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- 140 Kolekona Place
- Independent Speech Pathology Network
I have worked with VERY severe cases, which has afforded me the opportunity to work from the core of vowel production, establishing vowel accuracy and consistency quickly within the child's consonant repertoire. Typically this will include establishing accurate and consistent pure vowel production movements (ah, ee, & oo) within the child's consonant and familiar speech output repertoire, emphasizing accuracy for all contexts of speech that include the pure vowels that the child is able to produce/imitate. Emphasis includes family training and working with and training professionals across the child's weekly program, targeting positive practice (limiting practice of error productions), working from the child's familiar repertoire while maximizing novel attempts and approximations. Practice is intense and frequent, as the child's schedule and family financial ability allows (I am a private practitioner, and typically the families I work with engage me in advocacy, largely in the form of supporting school-based programs while increasing treatment frequency). Recommendation includes frequent treatment, especially initially.
In the past I worked with Apraxia Kids and hosted an Apraxia awareness event in the town of Moraga, CA. Currently, I have moved to the island of Kaua'i and am working with a few private cases as I establish myself here. I work with a very proactive family with a child with severe CAS and hope to raise awareness of CAS and the current working principles in detecting treating CAS here in Kaua'i.
From the beginning, parents are engaged to be active participants and to actively practice within and between sessions. Families are invited to videotape any aspect of treatment at any time and videos are shared with other professionals according to the parent's direction/discretion.
The family, typically one or two parents, are engaged dynamically in the execution of the treatment plan and trained in ways to manage generalization right from the beginning of treatment. The family and related professionals are engaged in moving quickly between block and random practice, from specific drill to real-world utilization, from speech to use of speech within linguistic contexts. To facilitate practice every day and several times within a day, families are provided with easy ways to incorporate both drill and linguistic-based speech practice as part of the their daily routine.
Increasingly I have decreased the use of high and low tech systems for families that seek my intervention for the primary goal of increasing speech comprehensibility/intelligibility. I have extensive experience with high (not as much recetnly) and low tech (more commonly, as the children I serve tend to be "lower" functioning in addition of CAS) systems, however, it has been my experience that all too often, especially within the school district service delivery model, that speech therapy becomes secondary to use of systems that emphasize language and functional communication in very young children. While it is easy to understand and consider how these systems can and should work together, my experience has been that AAC systems are used alternatively far more than augmentatively, with a resignation toward verbal/vocal communication in children who are young enough to learn the motor movements for sufficiently comprehensible speech and who should have a right to that function. My concern has been that the school-based service model does not have the capacity to provide adequate speech services for children with severe speech and language disorders that may require intensified and frequent treatment, let alone across two or more communicative systems (speech, AAC sign language, etc.) IF an alternative/augmentative system is incorporated in my intervention, where speech output is primary, it must use speech with the augmentative system. For example, if the child points to cookie, the accompanying core vowel along the way to the best approximation currently available to the child, is REQUIRED. Clearly, all approaches vary based on the child's current skill set coming into treatment. A child with an AAC system, for example, that functionally communicates with it and now is late in the game, adding speech, will be on a different program that a child who is young, starting out and maybe has access to good speech intervention along with AAC from earlier on in their communicative life.