Friday, June 9, 2017

Impact of Noise on Hearing Loss

This week, I have a guest, Kate Willett, who will address an important issue about protecting our children's hearing.  Kate is a freelance writer located in Los Angeles, CA.  She writes about health, politics, and comedy.  She is a graduate of the University of California, Berkeley.

Many of us spent our teenage years listening to our parents warn that if we kept listening to music that loudly, we might damage our hearing.  Is there any truth to it?

Hearing loss in one ear can be caused by a variety of factors including:

  • Illness
  • Injury
  • A foreign blockage in the ear
  • Wax
  • Tumor

If the hearing loss is in both ears and is sudden, it might be caused by:

  • malformation of the inner ear
  • head injury or trauma
  • prolonged exposure to loud noise
  • neurologic conditions, such as multiple sclerosis
  • an immune system disease, such as Cogan syndrome
  • Meniere disease, which is a disorder that affects the inner ear
  • Lyme disease, which is an infectious disease that’s often transmitted through tick bites
  • ototoxic medication, which can harm the ear
  • venom from a snake bite
  • blood circulation problems
  • abnormal tissue growth or tumors
  • blood vessel disease
  • aging

Despite the many causes of hearing loss, acoustic trauma is one of the most common. Surprisingly, noise is an even bigger cause of hearing loss than age. According to the New York Times, “Tens of millions of Americans, including 12 percent to 15 percent of school-age children, already have permanent hearing loss caused by the everyday noise that we take for granted as a fact of life.”

Acoustic trauma is injury to inner ear that’s the result of loud noise.  It can be caused by one very loud noise, such as an explosion, or from long-term exposure to loud noise at a lower decibal such as rock concerts or listening to music loudly with ear buds.  Those at high risk include:

  • People who work in jobs with loud industrial equipment
  • People who live or work in areas where loud noises, such as construction, occur for long periods of times
  • Musicians or people who attend many loud concerts
  • People who use gun ranges
  • People who encounter very loud sounds without using ear plugs

When you’re exposed to very loud noises, your eardrum may be ruptured or other injuries to the inner ear may occur.  

Sound causes your eardrums to vibrate, and those vibrations are transmitted to your inner ear. Fluid carries the vibrations to hair cells, which stimulate the auditory nerve. The auditory nerve carries the impulses to your brain, which interprets them as sounds. Most noise related hearing loss is caused by the death of the hair cells.

The effects of noise exposure are cumulative, which means that many older people experience hearing loss.

To protect yourself from acoustic trauma:

  • Use ear plugs when around loud noise
  • Don’t listen to music loudly
  • Be mindful about the time you spend around loud noises

Acoustic trauma cannot be reversed, so be careful with your ears.  If you’re experiencing hearing loss of any kind, see your doctor immediately to identify the causes.  Unfortunately, your parents were right.  If you want to protect your hearing into old age, turn that music down.

Thursday, May 25, 2017

Tales from the Barn

A couple years ago, I had the good fortune of meeting the owners at a nearby occupational therapy clinic: Fingerprints in Naperville, Illinois. Since then, we have referred clients to each other and collaborated on treatment plans for a couple little ones. In April 2015, my practice: Naperville Therapediatrics, was invited to participate in therapeutic riding sessions with Fingerprints at a barn in Plainfield, Illinois. After two months, I learned much about the many benefits of horseback riding and its positive impact on physical, speech, language, and social communication development. This post reviews some of the themes that Ready, Set, Ride organized and the prompts/ cues that we incorporated as physical and speech therapists to address one, young client's unique needs. 

I'm not sure who enjoyed the themes that Ready, Set, Ride used in their sessions, myself, or the young riders. Among my personal favorites were the baseball, pirate, grocery shopping, and birthday themes. During baseball week, riders took turns swinging whiffle bats and trotting bases during much of the session. The coordinator was kind enough to give me a week's notice about this theme, so I donned my favorite Red Sox t-shirt and printed some simple CVC visuals, laminated them, and attached them to an accordion corded key chain so I could prompt my client with his target sound pattern and remain hands free. Pirate week included some thrilling sword fights, treasure hunts, and ring tossing as we followed along and practiced some motor planning patterns such as "P/Pow" and sound imitation for "Ar." Most of us do not enjoy food shopping, present company included, but it is way more fun to reach, twist, and grab a food list while riding a horse. With list in hand to coordinate holding the reins and a paper, riders searched different stations for objects matching items on his or her grocery list. Not only were there plenty of opportunities to exercise core muscles, but we were also able to work on varying communicative intents to label foods and comment about likes and dislikes using vocalizations. Finally, the birthday theme gave us an opportunity to improve imitating oral motor movements while we removed ice cream and sprinkles from the corners of our mouths by using just our tongue and lip musculature. I acted as a mirror for my client as he tried imitating the mouth movements while keeping his eye contact. It was great being in a position where my client could easily maintain his gaze and focus on my mouth without me having to continually find ways to get his attention.

It was rather impressive watching my young rider improve his strength, balance and coordination in just a few weeks. The physical therapy assistant who walked along the other side of our rider provided weekly feedback to caregivers about noticeable improvement in our saddle-free riding client, especially with regards to range of motion and core strength. Meanwhile, on my side of the horse, our rider was learning how to coordinate moving and vocalizing, which was one of the most challenging goals for this youngster. Typically, goals of this nature require all sorts of encouragement and games with bells and whistles to prompt client participation, but on horseback, you do not need to go that extra mile. The horse takes care of all of that for you! I only worked with this client at the barn and his mother would tell me weekly that her son did little during their clinic based treatment sessions, but I saw a completely different child in my setting. From start to finish each week, it took very little to encourage him to try different positions, such as facing backwards, and imitate sound sequences. In fact, the only time he responded with "no" was when we asked him if he wanted to go faster and "Trot", but he allowed it nonetheless and we eventually stopped asking and told him it was time to make the horse "Trot."

Along with having challenges coordinating movements and vocalizations, my client struggled with initiating requests using vocalizations. However, as the weeks progressed, he became a bit more spontaneous with initiating actions. At first, we prompted him to say "Walk on", "Trot on", and "Whoa", but after a couple sessions, he proudly and loudly initiated these commands in order to get his horse moving. Even at a young age, he knew that if he didn't speak up, then his horse would not move much! Right up to the last session, he did struggle with saying "Whoa" without prompting, so we worked him down from a brief "3, 2, 1" countdown to give him some time to take in his surroundings and get the word out. Besides initiating actions, I observed our rider initiating greeting the animals that roamed the barn as I had modeled for him during the first half of the spring program. The language opportunities were seemingly endless in this natural setting.

If you are ever given an opportunity to step out of your clinical space and work with a client in any natural setting, then I highly recommend you venture to the great outdoors! Barns, swimming pools, restaurants, and zoos have all the materials and stimulation that you will need, so leave those therapy bags at home and go have some fun.

Monday, February 6, 2017

My Bag of Tricks in a Bin

Whether you are an SLP in home care, private practice, or school settings, one common ground remains constant: we all need a bag of tricks.  We need to have something readily available that aids in improving attention and interest in the speech and language task at hand.  This collection may be a combination of communicative tempters and sensory stimulating tools and/or visual reminders to stay on task.  In my private practice world, my bag is a bright, deep, red bin that matches my office decor and sits comfortably between my seat and a wall, making it difficult for clients to grab.  This bin holds my tried and true tempters and sensory items.  Allow me to dump out the contents and give you a closer look at what is inside.

First and foremost, I have your ever-fancy, re-purposed slab of cardboard covered in white contact paper and Velcro.  This board, which has saved many a speech sessions, is accompanied by a ridiculous collection of pictures stored categorically in a giant binder.  From toys to foods to letters and numbers, you name it and I have a picture of it laminated with a Velcro dot on the backside.  These visuals give several of my clients a better sense of what we will be addressing in our 50 minute speech and language session.  Once a task is complete, clients remove the picture and drop it in my dollar tree bin marked, "all done."  Using this system helps clients visualize and therefore comprehend how long he or she will be spending time with me working on all the hard stuff.

Next up in the bin are my son's old, monster feet.  These brightly colored feet are made of a thick, durable foam and attach to cords and a handle.  Clients take work breaks by stepping onto the feet and pulling up on the cords by the handles to walk about the room.  My OT colleagues have taught me that these feet give clients a better sense of where their bodies are in space, which in turn helps them organize and attend.  Monster feet come in handy during transitions into and out of my office space too.

Rolled up and folded in half is my two yard piece of stretchable, fabric sleeve purchased at Joann's fabrics.  I used a coupon and saved a little money on this fabric, so it only cost about twenty dollars.  A private practice OT, with whom I often collaborate regarding shared clients, suggested that I purchase this ready made fabric tunnel to assist clients needing proprioceptive input.  Unlike standing tunnels, this sleeve allows you to push and stretch while inside.  Clients sometimes crawl through this or step into it and push against the fabric while standing upright.

Not all of my goodies will fit inside my bin, so my fidget cushion rests just next to it.  I have had this particular cushion for so long that I cannot remember where I purchased it.  Like anything else, I am sure you can find one at Amazon.  I especially like my textured cushion because it works like a balance ball without risking injury.  It's not something that you would use throughout a 30 or even 50 minute session, but perhaps will come in handy for a 10-15 minute task.  One benefit in using this cushion is that it helps some clients reduce the need to move about the room for a gross motor break by letting them get their wiggles out while seated.

Now, let's talk about fidget toys.  I have a few in my stash that I use either as a reward choice for having completed a work task or as a fidget for keeping little hands busy while seated and listening to auditory bombardment of target sounds.  Koosh balls are always popular as are putty.  I am working towards having my AAC users request these items using descriptive words such as "big purple" for a large koosh.

Finally, it never hurts having some tempters nearby.  My favorites are wind up toys and poppers.  These come in handy at the end of a session when I am trying to finish calculating my data because they keep my little friends from pulling out toys on my bookshelf or hitting the buttons on my copier.  It's also good to have tempters nearby on those days when you need to quickly shift gears because that cute craft or sensory bin may not be doing it for the little one in front of you.

What about you?  What do you have in your bag/bin/container of tricks to assist your clients in attending during speech and language sessions?  Leave me a comment and let me know!

Monday, January 23, 2017

Telepractice- Your Questions Answered

This post summarizes my experience over the last six months working as an independent contractor for Presence Learning.  The opinions expressed here are solely mine without compensation.  If you would like to learn more about telepractice services at Presence Learning, then you can watch this link about the company.

A Day in the Life of a Presence Learning Telepractitioner

If you are like me and are a "hands on" learner and you want an opportunity to see a telepractice therapy room, then email me at

Before I delve into my telepractice world, let me provide a little background about my life as a speech pathologist.  I began this fabulous career in 1995 as a speech assistant at elementary and middle schools and then earned my masters in December 1998 at Northern Illinois University.  Over the course of my career, I have worked in both public and private elementary and middle schools, a severe to profound system, acute and rehabilitative hospitals, and early intervention.  I know that seems like a big list, but my time in the hospital settings were per diem.  In the summer of 2012, I opened my private practice part time and then grew to full time less than two years later.  My cozy space is in my home and I run a one-woman-show, which means that I take intake calls, provide evaluations and therapy, and submit my own insurance claims.  Once I found my rhythm in private practice, I noticed blocks of time that were especially hard to fill with clients between the hours of 11 am and 2 pm weekdays.  Not only did I constantly have this down time, but I also noticed a dramatic dip in therapy attendance across the board when the new year began and insurance deductibles reset to zero.   I started researching telepractice services to fill those daily voids and provide a reliable source of income during those periods of frequent cancellations and low attendance.

Last February, I took some time to speak with three telepractice companies and decided to pursue working with Presence Learning.  With almost six months under my belt, I think that I have found my telepractice groove and filled those voids while enjoying predictable reimbursements.  Now that I paved the way for myself, I am happy to help my peers in their pursuit of this new world.  Below are some of the most popular questions that I am often asked about working in telepractice.

*How many hours a week do you work in telepractice?  At Presence Learning, I am required to work directly with clients for ten hours weekly.  In addition, I am compensated for time spent billing, consulting with parents, writing IEPs, documenting and planning sessions.  I am also paid if a client cancels with less than 24 hours notice or does not show for a session.  On average, I bill for 10-13 hours a week, which includes a combination of direct therapy time and some of the other indirect examples cited above.

*How many kids are on your caseload?  My position is a bit different than I expected it to be as I work with clients who are home schooled in virtual sites across California.  Many of my sessions are individual, but a couple are group speech.  In total, I have eleven clients right now, two of which are temporary coverage for RTI clients.

*How often are you paid?  I submit my bills on the last day of each month and then receive a direct deposit two weeks after invoicing.

*Do you need to find your own clients?  No, Presence Learning always assigns you clients.  This was important for me because I wasn't quite sure where to begin with telepractice.  I know that you can do telepractice on your own, but this was such a new world for me that I wanted to start with a reputable company and have them find my assignments.

*How does therapy work?  This is the most impressive part of working for Presence Learning: they have recently updated their therapy platform and it is AMAZING!  Clients meet me in "my therapy room" by following a direct link to my space.  We both need to use a computer (there isn't enough screen space to use an iPad) with a webcam to see each other.

One of the links that I am allowed access to as an employee is the library.  This "library" is loaded with lessons and activities that other providers like me have loaded into this storage space.  If I cannot find something I need in the library, then I can scan and upload documents or download activities on my computer and load them to the Presence Learning library.  I am always given the option to share things that I load publicly or keep it private for my use only.  This allows me to utilize those products that I love incorporating into therapy without infringing on copyrights.  I can also create my own flashcards and memory games using images stored in the library or my own uploaded pictures.

After searching and previewing documents, I began creating "queues" to store plans for articulation, language, pragmatics, vocabulary, and seasonal tasks right into my therapy room.  These queues appear condensed along the right side of my monitor so I can easily grab what I need for each session.  In addition to being able to load and store activities, I can collect data on client goals while in my sessions with a simple click of a button and even write SOAP notes.

Finally, there are tons of interactives in the therapy room.  During sessions we can activate a pencil to circle answers, play games using stamps as markers, add dice or spinners, display timers, and so much more!  I can reward clients for accurate responses with a quick, pre-stored animated video or search for a character of high interest such as Peppa Pig or Mickey Mouse to display a short animation.  Finally, I can load video contents into my queues to work on just about any speech/ language task that my little heart desires.  For example, I have stored a video of someone reading a seasonal book in a queue to work on answering WH questions.  Needless to say, clients are never bored!!  In fact, it is REALLY hard to say goodbye to them when time is up because many are so motivated by all of the features in the platform.

*Do you get holiday and summer breaks?  In my position, I have the same holiday breaks as typical school systems, such as MLK day and President's day.  I also had two weeks off at Christmas and will get a week off during spring break.  While I am not required to work in the summer, I understand that I may be offered an opportunity for ESY with any clients that are currently on my caseload qualifying for summer speech and language therapy.  This may vary from one contract to another though.

*Do you need to be certified in other states?  Yes, as of right now, I need to maintain my certification in the state that I live in, and Presence Learning will reimburse me for certification and renewal fees for licensure in states where my clients reside.  Since Presence Learning has a large client base in California, I was strongly encouraged to gain state licensure in CA to broaden my scope for a caseload.  It took a little work for me to complete this process, but Presence Learning fully reimbursed me and paid for time spent completing licensure tasks such as fingerprinting.

*Is your compensation similar to private practice?  While I am not authorized to discuss salary and reimbursement, I will say that Presence Learning was the only company willing to negotiate a starting rate.  Having worked as a contract therapist before, I knew the reimbursement rates would be lower in comparison to my private practice charges.  My intent was to fill a 2-3 hour daily void with clients and provide a reliable source of income during those periods of frequent cancellations and low attendance.   Thus far, my position at Presence Learning has fit both of those bills.

Thursday, December 8, 2016


This post contains some affiliate links.  No compensation was received for sharing my opinions about these products.

'Tis the season for talking about toys.  Besides the most obvious reason for buying toys at this time of year, I'm cashing in on the deals and updating my therapy closet.  Let's be honest though, I don't need a sale or holiday to buy toys because I pretty much shop all year round.  The toys that catch my eye typically have three things in common:

1) They make HARDLY ANY noise.  I'm probably not the first SLP to make this comment and I surely won't be the last!  Bottom line is that I/we want the kids to do the talking.  Sometimes that talking is a noise or part of a word and sometimes it's a word/phrase/sentence.  It's nice to be able to hear these moments without interruptions.  Now, having said that, a good, old fashioned single, noise making toy never hurt anyone.  For example, the Elefun makes a whirling sound when activated and I'm ok with that because it motivates kids to request "more", "go", and "stop."  You The bottom line is: I steer clear of those toys that kids get trigger happy with and all you hear are a million sounds and words all at once.  Not fun.  Personally, I avoided noisy, talkative toys when my son was little and I have lived quite happily in my SLP world for a couple decades without all the noise.

2) They fit right in with my theme.  Herein lies my year-round shopping problem.  I'm always looking to add materials to my theme units.  I can't help myself.  I have to admit that I love bringing out the Fisher Price Thanksgiving sets and Holiday train, Learning Resources camp fire sets, and Super Duper magnetic fish.  When these toys are only available for a short amount of time, I think you get more bang for your buck from them.  It's the same concept of rotating toys in your home so the old ones feel like new when you cycle through them.

3) They stand the test of time.  This rationale is two part: durability and traditional.  I like a toy that can take a beating and clean easily, so I reach for the plastic Velcro foods and walk right by felt food.  If I can't clean them fast with a Clorox wipe, then I can't have them in my therapy closet.  While there are always cute, new toys being released, I stick with traditional themes like Mr. Potato heads to work on learning about body parts.  Another great option is any toy that is alphabet-related.  Two of my favorite hits for kids in my private practice aged 2-8 years old are my wooden ABC puzzle and alphabet soup.  What better way to work on letter-sound recognition than with toys?!

Now that you know what I look for in a toy, I'd like to leave you with my top 20 favorite toys (in no particular order) in my speech and language therapy room.  Hopefully, this list will help you when shopping for someone you love this Christmas.

ABC puzzle (I especially like the puzzle with objects in the shape of the initial alphabet 


ABC soup by Learning Resources 

Camp set by Learning Resources

Melissa and Doug magnet puzzles

Mr. Potato heads

Lift the flap board books


Velcro fruits and vegetables

Lego ice cream cones

Gymboree bubbles (they last for a few seconds and don't leave much residue)

Storyteller Writing Box by Lakeshore 

Foam magnetic fish by Super Duper Publications

Monster feet


Nesting boxes (I have a SUPER cute touch and feel one with animals from Eric Carle's book: Polar Bear, Polar Bear, What do you Hear?)

Portable Vet Clinic

Klip Klop Princess Play sets


Melissa and Doug sticker collections

Learning Resources Magnet track

Thursday, October 13, 2016

Targeting /s/ blends through Literacy activities

Like most of my slp peeps, I am a planner!  I have theme-based lessons and materials that I have treasured over the years, so prepping for my private sessions is fairly easy.  Every once in a while though, I decide to gather some new materials to target common articulation, phonological, and/or language delays.

Just recently, I polled my colleagues on Facebook and searched my Pinterest boards to create a list of books for preschoolers that target /s/ blends.  Much to my surprise, I had several of the books that I needed on hand.  I only needed to order three of the seven books to complete my /s/ blend library. Here is the criteria that I used for my collection:
  • Short readings with no more than 2-3 sentences per page/picture
  • Repetition of early /s/ blend targets (i.e., stop, small)
  • Appropriate for children aged 4-6 years old
  • One book for each /s/ blend target
  • No more than two /s/ blend targets per book to meet cycles approach 
  • Seasonally appropriate books (I am a theme girl)
Now that I have my books on hand, I can use each in my session with my clients working on improving both listening and expression of /s/ blends.  Since the books are mine to keep, I wrote the /s/ blend target in permanent marker on the cover and I used a highlighter to mark the /s/ blend words in the books.  You can likely find any of these books at your local bookstore, library sales, or Amazon.  Maybe you have some already in your materials collection!!  I will close this post with a photo gallery of my Fall and Winter books.  Next Spring, I hope to compile my warmer weather collection.

Tuesday, September 6, 2016

Crack the Books by Mobile Education Store {{SEPTEMBER SALE}}

This post summarizes my experiences with using Crack the Books during speech and language sessions.  The unbiased opinions discussed below are solely mine with no other compensation other than redemption codes for these apps for trial and review purposes.  

The Crack the Books series by Mobile Education Store (MES) is such a favorite among my upper elementary and middle school clients and why wouldn't it be with all that it has to offer?!  Here is a great description of this product quoted directly from the MES website:

"Crack The Books™ is an multiple award-winning, state of the art, interactive book series for upper elementary students. Developed in collaboration with top universities, scientists, educators and specialists, Crack The Books™ is the first standard based, core curriculum aligned digital book series that includes both interactive enhancements and universal design accessibility features. Designed for all students, from children with special needs to students who are academically gifted, Crack The Books™ gives educators a powerful new teaching tool to help students of all academic skill levels meet state standards for reading comprehension."
The best thing about these books is their versatility.  You can adjust reading levels for 1st through 8th grade to suit the reader's ability with a simple click all while maintaining content.  This adjustment makes it possible for all students in one classroom to participate in a unified curriculum regardless of their reading ability.  The icing on the cake for a private practitioner is that you can target 3rd to 5th grade science and social studies core curriculum in your clinical settings.

This summer, I had some time to look at all the new updates and was delighted to see additions of coloring pages, activities, word searches, memory matching, and puzzles which include vocabulary and visuals from each of the subjects featured in the apps. What a great way to carry over curriculum vocabulary in a leisurely way!  Like the series, you can even adjust the difficulty levels during word searches, memory matching, and puzzle play so it can be fun, yet challenging for a variety of children.






In my opinion, the interactive interface in this series is what captures the attention of my clients.  One of my favorites in the Grassland series allows you to adjust temperature and rainfall and then visualize what the terrains would look like under specific parameters.  Many of my private clients ask to review these visuals long after we have completed reading chapters.  I believe that the interactive links and high resolution images and videos enhance learning and assist in retention of new information.

If you fancy the ability to navigate around the Earth's biomes, then you can find 3D interactive globes filed in the video gallery for each book.  These videos are incorporated into the chapters; however, if you want to find one quickly for review, then you can go directly to the index.  Again, I have found that using these models along with text enhances learning, especially for clients that I work with in private practice who need to visualize information and see images on a wider, dimensional scope. 


One of my middle school clients will make all kinds of bargains with me when she needs to read aloud during our comprehension drills, but she NEVER wants me to take a turn when it comes to reading a Crack the Books topic!  Just yesterday, she commented that the author is "funny" and she made sure that I connected with her mother about purchasing these apps for her home iPad.  This particular client also delights in exploring "Fun Facts" and quickly hearing how new words are pronounced via links in the text.  



I cannot wait to see the additional series that Mobile Education Store promises to release in the future!!  Right now, these five titles are HALF off for the month of September.  You can purchase them for $5.99 each or buy the bundle for $14.99 right now. Happy Learning!!

  • Pines to Vines- The Forest Biome
  • Blades- The Grasslands Biome
  • Seashores to Sea Floors- The Ocean Biome
  • Parched Planet- The Desert Biome
  • Aquatic Earth- The Freshwater Biome