After receiving a message that Marcel felt he was ready to go down to 1x/week, we had a discussion about his speech goals. Marcel expressed that he was stressed getting all his school work done and especially trying to finish an engineering requirement. Marcel was assured that speech should not be a source of stress so we needed to identify what was best for him right now. It was explained to him that clinically, it is not recommended to reduce our frequency of sessions. Considering Marcel's age and goals to improve our speech, it was best that we continued minimally 2x/week with daily home practice. The comparison to his tennis practice vs match play made sense to him. He realizes that he needs to practice more to generalize the speech skills to everyday conversation. We are currently working at the short phrase level of producing /R/ without distortion. We left our session with Marcel knowing, that we can "think outside of the box" and discuss other ways to still practice even if it was more frequent but shorter sessions and even practicing virtually. He was assured that I am committed to help him in the most productive and least stressful way.
This was our last session before Jonathan was leaving school. We reviewed the strategies for tongue placement and air-flow to produce a strong, but not too noisy /s/. With losing teeth, his airflow has been disrupted so we were working on re-establishing the skinny air flow for our target /s/. He said he wants to keep practicing so he was encouraged to practice with some of the lists I provided. He is a great, bright kid and a pleasure to teach.
Richard seemed to be in a better spirits from the previous week. His language has seemed a little more disorganized than usual. He is having difficulty organizing verbal responses that are grammatically correct and make sense. Some of his other therapists are also noticing some of the language confusion. We focused on regulating his system so we went outside for some movement. We discussed how activity always helps our brain work better. He was happy to be outside with his peers but quickly got frustrated when he did not understand the rules of one of the games. We later discussed how using his voice to ask for clarification can help him feel a part of the group, especially when he does not understand.
Marcel was a little stressed from other factors not related to speech therapy. We discussed some coping/problem solving strategies for getting through the stressful time. It was emphasized, that speech therapy should not be a stressor for him. He agreed and said it was not. He just had other things on his mind. He said he felt better and was ready to tackle our /R/ sounds. He liked the coarticulation exercised from the previous session so we reviewed those. Copies of the exercises were texted to him for home practice.
Marcel was motivated to practice the work list of frequent and most challenging words. He is doing quite well at the word level with 70% accuracy with minimal cues. However, during coarticulation in phrases or sentences, Marcel finds it more challenging to hit the target sounds. Using some nonsense words, we targeted the coarticulation specifically so he could find the rhythm of moving between sounds.
Jonathan was flexible with scheduling today so we had an earlier session than planned. He was in a silly mood so we practiced our /s/ sounds with silly sentences involving different animals. He was most fascinated by the giant squid so we used our creative story telling to create a story about a Giant squid using many /s/ words as describing and action words in the story. Jonathan was very pleased with his work and asked to read it to some peers nearby. His speech was noticeably improved when presenting to his peers.
Richard was quiet today and not his usual chatty self. He was anxious to get to Pokemon Go so he asked to do the work so we can move on. We have been working on self advocating so he was praised for being direct with his message and clearly asked for what he wanted. He was going through the motions with our speech practice but was focussed and attentive. He got frustrated during the sequencing/story telling task so he used his
words to ask if "can we take a break from this." I honored that request because of the direct, respectful and effective communication.
Santino once again happily entered the office and initiated social greet. He was clearly a bit tired, and Ingrid shared that he was sleeping when she had arrived at the house this morning. Santino rapidly entered the room and requested a familiar activity that was not within his visual field. He utilized a soft vocal volume for the duration of the session, although he sustained interest and exhibited the familiar happy demeanor and motivation that he typically does. Spontaneous requests for assistance characterized by increased sentence form use (help me+ action phrase) were noted this session 8/12 opportunities, and supported with phonemic carrier cue x4.
Use of "where" question forms (where (is) noun?) was noted within contextual sabotage tasks given phonemic cues and carrier phrase cues 6 times today. Instances of social referencing continue to be strong. Expanded engagement to include the concepts of "'trade" were successful once again, x8 cycles this session.
