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- Seenu
- Varughese
- 12121 Wilshire Boulevard, Suite 1350
Los Angeles
California
90025
United States - LKS & Associates
Los Angeles
California
90025
United States
I will ask the child to warm up by having him/her open his/her mouth big/small, moving his/her hands big/small, moving his/her tongue in and out to work on volitional movement. We will practice carefully selected targets many times with various cues. For example, given adequate attention skills, I will tell him/her “Watch me” and the child would have to watch my mouth movements as we practice targets together at the same exact time (which is called simultaneous cueing). We will work on saying sounds, words, and short phrases, often repeating them in different ways to help the brain and mouth work together more smoothly. Any motivation to participate should be quick and not take away from participation in multiple trials, as the main focus will be to practice target words as many times as possible. We may do jump/movement breaks (while incorporating target words into the movement break) or have very quick play breaks (e.g. pushing on a balloon car toy to elicit multiple trials).
Parents are an integral part of the therapy process. When a child is first starting speech therapy, it is important to practice the various movements involved in speech production. I would first model for parents how to help the child vary between big, fast, and tight movements (e.g. opening the jaw wide, moving the jaw fast, and moving the tongue out far, respectively) and then contrast those with small, slow and little movements (e.g. moving the jaw minimally, moving the jaw slowly, and only moving the tongue a little and loosely). Parents can then incorporate these movements into practicing at home to assist with generalizing the skills. As we tackle single word targets (e.g. (e.g. I/eye, me, baby), I would take the time to explain what we worked on, how the child performed, and what the parent can do at home to reinforce those skills—like practicing a few of the aforementioned target words during play or daily routines. I would emphasize the importance of the parent and I being part of a team and that their involvement helps their child make faster, more lasting progress in settings outside of the clinic.
Regarding low-tech AAC devices or communication methods such as using signs, picture communication boards, etc., I will often incorporate them into sessions to decrease initial frustration and assist in establishing joint attention and engagement. With high-tech devices that provide a verbal output, I will often use them as an additional verbal model for the child to listen to, as well as possibly imitate. The severity of each CAS case and the existence of any co-occurring speech and/or language disorders are important factors to consider. For those children who have more severe cases of CAS who also have these disorders, an AAC device will most likely be more like-term. For children with milder or moderate cases of CAS with co-occurring speech and/or language impairments, AAC may be temporarily used to bridge the gap between frustration and functional communication. The focus will shift to working on movement and transitioning between syllables, as well as motor planning and programming. Overall, any AAC method or device should be used in conjunction with verbal speech in a total communication method to repair communication breakdowns that may occur in order to mitigate frustrations associated with poor intelligibility.
