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- 3526 Longmire Drive Suite 102
- CHI St. Joseph Regional Health Center
My starting targets all depend on where the child is. I utilize all 3 cueing modalities, including verbal, visual, and tactile cues. I use the touch cues from the Moving Across Syllables program with good success. I like to write therapy goals working through a syllable AND placement hierarchy. For example, with someone who had imprecise vowels only, I would start by working on short and long vowels in isolation. If someone had imprecise vowels and an inconsistent consonant repertoire, say for example, they had trouble with bilabials, I would work on bilabials in CV combination, then CvCv, CVC, etc. I like to structure my treatment according to motor learning principles so sessions are heavy on drill, but also heavy on reward because these kiddos are working so hard! I think you have to be flexible and constantly looking for ways to motivate your the child. If they aren't able to attend to drill at a table, then I get creative and think of whatever "game" I can to get in as many speech productions as possible in the early stages of therapy. These kids are usually in therapy for a long time, so creativity is a must. Although I am often limited by insurance requirements, I try to see children with CAS for at least 3 sessions a week, if able. I always include family in sessions because they need to see and be there for our little treatment successes and know how to provide cues at home.
I have always had at least 1 apraxia kiddo on my caseload. I participate in raising awareness by wearing blue and informing others about CAS on Apraxia Awareness Day. Because I have consistently had kids on my caseload with apraxia, I have put several moms in touch with one another so that they could have a support system. One of my past patient's mothers eagerly meets with anyone I send her just to talk and be an understanding listener.
As mentioned above, and as a general rule, I have parents sit in on all my sessions. I think they need to be very involved from the get go. This includes helping provide case history and selecting high function target words. I also ask that they sit in on all my sessions and at the table so that they can be a part of their child's therapy successes and learn how to provide cues at home during their child's home practice. I teach parents how to do the same cueing that I do and encourage them to cue in the same way at home. I also have parents complete a daily home program with their child to facilitate faster motor learning and generalization.
I have used Pecs style sentence strips as well as various other low-tech devices including visual choice boards and visual schedules. I generally use a "first, then" board for my kids who drill where they can select what they are working for and see how close they are to getting it. I have secured an AAC device for one previous patient (iPad with TalkPath app) and have trialed iPads with Sonoflex, TD Compass, and MyTalkTools.