assess communication abilities, other do are RHD specific

• information of patient from charts, family, or other providers

Acute care - screeners Long-term - standardized assessment

typical on right LPR on left - tissue change - thickened secretions - edema

• think of push on swing as the push of air that causes vocal folds to vibrate; want to be gentle
• minimum pressure

don't "need" a specific volume, follow what baby shows they wants (e.g. follow their rooting and release)

Pierre Robin Sequence: Micrognathia (jaw is too small), so tongue goes up where the palate develops, therefore the palate forms in this u-shape (bottom right)

crowding (e.g. twins (rare))

22Q11 diagnoses is associated with cleft

bottom right

bottom left, mid-sagittal suture closed early brain had to grow another way

top right

LCD component

Cluttering spectrum behavior - identify cluttering behaviors 1st - then see if there are other dysfluencies

Cluttering and ADD - audible exhalations - fast-paced - irregular rate - excessive frequent dysfluencies - "mazing" - Lowest common denominator (LCD) perspective

Iceberg video notes: - This activity helps the client identify what they are feeling in association with their stuttering - Connection with community; less isolation in this experience - Finding the vocabulary to help with reframing in the future

Don't think narrowly, think broadly

                 Curriculum 
          Adverse --^-- Impact

Academic impact ^ Social impact

Age 0-5 (onset of stuttering) Age 6 (1st grade) --> age 14 (6th grade) (school-age) - As children continue to stutter beyond age 5, social tolerance goes down, social penalties/stigma increases (via teasing and bullying) - insistence of stuttering and intensification of behaviors as age increases (e.g. avoidance behaviors, physical tension) increases social stigma - learned helplessness - home has to be a safe space (desensitize parents on stuttering in order to achieve this); stuttering friendly environment

Video notes: - acceptance and avoidance - small changes to test authenticity

Self-disclosure/"Advertising"

Video notes: - hard to be a listening ear? - not always about solving things - validation - a skill to learn

Identity and stuttering can be complicated Acceptance is hard, let the person come to their own acceptance

• Class review: Pre-stutter
• easy onset softens laryngeal tension/posture; light touches
• prolonged speech --> alters rhythm

Mid-stutter - pull-out --> freezing reducing tension, then altering rhythm - movement and meaning is hard to focus on simultaneously

Post-stutter - cancellation --> say the stutter again using a technique (rewiring the stuttering experience)

Activity notes: - Voluntary/controlled stuttering is hard, but with practice and when put in different situations it can get easier - Speech is personal, some people many not want interference

Video notes: - diaphragmic breathing calming - prolongations using different timing - mindfulness - light articulatory contact: using light articulatory movement to minimize stuttering behaviors; minimizes tension - cancelations are less about producing the word again fluently, but rather the ability to identify the feelings associated with the stutter and how it feels in the body

Feedback notes: - feedback after every trail - notes what she sees; focus on tension - explaining each part - constant asking how they feel

Shaping the stutter: - teaching mindfulness for tension of stutter by playing with level - phonation is important - letting go of tension body is used to holding

STOP (for cancellation of stutter) S: stop the movement T: take a breath O: observe posture P: proceed with alterative position

Types of Techniques: - pre-stutter correction/modification: part of fluency shaping by changing rate and rhythm; proactive - pull out during or after MOS - post stutter correction/cancellation

Most of these types of techniques are done at or after stutter level

• in stutter or atter stutter techniques help with desensitization of tension
• never write PSS goal; counterproductive because stuttering needs to be practiced with these techniques

• more awareness/self consciousness about stuttering
• not always bad, if a PWS is covert, having them stutter more is better for intervention

not super appropriate, they typically not as aware of the development of their speech.

feedback from body that allows us to identify our body in space

• motor speech postures where we are intentionally mange stuttering (e.g. easy onset)
• knowing what one does when they stutter allows for one to change their stutter over time.

More sensitive to feelings of stuttering (motor feelings)

• changing speech pattern
• teaching new behaviors to increase fluency

• older than fluency shaping, from the 50s
• not changing stuttering patterns
• retain fluent speech
• reducing physical tension

Understanding this relationship is vital

Stuttering intervention requires a maintenance aspect

Think of PWS as the expert on their stuttering experience

0 - not stuttering 9 - severe stuttering

direct vs. indirect intervention Direct --> next slide set Indirect --> modeling within conversation (e.g. typical turn-taking, pausing, turn time, etc.)

• implement "special time" where family can focus on just talking with CWS and give uninterrupted attention (helps with data collection)
• implement one skill at a time; don't overwhelm parent

Give child more time to correct to learn that skill early

• Looking to see if child with recover spontaneously, or at risk of persistent disfluency

Things to keep in mind with this population: 1. * Is this typical disfluencies? 2. * Watch and wait vs wait and see 3. * How would we intervene?

phonics. sound-letter correspondence

phonemic

phonological

Good for case study assignment; used to rate severity of dysphagia

view in the picture - AP, anterior-posterior

thin liquid-honey is barium liquids, barium pudding is for solids

FEES is better at this

relate to capacities

wait and see --> passive watch and wait --> active

• concern and anxiety about their speech

• under 10% of syllables

• between-word disfluencies are common
• short duration stutter
• rhythmic

• trusting parent observation at home, it is typically the same that the SLP will see

"stuttering-like" disfluency - some whole word repetitions - some syllable repetitions

• if stuttering after a year, it is more likely to stick
• conditioned behavior
• should intervene as early as possible

• period of learning and unlearning of language development
• stuttering behavior is not highly developed at this point
• stuttering is more tolerated (socially/culturally) at the preschool age
• children have high notions of self-efficacy (kids think their good at everything at this time)

• Pattern of stuttering is more likely to stick due to brain developing language
• large cognitive load at this point in development
• parents reactions have a large effect on child in this stage

A+ ox3 - self - time - place - situation

aka bedside swallowing evaluation

maintenance/exacerbation - the more a child stutters, the more likely it is to "stick"

"trigger" --> developmental, environmental - learning

"set up" --> genetics - biology

there are many factors - personal - developmental - biological - environmental

can't use learning theory to explain stuttering onset, only consequent development

negative reinforcement

positive reinforcement

removal of negative stimulus (e.g. substitute a word, they they won't stutter)

associations

Disfluencies disrupt continuity --> Push (tension) response to restore continuity --> negative associations/consequences

• Disfluencies disrupt continuity (unconditioned stimulus)
• Push (tension) response to restore continuity (unconditioned response)
• due to negative associations/consequences, the body learns that they need to "push" thorough the stuttering, causing a tension response (conditioned response)

• learning by association
• Pavlov's dogs
• use this to understand diagnosogenic theory

• learning by consequence (reward/punishment)
• Skinner's mice

• this biological research was not really available when this theory was published, but now shows that it does not support the theory
• theory looks at overlaps between typical disfluencies and stuttering, but there are differences

• children are typically disfluent
• parent/concerned listener responses negatively to disfluency
• children develops stuttering disfluency in response to stress
• in diagnosing disfluency, we are creating stuttering behaviors

• something that one expects to do
• there is internal resistance to it
• physical struggle
• avoidance

learned behaviors

Ponder this review 1: - Less similar tasks pull less from neuronal resources - Speech and language are related, pull more neuronal resources - Physical development involves unfolding of innate biological sequence - Env. exposure is more important for speech/language developments, less on physical development (innate)

Ponder this review 2: - something about cognition

Ponder this review 3: - parents forcing children with stutter to speak can add stress - bilingualism is not a risk factor for stuttering persistence

*Hemisphere

Provide reason for stuttering itself (information counseling)

RTI does not supersede SPED

need to rule out limited bilingual proficiency when determining eligibility

2/2 = secondary to

gastroesophageal reflux (disease)

lower esophageal sphincter

Consistent swallow pattern (suck, swallow, breathe)

rhythmic bite

turning head towards stimuli with mouth open

2D sucking

children who have breast milk are more exposed to different "tastes" which can make them more open to different tastes

~6 months is when babies start eating solids/semi-solids; associated with sitting up/head control

Atypical motor movements may also be signs of atypical feeding/swallowing in the future

Swallowing disorders can occur throughout the lifespan, feedings disorders are often associated with peds

in communications style and language

parietal lobe damage on opposite side from where it is observed.

peripheral or upper motor neuron damage

damage to sensory pathways

tissue damage

lower motor neuro damage

upper motor neuron damage

Monoplegia and hemiplegia has upper cortical damage

Occipital - vision, visual processing

Parietal - sensory perception integration, proprioception, visual spatial processing, synesthesia

Temporal - auditory processing, memory, perceiving and interpreting speech (comprehension), hearing and recognizing speech

Frontal - attention, executive functioning, motor movement, planning, movement in speech, expressive speech

Type of Glioma

uncontrolled growth of cells