Last Minute Ideas!

I received an Email on Friday from Candra Grether on Friday, but was not able to get his posted until now. Hopefully you find these ideas useful either now or after the break!!

Two therapy ideas.

First, with Star Wars coming out over the weekend, The Stuttering Foundation posted the below article yesterday featuring Samuel L Jackson and James Earl Jones as examples of celebrities who have a history of stuttering. If you click on each person you are directed to a longer article about them. These articles contributed to thoughtful discussion with one of my fluency groups this morning.

Second, two of my MSD classrooms planned a holiday party for today with various games and activities. Last week I requested details about one of the activities and volunteered to create visual instructions for the students. Using PowerPoint and stolen images from a Google search (from various blogs, one being “Simply Kinder”), I put together two versions of visual directions (one with pictures + text and one with pictures only) so they could use milk cartons to make gingerbread houses. We have had a great morning of following directions, sequencing, and FUN! Here is the .pdf file of what I made as well as a picture of one student in action.

Thanks, Candra!!

I Love My Hair Literacy Unit

I wanted to go ahead and share the literacy unit based around the book I Love My Hair before break so that you have plenty of time to prepare before school starts back in January. Here are the ideas produced by our work group back in September:

Articulation activities:

  • Pulling words with the target sounds
  • Sort target words from text into beginning, middle and end
  • Use beads on a pipe cleaner (like her hair) to keep track of responses

Language activities:

  • EET using the beads for language activities
  • Sorting activities-sort barettes.combs for shape/color/size etc.
  • Copy pages to sequence (beg, middle, end)
  • Play dough hair shop for verbs
  • Have student draw favorite hair style then compare and contrast with Venn Diagram
  • Talk about descriptive words (such as curly, straight, wavy, soft, etc)
  • Synonyms/antonyms for older kids
  • Find figurative language
  • Story questions

Here is a YouTube version of the book.

This is a lesson created by a Kindergarten teacher for her class, but could be easily adapted to suit the therapy room. For this lesson she also uses the book Hairs/Pelitos.

Have you used this book before? What activities worked the best in your therapy room?



Assessment considerations for students with hearing loss

Today, Kristin Kelly (SLP at Heuser Hearing and Language Academy) shares some insight into assessing children with hearing loss. She says:

One of the joys and challenges of our profession is that we never know who is going to walk through our door.  We are constantly charged with learning about new topics and we often encounter students who are the only one of their kind on our caseloads.  I’d like to share some information that may help when assessing students with hearing loss since you may only have one on your caseload.  Students with hearing loss present with a wide range of communication abilities from severely disabled to non-disabling.  Some (but not all) of this information may apply to the student on your caseload.

Standardized Assessment

My goal during standardized assessment is to determine (among many things) how a student can perform in the areas of communication being examined in ideal conditions.  The impacts of noise, distance, inconsistent amplification and “real world” communication situations can be considered during the functional examination or other supporting evidence.  If the testing plan lists “hearing aid(s)” or “cochlear implant(s)”, they must be worn during testing.  If a student comes in with a dead battery or no amplification, I reschedule the testing.

1. Modality

a. Spoken Language.  Many students with appropriate amplification use spoken language to communicate.  Continue with standardized testing as you deem appropriate.  Be aware of lip reading.  Many students need a clear visual of your face for best performance.  I note in my report if I think a student is lip reading but I don’t discourage it.  I might address listening only skills during the functional exam by using a speech hoop.  (A speech hoop is an embroidery hoop covered in audio speaker fabric so a student cannot read lips or facial expressions but has access to the auditory signal clearly.  If you cover your mouth with your hand it distorts the auditory signal and they can still “read your cheeks”).

b. Total Communication.  If a student uses true total communication with spoken English and Signed Exact English, standardized testing can be administered through the interpreter and scores should be considered valid.  It would be wise to have a conversation with the teacher and the interpreter to clarify the use of SEE and ASL and how the test items need to be interpreted.

c. American Sign Language.  If a student uses ASL as their mode of communication, standardized scores should not be reported.  Since ASL has its own vocabulary, syntax and pragmatic rules, it should be treated like any other spoken foreign language.

2. Seating arrangements.

a. Sit on the side of better hearing.

b. Keep the protocol out of sight.

c. If there is one, work with the interpreter to determine the best seating arrangement.

3. Testing Behavior (ours…not theirs)

a. Students with hearing loss are typically VERY perceptive to visual cues.  This includes looking at the correct response picture, facial expressions when they point to the right or wrong picture, small gestures used when giving the directions, etc.  Be careful!

b. Processing time…allow extra before assuming that they do not understand

Non-standardized Assessment

The gold standard of non-standardized assessment is the language sample.  A language sample provides information about vocabulary, grammar/syntax, pragmatics, answering “wh” questions, comprehension, communication breakdown repairs, and articulation/voice/fluency in context.  I always try to use a sample of 100 words or more but will use less if that is not possible for that particular student.  I can even get my percentages for new goals from the language sample I used on the assessment if the sample is good enough.  The reason I often shy away from more formal data probes is that kids with hearing loss are often therapized.  They figure out what you are asking them to do on the first trial and then get the remaining 9/10 correct.  They can often perform certain skills in isolation but do not show those skills “in real life”.

Another factor in assessing students with hearing loss is to consider their receptive language more in depth.  This may include going to levels of listening before single word comprehension.  The following is a quick list of questions that I ask myself or the parent during early childhood evaluations.

Listening Skills.

1.  Detect environmental noises?

2. Turn to name being called?

3. Understand when music is on and when it goes off?

4. Understands some single words?

5. Can follow simple routine directions? (with/without gestures)

6. Understands a wide variety of words?

7. Can follow 2 step routine directions? (with/without gestures)

8. Imitates words? (how accurately)

9. Imitates phrases/sentences? How long?

10. Makes any discrimination errors (e.g. bat vs bag, eyes vs ice, goat vs boat)?

11. Has difficulty understanding you from a distance?

12. Has difficulty understanding you in noisy situations?

13. Has difficulty understanding you if he/she can’t see your face?

14. Can answer questions about something he/she heard? With picture support? Without picture support?


Other assessment considerations

1. Information from audiology

a. Current hearing status

b. Hearing age vs chronological age

c. Recent changes in hearing or in hearing technology

2. Child developmental history/Medical history

a. Cause of hearing loss

b. Risk factors for other learning difficulties or additional diagnoses

3. Parental input for modalities and amplification/Home support of recommended communication strategies


When in doubt, ask for help!  We all have our areas that we are passionate about and this is mine.   Give me the opportunity to “geek out” with you over these students! I hope this helps!


Book Study: Therapy Applications

Today is our final book study post, so if you haven’t gotten in all your comments, please do so before you leave for winter break! Today, Lexie Cunningham shares some therapy applications based on our book:

The conundrum of school-based speech therapy is presented in a raw and real fashion in this novel, as Katherine openly discusses her disdain and disappointment with speech therapy services as a child. From a speech therapists standpoint, we are constantly faced with the moral dilemma of adverse impact. In the case of Katherine, I have asked myself over and over again what it is I would have done had she been referred for speech therapy in our public school system. Clearly there is academic impact in that she avoids speaking during classroom activities/discussions. She is a loner in social situations with peers. She has few friends, and her teachers have no idea how to handle her stutter. Yet, Katherine despises having attention directed towards her disability. She would not want to have been pulled from class for therapy. From day one she was against formal speech therapy services. In her case, she states that she liked her first speech therapist and wanted to please her. However, when she wasn’t “cured” the first go around it made a lasting negative impression on her.

From a clinical standpoint, we have all been trained on stuttering modification therapy techniques vs. fluency shaping therapy techniques. I would venture to say that most of use of combination of both in our daily practice. We arm students with the fluency shaping techniques such as easy on-set, light articulatory touch and continuous phonation. At the same time, we also educate our students on stuttering modification techniques like pull-outs, cancellations, etc. We provide a safe and loving environment for our students to practice their techniques. Like with Katherine, many of us have students who are able to be completely fluent in our therapy rooms. They politely complete the tasks we give them, come religiously every week and even convey their appreciation for our time and patience. Yet, they continue to suffer once they leave our therapy rooms. So what do we do?

In my opinion, there are three big concepts from this book that have inspired me to modify how I conduct school-based speech therapy services for students who stutter:

  1. Honesty
  2. Education
  3. Collaboration

I can say with absolute certainty that in the last ten years, I don’t think I have ever sat down on day one with a student who stutters and had a real and honest conversation with them about my role. I was teary-eyed when Katherine stated in the book that she felt like a failure when two weeks following her first formal speech therapy treatment, her stutter returned and she felt like a failure. I wonder how her childhood years might have been different had her therapist stated from the beginning that she was not going to be able to “cure” her stutter. I want to make a conscientious effort with all my students to let them know up front that I’m here because I care, because I want to give them all the knowledge I have on the subject, because I want them to go out into the world armed with some tricks up their sleeves. I want them to know that nothing in life is a guaranteed success, but that they are not alone. I wish Katherine had been given that.

I hope that all of us who read this book feel the need to do a better job of educating teachers about how to handle students that stutter. Yes…we do give them handouts about stuttering. Some of us tell teachers not to spontaneously call on our kids, to give them plenty of time to prepare if they are required to speak in front of the class, etc. But do we educate them on our own non-verbal body language and how we are impacting the feelings and anxiety of the stutterer with our eyes? Or in Katherine’s case, even the lack of eye contact? Do we do a good enough job of educating adults in our buildings about the importance of not finishing sentences? And even more importantly, do we educate our students who stutter how to be self-advocates for themselves? Katherine mentions throughout the book that she was weary of certain people based on their initial reactions to her stutter. She was constantly making assumptions about how others perceived her. Again, I wonder how her childhood might have been different had she been told at a young age not to assume that people were judging her or feeling sorry for her. She speaks during her boarding school years how she amassed a small “army” of safe people. Yet, how neat would it have been for her to have had the confidence to go up to some of those girls or to a teacher and say, “That makes me uncomfortable. I stutter. Sometimes it takes a while for me to get out my message, but it doesn’t mean that I don’t have something to say.”

The most important impact this book has had on me is the need for collaboration with my students who stutter. I realize that they know more than I do, and should really be the ones driving the therapy process. It never occurred to me that my kids probably have an elaborate system in place for maneuvering through communicative exchanges until I read chapter four. Katherine lists her “tactics for communication warfare” which included speaking in an accent, timing when to enter a conversation, and word substitution to name a few. Perhaps before we begin teaching therapy techniques, we consult with our kids on what system they already have in place. If a student knows that they don’t stutter when they speak in an accent or when singing, start with continuous phonation or a modification of melodic intonation therapy.

In the end, with all of our students not just those who stutter, it’s really about showing them that someone cares. Yes…this is a job. We show up, we do our paperwork, we see the kids, and we get our Winter Break, Spring Break, and Summer Vacation with a pay check every two weeks. But with anything in life, in the end it’s about the relationships that we have made along the way. The people that we have impacted. The courage to do the right thing and the willingness to be kind even in tough situations. So love your students. All of them. The good and the bad. You will never know the impact that you have made on them…unless they decide to travel the world and write a book!

Thanks, Lexie!