Comparing School & Clinic Speech Services

By: Valerie Heneghan, M.A. CCC-SLP/L
Speech Department Manager

 As a speech-language pathologist who has worked both in school-based and clinical settings, I am often asked questions about the difference between these two settings. Overall, they work together! I’ll explain more.

School-based setting

Qualifications

Photo by Pixabay on Pexels.com

Schools have entrance and exit criteria for qualifying children for speech services derived by their district or state. Using formal assessment protocols, children may need to demonstrate a deficit of a pre-set standard deviation before they are eligible for services.  There is usually a wide range of differences from district to district, so it is difficult to predict qualification criteria prior to the evaluation.

Services:

School services can treat children with language, articulation, pragmatic (i.e., social), and voice/fluency disorders to make educational progress. These services may be delivered in a variety of ways including one-on-one, group setting, or push-in to the classroom.

A Clinic-based setting (like at Easterseals DuPage & Fox Valley)

Qualifications

Clinics typically do not have pre-set qualification criteria as they are not regulated by state or governing bodies.  Clinicians will qualify children for services based on clinical judgement using both formal and informal assessment procedures. Coverage for these services however may be dependent on the child’s insurance and/or may be an out of pocket expense.

Services

Clinics may be able to provide more specialized, intensive, or varied skilled services based on functional and/or medical necessity. Often these services are delivered on a one-on-one setting in the clinic, however additional options may be available.

Easterseals

At Easterseals DuPage & Fox Valley , we offer a variety of service delivery models including: one-on-one therapy, community base therapy (groups), co-treatment with multiple services, tele-therapy services in addition to providing services in our clinic, homes, and through our daycare setting.

We deliver a wide range of speech-language services cultivated by upholding ongoing continued education/ certifications, state of the art equipment, and collaboration with multidisciplinary teams.  Our speech-language services work to strengthen children’s communication and feeding skills so that they can participate fully in daily activities and achieve success.

Our speech-language therapy services address functional communication, language expression/comprehension, pragmatics, speech-sound production, voice, fluency, oral motor, and feeding skills. Areas of specialization include but are not limited to the following:

1. The Voice Box: A Motor Speech Lab, focuses on improving articulation, voice and resonance skills through cutting edge and innovative technology.
2. Oralfacial Myology addresses disorders of the muscles and functions of the mouth and face. These may address tongue thrust, dental malocclusions, breathing, speech, swallowing, and chewing.
3. Feeding services seek to ensure safety and adequate consumption of a varied diet. Treatment may address feeding issues related towards chronic diseases or syndromes, disorders of oral motor structure or development, growth disorders, failure to thrive or obesity, tube feedings, food allergies and sensitivities, gastrointestinal disorders, neurological conditions, constipation, diarrhea, sensory-related or Autism Spectrum Disorder-related feeding difficulties.

Our services continue to expand to meet the needs of the current populations that we serve.  Additional initiatives that we have been growing this year include: tongue/lip ties, auditory processing, and Spell-Links for improving spelling and reading comprehension.

I see value in both school and clinical settings!  I often encourage families that I work with, to consider both options based on the needs of the child.  Our therapists work with other disciplines like our Occupational Therapy, Physical Therapy, Audiology or Nutrition teams. We make sure to consult and involve all medical professionals and school therapists that work with a child, to  review goals and achieve maximal outcomes. To learn more about Speech-Language services at Easterseals DuPage & Fox Valley visit http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/speech-language-therapy.html.

NICU … Now what?

By: Cassidy McCoy PT, DPT and Celine Skertich, PT, MS,PCS

Having an infant born prematurely can be a scary experience. The team of physicians, nurses, and therapists that work with your infant until discharge do their best to assist in whatever your child may need during their stay. But once the baby is discharged, what can you do to continue to promote the appropriate development of your child?

Preemies develop differently, compared to full term infants, so here are a few tips and tricks from what you can do at home.

1. Head position changes

Typically, the preterm infant’s head size is large compared to their body, and are at a greater risk for developing Torticollis and/or positional plagiocephaly. Frequently changing the position of their head is important to prevent these types of concerns.

• Tummy time
• Turning their head to the left and right when on their back
• Alternating side lying

2. Reach, Prop and Play

Preemies tend to utilize their shoulder muscles to assist with breathing. It is important to transition them to using their shoulder girdle muscles to reach, prop, and play. Gravity can be your friend as you carry or position your baby in more upright positions to promote flexion and midline.

3. Promote flexion

Low tone is a common disorder that is seen with premature infants due to entering the world before they have had a chance to develop “physiologic flexion.”  These positioning ideas help to promote flexion and can aid in normal development for a premature infant

• Carrying your baby: be sure your baby’s arms are forward and hips and knees are bent to promote flexion.
• Swaddling
• Laying on stomach (prone) with arms bent with hand near mouth, head to one side and legs flexed underneath them
• Bouncy seat (such as the Baby Bjorn): promotes midline flexion in an upright position to aid in digestion. Gravity will also assist to relax the shoulders.
• Boppy Pillow

4. Promote Symmetry and Midline

• Swaddling is important for this
• Feeding with baby’s head and hands in midline (center of chest) and hips and knees bent
• Playing with toys (on back or on side), to promote swiping their hands towards midline
• Prone positioning – Remember back for sleeping, Tummy to play!

5. Support Social Interaction

• Black and white toys

At this point, your child’s vision is continuing to develop. Up until 4 months of age, a child can see black and white toys, or highly contrasted colors, better than distinguishing between colors. Red and Yellow are the first colors they can begin to see.

• Present your face at an appropriate distance

For the same reasons as above, present your face or a toy 8-10 inches away from your child when interacting/playing with them.

Know the signs of overload: Infants who are born prematurely can get more easily overloaded compared to an infant born at full term. Signs of overload include:

• Visual avoidance or wide eyes
• Splaying of the hands
• Hiccups
• Arching backwards
• Squirming

For most children who have undergone a stay in the NICU, it is recommended to have continued care through a NICU Follow-Up clinic.  The purpose of the NICU Follow-up Care is to monitor and manage ongoing medical conditions, provide support and guidance to parents and caregivers of the high-risk infant, monitor developmental progress to identify delays, identify need for referrals to other medical professionals a needed.

The ultimate goal at the Neonatal Follow-Up Clinic at Easter Seals DuPage & Fox Valley is to assist your baby in being the best that he or she can be. Click here to learn more about our clinic. 

Learning-Related Vision Problems

By: Carla D. Adams, OD, FCOVD

WHAT IS THE VISION TRIANGLE?
Some parents have received a notice that their child needs a complete eye examination.
Parents often take their child to an optometrist and anxiously watch as they are asked to distinguish between lenses. “Which is better -1 or 2?” While a routine exam is a good start it should not be the only test for many students. Since vision and learning are closely linked, problems with vision can often interfere with learning. A routine eye exam alone will not always detect all problems that could affect good vision and thus good learning. Parents should be aware of the vision triangle. There are three types of vision exams, two of which are beyond the routine exam performed by eye doctors. By understanding the vision triangle, it will help avoid frustrations. Parents are armed with options if their child should have academic problems related to how he or she interprets what is being taught, especially if the problems persists with eyeglass.

ROUTINE EYE EXAMS
The first part of the vision triangle is the routine eye exam (just like the example above). Routine eye exams can detect sight imperfections such as near-sighted, far-sighted and astigmatism. Routine exams can also detect more complex problems such as crossed-eyes and lazy eyes. These conditions are often diagnosed during routine eye exams and respond well to eyeglasses and contact lenses. However, if eyeglasses cured all learning related problems, then there would be an overabundance of “A” students. Clear vision or having 20/20 sight is only part of the vision triangle. Unfortunately, most optometrists and ophthalmologists do not proceed further.

FUNCTIONAL VISION
The second part of the vision triangle is centered on functional vision. To read smoothly, a child’s eyes must work well together. This is called binocularity. A depth perception test is one of several tests used to test this skill. Fine eye movements and focusing tests (accuracy, flexibility and stamina) should also be measured. There maybe deficits in this area if your child complains of reading problems such as eye strain, fluctuating vision that will not stay clear, words that float off the page or even headaches. Maybe you even suspect that one of your child’s eyes do not look straight. These types of deficits do not always respond well to eyeglasses or contact lenses which is why some students continue to have problems after a routine exam. Vision therapy is often a good approach to treating such problems. Typically, only a few eye doctors offer therapy. More will be discussed about vision therapy later.

PERCEPTUAL VISION
The third and final part of the vision triangle is perceptual visual testing. Visual perception involves not only the eyes but also the brain and how it interprets and organizes information. This type of disorder surfaces around the age of 6 when children first learn to read. You should consider perceptual problems if your child tends to avoid reading and writing. Children with perceptual problems may reverse letters, print poorly and have trouble learning. Eye glasses alone do not solve perceptual problems. A vision therapy consultation with a pediatric optometrist is advised when learning problems persist.

What is Vision Therapy (V.T.)?
Just as eyeglasses and contact lenses work well to treat sight imperfections (i.e., near sightedness, far sightedness, etc.), functional and perceptual problems are often best treated with vision therapy. It is a type of physical therapy for the eyes. The purpose is to resolve visual problems that interfere with reading and learning. V.T. helps children develop or improve visual skills, read with efficiency and changes how a child processes or
interprets visual information.

Vision therapy is a progressive program of vision exercises or procedures performed under an optometrist’s supervision. The therapy sessions are individualized for each child. The meeting sessions are conducted in-office, once a week.

Following is a list of symptoms that often respond well to vision therapy:

• Blurred or double vision
• Headaches or eye strain
• Crossed eyes or strabismus
• Avoidance or dislike of reading
• Short attention span when reading
• Turning or tilting head to favor one eye
• Rubbing the eyes
• Slow reading speed
• Difficulty remembering what is read
• Omitting or repeating works or confusing letters
• Poor eye-hand coordination
• Losing one’s place while reading or using finger as a guide

For more information regarding vision visit our website:
http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/clinics.html

Editor’s Note:
Dr. Carla Adams is a Developmental Optometrist with a specialization in pediatrics and vision therapy.  Her training includes an emphasis on serving children with special needs.  Dr. Adams is successful in treating children struggling in the classroom as well as children with attention deficit, PDD and autism.  She is a partner of the Easter Seals DuPage & Fox Valley Jayne Shover Center in Elgin.  Learn more about her care via  www.optique-eyecare.com

Down Syndrome Enters a New Era

By: Dr. Peter Smith, Associate Professor of Pediatrics, University of Chicago

Editor’s Note: Through a partnership with the University of Chicago, developmental- behavioral pediatrician, Dr. Smith leads a new Neurodevelopmental Disability Clinic at Easter Seals DuPage & Fox Valley which provides support for children with Down Syndrome, ADHD or Autism, disabilities that may include complex medical and emotional issues.

Dr. Smith also leads Easter Seals DuPage & Fox Valley’s multi-disciplinary team including an occupational therapist, speech-language pathologist, developmental therapist, audiologist and parent liaison in the Medical Diagnostic Clinic. This clinic specializes in early diagnosis of young children.

Current Processes Are Not Working

Individuals with Down syndrome (DS) are living longer and healthier lives than ever.  There is consensus that complete information needs to be offered to all parents of children with Down syndrome (both pre- and postnatal) regarding the current experiences, health outcomes, lifespans, and quality of life for individuals with DS.  DS represents a dramatic “success story” and the lives of individuals with Down syndrome are improving in every way measurable.  Unfortunately, this good news is too often not being shared with new and expectant families.  Doctors are not prepared for this task and parents report frustration with the process.

On the Cusp of Potentially “Game Changing” Therapies

In addition to the dramatic changes that have already occurred, DS as a clinical and research arena is on the cusp of developing even newer therapies that have the potential to improve cognitive outcomes.  Multiple research teams have protocols already enrolling study subjects.  For example, the team at the Jerome Lejeune Institute in Paris has an active study underway  that employs a combination of folic acid and thyroid hormone, targeting infants and primarily measuring cognitive performance during and after therapy.  Their preliminary work has shown significant promise and preliminary results might be released later this year.  Because of their early successes, there are ongoing efforts to mount a similar study here in the United States.  The NIH has recognized this new era and has launched an international registry (see https://dsconnect.nih.gov ).  However, this “breaking news” has not been widely disseminated.  Many worry that recruitment to these studies could be diminished due to the lack of awareness by primary care providers and the general public, which would slow the progress of the studies.

A Growing Number of States Have Addressed the Issue: Including Illinois

Because of the lack of general knowledge of both the dramatic improvements in the lives of individuals with DS and the emerging clinical trials in DS, a coalition lead (of course) by family support organizations has emerged.  They have initiated a new “information rights” movement that includes clinicians, policymakers, legislators, and researchers that has worked to enact new state laws addressing the problem of misinformation.  The first to successfully pass legislation was Massachusetts: in 2012, a coalition helped to pass a state law, mandating that clinicians provide accurate information and Referral to parent support organizations.  Most recently, Illinois, passed unanimous legislation in 2015, which proves that this is truly a bipartisan issue.

To learn more about our specialty clinics including the Medical Diagnostic Clinic, visit eastersealsdfvr.org.