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- 4616 Allamore Drive
- Play With Words
Following the assessment, I will make initial recommendations and determine initial therapy goals. The treatment will focus on improvement in movement transitions in the context of speech. At first, I provide maximum support for a child to achieve accurate production but will fade those cues over time. I will choose initial stimuli/target words based on a child's consonant and vowel repertoire and syllable shapes that he/she can achieve with cueing. If CAS is severe, I will choose fewer words to target and provide more support for accurate production. It is very important for a child to be motivated and engaged in therapy. I will often choose target words that will be the most beneficial to a child's social and emotional wellbeing: names of family members or pets, favorite toys, words like "mine", "mom", "eat" and "no" while considering a child's current emergent motor skills. For example, the child with severe CAS, who can only say few vowels and loves animals and cars, can initially practice vowel to vowel coarticulation while pushing cars down the ramp-" whee", cars crash- "uh-oh", police car can sound "Waaaaaahhhhhhh", monkey can ride the car-"oohooh eheh" and so on. Because the goal of treatment is to improve movement accuracy, it is important to implement the principles of motor learning. If a child is able to focus attention on my face and attempt imitation, I will use Dynamic Temporal and Tactile Cueing (DTTC) treatment approach. If the CAS is severe, the blocked practice of target words with multiple target repetitions will be the most beneficial at the beginning and will help to improve motor performance. As a child's motor skills improve, random practice will yield faster generalization of skills to other contexts. We will start with the simultaneous productions of target words, and this is why it is important for a child to watch my face. Sometimes a child might need tactile cues to achieve correct phonetic placement and correct timing. I am PROMPT trained and use the PROMPT tactile-kinesthetic (touch and feel) approach to guide a child's jaw, lips, and tongue to move to correctly form words. With time the prompts are faded giving the child increasing responsibility to produce target words on his/her own. Parents are an integral part of the therapy process: they are required to attend the sessions and practice target words in other settings which will drastically improve the speed of skills generalization. It is also important to remember that CAS often occurs with phonological delays and language disorders as well as cognitive delays and medical conditions. This is why thorough initial assessment and therapy tailored to an individual child considering his/her strengths and weaknesses is an absolute must for good therapy outcomes.
I always collaborate with other professionals working with my clients through phone calls, emails and school visits and discuss how apraxia affects child's communication and academic skills.
Parents are an integral part of the therapy process: they are required to attend the sessions and practice target words in other settings which will drastically improve the speed of skills generalization.
I often see children with severe CAS who are minimally verbal . Many of them are children on the autism spectrum. I encourage parents to bring child's augmentative communication device to speech sessions and model at least 50% of the time the language uttered in a session on child's device. I educate parents to continue at home in the same manner. I prefer AAC with robust vocabulary so the adults can model language with good vocabulary and grammar for a child to pick up on. Many children with CAS can express themselves well through AAC if the right amount of modeling is provided and this in turn reduces their frustrations during communication breakdowns..