August 29, 2008 - Finally finishing my Updating!

So, Brianna has been going to Shriner's Hospital for almost a year now for therapy. She was receiving speech therapy 2x a month, and OT and/or PT once a week. At the beginning of August, Brianna's speech therapist moved to Texas, where her husband received a scholarship to attend grad school, and an opportunity to pursue his dreams as a writer. It was sad to see her go, but, with such a wonderful opportunity being presented to them, it's understandable that they wouldn't want to pass it up. So, in the meantime, Brianna has been without her speech therapist. Because there's always a concern of antiprogress (I can't think of the term I'm searching for right now....), or losing ground, so to speak, Bri's OT, Denee, has been carrying on with some of the therapies from speech in our OT sessions.


A little about Bri's speech therapies....Right now, we're really working to try to give Brianna a system for communicating with us. We have three different ways for her to make choices, actually. The first way we introduced was with object cues. We hold up two objects in her field of vision, and ask her which one she wants. She has to look at the object she wants, (or, as is the case lately, the outfit), look at the person holding the objects, then look at the object again.

The second system we have for Brianna to make selections, is a simple "yes" and "no" system. We use the sign for "yes", and a "stop" hand to sign "no". The right hand is always yes, the left is always no. We ask her a question, ex: "Brianna, do you want to wear your jeans today?" Then we do the two signs, saying each sign as we do it. She'll look back and forth between the two signs, sometimes for several moments. But she eventually makes her choice and focuses on it.


The third system of communication we have introduced with Brianna is switch communication. We start out with two switches called Step-by-Steps. These are switches that are built to record voice commands/cues, as well as multiple stage directions. In the picture above, you can see one of the Step-by-Steps, the red and black button.


We program one of the Step-by-Steps to give Brianna choices, like, "Book, bubbles, computer", or "nap, bath, bubbles", with each choice being one "step". We program the second Step-by-Step to say something like, "That's the one I want!" We then hook the Step-by-Steps up to jelly bean switches, which are smaller versions of the flat, red and black switch you can see in the background of the first picture. Obviously, since Shriner's is non-profit, and all of the equipment is shared amongst several therapists and clients, it's not always possible to have the exact same equipment, or even the ideal equipment, when we need it. So, we make do, with textured switches (the soft, white one on the right side of her head seen below), or the egg switches, (the green one pictured.)


Brianna really enjoys making choices in therapy. One of her favorite choices is "fan". It doesn't hurt at all that, when she chooses the fan, Denee plays silly games with her, like, "Who gets the fan now?" and "Bump your chin with the fan".

We're not certain how much of Brianna's choosing is deliberate, and how much is just reflexive. Our best guess, several months ago, was about 70% deliberate. However, we treat every choice as a deliberate choice, because, regardless of the intentionality of it, it's setting up a pattern of behavior, and teaching Brianna to identify words, and to realize when a choice has been made. So, basically, in a nut shell, that's what Brianna's speech therapy sessions have looked like. Clear as mud, right?