Gestural Prompts for Apraxia – Therapy Techniques

Using hand signals (sometimes referred to as gestural prompts or visual cues) paired with specific speech sounds has been very successful at helping children with apraxia learn and use those sounds. Every professional book I have read about apraxia has a section on this technique. Every speech pathologist I’ve been working with uses gestural cues. It has worked exceptionally well with Ava. I’m going to explain the therapy technique, give you a specific example of how we’re using the technique with Ava right now, and then give you descriptions of several of the prompts we’re using right now.

Using hand signals is very simple actually. You just make sure your child is actually watching you, and then use the signal as you say the word. For example, right now we’re trying to get Ava to use the /t/ sound at the ends of words. She’ll say “ha” instead of “hat.” I will repeat the word emphasizing the /t/ sound at the end and at the same time I make the hand signal for /t/ (tapping the index finger on your upper lip right under the nose). The visual cue in addition to the auditory cue really seems to help her focus on that missing sound. Almost all the time now, she’ll then repeat the word adding the missing sound. She often uses the gestural cue herself when she repeats the word correctly. We’re also using the technique in the middle of words. Ava will say “tu uh” for “turtle”. If I use the hand signal for /t/ while emphasizing the /t/ sound that should be in the middle of the word, she will repeat, “tu tuh.” She still can’t make the /r/ or /l/ sound in that word, but she can add the /t/ in the middle.

These are the gestures we are using as our hand signals. You can use a different signal, it just needs to be consistent.

• T - tap the index finger on the upper lip right under the nose
• D - tap the index finger on the lower lip above the middle of the chin
• P - close your fist and pop it open (into a "5" position)
• B - use the ASL sign for /b/ and tap the hand gently against the side of your chin
• M - gently pretend to pinch both lips closed together with your index finger and thumb
• N - push index finger against one side of your nose as if you're trying to close one nostril
• SH - finger across your lips like you're shushing a child

There are more. You can find a hand signal (or make one up) for any sound you might be working on. Here is a link to a great video of a woman demonstrating a hand signal for almost every sound. Some of her signals are different from what I described above and that’s ok. You can use any signal you’re comfortable with as long as that symbol is consistent. Also, don't feel like you need to learn all of these at once. Pick one or two to start with and if that goes well you can always learn more. Be sure to choose a sound that your child is currently working on and check with your SLP. She or he may already be using a hand signal for that sound.

Other than tapping, this is the technique that has been the most successful with Ava. I highly recommend it.

Two and Three

Michael and Ava are only 15 and a half months apart in age. So, when Ava was born, Michael was a very young one. Parenting a one year old and a baby was… challenging. We got very little sleep. Michael didn’t understand that sometimes Mama and Daddy needed to tend to Ava, and Ava certainly didn’t understand that sometimes Mama and Daddy needed to tend to Michael. Everyone was in cloth diapers. We changed lots of diapers and washed lots of diapers. There was lots of crying. It was just a rough time. The learning curve for jumping from one baby to two was very steep.

Fast forward a year. Now the children are one and two. They’re both mobile, but not particularly steady on their feet. They’re still both in cloth diapers. Only one of them is talking. This was worrisome. They’re old enough to both want the same toy at the same time. Going out was a challenge because they were both at ages where they had to be closely supervised to make sure they didn’t tumble down a small step, or fall into the creek, or try to climb something they couldn’t get back down from. Again, challenging.

Now we’re at two and three. This stage is nice. They’re both out of diapers (except when asleep). They both talk (yea!). They’re both relatively steady on their feet. I no longer feel like they must be wearing long pants when they’re walking on the sidewalk to prevent bloody knees. They can feed themselves at the table. They can climb up and down most play structures successfully. They can both get up and down the stairs safely. Almost all the baby gates are down. Even the one at the top of the stairs is rarely used. They’re playing with each other. They’re having conversations with each other. I am starting to remember why I wanted my kids to be so close together. I wanted them to be playmates and friends. That is starting now and I like it. I’m beginning to feel less like I’m drowning and more like I’m taking control.

I expect things will only get better from here. Well, better until they’re both pre-teens and teenagers at the same time. That will be a whole new challenge that is thankfully still very far away.

The Weekly Review: Week Four

Viral Video of the Week: At least three of my "friends" posted a link to this video on facebook. There were news articles about it. I'm sure you've probably already seen it. This is a youtube video a mother posted of her 17 month old twin boys having a babbling conversation in the kitchen. Everyone loves this video. It's adorable. It makes people laugh. My reaction was different. It made me sad and jealous and I'm proud of neither emotion. It just really emphasized for me that I never had that in my household with either of my babies. They did not babble normally (ok, at all really). It wasn't until I saw this video that I realized exactly what I'd missed out on.

Sibling Moment of the Week There are so many little conversations to choose from. Yesterday we came in from playing outside and Michael told Ava, rather bossily, to take her shoes off. She said, "O-tay Mai-Mai," and proceeded to take her shoes off. It was cute.

Michael’s Surprise Accomplishment of the Week: I picked Michael up from school and gathered the art projects they were sending home. There was a page that was pretty much all orange scribbles (a map he tells me). In the upper left hand corner of the page he had written his name. It wasn't perfect, by any means. I could recognize the first two letters, and the last one, and the ones in between were just scribbles, but it was instantly recognizable. He had done it completely on his own. His teachers hadn't helped him. I haven't been working with him on writing his name. It just came out of nowhere. I was very impressed.

Ava’s Song of the Week: Ava will cradle a baby squinkie in her hand and sing Rock-A-Bye Baby to it. Well, she sings something like, "Ra a baba" over and over, but still. It's adorable.

Project of the Week: Our library system will let you log in online and place books on hold. They send you an email when the books are ready at your local branch. Then all you have to do is drive there, pick them up off the shelf, and check them out. I spent an hour choosing board books for Ava and juvenile fiction for Michael. I threw in a couple of CDs (Raffi and Tom Chapin) and DVDs (Handy Manny) for fun. Today I picked them up. New books and entertainment for free. I'm going to try to do it once a week. Kudos to our county library system.