SLP Category: Recognized by Apraxia Kids for Advanced Training and Expertise in Childhood Apraxia of Speech
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- Kerry
- Fewell
- Yes
- 1793 Desert Dawn Drive
Santa Clara
Utah
84765
United States - Red Rock Pediatric Therapies and Washington County School District
Santa Clara
Utah
84765
United States
I try to make therapy engaging and enjoyable while still maintaining focus on speech targets. Because the focus of treatment is to smoothly and accurately move from one sound and syllable to the next I use principles of motor learning and start with touch and visual prompts (Dynamic Temporal Tactile Cueing or DTTC) to help children accurately move their tongue, lips and other articulators through those transitions in motor movements that are required for intelligible speech. Like any motor task speech movements require a lot of practice with accurate productions of target movements. I try to schedule 2-3 shorter sessions per week versus 1 long session. During the therapy session I strategically choose 5 or less words to practice so the child has multiple opportunities to practice the correct motor movements. I strive to get at least 150-200 correct productions per session. Accuracy is important. In order to assure that children do not practice and repeat incorrectly I make sure to give them precise feedback on their productions. I begin practice with a simultaneous model, having the child say the target along with me and then move to a delayed model where they have to produce the target with increasing amounts of delay time from my production to theirs to work toward independently producing correct targets. I begin with "blocked" practice for learning specific movements repetitively and then transition to "random" practice of different movements for generalizing to speech outside of therapy. I use a variety of materials and activities in very short bursts to motivate and engage children and help them look forward to therapy sessions.
I have been a speech therapist for over 30 years and have had many children on my caseload with Apraxia of Speech. I have had the benefit of working closely with Occupational and Physical Therapists for most of my career and through that I have learned an enormous amount about motor learning theory. While working at a large hospital I was in charge of hosting continuing education events for SLP, OT and PT. Because of this I attended all continuing education even outside of the speech and language skill set. My first real work with CAS was inspired by Nancy Kauffman and what I gained most was the importance of accurate productions, multiple repetitions and shorter more frequent practice. Over the years I have followed the growth of research with CAS and have attended several education sessions with Edyth Strand regarding evaluation, treatment and use of Dynamic Temporal Tactile Cueing. I have also done reading and online education related to CAS. I have long used this type of cuing especially with very young and very severe cases of CAS. I am happy to hear the research support what I have experienced clinically for many years.
Parents are invited to attend all therapy sessions. When this is not possible they are given information regarding targets and performance of the child during the session. Once children are able to make accurate productions homework is given to the parent to provide frequent short bursts of treatment.
I have used AAC since the beginning of my career starting with pictures and moving on to the high tech speech generating devices of today. I have been a leader of an assistive technology team when I worked in pediatric rehabilitation at a hospital and now I am on the Utah Assistive Technology Team for preschool. My role is to work with parents, teachers, therapists and other staff to evaluate, procure and support use of AAC devices for a variety of children's needs. I have built core language into the preschool curriculum and assist all staff to provide multiple opportunities for communication with speech generating devices, picture communication as well as speech generating buttons. We have paper core communication boards in all of our classrooms at each work table, front of room and in the centers. We also have a core vocabulary board on the playground. It is critical to provide support for communication while children are working on their speech production to ensure that they do not develop further expressive delays, receptive delays from not being able to use speech effectively and develop healthy pragmatic and social interaction skills.