Center for Disabilities and Development
Nationally designated as
Iowa’s University Center for Excellence on Disabilities
Center for Disabilities and Development
877-686-0031 (toll-free, voice)
866-686-0032 (toll-free, TTY)
319-353-6900 (local)
Fall 2004
CenterLines
FRONT AND CENTER WITH USEFUL NEWS FOR FAMILIES!
In this issue:
· Cognitive Rehabilitation and Brain Injury
· When a Child’s Speech is not Understood:
· What is Developmental Articulation Disorder?
· Iowa’s Educational Network For Children with Brain Injury
· Finding Funding for Health Care
· New look for CDD Website
· Infections
· Tumors
· Medical emergencies
· Strokes
People who have brain injuries sometimes have problems with:
· Emotions
And cognitive processes such as:
· Problem solving
· Memory
· Attention
A person with a brain injury may have problems planning or starting activities. They may not be able to focus on work or school. However, a person with a brain injury can learn or relearn ways to concentrate, remember, and solve problems. This is called cognitive rehabilitation. It is a guided therapeutic approach focusing on retraining a person in the areas of:
· Language
· Visual processing
· Memory
· Problem solving
· Reasoning
· Executive functioning
This will not cure a brain injury, but it will help a person manage better in their day-to-day life.
The goal is for the person to achieve their highest level of functioning. At the Center for Disabilities and Development, treatment is designed for the individual by a team. It is based on an initial evaluation to diagnose problem areas. The team includes the:
· Education consultant
· Speech language pathologist
· Occupational therapist (OT)
· Physical therapist (PT)
· Client
· Family
· Local service providers
How an individual does on the evaluation determines the goals for treatment. There can be a wide variety of cognitive rehabilitation goals. A person might need to relearn their social skills. They may need to learn to manage impulsivity, inattention, or anger. A person then may substitute these newly learned skills for lost functions. These goals are designed to help a person improve everyday function to give them greater independence.
During treatment, the person receives ongoing evaluation and the goals are continually updated. The team uses tasks from work or school and incorporates them into the activities. This helps make it easier for them to return to school or work settings. Throughout the treatment, the team, the client, and their family work on the goals. In addition, the team works closely with local service providers to help prepare for the individual’s return to work or school.
The type and length of cognitive rehabilitation is different for each person. It may last longer than other therapies, such as OT or PT. The decision to continue or discontinue treatment is made by the team.
Here at the Center for Disabilities and Development (CDD) we have a long history of providing services to individuals with brain injuries through our outpatient clinic. Recently, CDD opened the Acute Neurotrauma Rehabilitation Service in our inpatient unit. This is a small, family-centered, acute neurotrauma rehab unit that works with children through young adult. This is the only such program that serves children in the state of Iowa. When a person is admitted, the team determines whether they should receive cognitive rehabilitation during their stay or through outpatient visits after they are discharged. The high number of pediatric patients makes an Education Consultant a vital part of the team. This is unique to CDD. It gives the team the opportunity for ongoing evaluation of academic achievement skills. The Education Consultant works with the student’s local school to help prepare them for reentry.
Pediatric Psychologist
319-356-1446
Sharon Helt, MA
319-356-3778
When A Child’s Speech is Not Understood:
What is a Developmental Articulation Disorder?
Parents often express concern when their child is not using speech sounds correctly or when their child’s speech is difficult to understand. Many wonder if their child will catch up.
Articulation refers to how a child pronounces words. It is the movement of the lips and tongue that produces sounds. A developmental articulation disorder involves the mispronunciation of speech sounds. The child may substitute one sound for another (“wabbit” for “rabbit”), omit a sound (“ca” for “cat”) or distort a sound (lisp). These errors are the child’s attempt to simplify speech as their articulation skills mature.
Children develop speech sounds in a typical order through about age 7-8. Vowels are acquired earlier than consonants. Easier consonants are mastered before more difficult ones. The following chart gives an indication of the order of speech sound development.
Age = Sounds Mastered
________________________________
2-3 = p, m, h, n, w, b, k, g, d, t, ng
3-4 = f, y
4-5 = r, l, s
6-7 = ch, sh, z, j, v, th
7-8 = zh
Misarticulations become a concern when the errors persist for too long, a number of sounds are in error, and/or the child is not clearly understood.
The causes of a developmental articulation disorder are often unknown. One of the most common causes is hearing loss. Even mild, temporary loss due to ear infections or allergies can impact speech sound development. A child’s hearing should be assessed whenever an articulation problem is present. Structural or neurological factors may be involved (cleft palate, cerebral palsy). Some children have difficulty planning and producing the movements of the lips, tongue, and jaw correctly. For some, oral motor weakness may be present. Other children have difficulty learning the “rules” for combining speech sounds, or have language delays. Most children who misarticulate sounds, however, are normal neurologically and structurally. They have difficulty hearing sound properly and/or producing sounds to match an adult model. Evaluation by a speech-language pathologist is the first step in determining the nature of the child’s articulation problem and whether or not therapy is needed.
There are several things parents can do to help their child’s speech including:
· Model correct production of the sound. Exaggerate the sound and make sure your face is visible to your child.
· Read books with pictures that contain problem sounds.
· Use everyday routines and activities to model words that contain problem sounds. Examples include mealtime, bath time, grocery shopping, riding in the car, and playtime.
· Create sound “books” or “placemats” using pictures from magazines.
· Respond to your child’s message and not to the way it was said. Avoid calling attention to your child’s errors by correcting or imitating their productions.
Nancy Almasi, MA, CCC-SLP
Speech-Language Pathologist II
319-353-6147
Iowa’s Educational Network for Children with Brain Injury
And the Center for Disabilities and Development
Brain injuries are common in children. When students have a brain injury, they may experience new problems with learning and behavior. It can be frustrating for parents and teachers to manage these problems and try to return a student to school. Dealing with all of this may require special support and assistance for children, families, and local school staff.
The Iowa Department of Education has created Brain Injury Resource Teams at each Area Education Agency (AEA). These teams are designed to meet the needs of children with brain injuries. They are there to provide support to parents and teachers. To help with this process, the Iowa Department of Education has contracted with the Center for Disabilities and Development (CDD) to establish a Brain Injury Resource Team. This CDD team is available to provide consultation to the AEA teams.
AEA Brain Injury Resource Teams may include members from:
· Education
· Nursing
· Occupational therapy
· Physical therapy
· Psychology
· Speech/language
· Social work therapy
Each team has a contact person. They are there to help aid communication among agencies about children with brain injury. The AEA teams provide consultation for:
· Parents and other family members
· Local school personnel
· Rehabilitation and hospital staff
Go to www.uihealthcare.com/cdd then click on “Programs and Services”, then under Programs click on “Iowa’s Education Network for Children with Brain Injury.” This web page will give you more detailed information on this program, as well as a list of all AEA contacts.
For more information about the consultation service provided by the CDD, contact:
Sharon Helt, MA
319-356-3778
Finding Funding for Health Care
Are healthcare costs a concern for you and your family? Staff at the Center for Disabilities and Development can help. We can talk with you about a variety of programs that help families with their health care costs.
Assistive Technology Funding Specialists, Iowa COMPASS
Sue Deets and Jennifer Britton are the assistive technology (AT) funding specialists with Iowa COMPASS. Assistive Technology is equipment that helps people with disabilities do things they couldn’t do without that equipment. [You can view a list of assistive technology at: http://www.uiowa.edu/infotech/ATDevice.htm.] Anyone in Iowa can call them for information about funding for AT, such as:
· Private insurance and other private AT funding resources
· Federal and state AT funding assistance programs like Medicaid and Medicare
They can help you understand potential resources, and give you information on who to call and how to apply. You can read more about the information they have available at: http://www.uiowa.edu/infotech/Funding.htm. Jennifer can also provide referrals to free AT legal advocacy. Contact both Sue and Jennifer at:
800-779-2001 (toll-free, voice)
877-686-0032 (toll-free, TTY)
319-353-8777 (local)
New Look for CDD Website!
The Center for Disabilities and Development has just finished updating and revamping our Website. Go to www.uihealthcare.com/cdd to take a look.
We’ve got a new look, a new format, and great information. We’re still under development, so pardon our construction. There may be a hole here and there, but we hope to have them filled in soon. We also expect this to be a dynamic site with regularly updated and new information, so be sure to come back often!
We welcome any input you may have - please contact the CDD Webmaster at cdd-webmaster@uiowa.edu with any questions, concerns, feedback, and ideas.
CenterLines for families, the newsletter of the Center for Disabilities and Development at the University of Iowa Hospitals and Clinics, is published three times a year. It provides families with current information on child and adult development, issues affecting people with disabilities, and CDD resources available to them and their families. The newsletter is available in print, and also online at http://www.uihealthcare.com/cdd ‘ Centerlines for Families.
Newsletter staff
Editors
Amy Mikelson
Elayne Sexsmith
Graphics editor
Lori Popp
Editorial board
Joni Bosch
Barbara Nidey
For correspondence relating to the newsletter, or to request permission to reproduce information from it, please contact:
Barb Nidey
Center for Disabilities and Development
University of Iowa Hospitals and Clinics
100 Hawkins Drive
Iowa City, IA 52242-1011
The role of the information in this newsletter is not to provide diagnosis or treatment of any illness or condition. We strongly encourage you to discuss the information you find here with your health care and other service providers.