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Cognitive Communication
I recently attended a workshop by Jane Yakel of Virginia. She is a speech pathlogist who has worked a long career with cognitively impaired adults but as I study the brain more and more I find these individuals have much to teach those of us who work with children. The brain issues easily cross the age barrier and therapy is very useful for our students. She had some interesting definitions:
Communication is verbal or non-verbal: listening, speaking, gesturing, reading, writing in all domains of language (phonologic, morphologic, syntactic, semantic and pragmatic).
cognition is processes and systems: attention, perception, memory, organization, problem solving, reasoning, judgment, decision making (executive functioning and frontal lobe stuff)
The domains of Cognition are: Attention, memory and Executive Functioning (the monitor)
Attention deficits are divided into 6 types:
selective attention (ignore interfering background information)
focused attention: stay with one thing
sustained attention: stay with one thing over time
divided attention: multi-tasking
shifting attention: stop on attention and move to another then come back
directed attention:Manage attention, stop and start as needed
Processing speed is the primary problem (not processing skills): most process so slowly that they lose the context of what is happening around them or the listening has moved on.
"Stage" Model of Memory: Stage 1: Encoding or registration (holding and Acquiring Stage 2: Storage or consolidation Stage 3: Retrieval (calling back information for use)
Working Memory: doing all of the above and then holding it and manipulating it in your brain to use it to solve a problem.
She is a good speaker and well worth going to a workshop if you get a chance.
Differential Diagnosis
One of the most difficult and most critical things that a speech/language pathologist is trained to do is differentially diagnose areas of delay. This is usually done on an ongoing basis throughout therapy. However, a generally good article appeared in The ASHA Leader written by Edythe A Strand and Rebecca J. McCauley. It shows the difference between Dysarthria (motor speech disorder), CAS (Childhood Apraxia of Speech) and Phonological Disorders. Dysarthria usually involves neurologic signs, usually accompanied problems with feeding and oral-motor concerns. The intelligibility is poor and usually no family history of speech problems. CAS is a problem with planning the sounds. The child may be able to produce a sound when not trying to but when thinking about it they cannot produce it. They may not be able to blend one sound into another without great difficulty. Their errors are unusually and they maybe able to produce developmentally more difficult sounds but struggle with vowels. Often these disorders are not exclusive of one another and therapy must be done by a licensed speech/language pathologist with experience in these areas.
AAC Devices
Some interesting changes with AAC devices. Our clinic has been using the proloquo2go for sometime now and many students are very successful with it. You will need to purchase the external speaker and case , however. Also if you get it on the itouch you will not have an internal camera and you will have to download your pictures from another source into the itouch and then into proloquo2go. Boy is it nice to have the camera. I just see an item the students should add or a field trip he/she is on and take a picture, download to the proloquo2go and they have it immediately , very nice.
PODD: this is a communication device (book but has a download too) developed in Australia: It requires a communication partner to turn the pages. This is to facilitate a more social use of the communication device and to encourage a greater use of cognitive processes. However, one size does not fit all. If your child is using a system now and it is going well, be careful about changing. We will see in the future how successful this system is but each child should have a system specifically designed for themselves. Many children do better with voice output devices so keep that in mind too. When the facilitator is turning the pages make sure they have not lost the communication moment with the student.
Talk to your speech pathologist about the pros and cons of any AAC device for your child/ student. |
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