10th Annual BHSM FREE Screening!

May is Better Hearing & Speech Month (BHSM) which gives SLPs and Audiologists the chance to educate the community about what our professions do.  For 10 years, STG has provided a FREE screening for children ages 3-6 to celebrate #BHSM!  Each year, families attend this event to learn about speech-language development and to see how their children are doing.  If services are recommended, they then learn about resources available in our community (Nevada Early Intervention, ChildFind, UNR Speech & Hearing Clinic).  We also share what sets services at a clinic/office like ours apart from the services offered through early intervention or the school district.  This year our screening will take place on Saturday, May 20th from 10am until 2pm.  An audiologist, speech-language pathologists, and occupational therapists from STG and Silver State Hearing & Balance will screen hearing, speech-language, and fine-motor/sensory/self-help skills.  If you have questions or concerns in regard to your child's skills, this is your chance to come meet the professionals who have years of experience and knowledge in this area!  Visit asha.org for more information about BHSM and our professions!  

STG is turning 10 and we’re having a party!

Come one, come all to help us celebrate and party!  Planning for the 10th annual STG open house is well under way as we prepare to turn 10 and enter double digits.  The carnival will feature games, prizes, hot dogs, popcorn, a photo booth, and more…  Join us THURSDAY, MAY 19th from 5:00 to 7:00pm.  We would love to see old and new faces as we reminisce the past 10 years!  Be sure to check our Facebook page as we will be sharing photo memories over the next month!

May is Better Hearing & Speech Month!

For nine years, Sierra Therapy Group has celebrated Better Hearing & Speech Month (BHSM) by offering a FREE screening!

• What: FREE screening for children ages 3-6, the screening will assess hearing, speech & language skills, and fine motor/self-care/sensory skills
• When: Saturday May 14th, 10 am to 2 pm
• Where: Sierra Therapy Group, 9520 Prototype Court, Reno, NV 89521
• How: Please call (775) 852-6323 or email shawna@sierraspeech.com to reserve a spot, spots typically fill prior to the day of the screening!

This year clinicians from STG are teaming up with Silver State Hearing & Balance to complete the screenings.  Please pass this information on to any family you think could benefit from this outreach event!

How can occupational therapy help your child improve his/her attention?

What is attention?

Attention is the ability to stay focused on a task from the beginning until completion.  Attention skills allow us to “tune out” information that isn’t important to the task at hand.  Having the ability to stay on task and finish activities is important for skill development.  Attention is one piece in the puzzle of executive function.

So what are executive functioning skills? There are three main skills that make up executive functioning:  working memory, mental flexibility, and self-regulation.  Executive function serves as the control system of the brain.  It allows us to organize incoming information, ignore distraction, and change gears.   Self-regulation allows us to control our own level of arousal and alertness and adjust it to suit a specific activity.  It allows us to pay attention and make safe choices.

Children born with the ability to develop executive functioning skills, but some children may need more help than others to acquire them.  Children with ADHD or a sensory processing disorder (SPD) may have a more difficult time gaining executive functioning skills.  They may have difficulties getting started on tasks, keeping their attention on a task, following multi-step directions, organizing materials, and managing their time.  Children with executive functioning impairments may over or under react to problems, they may have difficulty making and keeping friends, and have low self-esteem.

Occupational therapists work with children to identify how these challenges are impacting their daily occupations.  These occupations include performing self-care, being a good student, interacting socially with family and friends, and being successful at play and leisure activities.

Occupational therapists have tools to help children with executive function and self-regulation issues.  An occupational therapist may use specific programs and strategies when working directly with a child or recommend changes to the child’s home and school environments and routines.

There are a few programs that occupational therapists use to teach children about self-regulation.  These include The Alert Program (How Does Your Engine Run?) and The Zones of Regulation.  These programs teach children to identify their own state of arousal, understand when different alertness levels are appropriate, and use sensory strategies to adjust their alertness when necessary.

Occupational therapists may develop a personalized Sensory Diet for children to help them maintain an optimal alertness level for school and/or home.  Some children may need calming strategies to improve attention at school or to prepare for bedtime.  Other children may need arousing strategies to combat lethargy.  Different sensory integration techniques and strategies can be taught to children, families, and teachers.  Examples of these include the Wilbarger Brushing Protocol, Mindfulness Training, and yoga practice.  Diet may also play a part in self-regulation.

Occupational therapists can also target executive functioning skills through practicing discrete skills (i.e. activities that have a clear start/stop point such as puzzles, mazes, and dot-to-dots), using picture schedules so that the child can understand the sequence of an activity or his/her day, moving through obstacle courses, using timers to teach time management and help with transitions, and playing memory games.

Some of the environmental modifications that occupational therapists may recommend include:

• Set up a distraction-free environment. Use privacy dividers, noise cancelling headphones, or ear plugs, or seat the child facing away from other children or a window/door.
• Establish a homework routine to avoid procrastination and distractions.
• Use aids like calendars, daily planners/organizers, computers, or watches with alarms.
• Use visuals; Prepare visual schedules and review them several times a day.
• Create checklists and “to do” lists, estimating how long tasks will take. Use checklists for getting through and activity or assignment.

Occupational Therapy and Vision

Vision is more complicated than whether or not your child needs glasses.  Children may have difficulty jumping their eyes from word to word while reading, following a moving object with their eyes, or perceiving what they are seeing.  There are some signs of vision problems that parents can look for in a child:

• Squinting or rubbing his or her eyes
• has a short attention span
• avoids reading, writing, and or other fine motor activities
• frequently complains of headaches
• tilts his or her head to one side while reading or writing
• messy handwriting
• difficulty remembering what he or she read
• has difficulty with sports, may seem clumsy

It is always the goal of occupational therapy to promote independence with daily occupations of living.  For children, the most important occupations of living are play, self care, and school skills.  When a child is having trouble seeing he or she may have trouble with play, self care, and especially school skills.  This is when occupational therapy can help!  Occupational therapists work with children to improve vision as well as learn and use strategies to work around vision issues.

There are many different types of vision impairments that children may be struggling with.  The impairment may be severe as legal blindness or as simple as sensitivity to bright lights.  Occupational therapists gather information about your child’s vision through a few different means.  You may have already taken your child to a developmental optometrist.  These types of optometrists specialize in rehabilitation of vision issues using lenses and/or exercises.  Occupational therapists and developmental optometrists often work together.  The developmental optometrist has more sophisticated testing equipment for vision and can share his/her findings with the occupational therapist.  Occupational therapists can seek out special training in screening for eye movement skills such as near-point focus, far-point focus, shifting focus between near and far points, smooth eye movements to track a moving object, eye jump movements needed for reading, and peripheral vision.   Occupational therapists can also evaluate how a child is perceiving vision.  These visual perceptual skills include visual closure, visual discrimination, visual memory, and figure-ground.  Finally, the occupational therapist can evaluate how children use their eyes and hands together to perform everyday activities such as writing, buttoning, and cutting.

After an occupational therapist has a clear picture on how a child is seeing a treatment plan can be formed.  This treatment plan will most likely include vision exercises to improve eye movement skills that will be done in with the occupational therapist and as homework.  Visual skills can be worked on through fun activities such as dot-to-dots, mazes, bean bag toss, and puzzles.  Movement and vision are closely related so occupational therapy will include many activities that require eye-hand coordination while the child is performing challenging activities such as jumping on a trampoline or swinging from a trapeze bar.   Occupational therapy may also address sensory sensitivities to light and visual clutter through a sensory integration program.

Occupational therapists can also suggest many strategies to try to improve vision; especially in the school setting.  Examples of these strategies include using lower watt bulbs in the lamps at home, using a cut-out book mark when reading, using colored overlays to improve contrast and highlight text, writing on a slant board instead of a flat desk top, and writing on raised-line paper.

If you have concerns about your child’s vision please contact Sierra Therapy Group and speak with one of our occupational therapists.  We would love to work with you!

Tips and Tricks For Successful Trick-or-Treating with a Child with Special Needs

As summer turns into fall, our favorite holidays approach.  For kids with sensory processing, motor or speech difficulties, holidays can present a unique challenge and Halloween is no exception.   Other children in costumes may be unpredictable or loud, the change in routine may disrupt sleep routines and challenge self-regulation, saying  “trick or treat!” or answering strangers’ questions may be a source of nervousness or stress and costumes may be itchy or uncomfortable.  Here are a few tips and tricks to make this Halloween a successful one:Prepare your child for trick-or-treating by watching kid-friendly movies that show how this holiday pastime works.  Suggestions include “It’s the Great Pumpkin Charlie Brown!” and “Casper.”

• Prepare your child for trick-or-treating by watching kid-friendly movies that show how this holiday pastime works.  Suggestions include “It’s the Great Pumpkin Charlie Brown!” and “Casper.”
• Practice trick-or-treating in the safety of your home or at daycare before venturing out into the neighborhood at night.
• Choose a costume with your child’s sensory, speech or motor challenges in mind. Avoid scratchy or itchy fabrics and be aware that masks may make it difficult to navigate streets and sidewalks safely.  Allow your child to try the costume on before the special night in order to work out any issues with fit or comfort.
• Keep routines as consistent as possible. Go trick-or-treating right after dinner and try to be in bed as close to the usual time as possible.
• Create a neighborhood map to add some predictability to a potentially unpredictable experience.
• Create a social story to prepare your child for the events, safety rules and social expectations of trick-or-treating. An example can be found at: http://www.oneplaceforspecialneeds.com/main/library_trick_or_treating.html.
• For children who are non-verbal, consider carrying a card to help them express themselves and participate more actively in trick-or-treating. For example,

Trick or Treat!

Hello, my name is _______________ and I’m not yet able to say “Trick or Treat” or “Happy Halloween,”  but I’m trying. Thanks for understanding and

Happy Halloween!

For more ideas on how to maximize your child’s successful participation this Halloween, feel free to ask your speech or occupational therapist.  We look forward to celebrating the holidays with you and your child!

Tips and tricks were adapted from Lisa Ackerman’s article at TACA.org.

The Scoop on Stuttering

WHAT IS STUTTERING/DISFLUENCY?

Stuttering is an interruption within the normal flow of one’s speech. Everyone demonstrates a natural level of disfluency in their speech and children can display higher amounts of “normal” disfluency as their language skills emerge. The types of stuttering and frequency of the disfluencies dictate how “fluent” a person’s speech is perceived to be.

What is considered typical?

There are two general categories for disfluent speech. Typical disfluencies refer to interruptions that are considered “normal” within speech. Atypical disfluencies refer to stutter-like behaviors perceived by listeners as excessive interruption within speech or abnormal tension associated with speech production. As children develop speech and language, variations of disfluencies can appear and disappear. Paying attention to the time since the onset and the types of stuttering can be helpful in deciding whether or not an evaluation is needed.

Typical (Non-Stuttered) DisfluenciesAtypical (Stuttered) Disfluencies

Hesitations (pause)*Repetitions of sounds or syllables (“Li-li-li-like this”) [typically repeated four or more times]

Interjections (filler words: uh, um, like)Prolongations (“L_L_L_Like this”) [prolongation of one sound]

Revisions (“I want…I need that”)Blocks (“L—–ike this)                 [word is stuck without moving air]

*Repetitions of whole words or phrases [typically repeated three times or less] 

NOTE: “Non-stuttered” disfluencies can be used to avoid or postpone stuttering (e.g., “I uh, you know, uh, I want, um, to go with you.”)*Often has associated tension

Is this developmental?

Developmental stuttering is stuttering that appears in early childhood and naturally diminishes over time. Persistent stuttering is stuttering that continues past the early childhood years.

Developmental stuttering typically emerges in early childhood years (2-6 years old) and lasts less than 6 months. Research shows that if a child begins to stutter before age 3, there is a high probability (up to 75%) that he/she will spontaneously stop stuttering. If stuttering emerges after age 3 or has persisted over 6 months since the initial onset, an evaluation with a speech-language pathologist would be recommended.

Important factors for determining a therapy recommendation include: family history, age of onset, gender, length of time stuttering has persisted, types and frequency of disfluencies observed, reactions or emotions associated with stuttering, and other present speech-language and/or attentional, sensory, or neurological disorders.

What happens in therapy?

Stuttering therapy typically includes integrating strategies to increase fluency and decrease tension, however, the key in properly treating stuttering is to also address associated thoughts, feelings and social impact.

Our main goals in therapy include:

(1)        Making talking easier

(2)        Developing healthy attitudes and feelings about talking

Making talking easier is achieved by learning speech tools. These tools help the speaker to produce speech in a different way, such as reducing the amount of tension in the speech system, beginning a sentence with more air, or stuttering in an easier way.

Developing healthier attitudes and feelings about talking is achieved by learning to respond to speaking situations with less anxiety, become more confident in the ability to use speech tools, and use problem solving skills for difficult speaking situations.

Not everyone needs to change how they feel about talking. Many kids and teens are confident and willingly talk to others. For some, however, talking can produce feelings of anxiety or fear, even guilt and shame. Overcoming these negative attitudes and feelings can be just as important as learning to talk more easily.

Families also play an important role in the management of stuttering in children. Therapy is characterized by parental involvement and direct treatment as well as providing an environment that encourages slow and relaxed speech and allows the child time to talk

Talking more fluently is only one part of being a good communicator. Learning to take turns, not interrupt, and using eye contact when speaking are also important communication skills.

What can I do to help?

* Speak with your child in an unhurried way, pausing frequently. Wait a few seconds after your child finishes before you begin to speak. Your own easy relaxed speech will be far more effective than any advice such as “slow down” or “try it again slowly. For some children, it is also helpful to introduce a more relaxed pace of life for a while.

* Try to increase those times that you give your child your undivided attention and are really listening. This does not mean dropping everything every time she speaks.

* Asking questions is a normal part of life – but try to resist asking one after the other. Sometimes it is more helpful to comment on what your child has said and wait.

* Help all members of the family take turns talking and listening. Children find it much easier to talk when there are fewer interruptions.

* Use descriptive praise to build confidence. An example would be “I like the way you picked up your toys. You’re so helpful,” instead of “that’s great.” Praise strengths unrelated to talking as well such as athletic skills, being organized, independent, or careful.

* Set aside a few minutes at a regular time each day when you can give your undivided attention to your child. This quiet calm time – no TV, iPad or phones – can be a confidence builder for young children. As little as five minutes a day can make a difference.

* Don’t finish his/her sentences. Children who stutter know what they want to say and generally don’t like it when their sentences are completed for them. It elevates their stress levels, possibly increasing instances of stuttering.

* Wait patiently for a child to finish. Don’t rush a child who stutters. Provide adequate wait time for him/her to complete the thought.

* Watch your body language. Children are very aware of your non-verbal reactions to their speech. Keep your face neutral, with an unchanged expression when the child stutters.

* Educate others about the child’s disorder. Children in the class will be curious about the child’s speech. Sometimes they will tease the child about his/her speech. If you teach them about the disorder in a fun, educational way, this may alleviate some of the discomfort.

* Keep an open door. Allow the child to come to you at any time to talk about school, family, or any other issues he/she might have.

* Monitor the child’s classroom achievement. Some children who stutter begin to do poorly in the classroom setting. They may stop volunteering to answer questions or speak in front of the class. Make sure you notice any changes in the child’s classroom performance and notify parents if changes occur.

DO YOU HAVE ANY RESOURCES FOR ME?

Meeting people face to face is a great way to learn that if you stutter, you are not alone. There is currently a National Stuttering Association (NSA Kids) family support group being developed in Reno designed for young children who stutter and their families, led by one of the Speech-Language Pathologists at Sierra Therapy Group. This group will occur the 3rd Tuesday of each month from 6:30-8:30 p.m. and the first meeting will be on June 16th. For more information or if you are interested in joining this support group, please contact Ashley at (775) 852-6323.

In addition, be sure to check the following reputable and research-based online resources:

• National Stuttering Association (NSA): http://www.westutter.org/what-is-stuttering/stuttering-info/
• The Stuttering Foundation: http://www.stutteringhelp.org/resources
• Stuttering Center of Western Pennsylvania: http://www.stutteringcenter.org/stuttering-center-forms.html

May is Better Hearing & Speech Month!!

Spring is such a great time filled with new energy, budding flowers, and bright colors!  It is the perfect season to celebrate Better Hearing & Speech Month (BHSM)…early identification and intervention is key to helping children who experience speech, language, and communication impairments.  50% of children who are “late-talkers” at age 2 will go on to develop a speech-language impairment.  At age 2, we are unable to diagnose which children will out-grow the delay and which ones will go on to experience a disorder.  So, if children show red flags at age 2, it is best practice to provide therapy.  One milestone we check for at age 2 is in regard to vocabulary.  Children typically produce at least 50 words and begin to form two-word utterances by 24 months.  Check our website for more milestones…

Annually Sierra Therapy Group celebrates BHSM by providing FREE screenings for children between the ages of 3 and 6.  Our 8th annual screening is scheduled for Saturday, May 30th, from 10 am to 2 pm.  We are partnering with the UNR Speech & Hearing Clinic to provide hearing screenings as part of our event.  The screening will assess hearing, speech & language skills, and fine motor/self-care/sensory skills.  If you are interested, please call or email (annelise@sierraot.com) to reserve a slot as our schedule typically fills up for this event.

In addition to the screening, we host an annual open house every year.  This year the 9th annual Open House is scheduled for Thursday, May 14th, from 5 pm to 7 pm.  It is an opportunity to meet our staff/clinicians and ask any questions you may have.  Anyone and everyone is invited tostop by the office for fun, games, and snacks.  This year, Sierra Therapy Group will transform into Candy Land!!

Happy Better Hearing & Speech Month!!  Please let us know if you have any questions at all…  More blogs will be posted throughout the month highlighting different areas of what we do…

Developing Fine Motor Skills

Do you know a child who has difficulty with handwriting, fastening buttons or opening a zip-lock bag? They may benefit from activities to further develop their fine motor skills.

What is Fine Motor?

Fine motor is the strength and coordination of small muscles in the hands and wrists.  Buttoning a shirt, zipping up a backpack, writing a sentence, cutting paper, beading a necklace and picking up a Cheerio that landed on the floor are all examples of fine motor skills.

Fun Activities to Promote Fine Motor Development:

• Bubble wrap: pop by pinching with fingers
• Spray bottle: squeeze spray bottle of water in the bathtub; outside on plants or at targets
• Sponges: squeeze sponges to transfer water from one bucket to another, paint with sponges or squeeze out sponges while taking a bath
• Kitchen tongs: pick up objects using serving tongs
• Clothespins: attach them onto the edge of a box or connect them into a long chain
• Rubber stamps: dip stamps in ink and press onto paper
• Stickers: peel stickers and place on paper to make art
• Scissors: cut paper, cardboard, Play-Doh or sandpaper
• Hole punch: create confetti out of construction paper and glue it on a piece of paper to make a design
• Staple: craft a paper-chain a snake by stapling loops of paper together
• Crumple paper: crumple scrap paper and throw at a target, crumple tissue paper and glue on construction paper as an art project or crumple scraps from a cutting project on the way to a trash can
• Tear paper: tear small strips of paper or tissue paper to make a collage
• Color: color with broken crayons to encourage use of fingers instead of the whole hand
• Crayon Rubbing: rub side of crayons on paper
• Painting: paint with a paint brush, Q-tip, sponge or fingers
• Vertical Surface: tape paper to a vertical surface such as a wall to increase wrist strength
• Mirror writing: write o n a mirror with a dry erase marker
• Play-Doh or putty: roll it, pinch it, press it, make a snowman, pancake or snake
• Baking: squeezing dough, pressing cookie cutters into dough or rolling cookie dough into balls
• Peel fruit: peel or help peel oranges, mandarin oranges, bananas, etc.
• Beading: string beads, Cheerios or Fruit Loops on to string or pipe cleaners
• Eye droppers: transfer water from one cup to another, put one drop of food coloring into different cups of water, mix the colors to see what happens, then create a masterpiece by dripping colored water onto a piece of paper with an eye dropper
• Tug-of War: use a large-diameter rope or large towel twisted lengthwise
• Finger puppets: moving one puppet/finger at a time
• Coins: grasp from table top or floor and insert into container with slit in the lid
• Pom poms/cotton balls: place into a container with a hole in the lid
• Pipe cleaners: turn a colander upside-down and insert pipe cleaners into the holes
• Hammer: turn an egg carton up-side-down and smash each egg compartments or play with a plastic hammering toy
• Games: check your closet to see if you have any games that require fine motor skills like Don’t Break the Ice, Bed Bugs, Operation or Pizza Pile-up
• Finger bowling: flick marbles, M & M’s or Skittles into a goal
• Ball rolling: roll a tennis ball up your leg or arm

Zones of Regulation

Each day, we all are presented with experiences that test our self-regulation, or our ability to cope with frustration, challenge or disappointment while maintaining or efficiently returning to a neutral mood.  These daily challenges may include the irritation of road construction, a frustrating or aggressive coworker, a day that never seems to end, a fussy toddler or a cold that you just can’t seem to get over.  Regardless of the situation, most people are effective at finding something they can do to help their state of mind.

Children, however, are still in the process of learning how to self-regulate and for many, self-regulation doesn’t come naturally.  This is especially true for children with sensory processing challenges who seem to experience or sense the world more intensely than others. Each loud noise in the kindergarten classroom is irritating or frightening, each smell in the lunchroom nauseating, each outfit they wear irritating.  For these kids, self-regulation is a significant challenge, with meltdowns, anxiety, frustration or avoidance of typical childhood activities frequent.  At Sierra Therapy Group, this is where using the “Zones of Regulation” curriculum by Leah Kuypers, MA.Ed. OTR/L, can be immensely helpful.

The “Zones of Regulation” is a systematic self-regulation curriculum aimed at categorizing our daily emotions under four zones.

• Blue zone includes feelings of sadness, boredom, tiredness or illness.
• Green zone is our ideal state of alertness in which we feel happy, focused and ready to complete a task.
• In the yellow zone, children identify feeling frustrated, overwhelmed, silly or nervous. It’s hard to focus in the yellow zone.
• Finally, in the red zone, children experience feelings such as intense anger and fear and actions such as yelling or hitting.

Through the categorization of feelings and states of alertness into these different zones, exploring when each zone is expected (e.g. it’s expected to play actively and be silly on the playground, but it’s unexpected to run around at a quiet restaurant),  then learning how to choose sensory strategies to these feelings and alertness levels, children become more adept at identifying and managing their feelings, understanding the feelings of others, and adjusting their alertness level or mood to match the situations they experience.

Let’s look at an example:

• Andrea is a kindergartner who is very sensitive to light, sound and kids getting into her personal “bubble.” She loves her teacher, who speaks softly and is very patient.  She wants to play with her peers at school and at the park, but is often overwhelmed by how quickly they move and how much noise they make.  Andrea is often found playing by herself on the playground or at birthday parties.  She appears to be a calm, friendly child when she interacts with patient adults or a single calm peer, but Andrea has gotten a reputation for being pushy or aggressive with the peers who bump into her, take her toy or make a loud noise.  She’s struggling to pay attention in the classroom, becomes very upset at birthday parties and other family events, has very few friends at school and has gotten in trouble four times in the last week for biting or hitting.  In the mornings, it’s often difficult for Andrea’s mom to get her ready for school because Andrea says that the other kids don’t like her, she gets bored at recess and Thomas keeps bugging her over and over again.
• Andrea’s mom is feeling stressed because she wants Andrea to enjoy school and have friends and doesn’t understand why her sweet daughter struggles so much in environments that most children love.
• During individual occupational therapy sessions, the occupational therapist may start by listening to mom describe her observations and concerns and to Andrea tell about her day at school or the most recent birthday party or group play date she attended. Through a game of feelings BINGO, zones charades, animal walks in the gym or a quick worksheet, Andrea begins to learn about all the feelings she experiences and the zone they match with.  She learns that all children and adults experience every zone, but is also learning that the green zone feels the best to her brain and her body.  Through the careful selection of sensory strategies to try at home, school and in the community, Andrea and her mom discover ways to cope with many of the daily sensory experiences Andrea encounters and notice that Andrea appears happier and calmer and has only gotten in trouble for hitting one time this week.  She’s even found another child at school to play with at recess sometimes.
• As new challenges arise, such as the introduction of a dance class or an unfamiliar errand with mom, Andrea and her OT talk about what zone(s) she experiences during these situations, ways to figure out what zone is expected, then problem-solve ways she can cope with the situation and stay in (or return to) the green zone. Through games, role-playing, interactive review of concepts and trying out sensory strategies in a variety of situations, Andrea learns many activities or strategies she can try the next time she’s feeling stressed, overwhelmed, nervous or irritated!

For more information about the Zones of Regulation, check out http://www.zonesofreg