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- 1268 Main Street, Suite 204
- Pediatric Communication Center
My treatment approach for children with CAS is not a "one size fits all" approach. Treatment is always based on an individual client's needs, however, evidenced-based practice and the principles of motor learning are always incorporated into therapy sessions. Within all sessions, a client is aware as to why he/she is in therapy and what he/she is working on in sessions and at home. I like for a client to have a level of motivation and ownership in the therapy process so individual therapeutic activities are tailored to the client and are fun. Typically, I recommend frequent treatment sessions during the week as this has been shown in the research to facilitate improved motor learning as opposed to less frequent and longer therapy sessions. Recommendations are made based on individual client need and severity of CAS. Within sessions, a high frequency of speech production practice trials are obtained. I typically begin with massed practice when a child is first learning a motor plan and then move to random practice to promote generalization of skills. I utilize Dynamic Temporal and Tactile Cueing (DTTC) methods, starting with simultaneous productions, a slowed rate and multi-sensory cueing to facilitate accurate motor plans for targeted words. Once a child has demonstrated successful simultaneous productions of a target, I move to direct imitation both immediately and delayed. At the direct imitation level, I will begin to vary prosody/intonation by using silly voices, character impressions etc. From there, we move to spontaneous production, often by having the client complete carrier phrases, answer questions etc. For multi-sensory cueing, I use David Hammer's sound names to cue for use of specific phonemes (e.g., the tippy sound) and provide verbal cues to assist in motor planning such as "start with your popper sound, lips close together." Visually, I use hand cues from Nancy Kaufman or Easy Does It for Apraxia. If a client is wiling to watch my productions, I always ask him/her to "watch me." I find this to be especially important in the simultaneous production phase of DTTC.For many of my clients, I develop functional word/phrase/sentence lists and allow clients and families to select words added to this list. These can be practiced in therapy and at home. We also add these words to a "brag book" so that clients can share his/her successes with family members/teachers etc. I am PROMPT level 1 trained, however, do not tend to use tactile-kinesthetic cueing unless a child seems to respond to this level of prompt. Within my practice, I typically find that DTTC and use of multi-sensory cueing is effective for change within a child's motor system. Knowledge of performance and knowledge of results is always incorporated in therapy sessions. Typically, I begin with knowledge of performance cueing when a child is first learning a motor sequence and then fade to knowledge of results feedback as we are moving toward generalization. I also reduce the frequency and timing of feedback as a child is moving toward generalization as well. Within sessions, I use a rule of 3 or 5, always having a goal of producing a target 3-5 times.
As a way to give back to Apraxia Kids, I served as the 2019 volunteer walk coordinator for the Greater Hartford Walk for Apraxia. Currently, I am a member of the 2020 Walk Committee as well. Furthermore, at the 2019 National Conference, I presented with a group of bootcamp trained speech-language pathologists and also participated in the “SLP is in” booth to answer questions parents had about their children with CAS. In the fall of 2019, I presented at a local community workshop at UCONN on the principles of motor learning and evidence-based treatment approaches for CAS. I train my employees on how to evaluate and treat CAS; my employees are listed on the Apraxia Kids website as well.
I make yearly financial contributions to Apraxia Kids as well as sponsor the Greater Hartford Walk for Apraxia. On occasion, my private practice continues to hold apraxia play groups free of charge to patients with CAS.
Parents play an integral role in the therapeutic process. At the beginning of each session, I ask parents how things have been going with home practice. We discuss successes and areas of concern. At the end of sessions, I consult with the parent to discuss what was worked on, how their child performed in the session and what was helpful (what cueing was beneficial) to elicit accurate sequences/target words/phrases etc. If possible, parents are always welcome to sit in and observe sessions so that cueing methods can be observed and practiced by the parent. If a client does not respond favorably to his/her parent being in the room, these cueing methodologies are explained and demonstrated at the end of the session. Parent feedback, suggestions for practice and concerns are addressed and considered each time a child is seen for treatment.