Multi-Sensory Approach to Achieving Speech Outcomes: An Interview with Dave Hammer, SLP (Guest Post)

OPPEN CAS Interview with Dave Hammer, MA, CCC-SLP, Apraxia Expert & Director of Professional Development & Speech Services

Before 2014, our Founder Brooke Rea knew very little about “multi-sensory approach” and a man who would come to change her life: David Hammer. While preparing for CASANA’s Bootcamp (Childhood Apraxia of Speech Association of North America’s Intensive Training Institute), Brooke was required to watch a training video of Dave speaking to an audience about his “Multi-Sensory Approach to Achieving Speech Outcomes.” While she had intended to watch the video and make dinner for her family at the same time, her husband found her an hour later standing with a knife in one hand, writing notes furiously with the other, and absolutely no progress on dinner preparation. The kind of therapy Brooke had been aiming to provide for years finally had a name and a structure: A Multi-Sensory Approach.

Hi, Dave! Thanks for taking the time to talk to OPPEN CAS today. Maybe you could start by telling everyone a little bit about your background and how you have come to be so heavily involved with CASANA?

First of all, I am humbled by your introductory paragraph. It means a lot to know that you have had an impact in your career. The dinner prep example sure brought a smile to my face and a charge to my soul which we all need these days. Close to 22 years ago, a little boy named Luke and his family came into our clinic at Children’s Hospital in Pittsburgh, Pennsylvania. To paraphrase your words, that encounter “would come to change my professional life” forever. My specialty at the time was childhood and adolescent stuttering. But as soon as I began to work with Luke and was challenged not only by his intense struggles to communicate AND by his mother, Sharon Gretz (who would later become the Executive Director of CASANA, to be my best, I found my life’s work as they say. I was encouraged by my boss at the time, Dr Tom Campbell, to start making videos of Luke which then led to the first talk that I gave on childhood apraxia with the videos of Luke and his mom as the foundation for that talk. Since then, I have given hundreds of presentations on CAS.

When the CASANA organization came into being, I was involved from the outset. I was a guest speaker at the first parent meetings for CAS. I helped to make the first DVD called “Hope Speaks” which reached out to families who were struggling with this challenging motor speech disorder. Fast forward to almost 3 years ago, when I was thinking about “retiring” from Children’s Hospital after a 35-year career as a practicing SLP, when the opportunity presented itself for me to join the staff at CASANA. Since then, I have been fortunate to have worked with a “small but mighty” group of dedicated staff at CASANA to support children, families, therapists, and researchers all over the world.

How and when did your “Multi-Sensory Approach” come to life?

The “multi-sensory” approach has evolved gradually over the years. Early on I realized that I had to have a lot of “tools” in my toolbox (yes, pun intended with my last name “Hammer” ☺), given that the strategies I used with Luke did not always work with other children with CAS. I did not realize at the time that the strategies that I was naturally experimenting with, and eventually employing, had a strong foundation in motor learning theory. The approach comes from an eclectic mix of approaches that I have read about and learned about over the years, as well as incorporating my own ideas, while keeping in mind the tenets of motor learning along the way. I did not name the approach personally, but when others were trying to describe what I did in my therapy, “multi-sensory” was selected as the best descriptor. I continue to feel that SLPs working with children with CAS need to be armed with a variety of strategies rather than just relying on a “one-size-fits-all” approach.

How would you best describe your Approach to families and professionals?

Given that there are no packaged materials for this approach because of the ever-changing nature that ensures individualized therapy, it can be challenging to describe. My guiding principles include the following:

1. Establish a trusting relationship with the child and family by attending to the “whole” child and not just what is or is not coming out of his/her mouth.

2. Find out what activities/games/apps give children their “brain tingles” and makes them willing to engage in repetitive motor speech practice in therapy and at home, which intrinsically is not that much fun.

3. Support vocal/verbal risk-taking which many of our children lack due to their struggles with verbal success.

4. Include a range of supportive cues such as sign language, gestures, touch cues, visual prompts, and pictures that parents, teachers, and other significant adults learn so that they have more options then just providing a word for the child to imitate. I always say that we need to move away from “I say it…you say it” as soon as possible to make sure that the child’s speech motor system is “doing the work” more often.

5. Use a mix of table time and floor time with a “drill-play” foundation.

6. Pay close attention to the type of feedback being given so that in the early stages of therapy, knowledge of performance feedback (e.g. “I liked how you popped your lips that time!”) is prioritized over knowledge of results feedback (“Good job”).

7. Establish clear goals that build syllable shapes and word sequences, while ensuring that prosody (inflection, stress, rhythm) is targeted from the beginning of therapy.

Why do you think so many clinicians and families subscribe to your Approach?

First of all, there are others who, like me, evolved into using an eclectic approach but because I was associated with CASANA, it became an approach that was linked with my name. I think many therapists and families subscribe to a multi-sensory because it IS individualized, flexible, and adaptable which are critical since we know that children with CAS are not a homogeneous group. We are tapping into other potential systems of strength to support verbal speech. Even though it is challenging to be thinking on your feet at all times, the progress that we see when we use an eclectic approach continues to motivate us to keep using multi-sensory therapy strategies. The approach is also geared toward ongoing family training and monitoring of how home practice is going to ensure optimal carryover outside of therapy.

In a world of “published” and “available for purchase” programs, how do you think the “Multi-Sensory Approach” stands out? How come we can’t BUY your program?

It is difficult to package this kind of program since it is ever-changing and draws from a number of strategies and other programs. The core vocabulary is never the same and is designed based on what is salient and functional for the individual child. I have found that the best way to “get the word out” is to do workshops and presentations that focus on the foundational aspects of the approach and showing associated videos, while challenging audiences to adapt their own intrinsic abilities with solid critical thinking skills.

Are there any workshops or presentations that our followers can attend or access to learn more about “Multi-Sensory Approach”?

We do have a number of webinars in the apraxia-kids.org on-demand webinar library (hyperlink: http://www.apraxia-kids.org/on-demand-apraxia-webinars/) that I have done for CASANA. These include:

• “An Overview of a Multi-Sensory Approach to Therapy”
• “Preschool Therapy: Strategies in Action”
• “Stuttering, Disfluency and CAS”
• “Sibling Struggles, Support, and Strategies”
• “Thumbsucking, Pacifiers, Tongue-Tie Oh My!”
• “Those Darn Rs: Strategies for Remediation of Persistent R Distortions”

Many of the workshops that I do, that are not the ones organized directly by CASANA, are for organizations that have closed registrations. In other words, it may be a school district, hospital, state association conference or private practice group that invites me to speak to their group with no option to open it up to others outside their organization. I do not currently have any upcoming workshops in the USA or CANADA that are open to all.

Is there anything about your Approach that you think is misunderstood by others?

Hmmm…that is a great question and one that I have not thought a lot about. I would say that it may look like “play without purpose” but that can be very misleading as there are constant goals embedded within the drill-play activities. At any point in time, parents should be able to clearly see the goals that are being targeted or at the very least, I should be able to give them a detailed answer when asked what my goals are with their child.
You’ve worked with thousands of kids during your career as an Apraxia Expert. Have you ever met a child or family this approach didn’t fit?

Because it is so adaptable, it is less likely that you could not find some aspect of this approach that would work with a child. I would say that I have recommended certain more structured programs for some children whom I have evaluated based on the child’s needs and willingness to engage in more drill-like activities. This would most likely be in the early stages of building speech motor planning skills, with a multi-sensory approach possibly kicking in later as therapy progresses.

As an expert and well respected clinician, what words wisdom or inspiration do you have to share with clinicians just starting their practice in CAS?

Wow, there is so much I have learned over the years. What comes to mind are the following:

1. Always be open to learning more about yourself as a therapist by “taking the risk” and videotaping your therapy as much as possible. This will help you to learn not only about the child but about yourself as a therapist. It will also provide you an ongoing record of the child’s progress so that you too may someday be able to give talks about your work with children and families.
2. Know from the start that it will be a journey which can be both extremely rewarding and extremely frustrating given the variable nature of progress for children with CAS.
3. Keep the family communication strong and check to make sure you are not overwhelming parents/caregivers and that they truly understand home practice recommendations and the role they can play in supporting your therapy.
4. Have fun – you and the child can have lots of fun in therapy while working hard!
5. Maintain high expectations of yourself, the child and the family. Children don’t make optimal progress if we “lowball” our expectations.
6. Parents want honesty – let them know if you don’t know an answer to their question or are not sure about what direction to take. It’s always best to put it out there for discussion and reflection in the “partnership” is so critical to optimal progress for the child. If the child stays the center of focus, admitting what we don’t know can go far.

Thanks Dave! We really appreciate your time in sharing more about the Multi-Sensory Approach and how it can improve a child’s speech outcomes in therapy. We know you came to speak in Guelph, Ontario in 2015 – we hope you might come back up to Ontario again soon!!!

DAVE WORKS AT CASANA AS THEIR DIRECTOR OF PROFESSIONAL DEVELOPMENT & SPEECH SERVICES, AND PROVIDES VIDEO AND IN-PERSON CONSULTATIVE SERVICES AT THEIR OFFICE IN PITTSBURGH. IF YOU’RE INTERESTED IN WORKING WITH DAVE YOU CAN CONTACT THE OFFICE AT 412-343-7102 OR HTTP://WWW.APRAXIA-KIDS.ORG/DAVE-HAMMER-HELPING-CHILDREN-WITH-APRAXIA-OF-SPEECH/
WHEN NOT IMMERSED IN CHILDHOOD APRAXIA OF SPEECH, DAVE ENJOYS SPENDING TIME TRAVELING WITH HIS WIFE OF 40 YEARS AND HIS ADULT CHILDREN WHENEVER POSSIBLE. HE FEELS FORTUNATE TO HAVE TRAVELED TO ALL BUT 3 USA STATES AND ALL BUT 3 OF THE CANADIAN PROVINCES. HE LOVES THE OUTDOORS AND READING A GOOD BOOK. VACATIONS OFTEN CONSIST OF ADVENTURES SUCH AS DRIVING 2000 MILES THROUGH NEW ZEALAND ON TREACHEROUS NARROW MOUNTAIN ROADS AND ZIPLINING, GONDOLA RIDING AND CLIMBING WHISTLER MOUNTAIN IN CANADA.

If you’re interested in viewing the Hope Speaks there are 2 copies available for lending at the Childhood Apraxia & Speech Therapy Centre’s Childhood Apraxia of Speech Resource Centre.  Also available to borrow are numerous other CASANA materials including a book involving “Captain Hammer” & Super Sean: The Case of the Missing G