Deep Breath in and Exhale Out

The irony is not lost on me that I am battling pneumonia while writing a post on the importance of good respiratory support! Haha! I am very passionate about this topic because I have seen first hand how it can help a multitude of areas including sensory, speech, and fluency. When we feel anxious or nervous, what do we tell ourselves? Stop, take a deep breath in, and exhale out all the stress. Respiration alone does not solve everything, but it serves as a good base, a jumping off point that helps us have more success as we tackle the other goals ahead.

Step 1. Diaphragmatic breathing or what some refer to as belly breathing is when we access our diaphragm upon our inhale. When you inhale, your belly should move outward (but don’t force it) and as you exhale, the belly moves inward. This helps pull more air in while also reducing tension from the laryngeal and pharyngeal areas which will allow for better control of exhaled breath for improved vocal quality, intonation, stressing, rhythm, phrasing, and correct realizations of phonemes.

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Step 2. Now that we have established the correct breathing pattern, we will work on increasing the vital capacity of lungs along with facilitating control of inhalation and exhalation. We will start by having the client breath in (through nose) to a count of 3; hold for a count of 3; and then exhale (through mouth) for a count of three. Repeat this several times while extending exhale to counts of 4, 5, 6, and on to 10. Make sure there is no neck or facial tension and no shoulders-to-ears action happening.

Step 3. Next, we will further address improving the strength and coordination of the respiratory muscles through a series of exercises listed below:

  • Breathe in to a count of 3 and exhale breath on /h/ or /s/, sustaining sound for up to 20 seconds.
  • Practice increasing/decreasing intensity of /s/ as follows (use /a/ if client cannot produce /s/:
    1. SSSSssss (louder to softer)
    2. ssssSSSS (softer to louder
    3. ssssSSSSssss (soft, loud, soft)
    4. ssssSSSSssssSSSSssss (soft, loud, soft, loud)
  • Practice exhaling in a rhythmic pattern using /s/ or /a/ using __________for long sound and ____ for short sound:
    1. _________ ____ _________ ____
    2. ____ ____ __________ ____ ____ __________
    3. ____ __________ ____ ___________ ____ _________
    4. ________ ___ _________ _________ ____ ____ ____ _________ ____ ____

The exercises listed above were adapted from Robertson, Sandra J. and Thomson Fay. 1982. Working with Dysarthric Clients: A Practical Guide to Therapy for Dysarthria. Arizona. Communication Skill Builders. I use these exercises as a base for building a strong foundation for improved phonation, articulation, and prosody. I spend a lot of time during the first 4-6 sessions on these exercises and will taper off once I feel the client is using correct respiratory control. If at any point during treatment (could be 3, 6, or 12 months later) I notice an increase in disfluencies and/or decrease in prosody, I will work through each of these exercises again to regain better control.

It is important to note that these exercises can be done with a variety of clients because good respiratory control benefits all. It is even helping me as I am in the final stretch of this dreadful pneumonia and also when I am under a tight deadline! Try it out and let me know what you think! Namaste.

Late Talkers and When to Seek Help

Are you wondering if your child is ever going to talk?  Do you find yourself trying not to worry about it because your pediatrician said, “Sally will talk when she is ready.”  My rule of thumb is to ALWAYS trust your gut!  I am a huge advocate for early assessment and intervention for 3 major reasons:

  1. A specialist (Speech-Language Pathologist) will be able to answer most of your questions after spending some time with your child and will make the necessary recommendations.
  2. There could be another reason for the delayed speech that would require referrals to other professionals.
  3. The sooner the child starts therapy, the easier it will be to remediate their current patterns (and the parents) that will give way to improved speech production.

I’m sure you are asking yourself, ‘what are the red flags for language delay?’  The great thing about living in the age of technology is that you can put these 👆🏻 words directly into a search engine and you will pull up pages of articles on developmental milestones.  I will save you the trouble though and outline the ones I pay the most attention to.  Some of these are adapted from The Hanen Centre and some come from my 10+ years of experience working with children.

By 12 months

  • doesn’t babble with changes in tone – e.g. dadadadadadadadada or varied vowels – e.g. dadadededodo
  • doesn’t use gestures like waving “bye bye” or shaking head for “no”
  • doesn’t respond to her/his name
  • doesn’t communicate in some way when he/she needs assistance

By 15 months

  • doesn’t understand and respond to words like “no” and “up”
  • has less than 5 words in vocabulary
  • doesn’t point to objects or pictures when asked “Where’s the…?
  • doesn’t point to things of interest as if to say “Look at that!”  and then look right at you
  • doesn’t engage in play with others

By 18 months

  • doesn’t understand simple commands like “Don’t touch”
  • isn’t using at least 20 single words like “Mommy” or “go”
  • doesn’t respond with a word or gesture to a question such as “What’s that? or “Where’s your shoe?”
  • can’t point to two or three major body parts such as head, nose, eyes, feet

By 24 months

  • says fewer than 100 words
  • isn’t consistently joining two words together like “Daddy go” or “ shoes on”
  • doesn’t imitate actions or words
  • doesn’t pretend with toys, such as feeding doll or pushing car/stroller

By 30 months 

  • says fewer than 300 words
  • isn’t using action words like “run”, “eat”, “fall”
  • isn’t using some adult grammar, such as “two babies” and “doggie sleeping
  • isn’t following simple directions, such as “Get your shoes.”

3-4 years 

  • doesn’t ask questions by 3 years
  • isn’t using sentences (e.g., “I don’t want that” or “My truck is broken”)  by three years
  • isn’t able to tell a simple story by four or five years

*Remember, these are not developmental milestones, these are RED FLAGS that signal you to seek a professional opinion on what could be going on.  If you have questions about any of this, send me an email at shelley@empowertelespeech. com or give me a call at 512-593-8314 to chat.  I offer FREE over the phone consultations and from there can offer suggestions and recommendations.


Holiday Do’s and Don’ts

The holiday season is upon us which gets MOST people in a cheery and festive mood.  I say MOST because there are a handful of people who do not get excited about these festive times and I’m not talking about the Scrooges out there.  A lot of children will experience anxiety and unease as the first set of decorations start littering around the house and school.  Some children are very dependent on schedules and uniformity so when they see “new” items and “new” events going on in their day they will get extremely anxious and will express this in subtle annnnnnnd not so subtle ways.

You may see an increase in “meltdowns” as well as the intensity of the meltdowns.  You may start to see new behaviors and the timing of them may be completely off (to you).  Sleep regression could happen in addition to difficulty falling asleep at night.  Are you having an “ahh haa” moment yet?  I bet you are wondering how to prevent and/or address the impending doom  possible upset and preserve the joy of the season.  Well here is a list of dos and don’ts to help you get through the holidays “almost” drama free.

Don’t: Greet him/her upon waking up with your Santa hat on and Christmas music blaring and tell him “Guess what we are doing today?!?!?!”

Do: Prepare your child a few days before you start decorating.  Talk about the holidays coming up.  Show him/her last years Christmas pictures.

Don’t: Surprise your child with “fun” holiday activities after school or on the weekends.

Do: Contact your child’s teacher and ask what the schedule will be like in December.  Will they be singing Christmas carols?  Will they be making Christmas crafts?  Will they be watching a Christmas movie?  Will they be taking a field trip?  If yes to any of these then find out when, where, and what time.  Once you have this information, write out a calendar for the month and review each week with your child along with making a daily schedule as well.

Don’t: Get upset when your child wants to stay in their room when alllllllll the people come over for a holiday event.  Also, don’t get upset when they don’t want to participate in the “fun” games/crafts that the other kids are doing.

Do: Prepare. Prepare. Prepare.  You can never prep them too much.  Also, talk about what they are feeling and experiencing.  Use words such as “overwhelmed” and “worried.”  I like to use pictures with specific faces along with these “feeling” words.  Visuals are great to have on hand.

Don’t: Get upset when they are not happy about certain gifts they get, whether it be from Santa or Aunt Sally.

Do: Use words such as “unexpected” and “surprised.”  For example, “That present was not what you thought it was going to be.  That was unexpected.”  Also, prep them ahead of the gift exchange and tell them that “Every gift will be a surprise and we may not like it which is okay and we can talk about it after we leave so we don’t hurt their feelings.”

I hope some of these Dos and Don’ts will help your kiddos have a more enjoyable holiday which in turn will make yours enjoyable as well.  Just remember these top 3 things:

  1. Prepare
  2. Acknowledge
  3. Be flexible

I kept this post short, but trust me I could talk to you for hours about this because not only do I see this and address it with my clients, but my own child has a sensory processing deficit so I know first hand what you are dealing with.  If you want to chat more about this and need more ideas, send me an email and I will be happy to talk with you.  Even if you just want a fellow parent to vent to, I’m your lady.  You can email me at  Happy Holidays!

assorted color gift boxes
Photo by George Dolgikh on


Job Hunting Fun Facts

If you Google “Top Qualities Needed for a Job” the first thing you will see is “Good Communication Skills.”  We as Speech-Language Pathologists know that “good communication skills” mean more than just being able to simply speak to someone.  In order to have good communication skills one must have the following (in no particular order):

  1. Appropriate volume – talking loud enough where someone nearby can hear you and not so loud that the person 3 aisles down at the supermarket can hear you.
  2. Clear speech – also known as “speech intelligibility” and involves being understood by the listener.
  3. Good eye contact – this involves looking at the person you are talking to and also looking at the person that IS talking.
  4. Good listening – following instructions given verbally, looking at the speaker, answering questions.
  5. Understanding nonverbal language – being able to differentiate between the many facial expressions and gestures presented.

These are just some of the qualities that are considered “good communication skills.”  Often times adults with intellectual disabilities have impaired communication skills.  This will have a major impact as to what job they will be applying for and/or the position that they truly want.  Some may want to be a barista at the local coffee shop, but they are afraid to step up to the cashier station because they know the customer won’t understand them so instead they apply for a job that requires less communication.  Well guess what, friend that is where I come in to play!

Even as adults, individuals with speech and language deficits can still make progress!  You heard me right, you can still have that dream job that you always wanted!  Yes, sometimes old habits are harder to break, but that does not mean it is impossible.  Do I have your attention? Good.  Send me an email or call me and we can discuss your goals and how I can help you nail down that dream job!

closeup photo of person s fist bump
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Halloween Fun

It’s Halloween!  Kids of all ages love when special events roll through the calendar because it breaks up the every day hum drum.  In this post I will write a goal or goals along with an activity to target while having loads of fun.  Remember to let your creativity shine and expand these activities to other goals as well!  Have fun and Happy Halloween!

  1. Goal(s): Blowing is a great activity to address lip rounding, diaphragmatic breathing, and resonance.

Activity: All you need is a plastic spider and a straw.  Set kids up at the end of the               table and let the races begin!  Side note, I prefer to have kids standing and not                     hunched over as seen in the below picture when working on diaphragmatic                         breathing.  Also, make sure tongue is not touching the straw.

2. Goal:  This activity is great for addressing sounds and/or expanding sentences.

Activity:  Spooky Spider.  Get black construction paper and cut out a circle for body and 8 strips for the legs.  If working on sounds then write the target sound on the body and the words including that sound on the legs.  If working on expanding sentences then you can put a target word such as “spider” on body and then build on it by writing words on legs (i.e. The “spider” is black.)  There are many directions to go with this activity so expand as you see fit.

3. Goal: This activity is great for addressing sounds, expanding sentences, answering questions, targeting locational concepts, etc.

Activity: Monster Mouth.  You can get a paper bag or a tissue box and create a mouth to put items in.  Allow the individual to decorate the bag/box to create the look of a monster.  Once this is done you can gather items around house and “feed” the monster.  If they are working on specific sounds, then gather items that have those sounds in it and they must say what it is as they put it in its mouth.  If they are working on expanding sentences then have them say something like, “The monster eats the sock” or “The sock is in his mouth.”  Again, be creative and adjust as needed.

Monster Alphabet Craft & Activity

4. Goal:  Do you have a picky eater on your hands?  A round of Fear Factor is a great way of introducing foods of varying textures, smells, and tastes in a fun way.  This is also a great activity for older teens and they can “guess” what the food is that they are eating while remembering to produce their sounds correctly or use a complete sentence in correct grammatical order.

Activity: Fear Factor!  Get some candy and/or food of varying textures and tastes and place on a plate.  Blindfold the individual and have them smell, lick, and/or eat the food presented then let them guess what it is.  They can score points/candy if they guess it correctly.  You can even use the above mentioned Monster Mouth activity as a warm up for the younger kids that may be more hesitant.  Have them feed the monster an assortment of food first and then it will be their turn.  Have fun and be creative!

These are just a few ideas and you can find so much more on Pinterest.  Remember to make it fun and tailor it to what your specific goals are.  Happy Halloween!

photo of child holding jack o lantern
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