Current Approaches to Management of DAS Michelle D. White

Treatment No two children will present the same behaviors. Therefore, there is no one BEST management technique. The following slides offer some approaches that have worked well.

Principles Suggested as Important to the Treatment of Developmental Apraxia of Speech 1.Use of intensive paired auditory and visual stimuli 2.Production of sound combinations vs. isolated phoneme training 3.Focus on movement performance drill 4. Use of repetitive production and intensive systematic drill 5. Careful construction of hierarchies of stimuli 6. Use of decreased rate with proprioceptive monitoring 7. Use of carrier phrases 8. Use of paired movement of sequences with suprasegmental facilitators such as stress, intonation, and rhythm 9. Establishment of core vocabulary (especially for the nonverbal child) Edythe Strand, Ph.D. "Treatment of motor speech disorders in children," Seminars in Speech and Language, Vol. 16, No. 2, May 1995.

Therapy program that has been effective with a number of Apraxic children focuses on: 1.The motor patterns of basic target phonemes, bringing these productions to surface awareness and control 2.The reinforcement inherent in combination and blending drills for mastering production of the motor patterns of the critical syllable units of our language. 3.Teaching of volitional control of the emission of a key word vocabulary. Gerald Chappell. "Childhood verbal apraxia and its treatment," Journal of Speech and Hearing Disorders, Vol. 38, No. 3.

Other Strategies acquisition of as near normal volitional speech as physiological limitations will allow; emphasizing movement sequences; generating task continua according to phonetic principles; limiting the number of stimuli; intensive systematic drill; use of visual modality; facilitating response adequacy with systematic use of rhythm, intonation, stress,and motor movements." Mary Pannbacker. "Management strategies for developmental apraxia of speech: a review of the literature," Journal of Communication Disorders, 21,1988.

Other Strategies cont. concentrated drill on performance imitation of sustained vowels and consonants followed by production of simple syllable shapes movement patterns and sequences of sounds avoidance of auditory discrimination drills slow rate, self monitoring core vocabulary; carrier phrases rhythm orosensory perceptual awareness Mary Pannbacker. "Management strategies for developmental apraxia of speech: a review of the literature," Journal of Communication Disorders, 21, 1988.

Treatment approaches for developmental apraxia of speech 1. establish physiological support 2. enhance postural shaping and kinesthetic awareness for functional units of speech 3. enhance kinesthetic awareness for movement sequences 4. regulate rate and melodic flow Paula Square, Ph.D. "Treatment approaches for developmental apraxia of speech," Clinics in Communication Disorders, 4 (3), “….methods that highlight movement sequences and methods that heighten the melodic line and slow rate are the ones that have gained the greatest favor in the treatment of children with DAS and adults with acquired apraxia of speech."

PROMPT P - Prompts (for) R - Restructuring O - Oral M - Muscular P - Phonetic T - Targets ……involves the dynamic delivery of tactile and kinesthetic cues to the speech mechanism to signal place of articulation, timing of respiratory, laryngeal, and velopharyngeal activity, and the durations of valving constrictions or vocal tract postures Paula Square, Ph.D. "Treatment approaches for developmental apraxia of speech," Clinics in Communication Disorders, 4 (3), 1994.

The Adapted Cueing Technique (ACT) – Klick (1985) “focuses on movement patterns through enhanced visual feedback. That is, the clinician stimulates the child to say a phrase by providing the auditory model coupled with movement along side the clinicians face to indicate movement trajectories.” Paula Square, Ph.D. "Treatment approaches for developmental apraxia of speech," Clinics in Communication Disorders, 4 (3), 1994.

Jaffe (1986) 1.By repeated association the signs can help the child recall and correctly articulate sound patterns and produce correct syntactic sequences 2.Signs and speech help the clinician to slow the rate of presentation and help the child reduce the rate of utterance. Kathleen Helfrich-Miller, Ph.D. "A clinical perspective: melodic intonation therapy for developmental apraxia," Clinics in Communication Disorders, 4(3), 1994.

Treatment Summary Most treatment approaches share the following: Focus on movement across various spatial planes. The use of melody and rhythm. The use of repetitive production and systematic drill, correction and feedback, decreased rate, and targeted motor placement. Sensory cueing (e.g., kinesthetic, visual and tactile cueing); verbal cueing; touch cueing.

Prognosis No two Children with DAS will have the same features or traits and there are numerous factors that influence the outcome of therapy. However, it is important to remember: Most, but not all, apraxic children who receive therapy can become competent oral communicators.