By Maureen Gilmer, IU Health senior writer, firstname.lastname@example.org
Sara Cave almost has no words to explain the change in her daughter.
That’s because 4-year-old Helen Cave is finally finding her words, and they are music to her mother’s ears.
As Helen walks into the outpatient rehab space at Riley Hospital for Children, wearing her “Frozen” light-up sandals, her therapist introduces her to some visitors and asks her to tell them how old she is.
Helen shyly holds up four fingers, then quietly says, “I’m 4.”
It’s a remarkable change from when she began speech therapy.
Helen is the fifth of Sara and Eric Cave’s seven children, so when she wasn’t saying typical toddler words at age 2 like “mama,” “dada,” “up” and “ball,” they worried that something wasn’t right.
“She had no words; everything was ‘du-du-du-du.’ She understood – like when I’d say, ‘Helen, go get your sippie’ – but it was just a lot of pointing,” Sara Cave said. “There was no language developing.”
Helen was diagnosed with childhood apraxia of speech at about age 2½. Children with the motor speech disorder generally have a good understanding of language and know what they want to say, but they are unable to make their mouth form the words in a way that others understand.
While apraxia of speech sometimes is the result of stroke or traumatic brain injury in adults and children, Helen suffered neither.
“Everything but her speech has been completely normal,” Cave said.
Helen began virtual therapy through an early intervention program in 2020, but it was rough, her mom said.
“We just knew we needed more help; she was not making progress, so we brought her here.”
Helen has been coming to Riley in Indianapolis from her home in Columbus since January 2021, just before her third birthday. She sees speech language pathologist Ashley Finch for weekly therapy that combines play with work so seamlessly that Helen doesn’t seem to notice the difference.
“She’s come a really long way,” the therapist said, as she engaged Helen in repetitive word exercises in a light and playful manner.
“When we first started, we would begin every session doing just vowels. Her vowels were very distorted in the beginning,” Finch added.
At the mention of that, she and Helen begin moving their arms like cheerleaders as they practice the vowels A, E, I, O and U.
It was a long few months in the beginning, Helen’s mom said.
“Ashley kept saying that it will not always be this hard,” Cave recalled. “But it felt at the time like, ‘Oh my gosh, are we ever going to get there?’”
“Every week I see improvement. She still has quite a ways to go, but when she started, I don’t know that I understood her even as her mother.”
That was a frustrating feeling for mother and daughter, so Finch quickly began focusing on what she calls high-frequency words that came up every day – words like cup and eat – to help Helen better express herself.
Patients with the disorder benefit from multiple repetitions and repeated practice of sound sequences, words and phrases during therapy.
As Helen concentrates on a matching game, Finch asks, “What did you have for lunch today?”
The little girl first replies, “I don’t know,” then after thinking, she remembers.
It’s a big deal, hearing those words strung together. It’s major progress, and Cave is beyond grateful as she watches the smile spread across her daughter’s face.
“Ashley has been with us since the beginning, which has been amazing,” Cave said. “She is really good at incorporating play into sessions.”
As Cave is talking, Finch pushes Helen in a swing while the little girl practices counting – 1, 2, 3 … up to 10. Then it’s time to play a farm game, with Helen identifying the animals she sees.
The little girl, who loves playing with her siblings, swinging and riding her bike, responds cautiously when Finch scatters animal puzzle pieces on the mat.
“Tell me what animals you see,” Finch says.
“I see a chicken,” the little girl replies, followed by “bunny, pig, cow, mouse.” And finally, “a kitty!”
As they play, Finch pulls out her flash cards and practices another few words with Helen – dice, race, toss, face, mouse, house, kiss. Helen repeats them slowly and carefully.
Helen, who will start preschool in the fall, also works with a private therapist in Columbus who has consulted with Finch, and she sees a speech therapist through the school system at home in preparation for the start of school.
While at first she was reluctant to participate in therapy and would try to hide in her mom’s arms, Helen now is actively engaged in her sessions, cheerful and persistent in her efforts to expand her vocabulary.
“In those early days when there was a lot of resistance, Ashley did a really good job of being firm and having high expectations, but she was so kind,” Cave said. “She worked so hard to find something that would engage Helen.”
As Finch guides Helen through a small obstacle course, Cave recalls how this activity helped her daughter relax in the beginning.
“When she first started, the obstacle course was the saving grace. Sometimes I would sit outside the room because she would do better if I wasn’t right here.”
But now, Helen barely seems to acknowledge her mom’s presence, as she climbs through a tunnel and pops out to practice sentences with Finch: “I like ice cream. I sit on a lap, I have lips.”
“One thing we are focused on is movement – the way her mouth is moving,” Finch explained. “Apraxia is a motor speech disorder, so treatment looks a little different. We are really focusing on the way her mouth is moving and the planning it takes to form words.”
Helen is proficient at repeating words, but full sentences can still be a challenge, especially when stringing them together, her mom said. That’s when her intelligible language begins to break down.
“Typically, we want to see kids around the 80 percent level with intelligibility,” Finch said. “She is doing really well, and we are getting to that sentence level, but there are still situations where you can see that her mouth is not moving in the correct ways.”
Treatment for apraxia of speech can last for several years. Helen will continue to be assessed until she reaches that 80 percent level, but the past 17 months of regular therapy have made a significant difference, Cave said.
Just imagine the beauty of hearing your child say “I love you” for the first time.
Helen couldn’t form those words until she was about 3½, her mom said.
“It took my breath away the first time she said it, which was when I was tucking her into bed one night. I had waited a long time for that one!”
Photos by Mike Dickbernd, IU Health visual journalist, email@example.com