Multisensory Cueing in Apraxia Therapy

What is multisensory cueing? And why is it so important in apraxia therapy?

Multisensory cueing involves visual, auditory-verbal, and tactile cues. Children with childhood apraxia of speech (CAS) struggle with sequencing speech movements and transitioning between sounds. The use of multisensory cues aids children in developing new motor plans for speech movements.

Multisensory cueing is an important part of the DTTC (dynamic temporal and tactile cueing), which is an evidenced based approach to treating CAS.

VISUAL CUES:

The most effective method of visual cueing, is for the child to watch you produce the movement and move along with you.  I frequently say "watch me", "watch my mouth" or "eyes on me".  This draws the attention to my face and specifically to my mouth.  If the child needs to round their lips, I will point to my lips for additional cueing.  The child does not need to provide direct eye contact, but rather attend to your mouth for cueing.  

I frequently use sound cue cards to cue the child about the movement.  They also provide a metaphorical cue i.e. snake sound for /s/, tapping sound for /t/. 

Click here for more information on how I use sound cue cards in my apraxia therapy sessions.

Other visual cues include the use of mirrors, dry erase boards and hand cues.

Click here to see a therapy video using a dry erase board and sound cue cards.

AUDITORY / VERBAL CUES:

The most effective way to provide verbal cues is by giving children specific instructions on the movement they need to perform, particularly focusing on the first movement or initial position. (initial configuration). For instance, guide the child to position their mouth correctly to start the word accurately, such as instructing them to put their lips together for a bilabial sound.

Other verbal cues include:

Phonetic: provide a hint by producing the first sound in the word

Semantic: show a picture that refers to the word or a syllable in the word.  For example: for the word “stuck”, provide a phonetic cue for the /s/ and then show a picture of a “duck”

Metaphorical: “you forgot your snake sound” (for the letter /s/) or “round your lips more for the owl sound”.

TACTILE CUES:

Tactile cueing physically guides the child through the movements.  An evidenced based approach is PROMPT.  I am PROMPT certified and use this approach in my sessions,

You can develop your own tactile cues that provide the child with sensory motor information to facilitate accurate movement. 

Many children with CAS have difficulty with differentiated movements for speech.  This means that the child has difficulty moving their articulators independent of the other.  For example, when the child tries to round their lips, their jaw will slide. Lack of stability in the jaw is frequently the reason for this inability to make separate movements. Offering jaw support can greatly aid in promoting differentiated movement. 

Click here to see how how use jaw support to guide differentiated movement.

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Click here for a FREE MOTOR SPEECH CUES HANDOUT

Click on the picture below for more information about my treatment of apraxia course.  The course features over 60 therapy videos to demonstrate apraxia therapy techniques and multisensory cueing, in real life therapy sessions.  There is also a video demonstrating all the hand cues that I use.