Q: In your presentation called Improving Intelligibility in Apraxia and Dysarthria you mentioned that it is important to practice phonemes that they can do, rather than phonemes they can’t do.  Why is that?  

That’s a good question!  Van Riper and other old-time SLPs said that about 75% of every therapy session should be a rehearsal of things the child can do correctly, and about 25% should be material that is new, unfamiliar, and challenging.  Most SLPs today spend most of their time working on things the child cannot do.  I believe that that is a mistake, especially with apraxia.

Think of speech lessons like piano lessons.  Most of a piano lesson is a rehearsal of what the child already can do, and only a small bit brings in new material.  The piano teacher takes each lesson as an opportunity to add to what the child already can do.  I remember my old piano teacher… I would sit at the piano, and for six years she would start each weekly lesson by saying, “Show me what you have been working on.”  If speech is movement, and if apraxia is a motor speech disorder, then practice is what the child needs.  Practice sounds, syllable, words, phrases, and sentences like you might practice scales on a piano.

Also, I see apraxia from a sensorimotor perspective.  That means that I see apraxia as a problem in the organization of the tactile, vestibular, and proprioceptive systems (Ayres, 1980).  If this truly is the problem, then that means that the child’s real problem is in PERCEPTION of his own speech movements.  The way to help a child perceive his speech movements better is to add weight to the movements and to rehearse them many times.  Practice brings awareness, consistency, and control of movement.

Some of the drill can be drill for the sake of drill.  But make sure to take the drill into very functional work.  For example, if the child is working on S in the initial position of words, then chose a word that can be practiced over and over again in a functional way.  You might have the child count from 70 to 80, or you might have him answer 10 questions whose answers all start with the word “so”––

• Why do we eat food? (So we can live!)
• Why do ball players wear caps? (So the sun doesn’t get in their eyes.)
• Why do we use utensils to eat food? (So our hands don’t get dirty.)

Reference:

• Ayres, A. J. (1980) Sensory Integration and the Child. Los Angeles: Western Psychological.