Unintelligible

Nate's language is taking off in leaps and bounds!  Which is great news....except that now that he's taking more risks with language and saying even more things it has become even more difficult to understand him.  I am reassured by his SLP and a post I made on APRAXIA-KIDS Facebook that this is very normal.  Although it's become more difficult to understand him and we are all a little more frustrated with communication (Nate included), he's saying so many more things out of context which is a good thing.  We're moving closer to conversations beyond the typical "I want this or that".

Yesterday he went on a summer school field trip to the aquarium and the conversation went a little something like this:

Me:  Did you have a good time on your trip?  What did you see?

Nate: Ummm....[pause] cab

Me: You saw a crab?  [emphasized the /r/ in crab]

Nate: Uh-huh.   [pause]   A........spider cab.

Me:  Wow, a spider crab?

Nate: He hurt me?  (His question as of late is to ask if different animals or things will hurt him.)

Me:  No, he won't hurt you.

Nate:  [mumbled something like behind] gass (glass)

Me:  Yes, he's behind the glass.

Self-correction

I know it's been quite some time since I've posted any current videos of Nate.  Time has been flying by--I will soon.  We're quickly approaching the end of the school year and looking forward to a break from nearly daily speech therapy.

Nate has been saying and using so many more words!  At times it is still difficult to understand him, but he's able to tell us so much more!  He's finally able to say the long e sound (like the e in me).  It use to come out of his nose!  The therapists had tried working on this sound for a short period of time, but decided to wait.  It seems to have come on its own.  To be honest, it was one that I wasn't sure if he'd every be able to say correctly and there is no way to show someone how to make that particular sound.

Nate's been using his Go Talk more in therapy and we're still still waiting on a larger machine that is able to hold more visuals and recordings.  He is using it to work on sentence structure, to share information with friends, as well as support his language skills.

In class last week, he told one of his teachers, "Spider over here!"  He's even asking more questions.  In one therapy session his SLP was having him talk about things he did over the weekend.  When she told him that she had popcorn, he asked "You watch movie?"

The best part of his latest progress is that he is self-correcting.  Meaning, that at times when he hears himself say something and he hears it isn't a close approximation, he'll say it again.  Last week we were watching Blues Clues and he was imitating something being said on TV.  On his own, he said repeated it, heard that it wasn't quite right and said it again.  And just this morning I was making cinnamon rolls and he asked what was for breakfast?  I told him to look and see and his first attempt at saying cinnamon rolls wasn't quite right, so he said it again on his own.  Words like cinnamon rolls are still quite difficult for him--to get all the positioning and muscles coordinating, but it's huge that he's attempting these words on his own and correcting his own mistakes!

Big Boy

Nate recently turned 5.  He has been excited about it for a couple of months.  Now that he's 5, everything that he does, according to him, is because he is 5.

A few weeks ago we had Nate evaluated for an AAC device (Augmentative and Alternative Communication) device.  He qualified and we have started using a device called the Go Talk.

He's using it to work on grammar.  He communicates his wants and needs perfectly well, but we're working on articles and sentence structure.  We've only been using it for a couple of weeks, but we're hoping that he can work towards using the device to feel more comfortable participating in class activities that require responses.  Maybe he'll even use it for sharing time some day!

16 Months

For quite some time I've been wanting to post some video of where Nate started and where he is now.  Nate has been receiving speech therapy since his 3rd birthday, about 18 months ago.  In May of 2010 I posted a few videos of words or skills he was working on, like book, tree, the s-sound, and mom.

Here's Book:

And Mom:

And here's Nate 16 months later-

At breakfast:

Practicing his words:

And a bedtime story:

He is blossoming in his Montessori class and is becoming more involved in group activities.  He has friends whom he enjoys working and playing with and is more comfortable in asking for help.  He is also attempting to respond more to questions verbally.  He has a long way to go, but the videos help remind me of where he's come from.

Little Things

Today Nate had photos taken for his soccer team the Lil' Cougars.  As he sat proudly on the bench with his team, a grin from ear to ear, the photographer said, "Say Lil' Cougars" and his smile quickly disappeared.  I had never thought about something as little as having him say cheese would not be easy for a child with apraxia or that it would upset him like that.  Afterwards I talked to Nate and told him that the important part was smiling and not saying what the person taking the picture wants you to say.  Definitely something to remember.

AAC

The CASANA conference was amazing!  I'm so glad it was local and that we were able to go.  To be in a place with so many other people who understand what its like to have a child with CAS was reassuring and inspiring.


I learned more about AAC (Augmentative and Alternative Communication) devices.  I've read a little about these types of devices (as simple as picture card to as complex as computers like what Stephen Hawking uses).  They increase social interaction, allow increased information sharing and help create a self identity by lessening frustration by enabling communication.  


Unfortunately not many people are trained in using AAC devices, particularly the more high tech tools.  When creating an IEP, an AAC or AT (Assistive Technology) devices need to be included.
  
Funding for an AAC can be complicated, but this is an interesting resource: AACfundinghelp.com.  This website has a lot of information including funding sources, vocabulary or terms that show up on applications for devices.  


The most important realization that I had was that AAC devices are more than just enabling someone to make requests but are language systems.  Teaching kids how language functions--communication and dialogue patterns, being able to socialize with peers, and literacy skills.  Kids with language delays or disorders need to now how to use abstract language.


Some additional resources:


International Society for Augmentative and Alternative Communication-- works to improve the life of every child and adult with speech difficulties.


Center for Applied Special Technology--To expand learning opportunities for all individuals, especially those with disabilities, through the research and development of innovative, technology-based educational resources and strategies.


Assistive Technology Exchange Center--comprehensive assistive technology resource center that is one of Goodwill of Orange County’s vital health and human services programs-offer consultation and assessment services, equipment trial, equipment loan and reuse and support in learning how to use assistive technology equipment.

And a quick video showing one of the many electronic devices that allows all types of kids with communication disabilities to communicate:

It Takes 70 Muscles

Here's just some highlights of things I learned at the conference...

How to Navigate the world of CAS by Sue Caspari, CCC-SLP

• It takes 70 muscles (including 8 body parts) to utter a single syllable word!
• We can say 14 sounds in a single second..... like in the phrase "peanut butter cookies"!
• By the age of 2 - 3 years, most normal children have all the vowel sounds in English
• CAS is the breakdown in planning and programming of speech movements--where in space to move, when in time to move, and how fast to move
• It is a "discoordination disorder"
• Some things it is NOT: an intellectual deficit, incurable, or outgrown
• ASHA has a position statement on CAS, but there is a serious lack of well-controlled treatment addressing what interventions are most effective, this makes receiving proper diagnosis and treatment difficult ( I know this all too well! )
• What ASHA does recommend is 3-5 sessions of individual speech therapy a week

The Kaufman Speech to Language Protocol by Nancy Kaufman, CCC-SLP

Nancy Kaufman's presentation included a discussion of her materials (which I've talked a bit about in an earlier post).  It was exciting to see her and her discussion of strategies to use for cueing.  Many of which I want to use more of with Nate.  

She talked about how you should always build on the child's repertoire and increase the words and syllables used.  Functional words like (on, in, off, go, yes, no, help, etc.) are incredibly important as well as working towards what she calls "pivot phrases", such as: put on ______, help me ______, I want ______, or more ____.  Nate's been working on some of these, but I can definitely see where he needs to work on more than just the few that he's been using.  It's important not to just focus on nouns, but all of the parts of speech.

Cues she talked about:

• visual/tactile (signs, gestures, physical reminders)
• cognitive (explaining where to place lips or tongue...although there is some research to support that visual cues work better for apraxics than telling them what to do)
• oral posturing (forming the shapes of words with your own mouth, without voicing)
• contextual cues (fill in the blanks for songs, rhymes, books....she showed us this amazing video of a girl who could hardly speak, but could much more easily fill in the blanks in a song!)
• pivot syllables (practicing words with a syllable that is the same: bunny, money, Ernie, Winnie, etc.)
• giving the answer first and then asking the question (ex: Look at him riding his bike.  What is he doing?)  I particularly like this cue and plan on using it more as it gives a quick cue as to what words to use so Nate may be able to get his mouth coordinated a bit better.
• deletion of vowel in monosyllabic words (ex: for the word cup /cu/ /p/ instead of /c/ /up/)
• whisper cues (whisper the word)

I definitely want to use more cues, especially the giving the answer first and then asking questions.  And finally I was reminded that its not enough to just say good or good job, it's important to give specific feedback.