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- 3600 Hulen St. Suite D-1
- Carter Therapy
I begin primarily by building trust with my little patients with CAS. They need to understand that I will ask them to do things that may be challenging, but it will be worth-while; and with my help, they can be successful. We start with word forms that are within their ability, with some level of support. We build up those words until they can be produced volitionally. As those words are being developed and practiced with high frequency, I am always looking for new words that are important in the child's life and that they may be stimulable for, to bring new sounds and words into the repertoire. This is not necessarily based on the typical progression of speech sound development. In any given session, I target about 7-10 words with high frequency. After many years of treating children with CAS, I feel like the treatment techniques have become something of an art-form, knowing how to adjust the level of support for each production the child made. I adjust timing, pitch, and loudness to find the best way for the child to match the movements from one phoneme to the next. I generally do not focus on one phoneme at a time, rather the movement from sound to sound. I pay particular attention to the vowels and diphthongs, as these highly impact intelligibility. I do not teach approximations, and encourage accurate production on every trial. Other cues that I use, as needed, are tactile and visual prompts, for example manually helping the child squeeze his/her lips together , or using a pointing finger to highlight my lip movement for bilabials. As word forms develop, these are built into longer, multisyllabic utterances - phrases, and sentences. Throughout treatment, I am regularly observing and addressing language (especially morphological development), phonological awareness/pre-reading skills, and pragmatic skills, as I find that these are critical areas that are often challenging for children with severely delayed speech due to CAS. In addition, the use of signs, picture symbols and AAC are utilized as needed to help the children successfully express themselves and continue building their language and social skills, while we are working towards more intelligible speech.
I do not currently have strong involvement in the Apraxia community, other than being a resource that other professionals in the area, who turn to me for information about CAS or for sending referrals of patients that need this type of treatment. I have provided in-service training for the local ECI service. I have met with school teams, unfamiliar with CAS, to help them understand CAS further and more effectively treat patients that we share. I share research information with families who will be attending ARD meetings, so that they can effectively ask for and discuss CAS with the school teams. I have attended ARD meetings when families are not feeling heard by the school team, to support them in developing appropriate programming.
Parents are invited to be involved in the therapy sessions, though it is their choice as to how much specific involvement they wish to have. Parents are educated about the levels of cueing that are used (ex. slow- simultaneous, tactile cues...) and they are encouraged to try the techniques within the sessions, so feedback can be given and adjustments made. Parents are encourage to work on particular words/word forms that the child has shown success with. I do not provide word lists for drill. Instead, I demonstrate play based activities, or regular daily activities that would lend themselves to the need for these words. In this way the child will have greater motivation to use the words and can naturally be reinforced for using them. I encourage families to keep things positive, to avoid the "say this" prompt, and to use phrases like "let your eyes help you make the sound," "my mouth can help you" or "I love the way your mouth did just what my mouth did." All sessions end with a period to discuss successes and road blocks, and for parent to share words that would be high frequency or highly rewarding targets at home.
Many of my younger patients with Apraxia come with a highly restricted sound repertoire and therefore have unsuccessful communication attempts. Many are either "shutting down" avoiding communication or are having behavioral issues as a result of frustration. I often implement the use of sign language as a means for increasing successful communication attempts and expanding language.
When the use of speech and sign language continues to be insufficient for adequate expression, I have used both low tech (ex. PECS, Go Talk) and high tech (ex. LAMP WFL, and Dynavox). I have had significant training in using these resources. I work to increase one's ability to express needs, wants, and thoughts via AAC, and spend time training the family and the child's school personnel how to use the systems. This allows language to flourish, participation in social activity to expand, and helps to maintain socially appropriate behavior. I do, continue to work on speech accuracy while using AAC. I have had 2 patients, in my nearly 20 year career who did not make gains with speech, sufficient to support their communicative needs. Those are patients who were introduced to LAMP, and continue to work on expanding functional language with that as their primary means for communication.