Treatment of CAS Requires a Specialized Approach
Principles of motor learning and why they are important
The difference between learning and performance
Why progress is important

Treatment of CAS Requires a Specialized Approach

 

 

Speech therapy is critical for children with CAS, but not just any therapy. Effective treatment of CAS requires careful consideration of several factors to promote motor learning. Learn what is important in a speech therapy program for children with CAS. 

Principles of motor learning and why they are important

Speech is the most complicated motor activity we do. It requires rapid and highly coordinated movements of many muscle groups.  CAS results from difficulty planning and programming these motor movements for speech. Research has uncovered important knowledge about how humans learn motor skills, and this knowledge is referred to as “Principles of Motor Learning” or PML.  Treatment for CAS that follows these principles is carefully structured to help the child achieve the most rapid and enduring response to treatment possible, which is particularly important for children with moderate to severe CAS.  There many ways therapy can incorporate PML, including:

High amounts of practice - Frequent sessions (3-4 times/week) and lots of practice trials (opportunities to say the word) to promote motor learning

For children with severe CAS, few (5-7) verses many (15-20) words may be worked on during the therapy session allowing the child greater amount of practice on each word

The clinician will focus the child's attention and effort on speech. Games or pictures that capture the child's attention and distract the child away from the clinician may be used sparingly and only as needed to keep the child engaged in treatment

As the child becomes accurate producing a word or phrase, the clinician may fade or decrease cues to encourage the child to be more independent. This may include changing the cues and just telling the child if the word or phrase was accurate or not to encourage the child to self-monitor and self-correct.

Practice conditions will vary, meaning that different intonation and stress patterns will be incorporated into drill to help develop smooth and even speech.

The difference between learning and performance

Too often children with CAS demonstrate slow progress.  One explanation for this is that therapy is sometimes structured to promote success during practice in the therapy session (performance) but may not consider factors that enhance the retention and transfer of skills (learning).  Motor learning research demonstrates that performance during practice is a poor indicator of learning. So, children can do well during therapy sessions, but then have difficulty transferring the skills outside of therapy. Treatment methods that follow principles of motor learning are designed to promote learning so the child will be able to generalize and maintain skills.

Why progress is important

When a child has CAS, especially moderate or severe CAS, speaking is difficult and therapy is hard work. It is important for the child experience some “pay-off” for that work in the form of more successful communication. Choosing speech targets that are meaningful and useful to the child and structuring the therapy session to help the child learn those words as quickly as possible helps keep the child actively engaged in therapy and discourages negative avoidance behavior.

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