Trying to Be Understood with Apraxia

Working Toward Speech Intelligibility and the work involved

This week I had the chance to meet with several professionals…to be honest some wanted to work with me and some did not.  Because I have been there, I understand perfectly.  I started the conversation(s) with “Let’s begin with the fact that everyone wants to do their best and no one (that I have met in almost 20 years of practice) maliciously sets out with the intent of not doing their best work”.  This kind of opening, I have found, makes everyone human and can refocus the energy in the room back towards the child we are all working to move progressively forward.

Apraxia can be tricky.


Because it’s motor speech coordination.  And the motor impact may also be seen in gross and fine motor skills.  And the impact can reach to speech sound acquisition and literacy.  So a true articulation only approach, an AAC only approach,  an oral motor only approach, a phonological processing approach alone just won’t do.  With the  apraxia or suspected apraxia diagnosis/related motor coordination challenges, you are looking at a system’s approach of  neuromotor patterning, underlying weakened muscle movement, faulty articulation coupled with two problems.

  1. Right now communication need;
  2. Repair and Building of the communication speech motor system.

With apraxia, these two things need to happen at the same.

If you can imagine the base of the triangle with the two points on either side, the two areas that we need to adjust (1) Right Now; and (2) Repair-Build are both being addressed simultaneously and systematically allowing the sessions and intensive work to move upward towards the top and highest point of the triangle.

This is therapy.  It can be slow.  You can and will find glimmers as we move up the triangle…together.  And here is the truth.  The data will tell the story…and it should.

The data will tell us how well our tactile prompts are working; if the AAC system we are using is beneficial; and so much more.

The points here are:

  1. Intensive Apraxia Therapy can and should mirror ABA Therapy in that finding stimulus items that are reinforcing to build speech motor patterns and provide the repetitive practice needed.  (think neuropathways).
  2. Creating wordshells in how we will teach and plan to teach words.
  3. The Momentum (very true) needed.
  4. The data collection and specific nature of that data collection
  5. The fun is in the interaction, the motor movements, the objects or treats earned. the
  6. Systematic work AND real communication shaping is needed.  If I worked only on specific sounds but never on breaking down and teaching my client how to say his name, age, working on the names of family member’s or even phrases needed for social interactions..then my treatment is one sided.  It must and can work on the system to build and need to communicate at the same time.

Let’s answer a few questions together…

  • So can once a week or twice weekly be sufficient for the impact we want to see in speech intelligibility?  Maybe…maybe not.  Quality matters.  And you know what else matters?  Homework.
  • What can I do at home?  Many times when I am working with families, I will video myself practicing a few key phrases or words.  And these days with technology, it is a lot simpler.  Playing the video a few times a day and allowing your child to practice is efficient.
  • What approach is best?  Do I need a Kaufman, PROMPT approach alone?  Well…no.  The approach will depend on your child and equally important, the evidence in research, and the evidence based upon the data of the session.
  • How will I know if my therapy is working?  Data…for every target sound being addressed, for every word shell being addressed, for evidence of the oral motor tool being able to help the articulator(s) reach the correct position.
  • How long should we wait for speech before introducing technology?  Keep imaging the triangle…we need both.  Speech communication is highly critical…it gives the people around us the social evidence that we are organisms with thoughts and opinions.  The same goes for your child in a social and academic setting.  So, I’d vote yes…but seek the advice of an SLP (that has the specialty of apraxia and technology) to support the decision making.
  • If I suspect apraxia, who can diagnose?  A speech-language pathologist can diagnose apraxia.
  • How do I get started with Momentum?  Complete this form here to get started.
  • Registration is open for our Summer program downloads are here including our T.A.L.K program intensive.  This program is located in our Michigan location only families needing hotel and housing accommodations can contact our office for more information.

Let’s Thrive Together!



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