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- 812 South 2nd Street
- enTECH Rehabilitation at Spalding University
After an assessment and establishment of goals, I prepare for a session by finding toys, games and other motivating activities that I can use to address the individual child’s target sounds, syllable shapes and words. I want to ensure that I choose a small list of target words, with lots of opportunities for repetition with each word (as opposed to articulation therapy, where I would be targeting one sound in a lot of different words). Additionally, I would want to choose activities that are fun/motivating to the individual child, to ensure engagement. For example, if I had a child who’s working on VC syllable shapes, increasing consonant/vowel production in exclamatory words, and has a new target word of “apple” (a favorite snack), I would have the parent bring small pieces of apple to the session. One of my activities would be feeding apples to toys/stuffed animals and the child. I would first establish a simplified version of the target word (“apo”). I would hold the apple near my mouth while I gave models, to increase visual attention. I would also work on prosody by using the target word as a question when feeding it to others (“Apo?”) and as a statement/exclamation when accepting (“Apo!”). I would ensure that each piece of the apple was small, so that I could get lots of repetitions of the target word. To address other goals within that activity, I would work on “Yum/Mmm,” paired with movement (rubbing my belly) and work up to pairing the two targets together: “Apo? Yum!” In another activity, to address VC words, I might place animals in the barn, and work on “out” as we take them out. To address environmental sounds, I would work on pairing animal sounds with the VC word. During the activities, I would provide tactile cues (along with visual supports/other multi-modal cues that work for the specific child) to pair with sounds to increase body awareness and accuracy. I would also focus on play/movement-based activities, rather than doing table-top work. Additionally, I would ensure that my verbal models sound natural (not segmented, too fast or too slow). If the child was struggling with a target word, I would try either forward or backward chaining. I would ensure that the caregiver was present for the session, so they could observe techniques and I could give explanations/suggestions for home practice throughout the session.
My interest and involvement in the apraxia community began a few years ago, when I began seeing more kids with apraxia. That is when I started taking continuing education courses in apraxia, reading apraxia research and looking through the Apraxia Kids website. My goal is to attend the Apraxia Kids Bootcamp in the near future; until then, I plan to enroll in the webinar series to further my knowledge of apraxia.
Parents’ understanding and involvement in their child’s treatment is key. The first thing I do is make sure parents understand their child’s diagnosis, with an emphasis on how apraxia is different than other speech sound disorders. I then review evidence-based strategies that I use in therapy that are specific to apraxia, so that they can use the same strategies at home. Additionally, I work with the parents to create a “word wish list.” These are target words that are meaningful, salient, relevant to everyday life and realistically able to be mastered (for example, I wouldn’t choose “hippopotamus” as one of the first words to target). When parents are an active part of the treatment team and when they are providing input about what is important to their child, there is much more therapy buy-in. Additionally, once we have established target words for the week, I help parents think of natural ways to elicit target words. Apraxia should not be viewed as drill practice to do during a specified time of day. It should occur naturally and frequently. If one of our target words is “Mickey,” I encourage parents to play with Mickey cars and stuffed animals, get out Mickey stickers and use them for crafts, bake Mickey-shaped cookies, buy Mickey-themed diapers, play with Mickey bath toys, etc. That way, the target word is being practiced all throughout the day for maximum impact. All the while, the child is enjoying the activities and practicing the target word in a way that is low pressure and rewarding.
Determining the most effective form of AAC is my first priority. While my ultimate goal is to target the apraxia, it is crucial to establish some form of effective communication while the child is still an emerging verbal communicator. This will decrease frustration for the child and build communicative confidence. AAC can range from sign language (though this may be difficult if the child has limb apraxia/fine motor deficits), picture communication, communication boards, switches or more high-tech devices. It all depends on each individual child’s needs and abilities. Once I have established a form of AAC and trained the caregiver, I then focus on apraxia treatment strategies, while still encouraging use of AAC as needed.