Developmental Apraxia and Adult Apraxia of Speech

Apraxia is a general term that is used to describe the complete loss of this ability. There are two main types of speech Apraxia: acquired apraxia of speech and developmental apraxia of speech.

Acquired Apraxia of speech can affect a person at any age, although it most typically occurs in adults. Apraxia in adults is a neurological speech disorder, which results in impairment in the capacity to plan, or program sensory motor commands for the position and movement of muscles for the volitional production of speech. Acquired Apraxia occurs without significant weakness or neuromuscular slowness in the absence in disturbances to consciousness thought or language. This disorder affects the ideomotor production of speech and results in articulation errors, prosody changes with sequences of phonemes being affected. People with acquired Apraxia of speech have relatively preserved automatic speech behaviors (such as counting, or singing happy birthday).

Childhood Apraxia of Speech is a neurological childhood speech sound disorder where the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits. Developmental Apraxia occurs in children and is present from birth. The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody. Developmental Apraxia of Speech is characterized by inconsistent distortions substitutions errors of vowels and consonants, problems with volitional rather than automatic tasks, difficulties with multisyllabic words, difficulties with sequencing, poor lexical stress and other prosodic features. Children with Developmental Apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.

Hope this was helpful!

Remy

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Choosing an AAC device

ASHA defines Augmentative and Alternative Communication (AAC) as all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. The goal of using AAC is to provide the individual with the most effective and interactive communication as possible. When a child or adult’s needs cannot be met using natural communication methods it is likely that they would benefit from the use of a low-tech or hi-tech AAC device.

Low Tech/No-Tech AAC devices

Low Tech/No-Tech AAC devices are usually small and portable and contain information that supports the communication efforts of individuals with complex communication needs. Examples of such devices include PECS (Picture Exchange Communication System), Communication Boards. Communication Books, Communication Notebooks, Communication Wallets and Communication Cards/Labels. This type of AAC may be used to facilitate early implementation of AAC services and are generally low cost and portable. These devices are able to be personalized and contain photographs, pictures, symbols and printed words. Although there are several benefits to using low-tech/no-tech devices theses devices may be insufficient in providing users with access to communication because these devices have limited vocabulary, typically don’t contain language beyond the here and now and place a heavy burden on communication partners because these devices don’t generate speech or have a voice/print output.

High Tech Systems

High-tech systems have many options available in terms of vocabulary, messaging & rate enhancement options. These devices provide auditory and visual feedback to the user and allows them to communicate at a distance. High-tech devices allow the AAC user to send messages without first obtaining the partners’ attention through another mode and also come with features such as e-mail, Internet, phone, environmental controls. Examples of a high-technology devices include Proloquo2go on the IPAD, Dynavox Maestro and the Toby Lightwriter.

When going in for an AAC evaluation the individual and the Speech Language pathologist undergo the feature matching process. During that process the individual and the SLP determine whether the features of a specific device matches the communication needs resulting from the individual’s disability. A feature matching assessment starts with identifying the needs of the individual and matching the needs with the features of a communication device or system. Things that considered during the evaluation are access methods, meaning how the individual would be able to access the information on their devices whether it’s via direct selection (touch, pointing) or scanning, age, disability, and communication needs.

Techniques to Encourage Language Development

Language learning is a process that begins at birth. Between the age of one and four months infants can distinguish different speech sounds in isolation, by seven months infants can identify familiar words within sentences and between six to twelve months of age babies can perceptually tune in to language specific to their environment. This all means that infants, toddlers and young children, learn language from the people they spend their time with.

When working with young children I often use language facilitation techniques such as expansion, self talk and parallel talk to encourage language development. I often find parents ask me what they can do at home to continue with therapy and I often find myself suggesting these methods.

Self-Talk and Parallel-Talk are very simple language facilitation techniques. When using self-talk you essentially talk about what you are doing as the child watches. For example when you are at the grocery store with your child you say “Mommy is going to make dinner tonight, what do I need? First we need to by the pasta then we need to tomatoes, I want to grab this tomato because it looks big and red and juicy” Although this may feel a little silly when your child doesn’t talk back I promise it gets easier as you practice and you will become a pro at narrating your day to day activities to your little one!

Parallel-Talk is similar to Self-Talk but instead of talking about what you are doing you are talking about what your child is doing or seeing by modeling language. If your child is playing with bubbles you would say “Oh look you just blew bubbles they are so big, you blew one, two, three big bubbles, hooray you popped them!”. Or if your child is playing with a toy barn you could say” oh look at that pink pig he is dirty. Oh you have a cow your cow is brown and she is wearing a yellow bell”

If your child is speaking techniques such as expansion is a great way to respond to your child while providing them with a more complex language model. Expansion can be used when the child initiates communication. An example of this would be if your child says “Daddy Home” you can say “Daddy Is Home” which increases the syntactic complexity of the utterance but does not change the child’s initial meaning. I try to only expand a child’s utterance by one or two words so that the child is still benefiting from the more complex language model without the messaging becoming too confusing.

Hope you find this helpful ☺

Remy

Toys and Games to Promote Speech and Language Development in Toddlers/Preschool Aged Children

When working with toddlers and preschool aged children I always like to incorporate toys and games into my therapy. Child centered therapy such as this uses natural context and events to facilitate speech and language development. This play-based therapy is especially beneficial in maintaining the child’s interest and targeting speech and language goals without it being explicitly demanding. Play based therapy has been proven to help engage a child, maintain interest and can be effective in targeting speech and language objectives without the child even realizing it.

Here is a list of some of my favorite toys I use in my therapy sessions to encourage speech and language development:

Mr. Potato Head

Mr. Potato Head is one of the most versatile toys that can be used for language stimulation. Mr. Potato head can be used to promote expressive vocabulary in terms of nouns (hat, eye, ears, nose, shoes), action words (push, put on) and requests (give me, more, my turn). Mr. Potato Head also provides opportunities to increase comprehension and answering of wh- questions (what do you want first?, what does he need to see?, where do you put his hat?) and promotes turn-taking and joint attention. Mr. Potato head can also be used to promote identification abilities (point to his nose, eyes, ears) and facilitate your child’s ability to follow directives with increasing complexity (put on his hat, put on his hat then glasses, put on his nose after you put on his eyes).

Bubbles

Blowing bubbles is a fantastic way to work on and facilitate breath support and oral motor skills such as lip rounding. Bubble blowing also provides an opportunity for children to hone their language skills by requesting for the item “bubble, bubbles please”, requesting for an action “blow, give me, dip, open, pop” or repetition “more, again”. Bubble blowing also reinforces pragmatic skills such as turn-taking and joint attention (shared focus of two individuals on an object). The vocabulary associated with bubble blowing also reinforces the CVC (consonant-variable-consonant) context that I find myself always working on in therapy.

Echo Microphone

An echo microphone is a great resource for targeting specific sounds. I love to use the echo microphone in therapy for vowel sounds and vowel differentiation. I find the microphone to be a great way to incentivize imitation at any level or context. The microphone can also be a great tool to practice fluency skills such as light contact, slow easy speech and stretched vowels.

Play Dough

Play Dough is one of my favorite activities that incorporates sensory stimulation and provides children with great natural opportunities encourage language development. You can use play-dough to address many different skills by using certain accessories such as rolling pins and cookie cutters to facilitate your desired goal. Play dough can be used to encourage imitation and symbolic play schemas by shaping the play dough into various items (e.g. baking a cake). Play Dough can be used to facilitate the understanding and production of action words such as “roll”, “cut” “pull” “push” “squeeze” “open” and “take out”. I especiialy love Play Dough because it has a lot of vocabulary associated with it that contains that CVC (consonant, vowel, consonant) context that I am often trying to elicit. Play Dough can also be used to demonstrate concepts such as big/little, long/short and encourage color Identification.

Enjoy!

Remy

Advice for Parents of Children with Hearing Loss

Early access to sound is important. Hearing is critical to speech and language development, and learning. Research tells us that the critical period for the development of hearing in the brain is within the first six months of life, and therefore access to sound during infancy is essential for the auditory centers of the brain to fully develop. Thanks to mandatory infant screening programs, children’s hearing losses are now identified early, when intervention has the best outcomes.

What Parents Can Do

Parents can help children with hearing loss develop their auditory skills to their fullest capacity. Parents should play, talk, read, and sing with their child encouraging noisemaking and reinforce all efforts to communicate. Try and make activities auditory without violating the concept of the natural environment. Also, try and minimize background noise such as the radio, or television as much as possible.

Ensure that your child has the best possible access to sound through appropriate technology. When considering what technology may be appropriate for your child it is important to be educated about the differences between the devices available.

The Cochlear Implant

A cochlear implant is a surgically implanted device that provides electrical stimulation to the auditory (hearing) nerve allowing severe to profound individuals to hear. Cochlear implants are comprised of external components such as the microphone and speech processor worn by the user and internal components that are implanted surgically such as the magnet and the transmitter. In order to qualify for a cochlear implant candidates must present with a profound bilateral sensorineural hearing loss and demonstrate minimal benefit from amplification devices. Cochlear implants provide children, who are born with a severe-profound hearing loss, with access to spoken language code, increased ability to cue into a speaker and increased potential for incidental language learning. 

Hearing Aids

For individuals with hearing loss, hearing aids work by delivering amplified sound to the damaged auditory structures. Although hearing aids are easily accessible they are limited in their ability to help individuals with severe-profound hearing loss beyond environmental sounds and low frequency (low pitched) sounds in speech such as vowels. 

FM Systems

FM systems consists of a transmitter microphone, worn by someone such as the child’s teacher, and receiver worn by the child. The receiver works by delivering the sound signal directly to the child’s ear or hearing aid with an optimal signal/noise ratio (the ratio of the desired auditory signal to the amount of background noise in the environment). FM systems are appropriate for individuals with mild-profound hearing loss and are potable and easy to set up and use.

Hope this helps!

–Remy