<h1>Stuttering</h1>
Core symptoms
We all have times when we do not speak smoothly. We may add &quot;uh&quot; or &quot;you know&quot; to what we say. Or, we may say a sound or word more than once. These are called disfluencies.
People who stutter may have more disfluencies and different types of disfluencies. They may repeat parts of words (repetitions), stretch a sound out for a long time (prolongations), or have a hard time getting a word out (blocks).
The following types of disfluencies happen when someone stutters:
<ul>
<li>Part-word repetitions – &quot;I wa-wa-wa-want a cookie.&quot;</li>
<li>One-syllable word repetitions – “My-my-my name is.”</li>
<li>Prolonged sounds – “Fffffffrank is nice.&quot;</li>
<li>Blocks or stops – &quot;I want a (pause) glass of water.&quot;</li>
</ul>
<blockquote>
These core symptoms can vary in frequency and severity and the individual's situation and personal condition.
</blockquote>
Accompanying symptoms
Many people who stutter develop accompanying symptoms. They can be visible, for example tension of the facial muscles or body movements. Invisible are accompanying symptoms such as fear of speaking or the avoidance and concealment of stuttering. Words are exchanged at lightning speed, filler words are used or speaking situations are generally avoided.
Accompanying symptoms can be extremely stressful for people who stutter in everyday life, become more severe and lead to social withdrawal.
Why does one stutter?
Speaking itself is a highly complex process. Our brain must receive and process a multitude of impulses in order for the speech process to work. Some of these processes are impaired in people who stutter. The area of the brain responsible for controlling the speech muscles is not supplied without interference by the other areas involved. Thus, the preparation for the upcoming speech task fails - the person stutters.
According to current knowledge, the main cause of stuttering is seen in an inherited predisposition to it, which does not necessarily, but with a high probability, lead to the occurrence of stuttering. Stuttering is therefore a neurologically caused disturbance of the flow of speech. It does not allow any conclusions to be drawn about the intelligence, character or origin of the person affected.
According to the NIDCD, stuttering affects people of all ages. It occurs most often in children between the ages of 2 and 6 as they are developing their language skills. Approximately 5 to 10 percent of all children will stutter for some period in their life, lasting from a few weeks to several years. Boys are 2 to 3 times as likely to stutter as girls and as they get older this gender difference increases; the number of boys who continue to stutter is 3 to 4 times larger than the number of girls.
Treatment
Speech Therapy
After a comprehensive evaluation by a speech-language pathologist, a decision about the best treatment approach can be made. Several different approaches are available to treat children and adults who stutter.
Basically, there are two different therapy approaches used by speech therapists: Stuttering Modification on the one hand, and Fluency Shaping on the other. Both therapy programs last several weeks and especially Fluency Shaping requires intensive practice of the new speech patterns, as well as regular sessions after the end of therapy in order to avoid relapses.
<ol>
<li>Stuttering Modification/Non-Avoidance Approach:</li>
</ol>
Stuttering modification is not about trying to avoid stuttering, but learning how to deal with it better. The therapy approach is divided into 4 phases:
<ul>
<li>Phase 1- Identification: the person who stutters observes when stuttering events occur and how they feel about them.</li>
<li>Phase 2- Desensitization: Stuttering is intentionally observed in order to reduce negative feelings about stuttering by becoming accustomed to it and to notice during practical exercises that the listeners usually react very tolerantly to stuttering.</li>
<li>Phase 3- Modification: Techniques are learned to make stuttering more fluent - pauses are inserted, stuttered words are repeated slowly or are pronounced more slowly in the first place.</li>
<li>Phase 4- Stabilization: Finally, the fluent stuttering and the more relaxed way of dealing with it are stabilized and adopted into everyday life.</li>
</ul>
<ol start="2">
<li>Fluency Shaping:</li>
</ol>
Fluency shaping is the systematic development of a fluent way of speaking. The main focus of fluency shaping intervention is to increase fluent speech through teaching, for example, one or more of the following: easy onsets, loose contacts, changing breathing, prolonging sounds or words, pausing, as well as other methods that reduce speaking rate. The overall goal is to encourage spontaneous fluency where possible and controlled fluency when it is not.
<blockquote>
Through Synopsis app the speech therapist can find very quickly fluency goals, in order to plan her therapy treatment in a more efficient way.
</blockquote>
Cognitive Behavioual Therapy: This type of psychotherapy can help the person who stutters learn to identify and change ways of thinking that might make stuttering worse. It can also help resolve stress, anxiety or self-esteem problems related to stuttering.
Electronic devices: Some people who stutter use electronic devices to help control fluency. For example, one type of device fits into the ear canal, much like a hearing aid, and digitally replays a slightly altered version of the wearer’s voice into the ear so that it sounds as if he or she is speaking in unison with another person. In some people, electronic devices may help improve fluency in a relatively short period of time. Additional research is needed to determine how long such effects may last and whether people are able to easily use and benefit from these devices in real-world situations. For these reasons, researchers are continuing to study the long-term effectiveness of these devices.
<hr>
There is no known cure for stuttering, and like any other speech disorder, it requires therapy and practice to treat or manage it.
Approximately 75% of children recover from stuttering. For the remaining 25% who continue to stutter, stuttering can persist as a lifelong communication disorder.
From the Synopsis Team

Stuttering

<h1>Treatments for Down Syndrome</h1>
What is Down Syndrome?
According to the CDC, Down Syndrome is a condition in which a person has an extra chromosome. Chromosomes determine how a baby’s body forms and functions as it grows during pregnancy and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down Syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ That is why Down Syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenge for the baby.
Even though people with Down Syndrome might act and look similar, each person has different abilities. People with Down Syndrome usually have an IQ (a measure of intelligence) in the mildly-to-moderately low range and are slower to speak than other children.
Some common physical features of Down Syndrome are a flattened face, almond-shaped eyes, short neck, small ears, hands and feet, poor muscle tone etc.
Causes
As mentioned by the NDSS (National Down Syndrome Society), the cause of the extra full or partial chromosome is still unknown.
Maternal age is the only factor that has been linked to an increased chance of having a baby with Down Syndrome. However, due to higher birth rates in younger women, 51% of children with Down syndrome are born to women under 35 years of age.
The additional partial or full copy of the 21st chromosome which causes Down Syndrome can originate from either the father or the mother. Approximately 5% of the cases have been traced to the father.
There is also no definitive scientific research that indicates that Down Syndrome is caused by environmental factors or the parents’ activities before or during pregnancy.
Treatments
Down Syndrome is a lifelong condition. Although it can’t be cured, doctors know more about it now than ever. Services early in life will often help babies and children with Down Syndrome to improve their physical and intellectual abilities.
Most of these services focus on helping children with Down Syndrome develop to their full potential. These services include speech, occupational, and physical therapy, and they are typically offered through early intervention programs. Children with Down Syndrome may also need extra help or attention in school, although many children are included in regular classes.
Speech Therapy
The developmental differences of people with Down Syndrome can impact speech and language, for example:
<ul>
<li>Difficulties in articulation due to low facial muscle tone.</li>
<li>Harder to form sounds, because of a larger size of the tongue</li>
<li>Hearing impairments from frequent ear infections due to the presence of fluid in the ears.</li>
<li>Slower learning capabilities can delay speech milestones.</li>
</ul>
These differences lead to receptive language being stronger than expressive language. There are several preventative and proactive treatments that can be done early on to help bridge this gap.
Of course there is no hard-set protocol for the speech therapy of a child with Down Syndrome. Speech therapists need to alter these programs and accommodate the needs and skills of each child.
In general, the speech therapists aim to:
<ul>
<li>Improve oral motor skills</li>
<li>Develop eating and drinking skills</li>
<li>Develop emerging language skills</li>
<li>Improve and develop speech sounds</li>
<li>Use alternative and augmentative communication e.g. sign language and visual aids to support language learning.</li>
<li>Improve more complex speech disorders</li>
<li>Increase vocabulary</li>
</ul>
<blockquote>
The primary goal of speech and language therapy for children with Down Syndrome is to maximise the individuals communication to their highest potential across their home, educational and social environments.
</blockquote>
Occupational Therapy
Occupational therapists play a key role within the multidisciplinary team for treatment of individuals with Down Syndrome. Occupational therapists are able to provide practical support and advice, enabling individuals with Down Syndrome to live more independent lives.Occupational therapists work with many different diagnoses and in different settings, such as in early intervention services or in the outpatient setting.
The type of interventions occupational therapists use will depend on the difficulties which are highlighted from an initial assessment. The intervention program will be tailored to suit the individual and their needs. Occupational therapy focus on the individual's ability to complete skills to enable independence. These skills include:
<ul>
<li>Self-care</li>
<li>Fine Motor</li>
<li>Gross Motor</li>
<li>Play and leisure</li>
<li>Feeding</li>
<li>Skills related to a school setting e.g. writing, cutting etc.</li>
<li>Sensory development and regulation</li>
</ul>
Occupational therapists can help individuals with Down Syndrome by breaking down tasks into smaller steps, and then teaching them how to complete each step by step task. Occupational therapists can also provide appropriate aids and adaptations to assist with the completion of skills. This may include advice on positioning during certain tasks e.g. specially adapted chairs to use at school, due to the low muscle tone (hypotonia).
<blockquote>
Individuals with low muscle tone may have a harder time processing proprioceptive input. Because of this decreased proprioceptive input, people with Down syndrome frequently need more input in order to grade the force of their movements.
</blockquote>
Physical Therapy
Physical therapy is important during the early stages of the child’s development. Early physical therapy interventions for children with Down Syndrome can help to address any developmental problems and muscle weakness, whilst maximising function and their quality of life.
An initial assessment carried out by the physiotherapist will determine the type and severity of difficulties the individual is having with their motor skills and physical functioning. From the initial assessment the physiotherapist will implement an individualised treatment plan which will be tailored to the specific needs and abilities of the individuals.
Physical therapy can help individuals with Down Syndrome to:
<ul>
<li>Develop gross motor skills such as sitting, crawling and standing</li>
<li>Improve posture, balance, muscle strength</li>
<li>Improve gait</li>
<li>Improve joint range of movement</li>
<li>Improve independence in functional activities</li>
<li>Reduce the development of compensatory patterns</li>
<li>Decrease the risk of joint problems as they age</li>
<li>Increase endurance</li>
</ul>
<blockquote>
It is important that physical therapy interventions for individuals with Down Syndrome also begin at an early age to help prevent secondary complications developing.
</blockquote>
<hr>
Many conditions in people with Down syndrome are manageable with treatment and therapies. Medical care, support and education help them throughout their lives. Like anyone else, people with Down syndrome go to school, work, have meaningful relationships and can lead healthy and active lives.
From the Synopsis Team

Treatments for Down Syndrome

<h1>Speech and language milestones</h1>
Each child, even within the same family, has his or her own rate of language development. There are some variations in language abilities between children of the same age, but there are some basic developmental milestones.
Below are the milestones from the age of 1 month to 5 years, as listed by the American Speech-Language-Hearing Association.
Birth to 6 Months
<ul>
<li>Quiets or smiles when you talk.</li>
<li>Seems to recognize your voice.</li>
<li>Quiets if crying.</li>
<li>Makes cooing sounds.</li>
<li>Cries change for different needs.</li>
<li>Smiles at people.</li>
<li>Moves her eyes in the direction of sounds.</li>
<li>Responds to changes in your tone of voice.</li>
<li>Notices toys that make sounds.</li>
<li>Pays attention to music.</li>
<li>Coos and babbles when playing alone or with you.</li>
<li>Makes speech-like babbling sounds, like pa, ba, and mi.</li>
<li>Makes sounds when happy or upset.</li>
</ul>
7 Months to 1 Year
<ul>
<li>Turns and looks in the direction of sounds.</li>
<li>Looks when you point.</li>
<li>Turns when you call her name.</li>
<li>Understands words for common items and people—words like cup, truck, juice, and daddy.</li>
<li>Starts to respond to simple words and phrases, like “No,” “Come here,” and “Want more?”</li>
<li>Plays games with you, like peek-a-boo and pat-a-cake.</li>
<li>Listens to songs and stories for a short time.</li>
<li>Babbles long strings of sounds, like mimi upup babababa.</li>
<li>Uses sounds and gestures to get and keep attention.</li>
<li>Points to objects and shows them to others.</li>
<li>Uses gestures like waving bye, reaching for “up,” and shaking his head no.</li>
<li>Imitates different speech sounds.</li>
<li>Says 1 or 2 words, like hi, dog, dada, mama, or uh-oh. This will happen around his first birthday, but sounds may not be clear.</li>
</ul>
One to Two Years
<ul>
<li>Points to a few body parts when you ask.</li>
<li>Follows 1-part directions, like &quot;Roll the ball&quot; or &quot;Kiss the baby.&quot;</li>
<li>Responds to simple questions, like “Who’s that?” or “Where’s your shoe?”</li>
<li>Listens to simple stories, songs, and rhymes.</li>
<li>Points to pictures in a book when you name them.</li>
<li>Uses a lot of new words.</li>
<li>Uses p, b, m, h, and w in words.</li>
<li>Starts to name pictures in books.</li>
<li>Asks questions, like “What's that?”, “Who’s that?”, and “Where’s kitty?”</li>
<li>Puts 2 words together, like &quot;more apple,&quot; &quot;no bed,&quot; and &quot;mommy book.&quot;</li>
</ul>
Two to Three Years
<ul>
<li>Understands opposites, like go–stop, big–little, and up–down.</li>
<li>Follows 2-part directions, like &quot;Get the spoon and put it on the table.&quot;</li>
<li>Understands new words quickly.</li>
<li>Has a word for almost everything.</li>
<li>Talks about things that are not in the room.</li>
<li>Uses k, g, f, t, d, and n in words.</li>
<li>Uses words like in, on, and under.</li>
<li>Uses two- or three- words to talk about and ask for things.</li>
<li>People who know your child can understand him.</li>
<li>Asks “Why?”</li>
<li>Puts 3 words together to talk about things. May repeat some words and sounds.</li>
</ul>
Three to Four Years
<ul>
<li>Responds when you call from another room.</li>
<li>Understands words for some colors, shapes and family members</li>
<li>Answers simple who, what, and where questions.</li>
<li>Says rhyming words, like hat–cat.</li>
<li>Uses pronouns, like I, you, me, we, and they.</li>
<li>Uses some plural words, like toys, birds, and buses.</li>
<li>Most people understand what your child says.</li>
<li>Asks when and how questions.</li>
<li>Puts 4 words together. May make some mistakes, like “I goed to school.”</li>
<li>Talks about what happened during the day. Uses about 4 sentences at a time.</li>
</ul>
Four to Five Years
<ul>
<li>Understands words for order, like first, next, and last.</li>
<li>Understands words for time, like yesterday, today, and tomorrow.</li>
<li>Follows longer directions, like “Put your pajamas on, brush your teeth, and then pick out a book.”</li>
<li>Follows classroom directions, like “Draw a circle on your paper around something you eat.”</li>
<li>Hears and understands most of what she hears at home and in school.</li>
<li>Says all speech sounds in words. May make mistakes on sounds that are harder to say, like l, s, r, v, z, ch, sh, and th.</li>
<li>Responds to “What did you say?”</li>
<li>Talks without repeating sounds or words most of the time.</li>
<li>Names letters and numbers.</li>
<li>Uses sentences that have more than 1 action word, like jump, play, and get. May make some mistakes, like “Zach gots 2 video games, but I got one.”</li>
<li>Tells a short story.</li>
<li>Keeps a conversation going.</li>
<li>Talks in different ways, depending on the listener and place. Your child may use short sentences with younger children. He may talk louder outside than inside.</li>
</ul>
These stages are indicative, but they are an important guide that speech and language therapists should necessarily be aware of.
Knowledge of these stages is essential for proper assessment and information for parents.
From the Synopsis Team

Speech and language milestones

<h1>Ideas for a fun speech therapy session</h1>
No matter how good a person is at their job, sometimes they feel they need a refreshment, something different and fun. Routine is a problem in our daily work, especially when working with young children, who get bored easily. So here are several ideas that can be incorporated into a speech therapy session and will change the mood of young and old alike.
Motion
All children love to move! Through movement, they discover and learn new things faster while strengthening skills such as vocabulary, articulation, following directions, categories, etc.
<ul>
<li>Yoga. The child can also for as long as he maintains the pose, say 5 words that you have asked him. In addition, he will practice body awareness and right-left perception.</li>
</ul>
<img src="https://assets-synopsis.fra1.cdn.digitaloceanspaces.com/admin/files/idees-gia-mia-diaskedastiki-sunedria-logotherapeias-kartes-yoga-me-animal-poses.jpeg" alt="Cards with yoga animal poses for kids">
<ul>
<li>
Outdoor space: go outside in a yard or go to the nearest playground. The child can do slide, swing, hopscotch, race. Ask the child to describe the toys, how they are played or just work with colors and materials. You can also reinforce social skills by having the child talk with other children on the playground. In addition, you will be able to work on spatial concepts and sizes.
</li>
<li>
Ball: you can throw the ball to each other and say words that start with a specific letter or words of a specific category, e.g. fruit. You can also have the child throw the ball 5 times at a target or into a basket each time they hit one of your targets.
</li>
</ul>
Board games
A board game, in addition to being a recreational tool, can also be a good therapeutic tool. You can change the rules or use them as they are. Board games also help to strengthen vocabulary and memory, find solutions to everyday situations, improve articulation and phonology, etc. For example, the classic Snakes and Ladders can be adapted and players in order to progress should produce the words or phonemes, present in the squares. Build your own Snakes and Ladders board game according to the child's needs.
<img src="https://assets-synopsis.fra1.cdn.digitaloceanspaces.com/admin/files/idees-gia-mia-diaskedastiki-sunedria-logotherapeias-fidaki.jpeg" alt="Moderated for Speech Therapy board game Snakes and Ladders">
Thematic games
The child comes to the session and sings you Elsa's song or shows you his favorite Spiderman shirt. Take advantage of it! Children &quot;get hooked&quot; on certain heroes and children's toys and only want to engage with them. Draw their hero/heroine, sing the songs of the animation movie, describe pictures of the hero, say vocabulary related to the animation, use symbolic play related to the plot of the animation.
Crafts
Take out from the cupboard cardboard, glue, scissors, glitter, tongue depressors, finger paints and pom poms. Crafts are also a creative and fun way to practice and reinforce skills such as following directions, memory, staying on task-concentration, using vocabulary (tools), learning numbers, quantities, letters, etc.
<img src="https://assets-synopsis.fra1.cdn.digitaloceanspaces.com/admin/files/idees-gia-mia-diaskedastiki-sunedria-logotherapeias-diafores-kataskeues.jpeg" alt="different crafts">
Incorporate different activities into your sessions and you will see immediately that the child not only has fun, but is more willing to cooperate and performs better.
From the Synopsis team

Ideas for a fun speech therapy session

<h1>Goal setting in the therapy process</h1>
A therapist’s daily routine does not include only the therapy sessions, as many may believe. The professional responsibilities of therapists, cutting across all specialties, essentially involve extensive documentation work that incorporates record-keeping, collecting, organizing and storing of data, etc.
So, after completing the evaluation process and recording the areas the patient is under or overperforming, the next stage is setting goals. To do so, we take note of the areas in which the patient underperformed.
While this stage often confuses younger therapists, it is also a very time-consuming process both for their amateur and experienced counterparts.
The Synopsis app has been designed to facilitate the work of the therapist.
The way the process of setting goals is done through the app is easy and fast. After entering the evaluation results and the areas of underperformance, the therapist can choose the goals.
Initially, long-term goals are chosen. For example, for an occupational therapist, autonomy in clothing is a long-term goal. She then chooses the activities needed to achieve this goal, which are typically the short-term goals. In the example below, we would choose various activities, such as “wearing a shirt/pair of pants,” etc.
Since the therapist has immediate access to a detailed list of goals, goal setting can be completed in a few minutes with a quick search, either by writing a word or using some filters.
With a test of our app, you can see for yourself in practice how much your daily life can be facilitated and work streamlined.
From the Synopsis Team

Goal setting in the therapy process

<h1>The importance of communication among therapists</h1>
The responsibilities of professional therapists are wide-ranging, and they typically include assessments, sessions, parent briefings, goal setting, and preparation of progress reports. However, a very important and unmistakable aspect of our profession is maintaining constant communication with our colleagues and the interdisciplinary team.
Most of the time, we come across patients who join more than one treatment program, and this includes children and adults. Thus, the therapists working with the same patients, besides conducting one-to-one communication with them, must necessarily build an interactive link with the person in charge of the specialty. It is usually done in person, over the telephone, or through written notes in the patient’s file.
Though it may sound easy, those of us working in the special education sector must be aware that it is far from so. It happens very often that the therapist does not have enough time to write notes, work the same hours as her colleague, or cannot manage to extract time outside work hours to communicate over the telephone. It’s also observed that with so many people working together, vital information originating from different chats is lost altogether.
So, could there be a solution? The answer is an emphatic YES, thanks to the Synopsis app. Through the app, a therapist can easily and quickly communicate with colleagues by simply pressing a few buttons.
This app is packed with some impressive features such as:
<ul>
<li>The therapist-user can share a patient’s profile with a colleague, irrespective of whether the latter is registered on the app or not.</li>
<li>The colleague can access all the information the therapist has recorded, such as evaluation, goal setting, progress and performance of the patient, and even the comments regarding sessions.</li>
</ul>
The Synopsis app, besides enabling easier communication within a team of therapists, also saves time and reduces extra work burden for an individual therapist, thereby resulting in stress-free duty hours.
A demonstration test will convince you!
From the Synopsis Team