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 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:

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:

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!