Apraxia
of speech
And DTTC
Contents
01 What is Apraxia? 03 CAS
02 Types of Apraxia 04 DTTC
What is Apraxia?
A neurological disorder characterized by the
inability to perform meaningful and
purposeful tasks or movements despite;
The request being understood
The desire to perform the task
The necessary muscles work properly
The task has been learnt
Types of Apraxia
Ideomotor Buccofacial
The concept of Difficulty in performing
movement is understood
but there is difficulty in
Ideational movements related to
the mouth, tongue and
executing the movement. Difficulty in executing face.
E.g. Raising hand in class movement in the E.g. Unable to bite or
to answer but unable to
correct order or chew food
do so
sequence
E.g. Wearing shoes
before socks
Limb-kinetic Dr e s s i n g
Constructio Difficu lty in m o t o r
Difficulty in making
Inability to
nal plann i n g o f o n es e lf
precise movements draw or
e ss in g
construct wh ile d r
with limbs simple
cl o th e s
figures or E.g. Wea r in g
E.g. Having trouble shapes
n g w a y
E.g. Difficu th e w ro
in tying shoelaces. lty in
drawing a
tree
Childhood Apraxia
of Speech
Childhood Apraxia of Speech (CAS) is a
motor speech disorder where children
struggle to plan and coordinate the
precise movements needed for speech.
This results in inconsistent speech errors
and difficulty producing sounds
accurately, despite knowing what they
want to say.
Timeline
01 03
02 04
Early Signs (Ages 1-2) Diagnosis (Ages 3-5)
Identification (Ages 2-4) Intervention and Therapy
(Ages 3+)
Many children with CAS demonstrate a strong desire to
communicate but struggle with speech clarity, which can
lead to frustration and feelings of isolation.
The problem is with The muscles involved in
the brain's planning speech are typically not
and sequencing of weak or damaged but
the muscle require correct signals from
movements the brain to function
required for speech. properly.
Signs and Symptoms of CAS
Difficulty with
Inconsistent
Longer or
Speech Complex
Groping or
Errors Words
Effortful
Speech
Treatment and Support
for CAS
01 Speech Therapy
02 Family Involvement
03 Tech Tools
DTTC
Dynamic Temporal and Tactile Cueing:
A Treatment Strategy for Childhood
Apraxia of Speech
Contents
01 What is DTTC ? 04 Principles
02 Etymology, breakdown 05 Challenges and Considerations
03 Objectives 06 Comparative Analysis
What is dttc?
DTTC is a therapy approach that
helps young children learn how to
move their mouth muscles for
talking. It focuses on practicing
different mouth movements .
To be specific, dttc helps in
improving speech motor control
and planning
Etymology
DTTC was originally described as “integral stimulation therapy”. IS,
which emphasizes attention to the visual and auditory aspects of a
particular speech target, was introduced in the 1950s in contrast to
the traditional stimulus method used at that time, which was
primarily an auditory approach (Mysak, 1959). IS simply refers to the
method of having the child imitate a target produced by the
clinician, asking the child to listen to me/watch me/do what I do,
and the clinician’s provision of feedback. As DTTC has been refined
and studied for efficacy, Dynamic Temporal and Tactile Cueing
(DTTC) has replaced the name “integral stimulation” (Strand et al.,
2006) to illustrate more clearly the nature of the method.
Breakdown of
D
Dynamic
T
Temporal
T
Tactile
C
Cueing
The target is the DTTC varies the Facilitator uses It is done in order
dynamic type, frequency and some sort of to support a
continuous timing of feedback physical touch child’s likelihood
series of depending on to help a child of reaching
movement severity and reach success success towards
toward a progress within towards the the target of
temporal and performance for targeted. speech
spatial target. each target production.
utterance.
Developed by: Target Population:
Primarily children with severe
Edythe Strand speech motor planning issues
Objectives
Goal 1 Goal 3
improve the child's
sound Goal 2 ability to
assemble,
production retrieve,
improving the execute
muscle motor plans for
movement speech
around
mouth treatment in the
sensorimotor
planning
Principles
FE
Dynamic EDB Motor
ACK
Hierarchy CU& learning
of Cueing EIN G principles
Mutlisensory
Visual Auditory Tactile
Motor Immediate Gradual
learning Feedback: Fading:
principles Initially, frequent and
immediate cues (visual,
auditory, tactile) help the
As the child improves, cues
are gradually faded. This
aligns with the principle of
Cueing in DTTC therapy child understand and scaffolding, where support
produce the correct is reduced as competence
is closely related to speech movements, increases, promoting
learning principles . enhancing early learning independent performance
through positive and motor learning.
helps in the formation of stable reinforcement.
motor plans, which are refined
and adapted through
continuous feedback and
practice, core aspects of motor
Dynamic cueing
learning theory.
Important aspect of the
hierarchy of cueing
Dynamic Hierarchy of Cueing
(Therapeutic Technique)
Fundamental to DTTC is varying the amount of time
between the clinician's model and the child's imitative
response as an important means of scaffolding the child's
responsibility for movement specification. This is called
the temporal hierarchy.
Through the clinician's gradually lengthening of the time
between model and response, the child gains autonomy in
producing the movements for the
utterance.
Dynamic Hierarchy of Cueing
(Therapeutic Technique)
Challenges and
Considerations
1 2 3 4 5
Maintaining Generalization Parental Therapist Resource
Motivation of Skills Involvement Training and Availability
Expertise
Intensive Skills learned Ensuring Access to DTTC
and in therapy parents DTTC therapy might be
repetitive sessions may understand requires limited by
practice not easily and support specialized location,
can be transfer to the therapy knowledge availability of
tiring and everyday process can and skills trained therapists,
frustrating speech. be difficult. from the or financial
for children. therapist. constraints.
Comparative Analysis
DTTC Traditional Methods
Motor Learning Focus: Emphasizes Phonological Focus: Targets
accurate speech movements. sound patterns and errors.
Intensive Practice: Frequent, Moderate Practice: Less intensive,
repetitive sessions. regular sessions.
Multisensory Feedback: Uses Single Modality Feedback:
visual, auditory, and tactile cues. Primarily auditory/visual cues.
Hierarchical Cues: Moves from Standard Progression: Follows
high to low support. set protocols.
References
Strand E. A. (2020). Dynamic Temporal and Tactile Cueing: A Treatment
Strategy for Childhood Apraxia of Speech. American journal of speech-
language pathology, 29(1), 30–48. https://doi.org/10.1044/2019_AJSLP-19-
0005.
Maas, E., Gildersleeve-Neumann, C. E., Jakielski, K. J., & Stoeckel, R. (2014).
Motor-Based Intervention Protocols in Treatment of Childhood Apraxia of
Speech (CAS). Current Developmental Disorders Reports, 1(3), 197-206.
Strand, E. A., Stoeckel, R., & Bass, B. (2006). Dynamic Temporal and Tactile
Cueing: A Treatment Strategy for Childhood Apraxia of Speech. American
Journal of Speech-Language Pathology, 15(4), 378-386.
Thank you!
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