Therapeutic Options: Speech Therapy SSADH Symposium 2016 Therapeutic Options: Speech Therapy

The Story of Three Young Men Presented By Marie Coakley, MS/CCC Speech-Language Pathologist

Meet Sam

Meet Stephen & Thomas

Commonalities Very low muscle tone “floppy” Lack of body awareness Understand more than they can express Difficulty coordinating respiration with voice production and articulation Difficulty imitating motor movements including speech sounds and words Difficulty directing and maintaining eye gaze

Variances Severity of physical symptoms Cognitive ability Verbal output and articulation skills Reading ability

Total Communication Approach Several different therapeutic approaches were taught simultaneously: Gestures Vocalizations / verbal approximations of words Low tech and high tech augmentative communication devices Sign language

Advantages of Total Communication Enhanced development of communication skills across all settings Provided fall back communication strategies when ill or very fatigued Did not prove to be confusing to the children Each system provided a platform for developing the next skill set

Scaffolding of Communication 1. Gestures and vocalizations gain attention 2. Sign-Language facilitates verbal output 3. Picture systems with words facilitated pragmatic interaction and phrase use 4. Reading led to spelling and written communication 5. Practice of all modalities improved articulation

Scaffolding of Communication Gestures and vocalizations gained attention. Power of the Point!

Thomas using gestures and pointing to communicate

Scaffolding of Communication 2. Sign-language facilitated vocalizations that are shaped into word approximations.

Thomas using sign language to facilitate speech output.

Scaffolding of Communication 3. Using picture systems with written words facilitated pragmatic communication and forming phrases. “I eat nana.”

Scaffolding of Communication 4. Use of written words led to word recognition, reading and spelling.

Scaffolding of Communication 5. Practice of all modalities improved: - verbal output - articulation - speech intelligibility

Motivation is Key Sam loved computer games, board games, books and trains. Stephen loved music, music videos and books. Thomas loved movies, books and Disney characters. These loves were incorporated into every therapy session to increase engagement, focus of attention, and repetitive practice.

Therapy with Movies & Music

when therapy tasks did not engage So what happened … when therapy tasks did not engage or spark an interest in our young men?

Laying the Ground Work for Speech Occupational Therapy to help organize the nervous system in preparation for speech work Increase core strength, respiratory support and stamina Oral-motor stimulation Establish a non-verbal communication system Gestures for Yes / No Sign Language Picture Exchange Communication System

Stephen signing & vocalizing

It’s a Family Affair!

Family & Community Involvement Parents, grandparents, siblings and friends were integral to therapy sessions Peer interaction and social skills groups Open timely communication between home, school, medical community and private therapies Don’t waste time dealing with the clueless! Create a village of support!

Practice the Power of Patience Progress may seem painfully slow. Do not be discouraged! Lay the foundations first and build systematically from there. Set achievable goals and don’t let anyone talk you out of them. Motivation and determination make the magic happen.

Speak to the child as if they understand everything you are saying! This lays down a foundation of mutual respect. By not talking down to them, you demonstrate your understanding that they are intelligent individuals trapped within an uncooperative body.

Stephen Today

Nothing Nothing is out of line. Nothing is out of place. Nothing is right. I thought that I would get to say it out loud. I see now that nothing is as it should be. Nothing is as I wished. I thought that I would swear it to the world. I cannot say that I love you. But I still think it. I still think it. Stephen Kearney

Thomas Today

Sam Today