Thursday, May 26, 2011

Duke speech eval

We had a speech eval at Duke this week, for another opinion regarding apraxia. Or just for another opinion in general on what could be going on with Sweets. We were there for about 2.5 hours and while Sweets was shy at first (understandably), I think that she got comfortable and performed well for the eval.

First off, this SLP does NOT think that Sweets has apraxia. She said that there are too many things that don't fit. She said that maybe as she gets older she may show more signs of apraxia, but right now she doesn't. She also said that Sweets is doing so many good things that she feels really good about her progress, and she thinks that we have a good chance that Sweets will just "catch up" by the time she's 5, with therapy and hard work, of course. So that is very encouraging!

She did a test called REEL-3, which is a different test than what we had last week. On this test, there is a series of yes/no questions. The first number is based on when she gets 5 "Yes" answers in a row, and the second is based on when she gets 5 "No" answers in a row. For some reason, and oddly, Sweets actually scored lower on receptive language than on expressive language on this test. Neither the SLP nor I felt that this accurately describes Sweets, but that's just the way the test came out this time. She said that once she is 2.5, they could do a different test on her that might be more accurate. It seems like everyone uses a different test and it's just whatever test they like - not very "standard" at all.

Receptive Language: Raw Score 45 | Age Equivalent 16 months | Ability Score 78 |
%ile Rank 7%

Expressive Language:Raw Score 48 | Age Equivalent 20 months | Ability Score 85 |
%ile Rank 16%

Language Ability Score = 78

90-110 Average
80-89 Below Average
70-79 Poor
<70 Very Poor

I told the SLP about the recommendations from the EI eval, regarding using the picture boards and focusing on 20 words. She said that she didn't want to say that she disagreed with the other SLP, but that it's definitely not what she would have recommended. (Sounds like she disagrees to me...) She said that she does use picture boards for kids who can't/don't sign, but that since Sweets can sign that she wouldn't have recommended a picture board for her. She also said that she would continue to work on all vocabulary with Sweets. She said continue to sign and say the word together, and encourage her to try to do both as well, instead of just signing. She does this sometimes, but often she just signs. Our usual pattern is that she signs, I ask "Do you want XXX?", she signs again while approximating XXX. So we are to try to get her to do the approximation up front and prompt her with less. So instead of saying the whole word, I can try to shape my lips, or look at her expectantly, to give her the idea that I want her to say it. Gradually over time, of course.

She did demonstrate this technique with Sweets, and Sweets responded to it pretty well. She even got Sweets to say "On" which I have never heard her say before. This is a meaningful new word because it is a VC (vowel consonant) word, and all of her others are CV sounds, particularly CVCV words where C1V1C1V1, ie Mama, Dada, ByeBye, PeePee, NightNight (NiNi).

In the end, I felt a little confused because the two evals differed so much in their assessments and recommendations that it makes it hard to know what to do. It is looking like Sweets does not have apraxia, though we don't know what she does have either yet. Or if she is "just a late bloomer" after all this.

Monday, May 23, 2011

May speech evals

Sweets had her CDSA eval last week for speech. The SLP said that there are some features consistent with apraxia, but others that are not. At this stage, she didn't rule it in or out. We will have our Duke eval this week, so I'm curious whether they will say anything different. I have heard before that she may be too young to really be able to tell because she only just turned two. The good news though is that her receptive language seems fine, and her cognitive tested within average range this month too. Her expressive language is also not bad, in that she can sign to communicate (and she is learning new signs rapidly!). Her speech skills tested at 9-12 month level.

The CDSA eval SLP suggested making a list of about 20 words that Sweets would want to use frequently through her day, and working on those specifically, aiming for consistency and accuracy. So a more focussed approach instead of a broader approach. She also suggested that she could make us a set of picture cards for those words, one for home and another for daycare, to help Sweets identify what she is saying to us. That seemed like a good idea at the time, but as I think about it more I'm not really sure what that will give us, considering that Sweets can already sign all of those words (and a lot more) to give us a cue for what she is trying to say. What advantage would picture cards give us over the signing that she is already doing?

Sunday, May 15, 2011

Sure Step!

Our Sure Steps have arrived! I took Sweets for her fitting on Friday for her new SMO orthotics. The Sure Steps are made especially for her based on the measurements the orthotist took on her a few weeks ago. We got the flowers and bugs pattern and they are definitely nice. We also bought the Sure Step shoes to go with them, because I had heard that it can be hard to find shoes that fit over orthotics. These have a wide toe box and wide heel to accommodate the orthotics, and there are two insoles that are removable to fit with or without the orthosis.

We arranged the payment so that the insurance will be billed first. They will charge us a deductible (around $300-350) and then they cover 60%. What's left will be charged to the state early intervention, and they will pay 60% of that. In the end, I expect that we will have to pay about $150, but we'll see how it ends up.

I expected Sweets to fuss when we put the Sure Steps on for the first time, but she really didn't at all. She even seemed to like them right away! The orthotist showed me how to put them on her feet, pushing her big toe up and to the side to get her heel in deeply. The velcro strap is supposed to be pulled tight - "Snug is not enough" - so she made a mark on the outside so that we would be sure to pull it to the right amount.

SureSteps on, without shoes

SureSteps on with shoes

She is supposed to wear them for 1 hour the first day, 2 hours the next day, 3 hours the next day, etc until after 1 week she will be wearing them full-time. Today is day 3 and she seems to do really well in them. She is walking well, and best of all - she isn't falling down a lot! The reason we got them in the first place is because Sweets pronates her feet when she walks, causing her to fall down frequently. These are supposed to help with that, and they seem to already! They should also help her learn to run and climb.

Wednesday, May 4, 2011

Developmental Eval - cognitive

Today Sweets had a developmental eval. The eval was done at our home and took about 1.5 hours. By the end, Sweets was just not interested in participating anymore. I was surprised that she did the 3-piece puzzle (she usually has a lot of trouble with that), but she would not even really try the 9-piece puzzle. She just got up and walked away! LOL The evaluator did a test where she hid a toy under a washcloth to see if Sweets could find it. At first she found it every time. But when the evaluator hid the toy, and then moved the washcloths, Sweets failed to find the toy every time. There was also a part with matching pictures, which Sweets participated in but failed every time.

The evaluator used the Bayley Scales test again, which is what we had last year too. This time, she scored a 90 for cognitive! Yay! Last time she had scored an 80, which is borderline delayed, but a 90 is within average range! We are very excited about that, because as long as she can understand things, even if she can't speak, she can still learn to communicate in other ways. She's already communicating well using sign language, and I know there are many other communication methods too. Sweets was also scored for social/emotional and scored at 93, but we weren't really concerned there. She did not get scored for PT, adaptive, or speech because she recently had a PT and OT eval, and she has a speech eval coming up this month.