Children and Traumatic Brain Injury

bike-helmet-child

Spring is officially here!  As the snow melts (finally!) it’s time to break out the bicycles, scooters, skateboards and rollerblades.  Outdoor activities are a fun way to get kids moving and socialize, but if proper safety precautions are not taken, sports such as these can cause Traumatic Brain Injuries (TBI).  A TBI can be devastating, and can cause concussions or even comas, often resulting in deficits in a child’s memory, cognition, speech, language and feeding skills.

Possible Effects of TBI:

  • Loss of short term memory
  • Loss of sight or the ability to recognize objects
  • Loss of gross motor skills (walking, throwing)
  • Loss of fine motor skills (writing, holding a fork)
  • Loss of oral motor skills (skills needed for eating, articulation)
  • Loss of taste and smell
  • Loss of emotions
  • Inappropriate behavior
  • Increased anger and frustration
  • Depression
  • Dysphagia (difficulty swallowing)
  • Aphasia (word finding difficulty or difficulty expressing ideas through spoken language)
  • Dysarthria (reduced muscle tone in oral musculature)

Tips to Staying Safe:

  1. ALWAYS wear a helmet that fits properly. Protect your brain!
  2. Check your equipment—Are the tires inflated? Do the brakes work?
  3. Make sure you and your child can be seen. Wear bright colors and avoid riding in the street once the sun goes down.
  4. Be aware of any large potholes or obstructions on the road.
  5. Obey all traffic laws and ride with the flow of traffic, not against it.
  6. Be alert! Warn your children if there is a car approaching and ride closer to the side of the road.

Have a fun and safe spring, everyone! 🙂

Nicole C.

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Why it’s OK to Get Messy at Mealtime

messy-eating-baby

Many parents will spend a lot of time and effort trying to avoid making a mess.  Maybe you don’t want to dirty yet another adorable outfit of your little fashionista, or maybe you are sick of wiping the sticky coating off of all the surfaces those tiny fingers touch.  But there are many reasons why it is actually very beneficial to let your baby or toddler get messy when eating.  So grab your favorite bib and read below:

  1. Sensory Play

Babies learn about the world and their environment by using all of their senses. Often times, when babies mouth things they can be unsafe or unsanitary (eg. sandbox, playdough, etc).  When eating, babies can explore their sense of taste, texture, smell, and sight in a safe manner.  Integration of multiple senses helps for healthy neurodevelopment.

  1. Feeding Skills

Although it may take a little longer, be patient enough to let your toddler feed him or herself.  At 18 to 24 months, toddlers can usually feed themselves but may need some assistance.  At 24-36 months toddlers can typically self feed independently.  The only way your toddler will improve his or her feeding skills is through practice, which may mean more applesauce gets around the mouth than in! Help guide your child and reduce frustration, but allow for some independence.

  1. Oral Motor Skills

If you constantly wipe your baby’s mouth after every spoonful, your child will not have the opportunity to feel the food that is left on their upper lip.  The child will have no need to use their tongue to lick the perimeter of the lips.  Additionally, if you are spoon feeding your baby and scoop the spoon up to get a nice clean bite, the baby has no need to use their lips to clear the food off of the spoon.  These are missed opportunities to build oral motor strength, coordination, and range of motion.  Instead, wait until the end of the meal to wipe the baby’s mouth.  When spoon feeding, place the spoon straight into the baby’s mouth or turn the spoon sideways and let your child use their lips to clear the food (no scooping up!).

  1. Prevent Tactile Defensiveness

Many children are extra sensitive to certain sensations.  By immediately wiping a child’s hands and face, the child may associate being messy with feeling uncomfortable with foreign sensations.  Encourage your child to feel a variety of textures and desensitize them. Let them know it is ok to feel something mushy, wet, crunchy, etc.

  1. Keep Mealtime Positive

For many of our picky eaters, mealtime can be an anxiety-prone situation.  Fussing with napkins and wipes after each bite can add unnecessary discomfort.  Try to maintain a relaxed, positive attitude during meals and tackle the mess once the meal has ended.

Remember, safety should always be a priority.  If the mess is interfering with vision or breathing, immediately clear away the mess. Otherwise, don’t be afraid to start embracing your baby’s mess!

-Nicole Cohen, M.S. CF-SLP

To Be, Or Not To Be Gluten-Free?

gluten-free

Gluten, which is Latin for “glue”, is a protein composite found in wheat and related grains, including barley and rye. Recently is it becoming more and more common to hear of people going on gluten-free diets to lose weight, or due to a gluten intolerance; but did you know some people are using gluten-free diets as an alternative intervention method for children with Autism? This special diet may help improve digestion and reduce some characteristics of Autism, such as difficulty with communication and social skills.

How does it work?

Although this theory has yet to be proven true, some experts believe that often children with Autism have difficulty digesting gluten.  These undigested proteins turn into substances that act as opiates which may affect behavior and brain development.  Researchers believe that by eliminating gluten from children’s diets, parents may notice:

  • Reduced aggression
  • Reduced impulsivity (ex: calling out, yelling)
  • Reduced sensitivity to sensory properties (ex: refusal to eat crunchy textures)
  • Increased attention span

How do you start a gluten-free diet?

First, it is important to know what kinds of food contain gluten, and what foods are naturally gluten-free.  Children on gluten-free diets can eat fresh meats (unbreaded/battered), fruits, vegetables, rice, corn meal/starch, beans, soy, potato starch, and most milk products.  Children on gluten-free diets cannot eat wheat, wheat germ, semolina, oats, barley, rye, malt flavoring, and most gravies, soups, and sauces. Many products in the market are geared towards gluten-free diets.  The internet is a great resource to explore gluten-free recipes. Experts recommend a trial period of 3-months for children under the age of 3 and a 6-month trial period for children older than 3 years.  The diet should be introduced gradually, especially for younger children, as withdrawal symptoms may occur.

Are there any side-effects of going gluten-free?

There are some possible side-effects of eliminating gluten from your diet, including weight gain or weight loss, constipation, diarrhea, high cholesterol, and poor vitamin status.  Consult a physician or dietician for advice on nutritional supplements and to determine if going gluten-free is right for your family.

Going gluten-free is a big decision which affects the entire family, so it is important to weigh your options.  Remember that there is not enough evidence to support or refute that this is an effective intervention method for children with Autism, but there are parents who report improvements in their child’s behavior.  Even if your child does not have Autism, but exhibits sensory aversion, aggression, impulsivity, or a limited attention span, this may be an option to consider.

-Nicole C.

Bubbling with Excitement for Speech and Language

Blowing BubblesBubbles are one of my favorite activities to use in therapy.  Not only are they fun for the kids, but they can be used to target a wide variety of goals.  Here are some ways you too can use bubbles at home to practice speech and language skills:

  • Oral Motor skills– Bubbles are a great way to practice labial rounding. Model how to round lips for blowing bubbles and if needed, give your child some tactile support by gently pressing against the corners of the lips.
  • Language Development– For prelinguistic children, signs for more, me, open, or bubbles can be practiced. Always pair the gesture with the verbal model.  To find the signs for these words and many more, visit https://www.signingsavvy.com/. For children who are just starting to develop language, model short, 2-3 word phrases.
  • Requesting– Any activity like bubbles that is immediately reinforcing is great to use for requesting. Some simple requests may include “Open bubbles”, “More bubbles”, or “I want bubbles”.
  • Eye Contact– Children love watching bubbles grow. Wait until your child makes eye contact with you before blowing the bubble.
  • Turn Taking– Practicing taking turns blowing the bubbles. This can be done with any amount of people.  Model saying “My turn!” and “Your turn!” and wait for the child to say these phrases before giving them the bubbles.  Praise your child for waiting their turn and giving the bubbles to someone else once their turn is over.
  • Prepositions– Blow the bubbles in different locations and ask the child where the bubbles are. Blow bubbles up, down, under the table, on their feet, etc. Get silly with it!
  • Bilabial sounds– Bubbles are great to use when working on early developing bilabial sounds “p”, “b”, and “m”. Words to target may include “bubble”, “pop”, “more”, “me”, “blow”, “my”, “open”, and “up”.

Practicing these skills at home is a fun way to carry skills over from the therapy room to the outside world!

-Nicole C.

What is PROMPT Therapy?

prompt pic

PROMPT is an acronym which stands for Prompts for Restructuring Oral Musculature Phonetic Targets.  It is a tactile-kinesthetic approach which involves touch cues to the patient’s articulators.  The speech-language pathologist uses touch to manually guide patients through the production of a target sound, syllable, word, phrase, or sentence.   This technique embodies neuromotor principles and helps to develop motor control and proper oral muscular movements.  Sometimes traditional verbal and visual models aren’t enough to correct articulation.  PROMPT incorporates visual, auditory and tactile modalities which allows patients to feel where their articulators should be for correct pronunciations.  PROMPT also helps reduce unnecessary muscle movements such as jaw sliding or inadequate lip rounding.

Who can benefit from PROMPT?

PROMPT can be used to treat a wide variety of communication disorders.  It is most often employed when treating children with articulation impairments, phonological disorders, motor planning disorders (ie. apraxia), and language delays.  Children with hearing impairments can improve their speech by feeling where their articulators should be instead of having to rely on listening for the sounds.  PROMPT also may be a useful technique in the treatment of acquired communication disorders, such as aphasia and dysarthria.

Where are PROMPTs applied?

PROMPTs are designed to help patients get a feel for the manner and placement of muscles to produce a target.  Therapists use their fingers to gently manipulate muscles of the face, lips, and the mylohyoid muscle (behind the chin).  Tactile cues are also used to prompt voicing (lungs and larynx), jaw grading (mandible), and nasality (nose).

Who can practice PROMPT therapy?

Speech-language pathologists must be trained in PROMPT in order to use it properly.  All of the therapists at Long Island Speech and Myofunctional Therapy are PROMPT trained!

For more information about PROMPT visit: http://promptinstitute.com/index.php

-Nicole C.

Tips for Good Vocal Hygiene

Closeup of business people lying against white background and sh

Just as we take good care of our bodies, it is important to take good care of our voice.  Vocal abuse can hurt the voice and cause voice disorders, which can result in deficiencies in quality, pitch, and loudness. Below are some ways to avoid vocal abuse and practice good vocal hygiene:

  • Keep your vocal folds hydrated by drinking plenty of water throughout the day
  • Eliminate (or reduce) smoking and alcohol intake
  • Avoid yelling
  • Reduce coughing/throat clearing, which slam the vocal folds together at an average speed of 70 mph. Instead use a “sniff-swallow” technique
  • Eliminate (or reduce) caffeine intake, which is dehydrating
  • Avoid taking loudly in places with competing background noise
  • Increase the amount of sleep you get
  • Restrict medications that dry out the mouth, throat and larynx
  • Humidify the environment with a humidifier
  • Balance periods of excessive vocal demands with vocal rest
  • Relax your throat by practicing diaphragmatic breathing
  • Avoid whispering—instead talk quietly when necessary
  • Avoid aggressive laughing or crying
  • Use techniques such as clapping, whistling, or flickering lights to gain attention in noisy environments
  • Speak at a comfortable pitch

Practicing good vocal hygiene will help prevent vocal abuse and/or reduce preexisting symptoms.  A few minor adjustments to your lifestyle can make a major impact on your voice.

-Nicole C.

The Wonderful World of Wordless Picture Books

Literature is a great tool to practice speech and language skills.  Here are some of the many language benefits of using wordless picture books.

  • Wordless picture books are great for readers and pre-readers alike! Without the pressure of reading words, children gain confidence in their story telling skills, using the pictures to guide them.
  • Without words, your child has the freedom to be as creative as they want! Expand on your child’s phrases, and allow your child to play with language.
  • Parents or siblings can model the story, and then children can retell the story. Models should make sure to incorporate all aspects of story grammar (ie. characters, setting, initiating event, feelings, action, consequence, and resolution).
  • Practice taking different viewpoints. Have fun with it! Use different voices for each character, and practice using correct pronouns.
  • Model sequencing and using temporal words such as “first”, “then”, “next”, and “finally”.
  • Ask your child a variety of “wh” questions. Who is in the story? What are they doing? Why are they doing that? Where are they going? When does the story take place?
  • Practice inference skills. Before turning the page, ask your child what they think might happen next.
  • Wordless picture books can be read in any language; perfect for multilingual families!

Below are some of my favorite wordless picture books:

wordless good night gorilla

Good Night, Gorilla by Peggy Rathman

wordless chalk

Chalk by Bill Thomson

wordless tuesday

Tuesday by David Wiesner

wordless flotsam

Flotsam by David Wiesner

wordless boy dog and frog

A Boy, a Dog, and a Frog by Mercer Mayer

I hope you enjoy “reading” these books!

-Nicole C.