Category Archives: Assessment

Countdown to Christmas – Question 23: Monday 23rd December

Normally, when you drag a pointed object along someone foot from heel to big toe, the toe will curl down. However, in ALS, the toe goes in the opposite direction and point upwards. What is this called?

Test for ALS(a) The Rossolimo sign

(b) The Babinski sign

(c) The Stransky sign

ANSWER: The Babinski sign.

The Babinski sign is a test of what’s called the plantar reflex – the natural tendency for the toes to curl down when something is scraped across the bottom of the foot. In ALS, there is an abnormal response in that the toes go upwards. Actually, in infants up to the age of one, you can see the Babinski sign but it disappears and is pathological in adults.

The test is named after Joseph Babinski (1857-1932) who was a Polish neurologist. He presented his observation about the plantar reflex at a conference in 1896 in Paris, and it then became referred to as the Babinski sign or Babinski reflex.


About Joseph Babinski on Wikipedia.

About ALS from the ALS Association.

Countdown to Christmas – Question 21: Saturday 21st December

You are asked to evaluate a client who has had a stroke. Which one of the following tests is most appropriate?

(a) BDAE-3

(b) BDI-2

(c) BLT-2

(d) BTAIS-2

Therapy interview

ANSWER: BDAE-3: The Boston Diagnostic Aphasia Examination – Third Edition.

The BDAE has been around for some time now – one of the Dudes was using it in the 1980’s! – and it’s now in its third edition. It’s designed to determine and distinguish disorders of language function and neurologically recognized aphasic syndromes.  The test contains a short form for rapid access to diagnostic classification and quantitative assessment.

The BDI-2 is the Batelle Development Inventory and screens, diagnoses, and evaluates children from infancy to age 8. Domains include personal-social, adaptive, motor, communication, and cognitive.

The BLT is the Bankson Language Test for kids aged 3:00 to 7:00. It aims to measure children’s psycholinguistic skills in the three general categories of semantic knowledge, morphological/syntactical rules, and pragmatics. Not to be confused with the sandwich of the same name!

The BTAIS-2 is the Birth to Three Assessment and Intervention System, which screens language comprehension and expression, nonverbal thinking, and motor development.


The Directory of Speech-Language Pathology Assessments collated by ASHA.

The BDAE from PsychCorp, a part of Pearson Education, Inc.

The Dudes Do ASHA 2011: Day 1. On Traveling, Truth, and EBP

journey, (n). / /. A day’s travel; the distance traveled in a day or a specified number of days.

According to the English writer Oliver Goldsmith, “Life is a journey that must be traveled no matter how bad the roads and accommodations.” Well, in all honesty, when the journey is to the ASHA 2011 conference in San Diego and the accommodations are at the Hilton San Diego Bayfront, it’s hard to imagine anyone feeling any sympathy for our having to travel for hours and across thousands of miles to get here. When you’re sitting back in a swanky, high-priced bar drinking White Russians and nibbling on a $26 selection of gourmet meatballs, you keep glancing at the hotel entrance to see if the “Occupy San Diego” people are about to storm the building with flaming torches, dragging off “the rich” to a hastily constructed gibbet.

The Odysea Bar

Still, it’s not as if this is the regular lifestyle for the Speech Dudes. No sir! For every luxury hotel we stay in there are tales we can tell of others that involve insect infestations, bullet-proof check-in desks, ear-splitting air-conditioners, no air-conditioners (in a Coloradan summer), and one just on the edge of a European red-light district that rented by the hour. So rest assured the Dudes are immensely appreciative of their current locations, split as they are between the Hilton and the Marriott, also with a view of the bay.

Despite having traveled individually from the East Coast, Mid-West, and Canada, we are, after all, Speechies, and within minutes of ordering food and drinks at 10:30 pm PST, the conversation  shifted from how which is the worst airport in the US (Philadelphia  is currently in the running, says one of us) to Speech Pathology, specifically the issue of outcomes. Incredible as it may seem that a group of guys at a bar would want to get into Evidence-based Practice rather than the sad state of the NBA and the prospect of not being able to spend some quality time over Christmas secretly hoping LeBron James will twist an ankle and bruise his ego, we ploughed into the current fad for dropping iPads [2] on every kid with a pair of hands as the “miracle cure” from St. Stephen of Jobs and the Angels at Apple.

The messianic zeal of evangelical Jobbites [3] is such that the answer to life, the Universe, and everything, is quite simply “there’s an App for that.” And if there isn’t, then someone will make one and all will be well. It’s no use talking about “levels of evidence” or “controlled experiments” or even “proof” because there is, of course, lots of “proof” on YouTube, and, of course, sales of iPads outstrip the gross domestic product of several South American countries so they must be useful.

Already, Jobbites reading this are spluttering and trembling, their wobbling fingers poised to launch into a tirade of near-religious rhetoric in defense of the New World Order, where Apple will save the world by the benevolent use of the “One store to bring them all and in the darkness bind them.” But take a deep breath and hold back for just a few minutes.

Whether using technology for teaching articulation skills, sentence construction, fluency, AAC, literacy, and so on, the glamour [2] of the machine can cloud our judgment. Our pads, tablets, smart phones, and laptops are such magical totems that we really want them to be special. The trick is for us to make sure we are open-minded enough to see the benefits of new technology (or just new approaches in general) but not so open-minded that our brains fall out.

Sackett, Strauss, Richardson, Rosenberg, and Haynes (2000) [3] talked about using a foreground question to determine the quality of external evidence that can help us make informed decisions about using a new approach. The use the acronym PICO as a memory aid that helps us formulate a testable question;

  • A Patient or Problem
  • An Intervention (a treatment or evaluation)
  • A Comparison or Contrast
  • An Outcome (measurable, of course)

Thus, a good question to ask would be “If I use this app for a month (I) with my 4-year-old client with a hearing loss (P) will the improvement in selecting new images on the screen (O) be better than if I’d used simple picture books (C).”

OK, so you can fine tune this in a few ways but we’re writing a blog post not an EBP textbook. The point is that we do have the clinical tools to evaluate the use of flashy new technology if we ask the right questions. Just using an app for a month and noticing “change” tells you nothing; the client may have “changed” if you’d let them watch SpongeBob SquarePants with you because the interaction was the cause, not the app.

Healthy skepticism is not a rejection of change but a necessary perspective to evaluate the extent of change. What is dangerous about new approaches, technological or social, is when claims are made to efficacy that are based purely on anecdote and a wish to see things happen.

And who would have thought White Russians and meatballs could lead to this.

Time for bed…

Time for bed


[1] Curiously it is iPads and not tablets in general. A recent report asked schools if they were considering buying new tablet technology for the classrooms and 100% said iPads against 0% for any other device. Now, doesn’t that strike anyone else as odd if the education system is supposed to be evaluating things on merit? Or is this a triumph for Apple’s marketing department? Just a thought.

 [2] The word glamour not only means “fascination” or “allure” but also “a magical spell cast over a person to hold them in thrall.” Literary types might want to take a read, or re-read, of Tennyson’s Idylls of the King and the verses entitled The Beguiling of Merlin. This demonstrates poetically how the glamorous Vivienne enchants and defeats the Arthurian mythological wizard.

[3] A Jobbite is an individual who considers Steve Jobs and all his works as beyond criticism. Followers of Ayn Rand have a similar perspective, which ultimately can result in the emergence of cults. Although Jobs was unquestionably influential in the world of technology, it’s easy to forget that Apple succeeded because of the creativity and hard-work of its workers. Jobs himself didn’t actually sit down and build iAnythings – he facilitated it, and there was his skill.

[4] Sackett, D.L., Strauss, S.E., Richardson, W.S., Rosenberg, W. and Haynes, R.B. (2000) Evidence-based medicine: How to practice and each EBM. Edinburgh, Scotland: Churchill Livingstone.

Quackery, Hokum, Baloney: Separating Science from Stupidity

Suppose I told you that somewhere between Earth and Mars there is an invisible teapot that orbits the sun once every 666 days. The teapot is invisible because it is cloaked using technology developed by space aliens, who left it there to monitor our progress. They believe that once we make contact with the teapot, an alarm will sound and they will return to see if we are truly worthy of being galactic citizens.

Teapot in space

The Orbiting Teapot

The question you need to ask is; “Is that true?” and if so, “How do I know it’s true?” This is, of course, the fundamental question for Science. What do we know and how do we know it.

The invisible teapot was created by the philosopher Bertrand Russell back in 1952 and went like this:

If I were to suggest that between the Earth and Mars there is a china teapot revolving about the sun in an elliptical orbit, nobody would be able to disprove my assertion provided I were careful to add that the teapot is too small to be revealed even by our most powerful telescopes. But if I were to go on to say that, since my assertion cannot be disproved, it is intolerable presumption on the part of human reason to doubt it, I should rightly be thought to be talking nonsense.

But this is the 21st century, after all, and we are all sophisticated, intelligent people, and we have a wealth of scientific knowledge and instrumentation to help us test for the presence of the teapot. The “powerful telescopes” of 1952 have been replaced by much more sophisticated technology and we can now see much more of our solar system.

Bertrand Russell

Bertrand Russell

In principle, therefore, we could focus all the world’s telescopes along the elliptic plane and search for the pot. We already know what it looks like, we know it is between Earth and Mars, and we know it is cloaked. The cloaking business may make it trickier but we also know from current research that “cloaking” is little more than deflecting light around a mass. We could spot the teapot by looking to see if there is a teapot-sized region of space that makes stars behind it appear to change position; this is because the mass of the pot will cause light to bend ever so slightly (it why in a solar eclipse we can see stars on the edge of the sun that are actually behindit).

The key thing to note here is that we TEST for the presence of the teapot and refuse to accept it on faith. I may be able to spin the most wonderful story about the pot, about how beautiful and splendiferous it can be, and how much it has changed my life, but if all I have is my personal perceptions and ideas, you would be right to treat what I say as bullshit of the highest order.

The only way for me to prove that I am right is to provide evidence of the pot. If the telescopes suddenly reveal a sea-green piece of revolving pottery, orbited by teacups (hey, there may be more to the teapot than I knew!) then you should start taking me more seriously. When several independent observatories have pictures, and all independently identify its location by numerical coordinates, and spectrograph analyses all show its chemical structure, then I’m pretty much vindicated. And if after a few years NASA’s latest “Pot Probe” reaches that location and scoops up the teapot into its gaping maw, then that’s likely to be as much proof as any reasonable person would require to be able to say, “Yes, there IS a teapot in outer space.”

Testability is a cornerstone of Science. And the thing that has to be tested is a HYPOTHESIS[1], which is defined as;

A proposition or principle put forth or stated (without any reference to its correspondence with fact) merely as a basis for reasoning or argument, or as a premiss from which to draw a conclusion.

The aim of Science is to test a hypothesis, that is, to see if it is true or false. Now in reality, you don’t actually prove something to be “true,” you “support” it. Truth and support are two very different things. If my hypothesis is “All swans are white,” I can test it by sitting by a river bank photographing every swan than lands on the water in front of me. If I have several friends across the world do the same thing, we might find that all the pictures we have turn out to be white swans. Does this mean that “All swans are white” is true? Nope, it just means that there is overwhelming support, based on many observations and measurements by many people, that swans are white. However – and here’s the kicker – if we find just ONE black swan, the hypothesis is dead in the water. Gone. No amount of evidence can make a hypothesis true, but just one observation can make it false.

This is the principle of falsification, promoted and discussed at great length by the great philosopher of Science, Karl Popper, whose Logic of Scientific Discovery[2] is  a classic in the field. For a more relaxed read (and by “relaxed” I mean “requires a little concentration” as opposed to “Oh, my frickin’ head’s about to explode!”) you might prefer Objective Knowledge: An Evolutionary Approach[3], published in 1972.

Karl Popper

Karl Popper

It’s also explained eloquently by another Carl, Carl Sagan, in his 1996 book The Demon-Haunted World: Science as a Candle in the Dark. I can’t recommend this book enough to students who are eager to learn about the scientific method in an enjoyable and entertaining fashion. It is, perhaps, his best and most lucid book, and it beats me why this isn’t recommended as a high-school text or at least an undergraduate offering to all students. Many people have a woeful understanding of what science and the scientific method are all about and this one book explains it so well.

One particularly practical offering is Chapter 12: The Fine Art of Baloney Detection, where Sagan offers a number of ways to check whether a proposition or hypothesis is valid. Here’s the list for Baloney Detection:

  • Wherever possible you need to find independent confirmation of the facts. One person or test does not a hypothesis prove!
  • Encourage and engage in debate on the evidence by knowledgeable proponents of all points of view.
  • Don’t fall for arguments from authority alone; I may have a PhD in Astrophysics but that doesn’t mean there IS a teapot.
  • Be prepared to try multiple hypotheses.
  • Try not to get overly attached to a hypothesis just because it’s yours, THis is harder than you might think.
  • Measure, measure, measure. Objective numbers always trump personal beliefs, no matter how many folks share that belief.
  • If there is a chain of argument every link in the chain must work.
  • Sharpen up Occam’s Razor[3] – if there are two hypothesis that could explain the data equally well, choose the simpler.
  • Check to see if the hypothesis can, at least in principle, be falsified: Is it testable? If it isn’t testable, it isn’t science![4]
  • Can other people replicate the experiment and get the same result?
  • Conduct control experiments, especially “double-blind” experiments where the person taking measurements is not aware of the test and control subjects.
  • Check for confounding factors; make sure you separate as many of the variables as you can.

This is why evidence-based practice is so important. It separates the speculative from the scientific. The current rush to buy iDevices as a blanket solution for those individuals who need an AAC device is a good example of where hypotheses precede evidence. When someone turns up at the clinic doors with a kid, an iPad, and a recommendation from a video on YouTube that “this is the answer,” what do you say? There are many purported “evidential” video clips on the Internet that are well-meaninged attempts by parents to show how their kids have “improved” by using technology, but with no pre-testing and no measure of what “improvement” is, it’s impossible to call this evidence.

In their desire to help people with communication problems, it’s sometimes easier to believe in orbiting teapots than measure performance.

[1] The word hypothesis comes directly from the Greek ὑπόθεσις and means “placing under.” ὑπό is “under” and you see this in words such as hypodermic (under the skin), hypothalamus (under the thalamus), and hypochondria (under the breast-bone). The θέσις part orignal referred to the action of placing a foot or hand down to beat time in poetry or music, and it became, by extension, the putting down of a proposition or idea.

[2] Popper, K.R. (1935) Logik der Forschung (The Logic of Research) , Vienna: Springer; trans. The Logic of Scientific Discovery, London: Hutchinson, 1959.

[3] Popper, K.R. (1972) Objective Knowledge, Oxford: Clarendon Press. If you just want to focus on just one chapter, try Chapter 6: Of Clouds and Clocks, which can be read somewhat independently of the book as a whole, and is less dense than some of the earlier chapters. Popper isn’t the easiest of folks to read and in truth, I still have a hard time with much of his stuff on probability because of the math and logic involved, but he’s well worth the effort.

[4] “Pluralitas non est ponenda sine neccesitate” or “plurality should not be posited without necessity.” This is attributed to William of Ockam (1285-1349), an English Franciscan Monk and philosopher, who used this premise in much of his work and thinking, although the notion was actually a common principle in medieval thought. The actual phrase, Occam’s Razor, appeared first in 1852 and was used by the astronomer and physicist, William Rowen Hamilton. No mention of his looking for a teapot…

[5] The difference between Science and Pseudoscience often comes down to this rule of Testability. An idea that is inherently untestable is called metaphysical or speculation. You may well believe passionately that there are fairies at the bottom of your garden but unless you can subject them to testing, they are no more real than my orbiting teapot.

Urban Dictionary: The Speech Therapist’s Secret Weapon

wordle for this article

Wordle for this article

One of the most exciting things about language is that it’s in constant flux. Each and every day, new words get coined or new usages of old words appear. Sometimes, old words roll back the stone of the tomb and undergo an amazing resurrection. It’s also almost impossible to go through 24 hours without getting into a discussion – or argument – about words and meanings, with everyone eager to toss their own hats into the linguistic ring and fight to the metaphorical death for their interpretation of the “rightness” or “wrongness” of how we speak. Get five people around a table at a bar in the evening and you’ve got the makings of a damn good night out.

At some point in the intercourse, someone is pretty much guaranteed to whip out their smartphone of choice in an attempt to prove they are right.  (“Look, I’ll prove to you that fritiniency[1] is a real word!”)

The big question to ask at that point is; which dictionary are you using? There are so many to choose from, and so it’s not good enough to define a “real” world as “one that’s in the dictionary” unless you’re prepared to back it up with citing your source. I stand by [2] the hard-cover 1989 2nd edition of the 20-volume Oxford English Dictionary as my touchstone, along with its online edition, which has the advantage of adding new words at regular intervals. It is possible to have access to the online version on your smartphone (I have it on my Droid) but it can be costly if you don’t have access to an account at a university library [3].

After that, I’m a sucker for the online Merriam-Webster’s dictionary, which I use extensively for words that either have an American origin or American meanings that are aren’t reflected in the OED. I also recommend the Longman Dictionary of Contemporary English because it is primarily aimed at language learners and so has fairly simple definitions.

But for sheer audacity, profanity, fun, and currency, the Urban Dictionary is hard to beat. In fact, I’d say it can’t be beaten. It’s based on popular vote rather than any scholarly or scientific measurement, so just about anybody can submit a word and folks then vote on whether it’s a “word” or not. Lexicographers – professionals who study words for inclusion in dictionaries – don’t really see the UD as a “dictionary” but more as a dumping ground for hopeful monsters.  For example, as I type, the “Word of the Day” (9/9/11) is party hats, which is defined (by someone called “logos”) as “erect and pointed nipples.” The demonstration sentence is “hey, it must be cold outside because your mom has got her party hats on.” Interestingly, it also has the definition from 2005 of “Brittish [sic] (and occassionaly [sic] American) slang for condoms.”

Party hats

Party hats

UD is littered with such words and definitions. According to the site’s tagline, there have been 6,069, 024 definitions since 1999, and there’s a good chance that 6,069,000 won’t ever make it to the OED. But what you do get from skipping through this tsunami of trivia is a sense of how people understand words. You find out so much about how the man on the Clapham omnibus or Joe Sixpack sees language.

Let’s look at the party hats example simply because it is so current. First, the most obvious thing that stands out – pun intended – is that this is a compound noun made up of two already existing words. Using old words to build new ones is a common enough feature of English, and whether or not Mr. Average can actually tell you that you can use two bound morphemes to create a compound, he can do it! We can also see that it demonstrates the use of a plural morpheme. There is no example of it being used in the singular to refer to a nipple but type “party hat” nipple into Google (the quotes do an exact search and ignores “party hats”) you will find folks using it in the singular. For the really curious, you might want to look at how the UD defines the singular party hat; it has many more connotations than nipple!

Another crucial thing to notice is that people have a knowledge of metaphor that may well exceed their ability to explain it. To use party hats for “cold nipples” requires an understanding that words are inherent polysemous i.e. they have many meanings, and that such polysemy can be guided by semantic features. In this case, it is the semantic feature of “looks like.” In fact, this sound very much like the reasoning behind using Semantic Feature Analysis as a therapy tool; and that’s because it is!

This is the “secret weapon” element to accessing the Urban Dictionary – if you are allowed to [4″]! A stunning number of entries in the UD can be broken down by associative meanings. One of our #SLPeeps friends on Twitter, @kimberlyslp, tweeted just yesterday that “Kids don’t know words until they understand the semantic relations between them” followed closely by “Word retrieval improved when child knows the connections between words – the words are now closer together.”

Now do you see the link between how people use the Urban Dictionary and how humans learn words? The use of semantic relations isn’t just a “nice thing to do” it is, in fact, and essential! For a kid to know that the word glasses can refer to both things you wear to help you see and things you drink from, they have to comprehend the underlying semantic association of <MADE-FROM>; to know that swing is both an action and a noun, they have to understand <ACTION> as an associative strategy.

OK, so I’m not suggesting you necessarily start working on teaching the associative strategy of to your kids using the Urban Dictionary’s party hat – although I know a few young adults  and adults who’d revel in such wickedness! – the general point is that trawling the UD to see what real people use to make word associations is a great way to get new ideas for your teaching strategies.

The more masochistic readers – or sadistic educators looking for new articles to toss out to their students – might like to try to get hold a paper by Grondin et al (2008) entitled Shared features dominate semantic richness effects for concrete concepts [5]. Although the specific research is focused on noun-based association strategies, it is generally aimed at adding to the body of knowledge that suggests;

One factor that has emerged as important in understanding the computation of word meaning is the richness of a word’s semantic representation. Specifically, in many experimental tasks, participants respond more quickly to words having richer semantic representations. (p.1)

And the Urban Dictionary has no shortage of “rich semantic representations” on offer.

David Crystal, who once complained about being described as a “national treasure” because it sounded like he was dead, has a short, readable article online called Teaching Vocabulary: The Case for a Semantic Curriculum, which outlines the concept of using semantic fields as the basis for vocabulary teaching. Well worth downloading, although the quality of the scan is a little grainy.

There are a number of free “semantic feature” grids available out there on the interweb thingy but if you don’t want to expend extra energy by clicking to leave this page and go search, here is the Speech Dudes’s very own SFA Sheet 9-9-11 in a soothing shade of green. Feel free to print as many copies as you want and share with folks. It’s in PDF so anyone should be able to get a copy.

Semantic Feature Analysis sheet

SFA Sheet

[1] And yes indeed, fritiniency IS a real word, which dates back to 1646, and sometimes you may see it as fritinancy. It means “to twitter” and anyone following the Speech Dudes is fritiniencing on a daily basis. It comes from the Latin fritinnire, which means “to twitter” along with the noun-creating suffix, –ancy, which also derives from Latin.  There’s also a genus of plant called fritillaria, so called because ones of its defining visual characteristics is a checkered appearance reminiscent of a dice box – and the Latin for “dice box” is frittilus. This comes from the same root as fritiniency and refers to the sound of dice shaking, which is like the twittering of birds and crickets. Stick around – the Dudes have LOTS of trivia like this to share 😉

[2] Literally. I have my OED stacked on a narrow, four-shelf bookcase that’s taller than I am. This either demonstrates how big the OED books are or how short I am.

[2] If you are not a member of a university library, you are making a big mistake. Big. Huge! Most universities – or maybe just the good ones – will let you be a member, which also gets you access to online databases that include more journals than you can imagine. Trendy as it might be to think that a combination of Google and Wikipedia is all you need to find “facts” and “truth,” those big building filled with square paper things we call “books” are still useful. So do yourself a really, really big favor and go to your nearest big university library and sign up.

[4] Another fritinancer in the SLP twitterverse is the prolific @SLPTanya, who revealed in a moment of weakness that her palce of work didn’t allow access to the Urban Dictionary because it is deemed inappropriate. So it may well be that wherever you work could have some limitations on website access established by the High Poobahs of the System Administrators. You may have to simply sneak access by other means and keep the UD as a guilty pleasure. Sometimes I think downloading porn would be more acceptable to some system admins…

[5] Grondin, R., Lupker, S.J. and McRae. K. (2009). Shared features dominate semantic richness effects for concrete concepts. Journal of Memory and Language, 60, 1-9.