speech - Lessons in Speech with Nanette

SEVEN Not-So-Spooky Halloween Activities For Kids

October 9, 2024October 9, 2024 by Nanette

Styrofoam Pumpkin Halloween Craft for Preschoolers

Halloween activities for kids make fall one of my favorite seasons, with the changing colors, cooler days, slower pace, and holidays abound. As I transform my office into a festive space, I’m excited to share some affordable ways to incorporate a Halloween and fall theme into your speech and language sessions. In this recently updated post, you’ll find seven engaging activities, complete with a table for sensory bin ideas and a curated list of books with targeted speech and language goals. Let’s dive into these fun ideas!

Setting the Scene with Decor

Over the years, I’ve amassed a collection of Halloween decorations during post-season clearance sales at Target and Walmart. Seasonal items from the Dollar Tree also help me create a fun, inviting atmosphere. By adorning my space with plastic tablecloths, colorful banners, and haunted houses for storage, I aim to bring a smile to each client’s face. This vibrant decor encourages clients to comment and label objects, enhancing engagement during therapy sessions.

A favorite find has been a clearance door covering adorned with removable stickers from Target. These stickers have provided joy to multiple clients over the years. We work on following directions with commands like, “Put five pumpkins on the fence,” or “Give each pumpkin and ghost a hat.” This activity allows me to target both familiar and novel commands, adapting it to meet the varied needs of my clients.

Popular Halloween Books for Children

Halloween Activities for Kids: Book Recommendations

Book Title	Age Range	Incorporate Speech & Language Goals
The Little Old Lady Who Was Not Afraid of Anything	Toddlers to Pre-K	Sequence events as the old lady encounters different items in the story.
Room on the Broom	Toddlers to Early Elementary	Identify and describe the characters on each page.
We’re All in the Same Boat	Toddlers to Early Elementary	Discuss emotions and feelings of the characters throughout the story.
Five Little Pumpkins	Toddlers to Pre-K	Use finger plays to count and act out the pumpkins.
Boo! A Made-You-Look Book	Toddlers to Early Elementary	Practice vocabulary by naming items that appear in the illustrations.
Spookly the Square Pumpkin	Toddlers to Early Elementary	Discuss shapes and colors while reading.
The Ghosts of John*	Toddlers to Early Elementary	Explore descriptive language by talking about what makes something spooky.

Halloween Activities for Kids: Fun Pumpkin Craft

A perennial favorite is my Styrofoam pumpkins craft, featuring plastic facial parts from the Dollar Tree. This activity not only makes requests with complete sentences like “I need a mouth” or “I want eyes,” but it’s especially beneficial for my young language learners using speech-generating devices.

Clients love taking their creations home, and some caregivers have reported purchasing additional pumpkins and facial parts to enjoy this activity with siblings. I cherish when we discuss activities in the speech room that can be generalized to other settings—what a fantastic way to practice functional and seasonal vocabulary!

Turning Toys into Halloween Fun

This year, we’re getting creative by turning any toy into a Halloween theme! Using tissues and elastic bands, kids can make ghosts to hang from their toys or Magna-tile creations. This simple yet enjoyable activity promotes creativity while allowing children to practice vocabulary and sentence structure as they describe their spooky designs.

Make a Scarecrow Snack

One surefire way to win over kids is through food! We’ve created a scarecrow treat to practice sequencing, commenting, and requesting. I found this fun snack recipe in a Pillsbury Halloween cookbook years ago when my son was little. Here’s how you can make it:

First, spread white icing on a vanilla cookie.

Second, shred some Triscuit crackers to make straw.

Place shredded crackers on the sides of the cookie.

Add a candy corn nose.

Use chocolate chips for eyes and black icing for a mouth.

Add a gumdrop hat and then enjoy your treat!

Playdough Halloween Activities for Kids

Halloween Activities for Kids: Playdough Fun

Many of my activities for little ones aged 2-7 involve hands-on play and sensory time, and playdough is a fan favorite! I make my own batch using a quick and easy recipe. When we move on to a new color, I send the previous batch home with the client and whip up a fresh one.

I once discovered a sound sequencing activity using playdough and mini erasers. Clients worked on sequencing simple CV, VC, and CVCV combinations while pushing the objects into the dough. We can easily spend half of our hour-long session just playing with dough!

Halloween Activities for Kids: Sensory Bins

I love switching out sensory bins for seasonal activities. In September, we practiced sounds and words while digging through a bin filled with leaves, and in October, we hunted for targets in a Halloween-themed bin. Near Thanksgiving, I mix Velcro foods with fake gourds to target CVC words like “cut.” I typically find most of my sensory bin materials at the Dollar Tree and dispose of items that can’t be sanitized, replacing them each season.

Fall

Halloween

Thanksgiving

More Sensory Bin Ideas for Halloween

Theme Name	Materials Needed	Targets for Speech & Language
Ghostly Discovery	White rice, small ghost toys, spoons	Practice “more,” “help,” and descriptive words for what they find.
Pumpkin Patch	Orange sensory balls, green leaves, toy pumpkins	Target vocabulary for colors, sizes, and textures.
Spooky Sounds	Black beans, plastic spiders, scoops	Describe the sounds of each object and practice action words like “scoop” and “dig.”
Witch’s Brew	Green water beads, plastic cauldrons, spoons	Focus on verbs (mix, pour) and adjectives (slippery, slimy).
Monster Mash	Brown rice, monster figurines, measuring cups	Use comparative language (biggest, smallest) and practice counting.

Using Legos in Halloween Activities for Kids

I often have a couple of upper elementary students working on articulating /s/ or /r/. They love earning a Lego brick for each target they practice. Once all targets are earned, clients can create a Halloween character. Kids are often more imaginative than I am, and I let them lead the way in crafting without a predetermined plan. Here’s what one fifth grader created—clearly, he’s a Minecraft fan!

Halloween activities for kids Lego Ideas

Conclusion: Recap of Seven Activities

I hope you enjoyed this fall post and found new resources for your speech sessions! Incorporate these not-so-spooky Halloween activities—popular children’s books, a fun pumpkin craft, Halloween-themed toy creations, a scarecrow snack, playdough fun, sensory bins, and Lego creativity—to create a fun and engaging atmosphere for speech and language development. Happy Halloween!

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

How to Read an Audiogram

July 9, 2024July 6, 2024 by Nanette

Woman with her hand on her head trying to figure out how to read an audiogram

As speech pathologists, it is well within our scope of practice to help families understand how to read an audiogram and interpret the results of formal hearing evaluations. An audiogram is a chart that shows how well a person hears different sounds. Recently updated, this post begins by explaining how to read an audiogram, defining the measures used in formal hearing testing. It then covers the symbols used on an audiogram, followed by a discussion on the three different types of hearing loss.

How to Read an Audiogram: Understanding Frequency, Decibels, and Thresholds

Frequency

Frequency, also known as Hertz (Hz), denotes sound pitch, ranging from 250 Hz to 8000 Hz. An example of a low pitch would be the sound of thunder; for a midrange pitch, an example would be a telephone ring. A high pitch example would be the sound of cymbals clanging.

The bottom of the audiogram shows frequencies, or pitches, of sounds from low (125 Hz) to high (8000 Hz). Think of it like the keys on a piano, with low notes on the left and high notes on the right.

Decibels

Decibels (dB) mean intensity or loudness; and it is measured from 0 dB through 110dB. Normal conversational speech is about 45 dB. It is important to note that 0dB does not mean the complete absence of sound, but rather it is the softest sound that a person with normal hearing ability would be able to detect at least 50% of the time.

The side of the audiogram shows the loudness of sounds, measured in decibels (dB). The higher the number, the louder the sound. Zero at the top represents very soft sounds, and the numbers go down to 120, which are very loud sounds.

Threshold

We call the softest level at which your child can hear the threshold. In a hearing evaluation, an audiologist tests frequencies from low to high decibels until the client hears each pitch. The audiologist then documents the threshold for each frequency on the audio gram. When testing is completed with headphones, it is called “air” thresholds because the sound must travel through the air of the ear canal to be heard.

How to Read an Audiogram: Making Sense of Symbols

Your child’s audiogram should have a box explaining what the symbols used on the diagram represent. The right ear is marked with an O, and the left ear with an X to indicate air conduction test thresholds.

An audiologist uses a bone conduction test to determine the type and extent of hearing loss by assessing the inner ear’s function independently of the outer and middle ear. This helps differentiate between conductive, sensorineural, and mixed hearing loss. When using bone conduction, the audiologist places a small device behind the child’s ear, secured by a metal band. This device sends sounds via direct vibration of the bone and specifically tests the sensitivity of the inner ear. A < symbol denotes the right ear and a > symbol indicates the left ear’s responses to bone conduction. If testing reveals a hearing loss, the audiologist will compare results of air and bone conduction testing to identify the type of loss.

Audiogram of Conductive Hearing Loss

This particular audiogram is for someone with conductive hearing loss. Let’s break it down so it’s easy to understand.

Air Conduction: The X’s on the chart show how well sound travels through the outer and middle ear. In this audiogram, the X’s are all around 60 dB across different frequencies. This means that sounds need to be quite loud for the person to hear them, indicating hearing loss.
Bone Conduction: The arrows at the top of the chart represent bone conduction, which measures how well sound is heard directly through the inner ear, bypassing the outer and middle ear. In this audiogram, the bone conduction levels are normal, shown by the arrows near 0 dB.

The gap between the X’s (air conduction) and the arrows (bone conduction) indicates a conductive hearing loss. This means the problem is in the outer/ middle ear, where sound is not efficiently conducted to the inner ear. In simpler terms, the audiogram shows the inner ear works fine, but there’s an issue in the outer/ middle ear.

Understanding and Supporting Children with Conductive Hearing Loss

A conductive hearing is sometimes treatable with medication or surgery and is typically temporary. If your child has a conductive loss during peak learning, you may notice limited responses to language and little talking. While your child receives treatment, seize chances to let them watch your lips form sounds and use visuals. Even with one affected ear, they perceive speech as if underwater.

Audiogram of Sensorineural Hearing Loss

This image is an audiogram showing the results of a hearing test for a person with sensorineural hearing loss.

Right Ear (Red Circles and Brackets): The right ear’s air conduction thresholds (red circles) show that this ear can hear sounds at higher pitches with less difficulty than lower pitches. The bone conduction thresholds (red brackets) follow a similar pattern, confirming the sensorineural nature of the hearing loss.
Left Ear (Blue Squares and Brackets): The left ear’s air conduction thresholds (blue squares) indicate a significant hearing loss across all frequencies. The bone conduction thresholds (blue brackets) are similar to the air conduction thresholds, which is characteristic of sensorineural hearing loss.

Understanding and Supporting Children with Sensorineural Hearing Loss

A sensorineural loss occurs when the inner ear is not properly receiving sounds. Your child’s audiogram would indicate an air conduction threshold and bone conduction threshold with the same amount of hearing loss. Several factors cause this loss, including aging, prolonged exposure to loud noises, viral infections, disrupted blood supply to the ear, metabolic disturbances, accidents, and genetic predisposition. About 90% of people with hearing impairments have this type of loss. Regrettably, medications or surgeries cannot treat it, but hearing aids can enhance responses to sounds. Those with a severe hearing loss may benefit from a cochlear implant.

Audiogram of Mixed Hearing Loss

Red Circles (Right Ear Air Conduction): These indicate the hearing levels for the right ear when sound is delivered through the ear canal. The red circles mostly show moderate hearing loss across frequencies.
Blue Crosses (Left Ear Air Conduction): These show the hearing levels for the left ear with sound delivered through the ear canal. The blue crosses indicate moderate hearing loss across most frequencies.
Red Brackets (Right Ear Bone Conduction): These brackets represent the hearing levels for the right ear when sound is delivered directly to the inner ear (bypassing the outer and middle ear). They show better hearing compared to air conduction, indicating a conductive component to the hearing loss.
Blue Brackets (Left Ear Bone Conduction): These brackets indicate the left ear’s hearing levels with sound delivered directly to the inner ear. Similar to the right ear, they show better hearing levels compared to air conduction, indicating a conductive component.
Overall Pattern: The audiogram shows a combination of conductive and sensorineural hearing loss, known as mixed hearing loss. Your child may have a sensorineural hearing loss and develop a conductive loss due to fluid or wax in the ears. This is evident because the bone conduction thresholds (brackets) are better than the air conduction thresholds but still show hearing loss.

Understanding and Supporting Children with Mixed Hearing Loss

Supporting children with mixed hearing loss involves a comprehensive approach that includes regular audiological evaluations, the use of hearing aids, bone conduction devices, or cochlear implants, and the creation of an Individualized Education Plan (IEP) with classroom accommodations and special education services. Speech therapy is essential, with parents and caregivers involved in reinforcing strategies at home. Communication can be enhanced through sign language and visual supports, while environmental modifications like acoustic improvements and assistive listening devices reduce background noise. Emotional and social support, including counseling and social skills training, are crucial, along with continuous monitoring and adaptation of strategies as the child’s needs evolve.

How to Read an Audiogram: Hearing Ranges

The following indicates results for the average ADULT. Interpreting results for children is challenging due to variable responses, but these numbers provide a general sense of severity.

-10 dB to 25 dB = Normal range
26 dB to 40 dB = Mild hearing loss
41 dB to 55 dB = Moderate hearing loss
56 dB to 70 dB = Moderately Severe hearing loss
71 dB to 90 dB = Severe hearing loss
over 90 dB = Profound hearing loss

How to Read an Audiogram: Next Steps

After an evaluation using headphones in a sound-proof booth setting, your audiologist should be able to answer the following questions based on test results:

How well does my child hear at low, medium, and high pitches?
Does my child have a hearing loss?
If my child has a hearing loss, what part of the ear is affected: outside, middle, or inner?

How to Read an Audiogram: Take Away Points

In conclusion, understanding how to read an audiogram is an essential skill for speech pathologists, enabling us to better support families and collaborate effectively with audiologists. By comprehending the measures and symbols used in formal hearing evaluations, we can accurately interpret audiograms and provide informed guidance. This knowledge is crucial in identifying the type of hearing loss—whether it be conductive, sensorineural, or mixed—and in developing appropriate intervention strategies. Empowering families with this understanding enhances their ability to make informed decisions about their child’s hearing health and overall communication development.

For more details about audiological hearing evaluations, read my post: Why Does my Child need a Diagnostic Hearing Evaluation?

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

PROMPT Therapy- Useful for Childhood Apraxia of Speech

October 8, 2024February 21, 2024 by Nanette

Nanette Cote Providing Tactile PROMPT to Toddler

What is PROMPT Therapy?

PROMPT therapy is a dynamic, hands-on program for children with apraxia of speech in which the trained clinician shapes the movement of a child’s jaw, tongue, and lips using our hands in support of sound production. Although the use of touch and movement is an integral component, PROMPT is more than just executing tactile support. It is a program that incorporates all aspects of a child’s processing, understanding, and interaction.

PROMPT is an acronym for: Prompts for Restructuring Oral Muscular Phonetic Targets.

These areas of development, or domains, are known individually as: The Cognitive-Linguistic, (ability & language), Social-Emotional (socialization), and Physical-Sensory (muscle tone & senses) Domains. Together, these domains function in unison and influence each other to the extent that challenges in one area directly impact progress in another. This video for families on the PROMPT website visually explains the domains and PROMPT’s multifaceted treatment approach. Some children that may benefit from PROMPT include those diagnosed with motor speech disorders like apraxia and dysarthria, cerebral palsy, and autism. To determine if PROMPT is appropriate for your child, your clinician will begin with an observation and comprehensive evaluation.

Evaluation:

PROMPT is rooted in a Dynamic Systems Theory, meaning that clinicians must factor in cognitive, social, behavioral, sensory-motor, and physical influences on communication. Let us break these down into some specific questions that we as clinicians ask ourselves during a comprehensive assessment process:

Cognitive: What is the child’s ability to process sensory information and comprehend language? Does the child need visual schedules and/or other modifications and cues to learn new information? How should clinicians and parents’ scaffold, cue, and elicit language with the child?
Social: Do we need to work on establishing trust before diving into PROMPT? How does the child express his wants and needs (i.e., pointing, gestures, sounds?) How is the child’s non-verbal communication? What communicative intents does the child relay (i.e., greeting, requesting, commenting, responding to questions?) Is the child interested in engaging in communication and interactions with others?
Physical: What is the child’s skeletal system and muscle tone like? Do we need to provide additional supports in the environment to support skeletal and/or musculature issues? Does the child have difficulty with vision, hearing, tactile/touch?

System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH):

In addition to collecting information from a parent interview, a PROMPT evaluation also includes analyzing the movements necessary for speech. These yes/no questions are based on typical speech development. Next, the clinician transfers the results to a visual representation to rate the severity of the speech disorder. The System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH) provide us with practical information to develop a treatment plan.

PROMPT Therapy: Constructing a Strong Foundation

PROMPT Therapy- Useful for Childhood Apraxia of Speech (house lights turned on)

Marcus Neal, a PROMPT instructor, describes the Motor Speech Hierarchy as a well-built house with a strong foundation (jaw) necessary for sustaining the other structures (lips, tongue.) The jaw is the first articulator to develop, so we need to make sure that this foundation is ready to support sophisticated lip and tongue movements. Jaw stability and the ability to open our mouths in four graded levels (minimal to wide) helps us sequence movements for speech. In PROMPT, we incorporate vowels into a child’s practice because vowels shape jaw movements.

After completing a SAO, clinicians calculate percentages for each of these areas: tone, phonatory, mandibular (jaw), labial-facial (lips-face), lingual (tongue), sequenced movements, and prosody (inflections/intonation.) Next, we shade in the boxes for each of these areas on the MSH to help identify points of intervention. Given the fluid interaction between these Stages, we need to address three areas to work on immediately. While we cannot change a child’s tone, it is important to note limitations and consult with OTs and PTs for suggestions on improving posture.

After selecting three areas to prioritize, we develop goals and vocabulary lists to practice words/ phrases during functional activities. This list will include a variety of vowels, consonants, and blends with emphasis on core vocabulary. From the start, we blend words into phrases to work on prosody (intonation). So, we model and support with PROMPTs, “ma more!” or “go ma?” The reason for working on prosody early on is to help make speech movements fluid and vary communication intentions.

Service Delivery with PROMPT Therapy:

PROMPT Therapy- Useful for Childhood Apraxia of Speech (crop woman filling calendar for month)

Typically, young children with apraxia of speech benefit from at least two, 30-minute sessions. Depending on the degree of severity, services may range anywhere from a few months to several years. Other contributing factors that can impact longevity of services are medical conditions, cognition, social/pragmatic skills, sensory/tactile defensiveness, and comprehension delays.

Typical PROMPT Therapy Session:

If a child with apraxia of speech has limited verbal skills, then sessions will initially focus on using vowel sounds. As vocalizations increase, then PROMPT support shifts to productions of consonant sounds/words/phrases/sentences.

A typical 30-40 minute PROMPT session for apraxia of speech would proceed as follows:

Greeting and set up (5-10 minutes)
Motor phoneme warm-up reviewing the targeted words embedded in the session’s activities with 3-5 PROMPT supported repetitions per target. (5-10 minutes)
Most sessions have 2-3 activities, each lasting 5-10 minutes. These activities incorporate pertinent aspects from the Domains reviewed above factoring in picture supports, timers, movement breaks, supported seating, and any other cues the child may need for success. Speech sound movements are worked on during play to help the child attach meaning and strengthen memory.
Review home practice plan (5-10 minutes)

Here are some examples of activities that I have used for children with varying cognitive abilities during my PROMPT sessions:

early childhood: Toy Vet Play Set with word targets to address needs in tongue control and jaw movements (go, goes, take, push, home, help)
preschool: Play-Doh Kitchen Oven with words to help work on lips-face control with movements that require rounding lips (no, two, dough, do, “mo” for more)
elementary school-aged: Pop the Pirate Game practicing words that support improving jaw control, lip contact (pop, Bob, up, “hep” for help)
middle school-aged: Knock, knock jokes to address improving prosody (intonation) and tongue control (Who’s there? cat, kitten, bike, show)

PROMPT Therapy Supports:

PROMPT Therapy- Useful for Childhood Apraxia of Speech (Nanette Cote Providing Tactile PROMPT to Toddler)

There are four levels of PROMPT (Parameter, Surface, Complex, Syllable) with clinicians using at least 2-3 of these in one session. Here is a breakdown on each level and the type of support it provides a child:

Parameter: provides the most support you can offer through stabilizing/ moving the jaw and lips. There are 13 sounds supported at this level some of which include: h, p, b, m, sh, and vowels in words like “cat”, “father”, and “eat”.

Syllable: only used for consonant-vowel (CV) productions such as “go”.

https://www.youtube.com/watch?v=CiUVHjSvCvM

Demonstration of Syllable tactile for boo-boo

Complex: helps the child contract and/or tighten his tongue to produce consonants such as (r), blends (sh), and vowels.

Surface: these supports specifically help a child with placing articulators accurately, timing movements using rhythm and prosody, and transitioning from one sound movement to another to create words.

Demonstration of Complex and Surface tactile for /s/

PROMPT Therapy and Teletherapy:

PROMPT Therapy- Useful for Childhood Apraxia of Speech (child and parent looking at computer)

In 2020, PROMPT training for speech pathologists shifted from in person to virtual because of global shelter-in-place restrictions. The PROMPT Institute also developed specific training for clinicians using PROMPT via teletherapy. Parameter PROMPT offers the most support for a child and can be easily administered by a caregiver following a trained speech pathologist demonstration. Some surface PROMPTs can also be used in teletherapy with the clinician showing this support on herself, a doll, or willing assistant.

My hope in writing this post was to provide a thorough explanation of the dynamic intervention of PROMPT. This program is unlike any other that I have been trained in over the last two decades in the field of speech pathology, as I have witnessed tremendous success when applying this methodology with clients who have motor speech disorders. Both caregiver carryover and early intervention are crucial to these achievements, so please continue advocating for your child and seeking resources like the PROMPT website to further your knowledge and education.

If you want to find a speech pathologist in your area trained in PROMPT, then you can visit this link and conduct a search.

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

Understanding Phonological Disorders: What They Are and How to Help

October 7, 2024February 20, 2024 by Nanette

Mastering Teletherapy for Early Intervention: Portrait of cute girl participating in auditory bombardment with headphones on

What are Phonological Disorders and Processes? (school teacher showing a book to the children)

In this comprehensive guide, we’ll explore phonological disorders, discuss age-related expectations, and outline your role in supporting phonological goals at home. Whether early intervention or the school system has identified your child for services, this post provides valuable insights.

Evaluation, treatment planning, and homework for phonological disorders differ significantly from articulation and childhood apraxia of speech due to their distinct nature. Please note that this post does not take the place of a comprehensive and diagnostic evaluation for your child. There are many factors that we assess when developing an appropriate treatment plan. Talk with your pediatrician, child’s teacher, and/ or speech pathologist if you have questions and concerns specific to your child.

Understanding Phonological Processes in Phonological Disorders

There are nine phonological processes that we typically encounter in speech therapy: syllable reduction, syllable structure, cluster reduction, final consonant deletion, stopping, fronting, backing, gliding, and devoicing. Below are definitions, examples, and age expectations for suppression of each of these processes.

Syllable reduction: eliminating a syllable in a word should cease by 4 years old. For example, “puter” for “computer”.
Syllable structure: inability to produce part of a syllable. There are four of these such shapes (CV, VC, CVC, CVCV) with “C” representing “consonants” and “V” meaning “vowels.” Some examples of these shapes are: (CV) “bee”; (VC) “up”; (CVC) “cat”; and (CVCV) “baby.” A child with a phonological disorder may have difficulty producing several of these combinations for an undetermined length of time. Errors will be consistent unlike apraxia.
Cluster reduction: occurs when a child omits part of a blend, most often /s/ blends /sk, sm, sn, sp, st/. You may hear him say “kin” or “sin” for the word “skin.” Children should be able to produce blends together between 4-5 years old.
Final consonant deletion: omitting the last sound in a CVC word (“ca” for “cat”) should suppress by 3 years old.
Stopping: producing a sound that should be stretched like /s/ with a /b, d, p/ (“bun”, “dun”, or “pun” instead of “sun”) should end between 3-5 years old.
Fronting: making sounds that are produced further back in the mouth more towards the front. For back sounds /k, g, ng/, the tongue lifts in the back while the tongue tip stays down in the front of the mouth. A child who fronts sounds lifts the tongue tip to touch his palate and substitutes /t, d/ for back sounds. You may hear “tan” for “can” or “tookie” for “cookie” if your child is fronting. This process ends at 3.5 years old.
Backing: the reverse of fronting. Here, your child continues producing sounds made with the tongue towards the front of the mouth, lifting the back of his tongue. So, you may hear “do” for “goo” or “gog” for “dog.” This process is often seen in children with severe phonological delays.
Gliding: substituting an /r/ with /w/ (“wun” for “run”) or /l/ sound with /w, y/ (“yeyo” for “yellow”.) This process may continue through 6 years old.
Devoicing: occurs when a voiced sound at the end of a word is pronounced as a voiceless sound. For example, a child might say “bak” instead of “bag.” This occurs as children simplify speech patterns, typically resolving by age four.

Evaluating Phonological Disorders

What are Phonological Disorders and Processes? (Bowl of pastel colored alphabet letters)

Speech pathologists observe and screen before evaluations, guiding test choices. Analysis and probes help develop treatment plans for phonological delays.

A phonological delay is when your child omits, substitutes, and/or distorts a process. This is something that all children demonstrate at various ages, but eventually suppress as they enter the preschool years. These errors occur at a young age because a child’s speech mechanism (lips, tongue, jaw) is not yet fully, physically developed to move swiftly and precisely. As children grow physically, their speech becomes more intelligible. Those with phonological disorders may need auditory training to improve accuracy.

A phonological delay means multiple sound errors. For instance, using /d/ for /th/ in “thumb” doesn’t signify a delay. This example would likely be an articulation delay. However, if he uses /d/ in addition to one of more of these sounds: /j, sh, ch, th/ (i.e., “padama” for “pajama”, “dells” for “shells”, “lund” for “lunch”, and/or “dum” for “thumb”), then he has not suppressed a phonological process of stopping and needs intervention, especially if he is five years old or older.

One of my most popular, phonological goals is: Reduce cluster reduction for /s/ blends (sk, sm, sn, sp, st) in initial positions of words with 80% accuracy given supports as needed.

Treating Phonological Disorders

In phonological therapy, we work towards helping the child learn to suppress the process. The speech pathologist prioritizes processes occurring over 40% in a speech sample. Unlike articulation issues, phonological delays vary contextually. Two options for treating phonological processes are the cycles and complexity approaches.

Auditory Bombardment:

Auditory bombardment involves repeatedly exposing your child to correct target sounds in different contexts. By hearing these sounds frequently, your child’s ears get used to them, helping them understand and recognize the correct sounds better. Hearing the correct sounds over and over helps your child learn and imitate these sounds, making it easier for them to produce the target sounds correctly.

This technique strengthens your child’s ability to hear and produce correct speech sounds, enhancing their overall speech clarity and phonological awareness. Auditory bombardment provides essential auditory input, supporting your child’s speech sound development and helping them improve more effectively in therapy.

Homework

What are Phonological Disorders and Processes? (mother and son doing art work) — Photo by cottonbro studio on Pexels.com

It is nearly impossible to skip homework practice and make progress in phonological therapy. Again, your child’s speech pathologist will want a certain level of mastery in the therapy room before assigning homework practice. Once targets are identified, clients with phonological delays can benefit from engaging in listening training at home. Ask for appropriate book suggestions. The sooner you start, the better.

Conclusion

In conclusion, grasping the nuances of phonological processes is vital for effective intervention strategies. With thorough evaluation and targeted treatment plans, accompanied by diligent home programming, children can overcome phonological challenges more effectively. Encouraging parental involvement in home practice reinforces therapy gains and fosters lasting progress in speech development.

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

Wake Up Oral Motor: Helpful Routines for Improving Awareness & Feeding

October 8, 2024August 2, 2020 by Nanette

Portrait of shocked young girl with mouth open against red background

“Speech is movement made audible…, oral-motor therapy, as it is practiced today, can be defined as the process of facilitating improved oral (jaw, lip, tongue) movements.” Oral-Motor Techniques in Articulation & Phonological Therapy by Pam Marshalla, M.A., CCC-SLP

Sometimes, children need a little more than auditory and visual cues to make sequenced movements for speech. We know that making these movements brings them one step closer to pairing sounds with those motions. Adding tactile learning can be an essential piece in the puzzle for children who need to feel more information in and around their mouths before producing a sound.

Developing a new speech movement takes time, successful practice, supports, and extinction of inaccurate movements. This comprehensive oral motor wake up routine for home intends to support caregivers in using oral motor tools sold through Ark Therapeutic to prepare the mouth for feeding and/or speech.

Years ago, I connected with Ark and they graciously gifted me several products to try with clients on my caseload. I do not advocate purchasing or implementing oral motor products unless a speech pathologist has recommended these specifically. Comprehensive assessments support appropriate treatment planning and identify other medical, contributing factors like hearing loss or tongue tie that may need intervention prior to initiating speech-language therapy.

Develop Oral Awareness With a Wake Up Oral Routine

Before a child can develop sequenced movements for speech, he needs to be able to feel and attend to the structures of his mouth. Without this knowledge, he may not be able to perform tasks like putting lips together, moving the tongue, or chewing. As a result, these children do not comprehend an auditory (verbal) direction to “Lift the tongue up and make the /d, t, n/ sound,” even when you show them how it is done.

Oral awareness through “wake-up” practice helps children feel the boundaries in and around their mouths. One tool that I have used over the last two decades in private practice is the Z-Vibe by Ark Therapeutic. You can purchase this instrument alone or as part of a grabber in the form of the Z-Grabber. For more information on the Z-Grabber, please see my post on jaw work.

Tools for a Wake Up Oral Motor Routine

Ark’s Z-Vibe Oral Stimulator

This single probe tip instrument provides intense vibration input to support stimulation, improving awareness, and exploration. In other words, it helps “wake-up” the mouth before feeding and/or speech practice. While you can only use one tip at a time, there are over 35 different ones that you can twist and secure on the Z-Vibe.

Ark’s 10-Tip Kit Set for the Z-Vibe

This kit includes the following tips for the Z-Vibe:

Preefer
Probe
Mini
Hard Fine
Bite-n-Chew
Textured Bite-n-Chew XL
Hard Spoon
Soft Spoon
Hard Brush
Soft Brush

I will be describing a “wake-up” routine using the first, four tips in the list above: Preefer, Probe, Mini, and Hard Fine. You can read more information on the Bite-n-Chew and Textured Bite-n-Chew XL in my post about the jaw. The hard and soft spoons are helpful in transitioning infants to textured foods. These spoons are especially useful if your child stuffs his mouth full as this is a sign that he needs more information and input before being able to chew and swallow.

The Z-Vibe vibration with spoon tips give oral musculature appropriate sensory input and ensures safety while eating. Finally, the brush tips support oral hygiene and dental care. These are both good options for getting ready to use a regular toothbrush. Consult your child’s speech pathologist about appropriate tips.

Wake-Up Oral Motor Routine

ALWAYS maintain control of the Z-Vibe and refrain from letting your child hold the tool itself to place on his face. We do not want the child to use this tool like a toy and/or place it on bones like the nose or ears as this is a useless, sensory stimulation experience. You may allow your child to hold the device with you, but never independently.

Step 1:

When you first introduce oral motor tools, you will need to begin by having your child feel the gentle vibration on his hands, gradually moving up his arms and towards his mouth. We want to make every step of this stimulation a positive experience and starting at someone’s face is too intrusive. Hold and count from 3-5 on your child’s hands, arms, then cheeks using the Z-Vibe with Preefer Tip.

Preefer Tip: This particular tip was designed to roll along inner cheeks and/or lips to increase oral awareness. The ridged surface of this tip was a brilliant idea because it provides the perfect amount of stimulation without being overbearing.

Step 2:

Continue proceeding with caution and positive acceptance by alerting the outside of your child’s face before moving inside the mouth. Stroke the outside of your child’s cheeks in a downward motion, starting near his ears and moving towards the lips in three rows on each cheek, counting from 3-5 each time.

Step 3:

For lip awareness, you can continue using the Preefer tip or switch to the Probe or Mini Tip.

Preefer Tip: Hold vertically at one lip corner and roll it moving towards the opposite corner. If age appropriate, you can sing a song while you move back and forth 3-5 times or simply stretch out your counting.

Probe/Mini Tip: These removable tips have three surfaces: bumpy, striated, and smooth. Start out introducing the smooth side and then take baby steps towards trying the textured ones. Stroke the lips using one surface at a time applying gentle pressure and counting for 3-5 seconds. Please note that the Mini Tip is great for smaller mouths and infants.

Step 4:

Start moving inside your child’s mouth using the Preefer, Probe, or Mini Tip to alert the inner cheeks. This area is a boundary cue for moving foods towards the molars for chewing.

Preefer Tip: Roll the tip inside each cheek with an up-and-down motion while and counting for 3-5 seconds.

Probe/Mini Tip: Position the Z-Vibe Probe or Mini Tip horizontally on the bottom of your child’s cheek inside his mouth and then walk it up using counting or a song.

Step 5:

The last step is to alert the tongue. You may use the Preefer, Probe, Mini, or Fine Tip for this final part of the routine. The only area overly sensitive to vibration is the palate, or top of your child’s mouth.

Preefer Tip: Roll this across the middle of the tongue from side to side while counting from 3-5 repetitions.

Probe/Mini Tip: Start with the bumpy side for the first round of 3-5 repetitions and then repeat this count using the striated end. Place the Tip of the Z-Vibe a few centimeters from your child’s tongue tip, holding and gently pressing as you move the tip vertically back and forth. The Z-Vibe should maintain contact with the tongue during each of the 3-5 repetitions.

Fine Tip: To build awareness at the sides of the tongue, use the Fine Tip to gently stroke with a back and forth motion for 3-5 repetitions on each side.

Take Away Points for Wake Up Oral Motor Routines

1. I use a variation of the “wake-up” routine at session starts to build muscle awareness for feeding and speech.
2. Tactile sensation is part of my comprehensive plan for children with feeding and speech delays.
3. A multi-sensory approach includes auditory, visual, and tactile cues, supporting overall progress with caregiver training.

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

SIX Ways To Improve Vocabulary

July 10, 2024July 15, 2020 by Nanette

There are six effective vocabulary strategies to improve development. Explore our comprehensive guide to discover practical techniques and activities tailored to enhance vocabulary skills in speech therapy sessions. Caregivers can help improve their child’s vocabulary by practicing categorization, association, using themed-units, identifying attributes, and understanding context clues together.

The title: speech pathologist is rather misleading as it implies that we only work on speech. Whether we work in private practice, hospitals, or school settings, speech pathologists address language delays just as much as speech and articulation disorders. One aim of this post is to enhance expressive and receptive vocabulary skills, considering comprehension’s significance for meaningful language use. Some children excel expressively but require receptive skill development. Others need more focus on expression. Still, others can show a delay in both areas. After formal evaluation, a therapy plan is designed to best meet your child’s needs.

Vocabulary Strategies: Categorization

Vocabulary Strategies: Image of categorized fruit stand — Photo by Clem Onojeghuo on Pexels.com

There are a few strategies that we can use to help improve vocabulary skills. The essence of this work is to teach children how to store vocabulary concepts like a filing system. Categorization activities may involve asking the child to name or identify members of a target group. For example, three items that belong in a zoo group include: lions, tigers, and bears (oh my!) On the flip side, we can also ask the child to provide or find the category name for a group of its members. We address categorization skills every day in our functional routines when we put away groceries, laundry, and toys.

HOME ACTIVITY:

Easy vocabulary strategies using two paper tote bags — Photo by George Dolgikh on Pexels.com

I had the good fortune to work with some exceptional Speech-Language Pathologists early on in my career. During one of my observations, I watched students play a lively, category game using just brown paper lunch bags and small sheets of paper. This game can easily be adapted for children in 1st through 5th grade. If your child is younger and has a hard time reading, then you can always put pictures on the bags in place of words.

Before you begin, get at least 10 paper bags, and write the names of various category groups on each one. Then, make a list, using a small piece of paper or half of an index card, of 4-5 group members. For pictures on bags, create and attach them. Make groups like Colors challenging by listing specific members, not just primary colors.

This is how you play:

Have your child set up bags with category titles. Then, read category members aloud for your child to listen. Then, have your child take the paper and place it in the correct bag. At the end, I always go back and take a paper out of the bag and practice recalling category members. You can make it into a game by giving a point for every correct placement for the word list and a point for each member he or she can recall from the list.

Vocabulary Strategies: Associations

Vocabulary strategies: Part-Whole Associations — Photo by Sarmad Mughal on Pexels.com

Word associations are another example of teaching a “filing” system for word retrieval. These word pairs express a relationship that comes in many forms such as:

Opposites (night and day)
Synonyms (large and big)
Part-Whole (wheel and car)
Attributes (yellow and bees)
Functions (sleep and bed)

Vocabulary Strategies: Themed-Based Units

Theme-based vocabulary strategies: close up of leaves in autumn — Photo by BREAKS OUT on Pexels.com

Themed based units typically follow seasonal events, activities, and familiar sights throughout the year. You can even build categorization and association strategies using themed units. This approach can be effective because you teach what the child is exposed to in his or her everyday life, which can make these terms become more functional as the child can apply therapeutic learning naturally in other settings.

Vocabulary Strategies: Attributes

Vocabulary strategies: close up photography of different type of colors of paper — Photo by Pixabay on Pexels.com

Another strategy for improving vocabulary is teaching attributes for target words. Here, we incorporate games, worksheets, and homework lessons that focus on describing items according to their function or use, color, shape, and size. We can also use other senses like taste and touch to define words. In this way, we have taken one vocabulary word and taught up to six more while formulating definitions.

HOME ACTIVITY:

Here’s an association activity based on seasonal themes and incorporating attributes that you can do for each season of the year with your child.

SUMMER: First, make a yellow circle and write in the middle, “Things that make me think of summer.” Then, cut up to 10-15 strips of paper to make the rays for the sun. Finally, brainstorm associations together and write down answers on rays. Some associative words my son helped me come up with for this task included: pool, beach, lake, water, hot, heat, ice cream, sunscreen, vacation, and swim.

FALL: Create a tree with different colored leaves for association words: colors, windy, apples, pumpkins, football, leaves, Halloween, Thanksgiving, hayrides, and scarecrow.

WINTER: Use snowflakes for association words and form these into a giant snowball. Some suggested terms: cold, ice, snow, coats, hot chocolate, holidays, snowman, sledding, ice skating, and boots.

SPRING: Create a giant center to a flower and write these words on petals and stems: warm, crisp, rainy, bloom, flowers, green, jackets, growth, new, and muddy.

Vocabulary Strategies: Context Clues/ Word Parts (Prefixes, Suffixes)

Vocabulary strategies: College student writing on blackboard and using context clues

Utilizing curriculum vocabulary with older children poses challenges in language goals due to progress assessment difficulties in my experience. However, we can measure improvement in a child’s ability to interpret vocabulary meaning in context or demonstrate knowledge of word parts. One of my most treasured purchase from Teachers Pay Teachers (TpT) is product called: Context Clues Packet using Tier Vocabulary by Nicole Allison. It is engaging and comprehensive for both elementary and middle school students. I especially like having answer choices for determining vocabulary meaning in context because it teaches another strategy of eliminating less obvious selections.

As support staff, we are challenged with helping foster independence with our students. We will not be there during their classroom instruction or testing to provide cues and probes to increase comprehension, so we need to teach strategies for unaided success. Incorporating the above mentioned techniques into daily activities at home can significantly boost your child’s vocabulary development. Remember, even just reading together is a great way to expand language skills!

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

Why Visual Supports Make a Big Difference

July 8, 2024May 24, 2020 by Nanette

For children with speech and language delays, using visual supports like sign language, natural gestures, photographs, and digital pictures is incredibly empowering and educational in teaching comprehension and verbal expression. Imagine the frustration of a hungry toddler, unable to speak his needs, without any way to express his snack preferences. Having a visual support handy does not take the place of teaching your child speech skills. Rather, visuals enhance a child’s comprehension; help you identify the intended word to support your child in practicing saying it accurately; and reduce frustrations and negative behaviors. There are several ways that you can provide visual supports.

Using Sign Language For Visual Supports

Nowadays, it is very much in fashion to use sign language with young toddlers. Bookstores, libraries, apps, and mommy groups offer sign language resources for learning with ease and convenience. My favorite resources are produced by Signing Time. This company offers DVDs teaching sign language for babies and toddlers, featuring infant and toddler models. They’re highly recommended by many. The greatest thing about using sign language for communication is that unlike pictures, you always have your hands with you. Below are the top three reasons why caregivers and speech pathologists alike are using sign language.

It significantly reduces frustrations for both toddlers and caregivers. Toddlers often understand more words than they can express, demonstrating a larger receptive vocabulary compared to their expressive vocabulary. Your child knows what he wants to say, but he cannot get those words out just yet. Signing a word requires less effort and fewer steps than verbally producing the same word, making communication more efficient.
Teaching sign language supports speech development. Now that you have reduced those frustrating moments, there are naturally many more teachable opportunities in your day. For example, your child signs “milk” and you repeat the word “milk” a few times as you prepare the Nuby cup.
It supports receptive (comprehension) development. Children need to understand the meanings for words to bank those words into their spoken word repertoire. They may not say “milk,” but using the sign for it, they request it, reinforcing its meaning as they enjoy it.

Natural Gestures

In addition to sign language, you can use natural gestures with your child to help elaborate on communication. You are probably already doing many of these naturally (hence the term natural gestures.) Common examples seen with children between 9-21 months old are:

Waving hello and goodbye
Holding out your arm to show someone an object in your hand
Pointing to objects to express wants
Shaking your head to say “no” and nodding to say “yes”
Taking your hand and bringing you to a desired object
Making a movement to request an action (i.e., jumping to request trampoline play)
Giving a “hi-five”

Photographs: Dynamic Visual Supports

For some children, planning out a motor sequence to maneuver their hands to show a sign is incredibly difficult. I use sign language to enhance comprehension but rely on photos and digital images for effective communication of wants and needs. Photos of favorite items in a mini book or magnetic cases are handy. There are several goals in using these pictures:

Photographs narrow down the options and help you quickly understand your child’s wants. For example, if your child can make the first sound in a word, he may say, “guh” for granola, grapes, and gummies. If you have a photograph for each, he can continue to say “guh” and point to or look at the picture of the object he desires.
The natural progression in language development begins with comprehending names for objects. Children first learn that a three-dimensional object is called a “ball”. Using photos helps children understand objects. Show a picture of a ball to teach its representation. It enhances communication and comprehension.
Storing food and toy pictures in specific areas teaches categorization skills, aiding your child’s vocabulary development. We use this strategy to store new information and broaden both use and understanding for vocabulary words. Compiling food pictures in the kitchen and toy images in the family room teaches your child organization based on category.

Digitally Created Visual Supports

As your child becomes familiar with actual photographs of objects, you can transition to digitally produced pictures. These images are the creation of a digitally encoded representation of the visual characteristics of an object, such as an image of a ball that is not a photograph. Consult with your child’s speech pathologist to create a picture vocabulary, especially if your child has limited verbal skills or needs long-term support. If digital visuals are needed, then consider purchasing an iPad app. Custom Boards by Smarty Ears apps is well worth every penny!

In conclusion, integrating visual supports into your child’s learning journey can be transformative, offering a bridge between comprehension and expression. By utilizing sign language, gestures, and visual aids, you’re not only helping your child navigate communication challenges but also fostering a supportive environment where their needs are understood and met. Embrace the power of visuals as a tool to unlock your child’s potential and enhance their speech and language development journey.

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

Transform Communication with the Power of Floortime

October 8, 2024October 8, 2019 by Nanette

Embark on a journey of discovery as we delve into the transformative power of Floortime in embracing a child’s natural play inclinations. A while back, an Instagram photo inspired me to invite the photographer for a guest post about child-led play. Sara Roberts is an ASHA certified Speech-Language Pathologist based in New York. She received training in Floortime while in graduate school at Queens College. Floortime’s foundations greatly benefit her work with children on the Autism Spectrum in Early Intervention, preschool, and elementary school settings. You can follow her on:

Instagram: https://www.instagram.com/slptree/
Teachers Pay Teachers: https://www.teacherspayteachers.com/Store/Slp-Tree

Do you know how to play with children on the spectrum?

Playing with a child that barely or does not at all acknowledge your presence can be intimidating. It can make you feel lost. I have seen many adults (myself included at one time) try to interact by asking questions and get nowhere.

“You’re playing with the animals?” … No response.

“Which one is your favorite?” … No response.

“Can I have a lion?” … No response.

Strategies such as Following the Child’s Lead, Parallel and Self Talk, and Expansion are KEY to working on joint attention, engagement, as well as language and play development.

Here is an example of Floortime in action:

A child was playing with toy animal figures by silently standing the animals up and knocking them down repeatedly. I copied what he was doing while I modeled the words “up” and “down” both verbally and on his Augmentative and Alternative Communication Device (AAC). He did not pay too much attention to me, but he let me do it and he was being exposed to language (win!).

Then I added to his play idea by getting really animated when I said “down” and crashed the animals all over the table. This made him smirk and look up at me. We did the routine again and this time he imitated my crashing motion. After a few repetitions, I added the idea of the animals jumping over each other and he imitated that too! My hope is that he remembers this expanded play idea the next time the animal bin comes out and he will use the language I modeled for him.

Now what do you do with a child that does not play with toys?

A child was wandering the room and spinning around in circles. I copied him by spinning too while I modeled the word “spin.” After a few moments, I said “stop” loudly while I stopped spinning and put my arms up in the air. I kept repeating this, hoping that the child would establish eye contact with me and/or copy my action. He did not, so I copied his spinning and then fell to the floor while I said the word “down.” He never looked at me directly, but eventually he fell to the floor too! We kept repeating this until he let me hold his hands and we were playing a modified version of Ring Around the Rosie.

What about children who tend to focus on tactile stimulation?

Let us say a child is running his fingers along window blinds. First, copy his action by running your own fingers along the blinds next to him. Then narrate what you are doing with simple language such as “up, down” or “open, close.” After a few repetitions, expand on this idea by adding one new idea. For example, when the blinds close, you can say, “Goodnight!” and pretend to sleep. When the blinds open, you can say, “Good morning!” with an exaggerated stretch and yawn.

Let us say another child is running his fingers over a bumpy surface. Copy the action then narrate such as exclaiming, “Bump!” or saying, “bumpy, bumpy, bumpy” in a sing song voice. Then add a new idea such as introducing a toy car and having it drive over the bump.

Floortime: Takeaway Thoughts

These strategies may not give you results every single time, but you are exposing the child to language and different play ideas and that is always a success! Here is the bottom line when playing with children on the spectrum: copy what the child is already doing and then add to it! Sara Roberts, MA CCC-SLP

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

SPARK Cards: A First Person Review Of A Versatile Resource

November 3, 2024March 11, 2019 by Nanette

It’s always exciting for me to review a product, especially one as versatile as SPARK Cards! I can appreciate the hard work involved in creating educational items and the effort needed in promoting the tool. This is an honest review of how I found benefit in using SPARK Cards for sequencing in my private practice.

SPARK Cards Pros

Over the years, I have used SPARK Cards in my home office and teletherapy sessions with good success across a wide variety of ages, abilities, and settings. Some of my favorite features include:

Durable cardboard cards with a gloss finish to withstand being handled by many, little hands
Ability to use a dry erase marker to bring attention to teaching concepts
Functional stories that support making connections to daily living
Detailed descriptions for each card in a sequence to make session planning easier for the busy SLP and facilitate generalization of skills in the home setting
Hypothetical problem solving probes for each topic
Appropriate for children as young as four years old through middle school-aged clients

Teletherapy

I used these cards in teletherapy in two, different ways. One of my clients is working towards sentence formulation for functional tasks, so I scanned and loaded the Going to the Library deck in sequential order so we could address his goal without taxing the activity with sequencing. This particular deck is my favorite in the collection because we can talk about the library year round. I also like that the library itself mirrors a dated one that has patrons returning and checking out books the old fashioned way by handing them to a librarian. It’s a nice way to compare/contrast past and present features. I added some humor to the activity by joking about seeing a ladder. We addressed answering yes/no questions and problem solving in a lighthearted way that I feel improves engagement and attention in any task.

The second way that I used the sequencing cards was via my document camera. Another virtual client needs to improve sequencing skills, so I took three at a time from the Making a Lemonade Stand deck to provide choices while addressing sequential ordering. The three cards with kitchen backgrounds are my favorite ones in this series because I could again work on comparing/contrasting room features in the pictures to my client’s kitchen. Making these kinds of connections helps strengthen memory skills and brings much more meaning to our language activity.

Recommendations

While I LOVE the convenient portability of the SPARK collection and ease at which I can store it in my ever growing therapy closet, I would like to see the cards enlarged a little. Some of the smaller features are missed in my office sessions as I cannot magnify or zoom in on the cards as I can online. There is just so much fabulous detail in each card, that I would be saddened if my clients missed them.

I would highly recommend SPARK cards for home practice of all the above-mentioned language skills. Even children working on articulation goals could utilize this product, especially those needing drills at the sentence/conversational level. Specifically, the acronym SPARK stands for the following language probes embedded in each sequencing deck:

Sequencing and sentence formulation

Predicting, problem solving, picture interpretation

Analyzing and answering ‘WH’ questions (WHO, WHAT, WHEN, WHERE)

Retelling a story and reasoning skills

Knowledge of basic concepts and vocabulary

This comprehensive, affordable product promotes improving language skills at home. Since my original review, the developers launched more decks: SPARK collection 2 and SPARK Junior (appropriate for children 3 years and older).

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.

I Love You Daddy: Using Alexa to Help with Parkinson’s

July 19, 2024January 18, 2019 by Nanette

Parkinson’s Disease Diagnosis

Just prior to the 2018 national speech and language conference in Boston, the man who means the world to me, the one who sacrifices everything for his family, was formally diagnosed with Parkinson’s Disease. Learning about my father’s diagnosis of Parkinson’s Disease was a pivotal moment that deeply impacted our family’s journey.

For the last few years, my daddy has been losing weight and slowing down. We initially attributed it to old age, but in recent months, the hand tremors intensified, followed by a shuffling walk and breathy voice. Living in Illinois makes it hard to care for Pops, who still lives in the Rhode Island home I grew up in. I felt lost, sad, and guilty for not being closer to home. The 2018 ASHA conference was just what I needed, in a location where I could spend time with family. I could network with professionals closer to my dad, educating myself on his care and hopefully finding the best.”

Background and Training

I’ve been a speech pathologist since 1995, primarily with pediatrics. After my practicum at RI Veterans Hospital, I worked per diem. Needless to say, it had been a while since I serviced adults. What better way to learn about the most current treatment programs for Parkinson’s than at the national ASHA conference? So, in between sessions on teletherapy, stuttering, and augmentative communication, I took courses in cognitive and voice therapy for people with Parkinson’s. I also spent some time researching Big and Loud therapy (LSVT) in poster sessions and at booths.

The most informative course was the very last one that I attended at ASHA on cognitive therapy. While this course was geared towards cognitive group therapy in a nursing home setting, I started thinking about ways to modify the plans for my daddy. To summarize the ASHA session, the presenters discussed functional lesson plans that incorporated conversations about recent and past historical events. The purpose was to help with memory and retrieval skills and facilitate making connections with personal accounts.

Amazon Alexa

It dawned on me that my daddy and I could use our Amazon Alexa to inquire about historical events by asking: “Alexa, what happened on this day in history?” You can even further probe with a follow-up question: “Alexa, what else happened on this day in history?” The plan has been for each of us to ask our respective Alexa’s this information and then I call Pops first thing in the morning to review the material. Later in the day, after completing my treatment sessions in Illinois, I call Pops in Rhode Island and ask him to recall 1-2 historical events we discussed that morning. When possible, I try to include personal perspectives to assist in recall.

This daily interaction supports goals like clear commands and increasing vocal volume. Talking with my dad lifts his mood. Since starting this interaction, my dad’s tone has improved. I hear glimpses of the man I’ve always loved.

Modifying Programming With Alexa

On some days, I assess conversations, especially if he skips meals, resulting in breathy voice and memory issues. Those days, language cues aren’t effective, so I just review the information again. He recalls more detail when he listens to Alexa’s recount. We accept it’s okay to listen multiple times or take notes. I periodically remind him that it’s not about recalling, but what he taught me growing up, avoiding making him sad. Be kind to loved ones whenever possible, avoiding regrets about not showing care when you had the chance.

Nanette

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.