{"id":308,"date":"2013-08-02T16:48:43","date_gmt":"2013-08-02T22:48:43","guid":{"rendered":"http:\/\/speechchick.com\/?p=308"},"modified":"2013-08-14T16:39:23","modified_gmt":"2013-08-14T22:39:23","slug":"a-systematic-approach-for-viewing-and-treating-apraxia-of-speech-part-five-choosing-therapy-targets","status":"publish","type":"post","link":"https:\/\/speechchick.com\/?p=308","title":{"rendered":"A Systematic Approach for Viewing and Treating Apraxia of Speech: Part Five – Choosing Therapy Targets"},"content":{"rendered":"

Part Five: Choosing Therapy Targets:<\/span><\/b><\/p>\n

When I originally began working with apraxic children I often chose therapy targets based on which sounds were easier to produce in isolation.\u00a0\u00a0 I then targeted those sounds in a variety of syllable shapes based on the research I had done on other apraxia approaches.<\/p>\n

But I quickly learned that I had to change my approach.\u00a0 The reasoning for this change started when I began working with a specific severely apraxic child \u2013 lets call him Johnny.\u00a0 When I began therapy with Johnny he could only produce the \/ah\/ vowel.\u00a0 That was it \u2013 nothing else.\u00a0 I began by using the one vowel he had to shape others vowels until he had a few vowels. \u00a0\u00a0I then used the sustained phonation modeling technique to help him put the vowels he could produce together to produce vowel-vowel movement patterns.\u00a0 I then began targeting some consonants and I started with nasals because they are usually the easiest to target in isolation.\u00a0 Once he could produce his nasals I again used the sustained phonation modeling technique to help him put his nasals together with the vowels he could produce in consonant-vowel movement patterns.\u00a0 After teaching nasals I then moved on to teaching stops because they are usually the next easiest to produce in isolation.\u00a0 We spent quite a while working on stops because although he could produce them in isolation, he had a great deal of difficulty producing them in a movement pattern.\u00a0 I eventually moved on to fricatives and was surprised how quickly he picked up multiple fricatives and was able to produce them in consonant-vowel movement patterns.\u00a0 I then moved him on to liquids, affricates, and lastly I went back and taught him stops again \u2013 and this time he was able to produce them in consonant-vowel movement patterns very quickly.\u00a0 This is where I began to change my way of picking therapy targets and moving through them.<\/p>\n

I realized how important sustained phonation is to factor in when choosing targets for therapy.\u00a0 I actually think it is better to follow the progression of sounds that are easier to produce with sustained phonation than it is to follow the progression of sounds that are easier to produce in isolation.\u00a0 So I typically follow that format now and have seen a great deal of success.<\/p>\n

I use this continuum to help guide me through choosing target sounds:<\/p>\n

Sustained Phonation Target Continuum<\/span><\/b><\/p>\n

\u00a0Easier————————————————————————————————–Harder<\/p>\n

\"apraxia<\/a><\/p>\n

I then move the sounds as quickly as I can from isolation into syllables or movement patterns using this continuum to help guide me:<\/p>\n

Movement Patterns Target Continuum<\/span><\/b><\/p>\n

Easier—————————————————————————————————Harder<\/p>\n

\"apraxia<\/a><\/p>\n

Currently Johnny is able to produce all sounds in isolation (vowels and consonants), all sounds in vowel-vowel movement patterns, and all sounds in consonant-vowel movement patterns.\u00a0 We have recently moved onto the vowel-consonant movement pattern and he can produce these movement patterns with only vowels and nasals.\u00a0 My next step will be to work on fricatives in vowel-consonant movement patterns. \u00a0I hope the progression of therapy makes sense now.<\/p>\n

I realize that this will probably be a whole paradigm shift for therapists who work with apraxic kids (especially teaching liquids like l\/r BEFORE teaching stops like p\/b\/t\/d\/k\/g).\u00a0 I had to adjust my whole way of thinking when it came to choosing targets for therapy.\u00a0 However I have noticed that although it may take my clients a little longer to produce a fricative or a liquid in isolation as it would a stop \u2013 they can move those sounds into actual movement patterns a lot faster and in turn can use them in words and phrases much faster.\u00a0 I have now used this approach with many of my severely apraxic kids and have seen phenomenal results.<\/p>\n

I believe these results come from one specific fact\u2026<\/p>\n

We must give our apraxic kids enough time<\/b> and direction<\/b> with their speech movements so that they can remember<\/b> and repeat<\/b> the movements later.\u00a0 And sustained phonatory modeling is the best technique I have found for providing this time and direction.<\/p>\n

We are so used to treating regular speech kids \u2013 we often rely on our knowledge there to guide our decisions when treating apraxic kiddos.\u00a0 But keep in mind \u2013 what is the most difficult think for apraxic kids???\u00a0 I believe it is the movement<\/b> from one sound to the next.\u00a0 Any time you can slow down that movement and provide more cues, direction, and modeling \u2013 the easier time the child has learning.<\/p>\n

Think back to Part One of my apraxia posts.\u00a0 I compared speaking for kids with apraxia to driving around trying to find where you are going without any map or directions.\u00a0 Now \u2013 if you drive slowly, looking at the scenery, the signage, the roads, the details surrounding the drive \u2013 how much better will you remember how you got to your destination and repeat your trip again?\u00a0 A lot better right?\u00a0 Now compare that to zipping along a road as quickly as you can without having the time to take in the details.\u00a0 How much harder would it be for you to remember and repeat the trip?<\/p>\n

So \u2013 I like to compare producing sounds without<\/i><\/b> sustained phonation (p\/b\/t\/d\/k\/g\/ch\/j) to driving quickly without taking in the details of the drive.\u00a0 This will likely impede your clients\u2019 ability to remember and repeat the movement later.\u00a0 Likewise, I also like to compare producing a sound with<\/i><\/b> sustained phonation (vowels\/m\/n\/f\/v\/s\/z\/sh\/th\/l\/r) to driving slowly and taking in the details of the drive.\u00a0 When you use a sustained phonatory model it gives your clients extra time to visualize, hear, and feel the movement that occurred.\u00a0 This will increase their ability to remember how they produced the movement and to repeat it later.<\/p>\n

** For more information about my systematic approach to viewing and treating apraxia of speech remember to FOLLOW ME on my 7 post journey. \u00a0Remember to add your comments, feedback, and suggestions so that we can work together to conquer apraxia of speech!!!<\/p>\n","protected":false},"excerpt":{"rendered":"

Part Five: Choosing Therapy Targets: When I originally began working with apraxic children I often chose therapy targets based on which sounds were easier to produce in isolation.\u00a0\u00a0 I then targeted those sounds in a variety of syllable shapes based on the research I had done on other apraxia approaches. But I quickly learned that […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[54,57,34],"class_list":["post-308","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-apraxia-of-speech","tag-choosing-therapy-targets","tag-speech-therapy"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/speechchick.com\/index.php?rest_route=\/wp\/v2\/posts\/308","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/speechchick.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/speechchick.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/speechchick.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/speechchick.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=308"}],"version-history":[{"count":2,"href":"https:\/\/speechchick.com\/index.php?rest_route=\/wp\/v2\/posts\/308\/revisions"}],"predecessor-version":[{"id":341,"href":"https:\/\/speechchick.com\/index.php?rest_route=\/wp\/v2\/posts\/308\/revisions\/341"}],"wp:attachment":[{"href":"https:\/\/speechchick.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=308"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/speechchick.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=308"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/speechchick.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=308"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}