MRI at Children's Hospital and Speech Therapy at The Hear Center- August 27, 2009 (Ella Marie - 3 months 27 days)

What an early morning and late night! Mom, Ella Marie and I drove to Birmingham on August 26th to spend the night in a hotel for Ella Marie's MRI on August 27th. We had to be at the hospital at 6am. Of course that seemed super early, but on top of that Ella Marie could not nurse after 3am. Well that meant I needed to wake up and make sure I could nurse her between 2:30-3:00am. Between 3:00am and 5:00am Ella Marie could have pedialyte. Luckily Ella Marie liked it enough to take it. So of course we were pretty much up all night. Everyone at Children's Hospital was very nice. We met with the anesthesiologist who went over the procedure with us. They gave Ella Marie something that was like "laughing gas" to keep her still during the MRI. The procedure lasted about 45 min-1 hour. After they finished the MRI Ella Marie was moved to a recovery room where I could come in and feed her. We only had to stay about 30 more minutes and we were off to speech. What a busy day!

Kelli our AV therapist was so nice to move our appointment from Tuesday to Thursday so that we did not have to travel to Birmingham twice in one week. Mom, Ella Marie, and I piled into her speech therapy appointment. I say we piled in because it looked like we were going on vacation with all of her things. Below I have listed the things we went over during our therapy session.

• We discussed the need to check with the insurance company to see how many speech sessions are covered in a year. If we as a team feel like Ella Marie needs more than our allotted sessions Kelli can send in a letter to the insurance company to request more sessions.
• We discussed how we wanted Ella Marie to know that words/sounds can be long or short. This falls under the category of duration. We work on suprasegmentals. Some examples are listed below:

**With an object or with actually lifting Ella Marie we say "up, up, up, dowwwwwwwnnnnnnnnnn" With this simple activity she hears the word up as a short word and then down is elongated. We do this activity daily by lifting and lowering her, taking one of her favorite toys and making it go up and down while she is watching it (usually when we are using objects she is laying on her back on her blanket.).

**With an object that spins we say "spiiiiiinnnnnnnnnnnnnn stop or weeeeeeeeeeeeeeee stop". We have implemented this with the toys on her activity seat/bouncer.

**With a wheel that is attached to a stand (ours is from Leap Frog that also has the alphabet on it - for later), we say "roooooolllllllllllllllll stop". Again here Ella Marie is learning that sounds/words can be long or short. Duration can change.

**With a slinky we can say "pullllllllllllllllllllll, bounce, bounce, bounce". With each of these activities it is important to pair them with the motion, not just say the words.

**With a ball we can say "rooolllllllllllllllllll, bounce, bounce, bounce"

• Bouncing her our knee activity - In this activity, we bounce Ella Marie on our knee while saying bounce bounce bounce, stop. After stopping the bouncing and saying the word stop, we just look at Ella Marie and wait for some type of response. At the beginning this may be that her eyes widen or that she smiles, but the goal is to get her to vocalize to continue the play. For example after bouncing her on our knee and stopping we want to hear her coo or babble. We want to teach Ella Marie that her voice is power. When she vocalizes, something happens. It is basically like a cause and effect lesson. Because she cooed, I as the parent will continue the play with her. When Ella Marie coos we are supposed to point to our ear and say "I heard you Ella Marie, you want to do it again." At that time we repeat the activity.
• We were also told to take nursery rhymes and songs and pair the consonant "m" with different vowels and sing the tune. Our example was "Twinkle, Twinkle, Little Star". So for the first line we might sing it as "ma, ma, ma, ma, ma, ma, moo" etc.
• In the next activity we introduce Ella Marie to "noisemakers". This activity involves two people other than Ella Marie. In a chair, one of us holds Ella Marie (she can be facing either direction - we usually have her facing us). The other person stands behind Ella Marie and starts presenting the noisemaker. We had some musical items like a tamborine from Target. After presenting the sound, you slowly walk to one side of Ella Marie. The goal is to get her to turn to the sound and to recognize the sound that was presented. When we are teaching this activity we praise her for noticing/hearing the sound even if at first it is only from the visual clue. The person holding Ella Marie can turn Ella Marie to the sound if she does not turn on her own and point to their ear and say "Ella Marie, I heard the cymbals, did you hear the cymbals?" Then explain what the object is, the sound it makes, and how it feels (she can touch it). We also touch her ear and tell her that she heard the sound. Later the goal is that Ella Marie will turn and the person presenting the sound will not have to walk to one side of her. When we started doing this activity at home, we sat in a swivel chair so we could twist Ella Marie around to the sound. It is also important to provide wait time for Ella Marie to hear and process the sound. You do not want to show her the noisemaker before she would have had the opportunity to figure it out for herself. This activity falls under the category of "detection of sound".
• We discussed the importance of getting down on eye level with Ella Marie when we are working with her.

Finally we discussed the need for eliminating background noise. This includes not working with Ella Marie around a tv that is on, a loud refridgerator etc. A suggestion was made to go into every room in our house and close your eyes. Ask yourself "What do I hear?" These sounds could be very distracting to Ella Marie and should be eliminated when we are working with her.

In the paperwork from The Hear Center, it states that Ella Marie should have a minimum of 1 hour of therapy a day. This includes what you learned from the therapy session. It was explained to us that really it should be integrated throughout the day since all of her therapy is through play. Ella Marie should be having fun doing it.