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AAC for Apraxia

Pacing devices to reduce rate
AAC (letter boards)


Behavioral Management

all behavioral management approaches emphasize careful selection of stimuli, orderly progression of treatment items and intensive and systematic drill.


Principles of motor learning apply:

>Drill (motor programming)
>Self monitoring/corrections
>Teach/model/cue then fade
>Start with automatic speech
>Feedback (audiovisual)
>Repetitive/intensive practice
>Start consistently then variably
>Reduce rate, increase accuracy


Rosenbek’s Eight Step Continuum (1)

1. Integral stimulation – patient listens and watches SLP as she makes sound/word then patient imitates while SLP simultaneous produces target.


Rosenbek’s Eight Step Continuum (2)

2. Same as step 1 but patient’s response is delayed and the clinician mimes the response without sound during the patient’s response.


Rosenbek’s Eight Step Continuum (3)

3. Integral stimulation followed by imitation without any simultaneous cues from clinician


Rosenbek’s Eight Step Continuum (4)

4. Integral stimulation with several successive productions without any intervening stimuli and without simultaneous cues.


Rosenbek’s Eight Step Continuum (5)

5. Written stimuli are presented without auditory or visual cues, followed by patient production while looking at written stimuli.


Rosenbek’s Eight Step Continuum (6)

6. Written stimuli, with delayed production following removal of written stimuli. (count 10 seconds).


Rosenbek’s Eight Step Continuum (7)

7. Response elicited by question, “What do you drink your coffee in?”


Rosenbek’s Eight Step Continuum (8)

8. Response target produced in role play situation.


Sound Production Treatment (SPT)

Uses minimal contrasts (bye-pie) to aid in refining movement patterns that differentiate sounds andworks in hierarchy


Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPTs)

o Tactile-kinesthetic input – highly structured finger placement on patients face and neck tell the articulatory placement.
o Usually used with severe AOS with very limited verbal output.


Melodic Intonation Therapy (MIT)

> begins with hand-tapping rhythms, then going to simultaneous humming with clinician, addition of words, phrases, and gradual fading of model.
> Doesn’t use familiar tunes but emphasizes exaggerated pitch, tempo and rhythm.
> Eventually modified to spoken song, then speech.
> Success due to pulling in the right brain.



>May be useful in addition to other therapies but not by itself.
>EMG feedback may help to for muscle relaxation.
>Electromagnetic articulography provides visual feedback about tongue positions.


Severe apraxia (speechless) techniques

>Use automatic speech tasks
>Use carrier phrases – “I drink coffee in a ______”.
>Singing familiar songs, Happy Birthday, Jingle Bells, etc.
>Pair symbolic gestures with associated sound/word (waving bye, OK sign, finger to lips for “sh” etc.). This may help to elicit word.


Severe apraxia (speechless) techniques Phonation

>For problems initiating phonation – try yawning, sighing, coughing and shaping phonation from there; put clinician’s hand on larynx and slightly depress – ask patient to say “ah’; push in slightly on abdomen with patients mouth open to elicit vocal fold closure and possible phonation.


Techniques for sound, syllable, and word level

>May help to work on nonsense words rather than words with meaning.
>Work on isolated sounds then shape into words, hum then prolong this to “ma” then add final consonant so you have a CVC.
>Key-word technique –use words correctly produced to gain control over speech by answering questions with the word, read the word, etc. Then use the initial sound of this word to lead into another word.
>Cueing strategies are helpful especially phonetic placement cues.


Multiple Input Phoneme Therapy (MIPT)

>Used with severely aphasic and apraxic patients whose repetition abilities are impaired and who have frequent stereotypical words/phrases.
>May aid in reducing struggle to speak voluntarily.
>Identify most frequently occurring stereotype (such as go-go) and use this as target of treatment.


6 Steps of Multiple Input Phoneme Therapy (MIPT)

1. Clinician produces target many times emphasizing initial phoneme, patient taps simultaneously.
2. Patient then joins in with the repetitions
3. Clinician fades voice but mouths utterance and taps as patient says target.
4. Repeat these steps for other stereotypical utterances. The idea is to say these stereotypical utterances voluntarily.
5. Then work on new words with the same initial phoneme as the stereotypical utterance.
6. Targets then broadened to include all phonemes


Voluntary Control of Involuntary Utterances (VCIU)

Similar to MIPT but relies on written as well as verbal input.


Techniques at Multiple Syllable level

Pick a stimulable sound, keep utterance manageable works best with mild/moderate apraxics
>Focus on rhythm, stress and intonation while concurrently working on articulation.
>Use phonetic contrasts, bye-pie sing-sting, to-chew.
>Work on rate modification via pacing board, letter board, finger tapping, metronome.
>Contrastive stress tasks