Making Therapy Work

Posted by Landria Seals Green, MA,CCC-SLP on 7 January 2014 | 0 Comments

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I have long felt that "Therapy Should Make You Better".  This phrase not only sounds good, its also empowering.  But in practice, what does it really mean?  How does therapy really make a person better?  Is it stringing beads in Occupational Therapy?  Is it saying vowel sounds in speech therapy?  In practical application, how do vowel sounds and stringing beads actually help and empower families after the session(s) are over?  While the long term effects of those practices are building blocks to real skills, the real truth is they are not practical at all.  

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No More Tongue Depressors, Let's Use Food

Posted by Landria Seals Green, M.A., CCC-SLP on 12 October 2012 | 1 Comments

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As a child, I have never ever liked tongue depressors.  In fact, I recall as a child the mere presence of them and watching them come towards my mouth would result in severe gagging and occasional regurgitation.  Tongue depressors were a norm for me as a child as I was always a casualty of October strep throat.  Even as an adult, every September and October...I get a bit of a cold (when I fall off of my healthy eating regime).  I did  quickly learn, as a youth, to open wider and verbalize to the doctor that I did not require a tongue depressor. 

As a speech language pathologist working primarily with children with autism, I get their perspective quite frequently.  For those verbal, vocal, and nonverbal...I understand that often times you just don't want to share, you just want to relax and not work, and you just don't want the tongue depressor.  I have been fortunate to attend awesome schools and have extraordinary mentor SLPs in my young career.  These SLPs pushed me to the limits and today I am forever grateful.  One in particular, in the North surburbs of Chicago (Andrea, SLP), taught me how to reduce use of tongue depressors, horns, and the like to elicit speech and use real things. Andrea was the district consultant for Assistive Technology for children with Intensive Learning Needs in this special education school district.  First day, I was given assignments and told that my job was to make children better...get going.  She did not hold my hand at all (very different from the training and supervision a lot of new SLPs now this generational?!? hmmm)!

I was taught to reimagine how I could elicit the target sounds and integrate Anatomy, Nerve Function, Physiology with Real food/real objects.  Real: items that are part of the child's everyday world or exposure and accessible to families.  I quickly learned that the Twizzler wrapped in gauze (for weight) and dipped in applesauce (or any other flavor) can give a wonderful impact for placement cues for lingual back sounds (k, g).  I utilize P.R.O.M.P.T. and other tactile cues to support...but let's face it, food is much more appealing and welcoming when we think of objects that should come towards our face and mouth.

This week I have been working with a youngster trying to achieve bilabial placement for the production to [m].  We have some real coordination and placement issues.  I pulled out a trusty cracker.  and we held it with both lips at the place where the lips should be meeting for the production of the sound.  We did not over place this food item, but quickly transferred that placement cue to the production of the sound.  And he's got it. 

Social Emotional Learning is important when it comes to supporting motor speech disorders.  He likes crackers.  From a behavior analysis standpoint, I paired the "like" with the goal I am trying to achieve, and now I am shaping speech.  Communication connects people.  The tools we use to elicit these motor patterns, oral motor placement cues, must also support the transference of the connection to the desired movement.  Yes it takes thought and a great deal of time, especially if the youngster has aversions to textures, tastes, and the like. 

For those that are more Finicky Eaters, it is a wonderfully messy task to play with food from the feet up.  In Speech Therapy, Occupational Therapy, and ABA Therapy we are rolling our car toys over crackers and pudding, playing in foam, steping on fruit snacks and then moving up to the mouth.  Motor begats motor.  Sensory Motor processing supports speech therapy.  Both are important.    This week I have worked more than a sweat in treating children and loving every minute of it.  I just wanted to thank a school SLP who was my graduate mentor for a full semester while at Northwestern because I went back to the basics.

Enjoy and Be Empowered


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Speech, Occupational Therapy, ABA Therapy information for Michigan families

Posted by Landria Seals Green, M.A., CCC-SLP on 24 July 2012 | 86 Comments

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Effective September 1, 2012, SLC Therapy will be an in-network provider for ABA Therapy, Occupational Therapy, and Speech Therapy services for Cofinity/Aetna plans.  This will better serve our Michigan families and help support the financial impact of a diagnosis of autism.  SLC Therapy provides a center based ABA program along with Occupational Therapy (including Sensory Integration Therapy), Feeding Therapy, Speech Therapy, and Augmentative Communication Therapy. Home based ABA programs are also provided and based upon availability of staff, scheduling, and best treatment environment for clients. 

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Shaping Vocal Behavior in Children with Autism

Posted by Landria Seals Green, M.A., CCC-SLP on 20 July 2012 | 2 Comments

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I am always looking to improve quality and create a consistent and excellent standard of care for clients.  In looking at speech sound production and shaping vocal behavior especially in clients that are nonverbal, it is essential that the speech language pathologist identifies and distinguishes themselves from the ABA therapist providing a Verbal Behavior program.  While there is much overlap, the speech language pathologist is uniquely trained and positioned to provide intensity in verbal and vocal shaping programs. 

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Paraprofessional Support for Students with Autism, Specific Language Impairments, and other Disabiltiies

Posted by Landria Seals Green, M.A., CCC-SLP on 20 July 2012 | 1 Comments

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I have long maintained that paraprofessionals are individuals who are on the front line with children with disabilities.  They are part of the teaching, nursing, social work, behavior intervention support team rolled into one.  We wont discuss their compensation or any other societal -economic imbalances...we can stick to and maybe agree with the statement that training may not always be given to this professional as a priority.  Training not dictatorship, shaming, reprimanding, but true teaching and modeling of how.  Training also means that these professionals should have knowledge of and read the child's IEP and at minimum the PLAAFP form.  Quite frankly, it is a great suggestion that the child's goals, strategies, and reinforcers are posted throughout the classroom. 

A few years ago, I was asked to train paras before the beginning of school for 1 hour.  In one hour, I gave them tools for communicating with students with language based disabilities inclusive of autism, dyslexia, apraxia, specific language impairments and other disabiltiies.

In the investment of our children's future, please feel free to Paraprofessional training doc: How to Communicate with Students with Language Impairments

Enjoy and Be Empowered.


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Teaching Yes and No to People with Communication Disorders

Posted by Landria Seals Green, M.A., CCC-SLP on 20 July 2012 | 71 Comments

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Teaching people with communication impairments to respond to Yes/No questions requires a level of knowledge and understanding from the person(s) posing the question.  The person being a family member, a therapist, relevant person, or community provider. Therapists' working on Yes/No with clients, should understand that there are different levels of comprehension and thinking from clients that require increased levels of cognitive and language processing. 

There are five levels of yes/no question comprehension and cognitive thinking.  To be clear, each level should have a mastery of 90% inclusive of fluency.  Fluency is the response rate the client must answer the question.  Fluency is important because typical brain developer communication is rapid and requires answers rapidly.  While situational patience is provided sometimes, therapists' should not depend on this when pushing our clients toward Independence.  As a therapist, my benchmark is the typical developer and typical peer social communciation, cognitive, and language skills.  After all, inclusion is real and in order to prepare our clients, we must teach them the knowledge along with the verbal fluency the world requires.

So again, 90% mastery inclusive of fluency to increase levels of learning of the concept of Yes/No.

The first level of Yes/No is the Mand, Choice making level: The Sd or prompt is typically 'Do you want ____". 

In level one the clinician is asking the question plainly.  There is no addition of the word "or".  You are not saying Do you want the ____ or the ___?  The reason is for clean data and clean teaching.  So often, I meet children who have splinter skills.  This does not mean that the teaching was totally in error, but the science behind the teaching was not present.  The one thing I can attribute to my learning and knowledge in applied behavior analysis, is the scientifically segment the actual skill so that the skill is learned.  My influence as a speech-language pathologist has allowed me to always make sure that programs have included reasoning, thinking, and social connectedness.    In the first level of Yes/No, the client is learning to answer a simple yes/no question related to something that he wants. When teaching the concept of yes and no, the client is tasked to learn to give an answer...then we work on fluency (Fast and Accurate).  The actual stimuli should be visually present.  Another challenge level to expose the client to answering the question without the presence of the visual stimuli.  This is real life in the treatment room.  Parents ask their children "Do you want McDondalds" before arriving to the restaurant just to name a few scenarios.   Here is what your data sheet should look like

The second level of Yes/No is the Mand, Choice making with "or".  The Sd or prompt is now " Do you want the ____ or the ____?" 

Or is a different concept to learn.  We wait to include this exclusionary concept because the comprehension or lack of comprehension of this one word "or", can disrupt the clients acquisiton of the concept.  By completing the first level with 90% accuracy, your are ensuring that concept of answering Yes/No for manding is present.  The clients performance here shows that as a therapist we need to be teaching the understandign of "or", not the comprehension of yes/no.

The third level is Knowledge based Yes/No- item Name.  The Sd is now "Is this a _(item name___?"

In this skill set, its not really yes/no that the clinician is after.  Here we are asking clients to cognitively refer to their knowledge bank to answer questions.  This level of teaching should be reflective of the known knowledge.  The collaboration with other professionals who may also be working with your client is necessary especially here.  This program setlist should be reflective of the mastered receptive ID programs.  For example, if a child can identify "dog", then I can now add to his Yes/No program by asking "Is this a dog?" But he must already know the concept of the tact-label of the item before I add this to my new level of Yes/No programming.

The fourth level of Yes/No is Knowledge Based- Category Label.  The Sd is now "Is this a _(item label)___?"

In the fourth level.  The client must have knowledge of labels.  Their receptive language programs should now be moving to " A dog is an animal, A dog barks. A dog has four legs. A dog is a pet".  Only when data shows clients firmly have this information, do we add this level to the Yes/No programming.  Yes no is still relevant here because classroom teachers, community, and typical developers ask questions like this all the time.

The fifth level of Yes No is Knowledge and Reasoning. 
The concepts can be related to safety, daily living, and reasoning about general knowledge.  The Sd will vary, but should be documented so that identification of difficult question forms and concepts can be tracked and taught.  An example here is "Do you touch a hot stove?  Is fire hot? "

Based upon where I am going with this, readers can probably guess that I have had or overheard one too many conversations about a child's inability to answer "yes/no" questions.  And quite frankly, that's not enough information.  As clinicians we should be framing statements about what our clients are not able to do at the present moment with specific statements rather than generalities.  When the statements are general, I can assure you that the data collection and teaching are not specific enough.  Further, each teaching should have an error correction procedure that outlines how the clinican is correcting the error AFTER each trial.  This necessary, because we do not want clients to attend therapy getting many many trials and opportunities to NOT LEARN.  Therapy is an unplanned expense for families, yet they come with copays, coinsurance, and private fees.  We must SLPs, ABA therapist, and all those in between (with a license :-)....should be providing specific data collection and correction procedures.

Here is an example of a Data collection sheet for Level One

Enjoy and Be Empowered.

Landria Seals Green, M.A., CCC-SLP/L

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Toolkit Tuesday: Writing and Communication Tool for Parents and Therapists

Posted by Landria Seals Green,M.A., CCC-SLP on 20 September 2011 | 1 Comments

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Hi Everyone and Welcome to Toolkit Tuesday!

Each Tuesday I am committing to "share" tools that I've used to support clients and their progression in treatment.  My motto is "therapy should make you better".  Well I believe, one of the better methods is the use of technology.

This tool created by ReadWriteThink can be used by reading specialists, speech-language pathologists, parents, and tutors.  More than that, it can be used in a variety of ways.

Here are some suggestions:

1. Social Stories with an interactive Comic Strip. Set up the good idea, the bad idea, and the open ended comic strip.  Infuse the Conversation Colors to make the feeling states concrete and the story alive.

2. Conversation Skills and Fluency: It is important for the teacher to type!  (as this activity goes fast and after all, fluency is a goal).  With this, you can create a scenario, have the student take on a character and flow with the conversation.  Analysis comes after!

3. Written expression:  Move away from the essay and the lined paper or blank compute screen.  A quick comic strip can target any type of expository writing and actually target the quality of the skill acquisition rather than getting the length.  Length comes later.  AND this heightens the cool factor for the teacher and the socioemotional buy in needed to get to the goal of length.

4. Synonyms/Antonyms/Vocabulary:  In this idea, one character (teacher's character) can supply a simple statement.  The learner's character has to restate it using the targeted vocabulary words from classroom curriculum.  This supports the student's ability to demonstrate real vocabulary use and application to the curriculum.  The learner gets to demonstrate that he/she really understands the deep structure of the word through the development of a comic strip.


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AAC and the Digital Divide. Access and Money

Posted by on 31 March 2011 | 3 Comments

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I am the first to raise my hand or nod in agreement when and if the question "Do you think current top of the line AAC devices are cost prohibitive?" 

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