Augmentative and Alternative Communication (AAC) is a device or system that replaces or supports natural speech. AAC can be no-tech or low-tech, including such things as gestures, writing, drawing, manual sign, picture communication boards, letter boards, etc. It might also be high tech. This includes using an application on an iPad or tablet (i.e., Proloquo2Go, LAMP, TS Snap) or using a computer with vocal output, called a speech generating device. AAC can be a great tool in early intervention.

Individuals of any age with various different reasons in which they experience difficulty communicating might use AAC. This article will discuss how any child not verbalizing spoken language might use AAC. These children may exhibit a wide range of diagnoses, including autism, cerebral palsy, Down syndrome, developmental delays, and more.  Any child whose needs require more than speech alone to communicate may qualify to use AAC. 

Will AAC in Early Intervention Hinder Spoken Language?

A common worry or assumption is that AAC may hinder a child’s spoken language. This is a concern because AAC is not targeting spoken speech and language. Actually, the opposite is true. AAC research has shown that it can support speech and language development (Schlosser & Wendt, 2008). Research has demonstrated that AAC can help improve natural speech when using a multi-modal approach focusing simultaneously on natural speech and AAC. AAC provides a child with a mechanism to communicate, since they are unable to communicate using speech. Some children’s language abilities exceed their speech abilities. AAC provides them a way to use their language skills through a different outlet. This can reduce frustration related to communication, sometimes decreasing challenging behaviors arising from communication breakdowns. Additionally, implementing AAC early can increase vocabulary, development of grammar, and receptive vocabulary. 

In some cases, AAC will not be a long term need. As your child develops speech skills, they will generally use the path of least resistance to communicate. Therefore they will likely use spoken language if they are able to. 

If you think AAC might be a helpful early intervention tool for your child, your child’s speech language pathologist can help guide you through the process of receiving and implementing AAC. 

Small talk may sound easy enough, but it is a challenge for many adults, let alone children who grow up in a world of texting and social media. Teaching your child to engage in small talk makes them more socially aware and helps them communicate across generations. Use some of the following ideas to begin teaching your child to engage in small talk.

Meet and greet. Firstly, walk around your neighborhood and greet familiar neighbors. Begin with a simple hi/hello and introduce yourself and your child. When your child becomes comfortable with this, have them introduce themselves. From there, expand their small talk using some of the following ideas.

People watch. Sit and watch people in parks, on the sidewalk, shopping, whatever is available in your community. Guess at what the people may be interested in, how they might relate to their communication partner, and what their facial expression/body language may indicate.

Car talk. Practice small talk in the car where eye contact and body language require less attention. Practice longer topics while driving.

Small Talk Topic List

Brain storm a list of topics with your child. Small talk is a brief interaction so keep the topics brief. Some examples are the weather, the dog they may be walking, bicycle they are riding, how they are enjoying the day, what they may be doing at the moment. Prepare a few questions and practice them when greeting neighbors as above, and depending on your child, you may wish to make a list of topics NOT to use.

Wh-questions. Teach your child to use who, what, where, when, why questions vs. yes/no questions. For example, when meeting a dog walker ask, “Where does your dog like to go?” or “What does your dog like to play?” rather than “Are you walking your dog?” or “Does your dog like to play?”

Share. Teach your child to share something about themselves. It may be a new sport they are starting, a favorite game, book or movie. Provide guidance about topics that are and are not appropriate.

Holidays. Role play questions to ask grandparents, aunts, uncles, and adult friends. Give your child a little background information on each person who is likely to be present, such as a grandparent’s favorite old movie, aunt’s pet, friend’s new car, etc.

Remember to end it well. Give your child some standard phrases to exit the conversation. Phrases could be, “It was nice to meet you.”, “Enjoy the rest of of your day”, “Hope to see you again”, etc.

Check out MOSAIC’s blog to learn more about topics related to your child’s development.

As a parent or caregiver, it’s important to understand the different developmental stages of play in children ages 0-5. Play is not just a fun activity for children, but it’s also a crucial part of their development. Through play, children learn about the world around them, develop their social skills, and build their cognitive abilities. In this article, we’ll explore the different stages of play in children. We will also talk about what you can do to support their development. 

First Developmental Stage of Play

The first stage of play is solitary play, which typically occurs in infants and young toddlers. During this stage, children play alone and do not show interest in interacting with others. They may engage in activities such as exploring toys, touching objects, and making sounds. As a caregiver, it’s important to provide a safe and stimulating environment for your child to explore during this stage. 

Second Stage

The second stage of play is parallel play, which typically occurs in toddlers. During this stage, children play alongside each other but do not interact with one another. They may engage in similar activities, such as building with blocks or playing with dolls. As a caregiver, you can encourage parallel play by providing your child with toys and activities that they can engage in alongside other children. 

Third Stage

The third stage of play is associative play, which typically occurs in preschoolers. During this stage, children begin to interact with each other and share toys and materials. They may engage in activities such as pretend play, playing dress-up, or building a fort together. As a caregiver, you can support associative play by providing opportunities for your child to play with other children and encouraging them to share and take turns. 

Final Developmental Stage of Play

The fourth and final stage of play is cooperative play, which typically occurs in older preschoolers and early elementary school-aged children. During this stage, children work together to achieve a common goal, such as building a tower or playing a game. They may engage in more complex activities that require cooperation and communication. As a caregiver, you can support cooperative play by providing opportunities for your child to work with others. Encourage them to communicate and problem-solve together. 

In conclusion, understanding the different developmental stages of play in children ages 0 to 5 is crucial for supporting their development. By providing a safe and stimulating environment, encouraging parallel play, supporting associative play, and promoting cooperative play, you can help your child build their social, cognitive, and emotional skills. Remember to be patient and supportive as your child navigates these different stages of play. Enjoy watching them grow and learn through play. 

A sensory diet is not just for kids! A sensory diet can be individualized to many different ages to help support regulation needs. But, what is a sensory diet? A sensory diet is a set of activities that is designed to meet the specific needs of an individual. Therefore, the goal is to provide a structured and predictable sequence of sensory experiences throughout the day. This helps to assist with an individual’s ability to regulate their sensory systems and respond appropriately to their environment. Sensory diet activities are determined based on specific sensory needs. All activities are carefully chosen and scheduled into an individual’s day to assist with regulation of activity levels, attention, and adaptive responses. All the systems working together provides the body with the “optimal level of arousal”. A sensory diet includes a combination of activities and utilizes many of our senses.

Your 8 Senses

Firstly, we all have a unique sensory system. Just as no two people are the same, likewise, no two sensory diets are identical. Basically, throughout the day, all the sensory systems are working together to perceive and process sensory information coming from our environment and even inside our bodies. There are actually 8 senses that are in the body that make up our sensory system. The five basic sensory systems include: visual (sight), auditory (hearing), olfactory (smell), gustatory (taste), and tactile (touch) system. In addition, the other three “hidden sensory systems” impact how we experience our bodies in space and they include the vestibular, proprioception, and interoception systems.  

Our bodies and minds instinctively know the varying sensory input we receive throughout our day. Therefore, individuals will naturally seek out a variety of sensory input to help regulate their bodies. However, for some individuals this might not come automatically, and support to perform these strategies may be necessary.

Sensory Diet Activities for All the Senses

• Visual – scavenger hunts, I Spy, painting, puzzles, mazes, adjust the lighting
• Auditory – headphones, clapping games, musical instruments, white noise
• Olfactory – scented play dough, create smelling bottles, avoid scented soaps/lotion/perfume
• Gustatory – chewing gum, vibrating toothbrush, drinking from a straw, creating taste bottles
• Tactile – heavy work activities, textured activities, vibrating activities, squeezing activities
• Vestibular – swinging, spinning, bouncing, rolling, rocking
• Proprioception – crawling, bear walks, climbing, monkey bars
• Interoception – yoga, breathing exercises, temperature activities, social stories

Also, some things to watch for that may indicate an individual needs assistance with regulating their various sensory systems include:

• Emotional overreaction
• Hyper-attention or inattention
• Difficulty with transitions
• Sleep issues
• Impulsivity
• Poor social interactions
• Resistance to textures/food/clothing

Despite being aware of what to look for and exploring different sensory activities, children or adults may still be struggle to regulate their bodies. An occupational therapist can help design a sensory diet that is appropriate for an individual’s needs.

Finally, for more information regarding sensory diet and various activities, explore the OT Toolbox.

Parkinson’s disease (PD) is a progressive neurological disorder that affects movement, balance, posture, and coordination. It can also cause non-motor symptoms such as pain, fatigue, mood changes, and cognitive impairment. While there is no cure for PD, there are treatments that can help manage the symptoms and improve the quality of life of people living with PD. Physical therapy is one of these treatments that helps Parkinson’s disease.

PT can help restore or maintain physical function, mobility, and independence because physical therapists are trained professionals who can assess, diagnose, and treat movement problems related to PD. They can also provide education, advice, and support to people with PD and their caregivers.

How Physical Therapy Helps Parkinson’s Disease

Physical therapy helps Parkinson’s disease in many ways, such as:

Improving muscle strength and endurance

Both age and PD can weaken and decondition muscles. A physical therapist will prescribe exercises using light weights or resistance bands to improve strength. Because, more strength helps with balance and mobility.

Physical therapy helps Enhance amplitude of movement in Parkinson’s

PD can cause people to reduce the size and speed of movements. So, it can affect walking, speech, facial expressions, and gestures. Physical therapy can help increase the amplitude of movement by teaching overexaggerated physical movements, such as high steps and arm swings. This is a way to retrain the muscles and brain to compensate for the reduced movement that Parkinson’s can cause, and the LSVT BIG program is a specific set of exercises and activities that has been shown to improve mobility and quality of life.

Reinforcing reciprocal patterns

Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. PD can affect these patterns, which makes walking slow and unstable. Physical therapy can help to reinforce reciprocal patterns by using machines like a recumbent bicycle or elliptical machine. Practicing walking with arm swings is another activity that can help restore reciprocal movements. This can improve coordination, rhythm, and fluidity of movement for people with Parkinson’s. Dance and Tai chi are other activities that involve reciprocal patterns.

Physical Therapy Improves balance and posture for Parkinson’s

PD commonly impairs balance. Your brain uses a complex mix of what you see, your inner ear, and sensations from your feet and joints to maintain balance. Physical therapy can help to improve balance using exercises that challenge stability, such as standing on one leg or walking on uneven surfaces. PT will also focus on specific components of the balance system by doing things like having a person close their eyes to focus on the sensations from the feet and joints. Physical therapy can also improve posture by correcting any muscle tightness or weakness that may cause stooping or learning sideways.

Increasing flexibility and range of motion

PD also often causes muscle stiffness and rigidity. Physical therapy can help increase flexibility and range of motion with stretching exercises that target specific muscles. Common areas of issue are the hip flexors, hamstrings, and calves. Stretching regularly can also help to reduce pain and spasm.

Providing education and self-management advice

Physical therapy can help people learn more about PD and how it affects their movement. A physical therapist can provide tips on how to maintain safety when exercising, how to cope with fatigue or pain, how to use assistive devices if needed, and how to prevent or manage complications such as falls or freezing.

Sounds Great. Is There Proof?

Yes! Research backs up all these claims. One meta-study (a study that combines the results of many other studies) that covered 1827 participants found that when compared to no intervention, PT significantly improved:

• Gait speed and two-minute and six-minute walk test scores
• Freezing of Gait questionnaire
• The Timed Up & Go test
• Functional Reach Test
• The Berg Balance Scale

These results indicate improvements in mobility, endurance, strength, and balance. Gait speed is an especially important measurement. Physical therapists often consider gait speed a “vital sign.” This is because low gait speed has been linked to:

• Declines in functional mobility and increased disability
• Higher rates of hospitalization
• Higher fall rates
• Cognitive decline
• Higher risk of death

A larger meta study that included 191 studies with 7998 participants found that PT significantly improved motor symptoms, gait, and quality of life. Specifically:

• Resistance and treadmill training improved gait.
• Strategy training improved balance and gait.
• Dance, Nordic walking, balance and gait training, and martial arts improved motor symptoms, balance, and gait.

In conclusion, physical therapy is a valuable treatment option for people with PD, as it can help to improve or maintain their physical function, mobility, and independence. Physical therapy can also enhance their quality of life, confidence, and well-being. If you have PD or know someone who does, consult with a physical therapist who specializes in PD to see how they can help you.

References

1. Physical Therapy for Parkinson’s Disease – Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/physical-therapy-for-parkinsons-disease.
2. Physical Therapy and PD | Parkinson’s Foundation. https://www.parkinson.org/library/fact-sheets/physical-therapy.
3. Physical and Occupational Therapy for Parkinson’s: What to Expect. https://bing.com/search?q=physical+therapy+for+parkinson%27s+disease.
4. Parkinson’s Disease Treatment Physical Therapy. https://www.parkinsonsdaily.com/parkinsons-disease-treatment-physical-therapy/.
5. Physical, Occupational & Speech Therapies | Parkinson’s Foundation. https://www.parkinson.org/living-with-parkinsons/treatment/physical-occupational-speech-therapies.
6. Physiotherapy in Parkinson’s Disease: A Meta-Analysis of Present Treatment Modalities – https://pubmed.ncbi.nlm.nih.gov/32917125/
7. Physiotherapy versus placebo or no intervention in Parkinson’s disease – https://pubmed.ncbi.nlm.nih.gov/24018704/

While most handwriting, drawing, painting, coloring, and other play activities occur on a table or on the floor, those are not the only surfaces that can be used for these activities. Try changing up the activity and work on a vertical surface. Vertical surfaces support development and can make the activity more fun for children. In addition, changing the way you do an activity can help kids to focus and stay engaged longer. 

Why is Work on a Vertical Surface Beneficial?

Firstly, working on a vertical surface can support the development of a variety of skills. The skills supported by working on a vertical surface can carry over to everyday activities and to academic skills. 

• Bilateral Coordination – Depending on how the activity is set up, working on a vertical surface can also promote bilateral coordination. For example, the child may need to hold the paper on the wall with one hand while painting or drawing with the other hand. Setting up the activity this way helps provide the child with feedback if they are using both hands consistently. If they only use one hand the paper will fall.
• Wrist Extension/Pencil Grasp – Working on a vertical surface puts the wrist in an extended position which supports better pencil grasp and control of writing tools. 
• Shoulder/Elbow Stability – Working on a vertical surface requires additional shoulder and elbow stability. Having the child draw, write, or play on a vertical surface requires them to work against gravity and prompts strengthening of the shoulder and elbow. 
• Midline Crossing – Crossing midline naturally incorporates into play when using vertical surfaces as the child reaches with their dominant hand from one side of the surface to the other. 
• Core Strength/Posture – Positioning children in tall kneeling or standing can help to prompt better posture and core strength while working opposed to a slouched position at a table or desk

Activities to Try

Some activities that you can try at home that use a vertical surface include the following:

• Using Water to Paint Outside – This activity is simple to set up and requires very few materials. Give the child a bowl of water and paint brushes, and encourage them to paint the fence with the water, promoting painting on a vertical surface. 
• White Board – Simple drawing on a white board or chalkboard can be a great vertical surface activity. You can expand on this activity by playing drawing games such as tic tac toe or Pictionary. 
• LEGO Wall – Attach LEGO board to the ball and encourage your child to build with LEGO on the wall. You can get some more fun ideas for playing with LEGO here. 
• Car Wash – Set up a simple at home car wash. Use sponges with water and car soap to scrub and wash the car. 

These are just a few ideas to get you starting to work on vertical surfaces. Check our Your Therapy Source for more fun suggestions.