This Week in Speech Science #1

The Trifocus Framework and Interprofessional Collaborative Practice in Severe Disabilities

Authors: Susan M. Bruce, Susan M. Bashinski

Background: The majority of individuals with severe disabilities experience combined multiple disabilities and health issues. They are a diverse group of learners with complex communication needs. This literature review addresses:

  • The triadic structure of learner with disability, communication partner, and environment

  • The five strategies of the tri focus framework

  • The application of interprofessional collaborative practice (IPCP) to the triadic and tri-focus framework

Methods: Search of literature published from 1994–2015 on EBSCO and Google Scholar with keywords including name of strategy and also similar terms. Research studies included at least one individual with a severe disability.

What this means for your practice:

  • Three broad types of communicators with severe disabilities: (a) perlocutionary - preintentional and presymbolic, (b) illocutionary - intentional communicators, and (c) locutionary - intentionally use symbols.

  • IPCP is the collaboration of professionals and family members with diverse areas of knowledge and experience to provide a multidisciplinary approach in planning comprehensive communication interventions considering each learner’s cognitive, physical, visual, hearing, and tactual strengths.

  • The tri-focus framework organizes the IPCP team’s collaborative efforts in communication intervention.

  • Five instructional strategies of the tri-focus framework:

    • Enhancing sensitivity to learner communication - knowledge about learner’s communication as observed through behavior/alertness states

    • Utilizing routines - emphasis on daily activities that include a few specific elements, repetitive, and turn-taking

    • Increasing communication opportunities - provide communication temptations to facilitate increase in rate and intent of communication

    • Modifying the communication environment - consider the learner’s behavioral state and modify the tactile environment, auditory environment, visual environment, and taste and smell as appropriate.

    • Augmenting input - increase the learner’s receptive language by communication partner using pictures, SGDs, gestures, touch cues, or object cues to support comprehension.

Mary’s Case: An Illustration of Interprofessional Collaborative Practice for a Child With Severe Disabilities

Authors: Billy T. Ogletree, Nancy Brady, Susan Bruce, Evan Dean, MaryAnn Romski  Lorraine Sylvester, and David Westling

Background: Interprofessional collaborative practice (IPCP) was embraced by the American Speech-Language-Hearing Association (ASHA) in 2013 when working with persons with severe intellectual and physical disabilities. IPCP team members collaboratively work with other disciplines, patients, and family members to meet the needs of individuals with severe disabilities.

Participants: Single subject narrative of Mary encompassing from early childhood to young adult. Initially diagnosed with failure to thrive and later with spastic cerebral palsy, bilateral moderate hearing loss, and visual impairments with corrected functional vision.

Method: IPCP practitioners who worked with Mary from the following disciplines occupational therapy (OT), physical therapy (PT), special education, and speech-language pathology (SLP)  provide a case history and highlight optimal and missed IPCP opportunities throughout each stage of her intervention.

What this means for your practice:

The Early and Preschool Years

  • Positive IPCP Examples: Early services were team based with family directly involved; preschool staffing meetings included sharing by PT on collaborating;

  • Missed IPCP Opportunities: Lack of family engagement beyond initial assessment and treatment; a more integrated treatment approach; functional behavior assessment to determine expressive communicative functions; SLP reluctance to introduce AAC;

Elementary School Years

  • Positive IPCP Examples: Interprofessional collaboration principles towards assessment; introduction of speech generating device (SGD); family involvement

  • Missed IPCP Opportunities: As the development of communication skills and improved mobility and motor skills emerged, this raised new issues that were not always embraced (i.e., impact of visual impairment on ambulation, understanding her idiosyncratic communication, SGD that was permitted to go home)

Middle School to Current Day

  • Positive IPCP Examples: Team recommitment as she moved from the 9th grade; collaborative stance on her services; highly engaged family in assessment and treatment practices;

  • Missed IPCP Opportunities: Services lost momentum in 8th and 9th grade; incorporating benefits counselor (i.e., Medicaid waiver support, supplemental security income, social security disability insurance); access to the regular curriculum, consider variety of postschool life options        

Novel Morpheme Learning in Monolingual and Bilingual Children

Authors: Margarita Kaushanskaya, Megan Gross, Enanna Sheena, and Rachel Romana

Background: Recognized difficulty exists in establishing whether low scores on language measures in bilingual children suggest a language impairment or a momentary interruption in language knowledge. One alternative to standardized measures include limited training tasks where children are briefly introduced to information and tested on their ability to retrieve and apply this information. Limited training tasks have demonstrated sensitivity toward language impairment in monolinguals, such as where children are taught a new derivational morpheme, however validity has not been established for bilingual populations. There is a need to determine if this training tasks is sensitive to diverse bilingual populations.

Participants: Three groups of typically developing 5 to 6 year-old children:

  1. 25 monolingual English speakers

  2. 28 Spanish L1 bilinguals

  3. 19 English L1 bilinguals.

Method: Parent interview obtained to determine child’s developmental history, education, language use and exposure, relevant medical history, and family background. Parents also provided information about their level of education. Children participated in 2 to 3 testing sessions in which the novel morpheme learning task was given at the start of a session.                       

What this means for your practice: Based on the outcomes of this study across the three language groups, it suggests that this derivational morpheme learning task is perhaps appropriate to be further investigated to determine its sensitivity toward language impairment in English-Spanish speaking bilingual students. It is noted that levels of language exposure are based solely on parental report.

Assessing the Amount of Spontaneous Real-World Spoken Language in Aphasia: Validation of Two Methods

Authors: Michelle M. Haddad, Edward Taub, Gitendra Uswatte, Margaret L. Johnson, Victor W. Mark, Ameen Barghi, Ezekiel Byrom, Xiaohua Zhou, and Christina M. Rodriguez

Background: Aphasia therapy can increase language use in the clinic. But what about in real-life, spontaneous situations? What assessments are there to look at functional communication? Can assessments include the patient, instead of simply being about the patient?

Current assessments include: 

  • Communicative Effectiveness Index (CETI) - filled out by caregiver, no patient report. Also includes nonverbal communication - what if you only want to test oral expression?

  • American Speech-Language-Hearing Association Functional Assessment of Communication Skills (ASHA-FACS) and the Communication Activities of Daily Living Scale, 2nd Edition  - clinician assesses social communication and daily living skills. But this may be inaccurate if the clinician doesn’t interact with the patient outside the therapy setting.  

  • Communicative Participation Item Bank (CPIB) - filled out by patient, written response. Written expression is impaired in aphasia. Also, it goes broader than language-related deficits - may be too broad for SLP purposes.

Therefore, Haddad and colleagues created the Verbal Activity Log (VAL). They claim that the VAL is faster and more objective than other assessments. It has similar questions to the CETI, but both the patient report the answers. Also, the questions are less open-ended than the CPIB.

Participants: 16 people with aphasia.

Methods: Patients and caregivers were given the VAL, caregiver was given the CETI, patient was given the Western Aphasia Battery, Revised (WAB-R), and patient was asked to wear a tape recorder for 8 waking hours.  

The researchers compared the audio recordings to the VAL responses, and found that they are very similar. They also note that the VAL has more precise questions than any of the other tests.

What this means for your practice: This article shows that there are many considerations that need to be taken when assessing patients’ language outside of therapy. The assessments chosen must accurately show the client’s abilities, but not (a) be too complex for the client to comprehend, or (b) ignore the client’s input. The VAL attempts to rectify these problems.

Comprehensive Literacy Instruction, Interprofessional Collaborative Practice, and Students With Severe Disabilities

Author: Karen A. Erickson

Background: Literacy is an essential part of communication, especially in the academic setting. This article explores how SLPs can provide literacy instruction to students with severe disabilities.

Some Solutions:

  • Make sure that literacy instruction is comprehensive, i.e. it must address word meaning, written language comprehension, and fluency. This should be done in a similar way to literacy instruction for typically developing children.

  • Work on concepts of emergent literacy (also known as preliteracy), such as print awareness. Ways to foster emergent literacy include:

    • Shared reading, including dialogic reading (where the adult encourages the child to talk about the book, and expands upon those utterances).

    • Independent reading, even if the child cannot comprehend text. Use electronic books or book-related apps if more accessible options are needed.

    • Shared writing. These activities can involve adults writing what the child says, the child assembling sentences based on what they have previously said, etc.

    • Independent writing - This can be done on a computer keyboard or eye-gaze system if accommodations are needed.

    • Alphabet Knowledge. During shared reading, the professional can talk about letters and the sounds they make. In addition, students can learn about letters through alphabet toys and pairing letters with mnemonics.

Once emergent literacy has been established, then comprehensive conventional reading and writing can be taught, including:

  • Reading Comprehension. One way to increase reading comprehension is to do activities that require children to integrate and apply knowledge they learn in books in their lives.

  • Self-Directed Reading. This gives students more autonomy in selecting what they read, which improves their literacy outcomes.

  • Word Study. This will improve reading fluency, as students will spend less time decoding words. This can be taught either by spelling-based on onset-rime-based instruction methods.

  • Writing. Though it is important, it is often difficult to teach to students with severe disabilities. This article recommends teaching students how to select writing topics, and how to organize thoughts into writing.

What this means for your practice: Using the concrete suggestions mentioned in the article with help SLPs effectively teach literacy skills to students of all abilities.

This Week in Speech Science #2