Principles of motor learning in Childhood Apraxia of Speech (CAS)

ByLondon Speech and Feeding
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We use powerful motor learning principles to help children with CAS (Childhood Apraxia of Speech) learn how to produce better, clearer speech sounds in words, phrases and sentences.

What are these principles?

Principle 1: MASSED PRACTICE

This is where you see a child for lots of sessions in a shorter period of time, so for instance six weeks of three times weekly for 30 minutes.

This leads to motor performance or automaticity.

Principle 2. DISTRIBUTED PRACTICE

This is what I use, as most of my clients are not able to come and see me that often on a weekly basis. It is hard to travel in London and life is hectic. So I favour one session a week over say a term or two terms and a session is usually 45 minutes long.

This leads to improved Motor Learning and good generalisation.

During either Massed or Distributed Practice, we choose between 4 variables:

Principle 3: Constant vs Variable

Principle 4: Blocked vs Random

To explain:

Constant Practice is where we repeat the practice of a small handful of target words.

We practise the same target sound in the same word position, e.g. at the beginning of a word: ‘bee’, ‘bye’, ‘bow’, ‘baa’ or ‘key’, ‘car’, ‘cow’, ‘Kaye’ etc.

We keep the rate, pitch and intonation constant.

Variable Practice is where we vary the rate, volume, pitch and intonation of the targets

We use a larger number of sounds, and words that are motivating to say for the child.

For example, if a child loves Peppa Pig then I might choose the words: ‘Peppa’, ‘Daddy Pig’, ‘George’, ‘Mummy Pig’ and a couple of other favourite characters. My child might struggle with a number of sound sequences there but we will target them one by one.

We can also select simpler words like ‘cape’ and ‘cake’ or ‘tick’ and ‘tip’.

Blocked Practice is where we practise one target word for say five minutes then we move to another target word for the next five minutes and then we revert back to the first target word again and so on, so blocks of practice.

Random Practice means we practise several target words at the same time.

How do I decide on what to use?

Good question!

I always opt for distributed practice (weekly for up to 45 minutes).

Within that, I tend to find it most successful to start out with constant practice when a child is finding a certain sound sequence really hard and we need to just ‘nail it’. Bearing in mind I only pick sounds that my student can actually make in isolation, so we are not working on articulation! (where we focus on trying to elicit single sounds correctly – or even at all sometimes) Here in CAS work, we are working with sounds the student can make but is having trouble to add together, into a sequence that is needed to make a word sound right.

As soon as I feel we have some traction I will go to variable practice, i.e. I pick words that are either funny or interesting for the child and it can be a slightly larger number.

I tend to use blocked practice in the beginning or when working on vowels. That’s because it is more important we get our vowels right. They carry a word and are very important for overall speech intelligibility. Once we are on a roll, I tend to go more for random practice.

Example

Here in the video clip, we try and work the /e/ vowel in short words likes ‘bell’, ’fell’, ‘dell’, ‘sell’, ‘smell’ and I am using an AAC device to give a child’s voice as auditory feedback as well as using the PROMPT approach to help my student shape his vowels.

So this is:

  1. Distributed (1 x week for 45 minutes)
  2. Constant – we are practising the /e/ vowel in the same position in six different words
  3. Blocked – we did this: several repetitions of each word and after the sixth we moved to another sound, and then later we came back to this.

Please feel free to contact me if your child has speech sound difficulties. It is my passion. I love supporting children with apraxia.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    • Practise regularly: Short, frequent practice sessions are more effective than long, infrequent ones.
    • Make it fun! Use games, stories, and other engaging activities to keep your child motivated.
    • Work with an SLT: A qualified SLT can provide personalised guidance and support.

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    The /R/ sound can be challenging, but with targeted speech therapy and a focus on tongue placement, most children can achieve clear and accurate pronunciation.

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    Target Activities and Games For Kids
    Target Activities and Games For Kids

    Target Activities and Games

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    Each time your child picks up a sword they will need to say the target word 5 x, like:

    rip rip rip rip rip or run run run run run just like that in a row, bish bash bosh.

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    race race race race race and stick in another sword

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    You will therefore get…… 15 words per picture, and that makes….75 words , there that is nearly all you need to do.

    If you then do another little game like this one:

    Magnetic board game

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    Ray ray ray ray ray and DONE you will now at the end of this short round have 105!! target words done with just two little fun games.

    How good is this? Your child won’t hardly notice that they are in fact doing their speech therapy homework.

    You’re welcome 🙂

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    If you can think of any other alternatives on holiday and would like to tell me about them, I would love to see your comments below. We can never have too many holiday games!!

    If you are at home over the summer and you do have some games in the cupboard you might want to dust these ones down or buy one or two new ones (if you want to).

    Most games have multiple uses, and it’s always best to adapt a game to match your child’s interests and what motivates them.

    So let’s start…

    1. Pop up pirate: pop a sword into the barrel and watch the pirate pop up randomly. Practise social skills, speech sounds, expressive language (e.g., put a sword on a picture, say the word/sentence then pick up the sword and push it into the barrel).
    2. Word games such as ‘ISpy’, ‘I went to the shop and I bought…’, ‘describe a person and guess who they are’: perfect for when you’re on the move, whether travelling or walking. You can play this anywhere and still support speech, language and communication. You could play ISpy using your child’s special sound, or ‘I went to the shop and bought all things beginning with [insert special sound here]’.
    3. Shopping list: Orchard game is a game to practise categorising. We explain the analogy of the brain being like a filing cabinet. If information is all in the correct place, it’s easier to find, retrieve and use. You can also practise specific speech sounds in this activity. You could also put the words in a sentence to add more of an expressive language element.
    4. Wiggly worms: this Orchard game is all about phonological (awareness of sounds) awareness. Matching a letter with the word. You can also practise the sounds in the words (e.g, g-o-l-d = gold; m-a-ke = make). Talk about the elements, e.g., ‘g-o-l-d’ has 4 sounds, 1 syllable; ‘m-a-ke has 3 sounds, one syllable. You can talk about what words rhyme with the different words and what makes a rhyming word (i.e., the middle and end sounds remain the same).
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    8. Poo bingo: this is perfectly disgusting but equally fun for kids of about 3.5 years plus – if your child’s target is to practise /p/ sound this is the one for you. You can also learn all about the different animal’s poo, which I am sure you have always wanted to do!! The more we know about a word, the easier it is to store, retrieve and use. Yes, even talking about poo can help!! Also, it’s great for our visual learners.
    9. Simon says: a game that can be played indoors or outdoors. Parents can take turns being “Simon” and give various commands that your child must follow. This means that your child can practise their receptive (understanding of) language as well as their expressive language, speech sounds and social skills (such as turn-taking and initiating).
    10. Ker-plunk: this is perfect for practising your child’s special sound. Repetition is very important, but also can be monotonous, so finding a game that they enjoy is vital. Take turns to pull out a stick. Next, your child can either say their special sound or word (depending on what stage they are at) or hear a good model from other players.

    Do you still have questions? Contact Sonja for support.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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