C HILDHOOD A PRAXIA OF S PEECH Information from the Conference by: Margaret Fish MS,CCC-SLP.
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Transcript of C HILDHOOD A PRAXIA OF S PEECH Information from the Conference by: Margaret Fish MS,CCC-SLP.
CHILDHOOD APRAXIA OF SPEECHInformation from the Conference by:
Margaret Fish MS,CCC-SLP
DEFINITION OF CHILDHOOD APRAXIA OF SPEECH
“A neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of a neuromuscular deficit (e.g., abnormal reflexes, abnormal tone).”
In simple terms it is a disorder of motor planning.
CHARACTERISTICS
Inconsistent errors in production of consonants and vowels with repeated productions of syllables and words.
Lengthened and disrupted co-articulatory transitions between sounds and syllables
Inappropriate prosody (not always, sometimes their prosody is the best thing they have going for them)
Connected speech more unintelligible than expected given phoneme repertoire of results of single-word articulation test.
CHARACTERISTICS (CONTINUED)
Limited vocalizations/babbling during infancy. (“very easy baby, was so quite”)
Automatic speech (counting, singing, etc) better than volitional productions.
Groping or silent posturing Regression (loss of sounds and words) Poor diadochokinetic rates (pa-ta-ka),
accuracy, and rhythm. Difficulty producing volitional oral
movements Possible feeding difficulties during infancy
(unrelated to significant muscle tone weakness)
CHARACTERISTICS (CONTINUED)
Receptive language (typically) exceeds expressive language
Late in attaining first words At risk for literacy difficulty
ESSENTIAL ELEMENTS OF MOTOR SPEECH EXAM
Provide opportunities for child to: Produce words imitatively and spontaneously Produce words with increasingly complex syllable
shapes Repeat test items 3-4 times (not necessarily
sequentially) Execute non-vocal oral movements Produce phrases and sentences Produce challenging words with the benefit of
cueing (visual/tactile/proprioceptive)
FORMAL ASSESMENT INSTRUMENTS
KSPT- Kaufman Speech Praxis Test for Children (Kaufman)
VMPAC- Verbal Motor Production Assessment for Children (Hayden and Square)
The Apraxia Profile (Hickman)
TREATMENT CONSIDERATIONS
Focus on Phoneme Sequencing Provide Opportunities for repetitive practice Provide the appropriate intensity of service Select vocabulary thoughtfully (functional
vocabulary) Incorporate multisensory cues and feedback Focus on vowels Address prosody early on in treatment Incorporate phonetic modifications as
necessary Move quickly to phrases and sentences Facilitate carryover
MOTOR LEARNING THEORY
When teaching new movement patterns mass practice is recommended. (Hi mom, hi mom, hi mom)
When trying to habituate skills, distributed practice is recommended. (I got ball, give me, roll down, got it)
INCREASING PRACTICE OPPORTUNITES
Divide activities into three phases Set-up the activity Complete the activity Review the activity
(mailman activity example)
MATERIALS AND ACTIVITIES TO PROMOTE REPEATED PRACTICE
Echo microphone Puzzles Sound Puzzles String beads or pop beads Fisher Price Farm Fisher Price cash register Cars, trucks and ramps Train track and trains Mr. Potato Head Marble works Books and songs
MATERIALS AND ACTIVITIES TO PROMOTE REPEATED PRACTICE
Books and songs (The big book of exclamations)
Bubbles Zoo animals Playdough and accessories Wind up toys Games (my turn, your turn, #’s, colors, teach
vocabulary so they can play with friends) Familiar characters with accessories Dollhouse with family characters
QUICK GAMES FOR REPETITIVE PRACTICE
Pop-up pirate Cariboo Crocodile dentist Don’t spill the beans Silly six pins Lego creator Mousetrap Animal buddies Barnyard bingo Lucky ducks
Milk and cookies Silly faces Colorforms Memory games Lotto games Holiday and seasonal
game boards (super duper)
ACTIVITIES FOR CHILDREN WHO ENJOY MOVEMENTS
Bowling Basketball Long jump: put pictures of words on floor and
jump over them. Add a new word each time. (“ I jumped over a ____”, “ I jumped over a ___and ___and ____)
Picture hop Treasure hunt Mailman
ACTIVITIES FOR CREATIVE CHILDREN
Block designs Tall tower Dominoes Stickers Progressive drawing (guess what I’m
drawing) Earn it now-make it later crafts
MISCELLANEOUS ACTIVITIES
Go fish Memory Simon says Louder/softer (say word louder or softer) Hidden puzzle pieces (hide under target
words)
INTENSITY OF SERVICE
Motor learning research suggests that motor skills are: Acquired more quickly Attained more accurately And are better retained
With shorter, more frequent sessions
***She said in a perfect world a minimum of 3-5, 20-30 minute sessions a week is ideal.***
MULTISENSORY CUEING
Specific cueing techniques Rate variations Choral speaking (simultaneous production) Direct or delayed imitation Mirror Mime (take away your voice) Hand motions/positions (Pam’s place on youtube) Written letters and words Tapping/clapping out syllables Syllable manipulatives Sound names Phoneme placement cues Mouth pictures
PAM’S PLACE- VOWELS (FIND ON YOUTUBE)
VISUAL SYLLABLE WORDS
Toe May Toe
moo Vee
GIVE A LOT OF FEEDBACK
When teaching a NEW motor skill: Provide frequent feedback Provide immediate feedback Provide knowledge of performance
Tell what was not correct about the movement Tell what should be done differently next time
*Limit the amount of information provided- don’t overload*
FEEDBACK CONTINUED
Progressively fade extrinsic feedback Provide intermittent reinforcement and
feedback Begin to provide extrinsic feedback in form of
knowledge of results (was the target correct or incorrect)
Begin to delay feedback as skill level increases
PHONETIC MODIFICATIONS
Four ways to modify targets: 1. Choose simpler words
“Nana” for grandma “Uh huh” for yes2. Teach alternate articulatory placement (e.g. dental
placement for alveolors)3. Consider normal phonological patterns (Kaufman) Syllable reduction, reduplication, cluster
reduction, final consonant deletion, liquid gliding, or vowelization
4. Vowel simplification (e.g. pure vowels for dipthongs)• This gives children power and a function vocabulary• Honoring the modifications increases vocabulary
KAUFMAN’S SUCCESSIVE APPROXIMATIONS
“Day no” “di no” “di no so” “di no saur”
FACILITATION GENERALIZATION
Increase practice opportunities Increase flexibility by using many phoneme
contexts Reduce cueing Increase rate Reduce pausing between syllables/words Change feedback from descriptive
(knowledge of performance) to correct/incorrect (knowledge of result)
Choose functional vocabulary Enlist help of family/teachers
EXTRA INFO THAT I THOUGHT WAS COOL BUT DIDN’T REALLY PERTAIN TO APRAXIA MUCH…
Teach children to ask appropriate follow-up questions discretely:
Use question cue cards Limited choices of cue cards
“I’m feeling kind of sad today”
Where? Why?
CONVERSATIONS
Integrating the three basic conversation extenders through discrete practice:
What type of conversation extender is the student predominantly using?
Who is doing the most talking? Use chipper chat tokens, each person has their
own color. Put token on card when they do it.
Ask a question
Make a comment
Tell something about you
or someone you know
THE CONVERSATION TRAIN
Colored strips or small trains, one color for each person in the conversation
Lay strips side by side for each conversational turn
Include “talk over” or interruption strip Include “off topic” card
Talk over card
Off topic card