Client is an 8.5 year old bilingual boy referred for treatment of a moderate fluency disorder characterized by repetitions, prolongations, and blocks. He has a history of sound distortions that were resolved, as well as recurrent ear infections. Evaluation found moderately severe stuttering involving sound and word repetitions, with concomitant behaviors like tension. Testing found awareness of his stuttering impacts his experiences at school. Treatment is recommended to teach fluency techniques and address attitudes, with a good prognosis given his age and motivation.
Here is a great review of fluency for SLPs. It includes information regarding assessment and treatment, as well as consideration when working with bilingual students who have fluency disorders.
Speech sound disorders is an umbrella term referring to any combination of difficulties with perception, motor production, and/or the phonological representation of speech sounds and speech segments that impact speech intelligibility.
Known causes of speech sound disorders include motor-based disorders (apraxia and dysarthria), structurally based disorders and conditions (e.g., cleft palate and other craniofacial anomalies), syndrome/condition-related disorders (e.g., Down syndrome) and sensory-based conditions (e.g., hearing impairment.
Speech sound disorders include Articulation disorder & Phonological disorder.
Assessments include screening and detailed comprehensive assessment.
Effective treatment of speech sound disorder include Contrast therapy, Core vocabulary approach ,Cycles Approach, Distinctive feature therapy, Naturalistic speech intelligibility intervention,Non speech oral motor therapy,Speech sound perception training.
Here is a great review of fluency for SLPs. It includes information regarding assessment and treatment, as well as consideration when working with bilingual students who have fluency disorders.
Speech sound disorders is an umbrella term referring to any combination of difficulties with perception, motor production, and/or the phonological representation of speech sounds and speech segments that impact speech intelligibility.
Known causes of speech sound disorders include motor-based disorders (apraxia and dysarthria), structurally based disorders and conditions (e.g., cleft palate and other craniofacial anomalies), syndrome/condition-related disorders (e.g., Down syndrome) and sensory-based conditions (e.g., hearing impairment.
Speech sound disorders include Articulation disorder & Phonological disorder.
Assessments include screening and detailed comprehensive assessment.
Effective treatment of speech sound disorder include Contrast therapy, Core vocabulary approach ,Cycles Approach, Distinctive feature therapy, Naturalistic speech intelligibility intervention,Non speech oral motor therapy,Speech sound perception training.
Making Best Use of Speech-Language Therapy: When to Refer and What to ExpectBilinguistics
In this presentation, we discuss speech and language in school-age youth, identify when referral for Speech-Language Evaluation and Therapy would benefit the patient, and explain utilization of Alternative and Augmentative Communication (AAC).
How to Prevent Autism by Teaching At-Risk Infants and Toddlers to Talk
Presented at: Florida Association for Behavior Analysis Convention
September 2006
Authors: Philip W. Drash, Ph.D., BCBA,
Autism Early Intervention & Prevention Center, Tampa, FL
and
Roger M. Tudor, Ph.D.
Westfield State College, Westfield, MA
Bilingual Evaluations: Writing the FIE report for Bilingual StudentsBilinguistics
The cultural diversity of our caseloads is growing exponentially. Correctly identifying children with speech and language disorders is made easier by understanding how to use 1) the referral process, 2) the interview process, 3) formal assessment, 4) alternative assessment, and 5) reporting procedures to reduce our work and create truly rich data to confidently diagnose a child.
Getting rid of speech difficulties and swallowing disordersBrandon Ridley
Speech, language, and swallowing disorders are common challenges many children across the globe face. About 11% of the total population of these children (explicitly falling in the age group three to six years) have the highest recorded cases of these disorders, followed by those between the ages of seven and ten years (9.3%), and finally, preteens and teenagers with ages ranging from 11 to 17 years (4.9%).
Therapy for Communication Disorders in Children.pdfPiyushSharma12895
Resonance or voice disorders are issues with the pitch, volume, or quality of the voice that interrupt the message. A child in these circumstances may experience distress or torture while speaking.
Early detection and treatment can meet the child's developmental needs and prevent further delays. TalktoAngel helps people improve their communication skills through a variety of methods. The language teacher is powerful for the two youngsters and grown-ups.
Annotated bibliography prespared for a special education class. Ten papers presented. This bibliography involves hearing loss, with which I have some prior employment experience.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. Boston University
Rehabilitation Services
Academic Speech and Language Center
Name: Client
Clinician: Christina Deery, BS
Supervisor: Diane Parris, MS, CCC/SLP, BRS/FD
Presenting Problem
Client, an 8.5 years old bilingual male, presents with a moderate fluency disorder
characterized by whole and part word repetitions, prolongations, and blocks.
Concomitant behaviors include audible inhalations, poor eye contact, moving hands
about the face, foot tapping, and noticeable tension in the neck muscles. Client was
referred to the Boston University Speech and Language Center by Joseph Dorko, MS,
CCC/SLP at Boston Medical Center where an initial evaluation was conducted on
December 1, 2006. This evaluation indicated the presence of a fluency disorder and
recommended treatment at this facility.
History
The following information was obtained from case history form and parent interview
conducted on February 2, 2007 with Client’s father. Previous evaluations addressing
articulation, voice, and fluency concerns have been conducted at Boston Medical Center
(December 2006), Massachusetts General Hospital (July 2003, May 2004) and through
the XX public school system (March 2004). Past medical history and significant findings
from these evaluations have been included in this report.
Client is the first and only born child of Mr. & Mrs. XX. Due to the fact that Client was
born out of the country, there are no medical records available before January of 2003,
when he and his family moved to the United States. However, parent report and previous
evaluations indicate that labor and delivery as well as the initial neonatal period were
unremarkable. Client’s past medical history is remarkable for a submucous cleft and
recurrent otitis media, which was successfully treated with antibiotics and bilateral PE
tube placement in October 2002. He had a complete audiological evaluation in May
2003 with results suggesting normal hearing.
Developmental motor milestones were reported within the anticipated time frames.
Parent report indicates that Client received speech services in Columbia to resolve sound
distortions of the phonemes /s, z, sh/ and nasal emissions, difficulties consistent with the
diagnosis of submucous cleft palate. Client’s mother reports that she was pleased with
these services, and indicates that they were successful in resolving his misarticulations
and hypernasality.
Client currently resides in XX with his mother and father in a Spanish-speaking
household. Prior to moving to the United States at age 4, Client was a monolingual
Spanish speaker, and had limited exposure to English. Upon arriving in America, he was
Client File #:
2. enrolled in Kindergarten at the William McKinley School in MA in an English-speaking
classroom.
Client is currently in the third grade at XX Elementary School. Case history indicated
above average performance in history, mathematics, and science, and below average
performance in reading and language arts. Client receives special services in reading
after school.
Client’s father reports that Client is a respectful and smart boy who enjoys playing soccer
and riding his bike. His parents feel that he has adjusted well to living in the United
States, and has strong social and peer relationships.
Previous Evaluations
An evaluation at Massachusetts General Hospital XX Healthcare Center (MGH) in July
2003 revealed sound distortions of /s, sh, z/, and the presence of a mild/moderate fluency
disorder characterized by sound prolongations and word/phrase repetitions. Services
were rendered at MGH for two sessions before Client was discharged to the XX public
school system.
An evaluation within the XX public school system was conducted in March 2004 based
on recommendations from MGH. Vocal quality and fluency of speech were judged to be
within normal limits during this evaluation. Mildly impaired speech intelligibility was
observed in spontaneous speech, and was thought to be caused by rapid speech rate and
final sound/syllable deletions. Articulation testing revealed substitutions of f/th
(unvoiced) in all positions of words, and b/v in the medical position of words. Based on
the findings of this evaluation, direct speech and language services were not
recommended through the public school system. Fluency and vocal quality did not
appear to be interfering with Client’s academic performance or peer interactions.
A follow-up evaluation at MGH in May 2004 was conducted to address continued parent
concerns regarding fluency. At this time, Client’s mother hoped to re-initiate services
through MGH since Client did not qualify for services through the public school. Results
of this evaluation indicated the presence of a moderate/severe fluency disorder,
characterized by sound/syllable repetitions, interjections, and blocks. Secondary
behaviors included facial grimacing and body movements. Avoidance behaviors
included changing words mid sentence. Voice, pragmatic, and receptive and expressive
language skills were judged to be within normal limits. Client’s sound distortions and
hypernasal voice quality appeared at that time to have resolved. As a result of this
testing, individual therapy was recommended. Two sessions were attended before Mr.
and Mrs. Cardona reported seeking other services to better match their child’s needs and
learning style.
Client was seen for a fluency evaluation at Boston Medical Center in December 2006
following a referral from Client’s pediatrician, Dr. S. At the time of this evaluation,
Client’s mother was noted to be increasingly concerned about Client’s fluency, which she
felt had been gradually increasing in frequency and severity. She also indicated that
Client File #:
3. Client was being teased by his classmates, and had several negative experiences in the
classroom related to stuttering. The findings of this evaluation were consistent with the
previous evaluation at MGH. Results indicated the presence of a moderate/severe
fluency disorder characterized by part/whole word repetitions of 2-3 iterations,
prolongations, and blocks with some secondary and avoidance behaviors evident. Based
on this evaluation, it was recommended that Client receive speech services through the
Boston University Clinic.
Behavioral Observations
Client is a polite and friendly boy who cooperated throughout today’s evaluation. He
spoke openly about his stuttering, and was easily engaged in conversation about school
and sports. Today’s evaluation is felt to be a reliable representation of his speech and
fluency behavior.
Fluency of Speech
The Stuttering Severity Instrument for Children and Adults, Third Edition (SSI-3) was
administered to Client to evaluate the severity, frequency and concomitant secondary
behaviors associated with his disfluencies. Two speaking situations were analyzed
including a picture description task and an age appropriate oral reading sample for a total
300 syllables. Client received a total overall score of 27 on this measure out of a possible
56 which corresponds with a moderately severe rating when Client’s score is compared to
other school age children who stutter. Disfluencies consisted primarily of sound
repetitions, whole and part word repetitions of on average two iterations, prolongations,
and blocks. Several disfluencies were noted to occur in clusters (i.e. prolongation +
block, sound repetition + word repetition). The average length of Client’s three longest
stuttering events was 1 second. Concomitant behaviors associated with Client’s
stuttering events included noisy breathing, poor eye contact, visible neck tension, and
movements of the extremities (including moving hands about the face and foot tapping
and swinging). In conversational speech, Client was noted to use a high frequency of
interjections (i.e. uh, um, like), and often included a prolonged and audible starter to the
initial position of words (i.e. mand, mbut, hdo) during which visible tension in the
neck was observed. Frequent and quick inhalations as well as poor breath support were
also observed on some occasions. Two instances of word substitutions were noted in the
reading passage indicating the possible presence of avoidance behaviors.
Client completed Brutten’s Children’s Attitude Test (CAT) with a score of 23 (mean
score of children who stutter = 16.7; mean score of children who do not stutter = 8.7).
This score indicates that Client has awareness and concern about speaking. Client’s
father has indicated that there have been some difficult situations in school, which have
escalated to the point of Client indicating to his parents that he does not want to go to
school anymore. Client has commented that children often imitate his speech, and make
fun of his stuttering. He has not developed any strategies for dealing with bullying.
Other
Informal observation of articulation indicated the presence of all age appropriate sounds
in connected speech. Vocal quality and resonance were judged to be within normal limits.
Client File #:
4. An informal observation of Spanish and English language use in connected speech
indicates that it is within normal limits for conversational purposes. In addition, all
previous evaluations have found receptive and expressive language to be in the average
range. Reading skills were not assessed at the time of this evaluation as they are being
addressed in the school setting. Pragmatic skills were considered a strength.
Summary and Impressions
Client is a friendly and polite 8.5 years old bilingual boy who presents with a moderate
fluency disorder characterized by part and whole word repetitions, prolongations, clusters
and blocks. A high frequency of interjections and revisions were also noted in
conversational speech. Client appears to have awareness of his disfluencies and parent
report indicates that teasing and other negative speaking experiences are occurring more
frequently at school.
The prognosis for improved fluency of speech given appropriate intervention is excellent.
Positive prognostic indicators include Client’s age, supportive family, and motivation to
become fluent.
Recommendations
1. It is recommended that Client be seen for weekly individual fluency treatment
sessions. Sessions should be for one hour in length.
2. Treatment should include the following:
a. Increasing Client’s understanding of speech and disfluency. This will be addressed
though education of the basic anatomy for speech and identification of stuttering
moments.
b. Increasing fluency by teaching fluency enhancing techniques such as Easy Relaxed
Approach-Smooth Movement. This approach combines slight reduction in the rate of
speech and physical tension in speech muscles, and gradual movement into the rest of
sentences using normal speech pattern (Reardon & Yaruss, 2004). This approach will
be presented in a hierarchy beginning with words, moving to sentences and
eventually to structured conversational speech and reading. Eventually these new
behaviors should be transferred to “real-life” speaking situations that gradually
increase in difficulty.
c. Teaching stuttering modifications including pull-outs as a tool for Client to use during
moments of disfluency.
d. Counseling Client and his family about the nature of the disorder, feelings and
attitudes associated with stuttering, and available resources for children who stutter.
3. Testing of Client’s receptive and expressive language skills is recommended to
determine if there are additional factors contributing to his disfluency.
It has been a pleasure to work with Client and his family. Please feel free to call with
parental consent for further information: 617-353-7479.
___________________________
____________________________________
Client File #: