Transcript File - Kathleen Funck, MCD

TREATMENT METHODOLOGY
FOR ARTICULATION AND PHONOLOGY
Willis/Pancamo
Intervention
 What should be the therapy targets?
 What treatment approach should I use?
Training Approaches
 Vertical/Deep – intense practice on a limited # of targets. Tx
moves through a hierarchy of difficulty. Tends to be most
appropriate for kids with relatively few errors.
 Horizontal – attacks goals broadly; assumes that simultaneous
exposure to a wide range of targets will facilitate production of
phonemes or sd. patterns. Tends to be most appropriate for
client with multiple errors
 Cyclical - client practices given target for predetermined
amount of time, then moves on to another target. Focus on the
original target resumes later on in the tx program
Articulation Model vs. Phonological
Model
 Articulation Model emphasizes the motor
component of speech. Focuses on the incorrect
production of individual phonemes.
 Phonological Model emphasizes the linguistic
component of speech. Focuses on rule-governed
errors that affect multiple speech sounds and
follow a predictable pattern.
Intervention Approaches for
Phonological Disorders
 Phonological Process Targets
 Used for children with phonological disorders who
exhibit multiple phonemic errors with poor
intelligibility
 Cycles approach
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Very structured
Begins with the sound the child is most stimulable for
Utilizes auditory bombardment
 Metaphon Approach
Incorporates the child as an active cognitive participant
 So, the child must be aware of his incorrect productions, want to
modify it, and have the neuromotor capability of accurately
producing the target sound
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Intervention Approaches for
Phonological Disorders
 When using a phonological processes approach, teach
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the underlying concept in a non-speech task before
introducing it in a speech task
Phonological Processes that a child uses only
occasionally may be more easily modified
If using distinctive feature approach, early targets
should only differ by one feature to increase success
Distinctive feature approach predicts generalization
based on phonemes with common features. So, probe
ahead to see if spontaneous acquisition has occurred
Parent training/education
Intervention Approaches for
Articulation Disorders
 Single-Phoneme Targets
 Perceptual/Ear Training
 Identification of the target sound
 Location of the target sound
 Stimulation
 Discrimination
 Production Training
 Stabilization
 Carry Over/Generalization
Intervention Approaches for
Articulation Disorders
 Stimulability Training
 Used to increase the number of sounds in a child with
a very limited phonemic repertoire
 (e.g. Developmental Apraxia)
Selecting Goals
 Developmental Approach – tx targets are identified
based on the order of acquisition in normally
developing children
 Nondevelopmental approach – tx targets are
chosen specifically for each client
 Targets that are most relevant to child or family
 Targets that are most stimulable
 Targets that are most visible when produced
 Targets that will result in greatest gain in improving
overall speech intelligibility
Influences on Intelligibility
 Articulatory
 Omissions →Substitutions → Distortions
 WI → WM → WF
 Errors that occur on the most frequent sounds in a
language
 Phonological
 WI Consonant Deletion
 Glottal replacement of WM consonants
Influences on Intelligibility
Tx for a Functional Disorder
 Helpful Hints:
 Do not include more than one error sound in a stimulus word,
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phrase or sentence in the initial stages of therapy
Pay attention to phonetic context of words that contain the
target phoneme.
Tx sessions that elicit the greatest # of sound productions will be
most effective in establishing correct production as an automatic
behavior
Evaluate oral motor function
Use books that contain target sounds as immersion activities
(www.speechville.com, worksheet on Moodle)
Instruct parents to respond consistently to the content of the
child’s utterance before pointing out speech errors or modeling
correct productions
Tx for Organic Disorder
 The selection of initial therapy targets for organic
disorders is based on developmental approach b/c
the accompanying articulation deficits are the
direct result of structural/neurologic anomalies and
are not developmental in nature
Therapy Guidelines
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Hierarchy
 Isolation with model
 Isolation without model
 Syllable level with model ****
 Syllable level without model****
 Word level with model
 Word level without model
 What position in words?
 Carrier phrase with model
 Carrier phrase without model
 Phrase with model
 Phrase without model
 What position is the target word within the phrase?
 Sentence level with model
 Sentence level without model
 Structured Activity
 Spontaneous (Connected) Speech
Session Design
 Basic Training Protocol
 1. Clinician presents stimulus
 2. Clinician waits for client to respond
 3. Clinician presents appropriate consequence or
event.
 4. Clinician records response
 5. Clinician removes stimulus
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Session Design
 Task Order
 easy -hard-easy
 Work Efficiency/Pace
 Each session should provide the client with the maximum #
of opportunities to practice target behaviors
 The pace of each session must be geared to the learning styles
and rate of each client
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Session Design
 Materials
 Should be client specific based on age, developmental
level, language level and gender. Should be
interesting to that client
 Avoid time-consuming or complicated activities that
result in decreased # of client responses/session.
 Proxemics
 Should be socially/culturally acceptable
 Sitting very close to a child can aid in reducing
impulsive or distractible bx
 Can change depending on the specific activity you are
doing
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Key Teaching Strategies
 Direct modeling- clinician demonstrates a specific bx to provide
an example for the client to imitate.
 Used in early stages of tx (establishment) or when tx bx shifts to
higher level of difficulty
 Indirect modeling- clinician demonstrates a specific bx
frequently to expose the client to numerous well-formed examples
of the tx bx.
 Shaping by successive approximation – tx bx is broken down
into small components and taught in an ascending sequence of
difficulty.
 Prompts – clinician provided additional verbal or nonverbal cues
to facilitate a client’s production of a correct response
 Attentional, using exaggerated loudness or duration, hand cues ,
verbal cues , written cues
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Key Teaching Strategies
 Fading - stimulus or consequence manipulations are reduced in
gradual steps while maintaining the target response.
 Client produces multiple imitations for each clinician model
 Progressive reduction of the length of the bx modeled by the
clinician
 Expansion- clinician reformulates a client’s utterance into a more
mature or complete version
 Negative practice- client is required to intentionally produce a tx bx
in error
 Best used on a short-term basis, only after the client demonstrates
the ability to produce a given target consistently at the level of
imitation
 Target –specific feedback –clinician provides specific information
regarding the accuracy or inaccuracy of a client’s response relative to
the specific target bx
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HOMEWORK
• Useful after the establishment and stabilization of
tx bx has occurred
• Promotes generalization
– Purpose of HW is to provide practice of an existing
skill rather than teaching a new one
– Should be given only after client has demonstrated a
basic ability to accurately evaluate his or her own
performance
– Assigned in amounts that are perceived as
manageable by the client/fmly
– Should be assigned on a regular basis
– Should be given with simple written instructions
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Oral Motor Considerations
 Speech is not an isolated act but the product of a
highly complex and synchronized oral motor
system.
 Oral Motor function affects neuromuscular control
and organization needed for the production of
intelligible speech.
 OM deficits include: hypersensitivity,
hyposensitivity, weakness, and incoordination of
oral structures
Oral Motor Therapy
“To do or not to do”
 Proponents:
 Speech is founded on earlier developing non-speech
motor patterns.
 Reduced muscle tone in the oral-facial area results in
limited strength of the articulators used for speech.
 Normal movement and sensation significantly
influence motor learning. (Piaget)
 Speech is highly complex and is more easily learned
when it is broken into smaller components (when you
have to teach it that way)
Oral Motor Tx
“To do or not to do”
 Nay Sayers
 Little evidence-based research to demonstrate causal
relationship rather than correlational relationship.
 (See handout on Moodle for additional info)
Oral Motor Tx
 Potential Candidates
 Weak production of bilabials, droolers
 Poor production of sounds requiring tongue elevation
 Poor differential production of midrange vowels
 Hypernasality
 Forward resting posture of the tongue
Basic Goals of an OM Program
 Heighten consciousness of the oral mechanism
 Normalize sensitivity to stimulation in the oral area
 Inhibit primitive or abnormal oral reflexes in order
to enhance normal movement patterns
 Increase differentiation and stabilization of the oral
structures
 Refine articulation movements by increasing the
strength and ROM of the oral mechanism
Hierarchy of OM Treatment
1.
2.
3.
4.
5.
Address Postural & Positioning Issues
Normalize oral sensitivity
Increase Jaw Control
Increase Muscle Tone in Lips
Increase Muscle Tone in Tongue
Oral Motor Treatment
 General Guidelines
 Apply stimulation systematically and follow the same
sequence of steps each time
 Work from outside-in
 Use firm, slow touch vs. light, quick strokes
 Use visual feedback (mirror) to facilitate child’s
ability to categorize new perceptions and improve
tolerance of stimulation
 Explain procedures before and during
implementation