Our guest hosts tonight, April 16th, 2001 are Dr. Marilyn Agin, SLP, MD, and Lori L.
Roth, MA, CCC-SLP, who are both part of the volunteer professional
staff of the CHERAB Foundation, a personal support source for
apraxic and language disordered children and their families. They will
be chatting tonight about childhood oral/verbal apraxia.

Prior to medical school, Dr. Agin received her master's degree in
Communication Disorders and was a practicing speech pathologist
treating children and adults. Subsequently, she completed a combined
residency in Pediatrics and Physical Medicine and Rehabilitation at
New York University Medical Center and the Rusk Institute. She is
board certified in both fields.

As a practicing pediatrician, Dr. Agin was a keen observer of normal
development during the well visits for young patients.  She would
often identify children with speech and language disorders, including
apraxia of speech, neuromotor delays, sensorimotor dysfunction, and
children on the autistic spectrum.

Currently, Dr. Agin is the Medical Director of the Early Intervention
Program for the city of New York-the biggest program of its kind in
the country.  In addition, she treats developmentally disabled
children in a clinic setting and does private neurodevelopmental
evaluations for children of all ages.  She is passionate about early
referral for developmental delays and disorders and has lectured to
other Pediatricians and participated in numerous workshops on
developmental surveillance, screening and assessment.  She is a member
of the New York City Chapter of the Committee on Children with
Disabilities of the American Academy of Pediatrics.

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, as well as participates as an active Board
Member for the CHERAB Foundation/Children's Apraxia
Network. Ms. Roth is coordinating research projects presently
being developed by the CHERAB Foundation with the hopes
of finding effective treatment tools, dietary
supplements and diagnostic tests for verbal apraxia in

<Robin> We are very pleased to welcome Lori Roth and Marilyn Agin as our chat hosts
<Robin> they are both part of the volunteer professional staff of the CHERAB
    Foundation, a personal support source for apraxic and language disordered children
    and their families
<bilingualslp> is there a way to subscibe to the organization's newsletter?
<Marilyn Agin> We do not have a newsletter
<Marilyn Agin> We have a grouplist thru yahoo
<bilingualslp> i guess all the info is on the website
<Lori Roth> yes. www.apraxia.cc
<Robin> Deb, just go to the www.apraxia.cc website for listserv info
Lori Roth> Are there any questions about verbal apraxia that we can answer for the
<Robin> have any of our chat participants worked with apraxic children?
<bilingualslp> yes I have and I guess I have questions about differential diagnosis
<Lori Roth> Has anyone taken a PROMPT workshop?  Differential diagnosis is found on the apraxia
<bilingualslp> I have worked with children who appear to have the diagnosis-there
    have been times when I was not sure-
<bilingualslp> no I have not taken PROMPT
<Robin> what characteristics made you think the children were apraxic?
<Lori Roth> Let me say that there are at least 7 symptoms(?) that point to apraxia vs.
    other speech disorders.
<bilingualslp> I would be curious to hear about those 7
<Pamela> I have a 3 year old at the CV and VC level that repeats her words in a high
    pitched voice.  Is this common? 
<Lori Roth> 1. Significant difficulty imitating or producing on command oral motor
    movements (with sound).
<Lori Roth> 2. Inconsistancy in reproducing these movements.
<bilingualslp> ok so far I have been on target-what is next?
<Lori Roth> 3. Difficulty producing sounds in sequence even when the phoneme is
    produced in another word correctly and with no difficulty.
<bilingualslp> I have 3 kids that demonstrate the above and can think of others-
<Marilyn Agin> there are also neurologic signs on the physical exam
<Lori Roth> 4. breakdown in sound accuracy as strings of words increases in length.
<bilingualslp> inability to program the speech sound movements-this is what comes
    to mind when I think apraxia
<bilingualslp> I know the definition is broader and is more descriptive
<Lori Roth> inability to recall or pull up the motor patterns except in overlearned patterns.
<bilingualslp> by pull up you mean access?
<Lori Roth> yes. Remember there are also soft signs usually visible. SI, for example.
<Robin> Marilyn, perhaps you can also elaborate on the neurological signs
<Marilyn Agin> children will often have truncal and oral hypotonia and sensory integration
<Lori Roth> Oral motor apraxia can be accurately diagnosed by 18mo. through feeding
    difficulties. Verbal apraxia can be diagnosed after 3yrs.
<bilingualslp> this helps-limited diet and food refusal related to either?
<Marilyn Agin there  is often a history of resistance to increased textures
<bilingualslp> but not absolute food refusal?
<Lori Roth> yes. In fact these children prefer strong tastes. Peppermint toothpaste,
    pickles, lemon juice, and as Marilyn said, resist new food textures.
<Marilyn Agin> have you had med professionals in your locations make this dx?
<<bilingualslp> I have at times in NY particularly in childrens hospitals and in home
    care, nursing
<Lori Roth> Where children grow through periods of acceptance (windows of
    opportunities to introduce new textures and tastes)
<Lori Roth> these children get stuck early on.
<shelly> I have a question about service delivery .  I work in early intervention and
    would like to know how you can treat apraxia which requires such intensive treatment
    in just one one-hour session per week
<bilingualslp> I am thinking the same
<shelly> At what age would you recommend outpatient/clinical model tx?
<Lori Roth> Interesting question. Do the best you can. Set up a home program.
<Marilyn Agin> In NYC children can get tx 4x wk
<bilingualslp> that must have changed-when I lived there-4 times a week was
    unheard of but this is great
<bilingualslp> when did that start?
<bilingualslp> treatment that often-is that only for a diagnosis of apraxia?
<Lori Roth> Each state uses the 2 hours max. differently..but in NJ we can get 4 1/2
    hour of therapy sessions weekly.
<Pamela> What information does insurance require by the referring physician? Drs. do
    not know about apraxia here.
<shelly> we have had a rather large HMO in our area just cut speech therapy benefits
    entirely for children unless "medically necessary"  Any of you with similar problems
    and if so, any suggestions for parents?
<Marilyn Agin> If you give the proper dx code with a letter of medical necessity you
    can usually get payment
<Lori Roth> Marilyn has a wonderful response in the archives of the CHERAB
    Foundation adddressing just that. Join the www.apraxia.cc listserv and search it out.
<DebbieG> a young child with apraxia should be able to get therapy thru the county or
    school district and not need to go to an HMO.  Right?
<Marilyn Agin> Debbie, that is if the child is over 3
<DebbieG> A child birth thru 3 can get services thru the county here
<shelly> would a physician typically write a letter of medical nec?? for apraxia dx?
<DebbieG> I don't think a Dr. would write it up as medically necessary
<Lori Roth> why not?
<Pamela> Dr. Agin, I read your statement about dealing with insurance.  I used the
    code 781.3  Coordination difficulty.  Can this apply to speech musculature only
    and not gait?
<Marilyn Agin> Pamela, yes it can
<Marilyn Agin> I have used this dx for apraxia of speech
<Marilyn Agin> Also 784.69
<shelly> Birth to three programs are "family focused" models and getting funding for
    sessions to work one-on-one with the child more than one time per week is usually
<Lori Roth> This is not an educational developmental disorder. It is a medical
    neurological disorder.
<Pamela> Any quick, easy resources to provide physicians or insurance that this is a
    "neurologic" disorder, not developmental?
<Lori Roth> Why shouldn't parents get their tx paid for by their medical insurance?
<Marilyn Agin> shelly, it depends on the EI program
DebbieG> Yes.  EI program where I am always gives one-on-one services 2 to 3
    times per week
<shelly> what state are you in Debbie?
<DebbieG> NY - Long Island
<Marilyn Agin> NYS seems more progressive
<shelly> Lori, if it's a neurological disorder, why wouldn't medical insurance cover it
<shelly> I don't understand?
<Marilyn Agin> Some med plans have criteria for neuro involvement
<shelly> I think this HMO in particular is looking for a way to save money
<Pamela> So how do we get across to insurance that it is neurological? Do the
    children need to see a neurologist?
<shelly> Many parents and providers are upset to say the least
<Marilyn Agin> You can also see a developmental pediatrician
<Lori Roth> Children that you suspect are verbally apraxic need to be evaluated by a
    developmental Ped. or Ped. Neurologist familiar with apraxia. The CHERAB
    Foundation is presently gaining referral sources
<Robin> that would be great to have a data base of dev. pediatricians
<Lori Roth> Marilyn is instrumental in educating her collegues.
<Marilyn Agin> I was able to convince the Med Director of  Aetna/ USHC to give a child 5x
    wk sp tx for 3 mos
<Robin> Marilyn, are your colleagues receptive to your help?
<Marilyn Agin> Some are but many are dubious
<shelly> can't SLP's make the diagnosis??
<Lori Roth> Not if we want the neurological disorder dx.
<shelly> yes, good point
<Lori Roth> We cannot or should not dx a neurological disorder without the medical
    professionals substantiation.
<Marilyn Agin> shelly, yes, but I think it helps to have a medical dx for insurance
    purposes and to rule out other syndromes.
<Marilyn Agin> have any of you recognized apraxia in the autistic population?
<shelly> Do you typically not dx until age 3 and why?
<shelly> I have two who demonstrate s/s of apraxia at age 30 months
<Marilyn Agin> In some cases you can make the dx earlier
<Lori Roth> Phonological disorders, and latetalkers often display similiar
    criteria...Since by age 3 children should be speaking in 2.5 words (and that's low
    balling the range) words per utterance
<Pamela> Is it possible to be verbally apraxic and produce a string of vocalizations with
    intonation but not clear sounds.  She can't say two syllable words unless it is repetitive
<Lori Roth> Pamela..you're exactly correct. Here the child can produce a word with rep.
    syllables but change a vowel or consonant and everything breaks down.
<shelly> Marilyn, what signs do you look for in a neurological exam?
<Marilyn Agin> Shelly, a history of feeding problems, low muscle tone for starters
<Lori Roth> Many children cannot produce a 1 syllable word without adding a vowel at
    the end. stop becomes stopah
<Marilyn Agin> these children usually have motor planning problems like limb apraxias
<Lori Roth> Have you seen your kids slouch in their chairs, continue drooling when
    they are no longer teething, or continue to munch through food instead of
    demonstrating a more mature chewing pattern?
<shelly> what about attention difficulties??? I have one little guy who will not make eye
    contact or watch my face for cues unless I physically hold his chin and then attention is
<Pamela> I am with you on that one shelly
<shelly> also noticed that he does not have independent movement of tongue and
<shelly> that is, /l/ sound made with vertical mand. movements
<Lori Roth> Yes that too...Just because these children are apraxic doesn't mean that
    they don't also show signs of other learning difficulties. Do the kids you have look too
    serious too?
<Marilyn Agin> Yes, sometimes their self esteem is affected early
<Pamela> yes, one looks serious
<Pamela> I know that can be a sign of oral apraxia but she seems to imitate oral
<Lori Roth> Can these children smile on command?
<shelly> yes
<Pamela> I'll have to test. I just remember testing the tongue movements
<Erika> ...am I late?
<Robin> our students will be joining us soon
<Erika> ok
<Robin> hi Erika...no you're not late...we're winding up our prof. chat...getting ready for
<Erika> oh!
<Erika> carry on!
<shelly> one of my clients says sha sha sha for everything and has a great deal of
    difficulty even at the cv level
<Anonymous3631> I'm noticing a recent increase in referrals of children in the 18-24
    month age range, wtih oral and/or verbal apraxia:  many of them were delivered with
    suction applied to their heads.
<Anonymous3631> does anyone have any info on this?
<Anonymous4835> Hello.  I am new to this process of chatting.  I am interested to see
    what is being discussed.  I have a three year old son diagnosed with apraxia
<shelly> I'm wondering why, at 30 months he is not processing that he is not saying
    "true" words
<Robin> Do you recommend any specific test batteries to evaluate verbal apraxia??
<Lori Roth> As far as the tests are concerned...I use a receptive voc. test, a general
    language test where I focus on the receptive language area then evaluate oral motor
    skills and sounds Kaufmann Test of Praxis
<Pamela> Dr. Agin,  is there any connection to delivery problems and apraxia?
<Marilyn Agin> Not necessarily
<Marilyn Agin> I've heard of perfect deliveries and apraxia
<Marilyn Agin> So far we have not been able to come up with consistent neurologic data
    for apraxia
<Robin> 4835, is your son in therapy now?
<Robin> welcome all!  we will be starting our student chat in a few minutes
<Robin> we are chatting tonight about apraxia with our guest hosts Dr. Marilyn Agin,
    SLP, MD, and Lori L. Roth, MA, CCC-SLP
<Anonymous4835> My son has been in therapy since 18 months of age.  He was
    receiving speech 5 times per week but is now down to three times per week. 
<peg> I am an experienced practicing clinician
<shelly> peg, where do you practice?
<peg> Charlotte, NC
<Jamie> anyone from Philadelphia?
<Marilyn Agin> I have just changed computers, but I am here
<Anonymous8914> Peg, I just received a contact for help in your area if you are
    interested.  Is Oakboro around you?
<peg> I'm not sure how far it is.  I'm sure it's a distance (within an hour?)
<peg> I  can handle it, in another 4 weeks or so.
<peg> Call Presbyterian Hospital:  704-384-6631 to get me.
<peg> Once the children hit age 3 I have to give them up to the schools, can
    someone tell me how they do after this?
<Anonymous8914> Peg, I'll give them your number at the hospital-Thanks!
<shelly> peg, we were discussing insurance coverage earlier.  I would definitely refer
    them for private speech therapy because I don't believe they will get the intensive
    therapy they need in the school system

<Robin> Welcome everyone! We are chatting with Dr. Marilyn Agin, SLP, MD,
    and Lori L. Roth, MA, CCC-SLP, who are both part of the volunteer professional
    staff of the CHERAB Foundation, a personal support source for apraxic and
    language disordered children and their families
<Robin> what exposure to verbal apraxia have you had as students?
<shelly> Can you please tell me again how to refer clients to your foundation?
<Robin> www.apraxia.cc
<Anonymous4835> Should a child who is diagnosed with apraxia be discharged at the
    age of 3?  He has many sounds left to learn.
<Erika> I observed a client with Verbal apraxia ...... he has to be 7 years old
<Adrienne> Lori, how is Apraxia distinguished from artic problems?
<Anonymous8914> The name is Andria, it's a 5 or 6 year old just diagnosed
    with apraxia by the school.  The little girl only can say a handful of words and the
    parents are desperate.
<Marilyn Agin> 8914, how much tx can you give her? 
<Erika> how do you treat a child with verbal apraxia? oral motor therapy, and then
    speech stuff too?
<Marilyn Agin> Erika, you use both oromotor and touch cue therapy
<Lori Roth> Start with the oral motor stuff and follow with functional approximations for
    real important speech.
<Anonymous8914> HI!!!
<Robin> we would like to ask our slp students to ask questions to our expert hosts
<Adrienne> Marilyn, how do you use touch-cue therapy?
<Anonymous9080> At what point is a child determined to have developmental apraxia
    as compared to developmentally delayed
<Lori Roth> Have you heard of the PROMPT techniques?
<Marilyn Agin> It's similar to PROMPT
<Lori Roth> You probably do it . Placing your fingers along the child's lips to get a
    /p/,/b/, or /m/
<Adrienne> yes...
<Adrienne> that is used for more than apraxia right?
<Marilyn Agin> we also advocate the Kaufman technique of successive approximations as
    Lori described
<Lori Roth> Children with verbal apraxia (it's a neurological disorder not
    developmental at all)
<Lori Roth> have a difficulty in producing movements on command. They cannot
    reproduce movements or sounds repetitively and accurately.
<Erika> the child I observed could not get any alveolar stops...he backed them
    all...unfortunately his name was something like Tommy
<Erika> he worked so hard to get that tongue in the right place
<Marilyn Agin> some school districts are recognizing the problem and giving intensive
    1:1 therapy
<shelly> good for them!! Definitely not happening in PA
<Dyan> I have an apraxic FAS child on my caseload...she's a tough one
<Anonymous6167> Can it be determined what type of brain damage has occurred - if
    any - that causes apraxia in children?
<Marilyn Agin> there have been SPECT scans showing hypoperfusion in Brocas area
<Anonymous9080> SPECT?
<Erika> what is hypoperfusion?
<Dyan> decreased blood flow
<Erika> oh I see
<Robin> Erika , Adrienne, and students, what have you learned about apraxia in class?
<Vera> Is apraxia always caused by brain damage?
<Marilyn Agin> some of our kids are being educated in schools for the hearing impaired
<Adrienne> we have not talked about it, I know it is a motor disorder
<Robin> our experts can tell you what characteristics to look for
<Erika> we learned about it in my phonology class...
<Erika> and how DAS is different from most phonological disorders
<Adrienne> why in schools with hearing impaired?
<Dyan> Marilyn..is that for the severely apraxic who need to learn an alternative
    communication method?
<shelly> Marilyn, why would that be??
<Adrienne> yes, I did learn that too
<Marilyn Agin> no, some are oral schools
<Marilyn Agin> the schools for the hearing impaired use techniques that benefit apraxic kids
<Dyan> so why for hearing impaired?  Our state supported school for HH requires that
    children have diagnosed hearing loss
<Anonymous9080> Have they found that PROMPT works with children with DAS?
<Lori Roth> Schools for the hearing Impaired Aural/Oral Programs specifically present
    speech production in an organized heirarchy that appears to benefit the needs of
    apraxic children as well
<Erika> what is PROMPT?
<Dyan> couldn't those techniques be used in regular public school settings?
<Dyan> via communication disorder classes?
<Lori Roth> These programs (and I know since I was the coordinator of speech at one
    of them) focuses on the oral motor positioning of each sound and the movements into
    and out of the production into the next sound
<shelly> are we talking HI preschool ?
<Marilyn Agin> Lori is actually on the Board of one of these hearing impaired schools
<Dyan> is it a private or public school?
<Lori Roth> It is a private Infant and Preschool program.
<Dyan> ok..public schools at least in my state for HH (Hearing Handicapped) require child to be HH
<Robin> Lori, can you tell our students about some of the characteristics to look for in
    apraxic children?
<Lori Roth> Either way the children who are being educated as oral communicators
    need to be presented with a program which follows Daniel Ling's bend of education.
    Alexander Graham Bell's website can give you more
<Robin> can someone elaborate on PROMPT
<Adrienne> PROMPT involves tactile cueing right?
<Lori Roth> PROMPT is a philosophy as well as a system for cueing the articulators
    through touch how to more for a word.
<Marilyn Agin> the NJSHA is discussing this issue of teaching apraxics at HH schools at
    their mtg on May 4
<Adrienne> I dont understand the logic for apraxic children going to HH schools
<Anonymous9080> does PROMPT help the child to 'reprogram' their placement for
<Lori Roth> Apraxic children present 7 important symptoms.
<Lori Roth> 1. inconsistency in reproducing a motor movement or sound production.
<Lori Roth> 2. The inability to produce these movements on command.
<Lori Roth> 3. The improved ability to produce sounds in sequence with a model
    (imitation) but then not be able to re-create it.
<Lori Roth> 4. The presence of soft sign (neurological sign) such as hypotonia,
    sensory integration difficulties.
<Lori Roth> 5. A groping of motor movements for articulator placement for even familiar
<Lori Roth> 6. The decrease of accuracy in longer utterances even if only one sound is
<Lori Roth> 7. Difficulty organizing breath control and therefore pitch control .
<Robin> thank you Lori!!!!
<Adrienne> that helps a lot Lori! :~)
<Vera> My son is 3 and apraxic.  His therapist would like to discharge him.  It seems
    too early to do this for he has not learned all his sounds.  Any opinions?
<Marilyn> it's too early
<shelly> Yes too early
<Marilyn Agin> how many syllables can he sequence?
<Vera> He can say about 5 to 7 word sentences - as he tries longer sentences - he
    becomes unintelligible - but not always.
<Lori Roth> Most of these kids cannot sing a song. Speak in monotone and have other
    learning difficulties that are not yet visible.
<shelly> how common is it that children with apraxia have receptive processing
<Marilyn Agin> apraxics usually have normal receptive lang & cognition
<Anonymous2854> thanks
<Adrienne> why the learning difficulties then?
<Dyan> Is there a particular "boxed" program that you recommend? That is, one that is
    already marketed and ready to go
<Robin> you had mentioned the Kaufman Praxis earlier, right Lori?
<Lori Roth> Kauffman has a set of cards that are helpful
<Lori Roth> The front has simple pictures and the backs have a series of
    approximations for getting the kids to produce functional communication.
<Anonymous9080> any tips on approaching a parent when you believe the child
    should have a neurological workup?
<Marilyn Agin> 9080, just say it would be helpful to rule out neuro problems
<Marilyn Agin> a neuro workup is not usually invasive
<Anonymous9080> but it could be expensive
<Dyan> What is your opinion of the Easy Does it series?
<Lori Roth> EasyDoesIt is ok...but play with objects is the best.
<Dyan> thanks Lori
<Erika> there is a handout you can download for DAS on thinkingpublications.com...in
    the free ideas area
<Lori Roth> sounds good Erika thanks.
<shelly> how do parents respond to having their children enrolled in a HI classroom
<Marilyn Agin> shelly, they accept it well
<Lori Roth> I use a large medicine box (the ones that have a door for each day of the
    week). I hide an object under the door and ask the child to say Opah and then name
    the object. (To the best of their ability).
<shelly> I really think that's a great idea and would like to recommend it to one of my
<Anonymous8914> I'm the president of the nonprofit CHERAB Foundation, and we
    fought to have our son put into one.
<Anonymous8914> Our school system pays for it through "out of district placement"
<Marilyn Agin> usually the school districts pay for it
<shelly> without HI dx?? the schools will go for it?
<Robin> the CHERAB Foundation is a personal support source for apraxic and
    language disordered children and their families.
<Anonymous9080> how do insurance companies respond to differential diagnosis?
<Lori Roth> Each case is different. But there are ways to get some therapy for these
<Dyan> isn't that the case though when the district cannot offer the services
    themselve?  My district would provide 5x wk tx at school before they'd pay for private HI
<Anonymous8914> You need to prove the school's program is not appropriate-many
    are not for apraxia since most provide "inclusive therapy" (fancy word for group)
<Marilyn Agin> shelly, in NJ they are
<Anonymous9080> what does CHERAB stand for?
<Anonymous8914> Communication Help Education Research Apraxia Base
<Anonymous9080> thank you
<Lori Roth> And remember that the schools must only supply a program that is
    educationally appropriate not medically appropriate.
<Dyan> true Lori
<shelly> medically appropriate??
<shelly> Is that like medically necessary??
<Dyan> and as long as the program at school is meeting the educational needs of the
    child then the parent is going to have little success in getting them to pay
<Robin> everyone should check out the CHERUB website at www.apraxia.cc
<shelly> How can poor intelligibility not be educationally detrimental??
<Lori Roth> That is the important message you must get to the insurance companies.
    Medically necessary is best established by a ped. neurologist or a developmental ped.
<Anonymous9080> are you saying that children with apraxia need more 1:1 therapy
    than a school SLP can offer?
<Marilyn Agin> yes, medically appropriate is like medically necessary
<shelly> Lori, Got it!
<Dyan> shelly, if the program at school is addressing the intelligibility problem, then it
    is considered educationally appropriate
<Lori Roth> YUP..and the therapy must be appropriate..not the run of the mill artic
<Anonymous8914>   That's why it's wise to have speech professionals work together
    with the neurodevelopmental doctors to help apraxic children in school and insurance
<Dyan> right
<Dyan> appropriate being the operative word
<shelly> You and Marilyn have been soooo helpful.  I waited for this chat all weekend
    and I'm so glad I participated!
<Marilyn Agin> thanks!
<Lori Roth> thaaaaks.
<Lori Roth> Would you all tell you fellow students to sign up with www.apraxia.cc and
    get the digest listserv for more information.
<Robin> well, Shelly, we're glad that you came! We have had a lot of visitors
    tonight...Lisa, what do you think about a regular chat on the subject...monthly, weekly,
<Anonymous9080> I would  like to know if PROMPT has been determined to benefit
    children with apraxia over other techniques
<Lori Roth> There is no one best way for therapy.
<Anonymous9080> o.k. so it depends on the client
<Marilyn Agin> we hope all of you students will get interested in apraxia  and specialize
     in it
<shelly> I think this is a great tool for students.  I graduated four years ago and heard
    little about DAS in grad school. Never learned anything about dx or tx.
<Lori Roth> As I explain to parents, I use Nancy Kaufman's techniques sometimes,
    switch to PROMPT to elicit a sound, mix it with Kaufman and add my own touch. Voila a
    word comes out.
<Lisa> Actually, to explore the archives, they have to click "join our group" or go to
    http://www.groups.yahoo.com/group/childrensapraxianet  There is the option of no
    email web only
<Marilyn Agin> the diagnosis and terminology for apraxia is still controversial
<Adrienne> is there such a thing as developmental apraxia?
<Marilyn Agin> yes,  childhood apraxia is developmental
<Anonymous9080> does PROMPT help a child 'reprogram' their articulators?
<Lisa> Dr. Agin, what about the two apraxia questions on the neurological exams?!! 
<Vera> If there is brain damage - can the brain be "rewired" and are other areas of the
    brain affected?
<shelly> I use the term developmental to differentiate from acquired
<shelly> as in CVA
<Lori Roth> OK but be careful because insurance companies will throw the claim right out.
<shelly> yes I've heard
<Anonymous9080> hold it - we were told earlier that DAS is 'definitely not
    developmental' it is a 'neurological disorder'
<Adrienne> I am confused on that too 9080
<Erika> DAS stands for Developmental apraxia of speech, right?
<Lori Roth> Children are still so plastic that with intensive practice new pathways can
    be developed to allow for speech developemnt.
<Lori Roth> It is a neurological disorder.
<shelly> What term do you use Lori and Marilyn?
<Lori Roth> It is during the child's developmental years.
<Lori Roth> I use Verbal apraxia
<Marilyn Agin> oral/ verbal apraxia
<Marilyn Agin> it is a motor planning problem, and definitely neurologic
<Adrienne> ok
<Anonymous9080> verbal apraxia in adults is caused by a neurological insult - are you
    saying that the child has had a neurological insult?
<Marilyn Agin> yes, prob in utero
<Dyan> all my apraxic kids have had traceable neuro etiology
<Anonymous9080> how is it traceable?
<Lori Roth> 9080- to answer your q? that is the theory behind PROMPT. By touching
    and pressing specific points around the lips, jaw and chin we (SLP) can reprogram
    the artic.
<Dyan> FAS/ birth trauma, etc
<Anonymous9080> thank you
<Dyan> welcome
<Marilyn Agin> sometimes you cannot pinpoint but know from the symptoms
<Anonymous9080> can this be found in the med. reports/case hx?
<Dyan> yes..if you are given accurate info by parent
<Anonymous9080> if you see symptoms don't you need to have something solid to
    base a diagnosis on?
<Dyan> some parents are reluctant to let you know that they were doing coke when
<Dyan> but medical exams will ferret out possible origin
<Vera> Could bacterial meningitis cause brain damage resulting in apraxia?
<Marilyn Agin> yes, meningitis could
<Vera> In what way?
<shelly> Marilyn, you talked about SPECT results earlier, what about MRI??
<Marilyn Agin> MRI sometimes, but I think we have a better shot w/ SPECT
<Robin> our hosts have been chatting for some time now....are there any more
    questions about apraxia for Marilyn Agin and Lori Roth?
<Anonymous3440> are you scheduled to do any workshops or conferences in the near
    future so we can learn even more about apraxia?
<Marilyn Agin> we're thinking about it
<Anonymous3440> this would be wonderful...would you be so kind as to keep us
<Dyan> thanks Marilyn and Lori..appreciate your time and expertise!!
<Lori Roth> If you have any other q? and would like to write me -<lorislp@att.net>
    please do.
<Robin> yes, thank you very much to Marilyn and Lori for joining us and sharing their
    expertise...and thank you to Lisa Geng for all her work in the CHERAB foundation
<shelly> thanks to both of you for your time
<Anonymous9080> thank you - have a great evening
<Vera> thank you.
<Dyan> would love to know about upcoming conferences too!
<Robin> 3440, we hope to have more live chats on the subject.....are you on our email
    chat reminder list?
<Marilyn Agin> you can email me at mamadoc111@aol.com
<Adrienne> I learned more about identifying apraxia.. thanks Lori and Marilyn!!
<Lori Roth> watch for a notice on the apraxia.cc listserv.
<Anonymous3440> thank you both!
<Marilyn Agin> you are welcome!
<Lori Roth> Pleasure was mine.
<Marilyn Agin> bye
<Lori Roth> bye
<Robin> thank yo so much, Marilyn and Lori. Goodnight!