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!

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!

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!

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!

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!

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.

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!

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.

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?

Sunday, October 26, 2014

Sorting by Object and Color and Sequencing, oh my!

True confession: I frequent the local Dollar Tree at least once a week, sometimes twice.  If you can't find me there, then check the Target Dollar bins;). I'm always on the lookout for mini object erasers and small figures for classification drills to add to my collection.  Luckily, my son was willing to part with the erasers that he got in birthday party favor bags a couple years ago.  His generous donation helped me begin my now expanding collection!  To date, I have assorted colored bears and bugs, mini sweets and treats, dinosaurs, vehicles, and three sets of colored apples.

Several months ago, I set out on a mission for a container and clear, miniature buckets for sorting objects by color.  I immediately fell in love with this two bin stacking case from Target.  It was a little pricey, but I liked how it can hold two levels of play and also store some sequencing cards to accompany the objects.

The Dollar Tree had the perfect, miniature container and even better, they came in stacks of three!  These bins have my colored bears and recently acquired assorted colored bugs, which are from a thrift shop find!

The colored bugs were part of a Discovery Kids game that included sequencing cards.  I quickly learned that the cards were flying all over the place during my session with a busy client, so I holed punched and ring clipped them together.

When the activity is complete, I can simply close the lid and store it for the next client.  I'm hoping to save some materials set up time by having several activities always ready to go in my handy, dandy case.  I hope that this post inspires you to put together your own sorting kit!  

Friday, September 19, 2014

Ark Therapeutic- Supply Review and GIVEAWAY

Thanks to social networking, I have been fortunate enough to learn more about Ark Therapeutic supplies for oral motor treatment.  Years ago, I used a Z-Vibe, that was purchased by the Early Intervention program that I worked for, with great success.  I saw the immediate benefits of providing this kind of stimulation when the little boy I was working with gained better control of his anterior loss of saliva by putting his lips together following just minutes of treatment.  Since then, several new items have developed and I had my eye on a Z-grabber.  When I reached out to Ark Therapeutic, they graciously offered to not only send some resources for my review, but also took the time to get details from me about my clinical needs.  This post will review how I have been using many of the items in my collection to date along with direct links to the products at Ark Therapeutic.  

For starters, I busted out the Z-Grabber.  This tool is a combination of a grabber and Z-Vibe in one and I immediately loved it!!  I have used it with two clients, both of which have low tone and significant difficulty with jaw stability.  Neither of these clients were huge fans of a typical grabber and in fact, refused these despite my best, speech tricks.  It appeared that the vibration element for these clients was a necessity in order to work on jaw stabilization, but that may not always be the case. My once resistive clients are now accepting some bite and hold exercises using the Z-Grabber and now that these families have given the Z-Grabber a try and have observed the benefits of using one, they have put this product on their wish list for the holidays.

One HUGE benefit to purchasing the Z-Grabber instead of just the Z-Vibe is that you are getting two tools in one!  As though that weren't enough, you can also get an array of tips to switch out on the Z-Vibe end.  The tips that I was fortunate enough to try are pictured below with a brief description of how I used each of these at my private practice.  Many thanks to my son for modeling and agreeing to once again be my guinea pig.

The Probe Tip  has three surfaces: bumpy, striated, and smooth.  I started out introducing the smooth side and took baby steps towards trying the textured ones.  I didn't notice resistance to any surface with my client; however, every child is different so I would follow your client's lead.  This tip is best used for providing input to gums, palate, lips, cheeks and tongue using gentle pressure with or without vibration.  It is recommended that when using this tip on a client's palate, that you refrain from turning on vibration as this can be over stimulating for some clients.  It was my experience that turning the vibration on for tongue tip elevation distracted my client as he reached for the probe with his tongue and not his palate.  We will continue using this probe during speech sessions because this client seems to benefit more from tactile cues than with verbal only directions.

The Preefer Tip was designed to roll along inner cheeks and/or lips to increase oral awareness.  I have been using this tip as a "wake up" option by stoking the outside of my clients cheeks in a downward motion before moving inside his mouth to target bite/chew and tongue elevation.  I think the ridged surface of this tip was a brilliant idea because it provides the perfect amount of stimulation without being overbearing.

The Fine Tip is far less invasive than using your chubby, gloved finger or tongue depressor to point out tongue placement.  This handy tool not only helps pinpoint locations for tongue placement, but it is also skinny enough to position along the sides of the tongue for stimulation of sounds such as /r/.  I tried this tip out with my client working on tongue tip elevation for sounds /t, d, n/ and preferred this tip over the probe for him.  I like that I can also use this for future clients working on /r/ who require stimulation to the sides of the tongue for cuing tension.

The last tip that I tried out was the Bite-n-Chew.  It was a great option for my client who had a hard time starting with the Z-Grabber because the later is less flexible and harder to bite.  This Bite-n-Chew tip is smooth and somewhat flexible.  You can place it either vertically or horizontally on molars depending on your client's needs.  I have been using both this one and the Z-Grabber to stimulate biting with a client who prefers chewing on his left side.  I will continue using these tools immediately before snack time in our session as I have seen a dramatic increase in biting when foods are placed on his right side.  Prior to trying the vibes, this client would only take bites using his front teeth or left side and protest assertively when food was presented on his right side.  He no longer protests and will readily accept presentations on both sides now!

If you do invest in a tool that can provide vibration, I highly recommend purchasing the Tips and Techniques for the Z-Vibe, DnZ-Vibe, and Z-Grabber because it is a fabulous resource for specific exercises and stimulation techniques for using these tools.  I have mine tabbed with client names on pages with exercises that I want to continue testing and using in my practice.

In addition to the Z-Vibe family, Ark Therapeutic sells regular grabbers to assist with jaw stability, biting, chewing, and tongue coordination.  There are several different types to meet your client's needs from those with smooth narrow parts that suit tiny oral cavities to those with harder textures for older clients.  There are even options to purchase scented grabbers to motivate those less willing to accept presentations of these tools.  While I have not yet tried all of the grabbers, I have a decent assortment in my toolkit.  In the past, I have found that chilling grabbers or dipping them in foods tempt some hesitant clients to open wide.  For now, my clientele are moderately to severely involved and require maximum stimulation opportunities via vibration.  

Just prior to contacting Ark Therapeutic, I had purchased: Tips and Techniques for the Grabber Family from the Ark catalog.  Like the tips booklet for the Z-Vibe family, this handy how-to companion will give you step by step instructions for using grabbers for a variety of purposes.  Since a copy of the same book was included in my materials package from Ark, I decided to raffle off the donation to my followers!  I'm also adding a textured grabber for your oral motor toolkit.  You can enter the raffle for these must have items in the Rafflecopter at the end of this review.

In addition to the grabbers, the remaining items in my box of goodies were directed towards improving straw drinking: the Bear Bottle, a lip blocker, and one way valve.   Earlier this year, I began private services with a two year old who has a limited verbal repertoire and insists on drinking from a bottle.  He seems to be using this for soothing purposes and reportedly likes to carry the bottle using just his teeth.  While his parents have been working very hard on transitioning to straw and cup drinking, they definitely needed more ammunition.  Enter, the Bear bottle from Ark Therapeutic.  First and foremost, I liked this option for my young client because it's adorable and novel for kids.  We have been calling it his new "bottle" since he started using it.  At first, he pushed it away, but now he takes successive sips before drinking from his old bottle.  He has even named it: B and accepts drinking from it more often than he refuses.  I call this success!  While Ark Therapeutic was kind enough to include a lip blocker and one way valve, this client did not need these supports.  However, I noticed another client having difficulty sustaining a suction while straw drinking and the one way valve worked wonders for him.  This valve traps the fluid in the straw rather than let it drop back to the bottom when the suction is released.  One thing that I did notice about the lip blocker was that it would appear to stay in place on the straw after multiple uses and washes.  It is made of hard plastic and fits snugly into a straw.   There are five types of blockers sold by Ark which allows for graduation as your client improves his or her ability to position musculature for drinking without tactile feedback.

If you have any questions, Ark Therapeutic has a contact link on their website that you can access.  I am so thankful for their products and personal attention to details, both of which made my testing trial such a positive experience for myself and my clients.

Disclosure:  Ark Therapeutic generously donated supplies for this review.  No other compensation was received in exchange for this summary.  All opinions expressed here are unbiased and solely mine.
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9/22/14 UPDATE:  Ark Therapeutic is providing the coupon code SPEECH2ME for my followers for 15% off site-wide through the end of October!

Sunday, September 14, 2014

Speech and Language Pirate Sensory Bin

Ahoy Mattes!  I'm here to share a quick treasure that you can put together for your early elementary students just in time for national, "Talk like a pirate day" on Friday, September 19th.  This fun activity should surely keep you from walking the plank!  Arrrrrrr!

I picked up the rocks, blue beaded necklaces, and measuring cups at my local dollar store; mini treasure chest at oriental trading; and miscellaneous jewels and coins from my son's stash.  Anything shiny that you have at home should get the job done!

Language targets/ following directions:
Big, medium, small
First, next, last
Color identification
Shape concepts (i.e., Find something round)
"Put in" the treasure chest

Speech targets:
Dig, scoop, in, out
Naming colors
Labeling sizes/ shapes
First practice 25 speech targets, then dig for 25 treasures