golden rule for SLI assessment?

poor performance on non-word repetition test
--however only normed for age 5+ so SLI often not identified as early as we would like

informal assessment SLI

-transdisiplinary play based assessment
-Mac Aruthur Bates CDI

3 assessments for toddlers (pre-little linguistic)

-Rosetti Infant Toddle Language Scale
-Mac Arthur Bates CDI (language developmental)
-Vineland adaptive behavioral scale (VABS) -- nonlinguistic measures (cog, social, self care, motor speech & feeding)

Long term goal child language

Student will understand and use grade/age appropriate vocabulary

example articulation goal

accuarately articulate the following phonemes / / with 80% acc allowing for min cues (or allowing for visual and verbal cues) at the ____ level in the ___ position
will produce the phoneme /k/ in all word positions at the conversation level

long term goal articulation/phonological disorders

will produce all age appropriate phoneme in all word positions or reduce the use of
all age appropriate
phonological processes at the conversation level

stuttering modification techniques

-pull out
-preparatory sets

phonological processes that should disappear by age 3

-final consonant deletion
-weak/unstressed syllable deletion
-fronting (of velars)

phonological processing that naturally persist past the age of 3

-consonant cluster reduction

things to look for on oral motor exam


informal dysarthria assessments:

-diadokinetics (AMRs & SMRs)
-speech sample (conversational or reading)
-sustained vowel (listen for vocal quality)
-oral mech
-speech stress test (to elicit fatigue) -- count to 100 (myasthenia graves)

CAS characteristics

1) volitional speech worse than automatic speech
2) inconsistent speech errors on same target
3) impaired prosody
4) more errors as complexity of utterance increases (due to increased motor planning)
5) groping/silent posturing

language form start to approximate the adult model

5-6 years old

beginning to use figurative language

age 7-8 (luke)

adjusts language to the listeners age

4-5 years (claire)

object permanence (the knowledge that an object exists even when it is not in sight)

7-9 months
--uncovers hidden object
--variegated (non-reduplicated babbling)
--just before joint attention

when is joint attention established?

9 months
--illocutionary - intention without words
--understanding between two people that they are both interested in the same object

pre-linguistic assessment of non-linguistic skills
--motor speech & feeding, cognitive, social and self help
infants & toddlers

vineland adaptive behavioral scale (VABS)

when start to combine 2 words?

18-24 months
-when expressive vocab reaches 50

first morphemes to develop

- present progressive -ing
- plural inflections -s
- prepositions on, in
2-3 years

perlocutionary stage?

0-8 months
-non-intentional communication however adults often interpret it as intentional

Ilocutionary stage

9-12 months
-intentional communication without words
-joint attention
-protowords (gestures matched with consistent vocalizations/intonation patterns) ~~ represents symbolic relationship

locutionary stage?

12+ months
-intention + words

morpheme development:
2-3 years
3-4 years

-present progressive -ing
-irregular past tense verbs
-regular past tense -ed
-3rd person singular present (daddy cooks)
-auxiliary & coupla verbs

informal assessment:
Language Sample Analysis (LSA)

-picture description
-narration (tell a story)
-situations that elecit certain grammatical forms more often ie. retelling story elicits past tense morphemes
*MLU (follows age)
*TTR (type token ratio) >.5

5 aspects of language to assess

1. morphology
2. syntax
3. semantics
4. pragamatics
5. phonology (phonological awareness)
Literacy (phonological awareness precursor)

TOLD? (test of language development)

TOLD-P (primary) ages 4-8
TOLD- I (intermediate) ages 8-18

formal assessment TBI
early phase (RLA 1-3)
middle phase (RLA 4-6)
late phase (RLA 7-8)

1) JFK recovery scale
2) Rappaport Coma Scale
1) GOAT - PTA & orientaiton
2) O-Log - Orientation
1) FAVRES - higher level
4) SCATBI - specific TBI

adult assesses both language and cognition


parameters to be assessed for voice

1. acoustic (frequency, intensity, jitter, shimmer)
2. areodynamic (air flow & pressures)
3. physiological (direct laryngeal visualization: nasal flexible endoscopy
4. neurological (stroboscopy - visualization of VF vibrations)

voice assessments

- perceptual/subjective vocal quality
- objective (acoustic qualities - fundamental frequency, intensity, jitter, shimmer)
Voice Handicap Index
-direct laryngoscopy

Formal assessment of fluency

- stuttering severity insturment
- stuttering prediction instrument

Formal Assessment of Phonology

1) TOPAS (test of phonological awareness skills)
-Bailey ate topas and then called me on the phone
2) KLPA- Khan Lewis phonolgoical analaysis
-kahn artists on the phone
1) Goldman Fristoe Test of Articulation (GFTA)
2) Arizona Test of Articulation

formal assessment adult apraxia

ABA - apraxia battery for adults

hallmark of conduction aphasia (fluent)

profound deficits in repetition and oral reading with other language modalities a relative strength
-spared auditory comp but similar fluent verbal output

formal assessments CAS

-Kaufman Speech Praxis Test (KSPT)
-Apraxia Profile
-Goldman Fristoe Test of Articulation (GFTA)

formal assessments RHD

-MIRBI -mini mental inventory of right brain injury
-BURNS - right hemisphere subtest
--RHD have pragmatics I have to address that feels like a burn

what are the first deficits to treat for cog (RHD, TBI)

-attention & arousal

informal ways to assess for left neglect

-cancellation task
-clock drawing
-description of visual scene (cookie theft/Norman Rockwall photos)

3 formal assessments for aphasia

(high functioning)
(lower functioning)
---both give classification for aphasia type
- porch index of communication ability
**sitting out on porch listening to the song aphasia

description of non-fluent output

-slow, halting, effortful
-telegraphic, agrammatic
-content words (nouns/verbs) w/ no function words
-word finding errors (all)
-aware of errors & can become frustration by comm breakdowns
-decreased prosody
-decreased length of utterance

description of fluent output

-effortless, rapid rate
-pressed for speech (verbosity)
-empty, vague, meaningless content
-unaware of deficits
-less content words & overuse of function words
-jargon/neologisms --> paraphasic errors (semantic & phonemic)
-word finding errors (all)

formal dysphagia assessments

1. MBSS -instrumental
2. FEES - instrumental
3. SAFE - safe swallowing ability and function evaluation
----standardized protocol for bedside assessment of dysphagia

3 non-fluent aphasias

transcortical motor

3 fluent aphasias

-transcortical sensory
-conductive (really bad repetition & oral reading but spared auditory comp)

area of brocas area?
area of wernikes area?

posterior, inferior frontal lobe
posterior, superior temporal lobe

3 informal assessments to give for dysarthria

-speech sample or reading sample
-AMRs & SMRs
-prolonged vowel (check for vocal quality)

dysarthria formal assessments

-FDA - frenchay dysarthria assessment
-Dysarthria examination battery
-AIDS - assessment of intelligibility of dysarthric speech
**french sound like slurred speech
**got aids in france
(the French got aids)
(Freddy mercury got aids in France -- his speech

assessments dementia

-MMSE - mini mental state exam
-MoCA - montreal cognitive assessment
-SLUMS - st. louis university mental status exam
**dementia thinking back i used to drink a moca in the slums back in the day

what assessment would be good if you have both language and cognition going on?


Treatment ASD

-focus on social communication & emotional regulation by using transactional supports (visual and environmental changes and adult communication adjustments)
--more natural interventions with a focus on informal settings and increasing adult r

3 ideas for treatment focus for SLI

-focused simulation - bombardment of good/targeted language models
-understanding wh questions (helps with academic success)
-comprehension (following 2 steps commands/directions)

informal assessment SLI?

-criterion referenced tests?
--MLU, NDW, TTR, variety of words and sentence structures used
-parent interview (Mac Arthur Bates CDI= up to 3 years - standardized parent report form to track language + communicative skills)? can use it informally if c

formal assessment SLI (preschool- schoolage)

-CELF- P or 5

Formal Assessment Autism

- autism diagnostic observation schedule **gold standard dx autism

pragmatic skills to work on

-joint attention (eye gaze to direct comm partner attention)
-topic maintience (across 3 conversational turns)
-topic initiation
-turn taking
-social greetings & farewells (look at eyes, use a kind voice, greet partner - familiar & unfamiliar)

Goals of voice therapy

1. restore efficiency and function of vocal production
2. minimize impact stress of vocal folds
3. minimize phonatory effort
4. maximize vocal efficiency (power, projection of output)
5. improve coordination between respiratory system + laryngeal valving

phonological processes that should disappear before age 3 (treat first)

1. final consonant deletion
2. weak/unstressed syllable deletion
3. fronting

phonological process that persist after the age of 3

1. gliding
2. consonant cluster reduction
3. stopping

treatment for hyper-functional voice disorders (excessive laryngeal muscle action (too forceful of adduction); not enough airflow)

1) increase airflow (output)
2) decrease laryneal muscle action for phonation
3) increase coordination between phonatory and respiratory system
1. resonant voice therapy
--attending to sensory information -- feeling vibrations in face/mouth not throat/VFs

treatment for hypo functional voice disorders (deconditioning & weakness)
ie. presbyphonia (age-related atrophy) & VF paresis/paralysis (RLN- vagus damage)

1. hard glottal attack (push/pull on chair to strengthen laryngeal adduction)
2. vocal function exercises to increase glottal contact
3. biological/vegatative functions ie. throat clearing, coughing to get VF to adduct through natural biological functions

indirect treatment for voice disorders?

modify environment or vocal behaviors to reduce severity of condition and prevent future issues from occurring
-vocal hygiene
-teaching about the voice itself actually works
-ID internal & external irritants

informal perceptual analysis of voice looking at

1. pitch
--appropriate for gender & age
--pitch breaks (spasmodic dysphonia)
--monopitch (Cricopharyngeal)
-pitch range (if can't go high then decreased laryngeal elevation)
--low pitch= increased mass = lesion?
2. loudness (able to project)
3. vocal qual

purpose of effortful swallow (squeezing hard all the way down)

-increase pharyngeal stripping wave
-increase BOT retraction and connection to posterior pharyngeal wall

Purpose of Mendelsohn Maneuver (hold thyroid up to prolong laryngeal elevation)

increases UES opening and duration (less pharyngeal residue left behind)

CN X - Vagus controls

-larynx (voicing)
-velum (soft palate - VP closure for resonance & swallowing)

why thicken liquids?

delayed swallow reflex -- takes longer to get down

recommendations for delayed swallow

-thicken liquids
-chin tilt (widen vallecula and allow to pool there)

Lidcombe Program

A parent-administered treatment in everyday/home environment in which positive reinforcement is provided for stutter-free speech, and correction is used following stuttering.
(preschool age)

what if foundation for literacy?

phonological awareness
--target in language therapy early on!!
~~syllable awareness
~~phoneme isolation
~~ sound blending

idea for pragmatic goals

-turn taking across 5 turns
-joint attention for X minutes
-use eye contact to direct comm partners attention
-personal space (arm length distance)
-greeting familiar/unfamiliar comm partners - look in eye and say hello with kind voice
-inititate conversa

order of morpheme development

1. present progressive -ing
2. prepositions on, in
3. regular plurals -s
1. irregular past tense (came, went)
2. possessives -s
3. articles a,an,the
1. regular past tense -ed
2. regular 3rd person -ie. daddy cooks
3. auxiliary/copula verbs

which morphemes would you target first?

-present progressive -ing
-plurals -s
-prepositions on, in
***these are the first to develop

ways to informally assess written expression

**consider non-dominant hand
-confrontaional writing
-biographical information
-picture description (cookie theft or Norman Rockwell pictures)

informal assessment of verbal expression

-imitating sounds/words
-automatic phrase completions
-automatics - count to 10, days of week
-confrontational naming
-picture scene description - action card description - normal rockwall pictures, cookie theft

informal assessment reading comprehension

-matching words to objects/pictures - LARK Kit
-matching letters
-matching words
-complete phrases from f/o: 2

non-fluent aphasia characteristics

-broken, halting, slow speech (limited, effortful output)
-agrammatic, telegraphic
-mostly content words, no function words (grammar)
-word finding (anomia)
-co-morbid apraxia common
-reduced prosody
-spared comprehension
-right sided paralysis/paresis (h

fluent characteristics

-press for speech/hyperverbose circumlocutions (talk around)
-empty speech
-rapid rate of speech
-anomia (word finding)
-effortless speech
-jargon/neologisms --> paraphasia
-not aware of/unbothered by errors
-impacted auditory comprehension

informal assessment fluency

1. family report
2. teacher report
3. observation in environments outside of therapy (speech recordings)
4. speech sample for fluency count (>10% disfluencies) in different environments & different communication partners
*capture a variety of speaking sit

things to look for in informal assessment fluency (various speech samples in a variety of speaking situations and with a variety of communication partners)

-frequency of disfluencies (>10%) (book said 5 so it depends on who you're talking to.. so I would say between 5-10%)
-types of disfluencies (blocks, prolongations, repetition)
-duration of disfluencies (longer than 1 second)
-severity of disfluencies

formal assessment stuttering (fluency)

-OASES (feelings)
(stuttering severity & prediction istruments)

stuttering modification/manage stuttering approach

modifies moments of stuttering (to stutter in a more relaxed way)
-address fear & anxiety
-reduce/eliminate avoidance behaviors
-voluntary stuttering
-teach compensatory strategies to stutter easier
---cancellations, pull outs, preparatory

fluency shaping/fluency management technique

-does not address/focus on feelings/emotions about stuttering
-teach techniques to apply 100% of the time to PREVENT you from stuttering
---easy onset, soft articulatory contact, slow rate
-goal: spontaneous fluency

with a delayed swallow what is a affected most?

thin liquids -- can aspirate from pooling & residue

treatment for hyper functional voice disorder

-increase airflow
-decrease phonatory effort of VF/tension
Easy onset of voice
Continuous phonation
Flow phonation
Resonance (forward focus- attend to sensory info -- feeling vibrations in mouth/face not throat)

treatment for hypo-functional voice disorders

-hard glottal attack
-valsalva maneuver: push/pull on chair to increase laryngeal adduction (false VF)
-vocal function exercises to increase glottal contact
-biological/vegetative function: coughing/throat clearing - get VF to close throat natural biologi

purpose of flow phonation treatment

-increase airflow
-decrease laryngeal muscular forces
-increase coordination between respiratory & laryngeal subsystems
**only treat if have respiratory weakness

informal assessments voice

1. oral mech
-maximum phonation time (18-25 seconds)
-s/z ratio >1.4 laryngeal issue
-sustained vowel to listen to vocal quality
-Grandfather passage - listen to vocal quality
2. perceptual analysis of recorded speech sample
3. stimulability testing - see

overall goal for dementia

maintain effective communication with others to maintain quality of life as long as possible

use oral motor exercises on what

dysarthria & dysphagia

2 go to treatments for dysarthria

-oral motor exercises
-intelligibility strategies (increase loudness, pause, slow rate, wide mouth, over articulation)
-diaphragmatic breathing exercises if respiratory system is affected

treatment ataxic dysarthria

-uncoordination, unsteady (drunk like)
*slow continuous/controlled exhalation coordinated with onset of voice (increase coordination respiratory and phonatory systems)
*rate control (due to unsteady speaking rate): metronome, tapping, pacing b

hypokinetic dysarthria meaning

-not muscle weakness like flaccid (decreased strength/floppy like) but just decreased movement!
--so much rigidity it decreased ROM
**only dysarthria with increased speaking rate