Hammer’s Cues for Apraxia

By Pam Marshalla

I recently attended a seminar on apraxia taught by David Hammer, SLP. It was fabulous and I highly recommend it to all my readers!

David uses a combination of verbal cues, object cues, and gestural cues together in his work with apraxic children.  He bases this speech training on the theory that children with apraxia need a multisensory approach that focuses on phoneme sequencing.  The verbal cues he uses are names and phrases that describe the outstanding place, manner, and voicing features of target phonemes.  For example, the cue for /s/ is the “smiley windy sound” and the cue for /z/ is the “buzzing windy sound.”  These verbal cues then are paired with simple gestures and common objects to aid in the sequencing of these sounds into words.

For example, a therapist might use a fishing pole with a magnet on the end of the line in the classic “Go Fish” game to teach words that begin with /s/.  Consider the word so.  The client would be told to start by making the “smiley windy sound” as he runs his fingers down the fishing line from the pole to the magnet at the end.  The client then would be told to say /o/ as his finger touched a physical letter “O” that is lying on the table as the “fish.”  (The letter has a paper clip or staple attached to it so it will stick to the magnet.)  The child says /s/ as his finger travels down the line, and /o/ as his finger touches the letter.  Once the fish is retrieved, the child repeats the word so by itself, and then he uses it in a functional phrase or sentence. As in all cuing systems, the cues are faded over time until the client can perform without them.

Hammer stresses the importance of varying the context of the functional work so that the client will gain automatic control over his productions.  For example, once the child can produce this target word, he might be asked a series of questions by a puppet.  These questions might include, for example, “Why do we eat food?” or “Why do baseball players wear baseball caps?” The answers to these questions always include the target: “So we won’t be hungry” and “So the sun won’t get in their eyes.”  Verbal cues are given as needed.  These functional activities help the client generalize his newly learned skill to new contexts.  Automaticity of production is stressed; therefore the cues and other help are faded as quickly as possible.

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