Apraxia, Frequency and Intensity of Speech Therapy, Literature Review

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Apraxia

Literature Review: Frequency and Intensity of Therapy for Children With Apraxia of Speech

Click here to print a "text only" copy of this page for personal use when advocating for appropriate services from your child's school or appealing an insurance denial.

Penelope Hall, Linda Jordan and Donald Robin, Developmental Apraxia of Speech: Theory and Clinical Practice:

"Intensive services are needed for the child with DAS. Children with DAS are reported to make slow progress in the remediation of their speech problem. They seem to require a great deal of professional service, typically done on an individual basis. Therefore, clinicians working with DAS must accommodate this need and schedule as much intervention time with the child as the child and/or his/her circumstances can allow. Thus, the clinician may be thrust into the position of becoming an advocate on behalf of the child to assure that services are provided as frequently as possible. In some cases, the clinician may need to help the family find the financial resources or assistance they may need to cover the costs of professional service; a child with DAS can quickly become an expensive child to his/her family or school system base of the amount of therapy they typically require.

"The roles of parents, teachers, peers, and siblings in a child's program of remediation will also vary with the circumstances. If the child with DAS can tolerate additional work and interacts well with the selected individual, the speech-language pathologist may include family and/or teachers in the overall programming to provide additional response opportunities for the child to reinforce and strengthen performance on a particular speech target. Creaghead, Newman, and Secord (1989) stated that "nightly parental drill... is a necessity" (p.274). However, in today's society we recognize that the involvement of the family and teachers in the extra remedial programming may not be a practical recommendation to pursue.

"The definition of 'intensive' varies from clinician to clinician and from work setting to work setting. Rosenbek (1985), when discussing therapy with adult apraxics, defines the word as meaning that the patient and the clinician should have daily sessions; Macaluso-Haynes (1978), Haynes (1985), and Blakeley (1983) also advocate daily remediation sessions. Blakeley (1983, p.27) stated that 'I do not expect to provide speech education for children with developmental apraxia of speech on a cursory basis for it may be the most important part of their entire education.' ..."

Apraxia-Kids Web Site, http://www.apraxia-kids.org/,by Shelley Velleman, Ph.D., CCC-SLP:

"The decision about frequency and duration of therapy, as well as the age of onset for therapy, must take into account a number of factors. It must always be a decision made based on the individual needs of the child. The first factor, and most important to me, is the readiness of the child. Is the child able to sit for a reasonable period of time? Can she sustain attention long enough to respond to the therapist? Does she have the ability to follow oral directions? Can she respond to an adult other than a parent? Also, children will benefit from more or less therapy at different times in their lives. Sometimes, a child will be making great strides in their reading skills, and need a break from speech. At other times, motor skills will be regressing, and the decision will be made to concentrate on physical or occupational therapy. "We recommend therapy as intensively and as often as possible. Five short sessions (e.g., 30 minutes) a week is better than two 90-minute sessions. Regression will occur if therapy is discontinued for a long time (e.g., over the summer). "

Edythe Strand, Childhood Motor Speech Disorder Treatment:

"A few major principles in particular have direct relevance to treatment of motor speech disorder. The most obvious, yet surprisingly often disregarded, is that of repetitive practice. Motor learning occurs and becomes habituated toward more automatic processing only if enough practice trials occur." (p, 130)

"Pairing of auditory and visual stimuli is included in most approaches, and intensive, frequent, and systematic practice toward habituation of a particular movement pattern is suggested instead of teaching isolated phonemes." (p 130)

"DAS is often characterized as being resistant to traditional methods of treatment. It may be that traditional methods are not to blame so much as: (1) The child's individual needs have not been given enough attention, (2) principles of motor learning (e.g. sufficient practice, knowledge of results) have not been sufficiently implemented into treatment, (3) not enough attention has been paid to varying the oral relationship between stimulus and the response, and (4) sessions are too infrequent to allow sufficient motor practice..."(p 131)

"The principles of treatment for motor speech disorders just discussed may be hard to implement in some clinical settings, especially the public schools. Large caseload demands often prohibit individual treatment. Group therapy decreases the potential number of responses per session for each child and, therefore, the motor practice needed by children with apraxia or dysarthria. The schedules of itinerant therapists often prevent them from seeing a child more than once or twice a week, which would greatly impede potential progress. Although it may not always be possible to have an optimum clinical situation, it is important to consider the treatment needs of each child and attempt to find creative solutions that allow frequent individual treatment for those children who will most benefit." (p 137)

Mary Pannbacker, "Management Strategies for Developmental Apraxia of Speech: A Review of Literature," Journal of Communication Disorders, 21 (1988):

"Rosenbek and associates outlined the following principles for management of developmental apraxia of speech: acquisition of near normal volitional speech as physiological limitations will allow; emphasizing movement sequences; generating task continua according to phonetic principles; limiting number of stimuli; intensive systematic drill; use of visual modality; and facilitating response adequacy with systematic use of rhythm, intonation, stress, and motor movements."

Macaluso-Haynes reviewed management procedures and "these techniques involved: 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; intensive, frequent, and systematic drill, and orosensory perceptual awareness"

Niklas Miller, "Acquired Speech Dyspraxia," Disorders of Communication: The Science of Intervention, Margaret M. Leahy, c. 1989, Chapter 12:

"The work of LaPointe and Dworkin demonstrated improvement and the patients in the report by Wertz improved if they received motor speech training, but not as a result of general language therapy. Given the controlled conditions stipulated in the studies..., it is clear that speech dyspraxia can respond to therapy. All approaches involved an intensive pattern of therapy. Even if not seen daily be a therapist, patients carried out daily practice. The studies also re-emphasize the need for objective, principled structuring of therapy steps and the assessments that monitor them -- establishing baselines and controls, systematically manipulating variables (input, response demands, etc.) and monitoring which mode and combination of therapies are providing most effective for the individual..."

Robin Strode and Catherine Chamberlain, Easy Does It for Apraxia-- Preschool, Materials Book:

"Daily practice is critical for consistent progress. Children with DVA [developmental verbal apraxia] have difficulty locking in the motor sequencing for speech. Frequent short practice sessions are very important."

"Consistent and frequent therapy sessions are recommended. The intensity and duration of each session will depend on the child. At least three sessions per week are recommended for the child to make consistent progress."