May 26, 2012

Just Keep Swimming...Just Keep Swimming...

Our school year is quickly coming to a close. Depending on where you are in the country (or the world!) you may still have a few weeks left. I recently had to remind myself to just keep swimming after being slammed with piles of additional paperwork and folder audits. On top of that, the inevitable end-of-the-year upheaval is causing stress and some regression in students. My students with Autism Spectrum Disorder, Emotional Disturbance, and other issues struggle mightily through all of the unexpected changes.... classrooms are being packed up, schedules are altered, everyone is excited, and so many "special" events that require flexibility and heavy doses of social skills are happening. The kids and I have been having many discussions about handling the changes. Many of them have adopted our skill of asking their teacher in the morning, "Are there any changes today?" This has been a great help and eased many worries.

If your students start exhibiting behaviors that have been resolved for quite a while during this transition time, please take a deep breath. Yes, it is frustrating. I feel it, too. But regression during a big transition is very common. If your students have shown solid growth behaviorally and it seems like things are sliding backwards a bit give it some time before you start with a new intervention. Continue being consistent with your expectation and current plan. This will give your child the predictability they need during this time of transition. Keep emotions as neutral as possible so that the regression is not compounded by an emotionally charged response. Usually, the regression will stop and the skill will be restored after a short period of time. 

This weekend, I've asked parents to help their child with an activity that will help with the mixed feelings that can accompany the summer vacation transition. I asked them to help their child fill out this calendar for the first week out of school identifying their plans for each day. The plan does not have to be detailed. Just identify where they will be (home or traveling?), who they will be with, and a main activity they can count on.  It can be as simple as Thursday is Legos, Friday is a trip to the pool, Saturday is video games at home. I asked them to have their child post their calendar on the fridge or in their rooms. Doing this simple activity can help tremendously with decreasing anxiety and helping your students end their school year on a good note.

Now, I'm off to just keep swimming!  ~Kelley

May 22, 2012

My Speech Scientists!!!

For those of you wrapping up the school year, you might be feeling the pressures of PAPERWORK! I am no stranger to this right now, but somehow I have managed to push forward to provide the last bits of intervention that my students can take in and retain. Today, I want to share my proud moment in fluency therapy from this week.

For me, providing fluency therapy has been one of my greatest challenges and I am determined to continue improving in this skill. My own child was a preschool stutterer, and I had the opportunity to work with an AMAZING professor and clinician at the University of Texas clinic. That experience forced me to release my "fears" of fluency disorders, and shape the skills that I already possess. During the course of this year I have sought A LOT of guidance from my fellow colleagues with experience in fluency therapy. I have also done TONS of reading and research, and I am continuing to seek out to more knowledge of stuttering intervention (and eventually, I will be able to watch all of those fluency DVDs that I want to see!)

The best thing that one of my colleagues shared with me this year is this resource:

Find a copy from the Stuttering Foundation of America here.

One of my 3rd grade students really struggled with changes to his fluency this school year. This was my second year providing his treatment and midway through the year he hit a rough patch and started exhibiting some significant secondary features with his disfluency. In addition, he uses a high frequency of blocks and sound repetitions. I changed his treatment and moved him from group to individual therapy because it seemed pretty obvious that something had changed and was affecting his fluency. Using this workbook and with the help and support of his parents, I was able to help him identify emotions related to his stuttering. Then one day, he asked me "how do blocks happen?"

His desire to learn and understand the root of his stuttering inspired me! This child's desire to understand such a complex disorder helped me to become a better therapist in fluency treatment (and I still have so much more to learn!) So, I taught him all about the science of the speech mechanism. I drew a diagram for him and outlined the various parts related to respiration, phonation, and speaking. We found some images on google to represent what he learned. A few weeks later, we invited his mom into therapy, and he TAUGHT her all about the structures and functions of the speech mechanism. I also later learned that in his private therapy session, his private therapist was so impressed with his knowledge that she had him TEACH A YOUNGER child who was stuttering all about the speech mechanism. Soon, we all started noticing positive changes in his speech. The private speech therapist focused heavily on eliminating the secondary characteristics and soon the teacher and parent were commenting on how "calm" he seemed to be when speaking, despite his continued use of disfluencies.

Not long after that, I started working with another child who had a fluency disorder. This new student was in the same grade level and seemed a perfect mate to my current student because they are both quick learners. Soon, my current student taught the new student all of his expertise about the speech mechanism. They were both so interested in the topic and confident in their knowledge, that I encouraged them to teach their class. The next six weeks were spent dividing our sessions between direct fluency practice and developing a PowerPoint presentation for their classmates. They dictated the various aspects of the speech mechanism to me, and I helped them create the presentation. They drew their own diagram of the speech mechanism and labeled it:

I also found a variety of images and youtube videos for them to choose from to share with their classmates.
Here are the links to the videos that they chose from:
A Song Describing Respiration
A Student Created Video of Structures and Functions in Respiration (This is the one they chose to use.)
The Normal Larynx and Voice (I encouraged them to use this one because it had a "slow motion" picture of the vocal cords vibrating.)
Normal Vocal Cords during Phonation
The University of Iowa Phonetics (This link is GREAT for showing "speech helpers" make various sounds.)

Their presentation focused on Respiration, Phonation, and Talking. I couldn't believe how well they explained this to their classmates, and the videos were really intriguing. AND during the Q&A portion of their presentation, they answered ALL questions from their classmates without my help! Their classmates seemed as impressed as me to watch them share the science of speech, and their teachers were beaming (including me!)

So, the greatest lesson that these students have taught me is: never underestimate a student's willingness and desire to truly understand their disorder. Giving them the tools and words to communicate their disorders to others will help them to continue to advocate for themselves, a goal we had set for them. I feel pretty confident that they will soon be able to describe and explain to others how and why they stutter, and they will do this without fear of the reactions of others. AND, I can't wait to check on them in about 15 years. . .my guess is they will be finishing their graduate degrees in Speech/Language Pathology!!!! 

I hope that their story has inspired you the same way it has inspired me. I am so lucky to have the opportunity to be a part of the lives of so many amazing young individuals!


May 10, 2012

Reaching the "100" goal

If you are an SLP who sees most of their students in small group therapy, raise your hand.

If you are an SLP who sees students in articulation therapy and finds themselves getting "creative" to practice articulation skills "around the table", touch your nose.

If you are an SLP who struggles to get more than 30 trials per student of articulation practice during a small group therapy session, pat your head.

If someone near you is looking at you strangely by now, then that means one or all of these scenarios apply to you, and we have something in common!

If there is one thing that we all know as SLPs, it's that getting a child to correctly articulate their speech sound target is a great feeling (whatever level they are at). Getting that child to do that 20 times in a session is great. Getting that child to achieve that target 50-75 times per session would be ideal! And, for that matter, getting that child to exceed 100 trials correct in a single session would be AMAZING! This is so important because we typically only see these students once or twice a week for an average of 30-45 minutes per session. That means, in 7 days, the child MIGHT say their sound correctly 100-200 times. This also means they might say this sound incorrectly when they are outside of the therapy setting 500-1,000+ times (depending on their sound target)! I just kept thinking about these odds and wondering, "How can I possibly achieve a minimum of 100 correct trials per session?"

Then it hit me one day. . .I want to try using the "speech lab" concept IN the therapy setting. The idea of "Speech Lab" was presented through RtI presentations in our district and has been used in many districts around the country. The idea during RtI is to use a "general education articulation lab" and see if students would be able to master their articulation errors in a short, intensive program without going through a full referral and evaluation process.  In the "speech lab," students rotate through various "centers" to practice their sound targets and are facilitated by a "roaming" SLP.Programs seem to vary around the country, and in our district we have "piloted" such an idea; however, we have not fully implemented this. Super Duper Publications even has a product specifically for implementing such a program in RtI with their resource "ARtIC Lab: A Bilingual Response to Intervention Program for Articulation." Follow this link to find it.

So, as I said, we do not currently implement an articulation lab in our district, and I do not currently own a specific program. However, I have taken the concepts and practices, and started to implement them in my own speech room. I needed to be more efficient with my time and my students' time in groups of 4-5 students. In my speech lab, I have students rotate through stations for 4-5 minutes per station. My stations include "Listening Center", "Table Time", and "Sounds on the Carpet". Here is a description of each station:

Listening Center--In this station, I have students sit at my desktop computer and listen to their targets. I have done this a few different ways. I have used the "Garage Band" software to have students strictly listen to words that I voice recorded. I also used "Power Point" to create several presentations where I have paired pictures and words with my voice recorded. This seems to be more motivating for the students because they can "click" through the pictures. While the Power Point presentations are my favorite, they take a little time to create. Unfortunately, my files are too big to share here at this time. For students who have minimal stimulability, I have them "listen only." As my students increase their accuracy of production with minimal cues, they are instructed to listen AND say the words they hear.

Table Time--I use this opportunity to get 1:1 time with each student. While they are with me one on one, I target the sound that is the hardest or least stimulable for them. My goal while I'm with them individually is to increase their stimulability so that target can be transitioned into a more "independent" station.

Sounds on the Carpet--In this station, it is VERY important to have the students practice their targets at the level that requires the least amount verbal cues. I have taught my students how to provide "friendly cues" to each other and encourage each other. Also, since my speech room is pretty small, I am in "earshot" of each student and can offer added cues or change their target if I don't hear accurate productions. Also in this station, the students can engage in "quick" games to motivate them such as "Trouble" or "Uno".

During speech lab, I use the tools that I have on hand and I have even created some new ones. Here is what you might need if you want to try this, too!

1. A schedule for the "Speech Lab" rotation.--Grab mine here. This is what my schedule looks like:

I have it laminated and hanging on my white board. Since it is laminated, I am able to write the students' names on the schedule to let them know what "station" they are scheduled for. On the carpet, I usually have 2-3 students at a time (my preference is 2)

2. Articulation targets per student--I use artic cards or worksheets for this. My younger students do better with cards or sheets they can access in the speech room. My older students each have their own folder with their individual speech targets and they bring them to and from their speech sessions.

3. A Table or "area" with tools you will need for some 1:1 time such as a mirror, tongue depressors, gloves, data collection sheets, etc. for "table time". You might also want to keep a Speech Target handy. Grab mine here: Speech Target.

4. Motivating games for "sounds on the carpet". We like "Trouble", "Uno", "Topple", "Look Who's Listening," or just a pair of dice.

5. Counters. We used to use tally counters; however, they broke easily (guess I shouldn't have "cinched" on the brand). Now we just use post it notes and the students tally count their sound productions. Each student is responsible for keeping up with their own count and they use tally marks. At the end, they count up their sound productions and they love counting by fives, even my kindergartners!

6. Computer or voice recorder and headphones for listening station. We use a desktop, but anything that records your voice will work. My next step is to try my new Live Scribe Echo Pen (but that will be saved for a future post).

7. A timer. I set it for 4-5 minutes per station. When they hear it, they look at the schedule and make the switch!

8. Motivator chart. This can be accomplished in ANY way. I challenge each student to say their sounds at least 100 times per speech lab session. Then I set a "group goal" to work for a prize speech day such as a "Game Day" or "Popcorn Party". I have used a pom pon jar, a sticker chart, and a graph to track their progress. They are increasingly excited when they see their progress against another grade level!

In my experience since starting "Speech Lab", here is what I have noticed:
  • Taking the time to "teach" the expectations for each station is a MUST!
  • It works BEST with students once they reach the syllable or word level of their target sound.
  • It's best for speech practice up to the sentence level. (Once a student starts connected speech tasks, it can be done, but you have to get creative.)
  • It works best with at least 3-5 students; more or less I have found to be less effective and less motivating.
  • It doesn't work very well for students with minimal stimulability.
 I have shared my experience with some of my colleagues, and the most common question that I have received has been: "How can you say that you are giving them their speech time when they are not face to face with you?" My response is, I AM face to face with all of them while they are in my room, and they are CONSTANTLY practicing their speech targets instead of waiting for their peer to finish before they can start. They are still required to be active listeners also, and I have TRIPLED the targets produced correct per session. I have now seen more students reach connected speech tasks at a much faster rate than ever before!

If "Speech Lab" sounds like fun to you, I challenge you to try it out! So, put your had down, take your finger off of your nose, and quit patting your head. . .instead, get started toward reaching the goal of 100 trials correct per session!

Have Fun!

May 5, 2012

Have you Heard? APPS Sale Ends May 9th!!!!!

In honor of Better Speech and Hearing Month, Super Duper Inc. is putting all of their "Fun Deck" apps on sale for $1.99 until May 9th!!!! Most of these apps are usually $3.99-$5.99 and the "card deck" version of these are usually $10.95. If you have access to iPod Touch, iPhone, or iPad, these apps are digital versions of several "Fun Decks" that we use in the speech room and with our social thinking groups. Now, in APP form, they are more cost effective (and let's face it, we are all on tight budgets these days)!! Here is a list of Apps that work for various groups of students at ANY age level! I have divided the apps by how they can be used in speech therapy or in social thinking groups. Also, I have added a group that would work well as "writing prompts" that might be useful in a speech room, resource, inclusion, or classroom setting. Follow this link for the sale list if you are interested!  

Articulation Therapy--For students who are beginning to practice their sounds at the SENTENCE level and beyond, these Apps are great for carry-over of skills.

·     What's Being Said? Fun Deck
·     What Are they Asking? Fun Deck
·     What Are They Thinking? Fun Deck
·     Story Starters Fun Deck
Language Therapy--These Apps are divided by "type" of language to target. If your child is working on the type of language listed, these would be great tools to add.
  • Answering Questions:
o  Yes or No? Fun Deck
o  WH Questions at Home Fun Deck
o  WH Questions at School Fun Deck
o  How? Fun Deck
o  Following directions
·     Understanding and using correct Grammar and Syntax
o  Using I & Me (free)
o  Do and Does
o  Was & Were
o  Has & Have
o  Regular Past Tense Verbs
o  Irregular Verbs
o  Plurals
o  What Does Miss Bee See?
o  What's Being Said?
o  What are They Asking?
o  Story Starters
·     Improving Descriptive Language
o  What Doesn't Belong?
o  Compare and Contrast
o  Opposites
o  Homophones
o  Name That Category
o  Let's Name Things (free)
o  Story Starters
·     Expressive Reasoning (Inference, Predict, Problem solve)
o  Let's predict
o  What's Being Said?
o  What are They Asking?
o  Fact or Opinion?
o  How?
o  What would you Do at Home if...
o  What would you Do at School if...
o  How would you Feel if...
o  If...Then...
o  Understanding Inferences
o  Story Starters
o  What are They thinking?
·     Social communication
o  (Many of the expressive reasoning Apps would be helpful!)
o  Practicing Pragmatics
o  All About you, All About me
o  What are They Thinking?
o  How would you Feel if?
Fluency therapy--There are many descriptive and great pictures and scenes that can be used in these apps to practice Fluency strategies!

·     What's Being Said?
·     What Are They Asking?
·     What would you do if...
·     What are they Thinking?
·     Story Starters

Written Expression--There are many great photos and picture scenes that can be used in these apps to use as writing prompts.
  • What Does Miss Bee See?
  • How? Fun Deck
  • What's Being Said?
  • What are They Asking?
  • Story Starters
  • What would you Do at Home if..
  • What would you Do at School if...
  • How would you Feel if...
  • If...Then...
  • What are They thinking?
Many of these products have video tutorials online if you follow the link to Super Duper (this is where I get many of my own ideas). I don't work for Super Duper or their promotions team and I am not receiving any payment or merchandise for promoting their products; but I have hands on experience with many of their products, and I'm always looking for new ways to keep our students motivated to achieve their communication goals! 

Hope you can add to your toolbox! 

May 4, 2012

Simple Speech--"The Tiny Seed" by Eric Carle

It's time for another SIMPLE SPEECH idea! Incorporating literacy in the speech therapy sessions has become a passion of mine. There are SO many ENDLESS opportunities for speech and language when a storybook is involved!

One of my picks for April was "The Tiny Seed" by Eric Carle. If you are not familiar with this book, it is the story of a tiny seed that travels among other seeds across many lands until it finally lands on the ground. The seed begins to grow once it has water and sunlight and it ultimately becomes a huge flower that is taller than the houses and the trees. At the end of the story, the seed pouch opens up and new seeds blow in the wind in anticipation of growing into more beautiful flowers. I think this story is a fun expansion of the cycle from seed to plant and my students really seemed to enjoy it!

We used this story in speech to target so many goals including: vocabulary expansion, synonyms, descriptive language, compare/contrast, predictions, sequencing, story re-tell, story expansion, and articulation of /t, s, sm, pl/ to name a few! My students in articulation therpay became "speech detectives" and listened and looked for their target sound throughout the entire book, so we made it work for every sound in therapy! After we read the story, we made our own version of the story. The students retold the story while illustrating their own stories. We also practiced summarizing in first grade, and that was a bit of a challenge. This is how they turned out:

I expanded the activity based on the level of the students from PK-1st grade. First graders wrote their own sentences and expanded with more steps and more sentences.

After we completed our Tiny Seed stories, we planted "speech smiles". The students were required to come up with a list of items we would need to plant our own seeds and then describe "how to" plant and grow a seed. We planted several tiny seeds using Rye grass and gave them faces. Here is how they turned out:

Speech Smiles

We had such a great time with this activity and depending on the group, it took 3-4 sessions to complete all of the activities. One of their favorite parts of this activity has been watering and checking their plants daily. My students working on R were VERY excited that they could see ROOTS in their plants. I hope you have as much fun with this activity as we did!


May 1, 2012

Collaboration in Speech Therapy and Special Education--A Success Story

In honor of Better Speech and Hearing Month, we thought we would kick of May with a success story from our collaboration through speech therapy and special education services.

The story begins with a kindergarten boy . . . This young boy melted our hearts the moment we laid eyes on him, an adorable and huggable little guy. He came to us as a kindergartener after his previous educational team had deemed it necessary for him to have a second round of kindergarten. During his previous year in school, he was evaluated and found to have a speech and language impairment and had begun receiving speech therapy earlier that spring.

It didn't take long for us to realize that this child's challenges far exceeded that which could be provided by traditional speech therapy services alone. In addition to his deficits in articulation and language, he struggled with listening/attending skills, social/behavioral skills, and academic skills. As his SLP and case manager at the time, I had to work closely and diligently with his teacher and the campus staff to collect sufficient data needed in order to provide additional services. Thanks to an amazing campus and administration, we were able to begin providing him with additional inclusion and resource supports through our Social Communication Resources and Services Program while he was being evaluated for an additional disability.

As we began developing a program for this student, Kelley and I worked collaboratively to develop social stories in order to teach him school rules and routines. Kelley also worked diligently with the classroom teacher to develop positive behavior supports and teach behavior expectations through the use of discrete trial techniques. These same techniques were also used during his small group pull-out sessions in speech therapy and in the areas of reading and writing. Kelley and I also included this student in a co-taught Social Thinking group and started directly teaching social thinking skills such as Whole Body Listening and Expected and Unexpected Behaviors. We, along with his teacher and administrators, worked diligently through months of tantrums and tears with this child. As he came to the end of his kindergarten year, we saw significant changes in his behavior and attention.

Also in the midst of chipping away at this students behavioral challenges, we used collaborative efforts and techniques to make changes to his speech, language, and academic skills.  In speech therapy, I focused primarily on his motor speech deficit in a small group with 1-2 other students. It wasn't long before Kelley inquired about how this was being accomplished and she quickly was on board with trying out a new program to work on his reading skills. Together, we used various aspects of the Lindamood Phoneme Sequencing Program for Reading, Spelling, and Speech or LiPS Program.

This program, developed by Lindamood Bell, has a great series of visuals and techniques for developing all skills related to speech, reading and spelling. From a motor-speech aspect, I have used the Mouth Pictures and corresponding Phoneme cues to teach articulation skills. The cues are very descriptive and easy for students of all ages to understand.

Using these cues in speech therapy and then transitioning the same cues into this child's resource classroom really seemed to bridge the gap for him as he learned to identify and name letters and sounds and then sequence these sounds with appropriate coordination for speaking and reading. Using a multi-sensory and collaborative approach for this child significantly contributed to his progress in speech, language, reading, and writing. This type of program is inherently designed to help coordinate the development of all three of these skills. I highly encourage SLPs and teachers to coordinate their efforts and combine their expertise regarding motor-speech and oral language development with developing reading and writing skills.

Thanks to a great TEAM approach, this child is now at the end of his first grade year speaking with much greater intelligibility of speech, reading independently on grade level, and writing on grade level with minimal accommodations and daily supports. He remains in speech therapy to support continued increases in intelligibility of speech, particularly in the area of sequencing complex co-articulation as well as improving expressive syntax to age appropriate levels. But overall, this student's success is clearly the result of a collaborative approach.