Category Archives: speech therapy

October 12, 2013 · 8:16 pm

“Size matters not. Look at me. Judge me by my size, do you?”

Empire Strikes Back

For the last year and a half I have been often heard quoting “never tell me the odds” as Harry seemed to always be the kid that didn’t do anything by the book.
This phrase reminded me of a movie and sure enough it is a quote from one of the best Bloke movies of all time. To give you a clue, I feel like the Force has been with us in recent months; there have been no major illnesses, Harry’s balance is showing signs of strengthening close to normality and his speech has jumped into Hyperspace.

“Sir, the possibility of successfully navigating an asteroid field is approximately 3,720 to 1.”
“Never tell me the odds.”

Forgive me for using the Star Wars analogy but as I have spent the last few months convincing myself his slower progress with speech and his desire to only mimic words related to food, cars or trains is directly linked to his gender, I am going to run with it as appropriate.

In the last 2 weeks Harry has managed to surpass my stereotyping and is able to parrot a huge percentage of what we are saying to him. This is a skill you will notice in most 18 month- 2 year olds. You say a word and they repeat it back to you several times and then it forms part of their vocabulary. Given Harry’s hearing age is 19 months ( 17 if you take out the 2 months he was sick this time last year) this is spot on. In the near future we can wish he surpasses his hearing age to have  birth-age appropriate speech and language skills , but for now I am thrilled.

In his speech lesson this week, Beth and I spoke of his huge increase in vocab and given his desire to take in the language we are now moving to weekly sessions. This will give us the time to start working on expanding his vocabulary to include verbs or action words to add to the nouns and names he has learnt. With the addition of verbs he will be more able to start putting small sentences together. At the moment he is able to say 2-3 words together but they are phrases such as “see you later” rather than combining individual words.

I have dug into a great resource which Cochlear provides on their website. It is called the “Listen, Learn and Talk Auditory Habilitation Theory”. So for us laymen it is a chart showing age appropriate stages of listening and speech for babies and toddlers. Checkout http://www.cochlear.com/wps/wcm/connect/au/home/support/rehabilitation-resources/early-intervention/listen-learn-and-talk/listen-learn-and-talk

Harry has mastered all the 16-18 month old skills. In listening he discriminates between phrases and is now imitating words heard.The section of  Expressive Language covers the following for a 16-19 month old.
o Jargon disappears
o Increases vocabulary, 10 or more meaningful words
o Decreases use of gesture – relies on talking to communicate
o Imitates words heard
o Asks for more Receptive Language
o Understands more simple questions
o Begins to understand longer phrases with key word in middle of sentence
o Identifies more body parts
o Finds familiar object not in sight
o Understands 50 or more words and for speech in this age group

For Speech in this age group  toddlers increase single word approximations , most vowels  are present  but they still mainly producing front consonants  [p, b, d, m, n, h, w].

They next age group is 19-24months and there are certainly skills here he is yet to master but by no means does he need to master them all.

For listening (audition)  at this age they need to master the following list:

Auditory memory of 2 items,Discriminates songs ( yes mastered), Comprehends a variety of phrases ( yes mastered), Discriminates descriptive phrases ( not sure about that one!), Follows a two step direction, e.g. Get your ball and throw it. ( yes with very familiar routine such as shoes and socks)

Then there is Expressive language

Expressive Language

Uses new words regularly

o Increases expressive vocabulary to 30 words or more ( mastered)

o Attempts “stories” –longer utterances in jargon to get message across ( certainly not here yet)

o Begins to use own name when talking about self ( this will come )

o Uses possessive pronouns – mine ( certainly not here yet)

o May ask where questions Where car?

o By 24 months may use2 – 3 word phrases with nouns, some verbs and some adjectives ( this is what we are targeting in Speech classes)

The Receptive language and Speech sections for this age bracket are what we are working towards. I can list them here so you get an understanding of our benchmark and they are only a guide as each child is unique ( of course)

Receptive Language

o Completes two requests with one object

o Chooses two familiar objects

o Comprehends action phrases

o Points to a range of body parts, e.g. elbow, cheek

o Begins to understand personal pronouns –my, mine, you

o Recognizes new words daily

o Increases comprehension – decodes simple syntax

o By 24 months understands 250 – 300 words

Speech

o Approximates words

o Substitutes /w/ for /r/

o Uses suprasegmental features

o Most vowels and diphthongs present

o Consonants [k, g, t, ng] emerging

o Consonants[p, b, m, h, n, d] established – used in initial position in words

o Consonants often omitted in medial and final position

Let me end on this note. There is not an ounce of delay on Harry’s Cognitive skills . He has developed ahead of the game in this area and has really great fine motor skills ( probably to balance out the slightly delayed gross motor skills)

The list the provide for this age in this category goes as follows ands I can tick them all!

Cognition

o Imitates symbolic play, e.g. household activities

o Uses one object as symbol for another

o Places triangle, circle, square in shape board

o Imitates vertical strokes

o Threads three beads

o Begins to tear paper

o Imitates ordering of nesting cups

o Begins to categorize objects in play

o Uses two toys together

o Stacks blocks/builds tower

o Completes simple pull out puzzle

o Activates mechanical toy

Please watch the videos below to see Harry’s progress.

I know I’ve said it before  but it is “AWESOME”

 

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May 27, 2013 · 11:12 pm

Is 3 words a sentence?

DSC04654[2]

The month of May has brought new words, a more stable inside walk and some very in- tune singing. I would be bold enough to describe the recent developments in speech as a flourish of language.

Since we last connected Harry has spent many hours walking up and down our 12m corridor on the camping mats, barefoot, to bring his walk from a tilting totter to a proper toddler walk. Without fail everyday he will wander up and down the hall to the front door and back to the kitchen just to gain confidence walking. It is an innate response and I guess that is what it should be with babies so they can evolve.

His language has blossomed beyond my recent expectations. I have to say that I had resigned myself to slow progress in this area. A word or two a month has been the standard headway for the last 6-8 months and no one was sneering at this because those sounds he had grasped were significant and meant he fell within the boundary of the “hearing age” bracket we had allocated him.

Last count was 18 words in 1year of sound. That brought us unofficially to April. We are now about to move into June and Harry is about to turn 2. In the past 4 weeks I have been able to add 9 new words to this list and 3 sounds for vehicles. Phenomenal

  1. Ball (without the B)
  2. Sock (ock)
  3. Shoe (ooo)
  4. Row row (from the nursery rhyme)
  5. School (pronounced  “All”)
  6. Walkies
  7. Down
  8. Counting-1-6
  9. All day long (from Wheels on the Bus)photo

He also distinguishes when he plays with vehicles, the varying sounds they make. The ambulance and police car go “nee nar, nee nar”, the fire engine goes “ee-or, ee-or”, the train goes ” oo- oo”(the ch will come with time).

Having the appropriate sounds to go with play is a massive indicator for the Specialists to gauge how he is getting on. From the speechies and the CIC staff, to the Occupational therapist, they all comment on how appropriate his play sounds are for his real age. I am basking in this praise- it is music to my ears.

In our Speech lesson last week, Beth introduced Harry to an on-line karaoke website. You might well imagine how a toddler who can’t stand yet would benefit from a karaoke session. I think it was a shame there was no microphone or disco ball above us to bring the atmosphere into the room, nevertheless we started a journey on the Raising Children’s website (a Gov’t site) and fell in love with their version of Old MacDonald, Row, Row your boat and Open, Shut them, to name only a few nursery rhymes.

 

https://raisingchildren.net.au/baby_karaoke

 

The beauty of this site is that the words are sung slowly and in a great Aussie country drawl. Most are accompanied by a video with animated characters that do the actions for the songs clearly. I am conscious of Harry not spending all day on this as no toddler can cope with over exposure to electronics. Those telling signs that the I- device has expired as a babysitter when you try to graciously pull the item away from their inquisitive little hands and they tighten their grip into a vice around it. And scream!

Without a doubt a child who has lost a sense such as hearing is more dependent on sight to give them information. And so, Harry is drawn

wheels-on-the-bus-1

to anything that is overtly visual. This includes TV, and other visual electronic devices. There is a very fine line between him using them to learn and them burning him out with their visual references.

 

It was only yesterday that we were sitting in the kitchen reading to Harry as he had dinner (as it is often the time we do it to distract him enough to eat).  The girls were chipping in with their 2 cents worth of Old McDonald when suddenly I heard an “ All day long” that was nearly so clear that I thought it came from Alice. In perfect response Tess grabbed the hone and tried to get him to repeat it.  Check out the video and see what you think, but in our books that is a 3 word sentence and we are ecstatic!

oldmcdonald



 


 


 


 


 










	






	






	






	

	

				
		
		
	





			

	
	

		
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		April 28, 2013 · 9:36 pm	


	
OT, ST…Occupational therapy and Speech therapy start
	

		
ot signOT images


Despite all my efforts to find a “label” to apply to Harry’s delayed motor skills, I can’t seem to find one.    It is not a common issue; he is one in 20,000 with a congenital profound hearing loss, and even less has issues with balance.  It appears that it is a “bi-product”(and that is my own term) of his Deafness.


As you can imagine Readers, having followed this journey for the last year, I have discussed this need for a box or label with which to understand his issue with a number of Specialists- from our ENT, our Paediatrician to our Physiotherapist. But no-one seems to know exactly why Harry has these delays and he is struggling at the moment to stand on his own.


One consistent comment that has emerged through these discussions is that Harry is unable to work out where his body is in space. He requires a lot of sensory input to let his brain know that he is standing, the ground is beneath him and he can move up or sideways or go straight ahead in this space.


Our Physio appointments were only monthly and in between it was up to me to make things happen. It was only Physio that was trying to assist with his gross motor skills. It is like that with everything though- really the parents are the key to the child’s success. What you put in, they get out! I was trying as hard as I could but really everyone was waiting for it to just click into place for him.


OT clip art


So we have been bumbling along since January with Harry cruising around, and slowly getting more confident, but never really being able to go on his own as he couldn’t stand.  Every time he stopped he fell, either on his face or onto a vertical surface he could lean against.


He never starts from standing- he begins his walking experience by leaning against a person or a surface and then launches from there. And this is how he stops. There has to be something there to break his fall. He has not mastered the STOP by STANDING.


This is still where we are at the end of April. So between me, the Physio and the Paediatrician, we decided the only therapy we hadn’t really looked at for this issue was Occupational Therapy. I know nothing about this field. The Physio warned me I might find it “woolly” but quite frankly so was Physio. I was recommended a particular practice not far from home and set about to get Harry started. It took nearly 4 weeks for them to find a therapist that was experienced enough to tackle Harry’s issues. I now know why, as in between I randomly surfed the Web to see who else in Melbourne may have had experience with hearing issues and balance in Kids, phoned around and dragged us all off to see what they had to say. I spend endless nights drawling through reports on the Web about sensory issues and most notably Sensory Integration Disorder. It was the only thing that seemed to be close to what Harry was experiencing. It talked about the use of Occupational Therapy to assist with kids who couldn’t work out where their body was in space. It was not easy reading, as there were a lot of other social issues linked to this disorder, which Harry wasn’t displaying.


Did that mean they were to come- was there still more to unravel? I don’t think so. I think it was an exercise in learning not to self-diagnose.  It can be really soul destroying and ultimately damaging to all the work you have put in thus far.


The story ends well. I have  found a lovely lady who is an OT and has worked with kids with hearing impairments and she seems to know what she is talking about. She spent nearly 2 hours with us on the first visit to assess what may be the cause of Harry’s lack of equilibrium. In that 2 hours Harry had moments of walking without a wobble and it was enlightening for me. By the time I came to see the OT I was at rock bottom. I had convinced myself Harry was suffering from any number of disorders and was not making enough progress. I guess this is what comes of seeing so many Professionals- conflicting advice and opinions, when actually most of them, like us, don’t always know “Why” something is not clicking.


She then requested that we line our hallway , which Harry had stopped attempting to walk down, with rubber mats. The hallway was a means to get around most the house and he either crawled or pushed an object to get down it. When we tried to get him to walk down it alone he belted his head on the hard Jarrah floor so many times he just stopped trying. And who would blame him. This is because he seems to be missing the basic reflex of putting his hands out to save himself when falling. His head always hit the ground first. And with the delay in walking came enough age( or maturity) to know that it was a painful experience and not worth doing anymore.




password harry2011


I have some video with the mats down in our hallway and Harry’s sheer glee at being able to manoeuvre  himself solo for 12m. The first evening he walked up and back about 15 times just to make sure he wasn’t dreaming. The OT made some other requests which I have been doing and altogether I have seen a vast improvement in his steadiness and confidence over this week.


I will add a page into the Blog under Useful Links all about OT so if you think it might be something useful for you to read then it will be there.  We will be going weekly until our trip to the UK in June and so we will see what happens.


OT room

			

	
	

		
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			Video
		
			


	
First speech lesson at 23 months
	

		
 password “harry2011”


This is Harry’s first speech lesson learning the prompt technique for the sound B. We have started speech earlier than usual ( normally it starts at 3 years) as  I have been the pushy mother that insisted it was a good idea. Never one to stop still I noticed with the Specialists that he is  mastering the sounds for the consonants   “M”, “N”, “G”, “K”/ “C”.


But there is no attempt on his part to try to copy any words that start with the letters “T”, “P”, “B”, “H”, “D”.


These sounds are made from the front of your mouth , whereas the sounds listed above that he can do, are sounds from the back. The normal progression in developing these sounds is when a child masters the expellation of air ( is that a word)  to allow them to shape these sounds that are made further toward the front of your mouth. By 12 months most children would use “plosive” sounds and nasal sounds (p,d,m). This continues through to 18 months with an establishment of all the vowel sounds.


So where is Harry with all this.


He has not mastered the plosive sounds  and has mastered about 1/3 of the vowels at this stage. So we are trying to work out whether he might have a motor skill issue that is stopping him from forming those plosive sounds which would generally come earlier than the hard back of the throat sounds of “G”& “K”. He is certainly hearing them, as his comprehension is on target with a child his age ( as opposed to his hearing age). But he just never tries to imitate any words beginning with these sounds.


As he has experienced some delays in his overall gross motor skills ( such as standing, walking , sitting)  the Specialists are guessing that there is a possibility of a link between this speech delay and the gross motor skill delay.  That link could simply be that he had an All Mighty infection last September and it is taking the body a while to completely recover and get back to where it was at that point. We also know in little ones, that the body focuses on one major thing at a time and if the brain is preoccupied with walking,  then the speech is going to come second.


The one clear thing in all of this muddy water is that he is developing. The speech is coming along. Maybe not exactly in the order that other CI kids have shown, but despite the lack of some sounds he is joining more than one word to make short 2-3 word sentences. Every time he practices them they get clearer and clearer as long – as they don’t include P’s or B’s , T’s D’s or H’s!


He says” Hear ya go” when he is waiting his turn for a musical instrument in a class setting and the instrument is being passed from kid to kid, before he comes to him. He also says it to us when he is passing us a toy.


He says “See  ya”  when someone is going , along with “Gye , Gye” in stead of Bye , Bye. And there are many more such phrases.


He says “Ank you” instead of “Ta” ( something I am immensely proud of !)


By 24 months a child would possibly have a vocab of 30 words or more. I don’t think Harry has quite that many as about 6 of his are animal sounds, but he is not that far off. His hearing age is documented as not quite 12 months  now, as we have to take into consideration the 6-8 weeks without sound during and post-op of the period of Infection last year.


So, all in all, he is doing  so well.


CONGRATULATIONS , HARRY. meadal of awesome




 

			

	
	

		
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					April 27, 2013 · 11:23 pm