Part Seven: Keeping it Functional
Throughout my posts I have demonstrated a simple and systematic way to view and treat apraxia of speech. One of the main points of this approach is that you only need to focus on practicing movement patterns and they will generalize to words, phrase, sentences, and ultimately conversational speech. This is a great approach because it is simple and systematic (two things that I love in speech therapy). Focusing on movement patterns is not only simple for you the therapist, but is also simple for apraxic kids who often just need to be shown how to focus on one part of a word at a time to be successful. When they can focus on perfecting the individual movements, then the overall combined movements become easier and easier. However, there is one downfall to this approach and that is its functionality.
If you spend a whole session drilling the /m/ sound in vowel-consonant movement patterns (um, im, am, om, etc.) that is not as functional as helping the child say (no, I, go, bye, etc.). The /m/ movement patterns may not be usable in functional speech right away. Some therapists and parents want their kids working on learning things they can use right away in a functional way – and I totally agree with this. Speech therapy HAS to be functional otherwise it is inappropriate (in my opinion). So, how do you use a systematic and simple approach and make it functional.
In order to accomplish this I like to divide my therapy sessions into two segments. A drill portion and a play portion. My drill portion often looks like what you may call a “massed practice”. This is where I usually choose one phoneme/sound and one movement pattern to focus on (ex. /p/ in consonant-vowel movement patterns). If my client is much further along in therapy and can move quickly through the targets I will advance them to targeting multiple phonemes/sounds in one movement pattern (ex. fricatives in consonant-vowel movement patterns). We practice these targets many, many times during the drill portion of the session. I typically shoot for hundreds of repetitions depending on the child’s focus and compliance. I use games, toys, and other techniques to push the child to practice the targets and I usually require multiple trials (at least 10) before earning a turn or toy. You want the child to practice the targets many times – so that they will be able to remember and repeat the target later. I use the sustained phonation technique when teaching these targets and provide a great deal of visual, auditory, and tactile support to ensure that the targets are being produced correctly. I then try to speed up the target and reduce the amount of support with each production. My goal is for the child to be successful and independent when producing the target.
The next portion of my therapy sessions looks like a play portion. During this portion of my sessions I usually like to just play with the client. I usually come up with a few specific target words or phrases that contain the phoneme/sound and/or movement pattern we just practiced – but in a functional word or phrase. I then try to model the words/phrases during the free play as much as possible. I try to keep my verbal utterances around or slightly above the level of the child’s. I offer help (visual, auditory, or tactile support) when the child attempts to imitate the functional words/phrases I produced. I keep this portion of the session more light-hearted. I let the child lead more, and guide what we are going to do. I want them to feel that it is an environment where they can attempt to communicate and not be so overwhelmed. I want them to feel successful. I want them to realize that communicating (even if it is only a sound or two) can have meaning and can help them get their wants/needs met.
I believe that both the drill portion and the play /portion of the sessions are important. The drill portion is specific, it helps the child learn the movements in a very simple, slow, and systematic way. The play portion is more free, it helps the child learn how to incorporate the things they learn in the drill portion into their everyday life. I have found that using a drill portion and a play portion in my therapy sessions, combined with the movement pattern generalization theory and the sustained phonation modeling technique – that I have had a great deal of success with many of my severely apraxic clients.
** For more information about my systematic approach to viewing and treating apraxia of speech remember to FOLLOW ME on my 7 post journey. Please add your comments, suggestions, and thoughts so that we can work together to conquer apraxia of speech!!!
Thank you so much for these posts. I cannot wait to start using this with my kiddos! Could you explain a little more what the play portion of your session looks like? Also, what is the frequency and duration of your session?
The play portion is really just a more “child directed” portion of my sessions. This is where we play with games and toys. I use a lot of parallel talk – modeled words/sentences. I choose targets at or just above the child’s level. This part of the session is probably the most difficult because I have to be very flexible and creative within the session. I don’t pre-prepare too much for this portion. I just have ideas or words that would line up with the targets we focused on in our drill portion. I then try to “work in” more functional word/sentence models during the play portion. For example, if we worked on VC combinations in our drill portion – I would think of actual VC words to target during play (on, up, um, I’m, in, etc.). I would then auditorially bombard the client during the play portion with lots of models of these real words. I would provide the child with as much visual, verbal, or tactile cueing necessary for them to attempt to imitate these target words. Hope that helps (and makes sense).
Exceptional posts! What you are saying makes total “common” sense based on the research about CAS. Thank you!
Great information 🙂
from fellow SLT Jade
How long is your typical session (for a child with apraxia) and how many times per week?
Since I only take private pay clients it honestly depends on what the parents can afford. Most of my severe apraxic clients come 2 times per week for 30 minute sessions. Then they practice 5-10 minutes at home with their parents on the days they do not attend speech.
I wonder what is the best way to improve a lisp in a school age student
It depends on what is causing the lisp. I would recommend trying my Tongue Thrust Checklist to see if the child has a tongue thrust. If that is what is causing the lisp than you would need to treat the tongue thrust in order to eliminate the lisp.