Speech Therapy for Apraxia - NACD Home Speech Therapist is an iPad tool designed to improve speech sound productions and motor speech planning skills in people with apraxia, a speech disorder in which a person knows what they want to say, but has difficulty speaking the correct sounds, syllables, and words. The target users are children, but the app can be used with adults as well. I have a few children in speech therapy, which gave me and our speech-language therapist an opportunity to try out the iPad app.
What the app does
The apraxia program has 8 levels with speech sounds that are arranged appropriately in developmental sequence. The app doesn't teach the individual sounds, but focuses on learned sounds in various sound combinations. Each combined sound consists of consonant vowel (CV) syllables and are grouped according to their place of articulation, with the exception of the liquids (/l, r/). Within the practice sets, the target sounds vary in manner (how the sounds are produced) and voicing (whether or not the voice is used).
Users can choose to start at the beginning and work their way through the 8 levels or jump ahead and work on those sounds that need practice. The consonant groups practiced in the app include B P M; D N T; G K H; W; F V; S Z; SH CH J; and L R.
Level 1 starts off with 20 CV targets and is simple in its presentation with one CV syllable and image per screen. The images are simple and easy to recognize, which makes it especially suitable for children. The child (or adult) touches the screen and the auditory stimulus (sound) is presented. The child then repeats the sound and moves on to the next screen. The adult provides the necessary feedback to help the child improve their sound-making skills.
The next 7 levels all have 10 CV targets and are increasingly more difficult. If the child has the verbal recall ability, the complexity can be increased even more by asking the child to touch some (or all) of the stimulus items and then repeat them as a whole or partial sequence. This can facilitate rapid motor planning and sequencing.
The good and the bad
Just like any app, the NACD Home Speech Therapist has its strong points and its weaknesses. As we have seen with other tablet applications, this type of visual and tactile activity can hold a child's attention longer than traditional practice sessions, which is a good thing for parents looking to pack as much learning as they can into a therapy session.
This type of app also gives the child a sense of control and lets them progress through the program at their own pace. You have to monitor the pace, though, as a child left alone with the app could whip right through an exercise. The adult can try to control the pace by holding the iPad, but some children may resist (and by resist I mean cry uncontrollably) if the tablet is held out of their reach. You have to find the right balance between self-directed and parent-directed learning.
Not surprisingly, elementary school-aged children and even many preschoolers can learn to recognize the picture or letter combinations, and can try to say them without touching the screen or hearing the auditory input. Yes, this allows the child to progress to the point of producing sounds without the auditory input, but it could also lead to the child saying the response simultaneously with the stimuli. This makes it challenging for the adult to accurately assess the child's response when he or she speaks at the same time as the iPad. Thankfully, there is a simple solution -- just turn down the sound of the iPad until you can hear your child clearly.
The biggest drawback to the NACD Home Speech Therapist is the lack of visual movement or reinforcement when a stimulus item is touched. This not only takes away from the overall experience of the app, it also can hinder a child who focuses on visual instead of auditory stimulus.
Overall, NACD Home Speech Therapist is a useful tool for teaching CV phonemes to independent learners. It can be used by a speech-language pathologist in a school or clinical setting. It can also be used by parents to practice with their children at home. Note that the app does not replace the teaching of the individual phonemes, and would not be useful if the child needed visual cues from a speaker or an alteration of the auditory stimulus.