Oral Motor Planning and Apraxia Exercises | www.agentsofspeech.com

Sorry. Hey. Hello, this is Ming here. Sorry for being late for this live, but today's theme or topic is about apraxia of speech and oral motor planning or whatever you like to call it. So I got this as a request from a parent. We just get this kind of requests. Sometimes I do pick up on topics that parents ask me and I just talk about it here. Sometimes I don't. And that's because I've already planned it and I don't want to change it. That's the reason why. But today we're going to talk about like oral motor planning or just motor planning in general. So what is motor planning? All right, so motor planning is like something that you have to. It's a little bit abstract. All right. And what it is is basically there are different levels in terms of like when you have to execute a motor. How to say when you have the X, execute something motorically. Basically, if I want to touch this microphone, you know, like there's different things going on. Right. First of all, the brain needs to send a signal from like the primary motor card cortex down into the spine. And the spine hits there and then whatever. Right? And then the muscles move and, and so on and so forth. Right. So I don't want to be like, I'm not academic either. I suck at biology. I hate it. I don't know why I had to like talk about like, I learned biology all the way up to masters. But anyways, so motor planning is when maybe I will find a picture and just show it here. Let's Google it. So oral motor planning. So motor planning problems is more about. Not about the muscle itself because the muscle itself doesn't have a problem. Okay. It's the connection between like when the brain. I'm trying to find a good picture. It's between the messaging between the brain and the muscle like that. So let me just see if we have one good one here that I can. Obviously I did not prepare for this like a stupid person. Let me just find. I remember I have one in my computer. I'm just gonna go for it. Sorry. If you're watching on this on a recording, I am so sorry. Oh, this one. I'm actually making a course about this. Like speech sound disorders and stuff. I'll just show one of the slides I've been making. It's been taking me forever. So I'll just do this one. So let me just go back here. Share, share, screen, I guess Windows and this one. So if you can see this, right? You can see this. We need to look at the one at the corner, which is too small. So I'll make it bigger. All right, make it bigger. Don't worry about the stuff here, the words or whatever. Maybe I'll just full screen it. Does it work? Nope. Types of ssd. Okay, so this is what it is. It might be a little pixelated. So when you want to execute a motor, something motoric, first of all, you have something of an idea. And this is where in the brain I want something to happen. So I think about it. So the thing is, the brain starts thinking about. You don't do this consciously. It's unconscious. So it's about which words and in what order. I'm going according to this. This is super simplified. So I'm just going to. To go with it. It's just you need to understand the concept first before I tell you what to do. Right? What sounds in what order to say each word. Right. That's the next thing. And then the next part is where. So all of these above, like, which sounds, what. What words and what order, what sounds? These are linguistic problems, right? So it's more about, like, language. So if a child is, like, language disorder, they might not have these things. And so, like, sometimes, especially in the. In the. What's this? The red, maybe purple box? That box is more about phonological problems. And that is something I don't know how to explain to you in a short period of time. That's why I'm making a course to tell you guys about it. But the green part is where the motor planning happens. All right? What mouthparts need to move, what muscles, and in which order in order to execute the movement. So your brain does this automatically. It thinks about, oh, I have to move the lips in order to do the M sound and open it to do, like, to open the mouth, put the tongue down in order to say ma. Right. And your brain does this unconsciously to plan out what movements are required, and then the muscles move, and then the sounds come out. Right? So the planning is right before the motor. The motor execution. Okay? You have to remember that that's the planning part. That's motor planning. Okay? There's nothing wrong. Usually speaking, there is comorbidability. Crap. So hard to say. So what comorbid ability means is just that there are different disorders that happen together. Right? And it does happen. All right? But if we're talking about, like, just pure apraxia or like, pure, like motor planning problems, we're usually talking about just the. The green circle box thing. Right? Right before the muscles. And in between, the brain, like thinking about all the linguistic, phonological, whatever you call it, just the sounds and the words, it's the translation of that and planning what muscles to move and how the movements go. All right, so let me just stop sharing that. So that's a basic, like, very, very short version of that. And the parents said, oh, how do I do motor planning? So it's very, very hard to do motor planning. So let me go back and talk about what is. We did talk about apraxia before in the live, right? But apraxia, basically, you know, if you study it from, like, from a adult perspective, it's a little easier to understand because what happens is that when an adult has a stroke or has like a brain issue going on, they have a. They had, had past tense, had a full functioning language and speech, you know, functions in the brain, and they lost one of them. So like a whole puzzle they missed a piece of, right? So it's very easy for us to say, oh, that this, this individual, this gentleman or, or lady has this type of aphasia or like apraxia or dysarthria or whatever, right? These terms are making your head spin. But what I mean is it's very easy to see what apraxia looks like, okay? Sometimes it's like comorbid, as I said, and it's also masked by a lot of things. But usually it's easier to see within an elderly or adult case rather than a child because a child does a lot of like, the language hasn't developed the motor, their muscles haven't developed a lot of stuff. They haven't developed intellectually, they aren't as sound and we cannot ask so many questions and so on and so forth, right? So therefore it's much easier to see an adult. So let me tell you why we're talking about adult right now, because the. That will help you define and know what apraxia really is. So when you see a lot of like apraxia, right? When you see when, when, when, when person has a motor planning problem, you will see that they do a lot of what we call groping. And groping isn't anything like perverted or whatever, okay? Just get out of the way what it is. It's like it's trying to find the correct movement. And you see that their mouth is like trying to do something, right? And one of my students who has. Has a lot of facial grimaces. Facial grimaces is a cool way, way of saying, like making like just like that, you know, like, making very difficult faces, you know? So I just see. Joe, sorry, man. Thanks. Thanks for watching from Philippines. All right, so what it means is, like, they have an actual problem. They know that they're wrong. They know that, you know, when they say it, it's in the wrong order or wrong sound or whatever, and they're trying the best to do it correctly. The more they want to do it, the less accurate they become for some particular reason. So when you see apraxic patients inside of a hospital, per se, like back then, I remember one of them who was in Hong Kong, they couldn't, like, you can't. They couldn't really name something, all right? Like, for instance, if I held a phone up and I said, what's this? They're like, you can't do it. Okay? They can't do it. They just know the word, but they can't say it outright. But if they say something that is automatic, what's something that I have to have said hundreds of times? And in Hong Kong, sadly, what this entails is foul language, right? Because in Hong Kong, our. Our language is so, like, intertwined with just saying bad words. So when he was asking for. He was asking for help from a nurse in. In the hospital, he would, like, just say a bad word very quickly, right? So why am I telling you this is because a lot of children do not have automatic speech because they haven't had enough, like, language exposure, right? If their language delayed or speech delayed, how do you think they have. Have they even, like, they're not like an old man who's been swearing for, like, the past 60 years of their life, right? They don't have that motor plan. So. So when you're doing something like what we call voluntary, like we want to say something, then it goes one route, but the involuntary one, like, you say something so many times that becomes, like, reflex to you. It goes another route. So that route is not affected by apraxia or, like, motor planning problem, the one that you have to plan and think, like, something that you intentionally want to say, it becomes very hard. Okay? So what do we do with children is that we need to create more of these paths for them, okay? And there are actually two things that we do the most with children who have motor planning or apraxia of speech. Okay? We're not talking about, like, general oral apraxia or just general movement. Like, the whole body of. We're not talking about just apraxia of speech, okay? And this is something I learned when I was working in Hong Kong. Like, but you know, like, my ex boss was very into apraxia and in fact she, he was doing a PhD. So if he's watching this and I misrepresented his info, then, you know, by all means correct me and I hope that, you know, I am forgiven. But basically, for me, me at least after I've, I've read the information a few times and absorbed it, we do two things. Number one is that we expand the functional words that a child can do. So we're going to drill the kid in doing functional words that they will use every day. So what, what, what are functional words? Functional words are words that have a high frequency at home, meaning they're going to use it very frequently. And they are going to, it's just, it makes sense. We're not going to teach them to say like dictionary or whatever. I'm just looking at stuff here. We're not going to teach them to say like tree. Right. We might teach them to say tissue, like turn on, you know, like drink, eat, open, you know. These words are all very functional and high frequency. So we're going to take some of those and try to teach them as much as possible. Right. Okay. Second thing in speech is to create different patterns and different mode of planning things so that they can learn more. So for instance, the parent said, oh, my son cannot do like pa, right? Or whatever. So we're always trying to create new sounds. Okay. And then the second one is always thinking about how to help them sequence sounds better. All right? So this is true for nearly all speech sound disorders, not only apraxia. So for instance, if a child cannot do like the S sound, we're, we're always trying to create new sounds for them. All right? Create new, like, help them promote what sounds they don't have. Right? That's what our general, like, that's what speech therapists do. So if you're lacking a sound, you're saying something wrong, I'm going to fix it. I'm going to try best to fix it. And that is what you should do with a child apraxia, even if, like you're already doing like teaching him functional speech. And the functional speech, if it doesn't work, then, you know, you do aac, right? But we'll talk about that a little bit later. Okay. Like after talk about, like, I'll give you an example. So one of my, the kids who were, who was apraxic, what happens is that he couldn't say like the L sound or whatever. So obviously we will still use typical and Traditional, like, speech therapy methods. Even if he's apraxic, it doesn't matter. So we will try our best to teach the L sound and that. And the L sound is something that we're not going to try and push him to do in like conversational speech. That's just impossible. The second thing is we're going to do some sequencing. What does sequencing mean? So it's the fluency of going from one word to another. So our practice children, they have something really like not everyone is the same, right? Everyone is a little bit different. So like, what happens is that they have inconsistent errors. So there's something what we call like ddk, which I'm not going to try to say on camera, like dial. I can't even remember. Dial, whatever cratic rate or something. Okay. Um, so what it means is just like, can they go from like syllable to syllable? Syllable correctly. So the one that we use a lot is like pataka, Right. If you've seen a therapy session, they might even use it for therapy itself. So because. Right. Can they do that without much error and how fast and so on and so forth. Right. So if you see like apraxic child, more of a. I wouldn't say everyone is going to be like that because some are different, but because they're inconsistent. What's going to happen is they're going to go. They're going to screw it up. Right? And this will also happen with just general speech sound disorders. So I am confusing you right now. There are overlaps, right? But this also becomes something that we need to teach apraxic children is like the sequencing. So for instance, if they can go like we try to. We try to. I've never taught this to like, parents, right. So I'm trying to dumb it down here a little bit. Not saying that you won't understand. It's just that it's very difficult to tell you what, like for instance, syllabic structure. I have to tell you what's a. What's a constant vowel? Just I don't know if everyone's on the same page, right? So for instance, if we go like constant vowel, that's one syllable, constant vowel, like PA is cv, right? Because it's constant because of vowel. So it's cv, cv, cv, like three of them. So what we try to do is like, can they do cv, CVCV as a sequencing? If they can, then can we go to cvc, cvc, cvc, which is something like mom, mom, mom, right? B, M, O, M. It's like constant vowel Consonant. Right, Because M is a consonant, O is a vowel, and then M again, which is a constant again. Right. So can he or she do that? And that's going to help them increase the base level in competency and talking. Right? Because if you think about it, all we're doing is that we're stringing sounds together and we're sequencing sounds one after another. Right. So if we keep on doing that, increase their bass level, it's going to be easier for them to speak novel words. Right. And on the other side, we're also teaching individual sounds that they don't have yet and trying to promote it up and teach them. And on the other, other side, which is like we're teaching them functional language. And if they cannot say the words yet, we try to incorporate a lot of sign language and aac. Right. So let's answer a question first. So Mary says, how do you know whether a child is apraxia or typical early reader? Well, I don't know how these two got into a pair like apraxia and early reader. Right. If you say like, if you're talking about like hyperlexic, then that, that would be something else. Right. But okay, so aprex. Apria is. It affects children differently. So I'm not sure why you would say that a typical early reader would be like confused with apraxia. I really don't know why. Reason why I say this is because there's. Each child is different and if their spontaneous speech isn't good, maybe the reading isn't really affected by the apraxia. Okay. And you have to see like everyday communication instead of like telling me typical early reader, like, so what if they're hyperlexic? Right. Does that. What about like the, the sound errors when they're reading? Right. I don't know how to answer you, to be honest. This question. I really don't know, man. Like you put two, you put an orange and an apple in the same conversation for some reason. I don't get it. Okay, please let me know what you mean, Mary. Alright, so what's up? Tracy from Arkansas. I hope I've said that correctly. So anyways, I was going to talk about if they cannot do functional speech that well, which happens a lot. All right. And apraxia has different severities. Right. So if we're talking about a real like if maybe I can tell Mary this, right? For to get a child totally being like able to be diagnosed with apraxia, you need to have. They need to be at least three years old. That's the first thing. And not to mention that not many people are. Not many therapists out there are comfortable with giving such a diagnosis. That's because it's difficult to give a diagnosis. It's very hard to. Everyone just suspects it. Right. It's very hard to have a hard diagnosis on apraxia of speech. It's really hard. Not like it's. It's not as well researched. Excuse me. Or well documented as something, let's say, autism or like just articulation disorder. Right. So it's just something that we don't really know. And I don't know why it's being more prevalent in terms of not the amount of children who are getting it, but the amount of awareness that people are having, and they start thinking, oh, is my child apraxic or not? And it's very often than not, it's not apraxia. So I really think apraxia should be the least of everyone's worries at this moment in time. But I'm just saying. I'm just answering this question just in case anyone has, like, doubts, like, they don't know what to do and they've been suspected and so on. Right. So this is like the treatment plan for most apraxic children. Right. Number one, let me say it again. Is to create a functional. As many functional words as you can teach them. If you cannot, why do you. We do. We do this. We have to increase the communication intention. And if you. If your child is still struggling to learn a lot of functional words and it's very difficult for them, maybe sign language, maybe like some sort of augmentative alternative communication just like this, a long word for using iPad and unpacks, like picture exchange communication stuff. Right. Why we do that? And apparent. I get this email a lot. It's like Ming the speech therapist, our speech therapist decided, oh, let's do some pecs. And I'm like, I don't agree because my kid is already talking. And so wouldn't giving them, like, something like that discourage them from using speech? Well, the answer is like, no, or sometimes yes, sometimes no. Right. But why is it no? It's because it's about the act of communication. Right. So if someone. It's very. It's very hard and difficult to understand someone's speech. And all we're trying to do every day is just to, like, ah, if we force them to use it every day, they're gonna come to terms with it and learn better and use it every day. But speech is one thing, but how do we increase someone's language if they're hindered by speech. You know what I mean? How? Let me give an example, right? So I am a fully functional. Like, I can talk to you guys, right? So when I'm learning a different language, my brain is already thinking in language, but in my own mother tongue or in English or whatever, right? For me, sometimes it's a lot in pictures for some reason, or there's just not much going on in my head, you know, so is very different from a kid because they don't have that to think. And because they don't, they can't speak well. And speech is difficult. And you don't give them an outlet to practice putting words together and making sentences and learning how to do language, it's going to hinder their language development, right? And because speech is so hard, they don't want to talk as much. So again, they get less practice. So what you want is like, you use AAC or like sign language so that at least they can put words together, man, and they can combine like, concepts, like I. I go like toilet. I don't know, I'm mixing USA and Hong Kong sign language. But you get what I mean, right? At the very least, they can say, I sit down just by using this. Or they can use a picture or use, like, they can make sentences with that. So if you, yeah, the speech has already already been robbed away and yet you may still push them to use it. Isn't it better if you give them an alternative way to express themselves and then also learn language? And it's also like, oh, wouldn't they get too lazy to talk, man? If you think about it, you try to use pecs to describe what I just said to you or use sign language to say what I said to you. Have you seen those concerts with like, the sign language person at the, like a side, like a, like a circle, and he goes like, like the guy's like, talking and then the host is talking, and then the sign language person is like, like they're doing all that kind of stuff, right? So it's, it's. Talking is the most effective way. All right? Your child knows. Everyone knows, right? It's just the easiest. It's one, like I, I talk. It's a lot faster than signing or like poking a screen or giving you a card, right? So if someone's lazy, they actually should learn how to talk, if you know what I'm talking about. But at the same time, if it's hard for them, then how do they get the skills of communicating and the concept of putting different things together. I understand where a lot of parents are coming from, but at the same time, you're making it even harder if you think that way. Making it harder for the kid to catch up if you don't give them an alternative way. Okay, so that's. I'll make. Maybe make another video about aac, because this thing is still about motor planning. All right? So motor planning. I guess as much as I want a deep dive on this topic, I am no expert on this. I know enough to treat it, but I'm not an expert. Okay? That's just the end. Like, just the end of it. Like, there's a lot of stuff inside of the field where, you know, I'm generally enough to treat, but I don't have enough expertise in telling you exactly why. Okay. And that includes a lot of things. Like, includes, like, autism, includes, like, sensory motor disorder, whatever, you know, dyslexia. I don't know a lot of stuff about it, but I can do some treatment, you know? So at the end of the day, I'm not going to pretend that I know everything, and hopefully you respect that. And for apraxia, if you really want to, like, help your child, it takes a lot of practice. So one thing I want you to take away from this is that within 20 minutes of treating your kid for apraxia, the most effective is that you do at least, like, 200 trials. And that sounds like a lot, right? But it's not actually really that much. It just needs. You just need, like, 10 trials every minute, right? Which, to be honest, it's like six seconds per trial. If you really, like, hammer. Like, how long is six trials? You know, it's very. Sorry. Six seconds is very, very long. If you count it. It's like, I'm not gonna. I'm not gonna waste your time, but you get what I mean, right? So it's the intensity of practice. Okay. And you need to have goals for, number one, functional everyday communication. That's the thing. Second of all, are you exploring new sounds to help them with, like, the sounds they don't have. Number three, are you helping them putting the sounds together in a sequencing manner that makes sense to them. And that's pretty much it. We don't do oral motor stuff because it's not related. That's why it's called apraxia of speech, not apraxia of oral movements. Right. When you have oral apraxia. And it does also, like, happen with apraxia speech, but it's not necessarily always together. All right. Someone can have oral apraxia and speech is still okay. I've seen that happen. All right. I really have. It's quite crazy that you tell someone to do some oral movements like this. They can't. But they're speaking, so what's the problem? It's because they have oral apraxia and their apraxia of speech is not as severe as the oral apraxia. Right. So don't always fall into like doing oral motor stuff whenever you think there's a, there's a speech problem. It's not always the, the, the, the, the idea to go for it. All right. All right. So that's all for tonight. Thanks guys for tuning in. If you have any more questions, just leave them in the comment section. I will try my best to get to you and have a good night. I'll see you guys next week. Bye. Bye.