Hegdes pocket guide to assessment in speech language pathology, 2e 2001

Hegde’s PocketGuide to Treatment in Speech-Language Pathology NOTICE TO THE READER Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any of the product information contained herein Publisher does not assume, and expressly disclaims, any obligation to obtain and include information other than that provided to it by the manufacturer The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities herein and to avoid all potential hazards By following the instructions contained herein, the reader willingly assumes all risks in connection with such instructions The Publisher makes no representation or warranties of any kind, including but not limited to, the warranties of fitness for particular purpose or merchantability, nor are any such representations implied with respect to the material set forth herein, and the publisher takes no responsibility with respect to such material The publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or part, from the readers’ use of, or reliance upon, this material Hegde’s PocketGuide to Treatment in Speech-Language Pathology Second Edition M N Hegde, Ph.D Department of Communicative Sciences and Disorders California State University-Fresno Hegde’s PocketGuide to Treatment in Speech-Language Pathology, Second Edition by M N Hegde, Ph.D Business Unit Director: William Brottmiller Acquisitions Editor: Marie Linvill Development Editor: Kristin Banach COPYRIGHT ᭧ 2001 by Singular, an imprint of Delmar, a division of Thomson Learning, Inc Thomson Learning௣ is a trademark used herein under license Printed in Canada XXX 05 04 02 01 00 For more information contact Singular, 401 West ‘‘A’’ Street, Suite 325 San Diego, CA 92101-7904 Or find us on the World Wide Web at http:// www.singpub.com Executive Marketing Manager: Dawn Gerrain Channel Manager: Tara Carter ALL RIGHTS RESERVED No part of this work covered by the copyright here-on may be reproduced or used in any formor byanymeans— graphic, electronic, or mechanical, including photocopying, recording, taping, Web distribution or information storage and retrieval systems—without written permission of the publisher For permission to use material from this text or product, contact us by Tel (800) 730-2214 Fax (800) 730-2215 www.thomsonrights.com Production Manager: Barbara Bullock Production Editor: Sandy Doyle Library of Congress Cataloging-in-Publication Data Hegde, M N (Mahabalagiri N.), 1941– Hegde’s pocketGuide to assessment in speechlanguage pathology / by M N Hegde.—2nd ed p ; cm Rev ed of: PocketGuide to assessment in speechlanguage pathology c1996 Includes bibliographical references ISBN 0-7693-0158-4 (softcover : alk paper) Speech disorders— Diagnosis—Handbooks, manuals, etc I Title: PocketGuide to assessment in speech-language pathology II Hegde, M N (Mahabalagiri N.) 1941– PocketGuide to assessment in speechlanguage pathology III Title [DNLM: Speech Disorders—diagnosis— Handbooks Language Disorders—diagnosis— Handbooks WL 39 H462h 2001] RC423 H38286 2001 616.85'5075—dc21 00-049225 ABBREVIATED CONTENTS: ENTRIES BY DISORDERS Preface Aphasia Apraxia of Speech Articulation and Phonological Disorders Cerebral Palsy Cleft Palate Cluttering Dementia Dysarthria Dysphagia Hearing Impairment Language Disorders in Children Laryngectomy Right Hemisphere Syndrome Stuttering Traumatic Brain Injury Voice Disorders v vii 11 43 58 144 149 156 171 193 218 275 298 353 427 447 520 551 M N (Giri) Hegde is Professor of Communicative Sciences and Disorders at California State UniversityFresno He holds a master’s degree in Experimental Psychology from the University of Mysore, India, a post-master’s diploma in Medical (Clinical) Psychology from Bangalore University, India, and a doctoral degree in Speech-Language Pathology from Southern Illinois University at Carbondale A specialist in fluency disorders, language disorders, research designs, and treatment procedures in communicative disorders, Dr Hegde has made numerous scientific and professional presentations to national and international audiences He has extensive clinical and research experience and has published research articles on a wide range of subjects, including fluency and language, their disorders, and treatment Dr Hegde has authored or co-authored several highly regarded and widely used scientific and professional books, including Clinical Research in Communicative Disorders, Introduction to Communicative Disorders, Treatment Procedures in Communicative Disorders, Treatment Protocols in Communicative Disorders, A Coursebook on Scientific and Professional Writing in Speech-Language Pathology, Clinical Methods and Practicum in Speech-Language Pathology, A PocketGuide to Assessment in Speech-Language-Pathology, A Singular Manual of Textbook Preparation, A Coursebook on Language Disorders in Children, An Advanced Review of Speech-Language Pathology, and Assessment and Treatment of Articulation and Phonological Disorders in Children He is the Editor of the Singular Textbook Series and has served on the editorial boards of several scientific and professional journals Dr Hegde has received many honors and awards, including the Distinguished Alumnus Award from Southern Illinois University Department of Communication Sciences and Disorders, Outstanding Professor Award from California State University-Fresno, Outstanding Professional Achievement Award from District Five of California Speech-Language-Hearing Association, and Fellowship in the American Speech-Language-Hearing Association vi Preface The second edition of this PocketGuide to treatment procedures in speech-language pathology has been updated and expanded by more than 100 pages Information on ethnocultural variables that affect treatment has been added under each disorder and the steps involved in administering certain treatment procedures are described in more detail in the second edition Simultaneous revision of the companion volume, Hegde’s PocketGuide to Assessment in Speech-Language Pathology has also helped to streamline the information in the two books This PocketGuide to treatment procedures in speech-language pathology has been designed for clinical practitioners and students in communicative disorders The PocketGuide combines the most desirable features of a specialized dictionary of terms, clinical resource book, and textbooks and manuals on treatment It is meant to be a quick reference book like a dictionary because the entries are alphabetized; but it offers more than a dictionary because it specifies treatment procedures in a ‘‘do this’’ format The PocketGuide is like a resource book in that it avoids theoretical and conceptual aspects of procedures presented; but it offers more than a resource book by clearly specifying the steps involved in treating clients The PocketGuide is like standard textbooks that describe treatment procedures; but it organizes the information in a manner conducive to more ready use By avoiding theoretical background and controversies, the PocketGuide gives the essence of treatment in a stepby-step format that promotes easy understanding and ready reference just before beginning treatment The PocketGuide does not suggest that theoretical and research issues are not important in treating clients; it just assumes that the user is familiar with them How the PocketGuide is Organized Each main entry is printed in bold and burgundy color Each cross-referenced entry is underlined in burgundy Each main vii Preface disorder of communication is entered in its alphabetical order Subcategories or types of a given disorder are described under the main entry (e.g., Broca’s Aphasia under Aphasia) Specific techniques, most of them with general applicability across disorders (e.g., Modeling, Biofeedback, or Turn Taking) also are alphabetized Such specific techniques generally are described at their main alphabetical entry (e.g., Modeling under M) When appropriate, the reader also is referred to the disorders for which the techniques are especially appropriate For most disorders, a general and composite treatment procedure is described first For example, there is a general treatment program described for Stuttering, Treatment or Language Disorders in Children Following this description of a generic treatment procedure, specific techniques or treatment programs are described (e.g., treating auditory comprehension problems in aphasia, pragmatic problems in language disorders in children, or rate reduction in stuttering; and such treatment programs as Helm Elicited Program for Syntax Stimulation or the Monterey Fluency Program) Organization of entries varies somewhat for different disorders, but an example of a general organization used in the guide follows: Articulation and Phonological Disorders (Definition) A General Articulation Treatment Procedure Treatment of Articulation and Phonological Disorders: Specific Techniques or Programs Behavioral Approaches Contrast Approach Cycles Approach Distinctive Feature Approach Multiple Phoneme Approach Paired Stimuli Approach Phonological Knowledge Approach Phonological Process Approach Sensory Motor Approach Traditional Approach viii Preface Many treatment concepts and procedures are crossreferenced All cross-referenced entries are underlined in burgundy Therefore, the reader who comes across an underlined term can look up that term in a different place or context How to Use This PocketGuide There are two methods for the clinician to use this guide In the first method, the clinician looks up treatment procedures by disorders in their alphabetical order; an Abbreviated Contents: Entries by Disorders on page v will quickly refer the reader to specific communication disorders described in the guide Treatment procedures of the following major disorders are described in their alphabetical order: Aphasia Apraxia of Speech Articulation and Phonological Disorders Cerebral Palsy Cleft Palate Cluttering Dementia Dysarthria Dysphagia Hearing Impairment Language Disorders in Children Laryngectomy Right Hemisphere Syndrome Stuttering Traumatic Brain Injury Voice Disorders Under each of the main entries for major disorders, the clinician may look up subentries or specific types of disorders For example, under Dysarthria, the clinician will find the following alphabetized subentries and their treatment procedures: ix Voice: Specific Facilitating Techniques V glottal attacks, which may be beneficial to some (typically in persons with unilateral vocal fold paralysis); thus, the method includes two opposite manipulations applied to opposite problems ● Reduce hard glottal attacks • educate the client about the harmful effects of hard glottal attacks • model and demonstrate hard and soft glottal attacks; tape-record the client’s hard glottal attacks and let the client listen to them to understand their characteristics • begin training on soft initiation of voice with monosyllabic words that contain the /h/ in the initial position; when the client learns to initiate the /h/ words softly, train with words containing initial unvoiced consonants and then with words containing vowels • shape gentle onset with whisper as the initial response; ask the client to whisper the initial vowel and increase the intensity gradually until a soft phonation is heard • use also the yawn-sigh method to reduce hard glottal attacks • use also the chant to reduce hard glottal attacks • use simultaneous chewing and chanting to reduce hard glottal attacks • increase the response complexity gradually until the client produces conversational speech with soft glottal contacts ● Teach harder glottal attacks • educate the client about hard and soft forms of voice initiation • demonstrate and model harder glottal attacks by producing such words as pop, peep, bob, and beet in a sudden plosive manner; ask the patient to imi- 562 Voice: Specific Facilitating Techniques tate them and reinforce imitated or approximated productions • prove visual feedback of soft and harder glottal attacks on an oscillograph or Visi-Pitch௣ • use the pushing approach briefly to induce harder glottal attacks • increase the response complexity gradually to induce better approximation of vocal folds in conversational speech Glottal Fry A normal voice characteristic useful in treating voice disorders associated with vocal nodules, polyps, fold thickening, functional dysphonia, ventricular phonation, and spasmodic dysphonia; produced with relaxed vocal folds, minimal vocal fold tension, and minimal airflow ● Educate the client about relaxed vocal folds being better able to approximate in spite of the nodules and other masses on them ● Teach the client to say /i/ softly after a slight exhalation ● Ask the client to ‘‘Open the throat’’ and make the sound deep, with a slow series of pops ● Ask the client to produce the same tone on inhalation to see whether the fry is better produced on inhalation or exhalation because individuals differ; alternate between inhalated and exhalated phonations ● Ask the client to say words like on and off and in and out while producing the fry; tape-record the client’s productions that will serve as a model ● Teach phrase or short sentence productions in the fry mode; ask the client to say ‘‘Easy does it,’’ ‘‘Squeeze the peach,’’ or ‘‘See the eagle’’ and point out the improved voice quality to the client ● Ask the patient to practice speech in the fry mode at home 563 V Voice: Specific Facilitating Techniques ● Have the vocal fold pathology monitored by a lar- V yngologist; as the voice improves, they are likely to improve as well Half-Swallow Boom A method of treating low loudness and air wastage from the vocal folds; recommended for clients with Unilateral Vocal Fold Paralysis or Mutational Falsetto ● Ask the client to swallow and, as this action is still in progress, say ‘‘boom’’ ● Let the client produce ‘‘boom’’ in a low-pitched voice ● Ask the client to say ‘‘boom’’ louder and with less breathiness ● Have the client discriminate the normal production from the ‘‘‘boom’’ production with the help of taperecorded samples ● Teach the client to turn the head first to one side and then to the other and say ‘‘boom’’ each time ● Lower the chin while saying ‘‘boom’’ ● Ask the client to add sounds and words to ‘‘boom’’ (e.g., ‘‘boom /i/’’; ‘‘boom one’’) ● Teach the client to add phrases and sentences ● Fade out the boom and swallow ● Ask the client to lift the chin up and bring the head back to the midline as he or she produces normal speech Head Positioning Manipulation of head positions to promote better voice quality; recommended especially for clients with neurological disorders including dysarthria; may be used with clients who have hyperfunctional voice ● Give instructions, model different head positions, demonstrate their effects on voice, and justify the procedure to the client ● Experiment with different head positions to find the one that promotes better voice (e.g., head rotated 564 Voice: Specific Facilitating Techniques toward left or right; neck flexed downward with the face looking down); ask the client to produce some prolonged vowels (e.g., /i/, /I/, /o/, or /u/) as different head positions are tried to identify the best position ● Ask the client to hold the head position that helps produce the best voice ● Ask the client to produce words, phrases, and sentences ● Gradually fade the unusual head position into a more normal position Inhalation Phonation A technique of voice therapy designed to evoke true vocal fold vibrations in clients who are aphonic or those who exhibit ventricular phonation ● Raise your shoulders, inhale, and phonate a highpitched hum ● Raise your shoulders, inhale, phonate the highpitched hum and lower the shoulders; exhale, and produce the same sound; repeat this ● Teach the patient to produce inhalation phonation ● Teach the client to produce inhalation and exhalation phonation with corresponding shoulder movements ● Demonstrate the movement from the high-pitched voice to the exhaled low-pitched voice ● Reinforce the client’s attempts to bring the pitch down ● Fade the shoulder movements ● Have the client practice single words until a normal sounding voice is stabilized ● Move on to more complex responses (phrases and sentences) Laryngeal Massage A technique of voice therapy in which the laryngeal area is gently massaged and manipulated to improve vocal quality; recommended for clients with functional voice disorders with no organic 565 V Voice: Specific Facilitating Techniques V component characterized by a larynx that is positioned high during speech with some evidence of neck tension; some clinicians first try yawn-sigh with these clients and use laryngeal massage if the first attempt fails ● Ask the client to prolong vowels as you massage the larynx through the steps specified ● Encircling the hyoid bone with the thumb and the middle finger, make a circular motion with your fingers while applying light pressure ● Repeat the procedure, this time with the fingers working posteriorly from the thyroid notch ● Repeat the procedure at the posterior borders of the thyroid cartilage ● Gently move the larynx in downward and lateral directions by placing the fingers over the superior borders of the thyroid cartilage ● Reinforce any improvement in the client’s voice Masking A technique of voice therapy to treat clients with functional aphonia and those with poor voice quality because of inadequate auditory monitoring of one’s own voice; masking noise introduced through headphones ● Use a standard audiometer to introduce masking noise; so without any explanation ● Ask the client to read orally; turn the masking on and off for brief periods ● Tape-record the client’s reading to document possible changes in voice quality or the emergence of voice in the whispering aphonic patient ● Playback the tape-recorded sample to demonstrate improved voice quality or voiced productions by an aphonic client; contrast voice with and without masking ● Ask the client to match his or her improved voice or emergence of phonation without masking 566 Voice: Specific Facilitating Techniques ● Have the client read aloud under masking and, as the voice improves or phonation emerges, abruptly end masking; repeat this process until the client can sustain the gains Nasal/Glide Stimulation A voice treatment technique in which nasal glide consonants are used to promote better voice quality in patients with functional dysphonia, spasmodic dysphonia, and voice problems associated with vocal fold thickening, nodules, and polyps; words loaded with nasal glides seem to be produced with least effort ● Prepare a list of words with nasal consonants in them (e.g., man, moon, many, morning, many men, moon man, morning singing) ● Prepare also a list of words that are repeated with /a/ inserted between repetitions (e.g., man a man a man or wing a wing a wing; use this list as an alternative) ● Prepare a list of words with glide consonants /r/ and /l/ combined with nasal sounds (e.g., marrow, married women, only lonely memory, Laura ran around) ● Prepare a list of words with /l/ and /r/ that are repeated with /a/ inserted between each repetition (lee a lee a lee or rah a rah a rah) ● Have the client practice the selected words; reinforce improved voice quality ● Gradually move on to words, phrases, and sentences containing other consonants to improve voice in meaningful, spontaneous speech Open-Mouth Approach Oral openness during speech to increase oral resonance, reduce speaking effort, induce more relaxed speech, and to promote appropriate loudness, pitch, and quality of voice ● Give feedback on lack of mouth opening during speech; use a mirror if necessary 567 V Voice: Specific Facilitating Techniques ● Model greater and reduced oral openness; use a pup- V pet (greater mouth opening); contrast that with the speech of a ventriloquist (minimum mouth opening) ● Ask the client to imitate the two ways of speaking that you model ● Ask the patient to tilt the head down and speak ● Teach the client to self-monitor oral openness in natural settings ● Let the client practice speech with oral openness and reinforce for doing so Pushing Approach A voice therapy technique to promote better approximation of vocal folds; appropriate for increasing vocal loudness ● Instruct and demonstrate pushing ● Ask the client to push down on the arm of the chair or push up by trying to lift the chair by gripping the bottom of the seat while seated ● Ask the client to phonate and push simultaneously ● Reinforce the louder voice that typically results ● Increase the length of utterances with the louder voice ● Fade pushing Relaxation Training A method to teach deep muscle relaxation with or without the help of biofeedback (e.g., electromyographic feedback); recommended for clients with excessive tension, anxiety, and stress; may be appropriate for some voice clients because of their excessive muscle tension ● Use biofeedback instruments ● If no instruments are used, give instructions to contract and relax muscles ● Teach the client to discriminate between tensed and relaxed muscles by alternately asking him or her to tense and relax selected muscles (e.g., shoulder, neck, or jaw muscles) 568 Voice: Specific Facilitating Techniques ● Select facial, neck, and head muscles for relaxation training; ask the client to relax one set of muscles and tense them to appreciate the difference ● Manipulate head positions to induce relaxation ● Ask the client to imagine speaking situations that induce greater tension and immediately let the client relax the speech muscles ● Use relaxing head movements (positions) if necessary ● Use other appropriate voice therapy techniques in combination with relaxation ● Stabilize a relaxed speaking posture and improved voice quality Respiration Training Teaching clients to manage inhalation–exhalation cycles optimally for the purpose of phonation and sustained vocalization; recommended for clients with functional voice disorders who not seem to use their breath stream properly in voice production ● Explain the relation between breathing and speaking and between airflow and vocal fold vibrations ● Teach the client to inhale more quickly, more deeply than usual but exhale more slowly and in a controlled manner; to extend exhalation, ask the client to count to slowly and then to 10 slowly ● Ask the client to prolong vowels to teach controlled and prolonged exhalation that would better support speech; in progressive steps, teach the client to prolong a vowel for about 20 seconds ● Teach the client to inhale quickly between utterances ● Teach good posture, which promotes normal airflow management Tongue Position Modification Manipulating tongue position in the oral cavity to affect changes in voice quality and resonance; tongue typically positioned too far back results in cul-de-sac resonance; tongue typically 569 V Voice: Specific Facilitating Techniques V carried too far forward creates ‘‘thin voice’’ giving the baby talk effect ● Teach clients to carry tongue in its neutral position ● Modify the excessively backward tongue position ● Modify the excessively forward tongue position ● Instruct, model, demonstrate, and reinforce correct tongue positions Vocal Rest A voice therapy technique that requires little or no talking, typically for 4–7 days; vocal rest may be complete or partial ● Recommend mandatory vocal rest for clients who have undergone any form of laryngeal surgery; this helps promote normal healing of the surgical wounds ● Recommend vocal rest as initial treatment for clients who have such types of laryngeal lesions as vocal fold hemorrhage and mucosal tear to let the healing process begin ● Recommend partial (modified) vocal rest for clients who have a severe cold (and resulting laryngeal inflammation), vocal nodules, and vocal fold edema; note that partial vocal rest means talking only when absolutely essential and with appropriate vocal habits ● Instruct the client either to totally avoid or markedly reduce • speaking • shouting or screaming • singing or humming • whispering • coughing or throat clearing • laughing or crying • lifting or pushing heavy objects ● Have a family member monitor these activities ● Teach the client to keep a record of such activities ● Teach the client to self-monitor 570 Voice: Specific Facilitating Techniques Warble Tone Approach A voice treatment method in which the vocal pitch is constantly and continually shifted up and down to move the client out of the habitual monotonous pitch and thus to establish a pitch that is more appropriate to the client; recommended for clients with hoarse, strained, breathy, or rough voice regardless of its origin ● Using a visual feedback device (such as the VisiPitch), model a tone that is varied up and down in pitch and ask the client to imitate what you model ● Ask the client to produce the vowel /i/, constantly varying the pitch (loudness should also vary with it); when the most desirable tone is heard, ask the client to extend it ● Begin fading the warble tone after a few successful trials; ask the client to reduce the warble portion of the tone and extend the steady, desirable portion of the tone; give several trials ● Withdraw the warble completely and have the client practice the desirable steady tone ● Introduce phrases with vowel-initial sounds in the first word of the phrase (e.g., even now, easy day), and ask the client to produce them with the new steady, desirable voice ● Use more complex utterances and sentences to stabilize the new voice Whisper-Phonation Method A voice therapy technique that uses Prephonation Airflow to reduce Hard Glottal Attack; the client is required to whisper sustained vowel productions; gentle phonation is introduced as the vowel is being sustained ● Ask the client to whisper monosyllabic words that have vowel initiates ● Teach the client to whisper the initial vowel very gently 571 V Voice: Specific Facilitating Techniques ● Introduce gentle phonation as the end of the vowel is prolonged ● Gradually increase the loudness of the whisper until phonation is introduced ● Teach the client to blend the whisper into a soft phonation ● Reinforce speaking in a relaxed, breathy voice V Yawn-Sigh Method A voice therapy technique for clients with hypervocal function; uses the relaxing effects of the inspiratory yawn followed by an expiratory sigh and phonation ● Instruct and demonstrate the relaxing effects of prolonged inspiration involved in a yawn and the relaxed phonation that results with a sigh ● Ask the client to yawn and then exhale slowly while phonating lightly ● Ask the client to say words that start with /h/ after each yawn ● Teach the client to produce a gentle, voiced sigh while exhaling ● Teach the client to produce an easy, prolonged, open-mouthed exhalation after each yawn ● Ask the client to skip the yawn and teach the client to inhale normally and exhale a prolonged sigh with the open mouth ● Ask the patient to say ‘‘hah’’ after beginning each sigh ● Ask the patient to say additional words all beginning with the glottal /h/ ● Ask the patient to blend in an easy, relaxed, phonation during the middle of a sigh ● Fade the sigh and move on to words, phrases, and sentences Andrews, M L (1999) Manual of voice treatment: Pediatrics through geriatrics (2nd ed.) San Diego: Singular Publishing Group 572 Voice Prosthesis Boone, D R., & McFarlane, S C (2000) The voice and voice therapy (6th ed.) Boston: Allyn & Bacon Case, J L (1996) Clinical management of voice disorders Austin, TX: Pro-Ed Deem, J F., & Miller, L (2000) Manual of voice therapy (2nd ed.) Austin, TX: Pro-Ed Voice Prosthesis A small (1.8 to 3.6 cm) silicone device that has a valve at the back end and an opening at the front end; inserted into the tracheoesophageal puncture in patients who have undergone laryngectomy; allows air into the esophagus, which vibrates; the sound is shaped into speech; see Laryngectomy Voluntary Stuttering A treatment target in fluent stuttering approach of Van Riper; for procedures see Stuttering, Treatment; Treatment of Stuttering: Specific Techniques or Programs V 573 575 Wernicke’s Aphasia Wernicke’s Aphasia A type of aphasia caused by lesions in Wernicke’s area; characterized by fluent but meaningless speech, with impaired comprehension of speech; see Aphasia; Treatment of Aphasia: Specific Types Wernicke’s Area The posterior portion of the superior temporal gyrus in the left hemisphere responsible for formulation and comprehension of language Whole Language Approach An approach to teaching language and literacy that requires the teaching of all aspects of language (speaking, reading, writing) simultaneously; lacking in experimental support and now highly questioned; see Language Disorders in Children; Treatment of Language Disorders: Specific Techniques or Programs Whole Word Accuracy (WWA) A criterion measure used in multiple-phoneme approach of articulation treatment; the entire word is judged for accuracy (as against judging the accuracy of only the target phoneme) Wh-Questions Questions that begin with wh-; interrogative statements that begin with what, when, where, and who; treatment targets for language impaired children Wireless Systems Assistive Listening Devices that transmit messages from a speaker to a listener without wire connections; include FM auditory trainers and infrared systems; see under Aural Rehabilitation Word Combinations The same as Phrases W 576 ... Professional Writing in Speech-Language Pathology, Clinical Methods and Practicum in Speech-Language Pathology, A PocketGuide to Assessment in Speech-Language- Pathology, A Singular Manual of... Cataloging -in- Publication Data Hegde, M N (Mahabalagiri N.), 1941– Hegde’s pocketGuide to assessment in speechlanguage pathology / by M N Hegde.—2nd ed p ; cm Rev ed of: PocketGuide to assessment in. .. Hegde’s PocketGuide to Treatment in Speech-Language Pathology, Second Edition by M N Hegde, Ph.D Business Unit Director: William Brottmiller Acquisitions Editor: Marie Linvill Development Editor: