Wednesday, June 9, 2010

Summer Therapy Short notes

The first week of Summer speech therapy started out so smooth this year.
1. Thanks to another certified therapist getting on board and hiring 5 graduate students and 4 senior volunteers. (hint for professional- this is the way to go!)
2. Also, I was able to evaluate the clients early except one this year. That also made a big difference.
3. During the oral motor check make sure and watch out for jaw movement, lip tensing,
coordination problems and kids grinding their teeth. (this may pose problems on the mouthpiece sensors working properly.

The second week
1. More kids have broken sensors this summer than last, watch out for kids that grind their teeth. Add this question on your oral motor check. If this is the case, let the parents know this may be a problem with grinding through sensors on the smartpalate. They should see a dentist to resolve this, or at least therapist need to have the clients take the mouthpiece out more often, after saying several words, so they don't chew on it between words.
2. We also learned to not put too much denture adhesive on the mouthpiece. More isn't better, in this case, less is better, but you need little dots on four areas, front, back, and sides by the molar area. If this doesn't work well, try cutting small pieces of denture grip tape and put on the four spots.

The third week.
1. For better /r/ resonance, have the client look at the display and have them put their tongue near the last molars, keep the tongue there and have them push air over their tongue when they say their /r/ words. This improved resonance and /r/ production. Many clients have been saying /r/s too tight in the back of their throat, sounding like a growl, while others have their contact patterns to forward opposite of the correct contact pattern shape, weak /r/, deroticized. NOT everyone will have the same /r/ contact pattern, but generally the /r/ contact pattern looks most like the sound "ee" "oo" and "y in yeah"'

2. Another thing we learned was that some clients produced words in a harsh choppy fashion, so if we modeled the words in a smooth " sing song" fashion. then they produced the words more smoothly. I reminded them to let their tongue do the work not their head, neck or upper torso.

3. There is a progression of /r/ development. some progress from "re, r, r-blends, gr, kr, to front r blends; fr, br, pr, to complex /r/ blends; str, through all vocalic /r/ words." While others need to learn to adjust their tongue from either too forward, or too far back to the right placement by the second to the last molar, palatal area. Then after they can adjust their tongue, they need to slow their their words as they go from clear vowels to schwar /er/. In most cases clients didn't realize their were two sounds they were transitioning into. they thought it was just a /r/ word, which often was produced in a flat way.

The Fourth Week
1. We learned it's typical for clients to have intermittent high moments and frustrating moments. Everyone should be aware this is a natural process with most therapy, so no different using palatometer system. However, the best thing about using the palatometer visual display is that clients seem to "understand" better why it takes so much practice to accurately "train" new motor movements. They "see" the benefit of how "they" make the small positive changes happen.

2. Another thing that worked well with clients was to rotate through different sound groups.
Even if they have one sound to perfect, i.e. the/r/ sound, move through consonant /r/, vocalic /r/ and r blends. just to give a break from over working one area too long. Also alternate easy target words with difficult words so they can see, feel and hear their success. Success breeds more success.

3. All clients are making steady progress. It's a beautiful thing! Those working on correct /r, er/ are now able to say them in sentences with and without the smartpalate. As they advance, record them talking for 1-2 minutes, then let them pick out target words that they might need to work on as well as target words they did well on. Be sure and work on "natural" sounding phrases with accurate prosody. Many clients will focus so hard on producing accurate sounds that their speech becomes a little robotic if you don't add natural prosody into their practice.

The fifth Week.
Wow, It's hard to believe five weeks went by so quickly.
I got some great comments from my hired graduate students and volunteers. Here are their comments:
They found that the palatometer technology provided great visual displays where they noticed that clients made quicker progress with their speech and most "traditional" therapy techniques.
Client's understood where to put their tongue for correct placement
Client's worked better because they had on-line visual feedback.
Generalizing went will with most clients if they did their homework.

Parents and clients commented that they were impressed with the progress.
but many were worried that they will lose their "correct" speech patterns. Research has shown that even after a year, clients kept their accurate speech.

Client H, age 7.6 Third day of summer speech program.
Graduate Clinician helping with his practice.
It's typical to provide more prompts to "look" at
the monitor for young children.

This client has articulation and nasality issues but the visual tools helped him to produce his sounds more forward as he still worked on correcting "R" words. The vowel formant visualizer tool allowed him to see if he moved his vowel to the 'ER" position, while the palatometer tool allowed him to see his tongue contact for the "ER" or "R" position. It may seem confusing at first glance but we would point and look at only one thing at a time. It was nice to have them side by side as I was able to see that both displays confirmed the production accurately. It appeared that the palatometer visual display was easier for the child to understand and control.