Monday, May 4, 2015

Yes/ No Barn by Smarty Ears- Review and GIVEAWAY


Have you been looking for a fun way to work on yes/no questions?  Did you know that Smarty Ears has an app that targets a variety of these questions?  Would you like to learn more about yes/no barn and possibly win your own copy?  If you answered yes to at least two of the above questions, then keep reading!

Like all great Smarty Ears apps, this one offers profile setup and the ability to import existing data for clients via TRC.





My favorite thing about this app is that you have the ability to regulate the type of yes/no questions presented.  For me, the next best thing to collecting and storing data in an app is the option to set parameters and increase challenges appropriately.  The categories include:  Basic Questions; Look and Answer Questions; Fact Based Questions; Variable Answer Questions; Compare Pictures; and Questions About a Scene.  The picture samples below provide an example of each of these questions.


BASIC QUESTION


LOOK AND ANSWER QUESTION


FACT BASED QUESTION


VARIABLE ANSWER QUESTION


COMPARE PICTURES


QUESTION ABOUT A SCENE

I found that several of my young clients would purposely answer incorrectly to hear the auditory feedback, so I switched that feature off and now they only see a visual indicating the choice was accurate. You may also toggle on/ off for displaying the written question, hearing questions said aloud, and audio directions.

The actual picture cues and smarty symbols are great visuals and I love the background barn scene with animal noises.  I didn't feel that the images were too distracting and I liked being able to collect data about each type of yes/no question.  I'm using this app at the end of my clinical sessions for client practice as I complete my SOAP note and provide feedback to caregivers about our session.  I only need to keep an eye on clients to avoid allowing them to select the same responses without fully listening to questions.

Thank you to Smarty Ears for giving me an opportunity to review this app and for offering a redemption code for Yes/No Barn for one of my followers!  Please see the raffle below for your chance to win!  No other compensation was received in exchange for this review and opinions expressed here are solely mine.


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Friday, March 27, 2015

Group Speech Therapy at the Pool

“Aquatic therapy and children…is a medium… (in which) great things… (may) happen in the physical, cognitive and psycho-social realms…while providing a natural environment in which to practice ADL skills, communication skills, problem solving skills and motor skills…”
(From APT Newsletter, October, 1995, “Aquatic Therapy and Children—Welcome to the Water”, by Dori Maxon, PT, specializing in pediatric physical therapy for children with a variety of limitations including gross motor involvement.)

The idea of “Natural Environments” is a concept synonymous with Early Intervention.  As specialists, we provide our services most often in the naturally occurring setting, the family’s home.  Often, an Early Intervention site suggests a structured group setting for a youngster in need of peer modeling and other socialization opportunities.  The challenge for the therapists working at Hasbro Hospital’s Early Intervention Program in Rhode Island was finding a “natural” space where youngsters could be among typical peers and benefit from group instruction lead by a team of therapists. 
One day back in 2003, I was observing a toddler in his Gymboree class when somehow the topic of Early Intervention groups came up with another Speech Therapist from Meeting Street School in Rhode Island.  She had found a rental at the Jewish Community Center (JCC) in Providence and was co-treating a pool group with a physical therapist.  Shortly after, I found myself observing her group with my own “physical therapist partner –in-crime,” Kate Sparrow!  We watched, listened and took notes.  Clearance was easier than I thought; all it took was a couple phone calls to the Risk Management office at Rhode Island Hospital and we were ready to start a pool group for Hasbro Children’s Hospital’s Early Intervention Program.  Some would argue that the pool was not a “natural environment” since the families could not frequent the pool outside of our session and typically developing peers would not be participating, but it was a start and we were determined to help address a multitude of needs while showing families another option to enjoy time with their children. 
Finding people to participate was quick and easy.  Kate and I spread the word to our clients and asked co-workers to share the information on their home visits with children who might benefit from the group.  We suggested that families get medical clearance from their pediatricians since some clients were medically fragile.  We started with 6-10 families and asked caregivers to provide 1:1 assistance with their children.  Some families brought their babysitter/nannies/grandparents along to care for siblings who were watching on the sidelines!  Our attendance was nearly perfect and to this day, I’m not sure who had the most fun at those sessions, the therapists, kids, caregivers, or lifeguard (who often sang our songs with us while sitting in her chair!)
Music was an essential element to our group.   We used songs paired with movements that promoted speech and movement in a fun, rhythmical manner.  Our sequence became predictable since we always started and finished with the same songs.   Before we started our first session, we distributed a “Pool Group Agenda” that explained the sequence of our session in a parent-friendly manner and it discussed the developmental goals that the group would encourage.   The agenda explained that we would open with a welcome song to promote name recognition, greeting, turn taking, gesturing/vocalization.  We then noted that music and singing would be encouraged throughout several activities.  A complete description of Developmental targets for pool group are defined in this link:
Developmental Skills Addressed During Pool Group
Moving along on the agenda, we discussed that bubble play would entice children to use hand and eye coordination to “pop” bubbles with their hands and kick at them with their feet.  Bubbles were also a great motivator for children to request “more” through gestures, sounds, and words.   Following this description were summaries discussing target goals for slide and ball play.   Finally, the agenda noted that closing songs would not only promote following directions, but also closure for play activities. 
Amidst all this structure, we also let families enjoy some “free time” in the water with their children using kick boards and noodles for much splashing opportunities!  The best part about a group in this medium was that it excluded no one and included everyone regardless of age, cognitive or physical ability levels.  Our clients included children with Cerebral Palsy, Down syndrome,   Apraxia, Autism, and Expressive language delays to name just a few.



Flash forward to March 2015:  Our family relocated to Illinois several years ago and I launched both this blog and my private practice:  Naperville Therapediatrics.  Last Spring, after completing my part-time contract in a Catholic school, I started working full time in my home office.  While it's time consuming acting as an office administrator and speech pathologist, I can honestly say that I will never go back to working for someone else!  I've been fortunate enough to have found a private OT/PT practice within a couple miles of my home office and we have been referring clients to each other to improve services for families.  It was this relationship that fueled me once again to investigate starting another pool group.  After making several calls and following leads over the last two months, I'm pleased to announce that this July, my practice will be holding a six week language enrichment group at Rush Copley Healthplex in Aurora, IL!  I will be signing my contract soon and I'm hoping to not only have the OT/PT group: Fingerprints join forces with me, but also an ABA group has shown interest in participating at the pool!  Other than signing the contract and paying a nominal fee per client for the pool rental, all I need to do is add Rush Copley to my insurance liability policy.  I will bill participant's individual insurance policies using the 92508 group procedure code for our 30-40 minute session.  I couldn't be more excited and I'm hoping to offer more groups at the pool once this pilot one is complete in early August.  Below are some of the handouts that I used years ago as well as a link to a service note that we designed collaboratively at Hasbro Early Intervention.  I hope that this post has inspired you to step out of your comfort zones and seek natural opportunities for enhancing communication too!  Please feel free to contact me with any questions that you may have about how to start a speech language pool group at nanettecote@gmail.com.
Handouts for pool group
  • Water-play sections from Talking Time- Language Enrichment Activities for the Very Young from the Speech Bin.
  • Water Fun and Swimming by Caroline Larson, OTR from Pro-ed, Inc., 1990
  • Talking During Bath time by Anthony B. DeFeo, PhD, Diann D. Grimm, MA, CCC-EdS, and Patricia A. Paige, MS, CCC-SLP from Pro-Ed, Inc., 1988
  • Making Range of Motion Exercises Part of Your Child’s Day by Mary O’Connell, PT from Pro-ed, Inc., 1990

References:
“Aquatic Therapy and Children—Welcome to the Water!” excerpt from APT aquatic therapy workshop by Dori Maxon, PT; APT Newsletter, 10/1995
Note: APT= Association of Pediatric Therapists; based in San Francisco Bay Area
For membership: APT, 1193 Clear Lake Court, Milpitas, CA 95035


Monday, March 9, 2015

Comprehension Builder by Abitalk

Are you looking for a great way to address answering simple questions and improving sequencing words and phrases into sentences?  Then, Comprehension Builder by Abitalk may be just what you need on your device!  This handy app is available on both Apple and Android devices. The developers were kind enough to provide me a redemption code for review.  No other compensation was received and all opinions here are solely and unbiasedly mine.  Let's take a closer look at what this program can do for you.

First, you can create a user account or sign in as a guest.  The benefit to creating an account is you can collect and store data for individual clients/users.


Next, you have options to adjust your settings to best meet your needs.  For example, you can have questions read aloud, give voice to words and phrases when tapped, or hear audio reinforcement when questions are answered accurately.  These are just a few options to toggle "on" or "off."  The image below shows more selections available in settings.




Now that you are ready to play, simply select which of the three levels you would like.  The first level is the easiest introductory one that offers matching highlighted lines for sequencing the sentence.  First, the user is asked a few "wh" questions for which he or she selects the correct answer by tapping the appropriate phrase.  This level would have been perfect for several of my young, nonverbal clients who are not yet reading, had visuals been available with the phrases.



Level two proceeds in a similar manner as level one except you will not see color coded lines for phrase ordering a sentence.



Finally, level three prompts users to make a sentence about a picture given an array of words.  This level was particularly hard for one of my 11 year old language clients, while levels one and two were very easy.  I would like to see a transition to this level such as the option to have color coded lines for sentence formation in future app updates.



Users are given an opportunity to select from a number of "wh" question formats as pictured below.  Scores can be found in this report section.  Since I am likely to use this app as just part of my hour long speech and language session, I would like to see the developers adjust the total number of items to 20 as opposed to 30, 44, 52, or 57 in order for me to give some feedback after 10 minutes participation.


Overall, I liked this app because it offered three difficulty levels; a great number of tasks for working on answering questions; and an opportunity to sequence phrases or words in grammatically correct sentences.  I would be able to use Comprehension Builder with more clients on my private caseload if picture symbols were used with words.  It is my understanding that this app is just the beginning for these developers and we should expect to see much more from them in the future!

Monday, February 23, 2015

Five Electronic Free Options to Stimulate Communication


Chances are you are using your iPad, phone, or laptop to read this post.  Truth be told, I'm using my iPad to write it and later, I will use my laptop to publish it.  I'm on some form of electronic all the time.  Either I'm checking work emails; updating my client calendar; billing for sessions electronically; texting for my son's swim or soccer carpool; checking swim stats; paying bills; or keeping up with new and fun ideas for speech sessions on Instagram.  I dislike being connected to devices and I despise the example that I am setting for my nine year old son. Maybe that's why I still enjoy reading books- you know, actual books that I can purchase or borrow from my library.  It's the one time I can be off a device and model a leisure activity that doesn't involve something that I need to charge later.

Alas, my son is just as reliant on his devices (kindle, computer, DS) as I am, but he decided (ok, I coaxed him into it) to give up playing games on all devices for Lent.  That's right, for 40 days, we put away his kindle and DS and set his computer on the charger.  I have to say, he's been doing really well this first week, but we needed a game plan for his swim meet this past weekend.  You see, swim meets are a time to zone out on devices or tune out those around you with earbuds or headsets, eat, and wait until your next event.  I feared he might break into a cold sweat without his DS, but I was pleasantly surprised by what happened instead!  He easily rallied a group of his peers to play Uno Robotics.  As a communication professional, I loved listening to them make silly voices to record their names and I thoroughly enjoyed hearing their laughter as they played a round or two.  WINNING!

ONE
Being electronic free made me recall a time a couple summers ago when we didn't have devices and my son was participating in his first swim season.  Back then, I hole punched some dry erase activity cards; divided the cards into two stacks; attached them with a binder ring; threw a few markers and tissues in the swim bag; and watched the kids sit for at least an hour going through each and every card in his or her deck.  Since my son and his friends have out grown the activities on the cards, I divided the decks even further and will be giving these out to my private clients.  SUCCESS!

TWO
I started thinking about games that I used to play with my sister at restaurants when we were young and didn't have iPhones to keep us busy while we waited for our meals.  I remembered enjoying hangman, so I drew a page and slid it into a page protector.  Since the fall/ winter swim season just ended, I am going to test out this hangman game at the summer swim meets.  In the meantime, I will give it a whirl the next time we are out to eat. FINGERS CROSSED!

THREE
This next idea is one that requires nothing more than your voice.  No materials, pens, markers, or devices are necessary and you can safely play it in the car with your kids while you drive.  It's the alphabet game.  All you need to do is call out something you see while driving that begins with a letter in the alphabet.  The object is to "spy" things in alphabetical order before the journey is over or until the next rest stop.  Admittedly, I have found that the boys that carpool with us do not always enjoy this game over and over again, so sometimes, we mix it up and work on multiplication tables.  Most kids are always up for a little competition, so this has been a hit with the third graders in my life.  BOOM!

FOUR
Last, but certainly not least, there are books!  When my boy was a toddler, I had mini books in my diaper bag such as First Words/ Signs and Lift-the-Flaps.  His favorite "books" were mini photo albums filled with pictures of him with family and friends enjoying trips to the zoo or parties.  These kept him busy and entertained while in the shopping carriage or at the restaurant table.  Nowadays, there's a Harry Potter book or Diary of the Wimpy Kid one in the car and occasionally, there are USA swim magazines or Cub Scout Newsletters tucked in the backseat pouch.  YES!

FIVE
Don't get me wrong, there are so many great, educational apps out there and I didn't write this post to say that we don't need these devices in therapy.  In fact, I often recommend apps for articulation practice and improving language skills, but electronics do not need to be the only thing in your bag or car, especially for those kids who get lost in them.  It's virtually impossible to build turn taking and communication skills when a young child plays on a device.  I rarely use my iPad as a reinforcer for completing tasks in speech sessions because it closes the door rather than opens one for expanding communication.  Some time ago, I cleared all the games off my phone and reclaimed this as mine once again!  When my son asks me when he can have his own smart phone or iPad, I respond with the age that I was when I got mine, which was just a few years ago.  You can do it too, it's not too late!  If nothing else, then shut your phone off when you are at the park with your kids or during speech sessions if you happen to sit in on these.  Trust me, you will be amazed with the interactions that occur when you become present.

Sunday, January 25, 2015

Lego Snowman Reinforcer



Recently, I spent some time catching up on all those pins that I have on my Winter Pinterest board and I stumbled upon a cute, Lego craft.  When you have a nine year old at home, there is always a decent collection of Legos at hand.  This particular pin showed how to build a Lego snowman in a few, easy steps.  Some of the pieces were a bit challenging to find, so I asked my expert, Lego builder to create a simple snowman for me.  I think he did a pretty cool job, don't you?




Here's how I have been using this quick activity in my private speech practice:

1) practicing articulation sound targets while earning a brick
2) sequencing the numbers to stack and create the snowman
3) following directions using size concepts (small, medium, large)
4) sorting colors/ sizes
5) discussing things you need to decorate a snowman (hat, sticks)
6) using EET to describe a snowman

This activity has been a huge hit with my first through fourth grade clients.  Maybe I will employ my little, Lego creator to put together more of these seasonal combinations.  I hear he works for m & m's!  Suggestions for the next project are welcome!

Tuesday, January 20, 2015

Teddy Talker: A Multi-sensory approach to Sound Acquisition REVIEW and GIVEAWAY

Several months ago, this cute, little teddy bear caught my eye on Instagram when some of my speech blogging peers shared an image of Teddy Talker™ for a giveaway.   I was intrigued enough to contact Creative Speech Products and request more information about the Teddy Talker™ product line.  Linda Siciliano was generous enough to provide me with some samples to review the program and she has been extremely helpful by advising me as I navigate the trenches with several of my young, private clients.  After reading this review, you will find a raffle for a Teach Together Toolkit of your very own!  One, lucky winner will receive a manual AND digital version as well thanks to Linda's generosity.  No other compensation was provided in exchange for this review and the opinions here are unbiasedly mine.

The Teddy Talker™ program is an innovative tool designed to promote phonics and early sound production in young children by stimulating auditory, visual, tactile, and kinesthetic learning.  Everything you need for this dynamic program can be found in the reproducible pages of the Teach Together Toolkit.  First and foremost, I decided to color, laminate, and Velcro a Teddy of my own to have on hand for sessions.  Next, I created folders for each client that included the following:

Background information about the program
Bear face and lips for coloring
Teddy's tongue, teeth, and paper bag
Teddy Talker™ Alphabet chart
Sound Assessment summary


I wanted to be sure that even the youngest client had some ownership for the program, which is why I told caregivers that scribbles or even a single line across the bear's face was permissible.  I did not instruct anyone to color in the lines, which meant no hand over hand or adult coloring was allowed, except for coloring in the lips.




The colored alphabet chart came from the resource section of the Toolkit.  I was fortunate enough to get a larger, laminated copy of this handy tool to use with one of my visually challenged clients.  I have been using the alphabet chart with all of my clients when introducing and reviewing sound targets by asking clients to find the target sound on the chart.


Each folder also contained a consonant and vowel checklist for baseline collection to establish targets for programming.  Getting this information was easy with my Bear Tracks card deck!  I was pretty impressed that all those participating in the inventory collection (ages 2.5 through 6 years) had great attention to this task!



My approach to using Teddy Talker™ With each client was to first identify a developmentally appropriate sound target, and then copy age appropriate tool pages from the manual for weekly practice.  There are two types of worksheets in the Toolkit:  target pages and generic tool pages.  For my purposes, I started with the target pages using the following:

Build and Say:  tells you which lips to Velcro onto Teddy's mouth and provides detailed sound cues
See and say:  focuses on Teddy's face
Trace and say:  introduces muscle memory for target letters with one inch, bold faced capital and lower case letters
Rhyme and say:  great rhymes describing how to make target sounds

Given the ability levels and ages of my clients, I did not incorporate the remaining target tool pages:  Write and Say and Do and Say.

As though that wasn't enough, the Toolkit includes another 13 generic tool pages to be used with any speech sound or phoneme!  Worksheets in this collection include activities for drawing, coloring, writing, touching, talking, and listening.  This comprehensive collection helps support a multi-sensory approach to sound acquisition.  Anything and everything that you need to stimulate articulation is within the pages of the Toolkit.

With clients folders assembled, I eagerly started introducing Teddy Talker™ to four of my private speech clients.  Each unanimously took to the cute, furry guy in an instance!  Let's take a closer look at the results after a couple weeks of practice.

T.M. is a 3 year old boy with limited speech sound productions, intact comprehension skills, and suspected verbal apraxia.  His sound productions include vowel distortions, consonant-vowel utterances, and reduced accuracy during imitation drills.  Mother reported that he is typically resistive to practicing sounds with her at home.  Once Teddy was colored, I laminated the bear face and lips and gave mom Velcro to assemble pieces at home.  Results of baseline sound assessment revealed several emerging targets.  We started with /b/ and quickly added /n/ after the first week.  I copied Build and Say, See and Say, and Rhyme and Say tool pages for home practice.  Mother reported ease of participation for daily, quick practice drills.  After the first week, the /b/ target was 100% accurate in isolation name prompting began to put this target in the initial position of simple sound combinations.

C.S is a 6 year old girl with reduced speech intelligibility and an educational diagnosis of autism.  She has been using a voice output device for over a year to augment her speech and make her needs known.  Part of our private sessions focuses on using visual and tactile prompts to address increasing accuracy of sound targets in isolation.  While she has made significant progress with productions on demand, she continues to demonstrate p/b confusion.  We began Teddy programming with /b/ as she struggles more with consistently producing this target accurately.  Progress has been slow, but steady over the last couple weeks, but I am hopeful that this programming will also help support development of her literacy skills and help this smart, little one become more successful in her academic setting.

M.S. is a 6 year old girl who is essentially non-verbal and has a diagnosis of autism. She recently obtained a voice output device and has already shown remarkable use of her device with minimal prompting.  Part of our private sessions has focused on improving her volitional control of non-speech oral motor skills in a bubble hierarchy program.  She has made great strides with sustaining appropriate breath support and lip rounding, but continues to struggle with isolated sound imitation.  Since baseline assessment could not be taken, we began with /m/ and /a/ targets to later support production of /mama./  This little one especially enjoyed coloring her Teddy face!  While her on demand imitation of /m/ was still a struggle, she was heard spontaneously making this sound minutes after prompting, which is a huge accomplishment for this client!  I especially like this program for this bright, little girl because it will support sound-letter recognition, early writing skills, and rhyme in addition to sound vocalizations.

S.B. is 2.5 year old boy with a mild articulation delay and above average comprehension skills.   After months of both speech and occupational therapy services, S.B. has gone from using less than 5 words at the age of two years old to speaking in 4-5 word sentences.  He has demonstrated some challenges with sound imitation on demand and continues to delete more than 75% of final consonant sounds.  Results of baseline assessment revealed achievement of the eight early consonants (m, b, y, n, w, d, p, h) and some of the middle consonants (t, k, g.)  He showed emergence of producing the following:  f, v, ch, but was not heard making the ng or dz targets.  He also had all vowels except for "oy". Our targets for his program will be ng, dz, and oy.  S.B. also enjoyed coloring his Teddy face and chose to give him a pick bow tie to match the beanie baby bear that he happened to have with him the day we introduced Teddy! 

I will leave you with pictures of some supplements in my speech materials collection that I have added to the program.  I believe that using a mix of materials will help generalize sound practice outside of the Teddy Talker program.  I hope that this review helped share more information about this relatively new, dynamic program created by a speech pathologist to make our lives easier!  Happy talking!!


A to Z Coloring pages purchased on TpT from
Lavinia Pop titled:  Letter of the Week
Free bear rhyme from my local library about body parts on a bear 
Target dollar spot puzzles and Good-Night Owl book.
Both of these include animal sounds.







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Tuesday, November 25, 2014

Bridging the Gap between the Private and School Speech Worlds


Probably the most demanding, taxing job I had over the years in my speech world was working in the public school system.  Caseloads were always astronomically high and more kids were added to the roster with fewer discharges every year.  Then, you had to make time for report writing, evaluations, screenings, teacher collaboration, classroom lessons, therapy planning, documentation, decorating your closet space, and speech and language small group sessions. It makes my head spin all over again just writing about it!  Nowadays, there are these champion school speech pathologists that do all of the above and then go home and create products, write blogs, and somehow manage to eat and sleep before going back to work bright and early the next morning!  Even with all the challenges and stress, I wouldn't change a thing about my experiences and collaboration with so many heroes.  It made me the therapist that I am today and fueled my drive to pursue private practice.

When I set out on the private journey, I had three C's in mind:  Consult, Collaborate, and Connect.  I believe that these three actions help create a bridge between private and school speech pathologists working with the same client.

Consult:
Before I can take one step forward, I need to get caregivers to obtain and sign school consents so I can begin connecting with school professionals.  Once the paperwork is complete, I typically send an email to the school SLP introducing myself.  From there, we work on scheduling my school observation which typically includes observing my client in action and setting aside some consult/discussion time with the school SLP.  In my private practice, I try to make this observation within the first few months of the school year so I can begin helping the team collaborate goals in all settings.  To date, I have found that all school speech pathologists have been very receptive to my visit and many appreciate the collaboration, especially when updating annual IEPs.  Caregivers are especially grateful of this networking because it gives them more information about specific activities targeted at school.  I have found that my presence at a client's school setting is far less intrusive and distracting than a caregiver's.  Most children hardly notice that I am there, which likely wouldn't be the case if mom or dad was visiting!

Collaborate:
When I visit my client's school, I typically bring something that we have been working on in my practice.  While I do honor IEP goals, I also write some of my own based on my data collection, evaluations, and parent report.  In the past, I have asked parents to send a picture exchange communication book or highly motivating snack in preparation for my observation.  I have also brought pacing boards and oral motor tools like the Z-Grabber for demonstration purposes.  Sometimes, I don't bring anything.  Instead, I collect as much information as I can and follow-up via emails later with school staff.  Personally, I have found that I can obtain so much more valuable information during an hour observation as opposed to exchanging emails and phone calls with the school SLP.  It helps me to watch and listen to my colleagues because we all have our own unique styles and expertise.  Maybe it's because I am such a visual learner, but I make better connections when I see things happen in real time.

Connect:
The final, most important step in my game plan is connecting my consult visit and collaboration with the school team to the client's family.  Sometimes, I write my SOAP note during the visit and leave a copy for families.  Most often,  I type out my chicken scratches at home and review the documentation with caregivers at the next clinical session.  I can honestly say that every visit that I have had to a school setting has been a worthwhile, successful trip.  I've seen changes made in a child's diet, increased use of picture exchange communication, and improved execution of voice output devices.

My hope in writing this post was to send a message to all the school speech pathologists out there that you are doing an AMAZING job with all your responsibilities.  As a private therapist, I want to help improve carryover and make the best impact that we can for the families that we are blessed to work with at school and home.  If you are reading this post and work in the schools or private sector, then I'd love for you to share your success stories in the comments section.  Regardless of your placement, what do you look for when collaborating with colleagues?  What would help you improve your service delivery model?