Our guest host tonight, March 2, 2002, is Lori L. Roth, MA, CCC-SLP.
Ms. Roth will be chatting tonight about childhood oral/verbal apraxia.
Lori Roth is a Speech Language Pathologist/ Oral Motor Specialist with over 25 years
experience. Ms. Roth has practiced her skills in various settings including the public
schools and early intervention programs, but has always been focused on oral motor
skills and verbal apraxia. Ms. Roth currently has a full time private practice.
She regularly presents workshops in Oral Motor Skills and Articulation.      

<Robin> Welcome! Tonight we are chatting with Lori L. Roth, MA, CCC-SLP about oral/verbal apraxia.
<Lori>  Hello
<Robin>  Lori, can you give us an overview/definition of apraxia?
<Lori>  Verbal Apraxia in Children is thought to be a neurological disorder which is characterized
          by a motor planning problem for speech production.
<Lori>  Characteristics include groping for positions, good imitative skills if a visual model is
          present and poor auditory process/imitation skills.
<Lori>  There is Oral Motor apraxia and Verbal Apraxia...both are on a spectrum range of severity.
<Lori>  Standard Oral Motor activities and speech articulation tasks get poor results in therapy.
<Lori>  Everybody on the same page?
<Kathleen>  yes - keep going
<Lori>  There are different approaches I'm sure you have used and heard of...Nancy Kaufman's
          approximation approach and Debra Hayden's PROMPT (tactile cueing) techniques.
<bonniebee>  yes
<Kathleen>  Yes, could you give us some practical ideas on what will work/get results?
<Lori>  I do not tend to stick solely to one approach...and my private practice has expanded to 
          56 children under the age of 6.
<bonniebee>  Sounds wise
<Robin>  Kathleen, maybe if you describe a particular child you are working with, Lori can give you specific
<bonniebee>  Have you encountered apraxic children that also have some dysarthric components?
<Lori>  Yes. One does not preclude the other.
<Kathleen>  I am supervising a student with a child who is new to the school - about age . Artic is
          very poor, and he struggles for placement. When he does talk, intonation/prodsody are impacted.
<Lori>  Dysarthric speech is a motor weakness problem where apraxia is a motor planning. Work on the
          weakness first and then try the apraxia drilling.
<bonniebee>  Thanks for the response, Lori.
<Lori>  I usually try rhymes and simple songs with lots of repetitions.
<Lori>  Old McDonald, row,row row your boat, etc.
<bonniebee>  For the dysarthria?
<Lori>  Yes and another therapy task I have the kids do uses a large weekly medicine container.
<bonniebee>  How's that?
<Lori>  I put different items in the compartments and have them sing "What's in the Box".
<Lori>  Then open each door for their answer.
<bonniebee>  What is the tune you use for "What's in the Box" ?
<Robin>  Lori, were you recommending the rhymes and songs to Kathleen or to bonniebee?
<Lori>  To anyone who has to work on prosody and intonation. Try to remember that songs imitate the music
          of speech.
<bonniebee>  I use a lot of music with my kids. Thanks for the reinforcement.
<Lori>  There's a song "BLANK has a hat, now what do you think of that, I take off my hat and pass the
          hat to BLANK (the child sitting next to you)."
<Kathleen>  His prodody/intonation is poor, struggles in highly structured work, and spontaneous speech
          shows little to no carryover. Think we'll give the songs a try.
<Lori>  Make the song include vocabulary that's functional to him for his day, life.
<Kathleen>  I know we've used intonation therapy with aphasic adults - what is the length of time for
          carryover to phase out the singing?
<Lori>  It depends upon the child. Believe me they won't be singing arias.
<Kathleen>  I'm concerned with this fellow - very self conscious - we need to get him feeling successful in class.
<Lori>  For the combination kids I would start with oral motor strengthening and phase in apraxia work.
<Lori>  What's he interested in?
<Lori>  HArry Potter?
<Kathleen>  Yes - but a very restrained participant.
<Lori>  Invent spells and potions containing functional words in a saying.
<Kathleen>  I like that idea!
<kathleen>  Do you do the oral motor work in isolation?
<Lori>  Yes, first 10 minutes of the session OMT
<Lori>  Try to limit the consonants to m,b,p,t,d, and simple vowels.
<Kathleen>  That's good information.
<Kathleen>  Currently, he's struggling with reading - in an effort to incorporate with state SOL's we've worked
          in that area.
<Kathleen>  Also have another SLP with a non-verbal austistic preschooler. Recpetive skills good. Any suggestions?
<Lori>  Find sight words and have him say the words with familiar substitutions rather than accurately.
<Lori>  Nonverbal preschooler...I play Indians with these kids until I can get a spoken sound on command. You know
          the war cry..tapping you hand over your mouth while you vocalize.
<Lori>  I know this is not PC.
<Kathleen>  That sounds good.
<Kathleen>  He usually parallel plays at this point, but may imitate and show some interest with this.
<Lori>  Once you gat a sound shape it to /oh/ or /ah/...use it for 'open' and get out the medicine case (day a week
          compartments) with little objects of things he likes.
<Lori>  I also use a desk chair that spins around and/or a ball.
<Kathleen>  They may frown on the spinning with him - he's autistic and the stimming can really roll.
<Lori>  I either spin the child or bounce with sounds like bah or awow.
<Kathleen>  He may work well with the bouncing.
<Lori>  Most of these kids also have sensory issues and feeding issues.
<Kathleen>  Just working through getting him to be close has been a chore - we're getting there. No feeding issues
          thank goodness.
<janfri>  I am a mother of a 4 1/2 year old with verbal apraxia. Just trying to determine what type of therapy we should
          be seeking for her.
<Lori>  Please do not limit yourself to one therapy approach. But do make sure your therapist is experienced with verbal apraxia.
<janfri>  She receives private 2 hrs/week. The therapist just has her repeat words focusing on sounds such as sh, and s.
          Just wonder if there is anything else that should be done beyond repeating words over and over.
<Kathleen>  yes
<Lori>  Most definately!
<Kathleen>  Have you checked with public schools - you should have access - some systems have reliable therapists with experience
          in apraxia.
<janfri>  What should a therapist be doing with/for her?
<Lori>  Apraxia is a speech disorder that looks like a phonological disorder until you realize that the sounds you teach don't
          carryover to other words that have the sounds in the same place.
<janfri>  She also attends public preschool 4 times/week for 2 hours. They incorporate a lot of things throughout the day.
<Lori>  Where do you live janfri?
<janfri>  I live in Minnesota
<Lori>  Nancy Kaufman's clinic is in Michigan. Please call her since she is closest and may have a great recommendation for you.
<janfri>  Thank you. We just have worked with so many therapists over the years, as a parent also looking for the magic pill to
          cure all.
<Lori>  I will include Nancy's contact info with the resource material which will be added to this chat transcript when it is archived.
<Kathleen>  Janfri, apraxia can be frustrating - sometimes it seems progress is slow, hang in there. With the information you receive,
          perhaps you will find someone experienced and they can give you some ideas to support her at home as well.
<Lori>  Give me a second and I'll have it for you.
<Robin> The Cherub Foundation has excellent resources for apraxia.
<Lori>   Check out the website at www.apraxia.cc/CHERAB Foundation
<janfri>  Thank you. I will definitely check it out.
<Robin>  You can join their list serv which has many parents involved.
<Robin>  Professionals are also part of the list serv.
<Lori>  Also check out the apraxia-kids site www.apraxia-kids.org
<janfri>  I am very familiar with apraxia-kids. Just trying to find out all that I can.
<Marcela>  How do I get information on apraxia and assessments?
<Lori>   Both www.apraxia-kids and www.apraxia.cc have terrific information about what is
          needed in an assessment or you can pick up the handout I will be sending in to the chat archives.
<Robin>  Marcela, those websites can also be found on the resource link page of this website.
<Marcela>  And how do I get the archives?
<Robin>  The chat archives can be accessed from the homepage of this website by clicking the "chat archive" button.
<Robin>  The chats are listed by date and by topic also.
<Marcela>  Thank you very much.
<Robin>  Thank you, Lori, for sharing your expertise with us.
<Robin>  Goodnight all!