​This is a catch phrase that parents often hear in therapy office, IEP meetings, websites.  But what does it really mean beyond the obvious, literal sense?
I recently was referring to the old parable about the blind men and the elephant. If you’re not familiar with it, it tells of six blind men that came across an elephant. However, each man only touched one part of the elephant and thus created his own version of reality from that limited experience and perspective. One man, who touched the elephant’s side, likened it to a wall while another touched the tusk and determined that elephant is like a spear. It goes on with the trunk being a snake, the leg being a tree trunk, the ear a fan, the tail a rope. Limited perspective made them miss what an elephant truly is.
The most valuable times of my career as a Speech Language Pathologist have been when I was part of a multi-disciplinary collaborative team where we all learned from the other professional’s perspective and insight. I especially had a strong collaborative relationship with a most incredible Occupational Therapist during my time in the schools. The insight that I gleaned from her influences me daily and I often think, what would Julie do?
There certainly are some children who truly have a single, outlier difficulty that only requires one discipline. This might be a child with a lisp, or a child with fine motor deficits but no other needs. However, many of the children we see are more involved with sensory, behavioral, and functional communication needs. All of these factors contribute to the overall disorder or diagnosis of the child. Is the behavior preventing the child from communicating or are the behaviors a physical manifestation of the frustration of not being able to communicate? Are the behaviors a result of sensory issues such as visual or auditory distractions or difficulty self-regulating? Every behavior has a function. (Read last February’s blog!)
A child is not a static, one dimensional being and it is critically important to get different eyes on the child to create a comprehensive plan. This is why I am beyond thrilled to be adding our new ABA Therapy department to the Reaching New Heights. The behavioral approach differs from Speech and OT that are heavily based on theories of development. What works for one child may not work for another. Our team of experienced, diverse therapists is here to help the parents navigate through the maze of interventions. And all of the therapists will become better through working together and treating the WHOLE CHILD!

Every behavior has a function.
Last spring, a client’s Mom showed me her son’s “report card” from a very reputable preschool.  The teacher had given the 2 ½ year old boy “needs improvement” or “unsatisfactory” marks for most of the expected developmental skills even though I have seen him demonstrate these abilities.  Then I noticed where the teacher had written “he aggresses towards others for no reason.”
Every behavior has a function.
At the time of this report card, this child had limited verbal communication and a recent diagnosis of autism. Rather than verbally request help, he would cry, yell and/or throw the source of frustration. When someone took an object he wanted, he would hit or bite the source of his frustration.  Was he being “bad”? 
Every behavior has a function.
We live in a world where if a child throws something, we take it away. If a child aggresses toward someone, we isolate them (time out).  If something could be dangerous or could break, we remove it from the child’s environment.  Sure – this  provides a quick and easy solution, but are we TEACHING the child anything?  Teachable moments present themselves constantly. Use those opportunities to teach the child.
Every behavior has a function.
By now you’ve probably noticed my mantra.  It’s true and we must be cognizant of it, especially if we work with children with communication deficits. The child who aggresses rather than “gives up” shows me that he will persist when his needs are not met.  That is a positive indicator for improved expressive language.  The child mentioned above was using behavior to communicate his wants/needs and became frustrated when those needs were not met.  I would feel exactly the same way.
Every behavior has a function.  Here are the four main functions:

• Escape/Avoidance: The individual behaves in order to get out of doing something he/she does not want to do.
• Attention Seeking: The individual behaves to get focused attention from parents, teachers, siblings, peers, or other people that are around them.
• Seeking Access to Materials: The individual behaves in order to get a preferred item or participate in an enjoyable activity.
• Sensory Stimulation: The individual behaves in a specific way because it feels good to them.

 
As parents, teachers, and therapists, we must not be hasty to write something off as “just a behavior” without carefully considering the function. Removing objects and people from the environment is not a solution unless you plan on the child spending his time in an empty room by himself. Determine the function and then develop a plan.  Teach the child a replacement behavior; provide the child with supports; set the child up for success and celebrate the heck out of steps in the desired direction.
 
“FOR NO REASON”?  There is always a reason!

At Reaching New Heights, we talk a lot about “PROMPT”.  We feel so passionately about it, it’s even in all caps when we write it out. . .and no, we are not fixated on being on time.  What we are excited about is the specialized training that Donna and I have both received from the PROMPT Institute.  

In order to help kids learn new movement patterns, we touch our clients’ faces, giving support to their jaws and cuing their lips to close.  It’s one of the things that makes therapy at RNH look different than what you may be used to seeing with other speech-language pathologists.  These are our PROMPT cues.  Donna and I have learned a series of touch cues that we use on kiddos’ faces, neck and chest that help kids with motor speech problems.  We use these cues with supportive words to help little ones learn how to produce voicing.  “Turn on your voice.” We help kids tune into their lips, jaws and tongues and to move them more precisely.  “I like the way you closed your lips for that mmmmm sound.”  I tease that PROMPT makes me feel like I have “magic hands”.

PROMPT is more than just the cues to the clients’ faces.  The PROMPT philosophy of treatment helps Donna and I focus on kids whole well-being, beyond their speech.  We are always thinking about how their emotional, physical and language systems are developing and being challenged.  The PROMPT method prioritizes communication within positive, meaningful interactions.

Becoming PROMPT trained last month was invigorating!  It changed the way that I interact with kids and the way I think about their communication skills and differences.  I’m excited to put my new skills into practice. PROMPT has made me a therapist who is more connected with my clients!  

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Six years ago today, Reaching New Heights was born. I received my EIN number, making my dream a reality! I started seeing occasional clients in my home after my school day was complete.  I was amazed at how much I loved seeing kiddos in a setting other than school.
One year ago on April 1st, I opened the doors to my brick and mortar office and started seeing clients full-time in my incredible space! It was exactly as I envisioned it – fun, funky, playful.  NOT clinical at all.  I had several loyal clients from home follow me to my new space and it felt like it was meant to be. I truly break into a smile every time I enter my office!
My clients and their families have become an extension of my own family. We care about each other and support each other in a way I never experienced with clients/families in any other setting.  When my mother had her strokes in January and her recent surgery and setbacks, they prayed for us and supported us in ways I never expected.
Last week a Mom and Grandma of a client (who I am blessed to call my Friends) surprised me with a care package of humorous and tasty gifts along with an encouraging card. Others have allowed me to switch appointments to accommodate my needs to be with my Mom. They all have offered love and prayers. This is a part of being a business owner that I didn’t expect.
As a therapist, a big part of my job is counseling parents on how to help their child. I offer emotional support as well as guidance.  I now know that the “Reaching New Heights” is a family and I am so blessed to have these incredible, loving families in my life!

​My Mom was moved to a medical floor where she was evaluated by Speech, Occupational, and Physical Therapy. On the first day, she had difficulty speaking, swallowing, holding utensils in her right hand, and moving her right leg. However, my Mom’s cognition appeared to be relatively intact.  She was worried about missing appointments and other obligations.  She knew her whole week’s commitments.  I breathed a sigh of relief, but was still concerned about the other deficits.
On day 2, I arrived at the hospital early and was thrilled to find that Mom was able to hold a fork in her right hand and feed herself!  When she smiled at me it was more symmetrical and her facial droop was better!  AND her word finding was much improved!  Spontaneous recovery!  The brain was figuring out ways to do the things that the damaged parts of the brain used to do!
Neuroplasticity is the brain’s ability to reorganize and compensate for the damaged part(s) of the brain. My Mom’s brain was figuring out how to get back to normal.  People who “exercise” their brain tend to use their whole brain which increases neural connections.  My Mom “exercised” her brain more than the average person.  At 83, she plays in several bridge groups, reads the newspaper and books daily, is involved in church groups, volunteers at a food bank, is in a book club that has facilitators from universities, organizes a scholarship committee, and plays “Words with Friends” daily.
My Mom was moved to the Acute Rehab Department at UH Parma Medical Center where I used to work.  She received incredible intensive therapy from some of the best therapists I know. Daily improvement continued!
It is now 8 days post stroke. My Mom’s speech is only mildly slurred.  Aphasia (word finding) and dysphagia (swallowing) are completely resolved.  Her right-side weakness is continuing to improve.  Her cognition is intact. And after only 4 days of Acute Rehab, she is being released to home (with supervision) tomorrow!  My Mom is remarkable, but she still has work to do. 
Why did my Mom make such a fast and incredible recovery? She called me at the first sign of a stroke, within minutes. She had medical and therapeutic interventions beginning the first day. AND she exercised her brain daily. Neuroplasticity ROCKS!  

Last Tuesday morning, I saw on my phone that my Mom was calling and I answered. What I heard will forever be ingrained in my memory.  My Mom’s voice, usually strong and articulate, was out of control with crying and no discernable words with the exception of one.  “Stroke”. 
As a Speech Language Pathologist with experience in stroke rehab, I immediately knew she was having a stroke and could die or be severely impaired. I rushed to the hospital where my Mom was taken by ambulance.  She was conscious and oriented, but communication was difficult for her.
In the ER, it was obvious to me that my Mom was suffering from Aphasia and Dysarthria.  She also had right side weakness that affected her face, hand, and leg.
Aphasia is a communication disorder, typically caused by damage to the left side of the brain which contains the “language center”. It usually impacts the individual’s ability to express themselves verbally and in some cases, writing.  In my Mom’s case, she knew what she wanted to say but she couldn’t “get it out”.  She tried to say “heart” and instead said “house”.  
Dysarthria is a motor speech disorder also caused by damage to the brain.   It affects the muscles used for speech (tongue, lips) resulting in slurred or choppy speech. Her mouth drooped on the right side, her smile was asymmetrical, and her tongue deviated to the right when she stuck it out.  Her right hand and leg were also weak.  My Mom also demonstrated difficulty eating and swallowing (Dysphagia).
Finally, we received the results of the MRI which revealed, not one, but two strokes.  One on each side of ther brain. In a single moment, I went from being a Speech Language Pathologist to being the daughter of a stroke victim who just wanted her Mom to be ok.  Both the therapist and the daughter were terrified…but knew what the next steps would be. (to be continued)

I am from Cleveland and have lived here for my entire life.  And I’ve ALWAYS been proud of my city.  Winning teams are exciting, but they don’t increase my pride in Cleveland.  I love Cleveland for so many reasons that don’t even include sports. And I love our teams whether or not they bring home a championship.  Maybe I’m an optimist, or maybe I just root for the underdog!

I work with children who may seem like the “underdog”.  Speech and language skills that many of us acquired naturally, require direct teaching and practice for these children.  These skills are critical for the child’s success in communication, but they need extra “training”.  These children may seem less capable then their peers.

Some children are just naturally talented at something.  My oldest daughter was naturally talented at softball from an early age.  My other two daughters were naturally talented at dance.  However, they all were exposed to both activities and worked hard under the guidance of a coach or dance teacher to overcome their lack of “natural talent”.

When the Cleveland Indian pitchers had to bat in Chicago this week, I was struck by how nervous they appeared. Hitting is not their natural talent and therefore they may lack confidence in their ability. When Kluber got an RBI single, the joy in his smile was undeniable.  Imagine how empowering it is for a child to use newly acquired communication skills to express their wants, needs, emotions…to say “I love you” for the first time.
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The world loves stories of underdogs “winning”.  I am fortunate to spend my days making this happen for my clients, who in my eyes are ALL champions!

I recently watched a webinar regarding ethics in Speech Language Pathology.  The lecturer, who had a fabulous Irish accent, discussed what makes a Speech Language Pathologist clinically competent or even an “expert”.  Is it how many letters she has after her name?  (I am using female pronouns for the sake of simplicity.  I apologize to males in my field.) Is it how many articles she has published?  Is it her tenured position at a prestigious university? 
Of course the answer is no.  What makes a therapist competent is her continual quest for learning and researching.  She needs to be able to draw upon her knowledge and experience when making a clinical decision about a client.  AND she needs to be able to to combine her knowledge, clinical judgment, with the family members’ insight and desires when developing a therapy plan. 
Parents and clients are the greatest source of information, the TRUE EXPERTS, and they should feel involved and valued.  If parents feel bullied or discounted, therapy will not be effective.  Child first, family first…that is the philosophy at Reaching New Heights.