"Conference Welcome n

Whether you are an audiologist, speech-language pathologist, For consumer and other public interest representatives a student, or any professional interested in learning or keeping CASLPA/ACOA '89 will provide an opportunity to explore up to date with new developments in communication sciences perspectives and points of view in both the working sessions and disorders, CASLPA/ACOA's Annual Conference is an and the less formal conversations which characterize important event for you. CASLPA/ACOA's Annual Conference.

This Conference to be held in Toronto, May ID-13th Come and help celebrate the Association's 25th Anniver­ presents an excellent opportunity for you to compare notes, sary and interact with people of widely varied backgrounds exchange ideas, and touch base with colleagues from all who are involved with the professions of Speech-Language regions of the country. Pathology and Audiology. With your participation, everyone will benefit! The Conference is also a perfect opportunity for you to interact in a less formal atmosphere with CASLPA/ACOA's Uta Deppe Stewart President,Executive Director, National Councilors, and Com­ Anne Godden mittee Chairs on a "one-to-one" basis or voice your concerns Conference Co-Chairs at the Members Forum.

HON LOOKING BACK TO THE PAST, AND DIPPING IN TO THE FUTURE" Presidential Address Awards Banquet Friday, May 12, 7:309:30 pm CASLPAlACOA is celebrating its Twenty­ task force on manpower, and the provincial Fifth Anniversary in 1989. The Awards Ban­ association, SHANS. Involvement with quet this year will provide the opportunity to CASLPA/ ACOA has included an interim review the past accomplishments of the As­ position as National Councillor, membership sociation, to honour those who have con­ on the Committee on Meetings, and the co­ tributed so much to our profession in chairing of the CAS LP A/ACOA Conference Canada, and to look ahead to the next twen­ 1987 in Halifax. ty-five years. During her terms as President-Elect and Norma Wood is the current President of President, Norma had the opportunity to com­ the Canadian Association of Speech-Lan­ plete several projects, including the National guage Pathologists and Audiologists. Since Councillor Handbook and two Briefs on Ser- 1984 she has been an Assistant Supervisor in vice Delivery submitted to National Health the Speech-Language Pathology Division of the Nova Scotia and Welfare. From 1987 to 1989 she has been a Hearing and Speech Clinic in Halifax, Nova Scotia. CASLPAjACOA representative to the Advisory Committee on Health Human Resources, which has been examining the Norma graduated from Dalhousie University School of issue of shortages in the rehabilitation professions. Human Communication Disorders in 1982 and, since that time, has developed interests in all aspects of the profession. Norma has been an energetic, forward-looking president. In addition to her position as a clinical and administrative She has led the Association through a year of considerable supervisor, she has undertaken clinical and academic teaching growth and change. We can be proud to be represented by such at Dalhousie and has maintained an active role in professional an outstanding professional. affairs by serving on local community Boards, a Nova Scotia

JSLPAIROA (HCC) Vol. 13, No. I, March 1989 41 Canadian Association of Speech-Language Pathologists and Audiologists I'Association canadienne des orthophonistes et audiologistes 14th Annual Conference Hilton International Hotel Toronto, Ontario May 10-13,1989

WEDNESDAY, MAY 10

Time Session Presenter Room

3:00-9:00 pm Registration 7:00-9:00 pm Open Reception

THURSDAY, MAY 11

8:15-8:45 am Opening Address 12:00 - 5:30 pm Exhibits Open

9:00-12:00 noon INVITED PRESENTATIONS (Concurrent Sessions) Teaching Language to Language-Impaired Children Connell Toronto I Adult Aural Rehabilitation: Strategies for Assessment and Demorest, Erdrnan Toronto II Intervention (full day) Communication Options in the Acute Care Setting Mitsuda Lismer/MacDonald How I do it! Management of Individuals with Doyle, Leeper et al. U ni versi ty/Adelaidel Velopharyngeal Incompetence York/Richmond

8:30-10:00 am MINISEMINARS (Concurrent Sessions) AirlBone Conduction ABR in Screening for At-Risk Infants Yang, Mencher et al. Casson Workload Measurement System: Real Time Mencher, Hawke et aJ. Varley Analysis/Audit Guide Forensic Applications of the Communication Sciences Hunt Harris 10:30-12:00 noon Use of Self-Esteem in Speech-Language Pathology Saunderson Varley (Concurrent Sessions) Remediation Spoken Language Learning and Deafness: Model for lohnson Casson Maximizing Audition

10:30-12:00 noon PAPERS: SPEECH-LANGUAGE PATHOLOGY I (Consecuti ve Presentations) Pre- and Post-Clinical Voice Evaluation in Roy, Leeper Harris Functional Dysphonia Lesion Size and Location in Buccofacial Apraxia Mintz, Raade et al. Harris Amer-Ind Gestural Code: Means to Oral Communication Silvertnan Hams Augmentative Communication: "It takes more than one." Rothchild, Miller et al. Harris Use of Micro-Computers in Speech-Language Robertson, Murphy Hams Pathology Reports

I :30-3:00 pm MEMBERS FORUM Governor General 1:30-4:30 pm INVITED PRESENTATIONS (Concurrent Sessions) Adult Aural Rehabilitation (continued from am) Demorest, Erdman Toronto II Introducing the CELF-R Wiig Toronto I Cochlear Hearing Loss: Anatomical and Harrison Harris Physiological Changes Remediation of Stuttering in Children Conture Lismer/MacDonald I :30-3:00 pm I've Been Summoned - Now What? Williams Governor General

42 JSLPAIROA (HCC) Vol.i3, No. 1. March 1989 Program Summary

Time Session Presenter Room

3:30-5:00 pm Changing Perspectives in Leadership Charlton Governor General

1:30-3:00 pm MINISEMINARS (Concurrent Sessions) Workshops for Grandparents of Hearing Impaired Children Lane, Theimer Richmond Narrative Production and the Communicatively Impaired Catherall Casson Kindergarten Child: Part I Accessing and Exchanging Information through Fahey, Zegarra University Telecommunications 3:30-5:00 pm Narrative Production and the Communicatively Impaired Waine Casson Kindergarten Child: Part II

1;30-3:00 pm PAPERS: SPEECH-LANGUAGE PATHOLOGY 11 (Consecutive Presentations) Development of Symbolic Play in Twins Differing MacKeigan, in Auditory Function Skarakis-Doyle Varley Maternal Input/Langauge Development in Twins Differing Gale, Skarakis-Doyle Varley in Auditory Function Language Skills of Chronic Behaviour Disordered Children Mack, Warr-Leeper Varley A Child With Auditory Verbal Agnosia Gaines, Coup land et aL Varley Treatment Needs of the Closed Head Injured Child Rankin, Y ockey Varley Reading Skills in Orally-Trained Hearing Impaired Children Waters Varley

3:30-5;00 pm PAPERS: SPEECH-LANGUAGE PATHOLOGY III (Consecutive Presentations) Assessing Functional Communication in Infants Purvis, Glazer et aL Varley A Classification System for Assessing Intervention Needs Diamond, Springer Varley Validity Study of Kindergarten Language Screening Measures Kodama, Varley Warr-Leeper et al. Mother's Predictions of Infant's Development MacKenzie, Ganz Varley Social Communication in Normal and Language Impaired Finch, Fahey Varley Preschool Children Story Formulation and Oral Language Performance Markovich, Ramcharan Varley

3:30-5:00 pm PAPERS: SPEECH-LANGUAGE PATHOLOGY IV (Consecutive Presentations) Tracheoesophageal Puncture 1: A Rating Scale of Success Harrison, Schultz Richmond Tracheoesophageal Puncture 2: Factors Predicting Success Schultz, Harrison Richmond Fibreoptic Endoscopy of the Vocal Tract Witzel, Zuker et at. Richmond Laryngeal Airway Resistance Measures in an Older Population Holmes, Leeper Richmond Nasometer versus Perceptual Ratings of Nasality Bredeson, Garcia et al. Richmond Post-Uvulopalatopharyngoplasty Posterior Nasal Fricative in Sound Specific Velopharyngeal Brown, Witzel Richmond Incompetence: Twenty-Two Cases 8:00-10:00 pm Canadian Auditory Equipment Association Reception Toronto IJII

FRIDAY, MAY 12

10:00-3:30 pm Exhibits Open

9:00-12:00 noon INVITED PRESENTATIONS (Concurrent Sessions) Facilitating Generalization in Phonological Intervention Gierut Toronto! Prescribing Real-Ear Gain with Digital Hearing Aids Skinner Toronto II Spasmodic Dysphonia 1989: Research and Treatment Freeman Lismer/MacDonald

8:30-10:00 am MINISEMINARS (Concurrent Sessions) Teaching Meaningfulness to the Very Young Adams Richmond Cochlear-Implant Patient Team Approach: Hearing Impairment and Multiple Handicaps Duncan, Cooper et al. York Language Learning and Thinking: The Bloom Explosion Barrett Adelaide Interdisciplinary Assessment of Language/Learning Problems Ionson, Barber et al. Casson

JSLPAIROA (HCC) Vol. 13,No. 1, March 1989 43 Program Summary

Time Se$sion Presenter Room

Normal Dysfluency in Stutterers: Treatment and Research Meltzer, Mackay Varley 9:00-12:00 noon Volunteers as Service Providers for the Profoundly Baird, Turner Governor General Handicapped Preschooler 10:30-12:00 noon Speech-Language Intervention: Pediatric, Post-Lingually Adams Richmond Deafened Cochlear Implant Patient I :30-3:00 pm FM and Hearing Aid Interaction and Optimization Chasin, Edwards Toronto n KEMAR: Past and Present Uses Henrickson, Comeau York Pragmatics: Expectations, Realizations, Future Directions Gallagher, Johnston Toronto I

10:30-12:00 noon VIDEO TAPE PRESENTATIONS (Consecutive Sessions) A Neurolinguistic Approach to Speech and Language Darwish, Steig Adelaide Disorders in Children "Together we can know the world" (Books, Music, Manolson Adelaide Art, Games)

12:00-1:15 pm HANEN LUNCH FORUM

I :30-3:00 pm SCIENTIFIC EXHIBITS (Concurrent Sessions) Computer-Assisted Implementation of the Desired Seewald, Jamieson et al. Richmond Sensation Level Approach General-Purpose Hearing Aid Simulation and Testing System Jamieson, Raferty et a!. Richmond Augmentative Techniques for Clarification Collier, Woodall Richmond Pragmatic Activities: Stroke Patients and Families Roberge, Senecal Richmond CS RE: The Canadian Speech Research Environment Jamieson, Nearey et al. Richmond

I :30-3:00 pm PAPERS: AUDIOLOGY 1 (Consecutive Presentations) Canadian Test to Assess Visual-Consonant Abilities Gagne, Hassan et al. Adelaide Validation of a French-Canadian Speechreading Test Lalande, Lacouture et al. Adelaide Interactive Video System to Train Speechreading Gagne, Dinon et al. Adelaide Repair Strategies for the Visual Recognition Gagne, Wyllie et al. Adelaide of Misperceived Words Counselling Role of Audiologists: Perception of Parents De Lorenzi, Yang et al. Adelaide of tRearing Impaired Children Project for Inuit Hearing Impaired Hurteau, Crago Adelaide

1:30-3:00 pm PAPERS: SPEECH-LANGUAGE PATHOLOGY V (Consecutive Presentations) Phonetic/Acoustic Analysis of Intelligibility in ALS Kent, Weismer et al. Varley Alterations in the Acoustic Characteristics of Gritzen, Leeper et aJ. Varley Speech of ALS Patients Oral Stimulation for Comatose Closed-Head Injured Patients Yockey Varley Influence of Training on Phonemic Production McNutt, Landry Varley and Discrimination Self-Monitoring Judgments of Children with McNutt, Snow Varley Phonological Disorders

I :30-4:00 pm PAPERS: SPEECH-LANGUAGE PATHOLOGY VI (Consecutive Presentations) Morphosyntactic Impairment in Children with Severe Cronk, Moquin et al. Governor General Phonological Problems Assertiveness and Responsiveness of LD Children McCarvill, Governor General During a Comprehension Monitoring Task Skarakis-Doyle Training Teachers to Facilitate Language Renfrew, Warr-Leeper Governor General Teaching LI Children Contextual Cues to Aid Comprehension Gaines, Haigh Governor General Quality Assurance: Focusing on Outcomes Bandur, Barker Governor General Beginning Stutterers: Early Intervention Model, Jones-Prus Governor General Parent Workshop on Sound Stimulation Jones-Prus, Gretton Governor General

I :30-3:00 pm POSTERS: AUDIOLOGY (Concurrent) A Model for Adult Aural Rehabilitation Smith-Down, Latimer Harris

44 JSLPAJROA (HCC) Vol. 13,No. I. March 1989 Program Summary

Time Session Presenter Room

Comparing the Occlusion Effect and Attenuation Comeau. of Earplugs and Earmuffs Whitehead et al. Harris Comparison of Psychophysical and Electrophysical Booth Harris Measures of Frequency Selectivity Industrial Ultrasound Exposure and Noise Induced Lawson, Yang et al. Harris Hearing Loss Utilizing ABR Patients with Neurofibromatosis Pacciroetti Harris Case Study of Biotinidase Deficiency Packford, Monsma Harris

1:30-3:00 pm POSTERS: SPEECH-LANGUAGE PATHOLOGY (Concurrent) ReliabilityNalidity of an Aphasia Group Bredeson, Desmarais Lismer Performance Measure Physiological Speech Characteristics Following Leeper, Gagne et al. Lismer Cochlear Implant Vocal Function Following Radiotherapy and Leeper, Heeneman Lismer Vertical Hemilaryngectomy Quadravoc: Apparatus for Comparative Microphone Doy le, Ewert et al. Lismer Measures and Consistent Audio Recordings A Community Based Swallowing Program Bramberger, Lismer Hollward et al. Sex Recognition of Electrolaryngeal Voices Produced Dingee, Doyle Lismer by Normal Speakers Selective Attention of Stutterers and Non-Stutterers Revisited Schurr, Yovetich Lismer An Introduction to the FLUEN-SEE Program Whiteside, Mintz et al. Lismer A Cooperative and Integrative Approach to Speech-Language Scott, Warrick Lismer Pathology and Augmentative Communication Services Training New Phonetic Contrasts in Adults Moore, Jamieson Lismer The Role of Linguistic and Visual Information in Butler-Hinz, Waters Lismer Acquired Dysgraphia Verbal and Nonverbal Aspects of Comprehension Monitoring MuIlin, MacDonald MacLellan et al. Baby Talk: Encouraging Communication Between Ushycky, Girolametto MacDonald Parents and High-Risk Infants Perception and Production of Selected Phonemes by McDougald, MacDonald Children with a Functional Articulation Disorder Jamieson et al. The School Articulation Program Levine, Bredo et al. MacDonald Designing Effective Workshops for Preschool Teachers Lane, Theimer MacDonald

4:00-6:00 pm ANNUAL MEMBERS MEETING Toronto I/II 7:30-9:30 pm AWARDS BANQUET Toronto I/II/III 9: 30-12:00 am PRESIDENT'S RECEPTION Governor General 9:30-12:00 am CANADIAN UNIVERSITIES ALUMNI PARTY Carmichael/Jackson

SATURDAY, MAY 13

8:30-10:00 am INVITED PRESENTATIONS Developmental Changes in ABR: 33 Weeks Conceptional Gorga Toronto II Age through the First 3 Years of Life 9:00-12:00 noon (Concurrent Sessions) A Model for Orofacial-Sensorimotor Examination Kent Toronto I Multilingual and Multicultural Issues in Human Crago, Cummins Carmichael/Jackson Communication Disorders Facilitating Communication Development in Children with Wetherby Lismer/MacDonald Autism: Assessment and Intervention 10:30-12:00 noon Behavioral Research on Auditory Development Applied Nozza Toronto 11 to Clinical Audiology

JSLPAIROA (HCC) Vo/.l3,No. 1, March 1989 45 Program Summary

Time Session Presenter Room

8:30-10:00 am MINISEMINARS (Concurrent Sessions) Clinical Voice Laboratory: Cooperative Efforts in Doyle, Leeper et al. Richmond Appraisal and Diagnosis Theoretical and Practical Bases for Software Selection in Thomas-Stonell, Harris Language Treatment Hayden Language bnpairment and Otitis Media Keene, Jennings Adelaide Cognitive-Linguistic Management of the Head Injured Adult Hayter Casson Hodson Phonolgy Treatment Program: Pilot Study Lees, Mace Varley The Musician and the Audiologist Chasin York 10:30-12:00 noon Communication Board Use by Aphasics Merchant, Skarakis-Doyle et al. Adelaide Informal Testing and Language Sampling Procedures Halldorson Varley and Analysis Strategy Based Intervention for the LLD Child Gaines Harris Cognitive-Language Assessment of the Head Injured Patient Biskup, Hughes et al. Casson

1:30-4 :30 pm INVITED PRESENTATIONS (Concurrent Sessions) Assessment of Severe Aphasia Helm-Estabrooks Toronto II lnteractional Response Management: Application of Damico Toronto I Dewey and Vygotsky I :30-3:00 pm Tactile Aids for Speech Perception/Production by Weisenberger LismerIMacDonald the Hearing-Impaired 1:30-3:30 pm Service Delivery in Sparsely Populated Areas McEvoy (Chair) Carmichael/Jackson 3:30-5:00 pm An Aural Rehab Program for Adults with Acquired Sosidko, Storms LismerIMacDonald Hearing Loss

I :30-3:00pm MINISEMINARS (Concurrent Sessions) Sign Language for Parents: A Supplemental Interactive Model Adams York Conflict Resolution in the Supervisory Process Godden, Fey et al. Casson School and Social Language Skills: the Hidden Agenda Blagden Varley I :30-4:30 pm Velopharyngeal Insufficiency: Use of Diagnostic Witzel, Posnick Harris Information for Effective Treatment 3:30-5:00 pm Occupational Deafness: A Public Health Approach Getty, Hetu York to Rehabilitation Consultation Services for Children with Severe Tennant, Holt et al. Varley Multiple Handicaps

1:30-3:00 pm PAPERS: AUDIOLOGY 11 (Consecutive Presentations) Critical Differences for Aided Sound Field Thresholds Stuart, Adelaide in Young Children Durieux-Smith et al. Probe-tube Microphone Measures of Loudness Discomfort Stuart, Adelaide in Young Children Durieux -Smith et al. Procedures for Measuring the Auditory Area Seewald, Gagne Adelaide in School-Age Children Procedures for Selection and Fitting of FM Systems Moodie, Seewald et al. Adelaide with Children Central Auditory Processing and Amplification: A Case Study Down Adelaide Clinical Experience with the XOMED Audiant (TM) Tollos, Wade Adelaide Bone Conduction Implant

3:30-5:00pm PAPERS: AUDIOLOGY III (Consecutive Presentations) Central Processing Disorders: Hearing and Language Maclean, McCallum Adelaide The Effect of Acoustic Neuromas on Auditory Processing Thompson, Abel et al. Adelaide Drug Ototoxicity Down, Smith-Down Adelaide Frequency Specific Maturational Changes in the Derived Ponton, Winkelaar et a1. Adelaide ABRs of Premature and Fullterm Infants Speech via Bone Conduction: A Comparison of Transducers Dolan Adelaide

46 JSLPAIROA (HCC) Fol.13.No.l. March 1989 Thursday, May 11------

CONFERENCE PROGRAM

damage has been caused by a variety of factors. The presentation will Invited Presentations also touch upon other topics relating to cochlear hearing loss ranging from the effects of auditory deprivation during development to the principles of cochlear implant prostheses. The overall objective of this presentation is to give a biological perspective on sensorineural Audiology hearing loss that should broaden the audiologist's and speech-lan­ guage pathologist's understanding of the causes and symptoms of 9:00 to 12:00 and 1:30 to 4:30 deafness. Adult Aural Rehabilitation: Strategies for Assessment and Intervention Speech-Language Pathology Sue Ann £rdman Army Audiology and Speech Center 9:00 to 12:00 Waiter Reed Army Medical Center, Washington, D.e. Marilyn Demorest Teaching Language to Language-Impaired Children Department of Psychology Phi! J. Connell University of Maryland, Catonsville, MD Northwestern University, Evanston, IL

The extent to which hearing impairment poses significant com­ In order to teach certain aspects of language to children who have munication and adjustment problems for an individual is often the failed to learn those aspects on their own, it is necessary to structure result of numerous behavioral, environmental, attitudinal, and emo­ the language-learning situation in ways that lead children to learn the tional factors. Identification of variables that are contributing to language rules that control those aspects. It is not sufficient to teach communication difficulties is a prerequisite to effective intervention children simply to say the missing aspects under controlled condi­ and the key to successful rehabilitation. Clinical use of the Com­ tions. In this presentation, methods will be suggested for teaching munication Profile for the Hearing Impaired (CPHI) is the subject of language rules; that is, methods for translating the natural induction this presentation. The CPHI is a self-assessment inventory that was and deduction processes of language acquisition into clinical ac­ developed for use in a comprehensive aural rehabilitation program for tivities that can facilitate language learning. Teaching children to adults with occupationally related hearing impairment. Information induce language rules involves presenting them with information obtained from the profile can be used to determine rehabilitation goals from which to draw conclusions about the patterns in the language and to develop strategies appropriate for the specific adjustment data they observe. Teaching children to deduce language rules invol­ problems thereby maximizing the effectiveness of intervention. The ves presenting them with information that allows them to use their presentation addresses clinicians' responsibilities in identifying these innate knowledge of language to learn sets of rules that are not rehabilitative needs and developing appropriate strategies such as learnable by other means. It will be claimed that only methods like problem solving exercises, counseling services, and support group these that are designed to teach children language rules are effective activities for individual, family, and group intervention. in actually teaching language to language impaired children.

1 :30 to 4:30 9:00 to 12:00 Cochlear Hearing Loss: A Detailed View of the Communication Options in the Acute Care Setting Anatomical and Physiological Changes Which Pat Mitsuda Underlie This Disorder Harborview Medical Center, Seattle, WA R. V. Harrison Hospital for Sick Children, Toronto, ON The ventilator dependent or intubated patient presents health care professionals with a number of challenges. These patients are often A major part of the professional activities of audiologists and speech­ acutely ill and are unable to communicate orally because of diversion language pathologists involves patients with some degree of sen­ of airflow away from the larynx. Recent changes in technology have sorineural hearing loss. In recent years our knowledge concerning the increased the number of communication options available to in­ underlying causes of hearing losses and related symptoms has in­ tubated patients. However, selection of an appropriate augmentative creased considerably. The intention of this seminar is to review what communication approach depends on the decision-making processes is currently known about the anatomical and physiological changes of a team of experts. This team of professionals providing com­ that accompany cochlear hearing loss. First, the anatomy and physiol­ munication options for these patients are now able to select from a ogy of normal cochlear function will be reviewed. From this back­ variety of oral and nonoral approaches. A series of oral and normal ground I will consider the various pathophysiological conditions augmentative communication options (including high and light tech­ underlying cochlear hearing loss, in particular, experimental studies nology) will be discussed, with emphasis on patients who are can­ in animal models of sensorineural hearing loss in which cochlear didates for each approach. In addition, the skills required of the team

JSLPAlROA (HCC) Vol. 13, No. 1, March 1989 47 CASLPAlACOA Conference

will be reviewed with some discussion as to which team members cates that utilizing a group approach with these children and their may offer which skills. Prerequisites for communication, along with families can be highly successful. Such success appears related to the a screening protocol will be examined, followed by a discussion of group's detailed and systematic attention to both the abilities and an initial needs assessment and the actual selection process. Finally, interests of the child and the needs and understanding of the parents. the importance of family/staff training and follow-up will be outlined, Preparation of this paper supported in part by an OSEP grant including a discussion of a final needs assessment protocol. (G008850030252) to Syracuse University.

9:00 to 10:30 1 :30 to 4:30

How I do it! Management of Individuals with Introducing the Clinical Evaluation of Language Velopharyngeal Incompetence Fundamentals-Revised: CELF·R Philip C. Doyle Elizabeth Wiig Dalhousie University, Halifax, NS Texas Christian University Herberl A. Leeper, fr. University of West em Ontario, London, ON This presentation will provide an overview of the development of the ferald B. Moon CELF-R, its use in the diagnostic process, discussion about new and University of Iowa, Iowa City, 10 revised subtests, as well as information about interpretation of their David Stringer and Mary Anne Witzel scores. The Hospital for Sick Children, Toronto, ON

The management of individuals with velopharyngeal incompetency Audiology and SLP is of particular interest to clinicians faced with a variety of etiologies, diagnostic techniques, and therapeutic approaches. The need to coor­ dinate information from a number of anatomical and physiological 1 :30 to 3:00 descriptors ofvelopharyngeal function is often an overwhelming task. While many clinicians have experience with several approaches to I've Been Summoned Now What? the diagnosis of velopharyngeal function with a variety of patient Judgef. Williams populations. a variety of examination techniques exist that may not Judge of the Family court of Nova Scotia, Dartmouth, NS be part of their routine testing protocol. This miniseminar is designed to provide information regarding techniques and procedures currently This presentation is an overview of issues that are encountered when in use in North America. The format is unique for CASLPNACOA one becomes involved in a legal proceeding. Issues covered will meetings and will be in the form of Table Clinics. These table clinics include: 0) types of legal proceedings; (2) why would I be sum­ are divided into four segments: (I) perceptual/articulatory analysis moned; (3) what is privileged information; (4) can my files and notes (Dr. Doyle); (2) radiological (Drs. Stringer and Witzel); (3) nasendos­ be summoned; (5) what is an expert witness; (6) what can I testify to; copy (Dr. Moon); and (4) aeromechanical and acoustical (Dr. Leeper). (7) what is direct examination and cross-examination; (8) what can I Each segment will provide a 30 minute, intensive exploration of the do to prepare for testimony in court. methodology and exact procedures used by the clinician-researchers in the management of persons with velopharyngeal incompetency. Attendees will rotate from one table clinic to another every 30 minutes 3:00 to 5:00 to take advantage of the information presented in that specialized area. Changing Perspectives in Leadership 1 :30 to 4:30 Zann Char/Ion University Hospital, London, ON Remedlation of Stuttering In Young Children Edward G. Conrure Knowledge and skills for effective leadership and management can Syracuse University, Syracuse, NY be learned. The associated behaviors are fundamental to the develop­ ment of empowered people working together as a cohesive team. Join The purpose of this presentation is to discuss the remediation of with colleagues who have made the transition from practitioner to stuttering in young children (between two and ten years of age) manager, and share the peaks and pitfalls of being "the boss." During through the use of parent/child therapy groups. This approach is based this highly participative workshop, participants will have an oppor­ on the assumption that, for most children, stuttering develops from a tunity to: (I) discuss successful behaviors of leaders and managers; complex interaction between the child's environment and the skills (2) define goals related to technical, business, and relational skill and abilities the child brings to that environment (Conture, 1982). requirements; and (3) determine strategies to achieve these goals. Methods for changing environmental-child interactions to facilitate the child's fluency are described. Specifically, it is shown how parent/child fluency groups identify and modify young stutterers' Members Forum communicative interactions and speech production behaviours while Thursday, May 11 providing their parents with information, practice, feedback, and 1:30 - 3:00 recommendations for facilitating their child's fluency and related behaviour. Clinical experience to date at Syracuse University indi-

48 JSLPAfROA (HCC) Vol. J3.No. J, March 1989 CASLPAI ACOA Conference

Contributed Presentations Speech-Language Pathology Miniseminars 8:30 to 10:00 Audiology Forensic Applications of the Communication Miniseminars Sciences 8:30 to 10:00 Elizabeth J. Hunt Toronto Western Hospital, Toronto, ON Air-and Bone-Conduction ABR in Hearing Screening for At-Risk Neonates The purpose of this seminar is to acquaint the speech-language Edward Y. Yang and Andrew M. Stuan pathologist with an update on the field of Forensic Communications. School of Human Communication Disorders With the increased use of tape recordings in law enforcement, Dalhousie University, Halifax, NS security, and record keeping, the need for trained specialists in this George T. Mencher and Lenore S. Mencher relatively new field has developed. There are no specific training Nova Scotia Hearing and Speech Clinic, Halifax, NS program qualifications for an individual working in this area. Cur­ rently individuals with backgrounds in speech, computers, engineer­ Michael J. Vincer ing, acoustics, statistics, linguistics, law enforcement, and music are Grace Maternity Hospital, Halifax, NS working in this field. Historically, the speech scientist has provided valuable information to the field of forensic communication and has The auditory brains tern response (ABR), a non-invasive been instrumental in developing the area. As the field continues to electrophysiological technique, provides a powerful tool to evaluate grow it is important that the speech scientist and/or the speech-lan­ auditory function. A major limitation of the air conduction ABR in guage pathologist is included in the forensic communication team. neonatal hearing screening is its high false-positive rate for sen­ This seminar will provide an overview of the research and current sorineural hearing loss. This presentation will describe a modified application of the following major topics: (I) methods of speaker approach employing bone conduction ABR as an adjunct to the air identification, including voiceprints, voice line-ups, and machine conduction technique in identifying newborn infants with sen­ analysis, (2) techniques of speech decoding and enhancement, (3) tape sorineural hearing loss. The goal of this new approach is to provide authentication, including machine signatures and tape integrity; and more accurate testing procedures in the hearing screening for at-risk (4) acoustic analysis, including identification of gunshots and analysis newborn infants. The new hearing screening test consists of two of background noise. phases: (I) normative ABR data collection in which non-risk full-term newborn infants were tested using air and bone conduction ABR; and (2) ARR in neonatal hearing screening in which newborn infants 8:30 to 10:00 at-risk of hearing impairment were tested using air and bone conduc­ tion ARR. Workload Measurement System: Real Time Analysis and Audit Guide George T. Mencher 1 :30 to 3:00 Nova Scotia Hearing and Speech Clinic, Halifax, NS Conducting Workshops for Grandparents of Nanive M. Hawke Hearing-Impaired Children Audiology Consulting, Toronto, ON Susan A. Lane and Usa R. Theimer Gerald Jackson B.C. Elks Auditory Rehabilitation Centre, Surrey, RC National Hospital Productivity Improvement Program, Ottawa, ON

When a child is diagnosed as hearing-impaired the life of every The purpose of the Workload Measurement System is to provide an member within that family system is altered. Grandparents may go objective, standardized and uniform method of recording and report­ through a grieving process similar to what parents experience, for ing time and activities which allows for a comparison and analysis they, too, have suffered the loss of a "perfect" grandchild. The across Canada of speech-language pathology and audiology services, grandparents are in a unique position of being able to provide support as well as productivity, utilization, and cost data. The Nova Scotia to both the parents and the hearing-impaired grandchild. Although Hearing and Speech Clinic contracted to carry out a workload meas­ counselling and information is often provided to parents of hearing­ urement study of real times to develop a data bank of time values impaired children, the needs of grandparents are rarely considered. corresponding to the activities in the workload measurement system. The R.C. Elks Auditory Rehabilitation Centre offers workshops to The study was based on a 6 month sampling of activity throughout grandparents of hearing-impaired infants and toddlers. Examples of the entire province. The presentation will include the results of the workshop activities such as simulated experiences, team projects, and study and their implications. In addition the presentation will present problem solving will be discussed. Follow-up questionnaires com­ information on an Audit Guide adapted by the author for Speech-Lan­ pleted by parents and grandparents are used to assess the effectiveness guage Pathology and Audiology that is intended to help managers of these workshops in creating and maintaining support for the family develop effective monitoring of departmental activities. The guide is of the hearing-impaired child. di v ided into three components: corn ponent I describes a structure and process review to evaluate the department on an annual basis; com­ ponent 2 looks at staff input to the Workload Measurement System

JSLPAIROA (HCC) Vol.i3. No. 1. March 1989 49 CASLP AI ACOA Conference

and its accuracy; component 3 verifies output information through Interest in the narrative skills of language disordered children con­ establishment of normative ranges' for performance indicators. tinues to grow in the midst of clinical and educational recognition of the social and academic implications of deficits in oral narrative 10:30 to 12:00 production. The clinical focus at this point appears to be the search for viable assessment and intervention procedures for the school-aged Spoken-Language Learning and Deafness: Clinical population. Developmentally, however, it is generally acknowledged Model for Maximizing Audition that the roots of narrative skills can be traced to the preschool period. Barbara Ann lohnson Significant deficits in the narrating abilities of a group of kindergar­ National Technical Institute for the Deaf, Rochester, NY ten-aged, communicatively impaired children enrolled in the Glen­ rose Hospital's Preschool Language Group appeared to warrant Frequently, speech-language pathologists are asked to apply their clinical attention. Current assessment guidelines were found to be expertise to deaf individuals. Many professionals who perform this inadequate. This presentation will attempt to provide a preliminary feat have received minimal training in the acquisition of spoken organizational framework for the clinical assessment of narrative language in the presence of hearing impairment (lohnson & Paterson, skills with kindergarten-aged children. Procedures designed to elicit 1987). Therefore, this miniseminar will address the language-learning various narrative types will be described and transcripts illustrating needs of deaf individuals through some principles, procedures, and baseline samples from our disordered population will be presented. clinical examples. The focus will be on methods for maximizing the Problems in establishing clinically feasible measures of narrative residual hearing of deaf language learners using a developmental production abilities for this age group will be discussed. Based on the model. Research will be cited to show that with proper training, assessment information described in this mini seminar, guidelines for optimally aided residual hearing may in many cases be the key to intervention will be presented in Part 11. spoken-language development. Ten principles will be explained, corroborated by literature citings, and supported by clinical examples. 1 :30 to 3:00 Specific clinical procedures will be presented. Participates will gain Accessing and Exchanging Information Through exposure to some tools that should make way for the proper identifica­ Telecommunications tion of deaf individuals whose aided audition is potentially usable for spoken-language acquisition. Participants will also learn the impor­ Ronald Fahey and Luis Zegarra tance of maximizing audition and be introduced to some clinical Hotel Dieu Hospital, Kingston. ON procedures that facilitate spoken-language acquisition in the deaf through maximizing audition. Telecommunication provides for the rapid transfer of information among groups or individuals. Technology has now developed to enable both professionals working with the handicapped, and the 10:30 to 12:00 handicapped consumer, to access information as well as communicate Functional Use of Self-Esteem in Speech-Language with each other. This paper will provide a general overview of Pathology Remediation telecommunication systems available to computer users including the following: data bases, computer networking, electronic mail, and Roy Saunderson bulletin boards. A discussion of hardware and software requirements, Parkwood Hospital, London ON features, benefits, and costs will be presented. Options for accessing information services and controlling costs of telecommunications will An often ignored element of speech-language pathology remediation be addressed. Several popular systems will be presented in detail with is dealing with the patient's lowered self-esteem resulting from hislher information on other related systems being provided in a user friendly communicative disorder. A patient will evaluate hislher communica­ handout. Speculation on future applications of telecommunications tion performance in conversation and in therapy. If perceived nega­ in speech-language and hearing for information retrieval. consult­ tively, the performance will deflate self-esteem and interfere with ations, research, and intervention will be proposed. progress towards therapeutic goals. Besides the patient's own percep­ tions of hislher performance, significant others, such as family, 3:30 to 5:00 friends, and clinicians, also can affect the patient's responses to the communication disorder and undermine improvement (Houk, 1980; Narrative Production and the Communicatively Zola, 1981; Harvey & Greenway, 1982). At the end of this mini­ Impaired Kindergarten Child: Part 2 Intervention seminar participants will be able to: (I) understand the development Zillah Waine of self-esteem; (2) relate the grieving process to communication Glenrose Rehabilitation Hospital, Edmonton, AB disorders; (3) learn how to develop and maintain a patient's self-es­ teem; (4) utilize the management of self-esteem towards achieving The recent focus on oral narrative skills and literacy has resulted in speech-language pathology goals; and (5) relate information learned speech-language pathologists being expected to assess and develop to actual case studies. the narrative skills of language disordered children. However, little clinically useful information is available on assessing and developing 1 :30 to 3:00 narration in communicatively impaired children. especially preschool and kindergarten children. In addition. no information is available on Narrative Production and the Communicatively what intensive practice with narration can accomplish with language Impaired Kindergarten Child: Part 1 Assessment disordered children. The purpose of this mini seminar is to provide a Paul Catherall clinical framework for applying narration to intervention. Because the Glenrose Rehabilitation Hospital, Edmonton, AB types of narratives and contexts for telling them can affect narrative

50 JSLPAIROA (HCC) VoL 13. No. 1. March 1989 CASLP AI ACOA Conference

fonn, a variety of narrati ves from different contex ts will be discussed. • Amer-Ind Gestural Code: A Means to Oral A fifteen week group treatment program for preschool and kindergar­ Communication ten children which builds on infonnation gathered through baseline Anita H. Silverman and Sir MOr/imer B. Davis measures (described in Part I) will be reported. Goals and objectives Jewish General Hospital, Montreal, PQ related to each narrative type will be discussed and treatment proce­ dures will be illustrated through video presentation. Post-intervention This presentation describes the use of Amer-Ind gestural communica­ narrative examples will be compared to baseline samples. tion as a means of enhancing verbal expression in a case of severe oral motor apraxia. Mr. K. suffered a left frontal parietal infarct Paper Presentations resulting in severe oral motor apraxia, aphonia. and mild to moderate­ Session 1: 10:30 to 12:00 ly impaired comprehension, reading, and writing skills. Amer-Ind was introduced as an adjunct to traditional therapy giving Mr. K. a • Pre- and Post-Clinical Voice Evaluation of Patients broader repertoire for self-expression of ideas, feelings. and occurren­ Presenting with Functional Dysphonia ces. After five months. Mr. K. demonstrated diminished apraxia. At this time, re-education of articulatory movements was introduced in Nelson Roy and Herbert A. Leeper, Jr. conjunction with Amer-Ind. Intelligibility scores from spontaneous University of Western Ontario, London, ON language and phonetically balanced word lists are compared at the one and three year post infarct. Video tapes will show: (I) advanced Voice disorders which are not due to structural lesions fall under the Amer-Ind communication; (2) oral expression following one year of general descriptive tenn "functional dysphonia." While such voice therapy; and (3) two year post treatment outcome. Discussion of the disorders are common, there is little infonnation concerning their potential for use of Amer-Ind in conjunction with traditional treatment diagnosis and treatment. During a three year period,19 patients will follow. presenting with functional dysphonia were assessed by one clinician in a community based hospital setting. The selected sample of patients was managed by a combination of interview and voice therapy • Augmentative Communication: It Takes techniques. (Aronson, 1985). Effectiveness was analyzed using per­ More Than One ceptual and acoustic measures of vocal function. Results indicated a Nora V. Rothschild significant reduction of dysphonic symptoms within one hour, long The Hugh MacMillan Medical Centre. Toronto. ON tenn maintenance of acceptable vocal quality and significant reduc­ Debby Miller and Sherida Ryan tions in perceptual ratings of severity of vocal dysfunction. Measures Queen Elizabeth Hospital, Toronto, ON of voice parameters also showed changes. The results will be dis­ cussed in tenns of identification and effective management of func­ This presentation is a case study of a 21 year old man with a closed tionally dysphonic patients. head injury following a motor vehicle accident five years ago. This young man presents with limited upper limb control and an inability • Lesion Size and Localization in Buccofacial to speak. He is, however, able to communicate using partner assisted Apraxia: A Retrospective Analysis scanning with an alphabet display and a portable voice output com­ munication aid that he controls with a single switch using head Tessa Mintz and Adele S. Raade movement. The augmentative communication assessment and inter­ University of Western Ontario, London, ON vention program for this client was designed and implemented by Andrew Kertesz multidisciplinary teams drawn from a specialized augmentative com­ SI. Joseph's Hospital, London, ON munication clinic and a team specializing in continuing care for adults. The case presentation will focus on two issues: (I) the impor­ The relationship of neuroanatomicallesion localization and measured tance of light technology as well as high technology, and how they lesion size to degree of deficit in buccofacial apraxia is far from can be used to optimize communication with a range of partners in a conclusive. This study will attempt to extend previous research and variety of contexts; and (2) the importance of trial training with answer the following two questions: (1) What is the relationship augmentative communication devices for the client over an extended between severity of buccofacial apraxia and lesion size and localiza­ period of time with familiar partners and in a natural setting. tion? (2) What is the relationship between the absence or presence of buccofacial apraxia and lesion size and localization? Subjects in­ • Practical Use of Micro-Computers to Aid cluded 60 right handed patients who had experienced a single left Speech-Language Pathology Reports ischemic stroke. The patients were previously assessed in the acute Jeanne S. Robertson stage post-onset using the Western Aphasia Battery at the SI. Joseph's Nova Scotia Hearing and Speech Clinic, Sydney, NS Hospital Aphasia Laboratory. The presence and/or severity of buc­ co facial apraxia was detennined for each patient using the five item Christopher H. Murphy facial apraxia subtest of the WAB. Results will be presented in relation Children's Rehabilitation Centre. SI. John's, NF to lesion site and size infonnation from CT scanning done for each patient in the acute stage post-onset. After completing speech and language evaluations, speech-language pathologists find themselves faced with the time-consuming task of writing and detailed reports. In addition, many have long waiting lists for evaluation and treatment. In an attempt to address both of these issues more efficiently an Apple IIe micro-computer with word processor software was used to assist in conducting full evaluations

JSLPAIROA (HCC) Vol. 13, No. 1 ,March 1989 51 CASLPAlACOA Conference

of all clients on the waiting list. Each client was assessed using child responses to that input, and similarities and differences of standar~ evaluation procedures, and reports were written using a syntactic growth. The impact of hearing impainnent and the twin flexible report fonn which could be modified easily for individual situation on early mother-child interactions and language will be clients. Data collected during the project period revealed that the discussed. amount of time spent by the clinician on each individual evaluation report was reduced and the quality of the report was improved. • Language Skills of Chronic Behavior Additional infonnation will be presented on other practical, clinic Disordered Children uses of micro-computers including data-base programs and the use of Alison E. Mack laptop computers. Landmark School, Beverly Fanns, MA Session 2: 1 :30 to 3:00 Genese A. Warr-Leeper University of Western Ontario, London, ON • The Development of Symbol Play In Twins Differing In Auditory Function This study investigated the oral language abilities of 20 chronic Kathy MacKeigan and Elizabeth Skarakis-Doyle behavior disordered (CBD) children institutionalized in a psychiatric School of Human Communication Disorders facility. A wide variety of standardized language measures were used Dalhousie University, Halifax, NS to assess auditory memory, semantic comprehension, syntactic com­ prehension. semantic expression, and syntactic expression. As a group, CBD children performed significantly poorer than the nonna­ Traditionally, language and symbolic play have been considered tive population with 80% (16) of the subjects scoring in the below related domains of symbolic functioning. Contemporary research has average range on at least 20% of the language measures. Fifteen demonstrated a temporal correlation between the development in both percent (3) of these also had consistent articulation errors. Group domains. Symbolic play development is a hierarchically arranged results demonstrated more difficulty with comprehension subtests sequence of events, progressing from the investigative use of objects than expressive subtests. The language levels of 50% (10) were to sociodramatic play. This sequence has been documented in both inconsistent with expectations based on IQ scores. Scattered results nonnal hearing and hearing impaired singletons. Hearing impaired across the different language areas suggested that no specific lan­ singletons follow the same sequence of development but at a slower guage profile characterized this population. However, overall abstract rate than nonnal hearing singletons. Unfortunately, studies compar­ language and concepts, linguisticaIly complex structures. and tasks ing hearing impaired and nonnal hearing subjects often lack adequate requiring rapid processing of complex decontextualized material were controls. To control these factors, this study examined the develop­ shown to be difficult for the CBD children. ment of symbolic play in a set of twins differing in auditory function. In order to control for the twin situation, a third child, a hearing singleton was also studied. Longitudinal data was collected over a 12 • Case Study: A Child with Auditory Verbal AgnOSia month period by videotape for all three SUbjects between the ages of Barbara H. Gaines, Stuart G. Coupland, Mary Alice Saul1ders, and 20 and 36 months. Results will be discussed in tenns of the importance Han·ey B. Sarnat of hearing impainnent and the twin situation upon the development Alberta Children's Hospital, Calgary, AB of symbolic play. A case study of a girl with a severe auditory processing deficit will • Maternal Input and Language Development in Twins be presented. The convergence of neurophysiologic, audiologic, and Differing in Auditory Function linguistic profiles will be described from the initial diagnosis Sonya Gale and Elizabeth Skarakis-Doyle throughout three years of intervention. At five years three months of School of Human Communication Disorders age, the profound nature of this child's difficulty was first identified. Dalhousie University, Halifax, NS Although she was able to detect the presence or absence of sound, she was unable to consistently associate meaning to verbal stimuli. Clini­ The linguistic environment has been shown to be an important factor cal seizures were never observed. Electroencephalography indicated in language acquisition. Past studies have shown that mothers' speech epileptifonn activity, arising from independently discharging foci in to hearing impaired children is qualitatively different than mothers' the left and right central regions. Behavioral and electrophysiologic speech to nonnal children. Higher percentages of directives and findings suggested nonnal peripheral auditory function. Following a requests have been observed with a corresponding lower percentage six month period of anticonvulsant therapy, the EEG showed suppres­ of naming, labelling, and describing. However, research involving the sion of paroxysmal activity although background rhythm remained hearing impaired population is problematic, particularly in estab­ slow. Overthe three year period, regular re-evaluations of her auditory lishing appropriate control groups. Confounding variables can be and linguistic processing abilities showed improvements in auditory controlled by matching subjects. as in the use of twins differing in discrimination and verbal association. Serial language assessments auditory function. Thus, a longitudinal study of the mother-child revealed improvements in her verbal knowledge for comprehension interaction and language development of such twins was perfonned. Three children, twins differing in auditory function and a hearing singleton child to control for the twin situation, were followed from Members Forum the ages of 20 to 36 months. Play interaction between the mother and Thursday, May 11 the child was videotaped every four to six weeks and orthographically 1:30 - 3:00 pm transcribed. Results from three points in this developmental period Governor General Room will be discussed in tenns of the characteristics of maternal input,

52 JSLPAIROA (HCC) Vol.13,No.1, March 1989 CASLPAlACOA Conference

and expression. The role of written language learning in helping this Session 3: 3:30 to 5:00 child to compensate for her profound auditory deficit was clearly identified and will be discussed. This child's marked improvement in • Early Communication Scale: AsseSSing Functional auditory processing correlated with changes in her neurological status Communication in Infants and development of linguistic knowledge. Lorraine Purvis Hotel Dieu Hospital. Kingston, ON • Recognizing Treatment Needs for the Closed Head Susan M. Glazer and Annick Roustan Injured Child Ages Two to Eight Children's Hospital of Eastern Ontario, Ottawa. ON Lama ]. Rankin RonH. Smyth University of Alberta, Edmonton, AB Carleton University, Ottawa, ON Kenton L. Yockey Madigan Army Medical Center, Tacorna, WA The Early Communication Scale examines three areas of communica­ tive interaction: comprehension. expression, and play. It is designed for use by speech-language pathologists in the assessment and pro­ Acute medical centers are treating children with closed head injury gram planning of early functional communication. It is particularly caused by a number of factors. Like their adult counterparts they may useful in the evaluation of infants and children from birth to 24 months be admitted in varying degrees of coma on the Glascow Index, but as and of older language delayed or disordered children whose mental they emerge from deep coma, to coma vigilance, to being able to abilities are estimated to be within this range. Two methods of recognize familiar faces and distinctive features within the environ­ assessment are combined direct testing and parental report. This ment, their behavior and required treatment needs will be dissimilar ensures testing under standardized conditions, as well as considera­ to adult requirements. This presentation describes distinctive features tion of the caregiver's report of a child's typical behavior at home. that may affect assessment and treatment needs for the closed head The scale is based on a developmental model. Skills and behaviours injured child, including (I) the effect of pre-accident developmental relevant to communication that are normally present in the early milestones; (2) the extent of brain damage and the affected learning stages of language development are examined in detail. A pilot study skills; (3) the impact of so called cortical plasticity; and (4) the was conducted to standardize test procedures, determine reliability, elaborate panoply of family support and social-verbal stimulation. All and analyze correlations. This paper will describe the Early Com­ of the above features affect post traumatic development in children munication Scale in detail and examine the procedures and results of with closed head injury. The authors propose a multi disciplinary the pilot study. treatment model. The importance of continued and aggressive monitoring of the cognitive and learning outcome of these children during and after rehabilitation will be discussed, and the resultant • The Communication Profile: A Classification implications for special education needs will be stressed. System for Assessing Intervention Needs Judie A. Diamond and Robin S. Springer Mackay Center, Montreal, PQ • Component Skills in Reading in Orally·Trained Hearing Impaired Children The Mackay Communication Profile was developed in 1984 at the Gloria S. Waters Mackay Center, a facility for neurologically impaired children. It is School of Human Communication Disorders used as a classification system to assess the speech, language, and McGilI University, Montreal, PQ communication needs of individuals and groups, and to assist in the clinical decision-making process. The Profile consists of an initial­ Individuals born severely or profoundly deaf have great difficulty based key which permits each client to be classified according to achieving adequate levels of literacy. Furthermore, little is known current primary, secondary, and tertiary deficits. Since its inception, about how deaf children process written language and with which the usefulness of the Profile has expanded significantly into both aspects of the reading process they have most difficulty. To determine intervention and administrative areas and, in fact, has become a those factors which account for reading achievement in orally-trained cross-disciplinary method of communication. The design of the sys­ hearing impaired individuals, 56 severe to profound pre-lingualIy tem is based on simplicity and adaptability, factors which have deaf children from seven to 20 years in age were tested on a battery allowed for its evolution into a valuable clinical and management tool. of standardized tests and experimental tasks which assessed their The Profile, its clinical and management applications, and three case memory skills and their oral and written language skills at a number studies will be presented. oflevels. Results showed a significant positive relationship between spoken language skills and reading achievement. Of the tasks which • A Validity Study of Six Kindergarten Language assessed reading skills, single word decoding ability was among the Screening Measures best predictors of reading achievement. However, words were recog­ Sakie Kodama nized in a qualitatively different manner than for hearing children. Cornwall General Hospital, Cornwall, ON Results suggest that while similar factors may account for reading Genese A. Warr-Leeper ability in deaf and hearing children, deaf children may accomplish University of Western Ontario, London, ON some aspects of the reading task in a different manner than do hearing Christine L. Lay children. Toronto, ON Carol-Anne Ryan Kingston, ON

JSLPAIROA (HCC) Vol. 13.No. i.March 1989 53 CASLPA/ACOA Conference

The performance of 103 children ages fourto six years on six language University of Westem Ontario, London, ON screening measures was compared with their performance on a diag­ nostic language test to determine the effectiveness of the screening This study investigated the language abilities of students in grades measures. Unguided teacher judgment and the Language Id.mtifica­ seven and nine by means of a story formulation task, Its purpose was tion Screening Test for Kindergarten were found to have a higher to collect normative data on a number of language measures and to strength of agreement based on Kappa analysis that did the Let's Talk identify measures that distinguish grade levels. Forty students at each About Talking checklist, the Kindergarten Language Screening Test, grade level, meeting several criteria to ensure normal language the Preschool Speech/Language Screening Tool, and the Structured functioning, were selected to participate in the study. Subjects told a Photographic Expressive Language Test Preschool. It was deter­ story based on the three sequenced story pictures contained in the Test mined that the unguided teacher judgement was the most valid, of Written Language. The narratives were analyzed for story flow, simple, cost-effective, and time-efficient measure for the identifica­ grammar, text cohesion, text coherence, and vocabulary measures. tion of language-impaired children. Results for most story measures within grade levels were highly variable. Although most students maintained episode structure in their • Mothers' Predictions of Infants' Development and narratives, the number of main events included differed greatly. The Professional Evaluation: A Comparison number of words and sentences used also varied widely within grade levels. Several differences were found between students in grades Myrna L. MacKenzie and Candace K. Ganz seven and nine, with students in grade nine demonstrating better Western Washington University. Bellingham, WA language skills on many of the measures analyzed. Implications will be discussed. Although parent reports are frequently used during infant evaluations, there is a perception that these reports are inaccurate. The current study looked at variables that might affect parent report data, so that Session 4: 3:30 to 5:00 testers might answer the question: With which parent-infant dyads • Tracheoesophageal Puncture 1: A Rating Scale of will parent reports yield reliable information? Ten infants ages 12-34 Success months were given the Bayley Scales of Infant Development. Inde­ pendently, each infant's mother was given an interview version ofthe lill Harrison and ludith R. Schultz Bayley Scales. Both the test and the interview were scored to yield Montreal General Hospital, Montreal, PQ item for item and overall developmental indices comparisons. Results indicated that while the parent/professional agreement levels found This paper describes a clinical scale for determining the success of in this study substantiated earlier studies, the parents in this study the tracheoesophageal puncture procedure for voice restoration of tended to underestimate their children's development rather than laryngectomy patients. The literature includes reports of success rates overestimate. Specific types of test items were less reliably reported ranging from 54% to 95%, with variation in part due to different by parents. Clinical and research implications will be discussed. definitions of success. Our experience suggests that success is not an all or none phenomenon, but rather a continuum with varying degrees of success or lack thereof. Moreover, a definition of success should • Social·Communicatlve Interaction in Normal and include more than the dimension of fluency, the ability to produce Language-Impaired Preschool Children sound post puncture. Thus, three aspects of behavior degree of use, Amy Finch and Ronald Fahey quality of speech, and ability to care for the prosthesis are inde­ Hotel Dieu Hospital, Kingston, ON pendently measured, then totalled to produce an overall rating of success on a fifteen point scale. Inter- and intrajudge reliability scores Several studies involving normally-developing preschool children were found to be over 90% on each measure. Scores for functional, have indicated that they use a variety of verbal and nonverbal be­ marginal, and non-functional speakers are suggested. The nature of haviors to establish social relationships among their peers during free the tracheoesophageal puncture rating scale suggests a more realistic play. However, the literature is limited in regard to language impaired description of outcome. Its scoring system allows for measures of children's ability to establish these relationships. This study com­ progress, and its reliability permits more meaningful comparisons pared the initiations and responses to initiations of language impaired between series of patients. children with those of normally-developing children. In addition, the level of social participation in free play was compared. Eight children • Tracheoesophageal Puncture 2: Factors That identified as language impaired and eight normally-developing Predict Success children were matched on the basis of chronological age and sex and ludith R. Shultz andlill Harrison observed in two different settings. Each child was videotaped during Montreal General Hospital, Montreal, PQ dyadic interaction in a special playroom wi th three other children from their classroom. In addition, each child was observed during four free There has been considerable variability in reported success rates of play periods in the natural preschool classroom. Data will be tracheoesophageal puncture, ranging from 50% to over 90% This presented and implications for clinical intervention and additional variability most likely has been due to too few existing guidelines research will be discussed. regarding factors which affect success, lack of statistical analyses, and ill-defined descriptions of what constitutes success. This study • Story Formulation as a Measure of Oral Language predicted with stepwise mUltiple regression the effects on Performance tracheoesophageal puncture success of patient health, pre­ Karen S. Markovich. Sharon Ramcharan. and tracheoesophageal voice proficiency, use of a tracheostoma vent, Genese A. Warr-Leepel' extent of cancer, timing of surgical procedure, prosthesis type, pros-

54 JSLPAIROA (HCC) Vol. 13. No.}. March 1989 CASlPAlACOA Conference

thesis resistance, myotomy, clinician experience, patient age, and Rlaw were found to be higher in females than males, and a significant radiation. Success was defined in terms of voice use, voice quality, gender/resistance interaction was observed. Fundamental frequency and independence in prosthesis care, considered separately and in and Rlaw increased as intensity increased. Comparison with Rlaw combination. Twenty-seven surgical procedures performed on 22 data obtained from young adults (Leeper & Graves, 1984; Wilson, patients were analyzed. Findings indicated that voice use was posi­ 1984) revealed few significant differences, although different air tively related to clinician experience and to low resistance type flow/air pressure patterns were observed. Study results can be used prostheses. Voice quality was positively related to amount of radia­ to develop norms for this population; normative values are useful both tion. Independence in care was positively related to patient health and in identification and monitoring of voice changes. clinician experience and to secondary surgical procedure. Overall success was positively related to clinician experience, radiation, and • Nasometer versus Perceptl.lal Ratings of Nasality health, and was negatively related to age. These findings have im­ Post-Uvulopalatopharyngop lasty plications for patient selection, clinician experience, timing of Caroline J. Brede"'on, Linda J. Garcia, and Jean Gerin-Lajoie surgery, and decisions regarding prosthesis type. Ottawa General Hospital, Ottawa, ON fan RA Mackay • Fibreoptic Endoscopy of the Vocal Tract: Essentials University of Ottawa, Ottawa, ON of the Examination Mary Anne Witzel, Ronald M. Zuker, and WilUam S. CrysdaJe Uvulopalatopharyngoplasty (UPPP) has become an accepted form of Hospital for Sick Children, Toronto, ON treatment for snoring and sleep apnea; however, the literature has not yet discussed the potential problem of velopharyngf 11 incompetence Flexible fibreoptic nasopharyngolaryngoscopy provides excellent post-surgery. This study explores the pussible side effect of hyper­ visualization of velopharyngeal and laryngeal anatomy and function. nasal speech following UPPP. Subjects' speech was recorded pre­ For the examination to be complete many aspects of anatomy and surgery and on two occasions post-UPPP, using the Nasometer. This function should be observed. To ensure completeness and consistent microcomputer-based instrument uses separate microphones to cal­ data collection for clinical comparison the authors propose a stand­ culate the ratio of nasal versus oral amplitudes. Objective analysis of ardized protocol for conducting the examination and reporting the three reading passages, controlled for percentage of occurrence of results. The protocol includes patient selection, use of topical anaes­ nasal sounds, was compared to subjective nasality ratings made by thesia, audiovideo recording, and insertion and position of the scope two speech-language pathologists. No significant difference in to adequately visualize the anatomy of the velopharynx and larynx. nasalance pre- and post-UPPP was found, although inter-subject Important anatomical features examined include any fistulae along values and objective versus subjective measures varied. These trends the floor of the nose, the nasal surface of the soft palate, the eustachian are discussed in terms of physiological recovery and compensation. tube orifices, size and shape of adenoid tissue, pharyngeal pulsations, The utility of the Nasometer in studying resonance disorders is also size and location of tonsillar tissue, the epiglottis and laryngeal addressed. structures. The functional aspects of the protocol include the use of a standard speech sample; notation of extent, consistency pattern, and symmetry of veIopharyngeal and laryngeal movements in relation to • Posterior Nasal Fricative In Sound Specific speech; notation of movements of the dorsum of the posterior tongue Velopharyngeallncompetence: Findings in 22 Cases during speech; and methods to assess the patient's ability to alter and Susan L. Brown and Mary Anne Witzel improve abnormal movements of the velopharyngeal valve during Hospital for Sick Children, Toronto, ON speech. The posterior nasal fricative was described by Trost (1981). This • Laryngeal Airway Resistance Measures In an Older sound is characterized by audible friction with associated nasal air Population emission and is typically used as a substitution for /s/, /z/, "sh," or "zh". Several mechanisms have been identified in the production of Lori C. Holmes the posterior nasal fricative including partial closure of the Victoria Hospital, London, ON velopharyngeal (VP) valve by incomplete VP movement or the Herbert A. Leeper tongue Iifting up the soft palate; and enlargement or ballooning of the University of Western Ontario, London, ON VP port. This sound substitution may occur in patients with or without cleft palate and may be one of many errors or the child's only error. This study examined laryngeal airway resistance (Rlaw) in an older In order to define more clearly the characteristics of the posterior nasal popUlation. Subjects were ten males and ten females in three age fricative and to determine whether sound specific VPI could occur in groups (55;0 64; 11 years, 65;0 74; 11 years, and 75;0+ years). A patients with cleft palate, 22 patients were reviewed. All patients had non-invasive procedure (Smitheran & Hixon, 1981) was used to evidence of the posterior nasal fricative on speech assessment and investigate Rlaw in four intensity conditions (25th, 50th, 75th percen­ each patient had assessment of VP function by multiview tile of own intensity range and conversational level). Fundamental videofluoroscopy, nasopharyngoscopy, or both. Our findings indi­ frequency was monitored in the intensity conditions. Rlaw values for cated that sound specific vpi occurs both in the cleft and non-cleft the oldest group of females were found to be higher at each intensity speaker. In the cleft speaker, sound specific VPI is often one of condition than those of the younger groups. For males, however, the multiple articulation errors and appears to be one of the last articula­ Rlaw values of the oldest group differed from the values of the tion diffIculties to be resolved. In both cleft and non-cleft speakers, younger groups only at the 75th percentile of intensity. Values for speech therapy is the recommended form of management.

JSLPAIROA (HCC) Vol. 13, No. 1, March 1989 55 Friday, May 12

Invited Presentations 9:00 to 12:00 Facilitating Generalization Learning in Phonological Intervention ludith A. Gierut Audiology Indiana University, B1oomington, IN

9:00 to 12:00 Three key factors that influence generalization learning in the remediation of phonological disorders in children are the focus of this Factors to Consider In Prescribing Real-Ear Gain with presentation. Child-specific factors are internal variables particular Conventional and Digital Hearing Aids and unique to an individual child, such as a child's productive or Margaret W. Skinner perceptual phonological knowledge. Language-general factors are Washington University, SI. Louis, MO properties common to all languages, such as phonological universals. External factors are associated with the clinical environment, such as particular methods of treatment. The way in which each of these A major goal in prescribing real-ear gain for aids is to amplify sound, factors influences generalization learning will be described in light of particularly speech, within an individual's area of residual hearing. current pho~ological research. Also, principles that guide generaliza­ Factors to be considered are: (1) sounds and listening situations tion learning will be specified. These principles will be shown to have encountered in everyday life; (2) real-ear frequency-gain charac­ clinical application for enhancing and facilitating generalization teristics associated with (a) maximizing speech recognition and (b) learning in phonological intervention. The clinical application of providing acceptable sound quality; (3) ways in which conventional these principles will be illustrated with regard to structuring interven­ and digital hearing aids can be adjusted to provide the prescribed tion programs, capitalizing on a child's existing phonological skills, real-ear gain; and (4) further adjustments to provide greater benefit and predicting the nature of change during intervention. ·for the individual. A discussion of these factors will be based on results of research and clinical application from many centers and laboratories. In addition, the flexibility with which the desired fre­ quency-gain characteristics can be achieved with conventional, quasi­ digital, and fully digital hearing aids will be described. Contributed Presentations Speech-Language Pathology

9:00 to 12:00 Audiology

Spasmodic Dysphonia 1989: Research Findings and Miniseminars Treatment Options 8:30 to 10:00 Frances Freeman University of Texas at Dallas, Dallas, TX Teaching the Meaningfulness of Verbal Language to the Very Young Cochlear-Implant Patient Eight years of behavioral and brain-imaging studies lead to the Ross W. Adams conclusion that spasmodic dysphonia (SD) is a non-paralytic, House Ear institute, Center for Deaf Children, Los Angeles, CA supranuclear movement disorder, primarily, but not exclusively, af­ fecting the larynx. Findings from Magnetic Resonance Imaging This miniseminar wi\l expose the participant to an auditory habilita­ (MRI), topographic electrophysiologic brain mapping (BEAM), and tion program designed to facilitate the very young, prelingually deaf, regional cerebral bloodflow (SPECT) studies define cortical and/or cochlear-implant patient's understanding of the meaningfulness of subcortical lesions in 85% of SD patients. As a group, SD patients verbal language symbols. The program is based upon a principle of demonstrate multifocal, electrophysiologic, and metabolic dysfunc­ determining the extent of speech information electro-acoustically tion in three cortical regions. For individuals and for sub-groups, brain available to the individual child, and subsequently assigning linguistic imaging findings correlate with behavioral measures of language, meaning to this limited information in small, carefully-selected units. cognition, and speech and non-speech motor control. The full The participant will receive an outline of suggested speech units and symptom complex of SD, including both primary (vocal motor) and attachable meanings as well as the formula used in determining the secondary (non-vocal) symptoms, is explored. Alternative speech units appropriate for the individual child. Group participation hypotheses regarding site(s) of intrinsic neuronal pathology are of­ will be utilized to demonstrate implementation of this habilitative fered. Diagnostic and etiologic implications of the research are con­ approach and facilitate the participant's ability to apply this program sidered. Current treatment options, including surgery, paralytic to pediatric hearing aid users as well as cochlear implant patients. injections, drug, and speech therapy are discussed. Video studies of severely affected patients treated through "inspirational Speech" are presented, and vocal rehabilitation techniques, pioneered by Susan This issue of JSLPAIROA is your conference programme. Shulman, are demonstrated. Research findings represent the col­ Don't forget to bring it with laborative efforts of the research team of the Dallas Cent er for Vocal you to the conference. Motor Control.

56 lSLPAIROA (HCC) Vol. 13. No.i. March 1989 CASlPAJACOA Conference

8:30 to 10:00 hearing aid/FM condition), a "similar output" or a "modified gain" based on the improved signal to noise ratio when an FM system is A Team Approach: Students with Hearing Impairment utilized. Results of the theoretical analysis indicate that when using and Multiple Handicaps the hearing aid/FM combination, the preferred level is a "modified Jean Duncan, Michael Cooper, and Glenis Benson gain" which is roughly equal to the gain used by the hearing aid alone Edmonton Public Schools, Edmonton, AB minus 5-8 dB. A "similar gain" approach will tend to be judged as too loud by the user, and a "similar output" approach will yield a poor The first part of this seminar will introduce Student Centered signal to noise ratio when the environmental microphone is turned on. Programming by briefly summarizing the population of students served and discussing how an individual student's program is 1 :30 to 3:00 developed through: (I) program consideration; (2) the classroom teacher; and (3) multi-disciplinary assessment consultation, and in­ KEMAR: Past and Present Uses of the service. In the second part, a discussion of historical information about Acoustic Manikin the development of the service delivery approach will lead to a Larry K. Henrickson and Michael G. Comeau presentation of that approach, which will outline the following char­ School of Human Communication Disorders acteristics: (1) school/community based; (2) emphasis on least restric­ Dalhousie University, Halifax, NS tive environment; (3) responsive to changing needs; and (4) interactive and collaborative. Finally, information will be supple­ When the Knowles Electronics Manikin for Acoustic Research mented by the use of case studies including services to rural (KEMAR) was first discussed it was proposed as an acoustic simula­ mainstreamed students, urban main streamed students, and urban tion of the average adult. A second manikin has been developed by centre-based, self-contained classrooms. B ruel and Kjaer. The first part of the seminar w ill describe the history, development, and traditional uses of the manikin to characterize 10:30 to 12:00 hearing aids and ear mold acoustics. The second part will describe the acoustic and instrumentation considerations in setting up a KEMAR Intervention with the Pediatric, Post-Lingually laboratory. The third part will highlight contemporary uses for Deafened, Cochlear-Implant Patient KEMAR and the more recent B&K acoustic manikin. These uses Ross W. Adams include: (1) Discussion of calibration; (2) The characterization of House Ear Institute, Center for Deaf Children hearing aids; (3) a discussion of studies attempting to characterize the Los Angeles, CA attenuation of various HPDs; and (4) the use of manikins to charac­ terize telephone systems. This miniseminar will provide the participant with strategies for developing an auditory rehabilitation program aimed at enhancing the Paper Presentations pediatric, post-lingually deafened cohhlear-implant patient's ability Session 1: 1 :30 to 3:00 to comprehend verbal language symbols. Acoustic information made available by both the single channel and twenty-two channel devises • A Canadian Test to Assess Visual-Consonant will be discussed as it relates to goal setting in speech-language Recognition Abilities intervention. Similarly, an auditorially monitored, self-adjusting, feed Jean-Pierre Gagni and Richard C. Seewald back approach will be presented as it relates to the facilitation of the University of Western Ontario, London, ON child's ability to maintain verbal language production skills which are Rajaa Hassan intelligible in the majority of situational and listener contexts. Practi­ University Hospital, London, ON cal demonstration will be provided, and participation in group discus­ sions and brainstorming activities regarding implementation Investigations have been conducted to standardize a Canadian version techniques will be encouraged. of a visual consonant recognition test. The test consists of a colour videotape recording of 18 English consonants produced in a /aI-C-/a/ 1:30 to 3:00 format. The test material is presented by a Canadian female talker experienced in monitored live-voice speech production. One token of FM and Hearing Aid, Interaction and Optimization each of the 18 bisyllables was included in the final version of the test. Marshall L. Chasin The selection of each token was based on the naturalness of the visual Thornhill, ON production and accuracy of the VU level acoustic production. The Carolyn Edwards same token was used to generate five test-items which were presented Toronto, ON randomly throughout the test. An eight second response-interval was inserted between each test-item. The edited 90-item test was presented The characteristics of the interaction between a personal FM system visually-only to a group of 78 normal-hearing adults with nOImal and a hearing aid will be shown in terms of 2cc coupler data. Probe vision, as well as to a group of adults with an acquired hearing loss. tube measurement data will also be shown based on experience with The results obtained were used to establish distinct viserne categories over 200 children from the Metropolitan Toronto Board of Education. for the test-stimuli. The mean percent correct scores for visual con­ A probe tube microphone based protocol will be introduced and sonant recognition and viseme recognition were computed. The discussed which is both clinically expedient and theoretically valid. results obtained were consistent with previous investigations and Hypotheses will be tested to determine whether the user prefers a indicate that the test fOIms developed with a Canadian talker are "similar gain" (between the hearing aid alone condition and the appropriate for assessing visual consonant recognition abilities.

JSl..PAIROA (HCC) Vol. 13, No. 1, March 1989 57 CASLPAlACOA Conference

• Towards the Validation of a French-Canadian tion of the initial test word. The same 50 test words were used in each Speech reading Test of the three videotapes. The subjects were required to identify the test Nicole M. Lalande words that were presented in a visual-only mode. When the response Universite de Montreal, Montreal, PQ to the initial stimulus (Le., the test word) was incorrect, the other two stimuli for that test item were presented, and the subject was given a Yves S. Lacouture second opportunity to identify the test word. An analysis of McGill University, Montreal, PQ covariance revealed that simple repetition did not improve the ability Ginette Lafleur of the subjects to identify the test word but improvement was observed Centre Hospitalier regional de Baie-Comeau, Baie Comeau, PQ when the repair strategy consisted of a synonym or a paraphrase, indicating that the use of substitute-stimuli may be more effective than In developing rehabilitative services for adults with acquired hearing the simple repetition of the misperceived stimulus. loss we came to the conclusion that a speechreading screening test was needed. For a variety of reasons, we chose to develop a test involving two lists of unrelated sentences which we then evaluated • Counselling Role of Audiologists: Perception of for internal consistency and equivalence (Lalande et aI., 1988). This Parents of Hearing Impaired Children validation allowed us to arrive at two equivalent sets of statements Judith DeLorenzi and Edward Y. Yang which must now be tested for predictability and stability. We will School of Human Communication Disorders discuss the experimental procedure used in carrying out this valida­ Dalhousie University, Halifax, NS tion, and present our preliminary data, if available, Christine Santilli Nova Scotia Hearing and Speech Clinic, Halifax, NS • Assessment of an Interactive Video System in Train Speechreadlng It is recognized that parents of hearing impaired children benefit from Jean-Pierre Gagne, Diana A. Dinon, and Joanne M. Parsons counselling at the time of diagnosis (Williams & Darbyshire, 1982). University of Western Ontario, London, ON Some researchers (Stream & Stream, 1978) suggest that the audiologist'S role includes providing parents with information as well CAST, a computer-assisted speechreading training program, was as enhancing their understanding and acceptance of the disorder. designed to optimize speech-perception abilities among adults with Another investigator (Mitchell, 1981), however, recommends that an acquired hearing loss. The CAST program consists of eight training counselling be done by trained therapists if possible with the lessons, each focusing on a specifIC viseme category, and each audiologists providing only information to parents. This study including (1) a review of previously taught visemes; (2) the introduc­ evaluated how parents perceived the counselling role of the tion ofa new viseme category; and (3) practice of new and old viseme audiologist and the extent of counselling satisfaction at the time of categories. An investigation was undertaken to assess the effective­ hearing impairment diagnosis. A modified version of Client-Satisfac­ ness of the CAST program in improving speechreading ability. Two tion Questionnaire (Larson, Attkinson, Hargreaves, & Nguyen, groups of eight normal-hearing adults participated in the investiga­ 1979), consisting of multiple choices and open-ended questions, was tion. All the subjects completed a pre-training assessment protocol distributed to the parents to obtain information regarding parents' which consisted of: (I) a visual-consonant recognition task; (2) a test perception of the counselling they received. Findings were analyzed of visual-sentence identification with context; (3) a test ofvisual-sen­ using descriptive statistics, and recommendations were made. tence recognition without context; and (4) a test of visual recognition of continuous discourse. Half of the subjects (the experimental group) completed the CAST program. One month following the completion • The Project for Inuit Hearing-Impaired: Beginning of the CAST program, all the subjects underwent a series of the Third Phase speechreading tests which consisted of equivalent-forms of the pre­ Anne Marie Hurteau and MaI'tha Crago training test protocol. The results ofthe investigation will be presented McGill University, Montreal, PQ and the clinical applications will be discussed.

The Project for Hearing Impaired Inuit of Northern Quebec was • The Effectiveness of Three Repair Strategies on the implemented four years ago. This innovative approach has become a Visual-Recognition of Mispercelved Words model for out-reach programs servicing the Inuit children of Northern lean-Pierre Cagne Quebec. Our presentation will describe the latest results and modifica­ University of Western Ontario, London, ON tions in the development of the project's attempts to meet the specific Kim A. Wyllie needs and cultural differences of this northern population. The presen­ E.C. Drury School, Milton, ON tation will begin with a brief history of the program, the actual needs of the population and the present organization of the Project. Next, Experimental videotapes were used to assess the effectiveness of three the services being offered to school-aged children as well as adults different repair strategies: (1) repetition of the stimulus; (2) provision and preschoolers will be documented with specific cases that illustrate of a synonym; and (3) provision of a paraphrase. Three groups of the program's diagnostic and rehabilitative approach. Following that, normal-hearing adults viewed one of three experimental videotapes results of the different aspects of the intervention will be discussed. that incorporated one of the repair strategies under investigation. The focus will be on the need for continuing adjustment and re-evalua­ There were 50 test items on each videotape. Each test item consisted tion in such an out-reach program. The presentation will conclude of three stimuli including: (l) the test word; (2) a stimulus that with recommendations for the development of future audiological incorporated the repair strategy under investigation; and (3) a repeti- health care programs for Canadian Inuit.

58 JSLPAIROA (HCC) Vol. 13. No. 1 ,March 1989 CASLPAlACOA Conference

Poster Presentations future (Carstensen, 1987). Many of the studies have dealt with the 1 :30 to 3:00 effect on somatic and visceral tissues of patients receiving medical and dental procedures involving ultrasound. There are some studies • Comparing the Occlusion Effect and Attenuation of concerning possible hearing damage due to ultrasonic dental proce­ Earplugs and Earmuffs dures (Walmsey et al., 1988; Moller et aI., 1976). These studies did Michel G. Comeau. Larry K. Henrickson, and Edward Yang not probe the professionals who are exposed to ultrasound of greater School of Human Communication Disorders duration. The present study examined the possible correlation be­ Dalhousie University, Halifax, NS tween industrial ultrasound exposure and permanent change of hear­ ing sensi ti vity. The subjects were volunteers from ultrasound research Gordon L Whitehead and development laboratories. A comprehensive case history ques­ Nova Scotia Hearing and Speech Clinic, Halifax, NS tionnaire was employed and analyzed to exclude those with previous noise exposure. Subjects were then evaluated using otoscopy, acous­ Berger (1986) has suggested that data for the attenuation of hearing tic immittance measurements, and pure tone audiometry. Findings protection devices (HPDs) have most commonly been measured by were analyzed using inferential statistics and recommendations were testing sound field thresholds which occur at relatively low sound discussed. pressure levels (SPLs). Berger has further indicated that at very high intensities, both air and bone conduction pathways contribute to sound transmission reaching the inner ear. Since, at lower frequencies, • Case Study of Biotinidase Deficiency: Auditory and bone conduction is known to be enhanced when the ears are occluded, Visual Sequelae the use of HPDs may produce a measurable occlusion effect. The Kathy 1. Packford and Margery Monsma attenuation of these HPDs may be less efficient than expected when Glenrose Rehabilitation Hospital, Edmonton, AB used in the presence of high SPLs where the bone conduction pathway is involved. This study describes measurements of the occlusion effect This poster session documents a case study of a child with biotinidase for different types of HPDs using a forehead-placed bone vibrator. deficiency. This autosomal recessive metabolic disorder initially The study also compares the real ear attenuation at threshold and the manifests itself with seizures and hypotonia. The literature reports insertion loss as characterized by probe microphone measurements in sensorineural hearing loss, most of which is high frequency in nature, the external ear canal. The results of these measurements are dis­ in 40% of the cases. Visual problems are evident in about half of the cussed in terms of the relationship between the occlusion effect and children with the disorder. BaCkground information will be provided the effectiveness of HPDs at high intensities. on biotinidase deficiency. Technical information will include the results of audiometric findings including auditory brainstem response • A Model for Adult Aural Rehabilitation testing and visual evoked potentials. Anita S. Down and John Latimer Hotel Dieu Hospital, Kingston, ON • Utilizing Auditory Brainstem Responses in Management of Patients with Neurofibromatosis It has been suggested that hearing impairment represents one of the Daniel C. Pacciroetti largest chronic disabilities in North America today. Its prevalence can Glenrose Rehabilitation Hospital, Edmonton, AB be expected to rise as the proportion of elderly within the population increases. Adult aural rehabilitation programs have been plagued by Case studies will be presented on patients suffering from inconsistent patient referral, ineffective treatment planning, and poor neurofibromatosis in order to point out the need for the utilization of documentation of progress. These factors, in part, have led Auditory Brainstem Responses (ABR) in the management of this audiologists to question the remediation process as a whole. The patient population. Audiometric and ABR test results will be screening, identification, and assessment of hearing impair­ presented to illustrate that audiometric testing alone is not sufficient ment/handicap will be discussed as it relates to age, audiometric to determine the presence or absence of retrocochlear involvement in testing, the use of hearing handicap scales, and the social milieu of neurofibromatosis patients. the hearing impaired adult. A discussion of psycho-social adjustment among hearing handicapped adults will address the social consequen­ • Comparison of Psychophysical and ces of hearing problems. A perspective on counselling will outline the Electrophysiologic Measures of Frequency informational content and counselling strategies that would serve the Selectivity model program. John C. Booth University of Western Ontario, London, ON • Industrial Ultrasound Exposure and Noise Induced Hearing Loss Measures of frequency selectivity or tuning of the auditory system Kim M. Lawson and Edward Y. Yang potentially have important clinical applications. Most routine tests School of Human Communication Disorders used in clinical audiology today provide little or no information on Dalhousie University, Halifax, NS the selectivity of the ear. Several measures of frequency selectivity Gordon L. Whitehead are presently available but are not in wide use clinically. In a group Nova Scotia Hearing and Speech Clinic, Halifax, NS of normal hearing subjects, frequency selectivity was determined using both psychoacoustic and electrophysiologic procedures. The search for biological effects of ultrasound exposure has been in Measures include: psychophysical tuning curve, spread of masking, progress for many years and may justifiably continue far into the ABR tuning curve, and extra-tympanic ECochG tuning curve. The

JSLPAIROA (HCC) Vol.i3, No.i,March i989 59 CASLPAlACOA Conference

interrelationships between the various measures will be presented. In pathologist. The advantages and disadvantages of the clinical assess­ general, the electrophysiologic measures were often highly variable ments also will be addressed. and they often showed significantly less frequency selectivity than did the psychophysical measure. The validity, reliability, and limita­ 8:30 to 10:00 tions of these measures will be discussed.Friday, May 12,9:00 to 12:00 Language, Learning, and Thinking: The Bloom Explosion! Mark D. Ban'ett Speech-Language Pathology LinguiSystems, Inc., Moline, IL

Seminar The speech-language pathologist employed in today's school setting 9:00 to 12:00 is charged with a myriad of responsibilities and duties. Among the most important of the roles the clinician must fill is that of teaching Volunteers as Service Providers for the Profoundly language to the language disordered child both directly and through Handicapped Preschooler the supportive instruction of the child's classroom teachers. The AlIison J. Baird and J. Lois Turner language realm confronting the clinician has expanded beyond gram­ St. Amant Centre, Winnipeg, MB mar and syntax to vocabulary, problem solving, and even strategies for learning in the classroom. This miniseminar presents a language St. Amant Centre is a residence for approximately 250 individuals and learning framework that can be used not only in individual and with severe to profound mental and physical handicaps. In an attempt small group therapy, but also in classroom language and academic to provide an adequate service to these individuals, the Speech goals. It is based on Bloom's Taxonomy of Educational Objectives Pathology Department has developed a program which uses com­ and enables the instructor to classify the language demands that munity volunteers. In its current form, the program provides a very specific tasks and question types place on the student. Using the cost-effective means of one-to-one individualized service for pre­ taxonomy, the clinician can determine the language demands of the schoolers who reside at the Centre. The presentation will outline classroom and curricula and can suggest modifications of these lan­ information on the following: (I) a general overview of United States guage requirements to enhance the academic performance of lan­ and Canadian guidelines for the use of supportive personnel; (2) a guage disordered students. literature review on the use and effectiveness of supportive personnel; and (3) a description of the Volunteer Program at St. Amant Centre. 8:30 to 10:00 This program has application where the consistency and repetitious­ ness of programming and the relationship between client and inter­ Normal Dysfluency In Stutterers and Implications for vener have a more significant impact on progress than the expertise, Treatment and Research clinical finesse, and ongoing decision making of a paid professional. Ann Meltzer In addition, it will be of interest to those professionals employed by National Defence Medical Centre, Ottawa, ON Centres or Agencies where funding issues present as critical concerns. lanMacKay University of Ottawa, Ottawa, ON Miniseminars 8:30 to 10:00 Clinical research and management of stuttering have focused mainly An Interdisciplinary Assessment of Students with on two parameters fluent speech and stuttering with relatively little Language/Learning Problems attention to normal dysfluency. Previous studies have indicated that all types of dysfluency are more common in stutterers. Current Margaref lonson, Carol Barher. and Mm'ion Parkinson screening criteria, however, do not appear to differentiate between the The Hospital for Sick Children, Toronto, ON dysfluency arising from cognitive and linguistic processing, and the dysfluency associated with stuttering caused by a disruption in the School age students are referred to the Learning Evaluation Unit, motor production of speech, In this study, spontaneous speech was Child Development Clinic at the Hospital for Sick Children for analyzed in ten adult stutterers prior to treatment. Stuttering and evaluation of their learning strengths and weaknesses. From this normal dysfluency were identified independently. Normal dysfluency assessment recommendations are made for teaching and manage­ also was analyzed in a control group of ten non-stutterers. Results ment, Cases are sCreened by the Medical Director and the Psychologi­ indicated that stutterers had less normal dysfluency than non-stut­ cal Director and a decision made as to whether the student receives terers and that the frequency of normal dysfluency varied inversely an intensive (one week) or an intermediate (two day) assessment, with the severity of the stuttering. These findings have implications Many of the students referred have a language component so the forresearch methodology, the management of stuttering, post-therapy speech-language pathologist carries OUI assessments as a learn mem­ evaluation, and the persistent problem of maintenance of fluent ber and also consults with other teams when a full speech and speech. language assessment is not required. The team usually consists of a pediatrician, a psycho-education consultant, a teacher, and frequently the speech-language pathologist. In addition the services of a psychiatrist and social worker are available when required. The role Scientific Exhibits Friday, May 12 of the members of the team will be discussed. Two cases will be 1:30 - 3:00 presented demonstrating the integration of information from team Richmond Room members as well as the assessment carried out by the speech-language

60 JSLPAIROA (HCC) Vol. 13, No.I. March 1989 CASLPAI ACOA Conference

1:30 to 3:00 • Alterations in the Acoustic Characteristics of the Speech of ALS Patients Pragmatics: Clinical Expectations, Realizations, and lanet E. Gritzan Future Directions Thames Valley Children's Centre, London ON Tanya M. Gallagher Herbert A. Leeper, lr. McGill University, Montreal, PQ University of Western Ontario, London, ON ludith lohnston University of British Columbia, Vancouver, BC Donna Bandur and ArthuT 1. Hudson University Hospital, London, ON Pragmatic language models (Austin, 1962; Searle, 1969 Bates, 1976) have had a profound impact on our thinking about language, and This study assessed the changes in selected acoustic speech charac­ clinicians have embraced them in a remarkably short period of time. teristics of patients with amyotrophic lateral sclerosis (ALS) over a The apparent face validity of the functional language perspective that nine-month period. A protocol of several stimulus items examining was the core assumption of these various models was accepted by a the respiratory, laryngeal, resonatory, and articulatory levels of large number of clinicians who were working with language disor­ speech production was administered to five bulbar ALS subjects and dered children and adults. This acceptance was due probably to two seven nonbulbar ALS subjects during two testing sessions. Results of major factors. One was our growing frustration with the limitations acoustic analyses for the bulbar ALS subjects indicated that sig­ of an almost exclusively syntactic characterization of language be­ nificant changes occurred over time for diadochokinetic rates and haviors and the other was an intuitive recognition that there was sentence duration. No significant changes over time were found for something basically right about the field's earliest characterization of maximum phonation time, the degree of nasalization on oral sounds, language disorders as a typeof"socially defined disability." The focus voice onset time, vowel duration, duration of frication in monosyl­ of this miniseminar will be a critical review of the expectations that labic stimuli, and speech segment durations in sentence stimuli. The speech-language pathologists had for pragmatically based clinical nonbulbar ALS subjects did not demonstrate significant deterioration practice, and how those expectations have and have not been realized. over time. Results also indicated several significant differences be­ Several hypotheses will be discussed regarding why the literature has tween the bulbar and nonbulbar ALS subjects. Possible explanations evolved as it has. Critical limitations in our conceptualization about regarding the present findings are discussed. These results support, in pragmatic language models will be identified and discussed. The part, the existing qualitative descriptions of the course of speech miniseminar will also address the implications of what we have deterioration in ALS patients. learned for the development and use of functional language assess­ ment and intervention procedUres. Proposals and future directions will be discussed. • Oral Stimulation for Selective Comatosed Closed·Head Injured Patients Paper Presentations KentonL. Yockey Session 5: 1 :30 to 3:00 Madigan Anny Medical Center, Tacoma, W A

• Phonetic and Acoustic Analysis of Intelligibility in Amyotrophic Lateral Sclerosis It has been recognized that patients who are in coma will begin to Ray D. Kent, Gary Weismer, and Ruth E. Martin masticate when orally stimulated. Often a rooting or positive peri-oral University of Wisconsin-Madison, Madison, WI reflex can be elicited by any stimulation on or around the lips. These reflexes are brain stem triggered reflexes that, albeit reliant on cortical influence, are certainly not dependent on cortical control. Therefore, This paper presents results from a research program, whose aim is to the disinabition factors of bilateral frontal lobe injury as incurred in develop an explanatory assessment of the intelligibility of dysarthric many closed head injuries may cause reflexes to reemege appearing speech. Explanatory refers to the ability of the test to identify the similar to the nonnal reflexes observed in the developing infant. The phonetic and acoustic underpinnings of various intelligibility deficits. medical specialist who understands the importance of these basic To this end, a word-level intelligibility test is proposed wherein 19 neurologic reflexes may be able to provide an early oral swallowing phonetic contrasts are incorporated into minimal pair sets. This test and mastication stimulation program to selective closed head injured was administered to 25 male speakers with amyotrophic lateral patients in coma. This presentation describes a structured oral stimula­ sclerosis (ALS), 25 female ALS speakers and, to serve as comparison tion program using ice chips which led to coma patients' increased groups, 15 male and IS female nonnal geriatric speakers. Preliminary awareness and emergence from coma. The evaluative protocols and results indicate that, for the male ALS speakers, the phonetic contrasts procedures used in five closed head injured patients in coma will be most often associated with unintelligibility are related to velopharyn­ discussed. The interactive role ofrehabilitative and nutritional support geal articulation and laryngeal configuration. Further, in tenns of will be described. acoustic underpinnings, it appears that the slope of the second fonnant (F2) transition is highly correlated with overall intelligibility, as measured by the proposed test. Results are discussed in tenns of their theoretical and clinical implications. This work is supported in part Awards Banquet Friday, May 12 by P.H.S. Research Grant NS22458 from NINCDS. 7 :30 - 9:30 pm Toronto I/II/lII

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• Influence of Production and Discrimination Training processes. Group 2 children's production contained multiple pos­ on Phonemic Production and Discrimination sibilities (either immature or atypical) for a given morpheme, and of James C. MeNutt Group 3 demonstrated a free variation among erroneous forms and McGiIl University, Montreal, PQ omissions, suggesting the absence of any strategy for choosing one in particular. All the Group 3 subjects showed syntactic disturbance Chantal E. Landry of some kind, while in Group I sentence structure appeared entirely Sudbury-Algoma Hospital, Sudbury. ON normal. Within Group 2, some children used essentially intact syntax, while others appeared to have difficulty at the sentence level. These Speed-sound discrimination training frequently has been advised for data raise interesting questions as to the nature of expressive language children with phonological dis0rders (Powers, 1971; VanRiper, problems in children and the type of clinical intervention useful in 1978). However, past research has not examined the effects of training their remediation. perception upon production (and the reverse) in children who present errors for both production and perception. Data from three children who had production and perception problems affecting the "th" sound • Conversational Assertiveness and Responsiveness were evaluated within a single-subject reversal design that included of Language Disordered Children During a ComprehenSion Monitoring Task multiple-baseline measures for both production and discrimination training. Data for individual chiloren will be presented and implica­ Usa McCarvill, Elizabeth Skarakis-Doyle, and KathleenMullin tions for therapy will be discussed. School of Human Communication Disorders Dalhousie University, Halifax, NS

• Evaluating Self-Monitoring Judgements of Children Comprehension-monitoring involves the evaluation and regulation of with Phonological Disorders one's ongoing comprehension abilities. The result of monitoring is James C. MeNutt the knowledge that one has either understood the message or not. It McGilI University, Montreal, PQ is considered critical for successful participation in conversation and Dianne T. Snow other communicative situations, and in the acquisition of reading and The Dr. Charles A. Janeway Health Center, St. John's, NF problem-solving abilities, and is of particular importance for the language-disordered child who often finds hirn/herself in difficult Relationships between self-monitoring judgements made by children communicative interactions. Literature to date suggests that lan­ with phonological errors regarding the correctness of their produc­ guage-disordered children have difficulty with a variety of metalin­ tions and the number of their phoneme errors have been found by guistic tasks, including comprehension-monitoring. Fey has some investigators (Aungst & Frick, 1964; Lapko & Bankson, 1975; suggested that a lack of communicative assertiveness may contribute Wolfe & Irwin, 1973) but not by others (Wolf & Pilberg, 1971; to the language-disordered child's poor performance on comprehen­ SheIton, Johnson & Amdt, 1977; Snow & McNutt, 1987). Lack of sion-monitoring tasks. The present study investigated the effect of agreement among research findings may be due to the performance level of communicative assertiveness upon performance in a com­ on tasks used to evaluate self-monitoring judgements in children. prehension-monitoring task. Language samples obtained prior to Re-examination of some published data indicates that the scores participation in an ambiguity detection task were analyzed according obtained from the self-monitoring judgements may be at a chance to Fey's taxonomy of conversational assertiveness and responsive­ level. Testing procedures, problems, and a standard protocol for use ness. Social communication of language-disordered children was in examining the self-monitoring judgements of children with compared to two groups of matched normal children. Results will be phonological errors will be discussed. Data from children will be discussed and and clinical implications will be addressed. reported. • Training Teachers to Facilitate Language: Why Session 6: 1 :30 to 4:00 Didn't It Work? Catherine E. Renfrew • Patterns of Morphosyntactic Impairment in Children C. Hess and Associates, Hamilton, ON with Severe Phonological Problems Genese A. Warr-Leeper Carolyn Cronk, Dominique Moquin, Lambert Desehene, University of Western Ontario, London, ON and Miehele Bergeron Ecole d'Orthophonie et d' Audiologie Interest in the role of the teacher and the classroom in the facilitation University of Montreal, Montreal, PQ of children's language has been escalating as researchers continue to advocate movement towards the use of more naturalistic approaches Detailed analysis was made of spontaneous language samples from a to language remediation. Three junior kindergarten teachers were total of 31 children presenting with severely delayed phonological videotaped in their classrooms as they taught. Following this they development. Ages ranged from 4 to 7 years for the majority, with attended a one day workshop in the use of language facilitation three subjects at eight to nine and one-half years. For 13 children, the techniques for the classroom. Training consisted of presentation of study covered only those errors showing an influence of phonological the techniques through handouts, discussion, role-plays, and difficulties on morphological deficits. For 18 others, it was extended videotaped examples. Following the workshop, the teachers were to include an analysis of all forms of morphological error, including videotaped again in the classroom, and were asked to complete a omissions. Three levels of morphological impairment clearly questionnaire regarding their perceptions of the workshop and their emerged in both sets. Utterances produced by Group 1 children were use of the facilitation techniques. Results revealed that while the marked by immature forms entirely predictable from phonological teachers felt it was informative, the workshop was ineffective in

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increasing the teachers' use of language facilitation techniques. • Beginning Stutterers: An Early Intervention Model Teacher style may be related to the use of techniques. Findings are Deborah lones-Prus discussed in terms of the goals we set for inservice training, how we Oakville-Trafalgar Memorial Hospital, Oakville, ON attempt to meet those goals, and factors which we need to consider when developing training, how we attempt to meet those goals, and Beginning stutterers demonstrate slower voice onset times and longer factors to consider when developing training programs. segment durations than their normal peers (Adams, 1987). Since these differences may occur within six months of the onset of fluency • Teaching Language Impaired Children to use difficulties (Adams, 1987), early intervention may prevent the Contextual Cues to Aid Comprehension development of a more chronic disorder. A dual approach to treatment Barbara H. Gaines and Carol W. Haigh involved training parents to facilitate fluency skills, followed by more Alberta Children's Hospital, Calgary, AB direct treatment if needed. Five beginning stutterers ranging in age from 28-40 months were assessed within two to seven months of the Language impaired children may display difficulty comprehending parents' reports of early stuttering behaviors. The Stuttering Sellerity complex syntactic sentences. This study investigated whether lan­ Instrument (Riley, 1972) was used to measure stuttering severity at guage impaired children could learn to use pictorial and verbal the evaluation, at pre- and post-treatment, and during reviews. Two contextual cues to make predictions about the meaning conveyed by of the five children made significant gains with parent training alone, complex linguistic forms. Four language impaired subjects who were while the other three required both parent training and direct interven­ able to comprehend reversible agent-action-patient sentences, but tion to achieve and maintain fluency. The use of a dual approach to demonstrated difficulty processing reversible passi ve structures, were treatment may provide more efficient and effective treatment for the selected for study. A single subject baseline design was utilized. beginning stutterer. Subjects' accuracy for identification of active and passive sentences was measured across baseline and experimental phases.lnvervention • Parent Workshop on Sound Stimulation involved a contrast training phase (active vs. passive structures) and Deborah lones-Prus and E. Gay Gretton a meta-cognitive approach to cue application. In these phases, sub­ Oakville-Trafalgar Memorial Hospital, Oakville, ON jects learned when they needed to apply a cue and how to use the cue information to assist with difficult syntactic processing. Results indi­ Children whose parents attend their articulation therapy and complete cate that the language impaired subjects successfully learned to use a home therapy activities demonstrate significant gains over those cue strategy to improve their comprehension of passive sentences. children who receive treatment involving limited parental participa­ Individual differences in the subject's ability to benefit from cues tion (Fundala et al., 1972; Costello & Potter, 1983). However, many were observed. A model of language learnability which accounts for parents may lack the necessary knowledge or skills to take advantage the subjects' differences in strategy acquisition will be presented. of ongoing stimulation opportunities in the home. Formal parent Implications for developing effective strategy-based intervention will training groups have been implemented for early language stimulation be discussed. and could assist in the treatment of articulation disorders. This presen­ tation will discuss the rationale for parent workshops on sound • Quality Assurance: Focussing on Outcomes stimulation: the philosophy, general content, activities, and the results Donna L. Bandur and Patricia Barker of this form of intervention. Parents attended the workshops following University Hospital, London, ON their child's initial evaluation and prior to the provision of direct treatment. Parental learning was measured by a true/false question­ Over the past ten years, the establishment of quality assurance naire completed prior to and following the workshops. The children's programs has become a significant focus in health care delivery. progress was measured by reviews when possible and by parental During this period, the Speech Pathology Department at University ratings of their children's intelligibility with themselves and with Hospital has undergone some evolutionary changes in its approach to strangers. Parents made improvements on all questions and many of quality assurance and its Structure-Process-Outcome model. In its the children made marked gains in intelligibility. Active parent par­ infancy, the program concentrated on the "structure" and "process" ticipation in speech treatment can accelerate the child's progress, and elements, with emphasis on examining the technical aspects of service workshops can be an effective and efficient way of providing service. delivery. However, it was extremely time consuming and failed to reveal meaningful problem areas. Conducting chart audits was Poster Presentations viewed by staff as a dreaded academic exercise with little or no payoff. Session 1 : 1:30 to 3:00 A change in thinking about quality assurance included embracing notions such as patient satisfaction, efficiency, effectiveness, and risk • Perception and Production of Selected Phonemes reduction. As an initial project, departmental members chose to by Children with Functional Articulation Disorders determine the treatment outcomes for a large patient population Daniel F. McDougald, Donald G. lamieson, and retrospectively. In the process, potential problems with respect to Margaret F. Cheesman patient management were identified, which in turn raised additional University of Western Ontario, London, ON questions while providing opportunities for some creative problem solving. Concurrently, there was a noted change in staff attitudes Rvachew and Jamieson (1987; 1989) showed that a subgroup of about participating in quality assurance activities, with suggestions children who have a functional articulation disorder also present with for future directions readily generated. a remediable speech perception deficit. Using synthetic speech con­ tinua these speech perception deficits can be identified, and it appears that synthetic stimuli also can be used in a structured training sequence

JSLPAJROA (HCC) Vo/.I3,No.}, March 1989 63 CASLPAlACOA Conference

to help remediate the deficits. This paper will present the results of group of chronological age/cognitive-matched subjects. The children research that examined the efficacy of such training with a larger in these studies were given a task that required them to respond to group of children and generalized the work to include both perception directions which varied in degree of informativeness. Specifically, we and production of /sl.lsh/, /r/,Il/,/kI and Ig/. were interested in their ability to indicate their awareness of the ambiguity in the directions they were given. The first study analyzed • Designing Effective Workshops for the differences in each group's ability to respond correctly. The Preschool Teachers second study examined the patterns of nonverbal responses as indices of noncomprehension. Specific clinical implications pertaining to Susan A. Lane and Usa R. Theimer complexity of messages and tasks used in treatment programs will be B.C. Elks Auditory Rehabilitation Centre, Surrey, BC addressed.

Speech-language pathologists are frequently asked to present workshops for teachers of regular and special needs preschools. These • Baby Talk: Encouraging Communication Between workshops typically consist of lectures, films, and hand-outs. Adult Parents and High-Risk Infants leaming research indicates that this approach may not result in optimal Irene Ushycky and Luigi Girolametto learning by the workshop participants. This poster will outline The Hospital for Sick Children, Toronto, ON workshops for preschool teachers designed by the B.C. Elks Auditory Rehabilitation Centre staff. The design of these workshops is based Prematurity and respiratory distress syndrome are high risk indicators on adult learning principles. Experiential learning activities such as for disturbed interactions and subsequent communication delay. It has group problem solving, team projects. role playing, and simulated been hypothesized that high risk infants provide fewer distinctive and experiences are used to teach workshop participants skills such as: "readable" signals for their parents (Dunst, 1985; Goldberg, 1977). In identifying children with possible communication disorders, using turn. Field (1983) noted that the mothers tended to overstimulate their circle time for language stimulati on, selecting and reading appropriate infants, with negative results. This poster will present the content and story time books for children with speech/language disorders, and outcome of an education service offered to parents of high-risk using speech/language stimulation techniques during snacktime and infants. The participants in this pilot project were five parents and freeplay. their high-risk infants. The program consisted of six weekly two hour sessions held in the morning. Following each session. parental feed­ • The School Articulation Program back was elicited using evaluation forms. Parental questionnaires were readministered at post-program and one month later during Evelyn Levine. Lois Bredo, lennifer Purves, Talya Shen. Marnie home visits with a non-program interviewer. The results of the Rempel-Friesen, and Barb Luthi questionnaires will be discussed. Edmonton Public Schools, Edmonton, AB

The School Articulation Program was conceived and developed by Session 2: 1 :30 to 3:00 consultants serving on a School Aides Committee for the speech-lan­ Sex Recognition of Electrolaryngeal Voices Produced guage pathologists of the Edmonton Public Schools. It was designed by Normal Speakers for use by school program aides in an attempt to meet the needs of students exhibiting mild articulation problems. Consultants were Sandra L. Dingee and Philip C. Doyle School of Human Communication Disorders responding to the changing role of speech-language pathologists Dalhousie University, Halifax, NS within Edmonton Public Schools. Speech-language pathologists were adopting a more intensive consultation role and therefore finding less opportunity to provide direct therapy. The program provides detailed Research on the psychosocial adjustment of female esophageal lesson plans, twelve hours of training time, and an accompanying speakers has documented a concern related to the "masculine" sound videotape. Currently the SAP is being piloted by several EPS consult­ of their voices. Although one study has shown that naive listeners ants, and feedback is being collected and documented. distinguish the sex of esophageal speakers (Weinberg & Bennett, 1971). other studies of specific esophageal speech parameters reiterate the lack of differentiation between male and female voices. • Verbal and Nonverbal Aspects of Comprehension The failure to separate male and female laryngectomees into two Monitoring distinct speaker groups presents an important clinical problem. Kathleen Mullin, Nancy MacLellan. and Elizabeth Skarakis-Doyle Hence, the present project investigated sex recognition of normal School of Human Communication Disorders speakers who were trained to use several electrolaryngeal devices. Dalhousie University, Halifax, NS The following questions were addressed: (I) can naive listeners accurately and reliably identify the sex of electrolaryngeal speakers? Comprehension monitoring is one of a constellation of cognitive and (2) Do the acoustic features of three different types of abilities that deal with an individual's awareness of his or her mental electrolaryngeal devices influence speaker sex recognition? activities; in this case, knowing that one has or has not understood what has been said. Clearly, the ability to monitor one's comprehen­ sion is essential to successful communicative interactions, particular­ Canadian Universities Alumni Party ly when faced with an inadequate or ambiguous message. This poster Friday, May 12 session will present results from two investigations into the com­ 9:30 pm - 12:00 am prehension monitoring abilities of language-disordered children Carmichael/J ackson matched to a group of younger language-matched subjects and a

64 JSLPAIROA (HCC) Vo!. 13, No.i,March 1989 CASLP AI ACOA Conference

• A Community-Based Swallowing Program consonant position (initial, medial, final) varied, were measured Susan E. Bramberger, Faith Hallward, Amanda Manson, and before and after training. Findings of the study will be discussed as Debbie Ciotti-Bowman well as their implications for training and acquisition of new Hamilton-Wentworth Home Care Program, Hamilton, ON phonemic contrasts. This work was supported by grants from the Natural Sciences and Engineering Research Council of Canada. In response to a growing number of referrals to the Hamilton­ Wentworth Home Care Program for patients with swallowing dif­ • Reliability and Validity of an Aphasia Group ficulties, a multidisciplinary swallowing assessment team was Performance Measure initiated in the fall of 1987. The Home Care Program is a Ministry of Caroline Bredeson and Chantal Desmarais Health agency which provides health care to eligible citizens of Ottawa General Hospital, Ottawa, ON Ontario in their own residences. The team began with a speech-lan­ guage pathologist, a nutritionist/dietician, and an occupational Aphasia treatment groups are a common and popular practice. How­ therapist. The need for specialized nursing involvement soon became ever, objective evaluation commensurate with group activities is apparent and a VON nurse joined the team. The main goals are to infrequent as few appropriate tools exist. In order to capture the provide a coordinated assessment ofthe patient's problem, to imple­ communicative behaviors which comprised our group sessions, a ment appropriate interventions, and to educate the patient and pragmatic behavior tally form was devised. A pilot study was con­ caregivers about swallowing. The swallowing program will be ducted to measure the reliability and validity of this·form. One fluent presented including the referral process, the assessment protocols, the and one non-fluent participant were rated once weekly during out­ patient population, the types of intervention, and other aspects of the patient group sessions. Ratings were made on line and videotaped to team. allow for a second rating. Percentage of agreement was calculated between two clinicians' ratings of both patients under three assess­ • Quadravoc: An Apparatus for Comparative ment conditions. The feasibility of objectively capturing the com­ Microphone Measures and Consistent Audio municative behaviors of the participants in group treatment using the Recordings tally system will be discussed. Philip C. Doyle, Donald H. Ewert, and William J.E. Wallace School of Human Communication Disorders • A Cooperative and Integrative Approach to Dalhousie University, Halifax, NS Speech-Language Pathology and Augmentative Communication Services The value of audio recording as part of the clinical voice evaluation Laurie Scou and Anne Warrick is well established. While it is generally agreed that recordings should The Hugh MacMillan Medical Centre, Toronto, ON be obtained using relatively standard procedures, this goal is frequent­ ly a problem for a variety of reasons. This report will present the use This poster presentation will focus on the cooperative clinical of a recording apparatus which facilitates consistent audio recordings management of a 13 year old girl with severe speech and language (e.g., mouth to microphone distance, etc.). Additionally, this ap­ impairment resulting from a closed head injury. An initial speech and paratus permits simultaneous recordings of up to four microphones language assessment revealed severe oral motor involvement which for comparative purposes. This device, which we have termed Quad­ prevented verbal communication. The client's need for an expressive ravoc, was designed, developed, and is in current use in the Vocal communication system, in addition to intensive oral motor treatment, Function Laboratory, School of Human Communication Disorders. was recognized. Throughout the one year rehabilitation period, the The clinical utility of Quadravoc in our facility, as well as schematic program was continually adapted to meet the client's changing needs representations and photographs of the apparatus, will be presented. and capabilities. The close cooperation of professionals from the Speech-Language Pathology and Audiology Department and the • Training New Phonemic Contrasts in Adults Augmentative Communication Service of The Hugh MacMillan Medical Centre was required to integrate these services. The benefits April E. Moore and Donald G. Jamieson of integrating a range of augmentative communication modes with University of Western Ontario, London, ON speech therapy for oral motor difficulties will be illustrated.

Recent research has shown that a carefully structured training pro­ gram, using synthetic speech stimuli, can be particularly effective in • An Introduction to the FLUEN SEE Program helping adult second language learners acquire new, non-native Sylvia A. Whites/de, Tessa Mintz, Angela M. Hill, speech contrasts. Using a perceptual fading technique, Jamieson and Anne Godden, and Rodney Everitt Morosan (1986) demonstrated significant improvement in identifica­ University of Western Ontario, London, ON tion and discrimination of the voiced and voiceless English "th" sounds by francophone subjects and showed that under some condi­ Children who stutter often find it hard to grasp the abstract concepts tions such training might be quite robust (Morosan & Jamieson, and terminology used in fluency shaping programs. The FLUEN SEE 1989). The present study investigates the extent to which such im­ Program was developed in an attempt to alleviate this problem. provements in identification generalize to speech in contexts other Simple, fun visual representations for specific fluency shaping targets than those used in the training. Listeners' abilities to identify the were employed in a transfer and maintenance program with eight English phonemes /tI, Id/, and the voiced and voiceless "th" in the elementary school children. The targets were adapted from the Com­ context of synthetic and natural speech nonsense syllables and natural prehensive Stuttering Program (Boberg & Kully, 1985). This poster speech real word minimal pairs, over which vowel context and presentation will introduce the FLUEN SEE Program and discuss its

JSLPAIROA (HCC) Vol. 13, No. 1, March 1989 65 CASLPA/ACOA Conference

potential benefits. Visual representations for rate, easy onset, soft clinicians in developing treatment plans and evaluating vocal progress contacts, cancellations, breathing, blending, and loudness will be for the vertical hemilaryngectomy patient. displayed. Their uses in target introduction, monitoring, and homework tasks will be described. Using the program children were • Selective Attention of Stutterers and provided with a means to evaluate their own and others' target Non-Stutterers Revisited production in a specific fashion and parents were able to provide Susan D. Schurr children with more specific feedback in everyday situations. Stratford General Hospital, Stratford, ON Wil/iam S. Yovetich • Physiological Speech Characteristics of Individuals University of Western Ontario, London, ON Following Cochlear Implant Herhert A. Leeper, Jr., Jean-Pierre Gagne, and Silvia Vidas A persistanl problem in stuttering therapy is relapse. A cause of this University of Western Ontario, London, ON relapse proposed by Yovetich, Booth, and Tyler (1977) is stimulus Lorne S. Parnes generalization. The original stimuli are the stutterers' unique University Hospital, London, ON dysfluencies, with generalization occurring to normal dysfluencies. To test this hypothesis, sixteen stutterers and sixteen non-stutterers This study was designed to investigate the physiological charac­ were presented two dichotic shadowing tasks. In Task A, subjects teristics of speech in profoundly hearing impaired individuals under­ shadowed a fluent message while a competing normally dysfluent going cochlear implant. Three adults, each with an acquired, message was presented to the opposite ear. In Task B, subjects profound, sensorineural hearing loss of more than 10 years duration, shadowed a fluent message while a stutter-like competing message were seen as part of a larger project dealing with acoustic, perceptual, was presented to the opposite ear. The dependent variable was and aural rehabilitation therapy pre- and post-cochlear implantation. shadowing errors and consisted of the number of word omissions, A2l channel (Nucleus) cochlearimplant was used as the instrumental additions, substitutions, and intrusions. The results of this study device. Each person was tested before implantation, and three and six revealed no difference in shadowing performance regardless of the months post-implantation. An aeromechanical protocol designed to nature of the competition or the subject type. Stutterers reacted to assess the respiratory, laryngeal, velopharyngeal, and oral articulatory normal dysfluencies in the same way they reacted to stutter-like function was employed for the study. Results will be discussed in disfluencies. This supports the contention originally proposed. A terms of each individual's monitoring of the physiological subsys­ significant difference was found to exist for ear presentation. Post hoc tems serving coordinated aspects of speech production. analysis supported the notion that stutterers differ from non-stutterers in the processing of linguistic materiaL • Vocal Function Following Radiotherapy and Vertical Hemilaryngectomy: A Preliminary Investigation • The Role of Linguistic and Visual Information In Acquired Dysgraphia Herbert A. Leeper and Hans Heeneman University of Western Ontario, London, ON Susan L. Butler-Hinz and Gloria S. Waters McGilI University, Montreal, PQ Cindy Reynolds Vancouver General Hospital, Vancouver, BC Previous work on acquired dysgraphia classifies impairments as breakdowns in one of two general routines: the assembly of spellings Eight patients who received a vertical hemilaryngectomy following a using sound-spelling correspondences or the retrieval of stored or­ course of radiotherapy were examined for vocal function employing thographic representations. Current work with normals, however, has video-stroboscopic, aerodynamic, and acoustic measurement techni­ shown that skilled spelling is dependent upon a number of component ques. The results of this preliminary investigation suggest that with skills, not simply the two identified by this approach. The present the selected group of patients studied, vocal quality was rated as study investigated the use of phonetic, orthographic, morphologic, rough, breathy, and constricted. While some variability was noted and visual knowledge by R.M., a left hemisphere stroke patient R.M. between individuals, the general tendencies for the group included: spelled words and non words that differed in the type of information (I) incomplete glottal closure; (2) supraglottal structures fulfilled or that could be used to produce their correct spelling. Results indicated aided vibratory action of the remaining fold; (3) high average trans­ that R.M. showed a sensitivity to the linguistic properties of words glottal airflow; (4) reduced maximum phonation time; (5) high and and found words requiring visual memory skill harder to spell. Of the more variable vocal frequency habitually performed near the top of words requiring linguistic knowledge, those that could be generated the frequency range; (6) a lower, more variable, and restricted vocal using sound-spelling correspondences were easier than those depend­ intensity range; (7) a reduced vocal fold diadochokinetic rate; and (8) ent upon orthographic and morphologic knowledge. The observed overall conversational speech communication ability rated as ade­ pattern supports the notion that spelling ability involves a number of quate to good. This research has shown that physical vocal function cri tical component skills. analysis techniques can aid ENT and speech-language pathology

Annual Members Meeting Friday, May 12 4:00 - 6:00 pm Toronto I/lI

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Video Presentations may be displayed on the monitor, saved in a permanent patient 10:30 to 12:00 database, or directed to a printer. A Neurolingulstlc Approach to Speech and Language • A General-Purpose Hearing Aid Simulation and Disorders In Children Testing System H.2. Darwish and Patsy Steig Pearce Donald G. Jamieson, £mmet Raftery, and Ketan Ramji Alberta Children's Hospital, Calgary, AB University of Western Ontario, London, ON This videotaped presentation outlines a rationale and approach to collaborative efforts between the speech-language pathologist and We will demonstrate a comprehensive, integrated, microcomputer­ pediatric neurologist in the clinical setting. A neurolinguistic model based facility for research on hearing aid fitting and for clinical use. is presented which identifies correlations between the neuroanatomic The system interfaces with that described by Seewald et al. to permit substrate, the behavioral process, and speech or language pathology the clinician: (I) to use the results of formal hearing aid prescription for the encoding and decoding of auditory and verbal information. rules to design and implement a (digital) filter running on a digital­ Case presentations illustrate the behavioral features of each disorder. signal processing (DSP) board; (2) to use this DSP system to simulate the specified amplification for an individual patient; and (3) to Together We Can Know the World: Sharing Books, measure speech intelligibility directly, with the prescribed hearing aid Creating Together, Playing Games, and Making Music gain function, using computer-based testing procedures. The system requires an IBM/AT clone (e.g., Zenith Model 386 or 248, with math M. Ayala Manolson coprocessor and EGA or VGA graphics), an ARlEL DSP-16 digital The Hanen Early Language Program, Toronto, ON signal processing board, filters and associated analog audio equip­ ment, and a mouse. This work is being supported by Unitron In­ This set of four teaching tapes inspires, motivates, and trains parents dustries Ltd., by the Premier's Council Technology Fund, and by the to facilitate language learning within the pleasurable give and take of University Research Incentive Fund. Previous work on the project play. Why and how shared play enhances a child's opportunities to was supported by Health and Welfare Canada through the National connect and learn are demonstrated by parents whose children vary Health Research Development Program. in their ability to interact and communicate. The viewer becomes actively involved in the learning process as the tapes include specific segments for analysis and discussion. The tapes are designed as a • CSRE: The Canadian Speech Research Environment teaching aid to complement Part 11 of the Hanen Guidebook, It Takes Donald G. Jamieson and Ketan Ramji Two 10 Talk. University of Western Ontario, London, ON Terrance M. Nearey Audiology and SLP University of Alberta, Edmonton, AB

Scientific Exhibits CSRE the Canadian Speech Research Environment is a comprehen­ 1 :30 to 3:00 sive, integrated. microcomputer-based facility to support speech re­ search. One of the largest computer programs ever developed in • A Computer-Assisted Implementation of the TurboPascal, CSRE includes facilities: (1) to record and edit natural Desired Sensation Level Approach speech; (2) to analyze and/or compare speech tokens; (3) to parametri­ Richard C. Seewald, Donald G. Jamieson, Richard T. Schmidl, and cally synthesize speech sounds; and (4) to control experiments which K. Shane Moodie require the presentation of speech signals for perceptual testing. The University of Western Ontario, London, ON system requires an IBM/AT clone (e.g., Zenith Model 386 or 248. with math coprocessor and EGA or VGA graphics), adata acquisition A computer-assisted hearing aid prescription and fitting system system (e.g., ARIEL DSP-16, or Data Translation DT282112801A designed to implement the current version of the Desired Sensation plus filters), and a mouse. The software package is being made Level (DSL) approach to hearing aid selection for children (Seewald available as a research resource to university and hospital-based & Ross, 1988) will be presented. The DSL approach has evolved from researchers, for a nominal fee. This session will provide an overview a general goal to provide hearing-impaired children with an amplified and demonstration of CSRE, together with an opportunity for hands speech signal which is audible, comfortable, and undistorted across on use of the facility. The development of CSRE is being supported the broadest relevant frequency range possible. This IBM/XT or by grants from the Strategic Program of the Natural Sciences and AT-compatible microcomputer-assisted version accepts detection Engineering Research Council of Canada, and from Bell Northern threshold data for a given child, generates a prescription specified by Research. the selection model, and allows goodness of fit to be confirmed by the audiologist. Pull-down menus are employed with optional mouse • Pragmatic Activities for Stroke Patients and Their or keyboard control to provide a user-friendly environment. Results Families generated by the program include desired real-ear gain, full-on 2cc coupler gain, real-ear SSPL, 2cc coupler SSPL-90, and target aided lsabelle A. Roberge thresholds in dB HL. After performing the calculations, the program Centre Hospitalier Regional de I'Outaouais, Hull, PQ selects up to eight candidate hearing aids from a database. The Julie Senecal prescription, real-ear verification results, and list of candidate aids Ecole d'Orthophonie et d' Audiologie, Montreal, PQ

JSLPAIROA (HCC) Vo/.i3, No.i, March 1989 67 CASLPAlACOA Conference

Clinicians are concemed about therapy carry over into family life • "What Did You Say Again?" Augmentative while relatives of stroke patients express the need for information, Techniques for Clarification emotional support, and help with social activities. Over the past year Barbara M. Collier and Sandra M. Woodall the CHRO Speech Therapy Department has developed pragmatic The Hugh MacMillan Medical Centre, Toronto, ON group activities designed to address these needs and to counteract patients' and families' reciprocal avoidance of social contact. Ac­ tivities were designed (I) to correspond with real life experiences; (2) Augmentative communication techniques are being used effectively to create a need for speech while enabling communication through by individuals with a broad range of communication disabilities. non-verbal channels; (3) to provide built-in turn taking opportunities; Depending on the severity of the speech disorder, augmentative and (4) to stimulate communicative interaction that encourages communication may be the client's primary expressive mode of laughter. Videotaping of activities with family members, patients, and communication, or it may be used to augment speech production as clinician was followed by tape reviewing and discussion with par­ a clarification technique. This exhibit will focus on the use of aug­ ticipants. The families were able to recognize the effectiveness of mentative communication clarification techniques and strategies for non-verbal communication and to discuss feelings associated with clients who use speech as their primary means of communication, but and strategies for social reintegration. They suggested modifications whose speech is often.unintelligible to unfamiliar partners or outside and other activities formerly enjoyed by the patient. Two kinds of of known contexts. For these clients, speech therapy techniques and clinical tools will be exhibited: one is based on a popular adult game augmentative techniques may complement each other in achieving and uses material of increasing linguistic complexity; the other adapts functional communication. Case illustrations will be presented to existing games according to the design criteria and user feedback. demonstrate the various augmentative techniques and strategies used by these individuals. These will include techniques that can help establish semantic context (context displays), provide phonemic cues (alphabet boards, sound association displays, finger spelling, etc.) and other clarification skills. The client's individualized strategies for knowing how and when to use these techniques also will be presented.

Call for Research Proposals

VOICE for Hearing-Impaired Children is inviting applications -Statement of hypothesis to be tested for funding of research proposals that have relevance in promot­ -Methods (experimental design, procedures and proposed ing the development of language, the development of speech­ data analysis procedures) based skills and the identification, diagnosis and aural -Relevance of the proposed project habilitation of children with significant (severe to profound) hearing impairment. -Curriculum vitae of principle investigator(s) -Description of the responsibilities and duties of all per- Of particular interest at this time would be comprehensive sonnel involved in the research study of physicians' attitudes to the diagnosis and habilitation of -Consent forms and ethical approval from the relevant in- childhood hearing impairment. stitution -References Additional areas of research which would be considered for funding include: phonetics and phonology, diagnostic and -Budget (*VOICE is unable to provide funds for habilitative audiology, speech-language pathology, psycholin­ purchase of equipment) guistics, developmental psychology, sociolinguistics, special education, medical anthropology, epidemiology, genetics and VOICE for Hearing-Impaired Children is a province-wide counselling. organization of professionals and parents of hearing-impaired children who provide mutual support and information on hearing Please describe the proposed research in no greater than ten impairment. VOICE support for research is made possible double-spaced typed pages using the following headings. through a grant from the Trillium Foundation.

-Statement of Objective Submissions must be received by April 15, 1988. For more -Background and Literature Review information contact: VOICE for Hearing-Impaired Children. 271 Spadina Road, Toronto, ON M5R 2V3. (416) 928-1006.

68 JSLPAIROA (HCC) Vol. 13, No.], March J989 ------...-

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Saturday, May 13

Invited Presentations 1:30 to 3:00 Tactile Aids for Speech Perception and Production by the Hearing-Impaired Janet M. Weisenberger Audiology Central Institute for the Deaf, St. Louis, MO

8:30 to 10:00 Recent developments in the design of tactile aids have shown consid­ erable promise in transmitting information about speech to profound­ Developmental Changes in Auditory Brainstem ly hearing-impaired persons. This success has led to the availability Responses from 33 Weeks Conceptional Age through of several commercially-produced, wearable devices. which may be the First 3 Years of Life viable options for persons who do not benefit from conventional Michael P. Gorga amplification. In laboratory and educational evaluations of a number Boys Town National Institute for Communication of experimental and commercial devices over the last several years, Disorders in Children, Omaha, NE it has been found that the kind and degree of benefit provided by tactile aids varies across devices, as a function of such variables as the number of tactile transducers, type of tactile stimulation, and type of Although reports vary widely, hearing loss appears to occur in 5% to stimulus processing. The results of these evaluations suggest that 15% of the graduates ofintensive care nurseries. An additional 0.05% tactile aids, particularly multichannel devices that employ a number of all babies may have hearing loss associated with such risk factors of tactile transducers and convey information about the spectral as family history of hearing loss or maternal history of infection, drug content of the speech signal, can be of significant benefit in speech or alcohol abuse. The aud itory brainstem response is the best available perception. Studies with profoundly hearing-impaired children indi­ tool to identify hearing loss in these patients, as well as other difficult­ cate that aspects of speech production also can be improved through to-test patients. However, there are special methodological considera­ the use of a multichannel tactile aid, suggesting that even a relatively tions when the ABR is applied with neonates and very young children. brief period of training with a tactile aid can lead to improvements in This presentation will be divided between a practical discussion of speech production by deaf children. The implications of both speech how we assess infants followed by a more detailed discussion of the perception and production evaluations for developing training proce­ techniques we used to establish ABR norms for children ranging in dures and curricula for tactile aids are discussed. age from 33 weeks conceptional to 3 years of life. Specifically, we will describe our criteria for determining whether wave V thresholds, wave V latencies, interpeak latency differences, and interaural sym­ 3:00 to 5:00 metry fall within the age-appropriate normal range. An Aural Rehabilitation Program For Adults With Acquired Hearing Loss 10:30 to 12:00 Nadia Sosidko and Dana Storms Behavioral Research on Auditory Development Mount Sinai HospitaI/Toronto General Hospital, Toronto, ON Applied to Clinical Audiology Aural rehabilitation is not an event, it is a process. OptimalIy, this Robert J. Nozza process is individualized and interactive. Its goal is to assist the Children's Hospital ofPittsburg, Pittsburg, PA hearing impaired individual to achieve their communication potential. The main components of a comprehensive aural rehabilitation pro­ The behavioral assessment of infant hearing took a great step forward gram include: assessment of communication function, education in the 1970's with the development and refinement of visual reinfor­ regarding hearing impairment and its effects, selection of and orien­ cement audiometry (VRA). From early clinical studies, VRA tation to hearing aids and assistive listening devices, speechreading, developed into a tool that is commonly used in studies of develop­ auditory training. support groups, coping strategies. and referral to mental psychoacoustics and speech perception. We now have a better other disciplines. Within this process the onus is on the hearing understanding of the normal development of audibility, frequency and impaired person to direct their course of rehabilitation. In this presen­ intensity discrimination, binaural function, masking effects, and tation our program for adults with acquired hearing loss will be speech-sound discrimination and categorization as a result of the presented with case examples. head-turn with reinforcement paradigm. While VRA is used routinely in the clinic to obtain minimum response levels in infants and young children, little of the basic research that has been done using ex­ Speech-Language Pathology perimental adaptations of the procedure has been applied, either directly or indirectly, back to clinical issues such as those that 9:00 to 12:00 motivated its development. This presentation will include a review of several recent studies that were done using an experimental VRA A Model for Orofacial-Sensorimotor Examination procedure and will consider how such research might improve our by Ray Kent ability to assess infants in the clinic and/or influence our under­ University of Wisconsin, Madison, WI standing of the effects of clinical or environmental conditions on infant auditory function. Particularly for clients with known or suspected neurologic disorders of speech and language, a functional picture of the orofacial system must be obtained. A model for orofacial-sensorimotor examination

JSLPAIROA (HCC) Vol. 13. No.i. March /989 71 CASLPAlACOA Conference

will be presented. This model has three test components, each having specific examples from the Inuit culture will be used to illustrate the a menu of test objectives and procedures from which an individual interweave that exists between a people's cultural values, learning examination can be constructed, depending on client characteristics, styles, and patterns of caregiver-child communicative interaction. available instrumentation, and clinical needs. The Sensory Com­ Implications of this interweave for the appropriate practice of speech­ ponent includes evaluation of jaw position and bite force, vibratory language pathology with multi-cultural populations will conclude the sensitivity, 2-pointdiscrimination and texture sensitivity, touch pres­ first half ofthe session. In the second half, Jim Cummins will discuss sure sensitivity, oral sterognosis, kinetic cutaneous sensitivity, issues that pertain to second language learners: issues of assessment, barometric sensitivity, perioral and jaw stretch reflexes, tongue placement, classroom performance and instruction, as well as profes­ proprioception, thermal sensitivity, pain, gustation, and olfaction. The sional roles, educational policy and children's rights. Cummins' Nonspeech Motor Component is a set of test procedures to assess research documenting the psychological, speech, and language as­ nonspeech orofacial movements and the generation of forces or air sessments of ESL learners will be described. Also, the necessary pressures. The Speech Motor Component is constituted of tests for knowledge base for speech-language pathologists assessing second sustained phonation, prosody, diadochokinesis, articulation, and in­ language learners will be addressed. Finally, an open discussion telligibility. The test results in these three areas are interpreted with between the two speakers and the audience will take place. Clinicians respect to cranial nerve innervation, cognitive and motor complexity and interested participants are encouraged to raise their questions and ofthe tasks, participation of the various sensory and motorsubsystems concerns. of speech production, and normative performance for groups defined by age and sex. 1 :30 to 4:30

9:00 to 12:00 Interactional Response Management: A Practical Application of Dewey and Vygotsky FaCilitating Communication Development in Children Jack S. Damico with Autism: Assessment and Intervention Louisiana State University, Baton Rouge, LA Guidelines Amy M. Wetherby Language learning is most successful when real context and natural Florida State University, Tallahassee, FL expectancies are exploited (Dewey) through appropriate interactions with others (Vygotsky) to achieve an understanding of the world. Current defini tions of the syndrome of autism emphasize impairments Regardless of the cognitive capacities of the learner, this idea appears of language and communication as primary features. Therefore, the to be true. This presentation focuses on a naturalistic language inter­ role of the speech-language pathologist is becoming increasingly vention approach which implements these two important concepts. important in the educational process of children with autism. The Referred to as Interactive Response Management, this approach purpose of this presentation is to provide an overview of the com­ enables the clinician and the client to interact on an interpersonal basis munication problems characteristic of autism, with an emphasis on to achieve a powerful therapeutic effect. The presentation will be preverbal and emerging language levels. Informal procedures to divided into three sections. First, a brief theoretical discussion incor­ assess communication in this population will be presented with porating the work of the American Pragmatist, John Dewey, and the . videotaped samples for demonstration. Principles for targeting com- Russian psychologist, Lev Vygotsky and which demonstrates how munication intervention goals based on a developmental framework pervasive their ideas are to a wide range of disciplines. The second will be suggested. The importance of replacing idiosyncratic and section will detail the practical applications of their work when aberrant behavior with more conventional means to express that dealing with language disordered individuals. The third section will communicative function will be discussed. Intervention strategies to consist of actual demonstrations of the approach through a case study facilitate spontaneous communication will be presented, with a dis­ format. An extensive bibliography will be provided along with actual cussion of specific strategies for moving from echolalia to creative Individual Education Plans, therapeutic activities, and examples. language. 1 :30 to 4:30 9:00 to 12:00 Assessment of Severe Aphasia Multilingual and Multiculturallssues in Human Nancy Helm-Estabrooks Communication Disorders Boston Veterans Administration Medical Center and Martha Crago Boston University School of Medicine, Boston, MA School of Human Communication Disorders McGill University, Montreal, PQ There is both clinical and experimental evidence to suggest that global JimCummins aphasia is not a uni tary disorder. Instead, it appears that language and OIESE. Toronto, ON associated skills may be differentially spared or impaired in global aphasia. Careful identification of these skills can be crucial in predict­ This session is divided into three sections, featuring two speakers and ing recovery patterns and response to treatment. Furthermore, it is a discussion period. The first speaker, Martha Crago, will discuss known that the performance of global patients may be enhanced by issues of cultural context in the communicative interaction between controlling both input and output variables. The Boston Assessment children and theircaregivers. Literature on language socialization and ofSevere Aphasia (BASA) is specifically designed for assessing both the discontinuities of home and school patterns of communicative linguistic and non-linguistic cognitive performance in global aphasia. interaction in multicultural settings will be reviewed. Following this, In this short course, the BASA will be described, present case studies

72 JSLPAIROA (HCC) Vol. 13.1'10.1. March 1989 CASLPA/ACOA Conference

of patients evaluated over-time with this tool presented, and the the incidence of abnormal typanograms did not very significantly clinical implications of the research findings discussed. between the two groups.

Service Provision in Northern and 8:30 to 10:00 Underserviced Areas Anne Vincent The Musician and the Audiologist Cochrane District Health Council, Timmins, ON Marshall L. Chasin Kathy Wachs Canadian Centre for Performing Arts, Thornhill, ON Speech-Language Pathologist, MacKenzie, BC The musician as patient provides a challenge since his problems tend Bruce Shaw to be job threatening. A musician cannot remove himself from a noisy Audiologist, Laurentian Hospital, Sudbury, ON musical environment; this is his vqcation. This miniseminar is an Alison Bell overview of the general principles of audiological care for the Speech-Language Pathologist, Barrie, ON musician with examples of the work performed by the presenter with Mr. and Mrs. R. Parsons members of the Canadian Centre for Performing Arts Medicine. Data Parents, Tillsonburg, ON will be presented relative to alternative forms of hearing protection Steve McEvoy, Chair that allow the musician to hear the important harmonic structure of University of Western Ontario, London, ON his music and those instruments around him, but with all or part of the range lessened in intensity. The importance of completely sym­ The overall purpose of this panel presentation is to identify and metrical hearing for musicians will be discussed. The miniseminar promote discussion on issues relevant to service development in will provide the clinical audiologist with tools and information to help underserviced areas. This in turn is expected to allow individual the musician hear and continue to hear effectively in his unique service providers, administrators, advocates and others to develop vocational environment. strategies which will increase the likelihood of success of further attempts to develop services in their particular situations. Since iden­ 1 :30 to 3:00 tification and discussion of issues are the primary objectives of the presentation, a broad strategy of inviting input from a number of Sign Language for Parents: A Supplemental, different sources has been adopted. Interactive Model Ross W. Adams House Ear Institute Center for Deaf Children, Los Angeles, CA

This miniseminar will expose the participant to a modified version of Contributed Papers the original Sign Language for Parents curriculum, presented to CASLPA in May, 1988. While the original curriculum provided lessons sequenced to meet the communicative needs of parents of hearing-impaired young children at various stages of language Audiology development, this supplemental version offers a more eclectic ap­ proach to sign language instruction. It incorporates indepth language Miniseminars stimulation information and provides the student with extensive 8:30 to 10:00 interactive expressive sign language practice. The target population of this curriculum includes parents, professionals, and paraprofes­ Language Impairment and Otitis Media sionals who possess basic sign language knowledge but desire input WendyKeene on stimulating conceptual development in the hearing-impaired pre­ Surrey Place Centre, Toronto, ON schooler. Participants in the mini seminar will receive an outline of the Mary Beth Jennings four, concept-based units targeted in the curriculum as well as sug­ The Canadian Hearing Society, Toronto, ON gestions for other targetable concept areas. Selected aspects of one concept-based unit will be demonstrated in a group-participatory A number of investigators have concluded that a positive correlation manner. exists between language delay and recurrent otitis media in children (Berko Gleason, 1986; Holme & Kunze, 1969; Hassenstaab, 1987). 3:30 to 5:00 These investigators suggest that recurrent bouts of otitis media during the language learning years may cause language delay. Critics of this Occupational Deafness: A Public Health Approach theory (Paradise, 1983, Ventry, 1976) point out that many of the to its Rehabilitation supporting studies are riddled with flaws of experimental design and Louise Getty and Raymond Hetu that the statistical analyses applied to the data cannot be used to Universite de Montreal, Montreal, PQ demonstrate causal relationships. In the present study, typanometric and audiometric data was obtained on children attending the Bell Occupational deafness is the most prevalent disability in the Canada Speech & Language Centre, Speech Foundation of Ontario. workplace. A recent study in Quebec showed that more than 40% of Typanometric and audiometric data also was obtained on children workers in the industrial sector had a significant hearing loss due to attending a daycare centre in urban Toronto. Results indicated that noise. The hearing loss produces communication problems which are

JSLPAiROA (HCC) Vot. J 3, No. 1. March 1989 73 CASLPAlACOA Conference

interactional in nature. The disability is a source of problems for the threshold (DT), most comfortable listening level (MCLL), and loud­ hearing impaired person and also for everyone with whom he/she ness discomfort level (LDL) will differ as afunction of the acoustical interacts. The consequence of this is that rehabilitative help must characteristics of the signal, the individual's response criteria and reach everyone involved in the adjustments to be made. Based on this response capabilities, and the testing procedure employed. This in­ approach a paradigm for a rehabilitation program was developed. The vestigation initiated development of a set of valid and reliable consequences of these disabilities are examined in the workplace, audiometric procedures that can serve as a basis for amplification leisure activities, social involvement, family relationships, and in­ work with school-age children. Pascoe (1978) developed a test pro­ dividual well-being and self esteem and appropriate interventions are cedure to define the auditory area of adults. A modification of this then developed. A detailed report on seven groups will be given. The procedure was used to measure DTs and LDLs in a group of school­ planning of such groups will also be discussed. age children with sensorineural hearing impairment. Pure-tone stimuli were delivered via a button-type hearing aid receiver attached Paper Presentations to each child's custom ear mold. The real-ear levels associated with Session: 1 :30 to 3:00 DT and LDL were verified by means of a probe-tube microphone system. Intra subject reliability of these measurements will be • Critical Differences (In decibels) for Aided Sound presented. The application of these procedures in amplification work Field Thresholds in Young Children with children will be described. Andrew Stuart. Andree Durieux-Smith. and Robert Stenstrom Children's Hospital of Eastern Ontario, Ottawa, ON • A Procedure for Selection and Fitting of FM Systems with Children Many current hearing aid prescription schemes are audiogram -based. K. Shane Moodie, Richard C. Seewald. and Susan P. Hudson Hearing aid gain is prescribed according to degree of hearing loss. University of Western Ontario, London, ON Probe-tube systems are available, although most audiologists con­ tinue to utilize functional gain for verification of real ear hearing aid A primary goal in fitting children with FM systems is reducing the performance. Modification of amplification and/or ear mold con­ deleterious effects of noise, distance, and reverberation on speech figuration is usually assessed by repeating aided sound field threshold perception within the learning environment. The output charac­ testing, then evaluating measured performance against a desired goaL teristics of the child's personal hearing aids must be approximated in It is essential to know if differences obtained are real or the result of the FM condition if the child is to receive a consistent amplified from measurement error. Variability in test-retest sound field speech signal. A major difficulty in accomplishing this is the dif­ measures has been examined in adults, but not in the more difficult ference in the speech spectrum input to the two systems which varies to test child population where speculation suggests greater variability. both in its overall level and relative intensity as a function of frequen­ This study evaluates test-retest variability in a group of young cy. Furthermore, the means by which the output from the FM system children. Confidence intervals for different probability levels will be is transduced and coupled can influence the nature of the amplified presented for evaluating differences between aided sound field speech signal the child ultimately receives. In the final analysis, the thresholds. resultant real-ear output characteristics of the FM system may little resemble the prescribed frequency/gain characteristics of the child's • Probe-tube Microphone Determined Measures of personal hearing aids. The rationale and procedures for an Loudness Discomfort Levels in Young Children. electroacoustic approach to FM system selection and real-earverifica­ Andrew Stuart. Andree Durieux-Smith. and Robert Stenstrom tion will be described. Inherent difficulties and potential problems in Children's Hospital of Eastern Ontario, Ottawa, ON coupling FM systems to personal hearing aids will be discussed. Case examples will be used to illustrate fitting difficulties and electroacous­ Traditionally ,loudness discomfort level (LDL) measures are assessed tic results with this selection and fitting procedure. in individuals as a prerequisite to selecting the SSPL90 setting of a hearing aid, although predicting LDLs on the basis of hearing loss has • Central Auditory Processing and Amplification: proven to be poor at best. Kawell, Kopun, and Stelmachowicz (1988) A Case Study have recently developed a procedure to measure LDLs in children. Anita S. Down Several difficulties, however, may arise with this method. As a means Hotel Dieu Hospital, Kingston, ON of overcoming these problems, a new method utilizing insert ear­ phone derived stimuli delivered to a child's ear mold with probe-tube, Recommendations aimed at aiding an individual's in compensation microphone monitoring of real-ear sound pressure level is proposed. for an identified central auditory processing problem have been Intrasubject reliability of the procedure will be addressed. widely published, but tend to be vague. More controversial are the therapies aimed at strengthening the skills necessary for auditory • Procedures for Measuring the Auditory Area in processing. Claims that changes in neurological integrity have been School-Age Children demonstrated have not been supported scientifically. This case study Richard C. Seewald and Jean-Pierre Gagne will attempt to demonstrate improved central auditory test scores University of Western Ontario, London, ON when stimuli are presented in an altered frequency response pattern to a subject with normal peripheral hearing and a central auditory Regardless of patient age, the accuracy of hearing aid fitting will processing disorder. The male patient, aged 51 years, complained of depend in large part on the reliability and validity of the audiometric a long-standing difficulty discriminating speech in backgrounds of data upon which the selection is based. As recently pointed out by noise. Testing revealed that his peripheral hearing was normal and Skinner (1988), the values resulting from measurements of detection failed to suggest a retrocochlear lesion, though a central auditory

74 JSLPAIROA (HCC) Vol. 13. No. 1 ,March 1989 CASlPA/ACOA Conference

processing problem was demonstrated. A series of taped tests of a two alternative forced-choice procedure. Psychoacoustic measures central auditory processing will be presented and compared under two were made at two frequenCies, 500 Hz and 2000 Hz and two durations, conditions: (1) the frequency response of the stimuli unaltered; and 50 ms and 300 ms. Speech perception was measured using the Four (2) the frequency response of the stimuli unaltered for the left ear and Alternative Auditory Feature Test (FAAF). Confirmation of site and the same response, altered in a manner equal to that provided by the size of lesion was verified by CT and/or MRI scans. A detailed patient's hearing aid, for the right ear. The results will be discussed. anatomical checklist, using a five point rating scale, was used to define locus of lesion and extent of damage. These patients were compared • Clinical Experiences with the Xomed Audiant(TM) to a group of age-matched normal control subjects and a group of Bone Conduction Implant hospitalized control subjects. Performance deficits demonstrated by Sandra K. Tollos subjects with acoustic neuromas were dependent on site of lesion The Canadian Hearing Society, Toronto, ON rather than size of lesion. The primary processing deficit of these patients was processing of short duration signals. The relationship Phillip S. Wade, between nonlinguistic processing of frequency and duration and Toronto, ON speech perception will be discussed. This research has implications for understanding temporal integration in the intact auditory system. Sixteen patients were implanted with the Xomed Audiant(TM) Bone Conductor(TM) between January 15, 1988 and November 30, 1988. Twelve of these patients have received audiologic follow-up at The • Drug OtotOXicity Canadian Hearing Society in the form of evaluation and fitting of the Douglas B. Down external sound processor and careful monitoring of patients' adapta­ Kingston Psychiatric Hospital, Kingston, ON tion to the device for four to six months post-operatively. Preliminary Anita Smith Down results with the implant show aided soundfield warble tone thresholds Hotel Dieu Hospital, Kingston, ON within normal limits for 500-6KHz when patients fit very strict audio logic and otologic criteria for implant candidacy. Speech dis­ This presentation will review pharmaceutical ototoxic agents, the crimination scores for the aided (implanted) condition were 80% @ pathological findings subsequent to their use where such findings are 50 dBHL for patients fitting the proper criteria. Areas presently being available, and the clinical manifestations associated with these agents. investigated include bone conduction implant benefit vs. bone con­ Ototoxicity has been defined as "the tendency of certain therapeutic duction hearing aid benefit, and a comparison of aided benefit with agents and other chemical substances to cause functional impairment Xomed's two styles of processors for use with the implant. The and cellular degeneration of the tissues of the inner ear" (Hawkins, presentation will cover the results obtained through April 1989. 1976). As early as 1696 (Morton, 1979) the occurrence of temporary Criteria for appropriate implant candidate selection also will be deafness was noted among patients being treated with cinchona bark presented. Patient's reactions and impressions of the implant will be for fevers. Since that time, antibiotics, salicylates, anti-malarial discussed. agents, and diuretics have been identified along with other important sources of ototoxicity. If presbycusis, the most prevelant form of Session 2: 3:30 to 5:00 hearing impairment, is not the inevitable concomitant of age, but is due to the accumulation of factors such as drug ototoxicity (Downs, Central Processing Disorder: Hearing and Language 1987), then the thorough knowledge of this subject area could be an M. Wayne Maclean and Cindy McCallum important first step in the prevention of hearing impairment. Glenrose Rehabilitation Hospital, Edmonton, AB • Frequency Specific Maturational Changes in the Thirty patients referred for suspected Central Auditory Processing Derived ABR's of Premature and Fullterm Newborn Disorder received a battery of tests including: Dichotic Digits, Pitch Infants Pattern Sequencing, Competing Sentences, ABR and MLR. Two Curtis W. Ponton, Jos J. Eggermont, and Stuart G. Coup land patient profiles are reviewed. One whose audition was questioned University ofCalgary, Calgary, AB tested positive for language disorder. Another who presented with Richard Winkelaar poor speech articulation tested positive for Central Auditory Nervous Foothills Hospital, Calgary, AB System Dysfunction. The characteristics of the individuals are dis­ cussed. Referral, test and management practices receive comment. We have previously reported on frequency specific changes found in • The Effects of Acoustic Neuromas on Auditory the I-V interval in a group of four-month old infants (Ponton et aI., 1987). This investigation demonstrated that low frequency channels Processing mature earlier than high frequency channels. Specifically, it was Mary-Ellen Thompson and Sharon M. Abel found that the duration of the infant I-V interval obtained for low Mount Sinai Research Institute, Toronto, ON frequency derived ABRs using the high-pass noise masking technique Geqrge Wortzman and Morris Freedman (Don & Eggermont, 1986) did not differ from adult latency values. Bayrest Centre for Geriatric Care, Toronto, ON However, for the high frequency derived bands, the duration of the I-V interval was longer for infants than for adults. The present study Auditory Processing Skills of patients with acoustic neuromas were will compare the previously obtained results with derived ABRs studied using two experimental tasks: (1) psychoacoustic and (2) recorded from premature and full-term newboms to further illustrate speech perception. These psychoacoustic measures included detec­ the differential pattern of frequency specific maturation in the human tion, frequency discrimination, and duration discrimination, based on auditory system.

JSLPAIROA (BCG) Vol. J3.No.1. March 1989 75 CASLP AI ACOA Conference

• Speech via Bone Conduction: A Comparison of ces between the two groups. This suggests the generalization period Transducers did not produce the expected carryover for the experimental group. Thomas G. Do/an Some of the issues arising from this research are discussed. Portland State University, Portland, OR 8:30 to 10:00 This study examined the effect of transducer frequency response on The Clinical Voice Laboratory: Cooperative Efforts in the intelligibility of speech delivered via bone conduction. Perfor­ Appraisal and Diagnosis mance-intensity functions were obtained, on normal hearing subjects, using CID W-) word lists and a Practronic KH-70 and a Radioear Philip C. Doyle and Gera/d F. Manin B-72 bone conduction vibrator. The frequency response ofthe KH-70 Dalhousie University, Halifax. NS is smoother and broader than that of the B-72. Results were similar Herbert A. Leeper forthe two types of vibrators, and were comparable to results obtained University of Western Ontario, London, ON with a TDH-39 earphone. Hans Heeneman Victoria Hospital. London. ON

Speech-Language Pathology Interest in the clinical appraisal of voice disorders has grown substan­ tially in recent years. In particular, emphasis on the cooperative effort Seminar between the speech-language pathologist and laryngologist has be­ 1 :30 to 4:00 come an important aspect of the clinical diagnostic process. The purpose of this miniseminar is to present an overview of this clinical • Velopharyngeallnsufficiency: The Use of cooperation in two facilities, the vocal function laboratories at Dal­ Diagnostic Information for Effective Treatment housie University and the Halifax Infirmary in Halifax, Nova Scotia Mary Anne Witzel alld Jeffrey C. Posnick and the University of Western Ontario and Victoria Hospital in The Hospital for Sick Children, Toronto, ON London, Ontario. Specifically, this presentation will address issues pertaining to the joint, comprehensive clinical appraisal of voice This seminar provides comprehensive multidisciplinary information pathology. This will include the physical examination of the patient. on current approaches to diagnosis and treatment of speech problems simple methods for gathering reliable objective measures of voice related to velopharyngeal (VP) function. The presentation will cover (frequency, intensity, etc.), as well as measures of aerodynamic such topics as VP anatomy and function, speech problems associated support (airflows and pressures). Additionally, the value of with VP insufficiency, diagnostic procedures, and treatment. An in videolaryngoscopic documentation and perceptual assessment will be depth discussion on specific speech therapy techniques, prosthetics, presented. The value of this cooperative effort in these two and types of surgery is the focus of this presentation. This seminar laboratories will be addressed as it relates to clinical outcomes. stresses the importance of differential diagnosis of velopharyngeal function problems, and illustrates the use of this information for 8:30 to 10:00 effective and efficient treatment planning. Theoretical and Practical Bases for Software Miniseminars Selection in Language Treatment: Child and Adult Populations 8:30 to 10:00 Nancy L. Thomas-Stonell Hodson Phonology Treatment Program: Pilot Study, Hugh MacMillan Medical Centre, Toronto. ON Stage 2 Efyse S. Hayden Sally E. Lees and Unda M. Mace Baycrest Centre for Geriatric Care, Toronto. ON Children's Hospital of Eastem Ontario, Ottawa, ON This miniseminar will focus on the therapeutic uses of the computer The second stage of a pilot study examining the efficacy ofthe Hodson in speech-language pathology. Over the past few years a number of Phonology Treatment Approach was conducted using 14 preschool clinics have purchased hardware and software in the Apple lIe line. children with phonological disorders. These children had previously Although new technologies continue to appear, the clinical issues been matched for age, sex, and severity of disorder and then randomly inherent in the computer as a therapy medium do not change and have assigned to an experimental or a waiting list group. Treatment for the not received adequate emphasis. The benefits and limitations of experimental group involved the phonological approach developed computer rehabilitation are only beginning to be explored. Software by Hodson which is cyclical in nature. Post-testing immediately after programs need to be carefully analyzed to determine whether they the first cycle of treatment for the experimental group indicated provide advantages over traditional therapy techniques and address clinical differences between the groups but no significant statistical treatment issues such as the modality of stimulus presentation. Com­ difference. The second part of this pilot study involved cycle I puter rehabilitation also has some disadvantages. Most currently treatment of the waiting list group, and a three month generalization available software programs do not utilize the unique features of the period for the experimental group. Differences in the experimental computer. For example, tachistiscopic programs do not provide group prior to and following a generalization period were analyzed enough flexibility for clinicians to specify time features. While the using a repeated measures design. Similarly the waiting list group was computer can be a powerful therapy tool, it is important that programs tested prior to and following direct treatment of cycle I. Both groups specifically address the patient's needs. Techniques for evaluating the showed differences over time, but there were no significant differen- efficacy of currently available software will be reviewed. A

76 ISLPAIROA (HCC) Vo/.13. No.}. March }989 CAS LP AI ACOA Conference

demonstration of how programs can be authored to suit individual 10:30 to 12:00 client needs will also be provided. Cognitive-Language Assessment of the Head 8:30 to 10:00 Injured Patient lennifer A. Biskup, lulie Hughes. and Roy Saunderson Cognitive-Linguistic Management of the Head­ Parkwood Hospital, London, ON Injured Adult S. Carol Hayter The speech-language pathologist has had an ever increasing role over Hamilton General Hospital, Hamilton, ON the past decade in assessing the cognitive-language functioning of adults with closed head injuries. At one Rehabilitation Unit at a The survival rate of individuals with head injuries has shown a steady Southwestern Ontario Hospital, the speech-language pathologists increase in the last few years due to improved medical care at the scene have developed the Cognitive-Language Evaluation Protocol of the accident, in emergency, and in the trauma unit. With this (CLEP) to assist in the diagnosis of cognitive-language impairments. increase in numbers comes a need for speech-language pathology The Protocol incorporates standard language assessment of auditory intervention at an early stage of recovery and greater cognitive-lin­ comprehension; oral expression from a grammatical, articulatory, and guistic management throughout the recovery. Little is available in the pragmatic perspective; graphic expression for spelling, content, and literature that gives practical suggestions or therapeutic approaches. grammar; and reading comprehension. In addition, in the cognitive The Hamilton General Hospital is a Regional Trauma Unit. For the domain CLEP examines the processes of attending, from selective past nine years the Head Injury Team has worked with approximately attending to attending and discriminating auditory and visual stimuli; 600 adults with acquired head injuries that resulted in severe to memory, as evaluated across short- and long-term recall for learning moderate impairment. Overthe years we have developed a cognitive­ and with the effects of delay and distraction variables; organizational linguistic evaluation and therapeutic program based on the Rancho thought, which includes categorization, sequencing, associating, and Los Amigos Behaviour Rating Scale, The Braintree Hospital's synthesizing stimuli; and integrative thought processing to determine Traumatic Head Injury Cognitive Recovery Model, and the Maryland reasoning. processing of abstract information, problem solving, and Institute for Emergency Medical Services System's Cognitive-Lin­ decision making. A cognitive-language assessment should be as guis tic Evaluation. This miniseminar will describe the evaluation and comprehensive as possible in order to ascertain the degree of influence intervention approaches used by this team. that cognition has on language, and conversely, how language in­ fluences cognition. CLEP is one tool that allows such a comprehen­ 10:30 to 12:00 sive evaluation. Strategy Based Intervention for the 10:30 to 12:00 Language-Learning Disabled Child Bm'bm'a H. Gaines Informal Testing and Language Sampling Procedures Alberta Children's Hospital, Calgary, AB and Analyses Sharon G, HalldOl'son Many school. age children with language-learning disabilities ex­ Child Guidance Clinic, Winnipeg, MB perience difficulties coping with the oral discourse and written lan­ guage contexts of the classroom. These children may display The first section of this miniseminar will outline informal diagnostic underlying semantic, syntactic, or phonologic processing problems procedures including game-oriented informal tests, language be­ and may be limited in their application of meta-linguistic or meta-cog­ havior checklists, clinician-designed tests, clinician-adapted tests, nitive problem-solving. In order for language-learning disabled and behavior observation checklists, as important parts of a diagnostic children to learn from their linguistic environments, development of test battery. The second part of the miniseminar will outline language compensatory learning strategies is necessary. In this miniseminar, a sampling procedures for obtaining a variety of sample types, in model for teaching compensatory learning strategies will be particular: referential description; story description; process descrip­ presented. The intervention model includes five components of in­ tion; concept explanation; relationship explanation; and situational struction which have been derived both from clinical experience and analysis. Transcription and analysis procedures will be described, from the literature on meta-linguistics and meta-cognition (I) strategy including the Analysis o/Spoken Discourse Checklist (unpublished), awareness; (2) strategy definition; (3) instruction in strategy use; (4) with application to a particular case study. This checklist analyzes Practice in strategy use; and (5) generalization. The characteristics of lexical, topical, and cohesive features of language, fluency, and the the language-learning disabled child for whom this approach to clarification requests/responses of both the client and the clinician. strategy learning is best suited will be described. Specific examples Several other well-known language sampling analyses procedures of how the model can be used effectively to assist children with also are presented including: Mean Length of Utterance; Fourteen deficits be presented. Video-taped presentation of strategy interven­ Morpheme Analysis (Brown, 1973); and Developmental Sentence tion for children seen on a one-to-one therapy basis, in small language Scoring (Lee, 1979). Informal assessment and analysis of a variety of groups, or through consultation with classroom teachers will be language sample types provides an important supplement to a tradi­ shown. tional standardized test battery (Leonard et ai, 1980).

ISLPAIROA (HCC) Vo/.l3,No, 1, March 1989 77 CASlPAlACOA Conference

10:30 to 1.2:00 1 :30 to 3:00 Communication Board Use by Aphasic Individuals School and Social Language Skills: The Hidden Maureen Merchant, Elizabeth Skarakis-Doyle, and Linda A. Wozniak Agenda Nova Scotia Hearing and Speech Clinic. Halifax, NS Carolyn M. Blagden LinguiSystems, Inc., Moline, IL Provision of a communication boardlbook has long been acknow­ ledged as a conventional remediation practice in aphasia rehabilita­ Many language-learning disorders (LLD) students have trouble fit­ tion (DiSimoni, 1986). Research regarding the use of these devices ting in with their peers and learning the ropes of classroom interac­ with adults has primarily focused upon patients exhibiting severe tions. Although their grammar skills may be adequate for simple speech deficits in the presence of intact language processing skill conversation, they don't know the "hidden agenda" of conversation (Beukelman. Yorkston, Gorhoff, Mitsuda, & Kenyon, 1981). There that varies across everyday situations. The contrast between their is no empirical support for patient or device selection, no description communicative style and their peers' can alienate these students of how such devices enhance communicative effort, and most impor­ socially, emotionally. and academically. This presentation offers tantly, no demonstration of the efficacy of this approach with aphasic clinicians practical, hands-on techniques for remediating pragmatic clients. The purpose of this miniseminar is to discuss the findings and language skills of preadolescent and adolescent LLD students. The clinical application of a recent survey that documented aspects of author will present specific remediation techniques for ten common communication boardlbook use by adult aphasic clients from the deficit areas: conversation/free speaking, listening, detecting key perspective of recent advances in augmentative communication. information, giving information, advising/suggesting, predicting. ex­ Findings regarding such variables as amount of device use, com­ pressing feelings. disagreeing. justifying, and criticizing. Information municative partners and places, communicative functions expressed from Bloom's taxonomy as it pertains to a learning model will be via provided systems. and the perceived impact of communication woven into these techniques. Effective pragmatic materials which are boardlbook on communicative effectiveness will be reviewed and realistic and found in the students' academic and social environment clinical implications outlined. A case study will be presented to will be illustrated. Techniques for increasing personal responsibility demonstrate clinical application of survey results. Techniques for and enhancing student motivation will be reviewed. enhancing the users' capacity for initiation of communication board/book interaction will be summarized and procedures for in­ creasing the amount of time devices are used will be described. 3:30 to 5:00 Consultation Services for Children with Severe 1 :30 to 3:00 Multiple Handicaps Conflict Resolution in the Supervisory Process Wanda L. Tennanl, Elizabeth Holt. and Edwin P. Riediger Anne L. Godden, Sandy H. Fey, and Randi B. Fisher Robin Hood Association for the Handicapped, Sherwood Park, AB University of Western Ontario, London, ON This presentation will outline how the consultative services of a The nature of the supervisory relationship can "make or break" a speech-language pathologist are used with children with severe mul­ student practicum experience. Unfortunately, conflict is an all-too­ tiple handicaps two and one-half to 15 years of age. Type two frequent component. A major source of conflict appears to be poor consultation, one time or periodic contact, as defined by Frassinelli, communication between the supervisor and supervisee concerning Superior, and Meyers (1983) was the model of consultation used. expectations. A number of studies (e.g., Culatta. Colucci, & Wiggins, Following the assessment of the child's communication and feeding 1975; Smith & Anderson, 1982) have demonstrated that supervisors skills, consultation was provided to the classroom teacher in the and supervisees have very different perceptions of the supervisory following areas: setting goals, developing objectives and procedures process. These studies have investigated supervisor-student interac­ to meet goal(s). and monitoring progress. With this population, it was tions; however, similar conflict situations can arise between working found that the speech-language pathologist required expertise in professionals or paraprofessionals. Given the importance of the su­ feeding and augmentative communication as well as skills in the pervisory relationship in a variety of settings. it is imperative to p'Jan development of oral communication skills. Assessment of these for how communication between supervisors and supervisees can be children consists of a combination of observation, interviews with enhanced. One model of the supervisory process which addresses the parents and teachers, and formal assessment tools. Following the issue of differing expectations is that proposed by Anderson (1988). assessment, the speech-language pathologist works with the class­ This model can be applied to the analysis of conflict in supervision room teacher to develop both specific programs and general class­ and can, in our opinion, be used to facilitate understanding of the room strategies to develop the children's communication and feeding dynamics involved in conflict situations. This mini seminar will pro­ skills. Parents are considered integral to their child's program. Once vide participants with an overview of the theoretical model proposed the child's program has been developed, the parents are encouraged by Anderson and then will apply this model for analyzing conflict. to expect the child to demonstrate targeted skills at home. Video tapes The presentation will involve group problem-solving concerning of three children, ages four, eight. and 13, will be used to illustrate videotaped segments depicting conflict situations. the use of consultative services.

78 JSLPAIROA (HCC) Vol.i3. No.i.March 1989 FREIGHT r-1 CONVENTION ELEVATOR L-...J LEVEL BANOUET KITCHEN

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Executive Committee Manitoba 1988-1989 Manitoba Comite Executif Pat Lumsden-Owen PresidentJPresident Child Guidance Clinic of Greater Winnipeg Norma Wood 700 Elgin A ve, Winnipeg, MB R3E I B2 Nova Scotia Hearing and Speech Clinic (204) 257·7827 X204, (204) 254·6301 (H) 5599 Fenwick SI. Halifax, NS B3H 1R2 Nova Scotia (902) 423-7354, (902) 422-5054 (H) Nouvelle Ecosse President ElectJPresident-Elu Heather Maessen Margaret Chrisrie Nova Scotia Hearing and Speech Clinic West Main Health Unit 5599 Fenwick SI. 2110 West 43rd Ave. Halifax, NS B3H IR2 Vancouver, BC V6M 2E1 (902) 423·7354, (902) 466-7927 (H) (604) 261-6366, (604) 228-0690 (H) Ontario/Foreig n Vice President Governmental RelationslVice President Ontario/Etranger Aux Affaires Gouvernmentales Deborah Hayden Andree Durieux-Smith Bell Canada Speech & Language Centre for Children Chi Idren' s Hospital of Easlern Ontario 93 Grenville St. 40 I Smyth Rd. Toronto, ON M5S 1B4 Ottawa, ON KIH 8L1 (416)979·2437, (416) 293·2183 (H) (613)737-2379. (613)741-3467 (H) New Brunswick Vice President Professional & Educational AffairslVice Nouveau Brunswick President Aux Affaires Professionnelles et a la Formation Dianne Sharpe Kenneth Albanese 340 Wright Street 69 Forbes Ave. Fredericton, NB E3B 2E4 Guelph,ON NIG IG5 (506) 458-8353, (506) 454·7738 (H) (416) 890-1221. (519) 824-6115 (H) Newfoundland Vice President Finance & AdministrationlVice President Terre Neuve Aux Finance et Administration Gait Dieks·O' Keefe Christie Benrham Department of Speech Pathology 371 Orlon Park Rd. L.A. Miller Centre, 2nd Floor Scarborough, ON MIG 3T4 Forest Rd. (416) 438-6163 St John's, NF (709) 737· 7356, (709) 737-6560 (H) Executive Director/Directeur Executif Richard N, King Prince Edward Island CASLPNACOA lie Du Prince Edward 25 Main SI. West Anne M. Ferraro Suite 1215 Department of Health & Social Services Hamilton. ON L8P IHI 290 Water Street (416) 523-5790. (416) 388-2859 (H) Summerside.PEI CIN 104 (902) 436·7294, (902) 887·3359 (H) National Council Quebec 1988·1989 Quebec Conseil National Judirh Blumberger Alberta/Northwest Territories Institute de readaptation de Montreal 6300 aYe darlington AlbertaiTerritoires Du Nord-Ouest Montreal, PQ H3V IC8 Wendy Dawson (514) 340·2069, (514) 340-1167 (H) Glenrose Hospital Department of Communication Disorders Saskatchewan 10230-111 Ave. Saskatchewan Edmonton, AB T5G OB7 Colleen Kells (403) 471-2262, (403)439·2227 (H) SaskalOon Rural Health Region British ColumbialYukon Territory 122 Third Ave North Saskatoon, SK S7K 2H6 Colombie BritanniqueiTerritoire Du Yukon (306) 933·5372, (306) 242·3527 (H) Marilyn Miller 104·5990 East Blvd. Vancouver, BC V6M 3V4 (604) 228·2319, (604) 261-7082 (H)

80 lSLPAIROA (HCC) Vol, 13, No, 1, March 1989