Wednesday, May 18, 2011

Childhood Apraxia of Speech Therapy Fundamentals: Part 3 - Methods and Content

Childhood Apraxia of Speech (CAS) is neurological speech disorder that causes children to have difficulty with the motor planning, sequencing, and programming necessary to produce volitional speech. Therapy needs to address the core problem of motor planning for speech in the most effective way possible. Every child is different, so therapy must be customized. Therapy for a young child who is nonverbal will be different from therapy for an older child who is using multi-word sentences, but the speech is hard to understand. However, the basic underlying fundamentals of therapy for apraxia are going to be similar. These underlying fundamentals are based on current research and professional consensus.

What methods are used during therapy for Childhood Apraxia of Speech?

When reviewing the most effective methods for treatment of children with Childhood Apraxia of Speech there seems to be a unifying theme and that is neurology. CAS is a neurological disorder. The areas and pathways in the brain that are typically responsible for the motor planning of speech are not functioning properly. The purpose of therapy is to retrain those areas to be more efficient at their job and to recruit other areas and pathways in the brain to help when possible. The best way to enlist other areas of the brain to help out is to take a multisensory approach to therapy.

Multisensory Stimulation Techniques

Typically speech involves listening to a speech stimulus and responding appropriately. This uses specific areas in the brain that are separate from the areas that listen to and enjoy music. The speech listening pathways are different from the areas involved in watching and interpreting visual signals. The speech listening pathways are different from the sensory receptors that feel touch on the skin.

What does all of that mean for therapy? It means that when you use multiple sensory pathways when trying to stimulate speech, you recruit other areas of the brain to help out the speech areas that are struggling. So, the speech therapist may use music to try to elicit speech productions to enlist the help of the part of the brain that listens to and enjoys music. The speech therapist may use tapping (tapping, clapping, or snapping with each syllable) to enlist the part of the brain that involves rhythm and basic math. Tapping draws the attention to each separate syllable in a way that simply saying them separately does not. You can use tapping to engage multiple pathways by gently tapping the child's hand or leg along with the syllables which also engages the part of the brain that senses touch. The speech therapist may use visual hand signals paired with specific speech sounds to enlist the part of the brain that interprets visual signals. The speech therapist may use touch on the child's face to cue certain speech sounds or movements.

For children who are nonverbal, often big body motions like swinging on a swing or bouncing on an exercise ball paired with music can help elicit some first sounds. The therapist will try to engage different senses to find one type of stimulation that helps or a combination of stimulation methods that help elicit speech.

Manipulate rate

Sometimes slowing down speech can help. Doing things more slowly allows more time for motor planning. Your therapist may incorporate practice with slowing down speech production to try to help your child be successful at producing speech targets.

What does a speech language pathologist teach children with Childhood Apraxia of Speech?

This is an incredibly complex topic. I'm just going to try to give you a basic overview of the type of things your therapist will think about when choosing goals for your child.

Your therapist will choose targets for your child based upon their professional expertise, their assessment of your child's current skill level, their knowledge of which targets would be age-appropriate, what the child is stimulable for, and their assessment of your child's most pressing needs. (Your child may be missing 10 age-appropriate sounds, but one particular missing sound makes him or her really hard to understand. That would be the sound to work on first.)

When working with children with Childhood Apraxia of Speech therapists are usually following a therapy principle called a series of successive approximations. Essentially, the therapist starts with what your child can do and treats that as correct. Then they try to get that a little closer to "correct" and treat that new level as correct. Once that is well established, they make it a little harder and call that new level correct. For example, your child might be saying "ba" for "bottle," but not very often. First your therapist will treat that as correct, and just get your child to do it more often. Then the therapist will make the task a little harder and try to get your child to say "baba." Now "ba" is considered to be incorrect and "baba is considered to be correct. Once "baba" is well established the difficulty would be increased again to "bata." And so on.

Specific therapy targets will vary widely from child to child. The targets may include specific consonant or vowel sounds, eliminating a speech habit (like leaving off consonants at the ends of words), increasing the number of words in your child's vocabulary, increasing the types of syllables your child can use, and increasing your child's utterance length (from no words to one-word utterances, from one-word utterances to two-word phrases, from two-word phrases to three-word phrases, etc.).

Summary

Your therapist will carefully choose individualized targets for your child based upon their assessment of your child and their professional expertise. They will slow down their rate of speech and your child's rate of speech to allow for extra processing time. They will use multisensory therapy techniques in order to engage as many areas of the brain as possible to improve speech production. They will start with what your child can do and gradually increase their expectations over time as your child improves.

You just finished Part 3 of a three part series on Childhood Apraxia of Speech Therapy Fundamentals.
Read the other two parts of the series:

You might also be interested in the following articles:

4 comments:

  1. Hi-
    I just found your blog today and really appreciate all of the information you have posted. My daughter turned 2 this week- suspected apraxia- and my son is 13 months- so like yours our children are very close! I suspected something was up with M when she was about 6 months old because she had very little babbling. By 12 months we had her in EI and 6 months later added private therapy. Expressive speech is her only delay- and as is common- the gap between expressive and receptive for her is huge- recently tested 36 months expressive.
    We have seen many improvements over the last 6 months- she is now talking in single words- no two word phrases yet but I expect they are soon to come as she has over 50 words now. She can imitate quite well- but of course the sounds are not always proper. She drops off the ends of words and can't get 2 syllables together yet that aren't cvcv. Both of our therapists are very familiar with apraxia- private is using the speech EZ program- both are trying different things to see what works best for M. Neither is doing straight Kauffman or promt- but they are doing a sort of variation of these methodss- lots of repetition- building on words, etc. We will be in therapy 3 days in Sept. I would love your thoughts on number of days at this very young age for therapy. She has fun with it- but I also don't want to over kill it when she is 24 months. I'm also concerned because I've seen some people say kauffman or prompt or nothing- and as I said- we are using a variation of this therapy- she is clearly very young for straight drills. wondering what your thoughts are for a toddler as you have been in the trenches with this. EI administered Kaufman praxis test one day after her 2nd birthday and she was 3rd percentile- I was sick to my stomach. She is verbal and has improved so much- I really question her being that behind the average kid. This was just another hard day- but has me questioning whether I need to do even more. We are on nutriveda and fish oil since 18 months. We are in NJ so luckily have access to solid therapy- and found our private therapist as the office is very involved in the local apraxia community and treats many apraxic kids. Thanks so much for your time- your blog is great!

    ReplyDelete
  2. Tracy,

    First, an apology for taking so long to get back to you. August just kicked my butt. I'm trying to catch up now though.

    Second, it is nice to "meet" you. Your little ones are even closer together than mine and a little younger. I can appreciate the amount of work you're putting in right now.

    Third, congratulations on getting M into early intervention so quickly. You were a year ahead of me on that. So wonderful! She sounds like she's doing really well considering the expressive speech delay diagnosis. 50 words at two is great. I hope you'll bridge over to the two word combinations soon. That's such a huge step. If you click on the "Learn More About Apraxia" link at the top of the page you'll find an entire post I did on techniques to help move from one word utterances to two word utterances. You should check it out. It is one of my favorite all time posts.

    As for therapy frequency: I feel like you're seeing a lot of progress with your current therapy schedule. Three times a week sounds good particularly if your therapists are giving you some practice exercises for the days you're not going to therapy (If not, you might want to check out the Kaufman Workout book. It is excellent.)

    As for therapy types: Again, you're seeing good progress with what's going on right now. If your therapists are experienced with apraxia (and it sounds like they are) they are probably customizing therapy for your daughter based upon the best techniques from a variety of methods.

    I know what it is like to feel like things are going well and then get a test result with a low percentage number. I had one of those days myself. I just remind myself that those tests are just one small piece of information in a much bigger picture.

    Good luck, and thanks for reading!

    ReplyDelete
  3. Thanks for the informative article. There are few well-known speech therapy clinic in Kolkata who provide speech therapy in Kolkata. Looking forward to more informative articles from you.

    ReplyDelete

Web Analytics