Technology and Clinical application in assessment and therapy

1. Robert Saltzman, M. A. CCC-SLP Technology and Clinical application in assessment and therapy

2. Who am I?

3. I am a speech and language pathologist • Obtained a B. A. and M. A. from SUNY Plattsburgh • I have been practicing since June 2005 (almost 7 years) • I work for Boothby Therapy Services and currently placed at Richards School, Newport, NH.

4. WHY? • Biofeedback is a strong tool for improving self-awareness and implementing behavioral changes in students. • Video recording assessments allows for on demand review (improves evaluator reliability). • There is expanding research and evidence for the effectiveness of video-modeling for children on the Autism Spectrum.

5. WHY? • It allows for comparison of behavior over time. Allows you to monitor progress or lack of progress. • It allows for better assessments when evaluating multiple skills simultaneously. • It allows for multiple team members to observe and discuss behaviors. • It’s a motivating tool for students.

6. What Equipment is Available? • Laptop Computers with built in cameras • FLIP video • Video Recorders • The infamous iPad and iPhones

7. Software Beneficial for Video Recording • Windows Media Player • RealPlayer • Quicktime • Windows Movie Maker (free download for Windows XP and Windows 7; included in Vista Home Premium and Vista Ultimate) • FLIP software

8. GET PERMISSION!!! • Always get written permission to use picture and video recording. Be aware of school policies regarding video/photo of students. • Use documentation when obtaining permission from the students’ guardians. • You need the thumbs up before you can proceed.

9. I’ve got the equipment,I’ve got permission,What NOW?

10. Lights, Camera, Action!!!

11. Video Recording Tips for Assessment • During evaluations, it’s better if younger students don’t know they are being video recorded. • Make sure you have good seating and lighting ready. • Check battery power on recording devices. • Check memory on recording devices.

12. If you are using a laptop • I recommend Windows Movie Maker (WMM). • Cover the screen (post-it notes, paper) or have an alternate screen ready to go after pressing “record.” • Helpful tools: • Zoom in/out (referring to timeline) can help with video reviews. • Split and trim tools for editing. • When editing is complete, save as a movie file rather than a WMM project.

13. If you are using a FLIP • Invest in a mini tripod. • FLIP menu: turn off red light indicator when recording. • FLIP cameras come with the software included within the device. You can either save the files within the FLIP software program or with a different program.

14. If you are using an iPad • Position your iPad appropriately depending on the type of cover you have. • Use the rear facing camera during assessment. This is done by pressing the on screen icon to flip the camera. • You can transfer files to your computer through iTunes or through iMovie.

16. Organize!!! • Organize your electronic files so that they are easy to access. • 2012-1-27 (Year, Month, Day) • Student initials can also help to organize video • iPad videos and photos can be organized into newly created albums • They can be transferred at a later time. • Videos and photos can’t be renamed in the iPad unless you save it as a project in “iMovie”

17. Video Recording in Therapy Requires Advance Planning: • Prepare folders with pre-selected pictures and videos if you are working on projects with the students. • Downloading and editing videos may need to be done outside of work. • Have video ready to go before therapy session begins. • Rehearsal of activities might be necessary prior to filming your kids.

18. Uses for Video Recording and Photos • Articulation assessment and therapy • Fluency assessment and therapy • Social skills assessment and therapy • Video modeling • “Student Stories”

19. Video Recording in Articulation Assessment and Therapy • If possible, video recording (or at least audio recording) should be utilized in both standardized articulation testing and during informal measures of connected speech. • Video samples of speech will likely provide more information about oral motor movements during speech tasks that audio recordings can’t pick up. For example, video analysis can pick up on things like lingual dentalization, lip rounding, unreleased stops, minor sound distortions, and other facial gestures accompanying speech production.

20. Sample 1- Fletcher, kindergarten, 6 years,1 month • Developmental Apraxia of Speech • Highly unintelligible to the majority of communication partners including familiar partners. • Diagnosed with Autism and presents with generalized motor apraxia as well as difficulties with sensory processing.

21. Sample 2- Cam, first grade, 7 years, 0 months • Standard score of 81 placing him in the 5th percentile • Delayed acquisition of /r, l/ • Developmentally appropriate errors on other target sounds • Single word production for one to two syllable words is judged to be mildly impaired

22. GFTA-2 error chart

23. Video Recording = More Comprehensive Evaluation Excerpt from evaluation report- Perceptually, Cam’s articulation can be described as mumbling or blended together. Aside from his identified articulation errors, Cam exhibits difficulties with supra-segmental features of speech, specifically meaning that he has trouble with spacing or pausing between words. Furthermore, as Cam engages in conversational speech, his overall rate of errors increases. Based on video analysis, Cam was observed to make errors on sounds that were not identified in single word testing such as p/f to change a target word from "fire truck" to "piretruck". This was evident numerous times as he engaged in conversational speech.

24. Evaluation excerpt-continued Additionally, during conversational speech as reviewed during video analysis, articulation errors were characterized by imprecise contact of the tongue and the lips necessary for correct production of speech sounds. He had difficulty particularly with coordinating tongue tip and back of tongue movements which will result in a "mumbling" like quality defined by sounds being omitted, imprecise, substituted, or distorted. His speech can be very difficult to understand at times by both familiar and unfamiliar listeners and more so when the context is unknown. During conversational speech, there were instances in which Cam’s utterances were unknown even to a trained speech and language clinician.

25. Audio Recordings • Audio recordings can also be a powerful tool in justifications for special education qualification. • Informal measures of speech intelligibility can help when standardized testing is not enough. • Sample 3-Audio recording

26. Evaluation excerpt • Speech intelligibility can be defined as the extent a listener understands the speech produced by individuals with motor speech disorders. It is an overall measure reflecting not only the cumulative impact of the impairment but also the compensatory strategies used by the speaker. It is a primary measure of functional limitation (Yorkston, Beukelman, Strand, Bell, 1999). Unfortunately, a standardized test to measure speech intelligibility was not available during this evaluation. However, a more generic and subjective measurement of intelligibility was completed by obtaining listener judgments from both familiar and unfamiliar listeners to Cam’s speech. Judgments were based on a 4 point scale (25%, 50%, 75%, 100%). Three people participated in listening to audio recorded speech samples produced by Cam.

27. Evaluation excerpt-cont.

28. Video Recording for Articulation in Therapy • Recording of students’ performance in articulation tasks can be kept as a measure of progress. • Videos can be viewed by students to judge themselves in their productions or use of learned strategies. • Videos of students can be sent via email to parents/guardians. • Sample 4-students engaged in articulation therapy.

29. Video Recording in Fluency Assessment and Therapy • Video recording during a fluency assessment is absolutely essential to the evaluation process. “Live” syllable counts are very difficult to obtain and are stressful to evaluators particularly as we are observing for a variety of behaviors. • Video recording will allow you review and assess factors such as eye contact, body language, other physical concomitants (facial grimacing, excessive blinking, various secondary behaviors), etc.

30. Sample 1-Wally, kindergarten, 5 years, 11 months • Functional articulation and language skills • Severe level of stuttering with the presence of secondary behaviors • Appears to exhibit a “care-free” attitude and will interact in a typical manner • 375 syllables were analyzed. Wally exhibited stuttering events for 13.8% of the syllables spoken during the clinical speaking sample. These stuttered events were characterized by part word repetitions, whole word repetitions, phrase repetitions, and prolongations.

31. Sample 2-Dakota, second grade, 7 years, 9 months • Severe level of stuttering with secondary behaviors • Appears to exhibit a “care-free” attitude and will interact in a typical manner • 500 syllables were analyzed. Dakota exhibited stuttering events 11% of the syllables spoken during the clinical speaking sample. These stuttered events were characterized by part word repetitions, whole word repetitions, phrase repetitions, prolongations, articulatory and laryngeal blocks, and tension.

32. Video Recording and Fluency Therapy • Video projects can be great therapeutic tools for students who stutter. Projects can be customized to: • Teach students who stutter or don’t stutter about stuttering • Help students who stutter develop positive attitudes and feelings about themselves as communicators • Teach students stuttering modification or fluency shaping techniques • Video playback can be used to: • Have students review and identify their types of dysfluencies. • Have students identify and evaluate other behaviors such as eye contact, secondary behaviors, strategy use, false starts, circumlocutions, etc.

33. Talking Points • Video analysis=more comprehensive assessment and diagnostic report • Core and secondary behaviors can be defined in highly specific detail • Video review= more reliability and validity in frequency and duration measures of stuttering events

34. Video Recording in Social/Pragmatic Skills • Video modeling • Video Self Modeling • Video Modeling (peer or adult) • Student Stories • Powerpoint or Keynote based • Academic or Social skill based

35. Advantages of VM/Student Stories • Highly motivating • It doesn’t require social interactions • It helps to capture and maintain the student’s attention • It provides multimodal feedback to the student • It’s interactive for the student working on them • Tends to incorporate peers and environments the student is familiar with

36. Advantages… • VM/Student stories can be highly tailored to the student in regards to: • Targeted social skills • sample student stories\Sometimes People Do Things That I Don’t Like.ppsx • Language • Interests • Relationship to the curriculum • sample student stories\TRAINS.ppsx • Settings/environments

37. Resources • Carol Gray ASD specialist, www.thegraycenter.org • Michelle Garcia-Winner, CCC-SLP www.socialthinking.com • Sean J. Sweeney CCC-SLP, speech, language, and technology www.speechtechie.com

38. Resources • www.socialskillbuilder.com Social Skill Builder's series of innovative software programs use interactive videos to teach key social thinking, language and behavior that are critical to everyday living. The software helps kids learn and continue to build the skills of: • Problem Solving • Friendship/Life Skills • Critical Thinking • Emotions, and • Consequences

39. A Note on Resources • Use your clinical skills! As much as I like these resources, I personally don’t find any one resource to be the “end-all-be-all.” • The values and principles of these programs are a great starting point and should be incorporated. • Using existing formats can make your life easier, but don’t be afraid to be creative and create your own too!

40. Social Skills that can be Targeted through VM/Student Stories: • Expressing and identifying emotions • Other nonverbal messages such as body language, personal space, facial expressions, gestures, eye contact and eye gaze • Abstract thought for humor, figurative or non-literal language, perspective skills

41. Target Social Skills… • Conversational skills • Greetings, introductions, leaving conversations • Topic maintenance • Appropriate topics, “think bubble” vs. “talk bubble” • Asking and answering questions • Commenting • Interruptions • “Over-sharing”

42. Free video downloading and conversion software can be found on the internet. • Movavi Online Converter (WWW.ONLINEMOVAVI.COM) • Free Studio Manager (WWW.DVDVIDEOSOFT.COM) • AVS Video Converter (WWW.AVS4YOU.COM)

43. Samples • Video recording samples • Video modeling-YouTube has tons of uploaded videos for video modeling. • http://www.youtube.com/watch?v=Ojb_zmaymE0&feature=endscreen&NR=1 • http://www.youtube.com/watch?v=dZFJEBrZQxI&feature=related

44. Samples • Student Stories • sample student stories\Going to Music.ppsx • sample student stories\When My Schedule Changes.ppsx

45. Final thoughts • Put your clinical skills to use! • Exercise good judgment. • Cross your T’s and dot your I’s. Be familiar with school policies, get your docs in a row, get familiar with the equipment you have. • The more you do this, the easier it gets. • Familiarize yourself with what is already available. Follow developed formats to make life easier.