A+SPEECH THERAPY

Palatometer Speech Therapy Supports

2011-09-05T20:15:00.004-06:00

Even though the Palatometer Technology is a super visual tool, the certified speech therapist is also a vital part of the therapy process.

Tactile cuing is used to feel voicing.

Extra visual cues are used to "see" and reduce lip tension.

Independent practice is encouraged for 3-5 minutes; A process for the client to make "total connection" with the screen and make fine adjustments with the tongue without the therapist's feedback (Gold Standard scoring). Evidence based research from Anna Schmidt (2009) Kent State University.

Er Practice

2011-08-15T15:01:00.007-06:00

This boy was such a hard worker. He wanted his "er"s to come in and today he turned the corner with his own method of practice. He said "I like making the green lines." So I thought why not let him practice making more green lines with the 'er's. He demonstrates how he makes the green lines while practicing better 'er's. Last Friday he wasn't making clear 'er's in isolation or in words.
He is on his 9th session using the palatometer and can say most /r/ words in initial r, or r-blends like, fr, gr, kr, br, tr, so on. He also improved on 'or, ar, eer' but the 'er' was the hardest for him like so many other kids with /r/ issues.

He puts 'er' into words in this video."Bird, Bert"

IN THE NEWS

2011-07-12T15:08:00.007-06:00

Here are a few photos and video links of palatometer therapy. I'm using the palatometer technology, which is a visual tool that allows people to see exactly what their tongue is doing. It's a great speech tool.

New version of old technology aids speech therapy | The Salt Lake Tribune

www.sltrib.com
KSL.TV NEWS on palatometer technology.

Here is one more NEWS SITE.
http://www.deseretnews.com/article/705387805/Speech-therapy-a-cinch-with-new-tongue-technology.html

Summer Speech Program; Volunteer's Review

2011-07-10T21:18:00.004-06:00

Mrs. Dorais,

I had a fantastic experience volunteering with the intensive summer speech program. It was amazing working with these kids. They showed me that I really do love this field! The palatometer is one of the coolest tools I have ever seen. It really helps these kids, and older clients, understand how to produce sounds correctly, and I can't believe the progress they made!

Sincerely,
Cassie

Hello Mrs. Dorais,

I must say that I was incredibly impressed with the intensive summer speech program. It was well-organized and I was amazed with the progress that the participants made. They all (and their parents or grandparents) seemed so thrilled with personal articulatory and phonological gains. You and the other speech therapists were very much in tune with the specific needs of each client. You pushed them to work hard and make improvements, but not beyond their breaking points, so to speak. I really hope to develop such adeptness pertaining to a child's limits and behavior management.

Thank you again for the experience. It was extremely worthwhile!

Sincerely,

Liz Perry

Mrs. Dorais
Thank you for allowing me to work with you during the summer clinic. I felt comfortable in the clinic setting as you were so accommodating and inviting to me and all of the other volunteers . I learned a great deal about Speech Therapy and people in general. It was a special experience for me to see the concepts I have learned about in class be applied to real situations. Disorders of Articulation became real to me as I saw how the palotometer worked and practiced the /r/ phoneme daily with C. (one of Kristine’s patients). The concepts of Speech Anatomy were reaffirmed to me as I witnessed how simple breath adjustments and relaxation of the articulators could produce the perfect /r/ blend. It amazed me how the simple instructions of laying down, breathing in the nose, letting air out the mouth, opening up the vowels and saying words like “are”, “or”, “air”, “ear”, etc. while relaxing could be the perfect adjustment to making the /r/ sound perfect! Language Disorders and the stories I had heard Dr. Fujiki and Dr. Brinton share became very clear to me while I worked with sweet G. I learned how important language is as a communication tool and its everyday implications. I also learned how important family support is through the process of acquiring language. Watching mothers, fathers, and grandparents attend therapy sessions daily and then talking to them about their child’s accomplishments in speech was special for me. G’s mother, particularly, became a saint in my eyes! Hopefully that gives you an idea of what I learned these past several weeks. Thank you again for allowing me to be part of the experience. Have a wonderful summer!

Kimberly Clark

Intensive Summer Speech Program; Parent Review

2011-07-10T11:56:00.006-06:00

Thank you parents and participants!
Well it was unanimous that the Intensive Summer Speech Program was successful.
All the parents that took the time to submit the the program survey indicated that they felt the Summer Intensive Speech Program was either "very successful" or "extremely successful" for their child. It was also noted that they wanted more time with the therapists. This showed they liked what was going on. With this said, they didn't realize that the program was running on a research principle that indicated that 30 minutes of intense therapy time was optimal for most age ranges. This is done to avoid client burn out, or fade into poor production. Yes, some wrote it took a little time to get warmed up with some kids, but that was mostly due to the child's nature more than the program. Even if they got 20 minutes of optimal time, that is considered better than forcing work over 45 or 50 minutes.

Again thanks to the parents, clients, volunteers, and staff for their hard work and positive support! Each summer the demand has increased so I imagine it will continue to increase as usual. I look forward to next year's group. Please share your positive experience with everyone you know so the program can continue to grow and help others.

Instensive Summer Speech Program; Therapist's Review

2011-07-07T21:11:00.010-06:00

It's hard to believe 5 weeks of summer speech therapy could go by so quickly.
Tomorrow is the last day of summer speech program. It's bitter sweet, as it's been challenging for some clients yet so rewarding to see their progress. It's nice to be finished but hard to say goodbye to so many.

I continue to learn how to streamline and make therapy optimal for each client. This summer we tried a new system and it seemed to work quite well.
1. We practiced with a voice warm-up for some clients who needed to increase their "speech power" (loudness and breath support), and for other clients we went through the /R/ warm-up sheet. With some we had them play with the tongue coordination game.
2. We practiced words from the previous day's last target sound worked on for 5-10 minutes
3. We rotated through a new target sound during the 3-5 minute individual practice time. This practice time is one of the most critical components of speech therapy using the palatometer technology. This private time allows the client to really focus on making connection with the whole process, as they light up their tongue target display.
4. We reviewed and worked some more on their target sound, went over their scores, their challenges and so on.
5. If time was left, we practiced one more words with a new sound target during the 30 minute session.

The next day, it starts all over again, we first reviewed the last target sound that was practiced, so on. This practice pattern seemed to allow for more sounds to be corrected in a short period of time. If one target sound was troublesome, it was almost better to review lightly than to over work it. Once they get all their target sounds down well, we moved into recording (with a digital recorder or the Ipad) the client for 2-3 minutes with their spontaneous speech without the mouthpiece. Then we typed or wrote down every word they say with their target sound in it, next we reviewed the same words with the "smartpalate" back in their mouth on "gold standard" to see how they scored.

It's interesting what made articulation therapy using the palatometer technology incidental learning for some and more challenging for others. I'd have to say for the most part, clients with good work ethic, good attention made the fastest progress. However, even those that had more issues still made incredible progress with the palatometer technology and intensive speech practice.

If you add any layer of issues even for neuro-typical clients, like lack of motivation, lack of home practice, etc, it cut into their progress.

Fun Speech Parctice Idea

2011-06-13T21:08:00.007-06:00

Power Points can be a fun way to practice functional words and phrases.
The words were collected from parents from a invitation on google.doc that stated the child's current interests and list of words they attempted.
I used real photos from google images, real family photos, or children's favorite characters.
Then share your ppts with the family. Here are a few example of several different types of functional practice ppts.

1. Functional phrase "Time to . . ."

2. Functional word with several real photos.

3. Reward Practice, "Star Wars Words." As the child needs a break they can work "for this break"
and then print one page per week to collect the pictures to make a book to take home to practice.

Speech hierarchy

2011-05-31T20:22:00.003-06:00

When you get into a speech therapy program
you can expect the following hierarchy of steps
to go through in order to be proficient with your
new speech pattern.

Using the Green Sound Visual Display

2011-05-13T22:05:00.006-06:00

Articulation therapy; focusing on (er) in "bird"
You can use both the placement display and the green sound display.
Sometimes the green sound waves help clients focus on the manner of their speech by watching it. You can show them to watch for accurate consistent speech forms by making each word shaped the same.
You can also show them how they might make adjustments in their speech, by not adding intrusive sounds, or approaching their word incorrectly. For example, in this clip the child wants to approach the word "b, o, r, d" versus "b, er, d."

Practice Sample Video

2011-03-30T20:30:00.016-06:00

If a picture says a thousand words then what does this clip tell you. Notice how the child practices so well looking at the display, the child wants to make the computer light up. Great natural motivator for great practice.

Teaching K to a preschooler age 4

2011-02-09T10:18:00.002-07:00

Learning back sounds for a child can be hard, but teaching back sounds can be just as hard when you can't see what the tongue is doing back there, The palatometer display will show you and the child exactly where the tongue contact is.

In this first clip, notice that the child's tongue tip is touching the front and not in the back like it should in the word chicken.

In this second clip, the same child is trying to not touch the front part of his mouth but by saying it too far back. Notice there is no display (dots lighting up) contact because the child is saying the /k/ too far back in the glottal area. This is often a common error on the therapist part to keep this incorrect placement going without realizing it because it's so exciting to get a resembling /k/.

In this third clip, you and the child will see the back contact forming, like it should. It's not perfect yet but it's where it needs to be.

in this fourth clip, you and the child will see the contact for both /k/ words, bike and key.

this is a good facilitative technique to pair words when they have same tongue contact in both words but are in different locations in words; e.g. final vs initial position of words.

Newsworthy Item

2010-08-19T16:06:00.006-06:00

Hot off the press, CompleteSpeech is hosting a pilot program for PARENTS to get rental palatometer systems to use at home. This will allow parents to see more progress with their children as they will be able to monitor daily home practice.

This shouldn't take the place of seeing a certified speech therapist as they are the only ones qualified to evaluate your child's speech completely and accurately. They will guide you with what needs to be worked on and how to work through the speech issues.

If you are interested in this home program, leave a comment at https://www.completespeech.com/ they will love to hear your thoughts on this.

new video clips from summer therapy

2010-08-03T09:37:00.006-06:00

Client A, age 11, with unknown syndrome (to be determined) has articulation, prosody, multiple syllable and formulating complete sentences issues.

She was a hard worker, had good attention, pleasant, and very stimulable for remediation with visual prompts and displays. She made steady progress each week. She will continue with speech therapy with the palatomer technology but with less intensity during the school year.

This is a good reminder that children with more than just a simple articulation issues will require more time with therapy.

Research has shown that with every layer of concern: cognition, attention, motivation, sensory- hearing, oral defensiveness, severity of the problem, and multiple problems will affect their longterm prognosis. It not to say they won't make progress, they will, parents need to be more patient with the curve of their progress.

Informal gathering of data has been showing that articulation therapy with visual display using the palatometer has allowed almost all the clients to make faster progress (better curve) than traditional therapy in a shorter amount of time. (More research needs to be done of course)

Client A was working on her /r/ words in this clip.

Summer Therapy Short notes

2010-06-09T22:37:00.018-06:00

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.

INTENSIVE SUMMER SPEECH THERAPY HIGHLIGHT CLIPS

STAY TUNED; MORE TO COME

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.

Typical R practice using the Palatometer Technology

2010-02-10T13:17:00.009-07:00

This is only the fourth session for client M-3, female, age 9.4

Client is reviewing new unpracticed R words

Still the fourth session for client M-3, female, age 9.4

Client is practicing her correct /r/ words with a harder /r/ word

"reach" and "bear" Look how well she tries to get her

/r/ placement/sound on her own.

One Benefit of Learning Correct Swallow

2010-01-27T15:28:00.004-07:00

A high school client told me today that he realized that after he learned how to do a correct swallow he was able to swallow "pills" for the first time. He said it was kind of bad, that he could only take liquid form or his mom would crush pills and put it in yogurt. He feels more grown up now that he can actually "swallow" pills the right way. He said he use to choke and gag on pills or they'd come out of his mouth.

Technique to increase self-monitoring skills

2009-12-15T21:06:00.007-07:00

Many children with articulation problems have an underdeveloped auditory feedback mechanism thus it makes it hard for them to "hear" the difference in their speech to know correct from incorrect (distortions).

The palatometer provides another modality "the visual" modality to facilitate the underdeveloped self-monitoring process.

Here is a simple technique.

1. Record the child or adult saying a word three times in a row. Save the recording.

2. Play back the recording and have the client listen to each word again and judge each word by putting a mark on a written visual acoustic arrow as to how close to the correct target they were or how far from the correct target sound they were.

3, Then go back find the worst sound display and click through the visual display/target sound to see what went on, do the same clicking process of the display with the correct target sound.

4. Let the child tell you what happened. One mother said "I really don't believe HE can hear the difference" and the child said, " I sound the same as all the other kids not in speech." After going through the visual check of each sound, he said "I didn't get to a correct /s/ placement and it went into a different position which was incorrect placement for 3 msec., while the other good /s was held in the correct placement for 4 msec." He liked to use numbers. Wow, he was totally accurate with the description after visually seeing the difference once. After this process, he self-corrected incorrect /s/ words two times in a row in his connected speech. His mom just smiled big at him and he smiled back. He realized he made the correct adjustment and carryover from what he had just learned.

A video display of this techniques is coming soon.

correct Swallow palatogram video

2009-10-12T12:02:00.002-06:00

One of the major goals for correcting tongue thrust is to

establish and maintain correct swallow with liquids and foods.

Here is a new demonstration video of using the palatometer

system to teach tongue placement for correct swallowing pattern.

EVIDENCE-BASED THERAPY

2009-10-05T08:12:00.015-06:00

Therapists often want to provide the best evidence based therapy possible, but does it always translate into evidence based-results across all therapists?

There is no doubt that using the palatometer system provides such evidence based-results. Further more, using the palatomater system, could even -out the playing field for most therapists.

I'm kicking myself because I should have taken photos of before and after results of several tongue thrust clients that came in with occlusion gaps, ( even after two years of braces because of their tongue thrust problem.) This is a good lesson to be learned; take the time to snap a before and after client photo with dates.

The results were truly amazing. Only after ten sessions (5 weeks) the client's occlusion was beautifully fixed as well as his tongue thrust and speech. It's hard to put into words the sheer joy that comes over you, when your clients make tremendous progress. It's that kind of progress that all therapists dream of for their clients, but was made into reality with the palatometer technology.

PALATOGRAM DISPLAY

2009-09-19T16:04:00.020-06:00

"agah" "akah"

Notice the back two lines of the mouth, the /g/ has more contact points than /k/, that is really the only difference.

These are rough samples, not perfect samples.

Children who front their /k, g/ sounds often substitute /t, d/ for the back sounds. I have noticed that they often have very strong tongue tips, but somewhat uncoordinated muscles in regards to separating out tongue movement from jaw, lip or head movements. There are many strong opinions in the speech profession about whether this disorder would fall under articulation or phonological processes. I will take the stand on this situation as being a placement issues from my observations. If you want to read up on both sides of the issue go to ASHA.org website.

This brings us to HOW do therapists teach young clients to separate each mouth part yet teach the correct target sounds. Try having the client say a few words like " take, cat, mac, mickey," if all the Ks sound like /t/, most therapists cringe because they know they have their work cut out for them. Another hot debate is whether or not to use some oral motor exercises when teaching correct articulation. I'm with the mindset that you can use simple oral motor exercises briefly to help with placement and manner, but not to use them beyond their scope of utility.

I discovered a few good simple steps from close observation of clients and the assistance of the great palatometer displays. The amazing part was that I was able to see a client's progress from incorrect to correct placement in just three visits, (translated into two weeks) for isolated "K" and in word level. Most therapists without the palatomer technology work on velar sounds for months and months if not up to years.

Here are the steps for teaching correct /K, G/ placement with the palatometer.

1. Teach the client to keep their mouth open by saying "ah" (***watch out for jaw closure of any degree)

2. Now press a tongue depressor on their tongue tip as they keep their mouth open and say "kah or gah". (*** watch out that s/he doesn't push the depressor out, because they will). This simple exercise can be sent home with the depressor, so the child can practice the "kkkkah" sound with the parent as many times as they need to with and without the tongue depressor.

3. Next, have the client make a fricative /k/ like "kkkkah" sound with their mouth open, without moving their jaw closed, or moving their tongue tip up. (***Use a mirror, and s/he may have to hold their jaw still while keeping their mouth wide open)

4. Remember at first, the palatometer display showed that the client used his tongue tip to make the "kah" later as they can make the fricative "kkkah" the display will show no contact at all because they will try to make the "kkkah" very far back in the throat where the sensors do not touch. (this is all good !). When you see no sensors displays, this is great, it also means no tongue tip is being used to get the "kkkah" sound. (Cheer, this is progress)

5. Now you will start shaping that "kkkah" with k at the end of the word or middle of the word. (like (VCV in sack, or "ickey"), notice that their "k" dots will show on the display now, the "K" comes more forward producing a correct "k" sound, with no tongue tip display. This is the best because the client can now "see" they are producing the "K" correctly!

If you need to, you can go back through steps 1 to 3 again till the client can say "ickey", or "ick" or kick" or "ake, or "cake" use assimilation principle to help facilitate the two "k" sounds. later you can use font and back sounds in the word like pick, tick, pack, tack, but don't do this right away since they may revert back to fronting the /k, g/ to /t, d/. Wait on proceeding to harder words till the "K, G' is will established.

Three cheers for the Palatometer Technology!!!

Progress from word, phrase, to sentences

2009-08-19T14:50:00.009-06:00

Client E: Practicing /S/ sentences

Client E, came in three times per week, total 10 sessions

Came in with lisp, and strong tongue thrust

causing a gap between her teeth.

She is practicing /s/ production in sentence

level. She is in her third week and re mediated

all target sounds, established and maintained correct tongue

rest position and swallow with all liquids and foods

ARTICULATION THERAPY WITH THE PALATOMETER SYSTEM

2009-08-19T13:58:00.027-06:00

5-minute practice on

word and phrase level

Therapy session in action

with split-screen display.

Denture Paste Use, and more Aug 2009 lesson

2009-08-16T22:13:00.009-06:00

Denture Paste Use

I used denture grip paste to keep smartpalate in place with a child who had nubs for teeth. Don't use too much or too little denture paste, it can cause problems. If it falls out after 10 or 20 seconds, just put it back in the mouth and gently hold for another 10 seconds. Usually it take hold. The client can practice chasing dots with the "Tongue Coordination" game while the paste is setting up.

Children with tongue tied issues, should get it resolved first before working with the palatometer system. For others who have tongue tip weakness, You can also work on tongue tip coordination and strengthening for a week or two. This greatly supports therapy production.

Tongue Thrust
The palatometer system has proven to be helpful to remediate tongue thrust of all kinds within 5 + weeks, if seen minimally 10 sessions. If they have tongue thrust and sound errors, therapy time will vary and most likely take up to 20 sessions or so.

Getting placement of sounds is the easy part with the palatometer, getting it to carry over with clients who have apraxia is another matter. Neuro-typical clients do well with catching on to placement and generalizing new skills from word to phrase to sentence level. It still takes time to generalize to conversation.

Optimal Therapy schedule
The optimal therapy amount for success seems to be meeting three times per week for seven weeks, or 2 times per week for ten weeks.

For next summer intensive therapy session, try holding therapy 4 times per week over 5 weeks, this will be better, providing one more week for progress, than what we did this last summer which was 5 days per 4 weeks. Some clients that had multiple issues needed more time.

Hard of Hearing clients
Hard of hearing clients needed to work on more than just palacement, they have resonance issues, and voice issues.
Still work on placement first, then work on " forward focus" (forward airflow)- maybe using the vowel formant software, then work on oral/nasal resonance with the nasometer and visi- pitch for the prosody.

Voice Issues
One voice client improved his articulation and vocal quality with a variety of voice therapy such as Lee Silverman Voice Treatment for clean vocal fold adduction, Many Stemple voice exercises, breathing techniques, and talking through a straw (Titsa Method), which unloaded tension off their vocal folds, and direct digital manipulation of the voice box to increase relaxation around his throat.