How do you fit your therapy sessions into your day?

[Amber in AUS]

I feel like i am drowning and need some help working out how to fit everything into my day. Possum is 21m and requires several therapy sessions daily. The experts on our team would like to see -

 

10-15 minutes intensive language daily

10-15 minutes intensive signing daily

3-5 x 10 minutes sensory diet (proprioceptive, vestibular activities along with joint compressions)

 

I'm homeschooling my 3 older kiddos. My DH works away and is gone 3 weeks at a time. I feel like i need to streamline my olders back to basics to make some room in my day to get all these sessions in.

 

How do you all manage it?

[Walking-Iris]

I'm not sure what intensive language and signing therapy means exactly but I have used ideas from The Out of Sync Child Has Fun and Brain Gym with my oldest ds.

 

Usually I just try to get in an activity each day. We used to do joint compressions with a Wilbarger brush. I remember doing it in teh morning and at bedtime. Honestly I never did get the hang of the technique or what we were supposed to get from it. :tongue_smilie:

 

Since your kiddo is 21 month you may also look into Itsy Bitsy Yoga. I've used both the book for babies and the toddler book. You can support your child in any of the movements and that would give some movement activity each day. There's exercises for morning, playtime, and evening.

 

The thing about Out of Sync, Brain Gym, and Itsy Bitsy Yoga activities is that all the kids can participate. I firmly believe all kids benefit from these sensory diet activities regardless of any issues they may or may not have.

 

I've become real good integrating these things into the day as a part of life rather than a special "therapy" session that needs to be done like a chore. If you haven't seen the books I listed above I really recommend them.

[Dobela]

Are you saying 10 sessions each 15 minutes long? or a single session 10-15 minutes long? If it is just single sessions, then you are looking at approximately 2 hours of therapy a day. If it is 10 sessions per day, wow.

 

My dd receives 10 hours of therapy a week, spread over 3 afternoons, and is also supposed to be diong VT at home, wear an eye patch at home, and more. It is very, very difficult to do this and feel like I have adequately covered what my son needs. Since we will also be starting kindergarten this year with dd, I am also feeling the pressure to fit it all in.

 

For the last couple of years we did purchase the more expensive videos from BJU for my son because they freed me up some. This next year we won't be doing those and I am looking for other options. In other years we have skipped history completely and only done science as special classes thru the co-op.

 

Are some of the activities you can have your oldest do with the baby? For example, Teach her the sign language for the day and have her practice with the baby while you spend a few minutes with the others? You can also do 10 minutes of therapy while you have the other children diong some simple work independently. For my daughter, sometimes I have to wake her up earlier to begin therapies so that when my son is up I can focus on his needs. I also work very hard with him while she is napping or attending therapies outside of the home. You may also need to combine subjects - like they all do the same science and history or art. At times I have also hired a homeschool teen from another family to help me one afternoon a week with whatever I need help with - study with ds, or fold laundry, or play with dd while I work with ds, and so on.

 

:grouphug::grouphug:

[PeterPan]

You want to build routines. For instance do the joint compression at night after her bath as she winds down for bed. Boom, done.

 

The signing, well I would on a Signing Time video and plunk her in front of it. Will she sit or is she wiggly? When my ds was that age (well actually just a bit older because he was newly 2, so 24 months), he wouldn't sit through a whole Signing Time video. I had to turn on HALF a Signing Time video and sit with him. The box of videos I got also had baby signing time. With those he would sit better. It was a short-lived stage, because he quickly got to where he would sit through a whole video.

 

On the intensive language, I would build that in as intentional play. Also you can make short, predictable routines. For instance you may have a breakfast routine with how she gets her food to eat. Get in 3-5 minutes of that way. Read a book together for nap time for another 5 minutes of language. Play a game (peg stackers were big at that age, anything Melissa and Doug) and get in another 5 minutes of language.

 

My ds had NO speech at that age. Well I say none. When she inventoried him, he had two sounds (m, a) and one word (mama). But he never said anything. We lost him, and he hit a lot, etc. etc. When we started him on Signing Time, it was very passive for a while, enough of a while that I worried about whether it was doing any good. He would just watch. At some point it CLICKED, and then he started using the signs actively. So don't think this is some kind of failure on your part if that happens. You can put in the time and give the exposure, but you can't make the click or get it to where they initiate. With speech, what you *can* do is structure her environment to where she uses whatever speech she DOES have. Our SLP told us to put up ALL the toys. She wanted us to make it so NOTHING he wanted could be gotten without speech. For a while, the speech he was required to give was all he had: want that? say /a/! That was what he had, so he had to use that speech to get what he wanted. The more they have, the more you do. But that's how you sneak in language work all day long. And if you make little intentional routines for the times you interact with her, you can milk those for language. Little things absolutely add up!! :)

Edited June 14, 2012 by OhElizabeth

[Amber in AUS]

Thanks everyone especially OhElizabeth for the tips on routine and building it all in. I think THAT will be the key for me.

 

In total it works out to about 1.5 hours total per day that they want me doing 1 on 1 with him. At the moment i don't have time to scratch myself. We don't do the intentional play we need to or anything else for that matter, we are just so bogged down in school and running here and there for things. I really need to review my plan over the weekend and come up with something fresh for next week where i am building in those therapy times so we can get to it all.

 

Thankyou!

[PeterPan]

I think I missed that they want that sensory stuff 3-5X10 min. I was trying to figure out where you got 1.5 hours! Well first off, that's guilt-tripping yourself a lot to think with a number like that. I felt that way when I started doing therapy stuff with my ds too. It was this horrible game of: If I DON'T, he won't SPEAK. I get a pit in my stomach even thinking about it! It was this huge weight, and I thought I had to do all that OR ELSE.

 

So let's be realistic. I add up and see 50 minutes a day as the bare minimum of their suggestions. Start there. Things always take longer than you plan. If you plan 1.5 hours, you'll end up doing 2 and life suffers. Plan 50 minutes and let it bloom into more. Start lower. It's a lot of WORK for the dc to do these activities, and he probably CAN'T do them easily for the full amount of time. It WEARS THEM OUT. You're going to have a grouchy, tired dc if you do too much. So use the shorter times and work up.

 

Next, on that sensory stuff, you need 3 sessions. One is going to be with you at bedtime. The other two you're going to use your head about and get some group play going for. NOTHING SAYS *you* have to be the one doing it. You're going to get a trampoline and put ALL your kids on there. Recess, baby, recess!! You're going to hang a single line swing under a tree outside (and for this winter in your basement), and you're again, going to take turns and have recess. You're going to get some gym mats and balls to roll over and do weight-shifting. You're going to do whatever they're wanting you to do *together* with all your kids. What's good for him is good for them. Nuts, they could all possibly have slight issues too that will benefit from it. So think group activities you can do to get the sensory in. Don't even tell 'em! Just plan these could recess and break activities and let them think you're the coolest mom ever. After all, therapy stuff for OT is inherently play. :)

 

Don't make it more than it is. A little bit, done imperfectly, is a start. So for the OT stuff you have morning recess (#1), afternoon recess (#2) and bedtime (#3). You put in a Signing Time video for a quiet time for him while you work with the others. That's the signing. And once a day you sit down and play a game with him or read a lift-the-flap or I Spy book for 10 minutes. That's your speech. The trick for you is figuring out what your other kids are doing during that time and making that plan. Do your others play with neighborhood kids? If they do, then maybe they go out and you snag 10 minutes of speech with your little while they go play. Or maybe they have some mandatory quiet work in the morning for 15 minutes where you PLAN things for them that you KNOW they can do without interrupting you and you threaten them, on pain of death, to give you this 10 minutes or whatever alone with your youngest in another room. That's the structure end of this. But you can do that. Kids those ages can be assigned silent reading or coloring and copywork or whatever and do it, on pain of death if the leave the room, while you go work with your little.

 

BTW, what's the diagnosis on this dc, if you don't mind me asking? PDD-NOS? If it's apraxia, make sure you're looking into PROMPT. Like I said, my ds has moderate verbal apraxia, had NOTHING at that age, and she (the therapist) never ever intentionally made me that stressed. Yes he needs stuff, but good therapy works. I assume if you're looking at sign and working on speech so much there's praxis? For verbal apraxia, PROMPT is the ultimate. They do way more sessions with regular therapy and don't get nearly the results. If that's what you've got, P-L-E-A-S-E look into PROMPT. Less sessions, more effective. It's the only way to go. At Christmas (1 1/2 years of therapy) we were able to start cutting down our sessions dramatically. They teach you how to do it, so I can do therapy when we're doing anything. I can sneak in therapy with him when I have a whole bunch of littles and we're playing a board game. It's just astonishingly effective.

 

But whatever, none of my business. Just saying these therapists take no accountability for loading you up with a huge load of care and worries about therapy (show up 3 days a week, do this and this and this at home, blah blah). They're not gonna tell you if there's a more effective method out there they don't know. ;)

[Jennifer-72]

Routines are really one of the best ways to get speech in. Don't forget about bathtime! When ds was around that age I would line up some bath toys on the edge and do some songs like 5 green and speckled frogs, always pausing to let him fill in a word or two. Also lots of playful communication temptations around bath time - putting him in the tub and not turning on the water or leaving his clothes on when putting him in the tub to get some sort of communication attempt from him.

 

At the beginning of early intervention it can be very overwhelming. I felt like I had to do exactly what the therapist showed me. I am sure over the next bit you will find all sorts of ways to just incorporate things in your day. Don't forget that imitation games and songs are very valuable for speech. You need gross and fine motor imitation to get speech imitation. So things like having him follow actions to a gross motor song (particularly songs that are repetitive) with your other kids would work as a good sensory and speech session. Also I am thinking from your kids ages that playdough might be an easy way to get a few minutes of speech in, especially those p sounds. I remember sitting with ds and poking, patting and pulling the playdough and getting him to imitate me doing so. You could also set him and a sibling up rolling a ball or truck back and forth while pointing and saying my turn, your turn (to build that turn taking needed for speech). Not sure what your SLP has you doing for signing. When ds was that age we were targeting about 3-5 signs a week. I would maybe teach 3-5 at the beginning of the week to all the kids and challenge them to use them as much as possible. Then maybe have a small basket of toys handy to use for props in targeting those signs by his highchair and do a quick 5 minutes after he finishes lunch or a snack.

 

Hope something of the above is helpful.

[Amber in AUS]

I think I missed that they want that sensory stuff 3-5X10 min. I was trying to figure out where you got 1.5 hours! Well first off, that's guilt-tripping yourself a lot to think with a number like that. I felt that way when I started doing therapy stuff with my ds too. It was this horrible game of: If I DON'T, he won't SPEAK. I get a pit in my stomach even thinking about it! It was this huge weight, and I thought I had to do all that OR ELSE.

 

So let's be realistic. I add up and see 50 minutes a day as the bare minimum of their suggestions. Start there. Things always take longer than you plan. If you plan 1.5 hours, you'll end up doing 2 and life suffers. Plan 50 minutes and let it bloom into more. Start lower. It's a lot of WORK for the dc to do these activities, and he probably CAN'T do them easily for the full amount of time. It WEARS THEM OUT. You're going to have a grouchy, tired dc if you do too much. So use the shorter times and work up.

 

Next, on that sensory stuff, you need 3 sessions. One is going to be with you at bedtime. The other two you're going to use your head about and get some group play going for. NOTHING SAYS *you* have to be the one doing it. You're going to get a trampoline and put ALL your kids on there. Recess, baby, recess!! You're going to hang a single line swing under a tree outside (and for this winter in your basement), and you're again, going to take turns and have recess. You're going to get some gym mats and balls to roll over and do weight-shifting. You're going to do whatever they're wanting you to do *together* with all your kids. What's good for him is good for them. Nuts, they could all possibly have slight issues too that will benefit from it. So think group activities you can do to get the sensory in. Don't even tell 'em! Just plan these could recess and break activities and let them think you're the coolest mom ever. After all, therapy stuff for OT is inherently play. :)

 

Don't make it more than it is. A little bit, done imperfectly, is a start. So for the OT stuff you have morning recess (#1), afternoon recess (#2) and bedtime (#3). You put in a Signing Time video for a quiet time for him while you work with the others. That's the signing. And once a day you sit down and play a game with him or read a lift-the-flap or I Spy book for 10 minutes. That's your speech. The trick for you is figuring out what your other kids are doing during that time and making that plan. Do your others play with neighborhood kids? If they do, then maybe they go out and you snag 10 minutes of speech with your little while they go play. Or maybe they have some mandatory quiet work in the morning for 15 minutes where you PLAN things for them that you KNOW they can do without interrupting you and you threaten them, on pain of death, to give you this 10 minutes or whatever alone with your youngest in another room. That's the structure end of this. But you can do that. Kids those ages can be assigned silent reading or coloring and copywork or whatever and do it, on pain of death if the leave the room, while you go work with your little.

 

BTW, what's the diagnosis on this dc, if you don't mind me asking? PDD-NOS? If it's apraxia, make sure you're looking into PROMPT. Like I said, my ds has moderate verbal apraxia, had NOTHING at that age, and she (the therapist) never ever intentionally made me that stressed. Yes he needs stuff, but good therapy works. I assume if you're looking at sign and working on speech so much there's praxis? For verbal apraxia, PROMPT is the ultimate. They do way more sessions with regular therapy and don't get nearly the results. If that's what you've got, P-L-E-A-S-E look into PROMPT. Less sessions, more effective. It's the only way to go. At Christmas (1 1/2 years of therapy) we were able to start cutting down our sessions dramatically. They teach you how to do it, so I can do therapy when we're doing anything. I can sneak in therapy with him when I have a whole bunch of littles and we're playing a board game. It's just astonishingly effective.

 

But whatever, none of my business. Just saying these therapists take no accountability for loading you up with a huge load of care and worries about therapy (show up 3 days a week, do this and this and this at home, blah blah). They're not gonna tell you if there's a more effective method out there they don't know. ;)

 

Thankyou again! Great ideas of how to integrate these things into our day. I'm just sitting down and trying to nut out a plan for this coming week so that we can integrate more and this helps a lot.

 

At this point there is no diagnosis. I think the assumption is it is a speech delay owing in part to his prematurity (born 25w) and his hearing loss before he got grommets, over a year ago now, his follow up hearing test showed no hearing loss. He makes quite a bit of noise, mostly vowel sounds, and a few consonants he just doesn't have any words, or even repetitive sounds he uses to reference objects or people. He's a very frustrated little boy that's why we are going down the sign route to try and provide SOME method of communication. He also has some issues with understanding. He's only just started understanding what objects are and looking at or pointing to them when you say dog or car etc.

 

There are no sessions or workshops or anything like that. We see the speechie and OT once every few months and they tell me what they want done and then i have to work on it with him. It's just the way the system is set up here. When we move back to the city, hopefully before Christmas i am going to seek out a private speechie and OT and see if they have a different opinion and if they have anything different available. Until then i'm all he's got.

[Amber in AUS]

Routines are really one of the best ways to get speech in. Don't forget about bathtime! When ds was around that age I would line up some bath toys on the edge and do some songs like 5 green and speckled frogs, always pausing to let him fill in a word or two. Also lots of playful communication temptations around bath time - putting him in the tub and not turning on the water or leaving his clothes on when putting him in the tub to get some sort of communication attempt from him.

 

At the beginning of early intervention it can be very overwhelming. I felt like I had to do exactly what the therapist showed me. I am sure over the next bit you will find all sorts of ways to just incorporate things in your day. Don't forget that imitation games and songs are very valuable for speech. You need gross and fine motor imitation to get speech imitation. So things like having him follow actions to a gross motor song (particularly songs that are repetitive) with your other kids would work as a good sensory and speech session. Also I am thinking from your kids ages that playdough might be an easy way to get a few minutes of speech in, especially those p sounds. I remember sitting with ds and poking, patting and pulling the playdough and getting him to imitate me doing so. You could also set him and a sibling up rolling a ball or truck back and forth while pointing and saying my turn, your turn (to build that turn taking needed for speech). Not sure what your SLP has you doing for signing. When ds was that age we were targeting about 3-5 signs a week. I would maybe teach 3-5 at the beginning of the week to all the kids and challenge them to use them as much as possible. Then maybe have a small basket of toys handy to use for props in targeting those signs by his highchair and do a quick 5 minutes after he finishes lunch or a snack.

 

Hope something of the above is helpful.

 

Thanks for the reminder about using bath time. We could do more there easily :)

[Terabith]

Here's what you do. First, you relax. It LOOKS like a lot, but really it isn't too bad. You just have to recategorize a lot of what you do anyway and be more intentional about it.

 

You're going to read to him anyway, aren't you? So you try to read a variety of books each day. Make one a book of nursery rhymes and another a vocabulary book. Kids his age love those anyway. Richard Scarry's Best Word Book Ever, DK First Words, etc. Make signs for certain words as you point them out. Be more explicit in your speech. The most interesting thing I learned when my oldest was in early intervention speech was that I was talking WAY too much. I was thinking of that as enriching her language, but in reality, she couldn't follow. I had to slow down and use gestures and smaller words. Instead of, "Oh, look at that brown doggy over there near the fire hydrant! He's really big, isn't he? I wonder what his name is? He's a German Shepherd. That's the kind of dog he is." I was talking way too much. It was sort of like the adults in the Peanuts cartoons. She was hearing, "Blah, blah blah." But when I slowed down and stopped, pointed right at the dog and said, "Doggy! Look, doggy!" Then walked over and said, "Doggy! She's brown and soft. A brown, soft doggy. Feel how soft the doggy is. Doggy." Her language made huge jumps.

 

So you make reading a book a part of your getting dressed routine, or your cuddling in bed in the morning routine, or whatever works. You read another book or two before nap, and another book or two before bed. You have him watch a Baby Babble video http://www.amazon.com/Baby-Babble-Speech-Enhancing-Babies-Toddlers/dp/B00027OI1I/ref=sr_1_1?ie=UTF8&qid=1339863390&sr=8-1&keywords=baby+babble or a Baby Signing Time while you are working with the big kids. (Alternatively, everyone watches it together at some time.) You pick a few signs and use them as part of everyday life. It makes more sense to incorporate "milk, eat, more, kitty" when you are encountering them rather than a focused artificial time.

 

You're going to bathe him anyway. So you get in the tub with him and make bathtime a language enrichment time. Sing songs. Play with toys. After bath, give a massage and do joint compressions. Roll him up in a blanket and play Squish the Baby. Read a book. Sing a lullaby. Do some cuddling with finger plays and body awareness songs/ games. (Round and Round the Garden, etc) Get Naturally You Can Sing's Sing a Song with Baby cd and incorporate them into your day. http://www.naturallyyoucansing.com/books/

 

You're going to play with him anyway. Give the big kids some independent work for 15 minutes or so and have a play session modeled on Greenspan's Floortime. Your big kids can work for 15 minutes, and that gives you some focused time with Possum.

 

Do OT stuff as a family. Have pe together each morning and jump on the trampoline. Do some bear walks and wheelbarrow walks. Skip and gallop. Hop on one foot. Play on a scooter, swing on a swing or a trapeze bar. Do pencil rolls and forward rolls. Play Super Baby with all the kids. (It's a good workout for you!) Roll on exercise balls. You lay on the floor and have kids lay tummy to tummy with you and you roll around. Tickle and wrestle with everyone. Do a simple circle dance (Ring Around the Rosy, All Around the Mulberry Bush, etc). Sit in a swivel chair with a baby on your lap and spin in one direction, then stop and go in the other direction. Then have baby lay on his back in your lap and repeat.

 

In the afternoon have another pe/ recess break as a family. Can also do things like go to a park or swimming or a toddler gymnastics class. After dinner is active play with Dad time.

 

Cuddle and do bouncing songs. That gives you 3 OT sessions: pe/ recess as a family in the morning, active play (sneaky OT) in the afternoon, and some time with Dad after dinner or massage and compression at bedtime. Bath time and one play session are intensive language, plus you're incorporating focused language in book reading and daily life. Watching Signing Time and using signs in life is signing therapy. And you're done, without having therapy time at all, and it's all play.