App Review: Apraxia Ville

A few months ago, when I first saw the announcement that Smarty Ears was getting ready to submit their newest app, Apraxia Ville, to Apple, I was super excited!  If you are an SLP who works with children with Apraxia (or a parent of a child with Apraxia), you know that the key to effective treatment is frequent and intense practice.  (Want the evidence?  See "The Importance of Production Frequency in Therapy for Childhood Apraxia of Speech" by Denise Michelle Edeal and Christina Elke Gildersleeve-Neumann from the May 2011 edition of the American Journal of Speech-Language Pathology).  "Frequent intense practice," 

that means "drill," right?  Finding activities that incorporate drill and are motivating for our students can be 

challenging.  That's why I was so excited to check out this app and provide this review for you!

Here's Apraxia Ville:

As you can see, Apraxia Ville has a fun farm theme!  The first time you open the app, you have the option of  watching a video tutorial (narrated by Barbara Fernandes of Smarty Ears).  I highly recommend watching this video.  If you don't watch it the first time around, you can access it HERE (scroll to the bottom) or by tapping the "Support Button". You can also start a "Quick Play" session, "Select (and enter) Player" for data collection and reports, View your "Reports and (create) Homework," and contact Smarty Ears for "Support." Tapping "More Games" will give you a list of all of the apps available from Smarty Ears.

When you add players, you are given the option of using one of many avatars or a photograph:

You can select multiple players and even import players from Therapy Report Center (TRC - a free app from Smarty Ears to which you can import data from most of your Smarty Ears apps and view in one place!).  Tapping "Settings" allows you to modify the words used for each phoneme and even to add your own words!

There are three activities to choose from in Apraxia Ville - The Sound Windows; The Farm House; and The Words Farm:

The Sound Windows:

In this mode, you can target CV sequences.  The boy is animated to show the child how to produce the consonant sound and the girl produces the vowel sound.  You can activate production of the sound by tapping the child.  See the apple under the boy and girl?  You can slow down the speed of production by sliding the apple.  This will help children visualize how the sounds are made.

The default for this activity is /b/ and /a/.  However, you can change the sounds by tapping on the wooden sign with the sound.  Then you will be able to scroll through the available sounds:

Another fun feature - you can tap the camera icon (if your iPad has a camera) and have the child watch themselves produce the sound:

The Farm House:

When you choose this activity, you will be prompted to select syllable structures and phoneme targets for each student.  You can choose consonant sounds and/or specific vowels.  Note:  If you choose consonants and vowels, they won't necessarily appear in each word (e.g., selecting vowels will cause different consonants to appear in your activity).

In "The Farm House," target words appear in the main doors.  Selected players will appear in the upper windows, and you can utilize the Sound Windows if needed by tapping the magnifying glass.  To select a player/change players, tap on the avatar.  Icons for marking accuracy of responses will appear above the player's avatar.  You can mark a response as correct (green), almost/assisted (yellow), or incorrect (red):

You can also tap the red circle to record a student's production of the target words and the green triangle to play the recording back.

The Words Farm:

For this activity, you will be prompted to select the number of words per screen for each student.  You can choose specific consonant sounds and syllable shapes in the activity itself.

Here is what the activity looks like using two words per screen:

And here is an example using three words per screen:

Notice that you still have the option of marking the accuracy of responses and of recording responses.  You can change the target phonemes by tapping the phoneme circle (in the example above, I used /p/, /t/, /k/).  You can change the syllable shape by tapping the CV circle (your options are CV & VC or CVC).  You can tap any word to hear an audio model of that specific word.  Tapping the green arrow above the words will play and audio model of the three words in succession.

Reports & Homework:

From the home screen, if you tap "Reports and Homework," you can view data collection and generate homework for selected students.

You can view data by "History."  This will give you the Session Date(s), Session Duration, Number of Participants, Activity, Target Phonemes, Syllable Structure, and Accuracy:

You can also view data by consonant production:

And vowel production:

You can generate a homework document for students by selecting the target phoneme and syllable shape:

This will generate a pdf which you can email to yourself or to the parent, open in iBooks/Kindle, or print via Air Print (if you have that capability):

So that's a basic overview of Apraxia Ville (which sells for $21.99 in iTunes).  Here are some of my thoughts:

The Pros:

• The drill work that is necessary for targeting Apraxia can be tedious for both therapists and students.  Most of my students are much happier to work with the iPad than without.  This app makes the drill work more fun for all involved!
• I love that you can view the Sound Windows while targeting words in "The Farm House."  If a child is having trouble producing a word, this can be an incredibly helpful tool!
• I also love that you can use the iPad camera function in the Windows for students to view themselves making a sound.  
• I love "The Words Farm" for those students who have moved beyond the word level.  This activity is very similar to the Word FLIPS book from Super Duper that I use regularly within my sessions, but gives you more flexibility in that you can change the syllable shapes as well as the phonemes.
• Built in data collection and homework pages!  Data collection is fabulous, but the addition of generating homework pages is amazing!  You can print pages to share with parents and teachers.  This provides a great way to increase trials in the classroom and at home.

Changes I would like to see in an update:

• I used this app with a child who has a diagnosis of Childhood Apraxia of Speech (CAS).  She is working on sound sequencing in multisyllable words, so we used "The Words Farm."  After a few minutes, she said to me "I thought we were gonna play a game."  Even though the drill work is a necessary evil for students with this diagnosis, I would love to see some sort of reinforcement after a predetermined time frame (5 minutes, 10 responses, etc.).  Even something as simple as feeding the cow, brushing the horse, etc, would increase the motivation of students.
• I've gone back and forth about whether or not to include this point.  I decided to include it, even though I know it might not be feasible/prudent of the developers to make this change (More on that in a minute).  With respect to the syllable shapes, I would LOVE it if CV and VC were separated.  I've been using this app with a little guy who just can't switch between the two targets in one session.  We just skip over the VC words, but it would be easier if they were separated out.  With that said, I understand why they aren't...there just aren't enough VC and CV words for any given target!  However, if I was thinking it, some of you might as well.  

The bottom line:

Apraxia Ville is a great app for use with students with a diagnosis of CAS, Apraxia, motor planning difficulties, and even articulation/phonological delays.  We all know that drill-work is not fun, but this app can help to alleviate some of the tedium of the drills.  Apraxia Ville is great for students who are just beginning to sequence CV, VC, and CVC syllable shapes and also for students who are working on combining syllables.


What is your favorite way to "spice up" drill work for kids with CAS?

Guest Post: Incorporating Touch Cues into Speech Therapy

I'm sure you've all seen Speech Buddies making the rounds on some of your favorite blogs.  Well, did you know that they  have their own blog?  Here's the link:  Speech Buddies Blog.  I've found some cool ideas on there and I'm pretty sure you will as well!  One of the writers from the Speech Buddies Blog, Holly, has written a guest post for me to share with you today!  

[source: prweb.com]

We all know the saying- “seeing it is believing it”. Well for teaching speech sounds, the same is often true -you have to see it to articulate it. For many children, simply saying a speech sound out loud isn’t enough information to help them repeat it themselves. Children have to learn the correct placement of their articulators and how to produce sounds, often in a stepwise process. One technique for facilitating speech sounds is to use what are called, touch cues. Touch cues are a type of tactile cue, a technique involving the hands to show placement or highlight the part of the face being used to make a specific sound. Tactile cues are nothing new, and in fact a highly effective, evidence based practice that underlie the principles of Speech Buddies and the PROMPT program (Prompts for Restructuring Oral Muscular Phonetic Targets). While both programs have their own specific principles, touch cues in general can be used during play and other speech and language based activities with relative ease and just your hands and face.

For little ones, in particular, touch cues can provide a more visible and salient gesture. During play, they can help highlight individual sounds that go along with the toys and actions in a game or activity. For example, while saying “mat” (e.g., “lets sit on the mat”) a clinician might model the “m” lip position by using their middle and index fingers to push the lips together and produce the sound. These can serve as teaching tools or visual reminders. If the child leaves off a sound, for example, “ma” instead of “mat,” the clinician might use a visual tactile cue to prompt them for the “t” sound at the end of the word.

Clinicians should make the sound and show the cue on their face, and if tolerated, encourage the child to use their hands on the mouth of the communication partner to feel the way the mouth moves during production of the targeted sound.  Also if tolerated, provide the cue on the child’s face. Remember to model and use them consistently.

  

[source: speechymusings.com]

The cues themselves vary slightly according to different treatment protocols but generally follow that common gestures are used to show sounds that produced in a similar manner. If a sound requires a burst of air from the mouth, the cue will emphasize that. Some common examples include:

/p/: Place your index finger in vertical position touches both lips and then bring finger away from the lips while release air

/b/: Similar to /p/ but the finger does not move because no burst of air occurs

/m/: Place the tips of your index and middle fingers on your lips horizontally. Some only use one finger in the horizontal position under their lip.

/n/: Place your index finger next to the nose to cue nasality

/k/ and /g/: Place your index finger horizontally across the upper throat and tap your index finger up as you form the voiceless /k/. Use index and middle finger for the voiced /g/ sound to show that this sound uses the voice. .

/t/ and /d/: Place finger on the left or right side of the mouth near Cupid’s bow, which is above the lip. Use one finger to tap while you produce the voiceless /t/ sound and show two fingers for the voiced /d/ sound.

Post written by Holly F.

I want to take a minute to thank Holly from Speech Buddies for sharing this information with us today!  Also, I wanted to share that I do have a parent handout available on Visual/Tactile (or Touch) Cues that you can download for free HERE.

Feed the Penguin: Bilabial CV, CVC, CVCV words

Disclaimer:  This post contains affiliate links to Amazon.com for your convenience.  

A little while ago on my Facebook page, I asked you what activities you were looking for.  I was surprised at how many of you needed materials for children with Childhood Apraxia of Speech.  There were also a few requests for materials for Final Consonant Deletion and bilabial sounds.  This activity should cover those requests!

I couldn't come up with a snazzy name for it, no matter how hard I tried!  But, you get a large penguin:

You know me and my tissue boxes (if not, click the link!)...I cut out the mouth and attach the penguin to a tissue box.

If you don't like this penguin you can always make one with a Cricut.  This one was made with the Create a Critter cartridge:

You also get 4 pages of fish - 3 pages with target words, one blank.  You can use the blank page of fish to add your own targets, or simply as an open-ended reinforcer.

The target words all contain bilabial sounds - P, B, M.  The first page consists of CV words (P, pie, pay, bee, bow, boo, my, mow, moo):

The second page has CVC words (pin, pop, pan, bone, book, bat, moon, mom, mop):

And the third has CVCV words (pizza, pony, puppy, boo-boo, bunny, baby, money, mummy, movie):

I'm storing them in snack-sized ziplock bags with the page title so I can easily find the targets that I want:

Have your students say the target words on the fish and then feed the fish to the penguin.  You can also line up the fish and have your students practice CV sequences.

Graphics Credits:

Penguin:  From the Pond. http://frompond.blogspot.com  

Fish:  Love Two Teach. http://www.lovetwoteach.com/

Additional Graphics:  Graphics Factory.  http://www.graphicsfactory.com

Hope you like it!  You can grab a copy HERE. (If you grab it, don't forget to rate it!)

PS, Like the penguin theme?  Check out these cute games I found on Amazon!

Interview with Leslie Lindsay, Author of "Speaking of Apraxia"

There's a new book on the market on Childhood Apraxia of Speech - "Speaking of Apraxia:  A Parents' Guide to Childhood Apraxia of Speech," by Leslie Lindsay, R.N., B.S.N.  When her daughter Kate was diagnosed with Childhood Apraxia of Speech (CAS), Leslie looked high and low for information (particularly information for parents) on the disorder.  Not finding any books on the topic, Leslie, a child-adolescent psychiatric nurse, took on the daunting task of writing one!  Here's the result:

I had seen a few reviews of the book on other blogs and speech sites (see below for links).  I read the reviews on Amazon (all 5-star if you were wondering).  I ordered the book.  I thought it would be a good reference for myself as a Speech-Language Pathologist.  I also thought it would make a great addition to my resource library.  When Leslie contacted me about the possibility of featuring the book on Carrie's Speech Corner, I jumped at the opportunity!  This book truly is a wonderful source of information, not only for parents, but for SLPs as well.  Leslie was kind enough to sit down and answer some questions, and to provide a copy of her book for one lucky reader as well!

An Interview with Leslie Lindsay:

There are a few books about CAS geared toward SLPs. What is different about your book?

Well, I’d like to say the big difference between my book about CAS is that it is written from a parent’s perspective.  I really, really wanted a book when my own daughter (now 7 years and speaking quite typically) was diagnosed at the age of 2.6 years.  There wasn’t much available that really appeased me. 

This book covers much of the “journey” of apraxia, more than the treatment (though there is a chapter on that)—which is what those books geared to SLPs do.

In SPEAKING OF APRAXIA, readers will find information from suspecting a problem to getting help, navigating the school system, how to help your child at home, family/child coping, resolving apraxia, networking, and more. 

You’ve done a LOT of research on CAS for this book (probably enough for a degree in speech-language pathology!). How long did it take you to write the book? How did it feel to see all of your hard work come to fruition, to hold the final copy of the book in your hands?

Giggle, giggle!  Yes, I *did* do a lot of research on CAS and speech pathology in general.  It wore me out!!  I won’t lie.  It took me about 4 years from conception (“Hummm….there really ought to be a parent-friendly book on this subject”) to bookshelf.  Meanwhile, I was raising two young kids (oldest was 6 when the book was released, youngest 5), and “living” apraxia.  I researched not only apraxia, but also the publishing industry, how-to-writing books, wrote and submitted proposals to publishers and finally, finally secured a contract.

Getting the final copy in my hands was like welcoming a newborn baby.  Sure, it was a lot of work—the gestation, the labor—but there’s still work to be done, the “raising” (launching) of the book, if you will…you know, making sure it gets into the right hands.  It’s hard to see one’s “baby” out there making a difference.  But on the other hand, it’s so satisfying knowing that my words are touching the lives of another family walking the same path. 

Your daughter was first seen for a speech and language evaluation at 19 months, how old was she when she received the CAS diagnosis?

Kate received the final diagnosis when she was 30 months, or 2 ½ years old.  I was finally ready to hear the news.  I knew something was going on, it was just a matter of what.  My evaluating SLP and I are still in contact.  She will tell me—with a gleam in her eye—that I was “probably one of the only parents who came right out and asked point-blank what I thought the diagnosis was.” 

Was that the first time you heard the term CAS? What thoughts were going through your mind when you heard the term?

Never, ever had I heard the term CAS until my daughter was diagnosed.  Sure, I knew what apraxia was from my nursing background, but that was always in terms of stroke victims (CVA) or TBI (traumatic brain injury).  But to hear it applied to children and speech…well, I was clueless. 

When my evaluating SLP mentioned it to me, I shook my head.  I was perplexed.  “What’s that?” I recall asking.  She gave me a very precise and SLP-like answer, “A neurologically-based motor speech disorder.”  I was scratching my head… What does *that* mean?  Will my child be able to talk?  What can I do?  Plus, with my nursing background, I was eager for research and prognosis information. 

But, the way it was presented at the clinic that day was very laissez faire.  I didn’t get the severity of the diagnosis until much later, when I started doing hard-core research. 

Reading your depiction of Kate’s assessment session was an eye opener. As an SLP, I conduct evaluations sessions frequently. I typically take into account the anxiety of the child, but not the parent. Do you have any advice for SLPs to help parents deal with the anxiety?

Oh, we parents *are* anxious!  We want to be “super-parent,” we don’t want our kids to have anything different about them.  I think all parents would agree that we want our children to be “above-average.”  When there’s a glitch, we wonder what we did wrong.  Usually, nothing.  But, still the worry is there. 

As a SLP, help the parent understand that CAS is treatable, but serious.  Let me know that I am a valued part of the treatment process.  Give us time to ask questions.  Give us a moment to let things register and then grieve.  We may need a little extra support.  If you know of something (a book, article, group, website), don’t hesitate in sharing.  Most of all, realize that we love our children more than anything in the world. 

I wrote an article on this very subject for Future SLPs.  You can read it here. 

Speech progress can be slow in children diagnosed with CAS. That must have been frustrating for you as a parent. Can you describe that frustration?

Yep.  Frustration and impatience do not fare well for the parent of a child with CAS.  I remember Kate going to speech therapy for what seemed like months before she did much of anything verbally.  They were working on words I considered silly, like “up,” and “pop.”  I was so excited when we finally heard a two-word phrase! 

It’s also typical for kiddos with CAS to plateau with their speech.  We got to a point where Kate was doing “alright,” but I knew she wasn’t at a developmentally-appropriate level.  She wanted to stop going to speech.  She didn’t like it anymore.  I had to motivate her with small tokens/prizes like a trip to the park after speech.  We also wanted her to get ready for kindergarten, so we used that to our advantage, “You need to keep going to speech so you are ready for kindergarten.”  She had a timeframe in mind and that was motivating to all of us. 

You discuss different types of Complementary and Alternative Medical (CAM) interventions. Have you tried any yourself?

Yes!  We have tried Dr. Sears Omega-3 chewies and found that they were helpful.  Kate was a little more on-task and I did notice a surge in her vocabulary.  Now, here’s the caveat: was it all a coincidence?  Would she have progressed without the Dr. Sear’s chewies on-board?  I don’t know. 

We also have used yoga and relaxation techniques at our house.  Kate loves them!  Here is another link to an article I wrote for Omazing Kids.  http://omazingkidsllc.com/2012/08/11/childhood-apraxia-of-speech-and-the-benefits-of-guided-relaxationyoga-a-guest-blog-post-by-leslie-lindsay/

Finally, I can’t say enough great things about occupational therapy (OT).  We really felt this was the key that unlocked Kate’s voice.  Makes sense…CAS is a motor speech disorder, so all of the gross motor work done in OT is really helpful to these kids. 

Describe for us your proudest “mommy moment” during Kate’s journey.

The first one that comes to mind is when Kate told us (her dad and I) that she loved us.  We were on vacation and staying in a hotel.  Kate was about three years old  She looked up at us from bed as we were tucking her in and half-spoke, half-signed “I uv oo”  It melted our hearts. 

Okay, now to share another more recent moment.  I was super proud when Kate introduced me at the book launch party in April.  “And now, I would like to introduce my mom, Leslie Lindsay.”  She said this with perfect articulation, in a nice clear loud voice in a packed room full of friends, family—and to her—strangers. 

That's AMAZING!  She's made great progress!  You use the term “resolved” in your book. Can you explain why you use that word and what it means for a child with CAS?

It’s a big word, I know.  To many, the idea of apraxia being ‘resolved’ is a hard concept to digest.  Some feel the best word is ‘resolving,’ because it never really goes away 100%.  There are almost always still remnants lingering as these children grow into adolescence and adulthood, particularly when stressed or tired. 

For a child with apraxia, it means that their CAS is no longer a major concern.  CAS doesn’t stop them from being a typical kid; it’s no longer an impediment. 

But knowing that it once was a struggle is important for academic reasons—learning to read and write could be more troublesome.  Social nuances and the latest fad (especially if hard to say!) could trip-up some older kids (teenagers) with ‘resolved’ apraxia.

If there is only ONE THING readers take from your book, what would you like that to be?

Wow.  Another big one!  There is hope.  If you can dream it, you can do it!  And we’re in this together—it’s a family affair.  Well, guess that was two things, huh? 

I asked our Facebook fans if they had any questions for you, and I thought this question from Christine was a great one:  "What is the best way for us as professionals to tell parents that we suspect CAS?"

Fantastic question.  Again, I would direct you to learn more from the Future SLPs article.  But also: gently, privately (not with the child present, if possible).  If you can, schedule a meeting where both parents can be in attendance at the clinic.  Let them know CAS is serious, that you are there to help; you and the parents are a partnership.  Tell parents about your general goals for the child, how you work (many parents don’t have a clue about what SLPs do), tell them about how long treatment may take. Give them concrete suggestions on what to do when they leave your clinic that day—and on future appointments.  Equip them with resources.  They may not want them right then (overwhelmed), but do give them something—a book (okay, shameless plug!), a hand-out, brochure, even a hug!  Let parents know you can give them more when they are ready. 

Any final thoughts you’d like to share with parents and SLPs?

Believe in your child.  Whether it’s your own child or one you work with in a clinic setting (or school), never give up.  Know that these little people are the future.  Show them compassion and let them shine.


 

Thank you so much to Leslie for her time and for sharing her book with us!  
Enter below for a chance to win a copy of this fabulous resource!




Want more info?  Check out some reviews of "Speaking of Apraxia":

Playing with Words 365
[simply speech.]
ForeWord Reviews 
Jake's Journey to be a little man 
Words of His Heart

You can also check out Leslie's blog:  Practical Parenting...with a Twist 

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