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).
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.