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- 4220 Proton Road, Suite 165
For a child with moderate-severe CAS, I would typically recommend a frequency of 3-4 30-minute sessions a week, since shorter, more frequent sessions are shown to have better results for motor learning than longer, less frequent sessions. My first goal in therapy is always to ensure that the child has access to a functional communication system, whether that is their natural speech, sign/gestures, picture symbols, or high-tech AAC. While improving motor planning for speech is the ultimate goal, every child needs access to a way to communicate.
When it comes to motor learning therapy, the therapy model I most frequently use with moderate-severe cases, especially early in treatment, is Edythe Strand’s Dynamic Temporal and Tactile Cuing (DTTC). Early therapy sessions focus on developing readiness to participate in DTTC, by developing a positive rapport/relationship, learning what motivates the child, increasing their ability to attend to my face and movements, and establishing cues that help the child. It is especially important to help the child learn to move simultaneously with me so they can match my movements accurately when we begin word targets. Early targets will often be 5-10 words or phrases, selected based on sounds child can make successfully. We want these targets to be a variety of syllable shapes such as CV, VC, VV, CVC to prevent overgeneralization. These targets should be powerful and functional for the child, such as “yeah, no, me, mama, bye, up” etc. When the child is ready, therapy will be focused on achieving a very high number of correct repetitions of these targets through drill with quick, reinforcing play activities to keep the child engaged. Because correct practice is so important in motor learning, I will use as much cuing as the child needs to produce the target accurately. This cuing may include modeling (ranging from simultaneous to direct to delayed), verbal cues (i.e., open/close, big/small, tight/loose), tactile cues (i.e., PROMPT method and other tactile support to assist in placing articulators), gestural cues, visual, and/or linguistic cues such as fill-in phrases or questions. As the child’s production improves, this cuing is carefully faded to maintain correctness while giving less and less help, until the child is able to produce the target on their own.
As the child’s motor learning improves, this process moves more quickly and we are able to expand the number and types of targets we work on during a session. For a child who has moved beyond single words and phrases, I employ a more varied therapy approach, using the principles of motor learning to target new speech movements, coarticulation and prosody in longer utterances, and expressive language targets that have been impacted by motor learning, such as difficulty motor planning multiple verb tenses. I also offer Rapid Syllable Transition Training (ReST) when appropriate.
I currently work at Apraxia Dallas, which hosts the North Texas Walk for Apraxia and Apraxia Ranch Camp each year (COVID permitting), so I look forward to being a part of these amazing community events to increase awareness of Apraxia, raise money for Apraxia research, increase educational opportunities and access to services for families, and offer training opportunities for fellow SLPs. I also enjoy following Apraxia advocates and professionals on social media and would love to expand my use of online platforms to further support and educate others about Apraxia.
In our clinic we strongly encourage parents or caregivers to attend therapy sessions as often as possible and learn as much as they can about their child’s targets, how we practice them, and how to best carry over learning at home. Throughout sessions, I enjoy talking to parents about why we are doing what we are doing, and providing education about the motor planning errors/patterns I’m observing and targeting. When targets are ready for generalization, I reinforce the importance of correct practice (vs negative practice) and model how to best cue for success. Often by this point, the parent or caregiver has observed and participated in enough therapy to feel confident with home practice! Parents are also involved in the selection of targets, as they know best what their child needs to be able to communicate on a daily basis and will be motivated to practice and use.
I am a huge advocate for incorporating AAC with any child who needs access to more language than what they can produce using natural speech, which is very often the case for children with Apraxia. When working with children who may need shorter term AAC solutions or are early communicators, I have introduced a low-tech core board/binder or picture exchange system. For children with the fine/gross motor ability to use sign or gesture, many families enjoy this option as inexpensive, always available, and easy to implement for basic functional communication. When I am working with a child who needs access to a more robust vocabulary and a full range of language functions, I have helped families select and implement high-tech speech generating systems including LAMP Words for Life, Tobii Dynavox, and Proloquo2Go.