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- 200 E. Court St. Suite 708
- Yakos Therapy, Inc.
Treatment goals target imitation and following directions initially. We work on attending to cues and turn taking during play activities. We use recasting of target sounds during the play activities and provide reinforcement for any attempts to imitate either the sounds or play sequence. Once the child is familiar with therapy routine and following directions, we attempt to increase the number of vocalized imitations to target these sounds or syllables in mass practice. We continually probe for new sounds to add to the repertoire and use play activities to provide input about how sounds are made and the varied qualities of sounds. For example, as we stack blocks we prolong the vowel sound as we bring the block up, then let it click as we finish the word with the plosive /p/. Our treatment sequence will target the level one single vowel sounds in isolation, and then move to target diphthongs. I use PROMPT cues to provide help with motor planning for sounds and give feedback for jaw grading, lip rounding or retraction, and tongue movement. As we target the vowels, I will attempt to get consonant sounds as well and pair the vowel consonant combinations in CV and VC syllables. We always target syllable beat and rhythm using music. I use the CDs from Northern Speech Services with the video and some of the SUPER SIMPLE songs on youtube. We use rhythm sticks and shaker eggs. We target morphological endings and sentence structure. Even though the child is not able to produce the sounds, we are able to hear the appropriate number of syllable beats in imitation attempts. This results in increased awareness of expressive language grammatical rules, so when the child is able to produce the syllables in longer utterances, they are able to move in to using correct morphological endings and syntax. We provide our children with opportunities to engage in social language groups and may offer a few sessions where there is a half hour of individual treatment followed by 1/2 hour in a social language group setting. Our sessions last an hour, so we are able to provide therapy using a distributive practice approach and address various goals.
We have attended various continuing education workshops. Every year we attend the Illinois Apraxia Walk and sponsor our families who also attend. We have provided information for the Migrant Head Start in our community during our teacher training sessions. We take advantage of community outreach opportunities, such as MOPS group meetings, teen mom education, local hospital baby fairs, and Success by Six meetings and provide information about early detection and the importance of starting treatment in Early Intervention. We provide Early Intervention services.
Our parents are present for the entire session and provided with information regarding use of recasting in the home setting to reinforce sound awareness and provide feedback without criticism. We do not send home practice assignments until we are certain the child is able to produce the targets with accuracy to improve coordination rather than negative practice. We use the frequent recasting power point that Caroline Bowen developed to provide training in the use of this technique and encourage parents not to put pressure on the child to "say" so we can give them time to process the information. We show parents what to look for as a child progresses: attending to cues, posturing, vocalizing attempts... We instruct parents to reinforce attempts and let them know we are asking a child to do something that is tremendously difficult for them so it is important to reward them when they attend to cues. As the child progresses, we have some take home materials for practice i.e. interactive books with ASL signs to encourage gestural communication, picture choice folders to provide another option for communication breakdowns in the home setting, and material to provide fun practice of target syllables at home.
We use PECS for choice making and requesting during our sessions. Our families are provided with a PECS folder to use at home to help with communication breakdowns and provided the option of purchasing a PECS binder. We use ASL signs and give children the opportunity to request using multiple modalities. We use the picture system and ASL to provide opportunities to request using increased length of utterance and practice with pronoun/verb phrases, adjective/noun... phrases or sentences. A few of our children are using the NOVA CHAT SGD. In addition, we use various apps during therapy.