Thursday, May 3, 2018

Play by the numbers

All my toys are in cupboards in my treatment room. Recently, one of my parents was delighted that their child had “moved to a new cupboard!” I sort my cupboards by age and ability After all, language and play go hand in hand up til age five. Here are a few favorites:


6 months: Such a simple toy, but this easy grab-it ball for little hands is perfect for bilateral hand skills. Midline work increases the likelihood of sound production. 


2 years: Gearation! Probably the most popular of all toys in the cupboard. Great for bridging the gap between direct cause-effect and indirect cause-effect play.
Kids are moving from one to two words. As they begin to combine toys, they begin to combine words. 







3-5: Any Fisher price, Imaginext, playmobil or other symbolic play toy. Get those narratives going. Once they combine toys they are combining words. 


Elementary: 
Marbles. I can sort them, do science and verbal reasoning, make predictions with them (light? No light?, how many little marbles will it take to equal big?). If I have a marble maze to put them with, I can create an activity while working on speech sounds. 


Rush Hour: Play using
the answer key. For receptive task, the child must listen and follow 2-3 elements correctly with spatial directions. Ask for more info, find out if they missed something if the car can't drive out at the end. For a tougher expressive task, the child decodes the answer key (QL3 for green truck left 3) and provides the directions to the SLP or other kids if in a group.


For the complete, detailed list check out the handout on my website.



Wednesday, May 2, 2018

It’s a thing, you know

Cocktail speech: when a person uses generic words to ask or answer a question. 
Word retrieval difficulty: when a person has difficulty finding and retrieving the desired word. 

Cocktail speech is a common strategy for the child with a language learning disability with word retrieval difficulties. Using non-specific words often works for them in conversation because the listener tends to fill in the missing information.  When writing or providing specific information, generic words lead to confusion.
A fun way to address this is to work on those “bottom-up” *strategies. Create a situation where the child realizes on their own that they didn’t ask for more information or they didn’t provide accurate directions. This barrier game for mid-elementary kids is the last part of an activity where we have first:
1) pre-taught key words/concepts
2) classified attribute blocks in as many ways as possible and the child has labeled the big idea (size, shape, color,etc) 


Then I grab my super super magnetic board and we take those same attribute blocks and do a receptive and expressive language task. 
Did the child understand when I said “Put the blue triangle in the middle of the board” or “Place the large yellow square below the blue triangle”? If the items don’t match, then we need to figure out (and recall) what needed clarification. Sometimes it’s me that needed to provide more information. 

Then the child gets a turn at providing directions. I translate their left/right on my side so we match up. Did they tell me the shape they meant to say? Did they mean below or did they mean under? 

Easy peezy , lemon squeezy.  But so powerful! 

*bottom-up strategies are when the child is taught something without direct instruction. They learn from the activity. This method has more opportunity for acetylcholine  activation! Those epiphanies provide an extra kick.

*top-down strategies are direct instruction. Someone is telling the child how to do it. 

Monday, April 23, 2018

My neural neighborhood has a playground with a bouncy bridge

The lateral S can come from a combination of oral motor and instability elsewhere in the body. The jaw will deviate. The middle of the tongue is often used to stabilize instead of the trunk or core.  They’ve been building a neural neighborhood that says “SLSHHH” instead of “SSS”. Every time they reinforce that position, the stronger the connection. The SLP that has had enough will go to extremes to clean it up.
We use our knowledge of neurology. (Bet you thought I was going to mention peanut butter and tongue wagging). We know that mirror neurons are activated when the child sees/hears us produce the sound- even if they are not making the sound there is ACTIVATION. Where there is neural activation, there is the beginning of a neural connection that we are going to hijack for that skinny S. The more correct productions result in activation spikes which carry  down the synapse to the dendrites which connect with other neurons and more connections are created. We build a new neural neighborhood.
We are going to use the main concept in every motor/muscle based regimen the world over and require PERFECT PRACTICE. 
We are going to get the sound established so we can do the perfect practice.
We will use dynamic systems theory and utilize any underlying systems that are related: the swallow pattern and hearing history. We'll activate core and trunk stability, systems that support the jaw and tongue working independently of each other. 
We will provide support on the side of jaw deviation when eliciting the sound. 
We may make a snack hat and give the kid symmetry and resistive movement when  practicing.
We may place straws to the labial frenum to get that tongue to follow the straw movement for perfect S placement on the alveolar ridge.
We may need to address that swallow pattern if we can’t get the correct placement.
We will use diagnostic treatment to determine if the kid is a bottom S and need to change tactics. We will use diagnostic treatment so the treatment is most appropriate.
We will use pop rocks and alert the oral motor system that this is what VERTICAL feels like. We will use the pop rock placement as a cue for placement.
We will amplify sound and bombard that auditory system with the correct sound. 
We may put kids on therapy balls, anything that activates the core, while producing the sound.  Activating the core facilitates jaw/tongue differentiation and supports the stability for the S without too much verbal instruction. 
We will use the midline (because-corpus callosum)  to our advantage and have kids cross midline to promote the blending and elongation of the S. This can be swinging the arm across midline while speaking or talking and moving a sticker to the other side of a paper. It may be puppets with a big attitude. We are creative after all. We know that the more interesting we can be, the more acetylcholine is released and this is the glue that makes learning stick.
Car homework 
Kids have to practice repeatedly throughout the week in short bursts or the neural network flounders. Neurons must activate repeatedly to network.  
Practice must be perfect. It must be individualized for each child. 
Family is the biggest part of this entire process. Parent coaching is key. Parents and child must be empowered.
This sound can take forever to correct if the underlying systems aren’t incorporated to support the correct placement and production.  But we are the communication specialists. We get that sound. The family does their part. We get a neural neighborhood with a skinny S. Years later, the child vaguely remembers speech therapy with a lady with crazy hair and ridiculous puppets. WE know that incorporated in all those fun activities was science from our field and others that created that effortless neural neighborhood.