Highlights From CASANA’s 2014 Conference on Childhood Apraxia of Speech

Please welcome Katie Burch, M.Ed., CCC-SLP, as a guest writer today. Katie holds a special place in my family’s heart because she helped Jake find his voice. I was so glad she got to attend the CASANA conference this year and I am sincerely grateful that she took the time to share her experience.

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Wow! I have to say I was quite impressed with my first experience of CASANA’s 10th Annual National Conference on Childhood Apraxia of Speech in Nashville, TN this past weekend. What a delightful mix of parent- and professional-friendly sessions! All aspects of the conference were timely and organized, and the organizers/presenters exemplified heartfelt service with a desire to pursue and share practical knowledge.

An unexpected bonus for me was getting to know some of the parents of children diagnosed with CAS. Talk about some super cool people!! What a joy to see how dedicated many parents are to the development of their children’s speech and language skills!

Multi-Sensory Cueing

I was reminded that multi-sensory cueing is a super beneficial tool for eliciting correct speech production in children with CAS. Margaret A. Fish, MS, CCC-SLP reviewed a wonderful variety of auditory, visual, tactile, and cognitive cues with helpful video examples. I can’t wait to read her book, Here’s How to Treat Childhood Apraxia of Speech! I have certainly seen the positive impact cueing can have on the progress of speech and language development and appreciated Margaret’s perspective.

apraxia book

Reading Instruction

Specific considerations and modifications for reading instruction were clearly presented by Sue Caspari, MA, CCC-SLP, calling my attention to the grave need for incorporating reading into my therapy sessions. A resource she cited which I deemed worth exploring further was the “Accessible Literacy Learning (ALL) Reading Program.”

Ellen Brigger, MEd, Lead Teacher for the Apraxia Academic Program at St. Rita School for the Deaf, added to the topic of literacy emphasizing (among other things) the breakdown children with CAS experience when interpreting speech input (e.g., recognizing and differentiating sounds, storing words). In other words, CAS not only affects speech production but speech perception as well.

Useful resources with which she has found success included Orton-Gillingham drills, Sound Signs (which contain ASL signs), and Nanci Bell’s Visualizing and Verbalizing.

The importance of assessing/addressing a child’s speech perception skills as a component of speech-language therapy was further highlighted by Jennifer C. Dalton, CCC-SLP.

The SLP and Child Relationship

I personally enjoyed Leigh Mazaleski’s, MS, CCC-SLP spin on speech-language therapy focusing largely on the relationship between a child and his/her therapist. She addressed being in tune with a child’s emotions and helping him/her express them, using a variety of household items/activities to engage the child, and promoting humor within child and parent interactions.

Further, I loved Leigh’s recommendation for each therapy session to include targeted practice along with instructional play. Something else that stuck out to me was the idea that a therapist can be trained in multiple programs, but if she/he does not connect with your child, the benefit of therapy could be less than maximal.

Kaufman Speech to Language Protocol and K&K Sign to Talk kits/apps

What a treat to hear from Nancy Kaufman, MA, CCC-SLP and her colleague, Kerry Peterson, MA, CCC-SLP, BCBA! These ladies shared ideas regarding bridging sign language to vocal skills using principles of Applied Behavioral Analysis (ABA). The K-SLP (Kaufman Speech Language Protocol) and K&K Sign to Talk kits/apps were referenced and are widely used by many speech-language pathologists.

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I have frequently used the K-SLP cards and am strongly considering ordering the Sign to Talk kits/apps after encountering them at the materials exhibit. I found it amazingly insightful that these ladies mentioned creating a signing community (e.g., via use of videos) to enable a child learning sign language (even as a temporary communication system) to communicate with a variety of partners in numerous settings.

Additionally, as many children diagnosed with Autism Spectrum Disorder (and coexisting CAS) receive both speech-language therapy and ABA therapy, collaboration between these therapists can have a huge positive impact on a child’s progress.

CAS Research and Treatment

Megan Overby, PhD, CCC-SLP delivered guidelines for assessing and treating toddlers with CAS from a research viewpoint. In particular, she discussed differences in speech and language development between typical children and children with CAS. Comparisons were made in the areas of volubility (or the amount of vocalizations toddlers exhibit), consonant inventory, age of onset for babbling, use of voiceless sounds, and syllable shape.

Principles for treatment included focusing on babbling, establishing multiple consonants and vowels as building blocks for words, providing repeated modeling of developmentally appropriate vocalizations, and increasing frequency of complex syllable shapes (e.g., CVC, CVCV, VCVC).

The CAS Teen Panel

The conference was creatively and appropriately concluded through a question/answer session with a panel of teens who had previously been diagnosed with CAS. How delightful and heart-warming! These gals and guys expressed that their motivation to learn to communicate was high even at a young age.

They encouraged parents to complete any homework given to them by their speech-language therapist, cheer on their kids, never give up, and stay connected with other parents and professionals. Their advice to kids included learning to self-advocate, not being afraid to be themselves, and making friends who accept them as they are.

It was eye-opening to learn that studying foreign languages proved to be especially difficult, their speech often breaks down when they are tired (or consuming alcohol), and they sometimes tended to gravitate toward activities/sports that require minimal verbal communication. Increasing self-awareness of CAS and learning to be proactive in regard to academic/social modifications appeared to be of utmost importance.

Personal and Professional “Take-Aways”

My primary personal and professional “take-aways” from CASANA’s 10th Annual National Conference on Childhood Apraxia of Speech are as follows:

  1. I am more interested than ever in pursuing training in “The Speech-EZ Apraxia Program” developed by Lynn Carahaly (as many of the principles/topics addressed during the conference are encompassed in her program).
  2. I am passionate about and truly enjoy providing parents with helpful, practical resources and ideas to use at home for improving their children’s speech and language development.
  3. I have a heart for teens and would like to find a volunteer/ministry opportunity to serve/interact with them.
  4. Learning from other professionals leads to professional improvement and personal enjoyment.

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Thank you again Katie for sharing the highlights from the conference! And a big thank you to CASANA for offering such an awesome learning experience for parents and SLPs.  

Operation Big Boy

Jake is the baby of our family … the youngest of three boys.

Although Jake wasn’t diagnosed with apraxia until age three, he began speech therapy when he was a little over two years old. And even as a baby, before I knew the threat of a speech disorder loomed in the distance, my life was consumed with severe eczema, ear infections, mild asthma, and food allergies.

All of these things have eaten up my mommy time. And the combination of being the baby of the family, along with these other challenges, stalled out the typical big boy aspirations.

Jake will start kindergarten in August and will turn six in September. There are some skills I want him to have in place before he starts school and I have come to refer to this mission as “Operation Big Boy.”

What are the goals of Operation Big Boy?

1.) Bathroom skills - My neighbor, the Pre-K 4 teacher, has been all over me to make this happen for over a year now. It is the ultimate annoyance for a teacher to have a child that cannot take care of #2 moments.

I am having to play hardball with Jake because he’s been using his skilled mama as a crutch for several months. I have explained to him the proper way to do this job and when he calls for me I have to stand firm and say, “No, do the best job you can.”

2.) Thumb sucking - Oh my, this is a hard one and the one I have been the least disciplined on. Jake loves to suck his thumb when he goes to sleep. We were putting a sock on his hand at bedtime for a while and that was working for several weeks, but I just cave when he wants to do it. My husband is much better at enforcing this rule; I am a weakling.

3.) Going to sleep by himself - When Jake was about three, my husband started putting him to bed on a regular basis. He would snuggle and fall asleep with him. This habit resulted in a little boy that refused to go to sleep on his own.

But, success! For the past few months, we have a new routine … bath, probiotic, brush teeth, pajamas, read a book, and prayers. I snuggle with him for about a minute and then leave the room. He has adapted and is doing great.

4.) Tying shoes - After about two weeks, I gave up on this one and bought velcro shoes. I’m pretty sure at some point in his life he will figure out how to make this happen.

5.) Showering/bathing himself - Yes, pre-Operation Big Boy I was soaping my child up and drying him. In my defense, it’s always been important to me for him to bathe well because of his allergies. Not only does he need to make sure the allergens are off of him to promote wellness, but he also has flare-ups of eczema on his heels due to his grass allergy.

This skill is in progress. It’s been hard to teach him how to soap up properly and sometimes I cave and do it for him. But, for the most part I want to eliminate this chore in my life and the only way to do that is to teach him and stand firm.

6.) Swimming - Last week Jake took swim lessons for the first time. I swear, this kid would wear floaties for the rest of his life if I’d let him. I have been hesitant to put him in swim lessons because until this year, he couldn’t communicate very well – especially in a stressful situation. I didn’t want him imploding emotionally because he couldn’t express that he was terrified.

A few times last week it got ugly, but by the end of the four days, he was swimming pretty good and finally jumped in by himself. It didn’t come naturally or easily for him and many tears were shed, but he did learn some basic skills that he will be able to build on for the remainder of the summer.

Closing …

In addition to not forcing my child to do the skills above, I have been guilty of being a helicopter parent. I have just always felt the need to shelter and protect my little boy. I wasn’t this bad with my other two children. I think it goes along with the apraxia and/or food allergy territory. Don’t you think?

I’m a lot like Jake when his swim teacher had to throw him into the deep end last week when he was making up every excuse in the book not to jump in. I literally had to force myself not to go in after him, but I knew he had to figure this out on his own.

He had to learn. He had to grow. He had to swim, not sink. And as a parent, it is my responsibility to allow that to happen.

 

CASANA News

The time is finally here. The 10th Annual National Conference on Childhood Apraxia of Speech offered by CASANA will run Thursday, July 10th through Saturday, July 12th. It is being held in Nashville, Tennessee and many of the top apraxia experts in the field will be speaking.

All you apraxia mamas and SLPs better get out in that town and enjoy some night life! You all deserve some good music and cold drinks. I will be thinking about you all this weekend! I have personally never been to this event, but I hear that it is one awesomely amazing experience.

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I hope some of you will be able to attend. If you have not made reservations yet, I received an email from CASANA yesterday with a subject line that read “Walk-Ins Welcome.” For details on the conference, please click here for more information.

If you are going to the conference and are curious about what to expect, check out this post from last year. A mom in our apraxia community shared what it was like to attend the 2013 conference. Thank you again, Suzy for paying it forward and helping future apraxia mamas and CASANA conference attendees.

This year, Jake’s former SLP Katie, is attending the conference and will be reporting for us at some point next week. I am so excited that she is attending this event because she has a heart for children with apraxia and a work ethic to back it up.

While I was on the CASANA site this morning, I noticed that they are currently accepting applications for the 2014 iPads for Apraxia program. If you have a child with apraxia and do not have an iPad, there are so many great apps that can help reinforce what your child is learning in speech therapy. The application deadline is right around the corner – August 1st. For more information on this great program click here.

I hope all of you are enjoying your summer. I have not been posting as often because 1.) My children do not nap anymore and it becomes exceptionally difficult to write when you are interrupted every five minutes and 2.) I’ve been working behind the scenes on an allergy series that will update Jake’s condition. We have an allergist appointment Wednesday next week so I will be able to compare what his thoughts are vs. our integrative MD. After that appointment, this series will run in July.

Any thoughts/advice on the 2014 Apraxia Conference are welcome in the comments section …

 

 

Ways to Strengthen Auditory Memory

Jake has been working on strengthening his auditory memory for about a year now. Summer is a great time to work on this skill and I think this extra boost is going to help my boy out tremendously in school. We still work on many of these activities at home a couple of times a week and my ten-year-old typically joins in.

(Clicking on the links to the activities below will take you to my Amazon store. Purchasing Amazon items through these links just means that I receive a small percentage of sales generated. My compensation is not added to the sales price. My Amazon store is one feature that will be on my new site Family Live Life Well, which is currently under construction and will launch in September of 2014.)

1.) Look Who’s Listening! by Super Duper - This is expensive for a board game, but my kids and I think it is excellent. It can be used for a few years because it has three different skill levels on each card. I give Jake the easy to medium questions and my ten-year-old the hard ones. It is challenging in a fun way for both of them. Jake also played this game in speech therapy for a while.

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2.) I went on a picnic and ate … This is a great game for the entire family if you are in the car or if you’re trapped somewhere with your kids and you need to keep them entertained and quiet. Each person takes a turn adding an item to the picnic list and also recalling the other things that have already been said. For example, the first person would say, “I went on a picnic and ate an apple.” The next person says, “I went on a picnic and ate an apple and a pancake.” The next person says, “I went on a picnic and ate an apple, a pancake, and a sandwich.” And so on. Last year, Jake couldn’t always say the complete sentence, but I focused on getting him to recall the order and build on the number of  words he could remember.

3.) Auditory Memory for Details in a Sentence Fun Deck by Super Duper – We just recently got this through the mail as a gift from our former SLP. It is for more advanced kids – kindergarten through second grade. It is pretty simple … the parent reads a paragraph and the child answers the questions. This is really hard for Jake, but I know that he is capable of improving. My ten-year-old son and I are also terrible at this skill, so it is good for our brains also.

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4.) Soundtracks & Animal Soundtracks CDs by Galt Toys Inc. – I think this is a great auditory memory tool builder for little ones whose speech is still limited. I borrowed this set of CDs from a friend who is a Pre-K 4 teacher and recommended that I try them when Jake was about 3 or 4. The child listens to the sound (like a baby crying or an animal sound) and then places a marker on the bingo-type card. You could also let a child listen to two or three sounds at one time and then have them place the markers.

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4.) Hear Builder Auditory Memory App by Super Duper – This app is awesome and it is free, free, free. It works on a variety of auditory memory skills and Jake loves it.

hear builder app

5.) Hear Builder Auditory Memory CD-Rom Game by Super Duper – This is a great extension to the app above. We used to also do this a lot in speech therapy. Click here to see demos of the different skills this game focuses on.

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6.) Sticky note dial pad – Our SLP used to do this multi-sensory game with Jake and as simple as it is, I think it’s genius. To do this activity, write the numbers 0-9 on sticky notes like a telephone dial pad. The parent says a pattern of numbers (3 is a good amount to start with) while “dialing” them on the sticky notes. Tell child to follow the pattern with their eyes. Child repeats the sequence out loud while also “dialing.”

7.) To-dos at home – Simple, yet effective … “Go into your room and get a pair of socks and a short-sleeved shirt.” So, Jake has to hear the information and hold onto it in his brain for the 30-60 seconds it takes him to go to his bedroom. Our SLP taught him that if he can’t remember, he can repeat the information either verbally or in his head. We also use this exercise a lot for television channels. If he wants to watch tv upstairs, I’ll tell him what channel his show is on. He’ll repeat the number quietly, almost under his breath, all the way up the stairs … “863, 863, 863.”

How about you guys? Got any good auditory memory activities, apps, or games to share?

Acupuncture and Speech – Part 2

Today is the final installment of the pediatric acupuncture series. If you missed the other posts, they ran on Wednesday and Thursday of this week. Many thanks to Jessica Gross, Licensed Acupuncturist, for taking the time to share her expertise in this subject …  

needles

In my treatments, acupuncture needles for children are generally quite small and the needle retention time is around 10-15 minutes. I tend to do most needling on the back so the child will not be frightened by the sight of the needle.

An example of points that I use is below*:

Du – 15: Located in the middle of the neck about a half an inch from the base of the external occipital protuberance (the small bump you feel on the back of your head at the base of the skull). Usually, it is just within the hairline. This point is used for stiffness of the tongue with inability to speak, loss of voice and flaccidity of the tongue, amongst other things. It is located just opposite to the base of the tongue, hence the correlation. This point is also located on the channel that runs through the spine and into the brain.

acupuncture apraxia point

UB – 13: Located 1.5 away from either side of the spine, level with the T3 vertebrae. This point is used to nourish the lungs.

UB – 20: Located 1.5 away from either side of the spine, level with the T11 vertebrae. This point is used to nourish the digestive system, specifically the spleen.

Heart – 5: Located on the inside of the arm, 1 inch from the base of the wrist to the side closest the pinky finger. This point is used for sudden loss of voice, inability to speak, stuttering, stiffness of the tongue and other heart related disorders. The effectiveness of this point requires more extensive information regarding the theory of the acupuncture channels.

If you are not ready for acupuncture, or want something to try at home, you can massage these points for your children. I like to recommend a tapping or light “bird pecking” with the fingers along the spine. Or you can imagine that you are typing or playing the piano really quickly over the area. This way, you are more likely to find the correct area (even if you miss!) and there will be a lot of blood flow that is stimulated. Tapping and “bird pecking” is usually not as ticklish as actually massage as well.

Chinese herbs are of course an option but should be inquired about with a practitioner that is familiar with your individual health history.

*Acupuncture Point information cited from A Manual of Acupuncture by Peter Deadman.

Thank you again, Jessica! As with everything, finding the right professional that is educated, experienced, and “clicks” with your child is key. I am currently in this exploration process since Jessica has recently moved and I’m learning it’s just like anything else – there are lots of different personalities out there with different styles of treatment.

As I mentioned in Wednesday’s post, Jake is now getting acupuncture for allergy/inflammation purposes. When we were with Jessica, acupuncture was a supplemental therapy that was done in addition to speech therapy with a licensed speech-language pathologist.  

If you live in the San Diego area and/or if you would like to learn more about Jessica’s services, please visit her website at http://jessicagrosslac.com/.

Other Related Posts:

Inflammation and Apraxia 

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Acupuncture and Speech – Part 1

Please welcome Jessica Gross, Licensed Acupuncturist, as a guest writer today. This will be a two-part series. Today, will be a general overview of acupuncture and tomorrow she will discuss the specific points for speech as well as the at-home massage technique that we have been doing for about a year now. Enjoy!

Chinese medicine is a complete system of medicine offering treatment options for just about any ailment that the body may present with. However, many people are not aware of what Chinese medicine can treat, so there are many disorders that we have the ability to treat but rarely see come into our office. Speech disorders are one of them.

Although they were without a modern diagnosis, speech disorders were not absent from ancient society and treatments were developed for them. Chinese medicine, including acupuncture, herbal medicine and nutrition is a beneficial treatment option for those suffering from speech disorders such as apraxia.

When assessing any patient, an acupuncturist will acknowledge the chief complaint and then continue to examine and inquire each independent system in the body. This is because in Chinese Medicine, the systems are not separate. The digestion, the muscles and bones, urination, sleep, emotions, etc. all influence one another. It is quite difficult to deny this to be true when we think that each cell in our body is connected.

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If you were to hold hands in a circle and one person falls, does the rest of the group not feel even the slightest jolt or movement? Of course, they do. This is why we must consider each aspect of the body before jumping to any conclusions.

For disorders manifesting in the voice, an acupuncturist will pay very close attention to the energetics of the heart and the lungs. This is not to say that if there is an issue with the voice that one should have their lungs listened to or their heart examined. The Chinese organs are viewed slightly differently and have some additional “functions” due to their energetic capability.

Let’s look at the lungs first.

Giovanni Maciocia paraphrases the Chinese classical relationship of the lungs and the voice in his book The Foundations of Chinese Medicine:

The strength, tone and clarity of the voice are all dependent on the Lungs. When the Lungs are healthy they are compared to a bell, giving off a clear ringing sound, which is the voice. If the Lungs are weak, the voice may be low… Macocia p 141

Therefore, it is important to address the lung energy whenever correcting a problem with the voice. Many times, a weakness in an organ shows up in different places in the body. This is why for someone who may be suffering from loss of voice, weak voice, or more specifically, apraxia, there may also be associated lung disorders such as asthma, frequency to catch colds, chronic sinus infections & upper respiratory tract infections .

The lungs have a very close relationship with the digestive system as well. In Chinese medicine, this has much to do with their anatomical location. Therefore, if the digestive system is weak, it can affect the lungs so we may see associated food allergies, constipation or other digestive trouble.

The next factor would be to consider the energetics of the heart. The heart can effect the speech is a variety of ways. While the clinical theory behind the heart energetics can be quite difficult to grasp, we can relate to “being speechless” when your heart takes an emotional hit – be it good or bad. For some, this state of being speechless is pathological.

In order to assess the origin of the speech disorder, associated questions would be asked about the person to see if they are presenting with more heart related symptoms or more lung related symptoms. To give an example, heart related aphasia and apraxia is that which is generally seen in Alzheimer’s patients.

When treating speech disorders in children, it is important to first consider any energetic deficiency or energetic developmental delay and treat it with acupuncture, nutrition and herbs. In my treatment, I also work with the spine to ensure that blood is flowing properly and the nerves are being nourished as they develop. For this, I use acupuncture needles, massage and electric stimulation on the surface of the skin along the sides of the spine.

Tune in tomorrow for Part 2 …

All About Pediatric Acupuncture

Jake has been getting acupuncture for about a year now and today I’d like to share our experience. This week I invite you to relax, get your zen on, grab a cup of tea, and enjoy learning about something that I personally think is fascinating.

What led me to try acupuncture?

In the spring of 2013, I read about NAET acupuncture in the “Thinking Moms Revolution” book. This is a special type of acupuncture that is supposed to improve allergies. After reading more about NAET, however, and given the severity of Jake’s many allergies (7 food and multiple environmental), I didn’t feel comfortable with this treatment. But, it did spark the idea of looking into traditional acupuncture.

At the time, my mom was seeing Jessica, an acupuncturist at our integrative medical doctor’s office, and she highly recommended her. I followed my gut instinct and without really even knowing what to expect, made our first appointment. Despite the fact that “allergies” were the reason we walked into Jessica’s office that day, I was shocked when I saw improvements in other areas as well.

What results do I see when Jake gets acupuncture?

In our first sessions when Jake was four years old, I saw improvement in fine motor skills, creativity, independence, and clarity of speech. At age five, I still see fine motor and clarity of speech improvements. Once his fall allergies (ragweed) kicked in last year, I was surprised to see that acupuncture alleviates his allergy symptoms as well.

What about the food allergies? More on this later, as allergies are not a black and white issue, but in January Jake’s test results showed that his allergies have gotten substantially better. We are currently in an exploration process to see where we officially stand. I believe these results are due to a combination of acupuncture along with his specialized diet and supplement plan.

What happens in our pediatric acupuncture session?

No, it’s nothing like Po in Kung Fu Panda, so go ahead and erase this visual from your mind -

kung fu

Jake typically gets the following services (not at every session) that are dependent on his symptoms: acupuncture (6-8 tiny needles that stay in for 1 to 10 minutes), acupressure, massage, and cupping. Sessions usually last about 30 minutes.

The next question people ask me is, Does it hurt? That is usually followed by something to the effect of … My kid would freak out!

Now erase the post traumatic stress of what it’s like when your child gets a shot. It is absolutely nothing like that experience. In the book “Keeping Your Child Healthy with Chinese Medicine”, Bob Flows states …

When babies are first brought in to see the TCM (Traditional Chinese Medicine) practitioner, they may immediately recognize they are in a doctor’s office, and they may start to cry, remembering the pokes and prods, jabs and shots they have received at Western MDs’ offices. However, children soon learn that the TCM practitioner does not do any of that and that the visit is both gentle and kind. Therefore, children, by and large, love to go see their Chinese doctors. (pg. 58).

I 100 percent agree with this sentiment. Jake looks forward to his sessions and adores Jessica. If it hurt, he wouldn’t love it so much.

Are the needles safe? 

The needles that Jessica uses are sterile and each one comes in its own packaging.

How often do we go?

We began in May of 2013 and during the first month, we went two times a week. June and July we went one time a week. Once school started, we went about once or twice a month and/or when his fall allergy symptoms were acting up. We did not go during the winter months because Jake felt wonderful during this time because nothing was blooming and his apraxia had gotten substantially better.

Right now we are in the process of finding a new acupuncturist and I am going to aim for two times a month over the summer to keep Jake’s grass allergy symptoms at bay.

How much does it cost?

I have heard that acupuncture can run anywhere from $50-85 a session. It is covered in my family’s insurance plan with United Healthcare. Jessica was out-of-network so we had to first meet our $700 deductible (comprehensive/all medical costs, not just acupuncture services) and then it was covered at 70 percent. In-network is much more cost effective; the deductible is substantially lower and 100 percent is covered.

Want to know more?

Tune in on Thursday and Friday of this week for a two-part series by Jessica Gross, Jake’s acupuncturist who recently moved to California. She will be sharing the philosophy of acupuncture, the different points she focused on when treating Jake’s apraxia, and details of the at-home massage we do.