Speech/Language Characteristics: Prader-Willi Syndrome

Speech and Language Skills of Individuals With Prader-Willi Syndrome:

By: Barbara A. Lewis, Lisa Freebaim, Shauna Heeger, and Suzanne B Cassidy

 

 

Prader-Willi Syndrome is a genetic syndrome affecting 1 in 10,000-25,000 individuals. Considering how rare it is, I find it amazing that I now have two kiddos with this syndrome on my caseload. So this month for Research Tuesday, I read an article that investigated the speech and language skills of individuals with Prader-Willi. It was interesting and relevant to me because of the two little girls I treat, and I hope it will be to you as well.

 

The first thing that struck me when researching this syndrome is the lack of information provided by mainstream websites on the subject. It's a good wake up call to any therapist who thinks they can just briefly look up a syndrome online to get information. I found the information provided on mainstream websites downplayed the speech/language and cognitive impairments that can be found in these individuals. For example:

 

The Mayo-Clinic states that individuals with PWS may have "a poor sucking reflex due to low muscle tone," which initially leads to poor weight gain. In regards to speech and language deficits the Mayo-Clinic says this: "Speech is often delayed. Poor articulation of words may be an ongoing problem into adulthood." In regards to intellectual abilities of individuals with PWS the Mayo-Clinic states that individuals may have "mild to moderate impairment in intellectual functioning, such as thinking, reasoning and problem-solving (intellectual disability)...even those without significant intellectual disability have some learning disabilities."

 

The Prader-Willi Association sights the following characteristics of children with this syndrome:

-Feeding problems and poor weight gain in infancy

-Global developmental delay before age 6; mild to moderate mental retardation or learning problems in older children

One of the purposes of the article I read was to "examine the existing literature on the speech and language skills of individuals with PWS, and to report on the speech and language findings of a relatively large cohort of individuals with PWS."

 

Method:

The researchers examined the speech and language skills of 55 individuals with PWS. Ages ranged from 6 months to 42 years. Diagnosis of Prader-Willi was confirmed by a medical geneticist for each participant. Categories examined included: intelligence, articulation and phonology, oral motor skills, expressive grammar, prosody and voice characteristics, lexical comprehension and expression, and narrative abilities. Individuals were divided into age groups and tested using commonly used standardized tests such as the Goldman Fristoe Test of Articulation, the Khan-Lewis Phonological Process Analysis, the Peabody Picture Vocabulary Test, the Expressive One-Word Picture Vocabulary Test, and the Standford Binet Intelligence Scale.

 

Results:

 

Oral Motor Skills and Articulation:

-91% demonstrated some degree of oral motor deficits characterized by poor tongue mobility, shortness of the palate, and incoordination of the articulators.

-85% demonstrated mild to severe articulation impairment

-Articulation deficits remained present through adolescence

 

Voice:

-20% presented with higher than normal pitch

-24% presented with lower than normal pitch

-62% presented with hypernasality

-14% presented with hyponasality

-Harsh vocal quality was noted in 26% of participants

-Hoarse vocal quality was noted in 13% of participants

 

Language Skills:

-participants presented with impaired vocabulary, difficulty including story grammar components, and difficulty with reading comprehension

-deficits in reading comprehension persisted until adulthood

-participants also demonstrated decreased narrative abilities

 

In Summary:  

The researchers outlined a general course of development for individuals with Prader-Willi Syndrome. That course of development was described as follows:

-6 mos-2 years:  infants present with weak cry, feeding difficulties, hypotonia, and speech/language delay.

-2-5 years: first words begin to emerge, oral motor skills remain poor and intelligibility is poor

-5-12 years: residual articulation deficits, decreased receptive/expressive language abilities (including poor narrative and story telling abilities), hypernasality or hyponasality may be present along with abnormal vocal pitch

-12 years through adulthood: some articulation errors, some receptive/expressive language deficits, poor narrative abilities, and poor conversational skills, abnormal pitch and resonance characteristics  

 

As you can see, the speech and language deficits of individuals with Prader-Willi Syndrome are far more complex than indicated by a number of mainstream websites providing information about the disorder. Many families rely on the internet to gather information about what to expect as their child grows and develops. As speech-language pathologists it is important that we complete studies like this one in relation to all of the syndromes we treat. In addition, it is important that we provide this information to our families and recommend intervention as early as possible. Clinical judgment and thorough testing and observation should be completed to provide the best services possible. Furthermore, SLP's should be actively educating the public about how syndromes such as Prader-Willi can impact an individual's ability to communicate functionally in their environment.  Otherwise, the affects of these syndromes will continue to be downplayed by doctors and insurance companies.

 

 

 

So you think you want to do home health...

When I graduated almost 2 years ago from grad school, the job search and the possibilities for employment seemed overwhelming, daunting even. Should I work in a school, hospital, skilled nursing facility, outpatient clinic or home health? In what type of work setting did I want to foster my newly acquired skills? When I landed my first job I was thrilled to have the opportunity to work in both a pediatric outpatient clinic and in a nursing home. Both settings offered challenges and a chance to learn totally different skills. I'm thankful I had the opportunity to do both. But I would quickly realize that a healthy work environment was the key to happiness. There was office drama, and little control over my schedule. I felt opportunities for growth were limited, and that the patient's needs were not being put first. It all came down to management, and choices that were being made that indicated that the company I was working for was on a downward spiral with no looking up.

So I began exploring other options. I had several good friends who worked in home health who loved it. At the same time I began reading blogs about individuals who had adopted children, or worked with non-profit groups. In my heart I felt a longing; a longing to work with a company that put children first, and who supported the therapists that worked for them. I wanted to work in an environment where I could grow and learn. I wanted to make a difference in a big way. I wanted to create opportunities and really change the lives of my patients. Friends shared their stories of working with low income families and I felt inspired. And so I began my search and found my current job.

Nine months later I see no turning back. For one, I found a company to work for that truly embodies and shares my core values. On top of that, working in home health has been an incredible adventure. I love being in the homes of the children I work with. It's amazing how different therapy can be when the parents are there, involved and working with you to help their child. For example, one little girl I see, I started out seeing at her daycare. But when the daycare closed, the family had no choice but to keep her at home after school. So I started seeing her at home and what a difference. For the first time I am starting to see a real difference in how this little girl communicates. The family has been involved and learning to carry over the techniques I use with her. I have even seen a change in her feeding skills. The point is, that as a home health therapist I have a unique opportunity to see my kids in their natural environment. The parents of my kids are the most important people on my team. By counseling parents I hope to empower them to be advocates for their children. And in the home, it's so much easier to get them involved than in a clinic setting. I can take the child's toys and show the parents how to play with their children. I can involve the siblings in feeding therapy. I can go to their pantry and see what food items are available. I can go to their room and play with them to teach them language using their toys. I have learned to be a minimalist and in doing so I am starting to sharpen my therapy skills. It's easy to do therapy when you have everything there at your fingertips. But when you're forced to work with what the child has, you learn to go with it. And in doing so, the activities become that much more meaningful to the child because it stemmed from their interest.

That's not to say there are no challenges. Some days I walk in and the TV is blaring, or the dogs are barking. Or they have the running water turned off because of a leak they cannot afford to fix. There are weeks when I get cancelation after cancelation because a child is sick, or I show up at their door on the coldest day of the year and they aren't there because they forgot about another appointment they had with a doctor or the WIC office. But these are minor inconveniences. And I'm learning to train my families. I'm training them to organize, and stay on top of things, because God knows they are overwhelmed. Some are just better at managing it all than others.

 I have a families where the parents are just young and need a lot of support. A lot of times people give them a bad wrap...accuse them of not caring, or accuse them of being irresponsible. Many would say of my 19 year old mom, who got pregnant before she graduated from high school "she should have known what she was doing." I say to anyone who says this, "whoever is without sin, let him be the one to cast the first stone." Sometimes people make mistakes and then they have to deal with the consequences. And sometimes those consequences can be more difficult to handle than could have ever been anticipated. When that happens what they need is someone to say, "you have the power to make the best of this situation". And as a therapist, I have to look at the child I serve and focus on the fact that no matter what the circumstances are, this child needs help.  So there are days when being a therapist means being a counselor, cheerleader, encourager, or even an older mentor to help a child raise a child.   It's messy sometimes, and sometimes it's not pretty. And some days planning gets thrown out the window, but that's okay. I am a part of their lives. The most rewarding part is getting that text or phone call from a parent saying "thank you so much for all you're doing for my child." Or seeing a young parent begin to grow in confidence and take responsibility as she begins to learn how to navigate the murky waters of being a parent of a child with disabilities.

So in the long run home health was for me. I've found a way to be involved with my families in a way that I was not able to be involved before. I've found a way to feel like I'm really making a difference. And that's what it all boils down to. I think each of us has to look deep in our hearts and ask ourselves where we feel our skills could be used the most. We have to look back to the day when we decided to become a speech-language pathologist and remember why we chose to go into the profession of helping people. And then when you step out into that job market, find what setting speaks to you most. Every one of us has the power to make a difference, no matter what the setting. But even though a lot of us SLP's are wired alike, there are things that make us all different. I think the most important thing is to 1) find a company that shares your core values as a therapist and that will allow you to abide by our code of ethics, and 2) find a setting where you feel you can blossom as a therapist. Discover what's out there by talking to others, reading blogs and the ASHA leader. It's not just about research, it's about a wonderful supportive community of SLP's who know the day to day struggles that come with working in this field. I'm learning to lean on them more and more. And day by day I'm finding my passion in this field. I'm developing my own set of skills, and learning skills beyond what I ever would have dreamed.

A Call to Play!!

Over the past week or so I've been listening to a seminar in the car (one of the beauties of home health...time to think between therapy appointments) called "The Power of Play" by Cari Ebert, M.S., CCC-SLP (visit her website here: Learning Through Play). If you ever have a chance to hear her speak, I would encourage you to do so! Let's just say her seminar changed my life, changed the way I think about therapy, changed how I think about goals for my little ones, and changed my thinking about how I would raise my own children if I ever have them. Play is a powerful thing! I don't think I realized just how powerful until listening to the research presented in this seminar. So I decided to do something a little different for "Research Tuesday". The article I read isn't specifically "speech" related. However, I feel the information I'm going to share with you is completely relevant to our field. Some of us work in schools. Some of us work in home health with the birth-3 population. Either way, as SLP's we have the ability to empower parents, educators and policy makers to improve the future of education and the social, emotional and physical development of both typical kids and kids with special needs.

The information I'm sharing was taken from an article entitled "Crisis in the Kindergarten: Why Children Need to Play in School". You can read it here.

Think back to kindergarten...what was it like? For me kindergarten was half a day. My teacher's name was Mrs. Mick and she was AWESOME! I remember participating in free play at the "kitchen" station, making arts and crafts, coloring, playing with play dough, blocks, and a variety of toys. Somewhere in there I'm sure I learned my colors, letters, numbers, though I don't specifically remember. I went to kindergarten in 1985. Kindergarten rocked! I loved learning! Today, most children go to pre-school and kindergarten all day. In many schools and districts, curriculum is focused on teaching to the test, and has increased in academic focus as the years have progressed. In addition there is an increase in didactic, adult directed instruction in many early childhood classrooms across the country. When you combine that with the hyper-busy lifestyles of many American families, there is little time left for child-directed play and exploration of the world through free play.

Here are a few quotes from Crisis in the Kindergarten demonstrating how early childhood curriculum has shifted in recent years. Information provided here was gathered from nine research studies, which surveyed kindergartens in the country in order to: 1) collect the thoughts of educators, 2) find out what methods are being used currently in kindergartens today, and 3) find out what kind of time is allowed in kindergartens for child-directed, open ended play.

1) "New York and L.A. teachers consistently reported major differences between their views of the importance of dramatic play, block play, and sand and water play and their perception of the views of school administrators. A large majority of teachers indicated that such play is important, while roughly half of the teachers perceived administrators as not valuing it."

2) "Scripted teaching and other highly didactic types of curricula are widely used in kindergartens despite a lack of scientific evidence that they yield long-term gains."

3) "A separate evaluation commissioned by the Institute of Education Sciences found that the federal government’s Reading First program had significantly increased (by about 20%)  the amount of class time spent on didactic, phonics-heavy reading instruction; nevertheless, the program “did not have statistically significant impacts on student reading comprehension test scores in grades 1–3.” The evaluation also found that the program actually reduced second-grade students’ engagement in reading and writing."

4) "Play in all its forms, but especially open-ended child-initiated play, is now a minor activity, if not completely eliminated, in the kindergartens assessed. Teacher-directed activities, especially instruction in literacy and math, are taking up the lion’s share of classroom time. Standardized testing and preparation for tests are now a daily activity in most of these kindergartens."

So is there evidence to support child-directed, adult guided free play to facilitate learning in the kindergarten and beyond?

First of all, how do the authors of this article define play?
 The authors define play in this way: "we use the word “play” to describe activities that are freely chosen and directed by children and arise from intrinsic motivation. Within this definition are many different kinds of play, including dramatic and make-believe play, block play, sand and water play, art activities, play with open- ended objects, spontaneous physical play, exploring the outdoors, and so on."
Unfortunately, in the U.S., the development of "educational toys" and the promotion of "educational videos and products", by manufacturers who know nothing about child development have conditioned many parents to believe that pushing hard core literacy, math and academics on children earlier, leads to smarter more academically successful adults.
But just look at these statistics and quotes from Crisis in the Kindergarten....

1) "Long-term research casts doubt on the assumption that starting earlier on the teaching of phonics and other discrete skills leads to better results. For example, most of the play-based kindergartens in Germany were changed into centers for cognitive achievement during a wave of educational “reform” in the 1970s. But research comparing 50 play-based classes with 50 early-learning centers found that by age ten the children who had played excelled over the others in a host of ways. They were more advanced in reading and mathematics and they were better adjusted socially and emotionally in school. They excelled in creativity and intelligence, oral expression, and “industry.”* As a result of this study German kindergartens returned to being play-based again."

2) "China and Japan are envied in the U.S. for their success in teaching science, math, and technology. But one rarely hears about their approach to schooling before second grade, which is playful and experiential rather than didactic. Finland’s children, too, go to playful kindergartens, and they enter first grade at age seven rather than six. They enjoy a lengthy, playful early childhood. Yet Finland consistently gets the highest scores on the respected international PISA exam for 15-year-olds."

3) "The American Academy of Pediatrics, in its clinical report on the importance of play, found that “despite the benefits derived from play for both children and parents, time for free play has been markedly reduced for some children” and addressed “a variety of factors that have reduced play, including a hurried lifestyle, changes in family structure, and increased attention to academics and enrichment activities at the expense of recess or free child-centered play.”

So what are we doing? Why aren't  policy makers listening? And why aren't parents, teachers, educators, and therapists educating and advocating for our children? After reading this and listening to Cari's presentation I feel strongly that we are doing a disservice to our children when we ask them to develop skills at an age when their brains are not ready to learn them. We don't expect an apple tree to produce apples until it has first developed blossoms. In the same way, a child's brain develops sequentially, and purposefully, by design. Think about the progression of play as a child develops. First they explore their world by reaching for objects and placing them in their mouth. Next, they learn that doing things with certain objects (like dropping a cup on the tile floor) creates a certain effect. Next, they learn that the cup is for drinking, and will even put water in a toy cup and sip from it themselves. Finally, they learn to apply that knowledge to the world around them through pretend play. They take the cup and give the baby doll a drink. Even more compelling evidence of the importance of free play is found in the list of skills children develop through play. Take this quote, for example, "Young children work hard at play. They invent scenes and stories, solve problems, and negotiate their way through social roadblocks. They know what they want to do and work diligently to do it. Because their motivation comes from within, they learn the powerful lesson of pursuing their own ideas to a successful conclusion." WOW!

Cari points out in her seminar that play provides rich sensory experiences that help to develop life long connections in the brain. It is well proven fact that if you want the brain to learn something, provide information through multiple modalities. Think about studying for an exam. Most of us are not blessed to be able to recall information heard once in a lecture. Most of us had to also read the information, write the information, or speak the information out loud to truly recall it. And TRUE learning happens when we are able to apply that information to the world around us, to think critically about it and use it in a way that is meaningful. Compare learning colors by matching colored squares on an Ipad screen to learning colors by sorting through a laundry basket or walking through a field of muli-colored flowers! Free play allows creativity to blossom. Media and pre-programmed battery operated toys (i.e. Buzz Light Year toy) limit creativity and imagination. Imagine the possibilities in a generic astronaut toy compared to a battery operated Buzz that can only say "To infinity and beyond!"

So, what does this mean for therapists, teachers and parents? I join Cari in saying this...allow children to experience their world through play! Play with them and let them take the lead. Remove obstacles in your life that take away time for your child to truly engage in sensory rich, child-directed play. Step away from media sources of entertainment and limit your child's screen time. "The American Academy of Pediatrics (AAP) discourages TV and other media use by children younger than 2 years and encourages interactive play." Children learn through play, so encourage it as much as possible!!

As a home health therapist:
1) Limit use of the bag of toys. Going through a bag of "pre-planned" activities is adult directed and more didactic in nature. Go into the child's home and let them choose a toy. Or, let the child choose from your bag and build your therapy from there. A good therapist can create language opportunities from anything. This will increase the chances of generalization of skills and increase the child's willingness to participate in activities.

2) Step away from the Ipad. Build sensory rich opportunities for language learning. Relying on the Ipad inhibits a child's development.

3) Play with a purpose. Model appropriate play with toys in the same way that you model language. Think about where the child is developmentally and model one step up. For example, if the child is exploring their environment through exploratory play, demonstrate cause/effect.

3) Educate parents on different types of play: exploratory, cause/effect, functional and pretend play, parallel and cooperative play. Educate parents on ways they can create language rich opportunities in the home. Teach parents how to play with a purpose. Encourage them to step away from their phones and be involved with their child.

As parents of young children (under the age of 7):
1) Increase your child's opportunities for free play by limiting your child's screen time, and adult directed, didactic instruction at an early age. Guide your children and provide structure, while allowing them to experience their world through play. For example, let them explore letters/numbers on a magnet board in their room. Model language that builds understanding when the child shows interest, but move away from drilling them. Read books that model sounds, but let the child choose the book. Use their natural curiosity to guide your interactions with them.

2) Increase opportunities for free play by de-cluttering your schedule. Kids don't need to be on a "social schedule" with a list of "adult driven" activities to complete every day. Free play should happen every day, not just in play groups once a week.

3) Learn how to guide your child in free play by seeking help from professionals who know about child development

4) Advocate for child-directed, adult guided, play based kindergartens

Just think of the opportunities for learning in the world around us. We live in a vivid and colorful world! As adults, we have the opportunity to bring to life a 3 dimensional world for our children who unfortunately spend much of their time in a 2 dimensional screen. I'm calling all parents, teachers and therapist to bring free play back! Let children be children and watch learning and discovery happen!

Music in the NICU

Written By:

Jayne M. Standley, Jane Cassidy, Roy Grant, Andrea Cevasco, Catherine Szuch, Judy Nguyen, Darcy Walworth, Danielle Procelli, Jennifer Jarred, Kristen Adams

Published in: Pediatric Nursing

May-June 2010; Vol 36

 

I pulled this goodie out of my archives. I found it in a random search a while back and was so fascinated by the title I couldn't help but read it. I mean who doesn't love music, right? Henry Wadsworth Longfellow said  "Music is the universal language of mankind." Confucius said, "Music produces a kind of pleasure which human nature cannot do without." So how does music relate to the field of speech-language pathology? I hope by sharing this article with you, together we can discover how music can be used to promote positive outcomes in feeding therapy with infants.

 

First a little background:

Non-nutritive sucking is sucking for purposes other than feeding, usually on a pacifier, finger or toy. It is generally faster than nutritive sucking which is used for the purpose of feeding. Non-nutritive sucking is "theorized to contribute to neurological development by facilitating internally regulated rhythms." Non-nutritive sucking is beneficial in the following ways: 1) it helps to reduce of stress and physiological reactions in infants who are exposed to painful experiences in the NICU, 2) it decreases the patient's heart rate,  3) it increases the patient's ability to absorb oxygen, 3) it helps to promote weight gain, 4) it helps the infants to calm themselves, leading to increased energy conservation, 5) in conjunction with gavage feedings it decreases the length of the patient's stay in the hospital, 6) it helps to promote earlier transition to bottle feedings. In addition, music has been proven to have some of these same positive benefits on infants as well including: 1) decreased stress, 2) decreased length of hospital stay, 3) increased oxygen saturation, and 4) increased weight gain.

 

The purpose of this study:

The authors of this study set out to determine the effect of a pacifier-activated lullaby system (PAL) on "the cessation of gavage feeding of premature infants due to oral feeding achievement." In other words, they wanted to see how music used as a positive reinforcement for non-nutritive sucking could effect the feeding skills of premature infants. Specifically they wanted to: 1) determine if the number of trials with PAL affected feeding outcomes, 2) to determine if age of exposure to PAL made a difference in feeding skills.

 

Methods:

In this study there were 3 groups: 32 weeks, 34 weeks, and 36 weeks. Each group was divided by gender, then randomly assigned to one of the following categories: "no-contact", "1 PAL trial", or "3 PAL trials". There were a total of 68 participants. Infants receiving PAL trials were offered Wee Soothie pacifiers embedded with computerized chips that activated the PAL system in response to the infants' suck. The settings were placed so that even the weakest sucking response activated the PAL system. Trials lasted 15 minutes each and occurred at the same time each day 30 minutes prior to feeding. In addition, the music stayed on for 10 seconds unless reactivated by additional sucks. Data was gathered from nurses notes who were blind to the purpose of the study. The authors then looked at the number of days the infant required gavage feeding (defined by the period from birth to the last day of gavage feeding), the total number of days the infants remained in the hospital, and total amount of weight gain from birth until discharge from the hospital.

 

Results:

For infants who were 32 weeks results showed:

     -increased duration of gavage feedings

For infants who were 34 weeks results showed:

     -decreased duration of gavage feedings

     -decreased the length of hospital stay

     -more trials with PAL produced better results

For infants who were 36 weeks results showed:

     -infants who were not nipple feeding before the trial began nipple feeding after 1 trial with PAL,

      therefore the researchers were unable to compare the effect of multiple trials of PAL on this age

      group.

Overall, there was not a significant difference in weight gain of the infants who participated in the trials in any age group.

 

Discussion:

The researchers believed that the trials were most successful at 34 weeks because this is the age at which the infant is most neurologically ready to nipple feed. Therefore, if PAL is to be successful, it should be implemented specifically at 34 weeks of age. However, many of the babies had to be dropped from the trials in the 34-36 week age group because they became successful nipple feeders and were discharged from the hospital. Therefore there was a bias in the data concerning the length of hospital stay. However, this study does indicate potential in using this type of treatment to promote successful nipple feeding in infants.

 

Clinical Implications:

If PAL is used, it should be used starting at 34 weeks of age. Treatment should last 15 minutes and should be provided 30 minutes prior to feeding. Lullabies in the patient's native language should be used if possible. Patients who are appropriate candidates for this type of treatment would include pre-term infants with no known abnormalities that could interfere with feeding such as Down Syndrome, cleft palate, hydrocephalus or neurological disorders. Patients cannot be on a trach/vent and should demonstrate readiness for trials with oral feeds.

 

Comments from me:

I found this article fascinating and wonder how music could be used in other aspects of speech-pathology to promote progress with our little ones. The authors of this article suggested that lullabies be played in the infant's native language to provide input for language development. Is there research out there to suggest that music has a positive affect on language development? Does exposure to certain genre's of music impact language development (i.e. classical verses pop)? Every day I use music/singing to promote positive feeding experiences with my little ones and to help them tolerate oral motor stimulation and feeding therapy. But is there research that really backs up the use of music during other types of feeding therapy as a way to facilitate positive outcomes?

 

 

 

 

 

 

 

 

 



My Story: Becoming a Speech-Language Pathologist

Where do I begin? The starting point of my journey is difficult to pin-point. When I think back on my life, the stepping stones on my path are scattered throughout my experiences, even from the point of my birth. You see I was born a premie, 6 weeks early weighing 4 lbs, 3 oz. Recently, I was sharing stories with my mom about working with families of premature infants in a home health setting. This conversation led to her sharing how difficult it was for her when she was told I was not strong enough to breastfeed. "I really wish I had someone like you, in my home guiding me through the difficult process of feeding you. I suppose you were always meant to help babies learn to eat." As a child, I was fascinated by stories of children with disabilities. The first biography I ever read was about Helen Keller. To this day she remains one of my heroes. Growing up with 3 cousins with hearing loss I had heard about the impact their special education teacher had made on their lives. Their perseverance has inspired me throughout my journey.

By the time I was in junior-high I was convinced that I wanted to be a teacher, specifically a reading teacher. I held onto this goal even into my first two years of college at Texas A&M. It was there that I met my husband, got married and moved to the small town of Del Rio, Texas so that he could work in the family business. I planned to finish my teaching degree at Sul Ross University there in town. But, as we all know, life becomes more complicated when marriage enters the picture. Complicated in a wonderful way of course. But, we needed money. So I went to work for a vet in town, working as a receptionist at the front desk. I loved every minute of it. I loved the animals. I loved the world of medical terminology, treating patients, and surprisingly I wasn't grossed out by needles and bodily fluids. And actually, as my dad pointed out to me one day, it wasn't too surprising that I was comfortable in a medical setting. In high school my favorite classes had been Biology and Anatomy and Physiology. I decided that maybe becoming a vet tech was my future. I took courses to learn the basics while gaining experience on the job. A couple of years down the road and my husband and I moved away from Del Rio, and away from the family business. We moved back to my home town of San Marcos, Texas. There he went to work in a local hardware store and I found a job with a local vet in town. Springtown Veterinary Hospital. There I continued to use my people skills as an outpatient technician, performing technical skills like blood draws, x-rays and injections, while using my people skills to educate clients about their pets' medical needs. I enjoyed every minute of working with the clients. Dr. Nowland, my boss told me one day that he thought I needed to go back to school. He said that I had the gift of talking to people. I smiled and brushed his comment aside. I was happy as a vet tech. Or so I thought.

 But as the years passed I slowly began to feel that out there in the big world there was something else that I was meant to do. I needed to help people in a bigger way. I loved working with animals, but I loved people more. One of my co-workers at the time was pursuing a degree in physical therapy, another a degree in nursing. Each of them wanted to work with children. In talking with them, a longing began to grow inside of me. From my youth I had always loved children; loved playing with them and had wanted to be a teacher. But I had grown to love the world of medicine and wondered if there was a career that would allow me to grow my medical knowledge and interest while allowing me to educate children. It was then that I remembered my cousins and their speech teacher. I got on the Texas State website and began exploring degrees in the health professions department. Communication Disorders. It sounded fascinating! I wondered if this could be my future career. The next spring I took a few of my basic courses and signed up for Intro to Communication Disorders. During the first week of class the professor played a video of a man who was recalling his experience of losing his ability to communicate after a traumatic brain injury. "My speech therapist changed my life." Tears came to my eyes as I watched and listened, and I knew I had found my passion.

The next 6 years are really a blur. I continued to work at the vet while pursuing my education. The more I studied and learned about speech-language-pathology, the more I loved it. I especially loved my courses on dysphagia and neurogenic disorders. In 2010 I completed my Bachelor's degree in Communication Disorders and in 2012 my Masters degree. I completed my CFY in March of 2013, spending part of my time in a pediatric outpatient setting, and part of my time in a nursing home. I was thankful for the opportunity to have both experiences as I grew and learned what area of speech-pathology interested me the most. During that time my love for treating dysphagia and feeding disorders grew, and in July of 2013 I took a home health position at Christus Santa Rosa in their pediatric department. In September of 2013 I became Vital Stim certified. This job has offered me the opportunity to work with some amazing SLP's with experience in pediatric dysphagia, especially with the birth to 3 population. I also discovered my love for the birth to 3 population and early language development. Since completing my degree in 2012 I have learned so much and I am excited for opportunities to learn more. My hope is that one day I can specialize in pediatric dysphagia. My goal in creating this blog is to share what I learn along the rest of my journey. I hope you'll come along for the ride!

Welcome!

Welcome to Speech Therapy in a Big Purple Bag! The world can be a scary place without communication. And even scarier when the same muscles used for communication lack the strength to eat and swallow properly. Everyday thousands of children struggle with communication and swallowing disorders. Treating these disorders is my job. Changing children's lives is my passion. My goal in writing this blog is to share research with other speech-language pathologists, provide information  about resources available to families, and to share the day to day stories that make my job the best job on the planet. I hope you enjoy my blog!