Most of the kids we served had language or speech problems. We did a lot of assessment of kindergarteners. The kids were great! They were well-behaved and so much fun. I had to create a lesson each week to do with the groups. Because that age group is so focused on literacy, many weeks I went through a book and asked them lots of questions. Therapy was conducted in groups of 2-8 kids.

My favorite group was the preschoolers. The 3-year old preschool class was across the hall from our room, and we were in there quite a bit. According to state law, for every special ed preschooler you have to have a normally-developing peer. Of course the parents decided whether or not their child was normal, which made some interesting situations (there were two boys who were supposed to be normal, but seemed to have some mild autism characteristics). The class had about 14 kids. The special ed kids included 2 boys with autism, a boy with a seizure disorder (and did not speak), a girl with a cleft palate, and a boy with childhood apraxia (we think). The kids loved sitting on the adults laps during circle time. Sometimes I would have 2 or 3 kids trying to sit on my lap at once.

Here are a few funny stories from the semester.

We evaluated a little boy for speech and language. We see his sister for speech, and she is not the brightest light bulb in the box. After talking to the father, I think it might be hereditary. After the testing, the father asked if the boy would need speech. My supervisor said we would have to calculate the scores before we knew. The father said, “Well, if he has a 7 year old brain he won’t need to come to speech.” Then, with a very pronounced lisp and accent said, “I know where he gets his speech impediment from. His mom’s cousin has a real bad country accent.”

Dawson (one of the preschool boys whose mom is the teacher) went with his father to a meeting. The lady had short, dark, and curly hair. Dawson pipes up, “You have dark curly hair just like Miss Melanie!” When they got home the father asked his wife (the preschool teacher), “Who’s Miss Melanie?”

Fall Fun Day was a school-wide day of different activities to celebrate Fall. I helped the preschool class as they went to their various activities. Our first stop was singing and story time in the library. We sang a song, and then a lady portraying Mary Draper Ingalls told her story. Unfortunately, she didn’t do a good job of bringing her story down to a 3 and 4 year old level. Add Special Ed kids in the mix, and it was an interesting time. The kids did a great job paying attention during the first 15-20 minutes. But then attention started to wane. One 4 year old girl lay on the floor and sang the “ABC” song. Our probably-autistic boy started scooting closer and closer to the story teller and eventually had to be held. Thankfully he did not hum much during the story. At one point they passed around sunflower seeds for the kids to eat (since that’s one of the foods Mary found to eat on her way home). I was surprised how many of them like it. Our little syndrome boy devoured his seeds and then held his cup up saying “more” several times (meanwhile the story is still going on). At one point Mary talked about how she was in the river and she didn’t know how to swim. She asked what happens when water goes over your head. Instead of saying “you drown,” Dawson pipes up “You go up to God.” Mary didn’t quite know how to respond to that. Then she asked the kids what language we speak (like they know the answer to that). “Do we speak French?” The 4 year olds say no. “Do we speak Spanish?” The 4 year olds again say no. “Do we speak English?” Our little syndrome boy, who is pretty unintelligible above the one-word level says “no!” Thos of us who know the boy started laughing because listening to him talk you wouldn’t think it was English!

Our final stop on Fall Fun Day was to listen to a man talk about bee keeping. He mentioned honey and then he had some honey for the kids who wanted to try it. One of the aids went around and put it on the finger of the kids who wanted some. Several of the 3 year olds were interested until the honey was put on their finger. One “normal” kid had some sensory issues and started wiping it off on his clothes. The autistic boy gestured that he wanted some, so the aid went and put a large glob on his finger. While they were trying to get him to put his finger in his mouth he freaked out about the texture on his finger. He spastically shook his hand and honey went flying in the air, on the aid who was holding him (who didn’t react because she was probably expecting it) and the aid next to them who freaked out (she helps the other preschool class that isn’t as severe and I think she got some in her hair). It was pretty funny.

Here are some more stories about some of my patients.

In my other post about my externship, I mentioned the 80 year old doctor who had a stroke. He made a lot of improvement throughout the summer. When I left, he was working on some conversational speech he could use at his granddaughter’s wedding next week. He has a hard time with long words and words with several consonants in a row. In just a session or two he was able to say “speech” very clearly and made great improvement on “difficult” and “beautiful.”  Some more interesting facts about him…. Although he has a house in Bluefield, WV; he’s now living with his son and daughter-in-law in Wytheville. They don’t think he can ever live alone again. However, my supervisor and I disagree. Even living with his son he has a caregiver around the clock. He can communicate and can walk. Other than difficulty speaking, his mind is working well enough for daily life skills. Because he has to have a caregiver, it seems to me that he could live just as well at home as with his son. The other more interesting bit of information is that he owns about 5 miles of property along the New River. The New River Trail actually borders his property. He and his son both have a “cabin” there. Apparently these cabins are very nice. His son just built a picnic shelter, and his shelter is being constructed (out of stone). I can’t help but wonder how much that property is worth.

The other patient I mentioned in my other post was the man who pocketed the fruit and was being treated for a swallowing problem. I really enjoyed working with him. He was very funny. During the summer he retired from his job. Now he plays golf several days a week. He says funny things like “now that I’m retarded” (instead of “retired”) and “your generosity is overwhelming me” (once I told him I wasn’t going to make him eat during our session). One time he mentioned Shoney’s, and I asked if they still had their strawberry pie. I told him I love strawberry pie, my mom has the Shoney’s recipe, and I’ve never had a piece from Shoney’s. He told me I should go get some. The next time he came he asked if I had gotten my strawberry pie. I told him I hadn’t, and then he surprised me with a piece for me and my supervisor! I thought that was very sweet of him.

Another patient I didn’t mention was there for swallowing and voice problems. To make a long story short, he had cervical neck fusion surgery that should have kept him in the hospital for 3 days. Instead he was in for 21 days and couldn’t swallow anything (even his own saliva). At some point from when he was put under anesthesia to when he woke up someone had damaged his cranial nerve which resulted in not being able to swallow and vocal fold paresis. A stomach tube was incorrectly installed which got infected. Apparently, he should have died several times. Just last week the doctor told him his vocal fold was functioning at 90%. He has eaten a hamburger several times (with great care!), and he should be getting his stomach tube removed soon. This man has a garden, and he brought my supervisor and me cucumbers and yellow squash a few times. It sure was good!

We had some new patients such as two foster brothers. One was being seen because he doesn’t speak much and the other for articulation. The boys are supposed to be going back to live with their mom in a few weeks even though it sounds like she is violating some of her rules (such as letting the boys’ father be around). I guess since the 4 year old boy has been the one making comments about the violations the social worker is giving the mom the benefit of the doubt?

I evaluated and began seeing another boy these last few weeks. He is four years and eight months old. Most of what he says is unintelligible. He is not potty trained and he doesn’t know his colors. He has been in Head Start for 2 years and will begin a third year (because his birthday is after the cutoff date for kindergarten). I don’t understand how a child can go to preschool for 2 years and not even know his colors! I wonder how much of his problems comes from his environment.

I worked with two autistic siblings. The girl is 13. She has some speech, but she mainly uses it to quote lines from movies and who knows what else. Her mom wanted her to work on pronouns. It was very hard to get her to focus and even harder trying to teach her what to do. Apparently, the mom thought the girl’s autism was a result of vaccines. When she had her second child, she didn’t get him vaccinated…and he has autism too. Situations like that make me think that there MUST be a genetic component in some autism cases. The autistic boy is about 8. He regurgitates food in his stomach. He also hits, scratches, pinches, spits, and bites people. He is basically non verbal, although we can get him to say words when looking at picture cards. He improved some when I saw him so that he didn’t get too violent with me. I didn’t work with him by himself though! He also started pool therapy for occupational therapy. We didn’t think he would do well with speech therapy before or after the pool, so we sort of combined the therapies. We went to the pool and helped him get changed and used a visual schedule to prepare him for the pool. After being in the pool, we took him back and got him ready to go. I had never seen autistic children like this before. It was fascinating in a sad sort of way.

The last patient I’ll share is about a little boy about 3 ½. He is being seen because he doesn’t speak much. Apparently, he has made progress before the summer. This child seems to need some discipline. The last few weeks when we’ve tried to get him to say his words he pouts and says, “NO!” It gets pretty annoying. I also think some of this child’s problem is his environment, especially his mother. Apparently her other 2 children (teenage or older) have been in trouble with the police. My last day we saw this boy. He had a fever, but his mom brought him in anyways. Wednesday, my first day of vacation, I got a call from my supervisor. After we did therapy with this boy, his mother took him to the hospital. He was diagnosed with Swine Flu. Because my supervisor, the occupational therapist, and I all had contact with him, the hospital wanted us to take some medicine to help prevent us from getting sick. Andrew and I drove to Wytheville Wednesday night to pick up my medicine. Thankfully I’m still healthy. Hopefully it will stay that way!

That’s just a few of the stories from my externship this summer. In the fall I should be at the elementary school down the road. That will be very convenient because it will be within walking distance. When that externship is completed, I will be graduating with my master’s! I’ll post more about the externship when the time comes.

We see a large variety of patients in the rehab unit. So far the age range is about 16 months to 85 years. A lot of the patients come in for swallowing treatment. We place small electrodes on the neck or face which provide electrical stimulation to the muscles. This helps strengthen the muscles. The toddler and school age children are there for articulation, language, or auditory processing. The two children under 2 have trouble with swallowing, so we do oral motor exercises with them. There are several voice patients as well. Usually, voice patients are few and far between, but I’ve gotten some good experience with them. One had a total laryngectomy (where muscles, bone, and cartilage from the epiglottis to the trachea are removed so there aren’t any vocal folds to use for speech) and uses an electrolarynx. Another has one vocal fold that is very weak and doesn’t move much. Another patient (a preacher) just had cysts removed from his vocal folds so we are teaching him how to use his voice correctly. There are also a few patients who have aphasia as the result of a stroke.

Two of the most interesting patients are both in their 80s. The one was a medical doctor who was still practicing until he had his stroke. He is so sweet and is making a lot of progress, although he can’t really say much yet.

The other patient is there for a swallowing disorder. He has been putting his food in a blender and eating it that way for 10-15 years! The first time I saw him he was given some fruit to eat. He had eaten some and then said he was finished. My supervisor didn’t think he had swallowed very much for the amount he had eaten, so she had him open his mouth. Sure enough, he hadn’t really eaten any of the fruit. He had pocketed it all in his cheeks. He said he didn’t want us to feel bad because he couldn’t eat it, so he stuffed it in his cheeks and was going to spit it out after he left. Apparently he does this around other people. Aside from that story, he is a funny man and makes me laugh.

So far things at the hospital have been pretty slow. We’ve done several modified swallow studies where food is coated with barium and the patient swallows this food while an x-ray is taken. We watch the x-ray to see how the food is swallowed and if any of it goes into the airway. We’ve also seen 3 patients admitted to the hospital. So far I’ve just watched my supervisor evaluate those 3 patients.

I still have most of the summer to go for my externship. Hopefully I will continue to enjoy it even though I don’t care for the long drive (45 min one way). I’ll try to periodically update any interesting stories throughout the summer.

My first client was about 9 and came because he couldn’t say his “r” sound. He had attended clinic the previous spring, but hadn’t been back since. However, during the first session he said every single “r” correctly. During the year he wasn’t in clinic he began to use “r” correctly. Since there was nothing to help him with, he was dismissed after the second session.

It took a few weeks for me to get a new client. This one was coming for accent reduction. He was a new client and wanted help because he thought he had a very thick Spanish accent. I say “thought” because his accent wasn’t very thick at all. He was a 6′ 5 black man, and I felt very small standing next to him. We enjoyed working together. We worked on vowel sounds and using final consonants. He made progress. He was a very nice man. My classmates and teachers would see me walking with this huge man down the hall and would later ask if that was my client and comment on how tall he was.

My other client came once a week for stuttering. He made a lot of progress the previous semester, but I didn’t see as much this semester. We also worked on being descriptive in writing. His stuttering wasn’t too severe, but he also didn’t seem too interested on working to keep from stuttering.

For diagnostic clinic I had a partner. We spent a few hours doing speech and hearing screenings at a nearby preschool. The kids were so cute! Then we had 3 different kids where we did more specific testing. All 3 were between the ages of 3-5. The first boy came because of articulation concerns, but we determined his errors were age appropriate. The second girl was so cute and sweet, but we couldn’t understand a word she said. She was hard to test because we weren’t sure what she was saying, so we didn’t know if she was giving the right answers or not on the language portion of the test. The third girl didn’t talk much at all. She was shy and wanted her mom in the room. We had a hard time testing her as well. We ended up referring both girls to the clinic.

Diagnostics was difficult because I didn’t get along with the supervisor. She also took forever to edit reports. We would do multiple drafts and each time she would change different things or change things she had added in. She also tended to add in puncuation and grammar mistakes. She was very frustrating to both my partner and me.

This Tuesday I begin my externship at Wythe County Community Hospital. I’m sure it will be a very interesting experience.

I had two clients last semester. Both were nonverbal. The irony of it struck me at the end of the semester… I was doing speech therapy on two people that couldn’t speak!

My first client was an almost four year old girl with autism. She has been coming to the clinic for several years. She seems to have the  intellectual functioning of about a 1-2 year old.  She is a pretty girl and sweet until she doesn’t get her way. When she doesn’t get what she wants she throws a tantrum and screams and cries. Thankfully she is not violent. She constently hummed and experimented with her voice using vowels. I found out at the end of the semester that’s typical with autism. Because her communication was so limited she would take my arm and direct it toward an object she wanted but couldn’t get to. She loved bubbles and would smile and laugh and pop them for hours if allowed. I worked with her alone one hour a week. During that time we worked on getting her to look to request. I would deny the object or action until she looked at me. This often resulted in her crying. One hour a week she was in a group session with another autistic girl the same age. Another client was a 29 year old non-verbal boy with Rubenstein Taybi syndrome at about a 5 year old cognitive level. We had some fun experiences in group therapy!

My second client was a 66 year old woman. She had a stroke in 2001 and a stroke on the other side of her brain in 2005. She has aphasia (cognitive impairment), apraxia (no volitional control in motor planning and sequencing), and dysarthria (muscle weakness). Due to the apraxia and dysarthria she couldn’t speak. She had a laptop with some programs on it to help her communicate, but she wasn’t very good with it. Her husband really wanted her to be able to speak. During the semester we worked on oral motor muscle exercises to increase muscle strength, vowel sounds and typing on her laptop. She greatly improved on her communication speed with her laptop. She worked very hard and was a good client to have.  Oh by the way, she was trilingual and taught Spanish and French before her stroke (Spanish is her first language).

So, although I had some tough clients, I learned a great deal from having them. This semester I have two boys, and I will be working with them on articulation and stuttering. That is about all I know since I just got the assignment today. Hopefully I won’t wait until the summer to post about them!

My client began making some progress. Of course he has a long ways to go and will probably be in therapy for several more years. His mom said that she’s noticed his speech improving as well. That’s great news!

I want to explain what I did during the second hour of therapy (my last post about therapy talked about the first hour). During the second hour my partner Jenn brings her client over and we do group therapy. We focus on pre-literacy skills because research shows that children with a phonological disorder are at risk for later literacy problems. The boys are about the same age. It was funny at first because they didn’t interact with each other much at all. They grew more comfortable with each other, but I wouldn’t say they had become friends by the end of clinic. They eat a snack while we read them a book. They take a LONG time to eat.

We also do this silly little thing that goes “Bippity Bippity Bumble Bee, tell me what your name should be.” Then we say someone’s name and clap out the syllables. Jenn’s client can be a pill and he never clapped. My client would clap sometimes. We would clap out all of our names.

Our theme for the summer was Crazy Creatures Camp. Each week we focused on a different animal theme. We did Insects, In flight, Zoo animals, Farm animals, Seuss creatures, and Underwater. Having a theme helped us plan the activities.

Crazy Creature Camp

Then we introduce a word of the day followed by the letter of the day. Our goals were to teach the boys several new letters in both identification and sound. Then we would have activities where we would have them build something. Before they could put a piece up they would either have to look at a word and find the letters we were learning, listen to a sound and identify what letter it goes with, or listen to a word and identify what sound the word starts with by matching it to the letter. We did things like put spots on the giraffe, put bees in a hive, and build a caterpillar’s body.

Caterpillar Game

The boys loved the caterpillar activity. Our supervisor thought it was hilarious that the boys were practically pushing each other out of the way to take their turn. Jenn is artistic, so she drew a lot of these things.

By the end of the summer both boys met their goals of learning new letters. We were very pleased.

All I have left of summer school is a meeting with my supervisor to tie up loose ends of clinic. Then I get 5 ½ weeks of summer vacation!!