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Knowledge of Performance, Knowledge of Results

The child with CAS will require “feedback” in order for motor learning to occur. Two types of feedback to consider in treatment are “knowledge of performance” and “knowledge of results.” Knowledge of performance refers to feedback provided by the SLP that gives the child specific information on how a movement is performed or correction to the specific movement (i.e., ‘your tongue needs to be up more”, “build up that air inside with your lips closed tight”). Knowledge of results refers to feedback from the SLP regarding how well the overall speech attempt was performed (i.e., “Yes, you did it!”, “That wasn’t it, try it again.”).

Some experts suggest that knowledge of performance is more appropriate in early treatment phases and knowledge of results more appropriate as the child gains some control in their speech motor processing system. Clinicians, however, should give careful attention to feedback and make clinical judgments and evaluation related to the degree of external feedback provided, assessing the child’s internal feedback capacity and “self monitoring”. The end goal is for the child’s system to develop intrinsic feedback and self-monitoring. There is risk to providing too much or too little external feedback. If too little is provided, the child may fail to make progress because their system is not currently providing them with sufficient internal feedback. If too much feedback is provided, the child’s system will never be taxed to develop internal feedback loops and will possibly fail to take over the responsibility for independent processing. So, careful attention is warranted to the extent and type of external feedback provided by the clinician. This is a gentle process of providing appropriate feedback and backing off and observing the child’s ability to be accurate with volitional speech movement sequences using their own internal system of feedback.