From Silence to Sound-Part 3

Hank’s Emerging Story

Drumming Bridged the Gap to Blend Sounds into Words

“Reading” a simple written notation, Hank imitated fast versus slow beats on a drum after my modeling those rhythmic patterns. That method bridged the cognitive and auditory gap so he could comprehend the idea blending sounds in a sequential order. He was then able to “read” the mouth form cards representing specific sounds he could make, then imitate those sounds in a sequential order that created a specific noun. A picture and the written word representing the noun were introduced while I said the word slowly.

Hank had previously enjoyed playing a phoneme awareness game on the computer that required him to blend syllables and sounds together to represent a word pictured. This had previously been impossible, but he loved playing the game with someone giving him the answers. Now that game started making sense to him and he was able to accomplish the task with only minimum help. He also began trying to imitate the sounds he was hearing in the game.

Hank's "reading" simple rhythm patterns while listening to therapeutic music created a link in his understanding of sequencing verbal sounds into real words
Hank’s “reading” simple rhythm patterns while listening to therapeutic music created a link in his understanding of sequencing verbal sounds into real words

 

Following Verbal Computer Directions

Hank also loved playing the computer game, Hear Builder: Following Directions, which required identifying specific objects named and understanding basic language concepts (www.superduperinc.com). This game had been very challenging for Hank, but as he improved in his verbal imitation abilities he also improved in his following direction skills.

This was his favorite game at our last session. He required a written cue when a new concept was introduced to be successful at completing tasks requiring understanding of complex verbal commands. Each command must be visually and kinesthetically introduced before he comprehended the verbal signal. Usually he grasped the new concept in 2-3 trials. His mother used to sadly refer to him as her child with a “little brain.” She started realizing that Hank is quite bright with the right learning channel presented to him.

 

Separating Sounds to Approximate Words and Communicate Spontaneously

To my surprise Hank returned after a weekend spontaneously using the segmented sounds in a meaningful way to name the pictures we were paired with the question, “What is it?”  The auditory to verbal connection had been made and Hank wanted to learn to speak. He comprehended ideas faster after observing someone else performing the requested task even though it was a task he had experienced for numerous trials. On that basis, I quickly introduced him to Gemiini software videos as soon as they came out in Spring 2015. He began producing clearer long ‘a’ sounds when the videos were paired with separated static mouth forms, and pictures of words spoken (www.gemiini.org).

 

Blending Sounds to Create Clearer Words

Ten years old at this time, Hank’s verbal communication is just beginning to emerge. This is highly unusual for a non-verbal child this old to begin talking. He has just started synthesizing those segmented sounds together on some oft repeated words. His words are distorted and he has a flat robotic voice quality common to autistic children, but he is communicating and answering questions regarding preferences and requests appropriately. I am excited to be a part of Hank’s amazing journey from silence to sound. Addressing his auditory processing deficits has been a large part of this remarkable boy’s journey.

http://ctsdallas.com/Services/Therapies/IntensivePrograms.html

Hank’s story represents one child’s journey from silence to sound but it also embodies elements of numerous children who have been my teachers over the years. Hank’s story has been used with permission from his parents.

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From Silence to Sound-Part 2

Hank’s Continued Story

Neurofeedback Increased Alertness but Not Verbal Skills

He returned to see me after eighteen months with increased engagement in the treatment process, but he still could not imitate any sounds. Since he was now able to imitate specific static positions, I used these to activate certain areas of the brain to improve mirror neurons needed for speech imitation. Hank was now able to begin using the Interactive Metronome to increase neurological sequencing and timing with a focus on a predictable rhythm and imitating drum rhythms to tune into variable rhythms.  I have found rhythms are a key component to social engagement and often improve speech production. http://ctsdallas.com/Resources/RecommendedReading/RecommendedLinks.html See Autism Spot videos of Jane #3.

 

Hank Begins Communicating with iPad App

One day, mom reported that Hank had started making consonant sounds that he was using to gain her attention. He had also been taught to use an augmentative communication device at school. I recommended switching from the cumbersome one he had at school to the simpler and more compact iPad application that he could also use at home. He quickly learned that everything had a name and that naming things gave him power. He soon was able to create his own requests in sentences with picture cues on this device which increased his awareness and motivation to communicate with others.

 

Hank combines oral motor, basic concepts and multi-sensory strategies to elicit verbal communication
Hank combines oral motor, basic concepts and multi-sensory strategies to elicit verbal communication

Hank Starts to Vocalize Speech Sounds!

Each new skill brought Hank closer to verbal communication. After significant tactile cueing in one session, Hank was able to lower his tongue to make the first “speech-like” vowel sound he had ever produced. His focus on his mouth movements increased by watching my mouth comparing it to his mouth while making sounds looking into mirrors. He also looked at mouth forms and facial expression pictures and attempted to imitate the facial expressions. This was initially very challenging, but within two weeks he got better at the simpler expressions. The better he was at imitating facial expressions the better he became at imitating sounds both consonants and vowels, but he was still not combining them into words. Hank took another break from therapy due to personal reasons. When he returned 3 months later, he was using the consonant /m/ to gain his mother’s attention. He was shrieking the open vowel /u/ for random vocalizations but using the first speech sounding /a/ to specify specific object requests. He was now on the verge of being a verbal communicator.

From Silence to Sound

Non-verbal Ten Year Old Boy with Autism and Apraxia Gains Speech

Hank’s Story-Part 1

Autism and Verbal Apraxia Symptoms Treated from a Multi-Sensory Paradigm

Hank came to see me about the same time I was finishing therapy with Braden (https://janespeaksensory.wordpress.com/2015/06/29/effective-listening-to-improve-apraxia-of-speech/). I was feeling more confident with combining strategies to address more complex issues with suspected deficits in auditory processing.  Hank was autistic, mentally challenged, non-verbal, and severely apraxic. I was not sure how well he understood running speech, and I was suspicious that he might not have the cognitive abilities to engage in the treatment strategies. However, I saw a brightness in his eyes now and then, which encouraged me that it was worth a try. I used a multi-sensory approach involving movement, object and picture matching, tactile stimulation.

Referred to Physician for Inner Ear Evaluation

I referred Hank to a specialty M.D. physician who evaluated and treated underlying physical issues. He diagnosed Hank as having an inner ear virus and prescribed a protocol to address it. Hank made progress in gaining calmer focused attention, demonstrating that he had the capacity to understand and learn. I suspected his hearing and discrimination was quite compromised because of the inner ear virus being treated medically.

http://ctsdallas.com/Resources/RecommendedReading/RecommendedLinks.html   See Autism Spot Videos of Jane # 4 & 5.

Early Improvements

Tongue extension is an important oral motor step to lead to verbal expression
Tongue extension is an important oral motor step to lead to verbal expression

Hank loved playing therapeutic games on the computer and was good with those requiring visual reasoning and memory, but very poor with simpler games requiring listening skills. He was now able to blow devices and balloons independently with self- crimping, whereas producing an air stream on request from his mouth had been previously impossible. Hank was barely making any vocalization and his ability to imitate speech-like sounds was nonexistent even after several months of treatment.

Intensive Therapy with Multiple Sensory Inputs

Hank participated in a ten day program of intensive therapy using The Listening program and cognitive skill input. He began vocalizing but still was not using speech-like sounds. Following the ten-day program he began using The Listening Program with bone conduction equipment at home. His attention and focus continued to improve and he became more available to learn and be a part of his family and school community.  http://ctsdallas.com/Services/Therapies/IntensivePrograms.html

Hank could now sustain focus attention for task up to 5 minutes and was anticipating familiar routines. He was communicating non-verbally through gestures but no signs. He responded inconsistently to pictures which made augmentative communication a low priority at this time. Hank took a break from speech therapy to participate in sessions with a neurologist doing neuro-feedback.

Improved Listening Impacts Seizure-Induced Learning Disabilities

Carter’s Story

Nine year-old Carter participated in nine months of weekly language therapy using auditory processing and discrimination as the driving core. After being placed on medication to control a seizure disorder, he had been falling behind his private school classroom subjects across the board, and was demotivated and discouraged with low self-esteem. Testing at Center for Therapeutic Strategies showed he had deficits in both receptive and expressive oral language skills along with auditory processing and discrimination deficiencies. http://ctsdallas.com/Services/Evaluations.html

http://www.ctsdallas.com/Services/Evaluations.html

 

Carter used Interactive Metronome to improve his sequencing and timing by responding to a predictable beat
Carter used Interactive Metronome to improve his sequencing and timing by responding to a predictable beat

Listening Challenges Underlying Low Achievement

Carter participated in using the Interactive Metronome http://ctsdallas.com/Services/Therapies/IntensivePrograms.html to build sustained focus and attention and increased executive function skills for handling multiple inputs simultaneously. He listened to The Listening Program http://ctsdallas.com/Services/Therapies/IntensivePrograms.html in his sessions and later at home. He learned to discriminate sounds in words, segment sounds, and manipulate sounds in words for improved phonemic awareness. http://ctsdallas.com/Services/Therapies/ReadingisLanguage.html Carter improved his short term memory and decreased his impulsivity using the Brain Builder computer game by Advanced Brain Technology.

 

Academic Gains with Improved Language Processing Skills

After nine months of speech therapy with a focus on Reading is Language http://ctsdallas.com/Resources/RecommendedReading/CaseStudy-SensoryIntegrationDysfunctionUnderlyingMostLearningDisabilities.html and auditory processing skills, Carter was able to successfully transition from a small private school for children with learning disabilities to a large public middle school. His mother reported that his “Standardized testing recently administered show dramatic improvement in reading (90%ile), math (50%ile), and language arts/ spelling (30%ile).” She continued that he started The Listening Program at home three months later which brought “more changes in maturity and independence. He is now doing his homework independently and conscientiously. His emotional control has also greatly increased along with an increase in self-confidence, motivation, responsibility, and organization.”

http://ctsdallas.com/Resources/RecommendedReading/RecommendedLinks.html See Autism Spot videos by Jane Shook 4 & 5

Early Beginnings and Foundations

kids banner2My introduction to speech pathology began with a visit from a family friend when I was a junior in college. I heard about a new academic field where educators were addressing individuals who learned differently from the traditional academic model and usually had difficulty with focus and attention. Physicians and educators could not determine a physical cause. This group of people are now referred to as having “Attention Deficit Hyperactive Disorder” with another group labeled as having “Sensory Integration Dysfunction” (now termed “Sensory Processing Disorder”). I was fascinated by the exercises that were being implemented to get the brain “talking to itself” using stimulation of movement, touch, vision, and hearing. 

At the time I was in Speech, Drama, and Debate with a minor in biology, and was trying to figure out how those very disparate areas could merge into a vocation. When I spoke with my current Dean about my interest in this new teaching avenue, he directed me to enter the field of speech pathology within the same Department of Communication.

Making learning fun at preschool Camp Connections
Making learning fun at preschool Camp Connections

Click here to see my website and like my FaceBook page.

I found Speech Pathology perfectly combined my divergent interests in science (biology) and performing arts/ humanities (speech and drama). From my first class in Speech Therapy  I would get chill bumps from the information I was learning about the brain and communication processes. However, when it came to clinical practicum which involved mostly children, I was out of my element. I had not baby- sat for other families nor been around young children. I felt inadequate, so I developed a practice of praying to center myself and connect to God to teach me the people skills I felt lacking. That spiritual practice, begun in graduate school, connected me to focus on other people’s needs and what I had to offer them. This change in perspective gave me confidence to show up as a teacher and therapist. I also found I could use my performing skills to role play and have fun, which made learning happen more organically. I adopted the motto at that time that “A wise teacher makes learning fun!”  I have maintained both of those perspectives throughout my whole career.

A Not So Traditional Speech Therapist

Jane teaches sound awareness on a therapy ball
Jane teaches sound awareness on a therapy ball

I am Jane Shook, clinical director and owner of Center for Therapeutic Strategies, a speech therapy practice in Dallas, Texas. I serve individuals with communication and processing challenges using innovative, cutting edge strategies that increase brain performance so areas of weakness can emerge with less effort. I work with children, teens, and adults with sensory processing and executive function issues. I also offer a mentoring service for SLP’s, SLP-A’s and SLP students who wish to gain understanding in using a multi-sensory model in speech therapy sessions.

Click here to see my website and like my FaceBook page.

I offer traditional speech therapy for all communication disorders using not so traditional sensory strategies. This helps people use their strengths to improve their weaknesses. I use activities and exercises designed to increase calm, focused attention, looking and listening accuracy/ discrimination and the ability to effectively and confidently perform multiple tasks at the same time.

What are those “not so traditional sensory strategies?” I will be explaining that on this blog by using the stories of the individuals I learned from. The people I have worked with have been my teachers. It has been in searching for answers to help increase skills when traditional methods proved ineffective, that I learned new approaches.

I specialize in serving individuals with *phonological impairments * apraxia * auditory language processing * autism spectrum * developmental delays * verbal apraxia * learning disabilities * fluency and * feeding/ swallowing disorders.

On this site I will be reminiscing about the people and life events that have led me to incorporate these innovative strategies in my practice.

**All names that appear in my blog articles have been changed to protect the privacy of my clients**