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Promoting Health and Well Being: A Graduate Seminar in Prevention Jack Pickering, Ph.D., CCC-SLP College of Saint Rose Albany, NY American Speech-Language-Hearing Association Convention Friday, November 16, 2007 Boston, Massachusetts Purpose of the Course This course will explore the topic of prevention in communication sciences and disorders. Students will discuss prevention as an essential feature of health care and wellness, as well as a key feature of our assessment and intervention. Students in the course will: learn about the science of prevention and its place in health care and wellness, gain knowledge about prevention in speechlanguage pathology and audiology, research and present information about prevention take part in activities that promote the prevention of communication and swallowing disorders Purpose of the Course Consistent with ASHA’s educational standards in speech-language pathology, students in the course will: gain knowledge of the principles and methods of prevention for people with communication and swallowing disorders take part in prevention activities, including the selection, development, and dissemination of prevention materials Outline of Topics Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13 Week 14 Week 15 Week 16 Prevention: Definitions and concepts Preventing health problems and promoting wellness The science of prevention Models of preventative health Genetics and environment: Influences on health Prevention across the lifespan and multicultural issues Prevention of disorders of communication and swallowing Fluency disorders and disorders of voice Child language disorders Adult language disorders Cognitive/communicative disorders Preventing hearing loss Preventing communication problems with hearing loss Swallowing disorders and speech sound disorders Designing and implementing prevention programs Presenting your program and de-briefing Course Resources National/Governmental Agency Documents and Web Sites ASHA’s Curriculum Guide for Instructors and Students, as well as Selected Readings A Health Questionnaire to Start the Class Please respond to the following questions. You do not need to divulge highly personal information, if that would be uncomfortable. However, your thoughtful responses will get us started thinking about prevention in a broad, personal way. Are you engaged in any activities or behaviors that you consider preventative? If so, what are you doing and what are you trying to prevent? Are you aware of any factors (familial, environmental, behavioral) that affect your health (today or in the future)? Have you ever been engaged in clinical activities (as a student) that you consider preventative? If so, what are/were they? Annotated Bibliography For this assignment, students and the instructor will prepare an annotated bibliography on prevention that will be created throughout the semester. Students will be responsible for completing 5 annotations throughout the semester, and the following criteria must be followed: a) annotations will come from a variety of resources, b) at least 1 must be related to the prevalence or incidence of communication sciences and disorders, c) at least 1 annotation must come from a resource less than a year old, and d) each annotation will be word processed in 11 or 12 Times New Roman font. Annotations will be graded according to content, organization and mechanics. The annotations will be shared, so that at the end of the semester, each student and the instructor will have dozens of annotated references on prevention. Annotated Bibliography Title of Article: The prevalence of vocal fold nodules in school age children Journal Title: International Jl of Pediatric Otorhinolaryngology Authors: Akif Kilic, M., Okur, E., Yildirim, I., & Guzelsoy, S. Year and Number of Pages: 2003, pp. 409-412 Brief Summary: This study assessed 617 school children, between 7 and 16 years of age. The researchers used telescopic laryngoscopy to assess the structure of the vocal folds. Results indicated that 16.9% of the children had vocal nodules, with a male to female ratio of 2:1. This study demonstrated a high prevalence of vocal fold nodules in the children and adolescents studied. The authors stated that vocal nodules were usually bilateral. This study suggests that both clinical and school based speech language pathologists will likely treat children and adolescents with vocal nodules during their career. It is particularly important for school based speech language pathologists to inform parents, teachers and children about voice disorder and ways to maintain a healthy voice. Epidemiology epidemiology Main Entry: Pronunciation: Function: Etymology: Date: ep·i·de·mi·ol·o·gy \e-pə-dē-mē-ä-lə-jē, -de-mē-\ noun Late Latin epidemia + International Scientific Vocabulary -logy circa 1860 1 : a branch of medical science that deals with the incidence, distribution, and control of disease in a population 2 : the sum of the factors controlling the presence or absence of a disease or pathogen Definition of epidemiology from the Merriam-Webster Online Dictionary: www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=epidemiology Questions about Epidemiology What is epidemiology? Why should we care about it? How can an epidemiologist help us do our job? What is the incidence of communication and swallowing disorders in the United States? What is the prevalence of communication and swallowing disorders in the United States? Wait a minute…What are incidence and prevalence? Does the disorder matter when it comes to incidence and prevalence? Can we change incidence and prevalence of communication and swallowing disorders? What do risk factors and protective factors have to do with speech-language pathology? How do we reduce risk factors with our clients or potential clients? Can we encourage protective factors with our clients or potential clients? Levels of Prevention Primary Prevention is the elimination or inhibition of the onset and development of a communication disorder by altering susceptibility or reducing exposure for susceptible persons. An exposure means presence of a risk factor. Immunization to prevent infectious disease is probably the best known example of primary prevention. Other examples are using ear protectors in noisy environments to prevent noise-induced hearing loss and wearing seat belts to prevent head injury. See Spring into Science. American Speech-Language-Hearing Association. (1991). Prevention of Communication Disorders [Relevant Paper]. Available from www.asha.org/policy Levels of Prevention Secondary Prevention is the early detection and treatment of communication disorders. Early detection and treatment may lead to the elimination of the disorder or the retardation of the disorder's progress, thereby preventing further complications. Screening is an example of secondary prevention. A specific example would be the high-risk register for the detection of congenital or early onset deafness. If hearing loss is identified and treated early, the handicap may be reduced or eliminated. See Screening Opportunities. American Speech-Language-Hearing Association. (1991). Prevention of Communication Disorders [Relevant Paper]. Available from www.asha.org/policy Levels of Prevention Tertiary Prevention is the reduction of a disability by attempting to restore effective functioning. The major approach is rehabilitation of the disabled individual who has realized some residual problem as a result of the disorder. The history of the communication disorders professions has been one of tertiary prevention. Speech-language pathologists and audiologists have most commonly provided tertiary prevention by rehabilitating clients to maximal levels of function within the constraints of their preexisting conditions. See Student Presentations. American Speech-Language-Hearing Association. (1991). Prevention of Communication Disorders [Relevant Paper]. Available from www.asha.org/policy Spring into Science A program for middle school children from Capital Region Catholic schools Local colleges and medical facilities present workshops that focus on various healthrelated careers, including speech-language pathology and audiology The College of Saint Rose offers workshops on the prevention of hearing loss and voice problems Saint Rose students in the seminar plan and deliver all aspects of the 2 workshops Spring into Science Spring into Science Healthy Hearing The human ear is delicate structure that allows us to hear things around us. Unfortunately, our ears are constantly bombarded by noise that can harm your hearing. In this session work with graduate students from The College of Saint Rose to look inside the ear, test someone’s hearing, and learn how to protect your ears from damage. Care of Feeding of the Voice Our voice comes from a tiny pair of very strong vocal cords that vibrate about 270 times each second. Come and join College of Saint Rose graduate students to view the vocal cords in action and see what happens when the voice is misused or overused. Join in a test for voice problems and learn what you can do to take care of your voice. Screening Opportunities Speech and hearing screenings for students in our introductory course Voice screenings for students in teacher education and special education Area preschool and kindergarten speech, language, and hearing screenings Legislative hearing screening for May is Better Hearing and Speech Month NYSSLHA’s Legislative Hearing Screening Program The New York State Assembly presents a proclamation for Better Hearing and Speech Month Students meet Senator Hannon, the New York State Senate Health Committee Chair Student Presentations Your presentation will be 30 minutes in length, followed by a 15 minute question and answer period (Q & A). Please include: Brief introduction to your topic, including the organization A brief description of the relationship of your topic to primary, secondary, and/or tertiary prevention The main content of your presentation, which should focus on 5-7 related ideas or topics. You could use this time to discuss articles, information from your manual, or important details on the web At the end, take a couple of minutes to summarize your talk For the Q & A, begin by opening things up for questions. Then insert some of your own questions for the audience Prepare a handout with an outline of your presentation (2 or so pages) and a list of references. For references, include sections from your manual, articles, web sites, people resources, etc. Student Presentations: Topics Swallowing disorders Preventing aspiration after head and neck injury and/or surgery Preventing aspiration after nervous system impairment Disorders of speech sound production Preventing maladaptive articulation behaviors with cleft palate Preventing oro-facial cancer Fluency disorders Preventing the onset of stuttering in young children Reducing the impact of stuttering with adults Disorders of voice Preventing voice disorders with teachers and signers Preventing voice disorders in school-aged children Child language disorders Stimulating language in medically fragile children Preventing communication breakdown with children who have specific language impairment Student Presentations: Topics Adult language disorders Stroke prevention Family-centered intervention after aphasia Cognitive/communicative disorders Preventing brain injury Preventing communication breakdown after cognitive disorders Preventing hearing loss Universal hearing screening for infants Preventing noise induced hearing loss Preventing communication problems secondary to hearing loss Preventing speech and language disorders in children with hearing impairment Preventing communication disorders after acquired hearing loss Student Presentations: Grading I will grade this assignment using the following guide: The handout will account for 30% of the grade. The outline should be well organized, free of errors, and consistent with your talk. Your references should include a variety of resources. The 30-minute presentation will account for 50% of the grade. Your presentation should be well organized, well presented, and informative. It is expected that you will go beyond what is in the manual and mention the resources you used to put the talk together. The talk should be 27.5 to 32.5 minutes in length. I want you to consider this presentation like you would a convention presentation. The 15-minute Q & A session will account for 20% of the grade. This aspect of the assignment will be graded according to how well you respond to questions and the way in which you incorporate others into the session. If you have a chance to ask questions, they should be relevant and extend the discussion. The session should last between 13 and 17 minutes. A Class Activity: Planning a Prevention Program During the final class periods, 2 groups of students will plan prevention activities using the class materials in the Students’ Manual. The planning process will include the following steps: Form 2 groups of 8 students each Each group will select a target population Select and apply one of the models of prevention program design: a) Public Health Model, or b) Comprehensive Health Education Model Develop a written plan for the prevention program using resources in the Manual (See the questions in the beginning of this section) A Class Activity: Planning a Prevention Program At the end of the first class period, groups will report on their progress and the steps they will take to complete the project. During the second class period, groups will complete their work and present the program. The final report to the class will include the following: A description of the target population; the problem addressed by the program The program’s goals/objectives/outcomes The activities used to meet the goals/objectives or address the outcomes The procedures used to evaluate the program World Wide Web Sites www.asha.org – The American Speech-Language Hearing Association www.health.state.ny.us/nysdoh/eip/index.htm - NY’s EI Program. www.kidsource.com/ - Articles for parents. www.babyhearing.org/ - Information about hearing in babies. www.betterhearing.org/hearing_loss_prevention - This website also focuses on hearing loss, including how to prevent it. www.nidcd.nih.gov - The National Institutes of Deafness and Communication Disorders. www.cdc.gov/niosh/topics/noise/ - The National Institute for Occupational Safety and Health, a part of the Centers for Disease Control and Prevention. Also try www.cdc.gov/noish/noise. www.prevent-stuttering.com and www.speechcare.com/prevention.html Two website about stuttering prevention. www.ncvs.org – The National Center for Voice & Speech. www.blues101.org/articles/holistic.htm - A website for musicians. World Wide Web Sites www.biausa.org/Pages/home.html - The Brain Injury Association of America. www.strokeassociation.org - The American Stroke Association’s (ASA) website. This organization is part of the American Heart Association (www.americanheartassociation.org). www.stroke.org – The National Stroke Association (NSA). www.teenpregnancy.org – A website about preventing teen pregnancy. www.cdc.gov/nccdphp/aag/aag_oh.htm - From the Centers for Disease Control and Prevention. www.safetylit.com - A website about injury prevention. www.cpsc.gov – The U.S. Consumer Product Safety Commission. www.toysafety.net – A website devoted to information on toy safety. www.epa.gov/appcdwww/ - The Environmental Protection Agency. www.asmi.org – The American Sports Medicine Institute. www.andreasvoice.org/prevention.htm - A website about the prevention and treatment of eating disorders.