About a month after Grace’s implant was activated, she began speech therapy. Ideally, any CI recipient participates in ongoing speech and language therapy. In fact, at the Listening Center, it is considered an integral, mandatory part of the implant and rehabilitation process, and the therapy sessions are set up through the implant center. We were assigned to a therapist named Margaret, and began attending sessions two times a week.
The basic function test performed at the start of any therapy session, and, as Grace got older, at the beginning of the day at school, was to check her perception of the Ling sounds. These sounds represent the different frequencies commonly heard during speech – both high and low ones – and there are six of them: Ooh. Ahh. Eee. Mmm. Sss. Shh. If the CI user can perceive each of these sounds, then all frequencies of the internal equipment are assumed to be functioning. Using the auditory verbal approach, the person making the sound would hide his or her mouth behind a screen, or their hand, so that the CI user wouldn’t have the benefit of reading lips to help them form the picture of the sound in their mind. We were asked to do a sound check with Grace every morning, when her equipment first was turned on. This was also the kick-off activity of every therapy session.
In the beginning, she was so young that it was difficult to teach her behavioral responses to the Ling sounds. Margaret would demonstrate what she wanted Grace to do, by holding a toy or small object next to her ear. When she said one of the Ling words, she’d say, “Ooh! I hear that!” and drop the toy into a hole, or down a chute. This is not an easy skill to teach a 14 month old. We had fun trying, though. When that didn’t work at all, we would just try to read Grace’s eyes for a response – did she look up, did her gaze change direction, did she nod her head?
After 4 or 5 months, she had it figured out. By eighteen months of age, Grace had learned to repeat the sound. That way, we’d not only know she’d heard something, but that she had heard it correctly and could distinguish, for instance, the Ooh, from the Mmm.
By then, we had a new Speech Therapist, named Jennifer W. We would make the trip to Suburban Hospital in Bethesda, then, when Jen’s office moved, drive even further to a building off of Old Georgetown Road. Despite the travel time, I looked forward to those visits. It was always such a proud and affection-inducing experience to be with Grace during those times. She might be wearing her little purple velvety pants, and the flower-child white shirt with bell sleeves and little purple and orange flowers. And we’d find ourselves a parking space in that crowded parking lot, in the sun, in the rain, go into the building and head for the door on the first-floor, right off the lobby, where the speech therapy room was. Light brown curls bouncing. Big smile on her little heart-shaped face. “Hi!” she would say to the people passing by. If she saw someone in a white coat she’d ask, “Is Doc Tor Mama?” Her little white backpack bouncing on her back as she ran along the parquet tile floor.
Jen would do her Ling sound check. After a while, she’d get more complicated. Mee Maw. She’d say. And Grace would repeat. Wah Whee! Wah Whee!! She’d say back, mimicking Jennifer’s intonations perfectly. She’d move further and further away from the table, and Grace would mimic her voice, coming from behind the little embroidery hoop covered with cloth so Grace couldn’t read her lips. (Already, Grace had become extremely adept at lip reading).
Jen took careful notes after each little exercise, and she’d make a copy for me before we left. We kept the progress notes in a green folder they’d given us at the first therapy session. She would also write down anything I reported to her about what we’d remarked from the past week; things Grace had heard, things she’d said. Jen would show Grace pictures, a page with several images, say a word, and ask Grace to point to the picture of the thing she’d named. She’d read Grace a book and put little felt figures that represented the characters and objects from the book on a felt board as she moved through the story. She’d ask Grace to repeat words she said, again with her lips covered.
By the time Grace was eighteen months old, we dropped down to one session per week. She was getting ongoing, integrated, naturalistic speech therapy during her time at school, because this was the model the school followed. Grace was progressing so well that Jen, as well as our audiologist, Jill, at Hopkins, decided it really wasn’t necessary for her to go more than once a week.
Eventually, Jen W’s office moved again. This time, to the basement audiology space at the River School. Our drive was cut from forty-five minutes to fifteen. Our sessions were almost always in the afternoon. Sometimes, Grace would fall asleep in the car on the way there, and she’d be a bit cranky when we got started. Every once in a while, she had a tough time snapping out of it, and she’d be less responsive, less animated than usual. But usually, she was on. The whole time. She’d sit in her tall stool chair at the table, and tune in to Jen, her blue green almond shaped eyes making contact with Jen’s round blue ones. Grace often made Jen laugh, not just by her ardent, humorous responses to questions, but by her eagerness in initiating conversations. Grace would remark about the flowers growing in the window up along the basement wall. She would tell Jen about her favorite animal, her favorite food, her favorite color.
Periodically, Jen would perform some tests, so that we didn’t have to do quite so many on our next trip to Hopkins. Receptive language tests with pictures for Grace to identify by pointing, and expressive language tests in which Grace verbally named the objects. There were language comprehension tests in which Jen read one-step, two-step, and three step instructions aloud, some of them very complicated or strange, which Grace had to follow by placing objects in their proper place, or selecting the right ones. Choose the small, yellow bear. Put the little blue boy next to his mother. Find the long red pencil and give it to me. The funniest, oddest one by far was: Choose the person who shoots the rabbit. You were supposed to choose the dad, out of the different family figures. Weird.
Jen was a very good therapist. She was so visibly committed to what she was doing. She was methodical and kind. Patient. Sometimes, when Grace became fidgety or, to me, visibly bored, Jen seemed to have a hard time re-adjusting her planned activities to get Grace back on track. But this was her only challenge with Grace, who adored her. And she clearly loved Grace. We had no idea that Jen would be Grace’s last speech therapist. That Grace would, before she was three, get kicked out of therapy, much to the sadness of Jen, who loved spending her weekly hour with us. She told us, at the end, that as much as she enjoyed our sessions together, there just wasn’t really much left for her to do with Grace by then.