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Research Question:

What are the most effective treatment methods for developing verbal skills for school-aged children with severe developmental apraxia of speech?

Foundation Questions:

1.  What is developmental apraxia of speech (DAS)?

2.  What are the characteristics of DAS?

Tentative Point:

In doing this assignment I hope to share information regarding the most effective treatments for children with verbal apraxia. This will increase the readers' awareness of verbal apraxia, as well as how it is successfully treated.

Genres: 

Genre 1. Webliography             

Voice:  Clinician

Audience: General Public 

Rationale:  This webliography was chosen in order to inform the public about me and my general interests.

Genre 2.  Powerpoint Presentation 

Voice:  Clinician

Audience:  Client and Family

Rationale:  The powerpoint presentation will be developed in order to offer the client and his family some brief information about verbal apraxia and different types of treatment. 

Genre 3. Poem

Voice:  Client

Audience:  Client's family

Rationale:  The poem will help explain to the family what the client is experiencing because of verbal apraxia.

Genre 4. Email Exchange

Voice:  Mother of child with verbal apraxia.

Audience:  Another mother of a child with verbal apraxia.

Rationale:  The email exchange will describe the experiences of a mother of a child with verbal apraxia who was released from therapy  to the mother of a child recently diagnosed with verbal apraxia.

Genre 5.  Journal Entry

Voice:  Client

Audience:  Client (personal journal)

Rationale:  The journal entry will discuss the client's progress and/or setbacks during therapy.

Genre 6.  Observation Report

Voice:  Clinician

Audience:  Clinician

Rationale:  The clinician will record observations made regarding the client and use the results to form an appropriate plan for therapy.

Genre 7.  Pamphlet

 Voice:  Clinician

Audience:  General Public

Rationale:  The pamphlet will be used to inform the general public about verbal apraxia and treatment options.

Anticipated Integration of Genres: 

I plan to integrate all the genres by writing a letter from the client's perspective.  This letter will discuss the client's feelings about having verbal apraxia and how therapy is helping him.

Tentative Resources:

Aram, D. M., & Horwitz, S. J. (1983). Sequential and non-speech praxic abilities in developmental verbal apraxia. Developmental medicine and child neurology, 25 (2), 197-206. Retrieved September 7, 2005 from the Medline database 

Barnhart, R. C., Davenport, & M. J., Epps, S. B., Nordquist, V. M. (2003).  Developmental coordination disorder. Physical Therapy, 83 (8), 722-732.  Retrieved September 28, 2005 from Academic Search Premier database.

Chappell, G. E. (1973). Childhood verbal apraxia and its treatment. Journal of Speech and Hearing Disorders, 38 (3), 362-368. Retrieved September 28, 2005 from the ERIC Database.

Deger, K., & Ziegler, W.  (2002). Speech motor programming in apraxia of speech.  Journal of Phonetics, 30 (3), 321-356. Retrieved September 28, 2005 from the Academic Search Premier database.

Ekelman, B. L., & Aram, D. M. (1983). Syntactic findings in developmental verbal apraxia. Journal of Communication Disorders, 16 (4), 237-250. Retrieved October 7, 2005 from the PsycINFO database. 

Harris, L., Doyle, E. S., & Haaf, R. (1996). Language treatment approach for users of aac:  experimental single-subject investigation. AAC:  Augmentative & Alternative Communication, 12 (4), 230-243. Retrieved October 7, 2005 from the Medline database.

McAllister, A.  (2003). Voice disorders in children with oral motor dsyfunciton:  perceptual evaluation pre and post oral motor therapy.  Logopedics Phoniatrics Vocology, 28 (3), 117-126. Retrieved September 28, 2005 from the Academic Search Premier database.

Mirenda, P., & Mathy-Laikko, P.  (1989). Augmentative and alternative communication applications for persons with severe congenital communication disorders:  an introduction. Augmentative and Alternative Communication, 5 (1), 3-13. Retrieved September 28, 2005 from the ERIC database.

Skenes, L., & Trullinger, R. W. (1988). Error patterns during repetition of consonant-vowel-consonant syllables by apraxic speakers. Journal of Communication Disorders, 21 (3), 263-269. Retrieved October 7, 2005 from the PycINFO database.

Ziegler, W., & von Cramon, D. (1986). Disturbed coarticulation in apraxia of speech:  acoustic evidence. Brain and language, 29 (1), 34-47. Retrieved October 7, 2005 from the PyscINFO database. 

Always afraid to answer questions, so I

Pretend I don't know by shrugging.

Reading out loud is almost impossible

And I know everyone is looking when I try.

X is a sound I can never get right.

I wish I could talk like everybody else

And prove I am just as smart as them.

September 20, 2005

    I found out today what it is that's making it hard for me to talk.  I had to go to a lady who looked in my mouth and then made me say a bunch of different sounds and words.  It was pretty hard and I messed a lot of them up but she said I did good.  After I finished saying all the sounds and words she came back to me and mom and told us what I had the most problems with and that she thinks I have something called Verbal Apraxia.  Basically, my mouth has trouble trying to figure out what my brain wants it to do when I talk.  She said that she could help me if I started going to therapy so I'm starting in 2 weeks.  When we got home, we talked about it with Dad and him and mom said it would be a good idea and asked what I wanted to do.  I told them if it would help me talk right then I wanted to do it.  Mom called the place up and said we wanted to start working on how I talk and they set up a time for me to come in.  I start on October 10th. The lady told me that I would get better all of a sudden but I hope it doesn't take too long. 

 

October 10, 2005

 Well, I finished my first day of therapy. It wasn't that bad.  Basically, the woman had me to say the same things over and over. Then she had me try to say things that were close to the real word.  I did better at that then trying to say the real word.  I felt kind of dumb doing it because I knew I was messing everything up, even the really easy sounds.  I started to get mad over some of them because they weren't hard sounds but I still couldn't even come close to saying them right.  She also made me sing some of the words instead of just trying to say them.  This was even worse than just trying to say them because I hate to sing, I don't even sing in church on Sunday.   At least she sang with me so I didn't have to be the only one sound stupid.  The therapist (Mom told how to spell that) let me take a break whenever I did REALLY bad and she told me that, believe it or not, I was doing really, really good.  I don't know how much doing all that stuff helped but it wasn't too bad and if it works, it will  be worth it.

To:  soccermom05@email.com

From:  judybrooks1977@email.com

Subject:  son with verbal apraxia 

Samantha,

Hello, my name is Judith Brooks.  This week my son Matthew was diagnosed with verbal apraxia.  My friend Carol told me that your son was also diagnosed with this and he just recently finished his last therapy session.  I've been reading about verbal apraxia and I know that it's also called Developmental Apraxia of Speech and that it makes it difficult for a person to speak and in Matthew's case, the longer his sentence is, the worse he sounds.

But I really don't know what to expect to happen when Matthew starts going to therapy.  So I was hoping you could tell me some of the things that your son went through while in therapy.

With much appreciation,

Judith. 

From:  soccermom05@email.com

To:  judybrooks1977@email.com 

 Subject:  re:  son with verbal apraxia

 Judith,

I'd love to tell you about what our experiences are in dealing with verbal apraxia.  Sammy (that's my son's name)  required therapy 5 times a week and each session took 30 minutes.  This lasted for about 8 months and then we only had to take him twice a week and each session was 45 minutes long.  Sammy was in preschool when he started it and he absolutely hated the intense therapy. But as time went on, he began to tolerate it and would sometimes even be excited after particularly a successful session.  

After about 5 months everybody who knew him could tell he was improving.  My husband and I both wanted him to be able to say his name and he did just that after 13 months of therapy.  He went from saying "Na-Naa" to "Shammy".  He can now clearly say "Sammy" with no hesitation. 

It's hard to be patient when it's your child that is suffering but just hang in there and eventually you'll see improvements.  I found something that helped us was to keep a box or folder of everything we learned and did while in therapy.  It was a great way to keep all the information together and it really helped Sammy to see how far he had come.

Keep me updated on how Matthew is doing and please let me know if there's anything I can do to help.

Sincerely,

Samantha 

 To:  soccermom05@email.com

 From:  judybrooks1977@email.com

 Subject:  update on matthew

Hi Samantha,

 I just wanted to let you know how Matthew is doing so far. He did his fourth therapy session today. He isn't the most thrilled kid in the world to be going to therapy every week but he does like his therapist.  I get to watch him from behind a mirror and you were definitely right about it being rough to watch him struggle.  He won't do too bad as long as he only has to say one or maybe two words but anything after that, the poor guy falls apart.  I always feel like running in and hugging him but I force myself to sit and just watch the therapist help.  She's really been a lot of help so far.  That's not to say that Matthew's made any major accomplishments but at least now we know how to work with him at home in between therapy sessions.  You probably had to do most of these things when Sammy was in it but now we do a lot of songs and practice on sentences that we use a lot. 

I also wanted to tell you that I took your advice on saving everything he did and what we've learned.  I suggested the project to Matthew and he was all for it. 

The first thing we did was to keep all the information they had given at the clinic, such as a pamphlet on DAS and iformation from a PowerPoint Presentation (to be added) Matthew and I went to.

I spoke to a student named Chris Stout who's going to Marshall University to become a Speech-Language Pathologist and he told me that he has a weblog with a few links to information about DAS.  Chris happened to be observing Matthew when I met him and he was kind enough to let me see what he was writing about on a form.

Matthew has also been writing about how therapy is going in a journal and he wrote a poem using the letters from "APRAXIA."  I couldn't help but cry when I read it the first time.  It just breaks my heart that my little boy is going through so much pain and I can't just step in a make it all go away.  I didn't let him see me cry because I was afraid I'd upset him or think I didn't like it.  He's really proud of that poem and he loves the idea of doing this little project.  As soon as we get home from therapy, even before he eats, he writes in his journal and puts his speech homework for the day in a folder.

Anyway, I just wanted to let you know how it's going so far and to thank you again for helping us out.  I promise to keep you updated on his progress.

I'll talk to you soon.

Judy 

 

ADVANCED THERAPY OBSERVATION REPORT # 1

Name: Chris Stout                                        Client's Initials:  M.B.

Date of Observation: October 20, 2005       Age: 10

Length of Observation: Two Hours              Indiv.  Yes  Group 

Client Disorder:  Articulation (Developmental Apraxia of Speech)

1)  Describe 1 segment of the session you found to be effective (What appeared to go well? What was successful?).

    While observing the client, I noticed he was able to articulate two-syllable and three-syllable words more appropriately when the clinician tapped out the rhythm of his speech on the table.  When she tapped the table the client was to say a syllable of the word.  It sounded like this: "ki," tap, "tty," tap, "cat."  Before using rhythm, the client could only say "ki-at."  I also noticed the client relaxed somewhat after some initial shyness about listening to the tapping.  This was a major improvement because previous to this the client was getting frustrated.  I noticed he was starting to avoid meeting our (the clinician and myself) eyes and his cheeks were starting to redden.  However, after following along with the clinician's tapping, the client started to smile again in response to the improvement and our praises.

2)  Describe 1 segment of the session you found to be less effective and/or confusing to you.  (What do you think did not produce a desirable result?  What did you not understand?)

    Simple repetition of the entire word appeared to be the least effective.  The client could barely make an approximation of the words and was obviously getting frustrated.  He was unable to clearly say any word and this lead to him withdrawing.  As I said before, he started to stare at the floor or the word lists and his cheeks began to turn red.  After he attempted to repeat each word three times, the clinician decided to move onto another method that could might be more effective and boost his confidence again.

    I don't think this was  the most appropriate method for this client or at least not at that time.  I don't think he was fully aware yet of where his tongue was during speech and where it should be.  This was causing (I believe) a lot of his problems.

 3)  Discuss 1 element of the session that surprised you and/or you found contradictory to your understanding (information you have from class, common sense, experience, or expectations).

    I was surprised that the clinician didn't go back over tongue placement with the client after he did so poorly on the repetition of words.  I recall from a previous class that in order to ensure the client can correctly form sounds, he should first be able to know how the sound is correctly made and what it should sound like.  the clinician didn't do any of this, she simply went on to another exercise.

 4)  Write about:

•       What you learned from this observation

       Before observing this client, I had read about tapping out the rhythm to aid a client's articulation but I had never actually seen it used.  It surprised me how much of a difference it made for this client.  Although the words he said were not perfect, they were noticeably better than any of his previous attempts. 

    Another thing I saw during this therapy session was the discomfort DAS causes in children.  I have seen several sessions of therap for DAS but they all involved very young children who did not appear overly concerned about how their speech was.  This child was very uncomfortable with his inability to say the words.

•  Your feelings/reactions of the impact of the therapist's intervention on the client

       I thought the clinician did  a great job of responding to the client's feelings.  When she saw his discomfort she moved onto another method that was much more successful for the client, which relieved his discomfort.  She was also very good about praising him when he did a good job which made him more responsive. 

•  Your feelings/reactions of the impact of the client on you as an observer

    I can't help but think how frustrating it must be for this child.  He knows exactly what he wants to say and how to say it.  The problem is with the message from his brain to his muscels.  I think that being able to help him eventually speak clearly and easily would give the clinician the greatest feeling of satisfaction.   Knowing that someday I will be able to help somebody like this child speak clearly and easily is what made me choose this major in the first place.

What is Developmental Apraxia of Speech?

Developmental Apraxia of Speech (DAS, for short) is also known as Verbal Apraxia.  It is a speech disorder that interferes with a child's ability to correctly pronounce sounds, syllables and words by preventing the face, tongue, lips and jaw to work properly.  Usually there is nothing wrong with the child's facial muscles but the area of the brain responsible for telling the muscles how to move is damaged or not fully developed.

Main Characteristics of DAS:

Child struggles to speak

Child says words easily sometimes; other times has difficulty with same word

Child uses small number of sounds

Child has more difficulty with conversation than with imitating sounds

Child has difficulty combining words

Child sounds worse as the length of sentence increases

Child speaks slowly, rapidly or has uneven pace 

Cause of DAS:

DAS is a neurologically based speech disorder whose causes are unknown at this time.  Some theories suggest the impairment is the result of a small injury or difference in the area of the brain responsible for speech.

Treatment:

It is important to know that a child will not "grow out of" DAS.  Therapy is required to improve the child's speech.  This therapy is usually intensive and requires 2-3 sessions a week, beginning soon after the child is diagnosed.  Children can start therapy as young as 18 months and usually attend for 2-3 years.  Most children with DAS become proficient speakers after treatment.  In severe cases, augmentative devices may be used to aid the child.

For More Information:

If you suspect your child may have DAS, you should consult your local Speech-Language Pathologist.  To locate one in your area, visit: www.asha.org.  If you would like more information about DAS, please go to:  www.apraxia-kids.org or www.nidcd.gov.

Resources:

What is Developmental Apraxia of Speech?  Retrieved October 27, 2005, from http://www.tayloredmktg.com/dyspraxia/das.shtml#what.htm

Aram, D. M., & Horwitz, S. J.  (1983).  Sequential and non-speech praxic abilities in developmental verbal apraxia.  Developmental medicine and child neurology, 25 (2), 197-206.  Retrieved September 7, 2005 from the Medline database.