Bright Start Therapies has specialized in the assessment and treatment of Childhood Apraxia of Speech (CAS) for over ten years. Our CAS team members provide comprehensive evaluations, treatment, consultation and seminars statewide. Motor speech disorders require repetitive planning, programming, and production practice; therefore, intensive and individualized treatment of childhood apraxia is necessary. Our treatment approach depends on a number of factors, including the severity of the disorder and the communication needs of the child. A combination of approaches is often necessary including motor programming, linguistic approach, and sensory cueing including PROMPT, using augmentative and alternative forms of communication (AAC), such as gestures, manual signs, voice output devices, and context-specific communication boards. This involves utilizing as many important people in the child's life as possible to facilitate carryover and generalization of skills. We strive for a high production rate of 500-600 productions a therapy session. The targets are tracked on our self devised tracking sheets and new targets are updated on a weekly basis. We increase the complexity of the speech sound targets as the child reaches a desired accuracy in his speech production level. We include a functional word, phrase or sentence list depending on the child level and capability for increasing intelligibility. Tactile methods of speech facilitation are those that provide direct tactile input for correct speech production. Using these methods, the SLP applies pressure or otherwise touches the child's face, neck, and head to provide a tactile cue for correct production or speech movement gesture. For example, PROMPT© (Prompts for Restructuring Oral Muscular Phonetic Targets) is a dynamic tactile method of treatment based on touch pressure, kinesthetic, and proprioceptive cues. Apraxia in other systems may also play an important role in treatment. For example, the presence of limb apraxia may preclude using manual signs for functional communication, although sign language cues can still be used by others to support verbal speech, if the primary goal is to help cue words and word sequences. The presence of oral apraxia may support the need for either more aggressive or alternative approaches to the use of phonetic placement cues in speech treatment. Many children with CAS also exhibit phonologic impairment and language impairment and therefore these areas are assessed and addressed as well.