Summer Reading List

One of the best things about summer is finding time to read!  During the school year, my reading time is limited to a few minutes before falling asleep at night.  But in the summer, busy though I am with lots of chores and activities, I still make it a point to carve out some time each day to read, especially on rainy days which I feel Nature provides specifically for that purpose.  Getting lost in an exciting mystery, an inspiring biography, or illuminating historical fact or fiction book clears my head and recharges my batteries.  And as much as I relish the escape from work, I do try each summer to read one book related to our field to gain new insights and renewed compassion for people whose lives are very different from mine due to disability.  Here are some of the books I’ve read over the past few years that I would strongly recommend.  I’m linking the titles to Amazon so you can read more about the books, but encourage you to visit your local library or patronize your local bookseller, both so very worthy of our support!

My Stroke of Insight:  A Brain Scientist’s Personal Journey by Jill Bolte Taylor, Ph.D.  41xxS5wUJtL._SX330_BO1,204,203,200_This is the brutally honest biographical account of a young, healthy, brilliant neuroscientist who was devastated by a massive stroke.  Amazingly, she was able to regain functioning through incredible determination and countless hours of therapies.  The account of her eight-year journey to recovery includes her memories of being completely helpless and unable to communicate, yet perceiving the attitudes and emotions of caregivers, even when she could not comprehend their words.  I always share this information in my workshops with school staff who deal with students who have significant disabilities.  You can view Jill Bolte Taylor’s TED Talk here, but read the book, too!

Ghost Boy:  The Miraculous Escape of a Misdiagnosed Boy Trapped Inside His Own Body by Martin Pistorius.

Screen Shot 2018-07-19 at 9.35.36 AMWell, the title pretty much says it all!  Martin was a perfectly normal and healthy boy until he was completely debilitated at age 12 by an unknown virus that left him locked in his body for 10 years.  I did a review of this book on this blog in 2015;  you can read it here.  I always include information from this book in my workshops, as the memories of Martin as a profoundly disabled school-age boy are eye-opening and shocking, and serve as a reminder to all educators to always presume competence.  Through Martin’s recollections, we also get a glimpse of the effect his condition had on his parents — another important insight that I share.  Martin Pistorius also has a TED Talk entitled “How My Mind Came Back to Life — But No One Knew,” but read the book first so you are even more blown away by his recovery.

51HsAQlyqFL._SX321_BO1,204,203,200_41QZ3WNoKNL._SX329_BO1,204,203,200_Two other uplifting come-back stories are “In an Instant: A Family’s Journey of Love and Healing” by Lee and Bob Woodruff, which recounts the recovery of this ABC News journalist after a devasting head injury in Iraq, and “Gabby: A Story of Courage and Hope” by Gabrielle and Mark Giffords, about the US Congresswoman who survived an assassination attempt but was left with lifelong challenges.

31-E5HeYuEL._SX334_BO1,204,203,200_A fictional story that I really enjoyed — and would recommend for young teens as well — is “Out of My Mind” by Sharon M. Draper.  This is the compelling story of a young girl with CP who is the smartest girl in her school, but is considered by all to be mentally challenged because she is unable to speak.  Her determination will warm your heart and change the way you view people with disabilities.

41fxsXxLq9L._SX322_BO1,204,203,200_There are scores of books about autism.   Any book by Temple Grandin is worth reading, as she generously shares her “insider’s view” of being autistic and offers valuable advice to parents and educators. The writing of “The Curious Incident of the Dog in the Night-time” by Mark Haddon perfectly captures the voice and thoughts of a young man with autism who relates well to animals but has no understanding of human emotions, who hates to be touched and can’t abide the color yellow.

 

This immensely popular story was made into a Broadway play.  Unlike some of the others I’ve mentioned, this book makes for light reading but will keep you thinking, long after you close the book.

519TerFSCjL._SX331_BO1,204,203,200_I am currently reading the 560-page tome, “Neurotribes:  The Legacy of Autism and the Future of Neurodiversity” by Steve Silberman.  The author presents a fascinating and sometimes horrific history of autism research and treatment from its earliest days, and spotlights many people on the spectrum who have used their unique talents and perspectives in important, but often invisible, ways (think computer programmers, NASA, etc.).  Indeed, he makes the argument that autism and ADHD are not errors of nature but rather natural variations in human development.  I’m only half-way through the book, so I’m just about done the section devoted to the history of autism and look forward to reading about the author’s view of the future of neurodiversity.

41JNxY4tU-L._SX326_BO1,204,203,200_For a compelling and honest account from a parent’s perspective, I recommend “The Child Who Never Grew” by Pearl S. Buck.  Pearl Buck’s daughter, Carol, was born with disabilities at a time when such children were hidden away in institutions to avoid shame on the family.  Ms. Buck was determined to provide the very best care for her daughter and others like her, championing the rights and acceptance of people with disabilities.  She candidly shares her struggles as a parent in this story that still offers timeless wisdom and encouragement, nearly 70 years after its publication.

These are just some of the books that I have found to be entertaining, enlightening, and thought-provoking.  What books would you recommend to your SLP colleagues?

 

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Summer Freebies!

travelGuidesI’m sure that, for the first few weeks of summer vacation at least, school will be the last thing on your mind. But did you ever consider that summer could provide a treasure-trove of free therapy materials that you can use throughout the school year?? Here are some ways to make therapy fun and functional, and relevant to the curriculum for all of your artic, language, fluency, and voice students:

 

  1. Tourist brochures – Hotels, rest stops, and tourist destinations always have racks upon racks of cards and brochures that promote all of the attractions in the area, and they are FREE. Help yourself! These provide interesting stimulus material for reading aloud, discussion, and writing activities.
    1. Our fourth grade studies Pennsylvania history, so brochures from historical sites in our state are very relevant to their classwork. And it’s always surprising (in a sad way) to learn how many students have never visited local historical sites. Maybe sparking their interest will lead to family day trips in the region.
    2. Brochures from outside the state offer the opportunity to talk about history, geography, distance, and observable differences in the photos compared to your immediate environment. What do you see? What do you think it’s like there? Does it remind you of any place you have already visited? How long would it take to get there? What would be the best way to travel there? What would you have to pack for that trip?
    3. Provide brochures from a variety of locations and have the students discuss the pros/cons of each from their point of view.
    4. Use brochures as a reference for writing activities, such as writing a letter or postcard to someone about an imaginary trip or writing an ad to promote a tourist destination. Video the students presenting their ad – lots of fun, great carryover for artic, and useful for self-monitoring via playback.
  2. Postcards – not free, but usually cheap. Use as above, and also as creative story starters about “my best” or “my worst” summer vacation. Sort by common features (location, type of attraction, etc.). Locate the places on a large wall map.
  3. Maps and regional travel books – free to members of AAA. Maps alone offer so many language opportunities! Older students will enjoy learning how to look up tourist destinations and then plot them on the map to create an interesting itinerary. Read the hotel and restaurant listings, comparing amenities and price. Create math word problems related to these materials for students who struggle with that language. And don’t forget the maps that are often provided in amusement parks, zoos, historic villages, etc. With just a little thought, I’m sure you can come up with all kinds of storytelling, describing, categorizing, auditory memory, and sequencing activities that the students would really enjoy.
  4. Menus – lots of restaurants have take-out menus so, again, help yourself! With your artic, language, social skills and life skills students, use menus for:
    1. artic practice with multisyllabic words
    2. discussion of likes/dislikes and healthy vs. not so healthy choices
    3. role play ordering and taking orders in a restaurant – good for social skills, auditory memory (can the waiter repeat and/or write down what the customers ordered?)
  5. Bus and train schedules – available at all stations and depots. These provide practice with functional life skills, in addition to artic and language. Can they locate the quickest route to their destination? How much will it cost? How long will it take?
  6. “This Week in (vacation location)” booklets — use for planning a daily or weekly itinerary, comparing/contrasting and expressing opinions about listed activities, writing and then verbally delivering “ads” to get folks interested in the various events. (My students love to do news, weather reports, and commercials on video — motivating speech and language practice that provides playback for self-monitoring).
  7. Photographs of your travels — use for labeling, describing, writing captions.

Students love using these unconventional materials in therapy. Beyond the activities I create to support their goals, these materials spur the students to share stories from their own travel experiences, giving me the opportunity to assess their conversational artic, vocabulary, grammar, and ability to tell a story in sequence and with sufficient detail.

So, while you are out and about this summer, be on the lookout for these materials and ask your friends and relatives to do the same. Then create a “travel agency” nook in your therapy room and enjoy using these materials throughout the year!

Your Moment of Zen: Becoming One with /r/

In my last post, I wrote about how various technology – from free and cheap apps to expensive high-tech equipment – can be used to help students improve their articulation of vocalic /r/. But that’s not all I use. There are lots of useful, hands-on ways to increase a student’s awareness of position and tension, some as old as our profession itself.

image_20813The first tools I always use – and ones we revisit time and time again – are the trusty flashlight and mirror. Looking inside the mouth becomes a lesson about the “speech helpers.” Kids love exploring the structures and tongue movements, laying a solid foundation for all future instruction. We talk about how the lips, tongue, and jaw move for each speech sound, then work on motor imitation skills, beginning with obvious movements, such as popping one’s lips for /p/, then to more difficult and subtle movements, like raising a wide tongue up to the back molars. We explore the contexts of /k/ and /ee/ as a way to get to /er/.   Tongue Elevators (raising the tongue from low, mid, high) and Train Tracks (elevating the tongue, then sliding back on the molars) are part of the drills I’ve developed in my /r/ packet, and exercises that we use as warm-ups at every session. All of this is done with the flashlight and mirror. Old school still works.

A-427_Totally_Zen_FrogOnce we’ve gotten good visual information about the articulators and their expected position/movement/tension for /r/, we do all of the above….but with our eyes closed. This allows the students to really focus on proprioceptive feedback as I lead them through a variety of speech sounds and tongue movements. “Where’s your tongue? What do you feel?” This “moment of Zen” is invaluable in increasing their focus on and awareness of what their tongue is actually doing. This is a technique we revisit often. It’s amazing to see how much information the students get and can convey when their eyes are closed.

Screen Shot 2018-06-03 at 3.34.54 PMSometimes we need to “wake up” the tongue. The Speech Gizmo (really, a dental flosser) can be used for this. We rub-rub-rub on margin of the tongue, then the other, then lift the tongue to the molars. This is a useful strategy to start each session. The Speech Gizmo can also be used to gently guide the tongue up and back for /er/, as described in a previous post. I send these home with students and ask that they use them 10 times, each time they brush their teeth.

SW-032717-SillyPutty-Map1To further increase awareness of tongue shape and position, we make tongues out of Silly Putty. I use them in mouth molds from the dentist. This opens up discussion and awareness of wide/skinny, high/low, front/back.  See my previous post about this.

Earth_globe_stress_ball1Tension is critical for /er/, so we do tense/relax exercises with hands, arms, shoulders, jaw, tongue. We explore all of the vowels, again with eyes closed – which are tense, which are relaxed? Where do you feel the tension? When working on /er/, I often give the students stress balls to squeeze. This is especially helpful for students who have low tone. Standing up also helps increase tension.

IMG_0188And, in an activity that is both instructive and fun, we take a whole body approach as each student “becomes a tongue.” One by one, they step into the mouth (the doorway to the speech room), spread their arms and press hard against the molars (the sides of the door jamb). We notice how far away the tip of the tongue (their head) is from the front teeth (top of the door jamb). Again, words like “wide, back, tense” are used. As the student presses against the door jamb, he tries to replicate this with his tongue, making his best /er/. With this experience fresh in their minds, we return to the mirror and flashlight to see if our real tongues can do what the “student tongues” just did

Of course, there are many other tried-and-true techniques that might be needed: pressing up with the thumb at the root of the tongue, lying backwards over a therapy ball to let gravity help, working in contexts they can do to get to once they can’t, etc. As mentioned in a previous post, Char Boshart’sChar Boshart’s seminars, video presentations, and publications are a wealth of information about how to get inside the mouth and tame the tongue for /r/. Be sure to visit her site for /r/ and other invaluable information. I learn something new every time I visit! What tricks work for you? Please leave a comment so we can all benefit from your experience!

Tackling /r/ with Technology

A /t/ is a /t/ and a /k/ is a /k/. But, oh, that vocalic /r/ – the most complicated phoneme in the English language! Volumes have been written about how to fix an /r/ distortion. My go-to bag of tricks includes Char Boshart’s “The Easy R Therapy Program” and “The Entire World of R” books and cards. I’ve learned so much from Char’s books and presentations about how to facilitate tongue movement and tension; her website is a treasure-trove of great information, including free materials, videos, books, and blog posts.  Char Boshart’s “The Easy R Therapy Program” comes in hardcopy and digital versions, and there is even a condensed version for quick reference.   From “The Entire World of R” I learned that there are more than 20 allophones of /r/, each depending on the vowel context and position in the word, and that students can have some of these /r/ sounds perfected, while others remain stubbornly distorted.   Indeed, as part of my own /r/ remediation packet, I developed “Hit the Mark with /r/,” a quick screener to help me determine the vowels and positions in which the student can produce a good vocalic /r/ and those in which production breaks down.   “Hit the Mark with /r/” presents three words for each of the vocalic /r/ sounds (initial, medial, final) and a rating scale that breaks down production into 3 categories: “vowel and /r/ are distorted,” “vowel is OK but the /r/ is distorted,” and “acceptable vowel and /r/.” I follow this up with more in-depth probes, using Artic-U-Checks, which uses a similar rating scale of “incorrect,” “close,” and “acceptable.” A pattern I see over and over in my students: most initial and medial vocalic /r/ sounds are acceptable, but /er/ in all contexts is distorted, and so are all final /r/ sounds.

So, once I have assessed the type, place, and severity of a student’s /r/ distortion, therapy begins. In my experience, there is no one-size-fits-all approach to /r/ that will work for every student. Therefore, I am constantly expanding my bag of tricks, searching for that one cue, one technique that will flip the switch for each student. Multimodality instruction is key.

Screen Shot 2018-06-03 at 12.43.09 PMBecause vowel context is so critical to producing acceptable /r/ sounds, my favorite app is Vowel Viz Pro by Complete Speech. This awesome app analyzes vowel production in real time. As the student produces words with vocalic /r/, the spaceship zooms to and hovers over high, middle, or low planets, representing the various vowels. The visual feedback is very reinforcing to the students and is definitely a motivator. The effort I’ve seen students expend in achieving the goal with this app is amazing – far more than I could ever get with flashcards or word lists. You can read more about Vowel Viz Pro in my blog post, “Apps for Vocalic /r/.” If you use an iPad in therapy, you definitely want this app.  Another app from Complete Speech that you might find useful is “Speech Racer.”

smartpalate_system-1Another very useful piece of technology, also by Complete Speech, is a palatometer, called the SmartPalate System. A custom-built mouthpiece shows students exactly where their tongue is touching the palate (or not). I wrote about my experience with the palatometer in my post, “Watch that Tongue: A Trial with a Palatometer.” This tool is not only very useful for /r/, but was also great for lateral and frontal distortions of /s, z, sh, ch, j/. The downsides for school use: (1) the software is expensive, and (2) each student has to have a mouth mold made by a dentist, then a custom-built palate with sensors – also expensive. The best approach is to see the students every day for short periods of time. Research done by Complete Speech indicates that 20 sessions is the average for fixing a speech sound error. Imagine cycling students through 4 weeks of intense therapy with the palatometer, and it could actually mean a cost-savings or break-even, compared to traditional weekly therapy that could go on for months or years. Still, it could be a tough sell to most school districts.  A new product by CompleteSpeech is the TargetPalate:  a custom-made plastic palate that has bumps where the tongue should be touching for sounds that the student is making in error.  I haven’t yet tried this with my students, but imagine the tactile feedback could be very helpful.  Please leave a comment if you have already had experience with the TargetPalate.

Students can get good information from seeing and hearing themselves on video, using a free program like PhotoBooth on my Mac. I just had a fourth grade boy who was convinced his /er/ was pretty good, until he heard the playback on PhotoBooth. The look on his face when he heard the distortion reflected an important “aha” moment for him. Another student with a wicked /r/ distortion heard the app, “Talking Tom,” repeating the /r/ words spoken by him and other, more advanced, students. I’ll never forget the puzzled look on his face when he asked, “Why is Tom saying their words correctly and my words wrong?” (Note: Talking Tom apps are available for iOS and Android, but I caution their use as they have gotten to be a bit raunchy for school use).

In my next post, I’ll share my no-tech tricks for working on /r/. By combining these “tried and true” old school techniques with new technology, students remain motivated and make measurable progress.

Toy Box Communication

Box-toys.jpg

Two things I’ve noticed when working in Multiple Disabilities classrooms:  (1) the students don’t know how to play with a variety of toys, and (2) there is little peer-to-peer interaction.  There’s an easy way to address both of these needs while also building choice-making, visual discrimination of pictures (photos/symbols) and objects, and core language.  I call this therapy activity “toy box communication.”

Magformers.jpgFirst, you’ll need a variety of toys that provide a variety of sensory input: movement, sound, lights, vibration. Examples include:  a pull-back race car, fire truck with lights and siren, a vibrating bumble ball, a lightsaber, a light-up, musical magic wand, a fidget spinner, magnet blocks, wind-up toys, a light-up mirror, a radio or iPod, Simon game, battery-operated animals and toys, a doll that talks or cries,sound-activated toys, etc.  The toys should be age-appropriate and appealing to both boys and girls.  Also, consider the students’ physical abilities;  battery interrupters and switches may be needed for those who can’t turn on a toy’s small switch.  You’ll need a box or basket to contain the toys.

Create a communication card for each toy using labeled photos or symbols, or use these visual representations on a communication board or speech generating device, as appropriate to the students’ needs and abilities. In addition, provide a way for the students to move beyond choice-making to initiate, terminate, and comment during the activity by creating extra cards or adding messages to the communication board or device.  Examples include: “my turn,” “more,” “all done,” “That was fun!,”  “Boring!,” “turn it on,” “turn it off,” “stop,” “go,” and “help.”  The communication cards can be Velcro’d to a clipboard, binder cover, or eye-gaze frame.  Display at least three choices, or more if the students can handle a larger field.311xIo2mxmL.jpg

Working with a small group of 2-3 students, I introduce a few toys to the students, naming each, describing how it works, and exclaiming when the toy operates to acquaint the students with the toys and to get their attention.  I then put 3-4 picture cards on my binder cover and ask, “Who wants a turn?”  Any movement or vocalization counts as “I do!”

Student #1 touches, looks at, or gives me a toy card to make a choice.  I label it, “Oh, you picked the firetruck!”  I then offer two toys, the firetruck and another, to see if the student selects the correct toy.  I hand the student the desired toy and pause to see if the student can operate it independently.  If not, I present the card for “turn it on” or “help.” When that request is made, I show the student how to operate the toy and allow the student a minute to play with it.  I ask “do you want more or are you all done?,” modeling those choices on the binder.  If the student selects “more,” I allow another minute.  At the end of the minute, or if the student indicates “all done,” I ask the student to hand the toy to the next student for brief exploration. Once the toy has been passed to each student in the group, it goes back in the box.  Then Student #2 has a turn to make and play with his/her toy selection for a minute or two, passing it around the group when finished.  And so on….until everyone in the group has had 2-3 turns making toy choices or until attention to the activity fades.

Mead-The-Fidget-Spinner.jpgOnce the students have participated in this activity a few times and are showing familiarity with and even preferences for toys, I’ve added a “not here” symbol in the choice array so the students can indicate that they want something other than the 3 toys I’ve offered on the binder. “Oh, you want something different! What do you want?”  The choice cards are changed to include the toy you know the student prefers, and the activity continues.  It should go without saying that I am modeling, commenting, using a prompt hierarchy, and pausing throughout the activity, in a way that is individualized for each student.

The activity as described offers opportunities to practice:

  • initiating a turn
  • terminating a turn
  • choice-making
  • picture-object matching and discrimination
  • pointing, grasping, handing, or eye-gazing to communicate
  • fine motor manipulation of the toys
  • accepting a variety of sensory input
  • learning to give and get
  • attention to and interaction with peers
  • waiting and anticipation
  • making comments and requests through core and fringe vocabulary

It is possible to extend this activity in many ways to build additional play, communication, and motor skills with each of the toys.  Here are just a few ideas:

  • Sending the pull-back car to peers.
  • Rolling, kicking or throwing the ball to peers or other target
  • Building/knocking down blocks
  • Choosing hairstyles, accessories, makeup using the light-up mirror
  • Requesting the vibrating pad for relaxation
  • Making choices with radio/iPod — headphones or no headphones, what station or songs to listen to
  • Extending switch use learned in this activity to operate other devices for recreation, vocational training, and communication

Using toys in this way offers so many opportunities for skill development that can transfer to other activities and settings, and that can enrich a student’s life by expanding his/her range of leisure activities.