Appropriate Therapies for Apraxia + VPI

Question

Answer

This question had three components: 1) oral-motor issues (not otherwise specified), 2) VPI and
3) Childhood Apraxia of speech (CAS). In the case of oral-motor issues indicating true dysarthria, strengthening may be a component of treatment but the focus should be on facilitating speech production. Most children possess adequate strength for speech but have more difficulty with the rapid coordination of the articulators. In the cases of VPI and CAS, oral-motor exercises are not indicated. The best treatment for CAS focuses on producing sequences within the context of speech, not unrelated activities (e.g. oral-motor exercises). Oral-motor exercises are also not indicated for children with velo-pharyngeal dysfunction. The velum is an articulator and must also be coordinated during speech; the same breakdowns in coordination noted with the tongue, lips, and voicing can also be observed in the velum. As such, treatment for a child with hypernasality and suspected CAS continues to focus on improving coordination within the context of speech. If coordination of the velum does not improve along a similar trajectory as the other articulators for speech, the SLP should refer the child for further assessment of palatal function. An excellent resource on this topic was written by Heather Clark (2003). The citation is listed below.

Clark HM. Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology. 2003á :400-15.

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Erin Redle is the Coordinator of Clinical Research for the Division of Speech Pathology Coordinator at Cincinnati Children's Hospital Medical Center and an Adjunct Assistant Professor at the University of Cincinnati. She received her undergraduate degree from Miami University, her M.S. from Emerson College, and her Ph.D. from the University of Cincinnati. Her primary research and clinical practice areas are pediatric motor speech development and disorders and pediatric dysphagia.