Following Schuyler

Watching this video and this one too is encouraging to me. The latter is one a few years later. You can tell her verbal speech is better as well. This is why I keep at it and think AAC is so remarkable, it definitely could be better, there's so much more that needs to be done.

I talk different

It's been a long long time since I updated this blog. And come to think of it, I can think of a turning event in October 2008 (my last post)...I just through an IEP meeting for that particular case and can say, whew, and wow, what a (good one!) difference in so many ways.

So far, in my first year as a licensed SLP, I can say that I've got the skills and now it's learning how to communicate clearly to other professionals and parents. I guess it's the business/work part of the job, and goodbye the student days. I realize the extent of forethought on my supervisor's part and the little things that needed to be done in advance to facilitate a process so that steps down the road will go smoothly. I realize how much I need to pick up on that end.

This month: It's funny how I can experience the two very extremes of emotions all at once for the same case. It would appear that the depth of which a case can get tough is very deep and I have not yet touched, or even grazed, bottom. Besides the never ending quest to find the best way to treat, I've also been faced with a) a whole new world of non-verbal communication where conversations take place in subtle (and I mean subtle) little movements of muscles of various parts of the body (the body language so to say), and b) decisions...and c) presentations! I am most nervous about talking to a group of people, esp. when that group of people involved really smart people who are at the top of their field and/or people who are really looking to you for answers cause they don't have many (yet, I hope).

Epiphany

I think I had an epiphany yesterday. After the most challenging schedule to date (the first I really think I said that I couldn't do it) and trying and trying. I finally realized that what I was doing was just trying to please everyone, even at the expense of what I really believe to be right and the best, as truth can be. And I let myself be cornered. That's not what I got myself into this field to do...I came here to stand for my clients. And I don't know everything and never will. Simply saying that I will do my best is not enough for myself to carry on. Rest, take a step back. Rest in Him who gives me wisdom and strength for each day. All I am to do is keep a clear and bright mind. Ready to listen. A mind ready to learn. Eyes that see things as they are, observant, and not the way I am told things might be. Steady heartbeat, easy breathing. And rejoice in today, in the day that the Lord has made. Hands to serve, feet to walk where He leads. A heart to obey.

The day I stop enjoying my work is the day I know I need to stop and reevaluate.

Squinting into the light

I think the best possible session yet happened last week, in a different way. I recently started to see a toddler that presents like an infant. He usually has pretty low affect, very hesitant with unfamiliar people, high anxiety. Had dad play with him, and then I joined in. That worked...he allowed me to touch him, he reached out to touch me, didn't let me guide his movements, but good enough progress for that day! I had him in a bucket swing, with dad pushing him...he started laughing and making the most sounds I've ever seen him produce. And his laughter, giggling was the cutest thing that I've ever heard, and I've heard quite a bit of unique laughter come from many different kids. I felt a connection, a soft spot, a miracle in the making in this child. It was hilarious, it was heart-breaking. Clinically speaking, this session was one of the best, and the best yet in a while, because I got to talk to the parent a lot, gave the what, how and why to help his child's communication skills along. I just hope he's buying into it, so to say...we had a practice session, that made me realize more practice sessions were in order. He is a great dad, very willing and knows his kid too. Personally speaking, this was the best session since I got here, because I saw myself breaking away from I never want to have kids to, yeah, kids are pretty awesome miracles. The laughter, and the way the dad and the child looked at each other was priceless. I think that was the first time since I got to CA that I came up with that thought, and it was authentic, not an attempt to try to convince myself that I would like to have kids one day.

Tears

There has been quite a bit of tears going on these past few weeks. Man, this field is such an emotionally charged area. I've become quite calm and collected when these moments happen, but tears always do make my heart ache. I believe these tears came from frustration and misunderstanding. Frustration because of the limited ability to communicate a message and therefore understood and also limited shaping of a desired outcome (be it speech sound, social skill, etc.). Misunderstanding due to limited ability to receptively grasp verbal cues. As you can probably guess, it's kids that are doing the tearing up. But sometimes I do push the kiddos and I feel sad that they have to be thrown in an adult-like world at such a young age. We make it as child-like as possible, but who are we kidding? No kid should be going from one appointment to the next day after day.

Autism's answer

I was watching a whole range of laughing babies on YouTube with a friend yesterday, and then I thought hey, why not speech therapy? I came across various videos of speechies doing all sorts of sessions, and then came across these ABA autism videos...I think it's from a group of people in Australia. One video (one of many made by this YouTube user) was viewed quite a bit more than others. The parents of the child featured on this video appear to be advocates of ABA therapy, or to say it in other words, their child appeared to benefit from ABA therapy. And yes, I think it's great, but not for everyone and you have to really know what you're doing. My struggle to understand ABA and its place comes up when I see how it is based on behavioral theories, strictly observational...but then see how communication, one of the largest difficulties with autism, is so much more than simple cause-effect...so much to communication is subtle...I see so many kiddos that do benefit from ABA, but then hit a wall...they can say a whole bunch of words and will stop and listen when told, but then don't initiate...that's the huge wall that needs to be climbed. Can ABA teach a child to initiate? Another issue to want to know more about is, how does ABA address language function and use? They can teach language form and content just fine, but to use language in a social context...that is lost. What then is knowing language if you don't use it? It's so hard to untrain rote phrases and the idea that if I say something, I'd get something...communication is so much more than that...it starts with intentionality--attention, just knowing that there a communication partner around, and then goes all the way up to complex conversations still with that other human being. The child may be able to say his/her name and age and I love you with perfect enunciation when asked, but can he/she say it within context, in play with a peer or when given a hug by mum. I learned early on that the phrase 'I love you' is one that parents hope for, and ask a speechie to train in once the child shows signs of verbal communication...and yet, ironically, it's one of the hardest phrases to teach...it has all those higher level phonemes in it, it's a whole 3 words, and it's an abstract concept.

Out of the womb into gloved hands

I had an eval with a little one who was very very delayed...and it was hard cause you actually knew what the cause of the delays were (but then again, it's also frustrating when you don't know what the causes are). But he was a real cutie...and his parents thought he liked me :) That's always helpful in an eval...but he still didn't show me everything he could do, and was quite upset most of the time...all this poking and proding :C Poor baby. Anyhow, this just reminded me of how many kiddos I've come to know that are whisked off into the world of therapy and appointments and doctors since Day 1 of Life. Truth be told, early intervention is great, and the sooner the treatment, most likely the better the chance of 'catching up.' But then I think of the parents who hardly knew a normal childhood for their kids because of all this intervention and the children who never knew a normal day as a child because of all this intervention. You can tell a therapy child a part...at least a therapist can...therapized. I wonder how many parents still remember the one more treatment solution called the miracle. A miracle that will solve everything overnight. After attending meeting after meeting and one search for answers after another, how many still carry that glimpse of hope, that one day, everything will just click, that that unexplainable miracle will occur, just as it does sometimes for people with more concrete medical problems like cancer, etc. I think it's harder to remember because we're usually talking about long-term therapy care, years, probably ending at 9-12 years of age, if it's just an artic issue (or less depending on the delay), and going well into the teens years if it's language/learning disabilities, and probably a life-long process if it's cognitively based (e.g. autism, MR, etc.). I know I forget sometimes, after thinking and working on goals for the next 6 months, 1 year, 2 years, long-term, projected outcome, etc. But then I remember that, s***, we, as a profession, don't know squat about the ins and outs of how things work...we only know what we can see and what science can prove, and what our human experiences tell us. Sure it's a lot, but then again, who knows what the entire picture is like? Who knows if we're missing a critical piece except for time and trial-and-error? I wonder if the future therapist will read back into today's journals and say, oh, yeah, that's just like when they knew there was mass, and mass was made of something, and one day, discovered atoms weren't really the smaller unit of matter. The knowledge that we don't know everything drives me to believe that I need God in my therapy sessions. I need Him to work in the lives of these kids, patients, whether it be healing them, making progress, performing that miracle, or using their lives to teach the people around them...God knows exact what's wrong and how it can be resolved. And with the little we know and can do, He will work His magic and use our gloved hands to do His work.

Empathy

I was in a consult today whereby the parents were told they could expect their child to be in therapy for many years. It wasn't a quick fix, and the road ahead was long. Severe disorder, may not be completely resolved. And that was the truth as far as today could tell. And the mum started to cry. This is not the first time I've been involved in a case whereby a less than preferred prognosis was given and there were tears, but at some degree this was my first case whereby I play a significant role. I feel that responsibility as least. Today was preceded by the few years in which this battle has been fought, since birth. And I recently joined in. It's frustrating not being able to provide a cure. It's even more frustrating for the child, frustrating for a parent not being able to solve and alleviate the child's frustration. And even more frustrating knowing that the child understand what's wrong and is constantly affected by it at such an early age.

And then I got an email that a colleague's mum had passed away. A colleague not so far off in age from my own. I realized that times have indeed changed. It used to be grandparents that passed away, now it's parents. Friends don't live with their parents, they live on their own, independent decision makers.

On a separate note along the same line

I have a pretty tricky client...simple put, really tough. I guess I didn't put two and two together when I decided to work at a sensory integration clinic. Anyhow, one of my more sensory kids, the ones that don't know what input they need and you have to ease in the input without them running away, stayed with me for 15 minutes without being distracted internally or externally. Whew...AND *drum roll* imaginative play came out today!!!! That is super super exciting to see, I have not seen it in his age group but once or twice here since I started, all my clients being pretty low. And once I got the play initiated, gave a starter idea, he took it and ran with it...granted, it was just one more main idea added, but that is GENIUS! I am sooo proud of him. And I got the look on his dad's face when he did it, pure joy :) This is the child that ran the opposite way when he saw me...we'll see how this goes, hopefully continue in the right direction. And perhaps it's the hardest ones in the beginning that gives you as the professional the most satisfaction in the end. We'll see.

Bright sunshiney day

Yesterday I got news that a parent said she felt that her child had a connection with her, and that "I got her." That's one of the biggest compliments I could get from a parent, and that totally made my day, my week, my month, actually, the first positive affirmation deal since I started working. And it came the day after I thought I couldn't do this anymore, that I wasn't up to par, that I just was hitting the ceiling again and again and couldn't learn from my mistakes anymore, and just plain making mistakes. That compliment lifted me up again. And I know God knew I was at the end of my rope and needed something. I cry out to my God and He answers me. In all my sins, despite all my shortcomings.

I wonder what my role is in this field. The way things are going doesn't necessarily reflect how I thought things would be. Since the day I left Calvin, things have gone differently that I imagined it to be. I know I want to specialize. In what, I'm not sure...what I thought I would be, I don't see it coming anymore...maybe it will come back.

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!

Results

A number of my clients are showing wonderful progress. At times I let out a long slow breath, perhaps I what I do does help the client, and then, sometimes I reserve judgment and wonder if what I do does indeed make a significant difference for the better, never mind for the worst. I can never know for sure I think, not within the next few years as far as I can speculate. And then I also think, am I playing well a role on the team, cause I know the team that moves together helps the patient the most...if there is possibilities. Most of the time, I just pray and hope God will work His magic despite everything we humans mistakenly do. Good intentions mind you.

"Wanna pway?"

That's what the little cutie I used to work with always said when he saw me anywhere within his sight. And such a huge smile he had :D While the greeting was very cute and all, it was also not so to say appropriate, after all, that's pretty much all he said, plus a few other rote phrases, once I bent down and gave me back a smile and yes, let's go play. He was discharged after many weeks, and then I saw him again, still with the walk that resulted from his injury...I actually heard him before I actually saw him, I heard "wanna pway?" It was very gratifying to see that he recogized me, usually clients that young don't remember anything or anyone once you're out of the daily picture. I hope he's continuing to progress. I do miss the little one.

Aug 6th, 2007

I am no longer a student, officially. I no longer get student discounts on flights, movies, bookstores or hostels. Darn. Oh well, maybe I'll make enough moolah to cover all that.

Day 1 at work as a person that actually getting paid to do what I have been doing for the past 2 years, I can't believe I'm actually getting paid. This deserves a poignant pause.

*pause*


:) My biggest nightmare was that I would not be competent, I'd be doing treatment and goals that were not reliable and didn't make sense with no clinical judgment. Well, I was wrong. I'm a pretty awesome clinician--I may not be born with amazing talent, but I sure have developed some mad skills. This was an occasion where I felt it was ok to compare myself to others in my position/profession, since I had no objective working standard, and I compare my self to myself for progress and personal goals anyways. I'm not the best, but I accept that that comes with experience.

That said, I do worry and think about how my clients are doing. I work for a pediatric clinic now, hence, I want to see progress, I want to see my clients blossom. And I worry everyday if what I do will hinder, or enhance, progress. I need to see progress. I evaluate myself daily, after the day's treatment has ended, what did I do, how did I do it, was it effective, when was it not? And I observe other more experienced clinicians, what are they doing, is it effective, or not? And I see myself doing what they are doing for the most part, with touches of my own style mixed with conviction of what's effective (all that schooling...). But I do need to develop this clinical intuition and foresight, that would be my key to being a really super awesome clinician, a.k.a., one that bring life back to the person and his/her family.

My supervisors must be wondering where's the girl on the resume...I came as one who's mostly quiet and looking like a high schooler...can't help the young looks, I refuse to wear make-up daily at work. And I'm still learning to brush off those student attitudes, and be a professional, with a working person's demeanor. She's coming out.

More AAC

After 4 years in a liberal arts college and two (okay, one and a half to date) in graduate school, I finally had decided--I really like TBI and AAC, and I want to work with these two populations. Just found out about my internship placement--TBI peds, very excited!!!
Back to the now. The beginning of the semester was very roller-coaster-y for me. Things seemed to point to a certain direction and I was getting a little anxious but VERY excited because those far off future and near future plans looked enticing, more than I dreamed for myself. Perhaps I got too worry-wartish. I geared my semester to prepare myself for those after graduation goals. Thus far, I found out that I do do do love TBI and AAC. Especially serving the AAC population because I am just so anal about giving everyone "a voice, one speech therapy session at a time." I am discovering I am not gifted in this AAC area, and yet I wonder if that's okay. Even if I don't have this special instinct about things, is it possible that I still be good in the field and make an impact on the lives of those I serve in AAC? I want to be that good, not just pay-cheque good. Will I gain the skills needed, and above that in time? Or is this love, just a love that is not one to be put into action? Do I have the abilities? I'm no genius or superhero (-ine, for those who care about he/she stuff). But I want to do better, want to be effective, very effective. I guess I can try and see where I am at by the end of the semester. After all, that's what school is for. And then there's the other part of worrying: I do care what my supervisor thinks about my skills in this area. And I feel like I've let her down (okay, maybe that't not the best way to phrase it)...and I feel like I want to brilliant before her. I have to constantly remind myself that I am here to impress anyone (ok, to perform well and be real, but not impress) and the only one I should be concerned about what-they-think-of-me is God. What God sees me doing, thinking (scheming, hehehe). Finding my identity in Christ. The one whom I love will be the one that I think of and consider in what I do, what will so-and-so think. And that is God. Abba Father. Let me remember this always, O Lord.

AAC

Today was my first AAC evaluation ever. A little girl with CP, and I think after hearing in class and learning about AAC and physically disabling disorders, I finally got to the heart, or at least, had a little taste of what how it stands and lives in a person. She was amazing, bright and full of life. She expressed herself in all means possible that was available, given to her. At such a young age, she surprised me with understanding and problem-solving beyond her age. It was all up there, receptive language typical, IQ/cognitive typical...it was just the limiting body that prevented her from so much. 'Trapped in a body that betrayed her' is what one of my profs called it. When reaching out to pick up something, to touch something, the arm moves everywhere but at the target and betrays the mind's command. It takes so much longer to say or do anything, anything at all. You don't have privacy anymore, you always need another person beside you. The knowing is the worst I think. Or perhaps not. Perhaps it's the trying to get other to understand you that's the worst. Just because of the way you look. This reminds me of how God looks at our heart, the inside and not the outside. This experience allows me to revisit this revelation again in new light.

Summer II

Summer II is almost, just almost coming to an end. YEAH!
Doing camp was not as hectic as I had imagined it to be but it certainly did not leave room for anything else to do during the week. I learned lots about me as a clinician. One, preschoolers are energized beings that do not run out of energy...if they do, they turn grumpy before they run out of energy. And I am not loud or energetic or playful enough to keep them entertained to the level that they would appreciate. Secondly, kids who are old enough to walk and go potty themselves, etc. still can malleable in the mind and like to do things their way. But the fun is often out because they are also old enough to sit still and do serious work for acceptable long periods of time. So, therapy is still 'child-like' but less bouncing off the walls fun. It reminds me of Hey Dilly Dilly (Lavender Blue). Thirdly, I still don't know a lot and have a TON to learn which is kinda scary since it's almost time to graduate. But the key to learning is to keep those brain cells a-moving and a-pushing...which is tiring me out real quick.
I get to see First Child and her sister daily in the mornings...not talk and play with them, but I do get to see their smiles and get an occasional wave and bitty chatter.

I am an awesome clinician

I am an awesome clinician
I am an awesome clinician

This is my new mantra, in hopes of building myself up as an awesome clinician.

I got an adult client this summer semester, surprisingly. I had adults all last semester. But I just know I'm going to get kids in summer II and the Fall, and ECC and I am going to die then. But maybe it will turn out to be a pleasant surprise. Maybe I'll get an externship in the Fall, then no matter what age group I see, I'll be ok.

My client this summer is a peer, diagnose with TBI. Which reminds me constantly of how any life altering occasion can happen. It humbles me alot, so see the struggles my client goes through. She's only 5 months younger than me. She's also pretty amazing, I admire her spirit and the will she has to work work work to become better. She gets down at times, but not anywhere near at the danger level. She's also a challenge to me clinic-wise. Very high functioning, so I need to find ways to work on what needs to be worked on, and find out exactly what needs to be worked on and how. First high functioning client. Veyr interesting. I find that I rely a lot on her evaluation of how things went/are going. Very interesting.

Hmm...I don't think I've written about this: I volunteered at H.N. here in Mt. Pleasant for a month. It was the best month of clinic here ever! I hardly can say it was volunteering, I learned so much about different kinds of clients, how things work in the office, with other professionals, etc. It was great! I saw a whole variety of clients, you don't get these kinda clients in university clinics. It was interesting to see that.