Podcasts about Hearing Research

Does having a speech sound disorder put a preschooler at risk for persistent language and literacy delays? The latest research includes 290 effect sizes that compare children with speech sound disorders to their neurotypical peers. It indicates that the risk for children with speech sound disorders is greater for both language and literacy delays, and these delays, sadly, tend to worsen over time. Check out this episode and leave empowered with three steps you can take today to improve speech, language, and literacy outcomes when treating speech sound disorders. Ready to DSD? Don't delay. Roll up your sleeves and join the SIS membership at kellyvess.com/sis today. You can join for a month, receive powerful speech and language targets, and simply unsubscribe if it isn't for you. Walquist-Sørli, L., et al. (2025). Are speech sound difficulties risk factors for difficulties in language and reading skills? A systematic review and meta-analysis. Journal of Speech, Language, and Hearing Research, 68(1), 164–177. https://doi.org/10.1044/2024_jslhr-24-00170

Meta-analytic research indicates that speech-language therapists do not improve language comprehension for students with developmental language disorders. However, multiple studies have indicated that explicit narrative, story-retelling interventions can produce robust gains in language comprehension and expression. Put empirically-based strategies into practice this week by joining the SIS Membership at kellyvess.com Watch a free, 3-intervention secret workshop by clicking here. References: Law, J., Garrett, Z., & Nye, C. (2004). The efficacy of treatment for children with developmental speech and language delay/disorder. Journal of Speech, Language, and Hearing Research, 47(4), 924–943. https://doi.org/10.1044/1092-4388(2004/069)Pico, D. L., Hessling Prahl, A., Biel, C. H., Peterson, A. K., Biel, E. J., Woods, C., & Contesse, V. A. (2021). Interventions designed to improve narrative language in school-age children: A systematic review with Meta-analyses. Language, Speech, and Hearing Services in Schools, 52(4), 1109–1126. https://doi.org/10.1044/2021_lshss-20-00160Rinaldi, S., Caselli, M. C., Cofelice, V., D'Amico, S., De Cagno, A. G., Della Corte, G., Di Martino, M. V., Di Costanzo, B., Levorato, M. C., Penge, R., Rossetto, T., Sansavini, A., Vecchi, S., & Zoccolotti, P. (2021). Efficacy of the treatment of developmental language disorder: A systematic review. Brain Sciences, 11(3), 407. https://doi.org/10.3390/brainsci11030407

For our final Big Sky conversation, we sit down with Dr. Julie Washington from UC Irvine to explore how language, dialect, and poverty intersect in literacy. Dr. Washington brings her wealth of experience as a speech-language pathologist to discuss the unique challenges of identifying reading disabilities in African American children, dialect's role in learning, and how systemic biases impact educational outcomes. It's an eye-opening conversation highlighting the critical need to understand and support students from all linguistic backgrounds. Julie Washington, Ph.DS., CCC-SLP. Dr. Julie Washington is a professor at the School of Education at the University of California – Irvine (UCI) and a fellow of the American Speech-Language-Hearing Association. As a Speech-Language Pathologist, she directs the Learning Disabilities Research Innovation Hub, funded by NICHD, and the Dialect, Poverty, and Academic Success Lab at UCI. She also serves as the Editor-in-Chief of the language section of the Journal of Speech, Language, and Hearing Research. Dr. Washington's research explores the intersection of literacy, language variation, and poverty, focusing on understanding the role of language dialects in assessing and identifying language and reading disabilities in African American children. She also focuses on improving methods to develop oral language and written language skills in children growing up in poverty.  Theme SongSound of Home, composed and performed by Jens Koch and recorded at Yellowstone Lake in Yellowstone National Park. All rights to the recording and song are reserved by Jens Koch. Find him on Spotify.Share your thoughts and follow your host on X @OdegardTim

Join voice scientist, Dr Ingo Titze and Speech and Language Pathologist, Karin Titze-Cox as they discuss their book 'Voices Free after SOVT', exploring the science and application of Semi-Occluded Vocal Tract exercises. They delve into the benefits, implementation, and clinical applications of SOVTs, including using straws and tools to improve vocal health and performance. The interview is preceded by a brief review of the book from singing teacher and podcast host, Alexa Terry. KEY TAKEAWAYS The book 'Voices Free after SOVT' provides a comprehensive understanding of the science and application of SOVT exercises. SOVT exercises can be beneficial for singers, clinicians, teachers, and anyone interested in understanding the mechanics of the voice. Repetition, analogy, and clear explanations are used in the book to make complex concepts accessible to a wide audience. Different types of SOVT exercises have varying intraoral pressures and can be used to achieve specific vocal objectives. SOVT exercises can be used for evaluation, conditioning, and rehabilitation in clinical settings. SOVT exercises, such as using straws, can be beneficial for vocal health and performance. Finding the right resistance and pressure is important for effective SOVT exercises. Different materials and configurations can be used for SOVT exercises, depending on individual preferences and needs. SOVT exercises can help improve vocal resonance, muscle tension, and overall vocal technique. BEST MOMENTS  "When you pick up a book by Ingo Tietze and Karen Tietze-Cox, you know you're entering academic territory." "The deeper you go into the water, the less the tube or the straw makes a difference." "The material doesn't really matter much. That's our first conclusion." EPISODE RESOURCES BAST Book A Call https://ncvs.org/ Get your copy of  ‘Voice is FREE after SOVT' here: https://ncvs.org/book-purchase-voice-is-free-after-sovt/ Further watching: Why Straw – NCVS The Science Behind the Straw Exercise: Video 1  NCVS.org The Science Behind the Straw Exercise: Video 2 NCVS.org The Science Behind the Straw Exercise: Video 3  NCVS.org High Resistance Straw in Water (Karin Titze Cox and Ingo Titze) short update Relevant Links & Mentions:  Singing Teachers Talk: Ep.131 Mastering Research Papers: How to Read with Ease and Extract Knowledge with Kate Cubley Chris Johnson's Teach Voice: https://www.teachvoice.com/ John Henny: https://johnhenny.com/ The Intelligent Vocalist: Episode 356: SOVTs with Karin Titze Cox & Ingo Titze The work of Marco Guzman The work of Anne-Maria Laukkanen  Lessac-Madsen Resonant Voice Therapy  Singing Teachers Talk: Ep.164 Music and the Brain: The Science of Learning & Practice with Dr Molly Gebrian Part One Singing Teachers Talk: Ep.165 Music and the Brain: The Science of Learning & Practice with Dr Molly Gebrian Part Two Journal of Speech and Hearing Research: https://pubs.asha.org/journal/jslhr The work of Kitty Verdolini Abbott  (Singer) Renee Flemming  Vocal Tubes: https://www.vocaltubes.com/ Belt Box: https://www.beltyafaceoff.com/ Mindy Pack: https://www.mindypack.com/shop Resono Straw by Oren Boder: https://www.rayvox.co.uk/collections/all ABOUT THE GUEST  Ingo R. Titze, known as the father of vocology, coined the term with George Gates in 1989 and developed the original vocology curricula in 1990. He has held various appointments and written over 500 publications and six books on voice production. Karin Titze Cox, SLP-CCC, specialises in vocology and voice habilitation. She received her BA from BYU and MA from University of Iowa. She's worked in research, private practice, and clinic director roles in Salt Lake City. She's served on the Pan American Vocology Association board and National Center for Voice and Speech executive board.  

In this week's episode we speak start with a few reflections on NAIDOC Week and how Aboriginal and Torres Strait Islander ways of knowing, being, and doing add to our profession. Next, we speak with Dr Alice Hart from Curtin University about an approach for stuttering that includes both fluency and cognitive/behavioural supports. She discusses elements of Acceptance and Commitment Therapy, and the role that mindfulness and acceptance/values-focus can play in the fluency, communication, and quality of life for people who stutter. Resources: ACT Mindfully. (2024). Free resources. https://www.actmindfully.com.au/free-stuff/ Beilby, J., & Yaruss, J. S. (2018). Acceptance and Commitment Therapy for stuttering disorders. In B. J. Amster & E. R. Klein (Eds.), More than fluency: The social, emotional, and cognitive dimensions of stuttering (pp. 111-130). Plural Publishing, Inc. Harris, R. (2019). ACT Made Simple (2nd ed.). New Harbinger Publications, Inc. Hart, A. K., Breen, L. J., & Beilby, J. M. (2021). Evaluation of an integrated fluency and Acceptance and Commitment Therapy intervention for adolescents and adults who stutter: Participant perspectives. Journal of Fluency Disorders, 69, 105852. https://doi.org/10.1016/j.jfludis.2021.105852 Hart, A. K., Breen, L. J., Hennessey, N. W., & Beilby, J. M. (2024). Evaluation of an integrated fluency and Acceptance and Commitment Therapy intervention for adolescents and adults who stutter. Journal of Speech, Language, and Hearing Research, 67, 1003-1019. https://doi.org/10.1044/2023_JSLHR-23-00252 Speak-Up S05 E36: Stutter-affirming approaches and positive stuttering identity with Dr Christopher Constantino: https://soundcloud.com/speechpathologyaustralia/stutter-affirming-approaches-and-positive-stuttering-identity-s05e36 NAIDOC week resources: NAIDOC: https://www.naidoc.org.au/ Fed square flag raising: https://fedsquare.com/events/naidoc-week-2023-flag-raising NAIDOC week events: https://www.naidoc.org.au/local-events/local-naidoc-week-events First Nations Classic books series one: https://www.uqp.com.au/books/pack-of-eight-first-nations-classics First Nations Classic books series two: https://www.uqp.com.au/books/pack-of-eight-first-nations-classics-series-two SPA Aboriginal and Torres Strait Islander Culturally Responsive Capability Framework: https://www.speechpathologyaustralia.org.au/public/libraryviewer?ResourceID=884

Hearing loss in rural adolescents is almost double that of the general population of children. We might think of rural areas as peaceful and quiet, but sometimes it gets loud enough to cause harm. Our expert for this episode is Leigh Ann Reel, Au.D., Ph.D., Director of the Center for Speech, Language, and Hearing Research in the Doctor of Audiology Program of the TTUHSC School of Health Professions. Reel talks about hearing loss risks, diagnosis and treatment of noise-induced hearing loss in adolescents. 

Ann Densmore is a certified speech pathologist and audiologist with a doctorate in education from Clark University (specialty in child discourse) and a master's in human development and psychology from Harvard University Graduate School of Education.Resources:Douglas S, Dunkel-Jackson, Sun T, Owusu P (2022). A review of research related to the POWR intervention: a Communication partner intervention to support children with neurodevelopmental disorders, Current Developmental Disorders Reports, https://doi.org/10.1007/s40474-022-0244-6.Vallotton C, Mastergeorge A, Foster T, Decker K, Ayoub C (2017). Parenting supports for early vocabulary development: Specific effects of sensitivity and stimulation through infancy, Infancy, 22(1):78-107. doing: 10.1111/infa.12147. Knolle F, Vallotton C, Ayoub C (2018). Maltreated children use more grammatical negations, J Fam Child Stud, 27:453-464, dot:10.1007/s10826-017-0905-3. Olswang L, Prelock P (2015). Bridging the gap between research and practice: Implementation science, Supplement Article, J Speech, Language, and Hearing Research, doi:10.1044/2015_JSLHR-L-14-0305. Densmore A, Helping Children with Autism Become More Social (2007). Greenwood Publishing Company.

Get .1 ASHA CEU: https://courses.slpnerdcast.com/courses/podcast-quiz-foundational-knowledge-in-adult-dysphagia-abje0044Episode SummaryDɪsfeʒə? Dɪsfɑʒə? Təmeto, təmɑto? That is one of the many questions tackled in this week's episode with Dr. Lindsey Griffin, a leading professional in the field of adult dysphagia and assistant professor at Emerson College in Boston. For those of you not practicing in the field of swallowing, this episode will certainly ring some grad school bells as Dr. Griffin walks us through some swallowing bascs that include a refresher on the phases of swallowing and some tried and true strategies to support individuals with swallowing challenges (You guys remember the good ol' chin tuck, right?). Working in this area of our field already? You'll enjoy some powerful discussions on evidence-based, person-centered decision-making in dysphagia practice amongst several remaining resource and research limitations. Listen in and learn about the difference between restorative exercises and compensatory strategies, the why and how of tailoring intervention techniques to an individual's physiological impairments, and the role of technology in dysphagia care. You will no doubt find yourself following along with the maneuvers discussed, just make sure to swallow your coffee first!So, grab a plate of “minced and moist” snack foods and cozy up with Kate, Amy and Dr. Griffin for some nerdy swallow chat! You can learn more about Dr. Griffin here.Summary Written by Tanna Neufeld, MS, CCC-SLP, Contributing EditorLearning Outcomes1. Describe the difference between restorative exercises and compensatory strategies 2. Relate three restorative treatment techniques to the targeted physiological impairment3. Identify two devices used in dysphagia rehabilitationReferencesBhutada, Ankita M., et al. “Factors Influencing Initiation of Pharyngeal Swallow in Healthy Adults.” American Journal of Speech-Language Pathology, vol. 29, no. 4, 2020, pp. 1956–1964., doi:10.1044/2020_ajslp-20-00027.Humbert, Ianessa A., et al. “Swallowing Kinematic Differences Across Frozen, Mixed, and Ultrathin Liquid Boluses in Healthy Adults: Age, Sex, and Normal Variability.” Journal of Speech, Language, and Hearing Research, vol. 61, no. 7, 2018, pp. 1544–1559., doi:10.1044/2018_jslhr-s-17-0417.Martin-Harris, Bonnie, et al. “MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard.” Dysphagia, vol. 23, no. 4, 2008, pp. 392–405., doi:10.1007/s00455-008-9185-9.Valenzano, Teresa J., et al. “Respiratory–Swallow Coordination in Healthy Adults During Drinking of Thin to Extremely Thick Liquids: A Research Note.” Journal of Speech, Language, and Hearing Research, vol. 63, no. 3, 2020, pp. 702–709., doi:10.1044/2019_jslhr-19-00163.OTHER REFERENCE ON LAPTOPOnline Resources:IOPI: https://iopimedical.comEMST (Expiratory Muscle Strength Training): https://emst150.com/IDSI (International Dysphagia Diet Standardization Initiative): https://iddsi.org/ Disclosures:Lindsay Griffin Financial Disclosures: Lindsay is an employee of Emerson College. Non-financial: Lindsay is a member of ASHA SIG 13 and the Dysphagia Research SocietyKate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. Time Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Descriptions of the difference between restorative exercises and compensatory strategies 15 minutes: Descriptions of restorative treatment techniques to the targeted physiological impairment 10 minutes: Descriptions of devices used in dysphagia rehabilitation 5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Speech Language Pathology: Continuing Education Courses by SLP Nerdcast Course Title: Access Research Beyond the PaywallGet .05 ASHA CEUs and view the full course landing page: https://courses.slpnerdcast.com/courses/access-research-beyond-the-paywall-abje0132Earning Speech-Language Pathology CEUs Online is Simplified with SLP Nerdcast. On SLP Nerdcast you'll find SLP Continuing Education Courses, Masterclasses and Clinical Resources. To learn more about our services visit ▶ https://bit.ly/SLPNERDCAST To learn more about our membership and save 10% on your first year of membership visit ▶ https://bit.ly/SLPNerdcastMembership use code “YouTubeNerd” to save.Learning Objectives:Describe five free and legal strategies for accessing research articles Identify common myths about accessing research articlesExplain the different versions of research articles that authors may share References & Resources:Pfeiffer, D. L., Long, H. L., & Amin, M. E. (2022). Access Research Beyond the Paywall: Five Strategies to Read What You Need. Leader Live. https://leader.pubs.asha.org/do/10.1044/2022-0919-slp-aud-research/full/ Gaeta, L., & Harold, M. (2022, February). Clinical Access to Research in CSD: Myths and Money. Hosted by CSDisseminate. Available at: https://www.csdisseminate.com/events El Amin, M., Borders, J. C., Long, H., Keller, M. A., & Kearney, E. (2022). Open science practices in communication sciences and disorders: A survey. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2022_JSLHR-22-00062 Long, H. L., Drown, L., & El Amin, M. (2023). The effect of open access on scholarly and societal metrics of impact in the ASHA Journals. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2022_JSLHR-22-00315 Twitter thread: https://twitter.com/AcademicChatter/status/166642421185693286412 Foot LadderUnpaywallPaperPanda

To book an exclusive spot in our High Performance Leadership summit head here: https://www.trialtitudeperformance.com.au/registration1660014924140We have spoken about living with disability on this podcast before, but one disability that we don't often understand the full impacts of is deafness.Today's guest is David Brady and he has ample experience to share, including his insights into living with hearing loss. Profoundly deaf since birth, David grew up in rural Armidale, NSW and overcame many challenges. David was the Chief Executive Officer of Hear For You from 2013 to 2021. Prior to this, he worked in the Sports and Recreation management industry for 15 years. David represented Australia at the 2005 Deaflympic Games in Melbourne and played state-level Water Polo, Hockey, and Beach Volleyball. He is the current Chairperson of Deafness Forum Australia, member of the Advisory Board for Macquarie University Centre for the Implementation for Hearing Research, and was one of the architects of the Commonwealth Government Roadmap for Hearing Health for Australia.In this episode Dave shares:What his life was like growing up deafDespite his hearing impairment he was determined to be more than people expected, from getting his HCS to graduating UniversityThe negative reactions people had to accommodations for his disabilityWhether to put deafness on your resume or not.Being an athlete and the barriers around communicating on the sporting field.How he took his career further than anyone ever expected, and became a leader. The moment he heard his daughter for the first time.How he has contributed and wants to continue to contribute to the NDIS.Key Quotes“Do you put deaf in your resume? They'll immediately focus on your disability, or use it to tick off a box, and use you.”“When people are not including you you've got to include yourself.”“When you have to think about an $8000 hearing aid or $8000 on the family budget…For us we have to make the choice.”= More about DaveYou can connect with Dave via linkedin: https://www.linkedin.com/in/dave-brady-ceohfy-chairdfa?originalSubdomain=auYou can get involved with the podcast onlineTo try out our resilience course: https://www.challengesthatchangeus.com/surviving-2-thriving-course1On facebook in our community: https://www.facebook.com/groups/challengesthatchangeusOr on Instagram: @challengesthatchangeusIf you want to contact the podcast, email us here: support@challengesthatchangeus.comOr check out our website: www.Challengesthatchangeus.comIf you want to find out more about what Ali does, check out her business via the website: http://www.trialtitudeperformance.com.auFor her other business you can find it through the websites: www.altitudefitnessarmidale.com.au@trialtitudeperformance Hosted on Acast. See acast.com/privacy for more information.

NOTE: This episode is a rerun of a previously published episode. Get .1 ASHA CEU hereEpisode SummaryDɪsfeʒə? Dɪsfɑʒə? Təmeto, təmɑto? That is one of the many questions tackled in this week's episode with Dr. Lindsey Griffin, a leading professional in the field of adult dysphagia and assistant professor at Emerson College in Boston. For those of you not practicing in the field of swallowing, this episode will certainly ring some grad school bells as Dr. Griffin walks us through some swallowing bascs that include a refresher on the phases of swallowing and some tried and true strategies to support individuals with swallowing challenges (You guys remember the good ol' chin tuck, right?). Working in this area of our field already? You'll enjoy some powerful discussions on evidence-based, person-centered decision-making in dysphagia practice amongst several remaining resource and research limitations. Listen in and learn about the difference between restorative exercises and compensatory strategies, the why and how of tailoring intervention techniques to an individual's physiological impairments, and the role of technology in dysphagia care. You will no doubt find yourself following along with the maneuvers discussed, just make sure to swallow your coffee first!So, grab a plate of “minced and moist” snack foods and cozy up with Kate, Amy and Dr. Griffin for some nerdy swallow chat! You can learn more about Dr. Griffin here.Summary Written by Tanna Neufeld, MS, CCC-SLP, Contributing EditorLearning Outcomes1. Describe the difference between restorative exercises and compensatory strategies 2. Relate three restorative treatment techniques to the targeted physiological impairment3. Identify two devices used in dysphagia rehabilitationReferencesBhutada, Ankita M., et al. “Factors Influencing Initiation of Pharyngeal Swallow in Healthy Adults.” American Journal of Speech-Language Pathology, vol. 29, no. 4, 2020, pp. 1956–1964., doi:10.1044/2020_ajslp-20-00027.Humbert, Ianessa A., et al. “Swallowing Kinematic Differences Across Frozen, Mixed, and Ultrathin Liquid Boluses in Healthy Adults: Age, Sex, and Normal Variability.” Journal of Speech, Language, and Hearing Research, vol. 61, no. 7, 2018, pp. 1544–1559., doi:10.1044/2018_jslhr-s-17-0417.Martin-Harris, Bonnie, et al. “MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard.” Dysphagia, vol. 23, no. 4, 2008, pp. 392–405., doi:10.1007/s00455-008-9185-9.Valenzano, Teresa J., et al. “Respiratory–Swallow Coordination in Healthy Adults During Drinking of Thin to Extremely Thick Liquids: A Research Note.” Journal of Speech, Language, and Hearing Research, vol. 63, no. 3, 2020, pp. 702–709., doi:10.1044/2019_jslhr-19-00163.OTHER REFERENCE ON LAPTOPOnline Resources:IOPI: https://iopimedical.comEMST (Expiratory Muscle Strength Training): https://emst150.com/IDSI (International Dysphagia Diet Standardization Initiative): https://iddsi.org/ Disclosures:Lindsay Griffin Financial Disclosures: Lindsay is an employee of Emerson College. Non-financial: Lindsay is a member of ASHA SIG 13 and the Dysphagia Research SocietyKate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. Time Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Descriptions of the difference between restorative exercises and compensatory strategies 15 minutes: Descriptions of restorative treatment techniques to the targeted physiological impairment 10 minutes: Descriptions of devices used in dysphagia rehabilitation 5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

I'm Ellen Bernstein-Ellis, Program Specialist and Director Emeritus for the Aphasia Treatment Program at Cal State East Bay and a member of the Aphasia Access Podcast Working Group. AA's strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Dr. Kelly Knollman-Porter, who is a 2023 recipient of a Tavistock Trust for Aphasia Distinguished Scholar Award, USA and Canada. She will discuss how her interest in auditory comprehension and severe aphasia led to her work on reading comprehension.   Guest bio Dr. Kelly Knollman-Porter is an associate professor in the Department of Speech Pathology and Audiology at Miami University. She directs the Neurogenic Language and Cognition lab, where her clinical research focuses on the development of supports and strategies for adults with aphasia to facilitate reading and auditory comprehension. Her research also explores the subtle reading processing differences exhibited by adults with aphasia through eye tracking technology. Dr. Knollman-Porter directs the Miami University Concussion Management Program, where her secondary research focuses on the development of assessment measures and treatments to manage the cognitive and communication challenges often associated with mild traumatic brain injury. She has over 30 years of experience working directly with adults with acquired brain injury. Listener take-aways In today's episode you will: Learn about how wanting to help clients with severe auditory comprehension challenges motivated our guest to pursue her doctoral degree after 15 years in clinical practice   Consider some of the challenges SLPs face in assessing reading in clinical practice using current standardized measures and learn about some advantages of incorporating a reading questionnaire and close observation for getting a better understanding of your client's individual reading style, preferences, and needs.   Explore the contribution of text to speech (TTS) to the dual modality model for supporting reading success at the book level and some of the critical factors to consider when implementing this strategy with clients.   Investigate how eye-tracking technology can help us gain insight to an individual's reading strengths and patterns. Show notes edited for conciseness and clarity Ellen Bernstein-Ellis  00:10 Kelly, let me just pause and say welcome! Thank you for being here. Kelly Knollman-Porter  01:02 Thank you for having me on the podcast. I'm so happy to be here. Ellen Bernstein-Ellis  01:05 I am so excited you're here today. And as we talked, we always have a pre-meeting where we get to plan what we want to talk about in these podcasts, and as you know, I'm so excited to talk about book clubs and reading strategies. Thank you so much for being our guest today. Kelly Knollman-Porter  02:23 Thanks again, Ellen. And I have to thank you for your foundational work in the area of reading.  You can look back at a lot of the articles that myself or my research team have published and we reference you quite a bit. So thanks for your work also. Ellen Bernstein-Ellis  02:39 Thank you for that kind, kind mention. I was very fortunate to partner with Dr. Roberta Elman to create the Book Connection at the Aphasia Center of California and be part of that body of work. We like to start with an icebreaker to give our listeners a chance to get to know you. I will open by asking you to share how the Tavistock Trust for Aphasia Distinguished Scholar Award has or you think will impact your work? Kelly Knollman-Porter  03:06 First of all, I'd like to just take a moment to thank the Duchess of Bedford and Nicole Campbell from the Tavistock Trust for giving me this honor. I was just so surprised and excited to hear when I was given this award. I had the lovely opportunity a couple of years ago at a Clinical Aphasiology Conference to meet both of these amazing women. I've been so impressed by the work of the Tavistock Trust. It's not just work in the UK, they have spread this out across the globe. They really have done so much to not only help people with aphasia, but also help educate the public about aphasia, help us as clinicians get connected, and as researchers get connected in order to stay abreast of more recent research that's coming out in terms of helping people with aphasia. I am just so thankful and appreciative of receiving this honor from this great organization. But how will it help me? I can honestly say that right now we're in the process of starting a new study  and through the support at the Tavistock Trust, we are going to be able to provide funding to help support these research studies and hopefully get some of these funds back into the hands of our participants. I'm excited to keep that research moving through their support. Ellen Bernstein-Ellis  04:42 That's great. That was a really nice and gracious recognition. Yes, we're so appreciative of the work the Tavistock Trust has done. How about if we open by sharing a little bit about your professional journey? I think you considered yourself a non-traditional doctoral student.   You said you returned to get your doctorate after about 15 years of practice. Tell us a little bit more about what you were doing when you decided to return to your doctorate. And what were your passions that inspired you to return to school? Not an easy decision, I would guess. Kelly Knollman-Porter  05:19 No, it wasn't. I can honestly say I wasn't looking for it. I was very happy in clinical practice. I worked in a hospital for 15 years before coming to academia. I loved working in the medical field. I loved collaborating with other rehabilitation professionals, dieticians and physicians. I was very happy working in these environments. But Miami University actually reached out to me. They were wanting to further develop their adult program and they said, “Hey, will you come to academia and share some of your clinical knowledge and also lead the Miami University Aphasia Support Group?” They knew I had always had a long interest in working collaboratively with people with aphasia and clinically. So they asked me to come. I have to admit, I turned them down a couple times. And then finally, I made the big plunge and said, “Why not try it?” I wasn't really seeking it out. Originally, however, I was reaching a point where I was becoming frustrated with some of the reimbursement issues we were facing clinically. When working with people with aphasia, I sometimes felt like insurance was dictating how much treatment I could provide and how long I could provide it, even though I felt like many people could continue to make progress. I just felt like my hands were tied, and I was restricted. That was frustrating to me. I have to admit, when I came to academia, I was thinking, what can I do in order to explore this further? How can I potentially contribute to the research base in order to provide evidence to show that people with aphasia can continue to make progress, not just months after diagnosis, but 5, 10, 15 years? Because as a clinician, we've all seen it, absolutely. We know that people with aphasia want to continue to actively participate in life activities. And they can, if given the opportunity and the support. So, when I made that transition to academia, I quickly made the decision to go back and get my PhD. Primarily focusing on clinical research, specifically with people with chronic aphasia, Ellen Bernstein-Ellis  07:52 I am sure that there are listeners out there who may be sitting on that fence as well thinking, Should I do it? Should I pursue this doctorate? I just want to acknowledge and honor the challenges of being a doctoral student, especially while also being the parent of young children, but I just think it should be recognized. I was wondering, what was the best advice you got from your mentors? Because I'm sure you reached points in that process where you wondered, was this the right thing? And I want to support listeners who are out there thinking, “Can I do this? Should I do this?”  Kelly Knollman-Porter  08:30 It definitely required a team. When I decided to go back get my PhD, I had a 10 year old and a five year old. That just requires a lot of work, going to things after school for them and keeping your family a priority, but yet still working full time getting your PhD while commuting. And coming back, a special shout out to my spouse, who helped me keep all the balls up in the air. My family came along. I had amazing support from my in-laws and my parents, in terms of helping pick up the kids when needed. But I'm not going to lie, it was a challenge. And there were times when I wanted to throw in the towel. I wanted to say, “You know what, this is just too much for me to do right now.” But I did have people that came alongside me, that kept encouraging me, saying “It's okay, stay the course, what you're doing is good, and don't lose faith.” I have to give credit to Aimee Dietz. Dietz was my dissertation chair and she was very encouraging, supportive, and understanding that I was a mother and I had a life outside of PhD and work. She respected that. It was funny. She ended up getting pregnant at the same time and had her child. So I think we kind of supported each other through that. But one thing she said to me that I always remembered because she knew I loved clinical practice. I was like “Amy, maybe I should just go back to clinical practice?” And she said, “Kelly, you realize that your research is going to touch more people then your clinical practice.” Not downplaying clinical practice at all. But she said, “Your research has the potential of spreading information not only across our small geographic Midwest area, but also across the country and across the world.”  Ellen Bernstein-Ellis  10:35 What a wonderful piece of advice. No surprise, what a lovely mentor to have. Kelly Knollman-Porter  10:39 Absolutely. I think I told you this before, there was one very difficult day that I was having. My family was sitting around the dinner table and the house was a mess. I had grading to do and I said to my husband, “I'm going to quit, I'm not going to get my PhD.” And my 10 year old daughter was sitting there and her name's Anna. And she said, “Mom, what would you say to me if I told you I was going to quit something?” Ellen Bernstein-Ellis  11:11 What a wise 10 year old. Kelly Knollman-Porter  11:13 And at that moment, I realized that people were watching and other women might be watching and saying, “Hey, stay the course, persevere.” I am proud enough to say that that same daughter just recently graduated from vet school with her DVM and I hope that my perseverance helped her persevere also. Ellen Bernstein-Ellis  11:36 I love that story. Thank you for sharing it with our listeners today. Your doctoral work originally focused on the treatment of auditory comprehension in severe aphasia. I know that was one of your clinical loves. I want to recommend to our listeners since we can't cover everything today, your 2018 article,  we'll put it in the references of the podcast show notes, about intensive aphasia auditory comprehension treatment. Why don't you share how you became involved in reading comprehension? Because you started out in this auditory comprehension world, right? Kelly Knollman-Porter  12:13 Absolutely. Well, again, I really feel like comprehension is instrumental. There's been some work done that says people with auditory comprehension deficits, the more severe the auditory comprehension deficits, the greater risk of decreased success in rehabilitation outcomes. So I always had a passion for exploring auditory comprehension and different potential treatments to facilitate comprehension with people with chronic aphasia. But Aimee Dietz gave me that opportunity to do that. But it was interesting. During my dissertation process, I actually found out that my son had a pretty significant dyslexia. We kind of suspected it with him growing up, but then when you hit kindergarten, you really start to see the reading challenges kind of surface. And I remember talking with Amiee about reading. During that time, we were able to get my son connected to a great reading program that explored different compensatory supports to help facilitate any reading process, one of which was text to speech technology. And at that time, Amiee was collaborating with Karen Hux from the University of Nebraska on a potential reading study. And she says, “You're so interested in reading right now and you're interested in aphasia? How about combining those two loves, and getting involved with a reading study?” And the rest is history, that kind of landslide into a lot of research collaborations over the past 12 years that I've been involved with. But my son Eric did inspire that because seeing his success with text to speech with dyslexia, it made me think, why not text to speech with people with aphasia? What about that dual modality presentation?  Ellen Bernstein-Ellis  14:15 That's great. I also think you're showing us yet again, how often our personal journeys inform our research and clinical paths. I think that's a beautiful example. Reading has been repeatedly shown to impact quality of life for individuals with aphasia. They tell us that so often, but it's often challenging for clinicians to allocate the limited clinical time to assessment and treatment. Reading treatment takes a while to do so. I feel like I'm asking you to address the million dollar question here. But what are your recommendations on how to manage this challenge? And what are some of the challenges in assessing reading? I've alluded to the time, but why don't you elaborate? You've done a deep dive here. Kelly Knollman-Porter  15:06 Absolutely. And it is challenging because first and foremost, I find that a lot of our standardized assessments will try to tap into assessing the reading challenges, but it really only scratches the surface. I haven't found a really great standardized assessment that I can use and rely on that really helps direct my treatment course, You have to use a variety and you have to do some that you just make up on your own based on how exactly that person is responding. But generally, if I'm going to assess, I first have to start by having a really in-depth conversation with the person with aphasia or their care partner. First of all, you have to find out if reading is of interest to them, of course,and the types of reading materials that they like to engage with. I think about people in our Miami University aphasia support group. I have one individual who would read a novel a week prior to her stroke. I had another person in our group who said to me, “Kelly, you know what? I never read books.” It was not something of interest to him. You have to treat those two people very differently. You have to find out what their interests are. That's always where I start--with just an interview and talking with them about aphasia. And then I talked to them about their interests in terms of “Are you comfortable with technology? Are you not comfortable with technology?” I actually give them reading tasks. When I assess reading, I of course, start at the word level, and then creep up to the sentence level and add more complexity and length. But when I give them a paragraph to read, I don't just look at, did they get the answers correct or incorrect? I'm not only looking at accuracy per response, but how long does it take them to process that multi sentence information? So for example, if I gave them a four sentence paragraph to read, I watch them very closely to see how they're attacking that reading task. And that doesn't take that long out of your assessment time. I watch where their eyes are moving. I watch to see if their eyes are regressing back within a sentence while they're reading. And if I notice that they're really struggling, I also say to them, “Tell me, what are you having difficulty reading right now? Can you point to the words that you're struggling with? Can you point to the words potentially that you're skipping? Tell me about this process, and try to tell me how it's different from the way you read before.” And sometimes we underestimate what people with aphasia can tell us about their reading experiences. I have found that a lot of the people that I have worked with can be very specific about what they're having difficulty with. Now, there's always that small population that might not have the awareness. But it's still the majority of them that can. I was just working with a gentleman last week, and I was like, “Show me what you're having difficulty with.” And he pointed to the words that he struggled with, and that helped me understand. Are you having more difficulty with content words? Are you having more difficulty with verbs? Are you having more difficulty with articles? What is it about this process that's  making it hard? Because many times people with aphasia can read that paragraph very slowly and very carefully and end up with a high percentage accuracy in terms of performance, but if it's taking them five minutes to read a four sentence paragraph, it is too fatiguing, it's too much. And they're going to end up avoiding getting back to reading things that they want to read for pleasure. Ellen Bernstein-Ellis  19:18 Right, because the burden is too high. Kelly Knollman-Porter  19:21 Because the burden is too high. I really feel like if we can look at these things clinically, we just need to take a little bit of time to talk to the people and actively watch how they're attacking that reading task. Ellen Bernstein-Ellis  19:37 If I circle back briefly to the impact reading has on quality of life, your 2015 article does a beautiful job of describing the contribution of access to reading to the quality of life. This was a qualitative study that interviewed six individuals with aphasia to hone in on their individual reading preferences and supports. But before you describe these results, I'd like you to share with the listeners your reading assessment survey. You just talked about listening carefully and asking questions. I think that's harder than you're making it sound. But you've given us this tool that is an amazing springboard. Many of us probably have just informal tools, lists of questions that we've developed on our own over time. But in that article, you actually attach this beautiful, clinical tool. How did you go about developing this initial reading survey that you do? Thank you for including that in the article. That was wonderful. Kelly Knollman-Porter  20:46 Oh, absolutely. A special shout out again to my research team, Karen Hux, Sarah Wallace, and Jessica Brown. We spent many hours of our meeting time creating this questionnaire. Ellen Bernstein-Ellis  21:02 But that's great, these great clinical minds all coming together, embracing this questionnaire, planning to put it together, that's beautiful.   Kelly Knollman-Porter  21:10 Absolutely. I have to encourage everybody to try to get to be a part of a research team. We're stronger together than we are in isolation. I have the utmost respect for each of these women. They have taught me so much. We each brought to the table unique strengths. All four of us are unique in our own special way. And like I said, I've learned so much from them. But we bring that when we're creating our research studies. We always start with a rough draft. And then we question each other. We say, well, I've seen this clinically, or I think about this from a research perspective. I definitely brought to the table my clinical experience in working with people with aphasia, but then Sarah did also, so too Jessica, and so too Karen. Just working through what we saw were challenges that people with aphasia might experience and what we've found clinically to develop that questionnaire. Ellen Bernstein-Ellis  22:11 So, you created this questionnaire with a variety of sections that helps someone systematically go through understanding that person's reading preferences and strengths and try to get a sense of what their profile is, right? That's your starting point. And then you take it from there. Kelly Knollman-Porter  22:28 Exactly. What do you like to read? Do you like to read text messages? Do you like to read novels? Where do you like to read? How do you like to read? Do you like to hold a book versus do you like using technology? What are all the different ways that you personally like to read? I can honestly say one thing that we learned from the qualitative study, I know I'm jumping to that, was everybody has their own unique reading experiences. There's not going to be a one size fits all approach to the assessment or the treatment of anyone with a reading challenge. You will not find a cookbook approach to this. You have to do it on an individual basis. And if you do, I think the outcomes are going to be stronger. Ellen Bernstein-Ellis  23:20 Let's circle back to that 2015 article, we'll jump back and forth. Could you describe some of the key takeaways from that study? Maybe you could explain why you think that dual modality model, which we started to allude to earlier with text to speech, is so important to supporting reading success? That's part of my takeaway from that 2015 article.     Kelly Knollman-Porter  23:45 I wish I could tell you that in 2014, when we were initially planning this qualitative research study that we were thinking about TTS. I was from a distance, but we weren't actively looking at text to speech (TTS) at that time. But one thing that my colleagues and I felt we had to do first, if we were going to explore reading research more, we had to go to the people with aphasia to learn what they wanted. So, before we took our own personal opinions about what we thought people with aphasia needed in terms of reading, we thought we should start with a qualitative study and find out what they wanted and what they needed. And you know what, that was such an important starting place for our research. Because again, we found each of the people that I interviewed had their own unique needs, but yet every single one of them passionately wanted to read. They wanted to get back to reading and they wanted to read books. They wanted to read books about romance and they wanted to read about horror stories. I'll never forget one of our participants. She told me that she liked to read Stephen King novels. She laughed and says, “Kelly, you couldn't handle that.” And it's true. I don't like those scary stories. But, they wanted to read. They want to learn more about aphasia, but they just want to read what everybody else is reading. Ellen Bernstein-Ellis  25:23 You want to read what your peers are reading.  I will always remember this story where one of our book club members at the Aphasia Center of California was so excited at a book club meeting because he had taken the book that we were reading, I think it was Shadow Divers at the time, to the golf course. No one usually approached him and chatted with him. But he actually had a couple guys come up when they saw the book and engage with him in discussion. So it became this beautiful bridge of connection. I can't communicate as well, but they had this awesome commonality to share. It was just what they were interested in. So that example of just wanting to do what your peers are doing because there's such joy in being part of that reading community. One of my favorite parts of that 2015 article is also the clinical reading framework that's on page 19. It helps a clinician start to think about how to implement reading supports and strategies. I think that is a beautiful contribution. Could you describe that model for our listeners?  Kelly Knollman-Porter  26:30 Sure, of course, you start with the questionnaire, you start with asking them what they want to read and what they like to read. And then you do an informal assessment. And then, as we walk through that framework, you establish personally relevant goals, based on their unique reading needs and experiences. But then as you're considering treatment, you have to think about lots of different avenues that you can potentially go down. And that's going to be based again on their needs. Specifically, are they interested in technology? If they're not interested in technology, then that's going to take you on one route, but if they are interested in technology should you consider text to speech? If they're not interested in technology, will picture support facilitate their understanding of the written text? So basically, looking at personalizing the treatment approach. And going through a process of trial and error, looking at the length of the reading that should be used, or the complexity of the reading materials, and again, gearing treatment towards their unique personal needs. That's kind of what it's all about. Ellen Bernstein-Ellis  27:50 You really provide a very clear framework, and I think that always helps us with our clinical thinking-- to know what questions to ask and how to break it down. A wonderful follow up to that 2015 article, is the 2022 article that compared comprehension, processing time and modality preferences for individuals with and without aphasia when reading books using text to speech. Could you start by explaining or describing what motivated your work to be at the book level?  So often, we start with words and then sentences, but here, you took this big, big leap and started at the book level. Kelly Knollman-Porter  28:31 I'm going to swing back to my 2015 article real quick, if that's okay. Because I have to admit, one of the participants in that study gave us direction to go the TTS route first. So, of those people that we interviewed in that initial qualitative study, only one of them was reading more after his stroke than before his stroke. And this gentleman, he was in his mid 40s at the time, and very into technology. I remember when we were doing the interview with him, he was adamant. He was like, “Kelly, text to speech works!” So of the six people that we interviewed, he was the one that inspired us to start looking at text to speech more-- that eventually led to all these other studies. Because he said, “I've read a novel.” He laughingly told me that he read Fifty Shades of Grey, and he also was able to get online and, through text to speech, order things through Amazon or different mechanisms like that. We started exploring text to speech technology and the degree to which it could help from a dual modality presentation. So that kind of got us on that track. My colleagues and I explored the use of text to speech at the sentence and paragraph level to see if it helped. We really had mixed results, I have to admit. We were finding that sometimes it helped some people, but it didn't help all people. And we were almost getting a little frustrated with what we were finding, and we were feeling that we were hearing from clients. I have to admit, I've run into clinicians all over the country and they're like, “Yeah, text to speech works.” But we weren't seeing those strong outcomes with our research. It was right around the pandemic time. I said to my colleagues, “We're gonna have to take a big leap here with our research, instead of just looking at the sentence and paragraph level, why don't we just jump to books?” We know that people with aphasia want to read books. We have a feeling that the text to speech might help them at the book level. We know that this research is going to get a little muddy, there's going to be a lot of variables that we can't control for, but let's try to do a study based on what people with aphasia want. So we took this big leap of faith and did this book study. And this one was where we decided to control many factors in terms of having them read a certain section and then using text to speech and then read another section and then use text to speech for another section. There was a lot involved in it. But that's ultimately why--because people with aphasia told us that they want to read books. Ellen Bernstein-Ellis  31:45 I know we're going back and forth. But these topics are all integrated. Let's take a moment and ask you to talk a little bit more about text to speech and what you've learned about using it for individuals with aphasia. You started to again allude to some of the things, particularly the variability across people. There are pros. And there's cons. Before we dive in, I want to refer our listeners to this nugget, this beautiful little gem, that I found just last week. It was in the March 2023 ASHA Leader, and it's with your co authors Sarah Wallace and Karen Hux. The article lays out some of the considerations to take when introducing a client to text to speech technology, like how to do it in a systematic way, how to explore and allow for the individualization that is necessary, that practice is necessary. It's a great clinical perspective article. We'll put the link in our show notes. But what do you want to say about the lessons learned with text to speech? Kelly Knollman-Porter  32:47 Absolutely. It takes practice when you're considering using text to speech with a person with aphasia. First of all, you have to see if they're interested in using technology. If they have access to technology, that's your first question. And then, can they access the device physically? So lots of things have to be taken into consideration. If they show interest in using the technology, you need to sit down with that person with that technology that they choose. If that's an Android device, if that's Mac device, if it's a laptop, if it's an iPad, if it's a smartphone, you have to bring their device to the table and see to what degree they can access the necessary text to speech applications that are needed in order to use it successfully for reading tasks. If they cannot access it, then you need to take a step back and create an instruction manual to help with pictures and aphasia friendly formatting, in order to give them a step by step method to access that technology. So often, we start to use technology intuitively. We think everybody else should be able to use it that easily. But we have to make sure that the person can turn the device on. A lot of older people also have decreased circulation in their fingertips and sometimes when touching the app, they can't get it to trigger, so they have to warm up their fingers before accessing it. Ellen Bernstein-Ellis  34:33 I'm so glad you mentioned that because I can actually personally relate to that one. Because these nuances are so important. , I don't know if they're nuances, these challenges that you may not realize until you actually sit down and work with the person. Kelly Knollman-Porter  34:48 Absolutely. So when I know someone is interested in this, I always start with pictures--a detailed instruction book that shows you step by step what you have to touch in order to access that TTS system. I put it in a binder with a plastic coat covering over the top, so that they can have that manual sitting right there by their device. And then we practice with it. We say, “Okay, now I'm going to show you how to access this text to speech technology. Now you show me if you can do it using your manual.” And we go back and forth. We're not even to the reading part yet. You have to first access the system. If they show that they can then access it, then we actually get into playing with the different TTS features. So anything, from the speed of the voice presentation on TTS is crucial. You have to find that ideal speed for that person that's not too fast, and not too slow. That's going to help their processing. So, playing around with the speed. Also playing around with a voice. Do they want a male voice? Do they want a female voice? Do they want one with an accent? You'd be surprised people are very particular about the voice that they want. And then, also exploring the use of highlighting. Do they want to have highlighting? At the single word level? Do they want each word highlighted as it's read? Or do you want the full sentence highlighted? Or do you want no highlighting, because some people don't like the highlighting. So there's a whole sequence of steps that you need to go through in order to determine if someone is going to be able to access the TTS system, and then, if they're going to be able to use it successfully. And that does take time. And it takes experimentation and setting up a system for a person, letting them try it on their own. And then having them come back and ask, “Okay, what did you like? And what did you not like? Can we change this at all?” So it can be adaptive, it might change over time. We don't want to just give one structured TTS system to all people. It won't work. Ellen Bernstein-Ellis  37:17 I think that dovetails beautifully with my next question, which is, if we circle back to that 2022 article, I was struck by some of the variability across participants and that you were able to embrace that as a researcher and look at what that means.  The variability across people reinforced your approach of taking a strength-based model approach when assessing reading performance for your clients. Are there other outcomes you want to highlight from that study? Kelly Knollman-Porter  37:49 Absolutely. One thing we found overall, is that for the group as a whole, TTS technology helped them process the written materials faster, without compromising comprehension. I'm gonna say that again, so they could access and process the written information faster, without compromising comprehension. For some of them, that was huge, right? Because they were able to read that book with less time, and hence less fatigue-- Ellen Bernstein-Ellis  38:27 ---that reduces that burden we were talking about earlier, right, that sense of fatigue and burden.  However, so keep going. I'm sorry. Kelly Knollman-Porter  38:34 So we found it helps process the information faster. But as a group overall, we found that it did not improve their comprehension. And that's been kind of the thorn in our heel, more like, why is this text to speech not facilitating comprehension? Because if you look at the theory on dual modality, if you're presenting something auditorily and through writing, that should facilitate comprehension, right? But we weren't seeing that with all participants. Now, some of that could be the varying degrees of complexity of their unique type of reading problem that they had.  Then we did have a couple people that actually did show improvements in comprehension.  We had one participant that had a 20% increase in comprehension with TTS compared to the read only condition. We had another person with like a 10% increase. So this works for some people, in terms of facilitating comprehension, but not all. So we felt like we're getting close, but we're still not quite there. And that's why we're needing to continue to do more research.   Ellen Bernstein-Ellis  39:50 I just want to take a pause.  This research was all done during COVID. I want to thank you for how clearly you describe the training and materials needed for this study in that article. I have watched some of my colleagues trying to do research during COVID. They did some incredible things. Looking at that article made me wonder how did you do that?  I want to shout out your tenacity in accomplishing this during COVID. I think you mentioned that it gave you multiple “front porch opportunities” to solve tech challenges, because you had to go to the house of your participants, literally sit on the porch and try to fix the iPad, or the Kindle, or the whatever, and hand it back to them. So thank you for just hanging in there during a time when it was really hard to do research. I'm looking at the time, and I want to make sure that we get to your eye fixation behaviors and processing time in individuals with and without aphasia article. I've just covered a lot at the moment. Was there something you wanted to reflect on in terms of your “porch moments”  before we jumped to the eye fixation study? Kelly Knollman-Porter  41:11 I think as a speech language pathologist, it's kind of in our blood that we have to be very adaptive and flexible. Sometimes you have to jump in the car and drive and sit on the porch, especially. This is another challenge with using technology, if an update happens, and it totally changes the formatting of an application you're using all the time. Now, if a person with aphasia cannot always adapt to that, I would get a call, “Hey, Kelly. Something's popping up here. And I can't get rid of it.” So I would just hop in the car, and I'd say, put everything on your front porch. I will be there. I'm just going to sit on your front porch, and I will deal with the update. Ellen Bernstein-Ellis  42:02 That could be cold in Ohio. I'm picturing you sitting there with gloves and in a coat trying to fix things. Kelly Knollman-Porter  42:11 Yeah, that was about it. But that's our skill as speech language pathologists. Ellen Bernstein-Ellis  42:17 You showed a lot of dedication. You keep giving a shout out to your team and your lab.     Kelly Knollman-Porter  42:24 I have a special shout out to Mackenzie Pruitt, who worked on that study. She was a masters level student, and she was right there in the trenches with me. I have a great team. Ellen Bernstein-Ellis  42:35 I want to go back to this eye fixation behaviors study. While we're not likely to be able to assess eye fixation in daily practice because the equipment and technology is beyond what we would have in our clinics or private practices, but your results really hold clinical significance for understanding reading, processing strengths and challenges. Do you want to describe some of the highlights from that study? Kelly Knollman-Porter  42:59 I think one of the biggest frustrations when you work with someone with reading challenges is you really are not 100% sure how they're processing the written text. We're assessing them, we're watching them, we're seeing their response to the questions. But what are you having difficulty with? You can ask questions, you can watch their eyes clinically. But one thing that eye tracking technology has that I'm grateful for is, it showed me how people with aphasia process written text. And we wanted to specifically not just look at the word level, there's some great research out on word level processing and sentence level processing. But we wanted to take a big leap and look at multi sentence processing. So what are those eyes doing? What did they fixate on? What are they regressing to, and again, I'm going to give another shout out to Drew Bevelhimer. He was also a master's level student that was working in my lab at the time, who, again came alongside me to help get this eye tracking technology going. This really did show me how unique the reading challenges that people with aphasia have when reading multi sentence information. We specifically looked at how often they had within word regressions, like within a longer word within sentence regression--so when their eyes look back to another word within the sentence, and then how often they look back to a previous sentence. And one thing that that really showed us is with the use of text to text to speech technology, their numbers of regressions significantly decreased. So they did not have to regress as much while reading, which again, resulted in a decrease in processing time. Another thing that this study showed, which I and my colleagues thought was really interesting, we actually brought in a group of neurotypicals to do this study also. When we used the default text to speech voice rate,  we actually found the opposite results with neurotypicals. When using text to speech, set at that default speed, like right around 150 to 180 words per minute, they actually had more regressions with text to speech than in the read only condition. Ellen Bernstein-Ellis  45:39 So, you have to match the speed with the person. Is that where this is headed? Kelly Knollman-Porter  45:43 That is exactly where that's headed. It really reinforced to us how you have to consider the speed of that text to speech voice. Because if you do not have the appropriate speed, it can actually have some detrimental effects in causing more regressions. That's one thing, looking to the future, that my colleagues and I are going start looking at-- exploring how to get that synching better in terms of the eye movements with the rate of speech. Ellen Bernstein-Ellis  46:17 So is that is next in your research, where you're headed, Kelly Knollman-Porter  46:21 That's where we're headed., Ellen Bernstein-Ellis  46:23 I'm going to look forward to that. I just want to say that your body of research on reading and reading comprehension, and supporting and using strategies and understanding the patterns and challenges that people with aphasia have and how they get them back in the game to support them. I just think it's such a valuable contribution. I really appreciate this beautiful body of research. And there was another March 2023, ASHA Leader article, besides the one on text to speech, that describes how reading impacts return to work. It's an article that tells a story about your efforts to support a teacher who was working to return to the classroom. I'll put that link in the show notes too, because it's a beautiful collaborative, “we're going to do this as a team” story. And it wasn't easy. But it was very much supporting the individual goals and journey of your client. Do you have any parting advice as we wrap up for clinicians who are going to assess and work with reading with their clients? That's what this whole show has been about. But what else do you want to add we end?     Kelly Knollman-Porter  47:36 Don't be afraid to explore reading. I know it seems intimidating and overwhelming, because it is challenging to figure out what's specifically the problem, but I can honestly say that if you invest some time in it, the outcomes are going to be worth it for your clients. I look to some books studies that I've done here within our Miami University aphasia support group and, and I have many members that prior to the book club study that I did, had not picked up a novel for 15 years since their stroke, and through adaptive materials, and again, shout out to Roberta Elman's work in the Book Connection materials that her and her group have created. We've used them a lot here at Miami University. But through those adaptive materials that she's created, she's opened up a world of opportunity for people with aphasia to be able to access books. Giving people that opportunity to get back to reading materials that they'd like to read is just really rewarding. Ellen Bernstein-Ellis  48:55 Thank you so, so much for this conversation and for all the work you're doing. And we'd like to close with one kind of broader, big picture question. Kelly, if you had to pick only one thing that we need to achieve urgently as a community of Life Participation providers, what would that one thing be? Kelly Knollman-Porter  49:23 When we talked about this question, I was slightly discouraged because my ultimate reason for going and doing research was to provide research that will lead to greater reimbursement of services for people with chronic aphasia.  I hate to say it, but here are 15 years later, that's still my big takeaway point. We need to find better ways of helping people with aphasia in the chronic phases get reimbursement for services that they so desperately need. We also need to talk to clinicians across the country. We have to be very careful in terms of how we give services to this population. They can still make progress. They can still make gains. We just need the support in order to make that happen. I'm just going to throw one other thing out there. This pertains to the ASHA Leader 2023 article for the teacher that was trying to get back to work. We need to find more opportunities for people with aphasia to still have part-time jobs without losing their benefits, because they're caught between a rock and a hard place. If I go back to work a little bit, I'm going to lose my benefits. I remember in that article, Christine Bowles, who we interviewed, shared working full time is too hard, but I still have more to give. I still have more to give. I'm not done yet. I'm only in my 40s. Why can't we give people with aphasia more opportunity to work without losing benefits?  Ellen Bernstein-Ellis  51:09 Thank you for that message. I think it's critical and one that a lot of people face and think about. So thank you for bringing that up. And for participating today. It's been a wonderful opportunity to talk about your work. Your passion and excitement comes across so much. And I'm going to thank our listeners for listening today. And I just want to remind that our references and resources mentioned in today's show, just see our show notes. They're available on the website, www dot aphasia access.org. And there you can also become a member of our organization and support the podcast and all the other great work that's being done by aphasia access, and you can also browse our growing library of materials and find out about the Aphasia Access Academy. And if you have an idea for a future podcast episode, email us at info at Aphasiaaccess.org. For Aphasia Access Conversations. I'm Ellen Bernstein-Ellis. And thanks again for your ongoing support aphasia access   References and Resources The reading intake questionnaire discussed in this interview, is accessible here: https://aphasiaacc.memberclicks.net/assets/docs/Reading%20History%20Questionnaire-Knollman-Porter-AphasiaAccessPodcast.pdf   To see examples of adapted book club materials mentioned in this episode, go to: The Book Connection on the Aphasia Center of California website: https://aphasiacenter.net/the-book-connection/   Hux, K., Wallace, S. E., Brown, J. A., & Knollman-Porter, K. (2021). Perceptions of people with aphasia about supporting reading with text-to-speech technology: A convergent mixed methods study. Journal of communication disorders, 91, 106098. Hux, K., Knollman-Porter, K., Brown, J., & Wallace, S. E. (2017). Comprehension of synthetic speech and digitized natural speech by adults with aphasia. Journal of Communication Disorders, 69, 15-26. Knollman-Porter, K. (2023). Navigating a Job's Language Demands After a Stroke. Leader Live. The ASHA LEADER, 28(2), 42-46. Knollman-Porter, K., Bevelhimer, A., Hux, K., Wallace, S. E., Hughes, M. R., & Brown, J. A. (2023). Eye Fixation Behaviors and Processing Time of People With Aphasia and Neurotypical Adults When Reading Narratives With and Without Text-to-Speech Support. Journal of Speech, Language, and Hearing Research, 66(1), 276-295. Knollman-Porter, K., Brown, J., Hux, K., Wallace, S., & Crittenden A. (2022).  Reading comprehension and processing time when people with aphasia use text-to-speech technology with personalized supports and features.  American Journal of Speech-Language Pathology, 31, 342-358. Knollman-Porter, K., Dietz, A., & Dahlem, K. (2018). Intensive auditory comprehension treatment for severe aphasia: A feasibility study. American Journal of Speech-Language Pathology, 27(3), 936-949. Knollman-Porter, K., Hux, K., Wallace, S. E., Pruitt, M., Hughes, M. R., & Brown, J. A. (2022). Comprehension, Processing Time, and Modality Preferences When People With Aphasia and Neurotypical Healthy Adults Read Books: A Pilot Study. American Journal of Speech-Language Pathology, 31(6), 2569-2590. Knollman-Porter, K., & Julian, S. K. (2019). Book club experiences, engagement, and reading support use by people with aphasia. American journal of speech-language pathology, 28(3), 1084-1098. Knollman-Porter, K., Wallace, S. E., Brown, J. A., Hux, K., Hoagland, B. L., & Ruff, D. R. (2019). Effects of written, auditory, and combined modalities on comprehension by people with aphasia. American Journal of Speech-Language Pathology, 28(3), 1206-1221. Knollman-Porter, K., Wallace, S. E., Hux, K., Brown, J., & Long, C. (2015). Reading experiences and use of supports by people with chronic aphasia. Aphasiology, 29(12), 1448-1472.   Wallace, S. E., Hux, K., Knollman-Porter, K., Patterson, B., & Brown, J. A. (2023). A Mixed-Methods Exploration of the Experience of People With Aphasia Using Text-to-Speech Technology to Support Virtual Book Club Participation. American Journal of Speech-Language Pathology, 1-24.   Wallace, S. E., Knollman-Porter, K., & Hux, K. (2023). How Text-to-Speech Aids Reading for People With Aphasia. Leader Live 28(2), 52-53. Wallace, S. E., Hux, K., Knollman-Porter, K., Brown, J. A., Parisi, E., & Cain, R. (2022). Reading behaviors and text-to-speech technology perceptions of people with aphasia. Assistive Technology, 34(5), 599-610.  

In this week's episode, we speak with Dr. Christopher Constantino from Florida State University in the United States. He discusses 3 stutter-affirming priorities for people who stutter and those who support them, recognising what is gained from stuttering, and developing a positive stuttering identity. Speech Pathology Australia acknowledge the Traditional Custodians of lands, seas and waters throughout Australia, and pay respect to Elders past, present and future. We recognise that the health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples are grounded in continued connection to culture, country, language and community and acknowledge that sovereignty was never ceded. Resources: For information, contact Dr. Constantino at cconstantino@fsu.edu Constantino, C.D., (2023). Fostering positive stuttering identities using stutter-affirming therapy. Language, Speech and Hearing Services in Schools, 54,42-62. https://pubs.asha.org/doi/10.1044/2022_LSHSS-22-00038 Constantino, C.D., Eichorn, N., Buder, E.H., Beck, J.G., & Manning, W.H. (2020). The speaker's experience of stuttering: Measuring spontaneity. Journal of Speech, Language, and Hearing Research, 63(4), 983–1001. https://pubs.asha.org/doi/10.1044/2019_JSLHR-19-00068 Campbell, P., Constantino, C., Simpson, S., (Eds.) Stammering pride and prejudice: Difference not defect. J&R Press. http://www.proedaust.com.au/stammering-pride-and-prejudice-difference-not-defect International Stuttering Awareness Day https://isad.live/ StutterTalk https://stuttertalk.com/ Audio transcripts for this and other Season 5 (2023) episodes are available at no cost on SPA's Learning Hub: learninghub.speechpathologyaustralia.org.au/spe…ast Check the episode's "Course Fact Sheet" to download. If you would like a free transcript from a previous season, please email learninghub@speechpathologyaustralia.org.au.

Lecture Objectives:- Understand the range of normal development for speech and language.- Understand signs and symptoms of speech delay or disorders requiring a referral to a speech-language pathologist.Resources:Identify The Signs of Communication DisordersStuttering (asha.org)ASHA's Developmental Milestones: Birth to 5 YearsLearning More Than One Language (asha.org)Bilingualism_PrimerPediatricians.pdf (washington.edu)Baby Sign Language in the development of young hearing children: A review of selected studies - OvidDSThe effects of sign language on spoken language acquisition in children with hearing loss: a systematic review protocol - OvidDSUsing the Childhood Autism Rating Scale to Diagnose Autism Spectrum Disorders - PMC (nih.gov)Clinical Characteristics Associated With Stuttering Persistence: A Meta-Analysis | Journal of Speech, Language, and Hearing Research (asha.org)Crowe, K. & McLeod, S. (2020). Children's English consonant acquisition in the United States: A review. American Journal of Speech-Language Pathology. https://doi.org/10.1044/2020_AJSLP-19-00168Healey, A., Mendelsohn, A., & Childhood, C. (2019, January 01). Selecting Appropriate Toys for Young Children in the Digital Era. Retrieved November 04, 2020, from https://pediatrics.aappublications.org/content/143/1/e20183348McLeod, S., Crowe, K., & Shahaeian, A. (2015). Intelligibility in Context Scale: Normative and validation data for English-speaking preschoolers. Language, Speech, and Hearing Services in Schools, 46(3), 266-276. https://doi.org/10.1044/2015_LSHSS-14-0120Pontecorvo, E., Higgins, M., Mora, J., Lieberman, A.M., Pyers, J., & Caselli, N.K. (2023). Learning a sign language does not hinder acquisition of a spoken language. Journal  of  Speech, Language, and Hearing  Research, Vol. 66, 1291–1308. https://doi.org/10.1044/2022_JSLHR-22-00505Ravichandran, P., France De Bravo, B., & Beauport, R. (2017, August 14). Young Children and Screen Time (TV, Computers, etc.). Retrieved November 04, 2020, from http://www.center4research.org/young-children-screen-time-tv-computers-etc/

This week, Brian Taylor welcomes Professor Christina Roup from The Ohio State University to discuss adults with normal audiograms and self-reported hearing difficulty. The prevalence of this condition is estimated to be around 12-15% in younger and middle-aged adults, with a higher prevalence in older age groups and those with a history of traumatic brain injury. Dr. Rouf reviews some of the latest research on this topic and how it can inform clinicians who work with this population. She also presents insights from her research, where she found that amplification with mild gain hearing aids significantly improved speech-in-noise performance for adults with normal audiograms and self-reported hearing difficulties. She encourages clinicians to listen to their patients' complaints and take them seriously, using speech-in-noise tests as a routine part of their clinical battery to provide appropriate treatment options. Studies mentioned in this interview: Beck, D, & Danhauer, J.L. (2019). Amplification for adults with hearing difficulty, speech in noise problems – and normal thresholds. Journal of Otolaryngology-ENT Research, 22(1), 84-88. Cameron, S. & Dillon, H. (2007). Development of the Listening in Spatialized Noise- Sentences test (LiSN-S). Ear and Hearing, 28(2), 196-211. Helfer, K. S., & Jesse, A. (2021). Hearing and speech processing in midlife. Hearing Research, 402, 108097. Helfer, K.S., & Vargo, M. (2009). Speech recognition and temporal processing in middle-aged women. Journal of the American Academy of Audiology, 20, 264-271. DOI: 10.3766/jaaa.20.4.6 Roup, C.M., Custer, A., & Powell, J. (2021). The relationship between, self-perceived hearing ability and binaural speech-in-noise performance in adults with normal pure-tone hearing. Perspectives of the ASHA Special Interest Groups, 1-12. Roup, C.M., Post, E., & Lewis, J. (2018). Mild-gain hearing aids as a treatment for adults with self-reported hearing difficulties. Journal of the American Academy of Audiology, 29, 477-94. Spankovich, C., Gonzalez, V. B., Su, D., & Bishop, C. E. (2018). Self reported hearing difficulty, tinnitus, and normal audiometric thresholds, the National Health and Nutrition Examination Survey 1999-2002. Hearing Research, 358, 30-36. DOI: 10.1016/j.heares.2017.12.001 Tremblay, K., Pinto, A., Fischer, M.E., Klein, B. E. K., Klein, R., Levy, S. . . . Cruickshanks, K. J. (2015). Self-reported hearing difficulties among adults with normal audiograms: The Beaver Dam Offspring Study. Ear and Hearing, 36(6), e290-e299. DOI: 10.1097/AUD.0000000000000195 Be sure to subscribe to our channel for the latest episodes each week and follow This Week in Hearing on LinkedIn and Twitter. - https://twitter.com/WeekinHearing - https://www.linkedin.com/company/this-week-in-hearing - https://hearinghealthmatters.org/thisweek/

Kristin Schaaf, MA CCC-SLP, LSLS Cert. AVT Kristin is a Listening and Spoken Language Specialist, Auditory Verbal Therapist and Speech Language Pathologist practicing in Indianapolis, Indiana. She is also the school's Professional Learning Coordinator and, in this role, she develops, implements, and mentors professionals in the field of Listening and Spoken Language. Kristin works at St. Joseph Institute for the Deaf Indianapolis an OPTION Schools, coaching parents to develop their child's listening and spoken language in naturalistic ways in their home environments. Kristin's 15-year experience spans from working with toddlers and primary aged children who are deaf and hard of hearing who are learning to listen and talk with cochlear implants and hearing aids. Kristin is a member of ASHA, ACAI, and AG Bell Association. Contact Information: knschaaf@gmail.com LinkedIn: https://www.linkedin.com/in/kristin-schaaf-75230073 School's Website: www.sjid.org ASHA Learning Pass Presentation by Shannon Sharma and Kristin Schaaf: Partnering with Families in Educational Settings: School-Based Virtual Parent Coaching -        Direct Link: Partnering with Families in Educational Settings: School-Based Virtual Parent Coaching Shannon Sharma, MS, CCC-SLP, LSLS Cert. AVEd Shannon is a Listening and Spoken Language Specialist, Auditory Verbal Educator and Speech-Language Pathologist practicing in Northern California. Shannon works for Foundation for Hearing Research, including Weingarten Children's Center school and therapy clinic and BabyTalk teleintervention. These programs specialize in helping children with hearing loss, from infants to adolescents, to develop listening and spoken language skills with the support of hearing aids and cochlear implants. Shannon is committed to developing partnerships with families through strengths-based parent coaching. She developed and organizes the Parent Education Program to further ensure that families are supported in their journey. Outside of direct therapy services, she enjoys mentoring professionals who are interested in auditory-verbal therapy, as well as sharing her expertise in hearing loss and passion for parent coaching and teleintervention at conferences and universities. Shannon is a member of ASHA and the AG Bell Association.  Contact information: shannon.c.sharma@gmail.com LinkedIn: https://www.linkedin.com/in/shannon-sharma-slp/ Foundation for Hearing Research: https://foundationforhearing.org/ You can listen to this episode wherever you stream podcasts and at www.3cdigitalmedianetwork.com/telepractice-today-podcast

Picture this: you're standing in the energy drink aisle of your local supermarket, scanning the cans of vibrant colors and flashy designs. Among the long list of ingredients, you see one name pop up repeatedly - taurine. Ever wondered what this mysterious ingredient is and how it impacts your body? You're not alone. Taurine, a common component in energy drinks, has been the subject of numerous research studies and health discussions. Many claims swirl around this ingredient, from incredible health benefits to potential side effects. But how many of these claims are backed by science? Taurine Health Benefits Taurine, often known for its presence in energy drinks, plays a crucial role in various bodily functions. This amino acid, naturally found in meats, fish, and dairy, provides a myriad of benefits, from supporting heart health to boosting athletic performance. Let's delve deeper into these benefits. Heart Health: Taurine shines particularly bright when it comes to heart health. It aids in regulating blood pressure and lowering cholesterol levels. Notably, taurine helps combat atherosclerosis, a process where plaque builds up in your arteries, leading to a potential heart attack. Research in the Experimental & Clinical Cardiology Journal discovered that taurine supplementation effectively reduces the risk of heart disease in individuals with high cholesterol.Beyranvand, Mohammad R., et al. "Effect of Taurine Supplementation on Exercise Capacity of Patients with Heart Failure." Experimental & Clinical Cardiology, vol. 16, no. 2, 2014, pp. 54–57. Thus, maintaining adequate taurine levels can be a significant step towards a healthier heart. Athletic Performance: Taurine is a beloved supplement among athletes and fitness enthusiasts. It plays a key role in muscle function, helping muscles work harder, longer, and safer. Taurine aids in transporting necessary nutrients to your muscles and reduces muscle damage during intense workouts. Research in the Amino Acids Journal showed that taurine supplementation improved exercise performance and reduced muscle damage in trained middle-distance runners.Balshaw, Thomas G., et al. "The Effect of Acute Taurine Ingestion on 3-Km Running Performance in Trained Middle-Distance Runners." Amino Acids, vol. 44, no. 2, 2013, pp. 555-561. Brain Health: Taurine also contributes significantly to brain health by acting as a neuroprotective agent. It helps regulate water and mineral salt levels in your blood, crucial for brain function. A study in the Journal of Biomedical Science suggested that taurine could potentially protect against neurodegenerative diseases by reducing oxidative stress and inflammation.Menzie, Janet, et al. "Taurine and Central Nervous System Disorders." Journal of Biomedical Science, vol. 21, no. 1, 2014, p. 19. Eye Health: Taurine plays a significant role in maintaining proper vision, even though it might not be the first thing that comes to mind when considering eye health. Taurine is found in high concentrations in the retina, and its deficiency can lead to severe problems, including retinal degeneration. Research published in Molecular Vision showed a direct relationship between taurine deficiency and photoreceptor cell death, leading to impaired vision.Froger, Nicolas, et al. "Taurine: The Comeback of a Neutraceutical in the Prevention of Retinal Degenerations." Molecular Vision, vol. 20, 2012, pp. 733-748. Hearing Protection: Similarly, taurine also appears to play a role in maintaining proper auditory function. A study in Hearing Research found that taurine may help protect against age-related hearing loss in animals.Brozoski, Thomas J., et al. "Taurine Supplementation Prevents Noise-Induced Hearing Loss in the Guinea Pig." Hearing Research, vol. 226, no. 1-2, 2007, pp. 36–45. Though this area is still under investigation, it is possible that taurine could provide similar benefits in humans. Anti-Anxiety: Anxiety is a common affliction in tod...

If there's one thing we all know, it's that our brains work differently.  We think, relate, and communicate in unique ways. That's why communicating with anyone requires you to be a locksmith of people.  You must know your audience at such an intimate level that you're able to find the right key to the right door, and adapt your strategy to achieve common comprehension. Communicating with neurodiverse individuals has shown to be a common roadblock for many, largely due to misunderstandings, false assumptions, and lack of awareness. The goal of today's episode is to explain neurodiversity, debunk the existing myths surrounding the topic, and discuss how to better communicate with neurodivergent individuals.  Specifically, we cover: Why understanding neurodivergent individuals matters (6:00) The definitions and cognitive strengths and weaknesses of individuals with ADHD, Autism, and Dyslexia (throughout) Actionable tips for communicating and collaborating with neurodivergent individuals (56:57) How to advocate for yourself if you are neurodivergent (1:05:07) Related AoC Resources: Book: Conscious Coaching: The Art & Science to Building Buy-In Upcoming Book: Stay In the Know Online Course: Bought In Free Access to the Presentation Mentioned: Creating The Optimal Coaching Environment Quiz: What Drives You? E130: How Understanding Drives Helps Build Buy-In E59: Nathan Parnham: The Difference(s) Between Coaching Male & Female Athletes E68: Carl Coward: Embracing Difficulty & Finding Your Way For books referenced in this episode and other recommendations, check out our newly revamped Reading List Referenced Resources: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Grandin, T. (1996). Thinking in pictures and other reports from my life with autism. New York: Vintage Books. Nigg, J. T. (2005). Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: The state of the field and salient challenges for the coming decade. Biological psychiatry, 57(11), 1424-1435. Price, D. A. (2012). Neurodiversity in higher education: Positive responses to specific learning differences. Wiley. Silberman, S. (2015). NeuroTribes: The legacy of autism and the future of neurodiversity. Penguin. Sonuga-Barke, E., & Thapar, A. (2020). The Neurodiversity Concept: Is it Helpful for Clinicians and Scientists? The British Journal of Psychiatry. Thomas, C., & Baker, C. I. (2013). Teaching an adult brain new tricks: A critical review of the evidence for training-dependent structural plasticity in humans. NeuroImage, 73, 225-236. Thomas, M. S., Annaz, D., Ansari, D., Scerif, G., Jarrold, C., & Karmiloff-Smith, A. (2009). Using developmental trajectories to understand developmental disorders. Journal of Speech, Language, and Hearing Research, 52(2), 336-358. How to Connect with the AoC Team: If you want more information on these and other similar topics, reach out to our team directly at info@artofcoaching.com! If you want to connect with us face to face, check out our Live Events schedule. And speaking of live events, this is your LAST CHANCE to sign up for our Apprenticeship Workshop in Canton, GA on July 29th & 30th.  Hosted by our good friends at PLAE, The Apprenticeship is a highly interactive 2-day workshop for those looking to improve their ability to communicate, lead, and build strong relationships.  This isn't a “rah-rah,” motivational, death by power point seminar.  On the contrary, by attending, you'll experience the practice, coaching, and feedback you need to truly grow.  And better yet, you'll get to take home a quantifiable communication evaluation tool, as well as several other tools to help you strategically approach any conversation.  Sign up TODAY.  We'll see you there! If an in-person event isn't something you can swing at the moment, we have good news for you.  TODAY KICKS OFF OUR JULY COURSE SALE - 30% OFF ALL ONLINE COURSES with promo code SUMMER30.  And for the first time ever, in addition to the course(s) of your choosing, you'll get exclusive access to our online community completely FREE for 3 months!  Our online community not only gives you access to an entire library of resources related to communication, leadership, building your brand, productivity & career advice (and so much more), but it also connects you with an entire network of professionals all over the world striving to improve themselves personally and professionally.  Don't miss out on this limited opportunity!  Gain LIFETIME access to your online course today HERE!

Join us for an exclusive interview on our show, Helping Hearts, as our host, Saankhya, engages in a captivating conversation with William Doyle, the esteemed Executive Director of the Foundation for Hearing Research. Delve into the fascinating world of hearing research, where we explore the latest cutting-edge advancements, breakthrough discoveries, and the Foundation's impactful initiatives. Gain valuable insights into the ever-evolving field and discover how this organization is dedicated to enhancing the lives of individuals with hearing impairments. Host: Saankhya

Welcome to the Aphasia Access Conversations Podcast. I'm Jerry Hoepner. I'm a professor at the University of Wisconsin – Eau Claire and co-facilitator of the Chippewa Valley Aphasia Camp, Blugold Brain Injury Group, Mayo Brain Injury Group, and Thursday Night Poets.  I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Dr. Alyssa Lanzi. In this episode, we'll be discussing Dr. Lanzi's research on mild cognitive impairment and the role of the LPAA approach in serving individuals with mild cognitive impairment and dementia. Biosketch: Alyssa M. Lanzi, Ph.D., CCC-SLP, is a speech-language pathologist and Research Assistant Professor in the Department of Communication Sciences and Disorders at the University of Delaware. She is an executive committee member of the Delaware Center for Cognitive Aging Research at the University of Delaware. Dr. Lanzi is the PI of a K23 award from the National Institute on Aging to investigate the effects of an intervention designed to improve the independence of older adults with mild cognitive impairment from probable Alzheimer's disease. She is also MPI of awards that develop, test and disseminate a large-scale online database to study the language and cognitive skills of older adults to help develop cost-effective biomarkers to identify adults at risk for dementia from Alzheimer's disease. Dr. Lanzi's research broadly focuses on investigating person-centered assessment and treatment approaches for individuals with mild cognitive impairment and dementia and prioritizes the implementation and dissemination of evidence-based practice to practicing health professionals.  Take aways: The LPAA fits interventions for mild cognitive impairment too. We need to focus on training the next generation to understand the applications of LPAA to other disorders and contexts. You don't always need a standardized test, you can use goal attainment scales to measure anything. We need to be prepared to counsel individuals with mild cognitive impairment, as we are often the discipline having those conversations. When we intervene with individuals with mild cognitive impairment early, we can involve them as collaborators. There is a continuum of counseling needs that changes over time. See Alyssa's counseling plus paper in SIG 2 Perspectives.   Interview Transcript: Jerry Hoepner: Hi Alyssa. Good to see you. Alyssa Lanzi: Hi, good to see you. I'm happy to have a conversation with you today. Jerry Hoepner: Likewise, I'm looking forward to this conversation. It's kind of tradition that at the beginning of podcast we talk a little bit about your journey in your path to the life participation approach. So, I'm hoping that you can share a little bit about why an LPAA approach is so crucial to your research and clinical interactions. Alyssa Lanzi: Yeah, Absolutely. Well, thanks for having me, and I'm excited to kind of give a glimpse into how we can start to think about the LPAA approach outside of aphasia, because I think I'm a little bit unique in that way. And I am clinically trained as a speech language pathologist, and I was fortunate that most of my master's training was in a really strong university-based life participation approach model for aphasia. So, I had a large amount of experience working with Dr. Sarah Wallace and Katerina Staltari, and really thinking about group-based approaches for aphasia care. And I really fell in love with the functional nature of that model and with my master's thesis really tried to think about, well, how can we do this with individuals at risk for dementia with thinking about group-based approaches and functional care. And then I went on to get my PhD at the University of South Florida with Michelle Bourgeois. With a really strong research focus on functional approaches for mild cognitive impairment and dementia but also had the opportunity to work clinically the entire time during my PhD at voices of hope for aphasia under Jackie Hinckley, really learning about the life participation approach for aphasia. So, I feel super fortunate in that I have a lot of clinical work and exposure with the life participation approach that really has driven my research. Although I don't clinically practice with the life participation approach anymore, it really is a key foundation and a key kind of framework to how I have conducted all of my research and run the lab at the University of Delaware, which I'm currently a research assistant professor at right now. Jerry Hoepner: Excellent. Yeah. And thanks for sharing that, I really believe there is not a lot of transferability and generalizability of the LPAA in the approach being someone who has one world or one foot in the traumatic brain injury world, and another foot in the aphasia world. There's definitely some strong carryover across those contexts, and I think members of aphasia access are really interested in thinking about how that extends into those contexts. So, I really appreciate that. And like I said before, you have quite the pedigree in terms of experiences with very life participation approach minded academics, and having some of those clinical experiences, is really just so crucial for those, you know, when you step into the research world that you're doing something that really applies. So, I know you already talked about Sarah Wallace and Dr. Satari and Dr. Bourgeois and Jackie Hinckley. But are there other people along that journey that have kind of shaped the way that you think about LPAA applications to aphasia but beyond obviously? Alyssa Lanzi: yeah, I think you know, really the names that you mentioned were kind of the key mentors in the process. However, individuals like Roberta Elman, and really her approach to kind of book and learning and reintegration was structured. But flexible activities are really kind of key to my thinking, and also, as you know, an early career researcher as well. Folks like yourself and Tom and Katie really show how we can also train students in this approach as well, which is kind of being key to figuring out how I really run this lab that's based in life participation. That's not only my line of research, but also supporting the next generation. I feel fortunate in that I have mentors that really have integrated a life participation approach in many different settings from big R1 universities to smaller, R2, and R3 universities to clinical practice settings to nonprofits. And I think I've taken pieces of all of those to really support my research and teaching pedagogy, and really life participation in that way, and without aphasia access, I wouldn't have had access to those leaders and mentors in the field like yourself, and it really has given me an opportunity to have conversations with these folks, and every single conversation has really impacted and influenced my work thus far. Jerry Hoepner: I think that tends to be a really common reflection on aphasia access that everyone is so accessible. So, the name really says it, and willing to have those conversations. And certainly, that supports us in all of those avenues, research, clinic, well and academic in terms of teaching as well so completely agree with that. Alyssa Lanzi: I think that's what's a beautiful thing about aphasia access and the life participation approach is that it's not just research, either. Right? It's research, it's clinical, it's teaching, it's mentoring, it's service. And I think we will probably talk about in a little bit. But in all of my work that's really what I try to think about, I don't just try to think about, you know, research, I try to think about well, how can I study this so it can actually be implemented in clinical practice? And then how can I also teach the next generation using this approach in that way? And I think that framework, although we often think of life participation as like a clinical approach. In some ways it's really this entire framework to all those kind of core components that are necessary in terms of teaching, research, clinical care and service. Jerry Hoepner: I really love the way that you describe that, because I don't know that that's been done really clearly before. But there is a thread running through all of those pieces, and it kind of speaks to your experience with Jackie Hinckley in terms of thinking about that implementation piece, and how we make sure what we're doing matters, and is the right stuff in the first place. And obviously teaching is near and dear to my heart, and being able to frame that in a way that students understand, but also feel like it's not something that's high in the sky that you know only a few people do, but that's accessible and usable by everyone, and even for my students. I mean, I know that a lot of my students will end up in a school setting, and I know that these foundational principles of LPAA still have relevance to them. So, I say, you know, regardless of where you're going. This content matters, and it should shape the way that you think conduct LPAA work. Alyssa Lanzi: Yeah, you don't have to be at a center to conduct LPAA work, you don't have to be with people with aphasia to conduct LPAA work, and that's the cool part of it. And having these conversations is an opportunity to kind of brainstorm with one another of, well how do we take you know, from the traditional mold, how do we kind of break that and really think of it as threads that can be kind of interwoven into all these elements that are core components of our discipline in a lot of ways. Jerry Hoepner: Agreed. Maybe that's a new task for aphasia access worker to kind of map all of those pieces, because I do think not. Maybe individuals have those pieces, but it hasn't been all put together. So, I appreciate that overview. Alyssa Lanzi: And yeah, hopefully. Jerry Hoepner: well. I've been having fun re-reading and refreshing myself on your work on. I used a lot of it within my teaching so. But it's always fun to see when you read something again that you pick up something that you just didn't even like process before or you don't remember you process it, maybe. But clearly, I mean, there's this thread going through all of it about person-centered strength-based care right at the heart of all of that. It really one of the things that stood out to me the last couple of days as I've been meeting is that emphasis on fostering choice and collaboration along the way in every single step with the with the individual, with mild cognitive impairment or dementia, with their family members. And I think that's really crucial. I mean whether you're kind of choosing an external memory aid, or script, or whatever is best right. Can you talk about how you facilitate those choices? Maybe a little bit about the kinds of tools that you use on one end, but also a little bit about how you just foster a mindset of that collaborative decision making, because, you know, sometimes people can just want to defer to you and say you tell me so. I'm interested in your thoughts on both of those pieces. Alyssa Lanzi: Yeah, Absolutely. Well, thanks for the flattering words, and I'm happy. You picked out the core elements there, because I think those are really kind of the key words of a lot of the work that I try to do, and starting really with person or family centered, in that way, and it's tricky. I think a lot of people say that their work is person centered, and we can always argue. What do you mean by that? And how do you ensure that, same with functional right? But something I try to teach people, and my students are just because it's related to something practical doesn't necessarily mean it's a functional approach, either, you know, so really kind of parsing out by what we mean by that. But in particular, with working with folks with mild cognitive impairment and dementia, the goal is to really support their independence for as long as possible, and then to support their quality of life right? And a lot of times when thinking about people with chronic aphasia, it's very similar in that way, right? And that, you know, kind of gotten to a point. Not that improvements can no longer been made, but the shift is really about like, well how can you live the best life as possible? Right? How can we get you participating in as many things as possible, and that's the same mindset when we're working with people with mild cognitive impairment in particular. So, when I'm trying to design the treatment approaches that I'm testing with my clinical trials. Really, the whole framework is, how can we make something structured and standardized but flexible to that individual's needs. So, I think it starts from a treatment level, figuring out what are the active ingredients? What are the things that can't be changed, what are the core elements that can't be changed. And then, once we figure that out, then the meat of the sandwich, you know the meat of the treatment can be customizable to that individual right. And a lot of this work really comes from McKay Solberg, and views of cognitive rehab as well. But I think, when we think about person centered, we need to think about what are the core elements of this evidence-based approach? What are the active ingredients? And then what are the things that can change in between right? And when we're talking about external memory aids, it's not enough just to give somebody a calendar right. We're not seeing that individuals actually continue to use this calendar later on. And I would argue that's because of 2 reasons, one because we didn't systematically train them, and the use of it and 2 is because we didn't include them in the process from the start to the finish. And you are asking about what kind of tools and what things can be helpful. And in terms of thinking about goal development tools, a lot of times we can lean on our colleagues and occupational therapy and use a lot of the models that they have for goal development. So, they have the COPM which I'm probably going to butcher the name, but it's the Canadian Occupational Performance Measure, I believe it is, and that can be a really great tool to have a structured approach to goal setting. Same with goal attainment scaling, and incorporating some motivational interviewing techniques on top of it. But the key is that you have some type of structure, some type of evidence-based approach, on top of the conversation that you're having right, just asking somebody their interests is important, but we need to think about what's the best thing for our buck, since we have such limited time with them. So those 2 tools, in terms of goal setting have been really helpful for me, paired with using patient reported outcome measures and kind of figuring out how to use that as an initial conversation, and then paired with some further probing of tell me more about these items. Tell me more about the issues that you're facing. And then what I think is tricky, and where I relate most to my life participation colleagues are, what are the outcome tools, or what are the treatment planning tools that we can use to design these participation approaches. And it's hard because most of the outcome tools that we have are developed for looking at impairment-based improvements, right? So very decontextualized type tasks and that's really tricky. If the treatments that we're doing are all meant to be functional and person centered and improved participation. But we're not looking at necessarily improvements in worthless learning, or serial sevens or things like that. So, I couldn't figure out any tools. So, part of my dissertation work was designing a measure that was really aimed to help drive treatment planning. And then look at if there's gains an actual participation, so that tools called the functional external memory aid tool, and my lab in the last year or so have tried to do a lot of work, and coming up with free resources to train students, clinicians, and researchers, and how to use this tool to drive treatment planning because it's a little bit of a different way than we think of how to use assessment tools. Traditionally we think of assessment tools to tell us is that that person has an impairment or not and this is not designed in that way. It's really designed to tell you how to design your treatment, and a functional meaningful in person-centered way. I don't have great answers of what the tools are, but I think collaborating with clinicians and collaborating with evidence-based researchers really helps us to try to fill that gap in some ways. Jerry Hoepner: Yeah, and I think you got at part of it when you talked about goal attainment scales that you could make that a measure of any goal that the person identifies themselves. You don't necessarily have to try to fit a tool around that you can just measure what they hope to change right, or what they hope to sustain in terms of function. So, I think that's really good and really helpful. Just want to kind of circle back to a couple of things you talked about active ingredients, and how to really recognize what those active ingredients are, what the cores are, and what is content that you can do without, so to speak, made me think of some of the recent work in RTSS from the standpoint of really mapping that out. But I think that principle of my own is really important. Just to be able to say what is at the core? What do I always need to do? And what is kind of supportive of that, and can be individualized? So that's really helpful. Alyssa Lanzi: That shouldn't be on the clinician either right? If you're a clinician listening to this like that shouldn't be on you. This is on the researchers to consider from the beginning, and this should be really clearly outlined in this plan. And it is somewhat hard to figure out what some of these analyses like what are the active ingredients? But that's really, if you go to a talk, if you're a clinician on this call like that's what you should be asking, when you go to these talks like, what are the active ingredients? What do you think is really evident of what's making the change? It's not on you to decide. It's really on researchers to be thinking about this from the beginning, and not for you to try to figure out by any means. Jerry Hoepner: Yeah, I think that's a really some really sound advice, because finding out what those active ingredients are that's really crucial, and I think there's times, and I won't say who, but I reached out to a researcher once to do some work related to their work, and I said, “So do you have some place where you have more specific information about what exactly you did?” And they said “it's all in the paper” and I was kinda like no, it's not all in the paper, and I think we're getting better at that, providing that information, at least to the best of our knowledge, what those active ingredients are. And you know this is on the researcher to provide that, and then to allow that clinician to be able to work within that framework. So, I'm really glad that you said that. I also wanted to highlight the fact that you talked about your measure, and I think the acronym is FEAT right? Alyssa Lanzi: FEMAT, yep, close. Jerry Hoepner: Sorry. Missed it. I missed one letter, but we'll make sure that that is in the list of resources at the end as well, so that people know how they can access that information, and you mentioned that you're trying to make as much freely available as possible. So I think that's really helpful for our listeners to know where to find that information. Alyssa Lanzi: Yeah, the tool can be downloaded completely for free. And there's educational and training resources for free on there as well as we just publish an open access manuscript, describing with case examples of how to use it as well, because if we as researchers want clinicians to use our work. Constantly, we're hearing the biggest barriers pay walls and everything else so really trying to make this as accessible as possible, so that individuals can actually use it in their practice. Jerry Hoepner: Well, that's really excellent. I really appreciate it, so I'll double check with you at the end, and we'll make sure we have all of that information there for the for the listeners to follow up on that. So, getting into the connection and the differences between someone with aphasia and someone with a mild cognitive impairment. There's a lot of overlap and most communication supports. And as I was reading your work, I was like overlap, overlap, overlap. But there's also some ground that isn't overlapping individuals with aphasia, particularly when you get to the cognitive kinds of constructs, and so forth. So, in terms of supporting someone with MCI or dementia. What are the key distinctions that you have in your mind about how to approach that. So, distinguishing them from maybe what you would use for a language assessment, or language support excuse me, for someone with aphasia Alyssa Lanzi: I think the good thing is, there's many more similarities than differences. Right? We have this strength-based approach, this idea of participation, reintegration, isolation, depression. These are all major psychosocial factors that we know are associated with both populations and also acute. You know older adults are highest at risk. Right? We're seeing similar populations in some ways as well, so that strength-based participation-based reintegration, type approaches are all very similar. You know the key distinction or the key differences, I should say, is unlike people with a stroke, there wasn't an event that caused the impairments right, and that instead, we need measures that are really sensitive to early declines right? So, it's not like these individuals had a stroke or a brain injury, and immediately referred to speech, language, pathology. That's a very different pipeline to referral in that way. So, speech, language, pathologists need to do a much better job of advocating for our role early on where I don't think we have to do as much of that advocacy with people with aphasia now. Yes, all the aphasia folks don't come at me either because I know there's plenty of advocacy work that we need to do as well, but it it's a little bit different right, and that once aphasia is diagnosed, it's pretty clear that SLPs are the one to go to for the most part. For individuals with mild, cognitive impairment it's a bit different. So, we need to do a lot of advocacy work, and many of our tools, unfortunately, are not sensitive enough to these early declines. What's exciting is that language is actually showing as a pretty promising tool, a pretty sensitive metric. So, hopefully in the next, you know, 5 to 10 years we're starting to actually definitely be involved because we're noticing language changes or sensitive to these early declines, but so one is the early process, and the referral process is quite different. The other key difference in my mind is the preparation for the future and that individuals of mild cognitive impairment are at a very high risk for developing dementia due to Alzheimer's disease and in my work I am talking about mostly these clinical syndrome due to Alzheimer's disease is usually the bulk of my work. But for individuals with mild cognitive impairment. We really want to set them up with these tools, so that we can develop really strong habits and routines now and really rely on the strength of procedural memory, so that if they decline, they have these really good systems in place, and that's a very different mindset than people with aphasia. So, the mindset in that way is very different in our role in preparing for the future. So, I think the referrals is probably the big pipeline. How they get to you. The coping and the depression is all there. But viewed a bit differently. It's not, Oh, my God! My life has drastically changed instead it's, Oh, my God! What's gonna happen, you know, in 2 3 5 years. So, it's all those same constructs are there, but the rationale and the underpinnings are a bit different. Jerry Hoepner: I want to just go back to a couple of the points that you said again. When I'm thinking about that that early intervention or early work with someone with MCI, I'm always telling my students part of what you said that idea that we want to establish those routines and habits. But the other thing I always think about going back to our previous discussion is that's the opportunity for them to make as many decisions about their future as they possibly can, and do that planning for the future. I find that to be a really effective way from a counseling standpoint to get them involved in kind of planning their future, and also building that acceptance right like this is coming. What can I do now to kind of take ownership and to take control of that versus if I wait, then it's going to be someone else's decision. Alyssa Lanzi: Exactly. Exactly. We describe it. A lot of you want to be in the driver's seat and not the passenger seat. Jerry Hoepner: Yeah, great metaphor. And I just wanted to mention one other thing when you were talking about that the fact that language is a really sensitive measure. You believe for individuals with MCI and predictors of for their dementia. You know some great work with the dementia bank in terms of talking about collecting samples and interpreting those samples. So, I know I'm kind of putting you on the spot for this. But any thoughts about that might lead us in the future in terms of knowledge. Alyssa Lanzi: Yes, stay tuned. We more than likely have a pretty big grant coming our way, which is going to be exciting. But the current biomarker tools for detection, are costly and invasive. We're having MRI and imaging techniques which are costing, You know, so much money. Blood is becoming, you know, blood based biomarkers are at least a bit more cost effective. However, there's still quite still, quite invasive, and there's only a certain person who wants to come into a lab, you know, and do those types of things. So what we're hoping is that we can use language, and that people can provide us with language samples in the comfort of their own home, right and really reflective of these functional tools and paired with these other. You know data, this, this other data that we're collected, we can make this really kind of informed decision or inform diagnosis. So, hopefully, you know, we can get to the point where that is the case that people can kind of just answer some questions from the comfort of their own home and their smart home and their computer. And you know, on the back end we can analyze their language, and then, provide them with some information about what we're thinking in terms of diagnosis and things like that. The most exciting thing to me in my mind about language is that hopefully, we can get a sample of individuals to participate who are actually representative of those who have the disease and that with many of these imaging techniques, and with many of the blood-based biomarkers and these invasive techniques, there's only a certain type of person you know who wants to come to campus and do these things, and most of our large databases are really white, high SES folks who are just, not those who are at greatest risk for the disease. So, what I'm really hoping for with as really the area of language grows, thanks to a lot of the work that we're doing, and Carnegie Mellon are doing with Brian and Davida, and also Kim Mueller and her group at Wisconsin. Is that not only can we use it as a sensitive measure, but we can get people to participate because, hopefully, it reduces the common barriers to participation in research studies. So that's really kind of a focus of where we're going. And then, hopefully, with that information, we can better support those who are at greatest risk living with this disease. Jerry Hoepner: Right and it seems like there's kind of a secondary effect to once you have those answers. There's a lot more SLP's than there are, you know, other mechanisms for measuring those bio measures. So, if you know that contact, maybe we can contribute to that earlier detection as well, so that's fantastic. Alyssa Lanzi: Yeah, which is why we need more SLPs going in this space, and I love aphasia work. I'm an aphasia clinician at heart. But I hope we see after today and through many of my other colleagues that the world overlap so much. But we really need a lot of researchers in this space, because speech language pathologists have a lot that they can contribute, and could very soon be at the forefront of the of the diagnosis as well. So, any students on the call or clinicians wanting to go back. My labs and others are really recruiting, and we need more individuals who are interested in researching in this space. Jerry Hoepner: Yeah, that's great to share. And hopefully there are some students and professionals out there that are thinking about that so definitely need that. Well, I'm going to change gears just a little bit. You've talked a little bit about depression and other mental health issues a little bit, isolation that occurs not only with aphasia, but with mci and dementia. I think we're all starting to get a better idea of our roles as speech, language, pathologists, in terms of counseling individuals with aphasia, MCI, dementia, traumatic brain injuries, etc. In re-reading your 2021 paper about counseling, plus I was really struck by how you and your co-authors mapped out this continuum of counseling needs kind of makes me want to do the same for everything so in activities from the first symptoms and diagnosis to the end of life, and I'll refer our listeners to figure one because it's a really eloquent framework for, and timeline for those changes. Will you share a little bit about the development and kind of the purpose of that timeline figure. Alyssa Lanzi: Yeah, thank you for the kind words that was probably one of the hardest things I've ever done was writing that paper, but we knew it needed to be done for many different reasons, but really to paint the picture that SLPs have a key role from the start all the way to the finish with these folks, and that's really what that figure is trying to highlight is that we can provide both primary and supportive roles to our colleagues from prevention and education all the way through end of life. And fortunately, that figure has really resonated with a lot of people which has been really helpful and I've actually gotten a lot of feedback from clinicians who've been able to use it to advocate for their role in this working with this population and doing support groups and things like that. So that's really great, because that's the whole point of it. But what's unique about this paper is that I work on a very interdisciplinary team of neuropsychologists and geriatric psychiatrists. And it was really interesting to come at it with all 3 of our mindsets for kind of developing this, because everybody has a very different education in terms of these important psychosocial constructs. So a really big shout out to my colleagues, Matt Cohen and Jim Allison, who really also helped me push my mindset of thinking about counseling as much more than just a conversation, and really thinking about counseling, plus as we call it, in terms of everything else right, and that a conversation is only the start of it, and that education and management and advising and referrals, that's all, that's all the big piece of it. So, I think that's why we were able to really round out this figure is because we were coming at it from 3 different disciplines as well, and then being able to go back to okay Well, what's within the scope of practice, of speech, language, pathology. The other thing about this figure is you'll see that the x-axis, the way that we looked at over time was by residential status, not by necessarily MMSE score or MoCA score right, and that framework was very much from my background in life participation approach in thinking about okay, let's think about them on a continuum of like residential needs versus what is their cognitive status on like an impairment type measure. I encourage people to think that way when we think about working with older adults in particular with neurodegenerative conditions, and that not thinking about them as a numerical value in a stage on one type of those measures because I think it opens up our roles, and also shows how hopefully within that figure that you can see that the roles overlap. Right, there's some roles that we start from our first conversation that we're going to continue all the way through the end of life. The other really important thing to consider with the figure, is in our field we have a really strong understanding of like language milestones in pediatrics, right? But what we don't have a really good strong foundation is, is understanding what is typical aging right, and our role in supporting healthy aging as well. Just as we support language development in pediatrics. So that's a big piece of this figure and a big piece of the counseling article is that we have a major role like we do in language development in healthy aging development as well, and that we can do a lot to support healthy aging and prevention just like we do in language development of kids, and also like we do like with the FAST acronym for stroke or with concussion protocols and management, we just haven't, yet kind of adapted that approach to aging, and that's what hopefully this figure gets us to start to think and talk about as well. Jerry Hoepner: I think it definitely does. And I really like that analogy or metaphor comparison between the developmental milestones, because I was thinking that as I was looking at the figure, this is really similar. It kind of reminds me of, like the norms we looked at when we were in child phono or child language development laid out in the same kind of framework. So, I think that's something that is really comprehendible by the average SLP, and I think that's helpful, and I and I love how you describe x-axis in terms of those descriptions rather than numbers, just so crucial to see the person from that lens rather than as simply those numbers. So. Alyssa Lanzi: Yeah, in addition to my LPAA colleagues, my early intervention birth to 3 colleagues, or who were the closest with in a lot of ways, I definitely the treatment approaches the in-home approaches. They're in the next group, I would say. That is pretty close to LPAA as well in some ways is early intervention. Birth of 3. Jerry Hoepner: Agreed. Yeah, that's it. Another really great point. The other thing I really liked about the terms and you mentioned this: I think part of this comes out of the interprofessional kind of nature of development. But when you look at them, sure some of them are, you know, you think. Oh, yeah, that's counseling still, but many of them you don't necessarily wait to. Oh, yeah, that's in my counseling tool belt, and I think it's important for people to recognize those things are a part of that counseling process, and that can make it a little bit more accessible. I mean, we know that from an education standpoint that people are intimidated by counseling, and they feel unprepared and inadequate to carry out those steps. So, I mean just being able to see that on paper and say, I can do these things, I know these things, I think, are a really valuable part of that framework as well. So. Alyssa Lanzi: And to make sure that when we are describing counseling to our students, we're describing that as well, right, because its such a daunting thing for our students and if we help them in the beginning set up education, it really breaks down some of the common barriers to providing counseling of its daunting and scary. But a support group is one really small element of counseling that's within our scope of practice and our scope of practice does define it really well. I just think that how we describe it in articles is way too specific, and we need to think about it much more broadly and through, like the journal that you're responsible for with teaching and language. And you know we're starting to develop these models which is really helpful as well. But I agree, I think we just need to step outside of our really kind of specific way of thinking about counseling, because once again, then, by having a more broad continuum viewpoint. It really shines through our role. And why we are such key players of the team. Jerry Hoepner: Yeah, agreed. I mean, we are always going to be the ones who are put in that moment, that counseling moment we have to be prepared and stepped into it so obviously. That's my bias. But I think we always are. Well, this has been a fantastic conversation, and I could go all afternoon, but want to keep this reasonable for our listeners too. So, I want to end on kind of a broad question, just in terms of what's your advice for SLPs and other disciplines, for that matter, in terms of working with individuals, with mild cognitive impairment and dementia, specific to the use of the external strategies and supports, but kind of weaving, counseling into those interactions? Alyssa Lanzi: Make sure we're really listening to our patients and our families and take that extra second to pause and really make sure they feel valued and heard because especially for these individuals, they're scared. They may not yet see consequences in their everyday life. So, we need to really have a lot of buy in, and good rapport with them from the beginning, because they can make key changes in their life that may actually delay the onset of dementia. But they need to have buy in from you, and they we need to really promote behavior change and to do that they need to feel, listened to and heard. So, take the extra second and make sure you're doing that. Then I think, make sure that we are providing evidence-based approaches around these strategies that we are teaching and the 3-step approach by Solberg and Mateer and the pie framework. All of these, you know, meta-cognitive strategy frameworks. It starts with education, and we need to make sure that our clients have a really big education of what even is the strategy? What are all the components of the different strategy? Why is it they are even using the strategy right? Don't, jump into training the strategy yet, really start with the education and use the teach back approach, and make sure that they can help you in that way and then make sure you also don't view your approach as linear, things are going to change right, and you're going to have to go back a step and go to education. But you know I think functional is key and important, but it doesn't mean that we take away the evidence based, either right. And it's really thinking about how to integrate both of those things, and being honest with yourself and your client if things aren't working, and you need to readjust as well. But if your patient feels valued and heard, then that's the first step, and we need to make sure that we're continuing that step all the way through to the end of the sessions. Jerry Hoepner: Absolutely agree. Well, again, it's been a fantastic conversation. So really, thank you so much on behalf of Aphasia Access for your time and your insights and hope to see you again soon. Alyssa Lanzi: Yes, thank you. Please feel free to reach out. And if you ever see myself or my Doc students, Anna or Faith, or my colleague, Mike Cohen, at a conference. Please say hi to us as well. We love talking about our work and brainstorming with others, especially in the LPAA world. Jerry Hoepner: Sounds terrific. Thank you, Alyssa. Alyssa Lanzi: Thank you. Jerry Hoepner: On behalf of Aphasia Access, thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access and to access our growing library of materials go to www.aphasiaaccess.org. If you have an idea for a future podcast series or topic, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access. Articles & Resources: Cohen, M. L., Harnish, S. M., Lanzi, A. M., Brello, J., Victorson, D., Kisala, P. A., ... & Tulsky, D. S. (2021). Adapting a Patient–Reported Outcome Bookmarking Task to be Accessible to Adults With Cognitive and Language Disorders. Journal of Speech, Language, and Hearing Research, 64(11), 4403-4412. Lanzi, A., Burshnic, V., & Bourgeois, M. S. (2017). Person-centered memory and communication strategies for adults with dementia. Topics in Language Disorders, 37(4), 361-374. Lanzi, A., Wallace, S. E., & Bourgeois, M. S. (2018, July). External memory aid preferences of individuals with mild memory impairments. In Seminars in Speech and Language (Vol. 39, No. 03, pp. 211-222). Thieme Medical Publishers. Lanzi, A. M., Saylor, A. K., Fromm, D., Liu, H., MacWhinney, B., & Cohen, M. L. (2023). DementiaBank: Theoretical Rationale, Protocol, and Illustrative Analyses. American Journal of Speech-Language Pathology, 32(2), 426-438. Lanzi, A. M., Ellison, J. M., & Cohen, M. L. (2021). The “counseling+” roles of the speech-language pathologist serving older adults with mild cognitive impairment and dementia from Alzheimer's disease. Perspectives of the ASHA special interest groups, 6(5), 987-1002. Links:  FEMAT Website  FEMAT Open Access Manuscript  Delaware Center for Cognitive Aging Research- Free Memory Screenings  Counseling+ Open Access Manuscript  DementiaBank Open Access Manuscript  DementiaBank- Free Discourse Protocol 

Welcome to this edition of Aphasia Access Aphasia Conversations Podcast. My name is Janet Patterson. I am a Research Speech-Language Pathologist at the VA Northern California Healthcare System in Martinez, California, and a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their efforts in engaging with persons with aphasia and their families through a variety of educational materials and resources. I am today's host for today's episode that will feature Dr. Jacqueline Laures-Gore. These Show Notes accompany the conversation with Dr. Laures-Gore but are not a verbatim transcript.     Dr. Jacqueline Laures-Gore     Dr. Laures-Gore is a professor in the Department of Communication Sciences and Disorders at Georgia State University in Atlanta, where she directs the Aphasia and Motor Speech Disorders Laboratory. Jacqueline's work spans topics in aphasia and motor speech disorders. For the past several years she has investigated the relationship between integrative health practices and aphasia rehabilitation.     In today's episode with Dr. Laures-Gore you will hear about: the relationship among stress, resilience, and coping skills, recognizing and measuring physiological stress and perceived, self-reported stress, the interaction of stress, anxiety, and fear, and the role integrative health practices can have in daily life and in aphasia rehabilitation.     Dr. Janet Patterson: Welcome to this edition of Aphasia Access Conversations. Today I am delighted to be speaking with my friend and colleague, Dr. Jacqueline Laures-Gore. Jacqueline is a professor in the Department of Communication Sciences and Disorders at Georgia State University in Atlanta, where she directs the Aphasia and Motor Speech Disorders Laboratory. Jacqueline's work spans topics in aphasia and motor speech disorders, including investigating working memory in persons with aphasia. In motor speech disorders, she and colleagues examined topics such as intelligibility in people who have dysarthria, and speaker and listener perceptions of speech in persons with dysarthria. She is a co-creator of the Atlanta Motor Speech Disorders Corpus, which is a comprehensive spoken language dataset from speakers with motor speech disorders in Atlanta, Georgia. This collaborative project gathered speech samples from non-mainstream, American English speakers residing in the southeastern United States in order to provide a more diverse perspective of motor speech disorders.   For over two decades, Jacqueline has been interested in how personal, physiological, and psychological factors affect people with aphasia, and aphasia rehabilitation. She has investigated topics such as stress, depression, mental health concerns, and how to assess their presence and influence. With her colleague, Ken Rice, she recently published the Simple Aphasia Stress Scale in the Journal of Speech, Language, and Hearing Research. The SASS is a single item self-report measure of acute stress in adults with aphasia.   Dr. Laures-Gore's work also investigated the power of laughter, mindfulness, meditation, spirituality, yoga, and integrative health practices for persons with aphasia. I am pleased to welcome Jacqueline to Aphasia Access Conversations today and look forward to talking with her about her clinical and research experience considering how integrative medicine can influence a person with aphasia and their rehabilitation, and the powerful effects that mindfulness, laughter, and yoga can have on life outlook, participation, and rehabilitation.   Welcome, Jacqueline. I appreciate your time today in talking with me about these fascinating and important topics.   Dr. Jaqueline Laures-Gore: I am very happy to be here, Janet, and very honored. I look forward to a very lively and fun conversation with you today.   Janet: Jacqueline I would like to start by asking you about the aspect of your aphasia research interests that includes important topics such as depression in persons with aphasia, stress, laughter, and spirituality. In fact, I believe you are among the first to write about the value of integrated health practice in aphasia. How did your career path and learning curve about aphasia take you to this line of inquiry?   Jacqueline: There's quite a bit of time that I spent with people with aphasia through my clinical work, and even early on before I became a speech-language pathologist and worked in a geriatric setting. There was a gentleman there who had aphasia and we did not really know how to communicate with him. He was very isolated. He sat by himself most of the time, was very alone. That image of him and what he must have been experiencing, and our inability to really know how to communicate with him, stuck with me over the years and definitely drove me toward a career in speech-language pathology, and specifically working with people with aphasia. Then, after becoming a speech-language pathologist, and working full time in rehab settings, it became very obvious that people with aphasia were more than the problems with phonology and semantics, and so forth. There was a bigger picture here, and there was oftentimes frustration. I watched and tried to provide some help to reduce frustration during some of the language tasks that people would be doing in clinic. But as I tried to look in the literature about well, what do we know about this frustration? What do we know about stress and the language system? What do we know about ways to facilitate language through the stress mechanism? What do we know about relaxation, and its effect on language, and so forth. All of those things really seem very under-explored in our aphasia literature. My curiosity definitely drove me to looking then, into a Ph.D., and having some great mentors who encouraged me to continue down this path of the fringe group. There weren't a lot of people who were very interested at the time in stress and thinking about what happens with the language system, or of mindfulness, meditation, and so forth. By far, I'm not the first to consider these things. McNeil and Prescott had a meditation paper, I think it was back in the 1970s. Cynthia Thompson had a paper on hypnosis, I think it was in the 1980s. There have been others, too.   Janet: I'm listening to you and thinking, we probably all had some sort of thoughts about this, as we see patients. I'm envisioning the patient that you saw in the geriatric center, we probably all have had patients like that. I'm impressed that you didn't forget, that you kept that in your mind as you moved forward. I think many of us didn't know what to do with it, didn't know how to think about this. Other things present themselves and we get busy with our worlds and our learning about phonology, or semantics, or syntax. It's hard to remember. I'm glad that you remembered and also, that you were brave enough to stay out there on that fringe, because not everybody is that brave.   Jacqueline: Oh, it's hard! It has been hard. It's gotten easier now, and hopefully, it will be easier for the next generation of researchers on this topic. Definitely my longtime collaborator, Rebecca Shisler Marshall, and I had difficulty getting things published. Thinking too, about research design, and approaching the topic with this particular group of individuals with communication disorders, it's a unique population. There's still a lot of growth regarding research design and establishing clinical trials, and we're just at the early phase of really investigating this.   I love that you were pointing out that oftentimes people forget that first person that they encounter with a specific communication disorder, and in this case with aphasia. I was 17, and I'm a few years older than 17 now, but I think, though, that for some individuals, there's a catalyst. It could be a personal experience, I hear lots of times when we have students coming through our program, “Oh, I had a family member who (fill in the blank) and had to have speech therapy”, or “I myself had to have some kind of speech therapy, and that's why I want to do this”. For me, at least, it was this individual that I was tasked to care for, and not really knowing how to care for that person. Definitely an emotional component there, and a feeling of responsibility.   Janet: I have visions of some of my patients when I was first starting out, boy do I wish I could have a do over!   Jacqueline: Oh yeah, obviously, I hear you.   Janet: This leads me to my next question. Your research has investigated some of the challenges that all of us, including persons with aphasia, experience such as depression or stress or mental health concerns, or coping with life's challenges, whether they're small challenges or large challenges. These words and concepts, I think they appear commonly in our conversations, and while people may believe they understand their definitions at a broad level, I believe that that may not be the case when we consider them in the context of treating our clients who have aphasia. How do you think about these concepts as they relate to persons with aphasia and their family members? And to our treatment programs? Could you give us some sort of guidance about how we might define and use these terms in our clinical work?   Jacqueline: Let's start with stress. Something that I have been talking a lot about lately, and especially with my doctoral student right now, is defining stress, defining anxiety, defining fear, and the differences between those three. When we think about stress, stress is really that threat in the moment. There are different ways in which we respond to that in-the-moment threat. One way is physiologic, and we have two biological arms of the physiologic stress response. One is the sympathetic adrenal medullary system, and the other is the hypothalamic pituitary adrenal axis. The first one, the sympathetic one, or the SAM, shows up with our heart rate and sweating, changes in our digestive system, and pupil dilation. The other one, the hypothalamic pituitary adrenal axis, that one will show up more with the changes in ACTH [adrenocorticotropic hormone] and downstream cortisol. All of those, though, have different effects on our body, and we can measure them with different techniques.   The physiologic stress response is adaptive, and stress is not always a bad thing. From an evolutionary perspective, having that stress response has been very beneficial for us, as humans. Now, when that stress response is consistently engaged, then it becomes problematic and oftentimes can become some type of illness or disease. In the short term in helps us to adapt to a potentially negative situation.   The other stress is more of a perceived stress. Perceived stress is the perception that there is a stressor, there is something in my environment that is creating this feeling of dis-ease. That perception of stress is reliant also on whether you feel you have, or you have coping resources. Do you have the support around you to help you deal with this stressor? For instance, do you have the financial means to help yourself, and some people rely on religious practices or spiritual practices to help them cope.   Anyway, so we have that self-perception of stress, and then we also have the physiologic stress, and the two do not have to match. Oftentimes, we can have somebody who reports themselves as perceiving stress and having a high level of perceived stress, but physiologically, it's not showing up. That makes it always a little bit tougher to study stress, and clinically to even assess stress. I'm not sure which is more important. Is it more important to not be perceiving stress? Or is it more important not to be feeling stress physiologically? I don't have the answer to that.   One of the things that's very exciting clinically though, is that there are more wearables now that can detect changes in heart rate, changes in skin conductance or skin response. I think that is going to be helpful eventually for clinicians who are trying to determine how stressful a certain situation is as far as a language task or a communication task.   We're also seeing more self-report measures of stress. We have the SASS, as you had mentioned, which is an acute measure. It's just one question and it's on a scale. Rebecca Hunting Pompon and colleagues created the Modified Perceived Stress Scale, which looks at stress over the last month, more of a chronic stress assessment.   You'd mentioned depression. We're seeing a lot more work in post stroke depression in people with aphasia in the last ten years or so. With that attention to the mental health of people with aphasia, we're seeing more scales that are at least being looked at, to help measure depression in people with aphasia, whether it be modifications of stroke depression scales that are already there but for the general population, or specific to people with aphasia. I see those as becoming more accessible clinically and us figuring out more about what we can be using in the clinic to look at depression.   Janet: This is fascinating, and I would love to spend hours talking with you in more detail about some of these measures.   In preparing to talk with you, I did a literature search of some of these terms like stress or depression, as they are linked with aphasia. I noticed that there were a few papers on the topic 30 or more years ago, but not many. In the last decade or so, as you mentioned, there has been an increasing number of papers that describe something about stress or depression, or how to measure it, or what to do about it. I think that this is a good trend, and it's certainly consistent with LPAA principles that seek to maximize the life experience of persons with aphasia. That said, I was challenged to draw consistent conclusions from the evidence that I saw. I'm wondering if you could summarize some of the findings from your research and experience and help us place this work in the greater context of evidence informed practice for aphasia.   Jacqueline: We know more about depression and functional outcomes, how post stroke depression can have a negative effect on functional outcomes in persons with aphasia. The problem is that the amount of literature is fairly small. Primarily, it's because that in the past, people with aphasia have been excluded from some of those studies. I see that changing now, where there is more inclusion of persons with aphasia. Then when it comes to stress, that literature is really, really just beginning, as far as empirical data to direct clinical care. In my work, what I've been able to show is that there are definitely some correlations, some associations between self-reported stress, and some aspects of discourse. I've been setting, at least most recently, picture description, for instance, or some type of narrative, and then looking at the discourse production to see if there's any kind of association with different aspects of self-reported stress. We found some things but nothing necessarily consistent. There's been some association with pausing, such as filled pause and unfilled pauses. We've seen that perceived stress can be either negatively or positively associated with those aspects of discourse. I think that right now, the evidence is a little unclear about what the effect of stress is on language.   I also always want to tell people that we really need to not always think about stress negatively. We need to think too about stress as an adaptive process. It may be that sometimes stress and language work together very nicely, and stress may give language a little boost. There was a 2019 paper that we had out looking at cortisol awakening response and diurnal variation, and we saw some differences between people with aphasia, and people without stroke and aphasia. The people who did not have a stroke and aphasia had a cortisol awakening response, which is that when we first wake up, the cortisol which is always in our body and is that very endpoint of hypothalamic pituitary adrenal axis, it releases glucose in our system and gives us sugar which gives us energy. For the most part, when people wake up, they have a lower level of cortisol. Then about 30 minutes later it starts peaking and then it continues to climb throughout the day. It's thought that that energy at the early onset of the day gives us a little bit of energy to get us going. In that 2019 paper, we didn't see that people with aphasia were following that pattern. That made us wonder if maybe there's an energy source that isn't fully functioning for people with aphasia, or at least isn't fully engaged in people with aphasia, and that could be contributing to language. There are a lot of things with that paper, too, that left us with more questions than answers. I think that's where we're at as a whole, with stress, with depression, with integrative health practices, is a lot more questions than answers still.   I do think that there's a sweet spot that maybe I won't, it will probably be maybe the next generation, I don't know if it'll stick around with my generation, or with me at least, but I'm trying to figure out what that sweet spot is for individuals. How much stress is too much stress, how much stress is just enough stress. Also, there's probably a big component of just inter- and intra-individual variability. What works for me, Janet, may not work for you. I think that's when clinical care really takes on that art piece, too, tuning into the person that you're helping and finding out what works for them.   Janet: I think you've said that so, so well. One of my fears is that this larger idea of the work that you're doing, people may see it as a bandwagon to jump on without really understanding the work behind it, the data behind it. So hearing you say, yes, we think there are some effects, but there's not enough evidence yet for us to say exactly what, in what way, for whom, all the time, under what conditions. Also bringing the ideas back into the art of the clinical work to pay attention to your patient, not just the responses that they're making linguistically, but also nonverbally, what they're showing you or telling you. Maybe take a step back to talk about, are they having a moment of stress? Or is something going on in their life that can be affecting their performance today? I think that's a good thing.   Let me turn a little bit in a different direction, because in addition to talking about and measuring stress and depression, your work is also focused on behaviors that can benefit all of us. Behaviors or activities such as mindfulness, yogic breathing, meditation, yoga. How did you become convinced that these activities can have a positive effect on a person with aphasia?   Jacqueline: Well, I don't know if I'm convinced. I am exploring.   Janet: Good point.   Jacqueline: It is yeah. I'm not convinced. I think, again, that there are differences between people and so that not everybody has a good experience with yogic breathing,  or is it maybe not appropriate for some individuals. Mindfulness can be very beneficial for people who are not necessarily aware of a certain behavior. But at the same time, when one becomes more mindful, there may be other emotions that come up. When you're introducing mindfulness into therapy you have to be aware that there may be some negative parts to introducing that and be prepared for some other emotions that may come up.   Stacy Silverman McGuire is a student of mine, and she did a thesis on laughter, yogic laughter. In that paper, we give a little qualitative piece to some of what she had studied and there were some people who just really enjoyed laughing and wanted to have more laughter in therapy. One person specifically commented that there's just not enough laughing that goes on in aphasia therapy. Another comment was that it was just weird; their experience was that this was kind of weird. People have different things that work for them, and some people don't like them. I think what we'll continue to find in this line of work is, again, that individual piece of what may work for some may not work for others.   When we look at some of these integrative health practices, many of them have roots in ancient medicines, whether it be ayurvedic medicine, traditional Chinese medicine, indigenous medicines, there's a long, long history. Some of the practices have become more secularized. Some of the practices have, I should say, religious roots to them, and in the western world have become a bit more secularized. For some people that we may be caring for, they may not be comfortable with some of these integrative health practices because of religious beliefs, or they may prefer more conventional medicine. So how's that, clear as mud?   Janet: It is more clear than mud, actually. Because it's what you said earlier. I don't think this is a fringe topic any longer, but it certainly is an unexplored topic. It's messy, it's difficult to examine. You talked about your challenges in thinking about research design, for example. And then, of course, there's the personal comfort with any aspect of this. It's not just the person with aphasia, but I'm thinking about if you're a clinician, how do you get to a comfort level where you can talk about mindfulness, or talk about spirituality? If you're not comfortable, then it's probably not a good thing for you to do, because your level of discomfort will spill over onto the client, who will certainly be aware that you're not comfortable talking about this. That may affect the interaction.   Do you have any thoughts or any advice or guidance you might give to clinicians as we think about this large, messy topic, if you will, and how we might be thinking about incorporating any of these things into our worlds?   Jacqueline: Yeah, I think a really good aspect of all of this is clinician comfort, and thinking about clinician comfort, even getting away from just the standard, traditional model of therapy, where we show a picture, and then we work on naming that picture. When there's been the movement since the late 1990s of the Life Participation Approach to Aphasia, and getting outside of just the impairment focus, and looking at life participation, and so forth. That goes along with A-FROM and all of that wonderful work that people before me have done. Clinicians had to feel comfortable with that, too, of looking at the bigger, broader picture. Now this adds another dimension as well, that I think feeds in very nicely to LPAA, and A-FROM and so forth.   When we think about things like meditation, awareness, even just doing something, not necessarily labeling it as meditation, but labeling it, as “Let's just focus on your breath for a moment. Slow down, and just breathe.” You can have a few deep breaths, and help that person get back into a state where maybe they are not over aroused with their stress system.   As far as the religion and spiritual aspect, it's part of one's culture. As we work with people who are culturally diverse, we are as speech-language pathologists, really responsible for becoming more comfortable with acknowledging all of the aspects of culture, which includes religion and spirituality. One's religious practices can have an immense effect on their perspective about therapy, about aphasia, about recovery. That is an area that we're learning more about specifically with aphasia. When we look at religious practices and healthcare in general, and there's a much larger literature out there than looking here, just within aphasia rehabilitation. So, again, I think we're going to be learning a lot more in the coming years about that aspect. But again, it is recognizing an important piece of one's culture.   I feel like I'm kind of just like rambling on.   Janet: Well, first of all, you're not rambling on. It's a winding road topic, if you will, it's not a straight-line topic. There are perspectives from all over that we have to consider. As you were talking, part of what I began to think was that there's a difference between acknowledging and respecting someone else's beliefs or spirituality or their culture, even if you don't understand it, or perhaps you don't personally practice it or personally agree with it. But you acknowledge it, you accept it, and put yourself in a comfortable position so that you can have a clinical relationship with the patient, and then achieve the goals that you want. That's what it seems to me like you're saying, or you're advocating for?   Jacqueline: Yeah, I think the hit the nail on the head.   Janet: Let me ask you a little bit more about your work on stress. You talked about two terms, self-reported perceived stress, and then stress, or maybe physiological stress. Could you define these terms a little bit more deeply, and give us some examples of how they appear in the lives of persons with aphasia, and without aphasia?   Jacqueline: Well, physiologic stress, again, can manifest differently throughout the body, because of the two different biological arms of the stress response. There is such a huge literature now on all of the stress-related illnesses that we have here and globally, and of course, stressors are different. They can be related to family situations, they can be related to income level, they can be related to health, political issues, wars. There can be the big things. Then that physiologic stress may be engaged with the smaller day to day things, such as a coworker, that is really hard to deal with, or a situation with a spouse or a sibling, or so forth.   And then there's the perception of stress, which I think is so incredibly important. Sometimes you may, Janet, have met somebody, or maybe you yourself are that person, who doesn't seem to get too worried about things. They seem to have a perspective that, “I can handle this, I got this, It'll turn out just fine”. They can kind of roll along with life. Then there are individuals where the cup of water spills and it's the end of the world. There's concern about little things. How we perceive stress is based on, I think, early life experiences. It's based on what we come into this world with and the modifiers in the environment, and then from there, form those who perceive stress and those who don't perceive a lot of stress. It gets back to coping. Some individuals have the ability to cope much better than other individuals and have a lot more to rely on in times of stressful events than others?   Janet: I think the coping that you mentioned is so important. A big part of our job is probably supporting that throughout our treatment, the rehabilitation program, so the patient can continue to cope with the challenges of aphasia.   Jacqueline: I agree, finding out how an individual's coping. We've been working on trying to develop a coping questionnaire for people with aphasia for a few years now. We're data collecting with that and hoping to have that available to clinicians. Right now, we don't have one that's aphasia friendly. We don't have a coping questionnaire to find out how are people coping? What are they relying on? Are they relying on maladaptive behaviors to cope? Are they drinking a lot? Are they abusing other substances? Or, are they reaching out to friends? Are they getting some exercise. There are some very positive ways of coping, and there are some natural, healthy ways of coping. Finding that out is very important clinically, and how do we do that? My answer is we need to develop a good questionnaire that's psychometrically valid, and so forth. Until then, clinicians can definitely ask, and use supported communication techniques, I should say, in order to get those answers to, “What do you do when you get really frustrated?”, and then have some pictures to point to perhaps, or words to point to whatever that person is able to best communicate with?   Janet: That's a great idea.   Jacqueline: Yeah. First of all, understand what their coping mechanisms are and strategies, and then help them to develop more or, through the Life Participation Approach, how do we help them to have access to those things that might help them to cope? If they were really engaged in group activities prior to their stroke and living with aphasia, then how can they get back to that? How can we have them engage again?   Janet: Well, you've just actually given a partial answer to the next question I want to ask you, which is how we can, as clinicians, incorporate some of these positive experiences or helpful experiences into our clinical activities. The thing is, like many of us, we may not be experienced at, say, incorporating mindfulness or yoga into our own lives, not to mention putting them into treatment. And so we likely have no idea how to start. Based on your research, and again, on your clinical experience, what advice can you give our listeners who may wish to add some of these ideas or some of these activities to our practice? Where do we start?   Jacqueline: I think getting back to that comfort level. What is the clinician comfortable with? And as you had pointed out, that if you're don't have that internal self-comfort of “I can have the person that I'm working with, kind of slow down, take a deep breath, maybe take four breaths in and out slowly”. If I don't feel comfortable doing that, then don't do it, because it's going to come off kind of odd. Having some comfort, whether it be practicing with oneself, or practicing with others before you get into therapy, I think that's really important.   Janet: There are practices such as yoga, for example. I think if you're going to incorporate yoga, you have to know what you're doing. You have to understand yoga, or you have to be able to do it or to instruct it. If you're not at that instructor level, there can be problems in the therapy session. So you wouldn't want to incorporate yoga, unless you are really skilled at it and know what you're doing. But there have to be some positive practices that are relatively easy to incorporate, maybe laughter or even a discussion of spirituality. I'm thinking about, sort of, the term Monday morning practice. What can clinicians do on Monday morning, without having to do a lot of learning about yoga or practicing yoga? What can they do on Monday morning, when they see clients that might help them begin on this path of integrative health practices or thinking about the other aspects of our aphasia rehabilitation? Does that makes sense?   Jacqueline: Yeah, yeah. Yeah. It is the “rubber hitting the road” sort of thing to all of this?   Janet: Exactly.   Jacqueline: There is adaptive yoga that Amy Dietz and Laura Bislick and colleagues had published in AJSLP, a couple of years ago. There are some postures that are presented that are accessible to clinicians. So they could look at those. There are some adaptive yoga techniques that are clinically accessible. Some very simple breathing activities. These are not complicated. It is just a matter of “Close your eyes; and for a moment, go ahead and take a nice deep breath in and out.” Recognizing that the breath really anchors everyone to the moment. When you have an individual that you're working with that seems to be over stressed and it's working against them in what you're trying to have accomplished in your therapy session, taking a moment, closing the eyes, and breathing will bring them back to that moment, moment of relaxation or to the present where they can approach the task with a different perspective.   Janet: It makes so much sense to me and even just doing it with you - for those few seconds, closing my eyes taking a deep breath, I felt a difference in my own self, just in the in the course of this conversation. I can imagine that it will produce a similar effect, resetting, if you will, the clinical environment, resetting the goals, and reducing perhaps any negative perceived stress that the patient might have. If they're thinking that they're not doing what they're supposed to, or they're not meeting goals, or they're having troubles. It's great idea.   As we bring this conversation to a close Jacqueline, are there any other pearls of wisdom or lessons learned in thinking about the influences of integrative health behaviors on language and communication, rehabilitation, not just for the people with aphasia, but also for their families, their friends, and for clinicians,   Jacqueline: I think lessons learned is keeping an open mind and really approaching aphasia, with the perspective that there is the language impairment, but there's also a bigger picture here. There are different approaches to recovery that can stem from traditional ancient medical beliefs that may help us during this modern time that we're in. I think keeping an open mind, but yet, maintaining some skepticism, too. We do want to continue to have science guide our therapies, as well as our clinical experience. It can be hard to have a convergence of the two at times. But I think that we can't ignore that there is more than just the language impairment going on.   Janet: We cannot ignore it. You're right, especially if we are proponents of the LPAA model, which incorporates the whole individual in living their life. I agree with everything that you've said and I'm finding myself thinking of that balance, too, between there is some stress that can be good, but don't have too much stress, because you don't want it to be a bad thing, and keep an open mind but have healthy skepticism. All of that's a good thing for all of us to practice.   Jacqueline: Not easy, it's hard to do, but it's a good thing.   Janet: Today's conversation has been, for me at least, thought provoking and enlightening and I hope it has been for our listeners as well. Realizing that additional work is necessary to provide an evidence informed foundation for incorporating many of the activities such as yoga practice, or mindfulness into aphasia rehabilitation, I believe that this is an avenue well worth pursuing in both clinical and research activities. I would like to thank my guest, Dr. Jacqueline Laures-Gore for sharing her thoughts and experience in this important area of clinical research and practice, Jacqueline, I greatly appreciate you taking the time to speak with me today, and for providing our listeners with the foundation and how to think about integrative medicine.   Jacqueline: You are very welcome. This was very fun. Thank you, Janet, for asking me.   Janet: Oh, you're welcome.   I would also like to thank our listeners for supporting Aphasia Access Conversations by listening to our podcasts. For references and resources mentioned in today's show, please see our Show Notes. They are available on our website, www.aphasia.access.org. There you can also become a member of our organization, browse our growing library of materials and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. For Aphasia Access Conversations, I am Janet Patterson and again, I thank you for your ongoing support of aphasia access                       References Aphasia Access Conversations Episode #98: An Aphasia Journey Through Linguistics, Neuroplasticity, Language Treatment, Counseling, and Quality of Life: A Conversation with Chaleece Sandberg Episode #95: Supporting Psychological Well-Being: A Conversation with Jasvinder Sekhon Episode #89: Aphasia is a Complex Disorder: Mental Health, Language, and More – A Conversation with Sameer Ashaie Episode #69: Motivation and Engagement in Aphasia Rehabilitation: In Conversation with Michael Biel Episode #67: Considering Depression In People Who Have Aphasia and Their Care Partners: In Conversation with Rebecca Hunting Pompon   Scholarly papers Bislick, L., Dietz, A., Duncan, E. S., Garza, P., Gleason, R., Harley, D., ... & Van Allan, S. (2022). Finding “Zen” in Aphasia: The benefits of yoga as described by key stakeholders. American journal of speech-language pathology, 31(1), 133-147. https://doi.org/10.1044/2021_AJSLP-20-00330 Hunting Pompon, R, Amtmann, D., Bombardier, C., & Kendall, D. (2018). Modifying and validating a measure of chronic stress for people with aphasia. Journal of Speech, Language and Hearing Research, 61(12):2934-2949. https://doi.org/10.1044/2018_JSLHR-L-18-0173  Kagan, A., Simmons‐Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, Threats, T., & Sharp, S. (2008) Counting what counts: A framework for capturing real‐life outcomes of aphasia intervention, Aphasiology, 22(3), 258-280. https://doi.org/10.1080/02687030701282595 Laures-Gore, J., Cahana-Amitay, D., & Buchanan, T. (2019). Diurnal cortisol dynamics, perceived stress, and language production in aphasia. Journal of Speech, Language, and Hearing Research, 62, 1416-1426. https://doi.org/10.1044/2018_JSLHR-L-18-0276 Laures-Gore, J., & Rice, K. (2019). The Simple Aphasia Stress Scale. Journal of Speech, Language, and Hearing Research, 62, 2855–2859. https://doi.org/10.1044/2019_JSLHR-L-19-0053 Laures-Gore, J., Russell, S., Patel, R., & Frankel, M. (2016). The Atlanta Motor Speech Disorders Corpus: Motivation, Development, and Utility. Folia-Phoniatrica-et-Logopaedica 68(2):99-105. https://doi.org/10.1159/000448891 McGuire, S.S., Laures-Gore, J., Freestone, E.J., & van Leer, E. (2021). Simulated laughter, perceived stress, and discourse in adults with aphasia, Aphasiology, 35:9, 1207-1226. https://doi.org/10.1080/02687038.2020.1787944  McNeil, M., Prescott, T., & Lemme, M. (1976). An application of electromyographic feedback to aphasia/apraxia treatment. Proceedings of the Clinical Aphasiology Conference, 151-171. http://aphasiology.pitt.edu/21/1/06-11.pdf Thompson, C.K., Hall, H.R., & Sison, C.E. (1986). Effects of hypnosis and imagery training on naming behavior in aphasia. Brain and Language, 28(1), 141-153. https://doi.org/10.1016/0093-934x(86)90097-0   urls Aphasia & Motor Speech Disorders Lab, Georgia State University  https://education.gsu.edu/csd/csdresearchoutreach/aphasia/?fbclid=IwAR1x5-CQxmiXkV4ZVcDbbt5oZmYw5VhZLKsmmw62xmh9XyC6O9sEzqV0mvU#stress-and-aphasia and https://www.facebook.com/gsuaphasia

Did you know that Developmental Language Disorder (DLD) can also co-occur with other disorders? Studies of children with DLD suggest some disorders co-occur more often. These include emotional problems, dyslexia and ADHD. “Comorbidity” refers to the presence of two or more disorders in the same person. These disorders can occur individually or link together. It takes a team of specialists to figure out if a person has DLD by itself or has additional disorders. In this episode of The Talking DLD Podcast, we're talking with Professor Sean M. Redmond about DLD & ADHD. If you'd like to learn more about DLD & ADHD join us for our NEW short course! More information here: https://thedldproject.com/course/dld-and-adhd/ About Professor Sean Redmond Professor Sean M. Redmond is a Fellow of the American Speech Language and Hearing Association and Board-Certified Specialist in Child Language. Dr. Redmond received his PhD from the University of Kansas in 1998 and joined the faculty at the University of Utah shortly thereafter. He has over 40 peer-reviewed publications as well as book chapters on the topics of pediatric language disorders, socioemotional behavioral disorders, and differential diagnosis. His scholarship has been funded by the National Institutes of Health. Dr Redmond has served as Editor in Chief for the Journal of Speech, Language, and Hearing Research and is a founding member of the website https://dldandme.org/ Grow your skills with us & support people with DLD Module 1: Diagnosing DLD with Confidence. Learn more. Module 2: Evidence Based Interventions & Strategies for Children with DLD. Learn more. Module 3: Planning Therapy & Measuring Outcomes for people with DLD. Learn more. Module 4: DLD + Co-Occurring Conditions. Learn more. International DLD Research Conference Keynote Series. Learn more.  What is Language + What is DLD - FREE Course. Learn more.

Researchers are beginning to better understand the lived experiences of persons with hearing loss. In this episode of This Week in Hearing, Bec Bennett reviews various coping strategies associated with untreated hearing loss, the limitations of amplification for improving overall well-being and how clinicians can better address the emotional and social consequences of hearing loss with her newly developed AIMER approach. Articles discussed in this interview: *Bennett, R.J., et al., Coping with the social challenges and emotional distress associated with 685 hearing loss: a qualitative investigation using Leventhal's self-regulation theory. 686 International Journal of Audiology, 2022. 61(5): p. 353-364. *Bennett, R.J., et al., How do audiologists respond to symptoms of mental illness in the 698 audiological setting? Three case vignettes. Ear and Hearing, 2020. 41(6): p. 1675-1683. *Bennett, R.J., et al., Perspectives on Mental Health Screening in the Audiology Setting: A 722 Focus Group Study Involving Clinical and Nonclinical Staff. American Journal of Audiology, 723 2021. 30(4): p. 980-993*Bennett, R.J., et al., Knowledge, beliefs, and practices of Australian audiologists in addressing 728 the mental health needs of adults with hearing loss. American journal of audiology, 2020. 729 29(2): p. 129- 142. 730 21. *Bennett, R.J., et al., Addressing emotional and psychological problems associated with 731 hearing loss: Perspective of consumer and community representatives. American Journal of 732 Audiology, 2021. 30(4): p. 1130-1138. *Bennett, R.J., et al Evaluation of the AIMER intervention and its implementation targeting the provision of mental wellbeing support within the audiology setting: a RE-AIM analysis. Submitted for publication

Welcome to this edition of Aphasia Access Conversations, a series of conversations about topics in aphasia that focus on the LPAA model. My name is Janet Patterson, and I am Research Speech-Language Pathologist at the VA Northern California Health Care System in Martinez CA. These Show Notes follow the conversation between Dr. Chaleece Sandberg and myself, but are not an exact transcript of the conversation. Dr. Chaleece Sandberg is Associate Professor in the Department of Communication Sciences and Disorders in the College of Health and Human Development at Penn State University.  She directs the Semantics, Aphasia, and Neural Dynamics Laboratory (SANDLab), which focuses on finding ways of optimizing language therapy for adult language disorders, with a primary interest in aphasia. Specifically, work in the SANDLab explores the neuroplastic processes that take place during successful therapy and how to enhance these processes. Additionally, SandLab work explores how cortical reorganization due to aging affects the way we interpret the cortical reorganization that results from language therapy.     In today's episode you will hear about: the importance of impairment-based treatment in a person-centered approach to aphasia therapy, the role of linguistic complexity in selecting treatment stimuli and supporting generalization, how speech-language pathologists can add aspects of counseling to treatment activities. Share Dr. Janet Patterson: Welcome to this edition of Aphasia Access Conversations, a series of conversations about community aphasia programs that follow the LPAA model. My name is Janet Patterson, and I am a Research Speech-Language Pathologist at the VA Northern California Health Care System in Martinez, California. Today, I am delighted to be speaking with my friend and research colleague, Dr. Chaleece Sandberg. Dr. Sandberg is associate professor in the Department of Communication Sciences and Disorders in the College of Health and Human Development at Penn State University. At Penn State, she directs the SANDLab, that is the Semantics, Aphasia and Neural Dynamics Laboratory. Efforts in the SANDLab are aimed at finding ways of optimizing language therapy for adults with language disorders, with a primary interest in aphasia. Specifically, the lab explores the neuroplastic processes that take place during successful therapy and how to enhance these processes. Additionally, the lab work explores how cortical reorganization due to aging affects the way we interpret the cortical reorganization that results from language therapy.   In 2022, Chaleece was named a Distinguished Scholar USA by the Tavistock Trust for Aphasia, UK. The Tavistock Trust aims to help improve the quality of life for those with aphasia, their families, and care partners by addressing research capacity related to quality-of-life issues in aphasia. Congratulations on this well-deserved honor, Chaleece.   Aphasia Access collaborates with the Tavistock Trust for Aphasia in selecting the awardees and is pleased to have the opportunity to discuss their work and the influence of the Tavistock award.   Welcome Chaleece, to Aphasia Access Conversations,   Dr. Chaleece Sandberg: Thank you so much for such a lovely introduction. I'm so glad to be here doing this with you and I'm so thankful to the Tavistock Trust for this recognition.   Janet: Chaleece, as we said, you were named a Tavistock Trust Distinguished Scholar USA for 2022 and join a talented and dedicated group of individuals. How has the Tavistock award influenced your work, both your clinical and your research efforts in aphasia.   Chaleece: So, first of all, I am so incredibly honored to be recognized as belonging to such an amazing group of scholars. These are definitely people that I admire, and I look up to and I want to be more like, and so receiving this award is not only supporting my ability to push some ideas forward that I've been having, but it's also giving me more confidence to go all in and make quality of life, an even larger focus in my teaching and research.   Janet: That is terrific to hear, because I think quality of life is so very important for all of us. We sometimes forget that idea when we get focused on our treatment or specific treatment protocol. In preparing for this interview Chaleece, I read several of your publications, including your work in treatment for lexical retrieval, and the Theory of Complexity. Would you briefly describe this theory and your work in this area?   Chaleece: I'd love to. The Complexity Account of Treatment Efficacy was introduced by Cindy Thompson, who is actually my research grandma, Lewis Shapiro and Swathi Kiran, who was my Ph.D. mentor. What they were finding was that while they were doing the Treatment of Underlying Forms, which is a treatment that supports sentence processing, when you train more complex sentence structures, like object class, something like, “It was the porcupine who the beaver hit”, right, you're going to get generalization to not only other object clefts, but simpler structures, like WH questions, so something like, “Who did the beaver hit?” Using this logic, Swathi started exploring the effects of semantically based therapies for word retrieval and found that training atypical words in a category promotes generalization to typical words in that category. The idea is that you're basically training this wider breadth of information that applies to more items. In the case of typicality, you're training semantic features that are really characteristic of these atypical items, like that “a penguin doesn't fly but swims”, and that you're also training these really typical features that apply to everything in that category, like, “a penguin lays eggs like most other birds”.   In my work, I've extended this logic to training abstract words. Now with abstract words the mechanism of generalization is slightly different. Rather than words sharing semantic features, they share associations. So, we train words in thematic categories, like “hospital” and “courthouse”, where there are these strong associative links between abstract words like “diagnosis”, and concrete words like “doctor”. The reason that it's more beneficial to train abstract words rather than concrete words is because they have a wider range of these associative links, so they can activate more concepts when you get that spreading activation within the semantic system. We've started calling it Abstract Semantic Associative Network Training for that reason, or it's AbSANT for short.   Janet: I think that is so fascinating. It makes sense because you're looking at a way to optimize therapy, which is what the SANDLab is all about. How can we, from a theoretical perspective and with data to support what we're doing, how can we be as efficient as possible in achieving the outcome that we would like to have for a person with aphasia? I think it's a perfect example of theoretically based treatment.   That leads me though, to the next question to say, I love your research. And I love that it's taken however many years and starting with grandma, Cindy and then Swathi, and now you. That's a lot of effort and a lot of work that clinicians don't have. The theory is so powerful, so I'd like to ask you, what are your thoughts on actions that clinicians might take to easily incorporate these treatment principles, or this treatment, into their clinical activities.   Chaleece: I've tried to really consider clinicians and keep clinicians in mind when I've been thinking about AbSANT. One thing that I've done is, I've made absent available for free on my lab website (SANDLab). There's also a tutorial published in Perspectives of the ASHA Special Interest Groups. And the idea is that that's kind of an easy to go to for clinicians. And even though we've only actually used a couple of categories in our research, so we focused on courthouse and hospital, we actually did norming on I think it's 17 categories, thematic categories, like football and holidays. And all of those words are available on the website, I also don't see why you can't create your own categories that are going to be personally relevant for your client.   One of our AbSANT clients that we had in our research study, after they were done, the husband wanted to continue to work with his wife on words for the holidays, actually. And so we talked about it, and he came up with some words in the category Christmas, that would be good targets, and they went off and used it. And it helped. They were very happy.   Janet: Kudos to you, Chaleece, for doing it like this. What you just described, about a person sitting in therapy and using your words and what you had created, and then going off and creating their own with your assistance, that is exactly what I think should be happening, as we think about therapy. That feeds quality of life, that feeds a person's ability to move back into whatever they want their life to be. Kudos to you for making this freely available to clinicians. They don't have to go digging into research papers or into journals to find and to piece together your work, it's there on your website. By the way, the link to your lab and this information will appear in the Show Notes that accompany this recording. So, thank you for that. I appreciate it. And I know clinicians will as well,   Chaleece: I understand being pressed for time, and I did want to make this as easy and accessible as I could   Janet: Chaleece, at the heart of your work in aphasia, as we just mentioned a few minutes ago has been optimizing treatment. One of your research interests supporting this direction, has been examining the neurological mechanisms that underlie behavioral change following treatment. Conducting research on this topic is challenging for many, many reasons. Yet, I think it's very important to aphasiology as we seek to understand the elements of a treatment protocol, and how the brain changes in response to stimulation. So, with that large question and that large research area, what have you learned from your work in this area?   Chaleece: You are right, it is a very challenging area to work in. One thing that is heartening is that my work seems to agree with some of the heavy hitters out there who are doing this work on a much larger scale. I think that in order to really get at the root of these questions, we do need these really large-scale studies across different sites that are going to be able to gather enough data so that we understand fully what's happening. But basically, it seems like no matter how chronic the person is, there is neuroplasticity related to treatment gains. We still don't really have a definitive answer regarding things like which hemisphere is better? Or is increased or decreased activation better? But it's looking like the answer is actually going to be quite nuanced and related to individual variability, which again, speaks to this idea that the more data the better. Luckily, there is a working group in the Collaboration of Aphasia Trialists, or CATS, that's working on this question. I am a part of that group and very honored to be a part of that group and contributing to this work. I do have some results from a pilot study that I did as a doc student. We found that left inferior frontal gyrus pars triangularis, so basically, Broca's Area appeared to be especially important for the AbSANT outcomes. We also found that when we saw generalization from the abstract to the concrete words, that areas that are normally responsible for concrete word retrieval, were being activated after therapy more so than they were before therapy. That's some nice evidence that generalization is actually affecting areas of the brain that are responsible for those items that are being generalized to. I have yet to analyze the data from my current study but stay tuned.   Janet: Oh, we will. I think that there's a large body of data, as you said, from other people who've done larger studies, and lots of people have been focused on this question for a while, and you are as well. It's a bit daunting for clinicians, again, to think about how to wrap your head around the idea and the evidence. We all believe that the brain is changing, but to wrap your head around the evidence that says, “Well, how is this happening?” and, “What can I do that will facilitate it happening a little bit more quickly or a little bit more thoroughly?” So, I realize I'm asking you a speculative question that's sort of out there, but I'm going to ask it anyway. What are some of the ideas from your work that clinicians may find useful to think about on Monday morning, when they walk in to interact with their clients who have aphasia, and their family members and care partners.   Chaleece: I think one of the things that I really would like to underline is don't be afraid to challenge your clients. We actually learn better when we're challenged, and learning is what's going to cause those changes in the brain. Probably the most important thing that I would like for clinicians to take away from my AbSANT work is that it's worthwhile and not impossible to work on abstract word retrieval using a semantically based approach. Abstract words are so important for natural conversation. Training them seems to really help support retrieval of concrete words as well, and so you get more bang for your buck. I found that people, especially those with a little bit milder aphasia who are up for the challenge, really enjoy the metalinguistic discussion, and the chance to defend these really strong opinions that people have about the personal meanings of abstract words. And, again, the most important thing in terms of l the neural imaging in the neuroplasticity is that the brain always has the ability to change. I realize that our clients are later in life, they've had a stroke, maybe they're in the chronic phase of recovery, and they can still show neuroplastic changes. One of my highest achievers, in my study, when I was a doctoral student, both behaviorally and neurophysiologically, one of the people who showed the most neurological changes was 20 years post stroke.   Janet: That's amazing. When you talk about abstract language, it makes me think that so much of what we do, or at least as I look back on a lot of the treatments that we do, single words or visual nouns or concrete nouns, very simple, sometimes we say functional words. But then you step aside and listen to people talk and so much of what people's conversation contains is nonliteral words and abstract words. We don't talk like the words that we're using in therapy, and it makes perfect sense then, the way you're approaching this challenge of aphasia, to try to make your work more like what people with aphasia are going to experience during conversation. It's a big problem and a big challenge, but I think you're up to it, and I'm looking forward to seeing some of more of your work on AbSANT. Especially since it's such a challenging area of work. I appreciate you giving us specific suggestions of things that we might do Monday morning when we see our patients. So, this is not just a conversation and it's not just another academic lecture in how we think about treatment, but it has some very important real world applications for us. Thanks so much for that piece.   I'd like to switch for a few minutes, Chaleece, and talk to you about your interest and work in bilingual aphasia. How did you become interested in this line of work? And more importantly, what have you learned from your work in this area.   Chaleece: So, I've always been interested in learning other languages. I have actually attempted to learn a few languages and have not been that successful. But one thing that I realized while trying to learn these other languages is that I was really intrigued by the way languages work. As you're learning another language, you start to really kind of put the pieces together and see kind of under the hood of what's actually happening. And so, I got my undergraduate degree in linguistics, and I think that this kind of fascination with how languages work also partly fueled my interest in aphasia in the first place. I remember sitting in my language in the brain class, and a light bulb went off, I was like, “Oh, my gosh, this is exactly what I want to study!” This idea that this full language system that was completely developed, all of a sudden can get destroyed by damage to particular areas. And so, you know, that kind of set the stage for me wanting to study aphasia. And then when I got into Swathi's lab and she was doing bilingual research, I was so excited. I was like, “Oh, I am totally on board with this”. So, I volunteered for all the bilingual studies that I could, actually not speaking any other languages myself, but realized that I can still research other languages, even if I don't speak them. That was kind of an “aha” moment for me, which was very nice.   During my Ph.D., I got to know Theresa Gray, who was a fellow doc student, and she and I became really good friends. After graduation, we immediately began a collaboration. This was good news for me because I had gotten a job at Penn State, and we're in Central PA and there is not a huge bilingual population there. But there is an excellent center for language science at Penn State started by Judy Cole, Janet van Hell and Carol Miller. That has really helped to support my efforts in understanding bilingualism in general, and bilingual aphasia. So, the work that Teresa and I have done together has actually been really focused on getting culturally and linguistically appropriate materials out to bilingual clinicians. That was where we saw that we could do kind of the most good in this area.   But along the way, we found some really interesting patterns related to cross language generalization and language dominance and cognitive control. We've also had some really interesting insights from our students who've been working on these projects who have just made comments about the adequacy of the assessments that we're using. And so we're really starting to think about how that's going to affect what we know about people's languages that they speak as we're trying to figure out, you know, what's going on, after a stroke with these different languages. And it also just kind of brings to the surface, that there are so many limiting factors for individuals who don't speak English as their first language or don't speak English at all. There's such an enormous service disparity, at least in the United States, and work in aphasia research has been so English centric, that it's created these major barriers to having adequate services. But luckily, we're starting to kind of get on the ball a little bit, this field is receiving a lot more attention. There are some really great researchers on the case. I've been to some recent conferences where there have been a lot of great presentations. The Saffran Conference was dedicated to this idea, there was a great workshop by Jose Centeno. At the Academy of Aphasia, there were some really great presentations there on this topic. So I feel like we're, we're moving forward in trying to close the gap in services for people who are bilingual.   JANET: I agree with you on that. And many times, it's also on the clinician. Clinicians might be bilingual themselves, but they might not be. How can you best support the clinicians who does not share a language with the client or the family members yet still has to serve that individual? It's, again, another challenging area that you've undertaken the study. You are busy, I bet.   So in addition to everything you've been doing over all these years, I mean, the complexity and absent and bilingualism, you also have now added something to your area of interest. I'd like you to talk for a little bit about that, if you would, and that is your interest in counseling persons with aphasia. How did you become interested in that area of research? And I ask, because it just seems that there might be a story of a professional journey here. I love to tell stories and hear them, so I think this is a story that wants to telling.   Chaleece: All right, well, yeah, twist my arm.   Janet: Good, I was supposed to be twisting your arm, because I want to hear your story.   Chaleece: So, my husband and I, when we first got to Penn State, we became friends with a couple of people who are over in counselor education. The more we got to know each other and talk more about our work, the more we realized that we were missing a lot of information in each of our fields. I never had any training and counseling, and my friends, who were counselors, hadn't really heard of aphasia. One of these friends, you know, after we had started talking about aphasia, actually, her brother had a stroke and had aphasia and so this became a very personal topic for her. She's a rehabilitation counselor and I was so shocked to learn that this was not something that she had been taught in her training, not something that she had really come across. So, we decided to start lecturing in each other's classes, and start exposing each other's students to these ideas that we felt we had missed out on in our training. We also started digging into the literature, because we wanted to see exactly what was out there, like were we crazy and thinking that this was like missing information from each of our fields. And we weren't crazy, we weren't alone. There's a whole slew of professionals in mental health that don't know about aphasia and SLPs, on the whole appear to not feel adequately prepared to do any sort of counseling. So, we decided that we wanted to write a couple of papers to help practicing clinicians to provide counseling and for SLPs, to kind of understand more about counseling skills, and for counseling students to understand more about aphasia and things that they could do to help people with aphasia, and kind of bring more awareness to the issue. We also applied for some internal funding to start an interprofessional education project, aimed at better preparing our counseling students to work with people with aphasia and our SLP students to provide basic counseling. We're starting this in terms of a one off.  We take one counseling student and one SLP student.  We need to have them work together with a person who has aphasia, who's expressed some desire for counseling. Every semester we rotate out and have a new group. This has been such a rewarding experience. I've learned so much from my colleagues, the way that I teach my pastor students, the way that I run my research experiments, the way that I mentor students in my lab, all of that has changed so much, I kind of feel like my eyes have been open to this, this whole issue. In turn, I feel like I'm helping my students to be much more mindful in the way that they approach clinical practice and research to like, truly put quality of life first.   Janet: I think that's exactly right, and the way we should be thinking, and I agree with everything you said about counseling. We have a little project where we've been looking at motivation, which is different, I realize, but it strikes me that when you think about how we counsel and bring that into our treatment, and also think about motivation, or patient engagement and bring it into treatment, there's so much more that helps us facilitate behavioral change in a patient than just a specific treatment protocol that we're delivering. Because if we haven't got someone who we can empathize with or we can connect with or who's interested in change or understands why we're doing what we're doing, it's going to be a very long road, if we're only focused on the impairment based or the specific treatment protocol. So, I think it's great that you're exposing your students to different professions and really thinking about counseling. It's a great idea.   So that's a big journey that you've undertaken, and I'm sure it's not stopping here. It's an interesting journey. It's more exciting as I hear you talk about it; I hear the excitement in your voice and the passion in your voice. It's almost like you want to do everything, but of course, you have to go to sleep, and you know, there are limitations.   Chaleece: Right, right. Yeah, all of those things, right?   Janet: Yeah. Oh, exactly, exactly. But I will bet that you have a lot of new ideas out there and you are considering some next steps, both in clinical research and clinical activities. I heard this story of starting from a linguistic basis and maybe focused impairment, and now you're completely coming around, I don't think it's full circle, I think it's more like full spiral. You're still thinking about complexity and AbSANT, but you've got other pieces that I think will make a rich program. What are your new ideas that are percolating in that brain of yours that you'd like to see move forward?   Chaleece: So, I've applied for sabbatical? I haven't heard back yet whether or not I've received it, but I'm hoping that I can spend the next year focusing my efforts, specifically on what I see as being health disparities. It is related to both bilingualism and mental health and aphasia. So one of the things that I'm really interested in is, is expanding our IP program for counseling and SLP students. I'm also hoping to work with Jose Centeno to work to address service disparities in bilingualism. I know that that's a really big topic of interest for him and our interests seem aligned on there. I'm excited to learn more from him. I'm planning to meet with Amy Dietz and work with her to think more about some of these holistic approaches to aphasia rehabilitation. I've really enjoyed hearing about her yoga program that that she's been doing. I've always had this kind of nagging thought this was something that she and I kind of talked about and really connected on, it kind of goes back to interprofessional practice. It's this idea that we tend to ignore all of these other things that we don't see as being language related, right? We don't think about diet and exercise and sleep on cognitive outcomes. But there's so much research out there showing how these things can affect your thinking. So they must be affecting the rehabilitation outcomes in people with aphasia.   I have been interested in the role of exercise in aphasia rehabilitation, we I'm part of an am CDs writing group, and we did a review looking at the effects of exercise and aphasia. There's just a huge gap in the literature. So it's definitely an area that we should be focused on. I don't currently have an exercise research project going but, in the meantime, I have actually partnered with Francine Cohen at Temple to establish Aphasia Cycling Club. This thought had been in the back of my mind for a long time, my husband and I are avid cyclists. And I thought, you know, if people with aphasia could find this much joy in in cycling, and if they could do it together, like that would be great. But then I hesitated because I thought, you know, would they actually be interested? Is this something that anybody wants to do? Am I just a freak, because I like cycling, and I think everybody else should. But I decided to go ahead and reach out through the ARCH network, and I got a surprisingly positive amount of responses back that people were really jazzed about this. Frannie was one of those people that got back right away and said, “I am an avid cyclist, and I would love to do this.” So, I got really excited about it. I got pushed a little bit in the direction by Deb Myerson and Steve Zuckerman, because I don't know if people are aware, but they did this stroke across America campaign where they rode from Northern California all the way to Boston, to spread awareness for aphasia, they have stops along the way. I recommend looking it up because it's a very inspiring journey that they took. These things got me thinking that this could work. We've started meeting with some physical therapists and adaptive sports people in Philadelphia and in Hershey so far, to try and get this going. We're hoping to try and get some people in Pittsburgh as well. We're super excited about where this could go. If anybody listening to this has any suggestions, please contact me. I'm happy to receive any sort of feedback and suggestions that people have to offer.   Janet: What a terrific idea! Francine is such an enthusiastic person and. I think with the two of you leading this, it's just going to grow greatly, I think sometimes as we talked earlier, we get so focused on the language, we forget the people with aphasia would like to do other things. Or maybe they did other things before they had their strokes, and perhaps they have some physical challenges right now, so we tend not to think about bicycling. I think it's awesome. A Bicycle Club. That's wonderful.   Chaleece: I hope it works out. I hope that it provides people with as much joy as it's provided me,   Janet: I bet it will. I can see you doing something like, even if there's someone who has aphasia, who simply cannot end up riding, but if you have riders, and you take videos, and you involve the people who cannot ride with you in that manner, well, that also achieves a quality of life goal. I think.   Chaleece: That's a great idea.   Janet: Good. I hope it works out. I think of that because we have an friend who's an avid bicyclist, and he always straps on his head camera and will post his videos all the time about places he goes. Your cycling group, your aphasia cycling club, can do the same thing. What a great idea, I look forward to seeing it actually happen and seeing the videos that you make and the work that you do.   Chaleece, as we bring this conversation to a close, I would like to ask you to reflect on your interest in aphasia, your work with persons with aphasia and their family members and care partners, and in particular, your amazing journey from starting as a linguist to developing a bicycle club for people with aphasia. And I'm wondering if you have any pearls of wisdom, you might share with our listeners, or what I sometimes like to call Monday morning practices. And by that I mean ideas that clinicians can incorporate into their busy practices quickly and easily to perhaps change their thinking or change how they engage with clients.   Chaleece: In reflecting on my journey, I really maybe just to encourage other researchers to think about, so I started out really kind of focused in this kind of an impairment based mode, and gradually moved over to this person centered care, but I haven't discarded the idea of impairments based treatment, right? The idea is that you just kind of, house that in, you know, you fold it in to your person-centered care to the life participation. From my own research, the things that kind of float to the surface for me are, first that the brain can change long after the chronic stage has started. This, this idea of a plateau, I know that I feel like I'm preaching to the choir, probably about this idea, but it's still kind of amazing to me, how many people still feel like this is there's a plateau, right.   The other is not to be afraid to work on challenging tasks, like digging into the meanings of abstract words. With supportive conversation I found that this can be very rewarding, even for people who have very limited verbal output. In terms of I don't know, Monday morning practices like something easy to incorporate. I feel like I'll my pearls are kind of borrowed. There's a great one that I borrowed recently from Linda Worrall's amazing presentation as IARC. She suggested a way to form a simple habit was to just ask two questions at every treatment session. This could be a small change just to form better counseling habits as SLPs. She suggested at the beginning of the session to ask, “How are you feeling?”, which is a very different question from “How are you doing?” It allows people to open up a little bit more and actually talk about how they're feeling. Then at the end to ask, “What is the best thing that you're going to do today?” I started doing this as soon as she mentioned, I'm like, I'm going to do this. And I did it. I started doing it with all of my clinical research sessions that I do. It's really helped me to form better relationships faster with my research clients. I feel like they are telling me more about themselves. They really open up at the beginning of the session telling me how they're feeling, and that actually helps me to gauge how I go about this. Yes, for treatment research, you have a protocol, right? But the way you go about these treatment steps, you know, you can frame them in different ways, right? If I have a client who's feeling very anxious, I can say before each thing that we do that's challenging, I can say, “Okay, take a deep breath. All right. Now let's do this. This piece of the puzzle.” That seems to really, really help, It helps me to know where my clients are at to begin with, and asking “What they're doing? What's the best thing that you're doing today?” It's just so much fun to hear people get really excited about what they're doing. Sometimes they might say, “Well, nothing today, but tomorrow, I've got this great thing planned.” It's a really nice way to end the session on a really positive note,   Janet:  Borrowed or not, those are excellent pearls, and they are simple things that we can do. I do remember Linda Worrall's talk that you were referring to. It makes so much sense. We have these grandiose ideas, but you have to start with a couple of small things and how can you change your behavior tomorrow, very small, but that will pay great dividends. It sounds like those changes have paid great dividends for you already in your research sessions.   Today's conversation for me, has been exciting and interesting and thought provoking and would like to thank my guest, Dr. Chaleece Sandberg for sharing ideas, results, outcomes and thoughts from her clinical research journey in aphasia. Chaleece I greatly appreciate your taking the time to speak with me today, and again, congratulations on receiving a Tavistock Scholar Award.   Chaleece: Thank you so much. This was delightful. I   Janet: would also like to thank our listeners for supporting Aphasia Access Conversations by listening to our podcasts and learning from all of the guests that we've had over the years.   For references and resources mentioned in today's show, please see our Show Notes. They are available on our website, www.aphasiaaccess.org. There, you can also become a member of our organization, browse our growing library of materials, and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, please email us at info at aphasia access.org   For Aphasia Access Conversations, I am Janet Patterson and I thank you again for your ongoing support of aphasia Access   References Kiran, Swathi, and Cynthia K. Thompson. “The Role of Semantic Complexity in Treatment of Naming Deficits: Training Semantic Categories in Fluent Aphasia by Controlling Exemplar Typicality.” Journal of Speech, Language, and Hearing Research 46, no. 3 (June 2003): 608–22. https://doi.org/10.1044/1092-4388(2003/048   Mayer, J., Sandberg, C., Mozeiko, J., Madden, E. & Murray, L. (2021). Cognitive and linguistic benefits of aerobic exercise: A state-of-the-art systematic review of the stroke literature. Frontiers in Rehabilitation Sciences, 2. https://doi.org/10.3389/fresc.2021.785312   Sandberg, C. (2022). Tutorial for Abstract Semantic Associative Network Training (AbSANT): Theoretical rationale, step-by-step protocol, and material resources. Perspectives of the ASHA Special Interest Groups: 7, 35–44. https://doi.org/10.1044/2021_PERSP-21-00176   Sandberg, C. W., Bohland, J. W., & Kiran, S. (2015). Changes in Functional Connectivity Related to Direct Training and Generalization Effects of a Word Finding Treatment in Chronic Aphasia. Brain and Language, 150, 103–116.   Sandberg, C. W., Nadermann, K., Parker, L., Kubat, A. M., & Conyers, L. M. (2021) Counseling in Aphasia: Information and Strategies for Speech-Language Pathologists. American Journal of Speech Language Pathology, 30(6), 2337-2349.   Thompson, C. K., Shapiro, L. P., Kiran, S., & Sobecks, J. (2003). The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: The complexity account of treatment efficacy (CATE). Journal of Speech, Language, and Hearing Research, 46(3), 591–607. https://doi.org/10.1044/1092-4388(2003/047)   Worrall, L. (2022). The why and how of integrating mental health care into aphasia services. Presentation to the International Aphasia Rehabilitation Conference. Philadelphia PA, June.     URLs AbSANT    Abstract Semantic Associative Network Training. SANDLab. https://sites.psu.edu/sandlab/projects/absant/   Academy of Aphasia https://www2.academyofaphasia.org/about/   ANCDS    Academy of Neurologic Communication Disorders and Sciences. www.ancds.org   ARCH Network    Aphasia Resource Collaboration Hub  https://aphasiaresource.org   Collaboration of Aphasia Trialists https://www.aphasiatrials.org/   Eleanor M. Saffran Conference https://www.saffrancenter.com/conferences   Stroke Across America https://www.stroke.org/en/stroke-connection/stroke-onward/stroke-across-america

This episode is a rerun of a previous episode originally published on January 31st, 2021. Get .1 ASHA CEU hereEmbracing parents as communication partners is critical for our clients for a variety of reasons. Parents are primary communication partners for their children, and can play significant roles in acquisition and generalization of communication skills. And it comes as no surprise that since parents are unique communication partners, parent training comes with a unique set of challenges and benefits. In this episode we review literature and discuss the importance of embracing parents as communication partners. We also have the pleasure of interviewing Dr. Jean Blosser who has created some materials to facilitate bridging the gap between school / therapy and the home environment.Dr. Jean Blosser, CCC-SLP, EdD, is an ASHA Fellow, Fellow. You can learn more about Dr. Blosser here.Learning Outcomes1. State 3 reasons for engaging parents as partners2. Describe 3 teaching tools to improve home program development for parents 3. Describe two benefits of sharing visual supports with parentsReferencesBrown, J. A. (2016). Coaching in Parent-Implemented Early Communication Interventions: Understanding and Overcoming Individual-Level Implementation Barriers. Perspectives of the ASHA Special Interest Groups, 1(1), 144-153. doi:10.1044/persp1.sig1.144Pennington, L., Thomson, K., James, P., Martin, L., & Mcnally, R. (2009). Effects of It Takes Two to Talk—The Hanen Program for Parents of Preschool Children With Cerebral Palsy: Findings From an Exploratory Study. Journal of Speech, Language, and Hearing Research, 52(5), 1121-1138. doi:10.1044/1092-4388(2009/07-0187)Roberts, M. Y., & Kaiser, A. P. (2011). The Effectiveness of Parent-Implemented Language Interventions: A Meta-Analysis. American Journal of Speech-Language Pathology, 20(3), 180-199. doi:10.1044/1058-0360(2011/10-0055)Roberts, M. Y., & Kaiser, A. P. (2012). Assessing the Effects of a Parent-Implemented Language Intervention for Children With Language Impairments Using Empirical Benchmarks: A Pilot Study. Journal of Speech, Language, and Hearing Research, 55(6), 1655-1670. doi:10.1044/1092-4388(2012/11-0236)Roberts, M. Y., Kaiser, A. P., Wolfe, C. E., Bryant, J. D., & Spidalieri, A. M. (2014). Effects of the Teach-Model-Coach-Review Instructional Approach on Caregiver Use of Language Support Strategies and Children's Expressive Language Skills. Journal of Speech, Language, and Hearing Research, 57(5), 1851-1869. doi:10.1044/2014_jslhr-l-13-0113Thiessen, A., & Beukelman, D. (2013). Training Communication Partners of Adults Who Rely on AAC: Co-Construction of Meaning. Perspectives on Augmentative and Alternative Communication, 22(1), 16-20. doi:10.1044/aac22.1.16Weitzman, E. (2013). More Than Words—The Hanen Program for Parents of Children with Autism Spectrum Disorder: A Teaching Model for Parent-implemented Language Intervention. Perspectives on Language Learning and Education,20(3), 96-111. doi:10.1044/lle20.3.86Disclosures:Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder of SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. Jean Blosser Financial: President, Creative Strategies for Special Education, She receives compensation for consulting and conducting professional development workshops and in-services. She is the author and receives royalties from sales of the Lets Talk Today Calendar. She also receives royalties from sales of authored books. Jean has no non-financial relationships to discloseTime Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Review of reasons for engaging parents as partners.15 minutes: Review of teaching tools to improve home program development for parents10 minutes: Review of benefits of sharing visual supports with parents5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA CEUs, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Il vicedirettore dell'Institute for Hearing Research di Nottingham, in Inghilterra, afferma: “Puoi sballarti con il rumore. Il suono molto forte produce un senso di euforia che può creare dipendenza”. The Sunday Times of London riporta che le persone che usano uno speciale tipo di cuffie che si adattano all'interno delle orecchie, vicino al nervo uditivo, sono particolarmente vulnerabili a questo tipo di dipendenza. La ricerca indica che una tolleranza sempre più crescente può accumularsi per qualsiasi tipo di musica e che si possono arrecare danni irreparabili alle cellule dell'orecchio interno se il volume non è regolato correttamente. --- Send in a voice message: https://anchor.fm/corgiov/message

In this episode we discuss common questions and concerns that families have regarding this service model and the current research surrounding it. References: Akemoglu, Y., Hinton, V., Laroue, D., & Jefferson, V. (2021). A parent-implemented shared reading intervention via telepractice. Journal of Early Intervention. https://doi.org/10.1177/10538151211032211 Hao, Y., Franco, J.H., Sundarrajan, M., & Chen, Y. (2020). A pilot study comparing tele-therapy and in-person therapy: Perspectives from parent-mediated intervention for children with autism spectrum disorders. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-020-04439-x Quinn, E. D., Kaiser, A. P., & Ledford, J. (2021). Hybrid telepractice delivery of enhanced milieu teaching: Effects on caregiver implementation and child communication. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2021_JSLHR-20-00430 Retamal-Walter, F., Waite, M., & Scarinci, N. (2022) Identifying critical behaviours for building engagement in telepractice early intervention: An international e-Delphi study. International Journal of Language and Communication Disorders. https://10.1111/1460-6984.12714 Retamal-Walter, F., Waite, M., & Scarinci, N. (2022). Families' and professionals' perspectives of building and maintaining engagement in telepractice early intervention for young children with communication disability. Disability and Rehabilitation. https://​​10.1080/09638288.2022.2055161 Sadeghi, S., Pouretemad, H. R., & Shalani, B. (2021). Internet-based versus face-to-face intervention training for parents with excessive screen-time and autism spectrum disorder-like symptoms: A comparative study. International Journal of Developmental Disabilities. https://doi.org/10.1080/20473869.2021.1895699 Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. International Journal of Speech-Language Pathology. https://doi.org/10.1080/17549507.2018.1465123

Interviewer I'm Ellen Bernstein-Ellis, Program Specialist and Clinical Supervisor for the Aphasia Treatment Program at Cal State East Bay and a member of the Aphasia Access Podcast Working Group. AA's strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources.  Today, I have the honor of speaking with Dr. Jamie Lee who was selected as a 2022 Tavistock Distinguished Scholar. We'll discuss her research interests and do a deeper dive into her work involving the study of texting behaviors of individuals with aphasia and her efforts to develop an outcome measure that looks at success at the transactional level of message exchange.  As we frame our podcast episodes in terms of the Gap Areas identified in the 2017 Aphasia Access State of Aphasia  Report by Nina Simmons-Mackie, today's episode best addresses Gap areas:  Insufficient attention to life participation across the continuum of care;  Insufficient training and protocols or guidelines to aid implementation of participation-oriented intervention across the continuum of care;  Insufficient or absent communication access for people with aphasia or other communication barriers  For more information about the Gap areas, you can listen to episode #62 with Dr. Liz Hoover or go to the Aphasia Access website.   Guest bio Jaime Lee is an Associate Professor in the department of Communication Sciences and Disorders at James Madison University. Jaime's clinical experience goes back nearly 20 years when she worked as an inpatient rehab SLP at the Rehabilitation Institute of Chicago (now Shirley Ryan Ability Lab). She later worked for several years as a Research SLP in Leora Cherney's Center for Aphasia Research and Treatment. Jaime earned her PhD at the University of Oregon, where she studied with McKay Sohlberg. Her research interests have included evaluating computer-delivered treatments to improve language skills in aphasia, including script training and ORLA, examining facilitation of aphasia groups, and most recently, exploring text messaging to improve participation, social connection and quality of life in IWA.   Listener Take-aways In today's episode you will: Learn about why texting might be a beneficial communication mode for IwA Explore the reasons it's important to consider the communication partner in the texting dyad Find out more about measures examining texting behaviors, like the Texting Transactional Success (TTS) tool. Consider how Conversational Analysis may be helpful in understanding texting interactions Edited show notes Ellen Bernstein-Ellis Jamie, welcome to the podcast today. I'm so excited that we finally get to talk to you. And I want to offer a shout out because you mentioned two mentors and colleagues who I just value so much, McKay Solberg and Leora Cherney, and I'm so excited that you've also had them as mentors.   Jaime Lee  02:44 Thanks, Ellen. It's really great to talk with you today. And speaking of shout outs, I feel like I have to give you a shout out because I was so excited to meet you earlier this summer at IARC. We met at a breakfast. And it was exciting because I got to tell you that I assigned to my students your efficacy of aphasia group paper, so it was really fun to finally meet you in person.   Ellen Bernstein-Ellis  03:11 Thank you, that is the paper that Roberta Elman was first author on. I was really proud to be part of that.   I was excited to get to come over and congratulate you at the breakfast on your Tavistock award. I think it's very, very deserving. And I'm excited today that we can explore your work and get to know each other better. And I'm just going to start with this question about the Tavistock. Can you share with our listeners what you think the benefits of the Tavistock Distinguished Scholar Award will be to your work? Jaime Lee  03:43 Sure, I think first off being selected as a Tavistock Distinguished Scholar has been really validating of my work in terms of research and scholarship. It's made me feel like I'm on the right track. And at least maybe I'm asking the right kinds of questions. And it's also really meaningful to receive an award that recognizes my teaching and impact on students. And I was thinking about this and a conversation that I had with my PhD mentor McKay Solberg. And it was early into my PhD when we were talking about the impact of teaching and how important it was, where she had said that when we work as a clinician, we're working directly with clients and patients were hopefully able to have a really positive meaningful impact. But when we teach, and we train the next generation of clinicians, you know, we have this even greater impact on all of the people that our students will eventually work with throughout their career. And so that's just huge.  Ellen Bernstein-Ellis  04:51 It really is huge. And I have to say I went to grad school with McKay and that sounds like something she would say, absolutely, her value of teaching.  I just want to do a quick shout out to Aphasia Access, because I think they also recognize and value the importance of teaching. They have shown that commitment by their LPAA curricular modules that they developed and make accessible to Aphasia Access members, so people can bring content right into their coursework, which is helpful because it takes so much time to prepare these materials. So, if you haven't heard of these curricular modules yet, please go to the website and check them out.  So yes, I'm so glad that you feel your work is validated. It's really important to validate our young researchers.  I think there's an opportunity to expand who you meet during this year. Is that true? Jaime Lee  05:40 That is already true. This honor has already led to growing connections with other aphasia scholars and getting more involved with Aphasia Access. I'm excited to share that I'll be chairing next year's 2023 Aphasia Access Leadership Summit together with colleagues Esther Kim and Gretchen Szabo. We're really enthusiastic about putting together a meaningful and inspiring program. I am just really grateful for the opportunity to have a leadership role in the conference. Ellen Bernstein-Ellis  06:17 Wow, that's a fantastic team. And I, again, will encourage our listeners, if you've never been to a Aphasia Access  Leadership Summit, it is worth going to and everybody is welcomed. We've had several podcast guests who have said that it has been a game changer for them-- their first attendance at the Leadership Summit. So, we'll be hearing more about that.  Well, I want to start our interview today by laying some foundation for your work with texting and developing some outcome measures for treatment that captures transactional exchange in individuals with aphasia. And let me just ask what piqued your interest in this area? Jaime Lee  06:57 Yeah, thanks. Well, before I got interested specifically, in texting, I had this amazing opportunity to work as a research SLP with Leora Cherney and her Center for Aphasia Research and Treatment. And we all know Leora well for the contributions she's made to our field. At that time, she had developed ORLA, oral reading for language and aphasia, and a computerized version, and also a computerized version of aphasia scripts for script training. And these were treatments that not only improve language abilities in people with aphasia, but I really had this front row seat to seeing how her interventions really made a difference in the lives of people with aphasia, and help them reengage in the activities that they wanted to pursue-- reading for pleasure and being able to converse about topics that they want to do with their script training. So at the same time, I was gaining these really valuable research skills and understanding more about how to evaluate treatment. I was also able to start learning how to facilitate aphasia groups because Leora has this amazing aphasia community that she developed at what was then RIC. I'm just really grateful for the opportunity I had to have Leora as a mentor, and now as a collaborator. And her work really helped orient me to research questions that address the needs of people with aphasia, and to this importance of building aphasia community. Ellen Bernstein-Ellis  08:37 Wow, that sounds like a really amazing opportunity. And I think it's wonderful that you've got to have Leora as a mentor and to develop those interests. Then look at where you're taking it now. So that's really exciting to talk about with you today. Jaime Lee  08:54 As for the texting interest that really started after I earned my PhD and was back at the Rehab Institute, now Shirley Ryan Ability Lab, Leora was awarded a NIDILRR field initiated grant and I served as a co-investigator on this grant. It was a randomized, controlled trial, evaluating ORLA, combined with sentence level writing.  The two arms of the trial were looking at ORLA plus writing using a handwriting modality, versus ORLA combined with electronic writing or we kind of thought about this as texting. So we call that arm T-write. And ORLA was originally designed to improve reading comprehension, but we know from some of Leora's work that there were also these nice cross-modal language improvements, including improvements in written expression. This was a study where we really were comparing two different arms, two different writing modalities, with some secondary interest in seeing if the participants who were randomized to practice electronic writing, would those improvements potentially carry over into actual texting, and perhaps even changes in social connectedness? Ellen Bernstein-Ellis  10:15 Those are great questions to look at. Interest in exploring texting's role in communication has just been growing and growing since you initiated this very early study. Jamie, would you like to explain how you actually gathered data on participants texting behaviors? How did that work? Jaime Lee  10:32 Yes. So we were very fortunate that the participants in this trial, in the T-write study, consented to have us extract and take a look at their real texting data from their mobile phones prior to starting the treatment. So, for those who consented, and everyone, I think we had 60 participants in the trial, and every single participant was open to letting us look at their texts and record them.    We recorded a week's worth of text messages between the participant and their contacts at baseline, and then again at a follow up point after the treatment that they were assigned to. And that was so that maybe we could look for some potential changes related to participating in the treatment. So maybe we would see if they were texting more, or if they had more contacts, or maybe they might even be using some of the same sentences that were trained in the ORLA treatment. We haven't quite looked at that, the trial just finished so we haven't looked at those pre/ post data. But when my colleagues at Shirley Ryan and I started collecting these texting data, we realized there were some really interesting things to be learned from these texts.  And there have been a couple of studies, we know Pagie Beeson's work, she did a T-CART study on texting, right? And later with her colleague, Mira Fein. So we had some texting studies, but nothing that really reported on how people with aphasia were texting in their everyday lives.  Ellen Bernstein-Ellis  12:08 Well, Jamie, do you want to share what you learned about how individuals with aphasia texts are different from individuals without aphasia? Jaime Lee  12:15 We saw that first, people with aphasia do text, there were messages to be recorded. I think only a couple of participants in the trial didn't have any text messages. But we took a look at the first 20 people to enroll in the trial. We actually have a paper out-- my collaborator, Laura Kinsey is the first author. This is a descriptive paper where we describe the sample, 20 people, both fluent aphasia and nonfluent aphasia, a range of ages from mid 30s up to 72. And one striking finding, but maybe not too surprising for listeners, is that the participants with aphasia in our sample texted much less frequently than neurologically healthy adults, where we compared our findings to Pew Research data on texting. And our sample, if we took an average of our 20 participants and look at their texts sent and received over a week, over the seven days, they exchanged an average of about 40 texts over the week. Adults without aphasia, send and receive 41.5 texts a day. Ellen Bernstein-Ellis  13:36 Wow, that's quite a difference. Right?  Jaime Lee  13:39 Yes, even knowing that younger people tend to text more frequently than older adults. Even if we look at our youngest participants in that sample who were in their mid 30s, they were sending and receiving text much less frequently than the age matched Pew data. Ellen Bernstein-Ellis  13:56 Okay, now, I want to let our listeners know that we're going to have the citation for the Kinsey et al. article that you just mentioned in our show notes. How can we situate addressing texting as a clinical goal within the life participation approach to aphasia?  Jaime Lee  14:14 I love this question. And it was kind of surprising from the descriptive paper, that texting activity, so how many texts participants were sending and receiving, was not correlated with overall severity of aphasia or severity of writing impairment?  Ellen Bernstein-Ellis I'm surprised by that. Were you?    Jaime Lee Yes, we thought that there would be a relationship. But in other words, having severe aphasia was not associated with texting less. And we recognize, it's dangerous to draw too many conclusions from a such a small sample. But a major takeaway, at least an aha moment for us, was that we can't make assumptions about texting behaviors based on participants' language impairments, also based on their age, their gender. You know, in fact, our oldest participant in the sample, who was 72, was actually most active texter. He sent and received 170 texts over the week period. Ellen Bernstein-Ellis  15:22 Wow, that does blow assumptions out of the water there, Jamie. So that's a really good reminder that this to be individualized with that person at the center? Because you don't know.  Jaime Lee  15:32 You don't know. Yeah. And I think it comes down to getting to know our clients and our patients, finding out if texting is important to them. And if it's something they'd like to be doing more of, or doing more effectively, and going from there.    Ellen Bernstein-Ellis Wow, that makes a lot of sense.    Jaime Lee   Yeah, of course, some people didn't text, before their stroke and don't want to text. But given how popular texting has become as a form of communication, I think there are many, many people with aphasia, who would be interested in pursuing texting as a rehab goal.   Ellen Bernstein-Ellis  16:08 Right? You really have to ask, right?    Jaime Lee  16:11 Yes, actually, there's a story that comes to mind about a participant who was in the T-write study, who had stopped using her phone after her stroke. Her family had turned off service; she wasn't going to be making calls or texting.   Ellen Bernstein-Ellis Well, I've seen that happen too many times.  Jaime Lee   And when she enrolled in the study, and she was a participant at Shirley Ryan, because we ran participants here at JMU and they ran participants in Chicago. And she was so excited. I heard from my colleagues that she went out and got a new phone so that she could use her phone to participate in the study. And then her follow up data. When we look at her real texts gathered after the study at the last assessment point, her text consists of her reaching out to all of her contacts with this new number, and saying hello, and getting in touch and in some cases, even explaining that she'd had a stroke and has aphasia.  Ellen Bernstein-Ellis  17:13 Oh, well, that really reminds me of the value and importance of patient reported outcomes, because that may not be captured by a standardized test, per se, but man, is that impactful. Great story. Thank you for sharing that. So well, you've done a really nice job in your 2021 paper with Cherney that's cited in our show notes of addressing texting's  role in popular culture and the role it's taking in terms of a communication mode. Would you explain some of the ways that conversation and texting are similar and ways that they're different? Jaime Lee  17:45 That is a great question, Ellen and a question I have spent a lot of time reading about and thinking about. And there is a great review of research that used conversation analysis (CA) to study online interactions. This is a review paper by Joanne Meredith from 2019. And what the review tells us is that there are many of the same organizing features of face to face conversation that are also present in our online communications. So we see things like turn taking, and we see conversation and texting or apps unfold in a sequence. So what CA refers to as sequential organization.  We also see, just like in face to face conversation, there are some communication breakdowns or trouble sources in online communication. And sometimes we see the need for repair to resolve that breakdown. Ellen Bernstein-Ellis  18:45 Yeah, Absolutely. I'm just thinking about auto corrects there for a moment. Jaime Lee  18:51 And they can cause problems too. When the predictive text or the AutoCorrect is not what we meant to say that can cause a problem.Ellen Bernstein-Ellis  18:59 Absolutely. Those are good similarities, I get that.   Jaime Lee  19:03 I think another big similarity is just about how conversation is co-constructed. It takes place between a person and a conversation partner and in texting, we have that too. We have a texting partner, or in the case of a group text, we have multiple partners. There's definitely similarities. And another big one is that purpose, I think we use conversation ultimately, and just like we're using texting to build connection, and that's really important Ellen Bernstein-Ellis  19:32 Yeah, I can really see all of those parallels. And there are some differences, I'm going to assume. Jaime Lee  19:39 Okay, yes, there are some definite interesting differences in terms of the social aspects of conversation. We do a lot in person, like demonstrating agreement, or giving a compliment, or an apology, or all of these nonverbal things we do like gesture and facial expression and laughter. Those nonverbal things help convey our stance, or affiliation, or connection. But in texting, we can't see each other. Right? So we have some different tools to show our stance, to show affiliation. What we're seeing is people using emojis and Bitmojis, and GIFs, even punctuation, and things like all capitals. We've all seen the all caps and felt like someone is yelling at us over text, that definitely conveys a specific tone, right? Ellen Bernstein-Ellis  20:34 I was just going to say emojis can be a real tool for people with aphasia, right? If the spelling is a barrier, at least they can convey something through an image. That's a real difference.   Jaime Lee  20:45 Absolutely, I think some of the problematic things that can happen and the differences with texting have to do with sequencing and timing. Because people can send multiple texts, they can take multiple turns at once. And so you can respond to multiple texts at once, or that can lead to some confusion, I think we're seeing, but texting can also be asynchronous, so it's not necessarily expected that you would have to respond right away Ellen Bernstein-Ellis  21:16 So maybe giving a person a little more time to collect their thoughts before they feel like they have to respond versus in a person-to-person exchange where the pressure is on?    Jaime Lee   Absolutely, absolutely.  Ellen Bernstein-Ellis Well, why might texting be a beneficial communication mode for individuals with aphasia, Jamie, because you have spelling challenges and all those other things.   Jaime Lee  21:37 Yeah, I think it comes back to what you just said, Ellen, about having more time to read a message, having more time to be able to generate a response. I know that texting and other forms of electronic communication like email, can give users with memory or language problems a way to track and reread their messages. And in some cases, people might choose to bank responses that they can use later. We know this from actually some of Bonnie Todis and McKay Sohlberg's work looking at making email more accessible for users with cognitive impairment. So I think there are some really great tools available to people with aphasia to feel successful using texting. Ellen Bernstein-Ellis  22:30 That's great. I think banking messages is a really important strategy that we've used before, too.  Jaime Lee  22:37 So there's all these other built-in features, that I'm still learning about that are in some mobile phones, that individuals with aphasia can potentially take advantage of. I think some features might be difficult, but there are things like we've just talked about, like the predictive text or the autocorrect. And then again, all these nonlexical tools, like the emojis and the GIFS and being able to link to a website or attach a photograph. I think this is a real advantage to communicating through text. Ellen Bernstein-Ellis  23:10 It lets you tell more of the story, sometimes. One of my members talks about when his spelling becomes a barrier, he just says the word and then that speech-to-text is really helpful. It's just one more support, I guess.   Jaime Lee  23:24 Yes. And we're needing to find out a little bit more about the features that people are already using, and maybe features that people don't know about, but that they would like to use like that speech-to-text. That's a great point.    Ellen Bernstein-Ellis  23:37 Well, how did you end up wanting to study texting for more than an amount of use or accuracy? In other words, what led you to studying transaction? Maybe we can start with a definition of transaction for our listeners?  Jaime Lee  23:51 Sure. Transaction in the context of communication is the exchange of information. So it involves understanding and expression of meaningful messages and content. And this is a definition that actually comes from Brown and Yule's concepts of transaction and interaction and communication. So Brown, and Yule tell us that transaction again, is this exchange of content, whereas interaction pertains to the more social aspects of communication. Ellen Bernstein-Ellis  24:26 Okay, thank you. I think that's really good place to start. Jaime Lee  24:29 Part of the interest in transaction, first came out of that descriptive paper where we were trying to come up with systems to capture what was going on. So we were counting words that the participants texted and coding whether they were initiated or are they texts that are simple responses. We counted things they were doing, like did they use emojis or other multimedia? But we were missing this idea of how meaningful their text were and kind of what was happening in their texting exchanges. So this kind of combined with another measure we had, it was another measure in T-write really inspired by Pagie Beeson and Mira Fein's paper where they were using some texting scripts in their study.  We also love scripting. We wanted to just have a simple measure, a simple brief texting script that we could go back and look at. We had as part of our protocol a three turn script. And I remember we sat around and said, what would be a really common thing to text about? And we decided to make a script about making dinner plans. And so we're collecting these simple scripts. And as I'm looking at these data coming in, I'm asking myself, what's happening here? How are we going to analyze what's happening? What was important didn't seem to be spelling or grammar. What seemed most important in this texting script was how meaningful the response was. And ultimately, would the person be able to make dinner plans and go plan a dinner date with a friend. So it seemed like we needed a measure of successful transaction within texting. Ellen Bernstein-Ellis  26:23 Jamie, I'm just going say that that reminded me of one of my very favorite papers, whereas you started out counting a lot of things that we can count, and it did give you information, like how much less people with aphasia are texting compared to people without aphasia, and I think that data is really essential. But there's a paper by Aura Kagan and colleagues about counting what counts, right, not just what we can count. And we'll put that citation and all the citations in the show notes-- you're  bringing up some wonderful literature. So I think you decided to make sure that you're counting what counts, right? In addition to what we can count.    Jaime Lee  26:59 Yes. And I do love counting. I was trained at the University of Oregon in single case experimental design. So really, behavioral observation and counting. So I am a person who likes to count but that sounds, like counting what counts. I love that. Ellen Bernstein-Ellis  27:13 Yeah, absolutely. In that 2021 paper, you look at the way some researchers have approached conversational analysis measures and you acknowledge Ramsberger and Rende's 2002 work that uses sitcom retells in the partner context. And you look at the scale that Leaman and Edmonds developed to measure conversation. And again, I can refer listeners to Marion Leaman's podcast as a 2021 Tavistock distinguished scholar that discusses her work on capturing conversation treatment outcomes, but you particularly referred to Aura Kagan and colleagues' Measurement of Participation in Conversation, the MPC. We'll put the citation in the show notes with all the others, but could you describe how it influenced your work?   Jaime Lee  27:58 Yeah, sure. That's funny that you just brought up a paper by Aura Kagan, because I think I'll just first say how much Aura's work on Supported Conversation for Adults with Aphasia, SCA, how influential it's been throughout my career. First as a clinician and actually interacting with people with aphasia, and then later in facilitating conversation groups and helping to train other staff on the rehab team, the nursing staff. And now, it's actually a part of my coursework that I have students take the Aphasia Institute's free eLearning module, the introduction to SCA, as part of my graduate course, and aphasia, and all of the new students coming into my lab, do that module. So they're exposed really early on to SCA. Ellen Bernstein-Ellis  28:50 I'm just gonna say me too. We also use that as a training tool at the Aphasia Treatment Program, It's really been a cornerstone of how we help students start to learn how to be a skilled communication partner. So I'm glad you brought that up. Jaime Lee  29:03 Absolutely. So yes, Kagan's Measurement of Participation in Conversation (MPC), was really influential in developing our texting transactional success rating scale. And this is a measure that they created to evaluate participation and conversation. And they were looking actually both at transaction and interaction, I needed to start simply and just look at transaction first. They considered various factors. They have a person with aphasia and a partner engage in a five minute conversation. And they looked at factors like how accurately the person with aphasia was responding, whether or not they could indicate yes/no reliably, and could they repair misunderstandings or miscommunications. And then the raters made judgments on how transactional was that conversation? So, we looked at that measure and modeled our anchors for texting transactional success after their anchors. We had a different Likert scale, but we basically took this range from no successful transaction, partial transaction, to fully successful. And that was really modeled after their MPC.   Ellen Bernstein-Ellis  30:17 Wow. Thank you for describing all of that. Jaime Lee  30:20 Yeah. Another big takeaway I'll add is that, and this really resonated with what we were hoping to capture, the scores on the MPC weren't necessarily related to traditional levels of severity. So Kagan and colleagues write that someone even with very severe aphasia, could score at the top of the range on the MPC. And I think similarly, what we feel about texting is even someone with severe writing impairments could be very successful, communicating via text message, really, depending on the tools they used, and perhaps, depending on the support they received from their texting partner.   Ellen Bernstein-Ellis  31:02 You and your colleagues develop this Texting Transaction Success tool, the TTS, right? What is the goal of this measure?    Jaime Lee  31:13 The goal of the TTS is to measure communicative success via texting. We wanted this functional measure of texting, not limited to accuracy, not looking specifically at spelling, or syntax, or morphology, but something that reflected the person with aphasia-- his ability to exchange meaningful information. I think the measure is really grounded in the idea that people with aphasia are competent and able to understand and convey meaningful information even despite any errors or incorrect output. So this is really relevant to texting because lots of us are using texting without correct spelling or without any punctuation or grammar. Yet lots and lots of people are texting and conveying information and feeling that benefit of connecting and exchanging information. Ellen Bernstein-Ellis  32:08 It sounds like a really helpful tool that you're developing. Could you please explain how it's used and how it's scored? Jaime Lee  32:16 Sure. So the TTS is a three-point rating scale that ranges from zero, which would be no successful transaction, no meaningful information exchanged, one, which is partial transaction, to two, which is successful transaction. And we apply the rating scale to responses from an individual with aphasia on the short texting script that I was talking about earlier. So this is a three-turn script that is delivered to a person with aphasia where the first line there, we ask them to use their mobile phone or give them a device, and the prompt is: “What are you doing this weekend?” We tell the person to respond any way they want, without any further cues. And then the script goes on, we deliver another prompt, “What about dinner?” And then another prompt, “Great, when should we go?” Each of those responses, we score on the TTS rating scale. We give either a zero, a one or a two. We have lots of examples in the paper of scores that should elicit a zero, a one or a two.We feel like it should be pretty easy for readers to use.   Ellen Bernstein-Ellis  33:33 Wow, that's going to be really important. I always appreciate when I can see examples of how to do things. Jaime Lee  33:40 We did some really initial interrater reliability on it. The tools are pretty easy to score. We're able to recognize when something is fully transactional, even if it has a spelling error or lexical error, we can understand what they're saying. And a zero is pretty easy to score, if there are graphemes letters that don't convey any meaning, there's no transaction. Where things are a little more interesting, are the partial transaction. I think about an example to “What about dinner” and the participant responded, “Subway, Mexico.” So that's a one because the conversation, the texting partner, would really need to come back and clarify like, “Do you want to get a Subway sandwich?”  Or “Do you want to go eat Mexican?” It could still be really transactional, and they could resolve that breakdown, but the partner would have a little bit more of a role in clarifying the information. Ellen Bernstein-Ellis  34:36 When you were actually trying to validate the TTS and establish its interrater reliability in your 2021 article with Cherney you mentioned using the Technology Confidence Survey from the 2021 Kinsey et al. article. Having tools that allow us to understand our clients' technology user profile is really informative in terms of understanding what modes of communication might be important to them. We talked earlier about not assuming, right, not assuming what people want to do or have done. Can you describe the survey? And is it available? Jaime Lee  35:13 Sure, yes. This is a survey we developed for the T-write study, the ORLA Plus Electronic Writing study. It's a simple aphasia friendly survey with yes/no questions and pictures that you can ask participants or clients about their technology usage. from “Are you using a computer? Yes or No” or  “Are using a tablet?”, “Are you using a smartphone?”  We ask what kinds of technology they're using and then what are they using it for? Are they doing email? Are they texting? Are they looking up information? Are they taking photos?  It also has some prompts to ask specifically about some of the technology features like “You're texting? Are you using voice to text?” or “Are you using text to speech to help you with reading comprehension of your text?”  At the very end, we added some confidence questions. We modeled this after Leora Cherney and Ed Babbitt's Communication Confidence Rating scale. So we added some questions like, “I am confident in my ability to use my smartphone” or “I am confident in my ability to text” and participants can read that on a rating scale. We use this in the context of the research study to have some background information on our participants. I think it could be a really great tool for starting a conversation about technology usage and goals, with people who are interested in using more technology, or are using it in different ways. This (survey) is in the Kinsey et al. article. It's a supplement that you can download. It's just a really good conversation starter, that when I was giving the technology survey to participants, many times they would take out their phone or take out their iPad and say, “No, I do it. I use it just like this”. It was really hands on and we got to learn about how they're using technology. And I definitely learned some new things that are available. Ellen Bernstein-Ellis  37:20 I think many of us use kind of informal technology surveys.  I'm really excited to see the very thoughtful process you went through to develop and frame that (technology use). That's wonderful to share. Jamie, can you speak to the role of the TTS in terms of developing and implementing intervention approaches for texting? You just mentioned goals a moment ago? Jaime Lee  37:42 Sure. I think we have some more work to do in terms of validating the TTS and that's a goal moving forward. But it's a great starting place. If you have a client who wants to work on texting, it only takes a few minutes to give the script and then score their responses and gives us a snapshot of how effectively they're able to communicate through text. But in terms of developing intervention, to support texting, that's really where we're headed with this. I mean, the big drive is to not just study how people are texting, but really to help support them and texting more effectively and using texting to connect socially and improve their quality of life. But with any kind of intervention, we need a really good outcome measure to capture potential changes. Another reason I'm motivated to continue to work on the TTS, if people with aphasia are going to benefit from a treatment, we need rigorous tools to capture that change and document that potential change. 38:50 Ellen Bernstein-Ellis Absolutely. Absolutely. Jaime Lee  38:53 At the same time, I'd say the TTS isn't the only method we are focused on, we're really interested in understanding what unfolds during texting interactions. What's happening in these interactions. So, most recently, I've been working with my amazing collaborator, Jamie Azios, who is an expert in Conversation Analysis. I've been working with Jamie to say, “Hey, what's happening here? Can we use CA to explore what's going on?”  Ellen Bernstein-Ellis  39:25 Well, Jamie, you probably heard this before, but Conversation Analysis can sometimes feel daunting for clinicians to use within their daily treatment settings. In fact, we've had several podcasts that have addressed this and have asked this question. What are you finding? Jaime Lee  39:40 I can definitely relate because I am still very new to CA and learning all the terminology. But Jamie and Laura and I are actually working on paper right now, a CAC special issue, because we presented some data at the Clinical Aphasiology Conference and then will have this paper. We'll be submitting to a JSHL on how we're applying CA to texting interactions. That goal is really based around understanding how people with aphasia and their partners are communicating via texting and looking at these naturalistic conversations to see what barriers they're coming across, and what strategies they are using to communicate in this modality. Ellen Bernstein-Ellis  40:27 That makes a lot of sense. And it really circles back again to communication partner training. That does not surprise me. Jaime Lee  40:33 We're seeing some really interesting, creative, and strategic behaviors used both by people with aphasia and their partners. We're seeing people link to a website, or instead of writing out the name of a restaurant, you know, “meet me here” with a link, or using an emoji to help convey their stance when they can't meet up with a friend. They might have more of an agrammatic production. But that emoji helps show the emotion and we're seeing a lot of people with more severe aphasia using photographs really strategically. Ellen Bernstein-Ellis  41:09 So those are the strategies are helping and I'm sure that CA also looks at some of the barriers or breakdowns, right?  Jaime Lee  41:15 Yes, we're seeing some breakdowns, trouble sources in the CA lingo. In some instances, we see the partner clarify, send a question mark, like, “I don't know what you're saying”. And that allows the person with aphasia, a chance to self-repair, like, “Oops, here, this is what I meant.” And that's really useful. We also have seen some examples of breakdowns that may not get repaired. And we don't know exactly what was happening. In those instances, I suspect there were some cases where maybe the partner picked up the phone and called the person with aphasia, or they had a conversation to work out the breakdown. But we really don't know because we're using these data that were previously collected. So a lot of this does seem to be pointing towards training the partners to provide supports, and also helping people with aphasia be more aware of some of the nonlinguistic tools, and some of the shortcuts that are available, but there's still a lot to learn. Ellen Bernstein-Ellis  42:22 Well, Jamie, as you continue to explore this work, I know you're involved in a special project that you do with your senior undergrads at your university program at James Madison. Do you want to describe the student text buddy program? It sounds really engaging. Jaime Lee  42:38 Sure. This is a program I started here at JMU. JMU has a really big focus on engaging undergrads and research experiences. And we have students who are always asking for opportunities to engage with people with aphasia. Particularly during COVID, there weren't these opportunities. It just wasn't safe. But I know some of the participants from the T-write study and some people with aphasia in our community here in Harrisonburg, were looking for ways to be involved and continue to maybe practice their texting in a non-threatening situation. So this was a project and I was actually inspired by one of the students in my lab, Lindsay LeTellier. She's getting her master's degree now at the University of New Hampshire. But Lindsay had listened to an interview with one of our participants where she said she wanted a pen pal. And Lindsay said, “Oh, this participant says she wants a pen pal, I'd love to volunteer, I'll be her pen pal.” And I said, “Lindsay, that's great. I love the idea of a pen, pal. But if we're going to do it, let's make it a research project. And let's open it up and go bigger with this.” So Lindsey helped spearhead this program where we paired students with people with aphasia to have a texting pen pal relationship for four weeks. And in order to be able to kind of watch their texts unfold, we gave them a Google Voice number, so that we can watch the texts.  We've really seen some really interesting things. We've only run about 10 pairs, but all of the feedback has been really positive from the people with aphasia, they felt like it was a good experience. And the students said it was a tremendous learning experience.  We're seeing some interesting things. Using CA, Jamie and I presented this at IARC, sharing what the students/person with aphasia pairs are doing that's resulting in some really natural topic developments and really natural relationship development. Ellen Bernstein-Ellis  44:39 Nice! What a great experience, and we'll look forward to hearing more about that. Jamie, I can't believe how this episode has flown by. But I'm going to ask you a last question. What are you excited about in terms of your next steps for studying texting? Jaime Lee  44:57 I think we definitely want to continue the Text Buddy project because it's such a great learning experience for students, so we'll be continuing to do that. Jamie and I have applied for funding to continue to study texting interactions and use mixed methods, which is a pairing of both of our areas of expertise. I think there's just more to learn, and we're excited to eventually be able to identify some texting supports to help people with aphasia use texting to connect and be more effective in their communication.   Ellen Bernstein-Ellis  45:35 Well, Jamie, this work is going to be really impactful on the daily lives and the daily ability for people with aphasia to have another mode of support for communicating. So thank you for this exciting work. And congratulations again on your Tavistock award, and I just am grateful that you are our guest for this podcast today. Thank you. Jaime Lee  45:58 Thank you so much, Ellen. This has been great, thanks. Ellen Bernstein-Ellis  46:01 It's been it's been a pleasure and an honor.  So for our listeners, for more information on Aphasia Access and to access our growing body of materials, go to www.aphasiaaccess.org. And if you have an idea for a future podcast series topic, just email us at info@aphasia access.org. And thanks again for your ongoing support of aphasia access. References and Resources  Babbitt, E. M., Heinemann, A. W., Semik, P., & Cherney, L. R. (2011). Psychometric properties of the communication confidence rating scale for aphasia (CCRSA): Phase 2. Aphasiology, 25(6-7), 727-735. Babbitt, E. M., & Cherney, L. R. (2010). Communication confidence in persons with aphasia. Topics in Stroke Rehabilitation, 17(3), 214-223. Bernstein-Ellis, E. (Host). (2021, July 29). Promoting Conversation and Positive Communication Culture: In conversation with Marion Leaman (No. 73) [Audio podcast episode] In Aphasia Access Aphasia Conversations. Resonate. https://aphasiaaccess.libsyn.com/episode-73-conversation-and-promoting-positive-communication-culture-in-conversation-with-marion-leaman Brown, G., & Yule, G. (1983). Discourse analysis. Cambridge. University Press. https://doi.org/10.1017/CBO9780511805226 Fein, M., Bayley, C., Rising, K., & Beeson, P. M. (2020). A structured approach to train text messaging in an individual with aphasia. Aphasiology, 34(1), 102-118. Kagan, A., Simmons‐Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., ... & Sharp, S. (2008). Counting what counts: A framework for capturing real‐life outcomes of aphasia intervention. Aphasiology, 22(3), 258-280. Kagan, A., Winckel, J., Black, S., Felson Duchan, J., Simmons-Mackie, N., & Square, P. (2004). A set of observational measures for rating support and participation in conversation between adults with aphasia and their conversation partners. Topics in Stroke Rehabilitation, 11(1), 67-83. Kinsey, L. E., Lee, J. B., Larkin, E. M., & Cherney, L. R. (2022). Texting behaviors of individuals with chronic aphasia: A descriptive study. American Journal of Speech-Language Pathology, 31(1), 99-112. Leaman, M. C., & Edmonds, L. A. (2021). Assessing language in unstructured conversation in people with aphasia: Methods, psychometric integrity, normative data, and comparison to a structured narrative task. Journal of Speech, Language, and Hearing Research, 64(11), 4344-4365. Lee, J. B., & Cherney, L. R. (2022). Transactional Success in the Texting of Individuals With Aphasia. American Journal of Speech-Language Pathology, 1-18. Meredith, J. (2019). Conversation analysis and online interaction. Research on Language and Social Interaction, 52(3), 241-256. Ramsberger, G., & Rende, B. (2002). Measuring transactional success in the conversation of people with aphasia. Aphasiology, 16(3), 337–353. https://doi.org/10.1080/02687040143000636 Todis, B., Sohlberg, M. M., Hood, D., & Fickas, S. (2005). Making electronic mail accessible: Perspectives of people with acquired cognitive impairments, caregivers and professionals. Brain Injury, 19(6), 389-401. Link to Jaime Lee's University Profile: https://csd.jmu.edu/people/lee.html  mu.edu/people/lee.html 

The COVID-19 pandemic forced many researchers in the fields of psychological and physiological acoustics to scramble to find new ways to perform hearing research that is traditionally done in the lab remotely. The Acoustical Society of America Technical Committee on Psychological and Physiological Acoustics launched the Task Force on Remote Testing (https://tcppasa.org/remotetesting/) in May 2020 with goals of surveying approaches and platforms available to support remote testing and identifying challenges and considerations for prospective investigators. In this episode, we discuss their findings with two of the co-authors of the resulting papers, Ellen Peng, of Boys Town National Research Hospital, and Erick Gallun, of Oregon Health and Science University. Associated papers:“Remote testing for psychological and physiological acoustics: Initial report of the P&P Task Force on Remote Testing,” Proceedings of Meetings on Acoustics (POMA) https://doi.org/10.1121/2.0001409Authors: Z. Ellen Peng, Emily Buss,   Yi Shen, Hari Bharadwaj, G. Christopher Stecker, Jordan A. Beim, Adam K. Bosen, Meredith Braza, Anna C. Diedesch, Claire M. Dorey, Andrew R. Dykstra, Richard Freyman,   Frederick J. Gallun, Raymond L. Goldsworthy, Lincoln Gray,   Eric C. Hoover, Antje Ihlefeld, Thomas Koelewijn, Judy G. Kopun, Juraj Mesik, Virginia Richards, Daniel E. Shub, Jonathan H. Venezia, and Sebastian Wazand“FORUM: Remote testing for psychological and physiological acoustics,” The Journal of the Acoustical Society of America 151, 3116 (2022); https://doi.org/10.1121/10.0010422Authors: Z. Ellen Peng, Sebastian Waz,   Emily Buss,   Yi Shen, Virginia Richards,   Hari Bharadwaj,   G. Christopher Stecker, Jordan A. Beim,   Adam K. Bosen, Meredith D. Braza, Anna C. Diedesch, Claire M. Dorey,   Andrew R. Dykstra,   Frederick J Gallun, Raymond L. Goldsworthy,   Lincoln Gray,   Eric C. Hoover,   Antje Ihlefeld,   Thomas Koelewijn, Judy G. Kopun,  Juraj Mesik, Daniel E. Shub, and   Jonathan H. VeneziaVisit the Remote Testing Wiki.Read more from Proceedings of Meetings on Acoustics (POMA).Read more from The Journal of the Acoustical Society of America (JASA).Learn more about Acoustical Society of America Publications. Music Credit: Min 2019 by minwbu from Pixabay. https://pixabay.com/?utm_source=link-attribution&utm_medium=referral&utm_campaign=music&utm_content=1022  

Get .1 ASHA CEU hereEpisode SummaryEffective and efficient speech sound therapy is like poker. Find out how in this week's episode, entirely about the meat and potatoes of pediatric speech therapy-intervention for speech sound disorders. If you are working with kids who have complex speech sound delays or disorders, don't miss this chat with Kelly Vess and find out just how to add some serious oomf to your speech sound therapy secret sauce. Kelly is a research-to-practice SLP and author who has dedicated her career to helping preschoolers with speech sound disorders gain stronger speech skills, faster. In this hearty episode, Kelly walks us through the process of selecting appropriate treatment targets and enthusiastically outlines the complexity approach to speech sound intervention. If you want to make the most out of your 30-60 minutes a week (or less!) with your speech sound students, tune in to learn how to take fireworks over a chisel to the rock of speech sound intervention and help your kiddos get to mastery faster. Course AccommodationsThe transcript for this course is provided below. You can also email us at ceu@slpnerdcast.comLearning Outcomes and Course DescriptionThis course reviews strategies for selecting cluster treatment targets and how multi-modal cueing can be used for accurate productions. This course also reviewed how to make informed clinical judgments in selecting treatment targets.After this course participants will be able to:1) Select cluster treatment targets based on multiple phonological processes present to improve efficiency of treatment 2) Assess how stimulable treatment targets are to accurate production provided multi-modal cueing 3) Make informed clinical judgements in selecting treatment targets based on phonological processes (patterns), variability of production, stimulability for accuracy, and developmental complexitySpeaker DisclosuresKelly Vess financial disclosures: Kelly is the author of, "Speech Sound Disorders: Comprehensive Evaluation and Treatment," for which she receives royalties. Kelly Vess non-financial disclosures: Kelly is a member of ASHA Special Interest Group 1: Language Learning and Education.Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast.Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast.Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children.Time Ordered Agenda15 minutes: Introduction, Disclaimers and Disclosures15 minutes: Review of how to select cluster treatment targets to improve efficiency of treatment15 minutes: Review of how stimulable treatment targets are to accurate production provided multi-modal cueing.10 minutes: Review of how to make informed clinical judgements in selecting treatment targets based on a variety of motor speech variables5 minutes: Summary and ClosingReferences and ResourcesBaker, E., Williams, A. L., Mcleod, S., & McCauley, R. (2018). Elements of phonological interventions for children with speech sound disorders: The development of a taxonomy. American Journal of Speech-Language Pathology, 27(3), 906-935. doi:10.1044/2018_ajslp-17-0127Brumbaugh, K. M., & Smit, A. B. (2013). Treating children ages 3–6 who have speech sound disorder: A survey. Language, Speech, and Hearing Services in Schools, 44(3), 306–319. https://doi.org/10.1044/0161-1461(2013/12-0029)Case, J., & Grigos, M. I. (2020). A framework of motoric complexity: An investigation in children with typical and impaired speech development. Journal of Speech, Language, and Hearing Research, 63(10), 3326–3348. https://doi.org/10.1044/2020_jslhr-20-00020Gierut, J. A. (2007). Phonological complexity and language learnability. American Journal of Speech-Language Pathology, 16(1), 6–17. https://doi.org/10.1044/1058-0360(2007/003) Storkel, H. L. (2018a). Implementing evidence-based practice: Selecting treatment words to boost phonological learning. Language, Speech, and Hearing Services in Schools, 49(3), 482-496. doi:10.1044/2017_lshss-17-0080Storkel, H. L. (2018b). The complexity approach to phonological treatment: How to select treatment targets. Language, Speech, and Hearing Services in Schools, 49(3), 463-481. doi:10.1044/2017_lshss-17-0082Thompson, H. & Cummings, A. (2012, Noveember). Phonological complexity: Using three-element clusters in speech sound disorder treatment. Poster presented at the American Speech, Language, and Hearing Association (ASHA) National Convention. Atlanta, GA.Vess, K. Burgess, R., Corless, E., Discenna, T. (2016, November). Selecting complex consonant cluster targets: Are certain sound combinations more efficacious than others? Poster session presented at Annual American Speech, Language and Hearing Association, Philadelphia, PA.Vess, K., Hansen, L., Mae-Smith, M., Ridella, M., & Steinberg, E. (2015, November). Evidence-based intervention strategies to effectively treat preschoolers with speech sound disorders. Poster session presented at Annual American Speech, Language and Hearing Association, Denver, CO.Vess, K., Coppiellie, Ingraham, B., Reidt, M. (2017, November). Targeting /ɹ/ consonant clusters: Does generalization occur across phonetic contexts? Poster session presented at Annual American Speech, Language and Hearing Association, Los Angeles, CA.Vess, K., Liovas, M., Mocny, A., Vuletic, D. (2018, November). Applying the complexity approach to effectively treat severe speech impairment in preschoolers with ASD. Poster session presented at Annual American Speech, Language and Hearing Association, Boston, MA.DisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Get .1 ASHA CEU hereEpisode SummaryYou want to help people who stutter, but you can't ignore that gnawing feeling in your heart that you just don't think you know how. Gain more comfort and confidence from this week's engaging episode with Dr. Scott Yaruss- researcher, professor, clinician, and co-founder of Stuttering Therapy Resources. Learn the four most important words that center effective and person-centered stuttering inventions and pack your toolbox with the info, validation, and guidance that grad school just couldn't offer. You don't need to know everything before you sit with a person who stutters, but as a trained SLP and expert at being human, you likely bring more strengths to the table than you might realize. Add to the soft skills you already own with practical tips on resources to shift (or start) your fluency assessment and support approach. This pearls-of-wisdom-packed episode has more inspiring and thought-provoking one-liners than your favorite Instagram feed, so pull up a seat and get ready to completely change the way you think about stuttering.Learning Outcomes and Course DescriptionThis course reviews foundational knowledge related to stuttering. This course also reviews ways in which stuttering assessment and treatment has changed in recent years.1. Describe what is meant by the statement, "Stuttering is more than just stuttering."2. List 2 ways that stuttering assessment and treatment have changed in recent years.3. Describe what is meant by the statement, "It's okay to stutter."Speaker DisclosuresScott Yaruss financial disclosures: Scott is a co-owner of Stuttering Therapy Resources Inc. and receives an income related to intellectual property. Scott Yaruss non-financial disclosures: Scott does not have any non-financial relationships to disclose. Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast.Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast.Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children.Time Ordered Agenda15 minutes: Introduction, Disclaimers and Disclosures15 minutes: Review of the meaning behind the statement "Stuttering is more than just stuttering"15 minutes: Review of ways that stuttering treatment and assessment have changed in recent years.10 minutes: Review of what is meant by the statement "It's OK to stutter"5 minutes: Summary and ClosingReferences and ResourcesTichenor, S. E., & Yaruss, J. S. (2019). Group Experiences and Individual Differences in Stuttering. Journal of Speech, Language, and Hearing Research, 62(12), 4335-4350. doi:10.1044/2019_jslhr-19-00138OASESSchool Aged Stuttering Therapy: A Practical GuideAdditional Resources available at Stuttering Therapy ResourcesWHO ICFDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

A basic overview of hearing loss types and ways to optimize focus on sounds and words to build clearer language and speech in play. Related Articles: Does Otitis Media Affect Later Language Ability? A Prospective Birth Cohort Study | Journal of Speech, Language, and Hearing Research (asha.org) Ear Infections & Language Development (unc.edu) OtitisMedia (nih.gov)

My SLP professor, Dr. Stefka Marinova-Todd, is back on the SLP Corner podcast for a part two! She is a developmental psycholinguist with her main research interests being bilingual language development and second language acquisition. Dr. Marinova-Todd is an Associate Professor at the School of Audiology and Speech Sciences at UBC and is currently an Associate Editor at Applied Psycholinguistics, and is on the editorial board at Language, Speech and Hearing Services in Schools which is an ASHA journal. Previous podcast recordings with Dr. Marinova-Todd:25. SLP CORNER: Bilingualism and Language Development with Dr. Marinova-Todd26. SLP CORNER - SNACK: Bilingualism and Autism with Dr. Marinova-Todd86. The reference to Paradis' work on how monolingual SLPs could still do assessment on bilingual children:Paradis, J., Schneider, P. & Sorenson Duncan, T. (2013). Discriminating children with language impairment among English language learners from diverse first language backgrounds. Journal of Speech, Language and Hearing Research, 56, 971-981.Free resources fo the assessments used in the article that Johanne and her colleagues have provided on their websites:The ENNI instrumentThe Parental Questionnaire on first language development (ALDEQ)Two recent articles from the US on working with Spanish-English bilingual children:1. Lazewnik, R., Creaghead, N. A., Smith, A. B., Prendeville, J. A., Raisor-Becker, L., & Silbert, N. (2019). Identifiers of Language Impairment for Spanish-English Dual Language Learners. Language, speech, and hearing services in schools, 50(1), 126–137. 2. Elizabeth D. Peña, Lisa M Bedore, Mirza J. Lugo-Neris & Nahar Albudoor (2020) Identifying Developmental Language Disorder in School Age Bilinguals: Semantics, Grammar, and Narratives, Language Assessment Quarterly, 17:5, 541-558,CHILDES website: https://childes.talkbank.org4) The International Guide to Speech Acquisition (2007), Sharynne McLeod (Ed.), Delmar Publishers Inc.The Oxford Handbook of Speech Development in Languages of the World, which will be an updated and expanded version of the Guide, is coming up in the near future.Please rate and review the podcast and thank you for listening! Also, make sure to follow me on: Facebook - SLP Corner Instagram - slpcornerCheck out my blog: www.slpcorner.comSupport the show (https://www.buymeacoffee.com/slpcorner)

During this episode, Jerry Hoepner, a faculty member in the Department of Communication Sciences and Disorders at the University of Wisconsin – Eau Claire, speaks with Dr. Tyson Harmon, 2021 recipient of the Tavistock Trust for Aphasia Distinguished Scholar award, about his work that addresses factors outside of language that influence communication success.   In today's episode you will: Learn about the importance of contextual factors and how the environment can place cognitive demands on people with aphasia.  Learn about some potential cognitive factors that can prevent people with aphasia from participating fully in everyday communication.  Learn about how communication partner responsiveness and emotional arousal can affect everyday communication participation.  Learn specific strategies to help people with aphasia cope with these environmental, task, partner, and emotional demands.  Learn about strategies for helping people with aphasia to change their mindsets in a way that helps them deal with these everyday challenges.  Interview Transcript:    Jerry Hoepner: Welcome to the Aphasia Access Conversations Podcast I'm Jerry Hoepner, a faculty member in the department of communication sciences and disorders at the University of Wisconsin - Eau Claire. Today I'm joined by Dr. Tyson Harmon 2021 recipient of the Tavistock Trust for Aphasia Distinguished Scholar award. Tyson Harmon is an assistant professor in the department of communication disorders at Brigham Young University and is interested in the assessment treatment and psychosocial aspects related to aphasia and acquired apraxia of speech. His current research is focused on understanding how attention emotion and language interact to affect functioning and recovery and aphasia. I'm privileged today to discuss Tyson's work with him. Broadly, his work addresses factors outside of language that influence communication success contextual factors such as cognition emotion, environment, and social or partner factors. Those topics obviously fit within the model of LPAA, so I'm really excited to have this conversation with you today. Tyson I'm a big fan of your work and its relevance to what we do every single day so.   Tyson Harmon: Thanks so much for having me, Jerry. I really appreciate it, and just thrilled to be able to speak with you. You've always been just a great support to me and my work and I just have really appreciated your mentorship so thank you.   Jerry Hoepner: Thank you, and I can remember the first time we met, I think, maybe the first or second Aphasia Access Leadership Summit.   Tyson Harmon: That's right, it's been a few years.   Jerry Hoepner: Yeah, we were both 10 years old, at that time.   Tyson Harmon: Yeah, it's gone by fast.   Jerry Hoepner: It sure does it's amazing how quickly that goes by. Yeah well, maybe I'll start out with kind of a big question and ask you a little bit about your experience and your mentors in the LPAA model I know you've had some really good ones, but not all of our listeners are aware of who they are.   Tyson Harmon: Sure, yeah, I would be so happy to talk about that. So yeah, I mean I have been blessed to have many mentors and a lot of people who just take an interest in me and my work from early on, and I mean, as I mentioned Jerry, you've been one of those people. But I want to mention a few people specifically and I first need to mention my doctoral advisors Katarina Haley and Adam Jacks, I mean they have just had such a profound influence on who I am as a researcher. The topics that I'm interested in, the way I go about what I do in research, and for those of you who know Katarina and Adam you understand that they're kind of a package deal, they collaborate a lot and I was it was very blessed to be co-advised by them during my doctoral training. One thing about Katarina that I think is important to mention is, as we'll talk about today, I do both qualitative and quantitative work and Katarina was very influential in kind of mentoring me towards learning qualitative methodologies that really allowed me to pursue some of the psychosocial interests that I have and we'll talk a little bit more about so that has just been really, really important. I think, at that time, when I was an early PhD student at trying to figure out what my interests were and what methods I needed to get a handle on, I didn't really have the foresight myself to understand how important qualitative methods might be but Katarina did. And she really guided me in that direction which I'm really grateful for. And you know I guess just the other thing I'll say about Katarina and Adam is they just always were such excellent models for me of trying to really keep the people that we're trying to serve through our research in mind and to recognize them as people not subjects or participants and to try to you know just do things that will really help them and I have just been really grateful for that and remember that as I've tried to kind of start my own independent research trajectory so really, really grateful for them, and their mentorship and guidance. The other person I need to mention is Nina Simmons-Mackie. So I had been a fan of Nina Simmons-Mackie's work from early on, when I was a young master's student. And I was blessed, I think it was in 2014, to be able to have her as my ANCDS fellows mentor and so that was kind of the first time I was really able to interact with her one-on-one. And that was really, really meaningful to me. I even remember specifically some of the conversations we had, but the thing that has been most impactful is that you know, having just really admired her work for such a long time and then meeting her in person ever since that that time in 2014 every time I see her, she just takes such an incredible interest in me and in what I'm doing and I mean she'll read papers, when I send them her way she just gone above and beyond, to really mentor me and help me and, to be honest, I probably wouldn't have even been in the running's for this this award that you mentioned Jerry, if it weren't for her because she reached out to me and said, “Hey Tyson, I think you might be a good candidate for this, you should think about it,” and I, personally, I mean I sometimes, you know, feel a little bit inadequate, I guess, I struggle with feelings of inadequacy sometimes I might be the only one, but you know to me, I was like, ‘no I really like I am a good candidate for this?, this seems like a pretty big deal.' But with her encouragement, you know I put my name in the hat, I guess, I so I'm grateful for her just believing in me too. So yeah, I mean there's so many people I could talk about. I think I do need to mention one more person and that's Jacqueline Laures-Gore. So, you know her work and stress on aphasia has really impacted me and I was able to connect with her right as I was finishing my doctoral studies and she was able to kind of serve as a mentor for me, as I was thinking about where to take some next steps, and you know similar to other people I've mentioned she's just really taken an interest in me and my work and just been so generous about reaching out, so I think you know all of these people, obviously impacted me as because of the research interests their focus on the life participation approach to aphasia which is also kind of who they are, and they're great compassion, they have not only for people with aphasia but for me and so I've really just been grateful for that there's more people I could talk about, but I think those are hits on some of the big ones.   Jerry Hoepner: Yeah, that's a pretty good list, and I, I just want to highlight a couple of things that you said, because I think they're so important, when you discuss this idea of Katarina encouraging you to learn those qualitative methods. I think it speaks, and you talked about this a little bit, it speaks to the idea that you have the right kind of methods to answer the kinds of questions that you want to ask and that's really the way that you've approached it, in the way that we should all approach it, so I think that's just something to really highlight because it's you know not easy or effective to answer every question with the same methodology so.   Tyson Harmon: Yeah absolutely, so important.   Jerry Hoepner: And I really appreciate, and I'm not surprised, but the focus on seeing our research participants, and I even hesitate to say that word as it comes out of my mouth as people and, as someone who needs to benefit from the work that we're doing not just be observed and tested and all of those things, but there should be some tangible benefit or impact on them down the road at least because of our work with them, so I think that's just so, so important to highlight and I hope that others will recognize that importance as well. I know we as a company and in Aphasia Access surrounded by people who value that but I don't know that not everyone does, obviously so yeah.   Tyson Harmon: I mean, and just one other, maybe real brief anecdote I'm in thinking about that aspect, and particularly Katarina has influence on me in that regard, and one of the early qualitative pieces that I published was with Katarina and it was really an effort to try to understand whether treatment approach for apraxia of speech that she was kind of thinking about and developing was acceptable to the people that we were going to be using the treatment on, and so we did a qualitative study that all about kind of social validity to you know get that input from the beginning, as we were planning and designing that that intervention, rather than waiting until it has already been developed to get that feedback and so again just you know it's an example of I guess stakeholder engagement, which I've continued to be very interested in and grateful for the efforts that are going on in the field to get stakeholders more involved, from the beginning, from the onset of research. I think that's really important but, again, that was just modeled for me early on, through those mentors.   Jerry Hoepner: Yeah, and that's it! Stakeholder engaged research is just such an important element of that participant as a human being, who has you know, a stake in in the research that we're doing, and it has been should have some things to say about it so absolutely and what a just a great model and a great way to start out. In terms of your work as an academic, so to speak, or on that path and the other thing that I wanted to mention what goes back to your comments about Nina Simmons-Mackie and how generous and open she was an encouraging she was, and I know that definitely applies tonight because I think we've all seen that at you know Aphasia Access conferences and at ASHA and that any other place you might run into her, but I think that's true of so many individuals that are involved in Aphasia Access. I know that when I did the podcast with students that's something that was really almost shocking to them how easy it was to have a conversation with people that they've only seen their names in print before and feel like it's just you know, like you're talking to a friend or another just another regular human being, and I think it's really important for us to keep that.   Tyson Harmon: Yeah, for sure I tell my students often after I get back from conferences like you guys are in a great field, because the people in this field, or just nice, you know, like they're just so many nice people they're just genuinely you know, nice and easy to talk to and caring. So yeah, it's definitely something that I've noticed in my students have noticed that too.   Jerry Hoepner: Yeah, that emphasis on relationships that we bring to our work and our research our clinical work and our research definitely carries over, you know. We walk the walk, I'm hoping, in terms of this profession, so carries over to those relationships with other professionals as well, which is fantastic.   Tyson Harmon: And I think so.   Jerry Hoepner: Well, since I did bring up the Tavistock Trust for Aphasia Distinguished Scholar award, would you talk a little bit about what it means to you to be awarded this and potentially what its impact will be and has been on your research?   Tyson Harmon: Yeah absolutely I mean, first of all I just want to say how honored I was to receive this word award and frankly a bit shocked as well, I didn't really see it coming or expect it and you know it's meant a lot to me, and I think you know the one of the things that early on just hit me about this award that was the in not just the award but the Tavistock Trust for Aphasia in general is that you know this was founded by a person with aphasia and their family and to me, you know thinking about Robin to have a stock in relationship to this word is really, really meaningful because, again I kind of go back to what I said previously, but this is about people, and it really caused me to reflect like am I honoring the people with aphasia in what I do professionally and in college, as I mentioned cause me quite a bit of reflection, I think it was a confidence booster as well in that you know I it's nice to kind of have your work recognized and think, “Okay, maybe something I'm doing is making a difference” and, to be honest, this kind of came at a time in my kind of academic career I'd hit three years exactly in my professorial position and I was at this kind of point where I was like man is anything that I'm doing making a difference and, and so it was it was just kind of a nice affirmation of like okay like you know this, this does matter, the work that I'm putting in is not only noticed, but it can make a difference for people with aphasia, which is what I really hope and so yeah, I think that confidence and just a greater commitment, as I mentioned on people with aphasia and their families in terms of how it has impacted and will impact my research. I've been really grateful for the opportunity. That I've had with the encouragement of the Tavistock Trust for Aphasia Board to get involved in the collaboration for aphasia try and to make some connections with a physiologists who are working internationally. So, you know I think there's a lot of potential there and I really believe that. You know, to really make a difference we're going to need to do more and more collaborative work both within this country and internationally, so it has just been awesome just so honored to have received the award and really hope to honor the Tavistock trust and you know the Tavistock family in how I continue my research trajectory.   Jerry Hoepner: That's fantastic, and I just want to emphasize how important that is you mentioned CATS (collaboration of aphasia trialists), for us to kind of band together and address topics internationally that I mean, I think, maybe just even a few years back, it would have been a much bigger obstacle to be able to have those collaborations but now it's just kind of a part of what we expect and to be able to you know when you're looking at kind of niches in the field right some carved out little area of aphasia interventions and so forth. It's good to connect with other people that are in a similar or the same niche and can collaboratively accomplish a lot more in terms of that work together so I just think that's a really important outcome for sure.   Tyson Harmon: Yeah, well and I guess just the other comment I'll make about that is I'm always surprised at how like gracious people are when I reached out to them, they know like we're all so busy, and have so much going on but you know I've been able to have a few great conversations with international colleagues and people have just been so gracious and kind of responding and taking time and talking about overlapping interests and that's a really fun part of this, so I just encourage you know, maybe, people who are listening, who are like me and sometimes get a little bit nervous to impose on others like to just you know take that step and get conversation started.   Jerry Hoepner: Absolutely, that's great advice. Well, fabulous to lead into this discussion about your work with kind of the principles that direct how you work, and I think that emphasis on relationships and the human piece that people with aphasia are people that we need to serve and have their best interest in mind, is a great starting point for our conversation about your work, because that's essentially what it's based on and we'll start with asking you a little bit about your work on addressing those contextual factors and maybe that begins with a definition of contextual factors and how that plays into the questions that you ask in your research.   Tyson Harmon: Yeah, sure absolutely. So, you know early on, is a kind of began thinking about my research interests and such. And really you know, think about some of this in relation to the WHO-ICF which you know, has been kind of connected with aphasia and in the WHO-ICF is many of you now than we think of you know if we're applying this to aphasia the body structures and functions being kind of the aphasia itself and how the brain is affected by stroke, or otherwise, and activities and participation, but the bottom of that model is depicted graphically you have what the WHO-ICF refers to is contextual factors which are the personal and environmental factors and the model really suggests that these contextual factors can play a role at any of these levels to activities participation body structures and functions and I would say kind of the overarching goal of a lot of the work that that I do, and that we do in the aphasia lab here at BYU is really geared towards understanding the impact of those personal and environmental factors on communicative functioning and participation for people with aphasia and you know, I think that this is important because, if we're really going to promote participation for people with aphasia, then we need to first understand the challenges that are inherent in their everyday communication environments. Maybe what are some of those barriers what's prohibiting them from participating as much as they would like and you know, I think that that really is the first step to finding solutions right, we need to understand those challenges, first, so we can come up with solutions that will help them overcome some of those barriers so that's you know, an emphasis will have a lot of the work that we're doing and you know, we talk about in in my lab what I've started to refer to as the cognitive challenges for more kind of the environmental conditions that include complex attentional demand, so all of us when we're communicating in real life right, we are communicating in environments in context that are highly demanding and I was having a conversation with a student in my office just earlier today, and we have the door open and there are people talking in the hall right and that's you know, increases the demands that you have during that conversation, and this happens, or you know when we talk at home or in the car, I mean there's a radio on or TV on.   Jerry Hoepner: Agreed, Tyson and that's just that's just real life right?   Tyson Harmon: And so, I think it's important to think about that and think about then hearing kind of cognitive challenges that exist in our everyday communication environments. So, we kind of talked about that aspect, and we also in in my lab talk about what we refer to as social challenges you're more kind of the. Inner, personal aspects of everyday communication that can sometimes pose more demands, so the way that communication partners react to us the emotional reactions that we have when we're engaging in a conversation and so all of this, I think, is really important, too, but again can kind of heighten the demands in ours everyday community communication context, and so it kind of has to do with those contextual factors, some of these things relate to maybe the personal or environmental factors, but we need to really kind of understand you know what is going on in these everyday environments in order to promote that participation, and I think that's it kind of the long term goal of a lot of what we're doing.   Jerry Hoepner: And I think the emphasis on being aware or becoming aware of what those factors are you mentioned the you know talking to a student with people moving around in the hallway and talking and so forth and we're fortunate that often we can communicate without any you know compromise to our message at that point, but certainly with individuals who have aphasia that can play a role in how effectively they communicate and the best place to begin, as you described in providing those supports is understanding what those demands are having a better understanding of that I know that's a big part of all of the recent work that you've published is just becoming more aware of what those demands are so that you can make some sort of an adjustment, or you can train a communication partner to make some adjustment those kinds of things.   Tyson Harmon: Yeah and, in addition to that, I think you know, one of the things that we've been interested in, because I think it makes sense that you know this is going to affect communication and there's such great work on kind of how we support communication for people with aphasia that's so very important but you know we've also been very interested in like how does this actually affect measures of language, right? And are these demands and having a direct impact on spoken language production for people with aphasia and, you know again, kind of thinking about the relationships between kind of their environment and how people with aphasia function in terms of their language abilities.   Jerry Hoepner: Absolutely, so that that's really a good segue into thinking about what are those cognitive challenges that prevent people from participating fully in communication.   Tyson Harmon: Yeah, so you know we kind of just talked about things like people talking in the hall when you're trying to have a conversation, and you know I'd like to talk about a little bit of work that we're doing maybe in relation to kind of background noise. But you know before I go there, maybe a better starting point would be to think about kind of multitasking, which is hard for all of us, right?   Jerry Hoepner: Not sure if any of us really can multitask.   Tyson Harmon: yeah, it's kind of impossible actually, you kind of have to just shift your attention from one thing to another, even though we call it multitasking. But you know some of this work, about cognitive challenges or cognitive demands.   Again, focusing primarily on different types of environmental factors that can tax the attentional system. Actually, was born, as I was working on my dissertation and I became very interested in some of the previous work that had been done about attention and aphasia and some of Laura Murray's work, for example and you know, historically, you know, there was this interest in kind of the late 1990s early 2000s and attention and how that you know related to aphasia and kind of how dual task conditions might affect language, processing and people with aphasia and a lot of that was approached from a theoretical perspective to try to understand kind of the relationship between attention and language and how that is manifest in aphasia and all of that work was so influential in you know what I was thinking about as a doctoral student and I really kind of a approached my questions about attention and cognitive demands from I guess more of a practical perspective which or maybe a clinical perspective is a better way to put it which was more just like well let's figure out like regardless of theoretically the role that attention is playing in language processing per se and how it plays into kind of the big picture of how aphasia is manifest let's just think about how attentional demands are influencing people with aphasia and when they're trying to produce language and also think about you know how they are responding to these attentional demands and so I published an article with some of my colleagues in 2019 That was really kind of building off of some of Murray's work from the 1990s where we used a dual task paradigm to look at the effects of kind of complex attentional demands on narrative retail for people with mild or moderate aphasia and you know, we had for kind of our dual task condition we had these participants retell a story, while performing a tone discrimination tasks they had to discriminate between a high and a low tone, while in the process of retelling the story, we had 10 people with aphasia with moderate aphasia, and I should say 11 people with mild aphasia and impulse control participants and I think our findings were interesting and on one hand, they kind of confirmed what had been shown in the past, which was these attentional demands, you know, really take a toll on language production for people with aphasia more than their peers, who don't have aphasia but the other interesting thing that that we found, which was a little bit of a new insight, I think was that you know the control group so we back up a little bit so as I mentioned before everyone is affected by increased attentional demands right and that's not necessarily surprising and what our control group did is they slowed down significantly when retelling stories in order to maintain their accuracy and so they kind of allow themselves more processing time and then they were able to you know, continue to produce accurate language and the mild aphasia group did something similar, they just slowed down a lot more significantly more than the control group, but they also took a bit of a hit on at least language productivity right they weren't producing as much language during this retail experience so it did kind of affect them differently, even though they were trying to kind of compensate for those demands and the moderate aphasia group and really they took a the biggest hit in their accuracy, where they just and I had a really difficult time even producing accurate language during this story retail task when there were these complex attentional demands. So that's kind of one piece of work that we've done again kind of focused on the multitasking question or what we would call a divided attention condition. And the other one that I mentioned, I could talk about a little bit is a study that we actually just analyzed results from a few months ago, I have a thesis student her name is Brenda Nelson who's worked with me over the past two years, and she just graduated and has really done some great work during her time as graduate student here but she was kind of interested in in taking this idea of attentional demands and investigating and in a similar way how background noise might affect spoken language for people with aphasia so this is something we haven't even submitted for publication yet. We're kind of in the process of converting the thesis into an article, but so I'm not going to go into a lot of depth about the results or anything but I think it's a really interesting question that that Brenda has pursued and she's developed these different background noise conditions where she's tried to kind of simulate some types of everyday communication environments. So, there's a cocktail speech condition there's a lively conversation. There's a one-sided phone conversation. We were thinking, okay if somebody with aphasia was kind of in line at a grocery store and they're trying to have a conversation and there's somebody behind them on the phone what would that be like so it was really fun to kind of develop some of these conditions and think about how they might you know simulate some types of everyday communication contacts and yeah I think there there's some kind of interesting preliminary findings from her thesis work that you all can look out for the hopefully we'll get out soon so.   Jerry Hoepner: Absolutely, and just as a little bit of a preview, more than just changes to language production or lexical production but also changes to speech and while speech for sure, in terms of the fluency of speech and so forth Is that correct.   Tyson Harmon: Yeah so, I mean I think we're, you know, one of the things that we're seeing across these background noise conditions, is it seems like you know speech efficiency or the information units per word that seems to be one of the key measures is really taking a hit for our aphasia participants, but not making you know the background noise isn't affecting that for our control group. And again, this is kind of preliminary work, so I don't think it's confirmatory by any means, but I think it's kind of pointing in this direction that yeah There does seem to be maybe some real changes that are that are happening in in terms of just spoken language, and then I you know there's kind of a qualitative piece of this to where we've interviewed these people after they've participated, we haven't even really started to analyze this part truly we're kind of in the process of just you know, really familiarizing ourselves with the data which is kind of the first step of this analysis process and I have another thesis student working on that that qualitative aspect of the question, but I had a conversation with her, the other day, and again like and I guess take this with a grain of salt, because this was just a conversation after she has spent like hours and hours with these data. So, I think it's meaningful but, again, we haven't done a true analysis, but one of the things that's really standing out to her, is that the facial participants really seem to be talking quite a bit about how much they have to focus on producing language when there's background noise. And the control participants are like oh I didn't I didn't even notice it, they just like totally you know, are able to kind of filter it out, it seems like based on some of these comments, so I found that interesting again we'll get some more kind of concrete data that will be able to report on, hopefully, in the next month or so.   Jerry Hoepner: So that'll be interesting to find out, I mean it's, it reminds me of something that a lot of my clients with mild aphasia say right, even when their production and their fluency is pretty normal they talk about that effort in order to be at that level I am working really, really hard. It's not as though it just rolls off the tongue it's difficult work to be a success, successful from a communication standpoint as they are, so I think that's a really important point to highlight as well.   Tyson Harmon: Yeah, well in it, I guess, one other comment about that is um you know from some of the qualitative data we collected in conjunction with the multitasking project. You know that was another thing that kind of stood out to us as people were talking about how like they close their eyes or did you know different behaviors to essentially limit the amount of you know stimulation that they were receiving from the environment seemed in an effort to be able to really kind of put all of their resources into the language task right.   Jerry Hoepner: Right yeah, that makes sense. Do you have a sense of how those kinds of cognitive challenges and demands affect their participation in everyday communication?   Tyson Harmon: Yeah, that's such a great question we, and we have some work that we're actually doing right now, I think, is giving us, you know some preliminary kind of findings in that direction and so I guess you know to start out one of the things that I'll say in response to that question is, we do have a qualitative study that was published in 2020 where people kind of connect some of these intentionally demanding people with aphasia connect some of these potentially demanding kind of experimental conditions to what they experienced in their real life, and they are kind of making this connection they seems like and it's potentially demanding to do things like eat dinner with friends or talk, while driving they've had experiences I remember one of our participants talking about trying to go back to work, and it being so hard for her to have her boss talk to her, while she was trying to do something on the computer so just attending to those things at the same time. People have talked about kind of trying to control the TV while listening to their spouse obviously group settings tend to be a challenge, but in relation to your question, more directly. I think one thing that we're interested in is you know, is this actually affecting participation and you know in both have kind of the studies that I mentioned more from the qualitative standpoint, it does seem that people are kind of talking about this, how they're discouraged from participating when these demands are high. I remember one participant in particular, said that the some of the difficulties associated with these attention and demanding environments caused him to, and this is a direct quote from him, he said quote he became quote discouraged from saying anything. So, yeah, I mean again this is nothing confirmatory, but it makes sense right that, like when demands are so high, then you know people with aphasia going to have a harder time engaging in these communication opportunities yeah.   Jerry Hoepner: Absolutely, and it kind of reminds me of some of the work by Dalemens  that said, you know you can have a hard time initiating those interactions even when you're surrounded by people I mean yeah being in a context with people communicating doesn't necessarily mean that you're participating in that context, and if the demands are really hard, especially in a group context you may be there, but not really engaging fully in that interaction so.   Tyson Harmon: Yeah, absolutely. In reference to Dalemans' work, which is just awesome, by the way, I really admire that work um you know just that that idea that you know engagement and participation isn't just about the amount of communication and experiences or opportunities right actually it's what people with aphasia really want is they want to engage in meaningful ways and maybe if they have a you know a smaller quantity of communication experiences, but those are meaningful and then that's really what matters, and I think that is connected to what we're talking about here because you know we're cognizant of kind of these demands, and the effect that they can have on meaningful engagement from people with aphasia. Then you know we're going to be better enabled to kind of think about you know how to prepare our clients for engaging in meaningful ways and supporting people with aphasia so that they can have that meaningful engagement yeah.   Jerry Hoepner: Absolutely, I think that goes back to Dalemans' comment about people with aphasia would prefer smaller quantities of high-quality meaningful engagement, rather than big quantities of not so meaningful interaction so yeah that's a really great connection to your work for sure. Well, maybe we can move towards a discussion about social challenges and what the factors are that contribute to those social challenges for communication after vision.   Tyson Harmon: Yeah, sure I'd be happy to talk about that so. You know, first as a disclaimer you know there's all sorts of things we could think about in terms of cognitive and social challenges and we're really just kind of scratching the surface, on some of this with some of the work that I've done in the last few years and you know I'm really interested in how aphasia affects relationships in general but you know what I'd really like to kind of focus on during this interviews just some of the work that we've done in relation to kind of communication partner responsiveness and kind of emotional reactions, which is something that I've become increasingly interested in as well so should we start with maybe the communication partner responsiveness piece. I think that's a really great place to start I just think that when I read that work it's just such a fascinating and important concept right, the amount of.   Jerry Hoepner: Investment that the individual with aphasia perceives on the part of their partner and in terms of their interactions dictates how successful, they are the amount of stress that they carry about this, so I don't want to take all of your words out of your mouth so go ahead and delve into that just a little bit.   Tyson Harmon: Yeah absolutely um yeah so it just is, as you were saying you know we published, and this is part of my dissertation work they did with Katarina and Adam and published this study in 2020 and the essence was that we were interested in how responsiveness from a communication partner influenced spoken language directly for people with aphasia again, we had to kind of moderate to mild aphasia group and you know this was kind of a fun and interesting experiment to develop. We kind of thought about some of the principles and concepts and behaviors that are often involved in communication partner, training, but we wanted to develop something that you know, would allow people with aphasia to have an experience communicating with somebody who is you know, providing more kind of supportive mostly nonverbal feedback, so they weren't necessarily. You know, providing supports to help them get their message out, but they were just showing you know by how responsive, they were you know this kind of interest and engagement when the person with aphasia was talking, and so we had our participants with aphasia.   Jerry Hoepner: And can I interrupt for just a second because I wanted to highlight something that you talked about in the article about kind of useful or effective back channeling versus less effective, or almost intrusive back channeling. That just is so important in terms of thinking about those partners and how they kind of induce struggle or challenge, or how they support that success sorry to interrupt you sorry.   Tyson Harmon: Yeah no, absolutely yes. We kind of talked about this in the article is kind of these backchannel responses right where you know the participant or in this case, the case of this study, our participants with aphasia we're talking in in in the case of the supportive communication partners in the article we refer to these as responsive communication partners they're providing these backchannel responses. They show interest so they're nodding their head they're giving affirmations like they have an open body posture kind of leaning forward, you know all of these things that we would expect to show kind of interest and engagement and so that was kind of one of the conditions so who participants with aphasia were retelling the story with that partner, and in this case, we had students who were trained and we kind of had a protocol developed and made sure that we had fidelity that everybody kind of got a similar experience and then the non-supportive or unresponsive condition was where the communication partner was you know kind of showing these nonverbal behaviors they suggested disinterest they had a closed body posture they had poor eye contact and kind of this neutral facial expression every 20 seconds, or so it kind of just like looked away or glanced at their phone that was on the table and so we were able to kind of go through this and bring people through this experimental protocol, and then you know measure the outcomes of this in terms of spoken language production. Frankly, you know there wasn't a huge effect on the actual measures of language in this unresponsive communication partner condition. People in general did kind of slow down and we're a bit more can disfluent when talking to the unresponsive communication partner it wasn't much different between people with aphasia in the control group. Actually, the control group seemed to do that a bit more than the aphasia group not significantly, but just kind of on average.   But what was really interesting about this study and what I feel like one of the really key findings was at least for me was that when we analyzed the qualitative reports so we interviewed our participants after they went through this experimental protocol, and then we analyzed their comments about the experience, people with aphasia were talking about strong negative emotional reactions in response to that unresponsive communication partner and our control group they hardly talked about emotional reactions at all, and when they did, then they were kind of neutral, or sometimes even like more positive emotional reactions and, in that, combined with the fact that you know, in general, when kind of having this experience talking to an unresponsive communication partner people were self-reporting, you know kind of increased stress. I think that's important, and I think that you know the other thing that kind of adds to that that body of work is an additional kind of qualitative study that we did where you know people with aphasia were in at this point talking more about just their everyday communication situations and talked about how often they communicate with people who seem to be in a rush or who just give up on them or show signs of disrespect or disinterest and I mean this surreal thing that you know people, people with aphasia are experiencing and maybe it's not taking a huge hole in the moment on their language production but you know, I think that it has the potential to lead to these important kind of psychosocial impacts that may discourage participation down the road. And I mean, frankly in our qualitative work, one of the things that was surprising to us was how many participants described feeling kind of unsupported when communicating with familiar communication partners like family and friends which is why we thought about it more we were like okay I kind of makes sense because you know we're so close to those people we really get like the raw experience with them but you know, so I guess the point there is that, like if this is something that is a reality for people with aphasia and even when people aren't like blatantly poor communication partners, aren't blatantly rude like the notice when people are in a rush or when they you know aren't are not fully engaged or disinterested or ready for the conversation to be over. And it does have an effect, maybe even you know, maybe not on how they're producing language but on how they're feeling and the emotions that they're experiencing during that communicative exchange.     Jerry Hoepner: Yeah I think that's a really important thing to keep in mind, and both of those 2020 papers and we'll have all of these articles referenced at the end, so people can look them up and follow this important work but in both of those cases, you have listeners, who are unresponsive or less responsive in a hurry and that has that impact on their emotional kind of response you mentioned it may affect participation, but I almost wonder if it would affect their, you know, even though it didn't affect their language in that moment and wonder what the downstream effects are of you know, being with a partner who consistently is not responsive, in that way and you talked a little bit in one of those articles about what the person with aphasia might do to be able to kind of ameliorate or contend with that lack of responsiveness, you want to talk about that, just a little bit.   Tyson Harmon: Yeah and you know I think probably the, the best way to address, that is to talk a little bit about some of our findings from the kind of fully qualitative article, you know, one of the things that has been really intriguing for me to think about from the qualitative results of that study is strategies that some of our participants with aphasia were talking about that they use to kind of cope with the negative emotional responses and also some kind of the negative thoughts that are sometimes associated with the communication difficulties. So yeah, so why don't I maybe try to paint a little bit of a picture here for and what some of those findings were. So, you know, in that, in that study, one of the things that again just to kind of return to this, we were focused really on like everyday communication experiences so What are they doing in their actual life as they go out and communicate and kind of one of the themes was all about strategies that people with aphasia were using and you know it I think not necessarily so surprisingly most of them were talking about what I would consider behavioral strategies, so these were ways that they change their behaviors to kind of be more successful and in their communication experiences but what was more intriguing to me was the subset of participants who talked about what I would refer to as cognitive strategies things that they did to kind of change the way they were thinking or feeling in order to cope with these everyday communication challenges that they experienced and one of the things I think is interesting about what we learned from these participants is, I think it could you know potentially kind of serve as a launch point for some of the solutions that we might think about in terms of how to address some of this we're pretty good at the behavioral piece like we talked to people with aphasia about disclosing their aphasia and about you know advocating for themselves during conversation I think in these are things that you know they seem to be doing and they're obviously very important but maybe we don't think as much about how to address or how to help people with aphasia use strategies to cope with some of the negative thoughts and feelings, and so I think it's something that maybe we should think about a little bit more, and, obviously, for me, learning from people with aphasia what's already working for them is a great place to start. So, what we what we learned from these participants and, as I mentioned, it was just a subset of participants, I think it was about if I'm remembering correctly eight out of 21 participants that mentioned these strategies was that we kind of categorize these into three different areas of kind of things that they were doing. The first one was that some of these participants were talking about ways that they kind of changed their mindset to start thinking about challenges as opportunities for growth, and let me, maybe just read a couple quotes from our actual participants. One of them said listening is better than talking, most people doesn't listen, I mean I think I'm a better listener, and so this participant really thought that, because of aphasia become better at listening which is a bit of a kind of cognitive restructuring that probably happened right where instead of thinking about aphasia as a threat. She started to think about it as just a challenge that she could kind of face and use to grow, which I think is really interesting and there was another participant, who said aphasia is a good thing, not a bad thing so just again kind of looking at this and maybe a positive light, which really gets to you know some strategies that are used in in counseling psychology related to cognitive behavioral therapy, which is kind of that cognitive restructuring and kind of changing your thoughts I think you know, there are other ways to approach this from other kind of counseling psychology perspectives like acceptance and commitment therapy as well where you know they talk about cognitive diffusion and this idea of kind of separating yourself from your thoughts so, and you know you have kind of these negative thoughts that you recognize that those don't define you and they're not always true and just kind of letting them exist without having to combat them. So I think this is interesting and I actually want to acknowledge, like some of the great work that is happening right now throughout the world, related to kind of addressing some of these issues and I mean we could, I think, talk about several different groups are doing really interesting things kind of looking at how to integrate some of these counseling approaches with the work that we do in speech pathology with aphasia population. You know the other thing, so, in addition to change their mindset thinking of challenges is growth opportunities, some of our participants talked about empathy I really love this quote, so one of our participants said, ‘some people are nice and some people aren't.' I try to remember that you don't know what other people are going through, because everybody's living a tough life and you don't know so obviously this person with more mild aphasia, but yeah I just I think this kind of got me thinking about okay like are there ways that we can you know train our clients to empathize and take the perspective of others and that's a I think an interesting thing to think about and then the third kind of category of these more cognitive strategies was positive attitudes. And again, and I think there's some great work and thought being put into how to integrate some you know positive psychology into the work that we do. I think positive self-talk seems to have a place in kind of helping people with aphasia address some of these negative thoughts and feelings that they might experience and so you know I think there's just some interesting kind of strategies that already seem to be working for a subset of our participants with aphasia but one thing that I didn't highlight, which I think I should is that almost all of these participants who talked about these cognitive strategies had been living with aphasia for a really long time, so I think it was like you know over 70% of the participants that that mentioned these. And so, you know that makes me wonder, are some of the you know the people who are living with aphasia having to kind of live with this for a long time before they start really getting a handle on some of the you know, some effective ways to deal with those negative thoughts and feelings and is there a way that we as speech pathologist in our role as communication counselors, right? Addressing thoughts feelings attitudes beliefs, as they relate to the communication disorder is there a way that we can maybe step in and integrate some of that earlier on which would be helpful to more people. So again, those are just some questions that I have related to some of this, but I think you know some of the solutions in my thinking, right now, some of the solutions that are really going to make the most impact in this space are those that are addressing both communication and, and so I guess the language side of aphasia as well as the psychosocial impact of aphasia as kind of a package deal.   Jerry Hoepner: Yeah, I really think that ties things up really nicely in terms of this discussion, I love the term ‘communication counselors' or however you frame that. Sounds very much like something Katarina would say.   Tyson Harmon: Maybe I got that from her, actually.   Jerry Hoepner: Not sure, I'm going to tell her you came up with it first so it was really good. I, and I also want to emphasize the statement that you made about, you know, they've got these strategies but they've been living with aphasia for a long time, and how long did it take them to develop these strategies and is there a way that we can kind of shorten that trajectory and get them there a little bit more quickly, you know as I read that article I was thinking of the situations that we all have when we're having a conversation with someone who, maybe isn't paying attention to or we may be reading something into what they're thinking in the moment like, ooh the way they looked at me. Don't they like me? Or what a dumb idea that I just shared or whatever those internal thoughts are and having strategies specifically to deal with that have been kind of vetted at this point, a little bit by individuals with aphasia eight individuals with aphasia, but I think it's an interesting way to think about moving them closer to that by those strategies of changing their mindset of having empathy for their communication partners and being able to take their perspectives because they might be challenged at that moment as well, and then the positive self-talk and focusing on those positive attitudes as a way to kind of break that internal loop of, “I wonder what they're thinking about me or it doesn't seem like they're interested or it doesn't seem like they want to take the time.” So, I think those three things are a really good direction for us to take in terms of hopefully shortening that trajectory of people not having to figure this out over the course of eight to 10 years but, like you said, us as communication counselors being able to move them there a little bit more quickly if we know some strategies that work.   Tyson Harmon: Yeah, and I mean I, I agree, and I just I think, you know, this obviously is not like, you know, the solution, but I think it's a starting point. I think that's one of the things I love about qualitative work is that, you know, sometimes an appropriate starting point can be what's already working for a subset of people with aphasia and we can kind of in a way, almost follow their lead into kind of discovering ways to help more people and so I've really enjoyed kind of thinking about some of the work that I do in in that regard because, and I just think that we have so much to learn from the people that we serve, and hopefully we can help them learn from each other as well.   Jerry Hoepner: Absolutely, and what a great way to come full circle, as we started talking about stakeholder engaged research and for us to take their lead and to follow what they're already doing to be successful, so a fantastic way to kind of wrap things up. Boy, we could talk all afternoon, but this has been a terrific conversation, and thank you Tyson for joining us in this conversation and sharing these meaningful things and I thank you so much for having me.   Tyson Harmon: Absolutely.   Jerry Hoepner: On behalf of Aphasia Access, thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access and to access our growing library of materials go to www.aphasiaaccess.org. If you have an idea for a future podcast series or topic, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Resources:   Harmon, T. G. (2020). Everyday communication challenges in aphasia: Descriptions of experiences and coping strategies. Aphasiology, 34(10), 1270-1290.   Harmon, T. G., Jacks, A., Haley, K. L., & Bailliard, A. (2020). How responsiveness from a communication partner affects story retell in aphasia: Quantitative and qualitative findings. American journal of speech-language pathology, 29(1), 142-156.   Harmon, T. G., Jacks, A., Haley, K. L., & Bailliard, A. (2019). Dual-task effects on story retell for participants with moderate, mild, or no aphasia: Quantitative and qualitative findings. Journal of Speech, Language, and Hearing Research, 62(6), 1890-1905.   Harmon, T.G., Nielsen, C., Loveridge, C., & Williams, C. (under revision). Effects of positive and negative emotion on picture naming for people with mild to moderate aphasia.    Scadden, B.D. (2020). The Impact of Background Noise on the Spoken Language of People with Mild to Moderate Aphasia: A Preliminary Investigation. Master's Thesis at Brigham Young University. T. Harmon thesis chair/mentor. 

Join Laura from SLP mommy of Apraxia/Dyspraxia/Dyslexia and Cari from Cari Ebert Seminars as we sit down with Dr. Erika Levy who is an expert in the treatment for pediatric dysarthria for this special edition of uncorked! Dysarthria is a motor speech disorder that can co-occur with apraxia, but unfortunately there are not a lot of great resources for parents or professionals. Dr. Levy shares practical treatment ideas along with audio clips for examples. References: Levy, E. S., Chang, Y. M., Hwang, K. H., & McAuliffe, M. J. (in press). Perceptual and acoustic effects of dual-focus speech treatment in children with dysarthria. Journal of Speech, Language, and Hearing Research. Moya-Galé, G., Keller, B., Escorial, S., & Levy, E. S. (in press). Speech treatment effects on narrative intelligibility in French-speaking children with dysarthria. Journal of Speech, Language, and Hearing Research.

Get .1 ASHA CEU hereEpisode SummaryHey SLP's! Don't be distracted by the shiny AAC penny! It's all about language therapy and you've got this! This week, we welcome back Dr. Cathy Binger and Dr. Jennifer Kent-Walsh to share their pearls of wisdom around using typical language development to guide AAC practice. Tune in to focus on “the big C in AAC” as Dr. Binger and Dr. Kent-Walsh urge us to focus on language rather than technology as we support complex communicators to achieve their full communicative potential and give them access to the building blocks of language that they deserve. You'll learn how to start off right with goals and objectives that hold language and communication at the center, you'll hear all about the importance of getting a good grasp on receptive language using a variety of tools, and you'll round out the hour learning how to use these starting points to develop a solid AAC intervention plan using what you already know about-pragmatics, semantics, and syntax. This is a passionate episode that emphasizes progress over perfection and acknowledges the messiness of learning language for all young communicators, not just those with complex needs.Learn more about Cathy Binger and Jennifer Kent-Walsh here.Course AccommodationsThe transcript for this course is provided below. You can also email us at ceu@slpnerdcast.comLearning OutcomesDiscuss the importance of applying a developmental model to aided AAC language learning. List the language domains that should be considered when providing AAC language intervention.Describe evidence that supports an early focus on semantic and grammatical development for preliterate children who use aided AAC. ReferencesBinger, C., Kent-Walsh, J., & King, M. (2017). Dynamic Assessment for 3- and 4-Year-Old Children Who Use Augmentative and Alternative Communication: Evaluating Expressive Syntax. Journal of Speech, Language, and Hearing Research, 60(7), 1946-1958. doi:10.1044/2017_jslhr-l-15-0269Binger, C., Kent-Walsh, J., King, M., & Mansfield, L. (2017). Early Sentence Productions of 3- and 4-Year-Old Children Who Use Augmentative and Alternative Communication. Journal of Speech, Language, and Hearing Research, 60(7), 1930-1945. doi:10.1044/2017_jslhr-l-15-0408Binger, C., Kent-Walsh, J., King, M., Webb, E., & Buenviaje, E. (2016). Early Sentence Productions of 5-Year-Old Children Who Use Augmentative and Alternative Communication. Communication Disorders Quarterly, 38(3), 131-142. doi:10.1177/1525740116655804Binger, C., Maguire-Marshall, M., & Kent-Walsh, J. (2011). Using Aided AAC Models, Recasts, and Contrastive Targets to Teach Grammatical Morphemes to Children Who Use AAC. Journal of Speech, Language, and Hearing Research, 54(1), 160-176. doi:10.1044/1092-4388(2010/09-0163)Soto, G., & Clarke, M. T. (2017). Effects of a Conversation-Based Intervention on the Linguistic Skills of Children With Motor Speech Disorders Who Use Augmentative and Alternative Communication. Journal of Speech, Language, and Hearing Research, 60(7), 1980-1998. doi:10.1044/2016_jslhr-l-15-0246Tönsing, K. M. (2015). Supporting the Production of Graphic Symbol Combinations by Children with Limited Speech: A Comparison of Two AAC systems. Journal of Developmental and Physical Disabilities, 28(1), 5-29. doi:10.1007/s10882-015-9425-5Tönsing, K. M., Dada, S., & Alant, E. (2014). Teaching Graphic Symbol Combinations to Children with Limited Speech During Shared Story Reading. Augmentative and Alternative Communication, 30(4), 279-297. doi:10.3109/07434618.2014.965846Speaker Disclosures:Cathy Binger financial disclosures: Cathy is employed by the University of New Mexico; she receives grant funding from the National Institute on Deafness and Other Communication Disorders that supports her work on the topic we'll be discussing today. Cathy Binger non-financial disclosures: Cathy does not have any non-financial relationships to disclose. Jennifer Kent-Walsh financial disclosures: Jennifer is employed by the University of Central Florida; she receives grant funding from the National Institute on Deafness and Other Communication Disorders that supports her work on the topic we'll be discussing today. Jennifer does not have any non-financial relationships to disclose.Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children.Course Disclosure - Financial and In-KindFunding for this course was provided by one of our Corporate Sponsors, DTA Schools. Time Ordered Agenda:15 minutes: Introduction, Disclaimers and Disclosures25 minutes: Descriptions of the importance of applying a developmental model to aided AAC language learning15 minutes: Descriptions of the language domains that should be considered when providing AAC language intervention 10 minutes: Descriptions of the evidence that supports an early focus on semantic and grammatical development for preliterate children who use aided AAC.5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Get .1 ASHA CEU hereThis week's episode includes a free graphic organizer created by our guest. It may be helpful to download the handout first and have it handy while listening.Episode SummaryI'm just going to put it out there-motor speech is hard. Is it Childhood Apraxia of Speech (CAS) or not? How do I know for sure? What do I do to help?! Are the speech police going to come take my C's away if I don't do it right? This week, Apraxia extraordinaire Mike Bright returns, offering illuminating tools and strategies to help you look at (and listen to) your students' speech sound challenges in a whole new way. If you're a CAS newbie, you might want to tune in to previous episodes with Mike to get the basics before diving in here. This episode is the first of its kind on SLP Nerdcast, blending engaging case study audio with a graphic organizer on steroids to help improve your clinical ear and motor speech-related reasoning. Get the scoop on what to listen for to help you answer those tough motor speech differential dx questions and apply theory to practice as you listen along with Kate and Amy for the unique speech features often present in children with motor speech difficulties. Tune in to get some new “ear glasses” and start seeing real progress in those tough speech cases. No speech police, promise. Learn more about Mike Bright here.Course AccommodationsThe transcript for this course is provided below. You can also email us at ceu@slpnerdcast.comLearning Outcomes1. Identify three symptoms suggestive of motor speech difficulty.2. Identify a framework for prioritizing treatment objectives.ReferencesShriberg, L. D., Lohmeier, H. L., Campbell, T. F., Dollaghan, C. A., Green, J. R., & Moore, C. A. (2009). A Nonword Repetition Task for Speakers With Misarticulations: The Syllable Repetition Task (SRT). Journal of Speech, Language, and Hearing Research, 52(5), 1189-1212. doi:10.1044/1092-4388(2009/08-0047)Speaker Disclosures:Mike Bright Financial Disclosures: Mike is the owner of Bright Speech and Language, LLC. Non-financial: "Recognized by Apraxia Kids for Advanced Training and Expertise in Childhood Apraxia of Speech"Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children.Course Disclosure - Financial and In-KindFunding for this course was provided by one of our Corporate Sponsors, Easy Report Pro. Easy Report Pro did not contribute to the content of this course.Time Ordered Agenda:15 minutes: Introduction, Disclaimers and Disclosures25 minutes: Descriptions of a framework for organizing symptoms of motor speech difficulty45 minutes: Descriptions of case studies highlighting symptoms of motor speech difficulty5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!A big THANK YOU to our Corporate Sponsor, Easy Report Pro for the financial support to make this course possible! To learn more about Easy Report Pro visit https://www.easyreportpro.com/__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

In this episode, let's talk about the importance of an early diagnosis and early interventions. References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5). Washington, DC: American Psychiatric Association. Camarata, S. (2014). Early identification and early intervention in autism spectrum disorders: Accurate and effective? International Journal of Speech-Language Pathology, 16(1), 1-10, https://doi.org/10.3109/17549507.2013.858773 Fuller, E. A., & Kaiser, A. P. (2020) The Effects of Early Intervention on Social Communication Outcomes for Children with Autism Spectrum Disorder: A Meta-analysis. J Autism Dev Disord, 50, 1683-1700. https://doi.org/10.1007/s10803-019-03927-z Itzchak, E. B., & Zachor, D. A. (2011). Who benefits from early intervention in autism spectrum disorders? Science Direct, 5(1), 345-350. https://doi.org/10.1016/j.rasd.2010.04.018 Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120, 1183–1215. Koegel, R., Koegel, L., & Camarata, S. (2010). Definitions of empirically supported treatment. Journal of Autism and Developmental Disorders, 40, 516–517. Rescorla, L. (2002). Language and reading outcomes to age 9 in late-talking toddlers. Journal of Speech, Language, and Hearing Research, 45, 360–371. Vivanti, G., Kasari, C., Green, J., Mandell, D., Maye, M., & Hudry, K. (2017). Implementing and evaluating early intervention for children with autism: Where are the gaps and what should we do? Autism Research, 11(1), 16-23. https://doi.org/10.1002/aur.1900 Vivanti, G., Prior, M., William, K., & Dissanayake, C. (2014). Predictors of outcomes in autism early intervention: why don't we know more? Pediatr, 1(1). https://doi.org/10.3389/fped.2014.00058 For more information, head over to Aspect Australia - www.autismspectrum.org.au. Disclaimer: I'm not a professional, just a student with a passion for autism.

In order for children to encode, map, and learn novel words they must first take in and process stable sound representations from words they hear in their environment. Researchers have long identified that children with neurodevelopmental disorders have difficulty with this task. It has been especially observed in children with autism. It has also been known that sufficient sleep in adults, and children, supports memory and learning. Until recently researchers were unaware of how the sleep-learning connection played out in children who have autism. Recent work by Victoria Knowland and colleagues has begun to shed some light on the sleep-learning connection in children with autism. Their study evaluated 77 children ages 7 to 13, "30 of which were classified as having high autism symtomatology." The children in the study were all exposed to new phonological (word-sound) mappings in the mornings and their performance was monitored via repetition over a 24 hour period. The children also participated in a poloysomography study each night after they learned the new words. All children were followed up with 4 weeks later. Overall, the researchers found that children's sleep was found to have a positive impact not only the trained words, but it was also seen to be extended to new word items as well. The improved results, especially with generalization to new learning was observed to be heightened during REM sleep. Wonder if your child is sleeping enough? Here are the current sleep recommendations by age. 1-4 Weeks Old: 15 - 16 hours per day 1-4 Months Old: 14 - 15 hours per day 4-12 Months Old: 14 - 15 hours per day 1-3 Years Old: 12 - 14 hours per day 3-6 Years Old: 10 - 12 hours per day 7-12 Years Old: 10 - 11 hours per day 12-18 Years Old: 8 - 9 hours per day Reference: Knowland, V.C.P, Fletcher, F., Henderson, L., Walker, S., Norbury, C.F., Gaskell, M.G., (2019). Sleep Promotes Phonological Learning in Children Across Language and Autism Spectra. Journal of Speech, Language, and Hearing Research, 62(12), 4235-4255. --- Send in a voice message: https://anchor.fm/derick56/message Support this podcast: https://anchor.fm/derick56/support

Get .1 ASHA CEU hereEpisode Summary:You're a rockstar SLP. You read the research. You eat, drink, sleep EBP- but something still feels like it's missing... Reading the literature makes your brain hurt. You feel like you just can't make this research-based practice stuff work. It's like you're jumping into the research-to-practice gap without a parachute. Enter implementation science-the game changer, your parachute. Ok, you're probably like “Implementation what now? Never heard of it!” I'm with you. SIt tight, it will all make sense soon... In this episode, Dr. Cathy Bringer and Dr. Natalie Douglas uncover the what and why of implementation science and how it stands to change the EBP face of your day-to-day SLP life. There's ah-ha moments, pats on the back, validation, and more as this down-to earth research duo acknowledge the short-comings of the traditional research model and promise a brighter research-to-practice future- tearing down hierarchies, building up clinicians, and using implementation science to study clinical practices that will actually work in the “real world”.Learn more about Cathy and Natalie here.Learning Outcomes1. Describe a brief history of implementation science and its recent intersection with SLP 2. Distinguish between the traditional research pipeline and alternative research designs focused on implementation 3. List barriers and facilitators to SLPs engaging in clinical research ReferencesDouglas, N. F., Campbell, W. N., & Hinckley, J. J. (2015). Implementation Science: Buzzword or Game Changer? Journal of Speech, Language, and Hearing Research, 58(6). https://doi.org/10.1044/2015_jslhr-l-15-0302 Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231)Olswang, L. B., & Prelock, P. A. (2015). Bridging the Gap Between Research and Practice: Implementation Science. Journal of Speech, Language, and Hearing Research, 58(6). https://doi.org/10.1044/2015_jslhr-l-14-0305 Disclosures:Dr. Natalie Douglas financial disclosures: Dr. Douglas receives a salary from Central Michigan University and The Informed SLP; She also receives book royalties from Plural Publishing and has research funding from The American Speech-Language-Hearing Foundation. Dr. Douglas has no non-financial relationships to disclose.Dr. Cathy Binger financial disclosures: Dr. Binger is employed by the University of New Mexico. Dr. Binger non-financial disclosures: Dr. Binger is a member of ASHA and special interest group (SIG) 12. Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children.Time Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Descriptions of implementation science and its recent intersection with SLP15 minutes: Descriptions of the traditional research pipeline and alternative research designs focused on implementation 10 minutes: Descriptions of barriers and facilitators to SLPs engaging in clinical research 5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Dr. Fan-Gang Zeng is Director of the Center for Hearing Research and Professor of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences and Otolaryngology – Head and Neck Surgery at the University of California, Irvine. The goal of Fan-Gang's work is to help people with hearing impairments hear better. He does this using an electronic device (cochlear implant) that can stimulate a nerve to allow people with hearing loss to hear again. He also works to solve a hearing problem on the other end of the spectrum called tinnitus where people hear sounds that are not present in the environment. In his free time, Fan-Gang likes to get outdoors, play basketball, hang out with his kids, and cook. He received a Bachelor's degree in Electrical Engineering from the University of Science and Technology of China and his Master's degree in Biomedical Engineering at the Institute of Physiology Academia Sinica in Shanghai. Fan-Gang then went on to earn his PhD in Hearing Science from Syracuse University. He served as a research Associate at the House Ear Institute and an Associate Professor at the University of Maryland before joining the faculty at UC, Irvine where he is today. Fan-Gang is a member of the Acoustical Society of America, The Institute of Electrical and Electronics Engineers, the Association for Research in Otolaryngology, and the American Association for the Advancement of Science. Fan-Gang is here with us today to tell us all about his journey through life and science.

Dr. Katie Strong, Assistant Professor in the Department of Communication Sciences and Disorders at Central Michigan University talks with Dr. Natalie Douglas from Central Michigan University implementation science and how this applies to aphasia practice.   Natalie Douglas is Lead Collaborator at Practical Implementation Collaborative, an Associate Professor in the Department of Communication Sciences & Disorders at Central Michigan University, and an Editor at the Informed SLP. She completed her B.S. and M.A. degrees at Ohio University and after a decade of clinical practice as a speech-language pathologist in hospital and long-term care environments, she completed her Ph.D. at the University of South Florida. Her work aims to advance best, person-centered practices in communication and quality of life interventions for people with dementia, aphasia and other acquired communication disorders in adults. She additionally aims to empower local healthcare and educational teams to support best practices, quality improvement initiatives and person-centered care through applying principles of implementation science. In this episode you will:  Learn about what implementation science is and how this applies to aphasia practice Hear about how using an implementation lens can lead to better outcomes with clients and families.  Learn about Sam, the Bocce player, his sauce, and the importance of a person-centered approach to care in people living with dementia. KS: Natalie, welcome to the Aphasia Access Conversations Podcast. Thank you for joining us today.  I'm looking forward talking with you and having our listeners learn about your work.   ND: Thank you, Katie. I'm always so happy to talk with you, especially here today.  KS: So, I feel like we should share with our guests, a couple of fun tidbits about how you and I are connected before we get into the meat of today's conversation.  ND: Okay, let's do it. KS: So first and foremost, we are colleagues at Central Michigan University. We share actually share a wall. Our offices are in the same hallway, although with pandemic, it's been awhile since we have both been in the office together. So, we are colleagues and have a lot of great fun together. But we have another way that we are connected as well.  ND: Yes. So, we crossed paths. I think in the early 2000s. So, I was working at a certain hospital system from 2003 to about 2013. And then I came to find…this was in Florida, by the way, we're in Michigan now. And then I found out that you worked for that same hospital system, also as an SLP right before I started, or something close to it.  KS: I did! Yes, we came up to Michigan in 1999 so I was there just a couple of years before you were, and we had shared colleagues! ND: Amazing. KS: Crazy. ND: It was meant to be can't get away for me, I was going to find you!  KS: Absolutely, well fate! Fate. I love it! NS: Indeed. KS: Let me first congratulate you on being named a Tavistock Trust for Aphasia Distinguished Scholar. It's fabulous! Tell me a bit about what this award means to you.  ND: Thanks for that so much. And this award really means a lot to me. I'm just so truly honored, grateful and humbled to receive it, along with people such as yourself and many other esteemed colleagues. And upon finding out about the receipt of this award, it really kind of prompted me into a lot of reflection from when I first started studying speech language pathology. So, this was, you know, in my undergrad degree in 1997. And I, a couple years after that, was introduced to what aphasia was. And, you know, this was further nurtured by working with Dr. Brooke Hallowell. And then continuing, you know, through clinical practice and trying to improve life for people with aphasia, working with Jackie Hinckley in my PhD program. And it really had me become extremely reflective upon what I've been doing recently, which is more system level changes. So how can we ensure that people with aphasia and other communication disorders, how does everybody have access to the best interventions? How do we make it so that best practice is not based on where you have your stroke, geographically speaking? You know, how do we spread what we know, works for people? How do we get the word out so that it becomes routine based care? So, this award, it just served as a catalyst for a lot of deep reflection and gratitude for the work that I've done in the past and now and also for the work that needs to be done in the future. So, I'm just extremely grateful to the Tavistock Trust and colleagues and mentors for this really humbling award. So, thank you for that. KS: Congratulations! The award is well deserved, and we are excited to hear about your work, both the work you have been doing and the work the will come in the future too. Natalie, as we get started, I'd love to hear the story of how you became interested in implementation science as an area of research and expertise.  ND: Sure, so, I think like many of us, when I was working in a clinical setting, there were many problems that I didn't feel like I had the ability to solve with my clinical training. So, you know, I just, quite honestly would leave clinical practice at times feeling honestly, full of guilt and shame, quite frankly, because I felt like I wasn't giving clients and patients and people the best possible services for one reason or another.  KS: I feel like a lot of people listening who are working clinically or have worked clinically in the past can really relate to that. You know, we all get into this field to help people and then when you get into it, sometimes that help isn't as easy to do with a lot of the barriers that are in place.  ND: Yeah, exactly. You know, and for me, you know, there were some cases where it wasn't necessarily an issue of me not knowing what to do. So in in many cases, I had the knowledge and in some cases, I had the skills. Not in all cases, there was often a skill gap to but in some cases, I did have the knowledge and skills to provide a certain evidence-based practice, but I still wasn't. And until I came across implementation science, I thought it was my own personal, I mean, honestly, moral failing why I wasn't. KS: That's heavy. ND: Yeah. I don't know that everyone hits existential crisis, like I do. But I mean, I really did, because it didn't feel right. You know, it didn't. It didn't feel right. Um, so it was, you know, the inability to solve those types of problems that really kind of propelled me back into academia. And so, when I first started my Ph D program, with Dr. Jackie Hinckley, I thought I was going to do something with aphasia treatment research. And I don't know how she remembers this, but it was sometime around in 2009. Jackie gave me a monograph, just a little book by Dean Fixen and colleagues and it was about implementation science. And it talked about how there was an entire discipline, dedicated to really merging the gap between research and practice. And it showed that there are mechanisms kind of outside of me as a person that influenced what I was able to do clinically. So factors like, what the organizational culture is like, what the organizational climate is like, things like insurance, reimbursement, policy. You know, all of these factors that are really outside the individual realm of the clinician, that we have data to show that it really does, those other factors influence what we're able to implement on a clinical level. And so I just kind of devoured that monograph, and quite honestly, been thinking about it, ever since in one iteration or the other. Because it's not just our field, you know, it's not just speech language pathology, it's not just aphasia, you know. This is across education, mental health services, every medical specialty. You know, we the way that we've created these systems of academics and practice, we've kind of reinforced silos. And so, the two don't always meet without active work. And that, I think, is what implementation science can really do. It can provide tools to kind of bring those realms together.  KS: It sounds like it was really a mind-blowing experience for you to have that monograph in your hands. ND It was mind blowing. Indeed.  KS: And how lucky we are that it got into your hands. Well, I know many of us have heard that term, Implementation Science, but it isn't always clear what is meant by that. Could you help us to understand that a little bit more? ND: Right. I think that's a really great question. And I think it's definitely not something to take for granted. You know, as helpful as, as implementation science is to our discipline. Within implementation science, there are a lot of constraints in terms of like language and terms, so it can get a little bit foggy, hazy pretty quickly. But the NIH or the National Institutes of Health definition of implementation science is really the study of strategies to help to determine how to best implement an intervention or evidence-based practice into a typical practice setting, usually as delivered by typical practitioners. So, this is not a situation where you would hire an interventionist or a graduate student, for example, to implement your assessment or intervention tool in a typical setting. I mean, there's definitely nothing wrong with that. But that's not in that could be, you know, if you're following a stage model, you know, that could be a direction that you go. But I think the guts of implementation is having, you know, and I think the routine typical clinician is a beautiful, amazing thing. So, I hope it doesn't don't when I say routine and typical, I really don't mean it in a negative way. But to get just really everybody on board.  KS: You mean your average, fabulous, SLP who is out there working directly with clients and families.  ND: Exactly, exactly. So, what we can do is just like how you would study the effectiveness of an intervention, okay. So, you have, for example, communication partner training. That's an example of an intervention in our discipline has a lot of effectiveness data, right? We know that it works, right? When it under certain parameters, we know that it can support communication and other quality of life outcomes. So, what you would do is, in addition to studying the effectiveness of an intervention, or if the intervention has already been studied, you could study the effectiveness of an implementation strategy. So, for example, you might say, “Okay, if we put in some type of audit and feedback system, does that increase the uptake of communication partner training?” Or if we provide incentives in some way, like some type of certification, or honestly, you know, the ultimate, not the ultimate, but a very effective implementation strategy is paying people to do something, right. And so that's, we don't do that in our field. But if, you know, as I said, a little bit earlier, you know, this is something that's, you know, grown outside and kind of encompasses many disciplines. You know, if I think about myself, and what causes me, you know, to want to change my individual level behaviors, right? There's like, certain incentives that might get me to do that. But those are implementation strategies, and not necessarily the intervention itself. Right? So, implementation sciences, like how do we get it into that typical setting, delivered by a typical practitioner, in the best way? So, just like how you could comparatively assess, you know, two different naming interventions for aphasia, you could assess two different implementation strategies. You can say, “Okay, if I put audit and feedback in one condition, and then I put education and training and another condition, am I going to get different adoption rates?” Right, will, more people do it in x condition versus y condition? Does that make sense?  KS: Yeah it does. So, taking the example you used for communication partner training, and we know that it has a high level of evidence that it works, but I'm not sure if our fabulous, everyday clinicians are using it on a regular basis. So that would be a step to then have some sort of implementation study or protocol to help basically get the evidence out into practice. Is that what we're talking about?  ND: Yeah, it is right. So right. And you kind of said it without saying it. So, one example of an implementation outcome would be something like reach. Okay. So, it's like, if we looked at all of the potential places where communication partner training might be beneficial, right? How do we get that number up? You know, with fidelity to what communication partner training actually is, right? Which we know is not just handing somebody a handout, right? So, you know, those are the types of kind of questions that you might ask, you know, and we can use an implementation science framework to kind of guide our thinking, you know, like, how do we get this reach up? or higher? How do we know, you know? And it gets messy, you know, it definitely gets messy and there's, it's complex, a lot of these questions. But these are the types of questions that I really think we need to be asking if we're wanting to advance these positive outcomes for families. KS: Yeah. And I think that messiness kind of substantiates how you were feeling back when you were working clinically. Right? That you had this knowledge and skill.. ND: That is true. KS: But you can't actually get it going into your day to day practice.  ND: That's right. Yeah. KS: Thank you for explaining that. I really appreciate that, and I think our listeners will also. I do think it seems clear, and then it gets fuzzy. I know it's a deep area of science. Well, you and a few colleagues are working on a scoping review on the landscape of implementation science in communication sciences and disorders. Can you tell us a bit about what you did, what you found, and why this is important specifically for aphasia?   ND: Sure. Right. So, this is a project that I've been working on with some other colleagues. So, with Dr. Megan Schliep, Dr. Julie Firestein and Jen Oshita, and we're working on and again, we're, this is not published, so please take this with a with a grain of salt or 10. I mean, we tried to have good rigorous methods. So, we basically wanted to see because, you know, I, this, when I say this, like I, myself have wrote a lot of these papers. So, I'm like talking about myself, but we have a lot of talking about implementation science, and we have a lot of concept papers. And it's good, you know. We need to be talking about it. It's a new area. But we don't we wanted to know, where is the science, right? Like been we've been talking about it. So, the Journal of Speech Language and Hearing Research, they had a special issue in 2015. So that's like, you know, a few years ago now, the ASHA Foundation had an Implementation Science Summit in 2014. So, years are going by right? And so, we wanted to know, have these initiatives, you know, this discussion that we've been having has it resulted in any changes, right? Are we moving the needle when it comes to incorporating some of these methods into our clinical practice research? So, at this point, we ended up finding 82 studies that met our criteria. But what I think is really interesting for people with aphasia, is we did this communication sciences and disorders wide, so including all you know, pediatrics, adults, we did, you know, speech language pathology and audiology. We came up with 82 studies, but the, the patient population that was most represented, was aphasia. Out of all of those different, you know, potential patient populations. And I thought it was a really fascinating finding. You know, it makes me think that clinical practice, researchers in aphasia are really kind of on the cutting edge, you know, when it comes to studying how to get these best practices into typical settings. And I think it also means that in aphasia, we have a unique opportunity to move things down the implementation pipeline. So, like, we started, you know, you and I started talking a little bit about reach, right? So, it's like, how do we get something out? You know, get people doing it? Well another, you know, kind of further down that implementation pipeline would be an outcome such as sustainability, right? So, like, when there is no researcher in sight, right, like this clinical trial has ended years ago, how do we put mechanisms in place so that that intervention is still sustained right, within that own system? So I think in aphasia, we've got really, yeah, interesting opportunities to be able to look at some of these longer term outcomes. You know. Overall, like as a field, it seems like we're really, potentially overly relying on like training and education as an implementation strategy. And I think that can be, you know, a number of reasons that I'm speculating here but you know, most of us are trained from a behavioral education standpoint. So I think we're really comfortable, you know, in that realm, you know, in some of these other implementation strategies, I don't know that we really know about them or use them, you know, to this point. But I think, you know, overall, a lot of progress has been made. But of course, we have a lot of room for growth. But I think we have some really unique opportunities, especially in the aphasia world, which I think is very exciting. KS: Yeah, that is exciting. And I guess I'm feeling excited and proud and that kind of like ‘eek' as we are stretching ourselves and learning things about how we might move the science forward ultimately so we can help the people living with aphasia to live better lives or reach their goals or whatever it is that they are wanting to pursue. ND: Yes. Absolutely. KS: As you know, this podcast has a wide listener base with shared interests in aphasia. Researchers, clinicians, program managers, people living with aphasia, their care partners and family members. What are some steps that they can take to support implementation science? ND: I think that all of those people that you mentioned those different groups, so you've got researchers, clinicians, you know, program managers, administrators, people living with aphasia, and their families and friends, right? Every single group that you mentioned, right through an implementation lens, they are a stakeholder, an equal stakeholder, where their input engagement is not only valued, but also, I think, required, if we're going to have optimal implementations to support all the outcomes that we want, you know. And so, I think one of the biggest steps that we can all make, is kind of reaching across our silos are relationship silos, right? So, for a researcher reaching out to a clinician, if we're clinician reaching out to a researcher. We don't need to have these silos. Even though we might, we might say there's not a hierarchy with our mouths between researchers and clinicians. I think we kind of know that's not quite true, right? It's a thing that is maybe unspoken, but it can make people feel intimidated to reach out. But I think that, and it's not just clinicians and researchers, but also administrators, families, people living with aphasia, if we can all start to break down some of those silos. So, I think the project that you're involved in with Jackie Hinckley, the Project BRIDGE, is a really phenomenal example of that, where people are actively listening, and learning from another, you know. I think it's not just a nice thing to do, but there's data to support better implementation outcomes, if we do that kind of engagement work upfront. You know and something that I try to ask myself when we're having these types of discussions is who is missing? Right? Who was missing during these discussions? And how do we get them to the discussion? How do we get them to the table to discuss and to really, so that we can figure out what's important, and how do we reach across some of the boundaries that we have and start to have this conversation? KS: I'm envisioning a ‘talk with' instead of ‘about'.  ND: Absolutely. And you know, this is not…I see this as like a both a “both and” thing. And so, this is in no way minimizing or to the detriment of basic science work, right? Like, we're specifically talking about clinical practice research, which not everyone does, right? And we know that there's different stages. But this is kind of a “both and” right”? We need our basic scientists and we need that foundational level work, we do. But I think there's enough data in that research to practice gap to say that we need to start way earlier in terms of, you know, kind of start thinking about, if I'm a clinical practice researcher, and my intervention requires a certain amount of time. You know, so if it's like time per week, you know, in minutes or in days per week. And I know for sure that Medicare is only going to reimburse three times per week, right? Then it's like, okay, that's something that's so much easier dealt with upfront, right? And so I think this can allow us this lens can allow us to be a part of some of these policy discussions when it comes to third party payers and to say, “Hey, guess what, this treatment didn't work, when you only did it four times a week, you need to do it five” right? Or whatever the case may be, but to have to be thinking about the different layers. And I it's a lot to think about, right? It's a lot to think about. As opposed to, you know, getting this amazing level of evidence on a treatment, but then understanding that it potentially is not going to be feasible or acceptable in a real-life setting. Sometimes you can't fix that gap. You know, sometimes it might be a little bit too late, you know, so I think the more we can be thinking about that upfront, the better. KS: Yeah, I love it. I'm visualizing sitting around with our implementation lenses on with stakeholders at the table from all walks of life and moving things forward. Oh wow. I've got goosebumps, Natalie. ND: You do.  KS: I do. You are putting the challenge out. That's for sure. I'd love to switch gears a bit and talk about another recent publication of yours. You and Ellen Hickey have recently co-authored a book titled Person Centered Care and Communication Intervention for Dementia: A Case Study Approach. What was the inspiration for the book?  ND: Sure, yes. So, thanks for bringing that up and letting us talk about that, to appreciate that. So Ellen, and I were, you know, we were thinking, as you know, clinical researchers, and we both of us had spent, you know, several years in clinical settings, we were trying to make it easier for clinicians who wanted to implement Person Centered Care, kind of across the care continuum. And from what we could find, you know, there were a lot of outstanding resources available about certain techniques. So, you know, external memory aids, or maybe the Montessori philosophy, or spaced retrieval. But what we wanted to do was put everything in one place, if possible, with a real kind of focus on treatment, and emphasis on the person. So, one thing that we thought was exciting, was we went so far as to name each chapter after a person and their role in life.    KS: You sure did, I love it!   ND: As opposed to, you know, this is a chapter about vascular dementia. This is a chapter about aphasia, you know, but again, this is a “both and” situation, you know, we need to have that detailed information.    KS: You made that message loud and clear. Person centered, loud and clear.    ND: For sure, for sure. So, for every case, there's eight cases in there. For every case, we really dive in deep on what it would look like to do, you know, a person centered assessment, and then provide some kind of flexible templates and some gold banks, you know, we're hoping that it will give, you know, very bright clinicians, you know, who are already doing great work, more ideas. You know, and by seeing clearly, not every person is going to remotely resemble these eight cases in this book, but we hope that by showing and focusing on a lot of the nuance, it will help spark some more person-centered programming for some of our clients kind of across the Health care continuum.   KS: Thank you. It's fabulous. When I was reading the book, I noticed prominent in the chapters, you've adapted the Life Participation Approach to Aphasia and the Living with Aphasia: Framework for Outcome Measurement, a.k.a. the A-FROM, to working with people with dementia. You know Aphasia Access' work is so centered around LPAA or Life Participation Approach. I love how you are expanding this vision. Can you share how this came to be?   ND: Sure, sure. So, Ellen and I had both used the A-FROM in our clinical work and it really made sense to us that when we think about some of those layers. You know, you've got issues of, at the impairment level, if that's cognitive or language, you've got issues to consider around the environment, life participation and personal identity, right? We felt that these factors were really relevant across disorder types and that this could be a very helpful way to ground some of the interventions and planning for intervention, as well as look at some of the outcomes. So, the Aphasia Institute was generous enough to allow us to use that model, you know, in the book, and we just, you know, merely suggest. It's not been tested or anything, but we just suggested it might be appropriate for people living with dementia as well. You know? And I know that we've got a segment of our population with frontotemporal lobar dementia, you know, or with primary progressive aphasia variants, potentially, so I think sometimes it's good to think about some overlap across disorder types, you know, in terms of how we want to ground intervention and outcomes, right? Because when we're thinking about people with dementia, and aphasia, really, we have to think beyond the impairment not to exclude the impairment. And, you know, we're not doing that, but just to think, to add some layers to what we might want to measure, and what we might expect to see some changes in.   KS: Well I think it's fabulous. I wish people could see, but I'm actually holding the book in my hands as we speak. It's the right size.   ND: It's pretty skinny! (laughter)   KS: Yeah, the right size. (laughter) But seriously, I'd love to dig into one of the cases. In particularly, I'd like to talk about Sam, the Bocce Player who was inspired by your own grandpa. And I'm looking at the chapter and I see photos of your grandpa and our grandma and your children…and I mean Natalie, let's talk about Sam.    ND: So Sam is my grandpa, he is no longer with us. And he was just the most unique, hilarious, funny, just complete character. He was all about his Italian heritage. And, you know, it was extremely sad for him to struggle with a communication disorder towards the end of his life. And it was just really difficult to watch and see, of course. It was devastating. You know, that's why we're all here in this field, right? But the reason that I…there were multiple reasons I wanted definitely a way to remember and honor him. I'm very grateful for the time that we had together but he is definitely one who did and would like he would be the person who you would go into their medical room, if it was rehab or hospital and with the “usual tactics”, it would be a “patient refused” [scenario]. There's just like, no way that he would attend to activities like workbooks or, you know, traditional speech and language tasks. I mean, it just would not happen. And he would refuse things all the time. He was like super stubborn, but the things that he loved, you know, he loved. And I think he is somebody, that's a really great example of sometimes if we go in and we're not knowledgeable of the person, we could lose our opportunity to try to facilitate communication with somebody. So, what we have in the chapter and in real life, you know, really kind of focusing on passions, so he was able to be around my kids when they were smaller, his Italian heritage, and Bocce and food, you know. And using those things in kind of a nontraditional setting, we were able to have some really special moments of what I think were very joyful, participatory, person-centered moments. If we kind of went about it in traditional, you know, from a medical model, I just don't think that would be have been very impactful. So, the hope is that for those folks that we see that they're like “Get out of my room!” you know. We've all been involved and told to ‘get out!'.    KS: “You're fired!”   ND: “You're fired! Why are you here?” You know, trying to think creatively about what that might look like to support somebody's communication.  KS: Absolutely. And I think the way the chapter is set up, how we first learn about Sam's background, and his family, and job, and then we learn about the medical history. I know that's not how we always come across information when we're meeting clients, or patients, or people. Whatever we are calling them in the places that we are working, but I do think it influences how we view one another. You know. And being able to think about our clients as people. And how we might engage with them. This is fabulous. One of the things that I thought, you know I love to cook, Natalie.   ND: Yes, you do.   KS: You talk about Sam and his sauce throughout the entire chapter. And I'm guessing you aren't the one who isn't going to be the one to help me learn how to make the sauce, are you?   ND: I know. That's so terrible. When I was a kid, he owned a restaurant and on Tuesdays he would take me in there and we would make the sauce for the restaurant. And so, he would show me how to do it, and I basically just stirred it. And unfortunately, that's the only detail other than the love... I can't give you details about the sauce itself. And as you know, that's really not my jam at this point, but, you know.     KS: I guess as I was reading Sam's case, as well as all of the others, I just feel like you and Ellen have done such a beautiful job of bringing this very ‘person-first'. I could really see how I could adapt some of these ideas, assessments, and treatment strategies that you've put into the book, even if I didn't have someone exactly like Sam that I could implement them with. So, thank you. Thank you.    ND: Thank you.   KS: As we wrap up, do you have any final thoughts you'd like to share with our listeners?   ND: I again want to express my true, deep gratitude for chatting with you today and for the generous and forward-thinking community of Aphasia Access, truly a game changer for the field. If anyone is interested chatting more about implementation, I hope you reach out to me. I'm always more than happy to talk and brainstorm about ways that we can move this forward. There's also an Implementation Science and Aging Special Interest Group that's free to join. It's interdisciplinary with some people in mental health, nursing, social work. It's all people across disciplines who are interested in who are interested in merging the worlds of aging and implementation science, I can give you that info to put in the show-notes.    KS: Sounds great! We'll add that and your Twitter handle and website for Practical Implementation Collaborative to the show notes. Natalie, thank you for taking time to share your story and work with us. Congratulations again on the Tavistock Scholar Award.    ND: Thank you so much, Katie.    On behalf of Aphasia Access, we thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access and to access our growing library of materials go to www.aphasiaaccess.org If you have an idea for a future podcast topic email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Connect with Natalie Online Practical Implementation Collaborative  https://www.practicalimplementation.org/ Natalie Douglas on Twitter   @Nat_Douglas    Links Mentioned in Episode Implementation Science & Aging Research Special Interest Group  https://www.isarsig.org/  Project BRIDGE – Stakeholder Engaged Research www.projectbridge.online    Read More In-depth Bauer, M. S., Damschroder, L., Hagedorn, H., Smith, J., & Kilbourne, A. M. (2015). An introduction to implementation science for the non-specialist. BMC psychology, 3(1), 1-12. https://doi.org/10.1186/s40359-015-0089-9 Douglas, N.F. & Burshnic, V.L. (2019). Implementation science: tackling the research to practice gap in communication sciences and disorders. Perspectives of the ASHA Special Interest Groups, https://doi.org/10.1044/2018_PERS-ST-2018-0000  Hickey, E. M., & Douglas, N. F. (2021). Person-Centered Memory and Communication Interventions for Dementia: A Case Study Approach. Plural Publishing. https://www.pluralpublishing.com/publications/person-centered-memory-and-communication-interventions-for-dementia-a-case-study-approach  Schliep, M. E., Alonzo, C. N., & Morris, M. A. (2017). Beyond RCTs: innovations in research design and methods to advance implementation science. Evidence-Based Communication Assessment and Intervention, 11(3-4), 82-98. https://doi.org/10.1080/17489539.2017.1394807

Get .1 ASHA CEU hereEpisode Summary:Hey cog-com SLP's, looking for an episode that's just right? This one's for you! This week, the talented, outpatient adult SLP and host of the Speech Uncensored podcast - Leigh Ann Porter-joins Kate to talk about modifying CARTs and spot on ARCS in the creation of home programs for patients with mild aphasia. I promise, it will all make sense when you listen-Leigh Ann does an awesome job explaining so that even Kate (and I) can understand (haha, a little peds SLP humor, this stuff starts out as Greek to us!). You'll learn some tangible, holistic strategies to tackle patient needs across reading, writing, and speaking and get a good sense of how to stay within that magic “Goldilocks Zone” - not too hard, not too easy, just right for each individual client. Leigh Ann lays out a few down-to-earth home program ideas that build on a patient's strengths and foster the autonomy, independence, and the intrinsic motivation required for the hard work of rehab. And of course, there are great resources to explore as you implement these ideas, because Leigh Ann's got your back! Find a chair that's not too soft, some coffee that's not too hot, and cozy up for some nerdy aphasia learning!Learn more about Leah Ann here.Learning Outcomes1. Identify two evidence-based practices to use with patients with mild aphasia. 2. Describe how to modify treatment protocols to increase complexity level for mild aphasia. 3. Identify at least three resources for implementing treatment approaches with mild aphasiaOnline Resources:The Speech Uncensored Podcast: Episode 107: Discourse Treatment in Aphasia Therapy: Attentive Reading Constrained Summarization (ARCS) with Yvonne Rogalski PhD, CCC-SLPEpisode 14: Meaningful Aphasia Therapy with Sarah Baar MA, CCC-SLP.Aditional aphasia episodes on Speech Uncensored Podcast:References:Beeson, P.M. (1999). Treating acquired writing impairment: Strengthening graphemic representations. Aphasiology, 13, 367-386. Beeson, P.M., Hirsch, F., & Rewega, M. (2002). Successful single-word writing treatment: Experimental analysis of four cases. Aphasiology, 16, 456-473-491.Beeson, P. M., Rising, K., & Volk, J. (2003). Writing treatment for severe aphasia. Journal of Speech, Language, Hearing Research, 46, 1038-1060.Beeson, P.M. & Egnor, H. (2006). Combining treatment for written and spoken naming. Journal of the International Neuropsychological Society, 12, 816-827.Obermeyer, J. A., & Edmonds, L. A. (2018). Attentive Reading With Constrained Summarization Adapted to Address Written Discourse in People With Mild Aphasia. American Journal of Speech-Language Pathology, 27(1S), 392.Obermeyer, J. A., Rogalski, Y., & Edmonds, L. A. (2019). Attentive Reading with Constrained Summarization-Written, a multi-modality discourse-level treatment for mild aphasia. Aphasiology, 1-26.Rogalski, Y., Altmann, L., & Rosenbek, J. (2014). Retrieval practice and testing improve memory in older adults. Aphasiology, 28:4, 381-400.Rogalski, Y. & Edmonds, L. (2008). Attentive Reading and Constrained Summarisation (ARCS) treatment in primary progressive aphasia: A case study. Aphasiology. 22. 763-775.Rogalski, Y., Edmonds, L., Daly, V., & Gardner, M. (2013). Attentive Reading and Constrained Summarisation (ARCS) discourse treatment for chronic Wernicke's aphasia. Aphasiology, 27:10, 1232-125Disclosures:Leigh Ann Financial Disclosures: Leigh Ann is employed by The University of Kansas Health System and receive honorariums from SpeechTherapyPD.com. Non-financial Disclosures: Leah Ann is the host of the Speech Uncensored Podcast.Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Time Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Descriptions of the role evidence-based practices to use with patients with mild aphasia. 15 minutes: Descriptions of modified treatment protocols to increase complexity level for mild aphasia.10 minutes: Descriptions of resources for implementing treatment approaches with mild aphasia5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Get .1 ASHA CEU hereEpisode SummaryHow does the opening scene of Star Trek 2: The Wrath of Khan help us better understand test validity? Tune in to find out as Dr. Doug Peterson and Dr. Trina Spencer return to the Nerdcast to continue the discussion on dynamic assessment (DA). If you haven't already, beam back to Part 1 of the series to set the scene. In this follow-up, Trina and Doug weave just the right amount of side-tracked laughter, nerdy sci-fi narrative, and evidence-based discussion to rev up your DA engines and have you racing to the literature to explore a different assessment frontier that is more ethical, less biased, and much more versatile than norm-referenced assessment alone. Crack the jargon of norm-referenced assessment and gain some tangible DA tips and rationale as this crew unpacks the value of uncovering how children learn rather than what they've already learned when making a diagnosis and setting a functional and effective intervention plan across learning domains. Boldly go where few SLP's have gone before, enjoy some leftover cake and sandwiches, and get those CEU's that give you the gold you can apply to your caseload today!You can learn more about Trina and Doug here.Summary Written by Tanna Neufeld, MS, CCC-SLP, Contributing EditorLearning Outcomes1. Explain how dynamic assessment differentiates between language disability and language difference.2. Describe different applications of dynamic assessment that identify a disorder.3. Explain how dynamic assessment can inform intervention.ReferencesPetersen, D. B., Tonn, P., Spencer, T. D., & Foster, M. E. (2020). The Classification Accuracy of a Dynamic Assessment of Inferential Word Learning for Bilingual English/Spanish-Speaking School-Age Children. Language, Speech, and Hearing Services in Schools, 51(1), 144-164. doi:10.1044/2019_lshss-18-0129Petersen, D. B., Chanthongthip, H., Ukrainetz, T. A., Spencer, T. D., & Steeve, R. W. (2017). Dynamic Assessment of Narratives: Efficient, Accurate Identification of Language Impairment in Bilingual Students. Journal of Speech, Language, and Hearing Research, 60(4), 983-998. doi:10.1044/2016_jslhr-l-15-0426Petersen, D. B., Allen, M. M., & Spencer, T. D. (2014). Predicting Reading Difficulty in First Grade Using Dynamic Assessment of Decoding in Early Kindergarten. Journal of Learning Disabilities, 49(2), 200-215. doi:10.1177/0022219414538518Petersen, D. B., Gragg, S. L., & Spencer, T. D. (2018). Predicting Reading Problems 6 Years Into the Future: Dynamic Assessment Reduces Bias and Increases Classification Accuracy. Language, Speech, and Hearing Services in Schools,49(4), 875-888. doi:10.1044/2018_lshss-dyslc-18-0021Disclosures:Dr. Petersen and Dr. Spencer financial relationships: They are co-authors of the Story Champs curriculum and PEARL dynamic assessment. They receive royalties from the sales of those items. Dr. Spencer and Dr. Petersen have no financial relationships to disclose.Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. Time Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Descriptions of how dynamic assessment differentiates between language disability and language difference.15 minutes: Descriptions of different applications of dynamic assessment that identify a disorder.10 minutes: Descriptions of how dynamic assessment can inform intervention.5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!Credits: Summary Written by Tanna Neufeld, MS, CCC-SLP, Contributing EditorKey Terms and Additional Information provided by Maria De Leon, MS, CCC-SLP, Contributing EditorAudio File Editing provided by Caitlan Akier, MA, CCC-SLP/L, Contributing EditorPromotional Content provided by Ashley Sturgis, MA, CCC-SLP, Contributing Editor Web Editing provided by Sinead Rogazzo, MS, CCC-SLP, Contributing Editor__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

During this episode, Dr. Janet Patterson, Chief of the Audiology & Speech-Language Pathology Service at the VA Northern California Health Care System talks with Dr. Rebecca Hunting Pompon, assistant professor in the Department of Communication Sciences and Disorders at the University of Delaware in Newark, Delaware, about depression, the effect it can have on people with aphasia and their care partners, and how speech-language pathologists can recognize and address depression during aphasia rehabilitation.   Guest Bio Rebecca Hunting Pompon, Ph.D., is an Assistant Professor in Communication Sciences and Disorders at the University of Delaware, and director of the UD Aphasia & Rehabilitation Outcomes Lab. Prior to completing a Ph.D. in Speech and Hearing Sciences at the University of Washington, she earned an M.A. in Counseling at Seattle University and worked clinically in adult mental health. Dr. Hunting Pompon’s research focuses on examining psychological and cognitive factors in people with aphasia, and how these and other factors may impact aphasia treatment response. She also trains and advises clinicians on interpersonal communication and counseling skills adaptable for a variety of clinical contexts.    In today’s episode you will learn: about the similarities and differences among sadness, grief, and depression, and sobering statistics of their prevalence in persons with aphasia and their care partners, how the behavioral activation model can assist clinicians during planning an aphasia rehabilitation program for an individual with aphasia and his or her care partners, 5 tips to use in starting conversations about depression with persons with aphasia and their care partners, and fostering their engagement in the therapeutic enterprise,  the value of community support groups for persons with aphasia.   Janet: Rebecca, I would like to focus our conversation today on your work investigating depression, and other psychosocial factors that patients with aphasia and their care partners may experience. Let me begin our conversation by asking how we define and think about depression, because I think everyone has an idea about what depression is, and how it may manifest itself in an individual’s interaction with family and friends, and certainly in the past year, as we've moved through this worldwide pandemic, focus on depression has increased. You have studied depression in persons with aphasia, and how depression affects their care, so first, let me ask, how do you define depression? And then how often does it appear in persons with aphasia?    Rebecca: Depression is a concept that so many of us are familiar with. In one way or another, so many people have experienced depression themselves, or alongside a family member, so I think it's such a common concept. Likewise, many people know that the definition of depression that we use most often is about a mood disorder. Usually, the two fundamental ways we think about depression, clinically, is that it is either low mood, or it can be a loss of interest, or pleasure. So of course, we all experience this from time to time, but depression is really a much more marked, persistent low mood or loss of pleasure, or interest, and it can span across days and daily life and make a tremendous impact. Those two features go with some other features like a change in appetite, fatigue and energy loss. Some people experience a slowing of thought or slowing of physical movement, or experience trouble with concentrating, or trouble with focus. It also could include feeling worthless or excessive amounts of guilt, and it also can be accompanied by recurring thoughts of death, which can be with a plan or more abstractly without a specific plan. Those are the constellation of symptoms that can go with that formal depression diagnosis.   Of course, aphasia, as we all know, comes with some significant changes in functioning after stroke or other types of brain injury. Loss and grief are commonly experienced by many people with aphasia and their families as well. Unfortunately, those losses that are experienced with aphasia can lead to depression in a significant number of people. Let me give you a little bit of context on that. In the general adult population, maybe like 9% of the population or so may experience a mild to major depressive disorder at some point; the number goes up for people that have experienced stroke to about 30% or so. In studies of stroke survivors with aphasia, the number is significantly higher. We recently completed a study with about 120 people with aphasia, and about half of them reported symptoms that were associated with a depressive disorder, mild to major. And I think it's really important to note that this is based on 120 people that were motivated to participate, to volunteer for research. We really believe that actually, depression may be experienced by a quite a greater number of people with aphasia, because we're not capturing those people that are at home, they're not engaged in speech therapy, and we really wonder if rates of depression in aphasia might be quite a bit higher.    Janet: That is a stunning set of statistics when you think about all the people who don't report, can't report, or don't come into the clinic, and their feelings; their ideas are pretty much lost in the world. I appreciate the comment that the people participating in your study are motivated, and they experienced depression. It's out there, and we need to pay attention to it. As a clinician, how might one recognize the presence of depression in a client?   Rebecca: Depression can be really hard to observe at times. A lot of people with depression can mask their depression and seem to be doing fine. I've had this experience working with a number of people who seem to be really thriving after their stroke, but then getting into the details and discussing their life and their reactions, we come to find that they're struggling far more than we perceive that they are. Other times we may get some sense of an experience of depression, maybe we observe a lack of initiative or motivation during treatment or get some sense that our client is just not enjoying his or her activities the way that they used to, or the way that we hear from their loved ones, how they used to participate in their life. What do we do if we're wondering, “Hmm, depression? Is this a factor for this particular person?” It can be helpful to ask about the specific symptoms of depression, sometimes more than asking, “Are you depressed?” I that's true for a couple of reasons. First, some of our clients may associate the label of depression as having a lot of stigma. Stigma around mental health has been with us for a very long time, unfortunately, and it's really a barrier to making sure that we can provide care and address issues like depression in many people, not just people with aphasia.  Of course, the other thing about the label of depression is that some people just feel very disconnected from that label. They might hear depression and say, “Well, that's not me, I don't really feel sad.” But again, as we talked a little bit ago about those features and symptoms of depression, it's not necessarily just a sadness, it's about mood and so many other things that go with depression. It can be helpful to talk about those specific symptoms instead of just the label itself.    I wanted to throw this in there too, sometimes I've been asked this by a number of clinicians, “How do I tell the difference between depression and grief?” The short answer is that grief doesn't come with feelings of worthlessness or guilt or shame. It's not the turned-inward type of experience, whereas depression can be turned inward. Ultimately speech-language pathologists do not need to feel like they need to be mind-reader's; they do not need to feel like, “I am not a mental health expert, so therefore I cannot ask.” We can ask about depression and depressive symptoms. We can ask ourselves, “Does this person's mood appear to influence their everyday life or their recovery?” That might be the thing that will push us forward to ask a little bit more about what their experiences are like. Helpfully, there are a couple of screening tools that are really useful for clinicians, regardless of type of clinician. One is the Patient Health Questionnaire. It's a depression scale, vaguely named. It's also called the PHQ. The PHQ is a nine, or there's also an eight, item version. They're very simple scales. They've been developed for clinical populations, so the phrasing is quite short and straightforward. They use a Likert scale and they're very well validated screening tools that are also free. I believe we're going to have the pdf of the PHQ-9, which is nine items scale, in the Show Notes.    Janet: Right   Rebecca:  Great. Another scale that's been developed specifically for aphasia, though, it's really addressing caregivers or other proxy reporters, is the Stroke Aphasic Depression Questionnaire, or the SADQ, and it's available also for free. There are a couple of different versions. Again, that's been created for people with aphasia in mind, specifically their caregivers. So that's really helpful tools. In Short, these are great tools to use, and just give us a little more information as we're having a conversation about depression. They then give us some ideas about what next steps to take, including referrals that we might be thinking about.    Janet: Rebecca, those are excellent ideas. And indeed, those two resources you mentioned will be in our show notes. You speak about depression in patients with aphasia, but I believe that depression also affects the care partners of a person with aphasia. What do you see is the role of a clinician in recognizing depression in a care partner?    Rebecca: This is really, unfortunately, true. Depression is experienced by caregivers, including stroke caregivers and aphasia caregivers, and depression symptoms align, and maybe not surprisingly, with the degree of caregiving effort that's required by the family members. In other words, caregiver depression, can be higher when caregivers are working with a loved one who has more severe functional impairment. Here are even more sobering statistics. There was a study conducted, it's a few years back, about caregiving adults, ages 66 and up, so it's a lot of our clients, family members, and spouses, etc. Those caregivers who reported mental or emotional strain had a 63% increase in mortality risk compared to caregivers who did not report strain. That's a really shocking and sobering to think about. The takeaway here is caregiving burden, as it's often called, that s just a very, very real problem with us. Given that caregivers are such an important part of our client's recovery, their health and well-being are just incredibly important. So how can we support them? They're not our primary concern, because our client is, so what do we do? What do we do for caregivers to support them? Of course, we can ask how they're doing, certainly. Then we can also provide some support resources, support groups, counseling services, and the fact that we are doing much more online now has opened up opportunities for both caregivers and clients to participate in lots of different ways, to connect virtually, and so that's great.    Another really great tool that can be used is called the Caregiver Questionnaire. It's a questionnaire that has 17 items and was developed by the American Medical Association. It just goes through a listing of common caregiver experiences that can really be illuminating for caregivers. I've given this questionnaire to caregivers in different contexts, including in caregiver support groups. What I hear from caregivers, once they go through those 17 questions, is often they're surprised. They're often not thinking a lot about how they're doing themselves, because they're very focused on supporting their loved one. It can be really illuminating for them to answer the questions and realize, “Wow, I am really fatigued I'm really tired. And maybe I need some extra support”. What I sometimes recommend to clinicians is having this questionnaire on hand and providing it to caregivers while you're working with the client, and then maybe checking in at the end of the session to say, “You know, how was that for you?” And it's an opportunity, again, to provide some support resources that they can explore on their own. I think it's a really handy way to just shine a light for caregivers, saying, ”Hey you're doing a lot, we recognize that and we know you need support, too.”   Janet:  I think that's very important. It reminds me of the message you see on the airlines, you know, put your own oxygen mask on first, so that you're better able to help the other people. If you're a caregiver, you must take care of yourself, and we must help the caregivers take care of themselves so that they can better care for our patients with aphasia.    Rebecca: Oh, my gosh, so true.   Janet:  Depression typically does not appear by itself. You've alluded to that and mentioned that earlier. In your experience and investigation. How does depression interact with coping skills, resilience or motivation? Are there other interactions that we may see in persons with aphasia?    Rebecca: Oh, my gosh, depression, part of the reason that I studied depression, among other things, is that it's a really interesting experience. It's part of a grouping of some biophysiological processes that are so intimately linked together. I hope you don't mind if I geek out a little bit here.   Janet: Geek away   Rebecca: Geek away - All right. We know that when we perceive something stressful, like, let's say we're near a potentially dangerous animal or something like that, it's classic example. It triggers systems in our body that helps us respond, right, we've heard of the fight or flight response, where our adrenaline system jacks up so that we can move quickly, right or get away from the danger, or if we have to, fight it off. Then once the danger is gone, our body goes back to its normal functioning state, the adrenal system stops pumping out adrenaline and our heart rate slows to a normal rate, all that good stuff, right? So of course, our body does pretty much the same thing when we're not in danger, per se, but we are experiencing or we perceive stress; that could be public speaking for some, or a big job interview. Then thinking about people with aphasia, maybe it's really stressful to make that phone call to somebody, even someone they know well. They don't feel confident about their communication ability, and that can be incredibly stressful. Even though it's not danger, it still can kick our body's stress systems into gear, activating that adrenal response, etc. Here's the thing, though, if our body is entering that stress state pretty regularly, it gets regularly flooded with these stress biochemicals that can impact multiple systems. We can handle those biochemicals, we were built to handle those biochemicals. But we weren't really built to handle them all the time, or often over a long period of time. If those biochemicals are circulating in our blood, they can really have a damaging effect on our body, and they have a damaging effect on parts of the brain, that are really important for us as speech language pathologists thinking about treatment, right? So those biochemicals, and cortisol is among them, can diminish functioning of regions of the brain that we need for things like attention and memory, things that are really important for learning, right? What do we do in treatment - we learn. At the same time, these biochemicals can increase parts of the brain, like the amygdala, that are really central for emotion. In other words, if we're experiencing persisting stress over a period of time, we may have impairments in memory and focus to a degree, and we may also experience depression, anxiety, and other mental health challenges. I got really, really interested in stress and depression a few years ago, and as you mentioned at the beginning, we created a scale for chronic stress for people with aphasia. Using that scale we found, just as we would in the general population, that there are very close associations between reports of perceived chronic stress and reports of depressive symptoms. The bottom line is that chronic stress is significantly connected to depression, and it's significantly experienced by our clients with aphasia.   You asked about coping skills and resilience and that's another area that I've been really, really interested in. We know that there's an association between depression and resilience, or how people cope with stress. As resilience goes up, depression tends to go down. But we also have seen that this relationship is more complex than I anticipated. We are currently validating a scale of resilience for aphasia. We really want to understand better how resilience and depression and other mental health challenges fit together, and then how we address them.   Janet:  I think that's very important work because we're, when we engage on the therapeutic endeavor, when we begin treatment, it is a partnership. And both the clinician and the patient with aphasia, but also the caregiver, we have to be in there engaged in that process and moving forward to achieve whatever communication goals we have in mind for the patient. If a patient is not engaged because of low coping skills or low resilience, because of depression, that can certainly affect our treatment,   Rebecca: Agreed. It's things that we don't really understand. I mean, we understand to a degree, for sure, but I think with some time and some additional research, we'll be able to understand much more clearly how depression and resilience impact treatment, and also how we can capitalize on resilience and build it. I'm looking forward to uncovering some of these associations and understanding them better.    Janet: Oh, I look forward to reading your work on that. I want to ask you now the next logical and perhaps obvious question, which is how may depression experienced by a person with aphasia adversely affect the treatment, as well as the quality of life in that person, and with the person's caregivers?   Rebecca: We've talked about people who have experienced depression in one way or another, and depression is really mean. It is really a mean, mean process, that can sap our interests in things that we like to do and screw up our sleep and our appetite. It impacts others around us, of course, but yes, absolutely, depression can dampen motivation. That's one of its features, it can dampen motivation to get out of the house, or for our clients with aphasia, it can diminish how much initiative they want to take with activities, especially social interactions that really help with language function and recovery. It may diminish their initiative to seek support or to reach out and start speech therapy. Then, even when a person has decided to actively engage in therapy, depression may also limit how much he or she can take away from that therapy experience to a degree, given that it's harder to attend to things, it's harder to concentrate, it's harder to remember, when you are also struggling with depression. Then it's also that all of those things that contribute to how well we can engage in treatment and adhere to treatment recommendations. We need a level of motivation and initiative and energy to tackle assignments that our therapists might have given us to work on in between our sessions. There are just multiple ways that depression could influence treatment, either through those diminished cognitive processes, or the impact on engagement, and adherence. There are just a lot of questions that we have, still about these impacts on treatment, and how they influence the outcomes of treatment.    Janet: One of the things we've observed in some work we've done recently is that people talk a lot about motivation, or resilience or coping, but people haven't yet figured out what that means or how to identify it. I'm very glad that you're doing some of this work to help us understand how we can best approach the treatment effort and really assure maximum engagement of the patients to achieve the goals that we want to achieve.   Rebecca: It is really interesting. There is some really interesting work going on in some other allied health disciplines that is, I think, helping us to pave the way in thinking about how to ask these questions about engagement. It's for our clients as well. I am excited to move forward on that.    Janet: You're right about that! Speech-language pathologists are by nature, compassionate individuals, and would be responsive to a person with aphasia or a care partner who seems to show depression. What guidance can you offer for clinicians as they plan and implement a rehab program for a person with aphasia, who shows signs of depression?    Rebecca: Oh, first of all, Janet, I agree. Speech-language pathologists are such a big-hearted bunch and that is just a real plus for our clients. There are a number of things that we can do to consider depression and treatment planning. In addition to being aware of the impact of depression, and those engagement and motivation issues, the cognitive issues, and the screening that we already talked about, we of course, can make appropriate referrals. This can be easier for some clinicians and more difficult for others. Some clinicians who work in an environment like an acute care or rehab environment, may have access to a psychologist or social worker, rehab counselor, someone like that who can help step in and provide support or other resources. For other clinicians who work in outpatient settings, the best referral might be to the client's primary care physician. Unfortunately, as we know, there are just not enough mental health professionals with aphasia expertise; we need so many more of those. That's a whole other discussion, isn't it? The primary care physician and support groups can be some of the first people that we refer to, if we are working in an outpatient setting. In addition to those things we can also provide some information and training to family members, and our colleagues and our clinical teams about supportive communication techniques. Interestingly, people with aphasia have talked about how interacting with people that know a little bit about aphasia and know how to support communication really can not only facilitate the conversation, but also help improve their mood, and give them a little boost. They also talk about how important it is to both acknowledge their experiences and perspectives and struggles, and to have at the same time, a positive outlook, to use humor, to celebrate goals. All of those things have been things that people with aphasia have talked about as elements that really help in working with clinicians and others for that matter.    Another thing that has come up, and you and I have talked about this a little bit, is also about the tremendous impact of mental health challenges for people with aphasia. We talked a bit ago about the very high incidence of depression in aphasia. And so, people with aphasia have said in previous work that they really wanted more information about low mood and changes that can come with stroke, around mood and mental health, and wanted an open forum to talk about that, and continue those conversations with caregivers as well. That open discussion about depression, about other kinds of mental health struggles, can really help normalize it, help destigmatize it so that we can address it more readily.    Janet: That makes sense. And you know, one of the key points I heard you just say is that, as a clinician, it's important for us to be aware of the community resources that are around us, whether they're specific individuals like neuropsychologists or mental health workers, or support groups or community groups. Bearing that in mind that we're not alone, as clinicians working with patients with aphasia, we have a whole group of people who can contribute to this rehabilitation effort.    Rebecca: Absolutely. And I was going to add, in addition to the myriad of people that can be around and supporting people with aphasia who are struggling with mood issues and other mental health challenges, support groups are really amazing. I would say if I gave a couple of tips for clinicians, but I had three things that I was thinking of, that we can really encourage for our clients, and one is to really seek out those support groups and other opportunities for connection with each other. I mean, I think we all know that groups can be so amazingly effective at not only providing some opportunities for social connection, but also that emotional support, and kind of perspective-checking opportunities for our clients can realize, “Oh, I'm not alone, others are also struggling in a similar way.” I'm the biggest cheerleader for support groups, as I think we all are,    This is one of those broken record things. Exercise is another incredibly, useful tool. We all know, of course, that exercise is good for our health and our cardiovascular functioning, all that good stuff. But it also so helpful in improving mood and cognitive functioning. Getting outside and moving around is just so important. There is just scads of research across many health disciplines that talks about this and reminds us about the importance of exercise.    Here's the other thing that I think is really cool to suggest to clients. And that is, in simple terms, do more of what you like to do. There's been some work around behavioral treatment approaches for stroke survivors, including those with aphasia, using a framework called behavioral activation. Thomas and colleagues in the UK have done a little bit of work around this. The basic notion is that by doing more of what you like to do, provided it's healthy and not detrimental, of course, can really help improve mood. When we do things we enjoy, it releases endorphins, and it gives us some sense of satisfaction and well-being. That's exercise for some people, not for everybody. Other people may find doing creative things, or learning something new, or engaging in something that feels like it's contributing in some way. Those can all be things that can over time, help improve mood and outlook. This can be a little challenging for folks with aphasia; the things that they think about or reach for, or things they enjoy, are maybe no longer available to them because of their language and communication impairment, or other impairments that have come with stroke. So again, the support groups are so helpful. They can be places where people have an opportunity to learn about new activities or connect with opportunities that may fill that hole of things that they like to do, new things that they hadn't discovered before. I always have more plugs for support groups.   Janet: The things that you mentioned, they're simple, they're easy, but they're so powerful. Sometimes we forget that the simple things can often have the biggest change or make the biggest change, or the biggest difference for us. It's a good thing that you have been reminding us of those things today.    Rebecca: Simple things, and sometimes combinations like a couple of simple things together can make a huge impact.   Janet: As important as the treatment techniques are to address specific linguistic and communication goals, an individual's mental health state and their feelings of engagement with the clinician and the process are just as important, as we've mentioned several times today, What advice or suggestions or lessons learned, can you describe for our listeners that will help them become better clinicians, and address the whole person in aphasia therapy, including our role as clinicians in counseling, and I don't mean the professional counseling that is reserved for degreed mental health professionals. I mean the communication counseling and quality of life communication counseling.    Rebecca: Yeah, even though speech-language pathologists are not mental health experts, there really are a number of very simple counseling skills that can help connect with our client s and more fully understand how they're doing, where are their struggles are, how are they doing in terms of mental health. When we understand them more fully, what's important to them, what they're struggling with, then it's easier to build treatment plans that fit them as individuals. So, if I'm putting on my counseling hat, I have a couple of things that I would prioritize, I think I have five, five things that I would prioritize as a speech-language pathologist using some counseling skills.    Janet: I will count them.   Rebecca: The first one is really to consider their stage post event or post stroke. If the stroke or the event is new, we may be working more with the family; they may be in shock, they may be overwhelmed and struggling to take in the information that we and our clinical team are providing to them. Those conversations differ tremendously from the conversations we might have with clients and families that are in the chronic stage, because they have a better sense of aphasia and of what it means for them, what their everyday needs are, etc. I think considering first of all, the stage post stroke or post event is really important.    The second thing I would say is to find empathy and unconditional positive regard. It is good to know that depression is complicated, and it can come with emotions, a lot of different emotions and experiences from anger and frustration and shame, and so sometimes our conversations around depression can be uncomfortable. I would say, approach these conversations in an open and honest way about the client's challenges and maintain that unconditional positive regard even when we're feeling that discomfort ourselves. If they are angry and frustrated, we also may feel angry and frustrated or defensive or something else that doesn't feel very good as clinicians, or for anybody for that matter. Just remembering that unconditional positive regard, that we really all want the same thing. We want improvement. We want improvements in life and to face things like depression and find some answers that will really help push clients forward.    The third thing that I would say is giving clients and family members our full attention and listen really actively and carefully. Sometimes this can be just an extra 30 seconds, an extra 60 seconds of listening using some reflective techniques that can really provide some critical information about our client, their needs and priorities that we can use in treatment planning. At the same time, this act of listening very deeply, and reflectively can help build our connection with their client and that's going to help promote engagement, adherence, and trust, which is just so essential for the therapeutic alliance.    The fourth thing I would say is communicate multi-modally. I would say this not just for clients, but for family members as well. I myself have been the caregiver in situations where a clinician, never an SLP I will say, has come in and talked to a loved one and it was wasted words and time because nobody could take in that information. It was feeling overwhelmed and that that information might have come in as just some noise; maybe we remember one or two words from it and couldn't take the rest of it away, just given everything else that we were processing in that moment. I always say, never just say something, say it and write it or diagram it. This is just again, so important with clients and families who are stressed, who are depressed or anxious in some way. It is just so hard to remember when we're feeling overwhelmed. We can really support our clients and families by communicating in a multi-modal way. Even almost as important as summarizing what we've said and providing information again, I had a caregiver once say never tell us more than three things at once, because the fourth thing is going to be lost. I took that to heart; I understand that that makes perfect sense. And of course, providing a lot of opportunities for questions is helpful. That number four had a lot of pieces to it.    Here's number five, and this is really obvious, developing mutual goals with our client and revisiting them. Sometimes when our client is struggling with depression, we might find their treatment plan seemed like a great idea, seemed like a great fit for our client, and just falls flat. If our client is really struggling to concentrate or engage in an activity because of depression, it just makes sense to stop and revisit those goals and make sure they really line up with the client's interests and priorities, but also how they're doing and how they're able to engage given everything else that's going on - mental health-wise and otherwise.    Janet: Those are five excellent tips, Rebecca, excellent. And again, they're not difficult things to do, but they're so important, especially if you do all five of them together. I think our listeners are going to be quite pleased to learn about these five ideas that you have.    Depression experienced by persons with aphasia is not new, we've talked about this earlier, certainly as long as there has been aphasia, there have been people with aphasia and depression. But although it's not new, it has not been well recognized or really well studied, as you mentioned earlier on. During the past year, as a result of changes due to the pandemic, such as the stay-at-home orders, limitations on in-person activities, and the increase in virtual care, I believe depression and associated mental health and self-care concerns have increased and have come to the forefront of our thinking. Have you found this to be the case?   Rebecca: It's interesting. We are in the midst of a study right now, that's looking at how our research participants are doing during the pandemic as compared to pre-COVID, pre-pandemic. We're not done, we're midway through, but so far, we're seeing some really interesting challenges that people are reporting with everyday functioning during the pandemic, which it doesn't surprise us, of course, we're all struggling with functioning, I think, during the pandemic. We're not necessarily seeing greater levels of stress for the group we've done so far. Some people are reporting more stress, and some people are reporting less, which is fascinating. I'm going to give you some examples. Some people have said that they're not really that bothered by not being able to leave the house. Then other people are talking about how they're not able to do the things that they've always done, and that's been really difficult and stressful for them. So clearly, there's a lot of variety of experiences that we've heard so far. I'm really looking forward to finishing up that study and just looking at all the data together. Maybe the next time we talk we'll have some better news or a clearer picture about what people's experiences are like.    Janet: I'll look forward to hearing about that.    Rebeca: Separately, a couple of months ago, we chatted with our friends with aphasia and just asked, “Hey, what's been helping you during these lock downs, during this time of isolation?” And here's what they said: they said things like games and puzzles and dominoes were helping; listening to music every day. One person found brain teaser books were helpful and fun right now; several people were cheering for support groups that they were attending online; playing with pets; connecting with family over FaceTime. One person talked about chair yoga. Those are the things that our friends with aphasia are doing that they say are really helping.    I think we're all thinking about self-care right now. It's just so important, of course exercise and getting outside and learning something new. I think we've all heard of countless people that have learned to bake bread this year, me among them. Taking care of things like a new plant, and then just finding ways to connect with each other, though a little bit different than we were doing it before.    Janet: That is so true. I think we've all been finding those new ways and new things and new ways of connecting with people. Rebecca, you've given us much to think about today. Depression may not always be easy to recognize in an individual, and certainly its management is multifaceted. As we draw our conversation to a close, what are some words of wisdom that you have to offer to our listeners who interact with persons with aphasia every day? And who may be wondering, “How do I start a conversation about depression with my clients, or my clients’ caregivers?”   Rebecca: I would say first, be yourself, be genuine. When we are able to genuinely connect with our clients and their families, it really does strengthen the trust, and build our relationship for some good clinical work together. Then ask about depressive symptoms, as we've talked about before, and communicating openly about depression; not something that we should, you know, hide away, but actually discuss and regularly check in on, as well as providing some resources and support for what to do when someone's feeling depressed or struggling with mental health. Then listening fully and acknowledging the experiences of our client, the good stuff, the difficult stuff, all of it. They're really the experts on life with aphasia and they are such a critical part of our clinical decision making. Then keeping our eye on the literature as there is more clinical research on depression, and other psychological challenges in aphasia right now than I think ever before, which is incredibly exciting. So just keep an eye on that. And then I think this is a really important one - take care of yourself. Clinicians working with people with communication disorders are also experiencing depression. It can be a lot over time, and no one can be a great clinician if their own health, their own well-being is compromised, so do what you can to take care of yourself. Again, simple things, several simple things we can do to just make sure we're our most healthy and going to be the best supporters for our clients and their families.    Janet: Those are some very, very good suggestions. If I'm right, you have a paper coming out in Perspectives soon, about counseling skills, is that correct?    Rebecca: Yeah, there should be a paper coming out soon about counseling skills, and also about stages using those skills, depending on the stages post event or post stroke, hopefully, that'll be coming out really soon.    Janet: This is Perspectives for the Special Interest Groups within the American Speech-Language-Hearing Association. I have to say, I remember, oh gosh, many, many years ago, I wrote a paper for Perspectives on depression and aphasia, and at that time, there was not very much written about it; people were thinking a little bit more about quality of life. As I reread that paper before talking to you today, I found myself thinking how much more information is available now, how much more in the forefront is the topic of depression, and mental health and psychosocial skills, and how pleased I am that there are so many people who are really recognizing the importance of having these conversations with our clients and caregivers.   Rebecca:  I'm so glad that there's more available now, but I have to say thank you, Janet, for blazing that trail those years ago, you have been an inspiration clearly and I'm glad that we are picking up the pace on these important topics.   Janet:  And you indeed are. This is Janet Patterson and I'm speaking from the VA in Northern California, and along with Aphasia Access, I would like to thank my guest, Rebecca Hunting Pompon, for sharing her knowledge, wisdom, experience and guidance about this most important topic, the effect depression can have on persons with aphasia, and their care partners.    You can find references and links and the Show Notes from today's podcast interview with Rebecca, at Aphasia Access under the Resources tab on the homepage.   On behalf of Aphasia Access, we thank you for listening to this episode of The Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to access our growing library of materials, please go to www.aphasiaaccess.org. If you have an idea for a future podcast topic, please email us at info@aphasiaaccess.org. Thank you again for your ongoing support of Aphasia Access.   Links and social media Lab website: UDAROLab.com Facebook: “UD Aphasia & Rehabilitation Outcomes Lab” AMA Caregiver Self Assessment Questionnaire (free pdfs; 5 languages): https://www.healthinaging.org/tools-and-tips/caregiver-self-assessment-questionnaire   Citations Modified Perceived Stress Scale: Hunting Pompon, R., Amtmann, D., Bombardier, C., and Kendall, D. (2018). Modification and validation of a measure of chronic stress for people with aphasia. Journal of Speech, Language, and Hearing Research, 61, 2934-2949. doi.org/10.1044/2018_JSLHR-L-18-0173   Patient Health Questionnaire depression scale (PHQ)  PHQ9 Copyright © Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD ® is a trademark of Pfizer Inc. (open access)   Stroke Aphasic Depression Questionnaire (SAD-Q) https://www.nottingham.ac.uk/medicine/about/rehabilitationageing/publishedassessments.aspx  

Get .1 ASHA CEU hereEpisode Summary:How prevalent is CAS REALLY? Is it true that CAS is the most over-diagnosed of the speech sound disorders? How does treatment for motor speech challenges differ from “traditional” arctic treatment? The Nerd crew doesn't dance around these hot topics in this week's episode, although there is a catchy Kate jingle to start things off. Before you dive in, you might want to listen to a previous episode (Maybe it's Apraxia?: diagnostic considerations for childhood apraxia of speech) for a refresher on important diagnostic stuff to help set the stage for “...hitting the sweet spot in your [CAS intervention] dance”. Mike Bright is an SLP in the Boston area currently supporting kids with motor speech challenges in a private practice setting after more than a decade at Boston Children's Hospital. Mike has us digging deep into the grad school motor speech caverns of our brains to recall those sound intervention principles like mass vs distributed practice and constant vs variable practice. Even with so much jargon floating around, this practical discussion provides a child-centered and movement-centered lens from which to approach this complicated clinical niche, and has some awesome tips to keep drill sessions rooted in motor learning, client interests, and FUN! That's right, fun drill-who doesn't need some advice on making drills fun? Tune in and learn about the role of prevalence in clinical perspective-taking when supporting kids who struggle with hard to understand speech. You'll also dance away with some solid “stock” and individualized ideas for materials and strategies that go beyond your K-SLP Kit, but still to hold research evidence and motor learning principles at their core. You'll no doubt walk away with some big ah-ha moments because “When you look at it through the lens of movement, it makes so much sense!” You can learn more about Mike here.Learning Outcomes1. Describe the prevalence of childhood apraxia of speech?2. Describe three considerations for target selection for children with CAS.3. Describe five ways to vary speech production practice that support motor learning.ReferencesMaas, E., Gildersleeve-Neumann, C.E., Jakielski, K.J. et al. Motor-Based Intervention Protocols in Treatment of Childhood Apraxia of Speech (CAS). Current Developmental Disorders Reports. 1, 197–206 (2014). https://doi.org/10.1007/s40474-014-0016-4Maas, E., Gildersleeve-Neumann, C., Jakielski, K., Kovacs, N., Stoeckel, R., Vradelis, H., & Welsh, M. (2019). Bang for Your Buck: A Single-Case Experimental Design Study of Practice Amount and Distribution in Treatment for Childhood Apraxia of Speech. Journal of Speech, Language, and Hearing Research, 62(9), 3160-3182. doi:10.1044/2019_jslhr-s-18-0212Murray, E., McCabe, P., & Ballard, K.J. (2014). A Systematic Review of Treatment Outcomes for Children With Childhood Apraxia of Speech. American Journal of Speech-Language Pathology, 23, 486–504. https://doi.org/10.1044/2014_AJSLP-13-0035Online Resources:Integral Stimulation: https://www.apraxia-kids.org/apraxia_kids_library/integral-stimulation-method-adapted-for-children-as-dttc/The PROMPT Institute: https://promptinstitute.com/page/WIPforClincianDynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of SpeechPrinciples of Motor Learning in Treatment of Motor Speech DisordersA Systematic Review of Treatment Outcomes for Children With Childhood Apraxia of SpeechInterventions for childhood apraxia of speechA Randomized Controlled Trial for Children With Childhood Apraxia of Speech Comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme–Third EditionTreating Speech Subsystems in Childhood Apraxia of Speech With Tactual Input: The PROMPT ApproachFeedback Frequency in Treatment for Childhood Apraxia of SpeechUltrasound Biofeedback Treatment for Persisting Childhood Apraxia of SpeechREST - Rapid Syllable Transition Treatment: A free self directed learning resource for speech pathologists to learn how to deliver ReST treatment to children with Childhood Apraxia of Speech (CAS) and information for parents and the general community. https://rest.sydney.edu.au/CAS Treatment Methods Supported by Evidence Based Research: This website has different Evidence Based methods and free resources for parents and free videos and learning content for clinicians. https://www.childapraxiatreatment.org/cas-treatment-supported-by-research-evidence/Episode Key Terms and Additional InformationDefinitions were obtained through the ASHA website. Under Childhood Apraxia. https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/#collapse_6Sensory Cueing approach: Treatments that include sensory input (e.g., visual, auditory, proprioceptive and/or tactile cues) to teach the movement sequences for speech. Sensory cues can be used separately or in combination. PROMPT: PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets. The technique is a tactile-kinesthetic approach that uses touch cues to a patient's articulators (jaw, tongue, lips) to manually guide them through a targeted word, phrase or sentence. Integral Stimulation: This is a treatment method that involves imitation, and emphasizes both visual and auditory models. It requires a person to imitate utterances modeled by the clinician. Attention is focused both on the auditory model as well as visual attention to the clinician's face. It is often considered the “watch me, listen, do as I do” approach.Dynamic Temporal and Tactile Cueing (DTTC): This approach is like Integral Stimulation the only difference is that it adds layers of cueing to improve children's production accuracy.Biofeedback: This refers to the use of visual information to report on how sound productions are physically made. Biofeedback provides "knowledge of performance", which provides information about the persons' actual movement of speech sound targets. This can be demonstrated through several means, the most popular are through ultrasounds and electropalatography. Childhood apraxia of speech: Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is due to brain having planning problems to move speech parts like the lips, jaw, tongue. Therefore, the issue is not muscle weakness or paralysis instead, the child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say the words. Disclosures:Mike Bright Financial Disclosures: Mike is the owner of Bright Speech and Language, LLC. Mike Bright Non-financial: "Recognized by Apraxia Kids for Advanced Training and Expertise in Childhood Apraxia of Speech"Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. Time Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Descriptions of the prevalence of childhood apraxia of speech 15 minutes: Descriptions of considerations for target selection for children with CAS 10 minutes: Descriptions of ways to vary speech production practice that support motor learning 5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__Summary Written by Tanna Neufeld, MS, CCC-SLP, Contributing EditorKey Terms and Additional Information provided by Maria De Leon, MS, CCC-SLP, Contributing EditorAudio File Editing provided by Caitlan Akier, MA, CCC-SLP/L, Contributing EditorPromotional Content provided by Ashley Sturgis, MA, CCC-SLP, Contributing Editor Web Editing provided by Sinead Rogazzo, MS, CCC-SLP, Contributing EditorSLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Get .1 ASHA CEU hereEpisode SummaryWhat if I told you that there was a world where your assessment aimed to understand a child's ability to learn and not just what they know right now? There is! And it's welcoming you, with cake and sandwiches. The field of speech-language pathology has long depended on static, standardized, norm-referenced assessments to diagnose and support intervention needs for children with communication challenges. While these “formal” assessments certainly have their place in our field, research and clinical evidence supports dynamic assessment (DA) procedures as a true game changer. This week's episode (Part 1 of a Series on DA) challenges us to put down the flip book and test protocol (or at least nudge it over a bit on the speech table) and make room for DA measures that open the door to understanding the way a child learns. Joining Kate and Amy in welcoming the dynamic duo, Dr. Trina Spencer and Dr. Doug Peterson, who share their knowledge and passion about all that DA has to offer clinical practice. This episode has a little something for everyone, including some revolutionary ideas on the validity of DA to answer many clinical questions, perhaps even better than a static measure. Listen in and learn about the differences between outcomes with static and dynamic assessment methods, the pros and cons of each, and some tips and tricks for using standardized DA methods to get stellar data that can offer a wealth of valid and practical treatment planning and diagnostic information. And of course, it wouldn't be an SLP Nerdcast episode without a food analogy, so tune in for some “cake” and “sandwiches” to satisfy your nerdy assessment appetite. Bon appetit!Summary Written by Tanna Neufeld, MS, CCC-SLP, Contributing EditorLearning Outcomes1. Explain the theoretic basis of dynamic assessment.2. Explain the differences between static and dynamic assessment.3. Describe three dynamic assessment formats that SLPs can use.ReferencesKramer, & Mallett, & Schneider, Phyllis & Hayward, Denyse. (2009). Dynamic Assessment of narratives with Grade 3 children in a First Nations community. Canadian Journal of Speech-Language Pathology and Audiology. 33. 119-128. Peña, E. D., Gillam, R. B., & Bedore, L. M. (2014). Dynamic assessment of narrative ability in English accurately identifies language impairment in English language learners. Journal of speech, language, and hearing research : JSLHR, 57(6), 2208–2220. https://doi.org/10.1044/2014_JSLHR-L-13-0151Peña, E. D., Gillam, R. B., Malek, M., Ruiz-Felter, R., Resendiz, M., Fiestas, C., & Sabel, T. (2006). Dynamic Assessment of School-Age Children's Narrative Ability: An Experimental Investigation of Classification Accuracy. Journal of Speech, Language, and Hearing Research, 49(5), 1037-1057. doi:10.1044/1092-4388(2006/074)Peña, E., & Iglesias, A. (1992). The Application of Dynamic Methods to Language Assessment. The Journal of Special Education, 26(3), 269-280. doi:10.1177/002246699202600304Peña, E. D., Reséndiz, M., & Gillam, R. B. (2007). The role of clinical judgements of modifiability in the diagnosis of language impairment. Advances in Speech Language Pathology, 9(4), 332-345. doi:10.1080/14417040701413738Petersen, D. B., Chanthongthip, H., Ukrainetz, T. A., Spencer, T. D., & Steeve, R. W. (2017). Dynamic Assessment of Narratives: Efficient, Accurate Identification of Language Impairment in Bilingual Students. Journal of speech, language, and hearing research : JSLHR, 60(4), 983–998. https://doi.org/10.1044/2016_JSLHR-L-15-0426Petersen, D. B., Gillam, S. L., Spencer, T., & Gillam, R. B. (2010). The effects of literate narrative intervention on children with neurologically based language impairments: an early stage study. Journal of speech, language, and hearing research : JSLHR, 53(4), 961–981. https://doi.org/10.1044/1092-4388(2009/09-0001)Ukrainetz, T. A., Harpell, S., Walsh, C., & Coyle, C. (2000). A Preliminary Investigation of Dynamic Assessment With Native American Kindergartners. Language, speech, and hearing services in schools, 31(2), 142–154. https://doi.org/10.1044/0161-1461.3102.142Wolter, J. A., & Pike, K. (2015). Dynamic Assessment of Morphological Awareness and Third-Grade Literacy Success. Language, Speech, and Hearing Services in Schools, 46(2), 112-126. doi:10.1044/2015_lshss-14-0037Disclosures:Dr. Petersen and Dr. Spencer financial relationships: They are co-authors of the Story Champs curriculum and PEARL dynamic assessment. They receive royalties from the sales of those items. Dr. Spencer and Dr. Petersen have no financial relationships to disclose.Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. Time Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Descriptions of the theoretic basis of dynamic assessment.15 minutes: Descriptions of the differences between static and dynamic assessment.10 minutes: Descriptions of the dynamic assessment formats that SLPs can use5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!Editors: Tanna Neufeld, MS, CCC-SLP, Ashley Sturgis, MA, CCC-SLP, Caitlan Akier, MA, CCC-SLP/L, Maria De Leon, MS, CCC-SLP__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Get .1 ASHA CEU hereEpisode SummaryDɪsfeʒə? Dɪsfɑʒə? Təmeto, təmɑto? That is one of the many questions tackled in this week's episode with Dr. Lindsey Griffin, a leading professional in the field of adult dysphagia and assistant professor at Emerson College in Boston. For those of you not practicing in the field of swallowing, this episode will certainly ring some grad school bells as Dr. Griffin walks us through some swallowing bascs that include a refresher on the phases of swallowing and some tried and true strategies to support individuals with swallowing challenges (You guys remember the good ol' chin tuck, right?). Working in this area of our field already? You'll enjoy some powerful discussions on evidence-based, person-centered decision-making in dysphagia practice amongst several remaining resource and research limitations. Listen in and learn about the difference between restorative exercises and compensatory strategies, the why and how of tailoring intervention techniques to an individual's physiological impairments, and the role of technology in dysphagia care. You will no doubt find yourself following along with the maneuvers discussed, just make sure to swallow your coffee first!So, grab a plate of “minced and moist” snack foods and cozy up with Kate, Amy and Dr. Griffin for some nerdy swallow chat! You can learn more about Dr. Griffin here.Summary Written by Tanna Neufeld, MS, CCC-SLP, Contributing EditorLearning Outcomes1. Describe the difference between restorative exercises and compensatory strategies 2. Relate three restorative treatment techniques to the targeted physiological impairment3. Identify two devices used in dysphagia rehabilitationReferencesBhutada, Ankita M., et al. “Factors Influencing Initiation of Pharyngeal Swallow in Healthy Adults.” American Journal of Speech-Language Pathology, vol. 29, no. 4, 2020, pp. 1956–1964., doi:10.1044/2020_ajslp-20-00027.Humbert, Ianessa A., et al. “Swallowing Kinematic Differences Across Frozen, Mixed, and Ultrathin Liquid Boluses in Healthy Adults: Age, Sex, and Normal Variability.” Journal of Speech, Language, and Hearing Research, vol. 61, no. 7, 2018, pp. 1544–1559., doi:10.1044/2018_jslhr-s-17-0417.Martin-Harris, Bonnie, et al. “MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard.” Dysphagia, vol. 23, no. 4, 2008, pp. 392–405., doi:10.1007/s00455-008-9185-9.Valenzano, Teresa J., et al. “Respiratory–Swallow Coordination in Healthy Adults During Drinking of Thin to Extremely Thick Liquids: A Research Note.” Journal of Speech, Language, and Hearing Research, vol. 63, no. 3, 2020, pp. 702–709., doi:10.1044/2019_jslhr-19-00163.OTHER REFERENCE ON LAPTOPOnline Resources:IOPI: https://iopimedical.comEMST (Expiratory Muscle Strength Training): https://emst150.com/IDSI (International Dysphagia Diet Standardization Initiative): https://iddsi.org/ Disclosures:Lindsay Griffin Financial Disclosures: Lindsay is an employee of Emerson College. Non-financial: Lindsay is a member of ASHA SIG 13 and the Dysphagia Research SocietyKate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. Time Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Descriptions of the difference between restorative exercises and compensatory strategies 15 minutes: Descriptions of restorative treatment techniques to the targeted physiological impairment 10 minutes: Descriptions of devices used in dysphagia rehabilitation 5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Get .1 ASHA CEU hereEmbracing parents as communication partners is critical for our clients for a variety of reasons. Parents are primary communication partners for their children, and can play significant roles in acquisition and generalization of communication skills. And it comes as no surprise that since parents are unique communication partners, parent training comes with a unique set of challenges and benefits. In this episode we review literature and discuss the importance of embracing parents as communication partners. We also have the pleasure of interviewing Dr. Jean Blosser who has created some materials to facilitate bridging the gap between school / therapy and the home environment.Dr. Jean Blosser, CCC-SLP, EdD, is an ASHA Fellow, Fellow. You can learn more about Dr. Blosser here.Learning Outcomes1. State 3 reasons for engaging parents as partners2. Describe 3 teaching tools to improve home program development for parents 3. Describe two benefits of sharing visual supports with parentsReferencesBrown, J. A. (2016). Coaching in Parent-Implemented Early Communication Interventions: Understanding and Overcoming Individual-Level Implementation Barriers. Perspectives of the ASHA Special Interest Groups, 1(1), 144-153. doi:10.1044/persp1.sig1.144Pennington, L., Thomson, K., James, P., Martin, L., & Mcnally, R. (2009). Effects of It Takes Two to Talk—The Hanen Program for Parents of Preschool Children With Cerebral Palsy: Findings From an Exploratory Study. Journal of Speech, Language, and Hearing Research, 52(5), 1121-1138. doi:10.1044/1092-4388(2009/07-0187)Roberts, M. Y., & Kaiser, A. P. (2011). The Effectiveness of Parent-Implemented Language Interventions: A Meta-Analysis. American Journal of Speech-Language Pathology, 20(3), 180-199. doi:10.1044/1058-0360(2011/10-0055)Roberts, M. Y., & Kaiser, A. P. (2012). Assessing the Effects of a Parent-Implemented Language Intervention for Children With Language Impairments Using Empirical Benchmarks: A Pilot Study. Journal of Speech, Language, and Hearing Research, 55(6), 1655-1670. doi:10.1044/1092-4388(2012/11-0236)Roberts, M. Y., Kaiser, A. P., Wolfe, C. E., Bryant, J. D., & Spidalieri, A. M. (2014). Effects of the Teach-Model-Coach-Review Instructional Approach on Caregiver Use of Language Support Strategies and Children's Expressive Language Skills. Journal of Speech, Language, and Hearing Research, 57(5), 1851-1869. doi:10.1044/2014_jslhr-l-13-0113Thiessen, A., & Beukelman, D. (2013). Training Communication Partners of Adults Who Rely on AAC: Co-Construction of Meaning. Perspectives on Augmentative and Alternative Communication, 22(1), 16-20. doi:10.1044/aac22.1.16Weitzman, E. (2013). More Than Words—The Hanen Program for Parents of Children with Autism Spectrum Disorder: A Teaching Model for Parent-implemented Language Intervention. Perspectives on Language Learning and Education,20(3), 96-111. doi:10.1044/lle20.3.86Disclosures:Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder of SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. Jean Blosser Financial: President, Creative Strategies for Special Education, She receives compensation for consulting and conducting professional development workshops and in-services. She is the author and receives royalties from sales of the Lets Talk Today Calendar. She also receives royalties from sales of authored books. Jean has no non-financial relationships to discloseTime Ordered Agenda:10 minutes: Introduction, Disclaimers and Disclosures20 minutes: Review of reasons for engaging parents as partners.15 minutes: Review of teaching tools to improve home program development for parents10 minutes: Review of benefits of sharing visual supports with parents5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA CEUs, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!

Get .1 ASHA CEU hereWe were lucky enough to publish an article for the incredible blog, PrAACtical AAC. If you interact with AAC at all in your clinical work this blog contains a wealth of information. This episode is meant to be an auditory companion to the original article published on July 6th, 2020. Below is a brief excerpt from that article:Most SLPs working in AAC have come across a variety of different interventions in their practice. Some, like aided language modeling, are popular and commonly seen at conferences. They are the most popular option on the intervention buffet. Others, like discrete trial training, are like the mystery meat – you think you know what it is, you don't think you're going to like it, and you're going to watch while someone else tries it first. Sometimes these teaching procedures are straightforward, and sometimes they are confusing, intimidating, or complicated. You may find that choosing which intervention to use is influenced by your goals, your workplace norms, or the direct needs of the AAC user; but when it comes down to actually implementing that intervention it can feel like a very complicated experience. What is the intervention supposed to look like? What materials should I use? What goals are going to be supported by this intervention? How am I possibly going to take data on this while I'm also trying to do therapy? It can feel like a doozy, and we hear you. Our goal for this episode is to demystify the main item on the intervention buffet and give a “how to” for implementation.This episode is offered for 1 ASHA CMH (equal to .1 ASHA CEU). If you have questions about CEUs or how this works, please see our How It Works or ASHA Professional Development pages.Learning OutcomesDefine aided language modeling and describe how it is differentiated from instructional modelingIdentify strategies for planning for and implementing aided modeling interventionsIdentify strategies for collecting stakeholder input and generalizing aided modeling interventions to novel environmentsReferencesAllen, A., Schlosser, R., Brock, K., Shane, H. (2017). The effectiveness of aided augmented input techniques for persons with developmental disabilities: a systematic review. Augmentative Alternative Communication, 33(3), 149-159.Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23(1), 30–43. doi: 10.1080/07434610600807470.Cafiero, J. M. (2001). The effect of an augmentative communication intervention on the communication, behavior, and academic program of an adolescent with autism. Focus on Autism and Other Developmental Disabilities, 16(3), 179–189. doi: 10.1177/108835760101600306.Drager, D. R., Postal, V. J., Carrolus, L., Castellano, M., Gagliano, C., & Glynn, J. (2006). The effect of aided language modeling on symbol comprehension and production in 2 preschoolers with autism. American Journal of Speech-Language Pathology, 15(2), 112-125.Goossens,' C. (1989). Aided communication intervention before assessment: a case study of a child with cerebral palsy. Augmentative and Alternative Communication, 5(1), 14–26. doi: 10.1080/07434618912331274926.Kraat, A. W. (1985). Communication interaction between aided and natural speakers: A state of the art report. Madison, WI: Trace Center Reprint Service. Retrieved from http://www.eric.ed.gov/ERICWebPortal/contentde-livery/servlet/ERICServlet?accno=ED287275Romski M.A., & Sevcik R.A. (2003). Augmented input: Enhancing communication development. In Light JC, Beukelman DR, Reichle J, editors. Communicative competence for individuals who use AAC: From research to effective practice. Baltimore, MD: Paul H. Brookes; 2003. pp. 147–162.Sennott, S. C., Light, J. C., & McNaughton, D. (2016). AAC modeling intervention research review. Research and Practice for Persons with Severe Disabilities, 41(2), 101-115. https://doi.org/10.1177/1540796916638822Sevcik, R. A., Romski, M. A., Watkins, R. V., & Deffebach, K. P. (1995). Adult partner-augmented communication input to youth with mental retardation using the System for Augmenting Language (SAL). Journal of Speech, Language, and Hearing Research, 38(4), 902–912. doi: 10.1044/jshr.3804.902Online ResourcesOur original blog post on PrAACtical AAC: https://praacticalaac.org/praactical/aactual-therapy-using-aided-language-modeling/Disclosures:Financial: Kate Grandbois is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Amy Wonkka is an employee of a public school system and co-founder of SLP Nerdcast.Non-financial: Kate and Amy are both members of ASHA, SIG 12, and both serve on the AAC Advisory Group for Massachusetts Advocates for Children. Kate is a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG.Time Ordered Agenda:10 minutes: Introductions and disclosures10 minutes: Discussion of aided language modeling and describe how it is differentiated from instructional modeling20 minutes: Discussions of strategies for planning for and implementing aided modeling interventions15 minutes: Discussions of strategies for collecting stakeholder input and generalizing aided modeling interventions to novel environments5 minutes: Overview, discussion, and closingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts! Thank you FeedSpot!

The gang is back together for Episode 102 and the show has a new format.  The show was recorded the night of the Emmy's and the evening of learning about the passing of Kobe Bryant.  The crew comes to terms with the loss of an athlete and the role the Grammy's have in letting us know we are getting older.  On the show this week, Michelle sat down the author, Kari Knutson, of the article than ran in the ASHA Leader about crying in your car.  Is training social skills dehumanizing?  Also, can you predict Dyslexia?  We also have our SSPOD Shoutout, the SSPOD Due Process, the ASHA Spotlight, and the SSPOD Hot Take.    The Discord is up and ready for people to interact with the crew 24/7.  ----more---- SSPOD Shoutout: We want to know your #SSPODSHOUTOUT, like Kerry David, the owner of Join Hope Speaks.  Kerry trains providers and gives therapy to those who need it in areas that may not have the resources.      SSPOD Due Process:  Do you have a complaint or need to vent, then you want to participate in the #SSPODDUEPROCESS.  This week's due process comes from Talking With Tech's host, Rachel Madel.  She is upset about the gatekeeping involved in getting AAC devices to our students who need it.       Article #1: Dyslexia in children may be predictable.  A study running in the Journal of Speech, Language, and Hearing Research look at the link of Phonological Awareness and the prediction of Dyslexia in Children.  What do the results mean for your therapy setting?   Article #2: Some have called ABA therapy just dog training for humans.  What does training social skills really look like?  Can it be dehumanizing?  How can we change our therapy settings to be more open to all of our patients and students.    Interview: In the ASHA Leader, an article called “Whats EQ Got to Do with It?” Kari Knutson wrote an article looking at stress management.  Kari's first article in the ASHA Leader was edited and Kari found out the hard-way what an editors pen can do when the term “Cry in your car” was left in the article with no perspective or other information given.  Kari talks the process of this article and her original intention about stress management techniques.    ASHA Spotlight: Its time to look to your colleagues and get them nominated for the 2020 ASHA Awards.  Make sure you are showing ASHA who deserves to be nominated.    Hot Take: Matt takes the first hot take and takes aim at Internet Bullies.    Contact Email: speechsciencepodcast@gmail.com Voicemail: (614) 681-1798 Discord: https://discord.gg/3Tm5jrS   New Episode and Interact here: www.speechsciencepodcast.com podcast.speechsciencepodcast.com   Support Patreon – https://www.patreon.com/speechsciencepodcast   Rate and Review: https://podcasts.apple.com/us/podcast/speechscience-org-podcast/id1224862476?fbclid=IwAR3QRzd5K4J-eS2SUGBK1CyIUvoDrhu8Gr4SqskNkCDVUJyk5It3sa26k3Y&ign-mpt=uo%3D8&mt=2   Credits Intro Music: Please Listen Carefully by Jahzzar is licensed under a Attribution-ShareAlike License. Bump Music: County Fair Rock, copyright of John Deku, at soundcloud.com/dirtdogmusic Closing Music: Slow Burn by Kevin MacLeod is licensed under a Creative Commons Attribution License.   Show Links   Hope Speaks https://joinhopespeaks.org/   Predicting Dyslexia: https://pubs.asha.org/doi/10.1044/2019_JSLHR-L-18-0265?fbclid=IwAR3WUdRADN6NeuW7POdt7axG5KjMqoHxk434KcqGxGgr5JfIgs6ddrT2Cb0   Social Skill Training https://slpndc.org/social-skills-training/?fbclid=IwAR15TBwBEetjWhEeHMvNHEwjT0epiMH_gHg5-FRl4_VIJcsbI8jSSyCoPxc Social Thinking Curriculum: https://www.socialthinking.com/Products/think-social-curriculum-for-school-age-students?fbclid=IwAR2XtJ6gBPCycfZ6IIJDvVX8KpFxIecrYJVKO19aVj5Jdvl3ie7H4lkPTTA   Kari Knutson http://knutsonspeaks.com/ https://leader.pubs.asha.org/doi/full/10.1044/leader.SCM.25012020.34   ASHA Spotlight https://leader.pubs.asha.org/doi/10.1044/leader.AN1.25012020.64?fbclid=IwAR2z9NjG9_O-lH3A3CwKvVyPuju4Ej5TCeYoLgp2VnWDc3jKH9ek-6MN-x8     Intro Music: Please Listen Carefully by Jahzzar is licensed under a Attribution-ShareAlike License. Bump Music: County Fair Rock, copyright of John Deku, at soundcloud.com/dirtdogmusic Closing Music: Slow Burn by Kevin MacLeod is licensed under a Creative Commons Attribution License.     Speech Science Powered by: You!

Dr. Bob Davis share about his new book, Unseen Forces, which takes us into a world between worlds where science, reality and your consciousness meet at a data supported metaphysical crossroad.Davis is an internationally recognized scientist of sensory neuroscience and served as a professor at the State University of New York for over 30 years. He earned a Ph.D in sensory neuroscience from The Ohio State University. He has written three books: His 60+ academic articles appear in peer-reviewed journals which include The Journal of Scientific Exploration, Journal of Consciousness Studies, Journal of the Acoustical Society of America, Hearing Research, and The Journal of Neuroscience.https://bobdavisspeaks.com/Dr. Rita LouiseWill be discussing her latest book, Stepping Out Of Eden, which examines why humans act human, and surprisingly tackles the question from an ancient alien perspective.Bestselling author Dr. Rita Louise is the founder of the Institute of Applied Energetics and the host of Just Energy Radio. She is a Naturopathic Physician and a 20-year veteran in the Human Potential Field. Her unique gift as a medical intuitive and clairvoyant illuminates and enlivens her work. She is the author of the books Stepping Out Of Eden, ET Chronicles: What Myth And Legend Have To Say About Human Origin | https://soulhealer.comPlease check out our other pages and social media!https://kgraradio.com/paranormal-now/https://www.paranormalnow.netTwitter: https://twitter.com/Paranormal_NowIG: https://www.instagram.com/paranormalnow/YouTube-Paranormal Pop: https://www.youtube.com/watch?v=bz2FIUUshS8

Dr. Brandon Cox, Ph.D., is an Associate Professor at Southern Illinois University. Her research is focused on hearing loss and regeneration of hair cells (or sound sensing cells) in the inner ear. Listen along as Brandon shares her passion for education at an early age, how she developed an amazing memory recall and some of the tricks she used on the job to sharpen her memory skills, what prepared her for her early investigator career, and what lessons she learned and insight she hopes to provide young researchers who are pursuing their own labs.To learn more about Dr. Brandon Cox's lab, visit https://www.siumed.edu/pharm/faculty/brandon-c-cox.html

This episode revisits the concept of the 30 Million Word Gap concept, which we first covered in an interview with Dr. Doug Sperry (https://yourparentingmojo.com/wordgap/) a few weeks back. After she heard that I was going to talk with Dr. Sperry, Dr. Roberta Golinkoff – with whom we discussed her book Becoming Brilliant (https://yourparentingmojo.com/becomingbrilliant/) almost two years ago now – asked to come back on to present a rebuttal.  We’re going to learn a lot more about the importance of child-directed speech! This episode serves two purposes: it helps us to understand another aspect of the 30 Million Word Gap, and it also demonstrates pretty clearly that scientists – both of whom have the best interests of children at heart – see very different ways of achieving that end. References Adair, J.K., Colegrave, K.S-S, & McManus. M.E. (2017). How the word gap argument negatively impacts young children of Latinx immigrants’ conceptualizations of learning. Harvard Educational Review 87(3), 309-334. Avineri, N., Johnson, E., Brice‐Heath, S., McCarty, T., Ochs, E., Kremer‐Sadlik, T., Blum, S., Zentella, A.C., Rosa, J., Flores, N., Alim, H.S., & Paris, D. (2015). Invited forum: Bridging the “language gap”. Journal of Linguistic Anthropology, 25(1), 66-86. Bassok, D., Latham, S., & Rorem, A. (2016). Is Kindergarten the new first grade? AERA Open 1(4), 1-31. Baugh, J. (2017). Meaning-less difference: Exposing fallacies and flaws in “The Word Gap” hypothesis that conceal a dangerous “language trap” for low-income American families and their children. International Multilingual Research Journal 11(1), 39-51. Brennan, W. (2018, April). Julie Washington’s quest to get schools to respect African American English. The Atlantic. Retrieved from https://www.theatlantic.com/magazine/archive/2018/04/the-code-switcher/554099/ Correa-Chavez, M., & Rogoff, B. (2009). Children’s attention to interactions directed to others: Guatemalan and European American Patterns. Developmental Psychology 45(3), 630-641. Craig, H.K., & Washington, J.A. (2004). Grade-related changes in the production of African American English. Journal of Speech, Language, and Hearing Research 47(2), 450-463. Gee, J.P. (1985). The narrativization of experience in the oral style. Journal of Education 167(1), 9-57 Genishi, C., & Dyson, A. (2009). Children, language, and literacy: Diverse learners in diverse times. New York: Teachers College Press. Golinkoff, R.M., Hoff, E., Rowe, M.L., Tamis-LeMonda, C., & Hirsh-Pasek, K. (in press). Language matters: Denying the existence of the 30 Million Word Gap has serious consequences. Child Development. Lee-James, R., & Washington, J.A. (2018). Language skills of bidialectal and bilingual children: Considering a strengths-based perspective. Topics in Language Disorders 38(1), 5-26. Long, H. (2017, September 15). African Americans are the only U.S. racial group earning less than in 2000. Chicago Tribune. Retrieved from http://www.chicagotribune.com/business/ct-african-americans-income-census-20170918-story.html NAEP (2017). National student group scores and score gaps (Reading). NAEP. Retrieved from: https://www.nationsreportcard.gov/reading_2017/#nation/gaps?grade=4 (https://www.nationsreportcard.gov/reading_2017/#nation/gaps?grade=4) Rogoff, B., Mistry, J., Goncu, A., ,& Mosier, C. (1993). Guided participation in cultural activity by toddlers and caregivers. Monographs of the Society for Research in Child Development Series No. 236, 58(8), v-173. Ward, M.C. (1971). Them children: A study in language learning. New York, NY: Holt, Rinehart & Winston. Washington, J.A., Branum-Martin, L., Sun, C., & Lee-James, R. (2018). The impact of dialect density on the growth of language and reading in African American children. Language, Speech, and Hearing Services in Schools 49, 232-247....

Do you have to start teaching a second language from birth?  Does it help to get a nanny who speaks a second language?  Is there any way your child will retain the language you speak even though you’re currently in a country where another language is dominant?  Does learning a second language lead to any developmental advantages beyond just the benefits of learning the language? Several listeners have actually written to me requesting an episode on this topic, and one has been particularly insistent (you know who you are!), so I was very glad to finally find an expert! Dr. Erica Hoff (http://psy2.fau.edu/~hoff/) leads the Language Development Lab at Florida Atlantic University and studies language development and bilingualism in children.  She gives us the lowdown on the best ways to raise a bilingual child (and doesn’t mince words on how difficult it is) – and also answers my burning question: I’m not planning to teach my daughter a second language at the moment, so am I a terrible parent?   References Bridges, K., & Hoff, E. (2014). Older sibling influences on the language environment and language development of toddlers in bilingual homes. Applied Psycholinguistics 35, 225-241. Core, C., Hoff, E., Rumiche, R., & Señor, M. (2013) Total and conceptual vocabulary in Spanish-English bilinguals from 22 to 30 months: Implications for assessment. Journal of Speech, Language, and Hearing Research, 56, 1637-1649. Hammer, C.S., Hoff, E., Uchikoshi, Y., Gillanders, C., Castro, D.C., & Sandilos, L.E. (2014). The language and literacy development of young dual language learners: A critical review. Early Childhood Research Quarterly 29, 715-733. Hoff, E., Rumiche, R., Burridge, A., Ribot, K.M., & Welsh, S.N. (2014). Expressive vocabulary development in children from bilingual and monolingual homes: A longitudinal study from two to four years. Early Childhood Research Quarterly 29, 433-444. Hoff, E. & Core, C. (2013) Input and language development in bilingually developing children. Seminars in Speech and Language, 34, 215-226. McCabe, A., Tamis-LeMonda, C., Bornstein, M. H., Cates, C. B., Golinkoff, R., Hirsh-Pasek, K., Hoff, E., Kuchirko, Y., Melzi, G., Mendelsohn, A., Paez, M., Song, L. Wishard Guerra, A. (2013) Multilingual children: Beyond myths and towards best practices. SRCD Social Policy Report. vol 27, No. 4. Retrieved from: https://www.fcd-us.org/multilingual-children-beyond-myths-and-toward-best-practices/ Menjivar, J., & Akhtar, N. (2017). Language experience and preschoolers’ foreign word learning. Bilingualism: Language and Cognition 20(3), 642-648. Ramirez, N.F., & Kuhl, P. (2017). Bilingual baby: Foreign language intervention in Madrid’s infant education centers. Mind, Brain, and Education (online first). DOI: 10.1111/mbe.12144 Ribot, K.M., & Hoff, E. (2014). “Como estas?” “I’m good.” Conversational code-switching is related to profiles of expressive and receptive proficiency in Spanish-English bilingual toddlers. International Journal of Behavioral Development 38(4), 333-341.   (#)   Transcript Jen:                                      (https://www.temi.com/editor/t/zXCMEn5SF6d4XI6ppnTsOZ4fNF_1IGHkEkFE1cuXsqWJ874oPf9g9iY9j6vMF9cxBcDWCxE-6tezUIEOnBy46SUZ2J8?loadFrom=DocumentDeeplink&ts=37.96)                    Hello and welcome to the Your Parenting Mojo podcast. I’m very excited today to welcome my guest, Dr Erika Hoff, who is Professor and the head of the Language Development Lab at Florida Atlantic University. Several of my listeners have emailed over the last few months and I’ve asked questions about raising bilingual children, but I was having a hard time finding someone with expertise in this area. One listener has been particularly insistent with his questions on this topic; you know who you are. So when a friend of mine forwarded in New York Times...

Rebecca Lewthwaite received her PhD from the University of California, Los Angeles. She is Director of Rehabilitation Outcomes Management, and Director of Research and Education in Physical Therapy at Rancho Los Amigos National Rehabilitation Center in Los Angeles. She is also an adjunct faculty member in the Division of Biokinesiology and Physical Therapy at the University of Southern California. Dr. Lewthwaite’s research focuses on the role of motivational enhancements in motor performance and learning, in diverse individuals, from those undergoing physical rehabilitation to developing and high-performing athletes. Wulf, G., & Lewthwaite, R. (2016). Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning. Psychonomic Bulletin & Review, 23(5), 1382-1414. Freedman, S. E., Maas, E., Caligiuri, M. P., Wulf, G., & Robin, D. A. (2007). Internal versus external: Oral-motor performance as a function of attentional focus. Journal of Speech, Language, and Hearing Research, 50(1), 131-136. http://www.optimalmotorlearning.com

“Vision loss disconnects you from objects, but hearing loss disconnects you from people. We are social animals. When you lose your hearing, you lose your ability to communicate in the broadest possible sense, because you also lose your ability to speak effectively. And it’s about being connected to your environment. We do more than just listen to words and music with our ears; we understand what room we’re in, we understand threats around us… We don’t have eyes in the back of our head – and we don’t need them; we have ears.” This week, Professor David McAlpine, Director of Hearing Research at the Australian Hearing Hub, talks to Ben Mckelvey about the important role hearing plays in our communication and social interaction, how we can better protect our ears from harm with ‘noise diets’, and how a young Protestant boy from Belfast discovered his love for all things academic.

www.resound.com Laurel A. Christensen, Ph.D. is the Chief Audiology Officer for GN ReSound Group. In this role she leads a global team of 26 audiologists that are responsible for all aspects of audiology for the company including new product trials, audiology input to marketing, and global audiology relations which encompasses training and product support to subsidiaries world-wide. Previously, she was a tenured Associate Professor on the faculty at Louisiana State University Medical Center and part of the Kresge Hearing Research Laboratory in New Orleans, LA. In addition to her position at GN ReSound, she holds adjunct faculty appointments at Northwestern and Rush Universities. She served as an Associate Editor for both Trends in Amplification and the Journal of Speech and Hearing Research. Currently, she is on the board of the American Auditory Society and is a member of the advisory board for the Au.D. program at Rush University. Christensen received her Master’s degree in clinical audiology in 1989 and her Ph.D. in audiology in 1992, both from Indiana University.

Dr. Fan-Gang Zeng is Director of the Center for Hearing Research and Professor of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences and Otolaryngology – Head and Neck Surgery at the University of California Irvine. He received  a Bachelor's degree in Electrical Engineering from the University of Science and Technology of China and his Master's degree in Biomedical Engineering at the Institute of Physiology Academia Sinica in Shanghai. Fan-Gang then went on to earn his PhD in Hearing Science from Syracuse University. He served as a research Associate at the House Ear Institute and an Associate Professor at the University of Maryland before joining the faculty at UC, Irvine where he is today. Fan-Gang is a member of the Acoustical Society of America, The Institute of Electrical and Electronics Engineers, the Association for Research in Otolaryngology, and the American Association for the Advancement of Science. Fan-Gang is here with us today to tell us all about his journey through life and science.

Gregory Hickok, Ph.D. is Professor of Cognitive Sciences at UC Irvine, Founder, Director Emeritus, and current Fellow of the UCI Center for Cognitive Neuroscience & Engineering, Founder and Director of the Center for Language Science, Fellow of the Center for the Neurobiology of Learning & Memory and the Center for Hearing Research, and past Chair […]

Gregory Hickok, Ph.D. is Professor of Cognitive Sciences at UC Irvine, Founder, Director Emeritus, and current Fellow of the UCI Center for Cognitive Neuroscience & Engineering, Founder and Director of the Center for Language Science, Fellow of the Center for the Neurobiology of Learning & Memory and the Center for Hearing Research, and past Chair […]

Melvyn Bragg and guests discuss perception: how the brain reacts to the mass of data continually crowding it. Barry Stein's laboratory at Wake Forest University in the United States found that the shape of a right angle drawn on the hand of a chimpanzee starts the visual part of the brain working, even when the shape has not been seen. It has also been discovered that babies learn by touch before they can properly make sense of visual data, and that the senses of smell and taste chemically combine to give us flavour.Perception is a tangled web of processes and so much of what we see, hear and touch is determined by our own expectations that it raises the question of whether we ever truly perceive what others do.What governs our perception of the world? And are we correct to distinguish between sight, sound, smell, touch and taste when they appear to influence each other so very much?With Richard Gregory, Senior Research Fellow in the Department of Experimental Psychology, Bristol University; David Moore, Director of the Medical Research Council Institute of Hearing Research, University of Nottingham; Gemma Calvert, Reader in Cognitive Neuroscience, University of Bath.

Melvyn Bragg and guests discuss perception: how the brain reacts to the mass of data continually crowding it. Barry Stein's laboratory at Wake Forest University in the United States found that the shape of a right angle drawn on the hand of a chimpanzee starts the visual part of the brain working, even when the shape has not been seen. It has also been discovered that babies learn by touch before they can properly make sense of visual data, and that the senses of smell and taste chemically combine to give us flavour.Perception is a tangled web of processes and so much of what we see, hear and touch is determined by our own expectations that it raises the question of whether we ever truly perceive what others do.What governs our perception of the world? And are we correct to distinguish between sight, sound, smell, touch and taste when they appear to influence each other so very much?With Richard Gregory, Senior Research Fellow in the Department of Experimental Psychology, Bristol University; David Moore, Director of the Medical Research Council Institute of Hearing Research, University of Nottingham; Gemma Calvert, Reader in Cognitive Neuroscience, University of Bath.