Choosing a therapy
Which therapy is right?
The therapies listed here are all used to support individuals with speech apraxia. Therapists may sometimes use a combination of approaches. Although the therapies are grouped for children or adults, many can be adapted for either age group with some modifications.
Accessing Therapy Services, Apps and Resources
Speech and language therapy organisations
How to get referred in the UK
Referral via GP, hospital consultant, or self-referral in some areas.
Visit NHS.uk and search “speech and language therapy” with your postcode for local details.
How to find a speech and language therapist | RCSLT
Therapists are HCPC-registered and work under NHS guidelines
Referral for specialist Nuffield Speech Centre
Nuffield Speech Clinic Referral Guidelines JUNE2021
There are well over 100 national speech-language therapy organizations worldwide. The main umbrella organizations are:
International Organisations
- European Speech and Language Therapy Association (ESLA)
https://eslaeurope.eu
North America
- American Speech-Language-Hearing Association (ASHA)
https://www.asha.org
- Speech-Language & Audiology Canada (SAC)
https://www.sac-oac.ca
United Kingdom & Ireland
- Royal College of Speech and Language Therapists (RCSLT)
https://www.rcslt.org
- Irish Association of Speech and Language Therapists (IASLT)
https://www.iaslt.ie
Europe
- Bundesverband für Logopädie (dbl) – Germany
https://www.dbl-ev.de
- logopädieaustria – Austria
https://www.logopaedieaustria.at
- Association Nationale Française des Orthophonistes (FNO) – France
https://www.fno.fr
- Colegio Profesional de Logopedas – Spain
https://www.consejologopedas.es
- Federazione Logopedisti Italiani (FLI) – Italy
https://www.fli.it
- Associação Portuguesa de Terapeutas da Fala (APTF) – Portugal
https://www.aptf.org
- Norsk Logopedlag – Norway
https://www.norsklogopedlag.no
- Danske Tale-, Høre- og Synsinstitutioner (DTHS) – Denmark
https://www.dths.dk
Australia & New Zealand
- Speech Pathology Australia (SPA)
https://www.speechpathologyaustralia.org.au
- New Zealand Speech-language Therapists' Association (NZSTA)
https://speechtherapy.org.nz
Asia
- Japanese Association of Speech-Language-Hearing Therapists (JAS)
https://www.japanslht.or.jp
- Hong Kong Association of Speech Therapists (HKAST)
Home - The Hong Kong Association of Speech Therapists Limited
- Singapore Association for Speech and Hearing (SASH)
www.salts.org.sg
- Indian Speech and Hearing Association (ISHA)
https://ishaindia.org.in
- Bangladesh Society of Speech and Language Therapists (BSSLT)
Society of Speech & Language Therapists (SSLT) – Non-political voluntary professional organization
- Malaysian Association of Speech-Language and Hearing (MASH)
https://mash.org.my
- Taiwan Speech-Language-Hearing Association (TSHA)
https://www.slh.org.tw
- Korean Academy of Speech-Language Pathology and Audiology (KASA)
https://www.kasa1986.or.kr/
Middle East
- Saudi Society of Speech-Language Pathology and Audiology (SSSPA)
Home Page | Saudi Society of Speech-Language Pathology and Audiology SSSPA
- Israeli Speech, Hearing and Language Association (ISHLA)
https://www.ishla.org.il/
Africa
Professional-associations-for-Speech-Therapists-and-Audiologists-in-Africa.pdf
Fédération des Organisations d’Orthophonistes d’Afrique Francophone (FOAFA)
- South African Speech-Language-Hearing Association (SASLHA)
https://www.saslha.co.za
- Speech Therapists and Audiologists Association of Kenya (STAAK)
scoeasta.org asltk.wordpress.com
Central & South America
- Sociedade Brasileira de Fonoaudiologia (SBFa) – Brazil
https://www.sbfa.org.br
Specialist childhood apraxia of speech organisation Brazil Home - ABRAPRAXIA
- Colegio de Fonoaudiólogos de Chile
Inicio - Colfono Chile
- Colegio Colombiano de Fonoaudiólogos
CCF
- Colegio Mexicano de Licenciados en Fonoaudiología
https://www.comelfo.org.mx
- Asociación Argentina de Logopedia, Foniatría y Audiología (ASALFA)
https://www.asalfa.org.ar/
Private speech and language therapy in UK
Directly contact a private therapist via the Independent Speech and Language Therapists | ASLTIP
There is currently a shortage of private therapists working with speech apraxia.
Most therapists offer an intial 15 minute free or low-cost consultation to discuss needs
Average Costs
- Initial assessment: £250-£500
- Therapy sessions: £85–£225 per 45–60 minutes
- Travel/home/initial assessment visits may cost extra
Check the Register and find a registered health and care professional | The HCPC
It is normal practice for SLTs to work together if more then one therapist is involved in care. Currently service pressures in State provision can mean that services are limited and therefore this mode of operation is common.
Therapy dosage and frequency
Therapy dosage and frequency
What can I do at home?
Therapy dosage and frequency
Ideally, anyone with any form of speech apraxia should be assessed and treated by a speech and language therapist with expertise in motor speech disorders. However, this is not always possible due to location, waiting lists or cost.
If specialist therapy is not readily available, there are still many ways to support progress. Speech Apraxia International provides hundreds of hours of educational content through its website, webinars and training events. There are also many evidence-based speech therapy apps, online therapy resources and books that can support home practice.
For many people, it may be possible to see a speech and language therapist less frequently while following a structured therapy programme at home. Regular guidance from an experienced clinician, combined with consistent independent practice, can still be an effective way to develop and maintain communication skills.
FREE resources for helping speech at home
FREE resources for helping speech at home
The BBC have some great free resources
23 language and literacy tips to support your child - BBC Bitesize
We really like Peachie Speechie for free & affordable videos and materials. Use the button below. They have some fantastic resources. Quote
PSAF267 and get 10% off
How to help your child to start talking
The Speech, language and Communication Framework
Developed by The Communication Trust, this is a free online professional development tool. This has useful training and online CPD activities for practitioners that develop their own knowledge and understanding about the topic. The site also has useful case studies.
Early years child development training : Home page
FREE training program in early years development. The training is based on the Early Years Foundation Stage (EYFS) framework used in England. However, you may still find the content beneficial if you live outside England and are welcome to undertake the training if you wish
Tiny Happy People
With tips for during pregnancy to activities to try with your toddler this website includes lots of fun play ideas to encourage children’s communication skills. Includes SEND resources and activities for parents to try at home from pregnancy to age 5.
Talking Point
This is run by I CAN and has many resources, information and ideas about supporting children’s communication. The site also offers a free ‘I CAN Help Enquiry Service’ for you if you have questions.
Somerset Speech and Language Toolkit 2019
Accompanies the book 'Sunny’s Sound Play' and is copyright the author and J & R Press. Sunny's Sound Play read to camera.
Speech Apps and Online therapy
FREE resources for helping speech at home
Technology can be an excellent way to supplement speech and language therapy by providing additional practice at home, school, or in the workplace.
Adults
These resources have been chosen primarily for adults with acquired apraxia of speech, primary progressive apraxia of speech, and aphasia. Many focus on improving speech production, language, and communication through structured home practice.
Free Online Aphasia Therapy
Free online therapy activities to practise speaking, reading, writing and language skills. Particularly useful for independent home practice alongside speech and language therapy.
Aphasia Software Finder – Research and Evidence
https://www.aphasiasoftwarefinder.org/research-and-evidence
Summarises the research evidence supporting a wide range of aphasia therapy software, helping clinicians and families choose evidence-based digital resources.
Cuespeak
A personalised online aphasia therapy platform providing structured therapy activities that can be completed independently or alongside therapist support.
Please note: Aphasia and apraxia of speech frequently occur together following stroke or other neurological conditions. Many aphasia therapy resources can therefore also be valuable for individuals with acquired apraxia of speech.
Children
These resources have been selected because they provide accessible activities, therapy materials, and guidance for children with speech, language and communication needs. They are useful for families, schools and speech and language therapists.
HelpKidzLearn Bitesize Apps
https://www.helpkidzlearn.com/bitesize-apps/
A collection of simple, engaging educational apps specifically designed for children with special educational needs, including switch-accessible and early communication activities.
Free SLP
A large collection of free printable therapy materials, games, worksheets and activities covering speech sounds, language, literacy and communication skills.
Schools Guide to Implementing Online Speech and Language Therapy
https://www.lancashirespeechtherapy.co.uk/online-speech-and-language-therapy-schools-guide
A practical guide for schools explaining how to deliver online speech and language therapy successfully, including technology, safeguarding and staff responsibilities.
Online Speech and Language Therapy: 10 Facts You Need to Know
Answers common questions about online speech and language therapy, including who it is suitable for, how effective it is, and what families can expect from remote sessions.
2021 App Guide
www.abainpa.com/wp-content/uploads/2022/12/2021-App-Guide-Final-mobile.pdf
A comprehensive guide reviewing a wide range of speech, language and cognitive therapy apps for children
FREE therapy videos
CVC repetitive video (DTTC Kaufman - based)
CVCV reduplicated words for at home Childhood Apraxia of Speech practice
VC words for at home Childhood Apraxia of Speech practice
CV1CV2 words for at home Childhood Apraxia of Speech Practice
Apraxia Therapy CV Words - follow-along-style home practice video using the DTTC approach for CAS
AAC Resources
AAC Resources
Individuals with speech apraxia may temporarily or permanently benefit from AAC.
Print your own AAC boards
Free downloadable AAC resources
- Ace Centre resources – https://acecentre.org.uk/resources
- Smartbox paper-based Super Core boards – https://thinksmartbox.com/resources/paper-based-super-core
- Total Communication resources https://www.totalcommunication.org/
- Global Symbols
- https://onetalker.org
- Get PiCom – Home
Free AAC Apps
- Weave Chat AAC Full AAC app
AAC assessments
Resource center - Tobii Dynavox Global
DAGG-3 (Dynamic AAC Goals Grid) resource
AAC Companies
- Tobii Dynavox
https://www.tobiidynavox.com - Smartbox
https://thinksmartbox.com - CoughDrop
https://www.coughdrop.com - Proloquo
https://www.assistiveware.com
Useful websites
Stepping into AAC Home : PrAACtical AAC
Switch Access Resources
Switch Heroes – Jiao
A collection of free, switch-accessible games designed to help children develop cause-and-effect understanding, scanning, timing, and switch-use skills in a fun and motivating way.
iClick: Mains Controller for iPad
A wireless switch interface that allows one or two external switches to control compatible iPad and iPhone apps, making tablets more accessible for individuals with physical disabilities.
AAC Gameplay
A website offering reviews, recommendations, and ideas for accessible games that support AAC users, switch users, and individuals developing communication and access skills.
An online library of accessible activities, games, and learning resources designed for children with a wide range of learning disabilities and complex communication needs.
Provides hundreds of ready-made interactive learning activities covering early communication, literacy, numeracy, and cause-and-effect learning, many of which are compatible with switches and eye gaze.
Smooth Talker with Levels – Pretorian Technologies
Smooth Talker with Levels - Pretorian Technologies
A multi-level voice output communication aid that allows users to record and play back messages across multiple recording levels, supporting communication, choice making, and classroom participation.
Types of AAC
AAC ranges from simple, unaided communication methods to sophisticated speech-generating devices.
Unaided AAC
Gestures and Body Language
Natural gestures, facial expressions and body movements used to communicate. These may develop naturally or need to be taught.
Sign Language
A formal signing system where both the individual and communication partners use signs to communicate.
Low-Tech AAC
Object Symbols
Real objects or miniature objects attached to cards or boards. Particularly helpful for individuals with visual impairments or significant cognitive difficulties.
Picture Boards
Boards containing photographs, symbols or pictures that the individual points to in order to communicate.
Picture Exchange
The individual hands a picture or symbol to a communication partner to express a request, choice or message.
Written Communication
Writing or typing messages using paper, whiteboards, computers or mobile devices.
High-Tech AAC
Single-Button Voice Output Devices
A device with one button that plays a pre-recorded message when pressed.
Multi-Button Voice Output Devices
Devices with several buttons, each representing a different word, phrase or message.
Dynamic Display Speech-Generating Devices
Touchscreen devices where selecting a symbol speaks the message aloud and may open additional pages of vocabulary. These devices provide access to extensive language and can support communication across many situations.
Language Assistance
Supports to facilitate access to meaningful communication include:
- Interpreters – Convert spoken or signed language from one language to another.
- Translators – Translate written information into another language.
- Transliterators – Convert information between different forms of the same language or communication system (e.g. spoken English to Signed English).
- Augmentative and Alternative Communication (AAC) – Communication aids such as communication books, symbol boards, speech-generating devices, or communication apps.
- Bilingual clinicians or service providers – Professionals who can provide assessment or intervention in the person's preferred language.
- Captions and subtitles – Written text displayed alongside spoken information in videos or presentations.
- Visual supports – Pictures, symbols, photographs, written words, schedules, or diagrams that support understanding.
- Tactile supports – Objects, raised symbols, Braille, or tactile cues used to support communication for people with visual impairments or dual sensory loss.
Choosing AAC
Best practice when introducing AAC
AAC Resources
When selecting an AAC system, consider:
- Access method – Can the person point, touch, use eye gaze or switches?
- Vocabulary organisation – Grid layouts or visual scene displays with photographs?
- Portability – Can it be used across home, school, work and the community?
- Funding – Dedicated speech-generating devices and tablet apps may have different funding or insurance options.
- Trial first – Most clinicians recommend trialling different systems before making a long-term decision.
Do
- Model words while speaking.
- Use AAC during everyday routines.
- Keep interactions meaningful and enjoyable.
- Provide frequent opportunities to use AAC.
- Celebrate all forms of communication.
Don't
- Quiz people on where words are located.
- Restrict AAC to therapy sessions.
- Use AAC only for requesting.
- Expect immediate independent use.
- Put the device away between activities.
Best practice when introducing AAC
Best practice when introducing AAC
Best practice when introducing AAC
Introduce Core Vocabulary
- Start with common everyday words.
- Focus on high-frequency, flexible vocabulary.
- Build simple word combinations into phrases.
- Add topic-specific vocabulary later.
Model AAC
- Point to words while speaking.
- Model AAC throughout the day.
- Comment as well as request.
- Use AAC naturally during everyday interactions.
- Expect learning through observation.
Make AAC Accessible
- Keep the device within reach.
- Use AAC during meals, play, school and community activities.
- Encourage everyone to model AAC.
- Ensure family members, teachers and carers understand the basics.
Set Realistic Expectations
- Progress takes time.
- Plateaus are normal.
- Single words usually develop before phrases.
- Don't compare AAC progress with spoken language development.
- Consistent modelling is essential.
Children's Therapies
Children's therapies
These therapies are designed specifically for childhood apraxia of speech. Each approach provides a structured way to support the development of speech sounds, motor planning, and overall communication skills. They can be adapted for adults with some modifications,
Treatment decisions for speech and language
The Three Pathways
Clear speech → communication/language pathway
Some sound errors → articulation/phonology
Very unclear speech → motor speech pathway (CAS)
Meet a therapist who works with Childhood Apraxia of Speech
Hazel Shaw Specialist Independent Speech and Language Therapist BSc (Hons), MRCSLT, HCPC Reg
I am a Registered Paediatric Speech and Language Therapist with over 25 years’ experience and am passionate about working with children with speech sound difficulties, including Childhood Apraxia of Speech (CAS). I initially specialised in working with children with a cleft but found an equal interest in CAS.
I put my heart and soul into my work—though I’ll admit, it can be exhausting at times! Still, I believe wholeheartedly in every child I have the privilege to work with and I often find they teach me just as much about CAS as any textbook ever could.
Hazel is one of our 'Friends of Speech Apraxia,' helping us to answer your concerns
Meet a parent of a child with Childhood Apraxia of Speech
Kendra with her son Elliot have been dealing with the challenges of childhood apraxia of speech. She is become one of our parent champions and has also set up 'Elliot's Voice'. You can find more about her inspirational journey in the 'meet others' page of our website.
Motor-Based Therapy Principles
- Therapies designed specifically for childhood apraxia of speech (CAS) are based on motor learning principles.
- Focus on improving speech movement planning and programming, rather than teaching individual sounds.
- Target movement sequences, syllable shapes and accurate transitions between sounds.
- Use a hierarchical approach, progressing from simple to more complex speech tasks.
- Incorporate multimodal cueing (visual, auditory and tactile), with cues gradually faded to encourage independence.
- Common evidence-based approaches include DTTC, Nuffield Dyspraxia Program and ReST.
Principles of effective therapy
- Provide intensive, individual therapy, particularly for severe CAS.
- Aim for frequent, repetitive practice of meaningful speech movements.
- Select functional words and phrases that are important to the child.
- Practise in both structured activities and natural communication settings.
- Progress from repetitive drills to spontaneous conversation.
- Encourage self-monitoring and self-correction as skills develop.
- Augmentative and Alternative Communication (AAC) may be used alongside speech therapy to support communication.
- Non-speech oral motor exercises alone are not sufficient to improve speech.
Motor learning in therapy
- High-intensity practice is essential for motor learning.
- Frequent repetition leads to greater accuracy, generalisation and long-term retention.
- Aim for 50 or more target productions in a 30-minute session, where appropriate.
- Use both knowledge of results ("correct or incorrect") and knowledge of performance ("how to improve the movement") feedback.
- Gradually reduce feedback to encourage independent motor planning.
- A slower speech model can improve planning time and speech accuracy.
- Keep children motivated with functional, meaningful and age-appropriate targets.
- Treatment should be guided by the child's current motor speech abilities and adjusted as skills improve.
- A qualifed professional should always be consulted.
Dynamic Temporal and Tactile Cueing (DTTC)
A Different Focus: Movement, Not Sounds
A Different Focus: Movement, Not Sounds
A Different Focus: Movement, Not Sounds
Dynamic Temporal and Tactile Cueing (DTTC) focuses on whole movement gestures rather than isolated sounds. Vowels and prosody — often challenging for children with CAS — are targeted early. Word targets are highly individualized: instead of standard word lists or picture cards, the speech-language pathologist selects meaningful, functional words that match the child’s specific speech movement goals. This ensures therapy is relevant, motivating, and directly linked to the child’s real-life communication needs
Fantastic podcast on DTTC with Dr Edythe Strand by the Apraxia Foundation
https://open.spotify.com/episode/441nZzYYP1JrNxq5iQ39dg?si=gNXpBDfrS7GKqbxgBOfuzg
Individualized and Dynamic Cueing
A Different Focus: Movement, Not Sounds
A Different Focus: Movement, Not Sounds
DTTC uses cues tailored to each child’s needs rather than applying a fixed set of prompts. Cueing strategies may include slowing speech, speaking in unison, modeling mouth movements, or simple tactile cues. These supports are “dynamic” — increased when needed to help the child succeed and reduced as soon as possible to promote independence. The therapist continuously adapts cues during practice, ensuring the child stays engaged, avoids frustration, and builds confidence while developing new speech movement patterns.
Maximising Practice for Motor Learning
Because speech is a motor skill, DTTC therapy sessions are designed to give children extensive practice opportunities. Activities are structured to keep the pace brisk, with quick, simple reinforcements to maintain focus and motivation. The high number of practice trials in each session helps strengthen the motor planning and movement patterns necessary for clearer, more natural speech. This combination of relevant targets, personalised cueing, and high-intensity practice is what sets DTTC apart from many other CAS treatment methods.
This approach offers a high evidence base; click on the link to read.
Finding out about DTTC
Photo is
Dr. Edythe Strand
CCC-SLP an expert in DTTC
Dynamic Temporal and Tactile Cueing (DTTC) – Child Apraxia Treatment
Free training is available online
FREE Continuing Education Opportunities – Child Apraxia Treatment
DTTC Hierarchy
Principles of motor learning
www.grahamspeechtherapy.com/uploads/7/5/6/4/75649261/pml_freebie.pdf
PROMPT (Prompts for Restructuring Oral Muscular Phonetic Tar
What is Prompt?
PROMPT therapy is used with a wide range of children and adults who have motor speech difficulties. The most common clients have motor speech disorders, articulation problems, or are non-verbal children.
Speech Apraxia UK approached the PROMPT institute to ask if PROMPT was suitable for children AND adults. They confirm that it would be with some adaptation for this audience. Most PROMPT training is chargeable with ongoing registration costs.
How does it work
PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is a multidimensional approach to treating speech production disorders. It integrates physical-sensory, cognitive-linguistic, and social-emotional aspects to support meaningful communication. Suitable from around 6 months of age, it targets all speech production disorders. PROMPT focuses on developing motor skills for interaction, rather than just improving oral-motor movements or producing individual sounds or phonemes. PROMPT practitioners need to be trained by taking the usually paid PROMPT course
ReST Rapid Syllable Transition Training
How it works video
How it works video
https://www.youtube.com/watch?time_continue=3&v=hrv0r4Oqxs0&embeds_referring_euri=https%3A%2F%2Frest.sydney.edu.au%2F&source_ve_path=Mjg2NjY ReST has been tested for children up to 13 but is currently being trailed with adults. ReST Rapid Syllable Transition Training – ReST Rapid Syllable Transition Training
What is it
How it works video
ReST is an evidence-based treatment for treating children but could be adapted for adults with childhood apraxia of speech or ataxic dysarthria. Both disorders are motor speech disorders, where children know what they want to say but cannot plan in their heads the movements required for clear speech.
The basics
The basics
The ReST treatment uses nonsense words – words that sound and read like real words, but do not have any meaning. This allows children to concentrate on their movements, lessens the need for working on old words which already have errors and allows clinicians to make words specifically for each child’s needs
Kaufman Speech to Language Protocol
What is the Kaufman Speech to Language Protocol?
What is the Kaufman Speech to Language Protocol?
What is the Kaufman Speech to Language Protocol?
The Kaufman Technique is a motor-based speech therapy approach designed to help children with childhood apraxia of speech progress from simpler speech forms to more complex, adult-like words and phrases. It focuses on teaching the motor plans for speech through systematic, step-by-step shaping.
Strengths: adaptable for various ages and severity levels, promotes early communication success, motivating for children.
Considerations: works best with frequent sessions and may be combined with other approaches, such as DTTC, to address additional speech elements like prosody. .
Kaufman Speech to Language Protocol official website: kidspeech.co
Evidence review: The Informed SLP – Kaufman Protocol
Most Kaufman training and related resources are chargeable.
How it works
What is the Kaufman Speech to Language Protocol?
What is the Kaufman Speech to Language Protocol?
- Successive Approximation – simplifying words into easier forms the child can produce, then gradually shaping them toward the correct version (e.g., “banana” → “nana” → “bana” → “banana”).
- High Repetition – frequent practice to reinforce motor learning.
- Visual and Tactile Cues – prompts and modelling to guide mouth movements.
- Functional Vocabulary – focusing on words that are meaningful to the child’s daily life.
Photos from speechkids.com
Nuffield Dyspraxia Programme
Approach
Suited for individual need
The Nuffield Dyspraxia Programme (NDP3® Complete) is a flexible therapy designed for children aged 3 to 7, but it can be adapted for younger or older learners. It starts by building on the speech skills a child already has, creating a full inventory of sounds at different levels of complexity. With over 500 structured worksheets, it allows practice at home and school while keeping therapy fun, engaging, and motivating. Training is chargeable.
Suited for individual need
Suited for individual need
NDP3® Complete guides therapists in planning and progressing therapy in achievable steps, offering strategies to overcome challenges. Its adaptable approach means sessions can be personalised to each child’s needs, helping them stay motivated while making steady improvements. Combining structured practice with individualised planning, this programme supports confident, effective communication and long-term progress in speech development.
Course Beetle -Training in Nuffield Dypraxia Programme and Childhood Apraxia of Speech
Course Beetle -Training in Nuffield Dypraxia Programme and Childhood Apraxia of Speech
Dyspraxia Programme (NDP3®) Modules 1-4
The NDP3 treatment approach is currently one of two interventions with the strongest evidence for use with children with childhood apraxia of speech. This version of the course is taught live online as part of a group of fellow professionals.
Course Beetle offer live or on-demand versions of this popular course and it is an excellent way to learn.
Clinical Management of Childhood Apraxia of Speech
After the recently launched RCSLT (2024) Position Paper on Childhood Apraxia of Speech (CAS), this is a new, one-day course, delivered by Dr Pam Williams. This course provides a theoretical update and looks at assessment protocols and specific tools. We also consider differential diagnosis and evidence-based intervention approaches.
Other approaches
Music Therapy
Occupational Therapy
Music therapy
This can be a useful technique, but it is not usually effective as a standalone therapy for apraxia of speech. Instead, it is best used alongside other therapeutic approaches. For example, it may be helpful when working on prosody and other aspects of speech production.
(MedRhythms) - YouTubeSerenna Wagner talks about Melodic Intonation Therapy - YouTube
Neurologic Music Therapy - Stroke Rehabilitation (MedRhythms) - YouTube
NMT System of Standardized Techniques – Academy of Neurologic Music Therapy®
Effectiveness of metrical pacing in the treatment of apraxia of speech
Effectiveness of metrical pacing in the treatment of apraxia of speech : Aphasiology: Vol 22, No 1
.
Occupational Therapy
Occupational Therapy
Although Speech and language therapists treat speech apraxia, occupational therapy can be useful to include for example to moderate sensory input or enhance the therapeutic environment.
World Federation of Occupational Therapists Global- professional body representing occupational therapy organisations in over 100 countries
National occupational therapy organisations
North America
- American Occupational Therapy Association (USA)
- National Board for Certification in Occupational Therapy (USA)
- College of Occupational Therapists of Ontario
- Canadian Association of Occupational Therapists
United Kingdom
Ireland
- Royal College of Occupational Therapists
- Health and Care Professions Council
- Association of Occupational Therapists of Ireland
- CORU
Europe
- Council of Occupational Therapists for the European Countries
- Deutscher Verband Ergotherapie
- Association Nationale Française des Ergothérapeutes
- Associazione Italiana Terapisti Occupazionali
- Nederlandse Vereniging voor Ergotherapie
- Colegio Profesional de Terapeutas Ocupacionales de España
Australia & New Zealand
- Occupational Therapy Australia
- Occupational Therapy Board of Australia
- Occupational Therapy New Zealand - Whakaora Ngangahau Aotearoa
Asia
- Japanese Association of Occupational Therapists
- Hong Kong Occupational Therapy Association
- Occupational Therapy Association of the Philippines
- Malaysian Occupational Therapy Association
- Singapore Association of Occupational Therapists
- All India Occupational Therapists' Association
- Occupational Therapy Association of Taiwan
- Korean Association of Occupational Therapists
Middle East
- Saudi Occupational Therapy Association
- Emirates Occupational Therapy Society
- Occupational Therapy Association of Israel
Africa
- Occupational Therapy Association of South Africa
- Occupational Therapy Africa Regional Group
- Occupational Therapists Association of Ghana
- Occupational Therapy Association of Nigeria
- Kenya Occupational Therapists Association
Central & South America
- Confederación Latinoamericana de Terapeutas Ocupacionales
- Associação Brasileira dos Terapeutas Ocupacionais
- Colegio de Terapeutas Ocupacionales de Chile
- Colegio Colombiano de Terapia Ocupacional
- Colegio Mexicano de Terapeutas Ocupacionales
This is not exhaustive—there are over 100 national occupational therapy organizations affiliated with the World Federation of Occupational Therapists.
Biofeedback
Biofeedback
Biofeedback provides real-time visual or auditory information about speech movements that cannot normally be seen or heard. It allows individuals to observe how they are producing speech sounds and make immediate adjustments, complementing traditional motor-based speech therapy.
What is Biofeedback?
Biofeedback uses technology to give visual or auditory feedback about speech production, helping individuals:
- See tongue movements.
- View airflow or articulatory patterns.
- Compare their speech with a target production.
- Learn correct speech movements more efficiently.
- Improve speech accuracy through repeated practice.
It is particularly useful for individuals with:
- Persistent speech sound disorders
- Residual speech sound disorders (RSSD)
- Childhood apraxia of speech (in selected cases)
- Acquired apraxia of speech
- Dysarthria
- Difficulties producing sounds such as /r/ and /s/
Types of Biofeedback
Ultrasound Visual Biofeedback (UVB)
Uses an ultrasound probe placed under the chin to display real-time tongue movements.
Benefits include:
- Visualises tongue shape and position.
- Helps teach complex tongue movements.
- Particularly useful for persistent speech sound errors.
- Supported by a growing evidence base.
Visual Acoustic Biofeedback
Converts speech into visual displays such as:
- Spectrograms
- Waveforms
- Acoustic displays
Allows individuals to:
- Compare their speech with a target.
- Modify speech based on visual feedback.
Electropalatography (EPG)
Uses a custom-made artificial palate fitted with sensors.
It provides information about:
- Tongue-to-palate contact.
- Timing of tongue movements.
- Accuracy of articulatory placement.
EPG is widely used for persistent articulation disorders and some cases of cleft palate and motor speech disorders.
SmartPalate®
A commercially available palate containing pressure sensors that:
- Tracks tongue contact.
- Displays tongue placement on a computer screen.
- Provides immediate visual feedback during therapy.
Generally suitable for:
- Older children
- Adolescents
- Adults
Opti-Speech
A commercial biofeedback system that:
- Tracks speech movements.
- Provides visual feedback during therapy.
- Can support treatment of persistent articulation errors.
Benefits of Biofeedback
Research suggests biofeedback may:
- Improve speech accuracy.
- Accelerate learning of difficult speech sounds.
- Help individuals understand tongue placement.
- Reduce frustration when traditional cues are ineffective.
- Increase motivation through immediate visual feedback.
- Improve clinical efficiency when used alongside motor-based intervention.
Evidence
Current research supports biofeedback for selected speech sound disorders, particularly persistent articulation errors.
Studies have shown:
- Children receiving ultrasound biofeedback for persistent /r/ errors improved more rapidly during early treatment than children receiving traditional motor-based therapy.
- Ultrasound visual biofeedback has been validated for both assessment and treatment of speech sound disorders.
- Numerous systematic reviews support biofeedback as an effective adjunct to conventional therapy for school-aged children with persistent speech sound disorders.
Most of the strongest evidence relates to:
- Persistent /r/ errors
- Persistent /s/ errors
- Residual speech sound disorders (RSSD)
The evidence base for Childhood Apraxia of Speech (CAS) is currently much more limited, although biofeedback is increasingly being investigated as a complementary treatment approach.
Clinical Considerations
Biofeedback is generally most effective when:
- Combined with evidence-based motor learning principles.
- Used alongside traditional speech therapy.
- Delivered by clinicians trained in interpreting biofeedback displays.
- Tailored to the individual's speech goals.
Limitations
- Specialised equipment can be expensive.
- Not all clinics have access to ultrasound or EPG systems.
- Additional clinician training is required.
- Not every individual benefits equally.
- Biofeedback is not a replacement for comprehensive speech therapy.
Useful Resources
New York University
Children Receiving Biofeedback Speech Therapy Improved Faster than Traditional Methods
University of Strathclyde
Electropalatography (EPG)
Ultrasound Visual Biofeedback
Neuroscience News
Children Receiving Biofeedback Speech Therapy Improved Faster than Traditional Methods
SmartPalate®
Opti-Speech
Finding the right therapy for you
Adult therapies
These therapies are designed specifically for adults with apraxia of speech. They focus on improving speech clarity, motor planning, and communication confidence. Each approach provides structured strategies tailored to an individual’s specific needs.
Neurological disease /stroke speech apraxia support.
Stroke Language Therapy Groups
Stroke groups such as the Stroke Survivors Speech & Language Support Group offer help with speech and language post-stroke by a team of trained volunteers. They run groups over Cheshire, UK and have an online group and are a growing charity offering support in this area. Liz Bedson the CEO is also a Friend of Speech Apraxia, one of our fantastic team of volunteers. We are delighted to work in collaboration with this fantastic charity
Adult Therapy Apps
Speech and Language Therapy Services around the world can be both restricted or expensive. Therapy apps can be a useful way of extending therapy. Adult apraxia of speech apps include Tactus Therapy and Cuespeak.Jon Hunt developed the Cuespeak app and is a Friend of Speech Apraxia, please do message questions about apps.(pictured is Jon Hunt creator of Cuespeak)
Think about
Recording capability?
Microphone or no microphone
Recording mechanism–Intensity/ repeated practice–Stimulus selection/ practice structure–Feedback–letting go
Self: playback
Automatic speech recognition
Lee Silverman Voice Technique
Although not a mainstream therapy method for speech apraxia, The Lee Silverman Voice Technique has been shown to be valuable in helping sufferers of primary progressive apraxia of speech. https://www.mdpi.com/2076-3425/14/5/417
Voice Banking
Summary of main techniques for acquired apraxia of speech
Individuals with primary progressive apraxia of speech might consider voice banking. Voice banking is where you can record yourself reading a set list of sentences, recording all the sounds needed for speaking. A voice banking provider then uses your recording to create a computerised version of your own voice. If needed this can be used on a communication aid so the voice sounds more like you.
If you have not been referred to a speech and language therapist (SLT) ask the health and social care professionals you are in touch with for one. It is useful to talk through your options around voice banking and AAC and to have SLT support during the process of voice banking. To bank your voice you will need access to the internet, a laptop or a PC and a headset microphone. Some services offer the ability to bank on a smartphone or tablet, however, others continue to suggest the quality of the recording is better when completed with a computer and a headset microphone We have provided the following comparison chart to enable you to choose the most suitable voice banking service that meets your needs. Other services may be available.
This pdf put together by the MND organisation lists and compares 3 organisations. We do not endorse or recommend any specific voice banking service and we recommend discussing voice banking and communication needs with your speech and language therapist at the earliest opportunity. If you do not yet have a speech and language therapist, ask to be referred by your GP, neurologist
Summary of main techniques for acquired apraxia of speech
Summary of main techniques for acquired apraxia of speech
Summary of main techniques for acquired apraxia of speech
Phonetic placement (Austermann etal.,2010, Ballard et al., 2007)
Sound production treatment (Wambaugh etal.,2012)
Repeated practice(Wambaughetal.,2012)
Speech Motor Learning Program (vanderMerweetal.,2007,2011)
Anodic tDCS stimulation + speech practice (Marangoloetal.,2011)
8-step continuum (Schneider&Frens, 2005)
8-step continuum +/- music therapy • Imaginedproduction; implicit phoneme manipulation (Cowelletal., 2010, Whiteside et al., 2012)
Phonomotor rehabilitation (Kendalletal.,2006)
Motor learning guided approach (Friedmanetal.,2010,Laskeretal.,2008, 2010)
Verbal and gestural training (Roseetal.,2006)
Visual feedback using electromagnetic articulography (Katzetal., 2010, McNeil et al., 2010)
Script training (Youmans etal., 2011a,b)
Other support or techniques
Summary of main techniques for acquired apraxia of speech
Summary of main techniques for acquired apraxia of speech
Prosodic (rhythmic pacing)
Alternative/augmentative communication
Multi-modal training(e.g.,gesture+verbal)
Multiple Input Phoneme Therapy (MIPT)
The approach
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
An evidence-based approach designed for patients with severe apraxia of speech who are caught in verbal motor loops, helping them create new neural pathways for effective communication.
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Severe apraxia of speech often traps patients in frustrating verbal motor loops where they produce stereotypic utterances—repetitive, invariant phrases that aren't contextually appropriate. These patients typically have limited functional vocabulary and minimal phrase production ability.
Neuroplasticity Foundations
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Neuroplasticity Foundations
MIPT harnesses the brain's neuroplasticity to create new neural pathways for speech production. By systematically using existing stereotypic utterances as a foundation, therapists help patients build bridges to new, functional speech patterns.
Neural Pathway Creation
Neural Pathway Creation
Neuroplasticity Foundations
This approach recognizes that even damaged brains can form new connections when presented with consistent, structured sensory input across multiple modalities
Treatment steps
Neural Pathway Creation
Treatment steps
1. Record and model the client's speech, providing gestural and prosodic cues.
2. Fade Cues
3. Introduce New Targets
4. Increase complexity
The evidence
Neural Pathway Creation
Treatment steps
Stevens and Glaser (1983) conducted a cohort study (N=5) with stroke patients aged 49-73, demonstrating significant gains in verbal expression and reduction of perseverative utterances at the single word level. Current evidence suggests MIPT is particularly valuable for patients who have not responded to traditional apraxia treatments.
8 Step Continuum Treatment
Overview of the 8-Step Continuum
Originally Designed for Severe Speech Apraxia
Originally Designed for Severe Speech Apraxia
The 8-Step Continuum is an articulatory kinematic approach for apraxia of speech. It emphasizes improving the timing and placement of speech movements using modeling, positioning, and repetition. Integral stimulation—where patients observe the clinician’s face during speech—is central to the method, engaging visual, auditory, and motor pathways to support speech production.
Originally Designed for Severe Speech Apraxia
Originally Designed for Severe Speech Apraxia
Originally Designed for Severe Speech Apraxia
This method was initially created for individuals with severe apraxia of speech. It offers a structured and intensive framework to rebuild speech abilities, especially when comprehensive intervention is needed to establish consistent sound production and improve intelligibility in profoundly affected individuals.
Adaptability for Milder Case
Originally Designed for Severe Speech Apraxia
Adaptability for Milder Case
Although designed for severe apraxia, the 8-Step Continuum is flexible. Specific steps can be selectively applied to treat milder cases, helping clinicians tailor therapy based on a patient’s unique needs, speech challenges, and progression without overwhelming them with the full protocol.
The 8 Steps of the Continuum
Further Validation and Clinical Use
Adaptability for Milder Case
The steps include (1) clinician and patient say word together, (2) patient says word while clinician mouths it, (3) patient imitates modeled word, (4) independent repetition, (5) saying a written word, (6) saying word from visual memory, (7) saying word in response to a prompt, (8) using word in natural conversation or role-play.
Evidence from Initial Studies
Further Validation and Clinical Use
Further Validation and Clinical Use
Rosenbek et al. (1973) showed improved articulation and sequencing in three individuals with severe apraxia using this method. These early results highlighted the potential of structured, multisensory cueing in restoring speech function for patients with profound speech-motor planning deficits.
Further Validation and Clinical Use
Further Validation and Clinical Use
Further Validation and Clinical Use
Deal and Florance (1978) validated the approach with four additional severe apraxia cases. Their work supported its clinical effectiveness and demonstrated that it could be adapted for use in home programs, increasing accessibility and reinforcing therapy through caregiver-led practice outside clinical settings.
Speech motor learning treatment
Overview of Speech Motor Learning Treatment
This approach systematically trains consonant and vowel production. It begins with simple nonwords and progresses to functional speech. Designed for individuals with childhood apraxia of speech (CAS) or acquired apraxia of speech (AOS), it addresses challenges in speech motor planning across varied phonetic contexts and longer utterances.
Initial assessment rates production ease of speech sounds. Based on this, 3–4 consonants and 3–5 vowels are selected. As speech improves, more difficult sounds are gradually added in stages, usually expanding consonants first, followed by vowels.
Professor Van de Merwe writes a guest contribution
Professor Van de Merwe writes for Speech Apraxia UK-The SML Program was designed to guide the individual in re-/acquiring these components of speech motor planning. The treatment stimuli of the SML program address this aim and software that generates stimuli can be downloaded from www.apraxia-anitavandermerwe.co.za. The treatment starts with a small number of vowels and consonants that the speaker finds easy to produce and are combined in nonwords arranged in series. Real words containing these sounds are also introduced from the start of treatment. Across time more sounds are incorporated. In addition to clinical evidence, two experimental studies showed positive effects in both a child with CAS and an adult with AOS (Van der Merwe, 2011; 2018).
Research Gate
https://www.researchgate.net/profile/Anita_Merwe/contributions
ORCID ID
Treatment and Clinical Findings
Treatment and Clinical Findings
Treatment and Clinical Findings
Treatment begins with consonant-vowel-consonant-vowel (CVCV) nonwords (e.g., “paba”) using the easiest sounds. It then progresses to CVC words (e.g., “pam”), then longer nonwords (e.g., “patikam”), before introducing functional real words and phrases. Each level builds articulatory complexity systematically.
Research by Van der Merwe (2011, 2018) supports the approach for both AOS and CAS. While surface gains in sound production are common, true improvements target underlying motor planning, supporting automatic speech use and long-term generalization beyond therapy.
Strengths and Limitations
Treatment and Clinical Findings
Treatment and Clinical Findings
Strengths:
- Structured complexity progression
- Individualized starting points
- Validated for adults and children
- Direct focus on motor planning deficits
Limitations:
- Unclear link to participation and real-life communication
- More research needed on quality-of-life impact and functional gains
Script Training
What is script training
Who Benefits from Script Training?
Who Benefits from Script Training?
Script training is an evidence-based intervention used to improve functional communication for individuals with aphasia and apraxia of speech. The client and SLT work together to create personalized scripts based on specific, meaningful interactions. These scripts are practiced repeatedly until memorized. Benefits include improved speech rate, sentence structure, and communicative confidence. The approach emphasizes real-world relevance, helping clients communicate more effectively in predictable, everyday situations that matter to them.
Who Benefits from Script Training?
Who Benefits from Script Training?
Who Benefits from Script Training?
Script training supports diverse client needs. For those with fluent aphasia, it provides structured language templates. For non-fluent aphasia, it offers repetitive, predictable phrases to reinforce speech. Individuals with apraxia of speech benefit through focused motor speech pattern practice. This method is especially effective for clients with defined communication goals, such as ordering food or greeting coworkers, where mastering specific phrases has a tangible, positive impact on daily interactions.
The Script Training Process
Who Benefits from Script Training?
The Script Training Process
Script training follows a structured but personalized format:
- Identify a functional need—a situation meaningful to the client.
- Create a script collaboratively therapist and client build natural, tailored dialogue.
- Engage in repeated practice—client memorizes the script with support.
- Implement in real life—client uses the script in actual settings, reinforcing confidence and effectiveness. The collaborative nature makes it empowering, helping clients take ownership of their speech improvement journey.
Supporting Research
Considerations and Limitations
The Script Training Process
Youmans et al. (2011) evaluated script training in three individuals with apraxia of speech. All participants successfully memorized their scripts, and two improved their speech rate. Most impressively, script retention was observed six months after treatment, demonstrating lasting effects. These results support script training as a viable intervention for enhancing long-term functional communication skills, especially when focused on relevant, practiced dialogues that transfer effectively to real-world use.
Strengths of Script Training
Considerations and Limitations
Considerations and Limitations
Script training is highly resource-efficient, requiring minimal equipment and enabling focused home practice. It enhances functional communication by building familiarity with real-life interactions, encourages participation, and boosts confidence in social scenarios. The collaborative process fosters engagement and ownership. As scripts are based on the client’s needs and interests, motivation is often high, and progress is both measurable and meaningful in day-to-day life.
Considerations and Limitations
Considerations and Limitations
Considerations and Limitations
Despite its strengths, script training has limitations. It’s best suited to predictable, routine interactions and may not generalize to more spontaneous conversations. Success depends on motivation and practice, which can vary among clients. It is not a comprehensive solution for all communication challenges but rather a targeted strategy to address specific goals. Integrating script training with broader therapy approaches often yields the best functional outcomes.
Pacing Therapy
What is pacing
Pacing Boards Explained
Benefits of Pacing
Pacing is a technique that breaks words or syllables into smaller, manageable parts to slow speech and improve clarity. By separating sounds that may otherwise blur together, it helps individuals speak more clearly and deliberately. Pacing is especially beneficial for people with apraxia of speech, stuttering, or aphasia with motor speech issues. It supports better intelligibility and enhances communication by making speech easier for both the speaker and the listener.
Benefits of Pacing
Pacing Boards Explained
Benefits of Pacing
Pacing slows down speech, reducing the impact of rushed or blurred articulation. It encourages more deliberate speech, improves intelligibility, and helps reduce listener confusion. Pacing also supports breath control and promotes self-awareness during speaking. By improving speech clarity, it allows for better participation in conversations. It is particularly effective for motor speech disorders, offering a structured way to manage and monitor speech production without relying on complex tools or technology.
Pacing Boards Explained
Pacing Boards Explained
Step-by-Step: Using a Pacing Board
Pacing boards are simple visual tools with dots or circles arranged on a plain background. Each dot represents a syllable or speech segment. The user points to each dot while speaking, helping break words into clear parts. SLTs model the technique, then the client practices by pointing as they say each syllable. This method builds independence, self-monitoring, and clarity, using familiar words or phrases to reinforce success and make speech feel more natural.
Step-by-Step: Using a Pacing Board
Step-by-Step: Using a Pacing Board
Step-by-Step: Using a Pacing Board
Model: SLT points to each dot while saying a word slowly.
Practice: The client repeats, pointing to each dot per syllable.
Apply: Use agreed everyday words or phrases during practice.
Progress: Encourage independent use and generalization.
This structured approach helps the speaker monitor and control their rate, promoting clearer speech and gradual mastery of pacing techniques for daily communication situations.
Traditional and Tech based tools
Step-by-Step: Using a Pacing Board
Traditional and Tech based tools
Pacing can be implemented using traditional paper-based boards or digital apps. Modern pacing apps often include features like audio feedback or animations to support speech rhythm. Both approaches reinforce consistency, aid clarity, and can be tailored to suit client preferences and goals. Whether using low-tech or high-tech options, pacing tools offer flexible support and can be easily integrated with other speech therapy interventions for optimal results.
Research evidence
Step-by-Step: Using a Pacing Board
Traditional and Tech based tools
Studies comparing Sound Production Treatment (SPT) and Metrical Pacing Therapy (MPT) found that most participants benefited from both approaches, with slightly greater improvements in SPT. Benefits included better speech intelligibility, reduced fatigue, increased participation, and enhanced prosody. Pacing also helps lower cognitive load during speech and promotes self-monitoring. It’s a low-cost, effective intervention that supports long-term speech development and can complement other therapies to meet diverse communication needs.
Next month- SLPFlow
Product Review
Read our independent product reviews.
Product reviews- want your product reviewed? email info@spee
SLPflow
User Interface & Accessibility
· Clean, minimal interface focused on speed and clarity rather than visuals.
· Very short learning curve: add a patient, press record, run the session.
· Screen layout is simple and uncluttered, making it easy to use during live therapy.
· Web-based platform; no need for high-spec devices or specialist hardware.
· Designed for clinicians, not clients, this is a back-end tool, not a therapy app.
· It is ideal for speech and language professionals
Clinical Function & Structure
· Built around an AI Scribe that records sessions in the background and converts them into structured clinical documentation.
· Automatically generates:
session overviews
SOAP-style or other SLT style progress notes
full written session transcripts
· Sessions are clearly segmented, making it easy to review what happened and when.
· Particularly helpful for long sessions (e.g. 45–60 minutes), where manual note-taking is time-consuming.
Automation & AI Features
· AI-powered progress notes are generated almost instantly once recording stops.
· Automated cue detection tags clinical cues used during the session, which can then be reviewed and edited.
· Patient goal tracking runs across every session, allowing progress to be monitored continuously.
· Goals are entered one per line, which works well for tracking and reporting.
· Outputs can be used to quickly populate reports such as IEPs.
Customization & Clinical Control
· Patient setup includes:
full name
age (in years)
condition notes
therapy goals (optional)
· Clinicians retain full control: AI notes must be reviewed and edited.
· Works best when supplemented with brief clinician-written notes to correct nuance or context.
· Not prescriptive, SLPFlow does not dictate assessment frameworks or therapy approaches.
Feedback, Accuracy & Limitations
· Transcription quality is strong, but not perfect.
· Occasional inaccuracies appear in summaries or SOAP notes, requiring clinician review.
· There is no audio playback, you cannot listen back to the session recording; only the written transcript is available.
· The system does not analyse speech accuracy or clinical effectiveness; it documents what occurred.
· You could not use the system to transcribe speech sound analysis.
Data Handling & Workflow Efficiency
· Uploads recordings quickly (usually a few seconds).
· Notes are stored in an organised, session-by-session format.
· Significantly reduces end-of-day paperwork and report-writing time.
· Particularly useful for private practice clinicians balancing high caseloads.
Evidence-Informed Use
· SLPFlow is clinically neutral: it supports documentation, not diagnosis or therapy decision-making.
· Effective use depends entirely on clinician skill and judgement.
· Appropriate for complex populations (including speech apraxia) only when paired with strong clinical reasoning.
· Not a substitute for dynamic assessment or motor learning principles.
Value & Cost
· $20/month
· 14-day free trial
· Low cost compared to the amount of clinician time saved.
· No tiered complexity, pricing is transparent and accessible.
Summary Recommendation
SLPFlow is a practical, efficient documentation and workflow tool that does exactly what it claims: it reduces paperwork so clinicians can focus on care. The AI Scribe is fast, intuitive, and genuinely useful, provided clinicians understand its limitations and take responsibility for reviewing and editing notes.
It is not a therapy app or a diagnostic tool, and not a replacement for clinical thinking. However, it does bring up AI suggestions for interpretation of session results. Used thoughtfully, it is an effective and affordable solution for busy SLTs who want accurate, structured notes without spending hours writing them. I thought it was excellent and it is like having a therapy friend. For speech apraxia, clinicians often have to transcribe speech which this will not do. However, it will collect notes for the rest of the session making it an essential tool.
(Speechapraxia.co.uk reviewed SLPFlow after approximately six months of clinical use. The software was not used as a diagnostic tool. See www.slpflow.com for further details.)
Cuespeak
User Interface & Accessibility
- Simple home screen with access to settings and user memory, reports.
- Intuitive touchscreen interface, accessible for individuals with communication difficulties.
- Particularly useful props for in-session communication, though the “feelings” tool does not track emotions over time (a missed opportunity).
- Runs on iPad, iPhone, and Apple Silicon Macs. Requires iOS 15 or higher.
Therapeutic Content & Structure
- One of the most extensive therapy libraries available on products reviewed (14+ modules).
- Covers: word and phrase production, sentence construction, understanding spoken/written language, reading and writing, question/answering, verbs, personal/family vocabulary, sounds and structure, and non-verbal reasoning.
- Each module has multiple exercise sets (e.g., verbs module includes 11 sets).
- Tasks are offered at easy, medium, or hard levels, with clear tutorials and “Tips” functions for each activity.
- Stays current with news-based questions and real-life conversational contexts, making it highly relevant for adults.
- It has some useful communication tools (e.g., map, notepad, numbers, time, days/months, feelings, and record-and-hear).
Customization & Adaptability
- Exercises can be configured to any level of difficulty, from occasional word-finding difficulties to severe expressive/receptive impairments.
- Option to create personalised content using therapy templates (family names, friends, pets, meaningful places, personal scenarios).
- If a word is missing from the database, users can request its addition.
- Thousands of videos are available (over 15,000) with syllable-level modelling and playback.
Feedback & Progress Tracking
- Users can record and review their own speech attempts and compare with video models.
- Session reports are generated and can be shared with therapists, friends, or family members.
- Sharing enables therapists to remotely configure and monitor therapy.
- While self-comparison is strong, there is no automated speech accuracy scoring.
Data Sharing & Collaboration
- Therapy sessions and results can be shared online, supporting remote therapy and collaboration.
- Family Sharing is supported (subscription can be shared across devices with the same Apple ID).
- Organization licensing is available with different pricing structures.
User Engagement & Motivation
- Keeps therapy relevant with up-to-date news discussions and everyday scenarios.
- Wide variety of modules and exercises reduces the risk of therapy fatigue.
- Supports independent practice or therapist-led sessions.
Technical Performance
- Generally smooth performance, though app updates each time it is opened, which can delay access slightly.
- Rated 4.6/5 on the App Store (263 ratings).
- App size: 125 MB.
Evidence-Informed Design
- Developed by specialist SLTs.
- Informed by up-to-date research into speech and language therapy.
- Strong focus on aphasia and word-finding therapy; less directly tailored to apraxia of speech, though speech recording and playback features may still be useful.
Value & Cost
- Subscription model:
- £9.99/month (auto-renewing).
- £132.99/year (non-renewing).
- £399.99/3 years (non-renewing).
- The 14-day free trial includes full content access.
- Family sharing is enabled for home users.
- Higher cost compared to one-off purchase apps, but reflects extensive and continually updated content.
Summary Recommendation
Cuespeak is an exceptionally comprehensive and adaptable therapy app, particularly well-suited for adults with aphasia and word-finding difficulties. Its vast library, real-life relevance, and ability to personalise therapy make it a powerful tool for both independent users and SLT-led practice. While less targeted at apraxia of speech than some alternatives, its recording, playback, and flexible customisation options can still support individuals with motor speech difficulties.
The subscription model makes it a more expensive option compared to one-off apps, but for users needing varied, personalised, and regularly updated therapy content, it offers significant value.
(Speechapraxia.co.uk reviewed Cuespeak in August 2025. The app was provided free of charge for review purposes. See www.cuespeak.com for further details.)