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- Teletherapy in Washington
For clients who are toddler or preschool age (2-4) therapy sessions will focus on parent coaching for techniques to use at home until the child is able to interact with imitation requests.
As an SLP who is primarily telepractice, I can also provide initial home visit sessions in my location for assessment and rapport, then move to teletherapy sessions. For more distant clients whose parents can participate with cameras a telepractice motor speech assessment can be included in the complete remote speech sound assessment. Language and stuttering assessments are also available via telepractice.
After CAS assessment, with parent and client input, a tentative initial target word list for therapy will be created. This list will be 5-10 words that are useful to the client's everyday speech and utilize sounds the client already has, in order to focus on more accurate movement and sequencing. This will start the process of training the brain planning for speech movements to become more intentional and accurate.
During sessions, at first, target words will be demonstrated and the therapist will glean information on the client's ability to accurately sequence the vowel and consonants to produce each target word, levels of cuing and difficulty will be dynamically adjusted as the client requires more support or increases consistent accuracy. Strategies of cueing may involve specific verbal instructions such as 'open the jaw more' or 'close the lips to start', and then moving gradually up to less specific cuing like 'that wasn't quite right, can you fix that?' Levels of difficulty will dynamically change, beginning with simultaneous production (the clinician and the client say the target word together), moving to requiring only a mimed model from the clinician, then to immediate imitation, then to delayed imitation, and finally to producing the target word independently in response to various verbal or visual stimuli. In addition, initially, one target word may be focused on in blocks of drills, without practice on other target words, until it can then be targeted randomly in sessions.
As mastery at the independence level is gained, the target word set will have replacement target words. Another component to solid progress will be utilizing various natural intonation patterns at all levels of difficulty, in order to engage this component of motor planning for accurate and functional sequencing and to avoid 'robot speech'. Homework of target words that have reached the independent/random level in therapy will be provided to parents, with coaching on how to implement the homework.
I have completed the pre-requisite DTTC online courses, in anticipation of joining an in-person DTTC 2-day workshop when they become available again after the pandemic. From an SLP perspective I frequently support parents on Facebook groups with their questions about apraxia, phonological delays, language delays, reading impact and obtaining school services. I follow apraxia gurus on Instagram and Facebook to keep abreast of offered ongoing educational opportunities to increase and hone my skills for evaluation and treatment of speech sound disorders.
Parents are critical to client's progress. Parents will be involved in initial and subsequent target word selection for functional communication. It is highly desirable that parents participate by watching each session, observe client intent and know target words at accurate spontaneous production. When client has achieved spontaneous production in two consecutive sessions on specific target words, these words will be sent home for homework; parents will be coached in how to implement the homework to facilitate carry over outside of the speech room.
While there are concerns by some parents that use of AAC can become a crutch and inhibit verbal speech development, research shows that it can decrease overall communication frustration and in many cases actually foster verbal speech development. Trials of low tech picture systems can be provided as indicated during therapy (samples mailed for trials, etc), as well as trials of tablet/iPad AAC software.