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- 201 Beechwood Drive
- ConnectAbility Speech and Language Therapy
First, I do everything I can to get them in a 1:1 or 1:2 group. In a school setting with a high caseload that requires sacrifice on my part but I know may CAS students need this small size in order to get mass practice and trials. I have studied and like to use the Dynamic Temporal and Tactile Cueing (DTTC) Approach but my sessions look different depending on the age of the child and the severity of CAS.
My sessions begin where the breakdown occurs although I always try to begin and end a session with success to keep the child invested in the activity. My therapy sessions are play based or literacy based - or what ever the child is interested based. My targets are FUNCTIONAL and MEANINGFUL to the child in order to give the child power through communication at a very basic level. When kids need prompting, I find out what works best for them and use that as often as possible. It might be physical or gestural such as using a straw/bite block or hand signal. It could be visual/verbal such as simultaneous productions with or without voice or using a mirror with a sound cue card attached. Sometimes a child only needs a metalinguistic or placement cue. I use what prompts and cues I need and then fade quickly when no longer needed. The goal is always 100%. Practice at the beginning is massed and blocked and and I let the student know how he or she did on a particular trial using performance based feedback - for example, ""I heard you say doe!"" or ""Where is that /s/ sound?"" As a child begins to master a syllable shape or word, I begin to randomize and make the trials more varied followed up by providing results based feedback (Good Work!) to encourage generalization before moving on to a new syllable shape target, always keeping the movement sequence at the front of my brain. NO SEGMENTING! Coarticulation teaches the most natural movement sequences so that speech sound natural. I use core words to create meaningful pivot phrases, eg, Go daddy, Go see, Go up. I use visuals to teach ""stretching"" the sound such as rubber bands, cars moving, whatever might keep the interest of the child. I like to involve whole body movement when possible for younger children. AAC if needed is a good idea to give the child some type of functional communication.
My involvement in the Apraxia community has been within the walls of my school while working with students and families. I have dedicated much of my free time recently reading, research and watching videos (thank goodness for YouTube and Instagram and Edy Strand, Carrie Ebert, Amy Graham, and Jennie Bjorem!) published and produced by some of the best in the field. My caseload in the school where I am employed is made up of students with many different communication disorders, but it seems that lately I have had the opportunity to work with more students with CAS. In addition to those on my caseload now, I have been called to consult with others who have questions about their students with CAS and have provided summer therapy to children with CAS. I am currently starting a private practice and I would like to specialize in treating children with speech sound disorders including apraxia. There is a need for someone in this area with that expertise. As my practice grows, I would like to provide educational materials to local pediatricians and child development specialists in my area to help increase awareness of CAS and also HOPE for a better life for children with the disorder.
In my school setting, parents are involved in the referral process and called back to review results. When a child has signs and symptoms of apraxia I inform them using modeling and descriptions as well as literature that is written in parent friendly terms. I help make each parent or caregiver feel as though they are in important part of the treatment process because they are! I explain to them how apraxia differs from more common articulation or phonological disorders and how the treatment differs as well. Children receive quarterly report cards or progress notes and I make materials that are appropriate for home practice and make sure they are sent home with the child each day and updated when needed. During the recent COVID-19 outbreak I have been able to continue to see my students via teletherapy and while this isn't always ideal, one HUGE benefit that I have discovered is having parents participate in therapy sessions. They get to SEE what I am doing which isn't possible in the school setting. The progress has been amazing for my students across the board.
Currently I use low tech with the student that I serve with severe CAS by providing cards (similar to smarty symbols or lesson pix) to help with language development and promote early literacy skills since this child has a learning disability, severe language delay and is also an ELL. They symbols also serve as communication "enhancers" to have needs met or to help the child express wants or desires in the classroom and school setting.