Nancy Potter

Washington State University

Credentials: Ph.D., CCC-SLP; Member of Apraxia Kids Professional Advisory Council
Hours of Operation: Presently, I only see children for therapy in our summer camp the last two weeks of June from 9 am to 4:30 pm because of research commitments.
Treatment locations: Office/Clinic
Spokane, Washington 99210

Overall Treatment Approach:
   I primarily use a DTTC approach (Dynamic Temporal and Tactile Cueing) with a small number of functional targets, fading of cues, and intense repetition. I use principles of motor learning with blocked practice while the child is acquiring a target and then switch to randomized practice. I vary reinforcement using knowledge of results and knowledge of performance when needed although with DTTC, correct productions (or closely approximated productions) are often self reinforcing. I use Phonic Faces as phonemic cues when addressing CAS and literacy. Depending on the results of my assessment, I may also address co-occurring childhood dysarthria issues of respiration, phonation, and resonance disorders as needed. Most of the therapy I am involved with is in the summer at Camp Candoo, a CAS camp.

Percent of CAS cases: 75

Parent Involvement:
   Parent observe the session while the graduate student I am supervising/co-treating at Camp Candoo is establishing the phrases and the client is accommodating to the intensive repetition regime. Parents are encouraged to video sessions. When the grad student and the client have an adequate working relationship, the parents join the 30 minute 2x/day therapy session during the last 10 minutes and share in eliciting the target phrases. Clients practice each phrase 10x before the next day of camp. We also provide parent education sessions on principles of neuroplasticity, DTTC, incorporating literacy, and advocating for your child. (I am academic faculty and although I have treated children with motor speech disorders for 40 years, my responsibilities in my present position are research, publish, research, publish, research, publish, teach, then therapy.)

Parent Explanation:
   Childhood apraxia of speech (CAS) is a subtype of a motor speech disorder (MSD). All MSDs are neurologic in origin, meaning the speech disorder originate in the brain. The outer layer of the brain, called the cortex, does most of the work needed for planning speech. In addition, there are small structures called the basal ganglia deep between the 2 halves of the brain and a structure in the lower rear of the brain called the cerebellum that all contribute to speech production. All these structures are connected by a complex network of fibers covered with a fatty substance called myelin. Myelin helps the connection fibers send signals 100x faster than fibers that don't have myelin. Sometimes the connections between the cortex, basal ganglia, and cerebellum are less than ideal. When this occurs, children may have difficulty with their speech as well as other motor skills. In CAS, children often know what they want to say but planning and programing the mouth, tongue, and voice to produce the sounds in order and in an age-appropriate manner is difficult. In CAS, both vowels and consonant sounds are often affected and many times the errors are inconsistent. The rhythm or prosody of the child's speech is often different also. Also, in CAS, as words and phrases get longer and more complex, speech becomes increasingly difficult to plan and program. The connections in the brain need multiple repetitions of the same phrase to build speedy connection fibers. CAS is not caused by weakness in the mouth and tongue. We don't often know the cause of CAS, but we do know how to help your child.

Community Involvement:
   I have worked with or consulted on hundreds of children who have CAS and other MSDs. I co-direct a summer CAS camp with Dr. Amy Meredith at Washington State University. I conducted the research study with Larry Shriberg and Edy Strand on classic galactosemia, which was foundational in defining characteristics of CAS and continue to conduct research on MSDs in children. I gave an invited Trailblazer presentation at ASHA with Strand, Wambaugh, and Yorkston on MSDs across the lifespan. I have given and am giving continuing education presentations on CAS across the U.S. . I wrote the speech and language guidelines for classic galactosemia which was published in 2016. Most recently, I have been working on developing an early intervention program with Beate Peter to examine if speech sound disorders can be minimized or prevented in classic galactosemia if intervention is started in infancy.

Professional consultation/collaboration: Yes

Min Age Treated: 5 years

Insurance Accepted: Yes