Congress was in the news quite a bit in December because of the many extensions that were set to expire the first of January if they were not extended. The therapy cap provision was especially concerning for those in speech, physical, and occupational therapy positions. Fortunately, it has been extended until February. However, it could still be eliminated unless Congress makes a more permanent decision. Had the legislation not been extended there would have been a 27.4% reduction in the fee schedule and exceptions for the early $1,880 therapy cap would have been removed. Just how important is it that these measures not be removed?

Giving Needed Care

There are two considerations to the therapy cap issue in regards to patients. First, is the fee reduction for providers. If Medicare reduces the amount providers will be paid, many will simply stop accepting Medicare patients. In some areas, it may be become impossible to find services locally and would make it necessary for patients to travel considerable distances to find the care they need. It may also mean they would have to begin services with a new provider even if they have developed a relationship with their current therapist.

The second problem is the amount of services a patient can receive each year. While there is currently a cap, it can be exceeded for special circumstances. Some patients may need years of therapy if they have had a severe accident or suffered a stroke. If there is a firm limit, there would be no way for them to receive the care they desperately need with their Medicare benefits. If they have no other insurance option many of these patients will simply not get the care they need at all. For a person who is trying to learn to walk or talk again this is unthinkable.

Livable Wage

While it is obviously important that the patients who need specific care are given the quality and quantity of treatments they need and deserve, it is also important that the professionals are able to make a living giving the care. In addition to paying the therapist, other staff must also be paid such as clerks and therapy assistants. If the Medicare fees are cut and the therapy offices decide to continue seeing Medicare patients, they may have to make staffing cuts because of the fee reductions. In a time where jobs are difficult to obtain, this could be a disaster for newer therapist and the staff that supports them.

Have you contacted your Congressional representatives to let them know how you feel about these possible cuts? While the cuts have been delayed, they have not been prevented. The American Speech Language Hearing Association maintains a database of representatives if you want to talk to your representative.

Medicare Therapy Caps is a post from: Sunbelt Staffing

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CAS, or childhood apraxia of speech, may also be known as verbal apraxia. This speech disorder is not fully understood, however, it causes the patient to be unable to fully perform the movements required to create speech. While it may be called by a variety of names, the important connection is the child has difficulty planning and following through with the actions required to speak.

A school speech therapist or speech pathologist may be called in to consult with the child and school to develop an Individual Education Plan, or IEP, to address the speech disorder.

Symptoms

 The signs for a very young child are different than those for an older child. However, the signs a school employed speech pathologist should look for in a school age child include:

• Inconsistent errors in creating a sound that are not due to the child’s age.
• The child understands language far better than he or she can speak.
• The child has difficulty repeating words, but words that are repeated are clearer than those created spontaneously.
• Child may visibly struggle when trying to form sounds or words.
• The child may have more difficulty with longer phrases or words than with those that are shorter.
• Speech may be more difficult when the child is anxious or upset.
• The child may be difficult to understand for anyone not familiar with his or her speech patterns.
• Words may be delivered in a monotonous or choppy rhythm and the wrong syllables may be stressed on individual words.

 Treatment

 Treatment for children with apraxia of speech is much more intense than other forms of speech therapy. Typically, a school speech pathologist will see a student once a week. Children with apraxia of speech need more frequent sessions, usually a minimum of three sessions per week. At first, the child will require individual sessions, and as improvement begins, he or she may be able to receive fewer sessions per week or be placed in group therapy for some sessions.

 In treatment, the focus is on improving the child’s ability to plan and sequence sounds as well as their ability to control the muscles needed for the production of speech. Specific exercises to strengthen these muscles are not necessary as the disorder is a result of a lack of coordination not strength. Multi-sensory feedback may be utilized to help children receive the feedback they need when attempting speech. For severe cases, the child may need to be taught sign language in order to more effectively communicate until speech improves.

 Finally, family involvement will be critical to the success of the student. They will need to be given specific instructions on how to help the child practice at home.

 How do you get the family involved with the treatment plan?

Apraxia of Speech is a post from: Sunbelt Staffing

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1. Speech Therapy for Toddlers
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Speech therapists are often the first people to work with children in a professional setting. Toddlers who show signs of having difficulty communicating may be sent to a speech therapist long before entering the public education system. For older children or adults, they may be the key to unlocking a patient’s ability to communicate with those around them. As much as speech therapists have to offer, they can’t be everywhere for each patient all the time. Until recently the only options for patients who had difficulty communicating was to spend time each week with a therapist and possibly purchase expensive equipment. For many, this equipment was prohibitively expensive and unattainable.

Fortunately, with the development of new technologies such as the iPhone and iPad, children and adults with communication deficits have access to technology that is specifically designed to facilitate communication and to teach communication skills. While an iPad is not inexpensive, it and all of the communication apps can be bought for far less than a thousand dollars, whereas historically, assistive communication devices were many thousands of dollars.

There are dozens of programs designed to help patients communicate and to expand their communication abilities. These four will help you, and your patients, get started.

ABA Flash Cards – Actions

It can be difficult for children to learn action words because they are fluid. Without seeing the action performed it is more difficult to convey the meaning of an action word to a child. The ABA Actions app shows a variety of actions such as brushing, rolling, tasting, and whispering in clear images. Children can have the action read to them and there is a musical component to keep children engaged.

iPrompts

iPrompts has several features to help children who are having difficulty communicating verbally. The application provides choices for children to begin communicating more effectively immediately and also allows them to learn how to verbalize their desires more efficiently over time. Some of the features of this application include picture schedules, choice prompts, a visual countdown timer, and an image library.

Proloquo2Go

The Proloquo2Go app is ideal for patients who have difficulty speaking. This is an augmentative and alternative communication device that has a vocabulary of more than seven thousand words, current symbols and a text to speech feature. The menu allows users to choose the type of communication they want to pursue such as requests for help, questions, basic communications, or the ability to search by word category.

iCommunicate

The iCommunicate application allows parents, teachers, or caregivers to fully customize the application with real world images unique to the child. These images can be accompanied by customized voice recordings and the application also comes preloaded with some audio. For images without audio there is a text to speech option. With these images, the user is able to create storyboards and routines for the child or present options for the child to choose.

Before devices such as the iPhone and iPad a piece of equipment with these sorts of abilities was only accessible to a small fraction of the children and adults who could benefit from them. Now there are app stores with dozens of options. Have you encouraged the use of these or other applications in your practice? What are your favorite iPad applications for patients with speech delays or communication deficiencies?

iPad Apps for Speech Therapy is a post from: Sunbelt Staffing

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Autism is a broad term that actually describes a wide spectrum of symptoms. A child with autism may be mostly nonverbal or they may be verbal but find communicating with others to be quite difficult. The range of speech in children diagnosed with autism is quite wide. Speech therapy can help children at both ends of the spectrum. A person with autism who is quite verbal may have a very difficult time comprehending the complex nuances within language. A nonverbal patient can learn to communicate without, or with limited speech, and with time may improve their spoken skill to a level where they can communicate with people more easily.

The type of speech therapy the child will engage in depends entirely on their developmental abilities. If a child is non-verbal, the therapist may use body language, sign language, imitation, or graphic representations, which can help children communicate before they are able to speak fluently. A child who has, and is able to use, a wide variety of words may need more help with conversation skills such as being able to take turns when talking to people or knowing what type of response is most appropriate in a given situation. A child who is learning to take turns may practice with role playing or with a scripted storyline, such as a play. This makes the experience both fun and educational as the child learns the importance of waiting his or her turn to say their line. A child who is not sure of the appropriate responses may need help with emotional context such as knowing to say “I’m sorry” if someone is hurt.

One of the most important things to remember about autism and speech therapy is that early intervention is best. As soon as possible, a child who has been diagnosed with autism needs to be working with a speech therapist familiar with the various levels of autism. Children who receive early intervention are more likely to acquire language skills. However, even children who start speech therapy at a later point in their development will still benefit.

For parents, one of the most difficult aspects of having a child with autism is not being able to communicate effectively with them. The uncertainty of what the child wants, or doesn’t want, is especially frustrating. Also, a parent who is trying to make themselves understood but is having no success may become frustrated with the child and begin to shut down and stop trying to communicate. This will lead to both the parent and the child being upset and frustrated. Speech therapy doesn’t just teach the autistic child to communicate with the world. It also teaches the child’s parents, siblings, and other relatives to communicate more effectively with them.

How do you help your patients with autism, and their families, learn to communicate more effectively?

Autism and Speech Therapy is a post from: Sunbelt Staffing

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There are two specialties that are experiencing rapid growth in the field of speech pathology, geriatrics and pediatrics. One of the reasons speech therapy for children is experiencing such rapid growth is because of the Individuals with Disabilities Education Act passed in 2004. This is a federal law that guarantees services to all children with disabilities who are eligible. The eligibility process requires an evaluation of the child by the appropriate authority. When a speech delay or impediment is a possibility, that authority is a speech therapist. With older children, a school official will typically be the one to initiate the evaluation process. But what about toddlers and children who are not yet in school? Usually, a pediatrician will notice something abnormal and write a prescription for an evaluation or the parent will request a screening because of concerns.

Evaluation

Evaluations will vary by state, but in general, the same types of things will happen. During the evaluation, the therapist will get on the child’s level and bring out toys or games. Then, using the toys to engage the child, he or she will begin asking questions and playing with the child in order to evaluate the child’s ability to communicate. Often, a child who is in for evaluation will not be able to fully communicate, and so the therapist may ask the parent or guardian for feedback about the child’s behavior and abilities as demonstrated in the home.

Some of the specific skills the therapist will look for include:

• Receptive language – what the child understands
• Expressive language – what the child can say
• Alternative communication – the ability of the child to communicate in a nonverbal way such as with gestures, pointing, and head movement
• Clarity of speech and the ability to make sounds
• Oral-motor skills – the ability of the child to control mouth and tongue movement for speech as well as eating or swallowing

Speech or Language Delay

One of the most common reasons for a toddler to begin speech therapy is a speech or language delay. Speech is the ability to verbally express language which includes the ability to form words. Language is the ability to retrieve and express information in a way that is meaningful through nonverbal, verbal, or written communication. These two delays will often overlap, although not always. Because of how closely the two are related, therapy for both may be similar.

Therapy

During therapy sessions the speech pathologist will play with the child for a half hour to an hour in a way that will encourage communication – for example, repeating a phrase as they do the action, such as throw the ball up. Then the therapist may drop a word in the phrase and have the child fill it in before completing the action, dropping more words until the child is able to say the entire sentence independently.

Working with toddlers with speech or language delays is very rewarding. You are able to watch as a child transforms from a frustrated toddler who is unable to express his needs and wishes to a happy little chatterbox. Do you work with toddlers? What is your favorite part of the job?

Speech Therapy for Toddlers is a post from: Sunbelt Staffing

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I first became familiar with speech therapy when a young cousin needed help with her speech impediment. Her mother and the teachers at the school helped develop a plan to help improve her speech, which involved a weekly session with a speech therapist. I never thought much more about it until my great uncle had a stroke and lost much of his ability to speak. A speech therapist was employed by the rehabilitation nursing home he was sent to, and she helped him regain much of his ability to communicate. This made me realize that there is an amazing need for speech therapy in both the younger and older generations.

Geriatric speech therapy has become an increasingly popular field. Baby boomers have brought the elderly population to new heights, with an even larger increase expected in the near future. This has led to an increase in the demand in speech therapists that specialize in helping elderly patients. Some of these patients need general help due to the natural aging process, while others need help with specific problems related to an underlying medical condition.

As you grow older, your vocal cords become less elastic and your larynx muscles weaken. This makes it difficult for many elderly people to speak as they once did, and it makes it more difficult for those around them to understand what they are saying. Speech therapy can help teach the patient to speak in a new way, with vocal exercises that will help them communicate more effectively. This benefits both the family and the patient tremendously. Because this is a condition that affects many people as they age, even if they have no other medical conditions, it is possible that geriatric speech therapy will grow even faster than other forms of geriatric care.

With my great uncle, his speech problem began after he had his stroke. This type of language impairment is called aphasia and is common in stroke victims. He received intensive speech therapy. His speech therapist worked with him several times a week for many months and then slowly backed down to once or twice a week. Eventually his speech did improve a great deal, although never what it was prior to the stroke. Still, he and the entire family were very grateful for the help of the speech therapist, and he was overjoyed at being able to communicate effectively with his family, friends, and doctors once more.

There are a number of environments where a speech therapist who specializes in geriatric care could thrive. Nursing homes, retirement communities, hospitals, and home health care centers may all contract with someone with this sort of expertise. If you are a speech therapist, have you ever considered focusing on geriatric patients? Do you prefer the challenges of working with the elderly?

Speech Therapy for the Elderly is a post from: Sunbelt Staffing

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I remember being a child in school, seeing the other children that used to be picked up by school aides for speech therapy. I knew that they were leaving for speech, but I didn’t really know what that was or why it was necessary. I just knew that I wanted to go and that I was so jealous of those kids who got to leave class, regardless of why it was.

As an adult, I see speech therapy in such a different light. It’s not about getting to leave class and do something different from the other students, although that is an incentive for kids who might otherwise be unwilling. It’s about correcting a problem before it gets to be an issue, and giving kids the tools they need to be confident, educated adults.

During my stint in the public schools, I talked to so many parents who were in denial about the fact that their little one needed to be in speech. You might be surprised how many parents are not comfortable with their child attending speech therapy. It’s important for parents to know how critical speech therapy is, and that it is not as serious as it may sound.

Speech Therapy Builds Confidence

When kids have speech impediments, they know it. Kids who talk differently from other children know that they do, and that can affect confidence. The age-old lisp, turning Rs into Ws, stuttering—these are some of the classic issues that cause students to need assistance from a speech therapist. Sure, these things may be cute when they are five years old, but at age 10, such problems aren’t so adorable.

If your child seems to be having trouble socializing at school and you know that they have a speech issue, consider enrolling them in speech therapy. Newfound skills build confidence, and they will be eager to show off their new speech skills by talking to other people.

Speech Therapy is Fun

As a child, speech therapy is fun. As an adult, speech therapy is a bore and may even be an embarrassment. For this reason, most adults who may benefit from speech therapy don’t get the help they need. Do your child a favor and allow them to attend speech therapy at school while it is still fun.  Not only does this take away from the bore of re Not only does this take away from the bore of regular curriculum, but it gives students something else to improve, work on and look forward to outside of their regular studies.

While it may not sound like a ball of joy to a parent, most kids find speech therapy to be fun and look forward to it.

Avoid Costs down the Line

When it is offered by the school, speech therapy is free of charge. It is part of the total educational experience, and is an experience that all parents who are offered it should take advantage of. Therapists can cost up to $200 per hour of therapy. Let them work for the school and teach your child now, or write the check later when you realize just how important speech therapy is to your child’s success—your choice.

The bottom line is this: nobody wants to admit the fact that their child has a speech issue, or any other type of trouble. Speech therapy does no harm, but it can do your child a world of good. It increases their confidence, their chances of success in school, and gives them the tools they need to combat their speech issue for the rest of their life. Do your child a favor and enroll them in speech at school if they need it. They will come home ranting and raving about the fun they had before too long, and you will see their speaking improve for the better.

Why is Speech Therapy Important? is a post from: Sunbelt Staffing

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A dear friend of mine, Sarah, is a school speech pathologist. Her position is also referred to as a speech therapist. During her years working with students she has come across numerous interesting challenges but none touched her the way Navi did. Navi was a student from Sri Lanka. In addition to being raised in a non-English speaking area and before he was transferred to an American public school, he also had medical problems that were making it impossible for him to speak. The most prominent medical issue was a severe cleft palate that had been untreated in his home country. In fact, his mother moved to America hoping to find treatment for her son. Other medical problems exacerbated the issue making speech acquisition almost impossible for the child. When my friend first encountered him, he was already in sixth grade.

Typically, students in public education with speech problems are not also ESOL. This did make the process more difficult because the student had only limited understanding of the English language. It required a team of teachers, an ESOL specialist, as well as Sarah to formulate an Individualized Education Program (IEP). The part Sara played was in teaching him to make sounds even with his medical problems as well as giving him alternative ways to communicate until surgery could be performed to make the speech process easier.

As with many children with extreme cleft palates, Navi had begun to communicate using a series of grunts and gestures. The various grunts evolve because it is not possible for children with cleft palates to make sounds normally and yet they still long to communicate with their family and other people they are surrounded by daily. Unfortunately, the family was not aware that this tendency to communicate through grunts and/or growls could actually hinder his ability to acquire speech, and thus allowed it to continue into his teens. This is often a very difficult habit for children to break, and it proved to be quite difficult for Navi to overcome.

Because of the extreme situation, and Navi’s inability to communicate at all with his teachers or fellow students, Sarah enrolled him in an elective sign language class. While this is an extreme measure, it did allow him to learn to communicate basic needs and desires with his teachers and classmates quickly. Within a week, he was able to ask to go to the bathroom, get a drink of water, and able to ask for help when he needed it. This slight improvement made a world of difference to Navi who began to come out of his reclusive shell and get to know the other students.

In addition, Sarah also began to work on breathing techniques and teaching Navi specific sounds and sound blends. This was a long process, but by his senior year, he was able to understand and communicate with his peers and teachers. Because his mother had not been able to afford the surgery, Navi’s speech was not what would be considered normal, but it was greatly improved.

Sometimes, no matter how much effort a speech pathologist exerts, a patient’s speech will never be completely normal. Therefore, this should not be the goal. Instead, a focus on making communication easier should be the primary focus. This will guarantee a positive result for the student and a rewarding experience for the speech pathologist.

Building Blocks Photo Credit: Valerie Everett http://www.flickr.com/photos/valeriebb/3474584087/

Learning to Speak – How a School Speech Therapist Helped a Child Communicate is a post from: Sunbelt Staffing

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