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Thursday, May 26, 2011

Motor Reconnect Apraxia Program 5/24/2011

Motor Reconnect Apraxia Program – Treatment Activities 5/24/2011

traveling the pathway of aphasia recovery
We now offer both online and on-site CEU Apraxia Treatment programs for SLPs.  If you are interested in participating in or sponsoring a Motor Reconnect Apraxia Program CEU program, contact Bill Connors at 724.494.2534 or bill@aphasiatoolboxcom.

While this newsletter is primarily intended for speech pathologists, it should also useful be for people with apraxia and their caregivers/coaches. If you missed the previous newsletter, you may review it by visiting our website at and clicking on Resources then Archived Newsletters.

SLP: If you would like to refer a client for online treatment or to consult with us in collaborative therapy, contact Bill Connors at or 724.494.2534 .

PERSON WITH APHASIA or CAREGIVER: if you would like to set up an online consultation or for more information contact Bill Connors at or 724.494.2534 .

This is the third and final in a series of newsletters discussing a new, innovative approach to the treatment of acquired apraxia of speech (motor programming problems).   Speech/language pathologists (SLP), people with apraxia, and caregivers/practice coaches routinely share with us at their disappointment with progress in apraxia treatment programs.   In response to this need, we have created the Motor Reconnect Apraxia Program.   Over 30 years in development, this program calls upon 21 key therapy and practice principles ( ).   Finally there is a program that truly approaches apraxia as a movement disorder with a focus on motor skills ( Mass, 2008).

In our last newsletter, we discussed in more detail principles and techniques of this Motor Reconnect Apraxia Program. At a recent professional workshop, Nancy Helm-Estabrooks offered, “The fact is that we are beyond using just linguistic therapy with people with aphasia.” (Helm-Estabrooks, 2011). Likewise, we are beyond just doing speech therapy with over-reliance on motor learning theory when treating people with acquired apraxia.   In our first newsletter on this topic, we compared and contrasted the motor learning principles used routinely in treating childhood apraxia of speech (CAS) with our proposed motor reconnect principles for treating people who have already learned how to talk but have an acquired impairment.   The difference between treating CAS in children and acquired apraxia in adults is remarkable and all too often overlooked by treatment programs.

Motor Reconnect Apraxia Program – The Program

Review of some key principles:

  1. Since acquired apraxia is different for each person, the techniques and activities may not all apply and/or may be initiated, suspended or reinitiated at various point in the treatment program.
  2. Disassociate jaw and vocal fold neural controls.
  3. Be aware this is errorful learning.  As with any motor re-training or conditioning program, we learn (reconnect) our muscle action and memory by attending to both our less accurate as well as inaccurate movement.  
  4. Increase metapraxia, the knowledge and awareness of apraxia and movement patterns  (Heilman, 2007).
  5. Improve deliberate control of vocal fold action (voicing, phonation).
  6. Establish effective use of proprioceptive feedback, the ability to focus on the sense of position, location and orientation and movement of the body and its parts  ( The Dana Guide, 2007).
  7. Establish presyllabic and preprosodic skills.
  8. Establish the effective production of vowels in primarily in relation to jaw position and as the building blocks for syllables.
  9. Simplify the client’s movement patterns.
  10. Establish syllables as the building blocks for speech motor programming.
  11. Simultaneously address any apraxia affecting arm/hand control.  This allows us: a) to begin to address keyboarding and screen literacy skills; b) work on any asymbolia (impairment in understanding and using symbols), facilitate the client’s metapraxia, and help the client improve independent therapeutic efforts by recognizing shared elements of the effects of apraxia on various motor functions of the body.

The specific elements of the Motor Reconnect Program for Apraxia – (targeted mental processes and skills):

  1. The Visual Definition of Aphasia – (metapraxia)
  2. Viking - concepts
  3. The basic Viking – pulsing syllables – (initiation; focused attention; vocal fold control; separating jaw-vocal fold neural controls)
  1. Modeled
  2. Independent on request – (initiation; dispersing speech perseveration; sound processing and working memory)
  3. Durational Viking – Stretching Vowels – (increase auditory and proprioceptive feedback)
  4. Intoned Viking – (pre-intonation and stress)
  5. Viking with an Attitude – (decoding and encoding prosody; sound processing; phonological and tonal working memory)
  6. Rhythmed Viking – (enhancing speech rhythm)
  • Scatpraxia:
    1. Scatpraxia: yes-no-delicious –(initiation; letting vocal variety happen)
    2. Scatpraxia: vowels
    3. Scatpraxia: varied vowels (letting vocal variety happen)
    4. Scatpraxia: bringing in the consonants – (syllablabification; syllable structure)
    5. Scatpraxia Group online – (vicarious learning; peer support)
  • Vowels
    1. Jaw positions – (the jaw as the platform for speech) production; establishing awareness of proprioceptive feedback)
    2. Around the Mouth – (vowel production using proprioceptive feedback; working memory for vowels; presyllabic)
    3. The Elevator: Alternating Vowels – (alternating attention; expandingr jaw neural controls)
    4. Long-Short vowels – (expanding the vowel inventory)
    5. Vowel Sequences From Memory -  (sound processing and working memory)
    6. Continuous Phonation – (introducing dipthongs)
    7. Blend Sounds into Words – (prosodic blending)
    8. V to VC words – (pre phonological assembly; syllabification)
    9. Alternate / h / -vowels –(enhancing laryngeal fine motor control)
  • Oral-Motor Coordination Program – (addressing naturalness of syllable structure and its supra-syllabic features)
  • Vowels Become Pronouns –(incorporating language elements; initiation)
  • Simple Conjugation- (transitions into canonical sentence structure)
  • Oral-Motor Coordination Program – (addressing naturalness of syllable structure and its supra-syllabic features)
  • Sound Embedded Verbs –(incorporating canonical sentence structure)
  • Sentence Intonation Patterning (prosody supports intent; )
  • GROUPS online ( ):
    1. Oral Motor Coordination
    2. Men’s Aphasia Bootcamp
    3. Coaches

    Heilman, Kenneth, and Gonzalez Rothi, Leslie, Apraxia – The Dana Guide,  
    Helm-Estabrooks, Nancy, Cognition and Aphasia: Clinical Implications, Pennsylvania Speech-Language-Hearing Association Convention, 4/7/2011, Pittsburgh, PA

    Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17, 277-298.

    Movement, Balance, and Coordination – the Dana Guide, Georgopoulos, Aposotlos, , November 2007

    copyright 2011 Aphasia Center of Innovation Treatment

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