touch more attention than some of us just a little and they have the ability to hear at a much bigger range and then also their ears can move and so they can if there's a sound that comes in you and i have to rely upon the fact that our ears are stationary they have muscles to their ears can move only drawback they also some of them have floppy ears that kind of cover that up some so it takes a little more work you have crossed speech and hearing in  but but i never knew you had other offices yes i have two other offices in addition to the one mcqueary and there is one that is in brentwood and also one in wexford where he was the first place that we got started this peters township area i came from around the syrians i was particularly interested in servicing the children the adults that lived in the area in which i grew up and so that's how we started here the other branch offices started as a result of meat and so there to a lot of different environments not just the office those are clinics that i just talked about but we start i can go through and talk about the different populations that we were absolutely so we start with early intervention which is a fantastic program that the state of pennsylvania has is the way that they operate it with this program entails if you have a child that you see a need from birth to age three and the need can be identified by a pediatrician by a dentist by a anybody in the medical field or a neighbor or relative are you can do it just by yourself and say my child needs an evaluat from birth to three that's a there's a really early years and a lot of people think that there's not a lot that goes on during that time however that's a peak time for a child to learn so when a baby is born in the first x number of months you typically see a child sm back at mom or dad or other people coming into their visual range you see them trying to interact if they get a little bit older they might reach out towards you they might be interested in curious and what you're doing they might start to their parents from the people that they're trying to interact with first words usually develop around a year these are just really gross ages and by three years they typically are by two years they typically are speaking and maybe two word sentences that parents can understand by three they're talking in in three words or plus that strangers can understand so during the period of time if some of those things aren't developing  child you call a child's name or make noise when the child doesn't respond where there's a loud noise doesn't startle or whether it's a name and you're trying to gain attention child doesn't respond that's another red flag that would say  something needs to be checked here just to make sure those early years in the past were something that really weren't attended to but as i was saying the state of pennsylvania they have developed  educational program that allows us to go in and evaluate a child based upon a red flag typically what happens that they're based by counties so that allegheny county has one or washington county has one they would send in a service corps dater would come in and look at your child first talk to the parents and then upon recommendation a speech pathologist a physical therapist an occupational therapist  ologist a person who specializes in development early development of a child might come in and evaluate your child in your home at your convenience and check and do a screen and see if there's anything that they can see that requires some type of therapy or some suggestions to the parents the really good part of this program is that it is geared towards the parents intervening so that parents get a lot of information they get to watch when you're working with their child they get information and how to best address whatever problem it has been identified it's a fantastic program as a result of that the child typically progresses during those three years and hopefully the idea is that they won't need anything beyond that also the parents become informed and educated as to what to look for and how to address their child great your speech pathologist would you explain to the audience what that means a speech language with allah just probably i'll give you my training first speech language pathologists needs to complete a bachelor's program better university and that's a four year program and then move on to enter into a graduate program that's a two to three year program after that you graduate with a masters in either education art science depends on what school you go to where the area you're identifying and from that then you become a speech language pathologist by doing a nine month after graduate on site and we back up during your graduate training you must in turn in several environments and collect ours from different populations that you'd work with different kinds of disorders so you might work in a clinic a hospital a nursing home a school and get all of those hours grueling thing but it's worth doing is addressed to the question about it absolutely wonderful professor and then i know that you go into schools in the school environment and make assessments and destruction as well would you tell the audience a little bit about that that's a good transition after you go through the early identification of a child from birth to three then eventually they're going to start to go into the school so we are in the areas around here as crossroads between here and we go in and we provide free screenings in the daycare centers so we'll go in and see if at that point in time there's still an issue that might need addressed and then we send home notes to the parents it's a free service that we provide and if there is something that needs to be done therapy wise or some suggestions we talked to the parents about it and can provide that service could you give us an example of something that you might pick up one of the screenings if we have a child who is in a daycare center and one of the one of the things that's a very easy  problem to identify is teachers will say to us sometimes or child care workers will say to us this child i don't know he's just not responding or this child isn't behaving like the other children in my class and we allow for a lot of individual differences but when somebody who is around children all day picks up that there's a difference in the child a lot of times that warrants a more careful investigation as to what's going on there the kinds of things that we look for when we do screenings in preschools and nursery schools same as we do in school is in regular schools as we look at their first of all we do an oral meca exam it's called we just look to make sure that all of their structures are in place a lot of times because in the space is right affects how you speak all that makes a difference it does and so that's the first thing we do second thing we do a quick auditory screening to make sure that they're hearing what they need to be hearing  then we start checking to see if there sounds are developing that's an arctic exam so we look at sounds and we see we have an idea of what ages they should be developing for example you sounds that are easy to produce by just putting your lips together you can teach somebody how to do that very quickly those sounds develop early the r s the ss those ones usually develop later those are little more complex and hard to describe how you would  pronounce words that have those sounds in them after the arctic exam then we look at language we look at how a child receives language can they understand what you're saying to them and we look at how they produce language how  communicate with you so it's not the sounds but it's how did how did they communicate with you did they use words to use gestures can they put words together with length to of sentences they typically do so a child is three four years old a three and they're talking communicating mostly with gestures not a problem well it depends if if a child has hearing issue maybe maybe they might have a hearing if so they're using gestures to communicate not a problem yes yes yes that's what you do and early on there are studies that show that if you're another country and they don't have the same sounds that we do if you start to babble in that country you learn those sounds by as you said mimicking babbling you're getting reinforcement for it and then you take that out and you put them into our language a lot of our sounds they don't ever fully develop because during those critical years they've not had that exposure to that which is that one to three  but right right so it is it's interesting how important that is so if i had a speech impediment some type in talking to my child can i pass that on that way through that making process you know you're not the only person talking to your child and if they see that kids are smart they see that you're using something that is different from what everybody else around them is using and so as a result of that they usually self correct that yes you can if you continue to do the same thing over and over and over again and a lot of times that does they can pick it up it doesn't necessarily mean they're they're stuck with it but i'll tell you a funny story my father had a friend and he would always say is that's right verily and my sister beverly would make fun of him instead of saying is that's right that's right but he and we started making fun of him and before long we were saying is that's right and not realizing we were saying he had it we had to going through the next thing that we evaluate is fluency which is some people refer to the staggering we look at i was going to ask those fluency a lot of times you can run in a family we don't know if it's something that you're actually picking up if it's environmental when you've been listening to somebody your parents who do that or if it's something that is just you're predisposed to it not quite sure where that comes from but fluency is another thing that we look at  possibly in order logical problem could be could be there's a lot of different lot of different even emotional causes yes stress related there's a lot of that i know somebody that that had a stuttering problem and it was really actually then he could talk better yes so when you were talking with him you would you would see his hand on the table or the arm of the chair and then he could speak right there are all kinds of compensatory strategies that we teach that other than just let's look at the kinds of things that you can do without doing anything visual so that other people can say but that that was a therapy technique and it was at some point there was a thing that you could draw a line slowly and have your speech follow that and it was just a mechanism to get you to slow yourself down there was something that that was a interesting technique it looked like a hearing aid and it would go in your ear and it would give a beat just like which you were saying ok right like a metronome is another one that would go through and it would take your speech and if if you talked really fast and you had a recorder that was putting that back at you repeating  ok and there was a time delay you would probably become disciplined because you're hearing something that you're saying and there is still aid from on a cell phone that happens you can't speak and suddenly showed up interesting enough people who are disciplined that makes them fluent so so there was something that looked like a hearing aid that kind of gave you that auditory feedback and that was used for a period time kind of our theory you do what works but the one thing that you want to provide them with is something that is lifelong and you don't want something to be a gimmick so that it it works for a short time and then doesn't do it anymore do you work with with stroke victims yes yes  new speech patterns right right the adult population we work with a lot in nursing homes hospitals but also in our clinics they come to us after they've typically come out of a hospital program and they'll come in for therapy as a physician for required or they're able to make an appointment and come in we like to always get a physician referral on everybody and i'm going to say a lot of that has to do with insurance also insurance typically covers a lot of the things we just talked about but as those times get harder and harder we always make sure that we have a doctor's order with that pediatricians and g p s with whoever can write a script for that it's not an issue control out of the balance that you have as you get older sometimes that's disrupted people don't know why that happens sometimes it's by accident it's an accident sometimes it's by medication or creation a lot of times it's by medication  you can get it we didn't talk about that tinnitus or tonight is and that's that's and that's a big issue and i love you to talk about the big issue that people come in with now many many times and they say this is driving me crazy and what it is is it's a sound that is present in your ear that you can you only can hear so it is real people say like a ringing in the right you hear it's real so that you can hear it and it doesn't go away to them so they're thinking they're stuck with this for life sometimes it comes as a result of how they feel connected within a biologic safe connected it with a lot of different medications sometimes it's just as i said it's a sudden onset many times it goes away just as quickly as it came other times they  can treat it with some various medications sometimes it can be something simple like you have impacted some room and it works and that can be removed and that's common the build up of your works yes it is if you think of what that's for it's to make sure that all of the dirt basically stays out of your ear where it can do damage and so it collects on the outside but over time now there are elements to it right and some people are prone to have a ton of it and some people it's never an issue and i've noticed that even with my you say to do not use the over the counter drugs that you put in that supposed to loosen the blacks in your ears so that it comes out ok it's something that has been connected with some of the things we were just talking about that would be some medical issues and the other thing is that sometimes it doesn't work but mostly it's the medical issues that becomes connected with we removed all of that those products from our office go to any n t even go to your p c p and see if they can just take it out it's a much safer way you're not going to damage anything and some people do it every year and i was just about to say is that once a year type of thing you should do if you can or whenever you feel if somebody comes to us for a hearing aid we do distribute hearing aids at our office too if somebody comes to us for that the first thing we do is look in their ear and many times their ears so plugged up with wax it would be ridiculous to test a person like that so we refer them to the e m t or to their p c p to get it removed and then they can come back and then you have a good idea of what the person is here and that person has a good idea of what he or she can hear that you have a basic a sound proof booth we do actually you with them i think yes so i remember disease i think i was in my late teens and there's disease but i never had a problem with it right right and now hearing was never an issue right and neither was being busy for just a short time right right and this important to get your hearing checked we do free screenings at our office if you need your hearing checked and just went to a screening mcmurry office would do that for you when you stop and you know appointment call i would call first from time to time your website and your telephone number will be put up on screen for the audience to have that information q when you work with a stroke patient do you see results oh absolutely absolutely there's no question about it  there is a period of time after stroke typically that's about six months that there's a period of time that they call spontaneous recovery where you can get some things back that come on your own ok if you have that enhanced by receiving services that's even better show and afterwards you can still for as long as we've had people but i think two years sometimes sometimes even three years that continue to improve significantly not where it's just something that because you're training new parts of the brain that's right that's right and so that the more effort you put into the more time you put into it you're going to get a better result right absolutely absolutely it's so all that's worth it the other part of that that's really important that often gets ignored this with children and with adults is that when you have somebody with you they suffer from that same problem that you have they're not sure what to do how to approach you how to help you whatever so we have that person whether it's a a parent with children or whether it's with the adults a spouse or significant other come in and actually watch and see what we do it makes it a whole lot easier on them to have a list of tools that they can use to help the person that they love so to me that's also part of the therapy it's not just working with that particular child or adult it's also working with those people who surround them and  here and you're young and there's a chance you have a speech issue as well yes yes you can hear difference in the person's voice which is the next thing that we scream for going back and this is critical items we look at for us and voice is something also that we screen for to see if a person has a horse for us a kind of hollow voice we've all heard that something that sounds hyper nasal different kinds of things that might indicate that there's a problem that exists and credible you mention that use you have hearing gauge there yes would you tell us a little background of what yes hearing aids came to be because i said i can remember seeing the picture of the person holding the horn right we've come a long way yes we have when probably when i first started practicing we had things called body aids that i don't know if anybody's as old as me but they looked like transistor radio they used to be held right here on your chest by different i think kind of awkward to having it right here people dropped food on it was it was a mess ok it went from that to different kinds of hearing aids and probably the one that most of us remember are the ones that just go behind the year does that work on a bone conduction type thing where there was a mechanism behind the ear and then that speaker part was in the yes in the here so it's collecting the sound from the outside so behind the ear then it went in the air and then came the age of younger people who needed hearing aid  y and that's listening to all of the different devices they do that plugged right into their ear without any protective mechanism that allowed intensity level so i like your buds because they're they less damaging then most of it has to with the volume it's about the volume of it you really have to watch that you can't listen to it just because you like loud music if you turned it on in a room you're always moving around in your you're kind of away from it but it would be like sitting next to a speaker at a concert you know you walk away from that your head's there i've done that and you get a headache right here right so that's what you're doing to yourself and to do damage there and then people that are firing guns and not protect  protection and actually working conditions right jack hammers right exactly builders that are using air compression tools so younger people demanded that they're not going to although they might need hearing aids or some type of assisted device they're not going to wear those bulky things that identify them differently than anybody else around them so what they look for was the technology that we have now is incredible and we finally found a hearing aid manufacturers thought that that was serious tone so those are teeny tiny the next one is and in the air one you can hold on oh you can't is minuscule wow and these all get program i don't even know how to hold  about that that they run two thousand six thousand dollars some range in their hearing aid i'm sorry insurance companies offer a incredibly small benefit towards them a lot of times insurance companies will offer benefits it looks attractive but the hearing aid technology they're giving you is not this they're giving you three year three years and all we want to play which are computer want your phones why not have the latest on what we can write what we need to survive yes and you're wearing it every day and if you're thinking about these expense of absolute and their you know instrument for business and pleasure because they're really a toy and it also has shown that your cognitive development to your ability to interact with people to stay smart as you get older it really hires absolutely