Re: Explain how Apraxia therapy is different?

[Guest guest]

Marie,

My son had st at school during the summertime. The slp didn't

really know to much about it. So she read about it. Then she

got " Easy does it for Apraxia " . My son used it for a total of 4

hours during the summer with her and with me working with him at

home he learned his long vowels! You might want to look up that for

your st to use with your child. Just do a search for it. It only

costs about $50.00.

Alison

> I have a limited amount of resources where I live .Although my son

does

> recieve EI services ..I am wonderng if I can direct my SLP to the

kind of

> therapy done for Apraxia ...right now she does alot of things

like repeating

> the same sound and sign language ..she is just barely addressing

his oral

> problems , which he seems to have the most problem with ?? I am

frustrated

> How is apraxia therapy different ???

> Thanks so much , Marie

[Guest guest]

Marie, below are quotes from a good article about what works for apraxia.

Here's my " translation " of a few of the paragraphs in the article:

The first paragraph quoted essentially says that " off-the-peg programmes "

can't be expected to work without the " human factor " coming into the

equation. In other words, therapy for apraxia shouldn't amount to a

therapist buying a book like Robin Strode's " Easy Does It for Apraxia " and

starting at Page One for every student diagnosed with apraxia. The therapy

should consist of an assessment of where the child is at currently, what

sounds s/he can already make and how consistently, and then a plan can be

made for " where to go from here " . Ally, for example, was able to make the

SH sound early on. Her R sound came in at a developmentally appropriate

age. Focusing on either of those sounds in therapy might be a waste of

time.

Paragraph two refers to a planned, systemmatic approach sometimes working

well. Some therapists will simply state that " We're going to work on p, b,

and m this month " . Others will document more specifically how many times

the child is able to execute those sounds within a session. Parents should

see some " method to the madness " even with a laid-back therapist. It might

feel like play-time to the child, but the parent will be able to hear a lot

of M-words and M-sounds over the course of the session. Parents should see

some progression over time (over a period of weeks or months), moving from

p, b, and m to other sounds. If you aren't seeing progression, you could

expect to see some troubleshooting on the speech therapist's part, trying

other ways to get the sounds.

Paragraph 3 explains that the severity of the problem will suggest treatment

options. A completely nonverbal child is more likely to be considered for

augmentative and alternative communication like sign language than a child

that can say some sounds. Some things that tend to work include using music

and singing, lots of repetition, working on oral motor movements that aren't

related to language (blowing a kiss, etc.), helping the child to make the

sound by touching his/her face or using a tongue depressor to move the

tongue to the right place, the therapist modeling the sound, and using

visual pictures as prompts. Showing the child that there are clues to be

found by watching others make the sounds -- and by listening to the sounds

as they're made -- is a helpful skill to teach. Sounds shouldn't just be

taught by themselves, like " make the mmmm sound " . The " mmmm sound " should

be paired with modeling and teaching age-appropriate m-words that the child

can use. The family should be shown how to help the child to get the sounds

out so that there is some speech practice at home that mirrors what was

learned in therapy.

The article proceeds to clarify more components of therapy. I know that it

can be hard to read through this stuff the first time due to the

professional terminology, but it's worthwhile for people who want to

understand what to expect from therapy.

----------------------------------------------------------------------------

----------------------------

Quotes from an article by Niklas , " Acquired Speech Dyspraxia "

Published in _Disorders of Communication: The Science of Intervention_,

Margaret M. Leahy, c. 1989 (excerpt received from National Information

Center for Children and Youth with Disabilities, 800/695-0285, free for

parents if you call and let them know you have a child with apraxia and

would like information)

Treatment: Some General Principles

" ...off-the-peg programmes linked to particular medical-model syndromes will

not necessarily address the needs of the individual client, other than by

default. ...pinpointing nodes of breakdown within a speech-production model

framework indicates which processes in speech production are leading to the

identified breakdowns in intelligibility and in turn shape the content and

form of therapeutic tasks.

" Several works deal in a general way with the objective design of

intervention (McReynolds and Kearns, 1983, Dworkin, 1991). There are also

several exemplary approaches to speech dyspraxia...which illustrate the

systematic construction and monitoring of therapeutic tasks and change

(Wertz et al., 1984; articles in Square Storer 1989; Dworkin, Abkarian and

s, 1988)... Other carefully designed routine clinic-based studies of

speech dyspraxia therapy include Lambier et al. (1989), Rau and Golper

(1989), Square-Storere and Hayden (1989), and E. s (1989).

" Intervention varies with severity of the disorder. ...the person may be

mute and efforts will be directed towards eliciting any sound and

establishing some (alternative) communication channel (Coelho and Durry,

1990; Fawcus, 1990). Methods include stimulation via so-called automatic

actions (singing, humming, over-learned material and series); via

paralinguistic and non-verbal gestures (tut-tut, yawning, blowing a kiss);

by physical placement of the articulators by the therapist; through

imitation (with/without verbal); and by following static or moving

pictograms/articulograms. Emphasis will be on looking, feeling, and

listening as much as on speaking... As soon as a sound is possible it should

be given a use. Elicitation and control techniques must also be taught to

the family...

" Less severe cases may manage approximations to sounds. The above

techniques can be used to stabilize and extend the repertoire. Once a sound

is stable it can be used to derive other position/sounds, and to stand in

contrast with another element. ..

" Which sound do you start with? Group data suggest a gradient of difficulty

rising through vowels, plosives, nasals, laterals, and fricatives to

affricates. Individual people do not necessarily conform. Hence the need

to establish each individual's pattern. ...For instance, /o/ [o with thing

on the top!] in English is visible, feelable, manipulable, and occurs

frequently -- but it is limited in the number of other sounds it stands in

minimal contrast with. Consequently choosing /o/ (with thing on top) in

favour of say /s/ or /t/ would not normally be a recommendation. Programmes

employing nonsense syllables (e.g. Deal and Florance, 1978) aim to tackle

the actual motor speech dysfunction more directly, ...therapy progresses

through increasing syllabic complexity, moving from familiar single-syllable

words in predictable, habitual circumstances to uncommon (for the person)

polysyllabic words in simple, and then complex, grammatical utterances, in

situations of increasing propositionality and decreasing external (visual,

tactile, contextual, etc.) support.

" ...Contrastive stress drills take a phrase and practise it with alternative

stress and intonational patterns, e.g. 'BUY him a red shirt', 'buy HIM a red

shirt', 'buy him a RED shirt', 'buy him a red SHIRT', ......there is

evidence that contrastive stress exercises may not (Liss and Weismer, 1994)

be equally successful with all speaker groups. In some cases

intelligibility may be improved simply by concentration on suprasegmental

features...Hargrove and McGarr (1994)...Prosodic Teaching Model ...As an

especial difficulty in speech dyspraxia is smooth transition from syllable

to syllable, techniques are useful which ease this by teaching with

coarticulation incorporated; ...modifying transitional complexity; or

permitting a degree of distortion... These strategies are dealt with more by

and Docherty (1995).

" ...Another method of deriving connected speech is by movement towards

prepositional language from less volitional. An often cited example is

fried egg from Friday. Others would be want to from 1, 2...Relearned or

intact 'chunks' can serve as carrier phrases for these or other words.

" ...The work of LaPointe and Dworkin demonstrated improvement and the

patients in the report by Wertz improved if they received motor speech

training, but not as a result of general language therapy. Given the

controlled conditions stipulated in the studies..., it is clear that speech

dyspraxia can respond to therapy. All approaches involved an intensive

pattern of therapy. Even if not seen daily be a therapist, patients carried

out daily practice. The studies also re-emphasize the need for objective,

principled structuring of therapy steps and the assessments that monitor

them -- establishing baselines and controls, systematically manipulating

variables (input, response demands, et.) and monitoring which mode and

combination of therapies are providing most effective for the individual...

" ...It has further been emphasized that speech dyspraxia may be a motor

disorder, but it exists within a linguistic framework, which in turn exists

within social interaction... Hence dyspraxia may be influenced by, and

simultaneously itself influence, co-existing language and dysarthric

disorders... "

[Guest guest]

A Big Thanks to everyone who responded about Apraxic therapy, I printed

all of them off for my SLP to read .

Thanks Again , Marie

[Guest guest]

Hi Marie and Everyone,

Thanks to Mikel's great translation from the article about what

works for apraxia! I found that to be so informative and helpful! In

addition, here are resources compiled that speak on the frequency and

types of therapy needed for Apraxia.

Mustafa

(may need to cut and past long links)

Speechville Express:

Frequency and Intensity of Therapy for Children With Apraxia of Speech

http://www.speechville.com/diagnosis-destinations/apraxia/links.html

From ASHA:

http://www.asha.org/speech/disabilities/Developmental-Apraxia-of-Speech.cfm

" One of the most important things for the family to remember is that

treatment of developmental apraxia of speech takes time, commitment,

and a supportive environment that helps the child feel successful with

communication. Without this, the disorder can persist into adulthood

with years of speech-related anxiety and frustration. "

Therapy Techniques Common For Apraxia:

http://www.suite101.com/article.cfm/speech_language_disorders/36847

" Apraxia therapy can seem pretty complicated and it may take a long

time to see progress, or so it seems. The key to success with any

apraxic patient or student is to find what works for him or her,

since every person is not the same. " By Schatze Rasmussen

A collection of articles from the ECHO website:

http://apraxiaontario.homestead.com/therapy.html

Child Apraxia Therapy Ideas:

http://www.speech-express.com/cgi-bin/redirect/redirect.cgi?link=http://www.mank\

ato.msus.edu/dept/comdis/kuster2/therapy/apraxiarx.html

Net Connections for Communication Disorders and Sciences, an Internet

Guide by Judith Maginnis Kuster

> I have a limited amount of resources where I live .Although my son

does

> recieve EI services ..I am wonderng if I can direct my SLP to the

kind of

> therapy done for Apraxia ...right now she does alot of things like

repeating

> the same sound and sign language ..she is just barely addressing

his oral

> problems , which he seems to have the most problem with ?? I am

frustrated

> How is apraxia therapy different ???

> Thanks so much , Marie