Client background:

Ameya is a 2-year-old girl with a diagnosis of Cerebral Palsy. She returned for a second intensive to focus on both speech and feeding. The goal of Ameya’s previous intensive in 2018 was to improve her oral feeding skills. When she returned in 2019, mealtime participation was targeted in the context of communication and an AAC system was created to expand her ability to express her wants and needs across daily routines and settings.

Ameya’s journey

See how Ameya blossomed during her therapy sessions at Key to CP in this case study, or continue reading below.

Goals before treatment:

Family goals centered around expanding Ameya’s ability to communicate during mealtimes to help increase oral intake and overall participation, providing her with a broader expressive vocabulary to better match her cognitive and receptive skills, and incorporating use of a speech-generative device to give her a voice at home and during preschool.

Treatment:

Ameya attended a five-day speech therapy intensive at Key to CP with one 90-minute session per day. Appropriate seating was identified and incorporated to maximize her access to static pictures and the Mini-com device (www.enablingdevices.com). Optimal access was identified with the help of the physical therapist along with parent input, including offering two picture choices or placing a picture/device to her left side to maximize fine motor control. 

Therapy initially focused on incorporating picture choices into play and social interactions. The concept of “my turn” and “your turn” was introduced in a variety of play and book-reading activities. Ameya quickly picked up on the power of communication and began indicating her wants and needs clearly. Instead of all of us thinking that her vocalizations in protest were her way of telling us she needed a break, we quickly discovered that she was being a typical 2-year-old and simply wanted a turn with the bubbles! That was a pivotal point in our week together.

Pictures were also used to expand her pretent play skills. Ameya demonstrated understanding of object function by choosing props during baby doll play (i.e, bottle, brush, etc) when given their function or during play with Mr. Potato Head when asked, “What do we smell with?” and presented with a picture of both eyes and a nose. It was very clear that Ameya had a lot of potential if we were just able to give her the words.

Finally, the Mini-com was introduced. She had had some exposure to a Big Mack button during home-based therapy sessions, but was a bit anxious about the voice output piece. Ameya clearly understood the words being targeted and her parents did a great job modeling use of the system themselves.

Results:

In just five days, I was able to use the family’s input to create a binder of picture cards to send them home with. Ameya’s parents were clearly in tune with her needs, but now had a way to facilitate her expression of these wants and needs. Ameya was able to demonstrate early pretend play skills, take turns in play and book-reading, show her sense of humor, and use words during mealtime to exert control which is critical for a toddler and led to improved participation and oral intake. This was truly a team approach and a huge success in my book!

Two months later, the family shared a video showing Ameya using her Big Mack (SGD) at home to take turns while reading a book with her mother. She had mastered this skill and shows her sense of humor and personality when letting her mother know she could NOT have another turn! We can’t wait to see what other skills Ameya shows us over the next several months.