Helping Clients With Aphasia Retrieve Words—On Their Own

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“I can’t hear it!” This was said by Mrs. A, a 67-year-old woman with aphasia, who actually hears fine. What she meant to say is that she can’t recall the sequence of sounds to express a particular word or idea. When we have that tip-of-the-tongue loss of a name, how do we try to remember it? What strategies are we using to get to that word that we can’t remember?

Our success depends on our ability to hunt and gather—and on the number of neural connections we can tap into to access the information. These skills are cognitive, not simply learned operantly.

In my last blog post, I talked about establishing cueing hierarchies and functional activities for our adult clients. This post looks at using the cueing hierarchy to stimulate the rewiring process. Sometimes I think that I am a sort of electrician rather than an SLP. I work on finding the connections based on observed behavior from evaluations or activities (like writing, gesturing or drawing) that require least intervention.

How do we develop these skills? How can we teach strategies for short and long-term functional success?

Sometimes, we spend the therapy session working on the most disabled aspects of the communication disorder: comprehension, word retrieval, writing and reading. But if we don’t tap clients’ best abilities to foster some success, and if we don’t address whether they are continuing to practice these skills outside the therapy room, how will compensatory skills, adaptive skills and new connections work for them?

Let’s look at Mrs. A, who said, “I can’t hear it.” She was telling me about the very connection that she lacks due to her aphasia: re-auditorization. She can’t hear the words or the phonemes that make up the words in what I call “her mind’s ear.” If given the first phoneme, or a carrier phrase, she almost always names the word. She is able to write the word about 75 percent of the time but can only read it aloud about 30 percent of the time. She will often be able to speak complex multisyllabic words or a short phrase when discussing a topic. Auditory and reading comprehension is 75 percent for paragraphs. She is very intact cognitively, but her affect varies emotionally from congenially engaged to depressed and angry.

She is about two years post-stroke and has an all-in-one AAC that she doesn’t use. Our goals must address her frustration by establishing immediate successful compensatory strategies for communication. Then we need to build skills that will help in the rewiring, so that she begins to cue herself. The rewiring will be difficult here because she doesn’t link the phoneme to the letters she is able to write. But if she can write the word and then read it aloud more often, she can develop a clear strategy for verbalization that will reduce her frustration.

We will begin by simply reviewing phonetic placement in monosyllabic words. I like to use real words—which have semantic value—rather than nonsense syllables. Consonant-vowels alone don’t work as well as consonant-vowel-consonants that mean something. Mrs. A started relearning that a /b/ means that the lips come together when starting a whole word like “beer.” We chose beer for the visceral, emotional connection it has for many people. We talked about when she might drink beer, such as at a baseball game, which lends itself to picture assistance to boost cognitive links. We initially used a mirror to model the placement while sitting next to her. We highlighted the first letter and said it with her. She saw the picture, then wrote the word.

Mrs. A can now produce the whole word “beer” after seeing a picture of it. Looking at the Cueing Hierarchy, we have moved from most clinician involvement to independent self-cueing for this phoneme. She is moving on to more phonemes rapidly so that we may not need to review every letter after a period of time. Mrs. A. is beginning to generalize the link to other sounds. New neuro-behavioral links and relinks are helping her associate the orthographic letter with a physical movement and the sound that is produced. New cognitive links and self-cueing has begun!

Next, she will need to use the strategy in controlled conversation and small groups to increase her comfort level and functional use outside of treatment. This is a big hurdle. Families and caregivers are crucial players and need to be instructed how to encourage communication without frustration. When possible, teach the caregivers and families how the strategy works. They will use it more readily at home and will see how it can work in a variety of situations, such as in restaurants.

Another client, Mrs. C, had a similar functional ability to write but not verbalize. With time, she was able to trace the first letter in the air to cue herself to say a word.

In both cases, skills that had been present were improved, then used to create a compensatory strategy for functional communication. We must teach our clients strategies for improving the scope of their communication without our cues, using their own strategies, thereby making them more independently functional. While available strategies are unique to each client, they usually take the form of low tech gesturing, drawing, writing, even circumlocution.

We want our clients to be learning and improving communication dynamically. If we always fill in all of the sentences or speak for them, they cannot make their own connections. When allowed to use strategies independently, they then blossom, not only communicatively but socially.

Betsy C. Schreiber, MMS, CCC-SLP, is a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders, and 18, Telepractice.

My Baby Can Play: How Productive Play Promotes Literacy

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My Baby Can Read…Play: How Productive Play Promotes Literacy

If you pay attention to the current toys, television shows, and materials for children like Your Baby Can Read! you should notice a cultural shift to the promotion of literacy, especially early literacy skills.  From older shows such as Sesame Street and Between the Lions to newer shows such as WordGirl, WordWorld, and Super Why! we see the push for phonological awareness skills and reading skills, which encompass rhyming, letter/sound naming and identification, sound segmenting and blending, and so on.

The available research clearly shows the importance of promoting literacy skills early, and the overall consensus is that oral language provides the building blocks for literacy.  So if oral language is the foundation, and if we achieve language through quality language input, how is that input provided for infants and toddlers?  Through play!

Besides daily care-taking routines that parents and children engage in (feeding, grooming, sleeping), the next most important activity they engage in (where crucial language input is provided) is play.

So, if appropriate play skills predict appropriate language skills, and if strong language skills predict literacy skills, then I see a clear link between play and reading.

I’m not suggesting reading to infants and toddlers is not valid and necessary; I am suggesting that perhaps there should be a greater, or at least equal, push for promoting quality play.  My meaning of play, however, is where the play partner of the child is engaging the child and providing quality language input naturally but purposefully.

In a nutshell, let’s not bypass the building block of play because we’re so concerned that children be able to read.

As a personal example, both of my toddlers love books.  From the time my four-year-old daughter was one, she would quietly sit on the floor going through baskets I had set around the house full of little books, and she would flip through the pages “reading” one book after another.  I often find my two-year-old son sitting in a rocking chair in his room surrounded by books “reading.”  He spontaneously points out characters and talks about the pictures.  His big sister also helps him out, making up stories for him based on the pictures as though she is reading…and he believes every word!

As parents, my husband and I have read to them consistently, have made sure books are readily available and accessible to them, and have encouraged them to talk about the pictures and relate what they’re seeing to experiences they’ve had, but I firmly believe their enjoyment of books would not have been fostered without purposeful play in our home.

Purposeful play is crucial in order to develop what I call the 4 C’s: Concentration (attention), Curiosity, Creativity (imagination), and family Connection (through a shared activity).  These four components are extremely important for promoting reading ability.

So as professionals, educators, and parents, let’s evaluate where we’re investing our time and resources and make sure the push for early literacy doesn’t overshadow or do away with the need for consistent and quality play, not through the latest electronics or gadgets, but using good ol’ blocks, dolls, cars, toy farms, puzzles, toy kitchens, playdough…and the list goes on and on.

For purposeful play suggestions, check out free tip sheets (known as P.O.P. sheets) entitled Purposeful Ongoing Play: Enhancing Language Skills Through Play.

(This post originally appeared on The Speech Stop)

Ana Paula G. Mumy, MS, CCC-SLP, is a multilingual speech-language pathologist and the author of various continuing education courses, leveled storybooks, and instructional therapy materials for speech/language intervention.  She has provided school-based services, home health care, and private services for more than 12 years and thoroughly enjoys providing resources for SLPs, educators, and parents on her website The Speech Stop.

Speech Therapy and Aging: Brain Plasticity and Cueing Hierarchies

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Given our knowledge of the plasticity of the brain, are we as clinicians or caregivers, able to help to develop new links with a behavioral model, by using gradated cueing hierarchies?  Could this low-tech and pharmaceutical-free form of treatment  have neurologically based implications for rehabilitation and adaptation in communicatively challenging settings?

Perhaps more testing with fMRI scans may be necessary to really prove the theory. Therapy approaches using cueing models have been well documented in the literature in speech therapy treatment for aphasia.  However, the way we use clinician originated cues can help create new links and expedite a broad area of cognitive and linguistic improvement, or maintain the functional status quo, unless we analyze the kinds of cues we are using and the amount of independence we are carefully eliciting from the client.

By looking at each task and cue needed on a continuum from simple to complex, concrete to abstract, you can construct a grid of where on the continuum the client functions and how you can provide a cue or help them provide their own cues for success.

The idea that the damaged axons and dendrites in the brain are looking for connections and stay active when the brain is activated, prompted me to want to create a cueing continuum (see http://carmichaellab.neurology.ucla.edu/integrated-view-neural-repair-after-stroke.) On the theory that the client can develop new pathways , if we always fill in the missing word or provide the first phoneme, then the client will never have to learn where to get it, via their own written word, for example.  But how do we get from writing the word for the client to having the client write the word in the air and say it? It all depends on the residual abilities, but the concept can be applied to everyone.

We have a 60 year old gentleman with TBI who is learning how to semantically cue himself to find a word. Initially, he had severe speech and cognitive impairments. Now, in conversation, he often uses circumlocution to get his point across. However, sometimes specific words are warranted, and this is difficult for him. He can sometimes spell the word aloud even though he cannot speak it. We had him do this several times with great success. Our next task was to remind him that he could do this to help himself.  Later we only asked him what he would like to do.  We are helping him build those dendritic links ( and learn to use a skill) by carefully reducing the amount of clinician prompting or cueing during the sessions and writing down the strategies for him to practice at home. Although there are many approaches to cueing, none of them seem to describe cueing in a continuum from most invasive to most independent. Many clinicians describe the cues as semantic or phonemic.  I found that there were nuances in cueing that I had learned over the years to allow the client to gradually become independent. When I had difficulty transmitting these ideas to my students, I created a loose continuum to mark where our clients fell given specific objectives, and how we could get their neurons to get closer together behaviorally if not actually by breaking the cues down.

Along with the goals we establish for our clients, no matter their abilities, we must always be evaluating their behavior and trying new materials and varied activities to facilitate language.

As we converse with others, we derive cues from the environment and from the people with whom we are speaking (that is part of the reason why conversation amongst the adult neurologically language-impaired looks better than when we test them by looking for specific words and longer utterances).

Our goal with cueing is to develop self-cues and elicit more language. A self-cue can be as basic as a gesture or a drawing, but if the client is doing it and communicating to me what he did for the weekend, then he has been successful. Often when the stress is lower or the focus is away from speaking, the words and incidental phrases flow more freely. The best reward is to see the expression on our client’s face when he says a few words effortlessly because he was engaged in the activity. But this is not we what we are trying to do. We are trying to give him real tools for those times he cannot utter a word.

When the client leaves the therapy room, we want him or her to be able to use their own skills, rather than rely on others. Since they may not be able to develop their own means of self-cueing, we include self-cue skill development as part of the therapy plan.  The client may or may not have the ability to provide his or her own cues, yet. But throughout the therapy and rehabilitation process, we work toward the skills of self-cuing no matter the level, such as writing, gesturing, drawing pictures, and talking about the item or activity with words that are available.

The Cueing Hierarchy Continuum is by no means linear, but will generally go from simple and most dependent to complex and independent. They follow the behavioral branches that may be used in clinic therapy logs. They are separated on my behavior grid in 3 categories: Clinician Assisted Cues, Clinician prompting (or reminding the client to use a strategy) and Self Correcting. This approach requires that the client learn about his strengths and how to implement them to improve what we would consider weaknesses. By identifying which cues are more dependent, we can be cognizant of allowing the client to work at a documented realistic level achieve the objective.

It is well documented that there is enough plasticity in almost any brain to stimulate, heal and renew brain function after a stroke or TBI. For cognitive loss during normal aging, the dementias and the progressive dementias, there is less clear documentation for which approaches are the most effective and pragmatic for our clients. However, similar principles can be used to establish functional objectives along with the family and caregivers.

How to develop skills? How to develop strategies for short and long-term functional success?  Sometimes, we spend the therapy session working on comprehension, word finding, writing and reading using a variety of materials.  But, if we don’t address what they are learning outside the therapy room, which they may visit one or two times a week, how will compensatory skills, adaptive skills and  new connections be utilized?   That will be the topic for next month’s post.

Betsy C. Schreiber, MMS, CCC-SLP, received a BA in Psychology and MMS Master of Medical Science in Speech Pathology from Emory University in Atlanta, Georgia. Her CCC was earned during the 3 years she worked at Hitchcock Rehabilitation Center in Aiken, South Carolina where she had the opportunity to learn about NDT and Sensory Integration with the original, Jane Ayres, working with LD and CP children and neurologically impaired adults. She is currently a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She has also served as an ASHA Mentor and hopes to participate in ASHA’s  Political Action Committee in the coming year. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders, and 18, Telepractice.

Crafty Apps for Language-Based Therapy

It is no secret; I have never been a crafty person. During my days in graduate school I struggled a lot with the fact that many of my peers were able to spend hours creating these amazing therapy activities with glue and various types of paper. Yes, I did question my ability to become a speech therapist when I saw one of my colleagues bring the cupcakes she had baked at home along with all these amazing cupcakes decorations for the session. I clearly was not capable of such a thing!  Oh, and of course there are the scrap-booking SLPs! Clearly, I had no idea that SLPs had to dedicate hours preparing meals, buying scrap-booking materials and other tools for various “crafty therapy sessions”. In graduate school, I appealed to my technophile side to create my sessions around my computer. I know what you are thinking…  “What about the iPad?”. I didn’t even own an iPhone while in graduate school (and the iPad was still years from being invented). Today’s post is dedicated to all my fellow speech therapists and teachers who lack “craftiness” and want to be crafty on the iPad! Blessed be the iPad!

Here are some of my favorite apps for fun, creative, and open language based therapy sessions:

1. Art Maker by ABC’s Play School ( $0.99) – Prepositions, vocabulary and more.

This application allows you to create scenes by selecting from various background options and pieces of craft that go with the theme.  You can also pick from your own photos and add various pieces of provided objects and crafting materials to your photo (see how non-crafty I am based on the photo below). The images are added to your photos. For those of you feeling a little adventurous you can even make a movie as you move the items around the screen. You can use this app for promoting language skills and vocabulary. Prepositions (put the star on her shirt, put the tree next to the dog, etc.) is also a great target to use this app for.

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2. Martha Stewart Craft Studio ($4.99) – Story re-telling and sequencing in one place.

This app is worth every penny I spent on it, I just wish I had it 6 years ago! The Martha Stewart app is very easy to use and offers so many possibilities. It allowed a non-crafty person like me to create a scrapbook page! The app comes loaded with possibilities. You can take photos of the students during the session or send a letter to the parents to send some family photos with the kids for the upcoming session. It is an amazing way for working on retelling a story and it is perfect for those sessions with adults! After you create each page you can print and send it home with the child. This is by far a much more cost efficient way to do a crafting session.

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3. ScrapPad- Scrapbook for iPad ( Free + buy in app) – Vocabulary &  following directions at no cost.

This app is very similar to the Martha Stewart application. It has several background, stickers, borders and embellishments you can add to each page you create. Using this app can be great for vocabulary as well as for following directions. Just like the previous app, you can also save the final work onto your photos and print them when you are done.

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4. Hello Cupcakes (Free + buy in app) – Great app for following directions with amazing visual support.

This fourth app is truly a helping hand for those who want to do a real life cupcake but are not as talented as most of my former co-workers. The app comes with a baking tray which gives you information on which materials you will need to create the cupcakes. This app is just phenomenal; it includes step by step photos you can use for creating each cupcake. The cupcakes can be quite elaborate but this app has so many amazing visuals and it will guide you and your students to create quite the cupcake project. This is the perfect app to guide students, especially students who can benefit from visual support, for working on following directions. The app has amazing visual details. The buy in app options offer a variety of themed cupcake options too.

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It turns out that not only I can be crafty, but I love being crafty on the iPad! Should I call myself technocrafty?

Barbara Fernandes, M.S; CCC-SLP is a trilingual Speech- Language pathologist, a geek  and an app developer. She is the founder and CEO of Smarty Ears Apps , a company that creates apps for speech therapy. Barbara is also the face behind GeekSLP TV, a blog and video podcast focusing on the use of technology in speech therapy. Barbara has also been a practicing speech therapist both in Brazil and in the United States. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues, 12, Augmentative and Alternative Communication, and 1, Language Learning and Education. Barbara has created over 21 applications for the mobile devices for speech therapists. Find her at GeekSLP.com or on Twitter at @geekslp.

Welcome to Kid Confidential: Let’s Play!

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Welcome to the first installment of Kid Confidential, a monthly column where Maria Del Duca, M.S. CCC-SLP will be discussing all topics related to speech, language and child development. 

First off, let me say that I am not a researcher, I’m an observer.  I’m just a clinician like you using Evidence Based Practice (EBP) and trial and error to make my way in the world of language development.  I do not claim to be an expert, but I have had a hodge-podge of experiences and have worked with amazing clinicians and educators who have taught me along the way.

Through my years of experience and my constant need for information I have exhausted the minds of those with whom I have worked.  I have badgered them with a barrage of questions about why and how they were doing what they were doing.  Most of the time, I have found teachers and therapists willing to share their knowledge with me.  So today, I’m paying it forward.  Let’s talk play skills!

I don’t know about you, but upon completing graduate school I knew a whole lot about normal language acquisition, how to read, understand and review a research article, and how to administer and interpret numerous standardized tests, but I knew nothing about play skills.  Of course looking back at it now, this seems a bit ridiculous when we think of the number of children on our caseloads that are younger than five years of age.  But at the time, I didn’t know what I didn’t know.

Research shows us that play really is the work of a child.  We understand that play skills affect cognition, pragmatics and language development.  According to Pretend Play: The Magical Benefits of Role Play, by One Step Ahead:

Pretend play facilitates growth in more than just the areas mentioned above.  Encouraging a child to participate in pretend play positively affects:

  • Imaginative thinking and exploration
  • Abstract thinking
  • Problem Solving
  • Life skills
  • Leadership skills
  • Communication development
  • Social Skills development
  • Use of “Theory of Mind” (understanding/taking another’s perspective)
  • Understanding of safety
  • Self-confidence and a high self-esteem

We know we should assess play skills in young children.  But do we know what developmental play skills look like when we see them?  According to the Developmentally Appropriate Curriculum: Best Practices in Early Childhood Education, otherwise known as “the EC bible” in the world of early childhood educators, there are three distinct types and five social stages of play children typically exhibit between birth and age five (Kostelnik, Soderman, and Phipps Whiren).  Do you know what they are?  Read all about them in the tables below.

Slide1 Slide2You can download your copy of the above tables here.

I would be remiss if I did not share a word of caution when assessing play skills.  There are many cultures that do not value the child-centered, independent play of our western culture.  In order to differentially diagnose deficit versus difference we must keep in mind any cultural differences of the child’s family.  For more information on this topic, read Multicultural Considerations in Assessment of Play by Tatyana Elleseff MA CCC-SLP.

So now we know what typical play skills look like.  How do you assess play skills?  What are your favorite materials to use?  What topics do you want to see discussed here on Kid Confidential?

Don’t be afraid to share your ideas by commenting below.  And remember…“Knowledge is power” (Sir Francis Bacon)!

Reference

Kostelnik, Marjorie, Anne Soderman, and Alice Phipps Whiren. Developmentally Appropriate Curriculum: Best Practices in Early Childhood Education. 5. Upper Saddle River, NJ: Pearson, 2011. Print

 

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook

 

Google on Apple: Search is Language

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Google is pretty much synonymous with search.  Though in the earlier days of the web, people went different places like Lycos, Yahoo, and Altavista, it’s second nature for most of us to turn to Google nowadays when we have a question or need a resource. Bing? Sorry, no.

The thing about web search, when you think of it…it’s language. We ask a question and get an answer. The results can be a list, a description, a fact, a picture to describe.

Often, a search can be very helpful when we discover those pesky gaps in our students’ world knowledge or vocabulary.

Most of us, including myself, probably turn most readily to the little Google field in the upper right corner of the Safari iPad app, which indeed does the job pretty handily. However, Google has been steadily improving its free (of course) Google Search app, and it now includes speech-to-text (Voice Search), regardless of the version of the iPad you are using.  Additionally, depending on the type of search you are making, the app will read aloud the results (so, text-to-speech), a feature related to what Google calls its Knowledge Graph, which helps zoom in on the most important facts about real-world items. Google gives us some ideas for the types of questions that work well with Voice Search.

To see how the Google Search app can be useful in your interventions, check out this terrific contextual demo centering around one of my favorite places: Cape Cod. I need to go to there right now. *Sigh* I hate January.

This post originally appeared on SpeechTechie.com.

Sean Sweeney, MS, MEd, CCC-SLP, is an SLP and technology specialist working in private practice at the Ely Center in Newton, MA, and consults to local and national organizations on technology integration in speech and language interventions. His blog, SpeechTechie (www.speechtechie.com), looks at technology “through a language lens.” Contact him at sean@speechtechie.com.

Collaboration Corner: Rethinking the IEP: Making Language the Foundation of Academics

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Collaboration Corner is a new monthly column written for ASHAsphere by Kerry J. Davis, E.d.D, CCC/SLP.  Kerry will focus on different themes that involve collaborating with colleagues and other disciplines. Thank you Kerry for sharing your ideas with the ASHA community!

We welcome guest bloggers and columnists; if you’d like to write for ASHAsphere, please fill out a blogger application here.

I work in a totally inclusive school district as an inclusion speech-language pathologist. My caseload consists of the neediest students in the district. Those kids are simply fascinating to me. I work with the soup-to-nuts kids; kids with severe learning challenges, kids with social-emotional disabilities, kids who are nonverbal. You know the kids where you try and crawl inside their neurology and figure out how they perceive the world? These students push me to be a better clinician. More importantly, they make me want to think creatively on how to make public school and inclusion work for them.

All of my students participate in a general education classroom. Students attend their neighborhood schools and access their day with a host of academic supports. All of my students have goals that allow meaningful access to math, language arts, science and social studies. And here’s the funny part, while all of my students have communication disorders, I am working to eliminate the designated “speech and language” section of many students’ IEPs.

Imagine taking the speech and language section off of the IEP! I can sense the collective raising of eyebrows….

But here’s the deal. I believe that one of the best parts of being a speech-language pathologist is that opportunities for learning are never-ending. Language is everywhere. Bruner (1996) discussed the need to connect learning through meaningful interaction. People learn when they can relate new information with old information. Semantic-connections allow for learning. Language is the vehicle for that connection.

So let’s back up to the IEP. Why do we tend to compartmentalize language and communication to a single goal area? It is unnecessary, and dare I say…inappropriate.

Collaborative goal-writing

So perhaps we should rethink our approach. A student’s IEP is based upon the team’s recommendations.

Integrating language-based goals throughout the IEP also encourages team ownership. Distributing language-based objectives throughout the IEP underscores the connection between language and academics. For students who need extra repetition and meaningful practice across contexts, these collaborative efforts foster skill generalization. So how does that look in an IEP? Here are some ideas my school-based teams have used (as a part of measurable objectives of course):

Math:

  • Develop the concepts of less, more, some
  • Answering wh-questions related to quantity
  • Following directions in a recipe, including gathering appropriate tools and materials

Science:

  • Provide similarities and differences(feature/function/class) between target vocabulary words
    • simple machines
    • animals and habitats
    • weather
    • states of matter
  • Using temporal markers, will demonstrate understanding of  a plant/animal life cycle
  • Answering wh-questions related to non-fiction text and picture books

Social studies/geography:

  • Matching clothing with seasons
  • Using attributes to describe the weather
  • Identifying and answering personal and biographical information (town, street, school)
  • From a book or activity, answer who, where, what doing, and when questions related to other countries and communities

English Language Arts:

  • Answering wh-questions related to character, setting and supporting events
  • Using temporal markers to create a personal narrative from a photograph
  • Use a home journal template to retell a two activities of the day
  • From a photo, use adjectives to describe an event or activity
  • Sequence pictures representing events from a picture book

Independence:

  • Communicating self-advocacy,
  • Asking clarifying questions,
  • Following checklists related to daily routines,
  • Following 2-step group directions

Some words of advice

I’ve used these ideas with children who have a variety of skill abilities. I use these ideas with children who have moderate to severe cognitive and communication challenges. Many use high-tech assistive technology tools, to accomplish these goals. Others use fill-in-the-blank cut and paste activities. The key is to scaffold the concepts in a way that will be meaningful. This does not mean lowering the bar for learning, these means thinking about how to embed naturalistically these ideas throughout the school day. Checklists can be used as part of getting ready in the morning. Narrative writing may include templates and photographs, or writing a letter home at the end of the day. Sequencing can be used in “how-to” books, or describing the life cycle of a frog. Comparisons can be drawn between a student’s home, and the Native American Wetu. All of these examples connect language concepts and learning in a meaningful way.

Gather the expertise in your team members and make the IEP work for those students that challenge you; you will be better practitioner for it. Not every team will be ready for this change. Through thoughtful discussion, creative planning and patience, the shift may not be as hard as you think.

References:

Bruner, J. (1996). The culture of education. Cambridge, MA: Harvard University Press.

Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her area of interest includes augmentative alternative communication, and working with children with multiple disabilities and learning challenges. I welcome various perspectives and lively dialogue. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

The Value of Early Intervention for Late Talking Children

Paul-Rescorla-PodcastPodcast: Episode 13
SLP Rhea Paul and child psychologist Leslie Rescorla discuss recent research on the persistence of language weaknesses at age 17 in late-talking children. Principles of early intervention from ASHA’s recent policy documents are highlighted, and Dr. Rescorla’s recent article in the Journal of Speech, Language, and Hearing Research is discussed. Read the transcript.

Lynn Johnston on the Challenges of Aphasia

Lynn-Johnston-PodcastPodcast: Episode 8
Lynn Johnston, creator of the comic strip For Better or For Worse and winner of the 2007 Media Award from ASHA, discusses the challenges faced by individuals with aphasia. Read the transcript.