Kelly Domiano

Chesney Center Therapies

Credentials: M.S., CCC-SLP
Hours of Operation: Tuesday/Thursday 2pm-6pm
Treatment locations: Office/Clinic|Daycare
Hammond, Louisiana 70401

Overall Treatment Approach:
   I believe in an intensive, functional and family-centered approach to treatment of children with childhood apraxia of speech. As recommended by ASHA, I encourage families to participate in 3-5 treatment sessions per week along with a detailed home program to ensure that the child receives the practice and feedback he/she needs to be successful. I also believe that treatment should be as functional as possible, which is why in the initial stages of treatment, goals are centered around building up a base of functional words and phrases. Therapy also focuses on motor planning in increasingly complex syllable and word structures, which are then trained at the phrase, sentence and conversation level. I use a variety of multi-sensory cues and a step-by-step system to fade cues and models to gradually encourage the child to communicate independently. I also encourage family members to be active participants in each treatment session to learn strategies and techniques to facilitate their child's communication in real time. A big part of therapy is counseling families on how they can incorporate information and techniques that they learn in therapy into daily interactions. Activities and materials used in therapy are fun, play-based and easily replicated at home.

Percent of CAS cases: 0.1

Parent Involvement:
   I encourage parents to be an active part of their child's treatment program. This means that parents are active collaborators in their child's treatment plan and are encouraged to participate in each therapy session. In this way, they learn and practice techniques and strategies to help their child both inside and outside the therapy room. Parents are also counseled on how to use the skills they have learned to help their child practice target skills in daily interactions. I believe that when families understand the specific goals and reasons behind those goals, the child is able to maximize his/her progress because consistent practice and generalization of target skills can be provided at home. I also believe that parents should feel empowered by their ability to make positive changes in their child's ability to communicate efficiently and effectively.

Parent Explanation:
   I describe CAS to parents in terms of what is IS, and what it IS NOT. I explain that CAS is a difficulty with planning, sequencing and timing of movements to create speech. A child with CAS knows what they want to say, but the part of their brain that is responsible for creating the message to send out the muscles of speech is having difficulty. I emphasize that CAS is a problem getting the message from the brain to the mouth, not with the 'mouth' itself. I also explain that it is NOT simply an articulation disorder (problems with knowing where to put the lips/tongue/teeth etc to produce specific speech sounds), a phonological disorder (problems with understanding the sound system of language and how those sounds can carry meaning and be manipulated to form words), or a problem with muscle weakness or other structural abnormality. Unlike articulation and phonological disorders, CAS can potentially affect non-speech oral movements as well. I explain that speech is a very complex task and in order for us to speak as quickly and accurately as we do, the premotor cortex in the brain is like the 'conductor of an orchestra' that coordinates the order in which the muscles in the mouth move, how fast/slow they must move, and how to transition efficiently between movements. All of this (combined with voicing and resonance muscle movements) needs to be carefully coordinated so that speech comes out smoothly. Any 'hiccup' in any one of these commands or a combination leads to inaccurate speech production (I then give examples of the behaviors their child is exhibiting, such as intrusive schwa, syllable segregation, etc), and, as one can imagine, the longer the 'command' the more of a 'mix-up' there will be (deterioration on longer utterances).

Community Involvement:
   Chesney Center Therapies has supported the Apraxia community by being present at and a Gold Sponsor of the 2016 Baton Rouge Walk for Children with Apraxia of Speech

Professional consultation/collaboration: Yes

Min Age Treated: 2

Insurance Accepted: Yes