Transcript Efficacy of the SATPAC Approach for remediating

Efficacy of the SATPAC
Approach for remediating
persistent /s/ errors
Stephen Sacks, M.A., CCC-SLP SATPAC Speech, Fresno, CA
&
Peter Flipsen Jr., Ph.D., S-LP(C), CCC-SLP
Pacific University, Forest Grove, OR
Disclosure-Stephen Sacks
Financial:
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Owner and Developer of SATPAC Speech and receives royalty payments.
Receives royalty payments from Marshalla Speech & Language.
Consultant for the Bureau of Education & Research and receives honorarium
compensation.
Nonfinancial:
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Board Member of the Oral Motor Institute
Disclosure – Peter Flipsen Jr.
• No financial or non-financial conflicts to report
Outline
• What are persistent speech errors?
• Current approaches to treatment
• The SATPAC Approach
• Study design and results
• Discussion
• Questions
Persistent Speech Errors
• Frequently encountered on school caseloads
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Mild distortions of /s, z, r, l/.
Hard to justify more than limited treatment.
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Minimal impact on intelligibility?
Usually little impact on academics?
• Have proven difficult to correct with traditional methods
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Ingrained bad habits?
Management Options?
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Traditional therapy but more Tx time?
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Unlikely; no more time available
Ignore?
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Probably not a good idea.
Negative peer reactions
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Reduced adult expectations
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See Crowe Hall (1991), Madison & Gerlitz (1991), & Silverman & Paulus (1989).
See Overby et al. (2007) & Lass et al. (1988)
Possible increased risk of emotional and behavioral problems
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See Beitchman et al. (1986)
Management Options?
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Modify the therapy sequence?
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Concurrent task sequencing (Skelton, 2004).
Relatively unstudied so far.
Modify feedback?
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Electropalatography?
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Still somewhat expensive and requires considerable training
Spectrograms? Ultrasound? Speech Buddies?
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All relatively unstudied.
The SATPAC Approach
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Systematic Articulation Training Program Accessing Computers.
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www.satpac.com
Combines the use of:
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1. Non-words based on facilitating contexts (with transition to real words)
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Helps get around ingrained bad habits, and
Takes advantage of coarticulation
2. Computer generated stimulus lists
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Progressively move through ever more challenging contexts, and
Avoid other error sounds that may interfere or are not in the student’s repertoire.
3. Practice at normal (or near-normal) speaking rate
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Avoids odd prosody, and
Promotes normal motor planning, and
Promotes generalization from an early stage
Multimodality Approach
to /s/ Remediation
Use of /t/ Sound (and other unusual things)
• /s/ is not mentioned
• Mouth is open which is not normal for /t/ (but only
temporarily)
Use of an Auditory Visual Model
to Contrast Correct/Incorrect
“EET”
Production
Use an Applicator Stick for Visual
Tactile Feedback
(EE-point)
Tongue Tip Pointing for
Visual, Tactile-Kinesthetic
Feedback
page 33
Tongue Pops for
Visual, Tactile-Kinesthetic
Feedback
EE Point Tip for
Visual, Tactile-Kinesthetic
Feedback
Tongue, Lips and Jaw
Differentiation
EET for Auditory,
Tactile-Kinesthetic
Feedback
KF Second Session
EETS for Auditory,
Tactile-Kinesthetic
Feedback
The French
/t/
page35
Systematic Articulation Training Program
Accessing Computers
SATPAC Procedure ChecklistEstablishment Phase
Practice Phase-Criteria for Completion
80%+ accuracy on the first 4 lists
@ 140 BPM
80%+ accuracy on List 5 at a
normal conversational rate with no
slowing down on the target sound
Practice Phase Lists 1 and 2
Practice Phase-Lists 1 and 2
Practice Phase Lists 3 and 4
Practice Phase-Lists 3 and 4
Practice Phase List 5
Contrastive Stress
Practice Phase-List 5
Generalization/Transfer Phase
Generalization/Transfer Phase
TALLY COUNTER
Generalization/Transfer Phase
Phrases
Generalization/Transfer Phase
Short Sentences
Generalization/Transfer Phase
Sentences
Generalization/Transfer Phase
Short Contrasts
Generalization/Transfer Phase
Contrasts
Current Study
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Sacks, Flipsen, & Neils-Strunjas (in press) revealed significant improvement in
persistent /s/ with the SATPAC approach when administered by the first author
(who is also the program designer).
Attempting to replicate using other clinicians trained in the approach.
Between groups alternating treatments design
Measure baseline performance, treat group 1 while group 2 waits.
Then measure performance on both and treat group 2 while group 1 waits
Measure both groups again and re-measure after an additional 12 weeks to check
for maintenance.
Participants
• 13 children recruited from two public schools.
• 7 males; 6 females – initial age 6;11 to 8;8 (Mean = 7;11)
• No previous speech or language treatment rec’d.
• 8/13 monolingual English speakers; 5/13 bilingual but English dominant.
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All presented with either dentalized or interdental versions of /s,z/
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Dentalized = sounds distorted
Interdental = may or may not sound distorted but looks atypical
Progress Measures
• Measured production accuracy of /s/ in:
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1. CPAC /s/ probe (words and sentences; Secord & Shine), and
2. conversational speech
• Allowed for measurement of performance in the structured context of
therapy and to monitor generalization.
CPAC /s/ Probe
Treatment Plan
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Participants randomly assigned to two groups
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Group 1 (n=7) included 5M; 2 F; ranged in age from 6;11 to 8;8
Group 2 (n=6) included 2M; 4 F; ranged in age from 7;5 to 8;3
No significant age difference
Individual treatment sessions by 2 clinicians who were trained on the approach
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Focus only on /s/
Each clinician saw about half the children in each group
12 weeks of treatment; 1 X 15 minute session per week = 180 minutes of total treatment.
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180 total minutes of therapy.
Observations about Treatment
• Variation between SLPs
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One SLP administered the program more faithfully than the other and consequently
showed significantly better results (7/8 90%+ in conversation vs. 2/5 90%+ when study
was completed).
• All completed Tx but 3 (2 from Group 1) moved at the end of the school year
and were no longer available at follow-up.
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Net result: missing any follow-up data for 1 participant.
Group Results (CPAC probe)
Change in CPAC /s/ Accuracy over Time
Tx Group
1
2
90
80
CPAC Mn %
70
60
50
40
30
20
10
0
Tx Group
Time period
1
2
1
1
2
2
1
2
3
1
2
4
Group Results (Conversational Speech)
Change in Conversational /s/ Accuracy over Time
Tx Group
1
2
70
60
Conv Mn %
50
40
30
20
10
0
Tx Group
Time period
1
2
1
1
2
2
1
2
3
1
2
4
Individual Results
• Not all participants achieved the same results
• 6/12 (3 from each group) followed an “ideal” pattern.
Saw change on both measures immediately after therapy and it was maintained at
follow-up.
% Correct /s/ over Time
Participant = JH
Participant = AG
Y-Data
% Correct /s/ over Time
Y-Data
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time
time
Individual Results
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1/12 showed immediate change after treatment on CPAC probe but no generalization to conversation until
follow-up.
1/12 showed gradual change over time on CPAC probe but no change in conversation until 24 weeks posttreatment.
% Correct /s/ over Time
% Correct /s/ over Time
Participant = PJ
Participant = AS
Y-Data
Y-Data
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“Delayed” generalization?
time
time
Individual Results
• At least one participant showed gradual improvement to acceptable levels
by initial follow-up but regressed at 24 week follow-up
% Correct /s/ over Time
Y-Data
Participant = TT
time
Individual Results
• 3/12 participants showed little or no change in one or both measures.
% Correct /s/ over Time
Participant = EL
Participant = SL
Y-Data
Y-Data
% Correct /s/ over Time
time
time
% Correct /s/ over Time
Y-Data
Participant = EP
time
Overall Results and Conclusions
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Group results show obvious effects for both the CPAC probe and conversational
speech.
Individual results showed obvious signs of improvement for 8/12 participants to
acceptable levels of performance on both measures.
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Doesn’t work for everyone.
With a relatively short treatment period (12 weeks) and relatively brief sessions
(15 minutes per week), the SATPAC Approach appeared to be effective at
correcting persistent /s/ errors.
Future Directions
• Need to determine efficacy with other errors (/r/, /l/).
• Need to evaluate whether each component is absolutely necessary.
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E.g., are the specific “establishment” procedures necessary or can any technique to
establish good /s/ work?
E.g., how crucial are the nonsense stimuli?
• Need to determine why some don’t respond to the therapy.
Questions?