Tag: speech therapy rowlett

Augmentative & Alternative Communication (AAC), Autism

Using Visuals for Expressive Language: High Tech Visuals

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Using Visuals for Expressive Language: High Tech Visuals

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

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

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.

Augmentative & Alternative Communication (AAC), Autism

Supporting Expressive Language with Visuals

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Supporting Expressive Language with Visuals

In our last post, we learned a little about how visuals can help with receptive language. This time, let’s spend some time looking at how visuals can help with expressive language. Visuals can be used to increase expressive language skills in both people who are non-verbal, and those who have verbal skills. They can serve as reminders (cues) to a person about the word they want to use, or the word order for what they want to express. In addition, visual supports for expressive language decrease the cognitive load for verbalization, and allow the individual to focus on talking.

There are two general categories of visuals that can be used for expressive language purposes: low tech/no tech with no voice (speech) output, and high tech with voice output. Individuals can use these visual tools to express themselves by: pointing to pictures/words that are available to express the word, handing the visual to their communication partner, or using eye gaze to look at the visual.

Three main types of low tech visuals that are used for increasing the expressive language communication of individuals are: choice boards/books, core language vocabulary notebooks, and PODD books. Choice boards are what they sound like, boards that have pictures or text choice options on them. A PECs (Picture Exchange Communication System) book would be a type of choice book. Choice boards/books are not solely limited to PECs style communication notebooks, and can be any type of board or book where the user is able to pick from a variety of choices to communicate. A core vocabulary communication board/book is a communication system that is comprised of a combination of frequently occurring vocabulary words that occur in a wide variety of communication environments. A PODD book (Pragmatic Organization Dynamic Display) is a book that is Pragmatic (uses realistic social language), Organized (words and symbols arranged in a systematic way), and uses a Dynamic Display (the ability to change pages to incorporate a robust vocabulary system).

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. High tech device use can be used both alternatively, and also augmentatively. If an individual has little to no verbal ability, their use of a high tech device (or a low tech one) is considered to be alternative- it is used instead of verbal speech. But a high tech device is not limited to individuals who are completely non-verbal. Many people who have some verbal skills use them augmentatively, or in addition to their verbal speech output. They may use the device to help them with vocabulary that is difficult to say, to make longer sentences than they are able to produce on their own, or to help repair or clarify verbal messages that they have spoken that may not have been fully understood by their listener.

In our next two posts, we will go over more details about the specific types of low tech visuals and high tech visuals that can be used to increase expressive communication skills for those who have difficulties with expressive language. Sign up to follow our blog on the right side of this page so you don’t miss anything!

Augmentative & Alternative Communication (AAC), Autism

Supporting Receptive Language with Visuals

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Supporting Receptive Language with Visuals

Visuals have gotten a lot of attention for how they can help individuals with structure, behavior, and learning, but they are also a fantastic tool to help out with receptive and expressive language. Come, join me and learn a little bit about how and why visual supports can help individuals in the area of receptive language. (We will discuss how they can help with expressive language in our next post).

            Individuals with autism spectrum disorders (ASD), as well as many individuals with ADHD (and other speech and language disorders that affect receptive language), have difficulties with receptive language skills. Here are some of the difficulties they can have with understanding and comprehending spoken (verbal) language:   

  • Auditory Attention
  • Auditory Synthesis
  • Auditory Discrimination

Auditory attention is the ability to pay (and maintain) attention to information that is presented auditorily, as well as shifting and re-establishing their attention to auditory information. Information that is presented auditorily, due to its transient nature, may not be processed because the individual was not able to maintain auditory attention.

Auditory Synthesis is the process by which a person’s brain makes sense of the auditory information it has just heard. The length of the message often correlates to difficulties with correctly understanding what was said: in longer messages a person with ASD often hears only the last part of the message: For example: “I do not want you to give the dog a hamburger” may be processed as: “give the dog a hamburger.”

Auditory Discrimination is the ability to hear and understand information in the presence of noise. People with ASD often have difficulty understanding verbal speech when there is any type of background noise.

Verbal language is transient; it is here, and then, it is gone. This can cause challenges for those who have difficulty with auditory attention, synthesis, and discrimination. Visuals, on the other hand, are not transient. They are permanent, or at least, semi-permanent (they are present long enough for the person to be able to get meaning from them).

If an individual has trouble with attention (including but not limited to auditory attention), the visual(s) will still be present when they are able to focus on the information; the person can also take needed time to shift their attention from one thing to another, and the information on the visual is still there! If an individual has trouble with auditory synthesis, the information on the visual can help them get the full meaning of the message, even if they only process a part of the message. If an individual has difficulty with auditory discrimination, visuals can help in a similar way, they can help the person to understand the meaning of what was said when there is other noise in the environment.

It is important to present visuals in combination with using auditory information to maximize the ability of each person to understand what was said. This also helps the person to learn what each visual means, as they hear the verbal language that goes along with each visual. It is imperative that visuals are not faded as verbal skills improve, however it is a good idea to consider changing their form over time to match the current skill level of each person they are being used with (for example: from pictures to text).

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General, Speech Therapy Tips

I think my child needs speech therapy, now what?

by cherylhoperisingLeave a Comment on I think my child needs speech therapy, now what?
I think my child needs speech therapy, now what?

You may have some concerns about your child’s speech and language skills, but you aren’t sure what to do about your concerns. Perhaps your child is having difficulty saying certain sounds, does not have the vocabulary you think they should have at their age, or is having difficulty producing words verbally at all.  Maybe they are having difficulty with fluent speech, and stutter when they are speaking. Or they could be able to say their sounds correctly, have a good vocabulary and sentence structure, but are having trouble with communicating with adults and/or peers in socially appropriate ways. What do you do with these concerns? Who do you talk to?

First, it is important to remember that your concerns are valid. If you are worried about your child’s ability to communicate, there are professionals available who can discuss your concerns and guide you in the right direction. Having a concern does not necessarily mean that your child has a speech and/or language disorder (problem), it just means you have a concern, and are looking for help in determining if your child might need help. So where should you turn?

First, it is always a good idea to talk to your child’s pediatrician. They know your child, and their medical history, and have basic knowledge of normal speech and language development. Consider making an appointment to talk to them about your concern’s, and see if they recommend a further course of action. In many cases, if your child is experiencing delays and/or differences with their speech, your pediatrician will be able to guide you on next steps. Please keep in mind that some pediatricians have a very cautious, wait and see approach. If your pediatrician suggests you wait and see, but you still feel like something is going on, by all means, pursue additional help.

The next step you can take, (or you can do this in the first place!!) is to contact a speech language pathologist (SLP) and consult with them about your concerns. After talking to them, they may suggest your have your child’s speech and language skills evaluated to determine if there is a speech and/or language disorder, and if there is, what course of treatment/therapy they recommend. SLPs (also commonly referred to as speech therapists) have specialized training in a wide variety of speech and language disorders, including how to both evaluate and treat speech and language disorders. But where should you look for an SLP to help you?

There are two main types of environments where SLPs work, the medical environment and the school environment. Depending on the difficulty your child is having, if they are having difficulty, you may choose to seek out assistance in one, or both environments. But which environment should you look to for help?

There are SLPs that work in the education environment through the public school system. The public schools are required by law to evaluate children ages 3+ with suspected speech and language disorders. If a child qualifies (states have varying state specific criteria for qualifying for services), the schools are then responsible for providing speech therapy. All of this is free. So although I now own my own private practice in speech therapy, as an SLP who spent the first twenty years of her career working in the schools, I highly recommend you start here first if your child is at least 3 (information on children under three in a moment). If your child is currently enrolled in school, let his or her teacher, (or school counselor), know that you would like to request a speech and language evaluation. I highly recommend you do this in writing. If your child is not yet enrolled, call your local school district special education department (you can just call the school district main line and ask for the special education department) and tell them you want to request a speech and language evaluation for your child. They will take you through this process at that point.

If your child is under 3, services that are available to them publically are provided through a program called Early Intervention (EI). Early Intervention services are available to you as a parent, and cost varies based on a variety of factors such as your income. You will want to contact your local EI service coordinator to request an evaluation for a child under 3. If you are not able to find their contact information, your local school district will be able to get you that information. Keep in mind that unlike services to children 3 and up, EI services are not necessarily free. They are however, typically available at a reduced cost.

SLP’s also work in a variety of medical environments including hospitals, outpatient clinics, home health (they come to your house), and in private practices (some are clinic based, some home based). Families who are interested in seeking evaluation, and potentially speech therapy services in the private environment simply call or email local practices to schedule an evaluation. Some, but not all SLPs in private practice offer short phone and/or email consultations (I do within my local area!) But why would you seek out the services of an SLP in a medical environment if school services are free? This is a very good question, and there are varied reasons families make this choice. Here are some of the reasons they do:

  • They want their child to get additional services outside of the school environment to maximize their potential for success.
  • Their child was evaluated by the school system, but was not eligible for speech and language services. Simply having a speech and/or language disorder does not always mean that a child will qualify for services. There are many reasons they may not, and it doesn’t necessarily mean they don’t need help. Sometimes, there is a need, but the school district isn’t able to meet that need because of state eligibility criteria.
  • Their child was eligible for services in the schools, but is embarrassed to be pulled out of class and the family prefers the private afterschool environment private therapy can provide.
  • Their child was eligible for services in the schools, but the family does not want them to miss any academic classes so they choose afterschool private therapy.
  • The family has chosen to homeschool, and as such, is not eligible for services in the schools. (Note: this is state specific. Some states do offer speech therapy services to children who are homeschooled and some do not. Texas WILL offer speech therapy to children who qualify who are homeschooled, however it is almost always offered at the local school building).
  • It is summertime, and families want their child to continue to receive the benefits of speech therapy over school break.
  • They want their child to receive the expert services of a private therapist who has dedicated their career to focusing in on specific types of speech and language disorders, and as such, can provide more specialized speech therapy for their child.

So there you have it. Some basic information on what to do if you are concerned about your child’s speech and/or language skills. Do you have specific questions that I might be able to answer for you? Please contact me and let me know, and I will do my best to help you help your child. Your concerns are valid, and your questions are welcomed.

Articulation

Articulation Therapy Home Program

by cherylhoperisingLeave a Comment on Articulation Therapy Home Program
Articulation Therapy Home Program

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?

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

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.