A Wayward Defender

I've been squeezing therapy with Ava in after her nap. She tends to wake up before her brother, so the time works fairly well. Yesterday, Michael woke up and came downstairs in the middle of our session and hung out nearby eavesdropping.

I have been working to get Ava to add in the "easy" final consonants (for Ava, /p, t/) at the end of the first word in a two word sequence or at the end of the second word in a three word sequence. So, we said, "wipe". Then, "wipe, wipe". Then, "wipe, wipe, wipe". That was fairly easy. So then we said, "Mama wipe". Also fairly easy. As soon as we add, "Mama wipe eye(s)" we lose the final /p/ sound in wipe. I was trying to get it back using visual, tactile, and gestural cues and she and I had gone back and forth several times.

Then, from behind me Michael piped up, "Mama! She SAID that!"

I love that his instinct is to defend his sister, but his timing wasn't the best. On the other hand, I did take a moment to explain to him what I was looking for demonstrating the difference and when I turned back to ask Ava to try one more time, she got it. Not a bad way to wrap the session up.

If You're Happy (Emotions Version)

I was first introduced to this idea several months ago by our Parents as Teachers home educator. I wanted to make our own version and couldn't remember the details so I did an online search for "if you're happy emotions" and found two helpful resources. This page shows the basic lyrics and some visual cue "faces" you can make. Another page gave me the brilliant idea to simplify the lyrics to make them more accessible to children with speech delays. Here's the project.

If You're Happy Song - Emotions Version with Visual Cue Cards

Making the Cue Cards

Group Planning

I sat down with the kids and drew a happy face. I asked them how the person felt and they responded "happy." I asked them "How else can people feel?" They responded "sad" and I asked how the face would be different if the person were sad. They told me a frown (and demonstrated for me). I made a sad face with a frown. We then worked together to discuss, demonstrate, and draw the other four emotions (sleepy, surprised, scared, and mad). We also chose the color for each emotion. I let the kids choose and so our colors are a bit unorthodox.

Make and assemble fronts and backs of Cue Cards

I then drew the faces on the circles and wrote the matching emotion and action on the back as a cue for myself when I was holding them up for the kids.

Identify Emotions / Sing the Song

There are a wide variety of activities to do with these cue cards.

1. Adult hold up the cards and leads the song.
2. Distribute the cards to the everyone (we had two each) and take turns holding one up and letting the person holding the card be the leader.
3. Use the cards to help the children learn to identify emotions (without singing) in flash card mode.
4. Have the children mimic the facial expression of the card you hold up.
5. Let the children make an expression and you try to guess which one they're making by holding up the matching card. They get to tell you if you're right or wrong. Get it wrong on purpose sometimes so they can enjoy telling you no.

Song Lyrics

You sing the song to the tune of If You're Happy and You Know it Clap Your Hands. If you are a teacher, parent, or early childhood educator who has no need to simplify the lyrics, just use the original wording. I'll give the simplified version in a bit.

Here are the originals:

1. If you're happy and you know it clap your hands...
2. If you're sad and you know it say "boo hoo"...
3. If you're mad and you know it stomp your feet...
4. If you're scared and you know it say "oh no"...
5. If you're sleepy and you know it take a nap (or close your eyes, or make a yawn)...
6. If you're surprised and you know it say "oh my"...

Here is how to simplify the lyrics:
If you are doing this activity with children who have speech delays, slow it way down and encourage them to sing along. (Or at least repeat "boo hoo," "oh my", and "oh no" when cued.) Once they have learned the song encourage singing by doing the activity where they get to hold the cue cards and lead the singing in turn.

If you're happy, happy, happy clap your hands.
If you're happy, happy, happy clap your hands.
If you're happy, happy, happy clap your hands, clap your hands.
If you're happy, happy, happy clap your hands.

If you're sad, sad, sad say "boo hoo".
If you're sad, sad, sad say "boo hoo".
If you're sad, sad, sad say "boo hoo", say "boo hoo".
If you're sad, sad, sad say "boo hoo".

And so on...

SLP Notes: This activity is great. You hit speech, language, vocabulary, and pragmatics all at once and can emphasize whichever is most important for your goals with a particular child. It can be adapted high (original version, fast pace, child led). It can also be adapted at a mid-level (modified version, medium pace, cued verbal participation). It can be adapted very low as well with modified version, slow pace, and only gestural participation or cued vocalizations (yawn, crying, snoring, exclamations of fear or surprise) to work on turn taking. Even using the activity to draw the child's attention to your facial expressions could help you work on eye contact if your goals are at that level. For vocabulary you get the emotions themselves, but also the parts of the face including eyebrows and terms like smile and frown.

I have NO IDEA!

The worry is so acute when they have no words and all the other children seem to be talking. Then, if you're lucky, you see progress when therapy begins and the feeling of relief is so profound. Sounds are better than silence. Single syllable words are even better than sounds. Two-syllable words or two-word utterances are even better than that. And then you get sentences, and lots of new words and you start to think it will all be okay.

Then there's a long plateau. Her immediate family understands her most of the time. I get a lot of practice, and at her age (2 1/2) she's almost always talking about something where I get some context clues. Being able to understand her most of the time gives me a false sense of security as well.

Lately, Ava is singing. It's adorable and a sign of great language development. Now, when I say singing, I don't mean the ABC song or Twinkle, Twinkle, Little Star. I mean just making up songs out of the blue.

She learned it from me. I make up songs about what we're doing all the time. If we're getting dressed I'll make up a silly song about putting on shirts and socks. If we're eating breakfast I'll make up a song about how our food tastes good to our mouth and then travels to our tummy to give us energy for the day. If the kids are running circles in the house I'll make up a song about how many laps they've managed to do. (I know, I'm a dork.)

A few days ago I noticed Ava starting to do the same thing. She made up a song about her baby and feeding her. Then she made up a song about going to the grocery store. I caught about one word in ten of those songs and only because I had some context to help with the guessing.

She's also making up songs about random thoughts in her mind. I can tell she's singing "words" and is super excited about whatever story she's telling. I can tell she wants an audience and wants to talk to me about her song. She's just bursting with pride at making up her own songs. I can see all of that clear as day.

And I have NO IDEA what the songs are about. None. It's killing me. It also makes me realize how unintelligible she is out of context and how very unintelligible she probably is to strangers. So sad. I must find more time for therapy.

Speaking of therapy, my new froot loop therapy reinforcer is working beautifully. She's bringing it over and asking to do speech just so she can have a froot loop snack. Whatever works! Being able to sit down with her regularly and get in sessions of a decent length is letting me get a better feel for her current skills and needs in terms of motor processing. Once I get things better sorted out I'll do a post on the topic.

Simple Homemade Therapy Reinforcer

Ava has an expressive speech delay (definitely a strong motor speech component and a significant phonological processing component). She sees an early intervention therapist weekly and we also see a local apraxia expert a little less often (once or twice a month on average).

(I'm getting to the therapy reinforcer, I promise.)

Even though I'm a certified speech therapist myself we don't do enough therapy at home. The therapist/client dynamic is hard between mother and daughter and I find her difficult to positively reinforce. Ava does respond well to froot loops. Froot loops aren't great for therapy rhythm though. It seems to take forever to chew one and she can't talk while chewing. Kind of counterproductive don't you think?

Then I had a great idea. It just popped into my head. The brilliant idea came as I was lying in bed. Working out the details in my mind stole at least half an hour of sleep, but it was worth it. So, the next day I made this:

I call it the Froot Loop Therapy Reinforcer. :-)

I pull a random froot loop from a bag after several repetitions (5-10 on an easy item, 1-2 on a harder one). She threads the froot loop on the matching color pipe cleaner. When she gets three of any one color she gets to eat them. It worked beautifully. It only takes a moment to pull one out of the bag and thread it but she likes that part so it is motivating. Then, every so often she ends up with three and gets to eat them (very motivating) and I can use those moments to mentally review what I want to do next or take a few notes.

It also has the benefit of working on color identification, color matching, and fine motor skills.

An alternative to froot loops would be threading color coordinated pony beads onto the pipe cleaners, but you just wouldn't eat them when the pipe cleaner was full. You'd need some other higher level reward (perhaps you could then thread three at a time onto yarn to make a bracelet for them to take with them at the end of the session).

Another advantage is that it is lightweight and can be folded flat for storage so if you travel for private practice or early intervention therapy, you could take it with you in a bag easily.

Here's how I made it.

1. Gather materials.
• Piece of cardboard.
• Piece of cardstock.
• Glue.
• Colored duct tape (optional).
• Pipe cleaners (red, yellow, blue, orange, green, purple).
• Tool to poke small holes in cardboard (I used a sewing pin).
2. Poke holes about one inch apart in a line across cardboard.

3. Cut pipe cleaners to about 2-3 inches long and feed them halfway through holes in cardboard.
   
   
4. Twist them together on bottom to hold them to the right length.
   
   
   
5. Cut cardstock to the same size as cardboard and glue cardstock to bottom of cardboard to hide the pipecleaners.
6. (Optional) Put colored duct tape along sides to make a pretty border and help prevent your edges from separating.
   
   

Speech Therapy Progress - So Slow

I realized that I haven't done a speech therapy progress update in almost 5 months. I can't believe that much time has passed. I've been doing fewer progress updates because there is less progress to report.

Last time I wrote a progress update I said that we were working on final consonants and that she was using /p/ and /t/ spontaneously about 30% of the time and we had pretty much no other final consonants. Now Ava is using final /p/ and /t/ spontaneously at least 60% of the time in phrases and sentences. She's also using or approximating most of the other early emerging consonants spontaneously at least 30-50% of the time. She can imitate final /s/ and /sh/ as well, but is not using those spontaneously.

We still don't have /k/ reliably. I'd say I've seen relatively little movement on this phoneme in 5 months time. Even in direct imitation with multiple cues she will substitute /t/ for /k/ at least 3/5 times. I am frustrated with the complete lack of progress on learning a velar sound.

Right now I feel like I understand Ava at least 90% of the time in context and at least 50% of the time if I have no context. I think she is significantly less intelligible to strangers. She is speaking regularly in 3-7 word sentences, but most of those are word approximations.

She has /p, b, t, d, m, n, h, f, j, w, s, sh, ng, and vocalic /r/ in her phonemic inventory.

I feel like her language growth has been phenomenal over the past few months. Sentence length and complexity, expressive vocabulary, and morpheme use has all improved significantly (as you would expect for a child of her age).

Speech progress has slowed and is becoming difficult to track. We have shifted out of the stage where we see rapid progress from beginning therapy. Now I am beginning to see that the remaining errors are significantly more stubborn and progress will be measured in small increments rather than leaps. It is disappointing, but not unexpected.

I know slow progress is much more typical of apraxia and motor planning problems than fast or even steady progress. It's just that when things moved so quickly at first I got my hopes up. I was hoping that she would be the exception rather than the rule. Why is there always another reality check just around the corner?

Apraxia Therapy Materials: Turn & Talk Early Sounds

Therapy Materials Review: Turn & Talk Early Sounds - Fun Practice with P, B, M, T, D, and N in Initial, Medial, and Final Positions of Words

This is a review of Turn & Talk Early Sounds. This easel book is published by Super Duper Publications. The book contains 600 illustrated words addressing the early emerging phonemes (p, b, m, t, d, n) in initial, medial, and final positions of one and two syllable words.

Target Audience

The publishers state that the target audience for the Turn & Talk Early Sounds book will be children from PreK-3rd grade. The pictures on the cards are appealing to children. I could see using selected sections with younger children who need practice on early emerging sounds as well.

Description of Turn & Talk Early Sounds

This product is a 11 inch by 4.5 inch spiral bound book with hard covers. The book has a built in easel so you can stand it upright. Inside you'll find an introductory section describing the contents of the book and giving tips for eliciting correct production of the target sounds. This section also includes a blank card you can use to write in the sounds in isolation or in VC or CV syllables with a dry erase marker if you want to work on the sounds at that level.

Phonemic Breakdown

The book has a tabbed section for each of the six phonemes: P, B, M, T, D, N.

Each section includes 100 words divided as follows:

• 20 Initial One-Syllable
• 20 Initial Two-Syllable
• 20 Medial Two-Syllable
• 20 Final One-Syllable
• 20 Final Two-Syllable

How to Use the Turn & Talk Early Sounds book

This book is going to be most appropriate for intense drill on these phonemes. Choose the section that addresses your goals and objectives for a child and use that section to drill. The pictures are fairly engaging, but you will probably need some motivational tool such as a turn at a game, sticker, or token.

Pros and Cons of the Turn & Talk Early Sounds book

• Pros:
• The Turn & Talk Early Sounds book is compact and easy to carry around.
• AT 100 words per phoneme, the Turn & Talk Early Sounds book includes a pretty good number of stimuli per phoneme.
• The five picture spread format allows you to do many repetitions easily. This is a great format for approaching therapy with apraxic children from a motor planning standpoint.
  
• The book is sturdy and has a built in easel.
• The illustrations are well done and appealing to children at a wide variety of ages.
• Cons:
• Although there are 100 words per phoneme, there are only 20 one syllable initial and 20 one syllable final pictures for each phoneme. Most of those 20 one syllable words are fairly complex including later emerging phonemes, vocalic /r/ sounds, and even blends. Therefore, if you are working with a child with a severe speech delay you may find this book to include stimuli that is mostly too difficult. My free articulation picture cards target these same phonemes at a simpler motor planning level, so if you need simpler look there.
• This book will work best for children needing a simple articulation approach to speech remediation. Most children with simple articulation errors are making errors with later emerging phonemes. This book may not address the phonemes you need most.

Bottom Line:

The Turn & Talk Early Sounds book is a good purchase if you need stimuli that address these early emerging phonemes. Just think carefully about whether the stimuli included here are actually going to be too difficult given that often children who need drill on early emerging phonemes are severely delayed and may have difficulty producing many of these stimuli because of the other phonemes included in the target words.

You might also be interested in the following products:

Apraxia Therapy Materials: Free Speech Therapy Articulation Cards

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Apraxia Therapy Materials: Word Flips

Apraxia Therapy Materials: Phrase Flips

Apraxia Therapy Materials: Word Flips

Therapy Materials Review: Word Flips - Flips for Learning Intelligible Production of Speech

This is a review of Word Flips. This flip book is published by Super Duper Publications. The flip book contains three identical 40-word card sets divided into sections by consonant placement (bilabial, alveolar, velar, and palatal). All 40 words are CV words.

Target Audience

The target audience for the Word Flips will usually be children with severely delayed expressive language typically between the ages of 2-5. The pictures on the cards are appealing to children. This book is ideal for children working on early emerging sounds in CV syllable structure.

Description of Word Flips

This product is a 11 inch by 4.5 inch spiral bound book with hard covers. The book has a built in easel so you can stand it upright. Inside you'll find three identical sets of picture cards divided by tabs into sections according to place of articulation (bilabial, alveolar, velar, and palatal). 40 words are included and they are all CV syllable structure.

Phonemic Breakdown

• Bilabial: /b/-4, /p/-3, /m/-4, /w/-4
• Alveolar: /t/-4, /d/-3, /n/-4, /s/-3, /z/-2
• Velar: /k/-2, /g/-2
• Palatal: /sh/-4, /ch/-1

How to Use the Word Flips book

• Simple repetitions. Choose target sounds that are appropriate for the child and practice them in repetitions of three. Work on sounds that share articulatory placement, or if increased difficulty is appropriate, alternate between different areas of placement.
• Alternating sets of three.
  
  • Same consonant, different vowel. Ex. "boo, bee, bee; boo, boo, bee; bee, bee, boo; boo, bee, boo; boo, bee, bye; etc..."
  • Same vowel, different consonant (same placement). Ex. "bye, bye, pie; bye, pie, bye; pie, bye, bye; bye, pie, bye; etc..."
  • Same vowel, different consonant (different placement). Ex. "pay, pay, day; pay, day, pay; day, day, pay, etc..."
• Random variation. Ex. "pay, key, show"
• Combine CV words to make CVCV words. Ex. "sew + pea = soapy" The book includes a list of CVCV words you can make this way from the CV words in the book.
  
  
  
• Combine CV words into short phrases. Ex. "Go zoo." The book also includes a list of phrase suggestions.
  
  
  

Pros and Cons of the Word Flips book

• Pros:
• The Word Flips book is compact and easy to carry around.
• The Word Flips book includes a fair amount of variety using real words at a very simple, CV level. You get 13 phonemes. All phonemes except /ch/ are paired with multiple vowels. This makes it a great book for working with apraxic children.
• The flip book format allows you to do many repetitions of the same CV syllable or many repetitions of alternating syllables. Again, this is a great format for approaching therapy with apraxic children from a motor planning standpoint.
  
• The book is sturdy and has a built in easel.
• The illustrations are well done and appealing to children at a wide variety of ages.
• Cons:
I really only see one con here. Overall, I like this resource a lot for children with a severe delay. The Word Flips book does not go into any one phoneme at great depth. So, for example, if you have a child who can only produce one or two phonemes, this book may not provide enough stimuli for an entire session of work. You might look into my free articulation cards which include 30 CV or CVC words for each phoneme if you need additional depth for a specific early emerging phoneme.

Bottom Line:

This book is great for children with a severe expressive delay who need work at the CV syllable level. The only caveat is that you don't get a lot of depth with any one phoneme.

You might also be interested in the following products:

Apraxia Therapy Materials: Free Speech Therapy Articulation Cards

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Apraxia Therapy Materials: Phrase Flips

More Flip Books On Sale

For those of you who thought the Phrase Flips book looked interesting, there are three more Flip books on sale at Super Duper this week. (No, I am not affiliated with Super Duper, I just like some of their products and I monitor their weekly 50% off sales.)

This announcement is just for your information. I haven't actually seen these books yet although I did order them. I'll do reviews of them when they come in.

The three on sale (50% off through Sunday, October 16, 2011) are:

• Say and Do Sound Production: This one focuses on production of vowels and consonants at the sound, syllable, and word level and comes bundled with an activity book with worksheets and therapy activities and a CD-ROM of reproducibles.
• Turn and Talk Early Sounds: This one focuses on initial, medial, and final /p, b, m, t, d,n/. Contains 600 illustrated words.
• Word Flips: This one contains three sets of identical picture cards for single syllable words. Sounds are sorted into sections by placement (bilabial, alveolar, velar, and palatal).

Apraxia Therapy Materials: Phrase Flips

Therapy Materials Review: Phrase Flips - Flips for Learning Intelligible Production of Speech

This is a review of Phrase Flips. This flip book is published by Super Duper Publications. The flip book is designed to let you easily address target sounds at an easy level (single syllable) level, moderate level (2-3 syllables), and advanced level (4-5 syllables).

Target Audience

The target audience for the Phrase Flips will usually be children ages 3 and up although I can imagine using the easy level with even younger children. The pictures on the cards are appealing to children. This book would work well for children using a traditional articulation approach to therapy. In skilled hands, this book would also be useful for variety working with clients needing intense practice using a motor speech approach to articulation however the book isn't really designed with that approach in mind.

Description of Phrase Flips

This product is a 11 inch by 4.5 inch spiral bound book with hard covers. The book has a built in easel so you can stand it upright. Inside you'll find three sets of picture cards divided by tabs into sections according to place of articulation (bilabial, labiodental, alveolar, palatal, and velar). The set of cards on the left are easy (single syllable). The middle set are moderate (2-3 syllables). The set on the right are advanced (4-5 syllables).

Phonemic Breakdown
The main focus is on initial and, at the multi-syllable level, functional medial productions of these sounds. In general, the easy level introduces 4 single-syllable words for each phoneme. The moderate level introduces a second word or syllable targeting that phoneme and the advanced level introduces a third. That gives you a total of 12 words per phoneme most in initial position.

• Bilabial (/p, b, m, w)
• Labiodental (/f/)
• Alveolar (/p, d, s, n, l)
• Palatal (/sh, ch, J, r)
• Velar (/k, g)

How to Use the Phrase Flip book

In a traditional articulation framework this book would be a great set of stimulus materials to practice phonemes in initial and medial position at increasing difficulty levels. The book would also be useful for generalization and practice for children with motor speech articulation problems (such as Childhood Apraxia of Speech) for specific phonemes that have already been taught and established at the single word or syllable level, but need additional drill at multi-syllable levels.

Pros and Cons of the Phrase Flips book

Pros:

• The Phrase Flips book is compact and easy to carry around.
• The Phrase Flips book covers a lot of territory. It has 16 phonemes in initial and medial position at three increasing difficulty levels. It will not help you get into great depth on any given phoneme, but if you need to carry something with you that covers a lot of territory, this might fit the bill.
• The book is sturdy and has a built in easel.
• The illustrations are well done and appealing to children at a wide variety of ages.

Cons:

• The Phrase Flips book does not focus on phonemes in final position.
• The Phrase Flips book does not go into any one phoneme at great depth.
• The flip format is something of a gimmick in this particular book. I cannot see a huge therapeutic reason to address one phoneme at the easy level, a different phoneme at the moderate level, and a third phoneme at an advanced level simultaneously. The only advantage is that you can take a level completely out of play by turning the entire set over so that a blank card shows at that level.

Bottom Line:

Nice resource for a SLP who typically needs to address articulation targets at multiple levels of difficulty just be aware that the book focuses mostly on initial and medial productions and doesn't provide a great deal of depth on any one phoneme.

You might also be interested in the following products:

Apraxia Therapy Materials: Free Speech Therapy Articulation Cards

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Sunny Articulation Test App - One Day Sale

I have been keeping an eye on an articulation test for the iPhone/iPad called the Sunny Articulation Test. I wasn't willing to buy it at the usual price of $49.99, but today (10/9/2011) it is on sale for $21.99.

It is a qualitative test, not a normative test, so it will not tell you how your child/student/client compares to other children his/her age. However, it will test all phonemes in multiple positions of words. It allows you to easily record productions of each test item so that you can go back later and listen again. It has a screening mode and a full test mode. The screening mode has fewer words and you simply indicate right or wrong for each target phoneme. The full test mode has more words and you enter the type of error for each incorrect phoneme. The test automatically calculates errors and does some simple analyses (how many voiced sounds were incorrect, how many voiceless sounds were incorrect, how many plosives, etc.). You can also automatically generate and email a simple report.

I will do a more complete review once I have had an opportunity to actually use the program, but I wanted to let you know about the sale in case you've been looking for an articulation test for the iPhone/iPad.

Wilbarger Deep Pressure and Proprioceptive Technique (Brushing Technique)

I have to admit, when our OT first introduced the "brushing technique" to us I thought it seemed a bit questionable. And yet I think it is working wonders.

First, some background. Ava seems to have a fair amount of tactile defensiveness. Prior to beginning occupational therapy she hated tags in her clothes. She never allowed me to fix her hair with barrettes or hair bands. She barely tolerated brushing her hair. For months, brushing her teeth involved pinning her down and brushing them as she screamed. She panicked every time she needed a band-aid. She is an extremely picky eater and her pickiness seems to be related to food texture. She doesn't like to get her hands messy and even as a very young toddler taught herself to use utensils rather than have to touch her food. Art activities were only tolerated when a paint brush or some other tool kept the paint from her hands.

Several weeks ago our occupational therapist gave me a surgical brush and showed me the brushing/deep pressure technique. At first it felt awkward and I was self conscious. Ava was a bit intolerant at first as well. After only a few sessions it became something we both enjoy. I tell her it is time for brushing and she hops right into my lap.

Now, you are supposed to do the technique every 90 minutes to 2 hours all day long. We don't. We do the technique twice a day before nap and before bedtime. I am going to try to incorporate it right after morning dressing as well. However, even with a twice a day schedule I have noticed changes.

Ava now lets me fix her hair. She is more tolerant of a wide variety of clothing situations. She is more adventurous with touching art materials, sticky foods, and muddy or dirty things. She's allowing band-aids without much of a fight. For Ava, the brushing technique has worked wonders.

She's also having a bit of a speech and language and social developmental spurt and I'm not sure that is all coincidence. I think that she's feeling more comfortable in her own skin and less overstimulated by her environment. That translates into more mental resources left over for communication.

So what is the Wilbarger Deep Pressure and Proprioceptive Technique?

This technique of brushing the skin and joint compressions was developed by Dr. Patricia Wilbarger, an occupational therapist and clinical psychologist with 30 years of experience working with children with sensory processing issues. The technique involves running a soft surgical brush (it reminds me of the brush the hospital uses to clean newborn babies) over the arms and hands, back, and legs and feet of the child with a firm pressure. The brushing is followed by a sequence of gentle joint compressions of the fingers, elbows, shoulders, hips, knees, ankles, and spine. The entire process takes only minutes and is often soothing and enjoyable for both parent and child.

Here is a link to a youtube video of an OT using the brushing technique with a young toddler. The video is pretty different than the way we do it. Our way separates the brushing from the joint compressions and is smoother, slower, and more relaxing.

Instructions for the Wilbarger Deep Pressure and Proprioceptive Technique (brushing technique)

Before I explain how we do the technique I should say that this is just the way that we do it as shown to us by our particular occupational therapist for our child. The technique may vary in other situations. Also, I highly recommend that you only perform this technique after being shown how to do it by a certified occupational therapist (which I am not).

Brushing
Use a soft surgical brush. Use pressure firm enough that the bristles on the brush bend. You may do the technique through clothes. My daughter often seems to be a little hot and sweaty and the technique seems to be easier to administer through clothing. Never brush the tummy or face.

We sing a song as we do the technique. At first I would modify the "This is the way we wash our hands, wash our hands, wash our hands. This is the way we wash our hands so early in the morning." song. The first verse would be, "This is the way we brush our arm, brush our arm, brush our arm. This is the way we brush our arm, brush our arm with Mommy." (and so on for each body part). Now I just sing the numbers 1-10 to the melody of a lullaby. It is soothing and peaceful and helps us keep a calming rhythm during the entire technique.

Sit down with crossed legs and invite your child to sit in your lap. Their back is towards you. Begin on whichever side of the body is most comfortable with you. We begin on the right. With a firm pressure, stroke up and down the full length of each body part in the sequence described from 3-10 times (as many as your child will tolerate) moving smoothly from one section of the body to the next.

1. Right arm and hand. (Both sides.)
2. Back. (Have child lean forward so you have room.)
3. Left arm and hand. (Both sides.)
4. Left leg and foot. (Both sides.)
5. Right leg and foot. (Both sides.)

Joint Compressions
You've now worked your way around the body in a circle with the brushing. Set the brush down and move right into the joint compressions. These are difficult to describe in text, which is why it is so important to have an OT demonstrate the technique for you. I will try.

1. Right elbow. Bend elbow 90 degrees supporting elbow from bottom with left hand and holding the wrist with your right. Gently push elbow down into your left hand 10 times.
2. Right shoulder. Straighten child's arm. Place left hand on top of shoulder still holding wrist with your right hand. Hold arm away from body and push straightened arm towards the shoulder 10 times.
3. Right hand's fingers and thumb. Gently squeeze each finger and thumb between your thumb and finger (one at a time) starting at the base of the finger and sliding towards the tip. Do this once per finger.
4. Left elbow. Same technique as before.
5. Left shoulder. Same technique as before.
6. Left hand's fingers and thumb. Same technique as before.
7. Left hip. Cradle the left hip from the bottom with your left hand. This is kind of like having your child sit on your left hand with the left side of their bottom. With their leg bent bring their leg towards their tummy almost like they are going to hug their legs. Place your right hand on their left knee and press down toward their hip 10 times.
8. Right hip. Same technique as before.
9. Knees and ankles. With the child still in your lap place both feet firmly on the floor with their legs bent at a 90 degree angle. Place your hands on top of their knees and gently press down towards the floor 10 times.
10. Back. Set them down on the floor right in front of you and have them cross their legs and sit up straight. Place one hand on their chest and the other on their back and press gently towards the floor 10 times.

Ava just melts into my arms by the end. It is a really peaceful time where we are completely focused on each other and we both enjoy it. The trick is to find the time in a busy day to work it into your routine.

Wishing for Another Year (Upcoming Evaluation Anxiety)

In quiet moments I am beginning to experience a sense of unease about upcoming changes. In five and a half months Ava will age out of early intervention. Before then she will be evaluated by our local school district to determine if she will continue to qualify for services.

Things are going so well right now. Ava has been making steady progress in speech. We finally identified a need for OT and are just now beginning to receive those services as well. The combination of speech and occupational therapy services is powerful and she is making progress.

I am both profoundly grateful for that progress and somewhat fearful of it at the same time. I am happy that Ava's ability to communicate is improving and her frustration is decreasing. I am happy that she's making progress towards her feeding goals. I am delighted to see her become a bit bolder with sensory exploration and a little less overwhelmed in environments that used to be overstimulating for her. At the same time, I am afraid that she will have made just enough progress that she will not qualify for services at the next level.

I feel like we are standing before a diverging path. One path takes us down a road where we can continue intense intervention through these early years and maybe, just maybe find ourselves in a place where she no longer needs extra help later on. I desperately want that path for her.

The other path involves being denied services. We will try to provide her with as many services as possible without help from the school district but it won't be the same. I worry that the second path will involve less intense intervention that results ultimately in her needing extra help for a much longer period of time.

I know it isn't that simple. I know there are always options even if they aren't the ones I want most. I just feel like this transition from the early intervention program happens so quickly. Many children are just settling into a program of services when they "age out" and have to go through another round of testing. Then, even if they do qualify, they go through another round of getting to know new therapists when the old ones were working perfectly well to begin with.

I find myself wishing that early intervention went just a year longer. Of course, I'm sure I'd still dread the transition even then, but at least she would have had the same set of therapists for 18 months rather than for 6 months by then.

Speedy Progress Right Off a Cliff

So Ava continues to do well with her feeding hierarchy. She's pretty much just accepted that she has to take a bite of the food she doesn't like in order to receive more of the food she wants.

Her technique so far has been to pop that food in her mouth and let it sit front and center on her tongue as if I had put something horrendously nasty in there. She grabs her milk and swallows it down as if it were a pill-tasting it as little as possible. In the name of substantial progress, I was letting the fact that she was treating perfectly yummy food like dirt go.

Well, yesterday morning, in the middle of our weekly OT session I had set her plate up with small pieces of sausage. They were the size of large blueberries. A bowl of cheerios to use as a reward had been set to the side. She asked for cheerios. I told her she'd need to eat a small bite of sausage first and I stepped away from the table to grab a knife. Usually I cut a tiny sliver off the larger piece of sausage for her to try.

Well, when my back was turned she popped the entire piece of sausage in her mouth and tried to swallow it whole by gulping several large gulps of milk. I turned around to see her choking back up all the milk and finally (thankfully) the piece of sausage too right back into her lap.

I calmed her down, cleaned her up, and told her I was proud of her for trying such a big piece. I then tried to explain that we can't swallow such big pieces without chewing them first. I'm pretty sure she didn't really get it.

So now we're working on teaching her to put food in the side of her mouth and to chew it up in an exaggerated way. We're teaching the technique with foods she likes first. Once she's really good at it, I'll have to insist she actually chew the things she doesn't like before swallowing them and getting a reward.

I'm pretty sure that this next step forward is going to be a big struggle.

Apraxia Therapy Materials: Kaufman Speech to Language Protocol Workout Book

Therapy Materials Review: Kaufman Speech to Language Protocol Workout Book

This is a review of the Kaufman Speech to Language Protocol Workout Book. The book was developed by Nancy Kaufman, MA, CCC-SLP. Nancy Kaufman is a nationally acclaimed expert in apraxia who has developed assessment and treatment materials in the area of apraxia. The book is 127 pages and is a 9" x 13" spiral-bound hardcover book. This book contains 16 different motor-speech "workouts" and some great resource pages in the beginning of the book on a variety of useful topics. Just like with the Kaufman Kit Level 1, the Workout Book focuses primarily on the consonants /m, p, b, t, d, n, and h/.

Target Audience

The target audience for the Kaufman Speech to Language Protocol Workout Book will usually be children between the ages of two and six. The pictures in the book were designed with those ages in mind. The book will be most useful for children who are struggling with producing simple syllable shapes and need to focus on the early emerging consonants /p, b, m, t, d, n, h/.

Description of the Kaufman Speech to Language Protocol Workout Book

This is a 9" by 13" spiral-bound hard back book with 127 pages. The book begins with resource pages on a variety of topics followed by 16 different types of activity pages. An SLP could pick up this book and use it with clients with very little advance preparation. I believe this book would also be useful to parents for home practice.

• Introductory Pages and Resources
  The book begins with some great explanations and resources:
  
  • Description of the Kaufman Speech to Language Protocol
  • Treatment Tips for Establishing First Words
  • Introduction to the Mutt Family (characters used both in the workout book and the treatment kit)
  • Explanation of Word Approximations
  • Discussion of Vowels
  • Pictorial Guide to Hand Signal Cues for Vowels
  • Vowel Workout
  • Pictorial Guide to Hand Signal Cues for Consonants
  • Discussion of Other Cueing Techniques
  These resource pages are very well done and are written in a way that is easy to understand and very useful. These first 26 pages add significant value to the person trying to use this book to help children with severe speech delays.
  
  Here is an example of one of the resource pages:
  
  
  
  
• Workouts
  The next section of the book consists of 16 "workouts". These workouts are exercises designed to easily elicit many practice productions of specific motor-speech combinations. Each workout begins with an explanation of the targeted skill (for the SLP) and is followed by activity pages that are well designed and engaging even for very young children. The workouts address the following topics:
  
  • Reduplication (CVCV)
  • Consonant Vowel (CV)
  • Same Initial Consonant Pivot Phrases with CV
  • Pivot Phrase "Open"
  • Naming Function: Noun-Verb-Object
  • "I Want" Pivot Phrases to Request Objects
  • "I Want To (Verb)" to Request Actions
  • Final Consonant Inclusion of /p, t, k/
  • Simple Bisyllabics (C1V1C2V2) plus CVC
  • Naming Action: Noun-Verb-Object
  • Sequence Stories: Noun-Verb-Object
  • Present Progressive Structure
  • Short Stories
  • Scripting Functional Language
  • Click here to see sample pages. (You may have to reload page after it opens.)

How to Use the Kaufman Speech to Language Protocol Workout Book

This book is a wonderful resource for any SLP. The early workouts are perfect for beginning work with children with severe speech delays. The later workouts are great for generalization of speech skills and are also great for working on expressive language skills as well. The book is compact, portable, and reproducible. It is a great investment.

Pros and Cons of the Kaufman Speech to Language Protocol Workout Book

• Pros:
  This book is sturdy, has great reference information, and has 16+ ready-to-go activities that are appealing and useful for a wide variety of speech and language students. The book takes you from eliciting single consonants and vowels to generalizing early emerging sounds in phrases and short sentences.
• Cons: The book is expensive. It only addresses early emerging consonants.

Bottom Line:

This is a great investment. The cost is high, but not completely inaccessible and worth every penny. You get a product that is educational for you, includes ready-to-go activities, is appealing to children, and is useful for a fairly wide variety of clients. It is also accessible and useful for parents that want to do extra practice at home for children with severe speech delays or expressive language delays.

You might also be interested in the following articles:

Apraxia Therapy Materials: Kaufman Speech Praxis Kit 1 (Basic Level)

Apraxia Therapy Materials: The Big Book of Exclamations

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Initial H: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview sets.)

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses the word sets. Let me know if there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

Instructions for printing and using the cards are included in the set.

NutriiVeda - Four Month (and final) Update

I haven't done a NutriiVeda update in quite some time. Before I give my final thoughts on the supplement, here's some basic information about how we used it. We never used a full two scoops a day, as recommended. The most we ever managed was about 1 1/2 scoops a day. For the first two months or so I was pretty consistent about getting that amount into Ava on a daily basis. After that we used the product fairly sporadically.

When we first started using the product I thought I saw an improvement in Ava's speech. I thought she was talking more often in longer utterances. Looking back, I'd say that the improvement was likely due to a developmental spurt or due to the speech therapy services she was receiving.

When we went on a family visit for about a week and Ava did not take the supplement I noticed no change in her speech and language. When we came home and began taking the supplement again I still noticed no change. After that, our use of NutriiVeda became more sporadic and I didn't put the same effort into getting it into her daily.

Now, Ava also has some suspected sensory issues. We haven't had our OT eval yet. One of the ways this effects her is to make her an extremely picky eater. I like the nutritional profile of the NutriiVeda as a meal replacement. It is high in protein and low in sugar. Several times a week I mix it into some yogurt and I feel good about giving it to her for purely nutritional reasons.

We are still buying the product. The company will let you call and delay the autoship for a month. We do that every other month. So, we're buying the product every other month instead of every month and we're doing that for nutritional reasons rather than because we feel it has had a significant impact on Ava's speech.

After having tried it, with high hopes, this is my final opinion:

If you can afford it, and want to try it, go ahead and try it. Many parents have reported that it works for their child and you can't know if it will help you unless you try it. However, unless the results are dramatic and you are positive that the product helped improve your child's speech, your money would be better spent on additional speech therapy or perhaps some speech therapy products to help you with home practice.

Final N: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview sets.)

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses the word sets. Let me know if there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

Instructions for printing and using the cards are included in the set.

Initial N: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview sets.)

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses the word sets. Let me know if there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

Instructions for printing and using the cards are included in the set.

Final M: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview sets.)

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses the word sets. Let me know if there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

Instructions for printing and using the cards are included in the set.