Friday, March 9, 2012

Light for Emma

With all of Emma's speech issues she's been tested and treated by the state Early Intervention program and by the local school system, she's had her hearing tested at least five times, she's on her second set of ear tubes, and she wears glasses. We have hoped that all of these interventions would somehow help Emma develop the ability to speak in a way that other people can understand, but she has made very little progress towards intelligible speech in the last year.

Emma is very smart, she has consistently tested at or above age level cognitively. She is bright and cooperative and tries very hard. She has long, complex sentences bottled up inside of her, but she cannot make her mouth move in a way that lets them out, or when they do come out it's nearly impossible to understand. She has made some progress with therapy. She can produce all the vowels sounds and the consonants hard g, b, p, m, and w consistently in words. This is great when she wants to talk about a mob or a bag, but not so helpful when she wants to tell me about a feather or scissors or a dolphin in the ocean. Hard g becomes her "fill-in" consonant that takes the place of anything else she can't pronounce so a feather is "geh-eh," scissors is "gih-eh-eh," and dolphin in the ocean would be "gah-ih ih eh oh-eh." Most strangers don't even realize she's speaking English, and I probably only understand her about 80% of the time. Hannah often serves to translate for Emma, since her brain seems to have acquired the ability to understand Emma's language better than anyone else's.

Last June Emma's neurologist recommended private intensive speech therapy, and after spending eight months on the waiting list, I finally took Emma for her first speech evaluation with a private speech pathologist. It was an amazing experience. After years of hearing well-meaning people assure me that Emma would "outgrow" this "speech delay," that "kids develop at their own rates," and that there was "nothing to worry about." I finally got to consult with a professional who didn't have her head in the sand. After an hour of testing and rating Emma's ability (or inability) to produce sounds and words and sentences, the speech pathologist diagnosed Emma with "severe oral apraxia" meaning Emma cannot coordinate the movements of her mouth to produce the complex sequences of sounds demanded by language. This is often seen in stroke victims, but in Emma's case a period of oxygen deprivation before or during birth would possibly explain this neurological deficit. More and more signs point to that for her.

There is no "outgrowing" speech apraxia, time does not heal this wound. But with that said, the speech pathologist was anything but bleak. Because Emma was so bright and hard working she thought that Emma would respond well to intensive speech therapy. She wants us to come at least twice a week to re-teach Emma the rules of speech: each consonant separately, then with a vowel, then with all the vowels, then in words, phrases, and sentences. Emma has very ingrained patterns or "rules" of speech that she has made up to compensate for her weaknesses and these need to be systematically broken and relearned correctly. The therapist believed Emma would quickly see that people understand her better and make the switch to the new system of speaking once she is taught.

Because I was still a little skeptical I brought up to the therapist how I had worked with Emma to teach her the "T" sound for over a week and how she finally produced the correct sound, but couldn't pair it with any vowel. Instead of saying "tah" Emma would say "t-gah." The therapist explained that "g" has become Emma's "go-to" sound, the sound she uses to help her produce any difficult sound. She then turned to Emma right there and worked with Emma on "t" and "ah" and then pairing them into "tah." Within one minute Emma was saying "tah," something I couldn't get her to do in a whole week. I am now a believer in this speech pathologist, and I believe she is just as excited to work with Emma. She told me to bring all 5 kids if I have to, that she would make it work because Emma needs this and will respond to this. I will do whatever it takes to get Emma there. Out of everything I could possibly do to help this child, I feel like this is the most important.

Speech therapy will be a big part of our family's life for awhile, but yesterday felt like the sun was shining through the clouds for Emma, and I can't wait to get started. I can't wait to hear everything Emma has to say, and to see who she will become once she and the world speak the same language.

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