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© 2002 - 2004,
Cheri L. Florance, Ph.D.,
Brain Engineering Labs,
All rights reserved
Cheri L. Florance, Ph.D.
Career History
Dr. Florance has organized the following information for parents, adult patients, and referring professionals. Your understanding of this material is important in determining good patient selection.Medical Speech Pathology and The Brain
Dr. Florance is a speech-language pathologist specializing in the treatment of neurological aspects of communication to improve attention, listening, speaking, reading, writing, and memory. Highly trained in the rigors of research, she has pioneered innovative treatment methods for over 30 years. Dr. Florance began her private practice in 1975. To achieve a successful outcome, patient-therapist selection is important. The following background has been compiled for you to study to help you decide therapeutic fit. You can then begin to decide if she is the appropriate companion for you as you embark on this journey of self-change and discovery.Early Training in Verbal Processing
From a family of professional musicians, Dr. Florance began her performing career at age 3. As her grandfather was a writer, researcher, inventor, and educator, she observed his creative study of auditory learning. From the 7th grade through high school, she taught dance lessons after school. She soon noticed that some children had difficulty following directions, sequencing steps, processing information, and staying on task. Before long, Dr. Florance was teaching blind children to tap dance. From this experience, she began to read and study the life of Helen Keller. She then noted how children decode to self instruct a motor response."In elementary school, 75% of classroom instruction is auditory. By high school, instruction is 95% auditory. Auditory processing is the brain's organizational system."
Ohio Department of Education Task Force on Language, 1992.
Verbal Versus Mechanical Intelligence
Dr. Florance's father studied aeronautical engineering and became a corporate commercial pilot. She helped him work on airplanes and completed a solo flight on her 16th birthday. The mechanical intelligence of science, mathematics, and engineering is the basis of scientific research. The integration of verbal and mechanical intelligence is the basis for learning. If verbal and mechanical processors do not work together in harmony, frustration and lack of behavioral self control result. According to Dennis Cantwell, M.D., Child Psychiatrist, 67% of attention and behavior-conduct disorders in children are caused by a language disorder.Training The Brain to Use Language
An Honor student, Dr. Florance completed undergraduate majors in French and Communication. During her junior year, she lived in Paris and in the French Honors House where no English was spoken."Learning a second language offers insight about the language-impaired. Most of us are intuitive language users. We do not actually learn to listen, speak, read, or write. These are specific pre-programmed functions. The brain's computer for language malfunctions in 20% of children and adults." Learning Disabilities Association, 1992.
Using The Arts as Language Stimuli
Dr. Florance was awarded a U.S. Rehabilitation Services Commission Scholarship as part of this grant, she was required to spend 20 hours per week working with adults who had vocational threats due to communication problems such as laryngectomy, stuttering, foreign accent intelligibility problems and auditory processing and language disorders. She completed an accelerated curriculum finishing a two-year master's program before her 22nd birthday. In 1969, working with the Delaware County Schools and The Ohio State University [OSU], she wrote original plays, music and lyrics to train the language skills needed for good first grade entry."Children with untreated language disorders have a 95% chance of having reading, writing, and spelling problems by age 9. Early language treatment is needed to change these odds." Donald Tower, M.D., The National Institutes of Health.
Application of Learning and Counseling in Treatment
In 1970, Dr. Florance was awarded a pre-doctoral research fellowship from the U.S. Department Of Education. As research assistant to Dr. John V. Irwin, an expert in experimental psychology, she implemented his protocols in school districts located in Mississippi, Tennessee, and Arkansas. Dr. Florance was responsible for supervising 10 graduate student trainees as they implemented the use of teaching machines and video training to correct communication disorders. To better understand the controversy about the clinical use of operant conditioning, Dr Irwin assigned Dr. Florance to learn to use psycholinguistic tests to evaluate auditory and visual processing skills under the supervision of Donald Ramp, Ph.D. and to use the Myers-Briggs and Rogerian counseling methods under Ms. Louise Ward."Changing the way the brain works to use language is very complex. The design of therapy takes careful planning by experts. Each elements of the therapy must be organized with attention to the emotional and behavioral response of the patient." George Shames, Ph.D. Clinical, Psychologist 1980.
The Impact of Training in Psychology on Communication
In 1972, at age 24, Dr. Florance was awarded a Doctoral Scholarship to serve as Director of the OSU Speech and Hearing Clinic. She was responsible for all faculty or student service delivery for the next three years. She developed and supervised student-training programs throughout the city and the Central Ohio area for all master's and doctoral level students. Professors from both the Departments of Speech-Hearing Science and Psychology supervised Dr. Florance's doctoral degree. Although she completed academic requirements for licensure in both areas, she chose to limit her practice to the treatment of communication disorders."Communication disorder affects self esteem. We learn to see ourselves as winners as we interact verbally with others and are reinforced." Frank E. New, Ohio Department of Education The ODE Language Handbook, 1991.
The Impact of Communication on Medical Care
In a three-year training program at Riverside and University Hospitals, she learned the Mayo Clinic Procedures for attention, memory and processing under the supervision of Jon L. Deal, Ph.D. Dr. Deal and Dr. Florance wrote many research articles that were published in Clinical Aphasiology, Journal of Speech and Hearing Research, and The Ohio Journal of Speech Pathology."Neurological language impairments such as attention, memory, or processing disorders are caused by congenital malformation of the language centers in the brain. Although educational problems can result, the cause of the problem is not an educational or learning disorder." The Neurological Basis of Language Disorder / NIH Monograph.
Knowledge About Normal Communication
From 1972-1975, Dr. Florance created research projects that became her doctoral dissertation in Psycholinguistics which was partially supported by a research grant awarded to her by The Ohio Department of Maternal and Child Health. Because she was enrolled in a dual degree program, professors from both the Departments of Psychology and Speech Pathology supervised and evaluated her work. She analyzed the verbal behaviors of preschool children in response to teacher instructions. She was also given a 3-year clinical mentoring grant to supervise five graduate students in rural Ohio providing speech and language rehabilitation to poor elementary school children. She used her work with normally developing preschoolers to help her design the programs for the delayed patients. Later, she replicated her studies with older children and college students. Decoding language in the classroom is the key to academic success."The neurological weakness for auditory processing begins before birth. By age 4, 60% of language-impaired children present symptoms of Psychiatric Disease. Early language therapy can prevent the onset of these devastating symptoms." Dennis Cantwell, M.D., UCLA.
The Florance Therapy Paradigm
From 1975-1978, working for the U.S. Rehabilitation Services Commission, Dr. Florance pioneered "The Florance Therapy Paradigm." The therapy phases combined learning theory with client-centered counseling.- Training the Target Behavior
- Training in Self Responsibility and Self Management
- Training in Transfer to Unconditioned Environments
- Generalization of Training
- Maintenance of Behavior
- Follow-Up of Permanence and Durability of Change
Medically Based Research
The Communication Disorders Institute
Dr. Florance established The Communication Disorders Institute [CDI] at St. Anthony Medical Center [SAMC] as a private practice in 1975. Over the next 12 years, the practice increased to a staff of 25 including occupational, physical, and speech therapists, social workers, psychologists, audiologists and creative arts therapists. Housed in a renovated parochial school on the SAMC campus, CDI offered inpatient and outpatient care. Programs were provided to Headstart, Catholic schools, The Ohio Penitentiary, geriatric facilities, neighborhood community centers, and the Order of The Franciscan Sisters of The Poor. Patients traveled from every U.S. state and many foreign countries to receive diagnostic or treatment services."Juvenile delinquents have an 80% chance of having a language disorder. Poor processing can lead to unintentional lying, frustration, humiliation, and embarrassment. The anger that results can lead to drug and alcohol problems or difficulty with compliance with rules at home or at school." University of Western Ontario, Canada Journal of Language Speech and Hearing in Schools, July 1992.
The National Institutes of Health
In 1978, Dr. Florance earned a five-year Teacher Investigator Award from the National Institutes of Health. Supervised by the internationally recognized clinical psychologist, Dr. George H. Shames, Dr. Florance was rigorously trained in the methods of psychotherapy and psychometric intelligence testing. This five-year training program offered her a unique and exciting educational experience. Dr. Shames and Dr. Florance published many articles, book chapters, and teaching materials. Their book, Stutter Free Speech, has been considered a classic work on the therapeutic relationship and operant conditioning."Our knowledge of the brain and language has dramatically improved in the last 10 years. As we are able to better pinpoint the specific cause of the disorder, then we can design tightly organized and effective treatment." Dennis Cantwell, MD, 1992.
The Impact of Coping and Compliance on Communication
In her NIH work, Dr. Florance evaluated psychometric and observational test protocols. She studied the role of brain science in communication, intelligence, personality, and copying/defense mechanicals. Working with Dr. Shames, she developed The Coping and Compliance Assessment [CCA] for predicting prognosis. She gave the CCA to hundreds of stutterers and surgical patients for planning treatment. She presented nationally with William Pace, M.D., former Dean, OSU Medical School and Larry Carry, M.D., former Chair, OSU Department of Surgery."Language impaired patients have difficulty predicting the consequences of their actions. Impulsive behavior results. Language therapy helps to strengthen the sequential thinking needed to weigh alternatives and handle thought options. Coping and compliance improve as language improves." The Neurology, Language-Learning Institute, Salt Lake City.
Brain Function and Intelligence
Dr. Florance was asked to design research with William Evans, M.D., Vascular Surgeon; to investigate the effects of altered carotid and cerebral blood flow on cognition, attention, processing, and memory. Endarterectomy patients were measured with I.Q., voice, and language tests. Questionnaires were given to patients and families. These studies noted changes in thinking or communicating after blood flow to the brain was altered and increased. Dr. Evans and Dr. Florance published these results in Surgery and Clinical Aphasiology.The human language system is essential to every daily act. The demands on our brain's language computer change from year to year. The books we read in second grade are very different from those in sixth grade. Everyone should have an annual language physical. Language impairments that are not treated get worse and can be life damaging." Dennis Cantwell, 1991.
Geriatric Communication and Cognition Laboratory
In 1983, Dr. Florance working with William Conway, M.D., designed the tests and laboratories for The Center for Independent Living [CIL]. The CIL was the geriatric rehabilitation unit at SAMC. The patients were tested in simulation labs including a Huntington Bank, Big Bear grocery store, NASA driver's module, Wasserstrom Kitchen and Mini-Apartment. Working with Columbus businesses and interdisciplinary professionals, she developed a comprehensive assessment process. Neurological patients were tested for levels of independent functioning. Changes in medication and rehabilitation were made on the basis of the results. Many patients destined for nursing homes returned home. Dr. Florance wrote articles, book chapters and presented at national meetings regarding this work."In the 1990s, treatment to improve post-stroke language is routine in most hospitals. For children, the neurological aspects of the language disorder require treatment that addresses the etiology of the disorder. Therapy in conjunction with school-based services, for example, offers a good marriage of treating both the neurological causes and the educational symptoms." Ron Goldman, Ph.D., 1993.
Build Your Brainpower Laboratories
In 1985, Dr. Florance worked with Jack Tetirick, M.D., Harvard-trained Surgeon and Director of Medical Education, Grant Hospital. They implemented pilot projects as a foundation for a brainpower lab for executives. Dr. Florance developed her Brain Friendly Communication Systems for business executives to improve oral delivery, power writing, speed of reading, and quick recall and fluid memory."Language disorders have been under-treated in the past. Language impairments affect 15-20% of the adult population. Problems identified at age 4 were still present at age 34." Journal of Speech Language and Hearing Research, 1992.
University Professor and Clinical Rotations
Dr. Florance was first hired as a University Professor and Clinical Researcher in 1970 and continues to teach at the University level for the OSU Medical School as an adjunct professor in Psychiatry. From 1983 until 1989, under the sponsorship of SAMC, she created a postgraduate residency for interdisciplinary training. Residents enrolled with backgrounds in speech-language pathology, occupational and physical therapy, nursing, and social work. Medical students and residents also participated in training experiences with children, adults and executives. Today, Dr. Florance provides teaching rotations for OSU medical students and graduate-level experiences for educators, psychotherapists and speech-language pathologists. She maintains an open door for visits from professionals and is a frequent workshop speaker. Transdisciplinary treatment requires the merging of many disciplines to address intervention design. Dr. Florance enjoys interacting with a variety of viewpoints in order to continually broaden her knowledge base."What does education often do? It makes a straight-cut ditch of a free meandering brook. The significant problems we face cannot be solved at the same level of thinking we were at when we created them." Albert Einstein.
Hallmarks of Dr. Florance's Research
Dr. Florance completed federally funded research projects for 14 consecutive years. She evaluated elements of the treatment design of her therapy. Issues studied include baseline prediction of prognosis, impact of schedule, relapse, and the role of significant others. Each year, national experts evaluated her work. Her choice of test instruments, treatment plan designs and outcome goals were rigorously evaluated. Dr. Florance's research history is one of the unique elements of her practice. Although the process of self-change is complex, the analytic database that accompanies her work offers a quantitative guide for decision-making. All of her research has been devoted to the understanding how to alter brain functions for multidimensional communication."Never doubt that a small group of thoughtful committed citizens can change the world; Indeed it is the only thing that has." Margaret Mead.
Honors
Dr. Florance was one of the youngest to be named Fellow by The American Speech, Language and Hearing Association, an award given to less than 1% of its members and the Distinguished Service to Mankind Award from Muskingum College. She has been invited to present workshops more than 200 times at hospitals, universities, and national meetings. She has set up programs in school districts throughout the U.S. She was selected by the Department of Health, Education and Welfare to serve as a U.S. Representative to Pakistan. She has served on national panels and committees, and was an editor of The Journal of Speech and Hearing Research. Her office has been selected many times by test developers and corporations as a field site for new tests and equipment. In the late 70's, she designed computers that could speak and biofeedback devices to boost auditory processing for corporations in the Silicon Valley. These corporations hired her to create multimedia presentations and keynote addresses in the high tech corporate world.USA Today, The Today Show, Oprah Winfrey, Hour Magazine, P.M. Magazine, CBS News, and numerous newspapers and magazines have interviewed Dr. Florance. The Mayor of Columbus, the Governor of Ohio and The White House have honored her.
"Try not to become a man of success but rather a man of value." Albert Einstein.
The Dublin Transdisciplinary Practice
In 1990, Dr. Florance moved her private practice to Dublin after SAMC closed to open The Language Gym containing 14 simulation labs utilizing advances in computer-video technology with special audio equipment. Since the arts continue to be a significant component, the Language Gym included an Art Lab and Therapy Stations, Computer Arcade, Reader's Theater, Writer's Workshop, Executive Excel Lab, Mental Workout Room, Parent Observation and Simulation Classrooms."Thought is the blossom, language is the bud, and action is the fruit behind it." Ralph Waldo Emerson.
For the next 10 years, services were provided in The Language Gym, Dr. Florance for patients ranging in age from two years old to geriatric adults. She served as the consultant for state agencies including The Bureau of Disability Determination and The Bureau of Vocational Rehabilitation. Once a week, she held language-learning rounds in which area physicians, psychologists, and other professionals discuss cases with her. The Medical Park, co-owned by Mt. Carmel Hospital, contained five pediatricians, four dentists, occupational and physical therapy and the Mt. Carmel Hospital Nutritional Center.
"All that you are is the result of all that you have thought." Buddha.
Communication and Intimate Long Term Bonding
Dr. Florance is the mother of three children: Vanessa, age 18, William, age 17, and Whitney, age 16. Whitney was diagnosed with severe autism, deafness and given an I.Q. of 46. This brain disorder disintegrated his sensory system to the point that Dr. Florance could shout in his ear and yet he could hear nothing. His arm was pinned in the door of a truck and he felt nothing. He had uncoordinated fine and gross motor systems. He has no memory of his life before age 7 years."My grace is perfect for you. For power is made in perfect weakness." Jesus.
Dr. Florance believed in her son. She saw the visual genius in his every day behavior that she had long-observed in less pronounced ways as a therapist. In Whitney's case, it became apparent that his visual mechanical intelligence was rapidly developing at levels far above his peers. Alone, she faced the dilemma of how to help Whitney achieve as a member of society. He "taught" her how to use his visual processors to create a brain architecture for language. Now an excellent thinker, he is succeeding in a very difficult college preparatory catholic high school. His language abilities in listening, speaking, reading and writing test well above his age level on the national tests given at school. He is an excellent athlete participating on the division II state championship football team, earning medals in track, lettering in wrestling. Dr. Florance credits Whitney with teaching her more than any of her prior experience or schooling.
"We make a living by what we get, but we make a life by what we give." Winston Churchill, severe stutterer.
Although Dr. Florance is very passionate about treating her patients, being a Mom brings her an even greater joy. She has always organized her practice to support the medical/educational needs of her children. She has always "employed" her children as test subjects for all of her experiments so that they can share her daily experiences first hand. Will and Vanessa worked daily helping Dr. Florance train Whitney to process language, to hear and to develop motor control. Dr. Florance, Will and Vanessa entered into Whitney's world of autism to bring him back to a language-based world.
"It takes a long time to become young." Pablo Picasso.
Communication Disorder and Psychiatric Disease
Autism is considered a psychiatric disorder by The National Institutes of Health. Therefore, at this juncture in her career, Dr. Florance created what NIH would call a "Senior Fellowship In Psychiatry". Her research training involved extensive mentoring from world-class scientists and also required that she mentor graduate student trainees. For the next five years, she hired nationally recognized experts to travel to her clinic and observe her providing therapy, review her charts, interview her patients and their families and critique her work. Her goal was to thoroughly understand the relationship between psychiatric and communication disabilities. In his book Psychiatric Disease and Communication Disorder, Dr. Dennis Cantwell, ULCA renown psychiatrist, presented a large body of data indicating that many mental health problems were caused by under-diagnosed and mistreated communication disorders, a belief that Dr. Florance had also been considering. Dr. Florance developed a working relationship with Harvard Psychiatrist Dr. John Ratey, author of Driven To Distraction, and Dr. Elizabeth Weller, NIMH expert on depression. David Daly, Ph.D., former Chair from the University of Michigan and Ronald Goldman, Ph.D. author of the Goldman Fristoe Woodcock tests combined efforts with Dr. Florance to help her understand the treatment needs of the emotional and physical aspects of communication disability. These experts along with prior consultants including Audrey Holland Ph.D., author of The Communication Activities In Daily Living Test, John C. Rosenbek, Ph.D., expert on staging treatment of motor speech disorders, Leonard La Pointe, Ph.D., Chair University Of Arizona and author of Test Of Auditory Processing and Reading Processing, and Robert Marshall, Ph.D., expert on auditory processing and listening comprehension all provided significant input into her thinking about how to re-design her practice to develop the perfect treatment program for Whitney.The Watterson Project
Having progressed significantly day-by-day, in 1998 Whitney wrote a letter to his congressman asking how he, as a U.S. citizen, could be freed from his special education status stating that " … making kids feel dumb at school was a crime." Dr. Florance worked with many patients and provided numerous workshops and in-service seminars at Bishop Watterson High School (BWHS) to sensitize the faculty in preparation for Whitney to enter the 9th grade. The selection of BWHS caused Dr. Florance to move her practice to Worthington."Never doubt that a small group of thoughtful committed citizens can change the world, indeed it is the only thing that has." Margaret Mead.
From Failure to Life Long Learning
In the summers of 1998 and 1999, Dr. Diana Raffman, a Yale-trained professor allowed Dr. Florance to use her Philosophy 101 as a practice lab for a group of 20 patients who were failing in verbal classes due to communication disabilities. From this treatment program, they learned thinking skills that they can use in all aspects of life. Each of these struggling students was failing because they were attempting to learn complex verbal material by processing it with a visual thinking system and they were unsuccessful. Dr. Florance taught them how to develop verbal and bimodal thinking systems, which enabled them to achieve the highest grades in the class.Because of her experience with Whitney, Dr. Florance has been searching for highly visual brains with no auditory processors, which she calls "The Maverick Minds." By 1999, her practice was 100 % devoted to these types of Maverick Mind patients.
"The significant problems we face cannot be solved at the same level of thinking we were at when we started." Albert Einstein.
She is mesmerized by the study of the creative brain and the impact communication processing has on the chaos of ingenuity. All of her current patients test as statistical "outlyers in many areas of creative thinking." She hesitates to call these patients "disabled," although they clearly do qualify under The Americans With Disabilities Act as communicatively disabled. In her laboratories, she is continually amazed at the brilliance and innovative thinking that these patients exhibit. Providing treatment for them is like training an Olympic athlete.