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Treatment Program for Childhood Apraxia of Speech
Ages: 3-10   Grades: PreK-5         

Apply the principles of motor planning to the treatment of childhood apraxia of speech with this program, complete with detailed instructions; 2000 stimulus pictures; and tactile-kinesthetic cue cards. 

 

Outcomes

  • Establish a wide variety of phonetic movements/motor plans
  • Produce phonemes from different classes of sounds in increasingly longer utterances
  • Improve intelligibility of speech
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The 65-page manual shows you how to establish motor learning for different syllable shapes and pattern sequences.  Incorporate research-based principles into therapy organization and goal selection and:

  • select target sounds and words to build intelligibility and promote easier acquisition
  • set up a practice schedule to maximize motor learning
  • use blocked practice to establish new motor sequences
  • use random practice to facilitate generalization of learned motor sequences
  • adjust the type and frequency of cues/modeling 
  • adjust the type and frequency of performance feedback
  • incorporate prosody training early in the treatment program 
  • use tactile/kinesthetic cue cards to support the establishment of movement sequences for speech

 The stimulus cards are customized to apraxia therapy with:  

  • 325 picture cards (three pictures per side for 1950 pictures)
  • 30 picture cards for multisyllabic words (one picture per side for 60 total pictures)
  • 12 tactile-kinesthetic cue cards 

The tactile-kinesthetic cue cards develop sound blending and syllable transitions.  Students produce a variety of phoneme sequences while moving one finger along a visual representation of the movement sequence.  These cards are coated, so you can write target sound sequences on them with a dry-erase marker.  The cue cards represent the following hierarchy of syllable structure: 

  1. CV words
  2. VC words
  3. CVC words
  4. Initial strident/continuant
  5. Final strident/continuant
  6. Medial consonants
  7. Backward chaining: /s/ blends
  8. Backward chaining: /l/, /r/ blends
  9. Three-syllable words
  10. Four-syllable words
  11. Repetitions: caterpillar
  12. Repetitions: dinosaur

      Students progress and:

      • establish a wide variety of phonetic movements/motor plans
      • stabilize sounds that are produced inconsistently
      • establish a core, meaningful vocabulary
      • speak with smoother syllable transitions

      Copyright © 2010

      Components
      65-page manual; 325 7½" x 2½" double-sided, coated picture/stimuli cards; 12 4" x 6" cue cards; 30 4" x 6" double-sided, coated picture/stimuli cards; data sheet; sturdy box
      • Certified speech-language pathologists with specialized knowledge in motor learning theory may diagnose and treat childhood apraxia of speech (CAS) (ASHA, 2007a).
      • Treatment of CAS should include both observation and execution to facilitate the formation of motor memories (Rizzolatti, Fabbri-Destro, & Cattaneo, 2009).
      • Mass practice supports initial learning of a motor skill while distributed practice supports generalization of learned behaviors (Hall, Jordan, & Robin, 2007; Strand & Skinder, 1999).
      • Treatment should target a variety of syllable shapes and phonetic contexts.  Speech production is highly dependent upon phonetic context and generalization of speech learning between contexts is minimal (Tremblay, Houle, & Ostry, 2008).
      • The emphasis of treatment for clients with CAS should be on movement patterns and sequencing of sounds (Caruso & Strand, 1999).
      • Repetitive practice is an integral component of treatment for clients with CAS.  One of the fundamental principles of motor learning is the need for a large number of repetitions of the same behavior in the same context (Hall, Jordan, & Robin, 2007).

      Treatment Program for Childhood Apraxia of Speech incorporates these principles and is also based on expert professional practice.

      References

      American Speech-Language-Hearing Association (ASHA). (2007a). Childhood apraxia of speech [Position Statement]. Available from www.asha.org/policy

      Caruso, A., & Strand, E. (1999). Clinical management of motor speech disorders in children. New York, NY: Thieme.

      Hall, P., Jordan, L., & Robin, D. (2007). Developmental apraxia of speech: Theory and clinical practice (2nd ed.). Austin, TX: Pro-Ed.

      Rizzolatti, G., Fabbri-Destro, M., & Cattaneo, L. (2009). Mirror neurons and their clinical relevance. Nature Clinical Practice Neurology, 5(1), 24-34.

      Strand, E., & Skinder, A. (1999). Treatment of developmental apraxia of speech: Integral stimulation methods. In A. Caruso & E. Strand (Eds.), Clinical management of motor speech disorders in children (pp. 109-148). New York, NY: Thieme.

      Tremblay, S., Houle, G., & Ostry, D. (2008). Specificity of speech motor learning. The Journal of Neuroscience, 28(10), 2426-2434.

      Author(s)

      Karen Czarnik

      Biography

      Karen A. Czarnik, Ph.D., CCC-SLP/L is an associate professor in the Department of Communication Sciences and Disorders at Saint Xavier University in Chicago, Illinois.  She teaches both undergraduate and graduate courses in the areas of clinical methods, developmental disorders of speech, fluency, and research methods.  She is also a clinical educator in the areas of prevention, diagnostics, and treatment at Saint Xavier University.  In addition to working at the university, Karen has worked in the public schools and in private practice.  She regularly conducts presentations for state and local professional and parent organizations on the topics of fluency disorders, language processing, sound production disorders, and childhood apraxia of speech.

      Introduction

      The Treatment Program for Childhood Apraxia of Speech is primarily designed for speech-language pathologists (SLPs) working with clients who present with sound production disorders secondary to a diagnosis of childhood apraxia of speech (CAS).  This program focuses on remediating a deficit in planning the motor sequences necessary to produce speech.  This approach to intervention has been used primarily with children between the ages of four and eight but also with children as young as three and as old as 12.  In order to use this program successfully, the client needs to demonstrate at least minimal attention to the clinician and the presented stimuli, and must possess the ability to imitate or attempt to imitate the clinician's model.

      Chapters 1 and 2 of this treatment manual include a review of the literature.  Although not exhaustive, it does provide guidelines on organizing practice and applying motor-learning principles during all stages of practice.  All references included in Chapters 1 and 2 mirror the organization of treatment strategies in Chapters 3 through 5.  Underlying research is included to aid the SLP in making informed clinical decisions when selecting treatment techniques for clients.  The following areas are addressed in these chapters:

      • definition and characteristics of CAS
      • ASHA position statement on CAS
      • issues in evidence-based practice
      • premises underlying effective treatment, including principles of motor learning and the implementation of integral stimulation

      Chapters 3, 4, and 5 focus on applying research to the therapy process.  These chapters are divided into guidelines for clinicians to consider before, during, and after practice and include:

      • how to use the included stimulus and cue cards
      • description, key points, and examples for each aspect of therapy

      Rather than a "cookbook" approach to intervention, this program provides the clinician with ideas, choices, and a rationale for therapy for individual clients.  Not every presented aspect of treatment will be effective with every client.

      This program includes the following stimulus and cue cards:

      • 325 stimulus cards, with three pictures per side (1950 total pictures):
        • target phonemes:
          /p, b, m, w, f, v, th, t, d, s, z, l, n, ch, J, sh, r, er, y, k, g, ng, h/
        • s-, l-, and r-blends:
          /sm, sw, sn, sl, sp, st, sk/, /fl , pl, bl, kl, gl/, and /kr, gr, tr, dr, tr, br, fr/
        • phonemes targeted in the initial, medial, and final word positions
        • CV, VC, CVC, and two-syllable words
        • three blank cards for writing up to 18 specific words for clients (e.g., names, interests)
      • 30 stimulus cards for multisyllabic words, with one picture per side (60 total pictures)
      • 12 Tactile-Kinesthetic Cue Cards to facilitate motor planning and movement sequences for speech:
        1. CV Words
        2. VC Words
        3. CVC Words
        4. Initial Strident/Continuant
        5. Final Strident/Continuant
        6. Medial Consonants
        7. Backward Chaining: /s/ blends
        8. Backward Chaining: /l/, /r/ blends
        9. Three-Syllable Words
        10. Four-Syllable Words
        11. Repetitions: Caterpillar
        12. Repetitions: Dinosaur
    • All cards may be written on with dry-erase markers.