For children with CAS, I use intervention approaches that incorporate the principles of motor learning, mainly dynamic temporal and tactile cuing (DTTC)/integral stimulation. I begin with a small stimulus set of functional words that contain sounds from the child's phonetic inventory or in syllable shapes that the child has mastered. For beginning targets, I consider the principles of motor learning that facilitate acquisition (massed practice, blocked schedule, knowledge of performance). The DTTC/integral stimulation hierarchy is used throughout treatment. To promote generalization, I focus on distributed and variable practice, along with knowledge of results and delayed or inconsistent feedback. As a child progresses in therapy, new targets are selected based on his/her current sound inventory and mastered syllable shapes. Targets are practiced until a child produces the word/syllable sequence with at least 80% cumulative accuracy and the 3-point scoring system is used to determine speech accuracy of any given target word/sequence. Prosody and rate are focused on during the course of treatment. Parents are coached on helping their child produced mastered words outside of the therapy setting and in strategies to increase their child's literacy skills.
I read journal articles frequently by the leading apraxia researchers, attend continuing education events, and counsel parents regarding where to find resources related to CAS and how to advocate for their children. In the future, I would like to take part in the apraxia walks and fundraising efforts.
Parents watch treatment sessions and are coached on how to elicit mastered therapy targets outside of treatment sessions. They are educated on communicative repair strategies, recasting, and language stimulation techniques. Parents also learn strategies to increase their child's literacy skills while simultaneously working on speech production. I provide them with websites and resources to learn more about CAS in addition to information about support groups.
I have used both low-tech and high-tech AAC systems for students with CAS. Most recently, I introduced the Speak for Yourself application on the iPad for a student with severe apraxia of speech who has made minimal gains in treatment. I modeled frequently used core words using aided language stimulation during preferred and highly motivating activities. Using the device, the student was more willing to attempt to produce the target words verbally. He was also able to communicate his thoughts and ideas when he was previously unable to do so (outside of the use of gestures, facial expressions, and vocalizations).