsessive-compulsive Effects on Speech Genetic Testing One of the functions of the Basal Ganglia is to control muscle movement. This includes the movement of the articulators. This leads to slurred and imprecise speech. Speech Pathologists provide their Huntington's patients with coping techniques including over-articulation. Genetic testing can be used in two ways. First tests can be used to confirm the diagnosis of HD. Second a test is used to determine if the mutated gene has been received before symptoms begin to appear. This is used by some patients when deciding whether or not to conceive. Works Cited Genetic Science Learning Center (2010, October 8) Huntington's Disease. Learn.Genetics. Retrieved December 2,2010, from http://Iearn.genetics.utah.edu/content/ disorders/whataregd/hunt/. Hodges, J.R. (2001). Early-onset dementia. Oxford: Oxford University Press. Mayo Clinic Staff. (2009, May 8). Huntington's disease. Retrieved from http://www.mayoclinic.com/health/ huntingtons-disease/DS00401. Schoenstadt, MD, A. (2008m July 9). Huntington's disease. Retrieved from http://nervous-system.emedtv.com/ h untington's-d isease/h u nti ngton's-d isease. html. 92 tendencies . As with any medication there are side affects that can range from insomnia to nausea. Physical and speech therapy helps patients to lead more normal lives. Additional Resources Huntington's Disease Society of America is a health organization dedicated to improving the lives of people with HD; www.HDSA.org HD Lighthouse provides the latest news about the diagnosis, treatment, care, research and the community of HD; www.hdlighthouse.org HOPES (Huntington's Outreach Project for Education at Stanford) is a student-run project at Stanford University dedicated to making scientific information about HD more accessible to patients and the public; www.stanford.edu/group/hopes Huntington's Disease Advocacy Center is an on-line resource center for HD families, by HD families; www.HDAC.org Huntington Project brings together all parties involved and affected by HD from scientists to family members. www.Huntington-Study-Group.org Huntington's Disease Drug Works provides information on present treatment options, drug developments and clinical trials. www.hddrugworks.org e Resource on Pick's Disease Honors Thesis lordanAmor Ball State University Spring 20 I I What is Pick's Disease? • Pick's Disease, affects less than 200,000 people in the US population. • Pick's disease makes up about 2-3% of all cases of dementia Pick's disease is now known as frontotemporal dementia (FTD) . Pick's causes shrinldng of the frontal, temporal, and anterior lobes of the brain. This new classification includes Pick's disease, . . prunary progreSSIve aphasia, and semantic dementia. People with Pick's disease have abnormal substances called pick bodies inside nerve cells in the damaged areas of the brain. Pick bodies contain an abnormal form of a protein. This protein is found in all nerve cells. But some people with Pick's disease have an abnormal amount of this protein. The exact cause is unknown. However, there is a strong genetic link. Many di fferent abnormal genes have been found to cause Pick's disease. Pick's usually begins between ages 40 and 60. behavior; lack of social tact; lack of empathy; distractibility; an increased interest in sex; changes in food preferences; agitation or, conversely, blunted emotions; neglect of personal hygiene; repetitive or compulsive behavior, and decreased energy and motivation. Common symptoms include language disturbance including, difficulty creating or understanding speech. Language problems often occur in conjunction with behavioral symptoms. Symptoms The symptoms of FTD fall into two clinical patterns that involve either changes in behavior, or problems with language. Behavior changes can be subclassified as either impUlsive or bored and listless. Symptoms include inappropriate social 93 Page 2 All-in-One Resource on Pick's Disease Treatment No treatment has been shown to slow the progression ofFTD. Behavior modification may help control unacceptable or dangerous behaviors. Aggressive, agitated, or dangerous behaviors could require medication. Anti depressants have been shown to improve some symptoms. Sometimes patients with Pick's take the same medications used to treat other types of dementia, such as medications that decrease the breakdown of the chemical messenger, acetylcholine (anticholinesterase inhibitors), and memantine. There is no conclusive evidence that these medications help. Effects on Speech The person with frontotemporal dementia may experience language difficulties, including: spontaneous conversation • • problems finding the right words • • a lack of circumlocution, using many words to describe something simple a reduction in or lack of speech Speech Pathologists can help the patients by targeting their specific problems. In addition the patient is provided with comfortable and safe environment in which to practice speech skills. Works Cited Additional Resources Association for Frontotemporal Dementias (AFID) Radnor Station Building #2 Suite 320 290 King of Prussia Road Radnor, P A 19087 [email protected] http://www.FTD-Picks.org Tel: 267-514-7221 866-507-7222 Frontatemporal dementia (Pick's disease). (2010, February 16). Retrieved from http://www.virtualmedica1centre.coml diseases.asp?did=718. Hodges, 1.R. (2001). Early-onset dementia. Oxford: Oxford University Press. Ninds frontotemporal dementia information page. (20 I 0, November 19). Retrieved from http://www.ninds.nih.gov/ disorders/picks/picks.htm. Pick's disease. (2010, November 15). Retrieved from http:// www.nlm.nih.gov/medlineplus/ency/article/000744.htm. What is fronto-temporal dementia (including pick's disease)? (20 I 0). Retrieved from http://www.alzheimers.org.uk/site/ scripts/documents_ info.php? categoryID=200 171 &documentID= 167 &gclid=CKJj4caxzaUCF Q08KgodtQvhlQ. 94 11--n-One Resource on Shake 8aby Syndrome Jordan Amor Honors Thesis Ball State University Spring 2011 are relatively large and heavy, making up about 25 0/0 of their total body weight. • Approximately 60% of identified victims of shaking injury are male. • It is estimated that the perpetrators in 65 to 90% of cases are males usually either the baby's father or the mother's boyfriend. • Approximately 30 per 100,000 children under age 1 suffered from brain injuries. • Approximately 1 of 4 babies diagnosed with SBS dies. • Approximately 1,200- 1,400 cases of SBS are diagnosed each year. What is Shaken Baby Syndrome? This type of traumatic brain injury happens when a baby is violently shaken. A baby has weak neck muscles and a large, heavy head. Shaking makes the fragile brain bounce back and forth and rotate inside the skull. This causes shearing, bruising, swelling, and bleeding that destroys brain tissue. The shaking action can result in severe brain damage or death. The characteristic injuries of shaken baby syndrome are subdural hemorrhages (bleeding in the brain), retinal hemorrhages (bleeding in the retina), damage to the spinal cord and neck, and fractu res of the ribs and bones. These injuries may not be immediately noticeable. The consequences of less severe cases may not be brought to the attention of medical professionals and may never be diagnosed. Shaken baby injuries usually occur in children younger than 2 years old, but may be seen in children up to the age of 5. Symptoms • Lethargy/ decreased muscle tone • Extreme irritability • Decreased appetite, poor feeding or vomiting for no apparent reason • Grab-type bruises on arms or chest • No smiling or vocalization • Poor sucking or swallowing • Rigidity or posturing • Difficulty breathing • Seizures • Head or forehead appears larger than usual or soft-spot on head appears to be bulging • Inability to lift head • Inability of eyes to focus or track movement or unequal size of pupils Treatment Emergency treatment for a baby who has been shaken usually includes life-sustaining measures such as respiratory support and surgery to stop internal bleeding and bleeding in the brain. Doctors may use brain scans, such as MRI and CT, to make a more definite diagnosis. 95 Page 2 AII-in-One Resource on Shaken Baby Shaken Baby Syndrome is 100 0/0 Preventable! Here are some alternatives when a baby won't stop crying: • Make sure the baby's basic needs are met (for example, being hungry and doesn't needing to be changed). Check for signs of illness, like fever or swollen gums. Rock or walk with the baby. Sing or talk to the baby. Offer the baby a pacifier or • • • • • • • • a noisy toy. Take the baby for a ride in a stroller or strapped into a child safety seat in the car. Hold the baby close against your body and breathe calmly and slowly. Call a friend or relative for support or to take care of the baby while you take a break. If nothing else works, put the baby on his or her back in the crib, close the door, Effects on Speech When a child has been diagnosed with shaken baby syndrome the Speech Language Pathologist will 'Jerform two types of assessment, formal and informal. Some of the areas that should be assessed include levels of attention, tolerance of stress, deg ree of cueing and prompting needed, processing time, fatigue. Also the clinician examines all types of language: expressive, receptive, written, and auditory comprehension. Two major disorders that are often seen are apraxia and dysarthria. Apraxia of speech is and check on the baby in 10 minutes. • Call your doctor if nothing seems to be helping the infant, in case there is a medical reason for the fussiness. To prevent potential cases of SBS, parents and caregivers of infants need to learn how to respond to their own stress. It's important to talk to anyone caring for your baby about the dangers of shaking and how it can be prevented. Additional Resources a motor speech disorder in which planning and programming required for speech sound production are disrupted Dysarthria is a weakness in the muscles or an in ability to control aspects for neuromuscular execution of speech. Works Cited The Arc of the United States 1010 Wayne Avenue Suite 650 Silver Spring, MD 20910 [email protected] http://www.thearc.org Tel: 301-565-3842800-433-5255 Fax: 301-565-3843 or -5342 ThinkFirst National Injury Prevention Foundation 29W120 Butterfield Road Suite 105 Warrenville, IL 60555 [email protected] http://www.thinkfirst.org Tel: 630-393-1400 800-THINK-56 (844-6556) fax: 630-393-1402 All about sbs/aht. (n.d.) retrieved from http://www.dontshake.org/ sbs.php?topNavID=3&subNavID=317. Cabinum-foeller, E. (2008, June) Abusive head trauma (shaken baby syndrome). Retrieved from http:// kidshealth.org/parent/medicaljbrain/shaken. html#. Child Welfare Information Gateway. (2008). Long term consequences of child abuse and neglect. Re trieved from http://www.childwelfare.gov/pubs/factsheets/long_term_consequences.cfm#societ. NINDS. (2010, May 6). Ninds shaken baby syndrome information page. Retrieved from http:// www.ninds.nih.gov/disorders/shakenbaby/shakenbaby.htm. Protecting children. (2010). Retrieved from http://www.americanhumane.org/protecting-children/? gcl id =CLKfu rDBzaUCFUS5KgodC1aq kw. Schoenbrodt, l. (2004). Childhood communication disorders: organic bases. Clifton Park: Thomson Del mar Learning. 96 Diagnosing and Treating Shaken Baby Syndrome Honors Thesis Jordan Amor Ball State University Spring 2011 Testing When trying to determine whether the patient's injuries are a result of Shaken Baby Syndrome (SBS) a detailed medical history must be taken including a specific time line of symptoms. A doctor will compete a physical exam to look for signs of inj ury. Next, tests are preformed including a CT scan and possibly an MRI to document the injuries and identify if they are a result of SBS. These tests may be repeated periodically to monitor change. X-rays are also routinely performed to check for any broken bones. Xrays are usually taken of the skull, extremities, spine, and chest. Initial Treatment Works Cited NINDS. (2010, May 6). Ninds shaken baby syndrome information page. Retrieved from http:/ I www.ninds.nih.gov/ disordersl shakenbabyl shakenbaby . htm. Shaken baby syndrome. (n.d .). Retrieved from http:/ I www .cdphe.state.co. usl psi cctfl canmanuall CurrentTopicsi nChild Maltx2.pdf. It is crucial that the incident is reported immediately and that the victim receives treatment immediately. The sooner the victim receives treatment the better his or her chances for survival. Emergency treatment for a baby who has been shaken usually includes life sustaining measures such as respiratory support and surgery to stop internal bleeding including bleeding in the brain. Speech Therapy When a child has been diagnosed with shaken baby syndrome a Speech Language Pathologist (SLP) is often referred to the case. There are many areas in which the SLP can be of assistance depending on the age of the patient and their ability levels before and after the injury. It is quite possible that an SLP would be in charge of performing a swallow study. This information allows the 97 patient to be given a diet that is most appropriate for them at that point in time. For clients that are a little older and have begun speaking the SLP can work on improving thei r speech by targeting specific problems. It is possibly that as a result of the damage the child has a problem with dysarthria. A child's speech may be slurred and imprecise. The speech pathologist would help the client place his or her articulators to form the desired sounds. As the child enters school it is likely that he or she would continue working with an SLP. One area that might receive therapeutic attention is pragmatics. Therapy could 'include turn taking and different types of grammatical morphemes. Play these games to in1prove your child's speech and language skills. HONORS THESIS JORDAN AMOR SPRING 2011 BALL STATE UNI VERSITY Games Aggravation, Boggle, Candy Land, Checkers, Chinese Checkers, Fish, I am thinking of. .. , Pictionary, Puzzles, Rumn1Y, Scrabble, Shoots and Ladders, Uno, Word Searches General Suggestions SpeechAlways use a carrier sentence with each tum. Always be sure the child is saying the carrier phrase or sentence each time. Also correct your child if they mispro nounce their target sound. Language: Be sure all players use complete sentences every time. Se lect a sentence that can be used for several games. Use descriptive words, opposites, similar words, verbs, ad jectives, adverbs, etc. Discuss with your child the different parts of speech you . are uSIng. 99 elpf I Hi t For C)-Die For Clin c Things to Know • Print flash cards on cardstock- it makes them hold up better and they are harder to see through. If possible laminate them. • Keep electronic copies of the forms you use on a regular basis. • As one progresses the less structure is required. You will become more comfortable and not so reliant on a written lesson plan. • Keep your text books. You never know when they might come in handy. • Become familiar with the tests you might have to administer. This will make the process smoother. • It is often easy to adapt games children already know to what you are working on in therapy. • Try to have as much fun as possible with your client (especially children). The more engaged they are the more they will learn. • Instead of using picture cards to work on vocabulary use picture books. • Use your supervisor, she or he is a great source of knowledge and is available to answer questions. Things to Know • Print flash cards on cardstock- it makes them hold up better and they are harder to see through. If possible laminate them. • Keep electronic copies of the forms you use on a regular basis. • As one progresses the less structure is required. You will become more comfortable and not so reliant on a written lesson plan. • Keep your text books. You never know when they might come in handy. • Become familiar with the tests you might have to administer. This will make the process smoother. • It is often easy to adapt games children already know to what you are working on in therapy. • Try to have as much fun as possible with your client (especially children). The more engaged they are the more they will learn. • Instead of using picture cards to work on vocabulary use picture books. • Use your supervisor, she or he is a great source of knowledge and is available to answer questions. Supplies to Have • Construction Paper • Playing cards • Crayons, markers, colored pencils • Play dough • Scissors, glue, and other art supplies • A quality cook book for children (for following directions) • Word family cards (phonological processing) Supplies to Have • Construction Paper • Playing cards • Crayons, markers, colored pencils • Play dough • Scissors, glue, and other art supplies • A quality cook book for children (for following directions) • Word family cards (phonological processing) Jordan Amor- Honors Thesis, Spring 2011 Jordan Amor- Honors Thesis, Spring 2011 100 HONORS THESIS BALL STATE UNIVERSITY SPRING 20 I I Books Blockcolsky, M.S., CCC-SLP, V, Frazer, M.S., CCC-SLP, J, & Frazer, B.A., J.D., D. (1987). 40,000 selected words. San Antonio: Pearson. This is a book containing lists of words for every sound in all possible positions. In addition the words are divided by number of syllables. Roth, F, & Worthington, C. (2005). Treatment resource manual for speech-language pathology. Clifton Park: Thomas Delmar Learning. This book is filled with specific therapy techniques and materials. Secord, W. (2007). Eliciting sounds techniques and strategies. Clifton Park: Delmar Cengage Learning. This book provides strategies for helping a client produce individual sounds. Shipley, K, & McAfee, J. (2009). Assessment in speech-language pathology. Clifton Park: Delmar Cengage Learning. This is an easy to navigate resource manual for a wide range of procedures and materials for obtaining, interpreting, and reporting assessment data. Therapy Materials Articulation Chipper Chat- Super Duper, This is a series of board games involving some of the most common error sounds. The game provides picture cards for initial, medial, and final sounds. Expanding Expressions Tool Kit by Sara L. Smith, This provides students with a hands-on approach to improving language organization. Webber's Jumbo Articulation Drill Book- Super Duper, Includes word lists pictures, phrases, and sentences for the most commonly erred sounds in all positions. Websites American Speech-Language-Hearing Association (ASHA) www.asha.org Is a comprehensive site with information from education to careers and certifications. Discover Education- http://www.discoveryeducation.comlfree-puzzlemakerl? CFID=12224149&CFTOKEN=63525910 This site has an awesome puzzle maker. EdHelper- http://www.edhelper.com/- This resource is especially valuable as a puzzle generators. Speech Therapy Ideas & Activities- www.angelfire.comlnm2/speechtherapyideas/ This site contains activities divided by category, disorder and some that are specific for schools. Net Connections for Communication Disorders and Sciences- http://www.mnsu.edu/comdis/kuster2/ welcome.html- Is a comprehensive list of websites for information on disorders and activities to do. Speaking of Speech- www.speakingofspeeech.com- Is a resource full ofa wide variety of materials, some resources are free and others have to be purchased. Super Duper- http://www.superduperinc.com/- Sells materials for speech pathologists. Games, flash cards, and tests are available as are other supplies. The Listen-Up Web- http://www.listen-up.orgledulspeech.htm This website is a comprehensive list other websites and some brief descriptions. The Sounds of Spoken Language- http://www.uiowa.edul''1lcadtech/phonetics/# This website is extremely helpful with older children and adults. On the website there are animated libraries of the phonetic sounds of English, German, and Spanish. 101 Works Cited 10 signs ofalzheimer's. (2011, April 20). Retrieved from http://www.alz.org/alzheimers_disease_10_signs_ oCalzheimers.asp. Activity planningformat 2008-2009. (n.d.). Retrieved from http://www .teacherplanet.com/1inks/redirect. php ?url=http://www.nipissingu.calprimaryju nior/downloads/ ACTIVITY .PDF. Activities to encourage speech and language development. (2011). Retrieved from http://www.asha.org/public/speech/developmentIParent-Stim-Activities.htm. All about sbslaht. (n.d.) retrieved from http://www.dontshake.org/sbs.php?topNavID=3&subNavID=317 . Alzheimer's association. (2010, November 30). Retrieved from http://www.alz.org/. Alzheimer's association ofAmerica. (2010). Retrieved from http://www.alzfdn.org/. Aphasia. (2011). Retrieved from http://www.asha.org/public/speech/disorders/Aphasia.htm. Arizona articulation proficiency scale, third edition (arizona-3) . (n.d.). Retrieved from http://portal.wpspublish.com!portaVpage?yageid=53,126681&_dad=portal&_schema=P ORTAL. Articulation disorders: treatment. (n.d.). Retrieved from http://www.c1as.ufl.eduiusers/rahuV4250/artn3.htm!. Auditory continuous performance test (acpt) auditory continuous performance test (acpt). (2011). Retrieved from http://www.pearsonassessments.comIHAIWEB/Cultures/en uslProductdetai1. htm ?Pid=O 15-800 5-600&Mode=summary. Bowen, Caroline. (1998). Ages and stages. Retrieved from http://www.speech-Ianguage therapy .com!deveI2.htm. 103 Bowen, Caroline. (1998). Pact: a broad-based approach. Retrieved from http://members. tripod.com/caroline_ bowenlclinphonology .htm I. Bredenkamp, MD, FACS, J. (2009, July 21). Noise-induced hearing loss and its prevention. Retrieved from http://www.medicinenet.com/noise_induced_hearingJoss_and_its-preventionlarticle.ht m. Cabinurn-foelIer, E. (2008, June) Abusive head trauma (shaken baby syndrome). Retrieved from http://kidshealth.org/parentlmedicallbrainlshaken.html#. CHAPPS pad of100. (2008). Retrieved from http://www.edaud.org/storelistitem.cfrn?itemnumber=4. Child welfare information gateway. (2008). Long term consequences of child abuse and neglect. Retrieved from http://www.childwelfare. gov/pubs/factsheets/long_term _ consequences.cfrn#societ. Classroom soundfield amplification: an introduction. (2008, December 15). Retrieved from http://www.extron.com/download/files/whitepaper/classroomsoundfieldampJev 1.pdf. Classroom amplification systems. (n.d.). Retrieved from http://www.esdl12.org/edtechlwhitepapers/Sound_Amp_whitepaper.pdf. Classroom sound-jield amplification systems. (1995). Retrieved from http://www.hear more.com/classamplification.htm. Cochlear implants. (2011, March). Retrieved from http://www.nidcd.nih.gov/health/hearing/coch.html. Cochlear implants. (2011). Retrieved from http://www.asha.org/public/hearing/Cochlear Implant/. 104 Configuration ofhearing loss. (2011). Received from http://www.asha.org/public/hearing/Configuration-of-Hearing-Loss/. Daily lesson plan. (n.d.). Retrieved from http://honolulu.hawaii.edulintraneticommitteeslFacDevComlguidebklteachtip/lesspln3.ht m. Daily lesson plan template #1. (n.d.). Retrieved from http://www.lessonplans4teachers.comldaily_lesson_l.php. Davidson, Tish. (2011). Phonological disorder. Retrieved from http://www.minddisorders.comlOb-PslPhonological-disorder.html. Directory ofspeech-language pathology assessment instruments. (2011). Retrieved from http://www.asha.org/assessments.aspx?type=&lang=English. Ear infections in children. (2011, January 05). Retrieved from http://www.nidcd.nih.gov/health/hearing/earinfections. Expressive language disorder. (2011). Retrieved from http://www.kidspeech.comlindex.php?option=com_content&view=article&id=211 <em id=506. Five steps to successfully coping with hearing loss. (2005, December 26). Retrieved from http://hearinglosshelp.comlweblog/five-steps-to-successfully-coping-with-hearing loss.php. Frontatemporal dementia (Pick 's disease). (20lO, February 16). Retrieved from http://www.virtualmedicalcentre.comldiseases.asp?did=718. 105 Funding sources classrrom audio technology. (2008, September 12). Retrieved from http://mws. mcallen.i sd. tenet.edulcidc/newsletter/archives/vo Iume9issue 1/08 09FundingSources. pdf. Genetic science learning center (2010, October 8) Huntington's Disease. Learn. Genetics. Retrieved December 2, 2010, from http://learn.genetics.utah.edulcontentldisorders/whataregdihuntl. Glossary o/terms. (2011). Retrieved from http://www.mtcus.com/glossary.html. Kohnle, D. (2010). Health tip: coping with hearing loss. Retrieved from http://www.medicinenet.com/scriptlmainlart.asp?articlekey= 115995. Hearing aid styles. (2011). [Web]. Retrieved from http://www.thingsforoldpeople.com/pagel2 Hearing loss (cont.). (20 11). Retrieved from http://www.emedicinehealth.comlhearing~oss/page2_em.htm. Hodges, l.R. (2001). Early-onset dementia. Oxford: Oxford University Press. How does your child hear and talk? (2011). Retrieved from http://www.asha.org/public/speechldevelopmentlchart.htm. Language-based learning disabilities. (2011). 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