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Better Hearing and Speech Month 2013

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Associate Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

May is Better Hearing and Speech Month (BHSM) when we raise awareness about communication disorders and the services that speech-language pathologists and audiologists have to offer.

When I entered into this field, most people I talked to didn’t really know what speech-language pathology was. People would ask, “So you fix kids’ /r/?” or “You teach people how to give speeches?”

Since then, several of my family members have needed to seek SLP services for issues ranging from speech-language concerns, to swallowing, to voice. Coincidentally, my mother even started working as a secretary for a communication sciences and disorders program, where she learned all of the speech-language-hearing jargon. Last summer, I had to take my own son in to confirm what I suspected, vocal nodules. Yep, he is a screamer, particularly when he is with his older brother. Getting a little boy to exercise good vocal hygiene is no easy task. So, ironically, my family’s examples now help me illustrate what our profession is to people who ask.

Chances are that, at some point in life, everyone we know will either need or have a loved one who needs the services of a speech-language pathologist or audiologist. The American Speech, Language, and Hearing Association (ASHA) reports that one in six Americans has a hearing, speech, or language problem which can negatively impact people’s ability to communicate at home, school, or work.

So, spread the word about our profession. You never know how timely the information you share might be.

Also, be sure to visit ASHA’s Better Hearing and Speech Month webpage at www.asha.org/bhsm/. Here you can download Pocket Pitches for SLPs, download the 2013 BSHM poster, share and read BHSM stories, and find many other resources both for professionals and the public.

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Las Vegas Scholarship Winners- LinguaLive 2013

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Associate Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

Here in the Upper Midwest, spring is on most people’s minds. The long awaited spring has arrived, at last. I must admit, however, that summer is already very much on my mind—summer in Las Vegas, that is. I am excited to attend and present at the LinguaLive leadership conference and team training event, July 28th and 29th in Las Vegas.

Twenty graduate scholarships have already been awarded, and two more will be awarded! Learn more about this opportunity by checking out the LinguaLive Video on the Lingua Health YouTube channel and applying by May 1st.

I hope to see you there!

 

 

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Language Intervention Resources

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Associate Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

I know that children really need their sleep, but I have to say, it gives me great pleasure to see my son curled up in bed with his book light on, intensely reading a book before going to sleep. I loved to read when I was his age, and now, I have grown to see children’s books as not just a literary genre, but as an amazingly rich art form. What a great profession we are in that we can share our love for children’s literature with our young clients while promoting their social and academic language skills.

This time each spring, the graduate students in my bilingual intervention class present their literacy-based language intervention projects. Using storybooks in intervention has been found to help children learn functional language skills and generalize them to meaningful contexts (Coyne, Simmons, Kame’enui & Stoolmiller, 2004). I love hearing the students’ perspectives on their experiences with creating their literature-based language intervention units. They tend to find that nearly any language target can be supported meaningfully within the context of their literature. They find how easy it is to tailor their use of the literature and design related activities to support children’s vocabulary knowledge, grammar, pragmatic skills, articulation, phonological awareness, and literacy skills in creative and engaging ways. They also find how easy it is to find books they can use to simultaneously support children’s world knowledge, appreciation for their own and other cultures, and curriculum content knowledge across subject areas.

Fostering children’s communication while also promoting their love of books, makes for rich language intervention. As Jacqueline Kennedy said:

“There are many little ways to enlarge your child’s world.

Love of books is the best of all.”

Helpful resources and websites

Coyne, M., Simmons, D., Kame’enui, E., & Stoolmiller, M. (2004). Teaching vocabulary during shared storybook readings: An examination of differential effects.  Exceptionality, 12(3), 145-162.

Gillam, R. B., & Ukrainetz, T. M. (2006). Language intervention through literature-based units. In T. M. Ukrainetz (Ed.), Literate language intervention: Scaffolding PreK-12 literacy achievement (pp. 59-94). Austin, TX: Pro-Ed.

Database of award winning children’s literature: http://www.dawcl.com/.  You can search for books by age, language, cultural theme, and genre.

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ASHA Resources: Practice Portal

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Associate Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

I recently learned about a wonderful new resource being introduced by ASHA, and I want to spread the good word. It’s the ASHA Practice Portal, currently accessible at http://www.asha.org/Practice-Portal/.

You can see that it’s being designed to be “Your source for vetted practice guidance.” The portal has links to many resources, such as client and patient handouts, tools for improving efficiency and management, information about various important clinical and professional issues (e.g., caseload/workload, SLP assistants), and evidence maps.

I really love these evidence maps. They were introduced by ASHA’s National Center for Evidence-Based Practice in Communication Disorders (N-CEP). What a fabulous, forward thinking idea! There are maps addressing assessment, intervention, and service delivery for a variety of specific speech, language, and hearing disorders. Presently, these include ALS, aphasia, autism, cerebral palsy, cleft lip and palate, dementia, head and neck cancer, Parkinson’s disease, pediatric dysphagia, hearing loss, social communication disorders, and traumatic brain injury. Then, within each box of the particular disorder map, you will find valuable information relevant to evidence-based practice: external scientific evidence, clinical expertise, and client/caregiver perspectives.

For example, if I need more information about intervention for children with cleft lip and palate, I can go to the Cleft Lip and Palate map, click on the Treatment box, next click on the Speech box, and then I am able to pull up a clinical guideline and systematic reviews, along with quality ratings of the resources. How convenient!

You’ll see that the website is currently in a trial version, that new information will continue to be added, and that feedback is welcome. Kudos yet again, ASHA!

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Bilingual Family Intervention

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Assistant Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

I recently received an inquiry from a father who was wondering about best intervention practices for children who are simultaneously learning two languages. His questions are so important, that, with his permission, I share his inquiry and my response with you.

“Dear Dr. Gorman,

I came across your work while researching treatment methods for language delays. My son is being raised in a bilingual household with a Portuguese-speaking mother and English-speaking father (me) in Brazil and has a language delay. Our therapist agrees that bilingualism is not the cause, but has suggested that we focus our attention on Portuguese, saying that learning two languages at the same time is more difficult and that English should be reduced to maximize Portuguese exposure.

I am my son’s main caregiver outside of daycare, and the therapist has asked me to not repeat or support the Portuguese exercises done in therapy in my own language. For example, if my son is learning colors in Portuguese therapy, I should wait at least a week to teach him colors in English. I was wondering if you would mind sharing your thoughts on these kinds of cases, and what the current research is showing about the best form of treatment for bilingual children.

Thank you so much for your time and consideration.”

“Thanks for your question.

There is no research evidence indicating that bilingual children with language delay do better if reduced to one language. Experts in speech-language pathology believe that parents should communication with their children in the language they speak best. The research does, however, provide very compelling evidence indicating cognitive benefits of bilingualism, among many others. Therefore, I would continue using the language in which you are most comfortable with your son.

Regarding vocabulary targets, I have observed that some children who are learning two languages simultaneously respond just fine when the therapy targets are similar in both languages. However, I have also noticed that some simultaneous bilingual children are more motivated in therapy when the activities and vocabulary targets differ by language. In other words, rather than repeating the same lesson in both languages, some children appear more motivated when the targets are selected to match the real language context in which they are more likely to use them.

For example, we saw a simultaneous bilingual child who had been receiving alternating-day intervention, in which the clinician presented the lesson in English on one day and then in his other language, Spanish, the next day. The child was making adequate gains in English but minimal gains in Spanish, and the clinician and parents were discussing giving up on the Spanish. When I was asked to consult, I recommended changing the plan to alternate the language and themes biweekly. We (the graduate student clinician and I) chose English language targets and activities that supported the skills he needed to be successful in his school setting (he attended school in English), and then the parents helped the clinician determine relevant Spanish targets and activities to help him be successful in his home setting (the parents spoke exclusively Spanish in the home). The child’s interest and progress was closely monitored, and his parents reported that this model was “mucho más efectivo” (much more effective) and motivating for him.

There is not as much research out there regarding bilingual therapy as we’d like, so sometimes it takes some creativity to figure out what works best for a particular child. The family is now thrilled they didn’t give up on the Spanish, which is very important for the child’s full participation in his family and community.

I would recommend that you and your clinician select targets that are most important and relevant for the language contexts in which your son is likely to use them. For example, what types of words/activities would help him communicate most effectively with you in English? Then, what targets/activities would help him best meet him communication needs in Portuguese? Sometimes these may be the same in both languages, but they do not always need to be. The key is for therapists and parents to work together to discuss the best approach to meet the child’s needs, to monitor the children’s response, and to modify the approach if needed.”

“Thank you so much.

Your informative reply is so helpful and will give me more confidence with this issue while working with our son and therapist. Most of the specialists we have met along the way have discouraged bilingualism, saying that as a child with a language delay he was “too fragile,” though the therapist we settled on is a bit more open. I will keep in mind what you wrote about using context-based learning targets for each language and see if the therapist can help me find targets for the English side as well as the Portuguese.

Thank you again for your kindness in taking the time to write; it’s a relief and a blessing to hear your more positive view on bilingualism based on evidence, and to have a sense that we are on the right track.”

I hope you find this helpful. See also “Language Intervention from a Bilingual Mindset” by Elin Thordardottir at http://www.asha.org/Publications/leader/2006/060815/f060815a.htm.

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The Impact of Television on Language Development

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Assistant Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

There is a lot of talk about the impact of television on children’s development.  Speech-language pathologists are also often interested in this topic. Last semester some of my student clinicians conducted a systematic review of the research to evaluate the effects of video programs designed for young children on toddlers’ language development.

Based on their review, the students concluded that watching such videos did not significantly boost young children’s language development, as some might suggest. Specifically, the research indicated that watching videos either did not impact young children’s language development or appeared to have an inhibitory effect, particularly in children with lower language skills.

On children’s behavior, however, a recent study by Dr. Dimitri Christakis and colleagues published in Pediatrics has revealed some positive effects of television. You might find this surprising, given that children often imitate what they see and given the amount of violence that occurs in many shows. The researchers conducted a randomized controlled trial to examine the effects of what they called a “media diet” intervention on children’s social competence and behavior.

The researchers did not aim to reduce television time. Instead, their media diet involved replacing regular television programming, which often displays aggression and violence, with educational and pro-social programming. Examples of such educational and pro-social shows included Dora the Explorer, Sesame Street, Curious George, Mickey Mouse Clubhouse, and Sid the Science Kid.

The intervention began with an initial home visit during which a case manager collected assessment data, talked with parents about their child’s media use, provided handouts about the intervention, and helped set goals with the parents. For twelve months, case managers followed up through mailings and telephone calls to help families choose educational and pro-social shows and problem-solve. The control group who did not change their media use received a nutrition intervention designed to promote healthy eating habits.

Results from the study indicated small but significant benefits of the media diet on children’s overall social and emotion competence. Interestingly, they also reported somewhat greater benefits to boys from low-income households.

It would be of interest to know if children with language impairment benefit to the same extent as children with typically developing language, or if they require additional teaching. Still, this study may promote a stimulating discussion with some of the families we serve.

Dimitri A. Christakis, D.A., Garrison, M.M., Herrenkohl, T., Haggerty, K., Rivara, F.P., Zhou, C., & Liekweg, K. (2013). Modifying media content for preschool children: A randomized controlled trial.  Pediatrics, 131, 431–438.

DeLoache, J., Chiong, C., Sherman, K., Islam, N., Troseth, G., Strouse, G., et al. (2010). Do babies learn from baby media? Psychological Science, 21(11), 1570-4.

Krcmar, M., Grela, B., Lynn, K. (2007). Can toddlers learn vocabulary from television? An experimental approach. Media Psychology, 10(1), 41-63.

Richert, R., Robb, M., Fender, J. & Wartella, E. (2010) Word learning from baby videos. Archives of Pediatric and Adolescent Development, 164, 432-437.

Zimmerman, F., Christakis, D., & Meltzoff, A. (2007). Associations between media viewing and language development in children under age 2 years. The Journal of Pediatrics, 151(4), 364-368.

 

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Posted in Home Speech Activities, language development, language impairment, literacy, poverty, SLP Advice, studying, teletherapy | Tagged , , , , , , , | Leave a comment

Linguistic Differences versus Deficits

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Assistant Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

In our field, students typically learn about the concept of difference vs. disorder in speech and language assessment of clients from diverse backgrounds. I will always remember one particular class discussion several years ago in which the following thoughtful comment and question arose: “Cultural and linguistic differences are not disorders, but are differences still sometimes perceived as deficits?”

This week, my students are embarking on a journey in which they will explore the concept of deficit in more depth by reading and discussing Dr. Richard Valencia’s book Dismantling Contemporary Deficit Thinking: Educational though and Practice (Routledge, 2010). Dr. Valencia received the 2011 Outstanding Book Award by the American Educational Research Association for this book, and it has also been a consistent favorite of my students.

Of importance to all professionals who work with diverse students, Dr. Valencia defines and analyzes deficit thinking. Deficit thinking refers to the idea that academic difficulty and failure is due to internal deficits in the student, related to various factors such as cultural and linguistic background, family socialization, and limited intellectual ability. In other words, the student and the family are to blame and should be fixed. However, this book challenges us to consider the impact of external factors on children’s achievement, reminding us of the importance of appropriate assessment practices and instructional approaches that are meaningful to students.

In summary, students reflect on and discuss how deficit thinking is a barrier to one’s ability to fully empower their clients. Free of deficit thinking, we as clinicians are better able to create the most favorable learning environments possible, to promote a sense of competence in our clients, to maintain high standards, and to foster our clients’ enthusiasm for learning, language, and literacy in effective learning communities.

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Posted in ASHA, Bilingual Speech Pathology, Communication Disorders Graduate Programs, deficit thinking, language development, language impairment, literacy, SLP Advice, slp assesment, SLP Therapy Ideas, Speech-Language Pathology Careers, Speech-Language Pathology Graduate Programs | Tagged , , , , , , , , , | Leave a comment

The Effects of Poverty on Language Development

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Assistant Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

According to the National Poverty Center’s analysis of 2010 data, 22% percent of children under the age of 18 are living in poverty. More specifically, they report that this rate is as high as 38.2% for African American children, 35% for Hispanic children, 13.6% percent for Asian children, and 12.4% for white, non-Hispanic children.

Poverty is not only a social problem; poverty is also a health and educational issue. While we do not think that poverty causes language impairment, research clearly indicates a relationship between poverty and language development.

We know that the human brain develops more rapidly between birth and age 5 than during any other period (National Research Council, 2000). Even before school entry, young children are learning many skills and developing the foundation for later learning.

From a medical perspective, poverty can be a source of toxic stress. Dr. Dipesh Navsaria from the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health explains that toxic stress experienced by children early in development can damage their developing brain architecture. This toxic stress causes increases in cortisol and epinephrine, which over time, damages the amygdala, prefrontal cortex, and hippocampus, which may result in impaired executive functioning, self-regulation, and self-control in the classroom.

Poverty is also associated with the quality of language input at home. In a well-known study, Hart and Risley (1995) documented what is known as the 30 million word gap. By age 3, they found that children from poor families had heard approximately 10 million words, children from working class families had heard 20 million, and children from professional families had heard 40 million words. Clearly, there are already significant discrepancies in children’s knowledge and experience even before they begin school, and this gap is difficult, if not impossible, to close. Moreover, the children from poor families heard 200,000 discouragements and 75,000 encouragements, while the children from professional families had heard 80,000 discouragements and 500,000 encouragements. It is important to note that these are associations which do not necessarily describe the quality of individual children’s language experience.

Poverty is a challenging confound when evaluating children’s abilities. Educators know that poverty makes it more difficult to identify children who have learning disabilities, as well as those children who are gifted and talented. While poverty does not appear to cause language impairment, we do know that poverty may be associated with lower language skills. Therefore, it is important to be mindful of children’s experience and to remember that standardized tests should never be used in isolation to make a diagnosis.

Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children. Baltimore, MD: Paul H. Brookes.

 

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SLP Opinions of Telepractice

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Assistant Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

The technological advances we have seen over the last decades are amazing. I first used a computer, the one computer at school, in junior high. I remember typing papers in high school on a typewriter, which my own kids have seen only in museums. They would probably think that white-out was nail polish.  Now we are rarely without a computer, iPod, iPad, or iPhone within arm’s reach. My three-year-old just asked if we could get him his own iPod. Technology has changed our daily lives, and it’s fascinating to consider how much technology is changing our profession.

You’ve probably heard about the recent surge in telepractice, or as it is also referred to, telespeech or teletherapy, in many fields including speech-language pathology. Comparatively, telepractice in speech-language pathology is still in its infancy. Due to its rapid growth, however, I’ve been incorporating this topic more and more into my courses, knowing that telepractice may very well be a part of my graduate students’ future practice.

ASHA defines telepractice as “The application of telecommunications technology to deliver professional services at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation (www.asha.org/practice/telepractice). The technology requirements typically include videoconferencing platforms and equipment, high bandwidth internet, scanners, printers, and headphones.

Many of you have already used some type of video chat system such as Skype. I’ve had some success using it so that my kids can chat with their family members overseas. Neither was too keen on sitting for as long as hoped, and the intermittent delays taxed their attention spans. It should be noted that Skype is not sufficiently secure for telepractice. A very helpful and detailed comparison of web conference platforms can be found at http://web-conferencing-services.toptenreviews.com/.

You may be wondering how well telepractice works when serving young clients. What do SLPs who have engaged in telepractice say about their experience? According to Mashima and Doarn (2008), although initially skeptical, most SLPs have had positive experiences.

Tucker (2012) interviewed several SLPs who all had more than five years of clinical experience and at least nine months of telepractice experience in school settings. As you might suspect, technical difficulties, such as interrupted internet access or problems with audio, were among the more commonly reported challenges.

Some SLPs also commented that difficulties arose when the support staff who were assisting the children were not properly trained to use the equipment, were not ready to begin the session on time, did not have the necessary materials ready, or were unable to resolve behavioral issues. In addition, challenges were reported when procedures were not clearly established for how the clinician and support staff would handle technical glitches during the session. Some noted disadvantages associated with having less contact with the students’ teachers, the inability to team teach, and difficulty promoting carryover of skills in the classroom. On a more personal note, you might wonder what it would be like not to have physical contact with your clients, their families, and colleagues. Among Tucker’s sample, one therapist described the format as lonely and difficult due to less physical movement.

ASHA clearly states that the quality of services delivered via telepractice must be consistent with the quality of services delivered face-to-face (ASHA, 2004). Training and establishment of clear “how to” procedures can help address many of the challenges previously described.

On the more positive side, one clinician who was interviewed described the telepractice format as exciting. Parents and teachers can indeed be involved. And while some children might not be suitable candidates for telepractice, some of the clinicians felt that many children actually made faster progress because the telepractice format helped elicit more responses than in-person service delivery. Clinicians reported that some children are particularly interested in the computer and more motivated to stay on task and that the headphones appeared to help some children concentrate and attend better. In addition, telepractice can reduce the time, transportation, and scheduling burdens on both families and clinicians alike.

Telepractice exists and will continue to grow because it fulfills numerous needs. There are shortages of SLPs in many parts of the country, and telepractice helps extend serves to remote areas. With the limited number of SLPs with expertise in serving culturally and linguistically diverse populations, telepractice can also help fulfill diverse clients’ needs. While we have yet to learn more about best practice and effectiveness, more and more resources about telepractice such ASHA’s webpage as indicated above are becoming available.

We can only imagine how else technology will change our profession in the decades to come.

 

Mashima, P. A., & Doarn, C. R., (2008). Overview of telehealth activities in speech-language pathology. Telemedicine and e-Health, 14, 1101-1117.

Tucker, J. K. (2012).  Perspectives of speech-language pathologists on the use of telepractice

in schools: The qualitative view.   International Journal of Telerehabilitation, 4, 47-59.

 

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Posted in ASHA, Communication Disorders Graduate Programs, SLP Advice, SLP Therapy Ideas, Speech-Language Pathology Careers, telepractice, telespeech, teletherapy, Uncategorized | Tagged , , , , , , , , , , | Leave a comment

Understanding Bilingual Issues in Speech-Language Pathology

By Dr. Brenda Gorman, CCC-SLP, Lingua Health Advisory Clinical Director and Marquette University Assistant Professor, College of Health Sciences Speech Pathology and Audiology

Dr. Brenda Gorman, CCC-SLP

Dr. Brenda Gorman, CCC-SLP

As another semester passes, I again reflect on the many successes, lessons, and changes that I have seen in speech-language pathology since I entered this profession.

Reflecting on one particular success in our field, I am so pleased to see the progression of knowledge of graduate students, both monolingual and bilingual, about bilingual issues in speech-language pathology. Perhaps it’s my imagination, but it seems that every year, more and more students are interested in and have a sincere appreciation for bilingualism. This, of course, will greatly benefit their clinical service delivery.

During one of my recent classes, consisting mostly of monolingual students, I walked around the room as students were engaged in small group discussions about their ideas and thoughts on service delivery for bilingual clients. I was truly impressed to hear what they were saying, talking about resources they could share with families and professionals about bilingual development, how to address the common myths about bilingual language development, how to support parents in creating rich language and literacy environments using the language in which parents can do so best, and how to think outside the box in order to serve clients when the clinician might not speak their home language.

The students were also very enthusiastic about what the research is indicating about the potential metalinguistic and numerous cognitive benefits of bilingualism. One group, for example, paraphrased research which indicates that the onset of Alzheimer’s disease is later in bilinguals than monolinguals by stating that “bilingualism exercises the brain naturally and helps keeps it healthy for longer.”

I am appreciative of all the wonderful research that has and is coming out which is enhancing our service delivery to our diverse population, of ASHA’s continued efforts to support best practice, and for the bright and talented students entering this profession who are eager and ready to help all of their clients reach their highest communicative potential.

I am looking forward to another wonderful semester!

 

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