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Episode Summary:

How prevalent is CAS REALLY? Is it true that CAS is the most over-diagnosed of the speech sound disorders? How does treatment for motor speech challenges differ from “traditional” arctic treatment?  The Nerd crew doesn’t dance around these hot topics in this week’s episode, although there is a catchy Kate jingle to start things off.  Before you dive in, you might want to listen to a previous episode (Maybe it’s Apraxia?: diagnostic considerations for childhood apraxia of speech) for a refresher on important diagnostic stuff to help set the stage for “...hitting the sweet spot in your [CAS intervention] dance”.  

Mike Bright is an SLP in the Boston area currently supporting kids with motor speech challenges in a private practice setting after more than a decade at Boston Children’s Hospital.  Mike has us digging deep into the grad school motor speech caverns of our brains to recall those sound intervention principles like mass vs distributed practice and constant vs variable practice.  Even with so much jargon floating around, this practical discussion provides a child-centered and movement-centered lens from which to approach this complicated clinical niche, and has some awesome tips to keep drill sessions rooted in motor learning, client interests, and FUN!  That’s right, fun drill-who doesn’t need some advice on making drills fun? 

Tune in and learn about the role of prevalence in clinical perspective-taking when supporting kids who struggle with hard to understand speech.  You’ll also dance away with some solid “stock” and individualized ideas for materials and strategies that go beyond your K-SLP Kit, but still to hold research evidence and motor learning principles at their core. You’ll no doubt walk away with some big ah-ha moments because “When you look at it through the lens of movement, it makes so much sense!”  You can learn more about Mike here.

Learning Outcomes

1. Describe the prevalence of childhood apraxia of speech?
2. Describe three considerations for target selection for children with CAS.
3. Describe five ways to vary speech production practice that support motor learning.

References

Maas, E., Gildersleeve-Neumann, C.E., Jakielski, K.J. et al. Motor-Based Intervention Protocols in Treatment of Childhood Apraxia of Speech (CAS). Current Developmental Disorders Reports. 1, 197–206 (2014). https://doi.org/10.1007/s40474-014-0016-4

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, 62(9), 3160-3182. doi:10.1044/2019_jslhr-s-18-0212

Murray, E., McCabe, P., & Ballard, K.J. (2014). A Systematic Review of Treatment Outcomes for Children With Childhood Apraxia of Speech. American Journal of Speech-Language Pathology, 23, 486–504. https://doi.org/10.1044/2014_AJSLP-13-0035

Online Resources:

Integral Stimulation: https://www.apraxia-kids.org/apraxia_kids_library/integral-stimulation-method-adapted-for-children-as-dttc/

The PROMPT Institute: https://promptinstitute.com/page/WIPforClincian

Dynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of Speech

Principles of Motor Learning in Treatment of Motor Speech Disorders

A Systematic Review of Treatment Outcomes for Children With Childhood Apraxia of Speech

Interventions for childhood apraxia of speech

A Randomized Controlled Trial for Children With Childhood Apraxia of Speech Comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme–Third Edition

Treating Speech Subsystems in Childhood Apraxia of Speech With Tactual Input: The PROMPT Approach

Feedback Frequency in Treatment for Childhood Apraxia of Speech

Ultrasound Biofeedback Treatment for Persisting Childhood Apraxia of Speech

REST - Rapid Syllable Transition Treatment: A free self directed learning resource for speech pathologists to learn how to deliver ReST treatment to children with Childhood Apraxia of Speech (CAS) and information for parents and the general community. https://rest.sydney.edu.au/

CAS Treatment Methods Supported by Evidence Based Research: This website has different Evidence Based methods and free resources for parents and free videos and learning content for clinicians. https://www.childapraxiatreatment.org/cas-treatment-supported-by-research-evidence/

Episode Key Terms and Additional Information

Definitions were obtained through the ASHA website. Under Childhood Apraxia. https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/#collapse_6

Sensory Cueing approach: Treatments that include sensory input (e.g., visual, auditory, proprioceptive and/or tactile cues) to teach the movement sequences for speech. Sensory cues can be used separately or in combination. 

PROMPT: PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets. The technique is a tactile-kinesthetic approach that uses touch cues to a patient’s articulators (jaw, tongue, lips) to manually guide them through a targeted word, phrase or sentence. 

Integral Stimulation: This is a treatment method that involves imitation, and emphasizes both visual and auditory models. It requires a person to imitate utterances modeled by the clinician. Attention is focused both on the auditory model as well as visual attention to the clinician’s face. It is often considered the “watch me, listen, do as I do” approach.

Dynamic Temporal and Tactile Cueing (DTTC): This approach is like Integral Stimulation the only difference is that it adds layers of cueing to improve children’s production accuracy.

Biofeedback: This refers to the use of visual information to report on how sound productions are physically made. Biofeedback provides "knowledge of performance", which provides information about the persons' actual movement of speech sound targets. This can be demonstrated through several means, the most popular are through ultrasounds and electropalatography. 

Childhood apraxia of speech: Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is due to brain having planning problems to move speech parts like the lips, jaw, tongue. Therefore, the issue is not muscle weakness or paralysis instead, the child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say the words. 

Disclosures:

Mike Bright Financial Disclosures: Mike is the owner of Bright Speech and Language, LLC. Mike Bright Non-financial: "Recognized by Apraxia Kids for Advanced Training and Expertise in Childhood Apraxia of Speech"

Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast.  Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. 

Amy Wonkka financial disclosures:  Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children.

Time Ordered Agenda:

10 minutes: Introduction, Disclaimers and Disclosures

20 minutes: Descriptions of the prevalence of childhood apraxia of speech

15 minutes: Descriptions of considerations for target selection for children with CAS

10 minutes: Descriptions of ways to vary speech production practice that support motor learning

5 minutes: Summary and Closing

Disclaimer

The contents of this episode are not meant to replace clinical advice.  SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated.  We are NOT PhDs, but we do research our material.  We do our best to provide a thorough review and fair representation of each topic that we tackle.  That being said, it is always likely that there is an article we’ve missed, or another perspective that isn’t shared.  If you have something to add to the conversation, please email us! Wed love to hear from you!

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Summary Written by Tanna Neufeld, MS, CCC-SLP, Contributing Editor

Key Terms and Additional Information provided by Maria De Leon, MS, CCC-SLP, Contributing Editor

Audio File Editing provided by Caitlan Akier, MA, CCC-SLP/L, Contributing Editor

Promotional Content provided by Ashley Sturgis, MA, CCC-SLP, Contributing Editor

Web Editing provided by Sinead Rogazzo, MS, CCC-SLP, Contributing Editor

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