March 3 marked World Hearing Day, an advocacy and awareness initiative by the World Health Organization. For people in the hearing community, the sense of hearing is one part of our overall communication health. In adults, untreated hearing loss is often associated with social isolation, fatigue, and feelings of depression and anxiety. It may be invisible to others, but its effects are very real. In infants and children, the effects of untreated hearing are of great concern. Unlike adults, infants and children are still learning how to communicate. People in the hearing community do that by listening to their communication partner’s speech. They also do that by listening to their own speech in a process called auditory feedback. If children cannot access the sounds from others and themselves, it can negatively impact speech and language development. The quieter sounds such as “s”, “sh”, “f”, “t”, and “k” can be difficult for a child with hearing loss to hear, so they may not say those sounds in their speech. This can make their speech more difficult to understand if they’re missing sounds that are frequent in the English language. Can you imagine missing part of the message? The a a the i. The sentence, “The cat ate the fish”, without some of the quieter sounds is impossible to decipher for an adult, yet alone a child. This would make learning language a difficult task. Fortunately, early hearing detection and intervention programs are in place to help support children and families with hearing loss. Audiologists and speech-language pathologists are just some of the health professionals that can help families on their hearing loss journey. Treatment looks different for different families and different situations. Some families opt for a spoken language approach, some opt for a sign language approach, while others do a combination approach. No matter the treatment approach, the goal is to support optimal communication development. By: Ruzzelle Gasmen, MSc. Registered Speech-Language Pathologist

I’ve had a few requests over the last six months to provide advice and answer questions for SLPs wanting to set up their own private practice. I’m by no means an expert but this is my two cents worth. The when and the why: I had worked in Public Health for 12 years and decided it was time to make a leap, the appeal of taking vacations when I wanted, and not when seniority dictated, was strong! I took a gentle sidestep into Private Practice at another clinic prior to setting up on my own. This learning experience was invaluable. I spent approximately one year as a contractor at a Private Clinic before beginning to take on private clients independently in another geographical area. I then built up a client caseload for over a year prior to considering taking on a clinic space. This was mainly to keep costs low, most leases are minimum three years and that’s a big commitment to make. Once I had a caseload, with steady new enquiries, it was time to rent space and hire employees. Writing it down in a sentence does negate the time it actually took! It’s not what you know; it’s who you know! The key has been surrounding myself with knowledgeable and supportive professionals that have had patience for someone that does not have a business background. There’s nothing worse than having someone roll their eyes at you. I have needed: *Bookkeeper – perhaps the most important person! It’s still like a foreign language to me when talking about reconciling corporate accounts and payroll tax etc. never mind the day to day logging of invoices and expenses. A good bookkeeper is an investment worth their weight in gold! *Accountant – files corporate taxes and liaises directly with bookkeeper *Business lawyer – needed for filing incorporation documents, reviewing business leases and other small business legal advice *Employment lawyer – Providing employment contract templates for hiring employees *HR Consultant – Assistance in putting HR law into practice with employees Things I’ve learnt: I never thought it would be easy expanding to having and running a clinic but the learning curve has been steeper than expected. It’s unusual for a new small business to make any sort of profit before two years in operation and therefore keeping costs low is incredibly important. The best investments in my opinion are the professionals discussed above, a great office manager and enthusiastic, motivated employees. I’m now lucky to have all of those but it has taken time and as in life, not everyone you meet in a professional capacity will be a good fit for your business and that’s ok. Definitely try not to get tied into long and expensive leases when you’re new to private practice. Shop around, there’s plenty of leasing agents out there and sublets if you want to contract in an existing clinic. Do research contractors versus employees thoroughly and seek advice. There are penalties for falling foul of the CRA on this. **I hope this is useful information to someone, all of the information is my personal opinion based on my experience. It is not to be confused with professional advice** By: Sarah Castell Registered Speech-Language Pathologist

During the pandemic we’ve all been stuck at home. Some of us have picked up new hobbies like gardening or bike riding, however we’re so far in they may have lost their allure, especially if you’re trying to find things to do together as a family! Introducing a new activity: cooking! It’s not the newest thing on the block but cooking together can be a fantastic way to bolster language and model language skills. Here are some things you can work on with your kids to build language skills through a fun(ctional) activity! Sequencing: Recipes are all about sequencing. Model “First we do _______, then we do ________”. This will reinforce following directions as well. You can increase and decrease steps based on your child’s ability! Boost Vocabulary: Use this as an opportunity to introduce novel ingredient names and kitchen tools! Discuss and learn new action words such as pour, stir, measure, dump, cook, boil. Ask questions on how the materials look, feel, smell and taste. Using WH- questions in general is a great tool. Cooking naturally engages in categories, grouping foods into cateogires such as meats, dairy, fruits, vegetables, baking supplies, etc. Work on requesting for tools and ingredients. Articulation: Choose ingredients and methods that help target speech sounds your child has difficulties with. Problem solving: Throughout the activity you can challenge your kids’ critical thinking skills to solve problems like good ways to crack eggs without getting shells inside, how to cut pastries into triangles from a circle or square or how to squeeze an orange without catching the pulp or seed. Teaches numerical concepts such as fractions, ratios and measurements as well. If your recipe requires cooking, you can have the kids draw up signs to set up a shop and create displays and fake money while they wait to teach monetary exchange as well. The learning continues after all the yummy food has been eaten! Take pictures as you go and print it into a little picture book that they can share the activity with classmates or guests once we’re allowed to have them in our homes! In conclusion, if done right, turns out cookies may help with language development after all! I’ve included some kid-friendly recipes/resources below to help you get started. Fret not if you’re not an expert cook, this is a fantastic pretend play activity as well. Happy cooking! https://www.makinglearningfun.com/themepages/RecipesPictorialDirections.htm https://speechsnacks.com/ https://tasty.co/article/melissaharrison/cooking-with-kids By: Theo Li

What is a heritage language?: Heritage languages are languages spoken in a child’s home that are not the language spoken by the majority community (Paradis, 2007). Other terms for heritage language include “home language”, “native language”, and “mother tongue”. In Western Canada, English is considered the majority language. The most common heritage languages in Metro Vancouver include Cantonese, Mandarin, Punjabi, and Tagalog (Statistics Canada, 2017). “Our family speaks a different language at home. Should I only speak English to my child?” This is a common question that parents ask speech-language pathologists. Rightly so as there are a lot of myths surrounding bilingual language development in children. Some parents ask this because they worry they could be confusing their child. They might hear their child mix English with their heritage language in the same sentence. For example, a bilingual Spanish-English child may say “I soy Michelle” instead of “I am Michelle” or “Yo soy Michelle”. This is called code-switching or code-mixing, and it is a typical part of language development in bilingual children (Paradis, 2007). Even bilingual adult speakers do this too! Other parents might ask this because they worry that speaking another language causes language delays. Fortunately, research shows that this is not true. A bilingual child’s total vocabulary in both their languages is about the same as a child who only speaks English (Petersen, Marinova-Todd, Mirenda, 2011). Their grammar develops roughly the same as English-speaking children as well (Genesee, 2005). Take Home Message: To answer the question “Should I only speak English to my child at home?”” No! Please continue to speak your heritage languages with your child! There are numerous benefits of speaking your heritage language that is supported by research evidence (Kai-Raining Bird, Lamond, Holden, 2012). Parents and children need a shared language to interact with each other. Having a shared language allows children to communicate not only their wants and needs, but also their creativity, humor, and aspirations. It also allows them to build connections with other family members who may only speak the heritage language. If language is connecting, a heritage language is connecting with your culture. So don’t hesitate to connect with your child using your heritage language in the home and beyond. By: Ruzzelle Gasmen Registered Speech-Language Pathologist References Genesee, F. H. (2009). Early childhood bilingualism: Perils and possibilities. Journal of Applied Research on Learning, 2 (Special Issue), Article 2, pp. 1-21. Kay-Raining Bird, E., Lamond, E., Holden, J. (2012). Survey of bilingualism in autism spectrum disorder. International Journal of Language and Communication Disorders. 47, 1, 52-64. Paradis, J. (2007). Early bilingual and multilingual acquisition. Handbook of multilingualism and multilingual communication, 5, 15-44. Petersen, J., Marinova-Todd, S.H, & Mirenda, P. (2011). An exploratory study of lexical skills in bilingual children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. DOI: 10.1007/s10803-011-1366-y. Statistics Canada. (2017, August 4). Proportion of mother tongue responses for various regions in Canada, 2016 Census. Retrieved from https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/dv-vd/lang/index-eng.cfm

October is AAC awareness month, so it is only fitting we shed some light on it. Unless you’re a fellow speech-language pathologist (SLP), or have had the fortunate experience of meeting an AAC user, this may be a foreign concept for many. What is AAC? Augmentative and alternative communication (AAC) encompasses communication systems, strategies, and tools that replace or supplement natural speech for communication. AAC is rooted in the philosophy that communication is not limited to just speech. Communication can come in many shapes and forms. For many of us, verbal communication is our dominant medium of choice, however, we also write, gesture, sign, and for some, use AAC. Communication enables us to both express ourselves and communicate with others. Functional communication, however, is the primary goal for most of us whenever we engage in social interactions; it is how we participate in various activities and across many environments. Similarly, the primary goal of AAC systems is to increase the functional communicative capacity of users, so that they too may increase their participation in daily activities (Light & McNaughton, 2014). Why AAC? AAC users may have diagnoses or disorders that limit their ability to use natural speech to communicate. The use of AAC provides them with the opportunity to engage with others and participate in a variety of activities—this could be communicating with family members, participating in classroom activities, or getting involved in community programs. As varied as the population of AAC users are, so are the number of system options that can be selected from—it is not a “one size fits all” model. AAC options range from low tech (e.g., pen and paper), to light tech (e.g., pictures created on a computer that are printed onto a page), to high tech (e.g., an app on a tablet). There is no “right” or “wrong” choice when it comes to selecting an AAC system, but it may take some time to find the best match. But... You may still have some concerns about opting for AAC, so here are three myth-busting truths about it: MYTH #1: Using AAC may isolate the user, or discourage them from developing and using verbal language. FACT: AAC use not only promotes communication and social participation, but also has been shown to reap benefits for speech production in children with developmental disabilities (Drager, Light, & McNaughton, 2010). MYTH #2: AAC is an easy alternative—they just figure it out. FACT: Learning to use AAC for communication isn’t any different than learning to speak or write—it takes explicit teaching, and lots of practice! As Jane Korsten very poignantly put it, “an average 18-month-old has been exposed to 4380 hours of oral language for about 8-hours per day since birth. A child with an AAC system who receives speech-language therapy 2 times per week for 20-30 minutes will reach the same amount of language exposure (in their AAC language) in 84 years.” It is going to take everyone—not just the SLP but also their family and friends—to help the individual learn to communicate using their system. Just take a peek into the lives of the Owens family at We Speak PODD! MYTH #3: We should wait for the individual to be ready before we introduce AAC. FACT: As a mentor once said to me, “If they can breathe, they can use AAC.” We are fortunate to live in a world where technological advances are constantly ongoing. With the right combination of systems and features, any individual—yes, regardless of age, mobility, or language skills—can find their AAC match. When all is said and done, AAC systems are just another tool that we can use to achieve functional communication and life participation. For some, this can make a world of a difference, and open them up to opportunities once thought unimaginable. By: Ina Lin Registered Speech-Language Pathologist References Drawer, K., Light, J., & McNaughton, D. (2010). Effects of AAC interventions on communication and language for young children with complex communication needs. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 3(4), 303-310. DOI 10.3233/PRM-2010-0141 Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication, 30, 1-18. DOI: 10.3109/07434618.2014.885080

It might come as a surprise to learn that a speech pathologist can help you with your chronic cough – so read on if you’re curious to know more about what we do in this realm of practice. Speech-Language Pathologists are highly trained in the anatomy and physiology of the head and neck, including detailed knowledge of the workings of laryngeal (throat) and respiratory (breathing) function. It follows that SLPs have valuable insight when it comes to chronic cough – as this issue is closely aligned with many other functions of the body that we are expert in, specifically swallowing and voice use. Current practice in Canada suggests that the best time to see an SLP is after you’ve had a thorough medical work up to explore whether there is a clear cause for your cough, and after trialling other approaches to the problem such as medications. There may however be an argument to see an SLP much earlier in the process of trying to fix the cough. What can I expect at an initial visit? At Speechease, SLPs will use a “whole picture” approach to your first assessment visit. You may expect to have a detailed history taken regarding your health, and questions about your life, including details about your work and home environment, family, emotional and mental health. All of these questions serve to inform our approach in treating your chronic cough. It may be helpful to bring along a written summary of your health issues and diagnoses as well as a list of any medications you’re currently on to the visit. You may also have a full assessment of your voice, palpation of your head and neck, analysis of your breathing and review of your posture. Diagnostic therapy may be utilized to scan for possible methods that would be useful in your treatment. What treatment should I expect? This can be difficult to answer generally, as every person is unique in their presentation and a good SLP will aim to tailor their treatment for every client they see. However, you may receive any of the following: Detailed advice on modifying your environment to reduce potential cough triggers Breath work; strategies to desensitise the throat and calm hyper-responsivity Voice therapy to encourage optimal function of the larynx and restore optimal physiology Manual therapy to the head, neck and upper body to reduce muscle tension Counselling and support focused on reducing life stressors and empowering the client to take charge of their body and their health. Treatment course is variable. Some people find resolve after a couple of sessions, for others it may need a longer time period. Sometimes, it might be determined that further medical assessment or treatment is needed to assist with resolving your cough. In this case an experienced SLP can direct you to the doctors or other healthcare professionals who can help, and advocate for you to get certain treatments. What evidence is there for this treatment? We’re glad you’ve asked! Please check our reference list, below. If you have any further questions please don’t hesitate to contact us; you can find our contact information here. References: Carroll, T. (2019) The Speech-Language Pathologist’s role in Chronic Cough. Chronic Cough. San Diego, Plural Publishing Inc. Chamberlain Mitchell, S. A. et al (2017) Physiotherapy, and speech and language therapy intervention for patients with refractory chronic cough: A multicentre randomised control trial. Thorax, 72(2), 129–136 Hutton, L. et al (2018) Patient-Reported Variables associated with the success of behavioural intervention for patients with chronic cough. UMCUR Presentation. Available online: https://scholarworks.umt.edu/cgi/viewcontent.cgi?article=1964&context=umcur Siciliano, A. (2017) Chronic Refractory Cough: A Case Study. Perspectives of the ASHA Special Interest Groups SIG 3, Vol. 2(Part 2) Slovarp, L. & Vertigan, A. (2019) When the coughing won’t stop. The ASHA Leader. Available online: https://leader.pubs.asha.org/doi/10.1044/leader.FTR2.24112019.50

In an era of iPads and high-tech toys being the primary source for entertainment for both adults and children alike, the art of play can often get lost. Play is crucial towards language development in children. Even when children play silently, they are soaking up information like a sponge. Children watch, listen and explore the world around them to learn and all of these contribute to obtaining important communication and language skills. Starting from infancy, babies watch and observe mouth movements as you talk and facial expressions to begin to correlate expressions with moods and feelings. Even mouthing objects has been shown to be a mechanism of exploration and vocalization (Iverson, 2010). Further on, they learn to imitate our actions and sounds as well. Children are even listening to us before they are even born! They can hear their mother’s speech and are able to discern sounds and speech patterns typical to their mother’s native language! All of these factors, and more, play (no pun intended) into how our children use their skills to learn about the world around them. They incorporate all that they have watched, heard and imitated to create purposeful language. None of this is best bolstered at home than through play. Not all play is created equal, however. According to the National Association for the Education of Young Children, 90% of play in preschool aged children in the US involves a toy (Trawick-Smith, 2018). They have been tracking how toys can impact children’s behaviour and what influences they have on thinking, interaction with peers and creative expression. Do all toys serve more or less the same function or is there a real difference? What they found after studying groups of children and sampling different types of toys were that the more basic the toys were, the higher they scored on the measures listed earlier. These toys are often referred to as Open Ended Toys. This means that the children should be doing more of the playing than the toy does. Often times this means disconnecting from the internet and no batteries. Some examples would be toy cars, wooden blocks and pretend play sets! Being present and in the moment with kids to present them with new vocabulary and circumstances to encounter. These activities can help boost language skills by introducing more vocabulary and novel concepts that they might not normally encounter! Iverson, J. M. (2010). Developing language in a developing body: The relationship between motor development and language development. Journal of Child Language, 37(2), 229- 261. doi:10.1017/s0305000909990432 National Association for the Education of Young Children. (n.d.). Retrieved from https://www.naeyc.org/resources/topics/play/specific-toys-play