Auditory-Verbal Therapy: Supporting Listening and Spoken Language in Young Children with Hearing Loss & Their Families

Deep conversation

Photo by juhansonin

Approximately 95% of parents of children with hearing loss are hearing themselves (Mitchell & Karchmer, 2004), and trends indicate that many parents are choosing spoken language as the primary mode of communication for their children with hearing loss. In fact, some states such as North Carolina, are reporting that parents are choosing spoken language options for their children with hearing loss more than 85% of the time (Alberg, Wilson & Roush, 2006), especially when they know spoken language is a viable outcome for their child. And, these parents are typically selecting approaches that support listening and spoken language, such as Auditory-Verbal Therapy, without initiating visual communication systems.

With early identification and the use of advanced hearing technology, children with even the most severe or profound hearing losses can access audition and follow an intervention approach focused on achieving typical developmental milestones in listening, speech, language, cognition, and conversational competence. Parents’ communication choices are based on their long-term desired outcomes for their child. Once those decisions are made, professionals providing early intervention and habilitative services should support the parents’ choices and provide the necessary support and intervention to ensure, to the greatest extent possible, that the child achieves those outcomes.

Definition of Auditory-Verbal Therapy

The Alexander Graham Bell (AG Bell) Academy for Listening and Spoken Language, which is based in Washington, DC, governs the certification of Listening and Spoken Language Specialists (LSLS), the practitioners qualified to provide Auditory-Verbal Therapy. The Academy defines the practice of Auditory-Verbal Therapy as:

“Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices. Auditory-Verbal Therapy must be conducted in adherence to the Principles LSLS of Auditory-Verbal Therapy” (AG Bell Academy, 2012).

The Principles of Auditory-Verbal Therapy: Defining Practice

The Academy has endorsed a set of principles that delineate the practice of Auditory-Verbal Therapy:

  1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal Therapy;
  2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation;
  3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing spoken language;
  4. Guide and coach parents to become the primary facilitators of their child’s listening and spoken language development through active consistent participation in individualized Auditory-Verbal Therapy;
  5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities;
  6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child’s life;
  7. Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication;
  8. Guide and coach parents to help their child self-monitor spoken language through listening;
  9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress, and to evaluate the effectiveness of the plans for the child and family; and
  10. Promote education in regular school with peers who have typical hearing and with appropriate services from early childhood onwards.

The Listening and Spoken Language Specialist (LSLS):

Two Paths to Certification

The AG Bell Academy has designated two paths to certification for Auditory-Verbal practitioners: LSLS Certified Auditory-Verbal Therapist (LSLS Cert. AVT) and the LSLS Certified Auditory-Verbal Educator (LSLS Cert. AVEd). The LSLS certification is awarded to qualified professionals who have met rigorous academic, professional, post-graduate education and mentoring requirements, and have passed a certification exam. Typically, LSLS certified practitioners are licensed audiologists, speech-language pathologists, or educators of the deaf who have the required background, training and experience in listening and spoken language theory and practice with children with hearing loss and their families. For additional information about certification as a Listening and Spoken Language Specialist (LSLS), speech-language pathologists and audiologists should contact the AG Bell Academy at academy@agbell.org, visit the website ate www.agbellacademy.org, or call (202) 204-4700.

References

Alberg, J., Wilson, K., & Roush, J. (2006). Statewide collaboration in the delivery of EHDI services. The Volta Review, 106, 3, 259-274.

AG Bell Academy for Listening and Spoken Language (2012). 2012 certification handbook. Available at www.agbellacademy.org

Mitchell, R.E. & Karchmer, M.A. (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign Language Studies, 4, 2, 138-163.

 

Dr. K. Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT, is an Associate Professor in the School of Speech-Language Pathology and Audiology at The University of Akron. His primary areas of research include spoken language acquisition in children with hearing loss, strategies for enhancing parent engagement in the intervention process, Auditory-Verbal Therapy, and telepractice. He directs the Telepractice and eLearning Laboratory (TeLL), an initiative to evaluate clinical practices in the area of distance service delivery in Speech-Language Pathology.

 

Knitting Multiple Modalities

Knitted owl hat

Photo by Burstyriffic

Before becoming a mom I taught K-12 classes, starting in second language classrooms. It felt like I was at home because I grew up as a simultaneous bilingual — a person who was presented with two languages from birth in an immigrant household. My parents met in an ESL classroom in the Mission district of San Francisco, so I grew up learning in ways that helped all of us which meant using all modalities — visual, tactile, auditory, kinesthetic. Hearing wasn’t enough — it’s so subjective. Are you saying ‘b’ de burro or ‘v’ de vaca? This image helps one to establish in the mind that very fast sounds are distinguished by so little when coarticulation is involved. It also seems so fast when learning a second language, so physically moving or tapping out the sounds really helps. And of course, there must be a reason why so much of the motor strip targets the hands — I feel therefore I learn. In my own studying, it is not enough for me to just hear. If I can touch it, feel it, sign it — I feel like I own it like the way a toddler mouths a book or a toy.

Using multiple modalities also made me think of a fairly recent experience. Two summers ago I wanted to knit a playmat for my kids, so I took a beginning knitting class co-taught by two women in my area. One woman relied on auditory teaching skills — I was so lost. Knit one pearl two — what!?! She went regular speed, thinking that’s what she needed to model so that we could learn to knit correctly. There were a group of us (20 total in the class) who were just not getting it. She kept coming to our group to retell us what she had already told the larger group. Repeating didn’t help. Still lost. She showed us again at her regular speed. Stressed. So contrary to what knitting addicts profess. “Way over-rated,” I thought of knitting, as my shoulders elevated toward my ears from the stress.

Then the other teacher came to us and gently placed her hands on ours to physically guide us in the pattern. She also made the pattern slower, much more exaggerated and larger in movement than the other teacher. BINGO!!!! Our eyes and minds that had previously felt as if they were on a fast spinning merry-go-round that didn’t give us a chance to hop on finally were able to catch up and get on. We got it! And not only did this small group of auditory strugglers get it, we outlasted the larger group and stayed with the project while many others dropped out. Ahhh…knitting wasn’t over-rated after all, but much more like a catnip invoked endeavor…

This experience reinforced something I intuitively knew from growing up in a household of second language learners, from teaching second language learners, and teaching my son who has special needs including severe dysarthria, severe CAS and ASD: all modalities help. I saw this espoused at ASHA’s 2011 conference in sessions regarding ASD. Also, it’s not just the modality but the speed and the size of the movement of these modalities which also help to get those neural networks firing and wiring for a meaningful experience.

So when I think of multiple modalities for our client population — I can’t help but think knitting….

 

Liz Guerrini has been a K-12 and college teacher for the past 18 years and is entering her final graduate year in Communicative Disorders at CSUN. She’s an Olympian who finds many applications of her sport world to the teaching and therapy worlds. She home-schools her bright and beautiful son who lives with trisomy 2, severe dysarthria, severe CAS, hearing loss, ASD and hypotonia. She is a member of ASHA’s Minority Student Leadership Program. Liz blogs at  Christopher Days, SLP to-Be and the Signing Time Academy.

Using Your iPad in Dysphagia Therapy

iPad fascination

Photo by rahego

So many people are using iPads, iPhones and iPods in therapy. While there are many other devices out there, I’m focusing on the “iDevices” because those are the devices that I know the best. It is very easy to find apps for pediatric speech therapy, even apps for adult language therapy. There are apps for language, articulation, AAC, voice, fluency, and a few for dysphagia, but not many. It seems that few therapists are using their devices for dysphagia therapy. In lieu of the small number of apps available for those of us specializing in dysphagia therapy, we can very effectively use our iDevices for treatment.

One feature that comes with any of the iDevices is the notepad. This looks like the yellow legal pads that I’m sure we’ve all used. You can use the keyboard or dock your device to a keyboard to type notes. Once these notes are done you can then choose the option to print or you can email it to yourself to print. You can also use Evernote (which is free) to create documents and access everything from any of your smart devices or from the computer.

I use Dropbox quite often. Dropbox is a cloud storage app. I have it installed on my computer, iPad, iPod and Android phone. I save files from my computer including journal articles, forms, documents, etc and can access them through any of my mobile devices or can access them via the internet on any computer. In addition to Dropbox (which is free for 2 gb), I use Carbonite. Carbonite is a yearly subscription (around $60 a year) that is a backup system for your computer, it backs up all of your documents, plus you can log onto your account from any computer via the internet to access all of your backed-up items and there is an iOs and Android app to access your files from your mobile device.

Dysphagia2Go is the new Dysphagia evaluation app that lets you use your iPad during your Clinical Dysphagia Evaluation to write a report with all of your findings. If you already have a computerized version of your report, you can email the results to yourself and copy and paste your findings. This app is available through SmartyEars and will have some exciting new updates soon!

iSwallow is available for Apple devices. iSwallow is a free app that allows you to show videos of each exercise for your patient and allows your patient to track their exercises and lets the therapist see how many times each exercise was completed at home. This hasn’t been a very functional app for me; fortunately it was free. You have to email the company to get a password to unlock the app and I tried many times, unsuccessfully, to get the password from them. Fortunately, I ended up finding another therapist that had the password to get it. Also, it would be helpful if you had patients that owned iDevices so that they could utilize it. At this time, I’m not willing to loan out my devices to allow patients to track. Most of my patients are 70 or older and don’t own iDevices.

Lingraphica offers 2 apps for dysphagia. One is a communication aid for the iPhone/iPod Touch that can also be used on the iPad. It allows a patient with dysphagia to communicate regarding their dysphagia, for example, “I need my dentures” or “I need to be sitting up to eat”. This would be helpful if you have an aphasic patient with dysphagia that would be able and/or willing to communicate these items with others. Lingraphica also has an oral motor app which has videos of each exercise being completed.

There are also several apps which show the structures, from a scope view. You can use iLarynx, LUMA ENT and URVL to look at the structures, or to use for patient education. They are also fun to play and see if you can “insert” the scope appropriately.

Lab Tests is a relatively inexpensive app, I think it’s $1.99 that describes the lab values and has normative data for lab values. This is nice if you work in an acute care hospital, where they typically draw daily labs to interpret what the lab values indicate.

Pill Identifier lets you search medications by shape, color or score. Telling you what the pill is, what the indications are, how it is available OTC or prescription. You can view images of the pill or look at information of each pill via Drugs.com.

3D Brain is a wonderful view of the brain to educate patients on lesions and where their lesions are located. It’s also a fun app to play with giving you views of the brain and descriptions of the areas of the brain.

I’m sure this is not a comprehensive list of the apps however, hopefully it’s a start to help you utilize your iDevice in your dysphagia therapy. Also, keep watching SmartyEars for possible new dysphagia apps.

 

Tiffani Wallace, MA, CCC-SLP, currently works in an acute care hospital in Indiana.  Tiffani is working to specialize in dysphagia and is working to achieve the BRS-S.  She is also a member of the Smarty Ears Advisory Board and co-author of Dysphagia2Go, and has a website about dysphagia, Disphagia Ramblings.

Eliciting the /r/ Sound- Taking the Pain Out of Therapy!

R Graffiti

Photo by CarbonNYC

The /r/ sound is one of the most difficult to teach in therapy. Several of my children struggle to produce the /r/ sound appropriately. Because of this, I wanted to see what other speech-language pathologists were doing during their treatment. I found out some new and interesting techniques that I am definitely going to try with my clients!

  • Auditory Bombardment– One technique, called auditory bombardment, involves the child listening to a repetitive and intense list of words including the targeted sound (in this case, the /r/). This evidence based procedure is supposed to assist children in their rate of sound development.
  • Imitation– This technique may seem obvious (“I keep modeling a good /r/ but they just aren’t appropriately imitating). Another option would be to have the child imitate certain animal sounds that are fun to make and may ease the child’s pressure of trying to model the sound appropriately. Some good animals to imitate are tigers (roarrrrrr), dogs (ruff, ruff), or birds (chirp, chirp).
  • Incorporate mirrors– Although the /r/ sound is hard to see with a mirror, I always like to incorporate them into my therapy sessions to increase awareness of mouth, tongue and lip movements.
  • Jaw movement– I often ask my clients to produce the /L/ sound. While they are doing this, I then model how to gently pull their jaws down until the /r/ sound is eventually reached.

There are plenty of other techniques to produce the /r/ sound, but these are the three that I find the most useful. Have any other techniques you want to share?

(This post originally appeared on Speechbop)

 

Erica Gosling, MA CCC-SLP is a full time SLP working in both Stamford, CT and New York City. She received her M.A. from New York University. She has worked in a variety of settings including schools, private practices and home based therapy. She has experience with a variety of communication disorders. For more information about Erica and speech therapy, please visit her blog at Speechbop.com.

The Best Speech-Language Pathologist Blogs from ‘A to Z’

Editor’s Note: In her daily work at PediaStaff, Heidi is Editor in Chief of the popular PediaStaff Blog for pediatric and school based therapist, and also created the PediaStaff’s Pinterest Site  for therapists and parents of special needs children.  The company’s continuing work to educate, share resources with, and support the special needs community has been featured on Parents.com, and Love That Max, (an award-winning special needs blog).   In addition, PediaStaff has been recently profiled by the well-regarded social media blog, The Realtime Report, for their innovative work on the Pinterest social media site.

 

Author’s Note:   I would like to thank the following speech-language bloggers for contributing to this article:  Activity Tailor, All 4 My Child, Future SLPs, Play on Words, Speech Lady Liz, and Speech Room News.

 

The number of Speech-Language Pathologists blogging and engaging in social media grew steadily in 2011. Those of us who are active on Twitter (we call ourselves the #SLPeeps), have been sharing articles and resources on blogs, Twitter, Facebook and LinkedIn. Recently though, the new social media kid on the block, Pinterest, has made it easier than ever for SLPs to engage each other and share ideas. And with all the sharing going on, it has given bloggers a new place to network their ideas and find inspiration for new ones. While I am not sure exactly if there is causality, it seems that Pinterest is inspiring SLPs to jump into the blogging world. We have counted at least nine brand new SLP bloggers since the first of the year and all of them are also on Pinterest.

I was recently speaking with Maggie McGary, ASHA’s Social Media guru, and we started talking about how great it would be to survey Speech-Language bloggers and compile a short-list of ‘must follow blogs’ for both SLPs and their clients.   Sean Sweeney has compiled a great list of blogs in the SLP Blog Bundle, but he doesn’t have a list of exactly who is in there, nor does he describe them anywhere one by one. So, since we have relationships with a great many of the regular speech and language bloggers already through our blog at PediaStaff, I mistakenly thought that I was well-suited for the job of compiling a ‘Best Blogs’ list. I emailed our contributors with a straw poll of sorts to get their votes for the best speech and language blogs in each of several areas. I waited patiently for results, and planned how I would deliver the findings to you in this column.

The results? Well…. The moral of this story is that there isn’t a short list! There are now a dizzying number of blogs to follow and most of them are definitely worth reading. What’s more, our respondents found it impossible to rank as “better” or “best” because they all have their own flavors and angles.

After the ‘best laid plans,’ fell through, what emerged was a list of the active blogs that were submitted as favorites, ordered from A to Z , plus some that are brand new that deserve notice.   In order to make this list, the blogs needed to meet the following criteria:

  • written by a speech-language pathologist or current graduate student
  • currently active
  • writes about (or shares resources on) speech language topics at least once a week (preferably more)
  • directed to either clinicians, parents and caregivers
  • has good ongoing continuity without multiple periods of inactivity in the past
  • professional and well edited for spelling, grammar, etc
  • shares more general resources and news than it does information on their own products or services

It is important to note that note that neither PediaStaff nor any of the contributors to this list specifically endorse any of these bloggers, nor make any claims to the clinical competence of the authors. In fact, a few of these bloggers keep their full names to themselves to protect their privacy, so we have no way of verifying if they are who they say they are. Please make your own informed decision as to the effectiveness/appropriateness of what these clinicians are sharing.   I know this is by all means not a conclusive list (especially since new great new blogs seem to be popping up like daisies!) but as of  March 2012, the following are the speech and language blogs that PediaStaff and our colleagues recommend that also meet the above criteria:

Activity Tailor – Kim Lewis, M.Ed, is a private practitioner working in school settings.  Her lovely blog includes easy, creative treatment activities and private practice tips. I especially like her clever seasonal ideas and occasional commentary pieces.

All 4 My Child – This Edublog finalist for best new blog offers book reviews, searchable by goal or theme with activities for use to meet therapeutic goals. This site also shares uniquely collaborative therapy ideas, experiences and musings related to social interaction written by co-treating SLPs and OTs.

ASHASphere – You are reading it now.   Definitely a “greatest hits” blog with tremendous articles for speech and language clinicians daily!

Becoming Olivia SLP – Olivia is a graduate student in Canada chronicling her experiences as an SLP student in video log (vlog) format. She is full of energy and creating quite a bit of chatter for herself amongst the ‘SLPeeps.’

Chapel Hill Snippets  – Ruth Morgan is a school-based clinician who highlights her “assorted observations both in work and play.” Her blog is insightful and well-written. Ruth’s free therapy shares (often downloadable books) are especially popular and well done.

Child Talk – Becca Jarzynski, who specializes in autism, writes a wonderful speech and language therapy blog for parents/caregivers that should not be missed. Her articles offer concrete ideas for parents to help their child communicate during “everyday life.”

Cindy L. Meester’s Blog – An oldie but a goodie, Cindy Meester’s blog has been extremely popular with SLPs since before blogging (and reading blogs) was trendy. While she blogs about all sorts of topics, she was recognized by the Edublog Awards as a finalist in the Ed Tech category.

Early Intervention Speech Therapy – Stephanie Bruno Dowling has a well-known blog on Advance for SLPs and Audiologists. It is unique among the blogs on this list in that it is only one of a few that specialize in Early Intervention.

Eric Sailers’ Blog – Eric is a former school-based clinician who blogs about technical applications for SLPs. He is also the creator of several apps including ArticPix.

Erik X. Raj, Speech Language Pathologist – Erik is a creative SLP, best known for former blog ‘ArticBrain’ which shared how to really engage kids in speech with humor and talk of ‘boogers’ and bugs! He is also blogging on Pocket SLP.   His current blog is a video blog.

Hanna B. gradstudentSLP – is a brand new blogger who has come onto the SLP blogging scene just in the past eight weeks. So far, she has made some very nice (and quite frequent) posts on a variety of school-based topics.

In Spontaneous Speech – This blog was recommended to us recently by several bloggers that speak highly of Cindy. We have started following her and suggest that you check her out as well.

If I Only Had Super Powers  – This blog is another “oldie but goodie” that has been around since long before blogging was popular. Although we have not gotten to know this blogger personally, she is on our ‘must read list.’

Jill Kuzma’s SLP Social & Emotional Skill Sharing Site – Jill works with students with Asperger’ Syndrome and other high functioning students with social and emotional needs. This blogger is well-respected among her peers in the industry and her blog has much to offer.

Let’s Talk Speech-Language Pathology – Brand new in February of 2012, this is a student blog with some nice potential. We are looking forward to reading her thoughts and ideas.

Little Stories – Kim Rowe’s parent oriented blog is new to us, but was recommended to be in this list by our colleagues at All4MyChild. Based on what we have read so far, it seems to have some great resources and insights for caregivers of young children with speech and language delay.

LiveSpeakLove – Another brand new school-based SLP blogger, Lisa at LiveSpeakLove, is an SLP in the Baltimore County Public Schools. She has creative activities and offers up a bunch of great Boardmaker shares, often with a seasonal bent.

The PediaStaff Blog  – I feel a bit awkward including our own blog in this list, but the contributors to this article insisted that I mention it. With posts up to five times a day, the PediaStaff blog aggregates and presents a collection of the clinical articles, treatment ideas, and news. Our staff combs over 100 therapy blogs, websites, and news wire feeds daily,  to ensure that PediaStaff readers receive the best information available as it is happens and is written.

Play on Words – This unique, ‘must-read’ blog focuses on toys, games and books that facilitate language development. Sherry Artemenko writes excellent book and product reviews, and also offers up specific ways parents can sneak speech language therapy practice into family fun time at home.

Playing with Words 365 – We discovered this blog through Pinterest. SLP blogger Katie is also certified in ABA. She has a well developed blog that, although written for parents and caregivers, is quite popular among her peers in the profession.

Say What Y’all – Here is yet another brand new school-based SLP blog with great promise. Clean and fresh, Haley Villines’ blog has a modern and creative feel that is echoed by her excellent articles, so far.

Speech Gadget – ‘Deb T., SLP’s’ blog features a variety of articles on books to use in speech language therapy, tools, websites, apps and other online resources. On hiatus for a bit, she seems to be back in action with regular (and excellent) posts and tips.

The Speech Guy – Quite active in the #SLPeeps community on Twitter and Facebook, Jeremy Legaspi, SLP, writes primarily about technology. His articles on worthwhile apps, interactive websites, and technology are definitely worth reading.

The Speech Ladies – This mother and daughter team has an excellent school-based blog full of colorful posts, creative ideas and free downloads. Highly recommended!

Speech Lady Liz – Liz Gretz is a second generation SLP with a great deal of energy and creativity. Her blog is oriented to parents and professionals alike and features tons of colorful, culturally relevant activities that the kiddos can get excited about. She is also very active on Pinterest.

Speech Room News – Young and full of energy, school-based SLP Jenna Rayburn posts fresh, fun activities to promote speech and language goals. New last year, the site was awarded First Runner-Up among in the Edublog 2011 awards in the ‘Best New Blog Category.’ PediaStaff is proud to have made the initial nomination of Speech Room News for this award.

Speech Techie – Sean Sweeney is no stranger to technically savvy (and wanna-be technically savvy) SLPs. He is a regular presenter at both ASHA and Boston University on using technology for Speech and Language therapy. This blog is a must read and is a past EduBlog first place winner in the ‘New Blog’ cateogory.

Speech Time Fun – “Miss Speechie” is also a brand-new and already prolific young blogger. Her posts are full of colorful, creative and fun ideas for the classroom.  She is active on Pinterest and often modifies ideas she finds there through a speech/language lens.

Sublime Speech – The explosion of creative new speech blogs continues with Sublime Speech. Lots of ‘Do It Yourself’ activities with free downloadable versions of her creative and ‘hip’ creations! Another one to watch!

Talk It Up Speech Therapy – Ashley Dyer McGeehon’s ‘Talk it Up’ is another brand new one to watch online. A school-based SLP, her ideas are current, interesting, and engaging.

Therapy App411 – This new group blog, also an Edublog nominee, is a collaborative effort of several of our favorite therapy bloggers. The aim is to review smartphone and tablet apps through a therapy lens. Is a must follow for SLPs interested in using smartphones, tablets and technology in the clinic and classroom.

There are several other blogs that I would like to offer honorable mention to that didn’t meet all our criteria.  For the most part they are just not posting often enough  (how dare those student bloggers pay more attention to their classwork than their blog!) or have taken too many extended breaks from blogging.   Please be sure to check out:  2 Gals Talk About Speech Therapy, Cree-zy, Crazy Speechie, Easy Speech and Language Ideas, Future SLPs, Geek SLP, Heather’s Speech Therapy, Landria Seals’ Blog, The Learning Curve, Lexical Linguist, Mommy Speech Therapy, Pathologically Speaking, and The Speech House

 

Heidi Kay is one of the founding partners of PediaStaff and is the editor-in-chief of the PediaStaff Blog, which delivers the latest news, articles, research updates, therapy ideas, and resources from the world of pediatric and school-based therapy. PediaStaff is a nationwide, niche oriented company focused on the placement and staffing of pediatric therapists including speech-language pathologists.