Once upon a time

I love working on narrative and looking at narrative development in children. It's something that I find many speech therapists tend to shy away from, but it is such a valuable tool. I had a lecturer and clinical supervisor who was very passionate about narrative and story grammar markers and all the fun stuff that goes along with it, and I ended up doing my Masters thesis on how 5 year old children tell stories. Here I looked at how children used a wordless picture book (One Frog too Many) to retell a story.
Through my thesis work and my clinical practice I have seen how informative narrative assessment can be, to critically evaluate a child's vocabulary knowledge, ability to relate events that happened and sequence events in logical order, use of appropriate syntax, ability to give clear descriptions, use of connectors, use of inferences and prediction, use of connecting words, referencing using pronouns, auditory memory, and so much more. It is fascinating to see how children of the same age can vary from giving very basic picture descriptions to producing true narratives filled with expanded details and  direct speech.

When I did my thesis I based much of my analysis on a narrative assessment which was a favorite in the University clinic by Black Sheep Press. This assessment called Peter and the Cat Narrative Assessment, is a norm referenced test which, after supported analysis gives an excellent descriptive profile for key language areas in narrative development. It also allows for planning goals for intervention in therapy.  It's a very interesting story, with beautiful illustrations about a boy who tries to rescue a cat from a tree and ends up being stuck in the tree, needing rescue himself. This allows for all the story grammar markers to be used: Setting, initiating event, response, plan, resolution, coda and gives you examples and guidance on how to transcribe and score them appropriately. It also looks at features such as story content and structure, vocabulary, connectors, adverbials, referencing and story register in the analysis. Couldn't get any better right?

Well it has!  I found out a few weeks ago that they made this amazing assessment into an iPad app (*fistpump*) ! It has the same cool features, great graphics and it's a very handy portable assessment tool for therapists. Guess what I downloaded quickly and have been using all week with my little ones! You can choose between male or female narrators with different accents, and it allows you to store each client individually, with their own recorded story and report. It also has password protection to ensure patient confidentiality of files. The pages turn like a real book, and I found the children were more engaged and focused during the assessment for both listening to the narrator and the retell.

Another good thing is that you can choose to exit the program and come back later to transcribe (who has time to transcribe the same time) and complete the analysis. Each page gives you the same descriptive profiles as the hard copy of the assessment and provides guidelines for analysis, then it compiles it all into a report for you to email and print for your records. How neat is that! The price of $49.99 I find is pretty reasonable for an established assessment, especially for the type of analysis it provides.

So if you're looking to venture into the wonderful world of narrative assessment and intervention give it a try!

Yo Ho Ho and a Bottle of Bubbles!!

Far far away on a small island in the Caribbean sea, it wasn't business as usual for one of the schools, as a crazy (by general consensus) Speech Therapist marched up and down shouting strange things like "Arrrrgh" and "Ahoy Mateys" and singing "Yo ho ho and a bottle of whatever came to her mind!" Just as they were deciding to make that call to finally give her the help she needed..... they learnt that it was Talk Like a Pirate Day!!!!

Shiver me timbers! First off I must say that I wasn't planning to talk like a pirate today, nor did I even plan to observe the day's existence. However the constant pirate tweets by @lessonpix and the @speechdudes, as well as an excellent blog post  from lesson pix with great tips for the day, got me hooked (giggle).

I headed for my toy cupboard and collected all the treasures I could find. Unfortunately I didn't have any pirate garb lying around, so this was what I came up with in the end.

And off I went to school, where I worked with children aged 14 months to 10 years. The highlight of the day of course was pop up pirate, which I used to target a range of skills, for individuals and groups. It went surprisingly well with my 4-6 yo group who are working on awareness of others, attention and listening, and turn taking and we had lots of fun. 

I had another group of little boys between 3-5 who are known to be runners and roamers, and our main focus is engagement, maintaining joint attention, imitation skills etc.  That group marched around the room with me shouting "Arrrgh" and "Yo ho ho. (and a bottle of bubbles)" They also enjoyed group favorite no. 2: putting the pirates on the pirate ship and sailing it across to each other :) 

I wondered to myself how I would adapt my theme for my baby group. We ended up doing lots of mirror play saying 'arrrrgh' and making fun sounds, and played the Pierre the parrot app on the iPad, which is always all round fun. 

However some little ones didn't quite like my "arrrgh" so we had to rock and go "shhhhhh" instead. 

My highlight of the day was showing a teacher how she could use AAC in her classroom for the children to play an interactive game together. I found a great board from Boardmakershare, which really worked well for requesting and building vocab and the children loved it! What I loved is that this board didn't only have vocab for the game, it also had visuals for 'my turn', 'your turn,' 'high five'  etc. which made the interaction even richer :)  

                                            He especially loved my 'Arrrrgghhhhhh!'

So I had a fun "Talk Like a Pirate Day' and, despite the strange looks from some teachers, I think the children had a blast! 

Did you do anything fun today?? 

The Wonderful World of Parachute Play

Me having lots of fun with a client yesterday

I'm always looking for fun new ways to keep children engaged and having fun while learning language, so when I was introduced to parachute play earlier this summer it became one of my top therapy tools. It is great fun for all ages, and can be used for individual sessions and with groups. With its bright colors and the ease with which it moves the parachute is an amazing sensory experience, particularly for those children on the spectrum.

If you don't know what parachute play is see here

My first parachute play experience occurred during my summer camp. I saw this lady's page being advertised on Facebook, and this was one of her party activities. I invited her in to do some of these activities with my little ones and I fell in love. She pulled out this huge parachute which she spread across the lawn and everyone was instructed to hold the many handles. We worked together to lift the parachute "up and down" "fast and slow" "shake shake shake" from side to side, listen for "stop and go," shake to the beat of a drum. Needless to say I was over the moon. She had me at 'shake shake shake.' She had lots of little songs to go with the activities which I was scribbling down quickly as we went along. There was one in particular about a little bunny, where she put the bunny puppet in the middle and everyone had to keep the parachute very still because he was sleeping, but then the bell went Ding-a-ling-a-ling and it was time for the bunny to WAKE UP, so everyone had to shake the parachute up and down to wake the bunny.

Another activity was one where she put some toy animals in the middle under the parachute, then she made an animal sound and a child had to dash under the parachute and pick up the correct animal. How cool is that!

My favorite was the popcorn game where she put some pretend popcorn in the middle (I think she got this from Lakeshore, later I recreated this with styrofoam chips), and went through the popcorn story where the parachute was a BIGGGG pot, you had to pourrrrrrr in the oil, shake shake shake the salt etc. then stir and stir and stir, then it starts to get reaaalllyyyyy hot (don't touch), then the popcorn starts to pop pop pop and you shake the parachute up and down to make it pop.  This was a big favorite with the little ones.
There were a few other ones that I liked, including everyone running under the parachute on a signal, and one with putting body parts over and under.
What amazed me was the level of engagement from children across a range of capabilities. Children who I would consider the most difficult to engage in sessions were taken up in the the activities and so fascinated by the parachute. Therefore you know what I did next.....I went here:

So now I have my own parachute. Which I have started to use a lot in individual sessions, mainly with the toddlers to start, for peek a boo and other engagement games and playing 'up up up...down.' I find the 10' is a good size for both individual and group sessions. We've been having a great time with it and I'd recommend it to any therapist looking for new tricks to keep children engaged :)

Dusting off the Cobwebs.....Realtalk

Hey everyone! Yes I am still here.

Yup months later I'm dusting off the cobwebs off this blog, shaking it up, and promising to write more often. Honestly I've been trying to organize and compartmentalize over the past few months. Those who know me know that the wheels in my head are always turning, most of the time too fast for me to catch up with. With running a practice, a blog, an app, slpchat, a magazine and everything else in my life it was time to put some things on hold and refocus. Unfortunately my twitter time has reduced significantly since these changes have happened and the blog posts have reduced to almost nothing, but I'm a work in progress, so hopefully that will change in the coming months.

I've decided to put all my focus right now into my practice. Those who are in private practice know that  it is TOUGH! I've found myself struggling and feeling absolutely overwhelmed in recent months, managing clients, admin work, accounts, keeping up on all the current trends, research, apps, everything. I've been forced to turn into superwoman! In a country where there are only 4 SLPs, to say the demand is high is an understatement, and that's where caseload management becomes difficult. Remember in grad school you had to sit with your tutor after a clinic session and reflect on your performance? What went well, what didn't go so well, what you would do differently next time. You need to constantly be doing this in your practice It's not just evaluating your patients' performance and progress, it's about looking at your performance and personal growth as a therapist and in some cases a business owner. A few things came to light in my reflections which I decided I would share:

1. Quality beats quantity anytime! It's better to have 5 patients that are getting the best service that you can possibly give, than to have 50 that you're not giving your best to.

2. There's a point when you have to say No (and stick to it), or at least a 'not right now.' People may get angry, but you can't please or help everyone. Your practice will be better if you don't take on more than you can handle. If people respect that you want to provide an excellent service they will understand.

3. Ask for help! There are people out there that have been doing this way longer than you have. Find out how they are managing everything. What strategies are they using to handle caseload management, deal with paperwork, stay on top of reports etc.

4. Realise you can't do it all on your own. Since hiring a personal assistant life has become so much easier. Delegate some duties, the time you're laminating those PECS pictures you could be planning some goals.

5. Set aside specific time for your professional development. I try to do at least an hour on Mondays, Wednesdays and Fridays. Speechpathology.com now has some of their seminars in podcast format, which I like to listen to in the car or at the gym.

6.  Improvise! I was having difficulty writing up session notes on the days that I was moving from house to house for visits. I then started to record my spoken notes on my phone's voice recorder (to store in a secure place) in the car on the way to the next patient so that it would still be fresh in my memory to write at another time.

7. Remember to still have a social life! It's important to maintain that balance between work and personal life. Take a break from writing those reports and go have a drink (However don't write reports while under the influence.....)

Hope those tips are of some help to someone reading. I have a couple blog posts in my head that I'd love to share, so hopefully they come soon :) Also look out for the newest issue of EasySpeak Magazine due to release next month. This magazine is my favorite hobby right now and I'm glad that it has been so well received across the field of Speech and language therapy/pathology :)

Making Sessions Functional!

You know those sessions that go really well, just as you planned them in your head? I know, I know we don't have them very often, but when you actually do isn't it magical.

I had one of those sessions today so I decided I had to write about it and share with you.

My patient is a 7yo, diagnosed with ASD. He is verbal and I'd say quite high functioning, but he has lots of difficulty coping within social situations and with higher language tasks. His play skills are also delayed for his age, particularly when it comes to symbolic/imaginative play. I've been trying to incorporate lots of his language tasks into many functional play activities that relate to his everyday routines. Today we worked on going grocery shopping.

We played a quick barrier game using the supermarket theme in the Magnetalk Match up adventures kit, to work on following directions and building vocab, amongst other goals.

We also talked about why we go to the supermarket, and the types of things we buy at the supermarket.

I found the perfect link for him, a video which actually shows a pretend play routine for going to the supermarket, so we were able to watch the video and model the steps. I loved that the video used pretend items for the activity, such as balls for fruits, and laundry baskets for shopping carts. We watched the video and made a visual timetable for each set.

It was then time for us to go pretend shopping. We drew our shopping list and looked around the office for items which we could use in our activity. A doll pram served as our shopping cart, balls were our fruits, and some empty jars for our milk, juice etc. Then it was time to go to the 'cashier' - a word modelled repeatedly to make sure he got the concept. We took turns being the cashier so that he could get an idea of both processes. Please remember to note "unload the groceries" as a step, since we tend to jump from putting the items in the shopping cart to going to pay. This is an essential step to note. I got a cool toy cash register that lights up and makes sounds for christmas so it was fun to use. We took turns scanning each item and deciding on suitable prices for them. Then we talked about how it mummy might pay with either cash or a credit/debit card, so we used a different method on each turn. After that we got the receipt and put the items into the bags to take home.

What I love about the adventures kit is that there are worksheets for extension activities that cover a range of language areas. Mum got the worksheets for the grocery shopping theme to carry home and work on. She also has the task now of taking him to the supermarket and talking him through the same visual schedule that we made.

It was a fun afternoon and I hope you can use it sometime in your therapy activities :)

New Year's Top 5 Toys

Happy New Year!!!!

My how the time has flown. I can't believe it's 2012 already.

I've just returned from a lovely vacation with the family in Florida and started work this week with lots of new energy. It's only when I started this week's sessions that I realized how much I missed my patients. Also funny is something I realized on my way back home from my trip. You know you're a speech therapist when one suitcase is filled with all toys and therapy materials.

I went crazy this Christmas with all the pre and post christmas sales on toys. I also think I bought out the whole of superduper pub. That company is going to drive me to bankruptcy!!! My assessment to buy the year was the MAVA. which I used for the first time last week and loved. I also bought the Magnetalk match up adventures kit, which finally went on sale at 50% off! I've wanted that one for a while!

I thought that to begin the year I'd share with you my top 5 toy buys to kickstart the therapy year

and maybe some quick ideas on how to use them in therapy.

1. Zippy Mat Hit the Moles Play mat (can be found here )

I snapped this one up at Publix, on 75% sale and paid and ran before they changed their minds. This was a steal at $6. This is an interactive mole that lights up, and the goal is to hit the moles' noses as they light up to score points. I've been using it mostly as a reinforcer/break between activities. Children say 5 target words then try to hit 5 moles etc. This one is a hit with everyone. It's also very interesting to see those children with motor planning difficulties struggle to hit the moles.

2. Frog in a box

Another HUGE favorite for me. I saw this last year in a Hanen video while I was doing the ITTTT program and fell in love. I've been searching for it ever since and finally found it here on Amazon this Christmas. It is the perfect cause and effect toy! What I love is that the frog actually pops right out of the box and lands somewhere nearby which the children are not expecting. It's a bit pricey to be honest, but definitely worth the money. I've built a routine with the box singing:

What's in the box

What's in the box

Tell me Tell me

What's in the box

Then we 'oooooopen' and 'POP' goes the frog ("Uh-Oh, you naughty frog") then we say "bye bye frog" put it back in and say "shut". Lovely language building activity.

3. The honking pig

Another one that makes me giggle. This is a nice switch adapted toy for teaching children the cause and effect relationship for initial switch use. I've been using it with my big mack device and laughing every time it walks, grunts and wags its cute little tail. If you're hooking it up to a big mack or big talk device you will need a 1/4" to 1/8" adapter to fit it. Make sure the company sends it the same time. Don't learn the hard way like I did. It's so amazing to see the little ones making that connection and looking from the switch to the toy as they press.

4. Wind up toys

Every speech therapist should have a set of these in a ziplock bag in their therapy bags. I found mine on sale at walmart for $1 each on boxing day and bought about 6. My favorites are the caterpillar, train, dinosaur and butterfly. I found a great idea in the Teach me to Talk manual about putting them in see through ziplock bags and to open give a long exaggerated zzzzzzzzzzip, while slowly pulling it across, then give the child a chance to do the same. Great also for imitation and fine motor skills.

5. The laughing monkey

Another cause and effect toy that makes me laugh. I picked this up during a long layover at MIA (Yes I'd find a toy store anywhere). I love it for maintaining attention and for shared attention. It works a treat with a little toddler I have with TBI who has difficulty maintaining attention. It also keeps the parents laughing in therapy.

So there you have my top 5. What are your favourite toys to use this year in therapy?