Jake's Journey with Apraxia

For quite some time now, I have been thinking of doing intensive speech therapy for Jake. While this journey has been filled with many ups and downs, we are finally in a new phase of apraxia … recovery. If I could turn back the clock, here are the questions and answers that I wish I would have known this time last summer.

How many days was our intensive at Foundations Developmental House and how often did we have therapy?

My family visited FDH the last week in May and Jake did 4 days (2 hours each day) of intensive therapy. The first and last sessions of the week were with Lynn Carahaly, the SLP who created the Speech-EZ Apraxia Program, and the other sessions were with Casey, another experienced SLP at FDH. Jake also had 2 music therapy sessions, so on Wednesday and Thursday, he was in therapy for a total of 3 hours instead of 2.

Holly, FDH’s Office Manager, was very accommodating to our preferences and most of our sessions were in the morning with breaks usually at 1-2 hour intervals. Prior to our intensive, Lynn and I talked on the phone to discuss my goals and concerns, and we also met a couple of times throughout the week without Jake. I left FDH feeling like a had an attack plan in place for the year ahead.

What did Jake do in his speech therapy sessions?

Our therapy sessions were filled with structured letter/sound/hand cue drills and also a variety of speech activities that focused on making Jake’s sentences more accurate. The therapists focused on his weaknesses: usage of articles, pronouns, and longer sentences. While the sessions were jam-packed with brain-intensive work, Jake loved going to FDH. Each day he would jump out of the car, waving a quick goodbye to his brother and daddy, and would run in the front door.

What was Jake’s favorite activity during therapy?

I think one of the best qualities a SLP can possess is good instinct. Many SLPs do not have this trait, but Casey is a perfect example of a speech-language pathologist who does.

One day when Jake came in at noon for his third session, Casey had an activity laid out on the table ready to go, but she immediately recognized that Jake had ants in his pants and seamlessly altered her plan. The result? What could have been a frustrating and less than productive hour turned into a completely different experience. Here’s how she began …

• Target Word: soccer ball (3-syllable word from the Speech-EZ picture cards)
• Jake said, “Soccer ball.”
• Casey told him to take the card and place it on a picture on the interactive rug that was in the center of the room.
• Jake ran full-speed (yes!) to the rug and put the card on the picture of the car.
• Sentence work was: “The soccer ball is on the car.”
• Once all the cards were placed on different pictures, Jake tossed a bean bag onto them and repeated each sentence again.

This was a perfect activity for him because he has trouble incorporating articles into a sentence. Frequently he will either put the small words in the wrong order, replace correct articles with incorrect ones, or may leave them out altogether.

What was music therapy like?

Jake has been in Kindermusik since he was 18 months old and I was really curious about what music therapy would be like at FDH. Jake loves music, but pairing words with a melody is very difficult for him. I think what sets FDH’s music therapy apart from a regular music class is that the session is one-on-one and Jake’s speech drills were reinforced through music. Much of our focus was on recalling longer sentences and the correct usage of articles via songs.

According to Allison, FDH’s music therapist, “The reason why music can be so powerful in the brain is that rhythm and resolving melodies are processed subconsciously, where you don’t have to think about it. Rhythm and melody can provide great anticipatory cues in the brain.”

Here’s an example of an activity Allison did using stackable animals …

• Jake put the hippo on top of the lion.
• Song work was: “The hippo is on the lion.”
• The song got longer with each animal that was stacked and by the end he had to recall the order of all the animals.
• For example: “The hippo is on the lion. And the dog is on the hippo,” etc.

This activity was hard for Jake and his brain was smoking by the end! He carefully said all those little words with the guitar that Allison was playing and used the hand cue at every single “the.” The catch is though, he really couldn’t sing the song. All he could do – which took every ounce of brain power he had – was to speak the words. Allison also gave me several activities to do with him over the summer, which I’m looking forward to.

What was a new & interesting thing that I learned? 

While Jake’s scores on his last speech assessment were very good at the one-word level, he has consistently scored low on recalling sentences and on concepts & following directions.

In other words, if I say a sentence of 5+ words and ask Jake to repeat it, he can’t recall it exactly. Secondly, if I say, “Point to the boy who is on the ladder next to the girl,” he might point to the boy on the ladder next to the dog. The problem is, he can’t hold onto the information in his brain long enough to process it and after a couple of seconds, all he can remember is “the boy on the ladder.”

I had never really thought this problem was a big deal because heck, he’s talking, right? I learned, however, that these issues should not be ignored it’s an indicator that he has a deficit in working memory. Jake has strong visual memory and memorization skills, but his auditory memory skills are weak. Exercises to strengthen his auditory memory will decrease his chances of future learning disabilities and will also promote more accurate speech.

What is the best way to teach Jake letters and the sounds that they make?

A big component of the Speech-EZ program is making sure that kids with apraxia have a comprehensive and firm understanding of letters and the sounds they make. Taking an aggressive approach with phonological awareness improves literacy skills and also helps with articulation.

Phonological awareness was a component in most, if not all, of our sessions at FDH. Pairing the hand cue with a visual of the letter is extremely important and will help Jake’s memory problem. It is also very important that he does the hand cue himself and doesn’t just watch and read the cues.

Casey and Lynn did drills to strengthen his letter/sound/hand cue skills and by the end of the week, Jake was zipping through the initial sound identification part of the Speech-EZ Target Sound ID app. Both Lynn and I wish we had it on video because his progress was astounding!

Did we come back with any other diagnoses?

No, although I am going to watch out for signs of Auditory Processing Disorder, which children with CAS are at risk for. I’m curious what the upcoming Pre-K 4 school year will hold for him.

Where do we go from here?

We are still doing speech therapy twice a week with Katie, our local SLP, who is also a believer in hand cues. At home I will continue to work with Jake on letters, sounds, hand cues, and introduce him to reading. I purchased the Target Sound ID app when we left FDH and once he masters first and last letter sound recognition, we will progress to the other apps in the Speech-EZ family.

 Many thanks to Lynn, Casey, Allison, Holly, and Linda for giving us an amazing intensive session!

For more information on Foundations Developmental House and the Speech-EZ Apraxia Program, please visit their website by clicking here.