Jack Pickering, Ph.D., CCCSLP

1
Promoting Health and Well Being A Graduate
Seminar in Prevention

• Jack Pickering, Ph.D., CCC-SLP
• College of Saint Rose
• Albany, NY
• American Speech-Language-Hearing Association
  Convention
• Friday, November 16, 2007
• Boston, Massachusetts

2
Purpose of the Course

• This course will explore the topic of
  prevention in communication sciences and
  disorders. Students will discuss prevention as an
  essential feature of health care and wellness, as
  well as a key feature of our assessment and
  intervention.
• Students in the course will
• learn about the science of prevention and its
  place in health care and wellness,
• gain knowledge about prevention in
  speech-language pathology and audiology,
• research and present information about prevention
• take part in activities that promote the
  prevention of communication and swallowing
  disorders

3
Purpose of the Course

• Consistent with ASHAs educational standards in
  speech-language pathology, students in the course
  will
• gain knowledge of the principles and methods of
  prevention for people with communication and
  swallowing disorders
• take part in prevention activities, including the
  selection, development, and dissemination of
  prevention materials

4
Outline of Topics

• Week 1 Prevention Definitions and concepts
• Week 2 Preventing health problems and promoting
  wellness
• Week 3 The science of prevention
• Week 4 Models of preventative health
• Week 5 Genetics and environment Influences on
  health
• Week 6 Prevention across the lifespan and
  multicultural issues
• Week 7 Prevention of disorders of communication
  and swallowing
• Week 8 Fluency disorders and disorders of voice
• Week 9 Child language disorders
• Week 10 Adult language disorders
• Week 11 Cognitive/communicative disorders
• Week 12 Preventing hearing loss
• Week 13 Preventing communication problems with
  hearing loss
• Week 14 Swallowing disorders and speech sound
  disorders
• Week 15 Designing and implementing prevention
  programs
• Week 16 Presenting your program and de-briefing

5
Course Resources
National/Governmental Agency Documents and Web
Sites
ASHAs Curriculum Guide for Instructors and
Students, as well as Selected Readings
6
A Health Questionnaireto Start the Class

• Please respond to the following
  questions. You do not need to divulge highly
  personal information, if that would be
  uncomfortable. However, your thoughtful
  responses will get us started thinking about
  prevention in a broad, personal way.
• Are you engaged in any activities or behaviors
  that you consider preventative? If so, what are
  you doing and what are you trying to prevent?
• Are you aware of any factors (familial,
  environmental, behavioral) that affect your
  health (today or in the future)?
• Have you ever been engaged in clinical activities
  (as a student) that you consider preventative?
  If so, what are/were they?

7
Annotated Bibliography

• For this assignment, students and the instructor
  will prepare an annotated bibliography on
  prevention that will be created throughout the
  semester.
• Students will be responsible for completing 5
  annotations throughout the semester, and the
  following criteria must be followed a)
  annotations will come from a variety of
  resources, b) at least 1 must be related to the
  prevalence or incidence of communication sciences
  and disorders, c) at least 1 annotation must come
  from a resource less than a year old, and d) each
  annotation will be word processed in 11 or 12
  Times New Roman font.
• Annotations will be graded according to content,
  organization and mechanics. The annotations will
  be shared, so that at the end of the semester,
  each student and the instructor will have dozens
  of annotated references on prevention.

8
Annotated Bibliography

• Title of Article The prevalence of vocal fold
  nodules in school age children
• Journal Title International Jl of Pediatric
  Otorhinolaryngology
• Authors Akif Kilic, M., Okur, E., Yildirim, I.,
  Guzelsoy, S.
• Year and Number of Pages 2003, pp. 409-412
• Brief Summary This study assessed 617 school
  children, between 7 and 16 years of age. The
  researchers used telescopic laryngoscopy to
  assess the structure of the vocal folds. Results
  indicated that 16.9 of the children had vocal
  nodules, with a male to female ratio of 21.
  This study demonstrated a high prevalence of
  vocal fold nodules in the children and
  adolescents studied. The authors stated that
  vocal nodules were usually bilateral. This study
  suggests that both clinical and school based
  speech language pathologists will likely treat
  children and adolescents with vocal nodules
  during their career. It is particularly important
  for school based speech language pathologists to
  inform parents, teachers and children about voice
  disorder and ways to maintain a healthy voice.

9
Epidemiology

• epidemiology
• Main Entry epidemiology
• Pronunciation \e-p?-de-me-ä-l?-je, -de-me-\
• Function noun
• Etymology Late Latin epidemia International
  Scientific
• Vocabulary -logy
• Date circa 1860
• 1 a branch of medical science that deals with
  the incidence, distribution, and control of
  disease in a population
• 2 the sum of the factors controlling the
  presence or absence of a disease or pathogen
• Definition of epidemiology from the
  Merriam-Webster Online Dictionary
• www.m-w.com/cgi-bin/dictionary?bookDictionaryva
  epidemiology

10
Questions about Epidemiology

• What is epidemiology? Why should we care about
  it?
• How can an epidemiologist help us do our job?
• What is the incidence of communication and
  swallowing disorders in the United States?
• What is the prevalence of communication and
  swallowing disorders in the United States?
• Wait a minuteWhat are incidence and prevalence?
• Does the disorder matter when it comes to
  incidence and prevalence?
• Can we change incidence and prevalence of
  communication and swallowing disorders?
• What do risk factors and protective factors have
  to do with speech-language pathology?
• How do we reduce risk factors with our clients or
  potential clients?
• Can we encourage protective factors with our
  clients or potential clients?

11
Levels of Prevention

• Primary Prevention is the elimination or
  inhibition of the onset and development of a
  communication disorder by altering susceptibility
  or reducing exposure for susceptible persons.
• An exposure means presence of a risk factor.
  Immunization to prevent infectious disease is
  probably the best known example of primary
  prevention. Other examples are using ear
  protectors in noisy environments to prevent
  noise-induced hearing loss and wearing seat belts
  to prevent head injury.
• See Spring into Science.
• American Speech-Language-Hearing Association.
  (1991). Prevention of Communication Disorders
  Relevant Paper. Available from
  www.asha.org/policy

12
Levels of Prevention

• Secondary Prevention is the early detection and
  treatment of communication disorders. Early
  detection and treatment may lead to the
  elimination of the disorder or the retardation of
  the disorder's progress, thereby preventing
  further complications.
• Screening is an example of secondary prevention.
  A specific example would be the high-risk
  register for the detection of congenital or early
  onset deafness. If hearing loss is identified and
  treated early, the handicap may be reduced or
  eliminated.
• See Screening Opportunities.
• American Speech-Language-Hearing Association.
  (1991). Prevention of Communication Disorders
  Relevant Paper. Available from
  www.asha.org/policy

13
Levels of Prevention

• Tertiary Prevention is the reduction of a
  disability by attempting to restore effective
  functioning. The major approach is rehabilitation
  of the disabled individual who has realized some
  residual problem as a result of the disorder.
• The history of the communication disorders
  professions has been one of tertiary prevention.
  Speech-language pathologists and audiologists
  have most commonly provided tertiary prevention
  by rehabilitating clients to maximal levels of
  function within the constraints of their
  preexisting conditions.
• See Student Presentations.
• American Speech-Language-Hearing Association.
  (1991). Prevention of Communication Disorders
  Relevant Paper. Available from
  www.asha.org/policy

14
Spring into Science

• A program for middle school children from Capital
  Region Catholic schools
• Local colleges and medical facilities present
  workshops that focus on various health-related
  careers, including speech-language pathology and
  audiology
• The College of Saint Rose offers workshops on the
  prevention of hearing loss and voice problems
• Saint Rose students in the seminar plan and
  deliver all aspects of the 2 workshops

15
Spring into Science
16
Spring into Science

• Healthy Hearing
• The human ear is delicate structure that
  allows us to hear things around us.
  Unfortunately, our ears are constantly bombarded
  by noise that can harm your hearing. In this
  session work with graduate students from The
  College of Saint Rose to look inside the ear,
  test someones hearing, and learn how to protect
  your ears from damage.
• Care of Feeding of the Voice
• Our voice comes from a tiny pair of very
  strong vocal cords that vibrate about 270 times
  each second. Come and join College of Saint Rose
  graduate students to view the vocal cords in
  action and see what happens when the voice is
  misused or overused. Join in a test for voice
  problems and learn what you can do to take care
  of your voice.

17
Screening Opportunities

• Speech and hearing screenings for students in our
  introductory course
• Voice screenings for students in teacher
  education and special education
• Area preschool and kindergarten speech, language,
  and hearing screenings
• Legislative hearing screening for May is Better
  Hearing and Speech Month

18
NYSSLHAs Legislative Hearing Screening Program
The New York State Assembly presents a
proclamation for Better Hearing and Speech Month
Students meet Senator Hannon, the New York State
Senate Health Committee Chair
19
Student Presentations

• Your presentation will be 30 minutes in length,
  followed by a 15 minute question and answer
  period (Q A). Please include
• Brief introduction to your topic, including the
  organization
• A brief description of the relationship of your
  topic to primary, secondary, and/or tertiary
  prevention
• The main content of your presentation, which
  should focus on 5-7 related ideas or topics. You
  could use this time to discuss articles,
  information from your manual, or important
  details on the web
• At the end, take a couple of minutes to summarize
  your talk
• For the Q A, begin by opening things up for
  questions. Then insert some of your own
  questions for the audience
• Prepare a handout with an outline of your
  presentation (2 or so pages) and a list of
  references. For references, include sections
  from your manual, articles, web sites, people
  resources, etc.

20
Student Presentations Topics

• Swallowing disorders
• Preventing aspiration after head and neck injury
  and/or surgery
• Preventing aspiration after nervous system
  impairment
• Disorders of speech sound production
• Preventing maladaptive articulation behaviors
  with cleft palate
• Preventing oro-facial cancer
• Fluency disorders
• Preventing the onset of stuttering in young
  children
• Reducing the impact of stuttering with adults
• Disorders of voice
• Preventing voice disorders with teachers and
  signers
• Preventing voice disorders in school-aged
  children
• Child language disorders
• Stimulating language in medically fragile
  children
• Preventing communication breakdown with children
  who have specific language impairment

21
Student Presentations Topics

• Adult language disorders
• Stroke prevention
• Family-centered intervention after aphasia
• Cognitive/communicative disorders
• Preventing brain injury
• Preventing communication breakdown after
  cognitive disorders
• Preventing hearing loss
• Universal hearing screening for infants
• Preventing noise induced hearing loss
• Preventing communication problems secondary to
  hearing loss
• Preventing speech and language disorders in
  children with hearing impairment
• Preventing communication disorders after
  acquired hearing loss

22
Student Presentations Grading

• I will grade this assignment using the following
  guide
• The handout will account for 30 of the grade.
  The outline should be well organized, free of
  errors, and consistent with your talk. Your
  references should include a variety of resources.
  
• The 30-minute presentation will account for 50
  of the grade. Your presentation should be well
  organized, well presented, and informative. It
  is expected that you will go beyond what is in
  the manual and mention the resources you used to
  put the talk together. The talk should be 27.5
  to 32.5 minutes in length. I want you to
  consider this presentation like you would a
  convention presentation.
• The 15-minute Q A session will account for 20
  of the grade. This aspect of the assignment will
  be graded according to how well you respond to
  questions and the way in which you incorporate
  others into the session. If you have a chance to
  ask questions, they should be relevant and extend
  the discussion. The session should last between
  13 and 17 minutes.

23
A Class Activity Planning a Prevention Program

• During the final class periods, 2 groups
  of students will plan prevention activities using
  the class materials in the Students Manual. The
  planning process will include the following
  steps
• Form 2 groups of 8 students each
• Each group will select a target population
• Select and apply one of the models of prevention
  program design a) Public Health Model, or b)
  Comprehensive Health Education Model
• Develop a written plan for the prevention program
  using resources in the Manual (See the questions
  in the beginning of this section)

24
A Class Activity Planning a Prevention Program

• At the end of the first class period, groups will
  report on their progress and the steps they will
  take to complete the project.
• During the second class period, groups will
  complete their work and present the program.
• The final report to the class will include the
  following
• A description of the target population the
  problem addressed by the program
• The programs goals/objectives/outcomes
• The activities used to meet the goals/objectives
  or address the outcomes
• The procedures used to evaluate the program

25
World Wide Web Sites

• www.asha.org The American Speech-Language
  Hearing Association
• www.health.state.ny.us/nysdoh/eip/index.htm -
  NYs EI Program.
• www.kidsource.com/ - Articles for parents.
• www.babyhearing.org/ - Information about hearing
  in babies.
• www.betterhearing.org/hearing_loss_prevention -
  This website also focuses on hearing loss,
  including how to prevent it.
• www.nidcd.nih.gov - The National Institutes of
  Deafness and Communication Disorders.
• www.cdc.gov/niosh/topics/noise/ - The National
  Institute for Occupational Safety and Health, a
  part of the Centers for Disease Control and
  Prevention. Also try www.cdc.gov/noish/noise.
• www.prevent-stuttering.com and www.speechcare.com/
  prevention.html - Two website about stuttering
  prevention.
• www.ncvs.org The National Center for Voice
  Speech.
• www.blues101.org/articles/holistic.htm - A
  website for musicians.

26
World Wide Web Sites

• www.biausa.org/Pages/home.html - The Brain Injury
  Association of America.
• www.strokeassociation.org - The American Stroke
  Associations (ASA) website. This organization
  is part of the American Heart Association
  (www.americanheartassociation.org).
• www.stroke.org The National Stroke Association
  (NSA).
• www.teenpregnancy.org A website about
  preventing teen pregnancy.
• www.cdc.gov/nccdphp/aag/aag_oh.htm - From the
  Centers for Disease Control and Prevention.
• www.safetylit.com - A website about injury
  prevention.
• www.cpsc.gov The U.S. Consumer Product Safety
  Commission.
• www.toysafety.net A website devoted to
  information on toy safety.
• www.epa.gov/appcdwww/ - The Environmental
  Protection Agency.
• www.asmi.org The American Sports Medicine
  Institute.
• www.andreasvoice.org/prevention.htm - A website
  about the prevention and treatment of eating
  disorders.