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      <title>My smart padlet by Rachel Berdecia</title>
      <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw</link>
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      <language>en-us</language>
      <pubDate>2026-01-16 15:28:33 UTC</pubDate>
      <lastBuildDate>2026-01-23 22:57:43 UTC</lastBuildDate>
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         <title>Day 1 - 1/7/26</title>
         <author>rachelberdecia</author>
         <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw/wish/3753691803</link>
         <description><![CDATA[<p>On our first day at the Clinic we were grouped into 4 groups of 3 including a 2nd year graduate student, a 1st year and an undergraduate. We split the 4 groups between dysphagia and feeding and CVI. I started my first day at the clinic working with dysphagia, cerebral palsy and feeding. Each of our groups within dysphagia had 2 clients a day. I encountered two clients diagnosed with CVI and cerebral palsy. Our first client was a 4 year old little boy presenting cerebral palsy with difficulties in feeding characterized by poor labial seal resulting in anterior loss, munching pattern of mastication, oral residue with suspension of aspiration due to coughing. We found him presenting moderate oral pharyngeal dysphagia. Through food play and toys we were able to evaluate this child and interact and educate the parents of the situation. They were very attentive and ready to learn to better their son. We were able to recommend keeping the child upwards and supporting his lips and jaw to allow for adequate consumption of food. Our second client presented CVI and cerebral palsy causing slightly reduced duration of mastication and dominance of one side of the mouth. We were able to evaluate this through play and observing their anatomy in the oral cavity. We were physically able to see low tone and a low moots posture with weak neck support. While this client had great potential to improve orderly chew we recommended the partners to increase lip support for drinking liquids and improve labial seal through sips through a cup. After our two clients I was able to reflect on this experience and how grateful I am for the resources we have in the US and the privileges we are given as a whole. Interacting with the parents and children was a very new experience for me. It was very refreshing and made me very hopeful to see how attentive they were and open to the recommendations we had to offer. They were very welcoming and accommodating allowing us to observe and learn while also evaluating their children which I can be formerly grateful for the knowledge and opportunity. Observing therapy in Sri Lanka challenged my assumptions about disability and access to care while also giving me perspective and empathy. Despite limited resources compared to U.S. clinical settings, the clinicians show high clinical skill, creativity, and cultural sensitivity while also being very welcoming.&nbsp;</p><p><br></p><p>Reflection </p><p>I learned that progress is not linear and that success looks different for every child based on the challenges they face day to day as well as family and caregiver education. I also learned that it's important to recognize strengths rather than only deficits mrs. Rachel King was able to help me understand that sometimes sharing the positives of a child's condition and improvement can uplift the family and provide hope for their situations. A challenge was recognizing how easily I might underestimate a child’s abilities based on diagnosis alone rather than observing the child's actions. When being able to see what a child is capable of after reading their files it was amazing to see how far they have come and how hard they try to accomplish communication and feeding. My take away from this experience was to take a strength based mindset while also being open minded and positive through evaluations to provide hope for the families while also being motivated to make a change.&nbsp;</p>]]></description>
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         <pubDate>2026-01-16 15:47:23 UTC</pubDate>
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         <title>Day 2 - 1/8/26</title>
         <author>rachelberdecia</author>
         <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw/wish/3758429030</link>
         <description><![CDATA[<p>Today I observed several clients presenting with moderate to severe feeding and swallowing disorders, many requiring highly individualized intervention strategies. One child presented with a history of airway abnormalities, prior surgery, and tube feeding, with the goal of sustaining nutrition without reliance on a feeding tube. I observed signs of delayed swallow initiation, extended feeding duration, anterior leakage, and upper airway obstruction during feeding. After playing and observing the child's abilities to swallow we were able to recommend upright positioning, pacing, and play-based calming techniques to reduce distress and support safer swallowing. Another client demonstrated oral hypersensitivity associated with ASD, including strong brand and environmental preferences. I learned about food chaining, where familiar foods are slowly changed to expand a child’s diet. I also learned about progressive desensitization where you have a child tolerate a food in the same room, playing with it, licking it, and eventually eating it. We were able to finally recommend that the mother practices food chaining and progressive desensitization. I found that the families were deeply involved in their child's conditions and improvement. They were willing to change their feeding habits and accommodate their child's needs. I was grateful that each family allowed us to learn and take time to observe their child for our own education and for their child's improvement.&nbsp;</p><p><br></p><p>Reflection </p><p>I learned that feeding therapy prioritizes safe eating before we can improve skills. Making sure a child can safely intake either solids or liquids. A challenge that I noticed throughout this observation was reinforcing patience and understanding that progress takes time and every little step and accomplishment along the way matters. Seeing the child with an MG tube not be able to properly intake foods was saddening however her parents made sure she had the resources and they had the education to initiate progress was refreshing as well as hopeful. Additionally I learned the importance of patience and child play when it came to children who are very selective with foods. Through patience and time we were able to get the client to not only touch the food but be able to interact and play with it. I will carry forward the ability to have patience and appreciate and celebrate every positive step towards success and improvement. As well as the importance of patience through every evaluation of all clients.&nbsp;</p><p><br></p><p><br></p><p><br></p>]]></description>
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         <pubDate>2026-01-21 08:09:02 UTC</pubDate>
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         <title>Day 3-1/9/26</title>
         <author>rachelberdecia</author>
         <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw/wish/3759045668</link>
         <description><![CDATA[<p>Today I was able to start observing cerebral visual impairment with Dr. Muttiah. One child demonstrated visual-motor compensatory behaviors, such as turning their head and using light to enhance visual access. The clinician used environmental modifications, such as lighting and toy placement, to improve visual engagement. We used colorful toys within a lightedand a darkened room to observe the children and distinguish between their challenges. I was able to observe the physical attributes to CVI or visual motor compensatory behaviors such as turning of the head to compensate for eye contact or shaking of the head. Some children reached for toys rather than looking straight at the toy. We found that they were able to respond to light when put into a dark room. Additionally I was able to observe children with color preference who responded to certain colors and certain lighting. In some cases being red in others being yellow or even a few colors. Another client had fewer than 10 words and relied on AAC for communication which does not hinder speech development but is a supplement for communication also known as “the voice” to those in need. While observing I noticed how proficient they were in using their device which made me understand and also have empathy for the struggles that come with knowing what you want to say but not having a way to verbally communicate it. Our last client presented with palpatory cerebral palsy, a 12 year old boy. Being an older client there were new challenges that were faced as well as new things to keep in mind when evaluating. For instance what toys we could use to interact with him and how we can get an accurate and reliable observation of him. Although he was unable to communicate he was able to use and interact with his AAC device. I found that families were eager to learn how to support their child's communication at home as well as the importance of caregiver education to the progress of our clients. Parent coaching is important showing that therapy extends beyond just your time in the clinic but at home practice as well.&nbsp;</p><p><br></p><p>Reflection </p><p>After observing it I was able to reflect on the strengths of AAC as well as the importance it has as a tool for a voice for many children. It was refreshing to see AAC being used early at young ages for children who could not ebay communicate. I learned what CVI was as well as how it impacts children's visual field and means of interacting. It was interesting to see children responding to different colors and movements in different lighting which was new for me. Challenges I saw during my first day of CVI were interacting with different age groups and knowing what was beneficial and what was influential to those kids' development. Something that will carry on to my future is advocating for AAC and growing more awareness on the technology and the influence it has on children and caregivers.&nbsp;</p><p><br></p><p><br><br></p>]]></description>
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         <pubDate>2026-01-21 16:20:59 UTC</pubDate>
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         <title>Day 4 - 1/10/26</title>
         <author>rachelberdecia</author>
         <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw/wish/3759053672</link>
         <description><![CDATA[<p>Today was day 2 of CVI. I was able to observe children presenting with dystonia, CVI, and cerebral palsy. I found that CVI evaluations were much more handsome as we had to directly interact with the children to test their movement between their limbs, eyes, and hands to see what would benefit their needs. To start our day I observed a child with primary dystonia syndrome with ataxic involuntary. movements, having tightness in the hands and challenges with communicating even with AAC. I found that the child had intent of communication but no way to verbally do so, as a result we attempted to use different parts of the body for AAC to instantly reach his feet. After evaluating the child we observed that the least fatiguing method of communication for the child was a low tech etran board. A board that would include 4 pictures of wants and needs including food, places, toys and things to eat. Due to the CVI we decided a strategy that can be used if using a visual stimuli on the top left corner of the visual field and give time to process it due to the visual latency. We then so a client with dystopia, CVI, and CP. We found they found interest in shaking and rattling if toys as a result we tested toys without sound to see they’re visual field which was found to be much more difficult for them. Due to the need for tactile input and movement we offered straggled to work with the child through AAC and play. After observing the clients I found that the parents were very patient with there children and willing to take the time to understand what strategies may be an addition to their development. Observing today challenged my view of high tech AAC it was a great example of AAC being useful even through low tech technology. I noticed that some families have more access to technology then others and sometimes a low tech board is more ideal as well as useful for certain diagnoses. </p>]]></description>
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         <pubDate>2026-01-21 16:27:53 UTC</pubDate>
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         <title>Day 5 - 1/12/26</title>
         <author>rachelberdecia</author>
         <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw/wish/3759067188</link>
         <description><![CDATA[<p>Today was our first day with early intervention for dysphasia. We started our day with a client who feared foods, presented with echolia. Jamal had a clear fear of foods causing him to struggle to eat and accept a variety of different foods. Through out this assessment we used positive reinforcement to help him be more comfortable with certain foods. For every bite he may have taken we’d play with a toy that way the positive interaction with food will lead to him being more comfortable with food having a positive view rather then negative. We used a fish toy to imitate eating as well as fake animals and a mouth mold to demonstrate the process of chewing. We found it beneficial to use a mirror as well and face it towards him so rather then watching the clinicians chew he would be able to watch himself as well. We finally were able to recommend that him and his parents take 3-5 minutes a day over exaggerating movements like chewing as well as trying 1-3 new foods a day and enforcing the motions even when food is not in the mouth. The second client we saw presented with dystonia, zerotonia, and trachiomalasia physically it was very evident may not be getting all the nutrition necessary. After observing her intake of food we found she had delayed otoromoral dystonia. We recommended her parents keep her at a 45 degrees angle allowing her to properly intake soft foods without choking. As well as pacing and keeping her jaw raised. Additionally we were able to continue to see and observe a client who presented with ASD and hypersensitivity being picky with foods and not consuming foods outside of a very small palate including a ham croissant’s and cashews. To being this intervention there was a goal to expand his palate through progressive desensitization, gradually making him comfortable in order to see progress with the foods. We started with offering foods he likes following foods he didn’t like. Through this and play we were able to see him play and handle different foods at the end of the session. I found that all parents were very eager to learn and make big steps towards progress from bringing in different tools, food, and knowledge we were able to consult them to the best of our abilities giving them techniques that may be useful. </p><p><br></p><p>Reflection </p><p>Overall I was able to learn a lot alot during intervention. Being able to watch the graduate students asses children then see them again for intervention was interesting as well as reflected the parents motivation and want to help their child especially seeing the long distances that were traveled to receive help. Today showed the power and importance of play during intervention. Therapy through play motivated and influenced most of the children to achieve small but meaningful goals. By starting therapy with toys and activities that were age appropriate the children were responding to the therapy in a more positive way. Similarly through play and the use of foods that the parents and caregivers were aware they liked we were able to make positive correlations with food assisting with the intervention and essentially the small steps towards development at home. A key takeaway from today's therapy sessions is the importance of connecting a nd playing with a child to provide adequate and successful therapy. A challenge that was faced was similarly the language barrier to fully understand what the parents are doing and what they can do to better assist they're child.</p><p><br></p>]]></description>
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         <pubDate>2026-01-21 16:38:04 UTC</pubDate>
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         <title>Day 6 - 1/16/26</title>
         <author>rachelberdecia</author>
         <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw/wish/3759082068</link>
         <description><![CDATA[<p>Today we are starting intervention for downsyndrome. Starting with a 5 year old boy with downsyndrome speaking a total of 25 words. Currently he is using a AAC device with 2 pictures a screen. We started our observation playing with colorful toys followed by questions to geta sample of understanding and what words he may use to describe the toys. We tested his two word combinations using books and the AAC device. We found our client was imitating as well as exploring the AAC device as a form to communicate showing interest and intent. To begin 2-3 word phrases asking him short questions and modeled how to use the AAC to respond. For example we asked him what he ate for breakfast and by using the AAC device he was able to respond. Additionally asking questions like how did you get here today, showing proficiency in AAC use. To test for spontaneous interaction we attempted to use books but moved towards the adapted books to see whether on not he would interact with those rather than books with solely words and pictures. We found that he benefited from AAC aswell was very interactive with certain toys and colors. We advised that he continues to use AAC as a form of communication from answering questions to describing wants and needs. For our second client we saw a two year old girl with downsyndrome. We began to interact with her through different toys like bubbles and other interactive toys that make sounds. We offered her options between toys where she was able to distinguish and choose between the two commonly choosing bubbles. She articulated sounds such as /m/ and /a/. Using the AAC she was able to choose what toy was wanted followed by imitation when playing with the toy. Often times she used hand gestures and sounds gesturing for what she wanted. There was clear intent of articulation however she could not finish articulating them. Knowing she produced the sounds /m/ and /a/ we modeled words like "meow" using the AAC device followed by the toy corresponding. Following this we then modeled pointing and putting hands on the head where she then imitated with time to process. We recommended at home that the parents model sounds knowing she watches and imitates. As well as continuing to model gestures. After observing found that parents and caregivers were very attentive and willing to team to support their Childs needs. They were very receptive and understanding of new techniques that may be helpful whether its modeling or AAC support.</p><p><br></p><p>Reflection </p><p>I further learned the importance and positive impact AAC has on children who may not have the ability to properly communicate their wants and needs. The avaz gave the children a number of options based on what they were able to distinguish and a certain amount of pictures they were able to understand. Through this the children were able to pick and choose what toys they wanted as well as respond to short phrases and questions. A challenge that we faced was the language barrier even though we had an interpreter providing the therapy was more challenging when the child new some words in English but not all. Something I will take away from this observation is the power AAC has as well as the power therapy has even through a language barrier every population deserves the right and ability to communicate. </p><p><br></p>]]></description>
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         <pubDate>2026-01-21 16:49:43 UTC</pubDate>
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         <title>Day 7 - 1/17/26</title>
         <author>rachelberdecia</author>
         <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw/wish/3759109117</link>
         <description><![CDATA[<p> Today we are working with CVI. I started my day creating a low tech etran board. With the help of Ayatis clinics speech language therapist we were able to mimic and create a low tech board by printing pictured with their corresponding words in Sinhala. We then were able to use these photos for a client with CVI. Our first client we began in the dark room we recalled her being more responsive to light. Using the dark room we used a spot light under 4 different toys with brake times in between with very limited distractions in a calm environment. This way she was able to see the toys in the dark room, however when lights are on and there was no spotlight granted toys were difficult to see. We then tried to use her AAC under light as well as sing songs to calm her down. While using the AAC device playing her the song that calms her down she was able to calm down, look, and interact with the device. We found she would go into a system of repetition as well as the need to reach for objects when not lit. She needed time to verbally and physically process objects and words and found she visually saw more objects under the lights. We also saw progress in her expressing her wants and needs saying she wanted her dad, the dog, and or a certain toy. I then was able to program the avaz myself for the intervention adding two different foods to provide her options and see whether she will interact and see the two herself. She was able to interact with the device and verbally communicate what food she wants therefore we did not need her to physically touch the avaz. As a strategy we recommended the parents continue to use AAC, interact with her in a dark room using lit toys and verbal words describing the toy to follow, lastly using rhythm to help her understand phrases. Thus technique could be useful because the left ear if dominant in speech processing and the right ear is dominant in hearing, this would benefit her because she struggled to hear. For our second client we have previously seen a 12 year old boy diagnosed with CP and CVI. We started intervention playing with him introducing vocabulary words. We found that he presented less shaking of the head and neck when looking. There was clear intent of interaction however it was very difficult for him to communicate. I was able to program the avaz to add new vocabulary words where we would then attempt to have him interact physically with it. He was vividly listening to the sounds and finally was able to reach to interact being a huge step. Even though the level of disability he was able to show intent and capability but lack of motivation. We offered the mother to take the vocabulary cards home that way at home she can show him the picture and he must choose the word which would eventually turn into communication through literacy. Overall I learned that It’s important that he uses the AAC device for more then needs and wants but for feelings as well. The parents were additionally very open to criticism as well as ways to improve development at home. They asked questions as well as payed attention to tools and technology we used to improve. </p><p> </p><p>Reflection </p><p>From today’s experience I learned the value of AAC whether it was low or high tech as well as how easy it is make a board that almost mimics an AAC device. I was able to print out photos with their correlating words for their personal use at home and for therapy. Something that stood with me during our last day was knowing that one of our clients has been seeing the speech language therapist since he was 1 years old and now being 13 he’s shown progress and ability even being disabled there’s clear ability and intent to communicate. In a way these sessions gave me empathy as well as a tremendous amount of hope towards AAC and therapy. It made me appreciate the little steps and milestones that mean the most to parents and their children’s development. </p><p><br></p>]]></description>
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         <pubDate>2026-01-21 17:11:24 UTC</pubDate>
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         <pubDate>2026-01-21 17:16:12 UTC</pubDate>
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         <pubDate>2026-01-21 17:18:21 UTC</pubDate>
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         <title>Excursions🇱🇰🐘🎉🏖️</title>
         <author>rachelberdecia</author>
         <link>https://padlet.com/rachelberdecia/knnihep27ikmb2pw/wish/3759126434</link>
         <description><![CDATA[<p>Between days of the clinic and after days at the clinic we were lucky to have some time to visit new places, explore shops, grocery stores, malls, new food, and new terrains including hotels in the mountains, on the beach and in the city. We started our trip with a walk though in Colombo exploring the markets and grocery stores. Although this was very different then Americans shopping it was similar in a way as well there were regular stores but markets of fruit outside where we were then able to taste and buy fresh fruit. Personally this was a really nice experience interacting with a new culture and tasting fruit I’ve never had before. I even found most fruits to actually be better and more fresh which I’ll deeply miss. Being the first time out the states a challenge I did face was the language barrier when shopping as well as the understanding of currency and its equivalent in the US dollar. After some time I was able to catch on but overall shopping was a very unique experience that I hope to come back to one day. We got the opportunity to experience traveling on the train which was similar to the NYC trains. I found that the view was beautiful as well as faster. Taking a tuk tuk in between through the city was something I wasn’t expecting coming to Sri Lanka however I actually really enjoyed although they don’t have them in the US for the fast pace living amd driving in Sri Lanka it only made sense people traveled on foot, bikes, motor cycles and tuks. On this trip we were fortunate to visit a elephant orphanage. My experience here was fantastic being able to see elephants to this magnitude was beautiful and have the chance to step in the water with them was a one of a lifetime opportunity. Additionally we visited a tea farm where we learned how the machinery works as well as the tea of Sri Lanka. We were given the chance to taste and buy new flavors to bring home. My mom being a tea drinker I was able to bring her black tea and silver tea from the shop. We also got to go to a elephant orphanage where we then enter the water and bathe an elephant. I will forever be grateful for this opportunity as I’ve never been so close to an elephant nor seen one in important. This was such a unique experience and I was pleased to have been able to get pictures and experience what it’s like with the wildlife in Sri Lanka. Following these excursions we visited a church where we then donated bookbags and shoes.The parents and the children are very grateful and it made me realize how privileged and thankful I am at home. They took pictures with us and gave us high-fives and I was happy to see that I put smiles on children’s faces. We then headed to our hotel which had a beautiful view and I was lucky enough to watch the sunrise every morning. We went on a tour at the temple where we were educated on Buddhism as well as being able to see a Buddhist tooth. And we additionally were able to watch a cultural dance, which was filled with life, drums, colors, fire, and beautiful costume, costumes, and dresses on men and women. Our next excursions continued in Galle. This consisted of a hotel on the beach where we got to enjoy the ocean, a pool and a city of tourist and shops. On our way here we had the opportunity to stop by a beach when men were pulling out a fish net. I made sure to take pictures to show my dad, knowing how appreciative and passionate he is about fishing. This was very cool to see because as a young girl me and my family would go fishing on the ocean. This was a once in a lifetime opportunity to watch a fishing net be pulled out of the water and I was intrigued to find out that it takes two hours to completely pull out the net. The rest of the time here we had the opportunity to rest and sit by the pool and swim with our peers as well as enjoy cultural food. I will forever be grateful for the opportunity that was given by SUNY Cortland and Dr. Muttiah. Through this trip, I was able to see a cultural difference as well as a clinical experience through a different lens. It gave me a new perspective of all the resources that we are given in America and how grateful I am to have access to these resources. This trip gave me the motivation to continue traveling, as well as new friendships, and forever friendships. </p>]]></description>
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         <pubDate>2026-01-21 17:25:25 UTC</pubDate>
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         <pubDate>2026-01-23 22:07:04 UTC</pubDate>
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         <pubDate>2026-01-23 22:07:31 UTC</pubDate>
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