Karen Ruehle-Kumar

Pediatric Speech and Language Specialists

Credentials: MA CCC-SLP; Recognized by Apraxia Kids™ for Advanced Training and Expertise in Childhood Apraxia of Speech
Hours of Operation: Monday through Thursday9 am - 6 pm* *these are flexible depending on therapist schedule and client needsPlease note that I am an employee of Pediatric Speech and Language Specialists; also we have two locations:6865 E. Becker Lane, Suite 101, Scottsdale, Arizona 85354932 W. Chandler Boulevard, Suite 3, Chandler, Arizona 85225Phone for both offices: 480-991-6560
Treatment locations: Office/Clinic
6865 E. Becker Lane Suite 101
Scottsdale, Arizona 85254
Phone: (480) 991-6560
Email: kruehle.kumar@gmail.com

Overall Treatment Approach:
   My treatment approach includes a variety of approaches to expand the child's ability to produce motor phonemes (both consonants and vowels) within increasingly complex syllable shapes always keeping in mind coarticulation and appropriate movement between sound production. I use various levels of cuing such as signs/gestures, visual cues (watch my mouth), tactile cues (PROMPT or hand signals for specific motor phonemes), verbal labels (e.g., lip popper, humming sound, turn your motor on, etc). I will use simultaneous production, vocal imitation, delayed imitation and non-vocal imitation to cue the child's productions. My therapy approach includes the use of mass practice at the start of an activity so the child understands what we will be practicing followed by distributed practice of those same targets within meaningful activities that target functional vocabulary and/or utterances. Blocked and random practice is also incorporated. Therapy is constantly being adjusted based on the child's skills and progress. When I am cuing a child, I talk to him/her about the motor movements he/she is making to produce the targets. My verbal feedback also includes descriptions of his/her oral speech movements and how to refine these. Feedback is very specific. The child knows what he/she is working on; I also give specific feedback about how the child performed and what he/she is supposed to do.The approach includes a strong home program that often includes the development of a core vocabulary for children who are minimally verbal or highly unintelligible. This is updated as needed. The home program includes parent education about CAS as well as ways they can practice at home. We work together on developing targets for therapy, also.Therapy is scheduled for frequent but shorter sessions: two to four 30-minute session per week. The child is usually working about 20 minutes of each session with time for parent training and discussion. I choose targets based on what the child presents with in regards to his/her phonemic inventory, syllabic complexity and developmental level. I keep in mind expanding the child's speech sound repertoire, syllabic repertoire and improving prosody.During therapy, I am also interested in developing the child's vocabulary (nouns, verbs, adjectives, function words) in context as well as improving the child's length, complexity and variety of utterance types. Many times this begins with the use of carrier phrases. I also consider the child's pragmatic skills (initiating, responding, greeting, commenting, etc).

Percent of CAS cases: 28

Parent Involvement:
   Parents attend therapy sessions either in full or in part, depending on what works best for the child. At the start of therapy we discuss long term goals and the child's communicative skills and needs. I ask parents' their impressions of their child's communication skills and what they hope to obtain for their child from the therapy process. This helps me to understand their expectations, their fears and concerns and to address these appropriately. I provide written goals and objectives with updates as needed. I give written and verbal information for parents to stay informed about CAS and their child's program. Parent education is ongoing. If a parent sits in on a session, I explain to them what I am doing and why. If parents are not in sessions, they are informed at the end of each or alternate sessions about the targets and the child's progress. Parents are also given written and/or verbal instructions and possibly materials to work on at home. I am very careful to instruct parents on what to expect from their child and how to work on speech at home, preferably in fun, playful and meaningful contexts.Literacy is a big part of my therapy and I encourage parents to read to and engage their children in books. I provide lists of titles for parents--these lists focus on rhyming, alliteration, vocabulary, categories, repetitive text, predictable books, etc. I may demonstrate to the parent how to interact with their children in order to maximize reading time and making it fun and motivating for the child.I provide written and verbal instruction and demonstration on how to "cue" their child for sounds, whether it is with gestures, sign, tactile cues and/or verbal feedback. Sometimes I will create materials or activities for the parents to use at home with their child. For children who are minimally verbal, I always ask parents to develop a core vocabulary of at least 10 words/terms to begin with and we work on these in therapy and at home. I show them how to put together a core vocabulary book that can be changed and expanded. I do a great deal of parent counseling and education about the impact of CAS on a child's communicative and social behavior in new situations, with unfamiliar people and in trying new communicative behaviors. I talk to them about the importance of trust in the therapeutic relationships, also. I will provide outside referrals for OT, PT and even feeding as needed.

Community Involvement:
   I have been involved with the Arizona Apraxia Support Group and have participated as a group leader several times in the Walk for Apraxia in Phoenix, Arizona.

Professional consultation/collaboration: Yes

Min Age Treated: 1 year

Max Age Treated:

Insurance Accepted: Yes