Friday, August 26, 2016

Lesson Learned Series 1 2016


1. At the beginning; Take time to teach slowly and accurately during the first two weeks of therapy session for  the following items; Each lesson begins with   the word "relax"  This helps start out the client in the manner that's best for learning the new way to speak.

    a) Placement- Location; where sounds are physically made with lip, tongue, jaw, teeth, so on.
    b) Manner of sound- How the sound is made; with correct airflow, central or lateral, burst or continuous, with full contact or minimal contact, etc.
    c) Voicing- If voicing is required or not (if the vocal fold vibrate or not;  e.g. say /s/, now say /z/  same with /p/ vs /b/, so on.

2.  Keep Parents in the loop:  Parents appreciate knowing what to expect from therapy; I let the the parents know the sequence of events.
     a) Build accurate sounds first (as noted above).
    b)  Then build consistent accurate sounds over many trials (build production number to 200-300 using a clicker. Also by using several methods;  the sandwich method; (start out slow rate, regular rate, slow rate, then move to regular rate, slow rate, regular rate.  Then fade the use of computer displays; look at the computer/ look away from the display if using the SmartPalate Technology, or use facilitating tools to promote placement like mirrors, straws, or flosser, then without them).
    c) Then work through the linguistic complexity; accurate sounds in all positions of words; initial medial, and final position, to phrases, sentences, conversation, Q and As, readings, retells, so on.

3.  The most frequent question parents have about speech therapy;  When will my child make the correct sounds on their own in everyday speech??  (in other words; when will they generalize what they learned in therapy to regular speech).
     a) The answer of course is "it depends" on the child's age. The older and longer a person has had persistent articulation error, the longer you can expect to create new "muscle memory" and fade the old habits.
     b) Mindset of the client;  does he only give his best practice during the "sessions" and never practices his "good speech" at home, in the car, at school, wherever he is too?. Recently I had several kids say, I don't think about my speech anywhere else except during speech time.  Do you see a flaw with that line of thinking??

4. Homework;  this ties in with generalizing- using their "good speech" patterns in other places and with lots of people.
    a) When parents help set up regular homework time, use data charts and provide rewards of some sorts, Progress flows more consistently and naturally. The practice time only needs to be 5-10 minutes per day  or at least 3X per week. 
Here are the rationales for practicing outside the therapy room.
Rationale for Homework
1. Develops better neuro-pathways with practice
2. Strengthens generalization and automaticity
3. Correct productions become more accurate and consistent with less effort.
4. Progress seen across linguistic complexity.