Apraxia – What it’s All About

Apraxia touches so much of our journey with Noah, I thought I’d take this opportunity to explain what it is.

According to the American Speech/Language Hearing Association,  ”Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. ”   There is a lack of information being processed in the brain about how to make skilled movement.

There are three types of apraxia:

1. Oral apraxia – this involves the motor planning required in feeding and swallowing.  Babies with Down syndrome often have trouble sucking and swallowing because of poor muscle tone and strength.  It is usually not due to apraxia.  (Noah had great difficulty nursing as a baby.  His tongue would also slip out of place and he’d wind up sucking on it instead of a food source.  This type of feeding pattern is common in children with Down syndrome due to their anatomy and poor muscle tone, so I don’t know if it was oral apraxia or not.)
2. Motor apraxia – this involves use of muscles required for gross motor activities.
3. Verbal apraxia – this is the inability to access or form speech motor plans which move the idea of the word from the child’s brain through the pathways in the brain to the mouth and out through the lips.  (This is the type Noah most certainly has.)

It is quite common for a child to have only verbal apraxia, although many therapists wrongly assume that if a child has verbal apraxia, it will also show up in gross motor and oral skills.

A child with verbal apraxia will be able to say some words sometimes and at other times be at a total loss.  They will often look like they are groping for words, or that a word is on the tip of their tongue but is refusing to come out.  A frustrating characteristic about this condition is that the harder a child concentrates on saying a word, the more their motor planning abilities come into play, and the harder it is for them to say the word they are attempting.  Often times their best speech production will be in spontaneous utterances leaving mom and dad saying, “Where did that come from, and how can we get him to say it again?”

For parents of children with Down syndrome, it is heartbreaking (for a while) to accept the diagnosis of Down syndrome and then to deal with all the therapies and sequelae that go along with raising these special children.  Once a diagnosis of apraxia is made, it can be overwhelming to have another condition to tackle, more hurdles to overcome.  The good news is that once diagnosed, apraxia can be treated effectively.  But I’ll save that for a future post.

A special thank you goes out to Kay J. Giesecke, MS, CCC-SLP  http://apraxiadallas.com/about_us.  She is known among SLPs as the guru of apraxia, and I learned a lot from attending her workshop at the 2012 TSHA convention.  An easy to follow handout of her workshop can be found at http://www.txsha.org/_pdf/Convention/2012Convention/2012Handouts/Giesecke,%20Kay%20-%20The%20Changing%20Nature%20of%20Childhood%20Apraxia%20of%20Speech%20Characteristics%20and%20Treatment%20Strategies%20Over%20Time.pdf.

Bringing PECs and Literacy Together – Find and Seek PEC Boards

When we hear the word “literacy,” we usually think of the ability to read.  We want our children “literate” by kindergarten or so, and we consider our children literate once they have read their first storybook.

www.wikipedia.org defines literacy as “ the ability to read for knowledge and write coherently and think critically about the written word. Literacy can also include the ability to understand all forms of communication, be it body language, pictures, video & sound (reading, speaking, listening and viewing).”  Sounds like a recipe for PECs and multi-sensory learning, doesn’t it?  As parents  of children with learning disabilities or differences, having this holistic approach to literacy is necessary as we deliberately plot our child’s course on the road to reading.

I want to make books come alive for our children.  I want our children to do more than just sit still while we read to them.  I want them to see the story, not just a bunch of random colors and shapes.  I want them to think about what they are seeing.  I want them to apply their knowledge to the new pictures and text on the written page before them.  I want them to take from the pictures and text on the written page new tidbits of knowledge.  I want these stories that we read to our much-loved children to do more than just entertain them for five minutes or so.  I want these stories and ideas to attach themselves to our children’s minds and hearts in the form of memories that will last a lifetime.

We did that today.  Wow, when I write it all out and see it in black and white, I realize we accomplished quite a bit!

My mind is still whirring from all I learned at the 2012 TSHA Convention.  Taking away a little bit from each workshop I went to, I’ve come up with a couple of ideas for literacy-based activities that I’d like to feature here on a regular basis.  Yesterday I posted our first Build-As-You-Go PEC Storyboard, and today I made our first Find and Seek PEC board.  Here’s how it works.

Method:  Find and Seek PEC Boards

Skills Targeted:

1. Literacy
2. Reading and Listening Comprehension
3. Generalizing
4. Matching

Process:

1.  Choose a short picture-based book to read to your child.

2.  Make PECs that correlate with different details in the pictures.

3.  Prepare the PECs (print, cut and laminate PECs.  Place velcro loop dots on the back of the PECs.)

4.  Prepare a PEC board (laminated paper with a length-wise strip of velcro hooks at the top, middle and bottom).

5.  Choose the PECs that you want to focus on for that session and place them face up in front of your child.

6.  Read through the book with your child, stopping to point out the details that you have a corresponding PEC for.  For example:

Mom:  (Pointing to a shoe in the picture) “Oh, look, what is she wearing on her foot?”

Noah:  (says or signs) “Shoe.”

Mom:  What color is the shoe?

Noah:  “Blue.”

Mom:  “Oh, she has a blue shoe.”  Do you have a blue shoe (pointing to the PECs)?

At this point, Noah will pick up the blue shoe PEC and place it on the PEC board.

7.  Alternatively, you may want to have a session with your child where you are only working on the PECs.  So you may read the book in one session, and work on PECs in the next.

In case you are wondering, the difference between Find and Seek Boards and Build-As-You-Go Boards are the BAYG boards focus on the main point of each page or spread, and the Find and Seek Boards focus on pictoral details that may not even come to light in the text.

One thing I have heard over and over again about working with children with learning disabilities is that we should always take things down to a level where they can be successful.  So don’t hesitate to only put one picture in front of your child at a time to choose from.  You are building up their abilities by taking baby steps.  The first thing they need to be able to do is to pick up the correct card.  So even if they are doing that without having to make a choice, they are being successful.  Reward them!!!!  Praise looks like ”Good job, way to go, that’s right, yes!”  Once they have that down, just have them choose between two cards at a time.  Slowly build up from there until they are looking through a whole book’s worth of PECs to find the right one.  Children are more likely to want to return to an activity that they have experienced success at (and come to think of it, so are parents, right?)

Stay tuned for my first Find and Seek PEC Board, coming soon!

2012 TSHA State Convention – Orthographics Part 3 and the Homeschool Connection

This is the third and final installment in this series on the workshop I attended on orthographic intervention put on by Keli Richmond of Literacy Speaks, but you’ll be sure to see more about how we are implementing this concept with Noah in the future.  Click to see 2012 TSHA State Convention – Orthographics Part 1 and Part 2.

Orthography - ”The study of letters and how they are used to express sounds and form words.”  Well, that sums it up in a nutshell, doesn’t it?  So we are teaching our children orthographics at the same time we are practicing speech when we show them the letters that correspond with the speech sound we are working on.  Without adding any more time to your routine, your child is getting literate at the same time they are learning to speak properly.

I think what excites me most about this idea is that it just makes sense.  And then there’s that nagging feeling that, wait a minute, haven’t I seen this somewhere before?  It wasn’t until I was back home and rested up from the convention that I realized this is not a new concept to me.  It was lurking somewhere in the shadows of my memory.  So I started digging through my various preschool curriculuae.  One of my favorite preschool programs is Little Hands to Heaven.  Another program I have had success with is Teach Your Child to Read in 100 Easy Lessons.  Both of these programs use orthographics to promote literacy.  Instead of requiring children to know the names of each of the letters before working on the sound, children are taught to recognize the letters of the alphabet by sound.  From experience, I can tell you that once a child can recognize a letter by the sound it makes, learning the names of the letters are easy.

Keys to Using Orthographic Intervention in Home-Based Speech Sessions:

1. Show your child a flashcard containing the letter you are practicing.  As you prompt him to make the sound, direct his attention to the flashcard.  This will cause him to associate the letter with the sound.
2. Use lower-case letters only on your flashcard.  The first words your little one will learn to read will consist of lower case letters, so these are the letters we will promote literacy on first.
3. Only teach one new sound per session.
4. Teach sounds in the order they are learning them in speech, not in alphabetical order.
5. Introduce ch, sh and th early.  (Teach these sounds according to flashcards as well.)

I do have to tell you that this is just a foundational principle behind the Literacy Speaks program.  You really have to see the program for yourself to wrap your mind around the full program.  I love the way Kelli does her word flashcards with the focused sound in isolation, then the rest of the word and then the entire word at the bottom of the card.  Flip it over and you have a picture of the word.  One of the things she pointed out is not to bring in the picture until the child has mastered the word.  In one video clip, a child actually flipped the card over to see the word without the picture in order to read it.  It seemed the picture along with all the letters was too much information and she needed to simplify it in order to read it.  Now that is one literate child!!!!!  I was so fortunate to be able to sit in on this workshop, because I think I can reproduce the skeleton of it for Noah now that I understand it.

http://www.facebook.com/pages/Literacy-Speaks/232325152896?sk=wall is the Facebook page for Literacy Speaks, and guess what!  Free daily printables.  How cool is that?  Even I can’t keep up with that pace.