9 September 2026

Coughing is a reflex when choking, but it is also something that one can do on purpose. Nathaniel doesn't have a strong cough reflex, so we have a machine that can help him. However, now he is also coughing on command when he wants to clear his throat or if he feels the need.

Nathaniel has started to type his answers in full sentences. The progression of asking him how he is doing has been like this: "Great", "Great!" (with punctuation), "I am feeling great!" Even more impressive is when he didn't want to respond to the speech therapist. She suggested that he just type what he wanted to do, so he did. He had to think of something that was not in front of him without any clues from the therapist, and he had to know how to spell it.

When we point to one of the caregivers and ask Nathaniel who he is, he usually has trouble signaling correctly. However, when we ask him to type the name on his iPad, he types the name correctly. Maybe we have been asking him too many questions and that has confused him.

The first time Nathaniel played the electronic memory game, Simon, he could remember more than 5 sequences. That is important because it shows that he has a working memory.