From the President: The Turn of a Phrase

“Habilitative/Rehabilitative Services” Is Heart of Health Reform

Hale, S. (2009, November 24). From the President: The Turn of a Phrase : “Habilitative/Rehabilitative Services” Is Heart of Health Reform. The ASHA Leader.


As health care reform dominates the news and the attention of both houses of Congress, an inescapable truth confronts our professions. If a health reform bill passes—and it is likely that one will—audiology and speech-language pathology services will be embedded in the phrase “habilitative/rehabilitative services.” Much like the hopefuls on American Idol, with this phrase we are either “in” or “out” of the reform package. If this language is part of a bill that is enacted into law, we can celebrate a significant advocacy achievement.

The key word is “habilitative.” Children born with communication disorders—those needing habilitative rather than rehabilitative services—have been left out of too many insurance plans for far too long. Many of us have experienced denials for children with communication disorders by insurers who refuse coverage for speech-language or audiology services. Particularly troubling is a growing trend in the insurance industry of dropping coverage for children who need habilitative services. Insurers claim that children born with disabilities are developmentally delayed and that their care should be addressed in educational settings rather than in the health care system.

This approach is at odds with the evidence base of our discipline. We know that the best time for cochlear implantation, hearing aids, early intervention for autism and other disorders, or augmentative and alternative devices often predates a child’s eligibility for educational services.

Children born with cognitive or communication disorders have the same needs as adults with pre-existing conditions—and, like those adults, should not be tossed aside by the insurance industry. It is indefensible to deny services to children born with cognitive or communication disorders but cover rehabilitation services for those who have acquired the same conditions. This predatory practice must end. Habilitative services must be a basic benefit, provided by all insurance plans.

Never underestimate the impact of a single word in legislative language—or even basic punctuation—on our professions and the people we serve. After all, it was an inadvertent comma inserted by legislators in the Medicare law that placed speech-language pathology and physical therapy services under a single financial cap. As a result, ASHA has had to advocate tirelessly for successive overrides to the cap. So the power of a word or phrase can make a tremendous difference—and in the case of “habilitative/rehabilitative services,” a positive one.

Children with congenital communication disorders have had no direct voice or vote in the recent congressional debate, but their concerns have been central to ASHA’s grassroots advocacy. Getting this language into all the proposed health reform bills was not easy. Many thanks to all of you who sent letters to members of the Senate Finance Committee when the committee’s proposal did not include that critical language. We must maintain our vigilance to ensure that it remains in the legislation and that we are able to respond immediately if the situation changes. Regardless of our feelings about specifics of the final bill or our personal politics, audiologists and speech-language pathologists and those whom we serve cannot risk being left out of any bill that goes to the White House for a presidential signature.

On your behalf, I have communicated with Sens. Max Baucus and Charles Grassley to urge inclusion of habilitative services in health care bills. Along with ASHA’s governmental affairs staff, we pointed out that many communication disorders are medical in nature and caused by neurological injuries or dysfunction that affect acquisition of communication skills. We emphasized that early and appropriate intervention can mitigate the need for intensive services in the future, thereby reducing costs and improving the overall health and well-being of children and enhancing the opportunity for independence and success as adults.

Federal health plans are embracing habilitative speech-language and audiology services. Beginning in January 2010, insurance companies under the Federal Employee Health Benefits Program will be required to provide these services. In the bigger health care reform debate, we should celebrate this recognition of the value of speech-language and audiology services and broadened coverage of habilitative services.

I am hopeful that any health care reform decisions will assure that all children receive the same benefits that members of Congress enjoy and that we will be responsible stewards for the most vulnerable members of our society and give them a chance at a better life. A phrase or a word can make all the difference.

Happy Halloween from your team at Chatterboxes!!

Toddlers Improve Language Development through Block-play

A toddler who plays with blocks may experience improved language development if he/she comes from a middle or low income family, according an article in Archives of Pediatrics and Adolescent Medicine (JAMA/Archives), October issue.

The writers explain "Early childhood represents a critical period in the development of young minds. The newborn brain triples in size between birth and 2 years of age. The long-standing presumption has been that certain activities during this period promote optimal development and that others may hinder it."

Imaginative play can help a child's memory development; it can also develop the roots of impulse control and language development, say the authors. Although an enormous number of toys make claims regarding a child's cognitive development, the majority of these claims are unproven.

Dimitri A. Christakis, M.D., M.P.H, University of Washington, Seattle and the Seattle Children's Hospital Research Institute, and team carried out a pilot study with 175 children, aged 1.5 to 2.5 years. 88 of those children were sent two sets of building blocks, plus two newsletters which offered suggestions for parents about activities the families could do with the blocks. The other 87 children were not sent any blocks until the study had been completed.

The parents had been told that they were taking part in a study of child time use. They filled in a questionnaire about basic demographic information at the start of the study. They provided time diaries that monitored their child's activities during two 24-hour periods during the trial. Six months after the study had started the parents filled in another questionnaire by phone - this included evaluations of their child's language skills and attention.

53% (92) of the families completed at least one diary entry. Exit interviews were completed by 80% (140) of the families. 59% (52) of families which received two sets of blocks reported block-play in their diaries, compared to 13% (11) from the other group.

The authors wrote "In this pilot study, we found that distributing blocks was associated with significantly higher language scores in a sample of middle- and low-income children."

The researchers found that the children who had received blocks had an average language assessment score 15% higher than the other children, indicating that a program that distributes blocks could be effective in boosting development. The scientists also reported that as far as attention scores were concerned, the two groups had similar scores.

The researchers suggest that block play may be replacing other forms of times use which do not encourage language development, such as watching TV.

The writers added "Further study (including laboratory assessments) to corroborate these findings and to explore whether attentional capacity could be significantly improved given a larger sample is warranted."

Arch Pediatr Adolesc Med. 2007;161(10):967-971
http://archpedi.ama-assn.org

Written by: Christian Nordqvist
Copyright: Medical News Today

Chatterboxes Sponsors Autism Speaks Walk 2009

Gene Associated With Language, Speech And Reading Disorders Identified

ScienceDaily (Aug. 28, 2009) — A new candidate gene for Specific Language Impairment has been identified by a research team directed by Mabel Rice at the University of Kansas, in collaboration with Shelley Smith, University of Nebraska Medical Center, and Javier Gayán of Neocodex, Seville, Spain.

The finding, reported in the current issue of the Journal of Neurodevelopmental Disorders, was discovered by examining genes previously identified as candidate genes for reading impairments or speech sound disorders.

The results point toward the likelihood of multiple genes contributing to language impairment, some of which also contribute to reading or speech impairment.

A gene on Chromosome 6 – KIAA0319 – was associated with variability in language abilities in a study of children with Specific Language Impairment (SLI) and their family members, as well as with variability in speech and reading abilities. Children with SLI who were selected for the study had no hearing loss, general intellectual deficit or autism.

Language ability involves vocabulary and grammar, whereas speech involves the accuracy of sound production. Both language and speech ability contribute to a child's ability to read. The finding that a candidate gene could influence all three abilities suggests a common pathway that could contribute to overlapping strengths or deficiencies across speech, language and reading.

According to Rice, "We don't understand the biological mechanisms yet but it's important that we have identified the first gene that could be involved across these three different dimensions of development."

Previous research has established that Chromosome 6 is among those that are linked to Speech Sounds Disorder (SSD) and Reading Disability/Dyslexia (RD). Rice said the findings are consistent with numerous reports documenting that language impairments and reading disability often co-exist.

The study involved 322 individuals, including children with SLI, their parents, siblings, and other family members. "We have come to realize that language really sets the platform for reading to emerge and to thrive," Rice added. "Without a solid language system, it's much harder to get reading going."

The study is part of a 20-year research program conducted by Rice, who is the Fred and Virginia Merrill Distinguished Professor of Advanced Studies and director of the Center for Biobehavioral Neurosciences in Communication Disorders at KU's Life Span Institute. Co-investigators on the genetics project were Shelley Smith, professor of pediatrics in the Department of Pediatrics and the Munroe Meyer Institute for Genetics and Rehabilitation at the University of Nebraska Medical Center, and Javier Gayán, Head of the Analysis Group at Neocodex, in Seville, Spain. Neocodex is a research company that specializes in genomics analysis.

Funding for Rice's research comes from the National Institute on Deafness and Other Communication Disorders, one of the National Institutes of Health.***

Classes teach kids with disabilities to ride bikes – without training wheels

Classes teach kids with disabilities to ride bikes – without training wheels

iPhone/iPod Touch Application for Children with Autism

Chatterboxes offers our clients trial therapy sessions using the iPhone/iPod Touch Application entitled, "Proloquo2Go." (http://www.proloquo2go.com/) We feel that this AAC application is compatible from a clinical perspecitve to more expensive Augmentative Communication devices.

Proloquo2.com notes, "Proloquo2go is a new product from AssitiveWare that provides a full-featured communication solution for people who have difficulty speaking. It brings natural sounding text-to-speech voices, up-to-date symbols, powerful automatic conjugations, a default vocabulary of over 7000 itesm, full expandability and extreme ease of use to the iPhone and iPod touch."

Chatterboxes SLP's are using Proloquo2Go with several children who are non-verbal ad on the Autism Spectrum, with great success. If your child is non-verbal and may need to use a device for communication, please do not hestiate to contact us for our clinical expertise with this product, or to learn whether this device my be a helpful component to your child's therapy plan.

Why Play-Based Therapy?

Play is a powerful vehicle for learning in the early childhood years and a critical source for expanding cognitive, language, motor and play skills. Play is an activity that children do naturally at home, at school and in the community, as it is highly motivating and fun! For these reasons, Chatterboxes SLP's feel that play is an ideal platform for speech and language therapy at the Preschool age.


Play-based therapy is a model of intervention that targets speech and language objectives within the context of play. Therapeutic play, such as this, is characterized by the use of toys and play scenarios within the context of play. Therapy occurs in a natural context, which often facilitates increased generalization of speech and language skills. Play-based therapy is often times less structured than other more standard approaches, and requires creative and flexible thinking on behalf of the SLP (Speech-Language Pathologist). It's these quick thinking SLP's that truly make play-based therapy a success for kids, as they transform arising play scenarios into learning experiences.


The following example of Play-Based Speech & Language Therapy can be illustrated via a previous session with a child whom we'll call Tommy: (Note: One of Tommy's Speech-Language Goals is to begin to use the pronoun "I" in connected speech).


First, Tommy chooses a toy from those available in the SLP's room. Today, Tommy chooses the Farm Set. Tommy, a creative and playful boy, who loves pretend play takes the lead. He implies that all of the farm animals want to play in the mud! The SLP sees an instant opportunity to target Tommy's goal of using the pronoun, "I."


The SLP notes, "All the animals are going to take turns jumping into the mud!" From here, the child and SLP say with great animation, "I jump in the mud!!" as each animal independently jumps into the mud. The animals love playing in the mud and, the SLP explains, "OH NO! The animals are so dirty; They need to take a bath!" As each animal gets in the bathtub he says, "I take a bath!" or "I need soap!" and then "I dry off!"


Aside from using the the pronoun "I" in the context of the play-sequence, the child is learning to take turns, (a precursor to conversational skills), while using imagination and higher levels of thought procesess. Such a play-based scenario promotes carryover of skills learned in therapy to everyday life.

Lisa Olshefski, M.S., CCC-SLP

Speech-Language Pathologist

Chatterboxes

http://www.teamchatterboxes.com/

Pragmatic Language Tips

There are several ways that parents and teachers can help children use language appropriately in social situations.


Some general suggestions are provided below to help children develop language in 3 major pragmatic areas. Although suggestions are geared primarily toward preschool children, they can be modified for use with older children as well.

• Comment on a child's topic of conversation, before introducing a new topic by adding related information. This will encourage the child to talk more about a particular topic.


• Provide visual prompts, such as pictures, objects, or a story outline to help a child tell a story in sequence.


• Encourage the use of effective persuasion. For example, ask children what they would say to convince their parents to let them do something. Discuss different techniques to present their message. For example:

1. Polite: "Please may I go to the party?" vs. Impolite: "You better let me go!"
2. Indirect: "That music is loud." vs. Direct "Turn off the radio."
3. Discuss why some techniques might be more persuasive than others

• Encourage a child to rephrase or revise a unclear word or sentence. Provide an appropriate revision by asking, "Did you mean....."
  
• Show how nonverbal signals are important for communication. For example, talk about what happens when a facial expression does not match the emotion expressed in a verbal message; e.g., using angry words while smiling.

For more information on pragmatic language, please visit www.TeamChatterboxes.com