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SLP Mommy of Apraxia: April 2014

Wednesday, April 30, 2014

What are you doing May 14th, for Apraxia Awareness Day?

It's the month of May, and in my world, that means starting to think about what to do for the second annual Apraxia Awareness Day.  Leading the movement is CASANA, a non-profit dedicated to Childhood Apraxia of Speech.  If you are interested, they have a bunch of great ideas on how to celebrate here, at their website Apraxia Kids.

I did write to my local papers, but my favorite of all was making and seeing collages of our kids' sweet faces and what really defines them.  In addition, everyone blogging and lighting up social media was really powerful.  You can read about my first ever one last year here: First annual apraxia awareness day!

It was a powerful and empowering day.  I NEEDED that day.  My daughter was 3 1/2, and though she was doing great, she still struggled to talk and wasn't talking at all in school unless she was with her SLP (speech/language pathologist).  Though we made a lot of gains that year, it was easy to get bogged down with what she "couldn't" do, and what she still needed to work on. I was navigating this brave new world of social media, and one of the positives to come out of it was seeing all the apraxia superstars on the facebook support group APRAXIA-KIDS - Every Child Deserves a Voice.  If you are not a member and your child has apraxia, you absolutely MUST get on this page.

The month of May I was able to see the "faces" of apraxia.  Parents could share what their child could do, and not just want they couldn't.  Posts brought tears to my eyes frequently, and on the awareness day, I felt honored to be part of such a great group.  A slideshow of all the pictures was made and set to music. I don't know the song, but the lyrics were "Living in the Hall of Fame, Everyone will know your name."

I watched it over and over, and every time I saw Ashlynn I teared up.  She wasn't living in any other hall of fame in her own part of the Earth, but here she was a hero with all the other kids.

So...I encourage all you moms of apraxia.  All you warrior moms.  All you worriers, sleepless nighters, criers, advocaters, non-stop tireless fighters, create a collage like this and post it to every social media at your disposal.  I guarantee, you won't be alone, and you won't be disappointed.  Bloggers from far and wide will be linking up!  Find and add your link here: Apraxia Link Up Let's see the faces of our apraxia heroes!!

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Vowel Viz Schools App Review and Giveaway!!

The people over at Complete Speech and Michelle over at Trust Me, I'm a Mom and myself all teamed up to offer you a great giveaway for the visual feedback app VowelViz!   I was not paid to review the app and am only offering my personal opinion not only as a mother with a child who has a speech delay, but also as an SLP who works with kids.

I was really excited about VowelViz because I love visual feedback to aid in therapy. The price for this type of programming has typically been very expensive, but since tablets have made many more things easily accessible, the people at Complete Speech created a quality and affordable app that provides visual feedback for vowels and the vocalic R sound. 

The company has offered great video tutorials to start using the app as well.   They are available at:

http://completespeech.ning.com/tips-main


The first thing you must do before using this app is go to settings (seen below) and play with the mic sensitivity.  Even though I watched the video tutorial, I failed to do this initially and I would have saved myself a lot of time had I remembered this step.


Once the mic sensitivity is adjusted, you can begin using the application.  You can also adjust the vowel tail lengths and choose varying themes.  If you are an SLP, the picture above probably brings you back to your grad school days learning the vowel quadrilateral.  We don't often reference the quadrilateral, but this is a great visual reminder of where vowels are produced in the mouth. Quadrants within the vowel quadrilateral act as relative targets and help users orient themselves to where in the mouth they should be producing the vowel. According to the website, "Learners are also able to see how their vowels compare with the researched averages of others."  Personally, I wasn't always exactly on the target; however, my clients and I did at least manage to hit within the range that is highlighted around each vowel.  (seen below)














If you upgrade to VowelViz schools, there are options to vary the themes and add flash cards, which is nice.  These simple upgrades make the app more fun and visually appealing.



My daughter and my 1st grade clients with R goals loved using Vowel Viz!  They loved seeing a visual representation of their voice and trying to move the ball into the target range.  I can see this being a great, practical tool to supplement therapy and/or provide great practice for correct production of vowels and the vocalic R. 

For Childhood Apraxia of Speech, vowel inconsistencies are a common characteristic.  Vowel distortions make a child extremely unintelligible.  Unfortunately, vowels and the R sound are difficult to teach because there is not a specific explanation for what to do with the tongue and other articulators in the mouth to make the sound correctly.  A visual feedback tool like Vowel Viz would be helpful for the client to visually see what the tongue is doing in the mouth.

What I don't love:  Though the company offers incredible videos on how to use their app, I was still initially challenged to figure out the right configuration so the app would work correctly and accurately.  However, once I adjusted the mic sensitivity and played around with it more, I really started to get the hang of it and feel it can be a valuable tool at home and in therapy.
What I love: I would definitely recommend upgrading to the VowelViz schools to get the full perks the app has to offer.  The change in themes are fun, and the flashcards are nice to have so accessible being within the app.  The vowel quadrilateral as a general frame provides another good visual feedback tool to help explain to clients what the tongue is doing in the mouth when making the vowels, and just having an affordable visual feedback tool is amazing.  I really look forward to more apps from this company, because visual feedback is so powerful in therapy.

To enter to win this great app, click on the link below!!  Like SLPmommyofApraxia on Facebook through the link below for easy entry!   Raffle closes May 12th at Midnight.  Winners will be contacted via email and have 48 hours to claim the prize, or it will be awarded to someone else! Good luck!!





a Rafflecopter giveaway

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Thursday, April 24, 2014

They want to put her in a special classroom....what does that mean?

I have a client who is usually brought in by her dad who drops her off and then waits in the truck.  Last night; however, he followed us back to the therapy room and asked to talk with me.
This normally reserved, stoic man had fear and sadness in his eyes.  He told me had just seen his wife briefly and she was crying.  She had a meeting with the school and they told her their daughter is eligible for a special classroom.  I knew what this meant.  I knew she had been being re-evaluated in anticipation of her 6th birthday.  At that time, the district has to figure out a "label" for why she is having learning difficulties.  Aside from her global apraxia, I could only assume they found an intellectual disability as well.

I was looking into his eyes.  This family trusts me.  They know I have Ashlynn, they know the struggles I have had and I know he thinks I understand.  Truth is, I'm just as terrified as him in that moment.  I was with him as a parent, not as the SLP I usually am.  I've been at IEP meetings where we recommend the "special classoom."  We always try to be positive and explain to the parents that the smaller setting will allow them to work at their pace.  This is all true.  In fact, I am the SLP for two "special classrooms" during the day.  The kids are learning, they are happy, and we are all here to see them succeed.

As a parent though, standing there with him, looking at his fear, sadness, trust, and just a glimmer of hope, my heart was breaking. I rambled and explained the process and the testing, and how a school usually gets to that decision.  A psychologist would have looked at her general cognitive abilities.  A score would be calculated and compared to national norms.  Scores below could indicate a cognitive disability; however, the social worker would be administering an adaptive/functioning assessment.  The parent and teacher would be interviewed and asked questions based on various adaptive skills she can do at home and at school.  If these came back below age expectations, a cognitive disability may be suspected.  However, in her case, the global apraxia would negatively affect the scores because a lot of the questions include daily living skills.  Finally, educational testing will look at her academic performance and compare it to her cognitive and adaptive scores.  If all the tests were low across the board, she most likely will be identified with a cognitive disability and be eligible for the special classroom.  If her cognitive and/or adaptive was high, but her educational scores are still low, she most likely will be labeled with a specific learning disability in the areas in which she struggles, and she may or may not be eligible for the special classroom.

His eyes glazed over.  I stopped talking.  I told him that it doesn't mean a thing.  It doesn't mean a damn thing.  I'm not giving up on her, and neither are they, and neither is the school, and just because she needs it now doesn't mean she'll need it forever; and I really, truly, meant that.  She might have to work harder, but work she will, and work WE will.  I told him that Ashlynn started in a special classroom, but now she is in mainstream with a lot of support. 

I thought of the Katy Perry song "Eye of the tiger."  All of us parents have to have the eye of the tiger.  It's hard, it's tough, we will cry, but we will also smile.  There will be challenges, but there will be triumphs.
"I got the eye of the tiger, a fighter, dancing through the fire, and I am a champion, and you're gonna here me roar!"

I love this definition of determination.  "The ability to see past challenges, rather than stare at them."  I encourage you all to do the same!



Wednesday, April 23, 2014

nacd apraxia app review















This was one of the first speech apps for apraxia that I bought.  It was enticing because it was a good price and the description looked much like a digital version of the Word FLIPS book I was using in therapy.

It starts with a screen that allows you to pick a CV consonant/vowel group, seen below.

For the purposes of this review, I chose the top group BPM.
 You then have your choice of levels.  Level 1 is really just to learn the pictures, so each picture is presented one time.  In Level 2, there are three required productions of the same word.  By Level 3 (see above), there are five pictures of the same word. 

By the time the you choose Level 8, the pictures change to have three different pictures depicting different words in alternating fashion.  (see below). 


You can choose to have the sound on, in which a verbal model is presented when you touch the picture; or you can mute the sound so a verbal model is not given when you press the button.
There is a also a "tracking" feature to tally correct/incorrect productions for data collecting purposes.

What I love
This app is great because of it's simplicity.  It's more fun for kids to practice these skills on the iPad then it is to use the flip book.  They are just more motivated by digital versions of everything these days!  Also, therapy for Childhood Apraxia of Speech requires A LOT of practice and repetition, and this app lends itself to multiple chances for repetitions in either blocked or randomized fashion (elements essential when treating motor based speech disorders).  
In addition, most of the kids I treat with apraxia like it.  You can get a quick "warmup" in using this app while getting a lot of repetition right off the bat.

What it's missing
I would probably use this app more, or longer during therapy sessions if it had some sort of reward or fun reinforcement.  However, since I only use it as a supplement to therapy, it's still a nice app to have. Also, just recently my daughter was confusing her t/k and d/g, so I went back to this app and we practiced using these pictures alternating between the two sound patterns.
The other thing that is missing is a voice record option.

Overall impressions:
I love this app for it's simplicity, price, and ability to get A LOT of practice in a short amount of time.  Most of the kids I treat with apraxia, and my own daughter with apraxia, have used this app successfully and enjoy tapping, repeating, and swiping the iPad.    I would highly recommend this app to parents and SLP's as a supplement to therapy for Childhood Apraxia of Speech.

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Thursday, April 17, 2014

What I would have told myself 2 years ago.

There was a time, a time not long ago but that seems like almost forever now, that when someone asked me Ashlynn's age I immediately became defensive.

"Why?" you might ask yourself.  Seems like a typical question among moms in that age group.
It is........... until your child is delayed.  Then that game isn't fun anymore.

Every time the question was asked, I found myself rounding down.  When she was almost 2 1/2, I still said she had just turned 2.  When she was almost 3, I said she was 2 1/2, because, you know, technically she still was only 2 1/2.  I might have been in some sort of denial, but at least to others she didn't seem THAT far behind.

I don't know if I was projecting (I probably was projecting), and I don't know if they really felt this way (pretty sure they didn't feel this way), but I felt like once they found out her age they immediately measured up their kid to her, and their chest puffed out a little further and their smile got a little bigger because they were SO proud of their little offspring; and I HATED it.

I know that sounds dumb, and I can't really tell you why I did it, but I did.  However, I can say now that I don't do that anymore!  Yes, all of her difficulties are still there but:

She's talking.
She has friends.
She learns in school.
She plays on the playground

And

She's the most loving and accepting out of ALL the kids in her class.
She's the kindest.
She's the most intuitive and she is by far the most advanced in lessons of the heart than others her age, and yes, that does make me proud of her and there is nothing wrong with that.  Just like there is nothing wrong with the parent who is so proud their child is verbally gifted, or an athletic super star.

A girl who is verbally gifted and can speak TWO languages already in her preschool class, turned out to be a loner and the class bully.  Despite being mean to Ashlynn, Ashlynn still is sweet and kind.  When we talk about it, Ashlynn tells me that the girl "is sad mommy"   and you know, Ashlynn's right.  Bullies are sad, and that's why they are mean, and the only person who sees that is Ashlynn.

 That's pretty dang impressive.  We all have our roads to battle.  That parent was probably bursting with pride at her daughter's early verbal skills, only to be fretful and worried now that her young daughter is already a loner and a bully.  I don't envy that mom, but I do understand that we all go through something that unites us as mothers.  We all have our worries, and we all lose sleep over our children.  No one gets left out.

I just wish I could have told myself this 2 years ago.








Tuesday, April 8, 2014

Still on a sippy cup

Ashlynn is 4.5 years old.  Though as a baby she never really had a problem latching or drinking out of a bottle, she eventually showed signs very early of oral apraxia.  I remember looking at some teething biscuits and the box saying it was for 9 months and older and thinking, "are they for real??"  She'll choke on that!!"
I remember my sister-in-law talking about babysitting my niece when she was under a year and feeding her cheerios, and again, I thought, "Seriously??  Ashlynn would choke on that!!"

I remember after I took her bottle away at 12 months, my mother-in-law said she had all three of her kids on a regular cup.  I know she didn't mean any harm by it, but at the time I felt like a failure.  Ashlynn could barely handle a sippy, and a cup?? Forget about it!

When she was eighteen months, my husband I decided to take a weekend vacation for two nights and left her with her grandma, and I remember I was still pureeing fruits and vegetables and had sent 8 jars of food. Now that I have a typical 18 month old, I can't believe she was still on purees at that point.  She could eat the occasional cracker, but she refused any other solids.

I can't totally remember when she finally started eating at least pasta and breads.  I do remember though one night going to Mimi's cafe and ordering their kids pizza.  It was more like a thin crust and she swallowed her bite whole and silently cried.  Her face turned red and she had that look on her face like when you eat a chip that isn't totally chewed and it scratches you going down.  Another instance, my friend brought over amazing fresh bagels from Panera Bread.  I cut Ashlynn's up into pieces.  As I was talking to my friend she started choking.  I ran over and pulled up her left arm and started patting her on the back.  The entire piece of bagel came up whole.  My friend was horrified and honestly, so was I.  I lived in fear, worried about when she would choke and I couldn't get it up.  Another time I fed her shells and cheese pasta roni and I remember telling her she needed to chew!  She would put it in her mouth, and then immediately swallow.  Halloween when she was two was pretty disappointing.  Give her M&M's?  Are you kidding?  What if she didn't swallow!! Skittles?  Nope. Sprees?  No way! Anything with caramel?  Not a chance.

I'm paranoid now.  I still quarter her hot dogs, grapes, blueberries.  I figured all kids have messy mouths, but now that I have my 21 month old son, his mouth is always cleaner than my daughter's.  He licks his lips and wipes his chin.  Here is a recent "ketchup mouth" pic of her on our Spring Break.  Isn't she a doll? She's so perfect, apraxia and all.


Which leads me to the title of this post.  She still violently chokes on liquids.  I'm talking about it went down the "wrong pipe," face turns red, lips turn blue, and we have to pull up her arm and pat her back. This is with a sippy cup!  My husband and I enacted a two sip rule, which is working. We tell her, two sips and then breathe.  We'll see how this goes, but I wish I had got her feeding therapy earlier.  This is usually done in early intervention through the SLP. She had all the symptoms: over-stuffing, choking, difficulty with chewing, and difficulty sequencing the steps for the swallow.  Hindsight 20/20.  If you read this, and this sounds like your kiddo, get them into early intervention!!  You won't regret it.  Now I have to decide if I put her in to feeding therapy now, do a swallow study...etc etc.

I hate apraxia.  I really, really, hate apraxia.  With apraxia, they don't "grow out of" anything.  They have to work for EVERYTHING, but the earlier the intervention...the better.

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