13 Jan Molly Eiseman
Posted at 17:01h in Uncategorized
Credentials: M.S. CCC-SLP: Recognized by Apraxia Kids™ for Advanced Training and Expertise in Childhood Apraxia of Speech
Hours of Operation: 9-5 Locations: 230 Grand Avenue Suite 303 Oakland, CA 94610 Kalmanovitz Child Development Center: CPMC 1625 Van Ness Avenue 3rd Floor San Francisco, CA 94109
Treatment locations: Office/Clinic|Home
Oakland, California 94610
Overall Treatment Approach:
My approach for treating children with CAS is to use the evidence available to create an ideal treatment plan for the child starting as young as possible. This always includes heavy parent involvement, a home program and an increased frequency and intensity of treatment. I employ the principles of motor learning and multi-sensory cueing. My approach pulls from a variety of sources and will be slightly different for each child, tailoring the cues, stimuli and progression of complexity to meet each child's needs. The cueing approach that I use is based on Dynamic Temporal Tactile Cueing in which cues are added and removed dynamically from trial to trail within practice to maximize the child's accuracy and move quickly to his/her ownership of the motor plan. For young children, the focus will be on a establishing a core vocabulary of very functional words. This will include visual, verbal and perhaps tactile cueing and will likely include signs and AAC. In addition, an emphasis on imitation is important at this young age to establish the skills needed to progress in treatment. Encouraging vocal play is also crucial at this early stage. Once a child has established a core vocabulary and is consistently attempting to imitate, the focus turns to increasing complexity. The elements of treatment then become: 1) Increasing the phonetic inventory including establishing new consonants and vowels, and expanding place and manner of articulation; 2) Increasing complexity and variety of word and syllable shapes; 3) Improving suprasegmentals including stress on words and phrases as well as intonation changes (i.e. more natural sounding speech). I believe that we are treating the whole child. In addition to speech goals we must have language goals and always help the family learn to carry over language rich activities at home, not just speech practice. We also need to be mindful of social-emotional development and social skills as these are completely intertwined with communication skills for young children. Lastly, we need to serve as a guide for the family. Among our most important roles is to educate and support them in advocating for their child, and to connect them to other families.
Percent of CAS cases: 50
Parents are an integral part of treatment. They truly know their child better than anyone. I enlist parents at every point in the process beginning at assessment and diagnosis. Parents spend the most time with their child and are a primary agent of change and can have a huge impact on progress. For that reason, I like to have parents help choose speech targets. They know what is most important and most motivating for their child. It's also crucial to train parents on how to cue their child to achieve accuracy in saying words that are almost mastered. Home practice is crucial for progress and I like to coach parents so that it's both effective and fun!
I have collected analogies from colleagues and mentors along the way. I like the analogy of trying to wiggle your ears. Your brain sends the message to your ears but they won't move. Maybe something else moves instead, like your eyebrows! Apraxia is a motor planning disorder. This means there is nothing wrong with the muscles. It's sending the message from the brain to the muscles about where, when and how to move that is the difficult part. Speech requires some of the fastest, most precise movements our bodies can make. It doesn't take much of a hiccup in that brain to muscle pathway for things to go awry. Most of us don't think about all of the complexity that it requires to speech. We don't even think about what our mouth is doing. Our kids with CAS have to work hard to learn those movement patterns. The good news is that we can help them learn them! And once they have them down, with lots of practice, they will become automatic. I like the tracks in the snow analogy. The first time you sled through fresh snow it's slow and laborious. But the 10th time it's easier, the 50th time it's even easier and from there it becomes smooth and fast! We can help our kids with CAS establish the right tracks in the snow so that their words are easy to say and become natural sounding.
I was introduced to apraxia years ago by a little patient of mine who was still the clearest case I have ever seen. I started doing trainings with CASANA online and going to every course I could find to learn more about how to work with him. Together, he, I and his mom learned what he needed and what helped him most. From there I was hooked and fascinated by this nuanced disorder and these small, hard-working communicators. I attended the 2013 CASANA National Conference and devoured the information. In 2014 I was chosen to go to the CASANA Intensive Training Institute. From there I have offered therapy as well as consultations to families and SLPs in my area as well as offered formal trainings to SLPs in Northern California at California State University: Chico. Most recently, I started an Apraxia Parent support group in San Francisco alongside a parent and fierce advocate of a child with apraxia.
Professional consultation/collaboration: Yes
Min Age Treated: 1.5
Insurance Accepted: Yes