Vesti

I sat on the spinning wheel (or whatever it's called) today with a client, thinking, if so many like to be spun around, why not try it myself...bad baaad idea...I got so dizzy I felt sick..but managed to remain composed and did not throw up. The room continued to spin while the wheel stopped and my head is still spinning 5 hours post-event. Ugh. I have a highly sensitive vestibular system...since coming to know sensory intergration methods...I have come to find reasons why I get so sick of sugar, fast movements and other oddities I have that other people don't understand why I don't like theme parks like Six Flags and other jerky rides.

PROMPT

PROMPT is a technique used to treat motor speech disorders, mostly heard when it comes to childhood apraxia of speech, which does not always qualify for services under biling codes, therefore you simply bill it under 'apraxia.' Anyhow, I observe that many more children that I see under age 3 are showing signs of apraxia (to begin with, they aren't vocal...so it takes a while to get them to vocalize, be spontaneous in vocalizations and words, and then figure, oh, now that I see your mouth moving, something's amiss...or rather, extraneous). The other biggie I'm seeing is grading of the articulators...it's kinda wondrous actually...why is almost every child I see having some grading difficulty? What causes it? Low tone? What low tone, if everything else in typical? That is the question I can't answer now and am itching to get an answer.
But PROMPT--from an academic standpoint (meaning the 'talk' in grad school and below), PROMPT is not viewed as very happily...of course there is not prefect method, and PROMPT is always referred to as 'having it's own place, which tends to be very narrow and specific.' And they don't tell you beyond, 'it's one method used to treat apraxia.' True...in a way. But now that I'm getting to know the theory and principles of PROMPT better, things are clicking and making a lot more sense...the different way speech movements are viewed by PROMPT is refreshing and to me, creates a clearer way of observation and systematic treatment, an explanation why errors happen in certain patterns. And especially when the child is not cognitively ready for verbal cues and attending long enough for visual cues consistently. It's also a way to be able to diagnose...haha...ok, I mean, screen...diagnose is such a D-word I am finding out.
In the speech as a job world, PROMPT seems to be either loved or rejected. One reason why not all like it is because the carryover, and dependence on prompts is difficult to eliminate over time. This is something I have yet to take a closer look at simply because 1)I am not PROMPT-certified (yet), and 2)I've only started working a few months, and those children that have been PROMPTed have not shown significant dependence on tactile cues over time, I do see the 'weaning off.' But then again, I'm working with really great clinicians. And although they use PROMPT, they also use best practice...whatever works best for the child. There's a beginning point where PROMPT would be most effective, and then an ending point, which is always gradual in the majority of cases.

The deal with all these techniques is, in grad school, you hear opinion, professional opinion of why they aren't best practice, and then you get out into the 'real world' and people are using these techniques (depending on setting I guess)...and you wonder if what you learnt in grad school is any good...sigh...I like school...you get to debate all these ideas and concepts and come up with crazy new ideas and people are willing to talk about them...and at work, it's just plain crazy, why would you want to think of that when it's not helpful to any specific kid?

Another biggie in grad school that I learnt concerned oral motor exercises...they are for strengthening purposes...therefore, the problem has to be weakness...and never never never use oral motor in Tom, Dick or Harry case...in the case of dysarthria, only flaccid dysarthria would qualify. And no doubt, O-M exercises are a hot topic now and generally, viewed as overdone. And now (please don't look at me with disappointment, prof) but I am doing them to children who are not vocal and think can benefit from tactile input (oral motor) to create awareness or articulators...the touchpoints for speech. And these kiddos have a general low to no body awareness or environmental awareness...like children with autistic tendencies, and those who keep crashing into walls and don't feel pain at normal thresholds. And it seems to work, or maybe not...they get PT and OT and all this other good input from peers and whatnot around them. So...but they's better communicators!

AAARGUHHH

I feel overwhelmed...part of me is relieved that I am finally feeling overwhelmed...I think I'm suppose to feel that way as part of the process of getting inducted into the world of working professionals. So, now that I am, ARRRRRRGUH! It all came crashing down like waves breaking over my head...and thoughts swam and crammed into a space too small to contain them all...names, names, names, too many names, and along with them histories and points to remember, allergies, developmental levels, family members, family dynamics, funding sources, reports to do, hobbies, therapies, schedules, lives, lives, lives...too many and too complex, twisting and wrapping around every which way. I hope I can take a deep breath, close my eyes, fix my mind on order, and pull out a name, focus on it, finish what needs to be done that associated with that name, and move on to the next, calmly, composely. Neat little boxes and defined lines are simply delightful right now.

I had piggie tails for hair today. Halloween, staff were required to dress up as part of the festivities...my suite's theme was cowgirls...since I lacked the cowboy hat, boots, shirt, belt and accessories, I figured I could do something to the hair. I borrowed the bandanna. A parent asked me what I thought of bottle feeding and transitioning from it...I said what I thought was correct by evidence based practice standards and added my own opinion based on what I saw in practice...the scary part is he said, "It's nice to know a professional's opinion on things, it gives reassurance and...professional (implying trustworthy)." Was what I said right? Was it true? I guess my deal is no one really takes me seriously most of the time, and my opinion never really counted all that much...and now it does...yikes! I am careful in what I say all the time, it tires me out...I have to be careful what I say to different persons, how much information I share...all this red tape and whatnot. At times I feel odd...here I am, hardly much experience to hoot about and being asked questions that weigh a heck of a lot. One of the little ones in my suite started coughing during snack time...as the speechie in the room, that was my call to investigate what was going on with the swallowing. My heart stopped when she showed no sign of stopping and the cough sounded far back in the throat...not a good sign...if she hadn't stopped coughing, as the person nearest to her, I would have start the Heimlich or CPR if things got worse...THANK GOD she managed to cough out the piece of food from her mouth. I was FREAKING out for sure...I had positions in my mind and was deciding if she was little enough to be treated like an infant or a small child...how many pushes, how much force...I've only done it on dummies!!! And she's such a fragile child too...low tone. I am so so so so glad something turned out to be nothing and I hope I never will have to perform any BLS on any child! It's odd still, how calm and anxious I feel at the same time. And calm...I had a patient that had mini seizures all the time, medication couldn't treat it completely. So midway therapy, he would seize and I'd be terrified it would get worse, and would pray; try to coax him out of it, and it worked mostly. Scary thing was it was hard to tell when he was having a seizure...you saw something odd about him, but seizures comes in so many ways I've learned. Funny how I got used to the routine of him seizing and being with him to help (help...more like hope with physical intervention) him through it...but it was never safe...thank goodness the nurses where done the hallway from the room!