rockwall speech therapy Archives -

Augmentative & Alternative Communication (AAC), Autism

Using Visuals for Expressive Language: High Tech Visuals

March 9, 2020March 9, 2020by cherylhoperisingLeave a Comment

In our last post, we talked about the use of low-tech/no-tech visuals to help with expressive communication. Now, we will look at some high tech visual support options that provide speech output. High Tech Visual use is typically done with a communication device that is either a dedicated communication device, or an iPad with a communication app. In this post, we are going to focus on iPad communication apps. Later posts will feature dedicated communication devices.

There are two free apps that I have regularly recommended to students/clients, their families, therapists and other educators working with them. Free apps are a great place to start because they are: FREE. Here they are:

GoTalk Now Lite

GoTalk Now Lite is the free version of the GOTalk Now app. This app is based on the popular static display GoTalk device (a static display device is one that is not computer based, relies on physical overlays, but has speech output). The free version of this app will:

Allow the creation of up to 5 individual boards that can be saved for future use (the paid version allows for an indefinite number of boards).
The boards can have from 1-25 icon spaces for pictures per page
The boards can be set up to link to each other
Capable of having message window to show combined pictures for a sentence, or not having a message window
Speech output can be either recorded human speech or synthesized computer speech
Pictures can be photos (uploaded or pulled into the boards from google images), symbolic pictures from GoTalk Now’s symbol library, or text

Verbally (Free Version)

Verbally (free version) is a keyboard based app that also has a list of frequently used words available for quick selection. Once a message has been created in the small message window, the speak button can be selected to play the message. There is also a paid version of this app that has more complex features such as the ability to save a variety of predetermined messages.

There are also a large (and growing) number of communication apps available for iPad. From my years of specialization as an AT Specialist/AAC Specialist I can vouch for all of these apps as being strong, functional apps. The apps I will be listing below (which are by no means all the communication apps that are available at this time) have the following features:

They are robust: capable of containing a very large number of symbols and vocabulary
They are dynamic: capable of having pages link to other pages with different vocabulary
They can use either recorded human speech or synthesized computer speech
They can be used with either picture based symbol systems or keyboards (the exception is Proloquo4text which is only text based)
They have word prediction capabilities built into their keyboards (word prediction is what happens when we try to text and are given a list of possible options for words)
The icon spaces can have photographs (imported from personal photo library or downloaded), symbol set based pictures or word based icon spaces

Lamp Words for Life: by PRC-Saltillo

Proloquo2Go: by Assistive Ware

Proloquo4text: by Assistive Ware

Snap Core: by TobiiDynavox

Tobii Sonoflex: by TobiiDynavox

TouchChat HD AAC with WordPower: by PRC-Saltillo

So which one of these apps is best? The answer is: it depends. All of these apps are complex apps that are best trialed first before investing in a purchase (price ranges from $50-300). I ALWAYS recommend to families that they work with a licensed SLP (speech therapist) to thoroughly evaluate their child/loved one’s communication needs first, then look into determining with the SLP which, if any app is the best fit for those needs. It is imperative to have the most up to date information about communication needs, across a wide variety of areas, in order to make the best possible determination about the use of high tech communication devices. This allows a good fit to be made, as well as a comprehensive plan for teaching both your child/loved one and your family how to use their communication device to meet these needs. The process for looking into the best fit for a communication device would be through a specific type of speech therapy evaluation called an AAC (Alternative & Augmentative Communication) evaluation. This is sometimes called an Assistive Technology Evaluation (AAC is a type of Assistive Technology).

So where do you start when looking for someone to help with an AAC evaluation? First, it is always best to start with the school system. As we have mentioned in previous blog posts, this is free. Talk to your child’s school SLP about your interest in looking at device options. Another option is to look for a private SLP in your local area who is an AAC Specialist. An AAC Specialist is an SLP who has spent dedicated time learning how to work with people who use AAC. Ideally, your private SLP will be able and willing to work with your school system, so that both the private SLP and public school SLP are on the same page in regard to device acquisition and use.

If you live in the Rockwall, Dallas or Collin County area I would love to talk with you for a free consultation about your child’s needs to see if I might be able to help you. I spent the majority of my career to date working as an AT Specialist (AAC Specialist) in both OH schools and in TX schools before starting my private practice. If you live outside those areas, and are in need of guidance, you are also welcome to contact me, and I will do my best to guide you to someone in your local area who can help.

In future posts we will delve into more details on some of these apps, as well as looking at how communication needs are evaluated, and how we can help you help your child with those needs. Sign up on the right to follow our blog.

Augmentative & Alternative Communication (AAC), Autism

Using Visuals for Expressive Language: Low-Tech (No-Tech) Visuals

March 4, 2020March 4, 2020by cherylhoperisingLeave a Comment

In our last post, we talked about the use of visuals to help with expressive communication. Now, we will take a look at some of the types of low-tech/no-tech visuals that can be used for this purpose. Low-tech/no-tech means that there is no speech output.

There are many types of visuals that can be used as tools to help with expressive language. One of the best places to start using visuals for expressive language is through the use of environmental labels. An environmental label is a picture, photo, or text based word that is placed in a physical location by the item it represents. For example, pictures of food that is inside a refrigerator can be put on the refrigerator. Pictures of items that a child likes to play with can be put right by the place their toys are stored. Having these visual supports available right near where they are located helps give the person using the visual a way to express what they want.

A choice board is another great way to provide visuals for expressive language. One of the most widely recognized types of choice boards is called a PECs choice board (Picture Exchange Communication System). It is a series of pictures that are on a 3 ring notebook used along with the PECs system. But a choice board does not need to be a PECs choice board, it can be any type of board with a selection of pictures that are available for a person to choose from to express something that they want.

Here, we see an example of a PECs style choice board

And an example of a non PECs style choice board

Another type of visual support that can be used for expressive language is a core vocabulary communication notebook. A core vocabulary communication board or book is a communication system that is compromised of a combination of frequently occurring vocabulary words that occur in a wide variety of communication environments.

Yet another type of visual support for expressive communication is a PODD book. PODD stands for:
Pragmatic – realistic social language.
Organization – words and symbols arranged in a systematic way.
Dynamic Display – changing pages

All of these communication systems can be excellent choices for a person that is having difficult using verbal language. It is important to keep in mind that there is no one single system that is the best fit for every person. Work with your child or loved one’s speech therapist to help find the type of low-tech/no-tech visual support that will work best for them. Keep in mind, that as your child or loved one’s expressive communication abilities increase, it may be necessary to add to their current communication system, or consider changing systems to meet their current need at that time.

In our next post, we will look at some high tech visual support options that provide speech output. Sign up on the right of this post to make sure you don’t miss out on learning more about using visual supports for expressive language.

Articulation

Articulation Therapy Home Program

January 22, 2020January 22, 2020by cherylhoperisingLeave a Comment

Speech Therapy for articulation typically involves doing a lot of drill based work on helping a client correctly produce a sound (or many sounds). Articulation therapy is designed to help a client correctly pronounce a sound, or sounds that they are having difficulty pronouncing. It begins with working on the sound in isolation, or in some cases, the word level, and then targeting that sound in different positions in the word (beginning, middle, and end). Clients listen to the therapist make the sound, watch their face to see how the sound is made, and are given guided practice to produce the sound themselves. The speech therapist will give the client feedback on their sound production, and work with them on shaping the sound so that it is produced correctly. Following work on producing the sound correctly in all positions in words, the client moves on to working on using that sound in words at the sentence level, and then on carrying that sound over into ordinary conversation. The work that the client does is very repetitive, and can, at times be uninteresting, although speech therapists are excellent at incorporating drill based work with activities such as reading a book, playing a game, or making a craft.

Speech Therapy sessions are often 30 minutes to one hour, and occur 1-2 times per week. Current research has found that, on average, clients do best when they are practicing working on the correct production of sounds for 5-10 minute intervals, 3-5 times per week, as opposed to the way speech therapy has been traditionally structured. This is because the work of improving articulation involves retraining the motor movements (physical movements) that the tongue, lips, jaw, and teeth make. To effectively and efficiently retrain motor movements, regular short bursts of practice are often more effective than less regular, longer periods of practice.

When a student receives speech therapy in a school setting, some speech therapists are now providing therapy in a model referred to as “5 Minute Articulation”. They work with a student for 5 minutes, drilling them on their sound, 3-5 times per week on a 1-1 basis. In my experience in the schools the past two years, I used this therapy methodology with all of my students in grades 2 and up for whom it was appropriate. I saw success rates in correcting their articulation that were, on average, 1-2 years ahead of the success they would have had doing 1-2 30 minute group sessions each week.

Once you have seen that kind of therapeutic success, you never want to go back to the former way of doing things. The question becomes however, how does one bring this methodology into the private practice setting? It is not feasible on a practical level, or on a financial level, for a family to have their child go to private speech therapy for short bursts that often throughout the week. Thus, the model of a home program for articulation was born. This model involves the following:

1. Initial session that includes an evaluation of sounds client is having difficulty with; (this includes a short write up)

2. Follow up within approximately one week to go over results, explain basics of articulation therapy for specific needs, and provide materials to get started for a couple of weeks

3. Future follow ups up in 2-4 weeks intervals (based on client preference and need) to see how home sessions are going, provide tips on working on sound, provide materials and training until next sessions

The client, with the help of their family, can then practice their articulation using materials that have been provided by the speech therapist, for 5-10 minute intervals, 3-5 times per week. Follow ups are scheduled based on client need and family preference, and provide a chance for the speech therapist to informally assess the progress the client has made during home practice, provide feedback on how to make continued improvements to their articulation, and adjust future practice as needed. This program is best suited to clients ages 5 and up who are able to do short routine practice sessions on a regular basis.

If you would be interested in learning more about how your child might benefit from this type of articulation therapy, or with any other communication need, please contact us. We are happy to answer any questions you have.

For more information on the 5 minute articulation model, go to: http://www.5minutekids.com/ResearchArticle.pdf

Fluency/Stuttering

So you’re a Speech Therapist, -you work with people that stutter, right?

January 14, 2020February 6, 2020by cherylhoperising

So you’re a speech therapist, that means you work with people that stutter, right? Hands down, this is the most common reaction I have to telling people I don’t know well what I do. What is interesting about the question is the fact that, although, yes, I do work with people that stutter, it is one of the least common disorders that SLPs (speech language pathologists, aka speech therapists) treat. It is, however, one of the speech difficulties people have that I enjoy working with the most, and it is one of the areas I have chosen to specialize in in my private practice.

So, how does a speech therapist work with someone that stutters? Many of you may have seen the King’s Speech, where initially King George IV has a speech therapist/teacher that has him work on his stuttering by putting marbles in his mouth. This is, of course, a ridiculous thing to do in general, let along to help with stuttering, but it was in fact, a technique that was used at one point in time. Thank goodness we know so much more now!

Speech Therapy for a person that stutters is, first and foremost, an individualized process tailored to each person based on their needs, interests, and goals. Treatment can include both indirect therapy and direct therapy, and includes a strong counseling component.

Indirect therapy includes family training and education, as well as training communication partners (teachers, family, friends…..) about stuttering. There are things that communication partners can do to help a person that stutters increase their confidence in their ability to communicate, such as not speaking over them when they can’t get a word out, giving sufficient pause time in a conversation, and not rushing the person when they are talking.

Direct therapy may include any or all of the following:

Training and practice using tools to increase fluency (decrease stuttering), with an emphasis on client directed use of the tools. Client directed tool use is important: it is paramount that the client gets to decide if they will use tools at all, and if they do, which ones, where, and when. The job of the SLP is to train a person on the varying tools, offer them the opportunity to practice with feedback, and get feedback from them on the tool. Questions such as how they like the tool, how helpful they think it is, and are they interested in using outside the therapy session. No one wants to be forced to use a speech strategy that they don’t like, and that isn’t helpful.
Educating the client on how speech is produced (speech anatomy and physiology for non SLPs!), and providing training on recognizing tension/stress in their body and how to work on reducing that.
Training the client that stutters on how to be a self-advocate in a variety of communication settings, which may include discussion or how to deal with bullying, discrimination or harassment because of their speech difficulty.
A review of the client’s attitudes/beliefs/feelings about their speech and their stuttering, as well as discussion regarding their individual needs in relation to being able to communicate more easily across a variety of settings.
Guidance with identifying communication situations that are stressful, and avoidance reduction strategies to help with reducing stress and being able to effectively communicate in those situations.
Learn about both famous and non famous people that stutter, and exploring their journeys through reading things they have written, watching video clips, art …..

An extremely helpful addendum to speech therapy is to help clients find other people that stutter to be around, talk to, problem solve stressful communication situations with, and learn from. Finding a safe community among other people that stutter is the key to being comfortable communicating that many people that stutter need. The National Stuttering Association (NSA) has chapters throughout the USA, a list can be found here: https://westutter.org/chapters/

In my practice, I hold the belief that treatment for clients that stutter is functional confident communication, not perfectly fluent speech. Stuttering, if it is not developmental (blog post on that soon!), is a lifelong speech disorder. It can improve, but it does not go away. (Any therapist, business, or other professional that tries to sell a cure or permanent fix is not being honest). I want clients to be able to communicate whatever they want, wherever they want, with whomever they want, regardless of how fluent their speech may or may not be.

As working with stuttering is a passion of mine, you can look for future blog posts on a variety of topics related to stuttering. If you have specific questions or things you would like to know about in future posts, please reach out to me through the contact page and let me know. I look forward to hearing from you.

Literacy, Speech Therapy Tips

Building speech & language skills in young children using repetitive line books

January 9, 2020March 27, 2020by cherylhoperising

One of the best ways you can help your younger child build their speech and language skills is through repetitive line books. Repetitive line books can be used to help with literacy skills, as well as with the following speech and language skills:

Learning sentence structure (grammar)
Working on articulation (pronunciation) if the sound the child is working on is in the repetitive line
Improving motor planning for children that have apraxia and/or other motor planning issues affecting their speech
Teaching inferencing and predicting skills
Using an Augmentative and Alternative Communication System (AAC) system: can be used with non talking systems such as Core Vocabulary Systems, single cell systems (like a Big Mac or Step by Step Sequencer), and with multiple types of robust electronic systems (including, but not limited to iPads with communication apps)
Teaching Easy Talking (using a moderate rate of speech with natural pauses) to help improve fluency in children that stutter

Using repetitive line books with your child is easy. Here is how you can do it:

During the first read through, you read the entire book
During the second read through, when you get to the repetitive line, leave out the very last word in the line when you read it, pause and see if you child will say it. If they don’t, just hold your pause for a few seconds, then say it and turn the page. Try again with that word on the next occurrence until they get that last word themselves. It is OK if they do not articulate it perfectly. If your child is using an AAC system, following the pause, wait for them to find the word in their AAC system and point to it, or touch it.
On each subsequent time you read the book, once your child has been able to communicate the last word, reduce more words you read from each phrase, moving from the end of the phrase to the beginning

For example, for the repetitive line: “No more monkeys jumping on the bed”

First Read: “No more monkeys jumping on the bed”

Second Read: “No more monkeys jumping on the ____”

Third Read: “No more monkeys jumping on ___ / ____”

Fourth Read: “No more monkeys jumping ___ / ___ / ____ “

And so on until your child is saying the whole line.

There are many wonderful repetitive line books out there. Your local librarian is a great resource to help you find them. Here are some favorites to help get you started: