SLP Mommy of Apraxia

Category: Apraxia

  • Favorite Holiday books for Speech Therapy

    Favorite Holiday books for Speech Therapy

    6 Favorite Children’s Holiday books for Speech Therapy

       1. There Was an Old Lady Who Swallowed a Bell by Lucille Colandro
    As with all the Lucille Colandro Old Lady Books, this is a repetitive children’s holiday book.  Nice target words that are repeated include “bow” and “hat” that can be used for repetitive practice.  The pictures in this book too are colorful and fun.

    Activities:
    Book Companion Pack on my SLP Mommy of Apraxia TpT store.  Find it here.

       2. Click, Clack, Ho! Ho! Ho! by Doreen Cronin
    Kids laugh at this funny, repetitive book in which duck gets stuck in a chimney
    and the barn animals take turns trying to get duck out.  The words for good
    repetition in this book include “uh oh” “oh no” and “ho ho ho,” which are nice
    CV and VC targets in the early stages of therapy.

    Activities: Free sequencing and comprehension book companion from Thumb Bunny Speech.
    Find it on her TpT here. 

    3. Bear Stays Up for Christmas by Karma Wilson
    Bear’s friends help Bear stay up for Christmas in a sweet and heart warming book. Repetitive Targets I use in this book include “up,” for the early stages of apraxia, expanding to “stays up” for kids who may be working on /s/ blends.

    Activities: I found a free read aloud companion on TpT from Making Lemonade in 
    Second Grade.  Get it here.

    4. The Gingerbread Man by Jim Aylesworth
    The classic tale of the Gingerbread Man is told in this fun story about a mischievous
    cookie.  Love a lot of repetitive targets in this book such as “me” or the entire phrase
    “you can’t catch me” (which can also target prosody), “man” in Gingerbread Man and the word
    “back” expanding to the phrase “come back” if possible.

    Activities:  Book companion pack on my SLP Mommy of Apraxia TpT store. Find it here. 

    5. Llama llama Holiday Drama by Anna Dewdney
    Llama llama is impatient for Christmas in this relatable book about a child’s anticipation
    for Christmas. I love the rhymes in this book and the repetition of “mama” and “llama”
    that can be targeted for repetitive practice, depending on the child’s repertoire.

    6. Dream Snow by Eric Carle
    Interactive with colorful and vibrant pictures, this book is a children’s favorite.
    Targets for this book include counting to five and repeating the words “on” or “snow” as
    each animal is covered with a blanket of snow.

    Activities: Freebie on TpT by Mrs Plemons Kindergarten.  Find it here. 

    Below you will find a free graphic I have on my TpT store explaining how to use repetitive books with your child to promote language and practice speech. My targets and books are always strategically selected based on the child’s sound repertoire. Click the picture to get the free download.

     

  • Thank you for choosing me to be your mom

    Thank you for choosing me to be your mom

    It’s Halloween, 2018.  You are a freshly turned nine-year old.  You are 9 years old. My mind immediately repeats a phrase from my dad,

    “Mr. Baskall, here’s your little baby girl.”

    I remember I would roll my eyes and scoff at him.

    “Ugh dad!” I would lament as he looked at me with eyes brimming with pride.

    I don’t have any words to describe or memorialize your entrance into this world, but I have your pictures.

    Halloween, 2009 was the most magical holiday that I have ever experienced.  It was the first holiday I ever experienced as a mom.  I was a mom.

    I was a mom!!

    On Halloween’s prior, the entire holiday was full of self-entitlement, but the Halloween of 2009 was full of something completely different.  I had given life to the most beautiful angel.

    My normally highlighted hair was brown, which is actually my natural color.  I had diligently not dyed my hair while pregnant with Ashlynn to ensure no harmful chemicals crossed my scalp, into my bloodstream, crossing the placenta and then hurting my baby.  I remember taking every precaution to ensure I had the healthiest baby my body could possibly produce.  An avid craft beer drinker from Colorado, I would refuse to even take a sip while pregnant.  I ate my lunch meat warm to avoid lysteria and eliminated all caffeine so my developing fetus was never exposed to any stimulant in utero.  I wore an industrial style mask when I painted her baby room to ensure she was exposed to no harmful fumes.

    So confident was I in ensuring I had followed every caution and recommendation, the thought never even once crossed my mind I would have a child with any sort of developmental delay.

    Life sure answered back with a big middle finger and boisterous laugh at that one.

    Every Halloween though, I become nostalgic.  I remember that new mom holding that tiny baby in her cute onesie with the pumpkin bum and beaming with pride.  I remember my husband dutifully reporting to work each day, but taking time to hold, hug, kiss and fawn over the tiny human we had somehow created together.

    I remember my heart being so full I thought it could actually burst from the amount of love that it was trying to contain inside.  Every Halloween, ironically, reminds me just what a GIFT life actually is. Yes, this day of the dead reminds me of how lucky any of us are to actually live.  Halloween always reminds me of how blessed I was to have a baby.

    I had no idea then, all the challenges life had in store for Ashlynn.  When I look at that picture, I see the instant connection a mother has to her child.  Our eyes are fixated on each other, and I know she trusted me to be the person to never give up on her.  I remember what an honor it is that Ashlynn chose me to be her mom, and I renew my commitment to never, ever, EVER, give up on her.

    I love you Ashlynn Kay.  Thank you for choosing me to be your mom.  I hope I never let you down.

     

  • SLP’s integral role in the five components of reading

    SLP’s integral role in the five components of reading

    When I was younger and learned to read, I remember I was taught phonics.  I remember the phonics workbooks I had, and would read the rules at the bottom of the page for spelling.  It was all very systematic. Little did I know at the time, phonics was just one part of the five components of reading that can contribute to reading disorders.

    Today, a concept called whole language dominates our public education systems.  Not every school district or school uses this approach, but very many of them do and it is at a detriment to our children who have reading disorders.  Some critics go so far as to say whole language is “anti-phonics.”  I don’t believe it’s quite that extreme.  However, for kids who have reading disorders, the vast majority struggle with phonemic awareness and decoding, which a whole language curriculum is not even close to adequately addressing.

    I’m fortunate that when I started my career, Ashlynn’s SLP was very knowledgeable on the topic.  I had no idea that learning about the five components of reading before my child was even conceptualized would come back and benefit her some day.

    So, what are the five components of reading?

    They are: Phonemic Awareness, Decoding, Fluency, Vocabulary, and Comprehension. These areas were identified by the National Reading Panel that was convened by Congress in 1999. It’s very important that parents and educators are aware of these five components, because weaknesses in any one component can cause a child to struggle to read.

    Speech/Language Pathologists can play a big role in reading.  They are trained and certified to treat children with three of the five components.  A Speech/Language Pathologist can work on phonemic awareness, vocabulary, and comprehension.  This is why they are frequently on IEP’s when children have reading disorders.  It is very infrequent that the older school-aged child with dyslexia is seeing the SLP to work on their “sounds.”

    Parents and educators all need to be aware and familiar with these five components if they want to help children effectively who are struggling to read.  During my time in Denver Public Schools, an excellent teacher advocated the use of a “fishbone” analysis when testing kids who were struggling to read.

     

    As you can see, it contains the five components of reading, and spaces to document a child’s performance in all five areas.  It could be possible to have a child who has difficulties in all of these areas.  However, more frequently a couple of areas usually stand out.  One area that is frequently a problem is with phonological awareness skills.  This can be tricky because elementary school children many times get identified with a reading disorder past the time that instruction with phonological awareness is taught.  Teachers jump right into reading instruction without realizing the child is lacking the basic building blocks for reading in the first place.

    So what is phonological awareness?

    Phonological awareness refers to a child’s ability to manipulate sounds out loud.  Tasks included in this umbrella might be to identify the initial sound in a word, blend sounds, segment sounds, identify the last sound in a word, or be able to identify and formulate rhyming words.  Logically it would make sense why this is a building block skill.  If a child can’t do these things out loud, it’s going to be very difficult to transfer these skills when looking at graphemes (letters).

    Phonics/Decoding

    Phonics refers to the actual act of sounding out words.  To do this skill, children need to have mastered knowing letters and letter sounds, and then be able to use this knowledge of letter sounds to “decode” a word.

    Vocabulary

    A child’s vocabulary many times affects background knowledge, which is important in reading.  If the words they are trying to read hold no meaning due to low vocabulary skills, it is going to be harder for them to understand what they are reading.  In addition, a child with weak vocabulary skills will have a harder time monitoring their comprehension when reading sentences.  I see this all the time as an SLP. An example of this would be if a child were to read the sentence “He saw the dog.”  Instead of “saw” he/she read “sam” and they would continue reading.  Many children without a language disorder would realize “He sam the dog” didn’t make sense and go back and try and fix the sentence so that it makes sense. Kids with language disorders have a very difficult time with this skill.

    Fluency

    Fluency refers to a child’s ability to read text accurately and quickly while maintaining good expression.  The ability for a child to read fluently helps with comprehension.  If a child’s fluency is slow and choppy, they may be allocating so much brain power to decoding that they are not monitoring comprehension. If a child lacks expression in their reading, this too can affect comprehension.

    Comprehension

    Comprehension is simple terms, means understanding what we read.  Kids with a mixed receptive/expressive language disorder or an auditory processing disorder frequently experience difficulties with text comprehension.

    What does this mean for parents?

    The bottom line for parents is that reading is a complicated process that has many components.  A deficit in one or more of the above listed components can cause a child to struggle when learning how to read.  Children with speech and language disorders are at high risk for reading disabilities. Being aware of all five components helps parents be more informed regarding treatment approaches and options their child may need to catch up in reading.

    This article contains information from the National Reading Panel’s Findings

     

    Laura Smith is a first and foremost a mom to two amazing children, one of which who carries a constellation of invisible labels including: Childhood Apraxia of Speech, dysarthria, SPD, ADHD, MERLD, dyspraxia, dyslexia, and cerebral palsy. She is a speech/language pathologist specializing in Childhood Apraxia of Speech following her daughter’s diagnosis.  SLPMommyofApraxia is her space to share her professional and personal experiences related to the complex but beautiful world of neuro-diversity and to spread a message of hope, positivity, acceptance, and kindness.

  • The true stars of Vegas organize the apraxia walk

    The true stars of Vegas organize the apraxia walk

    This weekend I was the guest speaker at the Nevada Walk for Apraxia and stayed with the walk coordinator Alyssa Hampson and her family.

    I flew in the day before the walk, and her house looked very typical of any other walk coordinator.

    It was bursting with items such as goody bags for the kids, prizes for the silent auction, food and beverages for breakfast, signage, T-shirts, and so much more.

    If you are a walk coordinator, or help coordinate a walk for any charity event, then you are probably very familiar with this typical décor that hijacks your living room the day before walk day.

    I am the mother to a child with apraxia.

    Being a walk coordinator is not just professional, it’s personal.

    I’m literally fighting to raise funds to go back directly to apraxia research , education, and programs so that each child who has apraxia in subsequent years has access to appropriate professional services.  It seems expected, or at least natural as to why I would have such as invested interest.  I’m fighting for my child and those like her.

    That’s why watching someone like Alyssa and her family was more than inspiring.

    Alyssa is the walk coordinator for Nevada, but she is also a wife of almost 30 years, a mother to two beautiful, young adult children (who don’t have CAS), and an SLP with a passion for Childhood Apraxia of Speech.  At her house for the past 3 years, the Walk for Apraxia has been a family affair.

    Her daughter came down from college with her friends to help Alyssa run the walk.  I was there because Alyssa had asked me to attend as the guest speaker.

    Lauren on the left with college friends to help out on walk day.

    The night before the walk, her husband helped pick up the bagels and balloons as her daughter printed out forms and signage that were to be used at the walk.  As I perused the silent auction items and game station activities, I discovered that Alyssa and her family had paid for much of these themselves.  As a fellow walk coordinator, I was struck by their generosity and willingness to spend so much of their own money to ensure the walk was a success.

    The day of the event was a full family affair, with another apraxia mom, Ashley Winter joining the crew with her husband.  Everyone worked diligently setting up an event that had been in the works for months.  Alyssa’s husband Dennis set up the silent auction, while his sister and their daughter’s friends helped decorate the park and set up for registration.

    Characters that had been secured such as a clown, the princess Elsa, McGruff the crime dog, and Deputy Dripp for the Clark County Police Department all showed up on time to provide photo ops and entertainment for the kids.

    I talked to many families and some SLP’s who specialized in apraxia and did my best to connect members from the community with each other.

    That is what these walks are about.  Community.

    The walk is the chance for families to connect with their people.  The walk is the place a family can go and not feel judged and just let their kids be themselves free from criticism.  There was one child who had to sit on the side watching the event for around 20 minutes before he felt comfortable to join in, and no one batted an eye.  There was another child who had a sensory meltdown during picture time and a parent looked at me and said,
    “ I want to just give her a universal sign that says, I’ve been there and I feel you.  You’re doing a great job.”

    Before the walk started, the coordinator Alyssa went live in her event facebook group and talked about the day to come.  Another apraxia mom in California commented that she was moved to tears that Alyssa was an SLP, not a mother, but who still was coordinating the walk.  Alyssa didn’t know why until I explained.

    Alyssa with one of her clients

    As a mother to a child with apraxia, my motive for coordinating the walk is clear.  I walk for my daughter.  For Alyssa, she has developed a special bond with kids like mine, so much so that it compelled her to donate and volunteer her time for kids like MINE.  For kids like YOURS!  It’s touching that a therapist cares so much for kids with apraxia that she is willing to give up her personal time, energy, and money to coordinating a charity even like that for the Nevada Walk for Apraxia. It’s amazing that she in turn inspired her entire family to do the same!

    Usually my favorite part of the walk is the medal ceremony, where the kids are honored with medals for all the hard work they put in every day to learn how to do the one thing many of us take for granted: learn how to speak.

    That was still a great part, but at the Nevada Walk for Apraxia this year, I had a different favorite part.

    I witnessed a family brought together by the shared mission to help kids like mine.

    They had no personal investment accept that the matriarch of the family was passionate about these kids and in turn, had made them passionate too.

    I marveled at her sister in law who made the beautiful crafts and decorations like the photo booth picture frames.  I looked on in amazement as her daughter, clipboard in hand, managed the day of event details with professionalism and meticulousness.  I looked on in admiration, and also amusement as her husband manned the silent auction and was so invested he took every donation personal.

    “No one is bidding Alyssa,” he exclaimed in his New York Accent.  “Whatevah, it doesn’t mattah,” he continued.  “If no one buys it then we will just buy it and that’s it.  We’ll buy it all and forgettah about it,” he said before storming off.

    As much as I was amused by his accent, I was more inspired by his passion.

    What did this man care that no one was bidding?  He didn’t have a child with apraxia. He only had client stories from his wife, but he had also become so personally invested and fell such in love with kids like mine that the success of the silent auction to benefit apraxia was now personal to him.

    Alyssa and Dennis

    Where did people like him come from?  I was amazed and touched.  My daughter and others like her benefitted from a New York Jew (his words not mine) living in Las Vegas who cared about kids like mine.

    How can one NOT be touched by that?  How can anyone who loves a child with apraxia not be touched by the dedication of this family? What is more, is how are families who DO have a personal interest in apraxia NOT this dedicated to the cause?

    It’s inspiring and the walks for apraxia around the country all have a personal and unique story like theirs.

    As I was leaving today, Alyssa pointed out that it was Rosh Hashanah.  Other than knowing it was a Jewish Holiday, I asked her the meaning of it. She sent me information that read,

    “Rosh Hashanah marks the beginning of the Jewish New Year.  We review the choices we have made over the past year, our actions and our intentions, as we attempt to honestly evaluate ourselves.”

    I couldn’t help but think of how symbolic it was to have Rosh Hashanah fall on this day I met a Jewish family coordinating the Walk for Apraxia.

    My friendship with Alyssa and her family grew this weekend marking the beginning of what I knew was great things to come in the future.  In addition, as a time of reflection and introspection, I hope that when her family evaluates themselves this holiday, they are proud for all that they do in their small part of the world raising funds and awareness for children with apraxia.

    I was blessed this weekend to get to know Alyssa and her family more intimately than I ever had. In the spirit of Rosh Hashanah, I spent time on the plane reflecting on my last year and my choices, intentions, and actions.   Am I living my life with authenticity? Am I true in my intentions and my actions? This is a great task for any of us to participate in, regardless of if we are Jewish or not.

    Ghandi once said, “The best way to find yourself is to lose yourself in service to others.”

    This family is living proof. Will you be next?

    Shalom and L’Shana Tovah!

     

     

  • Finding our umbrella. The last piece of the puzzle.

    Finding our umbrella. The last piece of the puzzle.

    In my opinion, Ashlynn’s birth history was significant.

    No, she wasn’t born premature.  No, there wasn’t a dramatic rush to the ER.  However, I was failing to dilate or efface and the labor was taking so long that vaginal fetal electrodes were placed on her head.  In addition, every contraction brought concern to the fetal hear monitor.  My OB recommended at least three times that I get a C-section; but hopped up on drugs and determined to deliver my baby naturally, I didn’t read between the lines.

    When Ashlynn was three months old I started to become concerned about her toes.

    My friend affectionately pointed out her “ballerina toes,” but they were cause for concern.  Her feet were always in a pointed flexed position, otherwise known as “plantar flexion.”  If I tried to stretch her feet to what is known as a “dorsal flexion,” I was unsuccessful.

    At her 6 month well baby check I brought my concerns to the pediatrician. She offered two possible solutions.  I could get a referral to neurology, or I could stretch our her tight heel cords each night and at the next well-baby visit we could re-evaluate.  I chose the latter.

    I was an SLP working in the severe needs classrooms before Ashlynn was born.  I co-treated with PT’s and watched them massage and stretch out kids with cerebral palsy for at least two years.  I tried to replicate the same motions and massages in Ashlynn, and meticulously stretched her out every night in the bathtub for 6 months.  At her next well baby check, her heel cords were loose and we could easily get her in a dorsal flexion.  A referral to neurology no longer seemed necessary.

    Ashlynn continued though to be delayed in every milestone.  I was convinced it was Cerebral Palsy (CP). I worked with her every night doing a speech therapy approach called “language stimulation.”  I was exhausted.  Physically and emotionally run down from working each day, but I would look at my daughter’s smiling face and pull reserves out from the depths because she was by far my most important client.

    At around a year I took her to a PT I worked with who saw children with CP everyday.

    “I think she’s fine, Laura,” she said to me. She had her crawl, stand, and try to walk.  I was relieved, but still skeptical.  When Ashlynn started to pull up on furniture I noticed she would stand on her toes.  I immediately and diligently would relax her calves or physically manipulate her legs to stand flat-footed.  When she finally went to walk (very late at 19 months), we didn’t have a problem with toe walking.  I felt relieved at the time; but little did I know I had successfully suppressed all the soft signs of CP through my training and experience with children who had severe needs.

    I’ll never forget her Child Find Evaluation shortly before she was three.

    I had been working with her every night on speech, and the progress was less than amazing.  I wanted to turn back a million times, but knew I had to take her to this evaluation to get her qualified for extra services. The diagnosis of apraxia smacked me hard in the face.  Though I instantly knew it was true, I was mortified I had not thought of it until that moment.

    I grieved.

    I had a difficult time looking myself in the mirror after that.  All questions of CP had been ruled out and I had missed a diagnosis of apraxia in my own child.  I was beyond disappointed and angry in myself. I struggled to look at myself in the mirror.  My confidence was shattered and I questioned as to whether I was really helping children or not.  I didn’t know it at the time, but looking back I think I was deeply depressed.  I decided during that time that I had to do something with this situation.  I could sit in sorrow, guilt and regret; or I could turn all this pain into a purpose.

    I started my blog and my mission to specialize in apraxia.

    During this time period I was PROMPT trained, Apraxia-Kids trained, and watched the Kaufman K-SLP method on video.  I became so fanatical about apraxia that I earned an award from ASHA for obtaining a crazy amount of continuing education in a short period of time.  During this time, Ashlynn improved and I finally started to be able to look at myself in the mirror again.

    Ashlynn went on to receive additional diagnoses of: dyspraxia, ADHD. SPD, and dysarthria at this time through various professionals.  I had accepted that Ashlynn seemed to have “global apraxia,” which is a term for kids who seem to be globally impacted by motor planning issues.

    I sought expertise from neurologists who ordered MRI’s and genetics but came up empty.   I knew from an article I had read once that in some circles, global apraxia was considered a type of CP; but no one would believe me.  I had settled on global apraxia, aka apraxia and dyspraxia until….

    At the age of 8, Ashlynn toes started curling forward.

    I had noticed it, but hadn’t done anything about it until her Grandma told me that she noticed it and Ashlynn told her they hurt.  Concerned I took her to her pediatrician who was completely stumped.  She did refer to me the orthopedic department at Children’s and I felt I was on another wild goose chase to figure out why Ashlynn’s feet were acting like this.  That was until a mother to a client I have with CP told me that toe curling is common is kids who have CP during the time of a growth spurt.  She referred me to a specific doctor at Children’s Hospital Denver called a “physiatrist.”

    I scheduled the appointment and arrived early with Ashlynn.  Trying to shake off nerves we played on snap chat and laughed.

    d.

    I was so proud of her pucker in the second picture because puckering has been a task that has been traditionally something that is difficult for her.  Finally we were called back and ushered to our examination room.

    The doctor and resident came in skeptical.

    They asked me why I was there and when I mentioned CP they looked at Ashlynn and seemed pretty dismissive at first.  CP?  Why on Earth did I think this girl sitting before them had CP?  I soaked in her skepticism and it killed me. Great.  Here we go again.  Another person who doesn’t believe me.  She had Ashlynn walk down the hallway away from us.  Ashlynn was scared so I walked with her.  The next task was to run and the doctor instructed Ashlynn to run by herself and explained she needed me to stay behind.  As Ashlynn ran ahead this woman began a running commentary of medical jargon I was desperately trying to keep up with.  She was talking to both me and her resident.

    “Notice the Pie Pan arm hold as she runs.”

    I looked at Ashynn’s peculiar arm and finger posture.

    “Sweetie will you skip now?”

    Ashlynn skipped happily down the hallway and Pam began her expert observations,

    “Notice how that pie pan hold switched sides.”

    Ashlynn returned.

    The rest of the evaluation went much the same.  I watched on in disbelief.  Somewhat invested but still skeptical, they had Ashlynn take off her socks and shoes and repeat the exam.  As she ran down the hallway, what had been no evidence of toe walking with shoes, revealed a slight toe walk without shoes.  I was in awe of Pam’s expertise and knowledge.  Her observations and running commentary were impressive.

    Back in the exam room the revelations were revealed.

    They tested all of her reflexes and Pam remarked how all of her reflexes were “brisk,” which was code for “not normal,” and observed that all of Ashlynn’s primitive or baby reflexes were still present.  When I questioned her she explained that children with CP never outgrow those early reflexes and will retain them into adulthood.  I was fascinated.  I had OT reports from multiple places that described how Ashlynn hadn’t lost her primitive reflexes, but I didn’t realize it was due to a possibility of her having CP.

    I knew from my apraxia blog groups that some kids with global apraxia received a dx of “ataxic cerebral palsy” early on.  This doctor had Ashlynn touch her own nose and then touch the doctor’s finger.  Ashlynn did well with this.  The doctor immediately ruled out ataxic CP.  I asked her if a child could improve on that task with OT (since Ashlynn used to be bad at that but has had therapy) and she shook her head and said there was no way Ashlynn had ataxic CP.

    Ok. I wasn’t even offended.  My mommy gut was telling me this woman knew what she was talking about and I was in the exact spot I needed to be.

    The next test, from a lay person’s view, seemed to be the most definitive diagnostic marker of the evaluation.  It was a “clonus test” that is done at the foot and ankle level.  I could google it and come up with this amazing medical definition, but I want to report this as a mom.  As they were testing reflexes, one reflex test they did put Ashlynn right back into those ballerina toes I saw as a baby.  They then tried to push up on her foot so she could achieve a dorsal flexion, and her foot started pulsing.  Apparently, pulses beyond 2-5 are considered abnormal and Ashlynn was at an 8 or above.  It was so significant, they couldn’t get her out of it without changing her body position completely.

    It was after this the treating MD told me that based on Ashlynn’s pie pan hand posture when running and clonus in the ankles, she exhibited symptoms consistent with dystonic cerebral palsy.

    I gasped.

    It wasn’t a gasp of pain or sadness.  It was…relief.  I couldn’t believe someone listened to me.  I couldn’t believe that after almost 9 years of knowing this was what Ashlynn had, it was only now being diagnosed.  I beat myself up for years missing apraxia.  It was so bad, it was what made me specialize in it.  I couldn’t look at myself in the mirror.  It was a big blow to my self esteem as a professional.  I thought I was a good SLP and then I had missed apraxia and CP was ruled out and I felt incompetent.  The guilt was overwhelming.  I did everything in my power to make up for the error.  I specialized in apraxia, received awards related to apraxia, and helped my daughter every way I knew how.

    To find out now that I had been right all along was a feeling I can’t put into words.  It had come full circle.  I actually did know my stuff  back then, but this experience with Ashlynn shot me to a place with apraxia expertise I could have never imagined.

    I was talking with a client I had who brought their daughter with diagnosed CP into see me for a differential dx over a year ago, and was telling her the story. Our stories our reversed.  Her daughter immediately received a CP dx, but no one believe her daughter had apraxia until she came to me to get a differential dx.  She said exactly to me what I said to that doctor.

    “So you believe me??  I’m not crazy?  Oh my gosh!! Oh my gosh!!!  I freaking knew it.”

    She went on to tell me this day that she was thankful that I didn’t know Ashlynn had this rare presentation of CP, because I probably would have went all in on the CP awareness train.  Instead, I went all in on apraxia and because of it; her daughter got the right dx and subsequent treatment she needed to find her voice.

    I had to agree that she was right.

    In the end, life has been a journey with my Ashlynn.  However, I actually and finally feel like all the pieces to her “puzzle” have been found.  A good friend said it best when she told me,

    “You found your umbrella.”

    I didn’t cry at any point during the evaluation or dx.  After we left I called my husband, mom, and mother in law and explained the findings over the phone with Ashlynn in the back seat. When I hung up my last phone call I heard this little voice ask,

    “Mama?  What do I have?”

    I didn’t expect to tear up when I answered her my voice cracked and I said, “Baby, you have cerebral palsy, or CP.  It doesn’t change who you are at all. It’s just something you have, like apraxia.”

    “That says Exit, Mississippi” she said right after, reading the freeway exit sign to our house; and in that moment, I knew everything was going to be okay.

     

     

  • Apraxia, dyspraxia, dysarthria and the link that tied them all together.

    Apraxia, dyspraxia, dysarthria and the link that tied them all together.

    Those familiar with my story know that I missed apraxia in Ashlynn because I was convinced she had CP (cerebral palsy).  She had a significant birth history and had to be pulled out via C-section and all of her motor milestones were late.

    Tummy time was a nightmare.  I was always so stressed about it because she literally seemed like she was suffocating and couldn’t pull herself up for air.  She would cry.  As much as I tried to prevent it she developed a flat head.  I remember asking the pediatrician if she needed a helmet but was told no. From 3-6 months she had developed a case of extremely pointy toes.  My friend affectionately referred to them as ballerina toes, but they were anything but cute.  I couldn’t get them flexed at all.  I kept thinking they just looked “spastic” to me; which is a term to describe very tight muscles in individuals with CP.

    When I brought it up to the pediatrician she said we could go to neurology or maybe I could just massage her calves every night in the bathtub and at her next baby well visit we would evaluate.  I decided to do that and if it didn’t work I would go to neurology.  I worked as a speech/language pathologist before she was born in severe needs classrooms and worked alongside physical therapists.  I did to Ashlynn everything I would see them do to our students.  By her next well baby visit, her feet could flex and she no longer had a standing ballerina toe pose.  There didn’t seem a need for neurology at that point.

    After that the rest is really history.  I received her diagnosis of apraxia right before her 3rd birthday, and then subsequently got her dx of dyspraxia, SPD, and ADHD through various OT places we went for therapy.  From that time on, I’ve accepted this was her diagnoses.

    Last year I decided I wanted to make sure I had checked all the boxes and got a referral to neurology.  It was not a good appointment.  You can read about here. They completely dismissed any chance of CP, but they did write orders for an MRI and genetics and those were two boxes I wanted to check off.  That all turned up empty.  They dismissed any neurological soft signs I had seen such as her pointy toes, flat head, and choking as a baby.  They actually dismissed dyspraxia and apraxia as well but that’s another story.  I let it go again because these are experts after all.

    That was until, a new development happened.  Ashlynn’s toes are curling forward to the point you can’t see her toenails because it looks like she is standing on them.  I took her back to the pediatrician who literally did not know who to refer me to.  She sighed a deep sigh and took a good 20-30 seconds to speak.  In the end, we decided on the orthopedic department at children’s, guessing it has something to do with her dyspraxia causing balance and coordination issues.

    As fate would have it, I’m telling Ashlynn’s symptoms to the mom of a client who has severe CP and dysarthria.  After I told her about our dr appointment and referral, she relayed to me that curling toes is common in CP, or any joint abnormalities for that matter, especially around the time of a growth spurt.

    My heart sunk.

    There is this feeling every mom can relate to.  It is this gut feeling that tells you when something is right and when something is wrong in your child.   At that moment, I immediately felt it. I knew that what I had thought all along was right.  Ashlynn has CP, and this woman standing before me knew of the person I should go see.

    She recommended I go to the rehab clinic at Children’s Hospital Denver who has a team of doctors who deal with this stuff.  I called this place in lieu of the orthopedic department.  The intake person went from being skeptical and asking me why I didn’t have a doctor referral to enthusiatically affirming she could get us in right away after I explained all of Ashlynn’s symptoms.  She then told me that me once Ashlynn was diagnosed, they can recommend the best plan of treatment.  When I got off the phone my mind was reeling.  What had I told that person that made their attitude change from skeptic to a certain dx?  I wasn’t sure, but at least I knew I was now on the right track to getting an accurate and complete dx for my daughter.

    I’m a firm believer that coincidences are put in our path for a reason.  It wasn’t a “coincidence” this client found me.  She had in fact been referred to me by Dr. Ruth Stoeckel, who had been my mentor at the Apraxia-Kids bootcamp. I was about to experience another coincidence that would light the path to the answers I was seeking.

    That same week I found out Ashlynn’s OT was leaving and a new OT would be shadowing her for the next two sessions.  When I went in, I told them both about Ashlynn’s new doctor appointment and that it was because I had always suspected CP.  The minute I said CP they both turned to each other, smiled, and then nodded in recognition.

    I’m sure when they looked back at me I looked angry.  Why on Earth would they suspect something like CP and not tell me?  I quickly had my answer.  The new OT had observed Ashlynn the week prior and after reading her chart suspected a mixed presentation of low and high tone.  She suspected it, because she herself had CP as well.

    My mouth probably dropped open.

    That was a lot to process.  For someone like me who believes coincidences are God’s way of telling us we are on the right path, this path was lit up like a Christmas tree and blinking.  I knew my initial hunches way back when Ashlynn was a baby were about to be finally confirmed, almost 9 years later.  I didn’t know what to feel.