Wednesday, November 8, 2017

Diagnostic Hearing Evaluations and Speech-Language Assessments

Dr. Eve Leinonen, Audiologist
This post was written in collaboration with a colleague who provides exceptional care for clients ages four and older in Naperville, Illinois.   Dr. Eve Leinonen has been practicing Audiology since 2007, when she earned her Doctorate in Audiology from Wayne State University in Detroit, MI.  She has worked in a variety of office settings, as well as with a hearing aid manufacturer as an Outreach Audiologist.  She has been the owner and principle Audiologist of Affordable Hearing Solutions since 2015.  Diagnosed with hearing loss at age 17, Dr. Leinonen can relate on a more personal level to the struggles and frustration that many with hearing loss face on a daily basis.  She is committed to helping patients choose the best treatment option for their hearing loss and lifestyle, and helping them continue to thrive in their every day.

Together, we hope to answer the following:
  • My child can hear me whisper, so why does (s)he need a diagnostic hearing evaluation? 
  • How does fluid and negative pressure in the ears impact hearing?
  • What are the types of hearing losses? 
  • How is a hearing screening different than a diagnostic hearing evaluation?
  • What are the different types of diagnostic hearing tests?
My child can hear me whisper, so why does (s)he need a diagnostic hearing evaluation? 
One of the essential components to a dynamic speech and language assessment is a diagnostic hearing evaluation.  If they haven't already, I strongly encourage families seeking my private speech and language services to schedule a diagnostic hearing evaluation before I assess articulation, expressive, and receptive language skills.  It is critical to rule out a medical factor for a speech and/or language delay that could negatively influence assessments and speech-language therapy.  The American Speech-Language Hearing Association (ASHA) acknowledges that, "Hearing is critical to speech and language development, communication, and learning" in an audiological information series from 2015 titled: The Effect of Hearing Loss on Development.  Specifically, a hearing loss can impact vocabulary development, sentence structure, articulation, and academic performance.  Our sounds are produced at many, different frequencies.  The inability to hear a sound frequency would impact a child's accuracy in producing that sound target.  This is especially evident with quieter sounds:  s, sh, f, t, and k.  A child with a hearing loss may also have difficulty hearing words with -s or -ed endings, making it difficult to both comprehend and express these structures.  If we do not have all the information that we need in planning speech and language services, then we may see limited progress and continued communication delays.

A common misconception is that intact comprehension negates a probable hearing loss.  While this may be true, the only way to be certain that a child does not have difficulty hearing is to complete diagnostic hearing testing.  It is very possible that a child with a temporary hearing loss can continue to follow routine, familiar directions; respond to subtle gestural cues such as eye gaze; and seemingly attend to conversational tasks.  However, it would be challenging for this same child to imitate a variety of speech sounds, especially if they are hearing sounds as though they are swimming underwater.

There are some telltale signs and/or symptoms that indicate a need for a diagnostic hearing evaluation.  Here is a list of the ones that I am most concerned about as a Speech Pathologist:

  • Delay in speech and/or language skills in comparison to siblings/peers
  • History of re-occurring ear infections or sinus infections
  • Difficulty imitating speech sounds 
  • Trouble following directions
  • Excessively loud talkers

How does fluid and negative pressure in the ears impact hearing?
Understanding the effect of fluid on hearing is crucial, especially for young children.  Fluid can give the appearance of normal air conduction levels at times, but the child is losing important speech sounds and cues.  Though it appears normal on paper, to them it sounds as though they are hearing underwater.  Speech and environmental sounds are muffled, thus effecting a child’s ability to hear and understand sounds correctly.  It’s possible that their “normal” levels of hearing without fluid are even better than what is appearing with fluid.  This reduction of hearing can appear to the listener as a “hearing loss” despite showing normal response levels.  Diagnostic testing is important as it will show whether the normal hearing thresholds reveal a conductive component (related to Conductive Hearing Loss and is a gap between air and bone conduction thresholds), thus indicating middle ear concerns.  A child may show normal hearing thresholds, however they could be greatly elevated due to fluid despite still falling in the “normal hearing range”.

Infants and toddlers are prone to excessive fluid build up in the ear canals because the Eustachian tube is parallel, giving fluids a cozy place to stay.  As toddlers grow, the  Eustachian tube begins to slant, which supports natural fluid drainage from the ears.  This is just one of the reasons why we encourage toddlers to sit upright while drinking to avoid adding more fluids into that ear canal. Children can fluctuate in and out of temporary hearing loss conditions and even have this fluid in the ears without an infection.  There are several misconceptions regarding children and hearing loss.  One is that if your child has “normal responses”, then their hearing is fine.  One particular aspect to look at is Tympanometry, which analyzes middle ear function.  Tympanometry can tell us if there is fluid or negative pressure in the middle ear, which can greatly impact hearing. 
What are the types of hearing losses? 
There are three kinds of hearing loss: conductive, sensoirneural, and mixed.  A conductive loss is often a temporary condition brought on by: fluid accumulation, ear infections, or a blockage of the Eustachian tube caused by an allergy.  A sensorineural hearing loss can be the result of a viral infection such as measles, meningitis, or mumps.  This damage to the middle ear may also be caused by head trauma or exposure to extremely loud noise.  Some people are born with a sensorineural loss while others may acquire one in old age.  These videos help explain causation for these losses and common interventions.

Conductive Hearing Loss

Sensorineural Hearing Loss

Mixed Hearing Loss

How is a hearing screening different than a diagnostic hearing evaluation?
It’s important to understand the difference between a hearing screening, and a diagnostic hearing evaluation.  Screenings are typically performed in schools to survey whether a child may have a hearing loss.  This only looks at how the child hears via air conduction (how we hear with sound traveling through the ear canal to the middle ear, inner ear, and then the brain). 

Diagnostic hearing evaluations look at all aspects of the hearing mechanism.  It looks at how we hear via air conduction, bone conduction (how the auditory nerve itself is responding), Word Recognition Scores (Speech Audiometry), Tympanometry and/or Otoacoustic Emissions (OAE). 

What are the different types of diagnostic hearing tests?
There are also different types of diagnostic testing available depending on the child’s age and ability to task during testing.  Visual Reinforcement Audiometry (VRA) is used for children who are old enough (typically 6 months-3 years), or are developmentally delayed, to respond to sounds in their environment, and looks for localization.  This is typically done in a sound booth with external speakers and toys that light up for positive reinforcement when a sound is presented.  Tympanometry and OAEs are typically utilized to make sure there is not any fluid, and that the hair cells in the inner ear are responding to sound stimulation.

Play Audiometry is utilized for children who are old enough (4 years or older) to task to a game or toys, but may not quite be old enough to raise their hand for each beep.  Usually the game involves dropping toys into a bucket when they hear a beep to help the audiologist establish thresholds.  Tympanometry and OAE’s can be performed as well as speech recognition testing.
Older children may be asked to raise their hand or push a button when they hear pure tone “beeps”, repeat words for word recognition score testing, and also Tympanometry and OAEs (if necessary).

If you have any further questions about the impact of hearing on speech and language development, then please visit these links for more details:

Newborn Hearing Screening

Beyond Early Childhood

Childhood Hearing Screening

How We Hear 





Wednesday, October 4, 2017

Classroom Activities to Enhance Empathy for Children with Special Needs

October is Down Syndrome Awareness month, so I wanted to dedicate a post honoring my 10 year old niece, Ella. She, like her parents, is a rock star who has a wonderful circle of friends, many extracurricular interests, and a love for all things science and Disney!  Ella's mom is my sister, Jennifer, who has always loved books, writing, and teaching.  By day, Jenn works as an English professor at Bunker Hill Community College in Boston and by night, she races to bring her girls to after school adventures, work on homework, and then get dinner on the table for her family.  Jenn has an incredible support system comprised of a mix of family, neighbors, and educators who work cohesively in providing care for Ella and her younger sister, Abby.  I have learned so much from this network over the last decade as I watch their tireless efforts in caring for and enhancing Ella's overall development.  One thing that I really wanted to share with my followers, was a presentation that my sister put together for Ella's elementary classroom a few years ago.  Jenn's intent was to help young children develop empathy towards a child with processing challenges and low tone.  These lessons were executed with great success and as a result, Ella developed lasting friendships with many of her peers.  If you are a parent, educator, or specialist working with young children, then the activities described so eloquently in this post by my sister can easily be adapted for many populations, so by all means, please share and pass these ideas along!!  Thanks to Jenn for taking the time to write about her presentation and experience in raising a rock star with Down Syndrome!

After six years of worrying, I found myself in a unique situation. My concern was that my child would have difficulty making friends because she has a disability. She does not have the same language skills as the typical six or seven-year-old. Despite that, we were lucky enough to move to a town that was populated with kiddos who not only took an interest in getting to know my child, but also went above and beyond to be her friend. While that all sounds wonderful, it can also be overwhelming for that same child who is constantly approached by her peers and does not know how to communicate that she needs space. So I took it upon myself to help my child’s peers understand her. What better way to do that than to have them “walk a mile in her shoes.” I spoke with her teacher, who allowed me to have time in her classroom to run two activities with the kiddos to help them better understand my girl. Here’s what we did:

First, we divided the class into groups of four. Within each group, someone needed to volunteer to stand in the middle. The other three remaining participants were each given a slip of paper with a different piece of information on each: birthdate, my favorite meal, and my favorite toy. The goal of the exercise was to have each of the three participants try to tell the person in the middle the information that was written on the paper they received. They were all trying to talk to the person in the middle at the same time. After about a minute of this exercise, we stopped and asked the children how they felt trying to communicate and listen. Those in the middle commented that it was difficult to listen to everyone, and they felt overwhelmed. It was equally frustrating for those who were trying to share their information to the person in the middle. I then transitioned to discuss how this exercise could apply to my girl. We talked as a group about how sometimes she would respond with an automatic “no.” Sometimes she would push people away. I asked the group what did they think they could do to help lessen these behaviors. And the children had some insightful answers. “Approach her one at a time.” “If she does say ‘no,’ then just say ‘OK,’ but wait for about five minutes and then go back to see if she wants to play then.”

The other exercise I did with them was a practice used by the Down Syndrome Society of Rhode Island. After making sure no one had food allergies, I handed out large marsh mellows to the children. I cut the marsh mellow in half because they were so large. I asked the children to put the marsh mellow in their mouths and had them store it in pocket of one of their cheeks. Then, they try to speak to one another and quickly discover how difficult it is to both speak and understand one another. After allowing everyone to eat the marsh mellow, we again talked about how it is sometimes difficult to understand my girl because she has low tone. When asked what they thought they could do to help understand my girl, some responses were, “Have her repeat what she says” or “Ask her to slow down a bit when she talks.”


Overall, I was so happy with the way these exercises went and the children’s responses to them. I knew these exercises were effective when a parent approached me at the end of the year and said that her son had come home the day we did them and with enthusiasm, told her that he now knew how to talk to his friend at school. The fact that he offered this information freely, gave me the sense that he was listening that day. If these exercises helped him to communicate better with my daughter, then it was not only a fun venture, but also an effective one. 


Thursday, September 14, 2017

Talk Like a Pirate with Articulation Hunt app

AHOY Mateys!!!  With Talk Like a Pirate Day coming up on September 19th, I have the PERFECT app for your articulation therapy sessions next week!  The developers at Home Speech Home recently released their new app: Articulation Hunt and were kind enough to allow me to review it.  Please note that the opinions expressed in this post are solely mine and without bias.

Settings:
First, a brief review of setup.  When you go into the Settings tab, you will see links for support and rating the app.  Also, there are three features that you can toggle on/off: voice activation, sound effects, and music.  Keep in mind that the voice activation feature does not have the capability to identify correct vs. incorrect sound productions.  Honestly, I am hoping that it stays that way for a long, long time because it makes having a communicative partner necessary to play this game.  These partners help monitor production accuracy and carryover into other settings.  You can only advance to reinforcing game play after sound practice once someone has rated productions as correct or incorrect.  With regards to the background sounds on the main screen, I personally have always enjoyed the soothing sounds of the ocean, so I kept my toggle switch for sound effects in the on position and listened to it while writing this post.  Finally, I took note that my younger clients between the ages of 4-5 years old, especially liked the music during games.  If it becomes distracting, then you can easily toggle it off.


Play:
Before you can start, you will need to add some players.  Once you click the + to add a player, you are directed to the screen below.



This app allows you to select up to 6 players at a time, but I only practiced with individuals in my private practice sessions.  It's wonderful that school SLPs have this option though as it allows many to participate in mixed articulation group settings.  You are able to personalize sound targets for each player.  Being able to play with multiple players also lends well for including family members in games for carryover practice.  To create profiles, simply tap the Add Picture button and select one of the following: take picture, camera roll, or use avatar.



If you decide to use an avatar, then you have two choices, which is just fine with me!  When clients have dozens of avatar options, I find that it takes forever for them to decide because we need to look at each and every one....., twice.

Now, it's time to play!  One of the best things about this app is that you can select to download sounds as you need them.  This is such a space saver and it only takes a few seconds to load new sounds. Once downloaded, you also have an option to pick one sound position for practice.  Below that, you will find options: slow, medium, and fast that are in reference to the speed at which the reinforcement game will be played.  More on that in a little bit.

The game begins with an actual image of a target picture and instruction to complete a certain number of productions.  If voice activation is on, then each time the client says the word, a star will change from grey to yellow.  Again, this does not mean that the app is rating correct vs. incorrect productions.  Rather, a communicative partner will need to rate productions with a green check mark or red X.  Once all productions are rated, you get to play a matching game using the same target picture just practiced.  The bottom right hand corner will display the picture while an array of picture bubbles float on by.  This is where the speed set up comes into play. Younger clients may need pictures to soar slowly across the screen in order to tap matching ones.  Tap and say the correct target to earn jewels, but make a mistake and you will get a skull head.  I like how this hand/eye coordination component was included in this app.  The game is a nice reinforcement and once 50 jewels are collected, you advance to another land with the same premise, but a different backdrop.    




Data:
After you have spent some time playing, you can go to the data tab and select the person you would like to view.  Here, you can see the date, target, position, and score.  If you want to add a note/comment, you can quickly attach one to the session.  All of this information can be emailed via the envelope icon in the upper right hand corner.




In summary, I liked several things about this app:
  1. Soothing sounds of the ocean on the main screen.
  2. Ability to play with up to 6 players for school articulation groups and/or home practice with family.
  3. Limited number of avatar choices eliminates wasting precious time looking through dozens of options.
  4. Saving space by downloading only the sound targets needed.
  5. Need for a communicative partner to rate sound productions.
  6. Hand/eye coordination game play.  
  7. Note section in data collection link to make comments.
In the future, I would like to see this app include phrase and simple sentence levels to grow with clients as they make gains in speech. This is likely challenging due to the voice activation component, but I would be willing to lose that in order to gain higher speech levels.





Tuesday, September 12, 2017

Mini Articulation Trinkets Shopping List



I'm all about three things:  getting organized, bargain shopping, and having fun in speech.  So, when Jenna at Speech Room News shared how she organized her mini articulation trinkets, I headed to Michael's during a great sale and picked up a storage box.  This purchase checked off the "getting organized" and "bargain shopping" goals, so now it was time to have some fun!  Incidentally, this cute box pictured above is currently on sale at Michael's if you want to snag yours soon!

The inspiration continued when I watched Felice at The Dabbling Speechie's SLP Summit presentation on Sensory Bins.  I loved her use of cut up straws for a sensory bin, so I bought a few bags of straws at the Dollar Tree and made my own box to serve as an I Spy bin ready to go.  I paid a little for the box at Target, but I just love these bins for storing so many of my activities.  I also used my favorite app on the planet: Custom Boards by Smarty Ears apps to create a matching sheet.  I wrote a detailed review about this app for Teachers with apps a few years ago that you can read here.



Next, came the really fun part: filling up the sound target bins.  The first stop was my son's miniature collection.  He tends to keep those small prizes from school fairs and birthday gift favors in a desk drawer, but he was more than happy to part with them.  Fortunately, he also LOVES Legos, so he graciously parted with several mini figures and accessories.  Next, I looked through my own speech materials and found some items from play sets and sensory bins. Last, I bought a collection of Dinky Doodads on Etsy.  Taking these steps was a great start, but I was short in a few areas. So, I made a list of specific things that I needed and built my collection over time.  Here are the remaining places that I searched for my mini treasures:
  • The Dollar Tree typically has a wind up toy or two by the cash registers.  I like having one of these in each sound box because they allow for a little more opportunity for target practice while you play with it.  You may also find magnet numbers, miniature animal figures, individually packaged specialty characters, and small Koosh objects at your local Dollar Tree store.
  • Target Dollar spots sometimes have mini object erasers in a pack of 4 for $1.  I recently found a fruit one on clearance for 30 cents that had a strawberry, banana, grapes, and a watermelon.  
  • Amazon has dollhouse furniture for objects like vacuums, lamps, and vases.
  • Michael's sells ABC letters in the bead work section.  It's a little pricey, but I get much use out of mine in these articulation bins and my play dough sets.
  • Party stores often have trinkets for favors or decor for themed parties that may come in handy like coins for a pirate party.
  • Walmart carries seasonal favors that are fairly priced.  I found a collection of stretchy body parts during Halloween a few years ago that the kids love.
  • IKEA sometimes carries animal finger puppets in a collection of 5-6 that are fun for varying play during a seek-and-find game.
Here is a peek inside a few of my articulation boxes.  Right now, I am only storing initial sound targets but you could certainly collect medial and final target sounds words too.  








Friday, June 9, 2017

Impact of Noise on Hearing Loss


This week, I have a guest, Kate Willett, who will address an important issue about protecting our children's hearing.  Kate is a freelance writer located in Los Angeles, CA.  She writes about health, politics, and comedy.  She is a graduate of the University of California, Berkeley.

Many of us spent our teenage years listening to our parents warn that if we kept listening to music that loudly, we might damage our hearing.  Is there any truth to it?

Hearing loss in one ear can be caused by a variety of factors including:

  • Illness
  • Injury
  • A foreign blockage in the ear
  • Wax
  • Tumor

If the hearing loss is in both ears and is sudden, it might be caused by:

  • malformation of the inner ear
  • head injury or trauma
  • prolonged exposure to loud noise
  • neurologic conditions, such as multiple sclerosis
  • an immune system disease, such as Cogan syndrome
  • Meniere disease, which is a disorder that affects the inner ear
  • Lyme disease, which is an infectious disease that’s often transmitted through tick bites
  • ototoxic medication, which can harm the ear
  • venom from a snake bite
  • blood circulation problems
  • abnormal tissue growth or tumors
  • blood vessel disease
  • aging

Despite the many causes of hearing loss, acoustic trauma is one of the most common. Surprisingly, noise is an even bigger cause of hearing loss than age. According to the New York Times, “Tens of millions of Americans, including 12 percent to 15 percent of school-age children, already have permanent hearing loss caused by the everyday noise that we take for granted as a fact of life.”

Acoustic trauma is injury to inner ear that’s the result of loud noise.  It can be caused by one very loud noise, such as an explosion, or from long-term exposure to loud noise at a lower decibal such as rock concerts or listening to music loudly with ear buds.  Those at high risk include:

  • People who work in jobs with loud industrial equipment
  • People who live or work in areas where loud noises, such as construction, occur for long periods of times
  • Musicians or people who attend many loud concerts
  • People who use gun ranges
  • People who encounter very loud sounds without using ear plugs

When you’re exposed to very loud noises, your eardrum may be ruptured or other injuries to the inner ear may occur.  

Sound causes your eardrums to vibrate, and those vibrations are transmitted to your inner ear. Fluid carries the vibrations to hair cells, which stimulate the auditory nerve. The auditory nerve carries the impulses to your brain, which interprets them as sounds. Most noise related hearing loss is caused by the death of the hair cells.

The effects of noise exposure are cumulative, which means that many older people experience hearing loss.

To protect yourself from acoustic trauma:

  • Use ear plugs when around loud noise
  • Don’t listen to music loudly
  • Be mindful about the time you spend around loud noises

Acoustic trauma cannot be reversed, so be careful with your ears.  If you’re experiencing hearing loss of any kind, see your doctor immediately to identify the causes.  Unfortunately, your parents were right.  If you want to protect your hearing into old age, turn that music down.




Thursday, May 25, 2017

Tales from the Barn

A couple years ago, I had the good fortune of meeting the owners at a nearby occupational therapy clinic: Fingerprints in Naperville, Illinois. Since then, we have referred clients to each other and collaborated on treatment plans for a couple little ones. In April 2015, my practice: Naperville Therapediatrics, was invited to participate in therapeutic riding sessions with Fingerprints at a barn in Plainfield, Illinois. After two months, I learned much about the many benefits of horseback riding and its positive impact on physical, speech, language, and social communication development. This post reviews some of the themes that Ready, Set, Ride organized and the prompts/ cues that we incorporated as physical and speech therapists to address one, young client's unique needs. 


I'm not sure who enjoyed the themes that Ready, Set, Ride used in their sessions, myself, or the young riders. Among my personal favorites were the baseball, pirate, grocery shopping, and birthday themes. During baseball week, riders took turns swinging whiffle bats and trotting bases during much of the session. The coordinator was kind enough to give me a week's notice about this theme, so I donned my favorite Red Sox t-shirt and printed some simple CVC visuals, laminated them, and attached them to an accordion corded key chain so I could prompt my client with his target sound pattern and remain hands free. Pirate week included some thrilling sword fights, treasure hunts, and ring tossing as we followed along and practiced some motor planning patterns such as "P/Pow" and sound imitation for "Ar." Most of us do not enjoy food shopping, present company included, but it is way more fun to reach, twist, and grab a food list while riding a horse. With list in hand to coordinate holding the reins and a paper, riders searched different stations for objects matching items on his or her grocery list. Not only were there plenty of opportunities to exercise core muscles, but we were also able to work on varying communicative intents to label foods and comment about likes and dislikes using vocalizations. Finally, the birthday theme gave us an opportunity to improve imitating oral motor movements while we removed ice cream and sprinkles from the corners of our mouths by using just our tongue and lip musculature. I acted as a mirror for my client as he tried imitating the mouth movements while keeping his eye contact. It was great being in a position where my client could easily maintain his gaze and focus on my mouth without me having to continually find ways to get his attention.



It was rather impressive watching my young rider improve his strength, balance and coordination in just a few weeks. The physical therapy assistant who walked along the other side of our rider provided weekly feedback to caregivers about noticeable improvement in our saddle-free riding client, especially with regards to range of motion and core strength. Meanwhile, on my side of the horse, our rider was learning how to coordinate moving and vocalizing, which was one of the most challenging goals for this youngster. Typically, goals of this nature require all sorts of encouragement and games with bells and whistles to prompt client participation, but on horseback, you do not need to go that extra mile. The horse takes care of all of that for you! I only worked with this client at the barn and his mother would tell me weekly that her son did little during their clinic based treatment sessions, but I saw a completely different child in my setting. From start to finish each week, it took very little to encourage him to try different positions, such as facing backwards, and imitate sound sequences. In fact, the only time he responded with "no" was when we asked him if he wanted to go faster and "Trot", but he allowed it nonetheless and we eventually stopped asking and told him it was time to make the horse "Trot."



Along with having challenges coordinating movements and vocalizations, my client struggled with initiating requests using vocalizations. However, as the weeks progressed, he became a bit more spontaneous with initiating actions. At first, we prompted him to say "Walk on", "Trot on", and "Whoa", but after a couple sessions, he proudly and loudly initiated these commands in order to get his horse moving. Even at a young age, he knew that if he didn't speak up, then his horse would not move much! Right up to the last session, he did struggle with saying "Whoa" without prompting, so we worked him down from a brief "3, 2, 1" countdown to give him some time to take in his surroundings and get the word out. Besides initiating actions, I observed our rider initiating greeting the animals that roamed the barn as I had modeled for him during the first half of the spring program. The language opportunities were seemingly endless in this natural setting.



If you are ever given an opportunity to step out of your clinical space and work with a client in any natural setting, then I highly recommend you venture to the great outdoors! Barns, swimming pools, restaurants, and zoos have all the materials and stimulation that you will need, so leave those therapy bags at home and go have some fun.


Monday, February 6, 2017

My Bag of Tricks in a Bin

Whether you are an SLP in home care, private practice, or school settings, one common ground remains constant: we all need a bag of tricks.  We need to have something readily available that aids in improving attention and interest in the speech and language task at hand.  This collection may be a combination of communicative tempters and sensory stimulating tools and/or visual reminders to stay on task.  In my private practice world, my bag is a bright, deep, red bin that matches my office decor and sits comfortably between my seat and a wall, making it difficult for clients to grab.  This bin holds my tried and true tempters and sensory items.  Allow me to dump out the contents and give you a closer look at what is inside.

First and foremost, I have your ever-fancy, re-purposed slab of cardboard covered in white contact paper and Velcro.  This board, which has saved many a speech sessions, is accompanied by a ridiculous collection of pictures stored categorically in a giant binder.  From toys to foods to letters and numbers, you name it and I have a picture of it laminated with a Velcro dot on the backside.  These visuals give several of my clients a better sense of what we will be addressing in our 50 minute speech and language session.  Once a task is complete, clients remove the picture and drop it in my dollar tree bin marked, "all done."  Using this system helps clients visualize and therefore comprehend how long he or she will be spending time with me working on all the hard stuff.

Next up in the bin are my son's old, monster feet.  These brightly colored feet are made of a thick, durable foam and attach to cords and a handle.  Clients take work breaks by stepping onto the feet and pulling up on the cords by the handles to walk about the room.  My OT colleagues have taught me that these feet give clients a better sense of where their bodies are in space, which in turn helps them organize and attend.  Monster feet come in handy during transitions into and out of my office space too.




Rolled up and folded in half is my two yard piece of stretchable, fabric sleeve purchased at Joann's fabrics.  I used a coupon and saved a little money on this fabric, so it only cost about twenty dollars.  A private practice OT, with whom I often collaborate regarding shared clients, suggested that I purchase this ready made fabric tunnel to assist clients needing proprioceptive input.  Unlike standing tunnels, this sleeve allows you to push and stretch while inside.  Clients sometimes crawl through this or step into it and push against the fabric while standing upright.




Not all of my goodies will fit inside my bin, so my fidget cushion rests just next to it.  I have had this particular cushion for so long that I cannot remember where I purchased it.  Like anything else, I am sure you can find one at Amazon.  I especially like my textured cushion because it works like a balance ball without risking injury.  It's not something that you would use throughout a 30 or even 50 minute session, but perhaps will come in handy for a 10-15 minute task.  One benefit in using this cushion is that it helps some clients reduce the need to move about the room for a gross motor break by letting them get their wiggles out while seated.




Now, let's talk about fidget toys.  I have a few in my stash that I use either as a reward choice for having completed a work task or as a fidget for keeping little hands busy while seated and listening to auditory bombardment of target sounds.  Koosh balls are always popular as are putty.  I am working towards having my AAC users request these items using descriptive words such as "big purple" for a large koosh.




Finally, it never hurts having some tempters nearby.  My favorites are wind up toys and poppers.  These come in handy at the end of a session when I am trying to finish calculating my data because they keep my little friends from pulling out toys on my bookshelf or hitting the buttons on my copier.  It's also good to have tempters nearby on those days when you need to quickly shift gears because that cute craft or sensory bin may not be doing it for the little one in front of you.




What about you?  What do you have in your bag/bin/container of tricks to assist your clients in attending during speech and language sessions?  Leave me a comment and let me know!