speech therapy - Lessons in Speech with Nanette

Mastering Teletherapy for Early Intervention

Mother with child in Teletherapy Session

By: Janet L. Courtney, MS, CCC/SLP

Founder and CEO of Lighthouse Therapy LLC

Lighthouse-therapy.com

I am excited to introduce Janet Courtney, CEO of Lighthouse Therapy LLC, a teletherapy company. With over 25 years’ experience, she’s passionate about mentoring and supporting others. You can find Janet’s blog at https://www.lighthouse-therapy.com/blog, contact her at Lighthouse at contact@lighthouse-therapy.com or call 888-642-0994.

Teletherapy for Early Intervention

“My son is two and he isn’t talking yet, is that normal?” “Our one-year-old doesn’t feed herself and has trouble holding a spoon, is that normal?” A teenage mom with a 2-year-old and a 3-year-old is feeling overwhelmed and doesn’t know how to handle her children’s bad behavior. All these scenarios are great examples of children who will benefit from teletherapy for early intervention. The federal Individuals with Disabilities Education Act, Part C, (IDEA) covers services for children and families from Birth through age 3. The Preschool Program of Part B covers children for ages 3 to 5 (Section 619). These programs mandate special education services to be provided to families and their children with developmental delays or disabilities.

Referrals

Who plays a role in spotting these issues in students? Referrals can come from different sources. Parents are usually the first to notice issues, but teachers or doctors may also notice delays. Seeking help is crucial as these services greatly impact a child’s development and future education. The first 5 years are critical for physical, social, communication, and academic development.

Referrals for Early Intervention or Preschool involve a team of professionals who create an Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). The team composition depends on the child’s needs. Together with parents, team members outline concerns and services for the child and family. An IFSP, in particular, involves the entire family, emphasizing education and consultation. The program also sets goals related to the child’s development.

Groundwork for Success

Some parents and professionals may question how telepractice can meet children’s needs online and if it’s effective. Will it really work? How can therapists gather data for eligibility without being physically present? These are valid concerns that need addressing, especially regarding Early Intervention (EI) and Preschool services provided through telepractice. When a child is referred for these services, developmental assessments and parent/teacher questionnaires play a crucial role in understanding the child’s functioning. These assessments and interviews can be conducted via telephone or through the telepractice platform, often sent electronically. Lighthouse Therapy’s platform ensures safe and confidential sharing of information, reducing the risk of exposing Personal Health Information.

Online Video Conferencing

Portrait of cute girl listening to music on headphones while using laptop at home

Therapy sessions are conducted via online video conferencing, allowing flexibility for sessions in the child’s home or preschool classroom. Clinicians coach parents on targeted strategies, observe progress, and adjust techniques accordingly. In preschool, a support specialist or assistant aids the child in joining sessions. Through engaging activities and documentation cameras, therapists monitor and guide students effectively. Lighthouse Therapy’s platform is adaptable, ensuring a dynamic experience for all involved.

Parent Coaching in Teletherapy for Early Intervention

As therapists, it’s crucial to communicate clearly with parents and caregivers, offering practical strategies to enhance communication and learning at home. We teach parents how to emphasize key messages and directions, provide repetition and modeling for the child, and encourage recording interactions to track progress over time.

Wondering how to make teletherapy sessions successful for young children? SLPs plan multiple activities for a 30-minute session to maintain engagement. Themes, interactive videos, picture activities, and memory games keep sessions lively. Using stamps, drawings, and show-and-tell encourages communication skills.

For a FREE ebook that details parent coaching, please subscribe below:

Developmental Links

It is important for the professionals to have access to developmental norms, so I have included a couple links:

Many areas of the country desperately need these services. Engaging telepractitioners will provide key services crucial to children’s future academic success.

I love you, Daddy

by Nanette Cote

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.

Going with the Flow

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.

FAQ: Playing with Water in Speech Pool Groups

by Nanette Cote

In December 2015, the ASHA Leader honored me in their Limelight section. Months later, emails flooded in with excitement and questions about playing with water in speech pool groups. Messages from SLPs globally, including Germany, and locally, such as Illinois, have been received and appreciated. In true SLP fashion, professionals asked poignant questions, inspiring a FAQ post about speech and language pool groups. This post later turned into a guide book: We Talk on Water (available on Amazon.) For detailed guidance on lesson plans, materials, billing, participant recruitment, documentation, and low-tech AAC, this book is essential!

FREQUENTLY ASKED QUESTIONS ABOUT SPEECH
AND LANGUAGE POOL GROUPS

Coursework and Training

How did you got started in doing treatment sessions in the pool? In 2003, I observed a pool group at a Jewish Community Center in Rhode Island. Soon after, I requested insurance coverage. It took a couple months before my job site hosted speech and language pool groups at the Jewish Community Center. My tasks were promoting the pool group, collaborating with a PT, and writing weekly service notes for billing submission.
Do you have any special certifications to help with your sessions in the pool? I acquired all of my training through experience. Hosting my first pool group with an exceptional PT taught me about water positioning and improving stability and attention.
Is there coursework or training for providing aquatic speech therapy services? One of the emails that I received following the ASHA Leader article was from Susan Nachimson who shared that she has been teaching a course titled: Speech Therapy in an Aquatic Setting since 1/2002 [California Board of Speech Pathology (PDP#129)].

Securing a Facility

How would I go about looking for other facilities that offer aquatic speech therapy services? If you are not interested in starting your own group and would rather observe pool group therapy, then begin by calling rehabilitation facilities. Many of these locations have heated pools that they use for physical therapy with clients.
How did you secure the pool? Six months before the services were slated to begin, I actively researched for the pool group session I wanted to offer through my private practice. First, I called three facilities and ask to speak with the aquatics directors. I followed up by meeting receptive individuals who rented their pool to rehabilitative agencies. I chose Rush Copley Healthplex
Do you think a neighbor’s pool with an outside shower and bathroom work? I’m not a strong swimmer, so I’d feel uncomfortable using a neighbor’s pool and taking on liability for the group. I also like being in the community and being able to offer pool group services to up to 10 families. Having the ability to invite several participants also increases opportunities for peer modeling and expands socialization.

Billing, Insurance, and Liability Coverage

Do you bill for it like a normal group speech therapy session? Yes, I bill my speech and language services using the speech group CPT code 92508. This code is an “un-timed” one, meaning that you can expect the same reimbursement whether you spend ten minutes in the water or sixty.
Did you bill to insurance companies or do the group sessions private pay? If you did private pay, what were your rates? I do a little bit of both depending on the insurance carrier and my network participation. I advise families with high co-payments near reimbursement limits not to use coverage, to avoid taking away sessions. Research insurance reimbursements and set charges accordingly, ensuring rates align with coverage and state regulations. You can expect to make significantly less for group services than for individual sessions.
How did you go about getting liability coverage to work with clients in the pool? I asked the pool facility what they required and in my circumstance, I only needed to add the location name to my existing liability policy. This addition did not require any additional fees. You should ask this question while researching pool facilities as this may vary depending on your state.
Do you pay pool rental fees? There are non-refundable pool rental fees at the facility that I use for group services; however, I ask families to cover these costs. Families are expected to pay a designated amount per group for each of the six weeks of my program. This fee is not prorated if they miss a session. I cannot afford the risk of paying for weekly services for each family without being able to bill for a session if the family misses or decides not to continue for whatever reason.

Goals and Session Outline

Do you have specific goals for each child while playing with water or is it more a general group therapy targeting various aspects of language (engagement, imitation, vocalizing, following directions)? Years ago, an EI PT and I devised a service form for pool group tasks, now adapted for my private practice. New students are offered a free consultation to align goals. I designed the SOAP note to allow me an opportunity to comment and expand on tasks and I used a local printing store to make carbons of the note so I can quickly provide families with feedback about the session. I also wrote an outline of all the developmental goals that you can address with children aged two through seven years old during pool group therapy.
Have you ever used pool therapy for middle school and high school students with autism? And if, what kind of activities did you do? No, I have only worked with children aged 2-7 in the pool.
Would you mind sharing more details about a typical pool therapy session? For more details about my group agenda, you can follow this link.
What songs do you use in pool groups? The most popular songs are: The Wheels on the Bus, If you’re Happy and You Know it (I use this tune for a directions game to sing, “Put the duck on your head, on your head”), Head, Shoulders, Knees, and Toes, Five Green and Speckled Frogs, Hello and Goodbye songs, All the Little Fish were Swimming in the Water, One Little, Two Little, Three Little Bubbles.

Other

Did you have an ongoing day/time for a number of weeks? Yes, my summer groups are weekly at the same day and time for six weeks total.
Did you have the parents in the pool too? A caregiver at least 18 years of age is required to remain with each child before, during, and after pool group sessions.
Were your classes 30 min or one hour? My water sessions are 30 minutes long, but “therapy” begins in the changing room both before and after water play. We talk about our sessions, what we wear in the water, and temperatures that day just to name a few.
Did you co treat with a PT? I currently work as a solo facilitator for my pool group sessions, but highly recommend working with a motor specialist when possible, especially if you are just getting started with pool group therapy.
How do you advertise (word of mouth, flyers at your clinic, etc.)? I bought local ad space but got no clients. Last summer, participants found me on social media, through ABA meetings, and referrals.

Not-so-Spooky Halloween Activities for the Young at Heart

by Nanette Cote

Fall is one of my favorite seasons, with the changing colors, cooler days, slower pace, and holidays abound. I transform my office and set up not so spooky Halloween activities for the young at heart for at least six weeks! Let’s take a closer look at some easy and affordable ways you can transform any space for fun and functional learning.

DECOR

Over the years, I have purchased many Halloween decorations at the end of the season clearance sales at Target and Walmart. I also collect seasonal items at the Dollar Tree for both crafts and decor. These materials help me to transform my office space into a fun, brightly-colored theme that usually brings a smile to a client’s face upon entering. Some of my typical decor lasts for a few years or more. I decorate with Halloween-themed items like a plastic cloth, banner, haunted houses for storage, and a bucket of books. The vibrant decor prompts clients to comment and label objects, enhancing engagement during therapy sessions.

A clearance door covering with removable stickers from Target was a favorite find, providing enjoyment for clients for years. The stickers were easily removable, allowing multiple clients to enjoy the task over several years. We worked on following directions like, “Put five pumpkins on the fence”, “Give each pumpkin and ghost a hat”, “Put the bat on the moon/window” and “Put the pumpkin on the ghost.” I liked that I could work on familiar and novel commands and vary this activity to meet the needs of many clients.

My Halloween book collection, mostly my son’s, is extensive, as seen below. I use them for sequencing tasks with clients. Manipulatives purchased from various sellers enhance language tasks with the books during sessions. Having these hands-on activities while reading books dramatically improves attention, which in turn increases word ordering sentences and responding to questions about the story. You can find some wonderful materials at these locations:

PUMPKIN CRAFT

Another huge hit every year is my Styrofoam pumpkins craft with plastic facial parts all courtesy of the Dollar Tree. We use this in language sessions to make requests with complete sentences like “I need a mouth” or “I want eyes.” This task is especially perfect for my young language learners using speech generating devices.

Everyone enjoys taking these home and recreating it. Some caregivers commented that they liked this activity so much that they purchased more pumpkins and facial parts on their own and made them with siblings at home. I love it when something that we talk about in the speech room can be generalized to other settings!! What a great way to practice functional and seasonal vocabulary and language skills!

SCARECROW SNACK

One sure way to a child’s heart is food! We have made a scarecrow treat to practice sequencing, commenting, and requesting. I found this creative snack in a Pillsbury Halloween cookbook that I bought years ago when my son was a mere toddler. You can see the steps in the images below if you want to make your own, yummy snack sometime.

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

Many of my activities for little ones between the ages of 2-7 include hands on play and sensory time. A fan favorite is play dough. I make my own batch for individual clients using this recipe that is quick, inexpensive, and easy. When I want to move on to another color, I send the play dough home with the client and whip up another batch.

One time, I accidentally stumbled upon an activity to work on sound sequencing using play dough and mini erasers/ objects. You do not need to practice the names of the characters on the erasers, unless you want to. My clients primarily worked on sequencing simple CV, VC, and CVCV combinations, so we used individual targets while pushing the object into the dough. I’m telling you, we could spend half of the hour long session just playing with dough!

SENSORY BINS

Speaking of sensory play, I also love switching out a basket or bin for seasonal activities. We have practiced sounds and words while digging through a bin filled with leaves in September and then hunted for targets in a Halloween-themed bin in October. Near Thanksgiving, I mixed Velcro foods with fake gourds to target CVC words like “cut”. I find much of my fill for these sensory bins at the Dollar Tree and typically throw away what I cannot sanitize and just buy new fill the next season.

Fall

Halloween

Thanksgiving

LEGOS

I usually have a couple upper elementary students working on articulation of (you guessed it) /s/ or /r/!! These clients have loved earning a Lego brick each time they practiced a target. Once all targets were earned, clients were given some time to create a Halloween character. Kids are so much more creative than I am when it comes to crafts, so I rely on them to make a masterpiece without laying out a predetermined plan. Here is what my a fifth grader conjured up: can you tell he loved Minecraft?

I hope you enjoyed this fall post and found a new resource or two for your speech sessions! Incorporate these not-so-spooky Halloween ideas into your therapy sessions, creating a fun and engaging atmosphere for speech and language development.

Six Opportunities for Modeling on AAC Devices to Support Communication

by Nanette Cote

Why you should model language on AAC communication devices: Unveiling the transformative impact of this crucial practice in enhancing communication skills. This post will help you discover how AAC communication devices facilitate communication growth, enabling users to engage in requesting, greeting, turn-taking, commenting, protesting, and responding.

SGD and AAC

Speech generating devices (SGD) are an electronic augmentative and alternative means of communication (AAC) for people with limited verbal ability. These devices can be used to augment someone’s speech that may be difficult to understand or as an alternative to speaking to make one’s needs known. Considering so many options available, experts recommend a selective and comprehensive team approach for determining which device to trial. I have joined school team meetings, aiding young clients in selecting a speech device. Witnessing their newfound communication skills fills me with joy.

Initially, we want the child to explore and feel ownership with an SGD, but it is just as important to model language on these devices as well. I have often heard parents comment that their children do not like having anyone else touch their devices. Respect their ownership, but let your child know you also need to touch the device to help them learn. Simply modeling verbally is not enough; you must also show your child how to navigate to words not on the initial screen page.

Model to Expand Communication

In my experience, most children begin using an SGD to request food and toys, which are tangible reinforcements for making your needs known. This can certainly support wanting to use a device again given the benefits. We often forget to model other communication intents beyond requesting, assuming a child will demonstrate them independently. Communication extends beyond “Ask and you shall receive.” We must demonstrate all aspects of engaging with others to our children. I’ll describe six communicative intents with examples for direct modeling on your child’s device. Teach diverse communication and guide children on SGDs to map and locate words effectively for various exchanges.

Requesting

In the opening of this post, I presumed that your child has already reaped some rewards in requesting foods/ toys using an SGD. That does not mean that we check the box on making requests, rather we expand on it. Using your child’s age and ability as guides, model simple phrases and/or sentences. A two-year-old or early language learner may find “I want a cookie, please” too complex without prior phrase development. A better option would be modeling “more cookie” or “no cookie.”

Greetings

This is a great way to elaborate on greetings beyond a wave hello and goodbye. Navigate to your child’s “people” page and model, “Hi, Nanette” or “Bye dad.” Go ahead and say hello and goodbye to toys as you take them out or clean up.

Turn taking

Asking for a turn using a word like “me” or combinations such as “my turn” adds variety to requests. It prevents overreliance on the device for food requests. You can model these during play or game time. This simple act is more powerful than you would think. Remember that the whole purpose of communication is rooted in taking turns to say or do something. Lay this foundation as soon as possible to open more doors to communicating with your child.

Commenting

Limit labeling items using “I see an apple” since it is not natural for us to walk into a room and start making these statements. Rather, teach sentences such as “I like this apple,” or “This apple is good.” Remember to model in the language structure appropriate for your child.

One fantastic opportunity for modeling comments is during shared book readings. Instead of reading your child’s favorite book to him, read it with him using his device by modeling things like, “Uh Oh,” “That’s silly,” “Oh no!” and “Great!” to make a variety of comments. Here is a video of an autistic youngster who mastered commenting independently with a Pete the Cat book.

Protest

Yes, I want you to teach your child to protest, but in a socially appropriate way using words and/or phrases. Model saying “no”, “mine” and “all done” and praise independent usage of making needs known. If your child routinely uses these to escape work activities, solidify responses. Then, explain it’s time to work first or offer another choice.

Respond to questions

Teach how to answer WHO, WHAT, WHEN, WHERE, and WHY questions using words, phrases, then simple sentences. You can model further by elaborating with descriptive words like, “It looks yellow.”

I have become most familiar with the Nova Chat SGD, which allows you to program information about something that happened during the school day and/or over evenings and weekends at home. So, when asked, “What did you do in school or at home?”, your child can learn to navigate to the page with this information to respond to these questions. A client collaborated with her school SLP to learn answering “All About Me” questions, a wonderful, functional communication method.

I hope that this post provided some specific examples of modeling a variety of communication intents on your child’s speech generating device. These early conversation starters lay a foundation for expanding language skills and developing social connections. Do not hesitate to get your hands on your child’s device and teach them these skills through modeling. You will amaze yourself at all the doors you open for communication.

Successful Group Speech Therapy at the Pool

by Nanette Cote

“Aquatic therapy and children…is a medium… (in which) great things… (may) happen in the physical, cognitive and psycho-social realms…while providing a natural environment in which to practice ADL skills, communication skills, problem solving skills and motor skills…”

(From APT Newsletter, October, 1995, “Aquatic Therapy and Children—Welcome to the Water”, by Dori Maxon, PT, specializing in pediatric physical therapy for children with a variety of limitations including gross motor involvement.)

Natural Environments and Early Intervention

The idea of “Natural Environments” is a concept synonymous with Early Intervention. As specialists, we provide our services most often in the naturally occurring setting, the family’s home. Early Intervention sites often recommend structured group settings for socialization and peer modeling. Finding a ‘natural’ space for group instruction among typical peers posed a challenge for therapists at Hasbro Hospital. A team of us put our heads together and identified an innovative therapy approach of group speech therapy at the pool, where fun meets effective communication enhancement in a unique setting.

And so it Begins

One day back in 2003, I was observing a toddler in his Gymboree class when somehow the topic of Early Intervention groups came up with another Speech Therapist from Meeting Street School in Rhode Island. She had found a rental at the Jewish Community Center (JCC) in Providence and was co-treating a pool group with a physical therapist. Shortly after, I found myself observing her group with my own “physical therapist partner –in-crime,” Kate Sparrow! We watched, listened and took notes.

Clearance was easier than expected. A couple of phone calls to the Risk Management office at Rhode Island Hospital sufficed. Some would argue that the pool was not a “natural environment” since the families could not frequent the pool outside of our session and typically developing peers would not be participating. However, it was a start and we were determined to help address a multitude of needs while showing families another option to enjoy time with their children.

Outreach

Finding people to participate was quick and easy. Kate and I spread the word to our clients and asked co-workers to share the information on their home visits with children who might benefit from the group. We started with 6-10 families and asked caregivers to provide 1:1 assistance with their children. Some families brought their babysitter/nannies/grandparents along to care for siblings who were watching on the sidelines! Our attendance was nearly perfect and to this day, I’m not sure who had the most fun at those sessions, the therapists, kids, caregivers, or lifeguard (who often sang our songs with us while sitting in her chair!)

“Sing, Sing a Song”

Music was an essential element to our group. We used songs paired with movements that promoted speech and movement in a fun, rhythmical manner. Our sequence became predictable since we always started and finished with the same songs. Before we started our first session, we distributed a “Pool Group Agenda” that explained the sequence of our session in a parent-friendly manner and it discussed the developmental goals that the group would encourage.

The agenda explained that we would open with a welcome song to promote name recognition, greeting, turn taking, gesturing/vocalization. We then noted that music and singing would be encouraged throughout several activities. Here is a complete description of Developmental targets for pool group.

What’s on the Agenda

Moving along on the agenda, we discussed that bubble play would entice children to use hand and eye coordination to “pop” bubbles with their hands and kick at them with their feet. Bubbles were also a great motivator for children to request “more” through gestures, sounds, and words. Following this description were summaries discussing target goals for slide and ball play. Finally, the agenda noted that closing songs would not only promote following directions, but also closure for play activities.

Amidst all this structure, we also let families enjoy some “free time” in the water with their children using kick boards and noodles for much splashing opportunities! The best part about a group in this medium was that it excluded no one and included everyone regardless of age, cognitive or physical ability levels. Our clients included children with Cerebral Palsy, Down syndrome, Apraxia, Autism, and Expressive language delays to name just a few.

Starting all over Again

Flash forward to March 2015: Our family relocated to Illinois and I launched both this blog and my private practice: Naperville Therapediatrics. One spring, I transitioned to full-time work from my home office after completing a part-time contract at a Catholic school. Juggling administrative tasks and speech pathology, I’m committed to independent work and collaborating with a nearby OT/PT practice to enhance services for families, inspiring me to explore starting another pool group. For more information on how you can start your own pool group, then read my post about Playing with Water.

We Talk on Water

In June 2019, I launched We Talk on Water, a guide book available on Amazon primarily for speech pathologists, but also useful for occupational/ physical therapists and parents/caregivers wanting to enhance overall communication with a pediatric population at the pool.

If you’re interested in learning more about stimulating your children in a water environment, take a peek at my guide book which is divided into four parts:

Background information on finding the right location and asking the right questions; documenting sessions; advertising; and billing/ insurance for speech and language pool groups.
Seventeen lesson plans for 2-5 years old.
Seven lesson plans for 6-9 years old.
Sample documentation (SOAP note, augmentative communication board, list of developmental targets addressed at the pool, registration paperwork)

For more details, you can follow this link to the Table of Contents.

References:
“Aquatic Therapy and Children—Welcome to the Water!” excerpt from APT aquatic therapy workshop by Dori Maxon, PT; APT Newsletter, 10/1995

Note: APT= Association of Pediatric Therapists; based in San Francisco Bay Area
For membership: APT, 1193 Clear Lake Court, Milpitas, CA 95035

Five Electronic Free Options to Stimulate Communication

by Nanette Cote

Chances are you are using your iPad, phone, or laptop to read this post. Truth be told, I used my iPad to write it and later, I signed on my laptop to publish it. I was on some form of electronic all the time. Either I was checking work emails; updating my client calendar; billing for sessions electronically; paying bills; working in teletherapy; trolling world news; or keeping up with new and fun ideas for speech sessions on Instagram.

I disliked being connected to devices and despised the example I was setting for my own son. Alas, he was just as reliant on his devices as I was, as were so many children. Electronics have become our social time and way to escape the stresses in the world. During the pandemic, social media served as our only connection with friends and extended family. As a parent, we chose our electronic battles and set limits, but we need to model the behaviors we expect from our children too.

Let’s discover five electronic-free options that ignite communication and engagement, offering enriching experiences beyond the digital realm for your child. These activities foster connection, creativity, and social interaction, laying a strong foundation for communication skills development in children.

Healthy Alternatives

Below are some electronic-free options to offer when the cell phones are on the charging station. These were games and toys that I had used with my own son over the years that helped him reconnect with his peers and family during social interactions.

Uno Roboto is a portable, lively version of the traditional card game. This game allows players to record names and create “house rules” that they use during game play.
One summer, I hole punched some dry erase activity cards; divided the cards into two stacks; attached them with a binder ring; threw a few markers and tissues in the swim bag; and watched the kids sit for at least an hour going through each and every card in his or her deck.
While writing this, memories surfaced of childhood games played with my sister at restaurants, before iPhones entertained us during waits. I remembered enjoying hangman and came up with an idea to draw a page and slide it into a dry erase pocket sleeve.
This next idea was one that required nothing more than your voice. No materials, pens, markers, or devices were necessary and you could safely play it in the car with your kids while you drove. It was the alphabet game. All you needed to do was call out something you saw while driving that began with a letter in the alphabet. The object was to “spy” things in alphabetical order before the journey was over or until the next rest stop.
Last, but certainly not least, there were books! When my boy was a toddler, I kept mini books in my diaper bag like First Words and Lift-the-Flaps. These kept him busy and entertained while in the shopping carriage or at the restaurant table. To this day, he has a book with him in the car, so it seems like we got him on the right track!

Take Away Thoughts

Great apps exist, but this post wasn’t about disregarding them. I suggest apps for therapy but advocate for balance. It is virtually impossible to build turn-taking and communication skills when a young child plays on a device. I rarely use my iPad as a reinforcer for completing tasks in speech sessions because it closes the door rather than opens one for expanding communication. Some time ago, I cleared all the games off my phone and I never looked back. You could do it too, it isn’t too late! If nothing else, turn off your phone when you’re at the park with your kids or during speech sessions you attend. You’ll be amazed by the interactions when you’re present.

Teddy Talker: A Sensory Approach to Speech Sound Acquisition

by Nanette Cote

The Teddy Talker™ program is a multi-sensory approach to speech sound acquisition created by Linda Siciliano to promote phonics and early sound production in young children by stimulating auditory, visual, tactile, and kinesthetic learning. This program aids children in grasping mouth movements for sound production through engaging visuals and rhymes, fostering successful articulation. I received a free kit suitable for both individual and group therapy, allowing me to introduce you to this program effectively.

The Teach Together Toolkit allows me to create programming specific to each of my clients, which I can send home for carryover practice and instruction. These folders may contain some of the following:

Background information about the Teddy Talker program
Bear face and lips for coloring
Teddy’s tongue, teeth, and paper bag for modeling accurate placement
Teddy Talker™ Alphabet chart
Sound Assessment summary

Personalization

In my opinion, one of the most important products in the Teddy Talker program are the visual instructions. Since home practice supports speech sound acquisition progress, I send a blank Teddy face home with coloring instructions. I want my young clients to have some ownership for the program, which is why I instruct caregivers that scribbles or even a single line across the bear’s face are permissible. In addition to the teddy bear face, families need a sheet of various mouth visuals. It is important to be able to see these visuals clearly, so I have parents color the mouth pictures. After coloring, families return papers to my office for lamination and adding Velcro, allowing us to change Teddy’s face for sounds.

The colored alphabet chart pictured below came from the resource section of the Toolkit. I got a large, laminated copy for a visually challenged client. The alphabet chart is perfect for introducing speech sound targets.

Each child’s folder may also contain a consonant and vowel checklist for baseline collection to establish targets for programming. As a parent, you may want to see your child’s progress and this checklist is a great way to track gains.

Bear Tracks Card Deck

Besides the Toolkit, I was provided a Bear Tracks card deck, which would be a great resource for home practice! I use mine with children as young as 2.5 years old to assess strengths and needs in determining therapy programming. The card deck includes instructions for game play that your child may enjoy, so be sure to ask your speech pathologist if this would be a good investment.

Worksheets

My approach with Teddy Talker™ involves selecting a suitable speech sound target, then copying relevant tool pages for weekly practice. The Toolkit offers 13 adaptable tool pages for any speech sound and various activities such as drawing, coloring, writing, and listening. There are two types of worksheets in the Toolkit: target pages and generic tool pages. For my purposes, I started with the target pages using the following:

Build and Say: tells you which lips to Velcro onto Teddy’s mouth and provides detailed sound cues
See and say: focuses on Teddy’s face
Trace and say: introduces muscle memory for target letters with one inch, bold faced capital and lower case letters
Rhyme and say: great rhymes describing how to make target sounds

I’ve successfully used this program with children aged 2.5 to 6, addressing a range of speech delays, from mild articulation challenges to pre-verbal.

Below are pictures of some supplements in my speech materials collection that I have added to the program. I believe that using a mix of materials helps generalize speech sound practice outside of the Teddy Talker program. I hope that this review helped share more information about this dynamic program created by a speech pathologist to make our lives easier! Happy talking!!

A to Z Coloring pages purchased on TpT from
Lavinia Pop titled: Letter of the Week

Free bear rhyme from my local library about body parts on a bear

Target dollar spot puzzles and Good-Night Owl book.
Both include animal sounds.

Bridging the Gap between Private & School Speech Worlds

by Nanette Cote

Working in the public school system was probably the most demanding and taxing job I had during my career. Caseloads were always astronomically high and more kids were added to the roster with fewer discharges every year. You had to balance report writing, evaluations, screenings, teacher collaboration, classroom lessons, therapy planning, documentation, and group sessions. It makes my head spin all over again just writing about it! School speech pathologists nowadays juggle duties, create resources, write blogs, and manage life before returning to work early. Despite challenges, collaboration remains invaluable. It made me the therapist that I am today and fueled my drive to pursue private practice.

When I set out on the private journey, I had three C’s in mind: Consult, Collaborate, and Connect. I believe that these three actions help create a bridge between private and school speech pathologists working with the same client.

Consult:

Before moving forward, caregivers must obtain and sign school consents so I can start connecting with school professionals. Once the paperwork is complete, I typically send an email to the school SLP introducing myself. School SLPs appreciate the collaboration during IEP updates. Caregivers are especially grateful of this networking because it gives them more information about specific activities targeted at school. I have found that my presence at a client’s school setting is far less intrusive and distracting than a caregiver’s. Most children hardly notice that I am there, which likely wouldn’t be the case if mom or dad was visiting!

Collaborate:

When I visit my client’s school, I typically bring something that we have been working on in my practice. I honor IEP goals but also create my own based on data, evaluations, and parent input. Parents may send PECS books or snacks for observations, while I bring pacing boards and oral motor tools like a Z-Grabber. Sometimes, I don’t bring anything. Instead, I collect as much information as I can and follow-up via emails later with school staff.

Personally, I have found that I can obtain so much more valuable information during an hour observation as opposed to exchanging emails and phone calls with the school SLP. It helps me to watch and listen to my colleagues because we all have our own unique styles and expertise. Being a visual learner, I comprehend better when witnessing events unfold firsthand, which might explain my preference for visual learning methods.

Connect:

The crucial last step is linking my consultation and collaboration with the school team to the client’s family. Sometimes, I write my SOAP note during the visit and leave a copy for families. Most often, I type out my chicken scratches at home and review the documentation with caregivers at the next clinical session. I can honestly say that every visit that I have had to a school setting has been a worthwhile, successful trip. I’ve seen changes made in a child’s diet, increased use of picture exchange communication, and improved execution of voice output devices.

My goal with this post is to commend school speech pathologists and enhance collaboration for better outcomes in both school and home settings. Share your success stories below! Regardless of your placement, what do you look for when collaborating with colleagues? What would help you improve your service delivery model?

Helpful Ark Therapeutic Tools to Strengthen the Jaw

by Nanette Cote

Stabilizing the Jaw & Eliminating Sliding

The jaw is the foundation in the house of speech musculature. Working on chewing helps improve jaw stability and strength to support both feeding and speech sound productions. Speech pathologists can help your child eliminate jaw sliding through speech therapy using a variety of oral motor tools. Before walking, infants must learn to crawl, developing muscles and coordination necessary for balancing and moving on two limbs.

The same can be said for speech sound productions. Children who do not chew various textures and/or have motor speech delays may not appropriately develop a stable, supportive base for lip and tongue movements, so sometimes it is necessary to teach a child how to stabilize and strengthen the jaw. We do this through oral motor work using tools known as Grabbers. Thankfully, Ark Therapeutic has helpful tools we need to eliminate jaw sliding in speech therapy. Years ago, the owner sent me tools tailored to my caseload needs for a hands-on review, free of charge.

Grabbers: Eliminating Jaw Sliding in Speech Therapy

Over the last two decades, I have purchased materials from Ark Therapeutic, who sell a large variety of Grabbers to assist with jaw stability, biting, chewing, and tongue coordination. These tools are perfect for children who do not need gentle vibration, but benefit from any of the following:

Alternatives to chewing on hazardous non-food items
Decreasing grinding teeth and/or biting knuckles and fingers
Transitioning from pureed (pudding) to foods with more lumps/ textures
Increasing mouthing for feeding and/ or speech development
Improving lip and tongue control
Establishing the idea of biting and chewing
Strengthening the jaw in stability and control

There are several different types of Grabbers to meet your child’s needs from those with smooth narrow parts that suit tiny oral cavities to those with harder textures for older clients. You can even purchase textured grabbers for additional mouth input. Consult with your speech pathologist about the right match for your child.

Z-Grabber for Increased Stimulation

The Z-Grabber is a vibrating chew tool that combines the best of both worlds, vibration (Z-Vibe) and chewing (Grabber) in one. You can either use the loop end as a handle or for chewing exercises. Your speech pathologist will use this vibrating option to provide more sensory input/information to support feeding and speech skills.

Practice biting with a Z-Grabber: Place it on molars, do a 3-5 second bite and hold, 10 times on each side. You want to make sure that he is not tilting his head back to bite. As children progress in their ability to hold that position without sliding the jaw, then I increase the challenge by gently tugging the Z-Grabber to provide an increased, jaw workout.

The multi-functional Z-Grabber allows you to switch a variety of probe tips on the opposite end of the grabber portion. With over 35 tips available, there is something for every child in various shapes, sizes, scents, textures, and resiliencies. Though various methods exist, I’ll offer only a few examples of jaw strengthening exercises using these tips.

Z-Grabber Tips for Jaw Work

Bite-n-Chew Tip: This tip is a great option for children who have a hard time starting with the Z-Grabber as it is smooth and more flexible. Align this tip laterally on your child’s lower molars, then gently press down to lower the jaw and hold. Tell you child to push up as you press down. Repeat this exercise 3-5 times on each side.

Bite-n-Chew Tip XL: This tip is an inch longer than the one above to help reach all the way back to the molars. It is also available in a textured version if your child needs even more input. Place either of these tips lengthwise along the molar surface one side at a time. Next, move the tip front-to-back and back-and-forth across the molars for 3-5 reps per side.

Animal Tips: There are three, friendly shapes for this tip of a cat, mouse, or dog with any of them appropriate for feeding or jaw work. You can perform similar jaw work as mentioned above using these tips. The ears on each double as spoons!

While there are many options with and without vibration for working on improving jaw strength and stability, I hope that this post helped defined some of the basics. Always consult with your child’s speech pathologist about the necessity of using oral motor products before making an investment.

For more information on oral motor “wake up” routines that can be performed before feeding or speech practice, head to this post.