Julie Pera

Many Gifts Speech & Language Therapy

Credentials: M.A., CCC-SLP
Hours of Operation: Weekdays, 8 am - 6 pm by appointment
Treatment locations: Office/Clinic, Home, Daycare, Private School, Community Locations
24 Lovewell St.
Gardner, Massachusettes 01440
Phone: 978-212-9663
Email: julie@manygiftstherapy.com

Overall Treatment Approach:
   For children with significant impairment: Choose a small number of target words (3-10) that contain consonant and vowel sounds that the child is successful with in some context, but cannot consistently produce when motor planning at the syllable/word level. Targets should have enough variability to ensure focus on motor planning not over learning a single sound or syllable shape. Targets should be functional to support carryover across settings. For children with moderate impairment: Choose 10-20 target words/phrases based on speech sound repertoire, syllable shapes, and number of syllables. As above, ensure targets result in motor planning practice by varying sound position in words, combinations, and length of production. For each target: Determine level of support needed (simultaneous production, immediate imitation, delayed imitation, spontaneous production). When the child is ready, practice the words embedded in functional carrier phrases (e.g. want ___, I see ___, You eat ___, more ____). Consistently monitor child for overall expressive communication skills, and implement low- or high-tech AAC to support language skills while working on producing understandable speech.

Percent of CAS cases: 7-10%

Parent Involvement:
   As I am transitioning from working in the public schools, to private practice and early intervention contracts, I expect that parent involvement will remain largely the same. In the schools, I involved parents initially in the evaluation and eligibility process by gathering information from them about how their child communicates with them, what situations are easiest and most frustrating, and identifying areas of strength that they can tap into while they do the hard work of motor speech therapy. I provided ongoing explanation of what apraxia is, based on the parent’s ability and readiness to understand or acquire more information. As we began therapy, parent input was critical in identifying targets that were functional, motivating and provided the right level of motor speech challenge. Some targets were approximations based on how important the word was to the family (example sibling names). Selected targets for practice were sent home when the child had reached a sufficient level of consistent independent accuracy, and parents were given verbal models (telephone or in person at pick up) or email descriptions of how to support the child in producing that target accurately in other settings. If the child was not able to demonstrate a high level of success, parents were advised to move on to other successful targets (current or prior) or provide higher levels of support, in order to avoid “practicing errors” or child/parent experiencing frustration. After engaging in some ongoing diagnostic therapy, the topic of possible AAC was broached with parents, to determine the best means to support communication while motor speech difficulty was still significant.

Community Involvement:
   I am involved in the apraxia community as a professional who works with children who have CAS and their families, and as a professional who seeks to engage in continuous learning about CAS in order to be a better provider.

Professional consultation/collaboration: Yes

Min Age Treated: Toddlers

Max Age Treated: Adults/Geriatrics

Insurance Accepted: Yes