Speech and language development

The journey towards language development/thinking skills/speech
(The initial stage-commenced in October 2004)

Children with cerebral palsy have severe delayed speech depending on the levels of the CP affliction-mild, moderate or severe...
Anandita was not a speaking child even at 2 years of age. Like all her development milestones, even speech was delayed. She was accustomed to gestures.To make matters worse we were not even made aware of by her motor therapist at the right time that she would need speech intervention. I finally started speech therapy for her in 2004.when she was 3 years old.
In the early stages she needed a lot of oral mouth and tongue exercises. Due to weak muscles tone this was essential and became a preparatory stage for further therapy.

Soon after, I was asked to make a list of the words I would like her to say right from the start of her day. My list included a Good morning,wash,give milk,Mamma-come-read,potty,etc,bye bye, see you, come soon,tape,song(when she wants music on),Mamma, give khana,give juice. Just some of the words that formed her daily needs.
So every time some task was required I would encourage her to say a word closest to that task in hand. Constant talking like a running commentary so to say was what I began doing with her. At 3 years of age she was not even a crawling child. She was on my lap and used to being carried. So whenever we went out or even if I was in the kitchen she would be with me and I would speak to her as to what I was doing etc.Initially it was tough but I soon got used to it.

Soon after this over a period of time, slowly concepts of in, on and under were introduced. Questioning was encouraged. What does Mamma like to eat? Where does Papa go every morning?
What does Papa do in office?
What fruit does Papa like?
It was initially more family focused as we were a part of her day to day life.

More creative questioning was introduced such as, objects” What is this? Diti would reply ‘chair’. Where is the chair? Is it in the bathroom? Her answer would be, ‘No, it is in the bedroom.” What is in Mummy’s’ purse? She would have to use memory to remember what was inside. She had to be encouraged to think and speech therapy I realized was not just about making her speak. It was to help her understand language, its structure, formation of sentences and enhance her thinking skills through a creative and holistic process.

Speaking of alphabets was then begun. We started with ‘F’.I would make her say FEE FI Fo Fum and bite her lower lip while saying these words. This was done more to enable her use her teeth and mouth to speak.
Oral exercises were continuing. I used a battery operated toothbrush to brush the inside of her cheeks, her tongue. She didn’t know how to blow so as a reward she was allowed to blow bubbles…or a flute and she even attempted a balloon with time. She was encouraged to use a straw .I put thermocol balls in a bottle and she would blow them with a straw. Candle blowing was her favorite pastime under supervision.

Since her lungs were weak, she was encouraged to say words with a lot of air. She learnt to say “Hello’ Hi, Haircut with stress on the H.She would always say Vuhhhh instead of Hhhhh.So words needed to be stretched out for her.

She then learnt P, T, K.
Pa ta ka
Pi ti ki
Po to ko
Pu tu ku
If you say those words you will see how for P the lips are used, for T, the upper pallete and for K, the inner mouth...

She needed a lot of encouragement to express herself. We played many games with her. We would show her a teddy bear with one ear missing and then ask her what is missing?
Or make her tear lots of paper and then blow it for fun to see how far it went. I spy games to improve her scanning skills.

In fact I noticed through the sessions that this was no formal session of teaching speech. Everything from simple games of sequencing, making stories from picture cards, picture matching was integrated into a fun creative wholesome learning experience for Anandita and the end result was to encourage her to understand and express.

For me it was an entirely new learning experience. From daily motor therapies that involved physical stretching and holding, this was not only new for me but also a very creative way of teaching children concepts.
Soon individual questions were introduced—such as ‘What?” What is this Anandita’? She would respond ‘iron’. Next question would be ‘Why do we use iron?” So her thinking process would trigger not just the question on what the object was but also the use of that object. Subtly knowledge acquisition was happening.

Sentence formations also were included.’ Where is the ball?” Ball on table (Diti's reply).’Which ball is on the table?” Her response would ‘red ball on table’. (At that stage we didn’t insist on usage of articles like "a 'and "the' as long as the reply was accurate and that meant she had understood the question.

I would be asked to show her a book, look at the pictures with her, she would name the objects and then the page would be covered and Anandita would be asked in questions .what she had seen on the page in the book.

While eating from a chips packet, I would underline the big lettering on the colorful packet with my finger and read it aloud.

To improve her muscle coordination which may have nothing to actually to do with speech lessons, Anandita would be asked-Before you clap your hands, comb your hair. This was a way of enabling her to follow instructions as well as motor movements and for her brain to understand which action followed which.
Further games like. saying a word and asking her to not say part of the word for example Swimming is the word.Dont say swim
Butterfly is the word, don’t say fly.
Then we shifted to smaller words like Papa, but don’t say ‘pa’.
I started using Dr Seuss’s books for rhyming words and a new book by Kathleen Lloyd-Times 1000 words to talk about which improved her vocabulary a lot.
The entire process was geared to improve her thinking skills.
What is always red in shape? would be one of the questions asked.
.
She would be made to link similarities between objects. I would show her a cake and a sweet and ask her what the same between them?
Same with an iron and a candle.
Tongue exercises were also ongoing. Putting the tongue out, tongue inside cheeks. Due to impaired muscle movements the tongue did not move freely...So the therapist would put a piece of sticky food item on the side of her cheek inside so that by reflex automatically and slowlyAnandita’s tongue would move towards it. There were so many things I was learning in each session spread over weeks and months.
Not just story telling, we did break up of words as mentioned before, rhyming words, picture reading and asking questions on what happened, finding out similarities and differences.
We worked on varied themes from food(what is common between apple and burger?),body parts,drinks,school(blackboard and teacher),sports,weather,things that fly, farm animals,occupations,insects,furniture,fish,birds etc—the list was endless.
And it was taught in such a creative way that it didn’t seem like teaching.

‘Niharika was hungry, her mother gave her cheese. What food did Niharika eat?

Medini aunty made Anandita do her therapy exercise. Which Aunty did u hear?

Inane questions they seemed but such immense learning for Anandita and me...
Like do doors slam?
Does an egg bounce?
Do muscles ache?
Does a friend help?
Do people dream?
Do you have a thumb on your toe?
Could you make a milk shake without milk?
Do fingernails break?
Does a candle tick?
If today is Friday then what is tomorrow?
Does a pen leak?
Does a zipper shout?
Can you use your fingers to walk?
Can you use your eyes to smell a flower?

A man was very tall. The doorway was very low. He walked into the room very fast. What happened?

My dad said ‘SMILE”.A bright light flashed. What happened?

Ananya wore nice white shoes and went out with her friends. She returned with her shoes very dirty. Where did she go?

Name something that has 4 corners? Name something that you can eat that has 4 corners?
What can you cut with scissors but not with knife? (Hair/paper).

By 2007 the sessions had become fewer but more varied and intensive. I was following a home programme in the interim period.
By January 2007, we had gradually moved on to more intricate questioning such as
Name 5 places where you can eat ice-cream?

Name 5 things you can see in a mall?
Or name 5 places where you can see many children?
When would I go shopping for toys?
How can I use the phone? (To hear, to speak, to charge, to send a message, to switch off)
Name 5 things one can eat with a spoon?
More descriptive details were introduced and the process of associating things together began.
Why do you carry a purse?
Or a situation- “I am going to have a small party. I am going to make sandwiches and pizza. What will I buy?

Why do we have doors?
And emotions, when do you get angry?
When do u feel sad?
When do u feel hesitant? /anxious/surprised/excited

“I was going on my way. Some boy pushed me, my things fell down. He picked it all up and helped me to put the things back. Was he a good boy or a bad boy?

I also started the process of ‘thinking aloud’ with her as I was walking with her or even at home as I was doing chores.

Her associations of the question “WHEN” was always to do with time and the clock. Slowly through different ways we changed that thought in her. Soon she was able to answer ‘when does Palak aunty buy chips? (During therapy)
When does Anandita wear her shoes? Etc


The ‘WHO”/WHY question was also handled through questions/situations...
“I have money to a man who uses scissors. Why did you give him money?
Who all do we give money to? It could be phone bill, therapy bill, fruit, grocer etc

Anandita had to be helped to ask questions related to any topic. I also had to see how much she could absorb from listening to a conversation. For example, I would tell her, there is a girl. She is wearing two ponytails. She is on the lawn.

Anandita’s speech lessons with Palak ended when we shifted to Pune in mid September 2007.I continue to meet her once a year.Last year; I was told that she had no speech issues except for clarity. Poor speech clarity is common in CP children and it would be unfair of anyone to expect perfect clear diction from a child who has motor impairments.

Her current oral therapy sessions involves many fun things from Om chanting to singing Sa-re-ga-ma-pa and also usage of the spiro meter to increase her lung capacity. We use different tastes-honey, lemon, salt with different textured cloth (denim, cotton, silk, wool, socks material) and stimulate the parts of her mouth-tongue, inner cheek, palate...

I would never trade this learning experience for any other because as Palak was not just her therapist and teacher. She was willing to equip me to handle Anandita's language needs in a guided manner, helping me along the way until she knew for herself that Anandita was now equipped. The resources she shared, the books and games she guided me into buying, the little nudges she gave me when she knew I was slackening just reminded me of the law of the Universe—one is always guided to the right person at the right time.Anandita and I, were to her.