Speech Therapy and Traumatic Brain Injury

Traumatic Brain Injury can have a significant impact on classroom performance and may affect cognitive, social, physical and psychological functioning which can vary from being quite severe or to being quite mild depending on the amount of damage. TBI usually results from accidents or from a blow to the head. TBI isn't used for a person born with a brain injury or injured during birth. For the most part, every brain injury is different as the part of the brain involved in the injury may vary. Many children will have lifelong disabilities as a direct result of TBI.
Some areas of difficulty in the classroom may include:
Difficulty with logic, thinking and reasoning
Slower to respond, react and complete actvities and tasks
Difficulty focusing attention
Physical limitations
Inappropriate social behaviors
Difficulty remembering
Frequently puzzled or challenged by grade level work
Difficulty learning
speech/language defecits
Some methods I can use in my classroom to deal with TBI students include:
-Become informed, work with the parents to understand as much as you can about the child
-Exercise patience and lower your expectations
-Set the student up for sucess
-Repeat instructions, directions as needed and provide one direction at a time
-Allow the student more time to complete tasks and reduce the workload if needed
-Activities/tasks requiring the student to concentrate for long periods of time should be avoided
-Remember that the student takes a longer amount of time to process information
-Have consistent routines and rules
-Keep distractions to a minimum
-Remember to assess this student with an approach that will meet his/her needs - i.e., additional time, more observation etc.
-Make sure the IEP is in place and that it is flexible - a working document.
-Remember the child may require a modified schedule and or a behavioral plan
-Remember the child may need direct support in organizational strategies
Assistive Technology I can use would include: (these may help with rehabilitation) watches with timers, headphones, wheelchairs, durable medical equipment, large print books, prosthetic memory aids, checklists, laptops for written assignments, datebooks, electronic signalling devices
References: http://www.mayoclinic.com/ - about TBI
http://www.neuroskills.com/ - facts pertaining to traumatic brain injury

Speech Therapy and Multipe Disabilities

I will be teaching speech therapy to school agedchildren with multiple disabilities. Multiple disabilities is a disability category under IDEA. Children with multiple disabilities will have a combination of various disabilities that may include: speech, physical mobility, learning, mental retardation, visual, hearing, brain injury and possibly others. Along with multiple disabilities, they can also exhibit sensory losses and behavior and or social problems. Children with multiple disabilities - also referred to as multiple exceptionalities will vary in severity and characteristics. These students may exhibit weakness in auditory processing and have speech limitations. Physical mobility will often be an area of need. These students may have difficulty attaining and remembering skills and or transferring these skills from one situation to another. Support is usually needed beyond the confines of the classroom. There are often medical implications with some of the more severe multiple disabilities which could include students with cerebral palsy and severe autism and brain injuries. There are many educational implications for these students.
Some strategies I might use in my own classroom will include: Ensuring that all students demonstrates respect for the multiply disabled student, Care needs to be given in my expectations of this student to ensure the child doesn't not become frustrated, accomodating the child's physical needs, such as restrictions and making sure assistive technology is present and working, following the IEP and regularly making adjustments to fit the child's needs, integration among peers, allowing a safety plan to be properly adhered to, allowing the involvement of other professionals such as occupational therapists, physical therapists, physio therapists, etc. Also I will remember that these children are likely to be completetly dependent upon us for most of their daily needs.
Some assistive technology includes: portable computers, microswitches, tangible and tactile symbol systems, choice boards, object prompts and symbols, physical modeling and prompting, software such as Visual Assistant, audio messages and instructions, hand held computers with touch screen, etc.
References: www.theteachersguide.com - all about multiple disablities and how to handle them in the classroom
www.projectideaonline.org - assistive technology

Speech Therapy and Orthopedic Impairments

I will be teaching speech therapy to school aged children with orthopedic impairments. Students with orthopedic impairments may either have been born with, or may at some time have acquired, problems with their bones, their joints and/or their muscles. Orthopedic problems may result from deformities, diseases, injuries, or surgeries. Afflictions such as cerebral palsy, Osteogenisis Imperfecta, joint deformities or muscular dystrophy may be present at birth. On the other hand, injuries or surgeries may result in the loss of a bone and/or muscle tissue and may include the amputation of a limb. Additionaly, burns and broken bones can also result in damage to both bones and muscles. Some orthopedic impairments include: Cerebral Palsy: A non-progressive disorder that is caused by damage to the brain. It affects gross and fine motor condition. Cerebral palsy may affect 1.5 to 2 of every 100 persons. The characteristics of cerebral palsy depend on the type. For example, spasticity is characterized by tense, jerky, and poorly coordinated movements. Many people with cerebral palsy have associated disabilities. Muscular Dystrophy: Occurs when voluntary muscles progressively weaken and degenerate until they no longer function. The prevalence rate is 1 in 3500 people. The age of onset is a wide range, from anytime between 1 and 80. Muscular dystrophy is thought to be hereditary or caused by gene mutation.Spinal Muscular Atrophy: A disease that affects the spinal cord and may result in progressive degeneration of the motor nerve cells. The severity runs from mild weakness to characteristics similar to muscular dystrophy. SMA is characterized in general by fatigue and clumsiness. The cause is hereditary and the age of onset is either in infancy or a later time or between the ages of 2 and 17.Polio: A viral infection that causes paralysis. People with polio may be bedridden, confined to a wheelchair or dependent on braces or crutches.Spinal Cord Injuries: Caused by accidents which result in quadriplegia or paraplegia. Some people may recover completely or may remain in a wheelchair. Intelligence is not affected by this kind of injury. Spina Bifida: A congenital defect that results when the bones of a part of the spine fail to grow together. It is the second most common birth defect and it affects .1 to 4.13 of every 1000 live births. It is characterized by the use of crutches or wheelchairs and in some cases physical, occupational, and speech therapy need to be addressed. Another problem is bowel and bladder control.Osteogenesi Imperfecta: Also known as "brittle bone disease." The bones may break easily and many may use a wheelchair. A person helping a person in this condition must be very careful.Multiple sclerosis: A progressive disorder where the nerve impulses to the muscles are short circuited by scar tissue. Initially mild problems may occur but as the attacks continue, a person may develop a multitude of problems. These include severe visual impairment, speech disorder, loss of bowel and bladder control, and paralyzation. Symptoms may regress as remission occurs.Rheumatoid Arthritis: Causes general fatigue and stiffness and aching of joints Students who are affected by this may have trouble being in one position for a length of time, as well as for some of the other impairments mentioned above.Degenerative Diseases: Progressive diseases such as muscular dystrophy and multiple sclerosis may limit gross motor functions and/or fine motor activity.Post-Polio Syndrome: A variety of problems are presumed to be the late effects of polio. The symptoms may include fatigue, weakness, shortness of breath, and pain.Motor Neuron Diseases:A group of disorders such as Amyotrophic Lateral Sclerosis (ALS), Progressive Bulbar Palsy (PBP), Progressive Spinal Muscular Atrophy, and Charcot-Morie-Tooth disease produce symptoms such as pain, numbness, weakness, loss of upper and lower motor functions, and problems in breathing.
Some methods I can use in the classroom with children with orthopedic impairments include:
*Special seating arrangements to develop useful posture and movements
*Instruction focused on development of gross and fine motor skills
*Securing suitable augmentative communication and other assistive devices
*Awareness of medical condition and its affect on the student (such as getting tired quickly)
*Shorten assignments
*Type assignments if appropriate
*Allow others to take notes for student
*Ensure that the student has access to all areas of classroom and school building
* Familiarize myself with the student's augmentative communication tool such as a switch or voice-output device
*Ensure that aisles are wide and free from obstruction to allow for wheelchairs of students with wide gaits
*Peer Assistance
*Extra time for assignments and testing
*Tape recording assignments/lectures
*Assistive technology
Some assistive technology might include:
~speech recognition software
~screen reading software
~augmentative and alternative communication devices (such as communication boards)
~academic software packages for students with disabilities
~slant boards
~large desk/table
ALSO: canes, crutches, wheelchairs, specialized exercise equipment, and specialized chairs, desks, and tables for proper posture development
References: - www.pecentral.org - strategies for the classroom
www.washington.edu - adaptive technology

Speech Therapy and Health Impairments

I will be teaching speech therapy to school aged children with health impairments. There are a range of medical diagnoses and subsequent health problems that can have a temporary or chronic impact on a student's academic performance. Common diagnoses include arthritis, cancer, Multiple Sclerosis, Asthma, AIDS, and heart disease. Unless the condition is neurological in nature, health impairments are not likely to directly affect learning. However, the secondary effects of illness and the side effects of medications can have a significant impact on memory, attention, strength, endurance, and energy levels. Health impairments can result in a range of academic challenges for a student. Problems may include missing class for unpredictable and prolonged time periods and difficulties attending classes full-time or on a daily basis. Health problems may also interfere with the physical skills needed to complete laboratory, computer, or writing assignments. Individuals with arthritis, for example, may have difficulty writing due to pain or joint deformities, making it a challenge for them to meet the writing requirements for some classes. Students with Multiple Sclerosis may not be able to manipulate small laboratory equipment or complete tasks that require precise measuring, graphing, or drawing. Prolonged sitting may pose challenges for an individual with chronic pain or back problems. Illness or injury may result in limitations in mobility which require the need to use a wheelchair or scooter for mobility. Some students must avoid specific activities that trigger their conditions. For example, a student with asthma may need to avoid specific inhalants in a lab.
Some things I can do in the classroom to accomodate these children include:
-Notetakers and notetaking services.
-Audio or video taped class sessions.
-Flexible attendance requirements.
-Extended exam time or alternative testing arrangements.
-Assignments available in electronic format.
-The use of electronic mail for instructor-student meetings and discussion groups for class discussions.
-Web page or electronic mail distribution of course materials and lecture notes.
-An environment which minimizes fatigue and injury.
Also technology that I can use in the classroom for these health impaired students can be an ergonomic workstation with adjustable keyboard trays, monitor risers, glare guards, foot rests, adjustable chairs, and anti-fatigue matting. Also, speech recognition computer input devices, ergonomic keyboards, one-handed keyboards, expanded keyboards, or miniature keyboards.
References: www.urbanext.illinois.edu - A variety of different health impairments and facts
www.umuc.edu - health impairments and the affects on a persons body
www.eric.ed.gov - health impairments in the classroom

Speech Therapy and Visual Impairments

The American Foundation for the Blind estimates that 10 million people in the United States are visually impaired. Visual impairment is a term experts use to describe any kind of vision loss, whether it's someone who cannot see at all or someone who has partial vision loss.People rarely lose their eyesight during their teen years. When they do, it's usually caused by an injury like getting hit in the eye or head with a baseball or having an automobile or motorcycle accident.Some babies have congenital blindness, which means they are visually impaired at birth. Congenital blindness can be caused by a number of things — it can be inherited, for instance, or caused by an infection (like German measles) that's transmitted from the mother to the developing fetus during pregnancy. Conditions that may cause vison loss after birth include: Amblyopia, Cataracts, Diabetic Retinopathy, Glaucoma, Macular Degeneration, and Trachoma.
Some things I might use in my classroom include: Seat or encourage the visually impaired student to come to the front of the classroom or presentation area in order to be certain that s/he hears all instruction/explanation correctly.Classroom handouts, especially those with pictures or diagrams. Avoid leaving doors and drawers ajar or chairs out from under tables and desks. Either keeping furniture consistent or informing and/or involveing the student in rearranging. Address all students by name so that the visually impaired student can learn to associate names with voices of classmates. Address the visually impaired student by name as well, so he or she knows when he or she is being spoken to. Always treat the visually impaired student equally with other students. This includes discipline and special privileges as well as involvement in extracurricular and leadership opportunities. Give the visually impaired student as many opportunities to help others as to be helped by others.
Some technology that is used for the hearing impaired include: contacts, glasses, surgery, translator, hand-held devices, Braille displays, Optical Character Recognition software, magnifier, etc.
References: www.as.wvu.edu - strategies for the visual impaired in the classroom
www.kidshealth.org - about visual impairment
www.tsbvi.edu -visual impairments and assistive technology

Speech Therapy and Hearing Impairments

I will be teaching speech therapy to school aged children with hearing impairments. Hearing impairment is the decreased ability to hear and discriminate among sounds. It is one of the most common birth defects. Each year in the United States, about 12,000 babies (3 in 1,000) are born with significant hearing impairment. Hearing impairment that is present at birth is called congenital hearing impairment. Hearing impairment also can develop later in childhood or during adulthood. Hearing impairment can be inheritet or nongenetic. Nongenetic causes include illness or injury occurring before, during or after birth. In some cases, the cause of hearing impairment is not known. About 90 percent of babies with congenital hearing impairment are born to hearing parents Genetic causes of hearing impairment can be:
Syndromatic: One feature of a group of birth defects that occur together. This type of impairment accounts for about 30 percent of cases.
Nonsyndromatic: A solitary birth defect. About 30 percent of cases of nonsyndromatic hearing impairment are caused by a mutation in a gene called Connexin 26.About one-third of cases of hearing impairment are caused by nongenetic factors. They include illnesses during pregnancy, such as:
Rubella (German measles)
Cytomegalovirus infections
Toxoplasmosis
Herpes infection
Syphilis
Preterm birth (before 37 completed weeks of pregnancy) also can be a cause.
After birth, head injuries and childhood infections (such as meningitis, measles or chickenpox) can cause permanent hearing impairment. Certain medications, such as the antibiotic streptomycin and related drugs, also can cause hearing impairment. Ear infection(otitis media) may cause temporary hearing impairment. Frequent and poorly treated ear infections can cause damage sufficient to impair hearing.
Strategies to use in the classroom:
If the student lip-reads:
Have students sit closer to the lecturer.
Look directly at the student.
Speak slowly, naturally, and clearly.
Slowing down slightly may help.
Do not exaggerate your lip movements or shout
If the student uses an interpreter:
Speak directly to the student rather than to the interpreter.
Signing may be distracting at first, but you and the other students will soon become accustomed to the interpreter's presence.
Give the student and the interpreter outlines of the lecture or written material, in advance, so that they can become familiar with new technical vocabulary.
Interpreters should not give their opinion of a student's progress as this can violate the student's rights.
Provide scripts of video and laser media when possible for both the interpreter and the student with a hearing disability (with or without captioning).
The interpreter is not to answer lesson related questions from the student with a hearing impairment. The student should direct all lesson related questions to the instructor.
When writing materials for hearing impaired students:
Break up long sentences.
Reduce difficult vocabulary load.
Reduce concept density.
When using a pronoun be sure that the antecedent is very clear.
Do not omit words such as: "that" where such words will clarify a sentence connection.
Stay with simple coordinating conjunctions (e.g., but, so, for, and) and avoid less common transitional words (e.g., however, as a consequence, nevertheless, although).
Keep cause-and-effect expressions in a very simple in form.
Keep conditional expressions which influence the meaning of a statement to a minimum (such as; if, when, assuming that, suppose, provided that, etc.).
If there is no other way to avoid using a difficult word, include a brief explanation in parentheses, however keep parenthetical explanations to a minimum.
If an important basic or technical word is to be taught:
Make meaning and application absolutely clear.
Use context as a memory aid.
Technology that can be used for the hearing impaired may include using e-mail to send notes to the student, or for student-to-student interactions, make use of the overhead for visuals, change auditory warnings on computers to visual flashes or signals, use visual warning systems to signal emergencies. Also cochlear implants and hearing aids are extremely helpful.
References: www.who.int - relates to deafness and hearing impairments
www.4hearingloss.com - technology for hearing impairments

Speech Therapy and Speech and Language

Speech and language disorders refer to problems in communication and related areas such as oral-motor function--sucking, swallowing, drinking, eating. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disability, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say "see" when they mean "ski" or they may have trouble using other sounds like "l" or "r." Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.
Some activities I might use in the classroom would include the following: ARTICULATION: HIDE & SEEK: Clinician hides the cards and the client finds them, says them each using good sounds. PICK 2: The client selects 2 cards from the deck at random and has to put both in 1 sentence that makes sense and with correct articulation BEAN BAG TOSS: Place the cards in a row on the floor. Select a winning card. Have client stand a few feet back and try to toss the bag on the winning card. The client must say the word on the card that the bag lands on. BALLOON BOUNCE: Bounce a balloon and try to keep it in the air. Each time the client hits the balloon s/he has to articulate the target sound or word correctly. FLUENCY DISORDERS: LOW LEVEL CATEGORIZING: Display cards of a category, clothing for example. Then say a sentence that the client has to finish by selecting the correct card. For example, the client should pick the hat picture if you say "I am looking for a piece of clothing you can wear on your head!" CIRCLE GAME: Place cards in a circle and have clients sit at a card. A bean bag is tossed to a player who says the word or a description of the card in front of him/her and then tosses the bag to someone else. LANGUAGE: SIMON SAYS: Place artic or picture cards (transportation cards for example) on a table and use directions such as "Touch the helicopter after you touch the sailboat." STAND BY: Place cards on the floor, direct the client to stand by, in front of, behind or over a card. Then you ask the client to follow directions such as "Stand by the helicopter."
Classroom modifications: Present directions at a slower rate, with more expression in your voice. Use simpler, shorter sentences.
Ask the child to repeat the direction over and over in a low voice (or silently) until the task is finished.
Have the child visualize the task before doing it.
Brainstorm with the child for ideas that will help her remember directions. Some children write notes to themselves, wear clothing items or markers of some kind like stickers on a belt.
Present directions in short, concrete segments, with visual cues.
Be sure the child is making eye contact when you
Technology that can be used include computers, communication boards, ear plugs/muffs, word prediction software, speech synthesizers, etc.
References: www.juniorsweb.com - activities that can be used in the classroom
www.oln.org - assistive technology for speech impairments
www.asha.org - speech and language impairment facts