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Multi-sensory Input for Speech Practice

Overall, most treatment methods in the professional literature describe variations of therapeutic multisensory input to the affected child. Use of multisensory strategies may incorporate input that is visual, auditory, proprioceptive and tactile in order to teach the child the movement sequences for speech. It is not yet understood exactly why such “inputs” assist in the articulatory accuracy or “speech motor learning” of children with CAS. One theory is that children with CAS do not benefit from sensory-motor feedback for their speech attempts in the same way as typically developing children do. Perhaps the feedback is faulty, reduced, or otherwise inadequate to provide meaningful assistance to the motor learning process. Essentially then, each speech attempt would be akin to the “first time”, with children with CAS failing to incorporate the sensory results of their speech effort into their next speech attempt. Feedback is an important aspect of motor learning. If a child cannot benefit from or does not receive intrinsic sensory feedback, theoretically it is possible that external or imposed feedback can help facilitate speech production skills. Another possibility is that over time visual or tactile cues may map an association for the child and thus trigger a type of “motor memory” for the articulatory goal.

Tactile methods of speech facilitation include methods that provide direct tactile input to the child’s face or articulators in order to “cue” them for the correct production. With these sorts of methods, the speech-language pathologist may apply pressure or otherwise touch the child’s face, neck, and head, to provide a tactile cue for correct production or speech movement gesture. (See information on the PROMPT therapy method)

Visual methods provide visual “cues” as to the shape, placement or movement of the articulators. Hand signs or cues often provide a visual cue. More technologically advanced methods such as electropalatography readouts, various computerized programs such as “Speechviewer” and other forms of biofeedback can also provide the child with visual feedback for speech movement performance. A visual cue may help to elicit an appropriate movement configuration upon a learned association.

Asking the child to slow down and to maintain articulatory configurations for a longer duration than is typical provides additional proprioceptive feedback in order for the child to have more opportunity to “feel” the position of the articulators (See information on The Dynamic Temporal and Tactile Cueing for Speech Motor Learning Method – DTTC). In some therapy methods such as the PROMPT and the DTTC methods, the clinician may provide touch to the jaw, face, etc. in order to provide additional proprioceptive input. Enhanced proprioceptive input, theoretically, may help the child benefit and learn from the motor experience and make adjustments to stored motor programs and plans based on such feedback and experience.

It is important to note that in all of these sensory modalities, direct and systematic training of articulatory movement sequences receives a high degree of emphasis. While the SLP may be called on to teach isolated phonemes at some point as well, this is not the key emphasis of therapy for children with CAS. Rather, the emphasis is on well-controlled sequences of movement patterns required for accurate production of a continuous string of phonemes (i.e.: continuous speech). Additionally, for children that have a significant deficit in speech motor planning and programming a “minimal pairs” (auditory discrimination) approach is not a primary element of treatment to elicit improved speech motor planning. The reason for this is that the treatment method should match the understanding of the underlying nature of the child’s disorder. If the child’s disorder is motoric (as opposed to linguistic), then a motor speech approach should be adopted. More linguistically or phonologically based approaches may also have a benefit for some children who ALSO have a linguistic or more traditional auditory perceptual or phonological deficit to their overall profile but such methods do not replace the need for speech motor strategies.