Briannas First Trip To The Speech Therapist

Brianna started speech therapy a few days ago ( after being on a waiting list for awhile ). The lady that is doing the therapy seems really great with kids and even though Brianna ( now 3 and a half ) is very shy around new people, it only took her about 15 minutes to warm up to the therapist and start talking to her. After a few minutes of playing house and naming some pictures on cue cards the therapist told me she is pretty sure Brianna is suffering from Verbal Apraxia . She is fairly certain that with extensive therapy she will be able to speak clearly. Brianna has quite the little language started - I understand every word she says but it is difficult for new people to figure out at times. She mixes up a lot of her letters so instead of for example : like , she will say 'yike' , instead of 'Faith' ( her sister ), she say 'Bay' ( she is unable to pronounce certain letter combinations like 'th', 'sh', 'ch' etc.), instead of 'that' she will say 'dat', etc. She is a very intelligent, funny & sweet little girl though - I am hoping that therapy will be able to help her acheive clearer speech so that everyone else can understand her and see how great she really is!

So our first therapy session consisted of some play time , including blowing bubbles and drinking from a straw ( to build up her muscles ), playing with a doll house ( naming all of the people in the house, talking about what they were doing etc. ), and doing some letter sounds with actions ( for lack of a better description ). The therapist said that starting with sounds she can do at first is always best so we are doing ' P, B & T' this week ( each one has its own little action ). All in all - even though it cost $100 for a one hour session - I think that it went well. We have to go back every week at least once - so it will be a costly recovery but at least Brianna likes the therapist which will help immensely ! I liked her too - it was great that she got down on Briannas level and really played with her, she also made a great effort to listen closely to what Brianna was telling her ( I had to translate a lot of it ) - but I am so thankful that we found a therapist everyone is happy with.

Here is a copy of the report that I received ( for those of you who may have a child with similar speech problems );
28.05.08

Brianna was accompanied by both Shasta and Brian for this initial session (as well as her toy dog, Casey). Although quite shy and initially quiet, Brianna cooperated quite well during the session but would not permit hands-on oral-motor intervention. As she felt more at ease, she used language more readily, sharing information related to her family and friends. Intelligibility of speech is compromised and Shasta’s reformulation was invaluable, both in providing an interpretation for an unfamiliar listener and in rephrasing for Brianna. A speech-language assessment had recently been completed at NPCC by Dorota Parafianowicz, SLP and similar observations were noted today in terms of expressive language skills and articulation patterns. Use of me/I pronominal substitution appeared consistent.
Phonological processes:
- deletion or stopping of all fricatives and affricates: Shasta noted that bite position to lower lip has been difficult to establish, even with practice in front of the mirror. Brianna typically places the lower lip over the upper lip during /f/ attempts. She also noted that /s/ can be elicited in isolation but not in combination with a vowel.
- fronting or deletion of all velars: backing could not be elicited today when a kinaesthetic cue for /k/ was tried (elbows moving backward as /k/ + vowel is modelled);
- reduction of many words to CV, deletion of final consonant;
- use of glide “y”, often in initial position before a vowel, as well as in medial position;
- Vowel variation was difficult to assess since Brianna was reluctant to repeat words on request. She was reported to use /jaI/ for “I”; /bε/ for her sister, Faith; and was noted to use “oo” in the context two; /bæ/ (black); /j۸/ for “up”
- some vowel variation was noted in her use of /tIk tIk/ (cat) and baby;
- inconsistent voicing of /t/ to /d/ and /p/ to /b/ e.g. “You bick” (pick) was also noted e.g. “doo” for “two”

I also received instructions on our 'homework' for the week which I made into a simpler version and printed out to hang on the fridge ( I also made up a little chart with a space to mark down each days progress - which activities we did , and how well it went ) One of the activities was to work with a harmonica ( for building up the muscles ), and Brianna has dragged that little harmonica everywhere with her for the entire week !!! She loves that little thing - and actually is good at it - even has a little sense of rythym ~ which she does not get from me !! This is the first weeks homework :


SPEECH THERAPY WEEK 1 ACTIVITIES

Bubble blowing: Model lip rounding and try to elicit a whispered “hoo” blow

Horn Blowing: Encourage blows of increasing length and remove horn after each blow in order to encourage repositioning of the lips

P/B & T Sounds: use kinaesthetic cues to elicit bilabials /p/, /b/ and /t/, always accompanied by a vowel; track any difficulty with vowel variation
Final Consonant Placement: Focus on eliciting final consonant placement in one-syllable words, as well as two-syllable marking of easier words e.g. those containing m, p. b, t (mommy, puppy, baby, tummy); focus on words targeting vowel shifts

Look For Backing: Focus on eliciting final consonant placement in one-syllable words, as well as two-syllable marking of easier words e.g. those containing m, p. b, t (mommy, puppy, baby, tummy); focus on words tar
geting vowel shifts.

Oral Motor Work: Introduce some oral-motor intervention at home (horn #2; bubble blowing; use of straws for all liquids and for fruit sauces/yogourts (without fruit pieces). Also suggested was the retrieval of a Cheerio placed on the lower lip (using her “bunny teeth”), as well as the use of pudding placed on the lower lip to encourage scraping of the lip with the upper teeth, both to encourage bite placement for /f/

We have been working on these things each day - and have another appointment on Monday. Hopefully progress with start soon - its a lot of work & money but will be so worth it !