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- 4220 Proton Road, Suite 165
- Apraxia Dallas, PLLC
My approach to treating children with CAS is rooted in the principles of motor learning through my choice of stimuli, organization of practice, and type and frequency of feedback. Therapy sessions are individual, intensive, and frequent. I choose stimuli based on the child's capabilities demonstrated in dynamic assessment, taking into account his phonetic repertoire, phonotactic complexity, and functionality of vocabulary for the child. In beginning stages of therapy, I aim to elicit between 200-300 attempts in a 30-minutes session. I target stimuli in a modified block approach to allow for enough repetitive drill to reinforce the accurate movement gesture for each target, but while preventing overhabituation and promoting generalization. As the child's motor planning becomes more efficient, targets are elicited more randomly to promote generalization. Blocks of practice are reinforced with a quick reward that is motivating to the particular child. I provide frequent and specific feedback that increases the child's knowledge of his performance. With continued improvement of motor planning, I lessen specificity and frequency of feedback, shifting to increasing the child's knowledge of results.
I tailor my treatment specifically for each child's needs. I most closely follow Dr. Strand's Dynamic Temporal and Tactile Cueing (DTTC) method. In less severe cases or in the later stages of treatment, I adapt my treatment from Kay Giesecke's methods, which focus on improving the movement gestures for particular phonotactic shapes in progressive stages. This method also heavily addresses coarticulation across words at the phrase and sentence levels, in various coarticulatory contexts, to ensure natural connected speech. I rely on an integral stimulation cueing hierarchy with a combination of visual, tactile, and gestural cues. Maximal cues for a movement gesture begin with a spontaneous production between the clinician and the child at a slowed rate, paired with tactile cues. Cueing is gradually faded as quickly as the child is able to be successful over repeated trials of a target to ensure independence and generalization. I emphasize prosody and coarticulation from the earliest stages of therapy. I also engage the child in the intent to improve movement parameters for speech, which is essential to his motor learning. I draw the attention of the child to my face to give the child more awareness of the movement gesture required for speech targets. Caregivers are advised to attend and participate in all sessions to receive training for home implementation and to aid in generalization.
I have been treating children with CAS since 2014 at two different private practices that both specialize in CAS therapy. Currently I work at Apraxia Dallas, where 85% of my caseload consists of children with CAS. I have volunteered at the Dallas Walk for Children with Apraxia of Speech in 2013, 2014, and 2015. I attended Dr. Edythe Strand's CAS Advanced Training Workshop in September 2017, the 2015 Apraxia Kids Convention, and numerous other continuing education opportunities to improve my clinical skills in CAS intervention. I frequently offer consultations with my clients' school-based SLPs to help educate others about CAS.
Parents/caregivers are advised to attend and actively participate in all therapy sessions. They are asked to take notes during the session and given specific instruction on targets and cueing methods. Materials used in session are sent home to be used in replicating the therapy session for extra practice. Parents provide valuable information about what targets are functional and motivating for the child. They can also report on generalization outside the therapy room, as well as any behavioral accounts.
I often pair basic sign language and/or naturalistic gestures with CAS intervention for speech. Integrating AAC (especially high tech) into CAS intervention for speech is a professional objective I have set for myself for the upcoming year, as several of my current clients need both. I will be consulting with other SLPs who specialize in AAC as I collaborate with them on treatment planning for these clients.