Showing papers in "Seminars in Speech and Language in 1997"

The aging voice

Abstract: A number of studies have found that listeners are often able to differentiate the voices of young and old speakers accurately. Following an overview of structural and functional changes found in studies of aging larynges, this article examines current findings on maximum phonation duration, voice quality, vocal jitter/shimmer, spectral noise, and fundamental frequency. Aging can affect vocal pitch, loudness, and quality, but such effects are highly variable across the aging population. Therefore, a thorough voice and medical examination is needed to isolate voice problems caused by vocal abuse or pathology from those due to normal aging. Pushing exercises may be a viable treatment option for those with age-related voice problems.

Common feeding problems in the intensive care nursery: maturation, organization, evaluation, and management strategies.

Abstract: This paper reviews current literature on feeding and swallowing of the premature and high-risk infant. If addresses issues of maturation and organization that affect feeding abilities. Evaluation issues including instrumental evaluations (e.g., cervical auscultation, modified barium swallow studies) are discussed. Finally, common problems seen in this population are described along with the wide range of management strategies to consider. Whenever intervening with this fragile population a team approach must be used; the individual needs and behavioral cues of the infant must be read, respected, and responded to, while ensuring that families play an integral part of the process.

Speech Production of Normally Aging Adults

Abstract: A number of changes in older adults' speech characteristics accompany aging. This article reviews the changes usually perceived in elders' speech, then focuses on several key components of older adults' speech that account for these changes: vowel productions, voice onset time and phoneme segment duration, and speaking rate. Although laryngeal factors are evident in older voices and associated with declining physiological conditions, certain changes are associated with advanced age.

Discourse Behaviors in Older Adults

Abstract: An overview of the changes in older adults' comprehension of language and discourse is provided before changes in production are discussed in some detail. Age-related changes in discourse production have been studied in terms of semantic skills, syntactic complexity, verbal fragmentation, information load, cohesion, macrostructural elements, and conversation. In spite of the heterogeneity in older adults' discourse behaviors, they have a tendency to use shorter, less complex sentences and more indefinite, ambiguous references. Nevertheless, the basic conversational skills of the normally aging elderly are usually well preserved.

The emergence of repair strategies in infants and toddlers

Abstract: This article describes the emergence of repair behaviors in young children as a reflection of three significant developmental achievements: the emergence of communicative intentionality, the development of socioemotional perspective taking, and the acquisition of effective communicative means. Because research in the emergence of preverbal communicative repairs is limited, a cross-sectional study was conducted on the ontogeny of repair strategies using the normative samples from the Communication and Symbolic Behavior Scales (Wetherby & Prizant, 1993). Patterns of early repair behaviors of typically developing children, as well as those of small groups of children with hearing impairments and pervasive developmental disorders, are presented. Findings of this study suggest that the ability to repair communicative breakdowns develops at the same time as intentional communication and that gestures are integral to preconversational repairs. Assessment and intervention implications for clinical practice are discussed.

Behavioral Issues and Implications with Pediatric Feeding Disorders

Abstract: Behavioral and interactional aspects of feeding problems are considered within a "total" child approach. Basic principles and guidelines for optimal feeding relationships are presented within a developmental framework. Factors that can underlie behavioral components are discussed. Children with limited appetites and food refusal typically demonstrate poor weight gain, or even weight loss, and are diagnosed as failure to thrive (FTT). Management of their food avoidance is designed to make the eating process enjoyable and nutritionally adequate.

Normal aging and environmental effects on communication.

Abstract: This article focuses on the role of communication in the successful adjustments and adaptations to normal aging by elders. It views communication as an essential tool for living safely and independently, for maintaining interests and a sense of purpose, for continuing important social and family relationships, and for exercising active control over quality of life and care. The discussion emphasizes the importance of physical and social environments to elders' communication efforts and suggests that an environmental approach to the communication problems of many elders may be more beneficial than the remediation of specific speech-language skills.

Pediatric feeding/swallowing teams.

Abstract: A team approach is advocated for the evaluation and management of children with impairments in deglutition. The complexity of their needs requires the coordination of evaluation and management efforts so that the impact of a child's feeding/swallowing impairment on general health, development, and overall well-being may be addressed. This article reviews the rationale supporting the use of a team approach, the organizational structures of teams, and the challenges of using a team model of service delivery to meet the needs of this population.

The role of support groups and stuttering therapy.

Abstract: Support groups for individuals who stutter provide an opportunity for consumers to incorporate emerging or newly learned fluency skills in speaking situations outside of the speech-language clinic. One major theme of this article is to promote the idea that support groups can be utilized by clinicians and consumers as an important adjunct to fluency therapy. In addition to addressing feelings and attitudes associated with stuttering, the supportive environment of such groups serves to provide individuals who stutter with opportunities to work on improved communication skills with several different communication partners. For many, this is an important step in the successful transfer of fluency skills from the clinic to the "real world."

Age-Related Effects on Speech Fluency

Abstract: This article provides a brief review of age-related changes in speech production before discussing fluency changes that have been found in aging, nonstuttering speakers. Most studies agree that old and young adults evidence similar frequencies of disfluency. The disfluencies of a 105-year-old woman were compared to the means of several geriatric groups whose average ages were more than 20 years younger. Overall frequencies and types were similar. Thus, aging speakers' fluency does not appear to be more susceptible to breakdowns than that of younger speakers, although there is some evidence that elderly speakers become much more disfluent than younger speakers under stressful conditions.

Nutrition assessment and management in pediatric dysphagia.

Abstract: Nutrition focuses on the intake and use of food material, whereas swallowing serves as the primary method of delivery for this nourishment. Swallowing dysfunction may compromise an infant's or child's ability to meet nutritional needs resulting in potentially long-lasting sequelae from the malnutrition. This article reviews clinical presentations of nutritional compromise; strategies for both oral feeding and enteral tube feeding regimens, including the provision of adequate fluid; and nutritional issues of specific pediatric populations who are at high risk for dysphagia.

Parents as Partners in the Treatment of Childhood Stuttering

Abstract: Speech-language pathologists involved in treating childhood stuttering have increasingly emphasized the need for parental involvement in intervention. In this article, we review prevailing theoretical models of stuttering and illustrate various ways in which these models can be used to guide practitioners in determining how best to include parents in intervention. We argue that successful parental involvement depends upon the ability of parents and clinicians to reach consensus on issues such as the parents' role in the onset and development of stuttering, the rationale for including parents in fluency intervention, and the importance early intervention. The article concludes with a discussion of specific ways that parents can assist in intervention through modeling, managing conversational pace and complexity, and, in some cases, directly instructing their children.

Brothers and sisters of young children with communication disorders.

Abstract: Family-centered approaches have revolutionized the way that clinicians provide services to young children with communication disorders and their families. With greater recognition of the significant impact that siblings have on each other's development and the potential stress and role confusion that siblings may experience when there is childhood disability in the family, it becomes more critical that the needs of siblings are considered and addressed. In this article, a variety of issues are considered relative to siblings' experiences. First, the roles of siblings and their effects on each other's development is reviewed, followed by a historical perspective of the impact of childhood disability on brothers and sisters. Next, sibling roles relative to a brother or sister with a communication disability are considered. Finally, clinical implications are discussed, with specific reference to active inclusion of siblings in family-centered assessment and intervention efforts.

Effects of aging on neuromotor processes of swallowing.

Abstract: Isolated swallowing difficulties are present in a substantial percentage of elderly adults. Most have no known medical basis, although some may be caused by underlying, but undetected, medical conditions. Others may result from conditions that indirectly affect swallowing. After an overview of the neuroanatomy and neurophysiology of swallowing, this article reviews findings on changes in swallowing that accompany aging. Some of the differences reported have failed to be replicated consistently, and other changes are subtle, their significance unknown. Most studies, however, have found decreased sensitivity in both the oral and pharyngeal cavities. It is concluded that additional objective clinical measures are needed to isolate changes in swallowing due to age from those resulting from other causes. Clearly, further research is needed.

Dysphagia with respiratory/pulmonary presentation: assessment and management.

Abstract: Breathing and swallowing are two of the most important basic functions that must be established at or soon after birth. Although each function serves a different purpose, they are intimately related by virtue of their sharing the same anatomic conduit for air and food. Thus, problems associated with swallowing and feeding can present with airway symptoms, and conversely, an airway problem may be made worse by feeding. This article discusses functional anatomy in relation to the clinical manifestations of airway problems in children with feeding problems. Evaluation and treatment of the most common problems by anatomic location is described, and the special complications of tracheotomy, chronic aspiration, and chronic sialorrhea (drooling) are considered in detail.

Considerations for conducting group intervention with adults who stutter.

Abstract: With recent changing trends in healthcare delivery and reimbursement, the focus on more efficient and cost-effective intervention has become increasingly important. A summary of desired clinician skills and responsibilities reported in the literature are presented along with information on structuring group intervention. Preliminary findings and a rationale for conducting speech therapy in a group environment with several adults who suffer are presented. In addition, findings and perceptions gleaned from the authors' experience in conducting group treatment with persons who stutter are also discussed.

Ethical considerations in pediatric dysphagia

Abstract: Speech-language pathologists (SLPs) are bound by ethical codes that reflect professional and institutional commitments. When professional activities involve working with children with dysphagia and other complex medical issues, SLPs frequently must make judgments that have bioethical implications. This article reviews general ethical theories and principles, examines SLPs' ethical commitments, and presents an approach for ethical decision making and reasoning. Case studies of children with dysphagia are presented to illustrate ethical dilemmas.

Normal aging and human physiology.

Abstract: This article discusses the physiological changes that accompany normal aging and current understandings of how environmental factors interact with a person's genetic mechanisms to slow or speed up the aging process. Chronological age is contrasted with biological age to illustrate the different rates and extent of anatomical changes and functional declines observed in older people of the same age, behaviors that appear to delay or reduce the inevitable progression of sensescence, the extraordinary heterogeneity of the aging population, and the complexity of the processes responsible for the consequences of human aging.

Family adaptation to a child's feeding and swallowing disorder: a social work perspective.

Abstract: The various tasks and demands faced by families of children with feeding and swallowing disorders are complex and multifaceted. While families' adaptations are idiosyncratic, there are systemic patterns of adaptation which consistently reflect issues of crisis, resilience, and change. A family systems perspective is used to describe the various cognitive, emotional, and social adaptation tasks of families with children who have dysphagia. Kubler-Ross's model (1969) for the grieving process is applied to the process of coming to terms with a child's difficulties and reaching an adaptive status.

The speech-language pathologist's role in stuttering self-help groups.

Abstract: This article reviews definitions of self-help and support groups, describes some basic views that speech-language pathologists and self-help groups have of each other, then comments on ways in which professionals are relating to self-help groups. These comments are based on answers to a questionnaire distributed to a sample of speech-language pathologists who interact with self-help groups. It is recommended that speech-language pathologists should relate to the self-help movement in stuttering as consultants.

Stuttering therapy in the elementary school setting: guidelines for clinician-teacher collaboration

Abstract: This article describes guidelines for developing an effective collaborative/consultative approach to the treatment of stuttering in an elementary school setting. Four primary areas of shared clinician/teacher responsibility are discussed, which include: education, observation, facilitation of fluent speech, and generalization of speech fluency. Although the speech-language pathologist should initiate the teacher's involvement in a child's therapy, both the clinician and teacher should work toward developing a mutually influential partnership, through which the specific needs of individual children who stutter can be addressed in a comprehensive manner.

Normal aging and the multicultural population

Abstract: This article documents the dramatic increase expected in the number of people over 65 years of age who will be living in the United States during the first half of the 21st century and describes how the age, health, and ethnic differences of this expanding group will comprise an extremely heterogeneous subpopulation. Differences in how aging and the health problems that accompany it may be viewed are discussed in terms of cultural influences and traditions. It is suggested that such differences in a growing segment of the population that is likely to have increasing needs for speech-language pathology services in the years ahead could pose significant challenges for the profession.

Gastroesophageal reflux disease and dysphagia in children.

Abstract: Gastroesophageal reflux disease (GERD) is a common problem in children that is sometimes associated with dysphagia. Choking, food refusal, and food "getting stuck" are non-specific symptoms that may arise consequent to reflux and esophagitis. Swallowing plays a role in reflux physiology, functioning as a major clearance mechanism after reflux episodes. Therefore, failure of swallowing to effectively perform that function contributes to reflux pathophysiology. The diagnosis and treatment of GERD in children must be carried out systematically and thoroughly. Multiple interacting factors are common, thus complicating the process.

Developing assistive technology strategies for infants and toddlers with communication difficulties.

Abstract: Communication is a process that begins at birth and continues throughout life. For young children with developmental delay or disability, the acquisition of expected communication skills may be compromised. Compromised communication skills, in turn, may lead to additional challenges when participating in daily activities and routines, forming social relationships, and developing independence. Assistive technology (AT) is one means by which a child's current communication skills can be expanded and enhanced within the child's natural environment. Increased awareness by both parents and professionals of the availability of AT has led to the inclusion of AT strategies within routine day-to-day early intervention practices. This article briefly highlights early aspects of communication development in typically developing infants and toddlers, then provides a framework through which AT strategies can be identified and utilized by parents and professionals to improve a child's existing communication skills.

Workplace in fluency management: factoring the workplace into fluency management.

Abstract: This article addresses competency-based standards and guidelines for the involvement of speech-language pathologists in the workplace of clients who stutter. It advocates broadening customary practices in stuttering treatment and suggests that speech-language pathologists should extend their scope of service delivery to the workplace. It presents a sequence for the collaborative involvement of the employer and other workplace members and proposes strategies for evaluating workplace based fluency programs. Issues of fluency management, transfer, maintenance, and efficacy are discussed in the workplace context. Also addressed is workplace communication as well as such factors as stereotypes, discrimination, and resistance to change which may impinge on workplace intervention. It is argued that structured intervention, transfer, and generalization within a collaborative workplace framework facilitates best practice for the fluency clinician and more appropriate outcomes for the diversity of clients who stutter.

Spouses as adjuncts in fluency therapy.

Abstract: Couples with one partner who stutters completed questionnaires about the fluent partners' awareness of their spouses' stuttering; their general knowledge about stuttering; how fluent spouses had helped their partners; and the nature and benefits of spousal participation in therapy. Findings strongly suggested that spouses may be helpful in therapy. Considerations and suggestions for involving spouses are made on the basis of these findings and those of surveys completed by speech-language pathologists (SLPs) who include spouses in fluency therapy.

A treatment protocol for young children at risk for severe expressive output disorders.

Abstract: The proposed protocol is intended for use with young children who are at risk for severe expressive output disorders in the presence of typically developing receptive, play, and cognitive abilities. It is specifically designed for children who exhibit avoidance of verbal interaction and poor imitative skills. The approach follows a normal progression of sound and syllable structure development and is sequenced so that targets emerge into conversational speech as soon as possible.