We've been trying NutriiVeda with Ava. I'm frustrated by the lack of anything other than anecdotal evidence of improvements, but given that lots of parents are seeing improvements with their children I had to try it. Tentatively, I feel like we've seen an increase in the amount of speech from Ava, and in the length of her sentences since we started using NutriiVeda about six weeks ago.
However, NutriiVeda is expensive and there is no scientific evidence. I came across a well written post on the blog of another mother with a daughter who has Childhood Apraxia of Speech. She tried NutriiVeda with her daughter for three months and did not feel like she saw significant improvements. She saw no regression when she stopped using the product. Check out her post on NutriiVeda. If you're thinking about trying NutriiVeda, you should read the opinions of people who tried it and didn't like it in addition to the posts of all the parents who love it.
While on the topic of the Apraxia Adventures blog, I really identified with her post on her son learning to kiss as well. I am way too familiar with that bittersweet feeling of being happy and sad (jealous!) at the same time.
Since both of my children have oral apraxia, I feel it when I see another woman's baby look at me and smile - so easily and naturally. I enjoy the smile. I enjoy the sweetness of it. And then I wish I had been able to experience that with my children. I wish it had been natural and easy. Or recently, I watched a video of a toddler Ava's age being interviewed by her mother about things like her favorite toy, food, game, etc. The video was adorable as was the toddler. Her speech was so clear. The sentences were so long. I want that ease for Ava. Will I always see other children through the lens of what I want for Ava?
Bah! Enough of this self-pity and sadness. Overall things are good. Improvements abound. I refuse to dwell overly long on depressing thoughts. I'll just share them briefly and then move on.
A Speech Pathologist Mother and Her Daughter Diagnosed with Childhood Apraxia of Speech
Thursday, May 19, 2011
Another Perspective (On NutriiVeda) Is Always Valuable
Wednesday, May 18, 2011
Six!!!
Ava loves cucumber and dip. She ate all the cucumber on her own plate (about 1/4 of a rather large cucumber). Then she eyed Michael's plate and asked if she could have his cucumber. He had already decided that he wasn't going to eat his, so he gave his cucumber to Ava. That quickly disappeared too. At this point, the girl had consumed half a cucumber.
She looked down rather pitifully at her plate and said, "No more on Ava's blue plate!" Six!! That's a six word sentence from the same little girl who had only three words in her entire vocabulary four and a half months ago. I'm practically speechless myself in awe and gratitude. (Standard disclaimer: No, that sentence was not pronounced "correctly" with every sound present, but all the words were there and I could understand them.)
She looked down rather pitifully at her plate and said, "No more on Ava's blue plate!" Six!! That's a six word sentence from the same little girl who had only three words in her entire vocabulary four and a half months ago. I'm practically speechless myself in awe and gratitude. (Standard disclaimer: No, that sentence was not pronounced "correctly" with every sound present, but all the words were there and I could understand them.)
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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 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.
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.).
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:
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