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- 5675 Venture Drive
- Nationwide Children's Hospital
I typically start with the sounds and syllable shapes that are already in a child's inventory and come up with a small set of target words (often high frequency words). I use stimulability testing to continue to add to that initial set of targets and move from single words to increasingly complex speech movements. My strategies and techniques differ based on the severity of the child. I see a range of non-verbal to highly verbal but unintelligible kids. I use a combination of Strand's DTTC, Kaufman word approximations, and Hammer's multi-sensory approach (i.e. touch cues, sign language, visual cues). I make sure to get in mass/blocked practice and move to random practice as soon as possible in order to promote motor learning. In addition, I work on varying prosody early in treatment. I listen to what and who my kids talk about and often choose targets based on their interests and motivations. For my kids who are very young and minimally verbal, my approach is a combination of Cari Ebert's 10 goals and Laura Mize's steps to building verbal imitation skills.
I have participated and raised money for the CAS walk for several years. I am one of four "go-to" speech pathologists at NCH regarding CAS. I often seek out information from other area SLPs as well as experts around the country via email. I act as a resource for families to get connected with the CAS parents support group and encourage involvement in the walk. I attended the 2016 National Conference on CAS and wrote a letter of recommendation for a mother of two children with CAS to obtain a scholarship in order to attend the National Conference in 2018. I further my education each year with online webinars from the Apraxia Kids website and other CEU opportunities.
I like to have parents in the room for therapy. For cases when this is not possible, I leave time at the end of each session to go over what we did in therapy. Parents are always aware of our targets. I never send home a target word for home practice unless it is a successful word in therapy/in the treatment room, given no to minimal cues. I teach parents exactly how I cue- what I say exactly or what gesture or mouth posture I use. I explain to parents what to listen for - in other words, what the child is saying or doing wrong. For many kids who are initially starting therapy, parents and I collaborate to come up with a core vocabulary book. I tell parents what their child's best production/approximation is and make sure they understand the expectation. I explain how expectations change as the child's productions improve and how our specific cueing strategies change and fade over time.
For more established patients, I have a large inventory of documents containing a single picture, 10-12 times on a page. I tell parents to practice just the one target on the page- for example a picture of a "home" in order to get repeated trials. If there is a target word mastered in the therapy at random practice, I tell parents to ask them a question to elicit the target word as a response, at home, in the car, on a walk, or at the store, at random. I teach parents how to read to their child with CAS. I teach them simplify the text rather than reading all the words in order to practice just 1, maybe 2 targets at a time initially. I ask parents to provide me with a list of 10 words that are high frequency and motivating to the child. I often present this as listing their child's favorite things. This information provides me with possible targets that I compare to the child's sound inventory and word shapes. From a combination of these 2 things, I am able to come up with stimulus words.
I use and teach basic sign language with kids who are learning to speak. Often if they are initially non-verbal or minimally verbal, those signs remain useful once more verbal language emerges. I use sign language as a prompt for verbal communication and fade it as the child is ready. I have found this strategy to be immensely effective in eliciting verbal speech.
If I suspect high tech AAC needs, I refer to colleagues that have extensive training in high tech AAC.