Therapy Progress - Steady Progress and Subtle Change

I was looking back at all of Ava’s progress reports and I realized that her progress has been very steady. Every 3 weeks or so, significant progress has been made. Here’s a quick summary.

• Beginning of January – Ava had only three “words” and very few consonants and vowels.  She couldn’t imitate.  She was starting to use gestures instead of even trying to communicate verbally.  We began therapy and Omega 3 supplementation in January.
• End of January -  At this point Ava would imitate when bribed with food.  She had learned several new consonant sounds and was using 15-20 words spontaneously.
• Middle of February - Ava was spontaneously trying to label things.  She had started two syllable words like “nanuh” for banana and “baby”.  She was making further progress on consonants and some progress on vowels.
• First Week of March - She started putting two words together make short phrases and sentences.  It was a huge step.  We were getting 3-4 syllables strung together at a time.  
• End of March -  Ava was continuing to practice multi-word utterances.  She was using them more frequently and would often use three word sentences.  Occasionally we would even hear a four word sentence.  We started using Nutriiveda.

 

At the moment, we’re trying to add a little clarity to Ava’s words.  Before, her words had no final consonants (“ha” for hat) and no medial consonants (“pu-ee” for puppy).  We’re using gestural cues to help her add those back in.  It’s working.  She’s occasionally doing it spontaneously (she’ll add the /t/ in the middle of turtle), but most of the time we have to remind her (using the cues).  When she’s imitating I’d say she’s successful about half the time.  It depends on the sound.  She does a great job with /t/ and /p/, but /d/, /b/, /n/ and /m/ are harder.  She doesn’t have /k/, /g/, /f/, or /v/ at all, so we aren’t even trying with those. 

All of these things are very concrete.  These are the kinds of things that speech pathologists choose as goals and can collect data on to track change.  I talk about this kind of progress because I am a speech pathologist and these changes make sense to me.  I’m proud of them.

There has also been a more subtle kind of change.  This is the change that my husband and parents notice.  It’s less about specific sounds, utterance length, and data and more about Ava as a person.  There’s been a change in her confidence.  She’s talking more.  She’s talking when she’s by herself in another room.  She’s chattering away in the back seat of the car.  She’s trying to sing, laugh, and make jokes.  She has conversations with her parents, grandparents, and brother.  She is no longer the baby who had to grab my hand and drag me to the refrigerator, pound on the door to get me to open it, and point to ask me for milk.  Now she can just ask, “Mi pea!” (Milk, please!)   It’s been a wonderful change to watch.

How do you measure progress in your little ones?

Nightmares and Dreams

I rarely remember my dreams, but I had what I consider to be the worst nightmare of my life recently.  The nightmare started out well, as they usually do.  Michael and I were in some kind of store having a great time together.  The shelves in this store were made out of a really lightweight plastic, and when a spot was empty on the shelf you could see through to the next aisle over.  Michael was on one side of the shelf and I was on the other and we were playing peek-a-boo.  We were both having a blast.  Then he started trying to climb through the hole to get to me and the entire shelf and all its contents began to fall towards him.  I tried to catch the shelf to prevent it from falling but I couldn’t hold it up.  That shelf and the next three shelves all toppled over like dominos burying Michael underneath. 

My first response in the dream was embarrassment – not worry.  The shelves were so lightweight I really thought he was ok under there and I was more embarrassed that we had made such a huge mess in the store and attracted so much attention.  Then I started frantically trying to dig him out.  When I found him, he was mostly limp and dazed.  He was confused and murmuring, “Mama” over and over again.  Then, in a flash, in the way of dreams I suddenly knew that this was very bad.  I cradled him in my arms sobbing.  I knew he was going to die.  Then I woke up.  My face was covered in tears and my heart was racing.  I felt sick.  Seriously, it was the worst nightmare of my life. 

As a contrast, I also recently remembered a good dream.  In high school I lived in Pennsylvania in a home with a pretty unique architecture.  For example, this house had two kitchens – one on each end.  It also had two bathrooms side by side.  The elderly couple who owned the house before us apparently liked to keep things separate and converted a screened in porch to an extra kitchen and one large bathroom into two small ones. 

In my dream my family as it is now (my husband and I, and Michael and Ava) were living in the PA house.  I was in the extra kitchen and found a previously undiscovered cabinet full of old toys.  The kids were elated.  As I pulled the toys from the cabinet I found a hidden door and tunnel.  We crawled into the tunnel and found a passageway that ended in a secret playroom and nursery.  The playroom was full of really cool 60s era toys and the nursery was kind of like the one in Peter Pan.   It was a bedroom for two decorated beautifully with two twin beds, small dressers, lamps, mobiles, a rocking horse, etc. 

As I describe it, the dream sounds pretty mundane and unremarkable, but it felt like adventure, discovery, and treasure all rolled into one and left me feeling happy.  Well, I was happy until I found out that I was awoken by my husband calling for assistance because Michael had thrown up.  Isn’t life with young children always like that?

Gestural Prompts for Apraxia – Therapy Techniques

Using hand signals (sometimes referred to as gestural prompts or visual cues) paired with specific speech sounds has been very successful at helping children with apraxia learn and use those sounds. Every professional book I have read about apraxia has a section on this technique. Every speech pathologist I’ve been working with uses gestural cues. It has worked exceptionally well with Ava. I’m going to explain the therapy technique, give you a specific example of how we’re using the technique with Ava right now, and then give you descriptions of several of the prompts we’re using right now.

Using hand signals is very simple actually. You just make sure your child is actually watching you, and then use the signal as you say the word. For example, right now we’re trying to get Ava to use the /t/ sound at the ends of words. She’ll say “ha” instead of “hat.” I will repeat the word emphasizing the /t/ sound at the end and at the same time I make the hand signal for /t/ (tapping the index finger on your upper lip right under the nose). The visual cue in addition to the auditory cue really seems to help her focus on that missing sound. Almost all the time now, she’ll then repeat the word adding the missing sound. She often uses the gestural cue herself when she repeats the word correctly. We’re also using the technique in the middle of words. Ava will say “tu uh” for “turtle”. If I use the hand signal for /t/ while emphasizing the /t/ sound that should be in the middle of the word, she will repeat, “tu tuh.” She still can’t make the /r/ or /l/ sound in that word, but she can add the /t/ in the middle.

These are the gestures we are using as our hand signals. You can use a different signal, it just needs to be consistent.

• T - tap the index finger on the upper lip right under the nose
• D - tap the index finger on the lower lip above the middle of the chin
• P - close your fist and pop it open (into a "5" position)
• B - use the ASL sign for /b/ and tap the hand gently against the side of your chin
• M - gently pretend to pinch both lips closed together with your index finger and thumb
• N - push index finger against one side of your nose as if you're trying to close one nostril
• SH - finger across your lips like you're shushing a child

There are more. You can find a hand signal (or make one up) for any sound you might be working on. Here is a link to a great video of a woman demonstrating a hand signal for almost every sound. Some of her signals are different from what I described above and that’s ok. You can use any signal you’re comfortable with as long as that symbol is consistent. Also, don't feel like you need to learn all of these at once. Pick one or two to start with and if that goes well you can always learn more. Be sure to choose a sound that your child is currently working on and check with your SLP. She or he may already be using a hand signal for that sound.

Other than tapping, this is the technique that has been the most successful with Ava. I highly recommend it.