Wednesday, February 26, 2014

Week 8 Down


8 weeks of the semester down and I feel like I'm coasting into another semester done. May be switching schools in in the fall, may not. It all depends. I will keep you posted. 

Good times with the family I live with and the kids I babysit. They continue to amaze me every day. I continue to think about my future and what it will hold. 

Miss the boyfriend like crazy, but try not to think about that too much. 

Not much else here to report. Class tomorrow, turning in a paper that is half done but will be done by noon tomorrow. Nothing like the last minute to light a fire under your ass. I thrive under pressure. I totally do. 

Monday, February 17, 2014

Clinical Methods Journal Entry 1 Draft

     I received my assignment, clinician, client, and supervisor and can honestly say that I am excited to begin this leg of my journey as a speech language pathology student. It will be exciting to take a step back from my position as a graduate clinician with virtually no preparation into a role where I can watch and learn while doing. My assignment is a 47-year-old male with a diagnosis of anomic aphasia and dysarthria. I immediately start thinking about my neural bases of speech and language course last semester and everything I learned about upper motor neurons and damage to the brain. I want to know so much about how this was sustained, if there was a stroke involved and how long this individual has been in therapy. I learned from reading the file that this is an individual who lives independently in Stillwater. He has been in therapy at the university clinic for eight semesters and. He is a Korean man adopted at age 7 to American parents. I instantly thought about culture and wanted to ask so many questions about culture and background without sounding “nosy.” After all, it is a part of my professional duties. I learned from chatting with my graduate clinician, Kristin Van Ostran, that he doesn’t retain much of the Korean culture because American parents in Oklahoma raised him. I learned that he was a product of the special education system as a youth and has learned how to cope with being an adult and thrive on the job (he works as a bus boy at the country club in Stillwater). On the day of my first observation I meet Ms. Payne in the observation room and she is always so encouraging. She mentions that this client will be a good one for me to work with and will give me many new experiences.

Love it

Warning: Speech nerd post ahead! 

Therapy notes, not necessarily data -- subjective

I need to get better about cuing; I know this. It seems so easy yet so difficult in practice. I know exactly what I am going to say in my head yet it comes out so so wrong out loud. Either that or its the confidence factor. Cognitive therapy isn't hard, but it's hard knowing when to cue and when to shut your mouth as a clinician and let the client think about what he wants to say. Because you know he has it in there somewhere and you know it will get up and out eventually but you only have 50 minutes a session. The clinician I am working with is super at it, either that or she seems super. I just tie myself in knots with the decisions I make in the spur of the moment and then invalidate my data because I didn't think that my cueing was accurate. If it doesn't make sense, then I can't count it wrong, right? This seems silly and maybe I am over-thinking it too much. I do like working with the older population and do enjoy cognitive therapy. I do enjoy research too. So maybe, I was thinking, I need to do the route of an SLP-A that works in a university and does research? Is that a thing?

Humor for the AM in a less than ideal situation

My mother has been up all night with my grandmother who needs emergency surgery. Naturally, being in grad school I said "welcome to my world" and "I bet this is bringing back memories for you." Her response was "never pulled an all-nighter in grad school because I always had two kids to get up and out to school in the morning." Touche. Well-played, I know where I stand now.

Sunday, February 16, 2014

It is a time to celebrate

It may not seem large to someone else, but to me --- its a big deal. I have made it six weeks into my semester. 12 to go. This is how I handle things now. It was moving so slowly, and when I came to this realization early tonight I almost screamed and wrote a big note with a happy face in my planner. I have no tests this week (and after three last week this seems like a big deal) so I can focus on breathing and catching up on things that were meant to be done two weeks ago. My research job is going well and I am learning so much. I have been given so much responsibility which makes me feel good because I know I can do it and continue to learn and grow. The test that I thought I bombed turned out to be a 92. It's not a hard life, only a few hard days. And in the grand scheme of things, everything will work out just fine. Now keep reminding me that so on the bad days I can come back and read this post and learn how awesome I was. What made me be in such a positive mood all of a sudden? I think it has to be the kittens I visited today. I am going to start visiting kittens at the rescue center down the street from me weekly. It will help with my mood tremendously. And I must go because I have clinic at 8:30. Ciao and good night.

Saturday, February 15, 2014

Monday, February 10, 2014

Therapy post

February 10, 2014
8:30-9:20 am

We started with the objective of working memory. The client was given 6 words to read and recall after another task later. The words were planning, working, thinking, writing, reading, and resting. I wonder how they were chosen or if there was a reason they were chosen. He had a difficult time remembering any of them on his own, and with cuing recalled the words planning, reading, and writing. I wondered if he knew the meaning of some of the words, which would affect his working memory because we remember information based on meaning. He kept saying “planting” for “planning” and that affected the rest of his memory because he also said “garden” and “tomato.” It might be a good idea to ask what the words mean as he is reading them for the first time. I am not sure what the purpose of the activity is though, and that would affect the way we do it.

We continued with inferences and assumptions, word retrieval, article practice, and pragmatics practice. During inferences and assumptions, the client was presented with a picture card and told to look at it for a minute. The card was taken away and the clinician asked questions that were already prepared about that picture. There were also inference cards (words and pictures) where the client would have to read a short paragraph and infer things about where they were, what they were doing, and how they felt while doing it. The questions were informal and conversational, and the client appeared to have no problem doing such

Compound words and spontaneous recall prove to be more difficult. After the client was asked to tell the clinician as many compound words as he could remember, he struggled with the task, pausing initially and saying words like “cedar,” “barbeque,” and “apple pie.” He was cued and given the example “mailbox” and then came up with words like “snowball,” “snowman,” “snow bear,” and “ice cream” before admitting that he was thinking of winter words. It’s funny how the brain works and I wonder if he knows what a compound word is or if he was counting syllables.

The article worksheet proved to be too difficult a task when read orally. It wasn’t until the clinician gave the worksheet to the client that he was able to successfully complete the task of identifying the article and replacing it with the correct one if it is wrong. He seemed to do well with identifying, and fairly well with replacing except on the tricky ones like “the airport” and “a security line.”

Pragmatics proved as well to be a difficult task. The client was given scenarios where he had to choose the best response out of four. “You are meeting a friend for coffee and he is two minutes late. What do you do?” A. Tell him to fix his watch, B. Tell him that he is late, C. Don’t worry about it, and D. Greet him and ask how he is doing. Immediately he wanted to tell him he was late. It took quite a bit of convincing from the clinician to convince him otherwise if he was even convinced. Pragmatics seems to be an area to work with.

Today I learned ---- It's OK to do contract work part time.....

But if you try and make it your full time only gig, you as an SLP get screwed....

Had a guest speaker recent graduate from the master's program come talk to our class today, and she just finished her CFY (Clinical Fellow Year --- first year out where you are supervised but still collecting a pay check) at an agency doing contract work for day care centers and families.

She has to do ALL HER OWN BILLING! (And if she does an evaluation and the kid doesn't qualify, she doesn't get paid for that hour, sometimes 2 hours!) I see now why people do this as a part-time after hours gig in addition to their job where they are collecting insurance and have someone that is paid to bill and talk to insurance companies. She said she loved the work, but she is young (23, not married with no kids) and has all the free time in the world, apparently.) I can't imagine how long people do this type of work before they BURN OUT. Just something to think about.

Here are the notes I took.

Dynamic Speech Group
Farah Cox  (405) 226-4911

Non-verbal/Severe population
Billing and reimbursement
Contract work
SLP does all of this herself

Low SES population
Very good people
Hispanic/language barriers
Google translate—translate letters
Caseload of 30 at a time
Sooner care has been approving kids for twice a week
Piedmont, Bethany, Oklahoma City, and Edmond…drive a lot
Homes and daycares
Evaluation contact high
Child doesn’t qualify – no payment

Establish rapport – build trust with people and daycares
Turned off the fact that you want to help
Very rewarding once you get past little things

How do you qualify a child for services?
1. Parent Consent – forms look different everywhere
Name, physician name and phone number – child must go to doctor and the parent must say that speech and language is a concern
Sooner care will deny a submission if the SLP dates for the parent

2. Screening
PLS 5 on an iPad – for a 3 year old
Screening summary
Meet parents

3. Parent note for the Doctor
Sooner Care will deny a “speech-language delay.”
They want more specific information.

4. Permission to Evaluate
Do an evaluate
Write up evaluation
IEP must be submitted
List of 8 items that you must have in order to bill for service

5. Documentation
SOAP Format

6. Milan Medical – Software used for Billing
How long you saw them
Can audit at any time
Billing and invoices are due Monday morning

Chapter 3 Speech Science lecture notes --- hardest class this semester

Chapter 3. Articulatory system
– Spectrographic analysis of vowels and consonants (stops, fricatives, affricates)Lecture 8 – 02/10/14
·      Spectrographic analysis
o   Spectrography is a method of identifying frequency, amplitude, and duration of sounds.
o   Frequency is displayed on the vertical axis, time is represented on the horizontal axis, and intensity of acoustic energy is represented by the darkness of the trace on the screen.
·      Spectrographic analysis of vowels
o   Vowels are characterized by first three formants.
o   They appear as wide, dark horizontal stripes, reflecting the concentrations of intense acoustic energy at those harmonic frequencies that have been amplified by the vocal tract formants.
o   The first format (F1) in vowels is inversely related to vowel height
§  The higher the vowel, the lower the first format (and vice versa)
·      High /i/ and /u/ à F1 ~ 280-310
·      Mid-high /I/ and /ʊ/ à F1 ~ 400-450
·      Mid-low /ɛ/ and /ɔ/ à F1 ~ 550-590
·      Low /æ/ and /a/ à F1 ~ 690-710
o   The second format (F2) in vowels is somewhat related to degree of backness
§  The more front the vowel, the higher the second format (but affected by lip rounding).
Frequency Range
F2 ~ 2250 ~870
F2 ~ 1920 ~ 1030
F2 ~ 1770~880
F2 ~ 1660~1100
·      Spectrographic analysis of Diphthongs
o   A diphthong is a vowel that changes its resonance characteristics during its production.
o   Characterized by first three formant frequencies
o   Produced by uttering two vowels as one unit.
§  This results in formant transitions.
§  Steady-state formants at the beginning of the sound, followed by formant transition, and then another steady-state portion.
·      Spectrographic analysis of Stops
o   Four important acoustic features
§  Silent gap
·      Time during which the articulators are forming the blockage and oral pressure is building up. Seen as voice bar for voiced stops.
§  Release burst
·      Follows the silent gap. Seen as vertical line extending into high frequencies. Lasts for 10 – 30 ms.
·      Seen for stops in initial and medial position, but not for final position.
·      Bilabial stops – diffuse spectrum, with energy spread out over a wide range of frequencies and more energy in the lower frequencies than in the higher.
·      Alveolars – diffuse with increasing energy in the higher frequencies or spread out evenly.
·      Velars – Compact with energy concentrated in a relatively narrow region.
·      Voiceless stops have bursts that are longer in duration due to aspiration.
§  Format Transitions
·      Articulators move from constricted position to open position following the production of the sound.
·      Can occur either from a voiced sound occurring before the stop, or both, lasts around 50 ms.
·      The slope of transitions – depends on the place of articulation of the stop and vocal tract position following the sound
·      A very low F1 – complete constriction of the vocal tract.
·      The transition for F1 starts from nearly zero and increases to the appropriate frequency for the following vowel
§  Voice onset time (VOT)
·      VOT – time between the beginning of the stop burst and the onset of the vocal fold vibration for the following vowel.
·      This is measured in milliseconds and indicates the coordination between laryngeal and articulatory systems.
·      Four categories of VOT – depending on the timing between the release of the burst and the onset of the vocal fold vibration:
o   VOT lead – VOT is negative indicating that the vocal folds are vibrating before the articulatory release (occurs for voiced stops).
o   Simultaneous voicing – voice onset and articulatory release occur at the same time.
o   Short lag – onset of vocal vibration follows shortly after the release burst.
o   Long lag time – vocal fold vibration time is delayed relatively long time after the articulatory release
·      VOTs for Voiced stops –    - 20 ms to + 20 ms
·      VOTs for voiceless stops –     +25 ms to 100 ms
·      VOTs depend on the place of the stop articulation and increases as place of articulations moves backward.
·      Bilabials -  shortest VOTs.
·      Alveolars – intermediate VOTs
·      Velars – longest VOTs
·      Fricatives
o   On a spectrogram – wide band of energy distributed over a broad range of frequencies.
o   Energy in fricatives is much longer in duration than stops.
o   Specific range of frequencies and the intensity of aperiodic sounds depend on the place of articulation of the fricative.
o   Fricatives are characterized by white noise, which is aperiodic sound that has its energy distributed fairly evenly throughout the spectrum.
o   The spectrum for fricatives depends on place of articulation because fricative noise is resonated most strongly anterior to the articulatory constriction.
o   Fricatives that are produced anteriorly (e.g., /f/, /v/, /ϴ/) do not have much of a front resonating cavity, so they have very low-intensity spectrum spread out over a broad range of frequencies.
o   The alveolar and palatal fricatives have more intense acoustic energy at high frequencies because of the way that they are resonated.
§  Stridents (/s/, /z/, /ʃ/, /ᴣ/) have much more intense energy than the nonstridents (/f/, /v/, /ϴ/, /ᶞ/)
·      Affricates
o   They are produced quickly combining a stop with a fricative, so the acoustic characteristics of affricates have elements of both stops and fricatives.
o   Affricates have a silent gap associated with the stop part of the sound.
o   Frication noise related to the fricative portion of the affricate sound follows the silent gap.
o   Fricatives and affricates look very similar on a spectrogram, except that affricates are shorter in duration.
·      Relevant questions for exam(s)
o   Identifying the spectrograms of vowels (your clue would be mainly based on the first two formant frequencies)
o   Identifying the spectrograms of vowels (your clue would be the transition of formant frequencies)
o   Identification of spectrograms of stop consonants (clue would be voice bar (if any), release burst, VOT, and formant transitions)
o   Identification of fricatives (based on the spread of intense acoustic energy)

o   Learn the VOT for voiced and voiceless stops