Recent research examined changes in speech skills of children who have hemiparesis and speech impairment after participation in a constraint-induced movement therapy (CIMT) program. The participants in the study included 18 children with hemiparesis and co-occurring speech impairment who participated in a 21-day clinical CIMT program. The Goldman-Fristoe Test of Articulation-2 (GFTA-2) was used to evaluate children’s articulation of speech sounds before and after the intervention using changes in percent of consonants correct to measure speech production. The results indicated the following:
children with hemiparesis and speech impairment made significant gains in the percent of consonants correct following CIMT.
gains were similar in children with left and right-sided hemiparesis, and across age groups.
The researchers concluded that due to the significant collateral gains in speech production following CIMT, the benefits of CIMT may also spread to speech motor domains.
Reference: Allison, K. M., Reidy, T. G., Boyle, M., Naber, E., Carney, J., & Pidcock, F. S. (2017). Speech production gains following constraint-induced movement therapy in children with hemiparesis. Journal of Pediatric Rehabilitation Medicine, 10(1), 3-9.
Therapeutic Play Activities for Children: digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy. Find out more information.
Check out these adorable, new Where is the Therapist clip charts to indicate where you are in the school building. Therapists are frequently traveling throughout the school from classroom to classroom or traveling from school to school. These signs will certainly come in handy for when school staff needs to ask a question or stop by for a visit during the day. They are only $1 per discipline! It includes 5 signs for each related service – 3 in color and 2 in black and white. The black and white versions have a similar pattern to the popular adult coloring pages if you are feeling crafty. The last sign can be edited to include 8 different phrases that you choose. You can type or write the phrases.
You will want to print the signs on card stock and laminate for durability. Just grab a clothes pin and indicate where you are. Color in the black and white version if you want or have the students help you color it in!
The working conditions survey results for school based therapists have been summarized. As you can see from the results, there were 431 responses the questions about working conditions. Frankly, I was shocked that close to 79% of the school based therapists felt that a national organization should be formed to establish working condition standards ( caseload, sessions per day, ratio of direct treatment to consultation with teachers etc) to improve outcomes for students receiving OT, PT or speech. Whether that comes to fruition or not, it seems obvious that therapists need some help or guidance. You can view the results below. Following the results are some of the comments that were added to the survey. Perhaps these results will help motivate additional research on the topic helping to make positive change. Please take a moment to answer the current survey on handwriting and keyboarding.
Here are some additional comments that were added to the survey. They provide a nice overview and what therapists might experience and some pros/cons for the idea of guidelines:
National standards would be nice. I live in a state that has very little school based representation, standards or guidance at the state level.
There needs to be a caseload limit. And when the limit is reached the therapist can be expected to look at discharges and if no discharges can be made then additional services need to be contracted out!
All states/ districts vary as do students. I think we need to belong to AOTA,APTA and ASHA and communicate with stakeholders. It would be difficult to prove that more time for therapists improves outcome of students as therapist expertise and goals and experience is as variable as the students we work with.
I don’t feel there is a national approach as these things vary by state, county, and city. However, I think there is a standard that should and could be placed by AOTA. It likely already is, and I’m just ignorant of it at this point (just started working in schools). I didn’t know what to ask for, and I ended up in a mess with little time and poor accommodations to service students. I do not get the opportunity to do my full frequencies, and push-in is being promoted, but in many ways is not helpful to the actual OT-related items I’d love to do.
I am the only OT servicing every student in three rural counties driving up to 75 minutes in one direction for one student. We are told it is the expectation as a salaried professional to complete your work at home.
State standards not National
Practice patterns and work expectations vary too much across the US to try to legislate working conditions. I review IEPs from other states and they are very different from state.
To make guidelines for workloads yes.
We need to have some sort of standard in order to incorporate all the factors that go into service provision. We used to have a formula that took into account number of schools, number of miles between schools and then number of service hours with number of students. Without a format, school divisions will continue to push for whatever the staff will bear!
I think to form established regulatory standards via a national/formal organization for school based therapist is an excellent and much needed idea!
I have been a school based PT for 24 years. Over that time, my methods of intervention have ‘evolved’ to encompass inclusion, embedding skills within the natural setting, etc. Unfortunately, our administration still equates IEP minutes with ‘that is all the time you spend with that child’ so therefore you should be able to see this many in this amount of time. Conversations around workload versus caseload are evolving, but in these badly funded school settings with a number crunching administrator, it is a difficult conversation. We desperately need supporting standards, etc to help us provide what we know is needed in order to address the needs of our students and their classrooms. Thank you for starting the conversation with this survey!
I have worked in many different school based settings, and I have found that each one is unique in it’s own way. The number if students that are appropriate depends on the types of students you have, and therefore cannot be assigned a random number to determine a caseload. That said, admin does need to understand the need for time for consult, research, observation etc and not look at the 1:1 contact with students only.
Group collaboration never hurts.
We need guidelines on our case-load size when working in the schools.
This could be provided at the state- or county-level rather than nationally.
A national organization would be great, but each student receives such individualized service that it would be difficult to establish working conditions that were uniform across the nation. Some areas favor direct pull-out therapy some favor favor push-in therapy of more consultative nature.
I feel like school based PT’s are such a small portion of the profession as a whole that we are often overlooked. It would be extremely helpful to have some national guidelines! I am currently overseeing a staff of 12 OT’s and PT’s in a school district so this would be helpful as an administrator as well.
This is already encompassed in AOTA or APTA. Not to mention that a group can suggest all they want but it is a long way to laws and financial support. The Feds have yet to fully fund their initiatives for Special Education of the 70’s.
I think there should be some sort of a cap on the amount of students on caseload for each occupational therapy practitioner.
Dedicated space to see students is a big problem!!
The wide variety of service provision across the country causes problems when children move and services change – it would be helpful if we could all be on the same page to determine when it comes to how, how much, where, when, etc for service delivery.
We are under teachers contract however do not benefit from all be fits such as allotted prep and planning time, scheduled lunch times, time for conferences. Traveling between multiple buildings sometimes takes lunch times as well. Scheduling always presents issues…
A national organization would be very useful for research.
Regarding the last question, guidelines rather than standards might be better. Each child and each classroom environment is unique and we must have the flexibility to adapt.
There are currently no guidelines out there that indicate the workload vs caseload for all therapists. We are left to advocate for ourselves in a system that has been notorious for having small budgets. I am constantly performing work at home on my own time, spending money to buy supplies needed to provide services and constantly on the run!
Every caseload, just like every student, is unique. The ratio of consult to direct treatment changes with caseloads and from year to year depending on need. Sessions per day can also change depending on the needs of students, special events, length of sessions, etc. Caseloads change depending on needs and could be larger with lots of consult or smaller with lots of direct service.
Not sure if we need an actual national organization, but better support at the state level, backed by AOTA.
A set of standards to refer to would be helpful because many therapists are working singly in school districts. Also as contract therapists rather than employees we often have very little say the hours that a district is willing to pay for and often little job security.
I hesitated to answer the last question. I’m not sure that is the answer, but having standards to refer schools to would give more weight to my one opinion about the quality of services being offered.
I find that I am often asked to observe, informally assess, or provide suggestions for students that are not on my caseload. I am happy to do this, but find it takes my time away from planning intervention sessions with my students. I wish there was time carved into my schedule to assist my building in general, in addition to time for my students. I want to be able to do both effectively.
Each campus and organization too unique. Goal is to work together to provide services for kids.
Although I think collaboration of ideas is always great, the way this question is worded sounds more like someone wants to mandate the situation. Every school district, available staff and caseload is unique and continuously in fluctuation as students move in and out, making set requirements impossible to maintain.
Back in the 80’s some practitioners and I began the movement for more organization among school based practitioners. We were instrumental in getting guidelines for best practice written as well as professional development and fieldwork sites for training. I have been actively practicing as a school based OT for over 30 years, never have I witnessed a more greater need than ever for a a national organization to support us and would be willing to help!
SLP have a caseload max in the schools. I see their caseloads going down. Caseload standards would be beneficial to our students and to our profession.
I have been a school therapist for nearly 20 years and caseload/level of service has been a constant struggle. Nationwide recommendations or guidelines in this area would be extremely helpful.
As a school based PT for 20+ years, delivery of services has evolved significantly. When we talk to our administrators about our needs, it would help to have standards to refer to as they still want to tie services to the amount of time on the IEP.
I am required to pay teachers union dues and benefit very little from those other than salary negotiation. Having our specific practices and related issues supported would be more appropriate.
I believe there should be guidelines from AOTA (APTA, ASHA, etc.) to set an appropriate caseload size- based on work load, not caseload. I have been in positions where I was over scheduled and didn’t have the time to provide adequate therapy to students, but the district was unwilling to help in any way. I do not believe in organizations, such as unions, to determine such standards.
I am willing to be part of that national organization.
Please take the time to fill out the current survey.
Perceptual and Motor Skills published research on visual motor integration skills in children with speech sound disorders (SSD). A SSD is defined as a “persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages”. Visual motor integration (VMI) is defined as the coordination of visual and motor functioning, which is closely related to academic skills. Since visual input plays an important role in learning the phonological structure of language, children use multimodal information to determine how to produce a sound by perceiving speech spoken both by themselves and others.
The participants included 65 Turkish children aged from 5 to 6½ years old (31 with speech sound problems and 34 age matched controls without speech problems). Each child was evaluated with the Ankara Articulation Test for evaluating speech sound skills and the Beery-Buktenica Developmental Test of Visual Motor Integration with its supplemental tests of Visual Perception and Motor Coordination.
The results indicated that the children with SSD scored significantly lower than the control group in Visual Motor Integration, Visual Perception, and Motor Coordination.
The researchers recommend that if a child has SSD there may be visual motor deficits. Even though phonological errors are a natural part of the developmental process, visual motor skills should be examined if the child’s speech sound development falls within a very low percentile.
Reference: Ercan, Z. G., Yilmaz, Ş., Taş, M., & Aral, N. (2016). Investigation of Visual Motor Integration Skills in Children With Speech Sound Problems. Perceptual and motor skills, 0031512516664894.
Visual Motor Collection: The 10 visual motor titles includes: Visual Motor Workbook, Visual Motor Exercises, Hole Punch Palooza, Patterns, Follow the Path, VINGO Visual Motor Bingo, Graph Paper Drawings, Letter/Shape Mazes, Grid Drawings and Penguin Pencil Challenges. Get 50% off for this collection of 10 titles via immediate download.FIND OUT MORE.
School based occupational, physical and speech therapists are frequently handing out stickers at the end of session for a job well done by a student. What if one day we started giving stickers to each other for a reward. What would yours say? Share in the comments!
Need rewards for your students instead of stickers? Check out Punch Cards and Rewards for only $2.99!
Learning to sit up, crawl and walk are all major milestones in a child’s early development – and parents often record these actions in baby diaries, photographs and videos. Developing motor skills allows the child to become more independent. But our research, backing a number of other studies, has shown that it may also say something about the rate of a child’s cognitive development, such as talking.
It makes sense that the ability to move affects how children see, think about and talk about their physical and social environments. Indeed, over recent years, it has become increasingly clear that cognitive development is more closely related to the development of gross motor skills, such as crawling or walking, and fine motor skills, such as grasping and manipulating objects, than many have previously considered.
In fact, it has been suggested that rather than assessing motor and cognitive development separately, they should be viewed as two connected cogs within a large, complex system, each dependent on the other and working together to make small steps forward in development.
It is therefore vital that more research investigates the relationship between motor and cognitive development, rather than focusing on these as separate parts. This will not only be important for understanding typical development, but could also help to explain the difficulties that some children face when the connections in the system are disrupted.
Early links
Learning language is a very long process for infants. They have to go through a period of working out how to use their mouths to make sounds, such as blowing raspberries. Then there’s babbling. Then comes the first word. Finally, children are able to build sentences and, later, to hold conversations.
Research has shown that before each of these language milestones, there is usually a change in motor actions. An example is babbling, where an infant repeats the same sound over and over again (“bababa”). In the few weeks before babbling starts, infants show a lot of arm movements, such as banging, shaking or waving. What is interesting is that after they start babbling, infants stop doing these movements as much.
Why would these two activities be related? It might be that they are both letting infants see what happens when an action is repeated, so they get used to the sounds and feelings of their bodies. Infants are learning that something they do causes something else to happen. It is like learning that when you press a button, a light comes on.
There are lots of other examples of new motor and language skills appearing around the same time. The fact that the motor action and the language milestone are so close in time suggests that the two parts of the system are developing together.
Motor difficulties
Our own research has focused on what happens when infants have difficulties in developing motor skills in a typical way. One way that we have done this is by looking at the relationship between motor and cognitive skills in autism spectrum disorder (ASD).
Language and communication problems are key to a diagnosis of ASD, but children with ASD also often show some difficulties in motor skills. We carried out a study with 53 infants who had an older sibling with ASD. This increases the risk that they will develop ASD themselves.
Working with the British Autism Study of Infant Siblings (BASIS) at Birkbeck, we found that these infants had generally poorer motor skills at the age of seven months compared to infants who had an older sibling without ASD. Importantly, we showed that motor skills at seven months predicted the rate of language development in the group of infants who went on to develop ASD themselves. This suggests that poor early motor skills could be one factor affecting the development of language difficulties, and that this might be particularly relevant for those at risk of developing ASD.
We are also investigating cognitive skills in children with developmental coordination disorder (DCD), which is diagnosed on the basis of motor difficulties which have an impact on daily living. We hope that these studies will help us to better understand the relationships between motor and cognitive development.
An important point to remember in this discussion is that children naturally develop at different rates. An infant may start crawling at any point between five and 13 months and still be within the age range expected for crawling. Some infants do not crawl on hands and knees at all, but shuffle, creep or just start walking so that they can move around the room.
This means that parents should not be worried that their child is not going to be “clever” or is not developing well if he or she is not crawling early. Crawling is one way of solving a problem, such as reaching a toy on the other side of the room, but it is not the only way. As a child’s body grows and muscles get stronger, better ways of solving these problems develop.
One future question to investigate will be whether there are critical time periods in the development of these skills which cause some children to develop atypically. It will also be important to work out the different paths that motor and language skills can follow. To answer these questions, future research will need to study children over time, and study the two sets of skills together.
To celebrate the 2015 ASHA Better Hearing and Speech Month in May, Speech Language Literacy Lab has partnered with 30 professionals from various fields to share tons of free resources and ideas across discipline about School Based Innovation and Response to Intervention (RTI). See the end of the post for all the great ideas!
School based therapists can easily help with Response to Intervention plans by suggesting brain breaks in the classrooms. Many students participate in RTI to help with academic skills and behavior management. An evidence based intervention that can assist with reaching these goals is movement breaks in the classroom. Research has shown that 5-20 minute movement breaks in the classroom can positively effect the following:
cognitive skills including executive function, attention span, memory skills and verbal comprehension
academic achievement on test scores
attitude changes in motivation and self concept
on task behaviors
organizational skills
motor planning
impulse control
In addition, research has also indicated that students can retain information longer when gestures are used to learn the material.
Why not suggest some simple brain breaks to get children ready to learn? Need ideas – check out Your Therapy Source Brain Breaks at http://yourtherapysource.com/brainbreaks.html. In a hurry and need some right now? Download some of these free printables:
Need to explain to teachers why movement in the classroom is so important? Download theMovement in the Classroom handout at http://yourtherapysource.com/wwh1free.html
References:
Centers for Disease Control and Prevention. The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services; 2010.
Crawford, Judy. Young students jog, jump and dance to retain what they learn. Retrieved from the Medical Express on the web on 1/25/2014 at http://medicalxpress.com/news/2014-01-young-students-retain.html#nwlt
You may manage your subscription options from your profile
Here is the information on all of the great posts for the blog hop.
5/3/2015 Response to Intervention in High School– A Journey from Abject Frustration to Collaboration and Student Success Stephen Charlton Guest blogs on Speech Language Literacy Lab
Download this FREE template to create your own Frozen art work using oral motor skills, water color paints, a straw and the template. You can download your copy at http://yourtherapysource.com/freefrozen.html
Here is another freebie from Your Therapy Source Inc. - Therapy News and Tips templates. Create you own monthly newsletter and tips hand outs to provide to teachers and parents. You can either type directly onto the templates (and even save them) or print the pages and hand write the therapy news. The templates are suitable for occupational therapy, physical therapy and speech therapy. Why not share the document between the disciplines to create an informative monthly newsletter from all departments. You can download the templates at YourTherapySource.com.
Developmental Medicine and Child Neurology published a study comparing the gross motor skills of 6-9 year old children with speech and language problems (n=105) with typical developing children (n=105). Using the Test of Gross Motor Proficiency Edition 2, the children were evaluated in 4 groups: those with speech disorders, those with language disorders, those with both and typically developing peers. The results indicated that all three subgroups with speech and language disorders scored lower on the locomotor and object control portions of the test. The scores on the test improved with age for the children with speech and language disorders but the scores were still behind their typically developing peers. The researchers recommend early diagnosis and intervention for children with speech and language disorders.
Reference: CHRIS VISSCHER et al Motor proficiency of 6- to 9-year-old children with speech and language problems Developmental Medicine & Child Neurology Volume 52, Issue 11, pages e254–e258, November 2010
Came across this new tool for augmentative communication called Tap2Talk. Seems like a nice alternative for augmentative communication. Watch the video for how it works. The positive features are: the price point, no Internet access is required, cool age appropriate tool and you can put in your own pictures and voice. One negative is that you do need sufficient fine motor skills to utilize a Nintendo DS. Perhaps you could adapt a stylus though. Any comments or thoughts?
I am thinking about starting a team blog for pediatric therapists. Basically it would be one location where different therapists could contribute content. It is similar to a list serve but in blog format. Want to see if there is any interest out there from other pediatric occupational, physical or speech therapists to contribute before I start it. Please answer the poll we have on the right sidebar. If we can get some interest I will start it next week. Sounds like a great, simple way for all pediatric therapists to collaborate more.
