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- 3424 Carson St, Suite 230
- Vivian Hsu, Speech Language Pathology
I love working with children with CAS. I have a hands-on approach as I utilize a combination of PROMPT theory and technique with some Beckman stretches and OPT (as needed if the child demonstrates oral weakness, poor oral coordination, and/or feeding concerns). Depending on the assessment results, I typically approach CAS by targeting planes of movement, as best described in the PROMPT motor speech hierarchy. - I start with mandibular control (jaw), then begin working on labial facial control and lingual control.. I typically establish target words to address the appropriate movements, providing tactile kinesthetic input. The types of PROMPTS would depend on the need, but I generally use a combination of parameter and surface PROMPTs initially and fade cues as motor learning begins. I do not use a 'syllable segmentation' approach as I believe in slowing down speech movements to allow for transitional movements, not breaking up words into syllables, as this leads to over stressed prosody and poor timing.
In 2006 and 2007, I began focusing on CAS as through the PROMPT courses (Introduction and Theory), while working at a multi-disciplinary clinic focusing on sensory integration. The clinic hosted several PROMPT courses, and I was able to help train a local school district with a PROMPT instructor. I also taught a PROMPT parent course in 2007. I began to do in services for local school districts on CAS and treatment after that.
It depends... in general, I want parents to be involved in the process and participate in therapy, especially for young children. For most children, this works out great! We are a team (me, the child, and the family) and I work first to establish that concept with children- that our sessions are a safe zone where they can practice and it's ok if it's not perfect. With parents, I use the principles of Hanen to teach them how to be child centered and yet also establish structure for targeted words. This takes practice as it often requires new interaction patterns with their child (ask less questions, add more pauses, model)... I also start to teach parents how to use their eyes not just their ears for speech sound production- to look at jaw movement patterns, retracted cheeks, etc. After the first month or sometimes a few months, I begin to train families on how to do parameter PROMPTs to help support their child's speech production. When it appears this is going well, and when a child is 80% accurate in the skill in therapy, I start to send homework, if the family is ready. Sometimes, families are not quite ready- there are other children in the home, etc. My first priority is for parents to be parents first, then spend 10 min per day with a 'speech hat' on, and go from there.
AAC is key for our severe CAS children- because communication comes first. I am so saddened when I meet children not only with CAS but also whole body praxis difficulties and their previous SLP was teaching them ASL as the primary form of communication. High tech AAC helps our clients learn syntax at the right age....I had a client who was nonverbal at age 6- she began using a high tech device at age 4. She became verbal and did not need to learn all the grammar rules- she had been formulating sentences on her device for years! I don't know what path each child will take, but my goal is to help them find their voice- be it their own voice, a computerized voice, or a combination of the two.