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Apraxia SLP Discussion with Lynn Carahaly and Lori Riggs

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Apraxia SLP Discussion with Lynn Carahaly and Lori RiggsMary May 25, 2013 Apraxia, Articles, Autism, Events, Let’s Talk: Speech and Communication, Special Needs, Speech/Language, Uncategorized 1 Comment
bshm 2013 post Apraxia SLP Discussion with Lynn Carahaly and Lori Riggs

For our Lets Talk Speech and Communication event 2013 we had an Ask the SLP – Apraxia with SLPs Lynn Carahaly and Lori Riggs. In this article we introduce Lynn and Lori and summarize the questions asked and the answers from our SLPs.

Meet Our SLPs:

Lynn Carahaly, M.A., CCC-SLP

67864 10151284169825365 1240082476 a 150×150 Apraxia SLP Discussion with Lynn Carahaly and Lori RiggsLynn Carahaly, M.A., CCC-SLP is a practicing Speech-Language Pathologist and app developer in Gilbert, AZ. Her private practice specializes in diagnosing and treating children with apraxia. She is the developer of The Speech-EZ Apraxia Program and has created several apps to support the treatment of apraxia, auditory processing disorders, and promote phonological awareness skills. She is a mother of two beautiful children. The iMums have reviewed the Speech-ez Apraxia Picture Sound Cards app here. You can see all the Speech-ez apps on the app store here badge itunes lrg Apraxia SLP Discussion with Lynn Carahaly and Lori Riggs

Lori Riggs, MA, CCC/SLP
391293 10151167058382174 1218397501 n 150×150 Apraxia SLP Discussion with Lynn Carahaly and Lori RiggsLori Riggs is a Certified Speech/Language Pathologist with over a decade of experience in providing speech therapy, cutting-edge oral motor therapies, and auditory training programs. She is Director of the Center for Speech and Sound for N.A.C.D. (the National Association for Child Development).When NACD collaborated with other professionals in 1998 to create The Listening Program, Lori was a member of the development team. In addition to supervising The Listening Program, Lori designs individualized oral motor protocols for NACD clients to improve feeding and speech. NACD has developed several apps, including Simply Smarter Kids-Memory and the NACD Home Speech Therapist apps, Speech Therapy for Apraxia and Speech Therapy for Apraxia-Words. Lori is a mother of two. You can see Speech Therapy for Apraxia on the app store here

badge appstore lrg Apraxia SLP Discussion with Lynn Carahaly and Lori Riggs

Q: Can you tell us about the Speech-Ez System for treating Apraxia ?
Lynn: The Speech-EZ® Apraxia Program is a structured program specifically designed to improve speech intelligibility for children with Childhood Apraxia of Speech (CAS) and severe Developmental Phonological Disorders.
The Speech-EZ® Apraxia Program uses multisensory strategies that incorporate visual, auditory, proprioceptive, gestural and tactile input in order to teach the child the correct movement sequences for speech. This multisensory approach addresses various levels of speech motor control, in particular: motor preparation and execution processes.

Q. Can you tell us about the N.A.C.D. System for treating Apraxia ?

At NACD we treat individuals as a whole, rather than a diagnosis or label. So for the clients that we work with, we are addressing all areas of development, including auditory sequential processing, language, speech production, motor planning for speech, motor skills, etc. We are addressing whatever the areas are that the individual needs to improve. With apraxia in particular, there are usually a number of different pieces that need to be addressed. But in terms of our apraxia apps (Speech Therapy for Apraxia and Speech Therapy for Apraxia-Words), they are merely tools to help parents and therapists address motor planning for speech through an organized hierarchy of progressively more complex productions. The user can pick specific sound groups to work on and then move through eight different difficulty levels for each group. The first app works with syllables, while the 2nd apps works with CVC words. So, again, the apps should not be viewed as a “system” in and of themselves. However they are useful tools when addressing motor planning for speech or even straight articulation.

Q. Do you have any suggestions for working on vowels with a student with autism who has a very limited sound inventory?
Lynn: If you are familiar with the vowel quadrangle (if not do a google search) you will want to start with the “corner” vowels which are the vowels in these words: beat, bat, boot, bar
Q : Any suggestions for training vowels? Thanks

Lori: Vowels are mostly a function of jaw grading. If jaw grading is the problem, then you may need to start there with oral motor exercises specific to that. But as with any oral motor functions, relate those movements to speech production as quickly as you can. For example, the long “e” sound requires a high jaw position (teeth are close together), while the “ah” sound requires a very open jaw, etc.

Q : I was wondering if you had any intensive apps that didn’t cost a fortune I could work on with my now 3rd grader? SHe was diagnosed with apraxia end of Kindergarten and we’ve been doing therapy, and the last 2 months the school districts therapist “left” and we had noone to help!!! We don’t have tons of $$ for an app, but need to fill that gap! Any suggestions???

Lori: Again, I don’t just look at a label or diagnosis when deciding how to approach treatment for any particular child. So I don’t believe one size fits all. But it is likely that NACD’s speech apps would apply here, as well as our app for sequential processing. They are all very affordable—Simply Smarter Kids-Memory ($1.99), Speech Therapy for Apraxia ($4.99), and Speech Therapy for Apraxia-Words ($4.99).

Q: What are your suggestions for apps that will help increase memory and assist with memory recall?

Lynn: Memory Train, Attention, kokako 123, Concentration: The Attention Trainer
Q : What are the best therapist for a 2 yr old with suspected apraxia

Lynn: therapist trained in an apraxia approach Speech-Ez, Prompt, Etc.. and someone who understand the principals of motor learning.

Q : What to do when all you have are vowel sounds…and an occasional consonant???

Lori: It’s really hard to be specific here because so much depends on what all the pieces are. So while I don’t have enough information to actually provide specific treatment activities, the parts I would be looking at as potential areas to address include: hearing/middle ear status, auditory sequential processing, oral motor skills, success in eliciting “pop-out” productions in more automatic contexts vs. production attempts in imitation. It is likely that all of the above would need to be addressed.

Q: What are your suggestions for a student that has mostly vowel sounds and an occasional /k/? We are really trying to get an /h/ and /b/ so that she might say hi and bye.

Lynn: The /h/ and /k/ are produced towards the back of the mouth so if the child has a /k/ intact I would attempt to produce a “weak” /k/ and see if /h/ could be stimulated that way. If the student also mostly has vowels attempt to mold a /kai/ , /ko/ , /ku/ /kak/ even though they aren’t real words you will be working on production along the vocal tract.

Q: is apraxia completely correctable….or is there always going to be speech and language issues due to this diagnosis??….thank you 🙂

Lynn: There will be children where Apraxia appears to have resolved itself through therapy. There will also be children who will have residual speech and language errors persistent. Children with Apraxia are also at risk for reading difficulties and a proper therapeutic approach should address literacy skills.

Q: My 3 year old is finally able to make the /i/ sound in “beep” but we are not having much luck getting him to use the /i/ sound in other words- he seems to be stuck in his old motor plans. Any tips?
Lynn: I would try coarticulation with your little one. Start the lips off closed and with a smile as you are about to say “beep” try to replace it with instead a /p/ or /m/ to form /peep/ or /meep/

Q: At what age can you diagnose Apraxia?

Lynn: There is not a set age criteria per say, however a child needs to have a large enough sound inventory in order to assess if they are indeed having difficulty with motor planning.

Q: Any good therapy materials or professional development opportunities that don’t cost an arm and a leg?

Lynn:Apraxia-kids.org has a number a webinars and on site trainings throughout the year.

Q: At what age do children or clients usually reach a plateau with remediation of apraxia? What is out treatment window?

Lynn: Each child’s prognosis is a little different. Other conditions and factors could also influence their progress timeline.

Q : Which assessment tool do you recommend for diagnosing apraxia

Lynn: VMPAC or Kaufman Praxis Speech Test along with a good language assessment

Q : Are there any free online screeners that SLPs can use to for a child they suspect presents with Apraxia?

Lori: Not that I know of.

Q : What are your suggestions for carryover of targeted sounds into conversation?

Lori: I go through a typical hierarchy of practicing sounds in progressively longer utterances—put target words into phrases; then practice in sentences. Then monitor spontaneous speech for these sounds and correct as needed. But at the same time I like to practice high frequency/high interest phrases and sentences that are specifically functional for that child. We do face-to-face practice, working on clarity for utterances that they are likely to need to use frequently. They may or may not all contain the target sound. I have the parents provide the list to practice so that I know we’re using pertinent content. It is a useful exercise both for increasing the child’s awareness of their productions and increasing overall intelligibility.

Q : What are your therapy suggestions for an Apraxic age 5-6 low intelligibility poor tongue control for lateral and elevation/depression? I would be interested to hear.

Lori: If tongue movement is compromised in general, then you might start with some oral motor exercises for those specific movements. (Sara Rosenfeld-Johnson is a good resource for that.) But then you quickly want to address those same movements in a speech context. Since muscle usage in not exactly the same for speech tasks vs. non-speech tasks, be sure you address the specifics of what that individual needs. So if tongue control is only an issue when it comes to speech, then you probably don’t need to start with non-speech-related oral motor exercises. Go right into working on specific speech sounds that require tongue elevation or depression. In other words, you must distinguish whether you are truly addressing a muscle weakness problem, a motor planning problem for oral movements, or a motor planning problem for speech.

Q : Do you recommend working with a brother (older) and sister (3) simultaneously or individually for the majority of the session (to get the most bang for your buck (it’s free therapy), but you know what I mean? Sometimes the provide good feedback for each other and other times I wanna cry! 🙂 Mahalo for your mana`o. (thoughts/opinion) Aloha!

Lori: If you are asking whether it can be useful to have a sibling help implement speech therapy activities, the answer is absolutely! If you are asking about two children who both need speech therapy, then it really depends on what your goals are as to whether it’s most efficient to work with them together or individually. It’s likely you could do some of both. Work with them together for activities they have in common or for language activities where it’s helpful to have another child participate. Then work with them separately for the other activities or for things where they need more intensive input and help from you.

Q : My mom is hospitalized now due to seizures….the speech therapist that is working with her mentioned apraxia…my mom is 73…will this apraxia go away or improve with speech therapy?

Lori: I have done a lot of work with adults with speech/language problems secondary to strokes or other neurological events. As with our kids, there is so much room for improvement with appropriate therapy. And as with our kids, they degree of recovery varies from one individual to another, depending on so many factors, including severity. But to answer your question directly: Can an adult with acquired apraxia get better with therapy? Absolutely.

Q : I worked with adults some time ago. After strokes and with some diseases they are diagnosed with apraxia. How are the children diagnosed? Not sure if my child is or not.

Lynn: VMPAC or Kaufman Praxis Speech Test along w

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