Monday, June 6, 2011

Therapy Progress - Small Details Add Up to Big Picture Progress (At least, that's the plan.)

I realized that I haven't done a real update on Ava's therapy progress and speech in quite a while.

Here are her previous updates, in order, for anyone who is just tuning in and is interested in the background:

It has become much more difficult to track Ava's progress. The difference between "My baby isn't talking!" and "My baby is starting to use words!" is pretty clear and exciting. The difference between, "She can't even imitate." and "She can imitate." is also pretty clear cut. The increase from single words to two-word phrases was obvious as well as was the increase to 3-4 word sentences. Getting a new sound is another simple, observable change. Well, we went through all of those easy to track changes and they were wonderful and I was feeling great. Then there was the reality check of a standardized articulation test. Overall, things are getting harder to track now, but I'll try.

Big Picture

Ava is certainly talking a lot. She pretty much never uses a single word utterance any more. She's rarely uses a two-word phrase. Oddly enough, now that she is more ambitious in her speech she is actually harder to understand. When her sentences are longer and particularly when I have no context, I have a lot of trouble understanding her. It is frustrating for me and for her. I can handle my frustration, but watching her get upset when I don't understand just kills me.

So, I suppose the good part of the "big picture" is that Ava's gained enough confidence to try more. In terms of the length of her sentences, she's pretty much age appropriate. Also, the more she talks the more opportunities you have to practice, refine, and correct. The challenging part of the "big picture" is that the more she tries to say the harder she is to understand.


Specifically, we are working on two main areas. We are trying to add final consonants (only the ones she can actually make) to her words. She does best with /t/ and /p/. Those sounds are easier for her because they are voiceless. She can imitate a final /t/ (like in hat) and a final /p/ (like in up) pretty much 100% of the time. She's also using them on her own when talking roughly 30% of the time. We're trying to work on final /d/, /b/, /s/, /n/, and /m/ as well, but those are all harder for her. She can imitate some better than others, and pretty much never uses them on her own.

The other thing we're working on is trying to get some new consonants. Specifically we are trying to get the /k/ sound. Ms. J says that she has gotten Ava to make a /k/ sound in isolation during her therapy sessions, but I just cannot get her to do it here at home. I even tried bribing her with M&M's, but still no luck.

Why these specific targets? Well, adding final consonants is huge. Leaving those sounds out makes her much harder to understand and as she starts to add those sounds back in, that should improve her intelligibility. Improving intelligibility (how well she is understood) is the reason for trying to get her to make the /k/ sound. /k/ will be the gateway sound for /g/ because they are a voicing pair. There are a lot of words out there that use the /k/ and /g/ sounds and right now she either leaves the sound out or substitutes a /t/ or /d/. If we can introduce the /k/ and eventually the /g/ she should get a big boost in her ability to make herself understood.

And so we march forward. We choose targets that we hope will get us that much closer to our overall goal of helping Ava express herself in a way that can be understood.

My goal for the next few weeks is to reintroduce structured home practice. She needs more repetitions. That is the core of apraxia therapy. Even if I have to resort to bribing the girl with candy, we will somehow get it done.

No comments:

Post a Comment

Web Analytics