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Apraxia Monday: “Speaking of Apraxia” Excerpt Chapter 7

By Leslie Lindsay

Here we are–back again to Monday (sigh).  Funny how that linear time thing works, huh?  I thought we’d plow right ahead where we left off before the launch of the book with another excerpt, this one is of Chapter 7:  All About Speech Therapy–Methods best suited to kids with apraxia. (From Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech, March 2012 Woodbine House). 

Therapy Strategies

Before we get into the nitty-gritty details of therapy strategies for CAS in particular, it’s good to know that there are two main types of approaches to speech therapy in general:

1)    The Bottom-up Approach. The SLP introduces easy to hard (simple to more complex) sounds/words such as vowels (V), as in “oh;” consonant-vowel (CV), as in “me;” vowel-consonant (VC), as in “up;” and consonant-vowel-consonant (CVC), as in “mom.”

2)   The Hierarchical Approach. The SLP starts where the child is presently performing; that is, she starts with what the child can say already.

Here, you will find various therapy strategies with a brief definition:

Therapy Strategy                  Definition

DIRECT MODELING  Used   in the early stages of therapy, the SLP demonstrates (models) the correct   pronunciation of a mispronounced word within a natural conversation. The   child looks directly at the therapist’s face. There may be immediate or   delayed imitation. You may like this example, “Watch me and say it with me. Now, say it as I mouth it. Now, say it   as I give you cues. Now, say it alone.”
INDIRECT MODELING  The   SLP provides frequent and correct pronunciation of a target letter. Say the   target letter is /B/:  “I see a boat. A blue boat. A big blue boat.   It’s beautiful.” A “back-door   approach” from SLP’s point-of-view.
PROMPTS/CUES(Prompt   is presented in upper-case for the purpose of this chart only. Please do not   confuse it with “P.R.O.M.P.T.,” a style of therapy developed by Deborah   Hayden, CCC-SLP) Can   be verbal or nonverbal. SLP might use this strategy to get the child’s   attention to focus; e.g., “Look at my   lips as I say kitty.” A visual prompt may involve showing a picture or a   card, or some other visual reminder. The goal here is to shape and stimulate articulators   (lips, jaw, tongue), improving functional communication.
SUCCESSIVE APPROXIMATION(May   also be referred to as “backward chaining”) Breaking   a word or phrase down and asking the child to get closer and closer to saying   it correctly over time—works well with multisyllabic words. For example,   Kelly had a hard time saying her name. Our SLP started with “say, ly [lee]” and then, “say Keh”—before long, she was saying “Kelly!”
EXPANDING Rephrasing   what was said in a more complex thought. “Cookie?” Becomes, “Oh, you want a cookie? Yummy. . . . I   love these oatmeal cookies. Here is a cookie for you.”
FADING Fading   is another way of saying eliminating a prompt. Once you have mastered a   certain skill, you no longer need that “crutch” to keep you going (think   training wheels vs. 2-wheeler). Now your child may only need part of the   prompt to respond.
ORAL AWARENESS & EXERCISE   For   a child who does not like touch to the face or does not seem aware of her   mouth structures, non-speech activities (oral awareness therapy) might be useful. If the SLP uses   hands-on cues and prompts, the child will need to allow touch. It is a   controversial topic, so if your child’s SLP works in this manner, ask what   she hopes to accomplish by using it. Her answer should be directly along the   lines of improving speech or feeding. Oral awareness and oral exercise should   be just a small part of each session and should be applied systematically by   the SLP. This type of therapy can be just the break a child needs after the   intensity of working on making speech sounds. Keep in mind, some kids with   CAS also have dysarthria, resulting from a weakness of the oral-facial   musculature. These exercises may help to strengthen them.
SYLLABLE FLEXIBILITY DRILLS (using Consonant – Vowel or Vowel – Consonant words) Uses   what the child can already say. Sequences such as ba-ba-ba-ba are repeated 4   to 10 times. Then the vowel is changed: ”now say bi-bi-bi-bi.” Next,   alternate the two sounds: “ba-bi-ba-bi.” Finally, throw in something   different: “bi-ba-bo-bu.” The difficulty is gradually increased over time.
Awareness   throughAUDITORY BOMBARDMENT Presents   words and phrases with targeted sounds. Similar to indirect modeling, above. Say   the targeted sound is /k/. You might read a list of words with the /k/ sound   to your child over and over. “I want you to listen as I read these words to   you: key, comb, coat, kitty, candy. . . .” You spend a minute or so reading,   two or three times a day. We even made up silly stories about words, “The   kitty wore his coat while he ate candy and carried the key.” Make it personal   to the child if you can. Help keep it fresh.
MINIMAL PAIR THERAPY This   type of therapy helps kids differentiate between two words that are different   in just one way, such as “bay vs. boy” and “cop vs. cot.” Minimal pairs can   also be used in listening activities as well as speech production activities.
MELODIC INTONATION THERAPY   (MIT)   This   treatment method was developed with adults   with impaired motor planning following a stroke (Broca’s Aphasia—these   adults usually have good comprehension, but poor speech). Melody and rhythm   are important for the prosodic features of speech such as word stress,   inflection, and emotion (a right   hemisphere activity). MIT has not been very effective for getting speech   motor plans/gestures to carry over to functional speech. This is probably   because motor planning/programming is mostly a left hemisphere function. MIT has been used with children in   combination with other approaches to facilitate the melody of speech.


Whew!  I know that was intense…but was it helpful?  Were you able to identify some of the techniques your SLP is using with your child?  Do you see some new ones that you may be interested in adding to his reportoire?  Remember, if you have any questions, please be sure to bring them up with your child’s SLP.  They are the ones best qualified to answer those questions.

Leslie Lindsay, R.N., B.S.N. is the author of the first-ever book written for the non-academic audience exclusively on childhood apraxia of speech.  She lives in suburban Chicago with two daughters–one of which has apraxia, a husband, and basset hound named Sally.  Speaking of Apraxia can be purchased through the publisher, www.woodbinehouse.com, Amazon.com, and Barnes & Noble.

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