Apraxia: One SLP’s Experience

Funny story. Well, as an SLP I found it entertaining anyways. I recently spent some time in Physical Therapy for TMJD.  Within my first session the PT describes how the left side of my face and neck are so tight that it is pulling the right side of my face. She thought this could be contributing to my ear pain and possibly my TMJD. She asked me to wink my right eye and close the eye tightly for five seconds. After several attempts I look at her and say, “I cannot wink that eye. I have never been able to.” She’s surprised.

Then, she asks me to retract the corner of my lips on that side up and back. I can’t. I could barely do the left side.  I’m giggling. She rolls a big ole mirror in so I can see what I’m doing.  She then points out how pronounced the tension is on the left vs the right in my neck area. ( By golly I’m alternating sides with that therapy bag that I carry now!)

For the next eight hours I am obsessed. In between appointments I am in the car looking in the rearview mirror, telling myself, “You will close that eye”.  (P.S. I can now close that eye.  I can move the lip unilaterally and I can create more tension in the neck on the weak side.  Someone had to be curious out there so I thought I would share.)  What is interesting is I do not present as weaker on either side when I talk, or eat, etc.

If you are an SLP  you know where this is going.  This experience made me think about my kids with motor planning challenges. Groping to make a sound or to imitate an oral motor movement. This is why we sometimes pause (before we fill that silence with Charlie Brown “wa-wa-wa”). It may take a moment for the child to respond. For example, most times I don’t say “ready, set, go”. I pause after “set” and see if the child can fill in the word.  My observations over the years is we are too quick to fill in that pause. (Ha! That is a life lesson too.)  Sometimes we need to pause. And, sometimes we don’t fill in the pause quick enough. It is a dance and using your best judgment.

That being said. I think about this instance for myself and my weak attempt at aerobics years ago. I was moving left and everyone else was moving right. My mom says as an infant I never crawled on all fours. She would put me in 4 point (good article) and I would rock. I army crawled and one day I walked.

I promise you I can talk just fine! Ha! But let’s talk about the motor planning piece for some of our kids. I remember years ago asking a little girl to imitate me lateralizing my tongue. She turned her head up and to one side. Her tongue barely came out of her mouth and she  overcompensated by moving her whole head. But, she still could not imitate the movement. I have had kids look at me like, “Yes, I will do what you are doing” but then not be able to imitate the sound.

I have had kids put their head down at which time it appeared it was too hard for them to imitate me.  Over the years, I often hear, “My child can say that word, he has said it several times before.” And, then I ask the question, “Is your child more apt to imitate a word spontaneously vs when you directly ask him to say a word.” Often, the answer is, “spontaneously.” It is almost as if the pressure is too much to make that movement or sound happen in that moment.

I am a fan of the concept of teaching kids some core vocabulary words using pictures. Why? Because, I often hear, “My child will imitate but he is not using the words on his own.” If the child can imitate a picture and sees the picture enough my hope is the imitation will translate into learning those words independently.

If I teach a child a set of visual cues that coincide with each sound and then fade the sound, the child can learn to imitate the sound given the visual cue only.  This places that child one step closer to spontaneous.  Then we fade the prompt. If you have been following me on this blogging journey and caught my post on Toy Selection and Prompts, you have heard me say it several times, “A physical or gestural prompt is easier to fade than a sound or a word.”  And, in my opinion it does not matter as much what visual cueing method you use, but that everyone helping that child is using the same one.

For years, I have been using a visual cueing method by a local woman in Naperville but when 2 of my kids visited Nancy Kaufman for evaluations I thought maybe it best to learn her method! I am a big fan of Nancy and her Praxis Cards. I have always used the idea of forward chaining to elicit sounds, often putting emphasis on the sound that is in error but then I learned about backward chaining as it relates to eliciting speech sounds too and let me tell you… It really really works for some of my kids!  For example, if the target word is banana and my child cannot produce the “ba” portion, I might model “na-na” and encourage 1 or more productions of “na-na”.  If the child learns to produce “na-na” then I go back and model “banana”.  Here is a great article by Nancy Kaufman and successive approximations as another reference.

Then, I come across resources such as the Big Book of Exclamations and I am thrilled to have another tool in my toolbox. I have had the first book for years, but have not been able to find it to share with others.  Little did I know it is on the Chatterbox website along with the SECOND BOOK  released this year! Lets talk about that book! The amount of detail and thought put into this latest book is amazing.  Consonant-Vowel, Vowel-Consonant, Consonant-Vowel Consonant, early vocabulary, pronouns, actions, 2 word phrases. And, bonus, on each page the author Teri (another SLP) gives suggestions on how to use the book. I can use my visual cues, my chaining methods, my pauses all while using this book.

When I think of some of my kids, the need for repetition, and the need for increased spontaneous speech, this book comes to mind as a great resource for providing those concepts. I used this book two weeks in a row with one child and this past week when I pulled out the book, he pointed to the monkey and said “uh-oh,” just as I had modeled the previous week.  But, hear me when I say, any child may benefit from this book. In my opinion it is not just for kids who have a speech or language delay.

Anywho, I could prattle on about Nancy Kaufman and this book, but I would love to hear what other resources you have for kids with childhood apraxia of speech. There are plenty of great resources and tools out there.  I just received a flyer of what looks to be a great training put on by another SLP on this very topic.  On my website you will find a few resources such as this link to 50 great books to use with kids who have childhood apraxia of speech.   If you enjoyed this post please consider sharing on a social media site or emailing a friend.   Next week we will take a break from our weekly posts and follow up the next week with a guest post from Kaitlyn Vokaty, an Occupational Therapist from Fingerprints Therapy.

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