Friday, December 16, 2011
Welp, I'm on holiday vacation! Technically I have a meeting in the AM, THEN I'm on vacation... but I'll count it now. I have some big plans for SpeechieSpeaking over the coming days. I want to do a redesign of the layout. I've gotten some great constructive criticism from Facebook friends (thank you!) and noticed some issues with viewing on Safari/iPad. Also have taken several pictures and gathered some information on topics I would like to cover. I know everyone will likely be busy in the coming two weeks enjoying family time, but at least for a bit of the time you might want some extra things to procrastinate with ;) Off to bed to prep for the AM meeting!
Monday, December 12, 2011
I had started writing this post quite a while ago, but I never got around to finishing it.

I tip my hat to you, Mr. Bear!
We got a neat bubble toy at the office from TheraPro! It is a Bubble Bear. The neat thing about it? You squeeze the bears belly to have the wand come up. As long as you have enough "bubble juice" in the container, it will make the wand bubble-blowing-fun ready. 

Pros: 
Cheap; easy to use; cute looking design

Cons:
If you or a child squeezes the belly too hard, the wand holder pops out of place. It is easy to stick back in, but just something you have to watch for. Sometimes there isn't enough bubble juice in the top part to blow bubbles. To fix this you can put your finger on top of the wand (keeping it in the top of the bear) while you squeeze the belly. That will let a little bit of bubble juice into the top area to refresh your wand.



Feel free to ask if you have any questions.
The holidays are here! :) 

Today is my last week of work before two weeks off for the holidays. I'm excited, and the office is buzzing with excitement. Of course, some of that may be due to the sugar rush from treats that some of the families have brought in - haha!


Although Thanksgiving is I guess more of a time to give thanks, I do want to take the opportunity to reflect on how happy I am with my job, my coworkers, and all of the wonderful families I serve. I love each and every one of the children I see, and I am excited to come into work each day to see their (most of the time) smiling faces. Even in the midst of the worst tantrums, I'm thankful that my job lets me get paid for playing games and making kids laugh and feel success all day!

Another thing I'm thankful for? The expanding number of readers for SpeechieSpeaking!


On Friday, I made the decision to purchase the domain for www.SpeechieSpeaking.com. It appears that it isn't quite up yet, so hopefully there hasn't been any issues with accessing the blog in the meantime.

Thinking of taking the time that I have a cancelled client to film a product review for an awesome app I love called ArtikPix! Of course, preparing for my afternoon children with some extra homework is probably a much better plan :)

Off to be productive!


Thursday, December 8, 2011
I had it this week.

I got a...

Totally awesome "A-ha!" moment.


The A-ha moment is that moment when the client you are working with just.. *gets it.*

It is seriously the most amazing feeling ever. I think I should have probably added a third person in my stick figure drawing of me crazy dancing with happiness.

Today, I did a crazy dance. The victory? A child who has a very hard time with fronting said "cup." Wow. Commence with crazy happy dancing now!
"Huh??"  --> "A-ha!!!"

Another a-ha... I am working with an older child on planning and writing for a variety of purposes. Currently we are tackling persuasive writing. My plan of attack for the day was to brainstorm together!

We talked through the topic out loud, and while we discussed it, I wrote down everything we said. We would think of negatives/positives for the ideas we discussed. Usually I write down notes and take data throughout the entire session, so I didn't tell the child that I wasn't doing just that in this particular session. After we were done coming up with lots of good points, I showed the child what I had written.

The child literally said:
Wow! This is like the essay right here! All I have to do is add more words to make the points sentences! 
As aforementioned happy dance is not always appreciated in the above 5 year old crowd, I happy-danced inside. He just had his "A-ha!" moment for why we outline and plan for writing.  That kind of learning experience is priceless. I could have told him a million times that outlining will help you plan essays, will help you write more clearly, will help you to stay on topic... but having him discover this himself - amazing!!

I hope to see many more "A-ha's" in my years to come as an SLP!

#slpeeps - Share your best "a-ha" moments! I would love to hear about them...
Welp. We don't learn everything in graduate school.

Not even remotely.

One thing I wasn't really prepared for was the fact that school systems, the government, even teachers/support staff... may not have your kiddo's best interest in mind. As an outsider, (and someone completely inexperienced with needing services), I always figured that if a child needed therapy, they got therapy. If a child needed some kind of AAC device, walker, writing tools, they got them. The reality is so far from this...

A lot of it stems from the core issue of money. Isn't money always the problem? You cut services here and there for X, Y, and Z, trying to save money for salaries, supplies, etc. Kids end up in group therapy sessions, 30 minutes weekly, with severe language impairments. One SLP may serve several schools in a county with over 100 kids on his/her caseload. I really marvel at the fact that any progress is actually achieved in the school setting.

Recent changes have brought a new system implemented in Florida classrooms called "RTI." You can read more about RTI on Wikipedia. They give a decent overview.

On the surface, RTI appears absolutely fabulous. We don't want children stuck receiving special education services when really all they needed was a little extra smaller tutoring sessions. We want to look at all children to identify potential learning disabilities/areas of difficulty so that we can implement appropriate services. RTI is supposed to be a structured way to go about this.

In reality, it is ... a beast. A nasty, paperwork filled, service delaying beast. I am incredibly happy that I do not work in a school system.

As you know, I haven't been practicing for very long. Despite my short stint so far as an SLP, I've seen several children get stuck going through the different tiers, for weeks at a time (!) making no progress and struggling. I see these kids come in to me upset, frustrated, and just wanting to give up on reading/language materials because they aren't receiving the true intensive services they need. In order to receive the highest tier of services -- or the most intensive service available -- a child must progress through the different tiers. The less intensive interventions must first be tried before a child can be moved to more intensive programs. Now what I didn't tell you is that the FIRST step in the RTI process is teacher observations and data collection. This alone could go on for a few weeks. Then you have smaller groups within the classroom... then perhaps tutoring of some sort... then maybe pull out into a resource class... I mean this goes on and on. You end up having a child struggle for an entire school year, failing miserably while they progress through the RTI tiers. And it starts all over again the next school year if an IEP is not put in place.

Makes.
me.
want.
to.
scream!

Let me add here that this is not always the case I'm sure. I'm sure there are school systems and areas that implement RTI wonderfully, and children receive services as needed, and there aren't frustrated parents and outside SLPs pulling out their hair.

Since I have digressed, let me get back on topic! The idea of this post is to NEVER GIVE UP THE FIGHT! And yes, my friends, you will be fighting.

It is not an uncommon situation for me to see a child that is just simply not being served well within the school system they attend. Parents must really become proactive at this point and become their child's advocate. It is our job as SLPs to support and educate parents to the best of our abilities so that they are able to successfully advocate for services. It can be a true fight to get the services that you know your child needs. But... never give up the fight.


I have had a recent case that I have been sending letters and e-mails back-and-forth regarding a child not receiving the services I believe she requires. We finally have an IEP meeting set up to discuss this matter. I cannot even begin to explain the weird crazy "We-made-progress!" dance I did when I got the e-mail. This matter has been going on for months, and the folks in charge did the best they could to brush us (the parent and I) to the side. We did not give up. We gathered data. We presented clear arguments. We cited IDEA (oh yes, we went there). We fought for our child! And hopefully, I will report back that it was successful.

Fighting for services is an unfortunate reality for parents and caregivers of special needs children. Again, I will state, as the parent/caregiver, you are your child's advocate. SLPs out there -- help to empower the families you see by providing them with information and support. Help them to be successful advocates to provide the BEST services possible. 


Hoping to report back that this particular "fight" was worth it... until then, adios!

Have a good "fight the system" story? Share it to encourage the good fighting mojo in others!
Thursday, December 1, 2011
Here is my short video review of the Time Timer. I show the "flaw" I have found with the battery. Not major, but good to know... enjoy!



Feel free to ask me if you have any questions. I will be doing a review of the TimeTimer iPad app as well.
Wednesday, November 30, 2011
Since my last entry dealt with infants getting chiropractic adjustments, I thought I should post some YouTube videos I found that show what this entails. Also received a recommendation to check out ICPA4Kids.org for more information. A testimonial from a mother of a child with torticollis: An infant getting a neck adjustments: A chiropractor explains why it can be beneficial to infants to receive chiropractic care and shows an adjustment using an instrument: I will be sure to post if I find any videos detailing how an adjustment would go to reduce the swelling of the lymph nodes in the neck (which the cutie I wrote about was experiencing). - Posted using BlogPress from my iPad
Tuesday, November 29, 2011
Okay, so this is not within my field of specialty, but I guess I'm throwing it out there for an chiropractors or SLPs who may have come across a case like this....

A friend of mine has a four month old that has had a difficult few months with management of oral/pharyngeal mucous. Also add onto that fun mix some projectile vomiting, and you've got some worrying symptoms. From the get-go he was breastfed, and he has done great! Consistently gaining weight, not appearing (from maternal observation) to have difficulties with suck/swallow/breath patterns. All seemed pretty normal as far as those areas go. Only other notable information is that he is a frequent feeder at times (1 to 2 hours in between feedings at night for example). Considering he can feed for a longer period of time, and go for longer periods of time in between feedings, it all balances out to a normal, healthy baby.

The mucous began to really be an issue. He began having periods of what was likely a penetration or aspiration of mucous causing some choking spells with difficulty breathing. Yikes! Poor little guy (and parents) weren't happy.

Added info update: The mom has talked to pediatrician who feels his drooling is a normal amount (they unfortunately live in a different state), woohoo! Mainly the issue appears to be overly thick mucous

The pediatrician, (and admittedly me) think perhaps it could be GERD (reflux). Another thought was that it might be due to a slight allergy to dairy products. The mother stops dairy products, AND... there is a significant improvement! Since dairy products can thicken mucous due to fat content, I am curious if this could carry over to breast milk thickness as well. I still have lots to learn about pediatric dysphagia.

Despite the significant improvement, the poor guy is still having choking with periods of apnea. The parents are awesome though, and they didn't give up trying to figure out what was up with their little one's feeding issues! (Add on... significant drooling; poor oral management of mucous) Through a friend that is a chiropractor, they learned that the little one appears to be suffering from a vertebral subluxation. 

Due to the trauma of  birth, vertebrae can become misaligned. If the vertebrae are misaligned, this can cause nerve difficulties and tightening of muscles. From what I read though, the idea of subluxation among chiropractors is not a 100% agreed upon diagnosis due to lack of clinical research evidence. Regardless, this could just be due to the lack of accurate/appropriate research being completed. Not my field to know the answer to that question... either way -- the doctor performed an adjustment on the baby and now it is a waiting game! He believes that this subluxation caused an over tightening of the neck muscles (comparative to whiplash), which may be causing difficulties in managing mucous.

I'm incredibly curious if this will help him out because:
a) I don't want him or his family to have to go through the pain of him having difficulties any more!
b) I'm curious if there are other cases out there which might benefit from chiropractic intervention.

Of course, it is not my place to recommend/refer a client to a chiropractor, but I would love to see if there is more information out there. A quick search of the ASHA journals didn't really turn up anything immediately.

So... we shall see!

Otherwise... next step I'd recommend? Perhaps a barium swallow study to make sure we've got 100% normal anatomy going on there. Course... I'm a Speechie, so of course I'd recommend that! 

:) Here is thinking happy thoughts that they have found a fix! AND.... I welcome any insight from chiropractors or pediatric dysphagia specialists that may have dealt with a situation like this before.

Time to head home and try to put my work out of my mind for at least a little bit. ;)

Update!: thank you for the comment with suggestions! I haven't recommended a swallow study to her yet because he has not had any major respiratory issues that would make me immediately think aspiration. I am guessing most likely penetration, no aspiration. But thickened mucous, difficulty swallowing appropriately... Hmm? Will update as we get more info. It is an "interesting" case (though it feels inappropriate to say that, I think my friend would agree)
I came into work a bit early this morning with the idea of completing my video review of the Time Timer. Unfortunately, I must have left the Time Timer at home during the break from work. I have the box, but no timer.

I did take the time to update my aStore (from Amazon). It now has a lot more products and no blank categories.

Also proud to announce that I am now the owner of Proloquo2go on my iPad! I still have to learn the ins-and-outs of the program to really utilize well, but I am incredibly excited. I have been accepted to be part of the Centers program through the company. Basically, it lists my company/location as a place that will complete evaluations and trials with a Proloquo2go device. Pretty neat!

I think I will try to go do some productive work to kick off the work week the right way. Until later...
Thursday, November 17, 2011
Haven't had the time or energy to update with the promised video on Time Timer, but it is coming. I have been trying to get items in order for work before we go on a week break for Thanksgiving. Typically, we would take the day off, day of, and day after for Thanksgiving off. This year we decided to take the full week as kids have a tendency to cancel last minute. Better to sit at home with your family then to be stuck sitting in an office.

With my time off, I do plan to do some more writing and reviewing of products. But... hello to all! Here is to Turkey Day celebrations!
Wednesday, November 9, 2011
As you know, I have mentioned the Time Timer in a few previous blogs. Some updates!

1. I have been using the 3" model in therapy, and it is a great visual, as I mentioned. A lot of my kids who aren't really very savvy with telling time ask me to set that one for them so they can see it. It has, believe it or not, prevented some tantrums. Woot!

2. It is not without flaws. I love how there is a plastic cover that can go over the face of it to protect it, but there is a design flaw. If the timer falls down onto its back (or falls down off the table), it knocks the battery out of the  holder. Then your timer stops going, or, when you set it back on the table and try to set it later, you might not notice that time is not elapsing for a minute or so. Boo. I'll do a video about this later.

3. I got the iPad version as well! At only $6.99, I figured it was worth a try. The iPhone version is somewhat sparse looking (from screenshots), so even though it was cheaper at $1.99, I went for the $6.99 version that is made for iPad. It does have several advantages over buying the cheaper iPhone version.

4. So far, no Android app! When I contacted the company, I was told to watch for it in the fall. I checked the Android Market last night, and no luck thus far. Perhaps it is still in the works...

Until later... when I have time to do a video!
Tuesday, November 8, 2011
I have to post a quick blurb to say I am positively blown away by the response to Makily's story/blog entry. A few folks expressed some very kind words, and I do want to acknowledge that I appreciate it very much.

It is awesome how a story that is simply that good and amazing needs no embellishments. A story that good speaks for itself. Makily, my darling, you are positively yelling with your story!

Hope I can do some more stories like this in the future. Being a speech therapist is truly an ah-mazing job. I seriously have little and big victories almosy every day with a child. It is so exciting for the child, for their family, and for me! (Can't lie... I'm selfish and love a good victory hehe) I can't share all those stories, but I always will be able to smile when I think of those kids.

Until another time....
Sunday, November 6, 2011
Due to privacy laws, I obviously can't (and wouldn't!) write about any of my clients. However, I have received permission from a special parent to write a blog about my experience and share some of her videos and content from the internet. I know the blog will do little to capture how amazing this child is, but I still would like to take a chance to share her story.

--
I met Makily when I was a graduate student. I was seeing her under the guidance of my supervising SLP. At first, I only observed my supervisor working with her. My first impressions were that Makily was a sweet, beautiful girl. She loved working with my supervisor, and they had a special bond. You could sense that Makily was just incredibly comfortable with the SLP. She would giggle and laugh and make wonderful eye contact to share stories without verbalizing with this SLP. My first impression was that I hoped I could get to that point with some of my future clients. That kind of bond is powerful.


Makily is a child that has had quite a journey in her life thus far. It is not my place to tell her story, but I can share links to blogs her mother has written. Please go to "My New Normal" to read her mother's blog about their amazing journey and daily life. It takes guts to share the kind of insights and feelings that Trish, her mother, does in her writing. I think she does a fabulous job of reaching out to many families who have children with special needs because of her ability to expose herself like that.


Makily is a child with Emanuel Syndrome. Emanuel Syndrome is a chromosomal disorder that is extremely rare. Makily has faced, and will continue to face, many many challenges in her life. With all that said, I must say this little girl is a warrior! She reminds me to smile in the face of adversity.

Another thing Makily has taught me... never underestimate a child. When you hear about the difficulties that accompany a disorder such as Emanuel Syndrome, it can be daunting as a therapist. Where do I start? What can I do to make a difference? Will this child be able to make progress?

The Criterion of the Least Dangerous Assumption by Anne Donnellan come into play here.
"The criterion of least dangerous assumption holds that in the absence of conclusive data, educational decisions ought to be based on assumptions which, if incorrect, will have the least dangerous effect on the likelihood that students will be able to functional independently as adults" 
What in the world does this mean?? Basically -- never make an assumption that, if you are wrong, will limit a child's ability to succeed. If you assume a child will never be able to talk or vocalize, or even read, then you won't work on those areas obviously. But... how will you know? How do you KNOW what a child can and can't do? 

I try to keep this in mind during my daily practice. If I provide the most supportive environment I can (visual, verbal, tactile, kinesthetic, auditory, etc.), is it possible this child may be successful in obtaining this skill? Invariably the answer is that I must try and see. If a therapeutic technique doesn't work, given time and family support, then you must consider an alternative.


Makily is an amazing example of this. She is beating the odds by living today! For the brief amount of time I worked with her, I saw her ability and her desire and her need to communicate. She would reach out her hand to start a toy or activity again. She would search for my eyes to tell me she wants more. She would try her best to vocalize and tell me verbally. You can't make any assumptions about Makily. She is a beautiful, strong, and happy child that has taught me so much more than I can put into words.

What does the future hold for Makily? Perhaps an augmentative device! She has had success with PECs in the past, and I am optimistic about this avenue of communication for this sweet little girl.


I know that this blog probably hasn't said much... but I hope it perhaps reminded others out there that it is important to never underestimate a child.  Thank you Trish, for letting me share what an impact Makily has had on my life!
As I have mentioned before, I update the website for the company that I work for -- TheraKids. I think the website I put together came out great, and with the help of my coworker, it has some excellent content. However, the fact of the matter is, how many of our current families are going to the website?? Probably none.

I decided this weekend to play with the idea of a TheraKids page on Facebook. A little playing, a bit of fiddling with Google, and... TheraKids, Inc. on Facebook is born! Let me give a little background how-to for others interested.

Opening up a business page on Facebook is done from within your regular profile. For me, there were already people that logged into a TheraKids location, so I only had to "claim" the page. (Isn't that an odd concept??) When you first load up your business page, you can't personalize the address. You must first get to 25 "likes"/fans in order to do this. Since I was eager to add the "like" button to our websites, I went ahead and invited my friends and family to like us. Once you get to 25 likes, you can then go to "Edit page." It will open up a bunch of options to personalize. Under "Basic Information" you will find the option to select a username. You cannot change the username once you select it, so get your best typing and thinking skills ready for that one. I chose: OcalaTheraKids. Since this username was available, our website on Facebook is now: http://www.facebook.com/OcalaTheraKids

Really pretty easy so far!

Now, I wanted to personalize the first page that people saw when they went to the site on Facebook. I didn't want a wall to be the first thing that came up, so I started fiddling with the idea of personalizing the page. Unfortunately, Facebook doesn't have built-in ways to do it through their company. However, you can use third-party applications to do this. Some of them are amazing looking... but cost a lot of money. Some of them take a little fiddling, but are free! I obviously opted for free.

I found a great tutorial from a blog here: http://www.labnol.org/internet/create-custom-facebook-page/19903/

What I did is build a website through (free) Google Sites that will automatically load whenever someone goes to my page. (Go here to see it) I customized the "tab" (or page) that will open automatically when people go to our site on Facebook under the "Edit Page" --> "Manage Permissions" area (Default Landing Tab). You use a third-party application through Facebook to create an app yourself that runs on your Facebook page. It then creates a "tab." I think the best thing to do at this point is to link to the video from the blog I cited above. Really not as bad to do as it seems! :) Enjoy!


Friday, October 28, 2011
As I hinted in my previous (and brief) updates, I have quite a few changes coming to my blog. I hope to post much more often, and I am hoping I can provide more posts that will answer reader's desires. While I haven't had anyone directly contact me requested this or that, I have been closely watching the view counts for individual counts. It helps to give me an idea of what my coworkers (or the random "Googler") finds interesting or needs more information about.

Also, I have added a few things from Amazon to link to products I love. Just like the other ads on my site, but done directly through Amazon. They are one of the few sites online I trust *almost* 100%. *As an FYI to my readers, I do get paid a few cents (something like that) if folks click on the links for the products I discuss*

For now, I'd like to post on the week that has passed.

It has been busy my friends. I have been a working slave, but it is all for a good cause. I have my new SOAP note system up and running. On a whim, I decided that I would do digital versions of my daily take-home homework sheets that I give to parents. Usually on these sheets I note how the child behaves (using a checklist) and then handwrite the goals we are targeting and work to follow up with at home. That can take a long time to write (as I think I have lamented about in another post). But wowza - I'm loving the electronic versions! I have all my children planned and prepped for Monday. It allows me to spend more time creating fun take home activities that parents can utilize. I love to create personalized materials based on each child's particular difficulties and strengths, but sometimes I am strapped for time so that isn't feasible. Now it looks like I may have a bit more time in my schedule! You would think a sane person would use that time to... ya know... breathe and enjoy life. But, what can I say? I enjoy life by overworking. I am my father's child.

I also completed my second DynaVox AAC evaluations. Again, the process was relatively pain-free and easy to complete. One of the children was so excited, he kept saying, "Wow, wow, wow, wow!" over and over. He was practically jumping out of his chair at the thought of getting one of the devices to use.

I have to say... the biggest hurdle I have found in augmentative device trials (aside from making the sad decision if a child is not quite ready for a device) is the insurance process. For instance, Medicaid requires that we have the school sign a form saying that they are in agreement with the suggested device. It doesn't bind them to use the device *or* replace the device if it is broken. However, for some reason, some school districts are not so gung-ho about signing this wonderful form. The real people hurt in this bureaucratic business of the paperwork are the children and their families. This just delays the time before they can receive a device that will help them to communicate their wants and needs. Some insurances only cover a small percentage of the devices. Others will cover 100% with no need for a school concurrence form. It is a frustrating mess of a system, that is for certain.

*le sigh* is all I can think... for now, I will just have to dream of my "THERAPIST OF THE YEAR" award when I get a device to every child who needs one....
Tuesday, October 25, 2011
I reviewed a bubble machine a few months ago from Gazillion Bubbles, and it has attracted quite a bit of attention on YouTube. As this obviously appeals to readers, I want to appease readers as best I can. I am going to go through toys, games, and books for children that I have found useful in the therapy setting and write a brief description and review for each. I will include the product info as well. I will try my best to always mention any cons I may have found for the item along with the pros. It will be fun to write more on this topic. Also have to report, the electronic SOAP notes were so awesome the last two days of work, that today after work I took the time and made an electronic template for my daily home progress notes for parents. Usually I write out a brief description of our short term goals (with examples) along with whatever the homework assignment may be. It can get very timely with the amount of kids on my caseload just to complete that preliminary paperwork step. Now I have a personalized, printed progress note for each child that will be easier to read and easier to make! Let's look at time comparisons: 1. Spend about 1 to 2 minutes writing out the short term goals for the 15 or so kids I see each day. About 30 minutes. 2. Rewrite the same short term goals (as well as an example for clarity) each time you see a child... even if it is two to three times a week.... Time spent on that? Well, the time is more ticking away your remaining "sanity/patience threshold limit" minutes. 3. Have all goals and plans pre-typed on computer. No longer attempt to scribble a note while an antsy two year old attempts to open and close every drawer on your desk. (Try writing out a home plan while repeatedly saying "no, no" and getting up to redirect the child to a more appropriate activity. Again, why chip away at your sanity like that?) Solution = print out those prewritten goals and homework plans each morning. Time? Probably 3 minutes total. Adjusting a goal? A few seconds... 3 minutes. Total. Wow. Got on a tangent there. Will write more as I get more time using my new system... Goodnight! - Posted using BlogPress from my iPad
After spending a good hour or two fiddling, I figured out how to do an electronic SOAP note through Excel2007. Now, it isn't perfect, but it is a step in the right direction. Currently I'm trying to figure out how to make formatting a little cleaner looking, but like I said, it is a start.

I can't keep this electronic SOAPiness to myself though... so I took a few images of the basic formula used to create my SOAP note. Here is how it basically works: 
  • - A key exists on a second page of your document. It is in a table format. The first column is where you fill in a number based on the options for the blanks in your field. Each row stands for each blank in your form.
  • - In my form (the first page with the SOAP note), I would type everything that stays the same in one cell, and then in the next cell I would put in a formula. The formula is the "CHOOSE" formula. It allows you to automatically fill in that cell based on a choice you make from another cell. 
  • - Here is an example of the formula that I might place in my first cell, column A, row 1  (A1):    =CHOOSE(B2,"with cheese.","without cheese.").
  • - In this example, cell B2 (column B, row 2) will be the place that I will either type a 1 for "with cheese." or a 2 for "without cheese." You don't have to have a key for the formula to work, but unless you have a super memory, you will want it.
  • - Let's look at it in pictures!
In this step, my cell D9 is the blank in my SOAP form. You can see my key off to the right. The formula I have inputted will fill in data based on the number I type in the cell N6.

Click to see this enlarged!

Here I create the next fill-in cell, E9. In this formula, it will fill in data based on the number I type into N7. You can see also that I have typed "1" into N6. This has autofilled D9 with the option 1 -- "with"

Click to see this enlarged!


In this final image, you can see that I have selected option 1 in N6 and option 2 in N7. These numbers are the choices for "with" "caregiver."
Click to see this enlarged!

Using this basic idea, you can create a form to select the types of treatment/behavior/etc. from a list of options you create.

What if you want to leave a cell blank? Just make that an option. The formula would look like this with a blank: =CHOOSE(N7, "parent.","caregiver", "  ")

If I were to type the number 3 in N7, it would fill in my cell with two spaces (the quotation marks do not transfer).

Please feel free to contact me if you have questions about how to implement it! I hope to create a form that has buttons to select instead of numbers in the future. Will take a bit more fiddling to figure that one out!
Friday, October 21, 2011
I work four days a week seeing clients in my private practice, but admittedly I could work an extra day just finishing reports, planning for therapy, and creating materials. Today I am headed in to do just that. I had an early doctor's appointment and decided I would come in to get some work done. Right now I am being extremely productive by getting my car washed. I have been researching online electronic methods of doing SOAP notes to no avail. It seems like the best options out there are just simply extremely pricey. I don't see enough clients to justify a monthly charge to document daily notes when I could do it for free written. Next week I will be completing my second AAC device evaluation with some wonderful kids. I am still waiting for my kids approved from my first evaluations to get their devices. It is a shame that the process has to be filled with so much paperwork, waiting, and crossing fingers. I have one child I am beginning to look into fundraising to get an iPad. On the topic of iPads, I recently purchased on for myself. It has a wealth-load of options and programs for doing therapy. I applied for a grant to receive a coveted Proloquo2go sponsorship and program. I saw their program first when I was in graduate school, and while it is not perfect, it is an excellent alternative to the thousands of dollars you can spend to get a dedicated augmentative device. With a 16gb iPad and the Proloquo software, a family would end up spending around $700. Much more feasible of a number than over $1,000 certainly. One issue with looking into an iPad or iPhone is the lack of insurance coverage. Because it is not a dedicated communication device, (one that is solely used for this purpose), insurance companies will not help to cover the costs. However, it is a good choice for a family whose insurance will cover only a percentage of the purchase of a DynaVox type system. Cost wise, the iPad may be a better alternative. One thing that amazes me is how resistant to the use of augmentative devices some folks can be. I think part of it is motivated by a fear, or lack of knowledge, about technology. And yes... I did say fear. It can be frightening to a person who is not comfortable or familiar with computers to suddenly have a very expensive computer under their care. There is always a fear that it could be broken, or a setting gets selected that is hard to find again. I hope through my work that I can help people to become more comfortable with the idea of using technology like this to better their lives. A little education can go a long way in empowering a parent to be successful using a communication device with their child. Parents are not the only ones nervous about using technology I'm their services... I highly encourage SLPs out there with an iPad currently to start exploring all that this wonderful device can do. It also is amazing how motivating the use of a touch screen device is to my kids. The other day one of my kids worked for about 27 minutes (out of a 30 minute session) to earn 30 second play periods of Angry Birds. We were doing intensive speech therapy drill, and oh yes, the child is only 6. Amazingly productive session thanks to my iPad. Better be off to do my paperwork now... Hope everyone has a happy and safe weekend! - Posted using BlogPress from my iPad
Tuesday, October 11, 2011
As I continue to get more comfortable in my role/job as a speech therapist, one thing I constantly find I need more of is... TIME!

Time is a hot commodity for SLPs. I have a caseload of about 40 kids I see individually in private therapy. I have to plan and print work for almost every one each week, and after each session I must complete a note that documents their progress. This kind of note is called a SOAP note. SOAP notes are used across the medical field, and we are no exception.


S - Subjective
O - Objective
A - Assessment
P - Plan

S -- In the subjective section, you give your subjective opinion about the client. This is where information about behavior would go. Was the child super duper or a stinker? Explaining in detail can help you to see patterns of behaviors. For example, if Child A had a tantrum every time that the parent came into the therapy room, I could see this and request that mom/dad step out.

O - In the objective section, we give information that is not based on opinion. For example, we would say what the treatment would included, if parent instructions were provided, etc.

A -In the assessment section, we assess how their work was for this session. Usually these needs to be stated in relation to their goals. For example:

Pt. will identify colors in a choice of two - 5/10 times; minimal cueing

You would want to be sure to document as clearly as you can the progress the child makes in a measurable way. If a child has not reached a goal, but is clearly making slow but steady progress, you will be able to see this in your assessment numbers. This will help you to readjust your goals as necessary. This is also where you would want to add information about how the child achieved this -- was it with minimal cueing or max cueing? Was it done independently (AKA spontaneously)?

You should document both long term goals (ex: increase receptive language skills) and short term goals (like the example above).

P - In the plan section you should document future plans for treatment. For example, when will the client return for therapy?


The A/P sections can kind of blur together a bit -- in some instances, I've seen long term goals only documented in the P section as it is a future plan. This is a rough outline for a format I use.


Currently, my company uses a template/checklist style list. We can check off for attitude, who the client was with, what treatment was included, etc. We still have to manually write out the information for each goal that was addressed. I'm hoping to think of a way to digitize this information so that we can simply do everything on a computer as a checklist. We will have to print the SOAP notes as we have a paper based system and not electronic, but the time I spend checking things, or writing out the goals feels like a waste of time.



If I find a good system for making a SOAP note that will automatically fills in your goals in the correct format, I will certainly share. If you are an SLP out there in the "interwebz" that has a good program they are in love with, please share!



Off to head home... hoping to get in some time with my new hobby (knitting)!

Monday, August 15, 2011
This Friday, I attended a conference in Orlando, FL for Reading with TLC. It is a program for reading that is a multisensory approach. It has ideas from Orton-Gillingham as well as LiPS. What is mainly different about it (that I LOVE) is the adorable letters! They use letters that have a mnemonic/story attached to each to help children remember the sounds connected. The stories really are cute, and easy to remember, and the kids that I have used it with have absolutely loved it.


Here is a quick snapshot I took with my phone of some of the letters:



They have a lot of information on their website. The program is relatively inexpensive to get the materials (how refreshing). The multisensory approach is a proven technique that works. Love that they took a proven method and added a twist to help it appeal to different children.

Check out their program. (By the way... training was only $25!! Watch for their condensed course -- totally worth it)





Visual Supports - Guess Who?

Another visual support I want to briefly mention is a "Guess Who?" support. Basically it is a one page print-out that guides children through questions to ask when playing the original version of Guess Who? I made this particular version with Boardmaker. I grouped items by the question starters (red), nouns/objects (bottom left), descriptive words (green), colors (yellow), and boy/girl. I put boy/girl seperate because that is such an important question! :)

Here is a picture as well as a video:





Visual Supports - Sentence Strips

Today I want to talk about a visual support -- sentence strips. Sentence strips are a great visual aid for working on asking/answering questions appropriately. What defines appropriately?
  • - Asking questions in the correct grammatical order -- "Can I have more please?" instead of "I can have more please?"
  • - Using questions to request for action and/or information -- if your child needs something, do they ask you with a question or simply tell you? (Think: "Juice please" versus "Can I have juice please?")
  • - Asking questions in conversation -- if your child has trouble thinking of things to talk to others about, conversational skills can be targeted by giving your child some visual supports on topics/questions they can discuss with others
  • - Answering questions in conversation -- if you ask a question, does your child respond appropriately?
* Keep in mind that certain types of questions (ex: Why) are not a skill that we expect very young children to be able to answer/ask appropriately... your SLP (or you, as an SLP!) will have to determine if this is an area that needs to be a focus in therapy.

Here are some pictures as well as a video showing sentence strips...




Monday, August 1, 2011
Okay, I'm going update crazy lately, but I did want to share this video. I have an office of my own at a pediatric private practice, and I am a decorator. Not professional of course -- it is more like I just feel comforted by organized clutter/decorations around me. I didn't want to decorate my office with anything that would be too distracting visually for my kids, and I wanted it to be something easy to do and cute looking.

Blik! (www.whatisblik.com)

Blik has vinyl wall decals that are awesome. There are lots of different designs available, but I chose this blowfish design (click here) and this removable/reusable alphabet design for a border (click here). I absolutely love them, and I filmed the process of me putting up the blowfish for those interested. On the pricey side, but it just brings a lot of warmth and happiness to the room.

Check out the video:
Product Review!

Here is a product review of the Gazillion Bubbles Bubble Cyclone!

To sum up the video, the bubble blower only gets an "okay" in my book. Not good for therapy. Too loud, too much trouble continuing and starting to make bubbles. It was cheap (~$6), but you get what you pay for in this case. Skip the loud one (although I believe I may have said it was okay in the video ;) ):

One of the unfortunate things I've learned from being a pediatric speech language pathologist....

... this is not a back friendly job.

Yes, like your spine/back. I guess I never thought about that as a "casualty" of the job, but it is really hard on your back to work with kids all day. Whether you choose to sit in a tiny chair (ouch my bottom), or to take a chair with a lever and lower it their level, you always somehow seem to have to scrunch up somehow and kinking your back 9 times out of 10. Which brings me to a tip for parents and new SLPs/graduate students --

don't be afraid to get on their level!

Yes. You are going to climb on the floor.
Yes. You will squish your legs under that child-sized table.
Yes. You will maneuver yourself like you are pop-locking to get some quality eye contact.

But boy, oh boy does it make a difference! Getting "down on their level" means that you are sure that you are eye to eye (preferably) or at least close so you can be sure they are paying attention, understanding what you are saying, and sharing attention on the same objects. If you can't get good eye contact with your child, or if you can't at least see the child's face, you have no clear indication of confusion, or small signs that the child is becoming overwhelmed. Sometimes just seeing a little uncertainty on a child's face will give you a clue to take it back a step and prevent a major meltdown due to frustration.

So my fellow Speechies -- Get down like James Brown!

And... if anyone has any suggestions for ways to sit more comfortably, do let me know ;)
~*~
Although I did use it for non-therapy purposes, I can easily see myself using the rest of the people cut outs I got from Michael's for some fun projects:

- Following complex or conditional directions
- Learning body parts
- My/mine you/yours
- Imaginative play or even role playing (for example with younger children who stutter)

Was about $2 for a bag of 12. They have boy and girl shapes, and skin colored shapes. Don't have a bag with boys and girls together so I would suggest getting the bag with girl shapes and just cutting them to make it boys.

Love good finds!

 
Sunday, July 24, 2011
As I've stated before, I'm a relatively "newly minted" speech therapist. I am fully licensed and now have my CCCs, but to put it in perspective, I graduated from my Masters program in May 2010. What does this mean? I still do have plenty to learn that the books just can't teach you!

So I would like to share about one of my most recent learning experiences --AAC Device Trials, Reports, and Other Joys... 


Let me get less jargony here -- AAC stands for Alternative Augmentative Communication. This basically means any/all alternatives to using only verbal language. AAC includes things like gestures, complex gestural language systems (think: ASL), pictures, buttons you press to talk, and computers that talk for you. An AAC device is any type of electronic device that helps in communication efforts. There are things like a "BIGmack" -- a big button that can activate a mechanical device, or can hold a recorded message. On the more complex end of the spectrum are what we call "Speech Generating Devices" -- ones like an iPad or a DynaVox Maestro. These devices are used to generate speech -- whether it be an electronic, artificial voice, or a pre-recorded voice. There is a lot of terminology with AAC, and I hope to dedicate a post to some of the bigger ones to explain it better. But for now, this will have to do.

Although I studied AAC in graduate school, experience is the best teacher. I have observed AAC evaluations in the past (several) and have written mock AAC device reports. Recently, I conducted four AAC evaluations at my practice.

I have to say, my DynaVox representative is amazing. As I don't have a device within my practice, I naturally have a lot of questions about how to go about the process.

I do have to say though, the report that Medicaid currently requires for approval to cover AAC devices is a beast. It is a rather lengthy report, so prepare yourself. I'm still trudging through mine, but I plan to finish them tonight. Energy drink anyone?

DynaVox is really good about helping to make the process easier. I haven't dealt with any other companies, but it is promising to see that the process has been simplified.

An area of AAC that I really would love to get into is the use of iPads as AAC devices. I don't have an iPad right now, but in the future I do plan to buy one. A good AAC program on the iPad that I have seen in use is Proloquo2Go.

I will write more as I enter the next steps of the approval processes.

Off to work on reports. Reportate. Reportation.

~*~
As promised, I contacted the developers at Time Timer to ask if they were currently working on an application for Android phones.

Here is the very prompt reply I received:

"Hello,

Thank you for your email. We are working on the Android application and hope to have it ready this Fall. Please check back in September for the release. Thanks!

Sincerely,
Jenny Davis
Time Timer LLC
www.timetimer.com"

So watch out for it! For now, you can buy it for PC/Mac and iPod/iPad/iPhone

~*~
Friday, July 22, 2011
It isn't perfect, but it is a darn good start!

I tinkered a bit with my boyfriend's Mac today and made a logo for my website on a neat program he has. Took a while, but I also edited the settings for the background and layout.

Yes, I have ads. I thought it would be worth a try to add some ads in the blog. They seem to be related to the content, so woo hoo! I can't click them, but if you do, please comment and let me know if you do find anything useful.

I plan to make some buttons and other goodies for the rest of the page, but for tonight, this will do.

Off to do something else!
~*~
Thursday, July 21, 2011
Product Review Time! This is a product I learned about in graduate school that I am dying to purchase, but just haven't gotten around to it. It is - a Time Timer! (http://www.timetimer.com)
8" Time Timer
(Image from Time Timer's Flickr stream for marketing!) This is an awesome timer tool that you can use with children who don't have a strong grasp on the concept of time -- extremely useful for children on the Autism Spectrum or those with ADHD. It allows you to select what time you want it to count down, and it shows a visual (red) representation of the time as it counts down. If you are a newbie SLP, or someone unfamiliar with the use of visual supports -- I can't stress enough how amazing the use of visual aids can be. When an individual has a language delay, a concept like time can be really abstract. "We just have a little bit more work left..." "I want you to keep working for a few more minutes" "Keep working until I say it is time for our next activity!" Sure, you could tell that to a typically developing child, and (so long as they are feeling like students that day) they will continue to work until you say it is time for the next activity. But what about a child that needs a strict schedule? What if the idea of the "when?" concept drove you crazy?? But when exactly? Imagine if you were working at a job and your boss said you'd get paid... sometime soon. What do you MEAN sometime soon?? I want a schedule! I want to know when! Children on the Autism Spectrum (the prime example I can think of) really benefit from a device that shows a visual representation of time. It takes away the necessity for understanding the concept of time and allows it to be representing visually -- a sand timer of sorts that you can set for whatever time you want. The child can see the time count down. TimeTimer is really the best device that I know on the market, but I will definitely keep an eye out for any other products that are similar. They have a bunch of different size timers as well as apps for PC/Mac and iPod/iPad apps. No Android app yet released, but I did e-mail the developers today to see if there was anything in the works for those of us on the Droid side. So -- this is my first product review on an awesome device that I think is worth a purchase! More to come later... ~*~


Another week is over, and unfortunately it was not the best of weeks sadly. I caught a cold and ended up losing my voice from coughing. Croaking and squeaking out animal sounds or "more please" to my two year old clients might frighten them!

"All done Ms. Kelseyyy!"

I figure I will start my blog out with an intro into what I do.

I get paid to play play doh. I bark and meow. I play Hungry Hippos and Candy Land for a good part of my workday. When I am not playing awesome games, I am helping families communicate with their children. I help moms and dads and caregivers have more successful interactions with their kids. I help children tell their needs and wants and reduce their frustrations. I watch kids learn to read and write stories, and hear them go from their first words and sounds to sentences and conversations. It is the best job.

I am a pediatric speech-language pathologist, and my job ROCKS!

I am a (relatively) newly minted speechie. I graduated from the University of Florida in 2010 with my Masters. I highly recommend this field. Best recommendations? Patience, a willingness to learn for life, a willingness to be goofy (!), and a love of kids if you work with that population.

Now, I should add here the PSA that speech therapists do a lot more than just work on "r" problems. Part of our training and field includes work in voice, feeding, swallowing, cognitive, and reading therapy. I so far have primarily specialized in early intervention work, reading and writing, language disorders, and some pragmatics work. I work with a lot of different kids and all of them have something about them that makes me smile

I hope to share any ideas and happy/funny stories on here as they happen. I look forward to sharing with other speeches out there in cyber world.

Until later!
~*~

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