A Day in Speech Therapy [Part 1]
The month of May is Better Hearing & Speech month, and here at High Hopes we are always happy to celebrate our Speech Therapy Program!
As the summer months and school breaks approach, Speech Therapy remains in full swing. Every week our clinic’s staff of just 9 speech therapists serves upwards of 196 patients in 231 speech therapy sessions.
Each client is unique and comes with their own individualized needs and goals. You may be surprised by the variety of things a speech therapy session can cover!
The complexities of speech and language are reflected in the many faces a speech therapy session can take on, and in the interest of spreading awareness about better hearing and speech, we want to take you on a journey through some of those complexities. So we shadowed a few speech therapists and picked their brains to get an idea of what a Day in Speech Therapy might look like.
9:00 AM – Hilary Robinson
Our first session of the day actually begins in a classroom in the High Hopes Inclusive Preschool. The client, also a student of the preschool, is in the middle of a class activity when her designated therapy time arrives. Since this little one’s goals in speech therapy include practicing sequential language and preschool concepts, as well as following detailed directions, it seems appropriate to begin the session by accomplishing the task she is already focused on in the classroom setting.
Once we are settled into a private treatment room in the clinic, Hilary fills us in on some of the goals she hopes to address with this patient before we get started.
To work on pronoun differentiation, Hilary pulls out a very simple board game setup, and a set of cards with pictures of boys and girls doing similar activities. The idea is that any time the patient can correctly identify whether “he” or “she” is doing something on a card, she gets to advance her token on the board game.
Hilary uses lots of repetition and prompting, sometimes phrasing the same idea in new ways to give our excitable little friend more opportunities to understand. Sometimes this patient may fixate on one part of a sentence, and not fully attend to the sentence as a whole. So much of the session is spent attempting to enhance her attention span, getting her to listen to the whole question and answer that way, instead of fixating on one word only (or on which picture she likes better).
The key with this particular sweetheart is to find what will motivate her to achieve. Sometimes she enjoys being heavily challenged, and sometimes it’s as simple as talking about familiar people and subjects, things about which she has lots to say.
On other days – most days, in fact – Hilary says it’s all about offering choices. Much like most adults, children like to hold at least some control over their own activities, so offering choices gives this little one a chance to exercise that agency, and it makes her more engaged in what they do simply because it was her choice to do it.
Hilary’s Highlight: Stuttering & Articulation
After returning the student to her classroom, Hilary and I took a little time to discuss a subject that is deeply in her speech therapy wheelhouse: stuttering and articulation.
When looking for articulation issues, Hilary says it’s all about consistency. If a child makes the same errors over and over in similar contexts, that is probably due to an articulation challenge or delay. Once a delay is identified, treatment options can be explored depending on the child’s specific needs.
With regard to stuttering, Hilary says many children will stutter up to a certain age, and that can be a natural part of typical language development. But a persistent stutter that comes alongside a facial tick or another physical signifier of struggle is likely going to require therapy to correct. Many times, a family history of stuttering is present in children who stutter.
Hilary says the best approach to tackling stuttering in children is to address what they are struggling with in terms that they can understand. You may talk about specific sounds as being “bumpy” or “smooth,” for example. Therapy for stuttering usually involves correction based on a child’s specific needs, through examples and targeted exercises.
9:45 AM – Lacey Horwitz
From minute one, Lacey’s approach with her 9:45 patient is noticeably different from the way most adults talk to children. But then, this patient talks to her very differently than most children talk to adults. That’s because Lacey’s 9:45 patient is a pre-kindergarten boy with multiple diagnoses affecting his mobility and muscle control. He uses a wheelchair to aid his mobility, and he uses a touchscreen “talker”, or Augmentative and Alternative Communication (AAC) device, to share his opinions.
Nevertheless, it’s clear there’s a rapport between them. She asks him questions, gives him time to respond, and respects his nonverbal answers. She kept him apprised of everything she was doing, and why she was doing it, making sure to keep him in the loop for the smoothest transition possible into speech therapy.
Lacey outlines some of this patient’s goals for us. Basically, she is working with him on expanding his language beyond requesting and commenting. Specifically, she’s looking for him to answer questions, seek information, and comment in social contexts. She also wants him to use full sentences, and to start to use his talker more effectively with people who aren’t his therapists.
This patient likes to talk and talk and talk and talk and talk, but only in certain ways. He balks at two-way conversations, like question-and-answer exchanges, and is very reluctant to use the talker with those outside a certain circle of adults. Lacey has to firmly direct his attention to pull him out of requests, and prompt him strongly to elicit the phrases and sentences she’s looking for.
However, with more exposure to friends and trusted adults who will use his “language” – that is, speak to him utilizing the platform he is trying to learn by helping him to use the talker, and even using it themselves as best they can – he should begin to gain more functionality with his device.
In addition, Lacey is trying to encourage this friend to use his own sounds, vocalizations, and signs as much as possible. She does jaw exercises with him, works on phonation, and tried to find word approximations he can articulate.
Lacey does not have access to a private treatment room during this session time (“This is why we’re expanding!” she jokes), so we set up camp in a corner of one of the large treatment gyms… until someone begins to vacuum nearby. Our little friend is frightened of the sound and can’t concentrate while the vacuum is on, so we pick up and move the session to a quieter location.
Just like in Hilary’s session earlier that day, the key with this patient, too, seems to be finding the motivating factor. He is very motivated and engaged by books, and loves to read all kinds. Lacey uses that to expand his language beyond his own emotional responses, urging him to talk about the events and characters in the books they read together.
And once again, choices seem to play a large part in motivation. Choices and rewards of stickers prove very effective in the second activity of the day. This friend has a definite opinion about what he wants to do, but sometimes the difficulty comes in getting him to choose one of the options Lacey offers. For example, Lacey asks if he wants to read a book or talk to a friend, and he answers, “Go bowling.”
But he is always very excited and motivated to talk to his favorite adults. At High Hopes, that includes Bond Henderson, a speech therapist in the clinic, and Emily Donoghue, a teacher in the preschool. We saw both during his session, and his face lit up as he frantically reached for the talker and worked to get his words out as quickly as he could, talking about recent trips to Target and asking to go to the mall.
At the end of the session, though leaving speech therapy can sometimes prove a difficult transition, on this day, he was proud enough of his accomplishments that the transition went smoothly.
Lacey’s Highlight: Apraxia, AAC, and Social Speech
Lacey met up with us a little later to talk about some of the areas of speech therapy in which she specializes. Beyond the Augmentative and Alternative Communication, about which she carries quite a bit of expertise, Lacey works a lot with apraxia and social speech therapy.
With apraxia, which she describes as a motor speech disorder that impacts overall intelligibility, Lacey says treatment is very variable. There are many kinds of apraxia. In childhood, however, apraxia has been described by those affected as being like a dream where you want to run, but you simply can’t. The signals get mixed up, and what the mind commands gets lost somewhere on the way to expression.
There are many research-based techniques that our therapists use to tackle apraxia, depending on the needs of the children affected. There is the Kaufman Approach, prompt intervention, Talk Tools, and the Easy-Does-It Approach, to name a few.
When it comes to social speech, Lacey says the goals can be many and nuanced. Primarily, her goal in social speech therapy is to teach children how to interact on the most basic levels. Sometimes, children need to learn how to play before they can learn to interact. Sometimes they need to improve their language first, and then build social skills on that foundation.
To address some of these challenges, Lacey runs something called “Friendship in Teams”: a one hour per week, large group social therapy session for children, which approaches social speech therapy through gross motor workouts, structured activities, and a focused lesson to learn for each session. But more on FiT at a later date…
The second half of the day continued to surprise us with new experiences, each as interesting and informative as the last! Check in tomorrow to see the conclusion of our exciting day in Speech Therapy, in [Part 2] of this post.