13 Jan Sheila Moskowitz
Posted at 17:01h in Uncategorized
Credentials: M.A., CCC-SLP, CA license SP 4145
Hours of Operation: Monday- Friday 4:00 PM -7:00 PM (Summer- Monday-Friday 10:00 AM -5:00 PM) Saturdays - 10:00 AM - 4:00 PM
Treatment locations: Office/Clinic|Home|Daycare|Other
Northridge, California 91326
Overall Treatment Approach:
This approach is focused mostly on young children, which are the majority of my caseload. However, I find that many older children who have not had proper CAS therapy, and need to start with the essentials at the beginning of therapy. I encourage families to schedule at least 2-3 sessions a week, if possible. All the people who interact with the child on a regular basis are encouraged to participate in therapy. Video taping of sessions is helpful for modelling and practice. I ask parents to bring pictures and word lists that are important to the child to guide their functional needs and goal selection. Using the results of the evaluation, I would pick target vowel and/or consonant motor patterns to start with. I use developmental norms to guide my choices, but focus on sounds that would produce functional vocabulary. I use multi-modality cueing and strategies (including, visual, tactial, auditory) to assist children with forming speech motor patterns. Therapy is hard work, but I use toys and pictures in a way that is repetitive, but fun (e.g. cars going down ramps, putting pieces in a game, playing on the iPad). Feedback of performance is essential in establishing new speech motor plans and teaching children how to manipulate their articulators. Mass practice is the basis of early practice for mastery. We would work with a small inventory until mastered and then move on to new patterns that can be mixed for practice with older patterns. I work in a hierarchy going from single sounds, to syllables, and then to words/word approximations using the child's inventory of motor patterns. At the same time as the motor pattern practice, I would also incorporate AAC and/or sign techniques to give the child access to communicating their needs. I elicit essential vocabulary for the child from his family and any other people in their environment, and teach the communication method to all. I strongly encourage all of the parents and caregivers to participate in the therapy session and for them to learn methods for practice at home, which is vital in order to get the amount of practice needed to be successful in apraxia therapy.
Percent of CAS cases: 75
I encourage all parents, family members, and caregivers to participate in therapy. They observe sessions, do the activities, and model for the child. I develop the goals with the parents and use their feedback to pick functional objectives and vocabulary. I also take an inventory of their communication needs and environments. I have parents use a notebook to write down activities, examples, and homework assignments. They are also asked to write down examples of their use of therapy activities at home and their outcomes. I explain why I select goals and methods. Demonstrating how they can work with their child and then having them cueing their child for therapy goals is an important part of parent training and each session. Sometimes with older children, it does not work out for the parent to sit in on therapy. When that happens, I meet with the parent after the session and have the child demonstrate the skills we have been working on. A notebook can be used with these parents also for homework suggestions and feedback. If a parent or both parents can not attend, I will work with whomever brings the child. We keep a notebook with feedback and homework for the parent. Videos and Facetime can also be used for parents or caregivers who can not attend. I try to provide parents with materials about CAS to share with others. I encourage them to reach out to other parents with children with CAS through Apraxia-Kids.org, Facebook groups, and the Apraxia walks.
When I first start to talk to parents about CAS, I use this analogy. "CAS is like learning to play a sport. Let's say tennis. You get a ball and a racket that are in good shape. Your arms, hands, and legs are working fine. You hire a tennis teacher and go down to the court. The teacher demonstrates how to throw up the ball to serve, and then how to hit it with the racket. You see what he is doing, and understand what to do. You try to serve, but the ball goes one way and the racket goes another. You have no idea what happened. You saw what to do, but when you tried your body did not do it." I tell them CAS is like that. The muscles of your child's mouth, lips, and jaw are functioning properly. They can see what their mouth is supposed to do, but when they try to say the sound or word, it does not happen. I say that CAS is a speech disorder that involves the motor planning for the production of speech sounds and speech sound combinations. I explain that at this point we do not know what causes CAS, though we are doing a lot of research and we are starting to get some clues. There is nothing that they did that caused their child's CAS. I tell them that their child does not have brain damage, and their oral motor musculature is intact. I explain that their child's brain does not have the motor patterns to form words or put sounds together. I tell them that CAS is a programming problem, much like a CD in a computer that is missing a program. I tell them about the therapy process and how it differs for kids with CAS. I try to explain that it will take a lot of practice, and determination. I reassure parents that we will find a way for their child to communicate.
I have been interested in CAS since the beginning of my career 37 years ago. I had been treating CAS in my private practice for a long time before my first David Hammer seminar in 2003. I did not realize until then how many parents there were who were having difficulty finding a qualified CAS therapist. Since then I have been educating myself as much as possible about CAS and therapy techniques. I started specializing in CAS in my private practice, which unfortunately often had a waiting list. So I started doing whatever I could to educate other SLPs about CAS. I spoke to graduate students at California State University, Northridge on the "Secrets of Apraxia Therapy Revealed" (8/12/2007), and the "Diagnosis and Treatment of Childhood Apraxia of Speech Made Simple" (2/22/2007). Then I looked for colleagues to mentor in CAS. I was fortunate to find several that were willing to put in several years of sharing clients and planning therapy. I recently started a new private practice with one of those colleagues, Linda LaRue, called "Speech Specialists for Young Talkers". We wanted to highlight our work with children with CAS so that parents could find a qualified therapist more easily. We also wanted to make ourselves available as a resource to other SLPs. (I recently got a call from an SLP who diagnosed her young son with CAS, but had no experience in CAS therapy.) We went to an Apraxia Walk in Irvine, California to network with parents and other professionals who care about CAS. I am now also working for the Simi Valley Unified School District. I have made it my mission to educate the SLPs I work with in my district and in all of Ventura County. I recently gave a workshop for my district SLPs on "Assessment and Treatment of CAS" with Linda LaRue (8-15-16). I organized a viewing of David Hammer's webinar "Preschool Therapy for CAS" for all of the preschool SLPs in my district (I had to bring breakfast, because it was so early) on 10-5-2016. Then I just served as a Presenter/Moderator for "How Do You Tell If Your Unintelligible Student has CAS" at the Speech Language Pathologists Chat and Share for our whole county (10 school districts) on 12-9-16. And now I'm here signing up for Apraxia-Kids SLP Directory, so that I can continue to reach out to children and families with CAS.
Professional consultation/collaboration: Yes
Min Age Treated: 2 years old
Insurance Accepted: Yes