AAC Myth Busting

Augmentative and Alternative Communication, or AAC, is instrumental for effective, efficient, and successful communication, especially for those with communication and speech disorders. Myths surrounding AAC can prevent families, individuals, and even some therapists from supporting AAC usage. Here are some of the top myths about AAC and why these myths are indeed, just myths.

Myth: Use of AAC discourages or hinders verbal speech production

Perpetrators of this myth believe that AAC will cause individuals to lose interest in talking or that they will only want to use AAC to communicate. Research studies show that AAC does not have a negative impact on verbal language (Millar et. al, 2006). Rather, AAC can actually support and encourage verbal language development. AAC is also beneficial for all-around development, as it supports expressive language skills, receptive language skills, literacy skills, play skills, social and pragmatic skills, behavioral skills, and frustration tolerance (Light et al., 2003; Millar et al., 2006).

Myth: AAC is only for pre-verbal or non-verbal individuals

Although AAC is extremely beneficial for those who do not speak, it is not exclusively reserved for these individuals. The term “augmentative” (the first “A” in AAC) refers to the use of communication systems to supplement speech. If an individual has limited verbal speech or demonstrates decreased understandability, AAC can help them effectively communicate. For example, people with motor-speech disorders often demonstrate decreased understandability due to muscle weakness, muscle incoordination, and/or planning/sequencing difficulties of the muscles involved in speech production. Even though these individuals have the ability to speak, they benefit from AAC to supplement their message when they cannot be understood or when they do not have the capability to produce the desired message. “Alternative” (the second “A” in AAC) refers to the use of systems by individuals with no-verbal communication.

Even individuals with intact verbal communication skills use AAC on a daily basis, as AAC emcompasses all of the ways that we communicate outside of talking. Use of facial expressions, body language, texting, emailing, gestures (e.g, waving, holding a finger up to the lips to indicate “shhh”), holding up objects, pointing to pictures, and writing are just a few examples of everyday AAC systems.

 

 

Myth: Children must reach a certain age or have certain prerequisite skills to use AAC

There is no evidence to suggest that children must be a certain chronological age to use AAC. Rather, introducing AAC during infancy and toddlerhood can have a positive impact on a child’s brain development. The National Scientific Council on the Developing Child (2007) reported that enriching experiences during infancy and toddlerhood (such as using AAC) establishes foundations for later brain development, which helps improve a way a child thinks and regulates emotions.

There is also no evidence that children need certain prerequisite skills to use AAC. In the past, children with cognitive or sensorimotor impairments were often excluded from AAC usage due to absent foundational skills. However, children with cognitive and sensimotor impairments have been shown to effectively implement and use AAC, provided individualized support. Further, implementing AAC with children with cognitive or sensorimotor deficits can have a positive impact on their global development (Ganz et al., 2011; Ganz & Simpson, 2018; Kasari et al., 2014; O’Neill, Light, & Pope, 2018; Romski et al., 2010; Walker & Snell, 2013). AAC can also enable children to demonstrate their cognitive abilities, especially in those who do not yet speak or have a reliable way to communicate. 

In short, no matter a child’s age or ability level, AAC promotes brain development and provides a way for a child to improve in a variety of developmental areas.

 

 

Myth: You must have good motor skills to use a speech-generating AAC device.

As stated above, there are no prerequisites for using AAC. Just as there are many different types of AAC systems, there are also a variety of ways to activate these systems. For individuals with significant motor impairments, eye gaze technology (using equipment to track eye movements) and switch scanning (activating a switch using a specific body part) are two of the most widely used access options. One of the most famous scientists of the 21st century, Dr. Stephen Hawking, lost voluntary muscle control throughout the majority of his body due to ALS. He activated his AAC speech-generating device using his thumb, then a switch mounted to his glasses, which picked up on small movements in his cheeks and face (DO-IT, 2021). Recently, researchers have helped completely paralyzed individuals activate AAC systems using just their breath and have even successfully found a way to activate devices using just the brain (Elsahar et. al., 2018; Moses et. al., 2021)

Individuals with vision, hearing, and other physical impairments are also able to access and use AAC systems, provided appropriate equipment and support. A team of professionals (occupational therapist, physical therapist, audiologist, vision specialists, etc.) should collaborate to help determine the best activation method for AAC based on an individual’s strengths and needs.

 

Myth: Children should start with low-tech AAC before moving on to high-tech AAC

Children do not have to demonstrate competence with a low-tech AAC system before moving toward a high-tech AAC system. (Don’t know the difference between low-tech and high-tech? Check out the previous blog post for more information!)

Since every child has different needs, strengths, skills, environments, and support systems, AAC should be selected based on those criteria, rather than a one-size-fits-all approach or progression. Further, since communication is most effective when it is multimodal, a combination of unaided systems, as well as aided low-tech and high-tech systems can be used in conjunction with one another to help provide the best functional communication outcomes.

A speech-language pathologist, as well as other healthcare professionals, can assist in the assessment, recommendation, and trialing of a variety of systems and modalities to determine the best fit for an individual. Even if a system is successful, modifications to the system or a replacement of the system may be necessary based on progress, changes, personal preferences, and other developmental factors. Flexibility, collaboration, and consistency is necessary for effective AAC interventions.

 

Questions or concerns?

If you have questions or concerns about your child’s communication skills, please contact us at info@playworkschicago.com or (773) 332-9493. The Speech-Language Pathology team and the Assistive Technology team are available to provide individualized AAC recommendations based on your child’s needs.

 

Nicole Sherlock, MA, CCC-SLP

Speech-language pathologist

Assistive Technology Co-Coordinator

 

Common myths about AAC (augmentative & alternative communication). Common myths about AAC (Augmentative & Alternative Communication) – Tobii Dynavox. (n.d.). https://www.tobiidynavox.com/learn/what-is-aac/common-questions/. 

Elsahar, Y., Bouazza-Marouf, K., Kerr, D., Gaur, A., Kaushik, V., & Hu, S. (2018). Breathing Pattern Interpretation as an Alternative and Effective Voice Communication Solution. Biosensors, 8(2), 48. https://doi.org/10.3390/bios8020048

Ganz, J.B., Earles-Vollrath, T.L., Mason, R.A., Rispoli, M.J., Heath, A.K., & Parker, R.I. (2011). An aggregate study of single-case research involving aided AAC: Participant characteristics of individuals with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 1500–1509. doi:10.1016/j.rasd.2011.02.011

Ganz, J., & Simpson, R. (2018). Interventions for individuals with autism spectrum disorder and complex communication needs. Baltimore, MD: Paul H. Brookes.

Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., … Almirall, D. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 635–646. doi:10.1016/j.jaac.2014.01.019

Light, J. C., Beukelman, D. R., & Reichle, J. (2003). Communicative competence for individuals who use AAC: From research to effective practice. Brookes Publishing.

Millar, D.C., Light, J.C., & Schlosser, R.W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49(2), 248–264.

Neuroprosthesis for Decoding Speech in a Paralyzed Person with Anarthria. Moses DA, Metzger SL, Liu JR, Anumanchipalli GK, Makin JG, Sun PF, Chartier J, Dougherty ME, Liu PM, Abrams GM, Tu-Chan A, Ganguly K, Chang EF. N Engl J Med. 2021 Jul 15;385(3):217-227. doi: 10.1056/NEJMoa2027540. PMID: 34260835.

National Scientific Council on the Developing Child (2007). The Timing and Quality of Early Experiences Combine to Shape Brain Architecture: Working Paper #5. http://www.developingchild.net

O’Neill, T., Light, J., & Pope, L. (2018). Effects of interventions that include aided AAC input on the communication of individuals with complex communication needs: A meta-analysis. Journal of Speech Language and Hearing Research, 61, 1743–1765. doi:10.1044/2018_jslhr-l-17- 0132

Romski, M., & Sevcik, R. (2005). Augmentative Communication and Early Intervention. Infants & Young Children, 18(3), 174–185. https://doi.org/https://depts.washington.edu/isei/iyc/romski_18_3.pdf 

Romski, M., Sevcik, R., Adamson, L., Cheslock, M., Smith, A., Barker, R., & Bakeman, R. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 53, 350–364. doi:10.1044/1092-4388(2009/08-0156)

University of Washington. (2021, April 9). Dr. Stephen Hawking: A Case Study on Using Technology to Communicate with the World | DO-IT. DO-IT: Disabilities, Opportunities, Internetworking, and Technology. https://www.washington.edu/doit/dr-stephen-hawking-case-study-using-technology-communicate-world

Myth: Young Children Must Wait Until They Can Use AAC. Tobii Dynavox (n.d.).

http://tdvox.web-downloads.s3.amazonaws.com/MyTobiiDynavox/Pathways_SCF_Myth-Young%20Children%20Must%20Wait%20Until%20They%20Can%20Use%20AAC_v1-0_en-US_WEB.pdf

Photo by Volodymyr Hryshchenko on Unsplash

Photo by Stephen Andrews on Unsplash

Photo by Palle Knudsen on Unsplash

Let’s “talk” about AAC!

What does smiling at a neighbor, sending a text, and ordering food by pointing to menu pictures have in common? They are all examples of AAC. By writing this blog, I am utilizing AAC to convey this message to you. So, the question is…

 

What is AAC?

Augmentative or Alternative Communication (AAC) refers to all the ways that we convey our thoughts and feelings without talking. Our world is full of AAC and for good reason- AAC is essential for well-rounded and effective communication across all stages of life. 

Individuals with speech, language, or voice disorders especially benefit from use of AAC to help increase their functional communication skills (Drager et al., 2010). Research has shown that use of AAC can increase expressive language skills, increase language comprehension, increase positive behaviors, increase social competence, and even support verbal language skills (Light et al., 2003; Millar et al., 2006).

People with communication disorders may benefit from additional support to incorporate AAC into their daily lives. Speech-language pathologists are trained to assess, recommend, and implement AAC with clients, based on their strengths and needs. At PlayWorks, we empower clients by using various types of AAC throughout therapy, as well as encourage AAC in home carryover activities.

 

What are the types of AAC? 

There are two general categories of AAC: unaided and aided systems.

Unaided AAC refers to the use of the body to communicate. Examples of unaided AAC include:

  • facial expressions
  • gestures
  • body language
  • sign language
  • non-word vocalizations (i.e., laughing, crying, cooing)

Aided AAC refers to communication supported by supplemental tools or equipment. These tools can be categorized as either low-tech AAC and high-tech AAC. Low-tech AAC includes tools that do not involve electronics or use of batteries. Examples include:

  • Writing
  • Objects
  • Pictures and symbols
  • Picture Exchange Communication System (PECS)
  • Communication boards or books

High-tech AAC refers to tools that use electricity, electronics, or batteries to operate. Some examples include:

  • Speech-generating devices
  • Recorded or digitized buttons/devices (such as the Staples “easy” button)
  • Computers (e-mail, texts, etc.)
  • AAC software on tablets, computers, phones, and other devices

Many dedicated high-tech AAC systems have supplemental equipment available that makes communication access and transportation easier. For example, certain devices have external speakers to help others better hear the speech-generated message. Cameras may be attached to track eye movements for those people who use eye gaze to create their messages. Devices may have special stands or carrying cases to make them more accessible for those in wheelchairs.

At PlayWorks, we support the use of low-tech and high-tech AAC by creating custom communication boards, using props or objects, and utilizing AAC applications on speech-generating devices.

 

Determining AAC needs

Communication is most effective when it’s multi-modal, or occurs in a variety of ways. Therefore, in order to best support individuals with communication delays and disorders, it’s important to implement and teach both unaided and aided AAC. Research shows that no prerequisite skills are required before starting AAC (Light & McNaughton, 2012; Snell et. al, 2010). However, it is important to consider a variety of personal factors when starting, including:

  • Current profile (physical/motor, language, cognitive, sensory, etc.)
  • Strengths and areas of need
  • Available communication partners
  • Setting or contexts in which the person will need to communicate
  • Resources available to both the individual and the communication partners
  • Individual preferences

Your therapy team will then use this information to determine which AAC tools and strategies will be most appropriate to trial, implement, and possibly purchase!

No matter a person’s age or ability level, AAC is a fundamental part of increasing functional communication. In my upcoming AAC blog posts, I will address common misconceptions surrounding use of AAC and expand upon ways to support an individual in their AAC journey. 

 

Questions or Concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9493. The Speech-Language Pathology team and the Assistive Technology team are available to provide individualized AAC recommendations based on your child’s needs.

Nicole Sherlock, MA, CCC-SLP

Assistive Technology Co-Coordinator

 

Citations & References:

American Speech-Language-Hearing Association. (n.d.). Augmentative and Alternative Communication (AAC). https://www.asha.org/public/speech/disorders/aac/. 

American Speech-Language-Hearing Association. (n.d.). Augmentative and Alternative Communication (AAC). https://www.asha.org/practice-portal/professional-issues/augmentative-and-alternative-communication/#collapse_1

Crowe B, Machalicek W, Wei Q, Drew C, Ganz J. Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature. J Dev Phys Disabil. 2021 Mar 31:1-42. doi: 10.1007/s10882-021-09790-0. Epub ahead of print. PMID: 33814873; PMCID: PMC8009928.

Drager, K., Light, J., & McNaughton, D. Effects of AAC interventions on communication and language for young children with complex communication needs. Journal of Pediatric Rehabilitation Medicine. 2010;3(4):303–310. doi: 10.3233/PRM-2010-0141.

Is My Child Doing What They Should? Milestones from 1 to 5 years

 

Do you ever find yourself comparing your child to their peers at the park or playground? Or maybe even comparing them to their older sibling? Do you feel like they are behind with their motor skills? What truly is “age appropriate”? In this post, we will cover age-appropriate milestones from age 1 to 5 years and what to do if your child isn’t hitting their milestones on time. 

What are developmental milestones?

Developmental milestones are physical signs of development that provide information with regards to your child’s development. There are milestones for each age range that will slowly emerge over time. Each child will develop on their own individual timeline, so keep in mind that some children may skip over milestones, while others may need a little bit more time to get where they should be. 

1 year

At 1 year, children are crawling well and begin to pull up into standing and walk while holding onto furniture (“cruising”). They may stand alone and take a few steps without holding on. At this age, it is best to provide many safe places for your child to explore. Using furniture such as a couch, coffee table, or ottoman is great for working on standing and cruising. 

18 months

At 18 months, children are walking quickly on their own. They are able to pull toys while walking and climb up into chairs without help. At this age, you can encourage development by continuing to provide safe areas for your child to walk and move around. Provide toys that your child can push or pull and balls to kick, roll, or throw. Bubbles, blocks, puzzles, and books are great toys to use at this age. 

2 years

Around 2 years of age, children begin to stand up on their tip toes to reach for objects placed up high. They are filled with energy—running, jumping, and climbing. They are now able to go up and down stairs while holding onto the railing or wall and stepping with both feet on each step. At this age you can work on walking backwards and ball skills such as rolling and kicking a large ball back and forth. Take your child to your local park or playground and encourage climbing and walking on different surfaces. 

3 years

By 3, most children are able to ride a tricycle (3-wheel bike). They are climbing well,running easily, and jumping off of surfaces. They are also able to walk up and down stairs on their own, with one foot on each step. To encourage development at this age, actively play and exercise with your child rather than having them passively watch a screen or TV. Allow your child to help with chores and carrying things. Get outside and have your child interact and play with other children. 

4 years

At 4 years, your little preschooler is able to hop on one foot and stand on one foot for more than 3  seconds. Most of the time, they are also able to catch a playground ball that is bounced or tossed to them and are showing improved accuracy in throwing4 year olds love to try new things and participate in make-believe play. You can work on these skills while playing pretend and building imagination with your little one. 

5 years

Around 5 years, you should expect your child to run fast to a target and turn around quickly to change directions. They can catch and throw a small ball, walk on a balance beam forwards and backwards, and stand on one foot for approximately 10 seconds. They may be able to skip or this skill might still be emerging. In order to work on their motor skills, arrange play dates and trips to the park with peers. You can also explore your child’s interests in your community whether it be trips to the zoo if they’re interested in animals or joining a gymnastics program at your local gym if they love to monkey around at the playground.

What if my child is behind?

If you are reading through the above milestones and have concerns about your child, it would be beneficial to first schedule an appointment with your pediatrician for a developmental screening. If the child presents with suspected delay, your doctor can then refer your child to a Physical Therapist (PT) for an evaluation. A physical therapist can use a standardized assessment tool in order to compare your child to their same-age peers. If a delay is indeed present, physical therapy services may be recommended in order to work on motor development, strength, balance, etc. 

Questions or Concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9493. 

Elle Faerber, PT, DPT

Physical Therapist 

 

References: Important Milestones: The Children’s Hospital of Philadelphia. (2014, May 05). Developmental Milestones. Retrieved from https://www.chop.edu/primary-care/developmental-milestones 

Your Baby By Five Years. (2021, May 17). Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-5yr.html 

Photo Credit: Photo by Joshua Choate from Pixabay

Congenital Muscular Torticollis: What is it and how can I help my child?

Infant smiling while laying on back

You may have heard the strange medical term “torticollis” from your pediatrician, neighbor, or friend. Frankly, it can be overwhelming and quite confusing to understand. In this post, we will review what torticollis is, reasons why babies may develop a torticollis, what parents can look for if they have concerns, associated impairments if left untreated, and tips on ways to prevent torticollis. 

What is torticollis?

The term torticollis is Latin for “twisted neck”. Congenital muscular torticollis (CMT) describes the posture of the head and neck caused by shortening or tightness of the sternocleidomastoid (SCM) muscle. This rope-like SCM muscle starts at the collarbone and sternum and inserts into the skull behind the ear. When this muscle contracts or is tight, it will cause the head to tilt towards the side of the muscle and rotate away from the involved SCM muscle. With this tightness, weakness on the opposite side of the neck may result. A torticollis is named for the side of the involved SCM muscle, either right or left.

What causes torticollis?

There is little agreement on what causes CMT. The most widely accepted theories include a difficult delivery requiring use of a vacuum or forceps and unusual positioning inside the uterus. Other risk factors for CMT include large birth weight, male gender, breech position, multiple birth, a primiparous (pregnant for the first time) mother, difficult labor and delivery, nuchal cord, and maternal uterine abnormalities.

What will a torticollis look like?

A baby with torticollis may present with the following: 

  • Tilt their head in one direction
  • Prefer looking at you over one shoulder rather than turning to follow you with his or her eyes
  • If breastfed, he or she may have trouble breastfeeding on one side or prefer one breast only
  • Have difficulty turning his or her head in one direction 
  • Some babies with torticollis will develop a flat spot on their head (plagiocephaly) caused by lying with their head consistently turned to one side
  • A small lump or “ropey” knot may also be felt in the neck due to a tight and tensed muscle. 

What can happen if a torticollis is left untreated?

An infant with CMT will be unable to have symmetrical movement of their head due to range of motion (ROM) and strength imbalances. If left untreated, associated impairments include jaw asymmetries, ear displacement, facial asymmetries, plagiocephaly, scoliosis (a curved spine), pelvic deformities and movement patterns that may affect normal development. 

What can you do?

If you have concerns that your child has torticollis or plagiocephaly, schedule an appointment with your pediatrician. Your doctor may teach you stretches and strengthening exercises to practice at home. They may also suggest taking your baby to a physical therapist (PT) for treatment. The skull is most malleable and with rapid brain growth during the first 3 months of life. This brain growth slows around 5-6 months. The sooner you address torticollis and plagiocephaly (especially before 6 months), the better and faster the outcomes!

While it is best for your baby to sleep on their back, incorporating various positions during supervised and awake playtime is great for strengthening his or her neck muscles. This includes tummy time, side-lying, and supported sitting. If your baby has a flat spot on their head, these positions can also help by relieving pressure off this area. You can do tummy time on the floor, on your chest, or even across your lap! Encourage your child to use their neck muscles to follow you or a toy with their eyes and head, especially turning their head to the side they least prefer. Start by working on this for 10-15 minutes total each day, gradually increasing as your child tolerates more. 

Another good way to encourage your baby to turn their head to their least preferred side would be to modify their room environment. This may include positioning their crib next to a wall rather than in the middle of their room. This will encourage your baby to use their weaker neck muscles to turn their head away from that non-exciting wall in order to look at whatever is interesting in their room. 

Questions or concerns?

If you have questions or concerns about your child potentially having torticollis or plagiocephaly, please contact us at info@playworkschicago.com or 773-332-9493. 

 

Elle Faerber, PT, DPT

Physical Therapist 

 

References: Campbell, S. K., Palisano, R. J., & Orlin, M. (2012). Physical therapy for children. Saunders. 

“Infant Torticollis.” Home – Johns Hopkins All Children’s Hospital, www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Infant-Torticollis. 

Photo Credit: Photo by Pexels at pixabay.com

Phonological Processes: What are they and is my child using them?

Do you find yourself asking your child to repeat what they said, utilizing your detective skills to figure it out, or perhaps acting as your child’s commentator for people that are less familiar with their speech? We know that children can sometimes be difficult to understand when they are learning to speak. It can be tricky to know if this is part of typical development or if your child would benefit from support. In this post, we will help you understand phonological processes and their potential impact on your child’s overall speech intelligibility.

What is typical for intelligibility?

Intelligibility refers to the amount of speech that is readily understood by a listener. A good standard for how well children can be understood by their parents is as follows:

  • By 18 months, a child’s speech is typically 25% intelligible
  • By 24 months, a child’s speech is typically 50-75% intelligible
  • By 36 months, a child’s speech is typically 75-100% intelligible

What are phonological processes?

Phonological processes are predictable developmental patterns that children use to simplify their speech as they are learning to talk. Your child might use these patterns if they are not developmentally ready to coordinate all of the precise movements required for production of certain sounds or syllable shapes that are more complex. For example, your child might refer to a cookie as “tootie” or a banana as a “nana.” Depending on your child’s age and stage of development, the use of these processes can be considered typical or can indicate a need for further evaluation. The chart below (from Mommy Speech Therapy) outlines the different phonological processes, their definitions, examples of each, and the approximate age at which these processes are typically eliminated as part of development, beginning around age three.

http://mommyspeechtherapy.com/

When should I seek support?

If your child uses these processes in their speech for longer than expected, uses many different processes, and/or uses processes that are less typically seen in development, their overall intelligibility can be impacted, leading to difficulties being understood by adults, peers, and other communication partners. In this case, your child could benefit from evidenced-based, individualized support to facilitate acquisition of age-appropriate phonological skills.

What else can I do?

Your child’s speech-language pathologist can help to determine which phonological processes your child is currently using and whether or not therapeutic intervention is indicated. If so, your child’s therapist will develop individualized goals and implement an evidenced-based treatment approach. Your child’s therapist will work with you to establish a home practice program in order to facilitate generalization of skills learned in therapy across environments and communication partners. If your child does not yet have a speech-language pathologist and you are concerned about their overall intelligibility or use of phonological processes, please contact our office to schedule a screening or a full evaluation with one of our experienced clinicians.

 

Questions or concerns?

If you have questions or concerns about your child’s overall intelligibility or use of phonological processes, please contact us at info@playworkschicago.com or 773-332-9439.

 

Ana Thrall Burgoon, MS, CCC-SLP

Speech-Language Pathologist

 

References: Bowen, C. (2011). Table 1: Intelligibility. From Speech-Language-Therapy.com. Retrieved March 15, 2021.

Phonological Processes. From Mommy Speech Therapy. Retrieved from http://mommyspeechtherapy.com/wp-content/downloads/forms/phonological_processes.pdf. Retrieved March 15, 2021.

 

Photo Credit: Photo by Kindred Hues Photography on Unsplash

April Showers Bring Sensory Powers!

Not only do April showers bring May flowers, but with these rainy days also come the perfect opportunity to have your child engage in fun and exciting indoor sensory activities to get their creativity flowing!

At-Home Olympics

Photo Credit: PublicDomainPictures via Pixabay

Do you love watching the Olympics? Now you can create your own version at home! At home Olympics can be a creative and fun way to provide your child with proprioceptive input as well as vestibular input. Proprioception is the sensory system that allows our body to understand where we are in space through our joints. Have your child participate in tug-of-war challenges to squeezing pillow challenges to provide this input. The vestibular system allows our bodies to understand what orientation our body is in space, how fast we are moving, and in what direction. Creating challenges from animal walk races to long jumping challenges can provide your child with the vestibular input they are seeking!

Scavenger Hunts

Photo Credit: iheartcraftythings

Scavenger hunts are a great way to provide your child with sensory input when cooped up inside from the rain. Have your child go on a scavenger hunt for different colored items, textures, or even smells. Provide additional sensory input by using animal walks to search room to room for the hidden items!

Crunchy Snacks

Photo Credit: Foodlion

Rainy day munching with a movie or game night is a great opportunity to provide your child with sensory input! Have your child help you prepare a crunchy snack to target their various senses, from interacting with different textures and smells to proprioceptive input from the big crunch. The crunchier the snack the more sensory input to their mouth!

Questions or concerns?

If you have questions or concerns about your child’s responses to various sensory input, please contact us at info@playworkschicago.com or 773-332-9439.

Urooba Khaleelullah, MOT, OTR/L
Occupational Therapist

Just Go to Sleep: Strategies for Improving Sleep Habits in Your Family

We all know sleep is important for maintaining a healthy, happy lifestyle. Unfortunately, sleep doesn’t always come easy, even to children. Some children, especially those with sensory processing issues and other difficulties, struggle to get to sleep and remain asleep through the night. What’s more, chances are, if your child isn’t sleeping, you aren’t either. The result is a cranky, sleep-deprived child and a cranky, sleep-deprived adult. Here are some strategies for improving your child’s “sleep hygiene,” or habits that promote healthy sleep.

Importance of a bedtime routine:

The first piece of advice that most people get about improving their sleep hygiene is to have a consistent bedtime routine. Maintaining a consistent bedtime routine is one of the best ways to help your child’s body know when it’s time to sleep. They will start to associate a particular time and set of actions with sleeping, which prepares their body for sleep before they even get into bed.

Establishing a routine goes beyond just having a set bedtime and wakeup time (although these should be as consistent as possible as well). A bedtime routine could start as early as a few hours before bed. Before bed, your child will need to brush their teeth, change into their pajamas, potentially take a bath or shower, and partake in whatever calming activities your family chooses. All of these activities should, ideally, be as consistent as possible from night to night. Try to make sure that all of these activities occur in the same order, at the same time, every night to help your child’s body recognize that bedtime is coming up.

Many experts recommend that beds not be used for for any activities other than sleep. If the bed is the place where your child sleeps, but also where they watch YouTube videos, play board games, hear a bedtime story, and do homework, then their body might be confused about what’s happening when it’s time to sleep. Consider moving those activities to a different location to help your child’s body understand that when it’s in bed, it’s time to sleep.

While it may be difficult to establish a highly structured bedtime routine every single night, establishing a routine and sticking to it as much as possible is one of the best ways to decrease sleeplessness for your child.

Using sensory regulation strategies to make a routine effective:

To make your bedtime routine as effective as possible, you might want to consider adding sensory regulation strategies into your normal routine! Sensory regulation refers to the body’s ability to take in information in the form of sight, sound, smell, taste, touch, proprioception (the feeling of where the body is in space) and vestibular awareness (a sense of balance and motion). When your body receives sensory information from the environment, that information can wake them up or calm them down.

Everyone’s response to sensory input is different, but generally, children find fast movement activities, like running or jumping jacks, exciting, while “deep pressure” activities, like being wrapped up in blankets, calming. Again, everyone’s different, so for some kids the opposite is true! However, this rule of thumb might be a good place to start: Try getting all of your exciting movement activities out of the way earlier in the day and stop them after dinner time, then, engage in some calming touch activities like a warm bath or massage as you start to get ready for bedtime.

It can be helpful to get a baseline idea of what calms or excites your child, so consider experimenting! Over the course of a few days, you can try out different activities and see how your child reacts to them. Is your child more active when you sing to them, or does it calm them down? Do they get energized by drinking a cool glass of water, or less? Here are some activities you could try to get a handle on your child’s personal preferences and responses.

Generally calming activities:
-Massage
-Being “squished” under pillows, or a weighted blanket, or having blankets wrapped tightly around them
-Taking a warm bath
-Slow rocking
-Chewing chew toys or gum

Generally energizing activities:
-Fast moving like running, jumping, or swinging
-Chewing something crunchy
-Drinking a cold glass of water
-Seeing bright lights, like a computer or television screen
-Hearing loud noises, including loud music

Once you know how your child responds to input, try to build a schedule that comprises of more energizing activities earlier in the day, then transitions to calming activities before bed. You can also try to incorporate these types of sensory input into activities you’re already doing; for example, if you usually read a book before bed, try having your child chew a chewy while you’re reading! This will help ensure you can develop a routine that’s effective for your individual child.

Other strategies for improving sleep hygiene:

If you’ve already implemented a sleep routine that incorporates calming input and your child is still having difficulties getting to sleep there are some other basic sleep hygiene techniques to try. Here are just some strategies you can use with your child to encourage appropriate sleeping habits:

-Make sure your child’s room is conducive to sleep. In general, people sleep better in environments that don’t have a lot of alerting light, aren’t too warm, are quiet and don’t have a lot of toys and objects to be distracted by. Your child’s room should be dark, cool, quiet, and uncluttered.

-Turn off screens before bed. TVs, cell phones, tablets, and computer screens produce blue light that tricks the brain into thinking it’s daytime. Try to limit your child’s screen time in the evening and stop all screen access for about an hour before bed. Once your child is in bed, take all screens out of their room to remove the temptation to get out of bed and start playing.

-Get enough exercise during the day. Children need a lot of movement to remain healthy and in control of their bodies! Make sure they have a lot of time outside, and a lot of time moving and playing before you start your calming routine after dinner.

Questions or concerns

If you have questions or concerns about your child’s sleep or sensory regulation, please contact us at info@playworkschicago.com or 773-332-9439.

Corrine Pratt, OT Student
Occupational Therapy Fieldwork Student

Photo credit: Simon Berger on Upsplash

Snow Day! Heavy Work Activities to Promote Sensory Regulation in Your Child

Snowy days provide great opportunities for heavy work proprioceptive input! Proprioception refers to our sense of awareness of body position, which our bodies process by receiving input through the muscles and joints. This type of input is typically calming for most children, but can also be alerting for some children. Proprioceptive input generally occurs through heavy work activities that involve deep pressure or weight through the muscles and joints.

What is heavy work?

Heavy work is a strategy used by therapists to target the sense of proprioception, helping children to understand where their bodies are in space. Heavy work refers to activities that push and pull on the body, specifically on the joints. When participating in heavy work activities, messages are sent from receptors in our joints to receptors in our brainstem. These messages serve to remind the brain and the body where we are in space. For children, this type of input is specifically helpful in promoting a calmer demeanor, increased attention and regulation, body awareness, improved sleep, and more organized behavior.

Try the following activities in the snow for increased opportunities for heavy work!

  • Have your child pull or push a peer or sibling on a sled. Heavy work is most effective when done until you child seems visible tired, so try supervising a trip around the block if your child seems up for it!
  • Have a snowball rolling contest! Compete with your child to see who can roll a bigger snowball. Pushing a large object, such as a snowball, provides excellent heavy work proprioceptive input to the shoulder joints.
  • Make a snow castle. Have your child pack snow into buckets, carry them to the other side of the yard or park, and flip them out to create a tower or castle. The body retains feedback from sensory input for about 90 minutes at a time, so you can always have your child go back and add on to his or her snow castle later in the day, when he or she may need more input.
  • Shovel! Shoveling is excellent heavy work. Give your child a shovel and allow him or her to help you clear off a porch, driveway, or some steps. Having your child carry the shovel full of snow over to make a snow pile will also be a great test of balance.
  • Explore some snow mounds. Supervise you child while he or she climbs up snow mounds made from shoveling or plowing. Walking uphill and through the snow provides plenty of resistance that makes for great heavy work!
  • Play snow hide and seek! Use a shovel to dig a hole and place a waterproof toy inside before covering the hole with snow again. Make sure this is a toy you wouldn’t miss in case it gets misplaced until spring! Have your child dig the toy out using his or her hands, a shovel, or a bucket.
  • Have your child pull a rake through the snow to create snow art!
  • Bury your child’s legs in the snow and let him or her move against the resistance of the snow to get out.

Questions or concerns?

If you have questions or concerns about your child’s sensory regulation, please contact us at info@playworkschicago.com or 773-332-9439.

Natalie Machado, MS, OTR/L
Occupational Therapist

Photo Credit: Katie Gerrard on Unsplash

What’s Inside the Mystery Box?!

Let’s make a mystery box!

It’s no mystery that families and children been spending more time at home than ever before. When we are constantly surrounded by the same scenery, including the same toys and games, it can be difficult to brainstorm ways to mix it up (without constantly rushing to the store or clicking ‘buy now’ on Amazon).

As a pediatric therapist, I am always seeking new ways to turn every day household items into fun, motivating, and enriching toys. I’ve found that some of the best toys are not ‘toys’ at all. One of my favorite non-traditional toys is a do-it-yourself mystery container/box!

This language-rich activity is appropriate for children at every developmental stage AND it only requires a few common household items. There are endless outcomes, variations, and possibilities with this activity!

Materials

  • An empty box or container (plastic flower pot, clean mini trashcan, big bowl, toy bin)
  • A short sleeve t-shirt
  • A rubber band to secure the t-shirt (optional)
  • Small items from around your home

Directions

  1. Collect the materials
  2. Pull the t-shirt over the top of the box/container, so that one of the sleeves lines up with the top or opening of the container.
  3. (Optional) Secure the t-shirt onto the box/container with a rubber band
  4. Place objects from around your home into the mystery box/container through the sleeve hole at the top. Choose objects that are safe to the touch- avoid sharp/pointed items.
  5. Take turns reaching inside of the mystery box. Encourage your child to use his or her hands (or even feet!) to feel the objects in the box/container. Ask your child to pull the objects out. *BONUS: Create a silly song to sing while you pull objects out! This song is to the tune of “Mary Had a Little Lamb”

What’s inside the mystery box?

Mystery box, mystery box

What’s inside the mystery box?

I wonder what we’ll find!

 

How to target speech, language, and social development during this activity:

  • Play ‘peek-a-boo’ with objects in the box! After modeling this phrase a few times, pause and wait for your child to fill-in-the-blank. Encourage your child fill-in-the-blank with the object label by modeling the phrase “It’s….a…”. Pause, look expectantly at your child, and wait for him/her to fill-in the blank.
  • Increase your child’s eye contact and joint attention by holding the box and objects by your face! Tickle your child with the objects or place box on your head to increase shared attention.
  • Encourage your child to follow 1-2 step directions (grab the bear, then put it in the box; pull a soft toy out of the box). If your child needs extra support, provide a model or use gestural cues to show your child how to follow the direction
  • Model grammatically correct phrases and sentences throughout the activity. Label and describe what you feel, see, and hear. Incorporate different word types into your models, including:
    • Exclamations (uh oh, wow, ooooh!)
    • Object names (box, bear, shoe, stick, spoon, playdoh)
    • Pronouns (my, your, his, hers)
    • Action words (shake, pull, feel, reach)
    • Location words (in, out, under, up, down)
    • Descriptive words (big, little, hard, soft, squishy, smooth, bumpy)
  • Practice turn-taking by taking turns reaching inside of the mystery box. Identify whose turn it is by pointing and/or using turn-taking language (It’s my turn! Now, it’s your turn!). Encourage your child to wait and watch while you take a turn.
  • If your child is working on specific speech sounds, place objects in your mystery box/container that contain the target speech sound in the object label. Each time your child pulls an object out, you can practice the target word 5x together! For example, if your child is working on the “b” sound at the beginning of words, you can include objects such as a ball, bird, balloon, bib, baby, bell, banana, etc.
  • Ask your child to guess what objects are inside based on what he/she feels! Once the objects are out of the box, compare and contrast how the objects feel and look. Make a list of similarities and differences between the objects.
  • Sort the objects into categories based on color, shape, size, or object function (things you eat, things you wear, animals, vehicles, etc.)

Not only is this activity great for building language, but it also targets many occupational therapy skills, such as the ability to discriminate and identify objects based on touch without the use of vision, increasing focus and attention on the hands and the sensory system, and increasing impulse control (as your child has to wait until he/she finds the right objects, via touch, before pulling it out of the box).

 

Questions or concerns?

If you have questions or concerns about your child’s speech, language, and/or play skills please contact us at info@playworkschicago.com or 773-332-9439.

Nicole Sherlock, MA, CCC-SLP
Speech-Language Pathologist
Photo Credit: Nicole Sherlock

Play Together!

What Are the Benefits to Social Therapeutic Playgroups?

Play is the universal language of early childhood. It has been proven that children learn from each other. Therapeutic playgroups are interdisciplinary programs that allow children with developmental delays to grow through learning in a social setting. In this group setting, children learn how to foster their engagement by developing social-emotional and cognitive skills along with their peers. Therapists help facilitate organic social interactions between children. Therapists help foster relationships by encourage children to use them as a resource to engage with others. Playgroups are play-based programs that allow for children to be intrinsically motivated by their peers, grow their problem-solving skills, and facilitate social language in a sensory friendly environment.

The power of a play-based playgroup allow for children to grow their sense of self. Play therapy is used to promote cognitive development and social-emotional strategies to help children succeed in multiple environments. These play-based activities encourage children to problem-solve in a natural environment that is different from their home. Problem-solving skills are important for children to develop as these skills will be with them throughout their lives. In these playgroup children also learn how to follow directions. Children learn from peer models to follow familiar and novel directions. Peers grow their engagement for structured and unstructured play-based tasks by learning alongside on another. Unstructured tasks promote creativity and allow children to grow their symbolic play skills. Structured activities allow children to attend to adult-led activities and grow their task completion. The cognitive and social-emotional skills that children learn from playgroups allow them to succeed in a variety of environments and throughout their educational experiences.

 

Rachel Weiser, MS, DT
Developmental Therapist

 

Photo: PlayWorks Therapy classroom, Photographed by Thomas | © 2019 TK Photography |