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- 45 Dressler Drive
- Yakky Duck Speech and Language Services
After targets are chosen treatment begins. I begin by practicing targets simultaneously with the client and over time increase the length of time in between productions until the child can spontaneously produce the targets. I begin with blocked practice, or practicing targets in quick succession, cueing the client as needed. As the child improves, we move to random practice, or practicing targets once or twice randomly throughout an activity. The reason for this is that research indicates blocked practice facilitates quick learning however random practice leads to better retention. Initially my goal is for a child to gain the skill but as time progresses we begin working on retention and carry over of the skill into everyday life. While practicing these targets within a session, my goal is always to produce as many trials as possible. CAS is a motor based disorder and the principles of motor learning tell us that more practice is better for muscle memory and leads to better retention. As such, the activities I choose are simple and reward based motivators that naturally provide opportunities for practicing a target 50-100 times per session. This can include games with many pieces where the child gets to move or place one piece of the game or toy in between each turn practicing the target word(s). Again, as time progresses and we move towards distributed practice these games become more complex and more functional for daily life activities and less drill-based. Finally, I always provide families with homework to do between sessions. While 30 minutes or 45 minutes a week can provide lots of great practice this is not enough. I use the metaphor of kicking a soccer ball once a week versus 10 times a day every day or practicing an instrument once a week versus everyday. CAS is a motor based disorder and requires the speech muscles to constantly practice the correct movements the same way we would practice for sports or other muscle related activities. I provide families with the current list of target words as well as with suggestions for practice at home personal to each client's needs, level in the cueing (simultaneous, direct imitation, etc.) and practicing (blocked vs. random) hierarchies, and home environment.
My involvement in the apraxia community involves sharing resources and materials with the families I work with. I also provide support to my fellow SLPs whenever they have questions regarding assessment or treatment of CAS. Along with this, I am also a member of social media groups that support the Apraxia community, such as Apraxia Kids and Apraxia Kids Canada.
Parents are very involved in my therapy process! At the initial session I have parents work with me to create a list of meaningful words to their unique child in order to begin working on those. I invite parents to sit in the room during therapy sessions so that they can observe the therapy including the words we are practicing and the cues I am using. At the end of each session I give parents the list of target words for that week to practice at home in order to encourage motor learning at home and increase their child's progress. I compare this practice to that of kicking a soccer ball or playing the piano. The more you practice the better you will be!
I have used AAC to support children with CAS as a way to supplement their message. For example, I worked with a child who could only produce work approximations. This child also had a low tech AAC device. He could point to the picture corresponding to the word approximation he was producing. This allowed a greater variety of people to understand his communication.