In [Part 1] of this post, we took you on the first half of a journey shadowing speech therapy sessions, trying to get an idea of what a Day in Speech therapy might look like. We summarized two sessions, one focused primarily on language and concept goals, another on functional use of an AAC device to communicate.
The rest of the day continued to surprise us, addressing even more speech pathology issues and providing an even deeper view of all that speech therapy can accomplish. See what the rest of the day held in store below...
10:30 AM – Brandy Storck
When we arrived to observe Brandy’s session at 10:30, we were not the only ones there to observe. The patient’s mother and home health nurse sat in on the session as well. Brandy described how beneficial that can be, allowing her to impart direct coaching for caregivers about creating a lifestyle of listening and speaking within a language-rich environment.
“From the moment he walks in this door, there’s nothing that’s not a listening and language opportunity for him,” Brandy remarks to his mother as they begin their activities for the day.
This sweet child was affected by auditory deprivation for the first five years of his life. Now on the other side of some complex medical issues, he is finally able to use hearing aids, and this intrepid friend is learning not only to hear, distinguish sounds, and comprehend their meaning, but to listen, to make his own noise, and to speak, all at once.
Everything Brandy says to him is expressed without visual clues. She does not point or mime, but demonstrates an expectation for him to listen. And she gives him plenty of time to do just that before repeating herself if needed, saying that all children, regardless of hearing ability, need to be in the habit of listening to something the first time it is said.
The first game of the day is designed to test the little dude’s ability to hear the entire spectrum of speech frequencies. The activity uses a shape-sorter and a screen held in front of Brandy’s mouth. Her little friend chooses a shape and holds the shape to his ear. Then he listens for Brandy’s cue (noises called Ling sounds -- 6 specific sounds: ah, oo, ee, mm, ss, and sh) from behind the screen. Only when he hears her use one of these noises specifically does he put the shape into the sorter. It was a fun little game, and he was a master of it.
Brandy also used this game as an opportunity for imitation, to show that not only can he hear a sound when it is presented, but he can also tell which one it is. She gave him a chance to try the sounds she used to cue him, and he tried all of them. Some of the sounds are works in progress, as he tries to figure out the best way to form them with his own mouth. But he is a very motivated young man, and he makes an effort every time she asks.
Next we moved onto an activity that is clearly a favorite with this one. Using a specially designed “telephone” toy, Brandy tested her patient’s auditory memory, his ability to recall a series of simple words and phrases in context, as well as speech sound imitation, and functional use of language. It is a routine that they have clearly visited before, and one he obviously enjoys.
It takes a little coaxing to move on to a new activity, but she soon wins him over. Together they do a little pretend play with a baby doll. The purposes of the seemingly silly play episode are to give him a little more stimulation in terms of language. She wants him to identify words at the end of sentences, or in the middle, and more than just nouns. And she wants to give him depth of language, filling in holes in his vocabulary with action verbs, descriptive words, and prepositions.
She can work with him on comprehension, listening, attention, imitation, and diverse sounds through pretend play. He even made his own “ssshhhh” sound, imitating running water during this activity, which is a small but meaningful step forward.
When Brandy pulled out a book to finish the session, her friend was about done. As she began to read, he climbed into his mother’s lap and pretended to snore. He had been in therapy non-stop since 815 that morning, and now almost three hours later, it seemed we were coming to the end of his tolerance level.
But Brandy made a point of elaborating on how well he did throughout the session, saying that the Occupational Therapy he’d had right before their session brought him in with a very organized body, and an attention-level primed for hard work.
As they left the room, Brandy tried to get him to try a new phrase: “See ya!” But though he clearly understood what it meant, he would not repeat the phrase, responding instead with, “Bye bye!” No less than eight times, the two of them repeated this back and forth “see-ya bye-bye” battle before Brandy capitulated with a laugh and the session was over for the day.
Brandy’s Highlight: Hearing Impairment
Brandy hung around for a minute to share a bit more about therapy for the hearing-impaired, for which she has specific training. She says that the main thing she tries to keep in mind when designing therapy for friends who are or were hearing-impaired is the amount of information they have to process, and the way in which they do so best.
When someone who is hearing-impaired acquires technology or undergoes a surgery that allows their hearing to improve, their world explodes with sound. A previously unused or under-used sense floods their brains with information that they now have to learn to filter through, and her job is to help facilitate that process. That way, hearing is not just something that’s happening to them, but it becomes a functional tool for understanding and interacting with their world.
1:30 PM – Karol Pilkinton
Our last session of the day is another preschool student. She is four years old, going on 16, and she is one sassy lady. Before we go to get her from her naptime in the classroom, Karol fills us in on the challenges and goals for her spicy patient.
This little one has excellent receptive language, so she understands most of what is said to her, but there is complex physical involvement with her own speech. She was born with a rare genetic disorder that affects the development of multiple parts of the body, including those of the face and mouth. This child was born with a cleft palate, which has since been somewhat corrected through surgery, and she has other oral and motor challenges with her speech due to her diagnosis.
Karol has been working with this little one on closing her mouth for plosives, sounds that we make by blocking airflow using the lips or tongue, like “p,” “b,” and even “t.” They’re also working on tongue placement for certain sounds, and they’re starting to work on sounds that use the back of the tongue, like “g” and “k.”
They are working to expand her ability to move the muscles in the roof of her mouth through motor oral exercises, and to improve the function and movement of her tongue, which is anatomically different than a typical tongue, due to her syndrome.
However, Karol informs us that we will also be doing something today in the session that might seem a little unusual to the untrained eye. We’ll be brushing our teeth.
Our little friend recently had some necessary, but unfortunately painful dental work completed. This has made her very “orally defensive,” meaning she is very picky about what goes into her mouth at the moment. We’ll be working on breaking down some of those barriers now that she is recovering.
Of course, first we have to wake her up. Barely awake, she dozes on Karol’s shoulder as we walk through the halls to the private treatment room where we’ll hold the session this afternoon. And the first thing we notice is that this little one definitely has the word, “No.” Throughout the 45-minute session, she says that word, clearly a favorite of hers, no less than 38 times (no really, we kept a tally)!
But Karol perseveres, offering choices for what to work on. As has been a theme in all the sessions we’ve observed, choices are every speech therapist’s best friend when it comes to cooperation. The first choice of the day is toothbrush vs. the “k” sound. But the patient is having none of it. So, Karol brings out the secret weapons – do we want to blow bubbles, or play with Larry the Squirrel?
Larry the Squirrel works miracles.
He is a little squirrel toy with a circular opening for a mouth. Little green bouncy balls come with him, and if you stick one into the opening and squeeze Larry’s tummy, it’ll come rocketing out and bounce everywhere! Instantly, our little friend gets excited, aiming Larry’s mini cannonballs at windows, walls, and ceilings, laughing and having a great time.
After Larry breaks the ice, the patient chooses to practice her “k” sound as her first activity. With the help of a tongue depressor to help her learn proper placement of her tongue, she practiced the “k” sound at the beginning of words, and she said the word “cow” just as clear as you like. Later on, the word “cake” came out quite clearly with no help from the tongue depressor at all!
Now it was time to brush her teeth, and boy howdy, she did not want to do it. Karol gave her lots of time to answer the request and to get used to the idea, and she tried everything, even imitating Winnie the Pooh asking her from his picture on the toothbrush handle.
At first, we just worked on brushing her lips, with no toothpaste, since opening her mouth was clearly out of the question, but she was very defensive even about the toothbrush gently rubbing her lips. So Karol began to sing a silly song, trying to catch her teeth with the brush when the little one smiled.
But when it comes down to it, the little one simply isn’t up to brushing her teeth today. So we take the little one back to her class. We’ll wait to brush another day.
Karol’s Highlight: Autism & Language Processing
After the session, Karol and I talk about a different kind of challenge with which she has a lot of experience: autism and language. She says early intervention is really critical when Autism Spectrum Disorder is suspected in a child. Language delays will only get worse if they are not addressed quickly.
Of course, autism is a spectrum, so every child’s needs will be unique to them. But Karol gives some examples of challenges and techniques that are common among children with this diagnosis. Expanding the attention span is a big one, as are comprehension and focus, and all are an essential part of working past language barriers. Some children may even find the use of an AAC system appropriate, as it helps to bridge the gap between the cognitive and the verbal.
Scripting can be a significant challenge, as can vocal and verbal stimming behaviors in some children. (For more information on these behaviors, see our What's Autism? post.) A child’s mood is very influential in how their expressive language functions on a given day, but it can be much more so in children with autism. Karol works to help children with autism respond appropriately to questions, social situations and stimuli, and emotional and environmental challenges.
The Final Word
All in all, this day was a diverse and surprising glimpse into what a Day in Speech Therapy can look like. The complex and widely varying needs, in only four sessions in which we took part, indicate just how broad the category of Speech Therapy truly is.
The four wonderful, persistent speech therapists we shadowed are just a small part of an entire team of people who work every day to bring light and joy and functional communication into the lives of the families they serve, and we are so happy to be able to support them as they do so.
We hope you enjoyed this journey through a day in one area of the High Hopes Pediatric Therapy Clinic. Stay tuned for more glimpses like this into other areas of our organization in the future!