During the assessment of an individual with suspected fluency disorder, there are some things to remember to make the assessment more comprehensive and useful. Here are some of those critical points to take note of during assessment.

Benefits Of Obtaining Both Reading and Conversation Sample

It is more beneficial to obtain both reading and conversation sample from school children and adults because this would give more reliability and credibility to the samples taken.

Since stuttering varies in different situations, a reading and conversation sample would allow the clinician to see the behaviors of the person in two different tasks. A conversational speech sample is likely to have more variability, while a reading passage would likely have less variability.

Information To Assess Motivation

Through interview, a therapist can learn a lot from his client. In fact, insight about the client’s motivation could be seen by asking the following questions like ?What do you believe caused you to stutter??, ?Has you stuttering changed or caused you more problems recently?, ?Why did you come in for help at the present time??, ? Are there times or situations when you stutter more? Less? What are they??.

Benefits Of Continuing Evaluation

No individual could be understood in an hour or two; that’s why continuing of evaluation is recommended. The clinician might overlook an important element at times and some times a vital clue will not be present in the samples of behavior taken from the limited time of the evaluation period.

Note The Difference When Assessing Feelings and Attitudes

Most of this information comes straight from the Speech Therapy pros. Careful reading to the end virtually guarantees that you’ll know what they know.

Assessing a school-age child’s feelings and attitudes would require the clinician to establish rapport and to get to know the child much better after some time, because the clinician’s judgment is also a fair measurement in the case of school-age children.

Talking to the child and observing his behaviors would be necessary. When the clinician has known the child much better, he could administer the A-19 Scale to the child. Other methods could also be used such as ?Worry Ladder? and ?Hands Down? that could be found in the workbook, The School-Age Child Who Stutters: Working Effectively with Attitudes and Emotions.

For adults and adolescents assessment of feelings and attitudes are usually done by administering tools such as, the Modified Erickson Scale of Communication Attitudes, the Stutterer’s Self-Rating of Reactions to Speech Situations, the Perceptions of Stuttering Inventory and the Locus of Control of Behavior Scale.

Remember The Role Of The IEP Team

An Individualized Education Program (IEP) team is appointed to a child to be the ones to consider reports by the clinician and other information. They decide if the child meets the state’s eligibility standards and if the child’s stuttering has a negative effect on his education.

If a child is eligible for services measurable, the IEP team sets goals and short-term objectives for the child. They also provide services needed by the child for improvement in the educational setting.

Goals Of Trial Therapy

Trial therapy for a school-age child is done to understand what approach might work and what might be difficult for him. This could increase the child’s motivation and positive outlook for the treatment. In the case of adults and adolescents, trial therapy is done for 3 main reasons.

First, is to get an idea of how a client would respond to different therapy approaches. Second, is to make a differential diagnosis between developmental, neurological or psychological stuttering. Third, it gives a preview to the client of what to expect during therapy sessions, in effect it would give them motivation to go on their treatment.

Take time to consider the points presented above. What you learn may help you overcome your hesitation to take action.

About the Author
By Anders Eriksson, feel free to visit his new GVO affiliate site: GVO

Have you ever wondered what exactly is up with Speech Therapy? This informative report can give you an insight into everything you’ve ever wanted to know about Speech Therapy.

A speech therapist has a vital role in the pre- and post op management of laryngeal cancer, because Laryngectomy patients have to undergo speech management. So here are some of the things to know about laryngectomy.

A Team Approach

Firs off, the management of laryngeal cancer requires a team approach. The patient gets to see a surgeon, radiologist, audiologist, speech-language pathologist, oncologist, physical therapist, maxillofacial prosthodontist, and a psychiatrist. All of these health care professionals work together to work on the management of the patient.

What Is Laryngectomy?

Laryngectomy is the total removal of the larynx. It is also the partition of the airway from the nose, mouth, and esophagus. A person that undergoes this kind of operation would have to breathe via an opening on the neck, called stoma.

Laryngectomy is done when a person has laryngeal cancer. It may be considered to be a traditional way of managing laryngeal cancer, since a lot of laryngeal cancer cases nowadays are treated with the use of chemotherapy, radiation, or other laser procedures. In severe cases that these don’t work, that is the only time laryngectomy is opted for.

Other than the larynx, other structures are also removed. These other structures includes Sternocleidomastoid, Omohyoid muscle, Internal Jugular vein, Spinal Accessory vein (CNXI), Submaxillary salivary gland. In most severe cases, the external carotid artery, strap muscles of the neck, Vagus nerve (CN X), Hypoglossal nerve (CN XII) and the lingual branch of the Trigeminal nerve (CN V) are also removed.

How Common Is Laryngectomy?

It is estimated by the American Cancer Society, in 2003, that around nine thousand five hundred people in the US were diagnosed of laryngeal cancer. This condition occurs about 4.4 times more predominantly with men than with women. Though, similar with lung cancer, laryngeal cancer is becoming increasingly frequent with women.

Most of this information comes straight from the Speech Therapy pros. Careful reading to the end virtually guarantees that you’ll know what they know.

Tobacco smoking is so far the supreme risk factor in having laryngeal cancer. Other factors include radiation exposure, asbestos exposure, alcohol abuse, and genetic factors. In United Kingdom, laryngeal cancer is rather rare, since it only affects less than 3,000 people per year.

Possible Problems

After total Laryngectomy, possible problems may occur. These include having a scar tissue at the tongue base, narrowing of the esophagus, partial tongue base resection, dysphagia, Xerostomia, mouth sores and changes in smell, taste, appetite and weight.

Effects And Impacts Of Laryngectomy

Laryngectomy has two mechanistic effects. One, it separates respiration from speech. Two, it keeps the pharyngoesophageal region intact.

There are also impacts that Laryngectomy brings about. The main impact would be the loss of voice for communication. You may also lose the ability to express emotions such as laughing. You also get physical problems with regard to tasting and feeding.

Laryngectomy is frequently successful in treating early-staged cancers. Still, undergoing through the procedure would require major lifestyle change. There is also a risk of having severe psychological stress due to unsuccessful adaptations.

After The Procedure: Voice Replacement And Care

After the patient’s larynx is removed, voice prosthetics is used. This serves as a replacement for the lost larynx, so that the person will still be able to communicate and speak. In this case, Laryngectomees would have to learn new methods of speaking.

They should also be constantly concerned in taking care and cleaning their stoma. Severe problems can arise if foreign materials and water enter their lungs via their unprotected stoma.

It never hurts to be well-informed with the latest on Speech Therapy. Compare what you’ve learned here to future articles so that you can stay alert to changes in the area of Speech Therapy.

About the Author
By Anders Eriksson, feel free to visit his new GVO affiliate site: GVO

There are different techniques used for the treatment of intermediate Stuttering. Such techniques are a mix of fluency shaping and stuttering modification techniques. Here are some of the commonly used techniques for treating intermediate stuttering.

Flexible Rate

Flexible rate is slowing down the production of a word, especially the first syllable. This technique is thought to allow more time for language planning and motor execution. In here, only those syllables on which stuttering is expected are slowed, not the surrounding speech.

Flexible rate is taught by having the clinician model production of words in which the first syllable and the transition to the second syllable are said in a way that slows all of the sounds equally. Vowels, fricatives, nasals, sibilants, and glides are lengthened, and plosives and affricates are produced to sound more like fricatives, without stopping the sound or airflow.

After the clinician’s model, the child produces the word with flexible rate, and successive approximations of the target are reinforced.

Easy Onsets

Easy onsets refer to an easy or gentle onset of voicing. Teaching easy onsets is like teaching flexible rate. The clinician models the target behavior by the use of a lot of different sounds and then he makes the child imitate the models. After the child tries to imitate, the therapist should reinforce the child’s successive approximations.

Some children, particular younger ones, may be helped to get the concept by performing an action, such as bringing their hands together slowly, as they produce an easy onset.

Think about what you’ve read so far. Does it reinforce what you already know about Speech Therapy? Or was there something completely new? What about the remaining paragraphs?

Light Contacts

Producing consonants with light contacts prevents the stoppage of airlow and/ or voicing that can trigger stuttering. Light contacts are taught by modeling a style of producing consonants with relaxed articulators and continuous flow of air or voice, depending on the consonant.

Plosives and affricates should be slightly distorted so that they sound like fricatives but are still intelligible. Modeling a variety of words with initial consonants and reinforcing the child’s successive approximations of the target accomplish teaching a child to use light contacts. The clinician can use a variety of games to make the concept of light contact more interesting.

Proprioception

Proprioception refers to sensory feedback from mechanoreceptors in muscles of the lips, jaw, and tongue. The effectiveness of teaching proprioception may be that it promotes conscious attention to sensory information from the articulators, perhaps bypassing inefficient automatic sensory monitoring systems and thereby normalizing sensory-motor control.

Children can be taught to use proprioception by having a child first hold a raisin in his mouth and report on its taste, shape, size, and other attributes. Children can also learn proprioception by picking a word from a list and then closing their eyes and silently moving their articulators for this word and being rewarded when the clinician guesses the word.

Children can be coached to feel the movements of their lips, tongue, and jaw as they say a word. Proprioceptive awareness can also be enhanced by using masking noise or delayed auditory feedback to interfere with self-hearing. In this, the clinician must look for slightly exaggerated, slow movements to verify that a child is trying to feel the movement of his articulators.

Scaffolding

It is useful with some children to ?scaffold? their use of superfluency by letting the listener/s know that we are working on our speech and sometimes by coaching the child in that fluency-friendly environment. This can be exhibited for example telling a stranger in a mall that the child and the clinician are working on their speech and would like to ask him some questions, another example would be when the child makes telephone calls.

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To begin with, the primary cause of aphasia should be stabilized or treated. After doing so, that’s the only time that a therapist can work on the rehabilitation of the patient. To recover a person’s language function, he or she should begin undergoing therapy as soon as possible subsequent the injury.

Speech Therapy: As A Treatment For Aphasia

Since there are no surgical or medical procedures that are currently available to treat Aphasia, conditions that result from head injury or stroke can be improved through the treatment of speech therapy.

For majority of Aphasic patients though, the main emphasis is placed upon optimizing the use of the person’s retained language skills and being able to learn to use other ways of communication to be able to compensate for their permanently lost language abilities.

Therapy Activities

The formulation of what activities to use during a speech therapy session is critically done and would highly depend on the therapists’ assessment and diagnosis results on the individual. However, there are some general activities that are done to treat Aphasia.

Exercise

Since most types of Aphasia would include right-sided weakness of the body and sensory loss, it is important for the patient to be able to exercise their body. Regular exercise and practice is needed to strengthen the weak muscles and prevent it from further degeneration.

The exercise activities do not have to be exhilarating. For the purpose of speech function, the therapist can exercise the patient’s weakened muscles through repetitive speaking of certain words, and projecting facial expressions, like smiling and frowning.

The use of food too is helpful, since the patient is able to exercise articulators needed for speech production like the tongue and jaw, which may be weakened due to the condition.

The information about Speech Therapy presented here will do one of two things: either it will reinforce what you know about Speech Therapy or it will teach you something new. Both are good outcomes.

Picture Cards

One of the tools used for therapy are picture cards. Pictures of daily living and everyday objects can be used to improve and develop word recall skills. Picture cards can act as a visual cue to increase the learning process of an Aphasic. These can also help increase the vocabulary of the patient.

By showing the picture cards and repetitively saying aloud the names of the objects in the picture, the patient will be able to exercise weak muscles and practice vocalization.

Picture Boards

Another tool for therapy are picture boards. Since aphasia can bring about difficulty in recalling names of activities, objects and people, use of material to help recall these names is very helpful. By making use of a board where the therapist places pictures of different everyday activities and objects, the patient can point to specific pictures to express ideas and communicate with other people.

Workbooks

The use of workbooks is also important in the treatment of Aphasia. Since reading and writing skills are affected, this is one way to exercise them. Workbook exercises can be used to sharpen an Aphasic’s word recalling skills and recover reading and writing abilities.

By reading aloud, hearing comprehension can also be exercised and redeveloped through workbook exercises.

Computers

With the development of technology, there are now computer programs that are used to treat Aphasia. Such computer programs can be used to improve an Aphasic’s reading, speech, recall, and hearing comprehension. In fact, the use of computers can bring about optimal results, since it can stimulate senses of vision, and hearing at the same time, helping speed up the learning process.

About the Author
By Anders Eriksson, feel free to visit his new GVO affiliate site: GVO

Imagine the next time you join a discussion about Speech Therapy. When you start sharing the fascinating Speech Therapy facts below, your friends will be absolutely amazed.

There is a lot of fluency shaping techniques used in speech therapy for fluency disorders. However, due to the advancements of technology, a new kind of fluency shaping approach is now available. This is possible by the use of biofeedback mechanisms.

Fluency Shaping At A Glance

In fluency shaping therapy, motor skills are acquired. But in order to have a successful therapy the client needs to have feedback. Since it involves physically learned behavior, the client should know if what he is doing is right or wrong.

For example, a therapist asks his patient to use diaphragmatic breathing. The client and the speech therapist knows if the client is doing it right or wrong because they could observe it by putting a hand in the patient’s stomach.

On the other hand if the therapist asks the client to execute air with vocal tension, and he does so, and then therapist asks the client to do it faster; it would be hard to observe and see the difference between the two actions. That’s why biofeedback devices were invented.

Biofeedback Mechanisms

A biofeedback mechanism is an instrument that shows the user’s physiological activity’s display and measurement. It is very helpful to increase the awareness of the client. The client has an increased control of the activity too. It provides real time feedback that is more reliable and precise than human observation. It is able to measure what can’t be seen or heard by human senses.

It seems like new information is discovered about something every day. And the topic of Speech Therapy is no exception. Keep reading to get more fresh news about Speech Therapy.

It is also helpful with to that SLP so that he can concentrate on the other behaviors of the client. If the client is a visual learner, it would benefit him very much and it may speed up his way to successful fluency therapy. There are devices that can be used not only in the clinic but at home too, so the client can practice even at home.

Some examples of this kind of devices are CAFET or the Computer-Aided Fluency Establishment And Trainer, Dr. Fluency, EMG (Electromyograph) and Vocal Frequency Biofeedback.

The Dr. Fluency and CAFET are computer based biofeedback systems. They make use of a microphone to monitor the user’s vocal fold activity. A chest strap is also used to monitor breathing. The change in vocal fold activity and breathing is displayed on the computer display. Instructions and error messages are also seen.

The device trains a lot of fluency skill behaviors such as: continuous breathing, relaxed diaphragmatic breathing, pre-voice and gradual exhalation, gentle onset, continuous phonation, adequate support of breath, and phrasing.

In a study of CAFET, 197 teenagers and adults used the program reported that just after six months of finishing the program, eighty-two percent met the fluency criteria. After twelve months, eighty-nine percent were fluent. Lastly, in two years of post-therapy, ninety-two percent were fluent.

EMG and Vocal Frequency Biofeedback is a device using an EMG working with a DAF (Delayed Auditory Feedback) mechanism. The EMG monitors muscle activity and if it detects something wrong a red light would turn on and the DAF would automatically play.

The use of biofeedback mechanisms can be considered to a breakthrough in the realm of speech therapy and fluency disorders. However, not every one can have access through it, since getting such devices can be very expensive.

Nonetheless, other fluency shaping approaches are still viable and have been proven effective already from years of practice.

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The following paragraphs summarize the work of Speech Therapy experts who are completely familiar with all the aspects of Speech Therapy. Heed their advice to avoid any Speech Therapy surprises.

There are six main types of fluency disorders namely: normal developmental disfluency, stuttering, neurogenic disfluency, psychogenic disfluency, language based disfluency, and mixed fluency failures. Due to the uniqueness and difference of each case, all of them require a different kind of management approach in speech therapy.

Management For Normal Developmental Disfluency

Developmental disfluency occurs during the critical period of speech and language development. A child is considered to have this condition if 5% or less of his overall speech-sample are repetitions and 1% or less are prolongations.

Etiologies of this condition could be: excitement while speaking, demands of Language Acquisition, Speech-Motor control is lagging, environmental factors like stress in the family (e.g. separation of parents) and the situations they are in, and daily pressures of competition.

Concerned parents still make their children with this kind of disfluency undergo therapy even if this could still possibly decline. These children are taught how to: decrease the rate of their speech, relieve other pressures that the therapist and parents mutually agree to change, and simplify their language.

Management For Stuttering

The onset of stuttering may occur between ages 1 ½- 11 years old but it mostly occurs during early childhood stage, which ranges from 2-6 years old. A condition is diagnosed to be stuttering when the speech has 5% or greater repetitions and 1% or greater prolongations.

There are several approaches to therapeutic intervention for early stuttering namely: environmental manipulation, direct work with the child, psychological therapy, desensitization therapy, parent-child interaction therapy, fluency-shaping behavioral therapy, and parent and family counseling

Management For Neurogenic Disfluency

Truthfully, the only difference between you and Speech Therapy experts is time. If you’ll invest a little more time in reading, you’ll be that much nearer to expert status when it comes to Speech Therapy.

The onset of neurogenic disfluency is varied. It can occur at any age but it usually appears during adulthood or among the geriatric population. The neurological events that can trigger the onset of neurogenic disfluency are as follows: strokes, head trauma, extrapyramidal diseases, tumors, dementia, drug usage, anoxia, cryosurgery, viral meningitis, and vascular disease.

Self-monitoring program is one of the most suggested modes for the management of this kind of disfluency.

Management For Psychogenic Disfluency

The onset of psychogenic disfluency is also varied. A condition is said to be under this category when 90% of the patient’s utterances have become disfluent when the emotional stimuli is present. This condition originates in the mind. The etiology could be acute or chronic psychological disturbances. Stress is another factor that may also cause the disorder.

Psychologists, psychiatrist and counselors can only provide treatment of this kind of fluency disorder. Speech pathologists prioritize treatment only of the bad speech habits, which may still be present after resolving the emotional issues of the patient.

Management For Language Based Disfluency

This kind of fluency disorder may arise in a child as soon as any newly introduced language skill emerges, specifically during the toddler to preschool stage. The fluency failure may be due to linguistic or motor immaturity. It can also be a result of the child’s struggle to acquire newly introduced and more complex language rules.

The management of this kind of disfluency usually focuses on improving the child’s language skills to increase his/her linguistic and motor maturity.

Management For Mixed Fluency Failures

The onset of this condition cannot be exactly determined, since it is an overlap pf two or more causative factors. No specific age for identification since onset may be sudden. Therapists must prioritize the most debilitating and/or the most correctable aspect of the disfluency.

When word gets around about your command of Speech Therapy facts, others who need to know about Speech Therapy will start to actively seek you out.

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By Anders Eriksson, feel free to visit my latest acquisition: Adsense Sites and make sure to download the free adsense sites package!

The more you understand about any subject, the more interesting it becomes. As you read this article you’ll find that the subject of Speech Therapy is certainly no exception.

Hearing is conversely associated with speech in that initial communication and hence understanding, arises primarily from learning spoken language through listening and building up symbolic thinking processes. This is why speech therapy is a must for people with hearing impairment.

Developing Auditory Awareness

Auditory awareness is the ability to be conscious of the fact that sound is present. During this period, the child is to learn to wear appropriate amplification. Therapy involves playing with toys that make sounds and listening to music.

Developing Auditory Attention or Listening

Auditory attention is the ability to give some real notice or interest to the sound that is heard.

The clinician focuses the child’s attention to the sound by saying two or three times: ?Listen, I hear something. What is that?? The clinician pats his ears, but does not show the source of the sound until the child is listening. The clinician rewards the child’s attention by showing the source of the sound.

Developing Auditory Localization and Distance Hearing

Auditory localization is the ability to recognize the direction from which the sound is coming from. Distance hearing, on the other hand, is the ability to hear the sound even from afar.

The therapist shows the child how to respond whenever he hears a sound. Some of the activities are opening the door when someone knocks, dancing to music, clapping to music, building blocks when a sound is heard, marching to a drum and picking the phone up when it rings.

Developing Vocal Play

Vocal play is the ability to use the speech structures to produce various sounds that are not necessarily meaningful but are sound productions nonetheless. This stage requires making lots of sounds when playing with toys, especially animal and vehicle noises: growl for the teddy bear, meow for the cat, or click tongue for the horse.

Developing Auditory Discrimination

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Auditory discrimination is the ability to identify one sound from another. Activities include reviewing vowel sounds and varying pitch, loudness and rhythm: oo— vs. oo-oo. For example, the therapist can build a train with blocks and say oo-oo or oo—, as the train is being pushed on the table. For older infants, they can look at books, making similar sounds for the pictures.

Developing Auditory Discrimination and Short-Term Memory

Activities include teaching discrimination of noise makers in audition and incorporation of phonemes into words in use.

Developing Auditory Processing

Auditory processing is the ability to associate sounds with memories of past events. Activities include naming of abstract ideas like sadness and joy. The therapist also starts to teach the child to call the names of the people that he has constant contact with.

Developing Auditory Processing of Patterns and Auditory Memory Span

Activities for the child’s audition include testing the child’s recognition of words and testing of auditory memory span. Auditory memory span is the ability of the child to remember in sequence the things that he has heard. An example would be the sequence of the instructions that the therapist gave to him.

Developing Auditory Figure-Ground Discrimination

Auditory figure-ground discrimination is the ability to choose among the sounds that are present in the environment and to focus on that one sound alone without being distracted by the rest of the surrounding sounds.

Activities for the child’s auditory skills include clapping or dancing to different rhythms, learning to count from one to ten, saying the alphabets, days of the week, nursery rhymes, holiday songs, prayers, his own address or telephone number, and also remembering two or three directions at a time.

Auditory Tracking

Auditory tracking is the act of listening closely to a material to be able to follow what is being stated in the said material. Auditory tracking using a tape recorder is included in the activities. Also included are reading aloud, practicing using the telephone, listening for information and using internal repetition.

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Imagine the next time you join a discussion about Speech Therapy. When you start sharing the fascinating Speech Therapy facts below, your friends will be absolutely amazed.

One of the not so noticed areas of rehabilitation medicine is Speech Therapy. In fact, a lot of people may not even know that something like this existed. It may be the case that this is your first time to encounter the field or you may have heard it somewhere, but don’t fully understand what the practice is all about.

The sad truth about Speech Therapy is that you may not encounter it unless the situation calls for it. However, getting to know what the practice is can be very beneficial information.

What Is Speech Therapy?

As the name suggests, speech therapy deals with speech problems that an individual may encounter. However, the field of Speech Pathology doesn’t only tackle speech, but also language and other communication problems that people may already have due to birth, or people acquired due to accidents or other misfortunes.

Speech therapy is basically a treatment that people of all ages can undergo through, to fix their speech. Although speech therapy alone would focus on fixing speech related problems like treating one’s vocal pitch, volume, tone, rhythm and articulation.

Goals Of Speech Therapy

Speech Therapy aims for an individual to develop or get back effective communication skills at its optimal level. Recovery mainly depends on the case and severity of your problem, especially if your speech problem is acquired, meaning you had normal speech skills before then you had an accident or abrupt incident that caused your current speech problem; thus, you may or may not get back your old level of speech function.

Speech Problems

Speech problems are mainly categorized into three namely: Articulation Disorders, Resonance or Voice Disorders and Fluency Disorders. Each disorder deals with a different pathology and uses different techniques for therapy.

Now that we’ve covered those aspects of Speech Therapy, let’s turn to some of the other factors that need to be considered.

Articulation Disorders

Articulation Disorders are basically problems with physical features used for articulation. These features include lips, tongue, teeth, hard and soft palate, jaws and inner cheeks. If you have an Articulation Disorder, then you may have a problem producing words or syllables correctly to the point that people you communicate to can’t understand what you are saying.

Resonance or Voice Disorders

Resonance, more popularly known as, Voice Disorders mainly deal with problems regarding phonation or the production of the raw sound itself. Most probably, you have a Voice Disorder when the sound that your larynx or voice box produces comes out to be muffled, nasal, intermittent, weak, too loud or any other characteristic not pertaining to normal.

Fluency Disorders

Fluency Disorders are speech problems with regard to the fluency of your speech. There are some cases that you talk too fast, in which people can’t understand you, thus, you have a Fluency Disorder of Cluttering. The most common Fluency Disorder however, is Stuttering, which is a disorder of fluency where your speech is constantly interrupted by blocks, fillers, stoppages, repetitions or sound prolongations.

Who Gives Speech Therapy?

A highly trained professional, called a SLP or a Speech and Language Pathologist, gives Speech Therapy. Speech and Language Pathologists are informally more popularly known as Speech Therapists. They are professionals who have education and training with human communication development and disorders.

Speech and Language pathologists assess, diagnose and treat people with speech, communication and language disorders. However, they are not doctors, but are considered to be specialists on the field of medical rehabilitation.

As your knowledge about Speech Therapy continues to grow, you will begin to see how Speech Therapy fits into the overall scheme of things. Knowing how something relates to the rest of the world is important too.

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When you think about Speech Therapy, what do you think of first? Which aspects of Speech Therapy are important, which are essential, and which ones can you take or leave? You be the judge.

There are different levels of play used in the assessment of children’s speech and language. These levels are used to measure children’s play skills. However, there are also play levels of social interaction that can give a general overview of the child’s play skills.

In general, there are six play levels of social interaction that children go through respectively. Each level becomes more complex than the previous one, and requires more communication and language skills than the other.

Unoccupied Play

The first level of play is unoccupied play. In this kind of play, the child may seem like he is simply sitting quietly in one corner but actually is finding simple things that he sees around him to be rather amusing. A typical adult may not notice that what the child is doing is already considered to be play, unless they observe meticulously.

The child may just be standing and fidgeting at times, but this could already be unoccupied play at work.

Onlooker Play

The second level is onlooker play. In this level, the child watches other children play but doesn’t engage in play himself. This is when children learn to observe others. Such play level can show a child’s attention and awareness skills.

Solitary Play

The third level is solitary play where the child plays by himself and doesn’t intend to play with anyone else. This level shows an outright manifestation that the child do have play skills, only that it is still at a level that no interaction is required.

A child can be at this level when he is already able to play functionally with an object, can play by himself up to fifteen minutes, and is able to follow simple play routines.

The information about Speech Therapy presented here will do one of two things: either it will reinforce what you know about Speech Therapy or it will teach you something new. Both are good outcomes.

Parallel Play

The fourth one is parallel play. This level characterizes children who play side by side but don’t communicate with each other. Neither do they share toys. It is said to serve as a transition from solitary play to group play and is at its peak around the age of four years.

A child is said to be in this stage when he is able to play alone, but the activity he is doing is similar with the play activity that other children beside him are engaging in. The child also doesn’t try to modify or influence the play of other children around him. Here, the child is playing ?beside’ rather than ?with’ the other kids in the area.

Associative Play

Next is the associative play. This is where the children still don’t play with each other but are already sharing the toys that they are playing with. This level shows the child’s awareness of other children, although there is no direct communication between them, other than the sharing of toys and the occasional asking of questions.

Their play session doesn’t involve role taking and has no organizational structure yet. The child still carries on the way he wants to play, regardless of what the other children around him are doing.

Cooperative Play

The last level is cooperative play. This is the final stage wherein the children are already playing together, sharing toys and communicating with each other.

This level usually happens at about the age of five or six, where children engage into group games and other highly structured play activities.

These levels can be utilized by the therapist as a guide when it comes to the interactions that he wishes to have with the child through play activities.

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When you think about Speech Therapy, what do you think of first? Which aspects of Speech Therapy are important, which are essential, and which ones can you take or leave? You be the judge.

There are three phases of management for laryngectomy: pre-operative, operative, and post-operative management. Each phase has its advantage and goals. A speech therapist plays vital roles in the first and last phase. Consulting a speech therapist during the first phase is equally important with seeing a therapist during the last phase, which is when voice rehabilitation really begins.

A speech therapist also has different roles in each phase, that’s why it is vital for a therapist to know the two phases he plays a role in.

Pre-operative Management

Pre-operative management includes informing the patient of the anatomical changes, and expectations regarding swallowing, voice, and the family as a part of the team. The therapist also informs the patient on the different speech options he has after the operation.

During this phase, the speech therapist should initiate ordering of the hardware or alternative means of communication. The therapist should also be open to questions that the patient may come up with. This is also the time for him to establish rapport with the patient.

The therapist can also offer re-assuring consultation with appropriate laryngectomee volunteers. This is also the time where he assesses the pre-laryngectomy speech and cognition of the patient. The laryngectomee is also informed with his prognosis, where the potential for recovery and long-term rehabilitation is discussed.

The advantages of this phase would be the evaluation of preoperative speaking skills such as speaking rate, articulation errors, accent patterns, oral opening degree when speaking, and vocal parameters. Cognition and hearing is also evaluated, along with oral-peripheral-mouth strength and sensation. The family can also get emotional support in this phase.

If you find yourself confused by what you’ve read to this point, don’t despair. Everything should be crystal clear by the time you finish.

Assessment is done by the use of modified barium swallowing or Fiberoptic Endoscopic Evaluation of Swallowing. The patient’s communication needs are also assessed where living situation, occupation, social requirements and hobbies are looked at.

Postoperative Management

During this phase, the therapist is given an opportunity to help lessen the patient’s fears, and depression. He should also help the patient to accept the loss of voice and swallowing difficulties. The motivation of the patient should be increased, so that he can easily learn how to use alternative speech. Social implications are also addressed. Arrangements for voice rehabilitation are also done during the early parts of this phase.

Firs off, the therapist should confirm if the patient is already medically cleared for therapy. Then he should review the treatment procedure, re-evaluate the patient’s swallowing function then give diet recommendations, and create a treatment plan.

Problems Encountered During Postoperative Management

After the operation some problems may still occur. With regards to Tracheostomy, the patient and therapist should always be watchful of stoma hygiene, cannula hygiene, stoma covers, excessive mucus in the trachea, mucus encrustations in the stoma, and stoma safety and first aid.

There could also be problems related to taste, swallowing, smell and digestion. The patient may find it difficult to trap air within the lungs. This can lead to difficulties in creating internal subglottic pressure, elimination of body waste and childbirth.

Problems of social adjustment may also be present. The patient may find it hard or embarrassing to use alaryngeal speech in public. The altered physical appearance of the patient may also be an issue. Sometimes, the laryngectomee also has unrealistic expectations regarding acquisition of alaryngeal speech.

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