Childhood Apraxia of Speech

Question 1

childhood apraxia of speech (CAS)

Answer 1

• label for a subset of children with SSDs
• not a medical diagnosis, label assigned to a cluster of characteristics
• enough verbal output to analyze speech sound production

Question 2

consensus on CAS

Answer 2

• due to inefficiency in motor planning and programming
• instruction to the musculature to move structures to teach a specific spatial and temporal target (at a particular time, at a specific rate and ROM, with the right degree of muscle tension)

Question 3

remember that children with CAS have difficulty with…

Answer 3

praxis, or the ability to plan, organize, and sequence movements of speech structures

Question 4

in other words, CAS relates to knowing

Answer 4

• which articulators are moving
• when they are moving
• how fast they are moving
• how much force and tension
• how to coordinate movements across articulators and sound sequences

Question 5

discriminatory features

Answer 5

• difficulty planning and programming
• groping and/or trialing an error behavior (particularly during elicitation/imitation)
• consonant and vowel distortions (most likely, the vocal tract shape isn’t quite right due to speed of movement)
• prosodic errors, equal stress
• inconsistent errors

Question 6

difficulty planning and programming

Answer 6

• “lengthened and disrupted coarticulatory transitions between sounds and syllables.”
• movements are awkward or clumsy as they attempt continuous movement across the syllable

Question 7

dynamic temporal and tactile cueing (DTTC)

Answer 7

• approach for kids with mod/severe CAS
• based on principles of motor learning-
• focuses on movement sequences (vs. individual phonemes)

Question 8

DTTC: movement sequences

Answer 8

• children with CAS need to learn the movement parameters needed to produce particular articulatory configurations and transitions into and out of these configurations
• use of dynamic teaching and learning moments that are based on child’s production: various types of imitation, multiple cues, slowed ROS to shape movement sequences, practice those sequences in speech

Question 9

requisites for DTTC

Answer 9

• child needs to be able to imitate and attend
• if not, start with play-based therapy and then move to DTTC

Question 10

DTTC fidelity checklist for children with severe CAS

Answer 10

• base targets on functionality, syllable shape, and vowel content
• provide the child clear instructions for each task
• draw attention to clinician’s face when needed
• use 4-8 targets in therapy
• use tactile cues when appropriate
• use a modified block organization for practice
• reduce background noise and distractions
• provide fading of feedback as child becomes more accurate
• sit facing child: close trials for each target per session

Question 11

treatment targets: considerations

Answer 11

• functionality for the child
• syllable shape: starting point dependent on assessment data, what level taxes the child’s system ZPD (always start at least at the CV, VC level)
• vowel content

Question 12

treatment targets: use

Answer 12

• assessment/stimulability data from your dynamic motor speech assessment (DEMMS)
• initial targets should not include phonemes for which the movements were not improved with cueing on your dynamic assessment

Question 13

clear instructions that address movement sequences

Answer 13

• need to practice complete movement gestures in correct coarticulatory context
• conscious practice: attention needs to be focused on improving movement accuracy
• use NSOMEs to increase attention to feeling of OM movement
• focused attention

Question 14

need to practice complete movement gestures in correct coarticulatory context

Answer 14

• don’t pause during a syllable and segregated movement
• become aware of movement gestures required for initial articulatory configuration and coarticulation

Question 15

conscious practice: attention needs to be focused on improving movement accuracy

Answer 15

• understand that they will be working on their lips, jaw, tongue so that it will make it easier for them to talk
• think about, consciously attend to speech movements rather than mindlessly imitating

Question 16

use NSOMEs to increase attention to feeling of OM movement

Answer 16

• move arms, then fingers, then mouth
• open their jaw really wide and then just a little to condition to these concepts to apply to speech production
• increases eye contact
• decreases tactile defensiveness

Question 17

focused attention

Answer 17

• use reinforcements that don’t take time
• use activities that provide opportunities for repeated practice and keep the focus on your face

Question 18

rate

Answer 18

• use slowed ROS when child is first acquiring new speech production skill: as production improves, reduce support
• reduced rate gives more time for sensory motor feedback needed to maximize
• varying rate can be effective tool during repetitive practice of targeted utterances: allows habituated or articulatory movement accuracy while working toward natural rate and prosody

Question 19

reduced rate gives more time for sensory motor feedback needed to maximize

Answer 19

• accuracy of movement
• tactile feedback
• proprioceptive processing

Question 20

supporting cues

Answer 20

encourage child to stay in initial articulatory configuration for a few moments to maximize proprioceptive processing before producing the rest of the word

Question 21

tactile cues

Answer 21

• help child imitate “bye” by physically assisting in achieving correct jaw and lip position, then saying the word together slowly
• step down via mimed cue

Question 22

mimed cue

Answer 22

remove voicing and focus child’s attention on production of smooth, continuous movement

Question 23

treatment and target dosage

Answer 23

• need enough trials/sessions to allow motor learning to occur and become habituated
• five 20-30 minute sessions/week = high dose (recommend two 15 minute blocks/sessions)
• 10-40 practice trials per target word

Question 24

mass practice

Answer 24

• more frequent sessions, fewer, less varied stimuli
• start here for kids who are non-verbal/very severe
• quick development of skill (motor performance)
• poor generalization (motor learning)

Question 25

distributed practice

Answer 25

• less frequent sessions, more stimuli that’s more varied, varying prosody
• takes longer
• better motor learning

Question 26

blocked practice

Answer 26

• used to establish basic motor patterns early on
• better motor performance, but not necessarily motor learning
• start here for more severe kids, but modify
• as each target becomes accurate, natural, produced in response to a question, move to more random, spontaneous practice

Question 27

random practice

Answer 27

• mix up all stimuli and practice each one
• facilitates generalization
• better motor learning
• takes longer to achieve consistent accuracy
• different contexts and conditions
• different prosodic contexts: varied prosody and loudness to practice more flexibility in motor planning and programming

Question 28

feedback

Answer 28

• knowledge of performance
• knowledge of results
• feedback in general, but KOP more specifically, more important early and in the case of more severe impairment
• later, need to decrease or over-reliance could lead to decreased ML
• timing and frequency

Question 29

feedback: knowledge of performance

Answer 29

• specific information about what they did or what they could change
• facilitates MP

Question 30

feedback: knowledge of results

Answer 30

• just feedback regarding right or wrong
• facilitates ML

Question 31

feedback: timing and frequency

Answer 31

• provide frequent feedback early on in treatment
• use immediate feedback (KOP) early in treatment and when impaired is severe (improves MP)
• as child improves, provide KOR infrequently with some delay after productions to facilitate ML