9/21/2020

Identifying the Correct

Path for Intervention in
CAS
Laura Baskall Smith M.A. CCC-SLP
VI National Conference
abrapraxia
October 3rd, 2020

Learning Objectives

 Listresearch-based approaches for CAS.

 Explain how to develop appropriate therapy
targets for CAS
 Explainhow to incorporate cues and
feedback into therapy for CAS

About Laura
My background
• Started as an SLPA (assistant) before becoming
an SLP
• Worked as an SLP before my daughter Ashlynn
was born and dx with CAS
• After Ashylnn’s apraxia dx, transitioned into
private practice specializing in CAS
• I’m passionate now about apraxia awareness!
• Fun fact! Dr. Stoeckel is my mentor!

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Wearing Two Hats

Where do I start?

 We MUST be incorporating the principles of motor

learning into whatever approach is utilized.
Approaches themselves may vary. There is not
ONE best approach to use with an individual with
CAS.
 What is important is the child is making progress
and continues to make progress!
 It’s also important to note that the approach will
need to be modified as the child makes progress.

Approaches for CAS

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How Apraxia Therapy differs from

Traditional Therapy
 MOVEMENT - Therapy for apraxia should be focusing on
the MOVEMENT. Coarticulation (movement between
sounds) is the focus as opposed to articulation(sound
production).

 Target Selection – Targets for apraxia do not necessarily

follow developmental norms. They should take into
account 1. sound repertoire 2. stimulability 3.
functionality (don’t forget prosody!)

Commonalities

 Principles of motor learning

See Maas’ presentation for full details
In a nutshell
High amount of reps with fewer targets
Performance feedback
 Cueing to help plan and program the movements
 Feedback: Knowledge of Results vs. Knowledge of
Performance

Pre-cursors for Therapy

 Develop a relationship with the child

 Incorporate the child’s interests
 Find common ground
 Would you want to work with you?

Inspire MOTIVATION

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Repetitive practice ideas

Toys

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Repetitive practice ideas

Games

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Repetitive practice ideas

Repetitive Books

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Repetitive practice ideas

Art activities

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How many?
 Number of target syllables/words
dependent on the severity

Target  Fewer targets for more severe

selection children

 More targets for less severe

children

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What sound sequences?

 Develop target words from
Target current sound repertoire
selection
continued  Avoid working on sounds in
isolation. Primary focus should
be at the syllable level

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What syllables
Target  Depends on the severity and type the
child has
selection
continued  Need to advance to new syllable shapes
as well as increasing number of syllables
ASAP

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What kinds of words?

 Functional Functional Functional!!!
Targets should incorporate all the
Target 
sounds in the child’s repertoire
selection attempting varying syllable shapes
and word positions.
continued  Should try to incorporate different
communicative functions:
commenting, requesting, rejecting,
greetings etc.

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Potential Target Words: Review

 Think words already in repertoire
 Think sounds already in repertoire
 Think FUNCTIONAL
 Incorporate current syllable shapes in the child’s
repertoire
 Amount of targets depends on the severity (lower for
more severe, more for less severe)
 Type of syllable shapes depends on severity and what
the child currently has

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Cueing

 Cueing is essential in the treatment for CAS as it

provides a way to help the brain plan and program
the movements for speech.

 Various types of cueing including: verbal, visual,

tactile, etc.

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Verbal Cue Examples

 /M/ humming sound

 /D/ drumming sound
 /P/ popping sound
 /S/ hissing sound
 /H/ breathy sound

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Example of visual cues

 Watching clinician’s
face

 Finger cues

 Picture cues
(Bjorem, Lindamood-
Bell and others)

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Example of visual finger cues

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A note on cueing

 Though cues are essential for helping the child

with the planning and programming component,
for true motor learning or retention to occur, cues
need to be faded.

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Distributed practice
 For carryover to occur, distributed practice is
essential.
 Within a session, mass practice can refer to a
large number of repetitions of a single target.
Distributed practice is fewer repetitions spread
throughout the session.
 Outside the session, distributed practice can
mean the practice trials a child gets throughout
their day. Parents can be some of the BEST
facilitators for this!

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 Knowledge of Results
 Information provided after
completion of the target
that compares outcome to
target

Feedback
 Knowledge of Performance
 Relates to the nature or
qualify of the movement
gesture specific to what the
child did (close your lips,
round your lips etc.)

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Video
example

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Recap

 Was there motivation?

 What sounds were targeted?
 What syllable shapes were targeted?
 What practice schedule was utilized?
 What cues were used?
 What feedback was used?

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SLP Mommy of Apraxia

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References
Allison, K. M., Cordella, C., Iuzzini-Seigel, J., & Green, J. R. (2020). Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping
Review. Journal of Speech, Language, and Hearing Research, 1-43.

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

American Speech-Language-Hearing Association. (2007b). Childhood apraxia of speech[Technical report]. Retrieved from www.asha.org/policy/

Ballard KJ, Robin DA, McCabe P, McDonald J. A treatment for dysprosody in childhood apraxia of speech. Journal of Speech, Language, and Hearing
Research. 2010;53:1227–1245.

Dodd, B., Holm, A., Crosbie, S., & McIntosh, B. (2006). A core vocabulary approach for management of inconsistent speech disorder. Advances in
Speech-Language Pathology, 8(3), 220 - 230.

Edeal, D. M., & Gildersleeve-Neumann, C. E. (May 01, 2011). The Importance of Production Frequency in Therapy for Childhood Apraxia of Speech.
American Journal of Speech-Language Pathology, 20, 2, 95-110.

Haibach-Beach, P. S., Reid, G., & Collier, D. H. (2018). Motor learning and development.

Kovacs, N., Kohen, F., Reilly, J., Maas, Edwin, Kohen, Francine, & Reilly, Jamie. (2017). Treatment of Childhood Apraxia of Speech: A Single-case
Experimental Design Study of Intensity of Treatment. Temple University Libraries.

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References
Maas et. al, (August 01, 2008). Principles of Motor Learning in Treatment of Motor Speech Disorders.
American Journal of Speech-Language Pathology, 17, 3, 277-298.

Maas, E., Gildersleeve-Neumann, C., Jakielski, K., Kovacs, N., Stoeckel, R., Vradelis, H., & Welsh, M.
(2019). Bang for your buck: A single-case experimental design study of practice amount and
distribution in treatment for childhood apraxia of speech. Journal of Speech, Language, and Hearing
Research. doi:10.1044/2019_JSLHR-S-18-0212

Maas, E., Gildersleeve-Neumann, C., Jakielski, K. J., & Stoeckel, R. (2014). Motor-based intervention
protocols in treatment of childhood apraxia of speech (CAS). Current developmental disorders
reports, 1(3), 197–206.

Maas, E., & Farinella, K. A. (April 01, 2012). Random Versus Blocked Practice in Treatment for
Childhood Apraxia of Speech. Journal of Speech, Language, and Hearing Research, 55, 2, 561-578.

Namasivayam, A. K., Pukonen, M., Goshulak, D., Hard, J., Rudzicz, F., Rietveld, T., Maassen, B., ...
Lieshout, P. (July 01, 2015). Treatment intensity and childhood apraxia of speech. International
Journal of Language & Communication Disorders, 50, 4, 529-546.

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References
Preston, J. L., Leece, M. C., & Maas, E. (January 01, 2017). Motor-based treatment
with and without ultrasound feedback for residual speech-sound errors.
International Journal of Language & Communication Disorders, 52, 1, 80-94.

Schmidt, R. A., & Lee, T. D. (2011). Motor control and learning: A behavioral
emphasis (5th ed.). Champaign, IL, US: Human Kinetics.

Strand, E. A., Stoeckel, R., & Baas, B. (2006). Treatment of Severe Childhood Apraxia
of Speech: A Treatment Efficacy Study. Journal of Medical Speech-Language
Pathology, 14(4), 297-307.

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