Part Four: The Sustained Phonatory Modeling Technique
So based on the theory I have presented (The Movement Pattern Generalization Theory) we may only need to focus therapy on a movement pattern basis (2 pure speech sounds with the movement in-between). This theory is great – but I am sure all of the therapists out there (as well as parents) are wondering how this theory translates into the actual therapy process. Well, that is where the Sustained Phonatory Modeling Technique comes in to play.
If we know that the issue with Apraxia of speech is a movement issue – then we need to be targeting the movement in therapy – right? But how??? Well, over the last five years or so I have been perfecting the way I deliver therapy to my clients with Apraxia. I have studied and used techniques such as the Kaufman Praxis program and the PROMPT therapy program. Both of these programs/techniques are exceptional and helped me gain a feel for treating children with Apraxia. However, I always felt that the beginning stages of therapy were difficult as I tried to narrow down which targets I was going to focus on first – which techniques would be the most effective – and so forth. Through trial and error I have been able to use the things I have been trained to use in conjunction with my own problem solving skills to create a systematic treatment approach for children with Apraxia.
This model consists of you (the therapist or parent) producing a pure consonant or vowel and sustaining it. While sustaining your sound – use visual and tactile modeling to help the child imitate the sound. As soon as the child has begun imitating the first sustained sound – you (the therapist or parent) move on to the next sound and sustain it. While sustaining the second sound – use visual and tactile modeling to help the child imitate the second sound. Do not move on to the second sound until the child has produced the first sound and sustained it. Move slowly from the first sound to the second sound so that the child can gain as much information as possible about the movement (auditory and visual information). But begin practicing the movement faster and faster each time in order to teach the child the natural (vs. exaggerated) way to say the target. As the child begins following your movement pattern from the first sound into the second sound – help enforce the correct movement with tactile/touch support. Provide as much support as possible in the beginning stages to help the child learn the movement pattern with as little error as possible. Fade the support as soon as possible to help allow the child to become independent at the movement pattern. This technique is great because it allows the child to hear the target, see the target, and feel the target in a systematic fashion.
The most important factor in this technique is the sustained phonation of sounds. This is because Apraxia is a MOVEMENT disorder. If you present a sound (without sustaining it) and then try to help the child imitate the sound, and then move on to the next sound – you actually end up working on the sounds almost in isolation (all by themselves) and you miss the movement between the sounds. The movement between the sounds is the most important part of therapy when working with individuals with Apraxia. Remember in my previous posts how I mentioned the difference between artic/phonological kiddos and kiddos with Apraxia?? For “typical” speech kids (artic/phonological) we teach them how to produce Point A (/b/) and Point B (/eI/) – and they fill in the dots between the two to make a word (/beI/ or “bay”). But for kids with apraxia we have to teach not only Point A and Point B – but we also (and most importantly) have to teach them how to produce the dots in between the two points. We are literally teaching the MOVEMENT. It is almost impossible to teach the movement in between the two sounds without sustaining your phonation during your model.
**To learn more about my systematic approach to viewing and treating apraxia of speech remember to FOLLOW ME on my 7 post journey. And please remember to provide comments and feedback so that together we can conquer apraxia of speech!!!