Credentials: MA, CCC-SLP
Insurance Accepted: No
Treatment Locations: Teletherapy available in the United Kingdom.
Phone: (425) 477-9252
Percent of CAS cases: 11-25%
Overall Treatment Approach:
My overall philosophy is that treatment should be fun and functional. I do not believe in using just one approach to treatment and will tailor my treatment to the individual child. However, I primarily use Dynamic Temporal and Tactile Cueing (DTTC) and incorporate the principles of motor learning. Target Selection:- I select targets based on the child’s current phonetic and phonemic inventories as well as the syllable shapes they produce. – I will change on variable at a time: new sounds are introduced in “old” syllable shapes and new syllable shapes are introduced using “old” sounds- I choose initial stimuli based on vowel errors – The number of targets depends on the severity, ranging from 5 targets for severe CAS up to 10 targets for mild CAS.- When selecting stimuli, I consider parent input, words that are extremely important for the (e.g. child’s name, names of pets/family members, favorite food/toy), and core vocabulary research (words that are used frequently are going to be more functional for the child) – Once a target meets criteria, a new one is introduced- Targets move from an “acquisition” phase to a “retention” phase DTTC: – The goal is to improve the child’s ability to assemble, retrieve, and execute motor plans for speech – At first, maximum cues are provided. They are then faded, giving the child increasing responsibility for programming and executing the motor plan on his or her own. – The constant adding and facing of cues is the most important aspect of this method. – A variety of cues (tactile, gestural, visual, auditory, phonetic placement) may be used as needed. I am PROMPT level 1 trained and will often incorporate the touch cues from PROMPT as part of this system. Principles of Motor Learning (PML): I incorporate the PML into my treatment sessions to maximize motor learning. I aim to maximize the number of trials per session by using quick reinforcers and short breaks. When a target is first introduced, I use a modified block approach and move to random practice as the target becomes more accurate. At first, specific, frequent feedback is provided, fading to infrequent, less specific feedback as accuracy improves. Other Approaches: For a child with more mild CAS or one who primarily needs to work on prosody, I may select Rapid Syllable Transition Treatment (ReST) as the treatment approach. Even if I do not use ReST in its entirety, I have found the framework helpful for teaching the concepts of “sounds, beats, & smooth.”
Working with children with CAS has been a passion of mine since graduate school. I was lucky to attend a school that had a Apraxia Kids Apraxia Bootcamp graduate as a clinical supervisor (Jodi Kumar, M.S., CCC-SLP). I learned a lot about diagnosis and treatment from her. During graduate school, I was a clinician for the Childhood Apraxia and Motor Planning (CHAMP) Camp and completed a research project on the use of Dynamic Temporal and Tactile Cueing (DTTC) at this camp. I presented this research at the 2016 ASHA convention in Philadelphia and the 30th World Congress of the International Association of Logopedics and Phoniatrics in Dublin, Ireland. I seek out continuing education opportunities related to CAS to improve my clinical skills with this population. When working with my families who have children with CAS, I refer them to Apraxia Kids for information and support. I work closely with patient’s family members and school speech pathologists (as applicable) to understand my treatment approach and ensure generalization across environments. I enjoy the opportunity to teach other speech pathologists about evidence-based treatment strategies for CAS.I lived and worked in London, England for almost 3 years where I had the opportunity to teach my colleagues about DTTC and best practices for the treatment of CAS as most of them were not as familiar with treatment for apraxia.
Parent involvement is very important in my therapy process. At the beginning of treatment, I provide parent education on the nature of CAS, the type of treatment used, and the importance of carryover into other environments. I ask parents to fill out a core vocabulary development sheet in which they identify potential stimuli that would be meaningful for their child. I ask them to include family members’ names, favorite foods/toys/activities/places, and any other words the parent feels would be extremely helpful for the child to be able to say accurately. Throughout treatment, we review and revise this information and work together to make sure the targets selected are functional for the child. I encourage parents to observe treatment sessions so they can better understand the treatment process and watch my cueing in action. My treatment sessions are 30 to 45 minutes in length with time at the end being reserved for “home program.” During the home program, I continue my therapy with the child and ask the parent to observe (if not already watching). I then discuss the homework with the parent and demonstrate what to do at home. Homework depends on the child’s level of success with each target during the session and the parent’s level of comfort with providing cues. If the parent demonstrates comfort using cues to help the child with acquisition targets, I will include these in the homework. If not, the homework will typically be retention targets. I like to incorporate targets into daily routines and suggest fun activities to make practice motivating! I always stress the importance of completing the homework and how this can impact progress in therapy.
AAC Use/Implementation Expertise:
AAC is a wonderful tool in our toolbox for the treatment of children with CAS. Many times, children with CAS experience frustration when trying to communicate verbally. AAC offers them a way to communicate important needs and wants more easily while we work on helping them say words and sentences more clearly. It can reduce frustration and build confidence in communicating. Therefore, AAC is often included in the treatment plan for a child with CAS at some point in their journey. For many, this will be a temporary way to increase communication until their speech improves to the point where AAC is no longer needed. For a smaller number of children with CAS, AAC may always be a primary means of communication that adds to what they are able to communicate successfully through verbal speech. I have experience implementing a wide variety of AAC options including basic signs, “low-tech” picture communication systems/boards, and “high-tech” speech generating devices/apps with robust vocabulary systems. I am trained in the LAMP (Language Acquisition through Motor Planning) approach to AAC and incorporate this into my treatment planning.