Dr. Ruth Crutchfield, SLP.D., CCC-SLP
University of Texas-Pan American, Edinburg, TX

Dr. Ruth Crutchfield is a lecturer and clinical supervisor at the University of Texas-Pan American. Dr. Crutchfield graduated with her master’s degree in Communication Disorders Bilingual/Bicultural from UTPA in December of 1997 and has held the Certificate of Clinical Competence from the American Speech and Hearing Association since then. Dr. Crutchfield received her Doctor of Speech Language Pathology in May of 2010. She practiced for seven years in the public school system and for four years as the director of speech-language pathology at a pediatric outpatient rehabilitation center. For the last three years, Dr. Crutchfield has been a clinical instructor and supervisor at the University of Texas-Pan American where she teaches language disorders in children, speech science and clinical report writing. Her experiences range from working as an SLP in the school system, working with the geriatric population in a nursing home and outpatient facility, and working with the pediatric population in all scopes in an outpatient rehabilitative facility. She has attended various workshops (i.e. SI for SLP’s, M.O.R.E., Beckman Oral Motor, Visual Phonics, Therapeutic Listening, Autism, Feeding Strategies, Dysphagia, Apraxia Kids, Fluency Therapy – Efficient Strategies, PROMPT, Carbone’s Verbal Behavior Therapy to name a few) from which knowledge she is able to draw from when forming a prescriptive treatment plan.

Introduction

It is important to acknowledge that music is used in the area of speech therapy largely due to the influence that has been received by the field of music therapy itself.  Music therapy is a profession that is delving on its own to provide proof of its effectiveness in rehabilitation of individuals with various disabilities.  For speech therapy, speech-language pathologists (SLP’s) have been using music to enhance their treatment plan.  At times, music is used to mark the beginning or ending of a session, or to enhance a certain activity that the SLP has prepared where a specific song emphasizes the language concept that the therapist is targeting in a private setting.  SLP’s in the schools work with the special education units where music may be utilized throughout the day.  The effectiveness of its use is evident in the manner in which the students successfully transition, or that morning routine is beginning.  These are all examples of how music is naturally utilized in therapeutic settings.  Molnar-Szakacs and Overy (2006), recently found through functional magnetic resonant imaging evidence suggesting that “music, like language, involves an intimate coupling between the perception and production of hierarchically organized sequential information, the structure of which has the ability to communicate meaning and emotion” (p. 235). Molnar-Szakas and Overy (2006) provide more of a substantial basis for using music in speech therapy. However, the question is posed: Is there evidence to prove that music therapy is effective for the specific purposes of speech and language therapy and what specifically can be done that is effective in promoting treatment outcomes?

Search Strategy

In order to provide evidence to answer these questions, a search was completed in the following databases:  CINAHL (2001-2011), ERIC (2001-2011) and all ASHA journals (2001-2011) with the search terms of music and speech therapy.  As a selection criteria, only randomized controlled clinical studies comparing music and its effect on speech therapy in normal hearing children were selected.  Additionally, attempts were made to find controlled studies that were focused on Spanish-dominant children, but this search provided no results. Two studies were found that met the aforementioned criteria.

Thompson, Schellenburg and Hussein (2004) completed a study where 43 six-year olds were randomly selected to participate in keyboard, drama, vocal or no classes at all. The purpose of the study was to investigate if enhancing a particular musical skill would increase the children’s ability to identify prosodic changes in their speech such as anger or fear.  The findings revealed that the children who participated in the music group (e.g. keyboarding and voice lessons) were able to identify the prosodic changes in speech at an equivalent level to the drama group and outperformed the group of children that received no lessons. The significance in this study was that the drama group was being taught how to act out emotion specifically. However, the music group increased awareness of prosody, naturally, due to the increased exposure to musical concepts.

Lim (2010) completed a study where 50 children with Autism Spectrum Disorder from the ages of 3 to 5 were randomly selected to participate in a study that included a group in music training, a group in speech training and a control group with no intervention.  The music group watched music videos of a story of 9 minutes in length while the speech group watched a video of a story being told over about 5 minutes in length via six training sessions.  Results via pre and post-testing revealed that the children in the music and speech groups presented with increases in verbal production. The higher functioning children in both groups did increase verbal production; however, the lower functioning children in the music group had significantly more verbal productions than the speech group.

What works for bilingual children?

Knowing that there is some evidence of how effective the use of music can be in speech therapy provides SLP’s with the ability to utilize music as a modality with more assurance.  What are the components of music that help children increase in verbalizations, in prosody awareness, and in clarity of speech (Crutchfield, 2010; Lim, 2010; Thompson, Schellenburg& Hussein, 2004)? Key practices noted were the repeated use of music in a structured and consistent manner, the type of music that was selected, the selection of terms for intervention targets, and the use of movement to enhance the musical experience.

Music was used in a structured manner before, during or after the sessions (Crutchfield, 2010; Lim, 2010; Thompson, Schellenburg & Hussein, 2004). It is feasible that if music is going to be used as part of the speech therapy session, a specific structure needs to be implemented.  For example, the session can be opened or closed with music, or a specific part of the therapy room can be allotted the music center where the child will complete the center at the midpoint of the session.  Also, music can be used as a parent/home program. The parent can be given a CD with the music that is being used in therapy to play at home to the child during an optimal learning time. The focus of this would be to provide the child with repeated exposure to the music; therefore, providing repeated exposure to the targets of speech therapy.

The music that was selected contained the therapy targets (Crutchfield, 2010; Lim, 2010); therefore, it is imperative that the music is carefully selected.  For example, the SLP needs to verify that the music being used contains the target vocabulary for the language concept that is being targeted, or the target words for the phonological pattern present, or of the phoneme that the child is producing in error.  There are options for selection in the use of music in Spanish.  The SLP needs to research and locate the music that is available.  Some SLP’s venture forth and write their own music and lyrics in order to assure that the concepts targeted are embedded in the music experience.

Additionally, movement was used throughout the studies found (Crutchfield, 2010; Lim, 2010; Thompson, Schellenburg & Hussein, 2004). In one study, keyboarding allowed the engagement of the hands.  In the same study, singing allowed for the engagement of the whole body.  It is the natural inclination of one to sway, clap, and move when listening to music.  Because of this, it is to the SLP’s benefit to implement kinesthetic or movement cues to enhance the music experience such as clapping, tapping, waving, nodding of the head, and body motion in order to bring the child into the musical experience all together.

Is there efficacy in the use of music as a modality in speech therapy?  The evidence is pointing towards a resounding, “Yes!”

References

Crutchfield, R. (2010).  Music Therapy Efficacy on Increasing Word Length in Spanish

Dominant Phonological Process Disordered Children.  Nova Southeastern University Dissertation Database.

Lim, H.A. (2010). Effect of  “Developmental speech and language training through music” on

speech production in children with autism spectrum disorders. Journal of Music Therapy,

XLVII(1), 2-26.

Molnar-Szakacs, I. &Overy, K. (2006). Music and mirror neurons:  from motion to ‘e’motion.

SCAN,1, 235-241, doi:10.1093/scan/ns1029.

Thompson, W.F., Schellenberg, E.G., & Husain, G. (2004). Decoding speech prosody:  Do

music lessons help? Emotion,4(1), 46-64, doi:  10.1037/1528-3542.4.1.46.

]]> http://blog.bilingualtherapies.com/treatment-resources/music-in-speech-therapy-with-children-who-are-bilingual-what-works/feed/ 6 http://blog.bilingualtherapies.com/treatment-resources/using-mobile-technology-in-speechlanguage-intervention/ http://blog.bilingualtherapies.com/treatment-resources/using-mobile-technology-in-speechlanguage-intervention/#comments Mon, 01 Nov 2010 11:56:28 +0000 Sean J. Sweeney http://blog.bilingualtherapies.com/?p=267

Sean J. Sweeney, M.S., M.ED., CCC-SLP, Instructional Technology Specialist, Newton, MA

Sean J. Sweeney is a speech-language pathologist and instructional technology specialist working in the public schools and in private practice in Newton, Massachusetts. He has presented on the topic of technology integration in speech and language at ASHA convention and is the author of the blog SpeechTechie: Looking at Technology Through a Language Lens.

I was very pleased to be asked by Nate Cornish to write a post on the Bilingual Therapies blog about the uses of mobile technology in therapy.  Although I have to disclose that I am not a bilingual therapist, I hope that my thoughts on the applications (apps, so to speak!) of technology for intervention will offer some guidance to clinicians in that subsection of our very wide field of practice.

I also admit that I was not necessarily an early adopter of mobile technology in my practice.  I have always been a huge Internet guy, with a strong interest in how interactive websites in particular can serve as a context for therapy activities. Initially I dismissed the iPod Touch as problematic on a number of fronts: it’s an iPhone minus the phone part, Wi-Fi dependent, and small in both screen and, necessarily, keyboard.  Then, Apple and the developers who had vision started doing amazing work in creating apps of every imaginable ilk, including many with educational relevance.  My own purchase of an iPhone, and initial trials of using apps with students, caused me to do a quick turnaround, and eventually I was unable to resist jumping on the iPad bandwagon as well.

The benefits to using mobile technologies are increasing on a daily basis.  First of all, let’s be honest about the fact that the iPod Touch and iPad are way cool.  Kids just light up and become instantly engaged when they get to use these superbly designed, bright, and shiny devices. But the flash is really just a hook to pull them into a learning context, and I often find that their requests to play specific games are few and easily redirectible.  The logistics of using apps on these devices are often extremely simple, from the interfaces of the apps themselves, the ease of directing students, portability and lack of cords, and frequently, connections with web resources so that data and work can be stored. Additionally, new apps are easily obtained, frequently free or very inexpensive. You can browse and quickly download new therapy tools right from the App Store on your device, or use iTunes and sync from your computer.

I am an advocate of thinking broadly about how technology resources can serve as therapy tools, beyond the many great apps designed specifically for speech and language therapy. If clinicians only use that type of app, they risk missing many others that, while created for other purposes, provide a great context for eliciting language.  For bilingual therapists, many apps can present a context for using multiple languages concurrently with the student, either through the app interface itself or through language cueing and scaffolding.  To bring the murky area of app selection into focus, I have suggested a set of criteria that SLPs can use when determining if a tech resource (including apps) would be well-suited for therapy activities: the FIVES criteria, standing for Free, Interactive, Visual, Educationally Relevant, and “Speechie.”  Here’s how it applies to selecting apps.

Free- Is the App free (or nearly free) or at least reasonably priced?  Part of the promise of mobile technology is inexpensive extensions of the technology that are achieved through apps. A great example of a free app for therapy activities is BrainPop Featured Movie, which offers a free short movie every day from the BrainPop site.  These movies are great contexts for building content vocabulary and using information mapping strategies such as graphic organizers.There are definitely exceptions to this rule, especially for specialized apps that are worth paying for such as ArtikPix and Proloquo2Go.

Interactive- Does the App provide a context for interaction between the clinician and student, eliciting language either through its interface or through a scaffolded discussion? We should look for apps that are more than just a link to a web-based presence and that take advantage of touch screens to engage the students in generating language or solving problems.  Interactive apps also allow creation and publication; try PicToon Lite, in which kids can practice language by adding stickers or word/thought bubbles to a photo!

Visual- Does the App make good use of the device’s potential to provide visual supports that scaffold language comprehension and production? Viewing pictures of curriculum and other contexts are a great way to build comprehension and elicit language, and kids are very motivated to inspect images on mobile devices.  Google Earth, for example, really puts the entire world in your hands; try navigating to landmarks and viewing the near limitless supply of geotagged photos in the Panoramio layer.

Educationally Relevant- For school-aged clients, does the App help them access abstract curriculum and provide a context for applying language-based strategies? The realm of education-based apps grows every day, placing complex and out-of-reach topics in students’ hands via interactives on mobile devices.  Slide by Slide is just one example; this app allows you to access shared PowerPoint-style presentations (via the SlideShare website) created by teachers on all sorts of curriculum topics.

“Speechie”- Does the App provide an opportunity to address the client’s or student’s specific speech and language goals?  As I stated, there is a growing collection of mobile apps designed specifically for speech-language assessment and intervention (see Eric Sailers’ great list of apps here and an additional list of special education apps at iPodsibilities). Also, apps such as Popplet, which allows you to make a semantic map on any topic and easily incorporate images from the web, clearly link to language goals around comprehension and expression.

There are also many apps specifically in Spanish, though this is still an evolving area and consists largely of Rosetta-Stone-style “Learn Spanish” apps.  MindSnacks Spanish appears to be a cut above, and a great entry point for use with kids and teens. To find more interactive language websites, try searching Google with the keyword “interactive,” or searching social bookmarking sites such as diigo or delicious for sites tagged as interactive.  Edublogs also has a great directory of blogs of all types, including language blogs, which often provide helpful links and reviews of apps and websites. Happy Hunting!

Carla Wood Jackson, Ph.D. CCC-SLP, Assistant Professor, School of Communication Science & Disorders at Florida State University, Tallahassee, Florida

Carla Wood Jackson, Ph.D. CCC-SLP is an assistant professor in the School of Communication Science & Disorders at Florida State University. Dr. Jackson’s teaching and research focuses on child language development and disorders. She has been a certified speech-language pathologist for over 16 years including service in public elementary schools. Dr. Jackson developed a multicultural/multilingual clinical program at Florida State University which provides outreach services to ELLs in surrounding communities. Her research has focused on facilitating early language and literacy skills of English language learners. She has presented on the topic at national conferences and published in professional journals such as Language Speech and Hearing Services in the Schools, Communication Disorders Quarterly, and Early Childhood Services: An Interdisciplinary Journal of Effectiveness. Jackson is in her fourth year as the principle investigator on a 4-year training grant focusing on serving culturally and linguistically diverse populations.

Dr. Carla Wood Jackson’s research lab, BLOOM, has focused on developing and examining language learning supports for young English language learners (ELLs). A series of language learning intervention studies have been conducted with the assistance of colleagues and graduate students in partnership with the Panhandle Area Educational Consortium on Migrant Education. Speech-language pathologists, teachers, and special educators continue to report challenges and obstacles in providing high quality intervention and instructional support for ELLs (Jackson, Leacox, & Callender, 2010). In response, the primary aim of BLOOM (Bridging for Language Outcomes in the Classroom) is to develop language and literacy interventions for young English language learners and refine and test implementation in authentic classrooms.

The use of native language expansions, referred to as “Spanish bridging”, during shared reading serves as a catalyst of English word learning by providing engaging, comprehensible input utilizing children’s stronger language. Spanish bridging shows promise as a transitional venue for facilitating English language learning, particularly in rich shared reading instruction. The use of children’s native language as instructional support during acquisition of English is controversial; however, burgeoning research supports the benefits of Spanish bridging for early English language and literacy development in some ELLs. The use of Spanish bridging demonstrated promising outcomes in the master’s thesis of Mirza Lugo-Neris (Lugo-Neris, Jackson, & Goldstein, 2010).

This project investigated word learning of ELLs in response to repeated shared reading with embedded instruction of word definitions in either Spanish or English. Children demonstrated growth in their word labeling in English, receptive understanding of targeted words, and expressive definitions in both English and Spanish intervention conditions; however, additional benefits were observed when the word definitions were provided in Spanish. Subsequent studies have examined supplemental Tier 2 and Tier 3 level supports for vocabulary learning including bridging with accompanying manipulatives (Jackson, Bancayan & Quiles, in preparation), voice-output pre-recorded definitions for preview and review, and bridging implemented through computer-mediated e-book instruction (Leacox & Jackson, in preparation).

Currently, doctoral student Lindsey Leacox and Jackson are extending the BLOOM project for broader implementation in preschool – 1st grade classrooms. Children practice and rehearse targeted English word labels by selecting the electronic links to hear a model of the English label and embedded expansion of the word definition provided in Spanish. Preliminary results support the use of Spanish-bridging during computer mediated instruction to facilitate English word learning. On-going longitudinal study of ELL’s vocabulary skill acquisition in English and Spanish is underway in the BLOOM lab at Florida State University.

Thank you for joining the April 2008 edition of Adelante!  This month, Dr. Leah Fabiano will discuss Phonological Treatment with Bilingual Individuals.

The information Dr. Fabiano presents includes:

• Reviewing existing research on bilingual acquisition and intervention with bilingual children
• Reviewing current approaches to bilingual speech and language intervention
• Completing the therapy goal selection process
• Completing the order goal selection process and choosing initial language of intervention

Please be sure to ask your questions or share your thoughts on this topic!