Speech Therapy for Children with CAS PDF

SPEECH THERAPY FOR CHILDREN WITH CAS Mohammed Alqahtani [email protected]  Heterogeneous Population:  - Children with CAS show varied communication profiles.  - Importance of individualized therapy approaches.  Focus on Speech Motor Processing:  - Therapy should target speech m...

SPEECH THERAPY FOR CHILDREN WITH CAS Mohammed Alqahtani [email protected]  Heterogeneous Population:  - Children with CAS show varied communication profiles.  - Importance of individualized therapy approaches.  Focus on Speech Motor Processing:  - Therapy should target speech motor planning deficits.  - Early and intensive intervention is crucial.  KEY FACTORS TO CONSIDER IN THERAPY FOR CAS:  1. Dynamic Disorder: - CAS is primarily a disorder of combining elements (e.g., syllables, words) rather than producing individual elements. - Difficulty lies in sequencing sounds, words, and sentences, which may affect both speech and reading abilities.  2. Impact of Communication Pressure: - Increased pressure and complexity can worsen the child's ability to produce speech. - Inconsistencies in speech production may be seen, especially when the child feels stressed or pressured.  3. Language Symptoms: - CAS often co-occurs with language disorders, which may emerge early or later as the child progresses. - Grammar, vocabulary, and reading may be affected. KEY FACTORS TO CONSIDER IN THERAPY FOR CAS:  4. Prosody Differences: - Atypical stress and intonation patterns are common, leading to speech that may sound robotic or unnatural.  5. Presence of Other Apraxias: - CAS may be accompanied by oral or limb apraxia, requiring coordination with occupational or physical therapists.  6. Complexity of Symptoms: - CAS is not the same as other phonological delays and can have unpredictable changes, making it challenging to treat. FREQUENCY AND INTENSITY  Need for intensive services: - Early therapy should be frequent and individual. - Frequency often ranges from 3-5 sessions per week for moderate to severe cases.  Factors influencing frequency: - Severity of speech-motor impairment. - Child’s age, tolerance for therapy, and willingness to practice at home.  FREQUENCY AND INTENSITY  High repetition is key to developing motor skills.  Sessions should provide numerous opportunities for practicing targeted speech movements.  Individual sessions allow for a higher frequency of target utterances.  Group settings may not offer the same level of repetition.  As speech becomes more intelligible, therapy frequency can be adjusted.  Therapy must be tailored to the child's unique needs.  Consideration for other speech/language needs and possible use of augmentative communication devices (PECS, SGDs).  MOTOR PROGRAMMING APPROACH - GENERAL TREATMENT PRINCIPLES  CAS is a disorder of the speech motor system.  Treatment must consider individual profiles and developmental stages.  Clinicians need to assess motor speech deficits alongside other language and communication challenges.  Frequent and Intensive Practice: Regular, repetitive practice of speech targets.  Skill Focus: Emphasize accurate speech movement.  Enhanced Sensory Input: Use visual, tactile, and cognitive cues in addition to auditory input.  Types of Practice: Consider random vs. blocked practice of target items.  Feedback: Provide knowledge of results and performance. 1- MULTI-SENSORY INPUT FOR SPEECH PRACTICE  Multisensory Strategies: Use visual, auditory, proprioceptive, and tactile input.  Tactile Methods: Direct tactile input to articulators (e.g., PROMPT therapy).*  Visual Methods: Use visual cues like hand signs, electropalatography, or biofeedback.  Proprioceptive Feedback: Encourage slowing down to enhance feedback. “While the SLP may be called on to teach isolated phonemes at some point as well, this is not the key emphasis of therapy for children with CAS. Rather, the emphasis is on well- controlled sequences of movement patterns required for accurate production of a continuous string of phonemes (i.e.: continuous speech)” 2- ESTABLISHING FUNCTIONAL COMMUNICATION  Initial Goal: Aid in establishing a functional vocabulary for severely affected children.  Vocabulary Choices: Select words based on the child’s consonant and vowel inventory. 3- SUCCESSIVE APPROXIMATIONS  Therapy Method: Shape word approximations with cues and input from the SLP.  Reinforcement: Reward successful attempts at word approximations.  Hierarchy of Practice: Start with simple vowel-consonant combinations, then progress. 4- DAVID HAMMER'S APPROACH “Once a core vocabulary has been established, it may be useful to incorporat e "carrier phrases", i.e., short sentence constructions in which core vocabulary can be inserted. For example, "I see _____", "Where is _________", "I want ______". Additionally, "power phrases" may be introduced as therapy targets. These are short phrases that may serve high utility to the child ("No way", "Get out", "Me too") and provide the child with functional communication.”  Core Vocabulary Book: Use a photo album with meaningful pictures to expand communication.  Sign Language: Enhance vocal output and reduce frustration.  Touch Cueing: Provide physical prompts to guide articulatory movements.  Family Involvement: Encourage collaboration with family and professionals. 5- SYSTEMATIC AND HIERARCHICAL STRUCTURE  Early Success: Focus on starting work at the level where the child is successful.  Incremental Progress: Build new CVC forms and speech movement patterns systematically. “Many methods employed for successful speech therapy for children with CAS are both systematic and hierarchical. A strong emphasis is placed on understanding the current level on which the child is successful and then incrementally building and shaping improved articulation accuracy and movement sequencing through systematically altering the phonetic length, articulatory adjustment, contexts, type of external cues and so on. Clinicians need to be careful to insure that children with apraxia have early success in their speech therapy sessions. One way to enhance this probability is to make sure that starting work is focused at the level at which the child can be successful and then incrementally begin to build new CVC forms, new speech movement patterns, new contexts, etc.”  6- SHELLEY VELLEMAN APPROACH  1. Be Dynamic: - Focus on movement patterns and the combination of speech elements (syllables, words). - Avoid isolating sounds unless they have a specific meaning (e.g., "mmm").  2. Include Activities with Varied Communication Pressure: - Use activities like singing or book-reading to lower pressure and improve automaticity in speech production. - Introduce AAC methods, like sign language or picture boards, to reduce frustration and support speech development.  3. Monitor and Treat Language Symptoms: - Address language issues directly, such as teaching grammatical endings in a phonologically appropriate order.  6- SHELLEY VELLEMAN APPROACH CONT.  4. Directly Address Prosody: - Begin working on rhythm, pitch, and stress patterns early on. - Use activities that incorporate music or varied intonation to improve prosody.  5. Incorporate Movement Activities: - Include co-therapy with occupational or physical therapists to enhance overall motor planning and speech production.  6. Provide Intensive, Frequent Therapy: - Short, frequent sessions are more effective than longer, infrequent ones. - Regular involvement from a certified SLP is essential for progress.