Making the Shift From Articulation Therapy to Motor Speech Therapy

Full transcript

Hi, it's Nicole coming in from the NYU Motor Speech Lab, and we are feeling so invigorated after attending the Apraxia Kids Conference these past couple of days. I highly recommend it if you haven't been. It's really special.

One of the things we talked about as a team here at the Motor Speech Lab, Dr. Case, Dr. Grigos, Emily Wong, and myself, was making the shift: making the shift from traditional articulation therapy to motor speech therapy. What exactly are we talking about, and what does that mean?

We know that childhood apraxia of speech is an example of a motor level of impairment that requires different goals and different methods of cueing. It really changes how we organize our sessions, and we really try to get as much practice as we physically can per session.

Making the shift is challenging. It's not only challenging for the kids coming into this treatment, it's also challenging for us as clinicians. How do we do this? We put conscious thought into the words that we choose. We're really watching the movement as well as listening to the productions. We're slowing rate to facilitate proprioception. We're paying attention to feeling the movement ourselves as we model the words. We're thinking about the goal of helping the child develop, refine, and habituate motor programs for speech.

So what are these shifts? Structured practice is the first one we talk about: removing distractors, removing the toys. At first I was a little afraid of not having all my things around me, but as long as you have quick reinforcers, the kids are with you.

Conscious practice, which is really a part of conditioning the child to get used to this type of treatment, is really important. In this type of treatment, we're working in blocks. We're working on the target word in blocks of 10 to 20 productions, and then we're doing a quick reinforcer. It's not your standard drill.

We're using dynamic multimodal cues to focus on movement. We showed one of my favorite cues in our presentation: for "banana," the little boy I was working with started mimicking a hand gesture, and it really facilitated getting this more challenging three-syllable word shape out.

We practice prosody, and we start early.

And we have this understanding that practice doesn't make perfect; practice makes permanent. So we want to avoid negative practice. If you start hearing or seeing your client going into an inaccurate production or an inaccurate articulatory configuration, you stop them immediately. We do not want negative practice. In the same vein, we really don't want parents practicing at home if the child hasn't really laid down the motor plan for that word, because then we can just be engaging in negative practice.

I hope this is helpful. Good luck making the shift.