Santino continues to confidently and knowingly initiate the transition into the office upon arrival. His sense of comfort and confidence is strong. He follows directional lead within the natural context, ( let's leave your backpack on the big chair, and sit on the side of the carpet etc). Social reference within the natural exchange is noted with increased frequency.
Santino actively scanned the room with greater curiosity today, looking under the table, under a covered area, looking to open the closet, and responded to the carrier "you're thinking let's..... "open the door." Response to natural yes/no questions noted today 6/6, head shake for "no" continues, with a vocal and gesture to indicate affirmation. Single noun labels predominate requests for desired items spontaneously 15/25 and the use of carriers 8/25 and with model 2/25. Action regulation continues to be noted following carrier phrases within play cycles with use of single action and action +object form with 8/12 and 4/12 respectively. Use of "help me' to request assistance was noted with use of visual cue and carrier phrase 5/6 and use of expanded form "help me +action" 1/6 today. 432 Hz continues to be utilized each session. Wonderful session once again.
The session commenced late today as Chris needed to utilize a school computer to connect this morning. Tech challenges ensued for the better part of 25 minutes. Once connected the session proceeded at per usual. Strong focus today on expansion into longer cycles of reciprocal contingent conversation. Lego characters that Chris had with him continue to serve as topic starters. Supports to "think together" and remember that your "talking partner' is a "team partner" were successful today. Additional activities focusing on increased use of cohesive and temporal cues within narrative generation were highlighted. Scaffolding supports to use " detail describing words" to share the ideas "in our mind" to best help your partner understand were extremely facilitative today.
Richard was excited to see SLP. He was just finishing up with OT, Willow Rossi. It was a nice opportunity for us to discuss Richard's goals and how we can support each other. While working on a "strong S" sound, Richard was able to demonstrate correct tongue positioning and benefitted from verbal and tactile cues. He asked to "see it" so using a mirror, he benefitted from the visual feedback. Richard requested some of the same activities from last session (robot building game that focusses on executive functioning skills: organizing, sequencing, and time management). Using a scavenger hunt format in a fun book, building language skills, Richard was able to produce target sound of /s/ in initial position with 60% accuracy.
Richard was tardy to today's session. He reported he had an accident in the car on the way to school. He required moderate redirection during today's session however this may be due to reduced amount of breaks from structured activities. /s/ phoneme was targeted at the word level today in all positions with the following data:
/s/ in initial position - independent: 12/20 = 60%, verbal cues 7/20=35%, incorrect 1/20=5%
s/ in medial position - independent: 16/20 = 80%, verbal cues 3/20=15%, incorrect 1/20=5%
s/ in final position - independent: 16/20 = 80%, verbal cues 2/20=10%, incorrect 2/20=10%
Richard demonstrated increased awareness of incorrect production of /s/ in all positions. He self corrected a few opportunities, which he did not do the last two sessions. As expected, he has not carried over correct production of /s/ in conversational speech however improvement was made during structured activities. Tactile, visual and verbal cues were utilized and effective for the most part. Great work, Richard!
Santino happily arrived and without hesitation rapidly walked directly into the office. Mom shared that Santino had fallen asleep early last night and was awake by 4am, noting that perhaps this may impact the session. Santino happily engaged with the materials provided within a choice framework. Noun label use to request desired items was supported with increased frequency today as carrier phrases. models and binary choices were often needed in succession. Spontaneous noun label use to indicate request was noted with decreased frequency today. Support to request assistance with use of the sentence form "help me +action" was successful given visual cues and carrier phrase for an initial 4/8 opportunities. Spontaneous request for assistance was noted on the remaining 4 opportunities via use of "help me." Santino utilizes a head shake "no' in response to question forms related to the immediate context with increased frequency. 432 Hz music continues to be utilized throughout the session. Santino was clearly tired this session, as Kim had noted as a possibility today, and although feeling fatigued, he was participatory and happy.
Session commenced via teletherapy following brief technical delay. Jamie had initiated contact via email just prior to session to share that Chris was at home today. The "scheduled appointment" email link that enables the connection was forwarded as per protocol to Chris' Batt school email. As per Jamie's request a new confirmation email needed to be re sent to an alternative email. This was successful. Christopher initiated the session by sharing the the he was very sad that a favorite Mario lego character was missing. Initial distraction regarding the missing Mario was strong, Gentle and supportive redirection was successful. Chris expanded on items of interest that he was eager to share. Allowance for reciprocity was supported, as attentional shifting was strong, characterized by use of familiar conversation starters ( "I gotta tell you something, Can I ask you something ? Wanna know something?") Cues and supports to support reciprocity were successful as increased cycles of Speaker/Listener exchange were noted. Additional responses to questions and comments increased as topics were guided by "observations" of the many items in his room that were seen through the screen. Expansion into tasks of identification of items based on use of attributes and location within his room was extremely successful. Sudden attentional shifts redirected back to the missing item he discussed as the session commenced were noted following approximately 45 minutes of engaged activity. Familiar strategies were shared with Christopher to support redirection and a "calmer " response to his dilemma. Familiar breathing strategies and techniques were utilized and once more discussed as a means to help the brain and body feel calmer and allow for better thinking and ideas. Christopher was participatory, and the techniques were successful as we "problem solved " together.
Richard was greeted in the hallway with a smooth transition to his room. Richard appeared happy upon greeting. The speech therapy session started with auditory discrimination with /s/ sounds in all positions. Richard discriminated with 100% accuracy. The sound /s/ was targeted in therapy today. Richard required moderate visual and verbal cues to elicit /s/ in isolation accurately. He independently produces a lateral "lisp" (the air escapes laterally). A verbal/visual cue of placing his thumb to his chin to prompt the airflow forward rather than laterally was effective in producing /s/ accurately. He was stimulable for /s/ in isolation with independent tactile cues. The /s/ sound in all positions was targeted today. 20 presentations of each position were targeted this session with the following accuracy and prompt hierarchy:
I: independent, VC: verbal cue, VisCue: Visual cue, IC: incorrect production despite cues
/s/ in initial position at the word level given model -
I=55%, VC=25%, VisCue 20%
/s/ in medial position at the word level given model -
I=55%, VC= 30%, VisCue=5%, IC10%
/s/ in final position at the word level given model-
I=55%, VC=25%, VisCue=5%, IC=15%
Richard required breaks between each targeted position however he did appear to benefit from them. Richard required minimal verbal redirection. He appeared to benefit from a cleared desk space without distraction. Richard responded well to verbal and visual cues to elicit /s/ at the word level. Well done, Richard!
A copy of the activities made to ensure continuity of care between therapists and teachers.
Santino once again arrived happily, briefly established eye gaze and walked promptly into the office. He placed his backpack down, immediately sat down and reached for a new activity that was placed on the table as he quickly scanned the room. Ingrid followed to the office door entry as we briefly exchanged conversation about Santino's breakfast and the expanded variety it contained. Santino quickly raised his hand and glanced at Ingrid, clearly indicating his desire for her to leave. He responded to the carrier phrase, "Ingrid is leaving now, it is our time together, and time to tell Ingrid....
"Bye Ingrid'." Santino utilized single noun labels, attribute +noun label across activities this session with 18/24 opportunities, following. model on 2/24 opportunities and with a carrier phrase on 4/24 opportunities. Action regulation within activities was noted on 12/14 opportunities given carrier phrase within play sequence cycles. Support to request assistance with use of the sentence form "help me +action " was successful given visual cues and carrier phrase 6/8 opportunities. Given a personal choice question to indicate a desire or to decline an item offered, Santino again utilized a rapid head shake "no" 4/4 opportunities. He again utilized the head shake "no " twice in response the question "Santino, may I have a turn to mix the balls and match them ?" Subsequent to those 2 responses, a similar inquiry was posed to him during a different segment of the same activity to which he briefly referenced and waited to allow my turn. Aspects of joint collaborative play subsequently continued throughout the session. 432 hz music continues to be utilized throughout the session. Santino hesitated at session closure, and following the sharing of "Santino, I am so glad that you feel happy when you are here, I'm glad that you will be coming on Mondays and on Wednesdays", he promptly participated in cleaning up the materials as Ingrid entered. Wonderful session once again.
Chris excitedly initiated the session today as Nicole shared that he logged in independently. Chris was eager to share new lego miniature Mario and Avenger toys that he had with him today. This sharing of highly motivational toys once again allowed for the immediate opportunity to focus on expansion of conversational reciprocity, the allowance of contingent question and comment related to shared context. Supports to allow for consistent response to both comment and question were provided, as Chris had eager intention to share items with a more directed listing of items. Subsequently, novel items were shared with him as well, providing a tool to support expanded use of attributes, and cohesive relationships between items within a semantic class. Cues to support the activity of "3 things I know" were provided across 12/12 items presented. Chris expressed fatigue as linguistic complexity increased. Encouragement to engage in cross pattern movement tasks was successful for a brief period. Guided support and strong modeling for pattern accuracy was provided. Ongoing guidance to support attention was provided today as well.
Richard gave a warm greeting and gave a quick orientation of the room. While chatting creating legos, Richard shared a lot about his favorite things and provided a nice informal speech sample. He was very excited to talk and share stories of his lego creation. Richard did not want to finish legos and said he needed 1 more minute. When the iPhone timer went off, he independently started cleaning up, only after a picture was taken of his lego. He remembered the directions from the beginning of the session to put used legos into a separate bag for cleaning. We then played a robot building game. During the game, we did an informal assessment of his phonological awareness skills with some of the letters/words used in the game. He was quick to say, "I don't know." With a little guidance, we "we figured it out together." The game also required some executive functioning skills (organizing, memory, planning, and sequencing). Richard demonstrated confidence in all areas. The session was moved outside to allow Richard to remove his mask to further assess speech production. Based on informal assessment, Richard demonstrated difficulty with /s/ sounds, s blends, multisyllabic words (he dropped a syllable), and other ending sounds. Many of the errors were inconsistent, showing that they are emerging. He was able to imitate every sound of concern, with a model and visual feedback (mirror). Discussed session with Mrs. Lazzara and suggested that 5 days a week might not be necessary. However, Mrs. Lazzara wants to be proactive and endorsed supporting the other areas of concern(outlined in the neuropsych eval) during sessions. She was happy to hear that both SLPs will be collaborating on Richard's plan of treatment.
