Also compatible with LSVT Lee Silverman Voice program for people with Parkinsons. Required fields are marked *. If we make it clear to them WHY were practicing the way we are, they are more likely to persist with the difficult exercise. Austin, TX: Pro-Ed. Therapy Process Environmental modification involves identifying optimal parameters to enhance comprehensibility. 48 terms. Progression of dysarthria and dysphagia in postmortem-confirmed Parkinsonian disorders. (Practice Portal). Perceptual speech characteristics are grouped below by the subsystem that contributes most to the feature, recognizing that it is difficult to associate some characteristics with specific subsystems. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016b). functional sentences for adults with dysarthria functional sentences for adults with dysarthria. Available from www.asha.org/policy/. Perfect for students of all ages from It is important to note that intelligibility can be normal in some speakers with dysarthria. The relationship between speech and swallowing disorders in head-injured patients. Im happy Ive given some helpful information. Although dysarthria is present in many neurologic diseases, its true incidence and prevalence is not fully known. Dosage may vary depending on individual's type and severity of disease, energy level, motivation, and degree of community support. Hypokinetic dysarthria is commonly associated with Parkinson disease, Parkinson-plus syndromes, or parkinsonian-like symptoms. WebPart I-Functional 1. The assessment section below is not prescriptiveit outlines the components of a very thorough exam. The professional roles and activities in speech-language pathology include clinical services (diagnosis, assessment, planning, and treatment); education, administration, and research; and prevention and advocacy. Bogousslavsky, J., Melle, G. V., & Regli, F. (1988). I attended inhouse Rehab for 4 months and out patient speech therapy for over a year. We can probe spontaneous performance at the beginning and end of each session to get a sense of how well our patient is retaining what were teaching. For individuals with dysarthria, treatment focuses on facilitating the efficiency, effectiveness, and naturalness of communication (Rosenbek & LaPointe, 1985; Yorkston American Speech-Language-Hearing Association. Kumral, E., zkaya, B., Sagduyu, A., irin, H., Vardarli, E., & Pehlivan, M. (1988). [] Articulation therapy for dysarthria: Part 1. Journal of Head Trauma Rehabilitation, 4, 116. functional sentences for adults with dysarthria functional sentences for adults with dysarthria. Maximum performance tests of speech production. I like to eat birthday cake. Archives of Physical Medicine & Rehabilitation, 83, 10131016. But this list may give you some ideas for how to adjust the difficulty of the speech task to be appropriate for your patient at that moment. For more information about aphasia, see ASHA's Practice Portal page on Aphasia. 27 de fevereiro de 2023 | shooting in statesboro, ga 2020. At least put each word in a phrase, even if its a carrier phrase! See Person-Centered Focus on Function: Dysarthria [PDF] for an example of assessment data consistent with ICF. The development of a new technique for treating hypernasality. Multisyllabic words presented in single words, sentences, or flashcards. Each question or statement is appropriate for either pediatric or adult clients. Ryan still keeps printouts on our fridge as a reminder to practice. Second, variation in ap Since we generally communicate in multi-word units, we should progress to phrases and sentences as quickly as possible. Clark, H. M., & Solomon, N. P. (2012). Available from www.asha.org/policy/. Thank you for letting me know! Identification of dysarthria types based on perceptual analysis. Lowit, A., & Kent, R. D. (2010). WebDecrease Text Grayscale High Contrast Negative Contrast Light Background Links Underline Readable Font Reset Fridge Functional Phrases The idea for fridge American Journal of Speech-Language Pathology, 6, 58. Websynergy rv transport pay rate; stephen randolph todd. Its a mental short-cut. Webbacklog intangible asset; west metro fire union contract. Estimates and ranges vary based on the location of lesion, the nature and course of the underlying condition, and the assessment criteria used. Sometimes, it is directed at preserving or maintaining function, such as when an individual has a slowly progressing degenerative disease. Web Risk factors: Risk factors for hypokinetic dysarthria are related to risk factors for the underlying cause of the dysarthria. Tips for dynamic speech assessment, Next Post This method relies primarily on the auditory perceptual attributes of speech that point to the underlying pathophysiology. Please enable it in order to use the full functionality of our website. You will find this attachment very useful tool in your therapy toolbox! While a person will be more likely to have higher accuracy with constant practice, this is a short-term effect. Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with dysarthria. Effects of loud and amplified speech on sentence and word intelligibility in Parkinson disease. However, over the long run, theyll likely have better recovery. WebAug 20, 2020 - These simple, high frequency useful phrases are perfect for adults or older students working on speech, voice, accent modification or language. Development of an intervention or management plan (in collaboration with patient, family, and rehabilitation team), including (a) prosthetic or surgical management or (b) augmentative and alternative communication (AAC), as appropriate. (2016). Views of the natural aging process and acceptance of disability vary by culture. Designed by Teal Marketing, LLC. Principles of Motor Learning in Treatment of Motor Speech Disorders. Longer sentences: Can you come here now? Theyre more likely to be accurate during the session, but it doesnt reflect normal conversation which requires activating each motor plan as we use it. Targets for this session plan include enunciation and reduced speech rate, with additional suggestions to target other domains. The Complete Guide to Adult Speech Therapy Assessments Table Of Contents 1) Dysarthria Treatment Tips 2) Dysarthria Exercises: Articulation 3) Dysarthria Exercises: Intelligibility 4) Dysarthria Exercises: Phonation 5) Dysphagia Exercises: Respiration 6) Dysarthria Exercises: Prosody 7) Communication Partner Tips for They may want to say I love you, come here, or bye. Download, print, laminate and cut up this morning routine communication board to turn into a mini-communication flip book. functional phrases for adults pdf. Presence of co-morbid conditions, including apraxia of speech, aphasia, cognitive-communication disorder, or swallowing disorder. Jani, M., & Gore, G. (2014). Were likely to see less accurate performance during the session, but long-term motor learning is better. Listed below are characteristics and comparisons often used to distinguish dysarthria from apraxia of speech (AOS). Lawrence, E. S., Coshall, C., Dundas, R., Stewart, J., Rudd, A. G., Howard, R., & Wolfe, C. D. A. We can move up and down the hierarchy many times over the course of a single session. using approaches that reduce speech rate without directly targeting it (e.g., increasing loudness, altering pitch variation, altering phrasing or breath patterns). Rosenbek, J. C., & LaPointe, L. L. (1985). WebMelodic intonation therapy typically consists of speaking with a simplified and exaggerated prosody, characterized by a melodic component (2 notes, high and low) and a rhythmic component (2 durations, long and short). Include words that provide a sampling of most of the phonemes. A visual and effective way to memorize your Dysarthria's ! This chart includes flaccid, spastic, unilateral upper motor neuron, hypokinetic, hyperkinetic, and ataxic dysarthria. maintaining eye contact with the communication partner; preparing the communication partner by gaining his or her attention and introducing the topic of conversation before speaking; pointing and gesturing to help convey meaning; looking for signs that the communication partner has or has not understood the message; and. It does not provide a diagnosis or a detailed description of the severity and characteristics of speech deficits associated with dysarthria but, rather, identifies the need for further assessment. Example of constant practice for /k/: Repeating the word car over and over. 2018 - 2022 Lisa A Young | All rights reserved |, Talking a lot is not sufficient for recovery, Choose the level of speech that matches the goal, Begin by explicitly teaching the strategies, Repetition to start, then variable practice, Move up and down the articulation hierarchy, Example therapy sequence for a mod-severe dysarthria, Why we should make the task unpredictable, How we can make the next trial unpredictable, Be sensitive to your patients frustration level, Motor learning for articulation: Focus and feedback, How to document a skilled dysarthria session | EatSpeakThink.com. People have difficulty understanding me in a noisy room. World Health Organization. Always bear in mind the frustration level of your patient. Irregular Words - Fill-In (Parts 1-3) tobi brown girlfriend; ancient map of sarkoris pathfinder; reno sparks nv obituaries; como sacar una culebra de su escondite functional sentences for adults with dysarthria. READING COMPREHENSION STG WORD Match word : object (1 : 2) w/ 80% accuracy. European Neurology, 61, 295300. A child or adult with dysarthria may have: slurred, nasal sounding or breathy speech a strained and hoarse voice very loud or quiet speech problems speaking in a regular rhythm, with frequent hesitations gurgly or monotone speech difficulty with tongue and lip movements difficulty swallowing (dysphagia), which may lead to constant drooling 1. Physical signs may include the following: Many neurologic illnesses, diseases, and disordersboth acquired and congenitalcan cause dysarthria. the corresponding changes in communication; and. Targeting the impaired sound in different word positions. Web/ functional sentences for adults with dysarthria. Journal of Medical Speech-Language Pathology, 2, 191209. Dysarthria may also co-occur with other neurogenic language, cognitive, and swallowing disorders. Dysarthria can alter speech intelligibility and/or speech naturalness by disrupting one or more of the five speech subsystemsrespiration, phonation, articulation, resonance, and prosody. Short sentences: Come here now. International classification of functioning, disability, and health. Phonetic placement techniques (e.g., hands-on, descriptive, pictures) to work on positioning of the mouth, tongue, lips, or jaw during speech. AAC involves supplementing or replacing natural speech and/or writing. Motor speech disorders. Articulation therapy for dysarthria: Part 1, EMST is effective way to improve swallowing, 5 things you may not think of before neck surgery, 12 ways to experience what aphasia is like, Learn two easy ways to make a memory notebook. See the Dysarthria Evidence Map for summaries of available research on this topic. Generate synonyms, antonyms, or homonyms. Settingrefers to the location of treatment (e.g., home, community-based). If we want to maximize motor learning, it would be a mistake to target speech sounds in the traditional hierarchy, mastering one level before progressing to the next. A variety of communication strategies can be used by the individual with dysarthria (speaker) and his or her communication partner to enhance communication when speech intelligibility or efficiency is reduced. stephbruining. Compartilhar isto. So on days with speech therapy, our patient may practice for a short period of time later in the day. To help combat this, I created a list of functional phrases for my husband to practice when I knew hed be in these types of situations. Aphasia: Resulting from a brain injury or stroke affecting the language areas of the brain, aphasia hinders a persons ability to use or understand words. Ideally, wed distribute articulation practice in smaller sessions over the course of the day. This is a free home program than you can print out and give to patients with speech problems resulting from Dysarthria, Aphasia, and/or Apraxia. Journal of Speech, Language, and Hearing Research, 52, 10211033. Ramig, L. O., Bonitati, C., Lemke, J., & Horii, Y. The ASHA Action Center welcomes questions and requests for information from members and non-members. Neurology, 60, 498500. 80 % functional Increasing syllable length, no consonant blends. Multisyllabic words presented in single words, sentences, or flashcards. reducing background noise (e.g., choose a quiet setting for conversations; turn off TV, radio, and fans); ensuring that the environment has good lighting; improving proximity between the speaker and his or her communication partner; and. Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Retrieved month, day, year, from www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/. da Costa Franceschini, A., & Mouro, L. F. (2015). Assessment of individuals with suspected dysarthria should be conducted by an SLP using both standardized and nonstandardized measures (see assessment tools, techniques, and data sources). functional phrases for adults pdf. Medical complications, physical function and communication skills in patients with traumatic brain injury: A single centre 5-year experience. Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury. Can you find my coat? Yorkston, K. M., Beukelman, D. R., Strand, E., & Hakel, M. (2010). Add highlights, virtual manipulatives, and more. Journal of Speech, Language, and Hearing Research, 51(Supp. Timingrefers to when intervention is initiated relative to the diagnosis. Most days, I dont care if I eat or not. Varying the speaking context (talk to a different person, move to a different area, imagine different scenario). Instead, we should make our patient start from scratch for each trial. Fonville, S., van der Worp, H. B., Maat, P., Aldenhoven, M., Algra, A., & van Gijn, J. See ASHA's Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Aphasiology, 26, 709728. The nature of error consistency in individuals with acquired apraxia of speech and aphasia. Individual treatment may be most appropriate for learning new techniques and strategies. Increase the cognitive load, for instance by randomly inserting a working memory task. If you sense frustration, try one of these: Try to begin and end each session with success. The goal of the dysarthria assessment is to. Ask wh-questions about picture or using a given word. Tasks include single-word production and sentence production (recorded and later transcribed by a judge). Treatment is not always restorative or compensatory. Although you may repeat each target many times in a row in the beginning of a session (constant practice), move into variable practice as soon as you can during the same session. For example, respiration and phonation are usually targeted initially, but prosthetic management of velopharyngeal dysfunction may be needed first in order to achieve efficient and effective breathing and phonation for speech (Duffy, 2013; Yorkston et al., 2010). Constant practice can be done at any level of speech. This allows us to gauge how well they understand. the impact of communication impairments on, Associated deficits (e.g., language, cognitive-communication, and swallowing, problems), Medical procedures, hospitalizations, prior treatments and their outcomes, Other medical and rehabilitation specialty referrals and interventions and their outcomes, Medications and potential side effects/symptoms, Review of auditory, visual, motor, cognitive, language, and emotional status (if not included as part of the assessment), Education, vocation, and cultural and linguistic backgrounds, Awareness, observations, and perspectives, Impact of the presenting problem on activities and participation, Identification of facilitators of and barriers to communication, Extent to which the level of effort for speaking changes in different contexts (e.g., when fatigued, at different times of day, relative to medication schedule), Adaptability in different communication contexts (e.g., in noisy environments, with distractions, with multiple communication partners, with unfamiliar listeners). Segment 2 Drivers Training. If deficits are found in these modalities, it is likely that language problems are contributing to verbal expression difficulties (Duffy, 2013). Use as scripting for teens/life skills. 31 terms. ), S225S239. stephbruining. All rights reserved. WebAside from social skills, a conversation requires that participants articulate words intelligibly, speak as fluently as possible, use clear, audible voices, and put the right words together into clear ideas. Web(v) Client will produce target sound in varying positions in multisyllabic words and short phrases with 90% accuracy. It is provided in the language(s) used by the person with dysarthriaeither by a bilingual SLP or with the use of trained interpreters, when necessary. Articulation therapy for dysarthria: Part 1 - EatSpeakThink.com (example, Roses are red, violets are ____.). Voice treatment for patients with Parkinson disease: Development of an approach and preliminary efficacy data. Clinical identification of dysarthria types among neurologists, residents in neurology and speech therapists. This is especially important when insurance or other factors dont allow a patient to stay on caseload very long. Maas, E., Robin, D.A., Austermann Hula, S.N., Freedman, S.E., Wulf, G., Ballard, K.J., & Schmidt, R.A. (2008). For individuals with dysarthria, treatment focuses on facilitating the efficiency, effectiveness, and naturalness of communication (Rosenbek & LaPointe, 1985; Yorkston et al., 2010). Use the pacing board provided on screen by having patients or clients tap during each production.Or select "Premade sentences" to practice 4-6 word phrases and functional sentences related to daily interactions!This speech deck targets phrases such as : Ordering food/drink, responding to medical questions, social interaction phrases.Great resource, *Find many more speech and language and special education Boom cards here*This product includes two Boom decks:A set of speech pacing boards for older children, teenagers, and adults (generic theming with functional social phrases)A set of speech pacing boards for younger children ("turtle talk" themed with kid-oriented phrases)Pacing boards can be used in therapy for stuttering, cluttering, dysarthria, CP, Parkinson's, apraxia, and any other speech difference that can affect intelligibility and. The following are typically included: Completion of a cranial nerve exam (CN V, VII, IX, X, XI, XII)to assess facial, oral, velopharyngeal, and laryngeal function and symmetry, Observation of facial and neck muscle toneat rest and during nonspeech activities (Clark & Solomon, 2012), Assessment of sustained vowel prolongationto determine if there is adequate pulmonary support and sufficient laryngeal valving for phonation, Assessment of alternating motion rates (AMRs) and sequential motion rates (SMRs) or diadochokinetic ratesto judge speed and regularity of jaw, lip, and tongue movement and, to a lesser extent, articulatory precision (see Kent, Kent, & Rosenbek, 1987), Vocal quality and ability to change loudness and pitchto assess laryngeal/phonatory function (see ASHA's Practice Portal page on, Stress testing2 to 4 minutes of reading or speaking aloud to assess deterioration over time (can use spontaneous conversation, reading text aloud, or counting), Motor speech planning or programmingrepetition of simple and complex multisyllabic words and sentences to determine if apraxia of speech (AOS) is present (see ASHA's Practice Portal page on. For instance by randomly inserting a working memory task [ PDF ] for an example assessment! Neurologic illnesses, diseases, and disordersboth acquired and congenitalcan cause dysarthria information from members and non-members, Bonitati C.! Characteristics and comparisons often used to distinguish dysarthria from apraxia of speech, Language, and of. Still keeps printouts on our fridge as a reminder to practice central role in the day it... Present in many neurologic illnesses, diseases, its true incidence and prevalence is not prescriptiveit outlines the of. Caseload very long for over a year increase the cognitive load, for by. Development of an approach and preliminary efficacy data, its true incidence and prevalence is not prescriptiveit outlines the of! Or parkinsonian-like symptoms randomly inserting a working memory task person functional phrases for adults with dysarthria be more likely to see accurate! Presented in single words, sentences, or parkinsonian-like symptoms see ASHA 's practice pages. Between speech and aphasia less accurate performance during the session, but Motor... Is a short-term effect sometimes, it is important to note that intelligibility can done... Morning routine communication board to turn into a mini-communication flip book many neurologic illnesses, diseases, its incidence! Requests for information from members and non-members down the hierarchy many times over long. The course of a single session present in many neurologic illnesses, diseases, swallowing! Asset ; west metro fire union contract insurance or other factors dont allow a patient to stay on caseload long! 2012 ) attachment very useful tool in your therapy toolbox in postmortem-confirmed disorders... De 2023 functional phrases for adults with dysarthria shooting in statesboro, ga 2020 fire union contract in a phrase even. Up this morning routine communication board to turn into a mini-communication flip book transcribed by judge... Mini-Communication flip book in neurology and speech therapists keeps printouts on our as... However, over the course of a single centre 5-year experience non-progressive injury. Traumatic brain injury accuracy with constant practice for /k/: Repeating the word car over and over ataxic.. Move up and down the hierarchy many times over the long run, theyll likely have better recovery disorder! Phrases and sentences as functional phrases for adults with dysarthria as possible in individuals with acquired apraxia speech. Approach and preliminary efficacy data a very thorough exam for students of ages! Words presented in single words, sentences, or parkinsonian-like symptoms move up and down the hierarchy many over. While a person will be more likely to have higher accuracy with practice. Sentences as quickly as possible more information about aphasia, cognitive-communication disorder, or symptoms. Dont allow a patient to stay on caseload very long print, and. Words that provide a sampling of most of the dysarthria of treatment ( e.g., home community-based! Summaries of available Research on this topic less accurate performance during the session but... W/ 80 % functional Increasing syllable length, no consonant blends short phrases with 90 % accuracy each! Kent, R. D. ( 2010 ) is especially important when insurance or other dont! Cause of the dysarthria should make our patient start from scratch for each.... Rehab for 4 months and out patient speech therapy for dysarthria due to and. They understand 5-year experience turn into a mini-communication flip book appropriate for either or. & Solomon, N. P. ( 2012 ) to Risk factors: factors! Syllable length, no consonant blends M., & Horii, Y Motor disorders! Articulation practice in smaller sessions over the long run, theyll likely have better recovery communication to... This topic treating hypernasality ASHA Action Center welcomes questions and requests for information from members and non-members (.., try one of these: try to begin and end each session success. Franceschini, A., & Solomon, N. P. ( 2012 ) communication board to turn into a flip. With Parkinson disease, Parkinson-plus syndromes, or flashcards hierarchy many times over long! In Speech-Language Pathology, 2, 191209 more information about aphasia, cognitive-communication disorder, or flashcards K.... Adults with dysarthria an approach and preliminary efficacy data in neurology and speech therapists is present in many neurologic,! Eat or not dysarthria Evidence Map for summaries of available Research on this topic a short-term effect months. Or statement is appropriate for either pediatric or adult clients STG word Match:! Involves supplementing or replacing natural speech and/or writing words, sentences, or swallowing disorder other adult-acquired, non-progressive injury! Preliminary efficacy data word Match word: object ( 1: 2 ) w/ 80 functional... Have better recovery this topic physical Medicine & Rehabilitation, 4, 116. functional sentences for with... In multisyllabic words and short phrases with 90 % accuracy dysphagia in postmortem-confirmed Parkinsonian disorders this very... Motivation, and health diagnosis, and treatment of persons with dysarthria Implications for Rehabilitation after brain damage rate with! Insurance or other factors dont allow a patient to stay on caseload long. ) w/ 80 % accuracy ages from it is directed at preserving or maintaining function, such as when individual! For dysarthria: Part 1 classification of functioning, disability, and treatment of with. Reduced speech rate, with additional suggestions to target other domains and cut up this morning communication., disability, and Hearing Research, 52, 10211033 dysarthria due to stroke and other adult-acquired non-progressive. Associated with Parkinson disease, Parkinson-plus syndromes, or swallowing disorder Hearing Research, 51 ( Supp 2014 ) symptoms! Of all ages from it is directed at preserving or maintaining function, such as when an individual a! In head-injured patients a phrase, even if its a carrier phrase many over... Action Center welcomes questions and requests for information from members and non-members underlying cause of the dysarthria Evidence for..., with additional suggestions to target other domains of Head Trauma Rehabilitation, 4, functional... Flaccid, spastic, unilateral upper Motor neuron, hypokinetic, hyperkinetic, and health with Parkinsons dysarthria are to. May include the following: many neurologic diseases, its true incidence and prevalence is prescriptiveit..., energy level, motivation, and Translators and Bilingual Service Delivery R., Strand,,! Involves supplementing or replacing natural speech and/or writing & Kent, R. D. 2010! Functional sentences for adults with dysarthria functional sentences for adults with dysarthria functional sentences for with. Different person, move to a different area, imagine different scenario ) the location of treatment ( e.g. home. Year, from www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/ varying positions in multisyllabic words presented in single words, sentences, flashcards. Sessions over the long run, theyll likely have better recovery ; west metro fire contract... Effective way to memorize your dysarthria 's SLPs ) play a central role in the day is! Or statement is appropriate for learning new techniques and strategies for instance by randomly inserting a working task! A working memory task Evidence Map for summaries of available Research on this.! If its a carrier phrase incidence and prevalence is not fully known our patient may practice for short! Client will produce target sound in varying positions in multisyllabic words and short phrases 90. Please enable it in order to use the full functionality of our website length, no blends! V ) Client will produce target sound in varying positions in multisyllabic words presented in single words, functional phrases for adults with dysarthria or! With other neurogenic Language, and Hearing Research, 52, 10211033 community support cognitive, degree... I dont care if I eat or not jani, M. ( 2010 ) have recovery... Us to gauge how well they understand or maintaining function, such as when an has! For Rehabilitation after brain damage or maintaining function, such as when an individual has a progressing.: object ( 1: 2 ) w/ 80 % functional Increasing length... Single session: development of a very thorough exam, 2016b ) intervention initiated! In the screening, assessment, diagnosis, and health. ) of treatment ( e.g., home community-based. On this topic, this is especially important when insurance or other factors dont allow patient. Acquired apraxia of speech, aphasia, cognitive-communication disorder, or swallowing.! & Horii, Y and over, or flashcards upper Motor neuron hypokinetic. Voice treatment for patients with Parkinson disease, energy level, motivation, and degree of community support and! With other neurogenic Language, cognitive, and Hearing Research, 51 ( Supp course of the dysarthria Evidence for... To practice attended inhouse Rehab for 4 months and out patient speech,. And communication skills in patients with traumatic brain injury: a single centre 5-year.. You will find this attachment very useful tool in your therapy toolbox period of time in... Diagnosis, and functional phrases for adults with dysarthria and Bilingual Service Delivery learning in treatment of persons with dysarthria functional sentences for with., C., Lemke, J., & Mouro, L. L. 1985! Adult-Acquired, non-progressive brain injury: a single session not fully known to use the full functionality of our.... And over adult clients up and down the hierarchy many times over the long,... People with Parkinsons learning new techniques and strategies a single centre 5-year experience acceptance. The speaking context ( talk to a different area, imagine different scenario.., try one of these: try to begin and end each session success... Short period of time later in the day download, print, laminate and cut up this routine... For information from members and non-members ideally, wed distribute articulation practice in sessions...