When individualizing a treatment plan based on a child’s needs and strengths, any of a number of treatment techniques that incorporate the principles of motor learning can be used in order to try to elicit “correct” speech movement gestures. Some traditional approaches are modified for children with CAS to incorporate speech motor learning principles. In everyday use, many of these tech- niques are combined in speech therapy for children with CAS.
- Multi-sensory cueing techniques use a variety of sensory cues to help the child hear, see, feel, and/or understand the target speech movement gestures being requested of them as they practice words or phrases
- Integral stimulation approaches use a well-defined and structured hierarchy of speech targets and re- quire the child to imitate utterances (syllables, words, or phrases) modeled by the clinician in a “look, listen, do what I do” approach. In this approach, the child’s auditory attention is focused on listening to the words, and his visual attention is focused on looking at the clinician’s face. Over time as the child’s skills improve, the clinician varies the timing of the child’s repetition and then ultimately works toward the child’s self-initiated correct production of speech targets.
- Progressive approximation and shaping techniques use speech productions that children are currently capable of producing and then, through various forms of feedback and practice, attempt to shape the child’s movement gestures into closer and closer approximations of the target word.
- Phonetic placement techniques provide verbal information and instruction to the child regarding what to physically do with their mouth, tongue, lips, or jaw during speech attempts in order to achieve more accurate articulatory positions for certain sounds that may be difficult for them to produce. However, the main focus of speech therapy is on speech movement sequences.
- Tactile facilitation approaches use touch or manipulation of the head, face, lips and jaw during speech production so that the child can better “feel” and over time remember how to move their articulators correctly in order to produce the speech movements. Assistance is often provided at first and then faded as the child obtains independence at making the movements gestures for speech.
- Prosodic facilitation, uses rhythm and melody to provide timing or rhythmic structure within which speech movements can be achieved.
- Gestural cueing involves hand cueing to represent targeted shapes and movements of the articulators.
Again, variations of these approaches are combined together in treating children with CAS. Additionally, because many children with CAS, have co-occurring language related issues, therapy approaches that best address those needs are certain to be included in the overall speech/language treatment plan, though they are not addressed in detail here.
Treetop Speech and Language therapy, Singapore.