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- 2290 E. Prospect Rd. Suite 4
- Achieve Therapy
I have found that children with CAS benefit from highly dynamic therapy approaches. We need to engage our whole system to really see how the motor planning is affected for each specific child. For this reason, our clinic has a weekly theme upon which all therapeutic activities are built. We try to engage all the senses in therapy sessions while maintaining strict control over distractions. We have found that having a theme provides a cohesive set of activities that makes carryover easier for parents at home and allows me as a therapist to choose very specific targets for the child based upon both ability and interest that are still highly functional. My goal for treatment of CAS is always the most functional change possible in the shortest amount of time. I begin the treatment plan at the level where is the child is beginning to breakdown to ensure challenge with some sense of success. We choose syllables and/or words of importance based on successful spontaneous consonants and vowels, frequently used words in the family, core vocabulary, and needed power words. We begin with the DTTC approach - simultaneous production moving to direct imitation, delayed imitation and finally spontaneous production. We work on stretching sounds rather than bouncing and have found backward chaining helpful for many children. Additionally, I focus on prosody and pitch for natural sounding speech early on. I always use a multi-modality approach - although the target itself remains consistent, how we engage the functionality of the target may change. I have found that if even very young children can see a sound, syllable or word is useful in many contexts, they are more willing to work hard to attain it. I use a cueing hierarchy as we move through targets. We utilize tactile, verbal/auditory, visual and metacognitive cues and fade cues and move from mass to distributed practice and from blocked to random targets as skills increase. We progress through targets as appropriate to develop functional, spontaneous and intelligible verbal expression
For the past few years, I have been involved with the Apraxia community only at a local level but recent changes in my availability now allow a more expansive involvement at a state/regional level.
Parents attend treatment sessions with their children. Parents are trained in the characteristics specific to CAS and cueing techniques to be used for carryover in the home environment. Parents are provided with written instructions for home practice activities based on the theme of the week at the end of each session that are specific to their child's needs and interests to best support parents outside of the clinic.
I believe AAC can play a vital role in facilitating functional communication for children with CAS. I always prefer verbal attempts but for many children at risk for learned helplessness, AAC is the perfect fit. I have written grants and have had the good fortune for some of my clients to receive iPads and appropriate apps. The way I choose to implement AAC for my clients is as a frustration fail safe first and foremost and as a tool for utterance expansion secondly. I believe AAC, whether low or high tech, is excellent for teaching the power of communication to a child who has not had the experience of communicative power verbally. Once we establish the usefulness of initiating and expressing needs and wants, I like to use the AAC device to help the have early success in expanding utterances but pairing a successful with a new challenging target. In this manner, the child learns his or her own power and control over the environment with the security of assistance for trying new targets. It has been my experience when using AAC in this way that children gain confidence to explore in messages with the device and then transition the skill verbally as able. For example, a young girl I am currently working with was recently using her device for requesting shapes for a puzzle. She verbally requested a successful target "more" and spontaneously used her device to request a new and challenging target "circle"