Over 3 years ago, I began working with Andrew, a young client with a diagnosis of cerebral palsy and childhood apraxia of speech. Unquestionably, he is the kind of child whose personality and infectious smile light up every room he enters.
Throughout our time together, each session brings squeals of laughter and enthusiastic waves from this hardest-working boy. In fact, our therapy has targeted both speech and feeding, but today I want to specifically highlight Andrew's remarkable progress in expressive communication. Most importantly, his journey clearly demonstrates how childhood apraxia and cerebral palsy can be effectively managed with structured, evidence-based intervention when combined with family commitment.
Understanding Childhood Apraxia of Speech with Cerebral Palsy
Initially, before I started working with Andrew, he was carefully evaluated by Renee Roy Hill, who created a specialized program plan tailored to his specific needs. Since I was new to oral placement therapy (OPT) at the time, her expert guidance proved invaluable to my work with Andrew.
To fully understand Andrew's challenges, it's essential to recognize what childhood apraxia of speech (CAS) entails. Essentially, CAS creates a significant communication breakdown between the brain and the oral motor muscles needed for speech production. Particularly, Andrew's case involved dual diagnoses. When a therapist faces both motor planning deficits from apraxia and physical muscle control issues from cerebral palsy, the situation becomes undeniably complex. Consequently, his case required specialized intervention strategies tailored to address both conditions.
Importantly, we began therapy with foundational techniques, specifically starting with voice activation exercises. Carefully, Andrew first learned to "turn his voice on" and produce basic "ahh" sounds on command. Additionally, these sounds served as functional requests for desired items. Significantly, they built the foundation for more complex speech production. However, initially this seemingly simple task remained challenging. Notably, it required up to 10 seconds of wait time per attempt. Furthermore, we could only accomplish about 5 successful productions during an entire therapy session.
To strategically address the motor planning deficits inherent in childhood apraxia and cerebral palsy, we incorporated the TalkTools Horn Hierarchy into our protocol. Importantly, this innovative tool system helped Andrew improve abdominal grading and airflow control. Clearly, both of these skills are essential for producing clearer speech. Following this approach, Andrew's speech became more intelligible so others could understand and respond to him.
The Speech-Feeding Connection in Cerebral Palsy and Apraxia
For children with cerebral palsy and childhood apraxia of speech, the relationship between feeding and communication cannot be separated. Fundamentally, oral motor control serves as the foundation for both functions. Clearly, understanding this critical connection is essential when planning any comprehensive intervention program.
Notably, Andrew's feeding exercises became foundational to his overall speech progress. Throughout three consecutive years, we incorporated the Bite Tube Hierarchy into every single therapy session without interruption.
This versatile tool system addresses multiple therapeutic goals simultaneously. Primarily, it strengthens Andrew's chewing ability. Similarly, it builds functional jaw strength. Above all, it develops the precise grading control essential for accurate speech sound production. Following this consistent practice, Andrew has gained significantly better control of his jaw movements. As a result, he now applies this improved control strategically to articulate speech sounds more clearly.
Andrew's Breakthrough: From Sounds to Meaningful Speech
The transformation has been truly remarkable to witness. Admittedly, Andrew initially needed extensive time to produce simple "ahh" sounds. However, over time he has demonstrated consistent, confident, and functional speech. Remarkably, during this process, Andrew says "Mom" repeatedly throughout each day. Evidently, this represents a functional, meaningful word that was not possible years ago when we started this journey together.
Additionally, each morning brings another joy. Genuinely, Andrew wakes up and produces his /w/ sound naturally and eagerly. More specifically, he's asking for his brother named Will. Remarkably, for a child with childhood apraxia and cerebral palsy, this everyday occurrence represents a significant milestone. Indeed, it reflects years of dedicated, structured intervention and consistent practice both at home and in the clinic.
Importantly, what makes this success story truly special is the family's unwavering commitment to Andrew's progress. Clearly, they have dedicated countless hours to supporting Andrew both in clinical sessions and at home. Ultimately, it is precisely this kind of consistency that drives lasting and meaningful progress in speech-language pathology.
Congratulations on your remarkable dedication and hard work, Andrew. Your progress inspires all of us working to support children with complex communication needs.
Notably, Vanessa will be hosting a LIVE webinar on Saturday, April 21, 2018.
BRIDGING THE GAP: PRIVATE PRACTICE AND SCHOOL SLPS WORKING TOGETHER TO TARGET SPEECH AND FEEDING
Saturday, April 21, 2018 @ 11 a.m.-2 p.m. 0.3 ASHA CEUs
Key Takeaways: OPT for Childhood Apraxia and Cerebral Palsy
- Dual diagnoses require specialized assessment: When childhood apraxia of speech combines with cerebral palsy, comprehensive evaluation becomes essential. Following that, highly individualized treatment planning tailored to the child's specific needs is crucial.
- Oral placement therapy strengthens motor foundations: Evidence-based OPT tools, including the Bite Tube and Horn Hierarchies, directly address motor control deficits. Significantly, these tools effectively target the specific challenges these complex disorders present.
- Speech and feeding are interconnected: Feeding interventions provide meaningful and direct support for speech development. Indeed, this is especially true in children with cerebral palsy where motor control matters most.
- Consistency drives results: Regular and structured practice in both clinical settings and home environments produces lasting benefits. Consequently, such practice creates lasting communication breakthroughs and functional speech gains.
- Progress takes time: Meaningful gains in childhood apraxia therapy develop gradually. Moreover, they unfold over months and years with structured, dedicated work. Certainly, professional guidance and family support are essential components.
About the Author
Vanessa Anderson-Smith is a TalkTools LEVEL 4 ADVANCED trained therapist and speech-language pathologist based in South Dakota. Moreover, she earned her Bachelor's degree from Augustana University and completed her Master's degree from The University of South Dakota, establishing a strong academic foundation in speech-language pathology.
In 2013, Vanessa took the important step of founding Anderson-Smith Speech Therapy, LLC. Notably, she specializes in comprehensive assessment and individualized treatment of motor-based speech and feeding disorders. Ultimately, her extensive expertise has spanned childhood apraxia, cerebral palsy, and oral placement therapy approaches, making her uniquely qualified to understand and support children with complex communication needs and their families.