TREATMENT METHODOLOGY FOR ARTICULATION AND PHONOLOGY

Willis/Pancamo

TREATMENT METHODOLOGY FOR ARTICULATION AND PHONOLOGYInterventionWhat should be the therapy targets?What treatment approach should I use?Training ApproachesVertical/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 ModelArticulation 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 DisordersPhonological Process TargetsUsed for children with phonological disorders who exhibit multiple phonemic errors with poor intelligibilityCycles approach Very structuredBegins with the sound the child is most stimulable forUtilizes auditory bombardmentMetaphon ApproachIncorporates the child as an active cognitive participantSo, the child must be aware of his incorrect productions, want to modify it, and have the neuromotor capability of accurately producing the target sound Intervention Approaches for Phonological DisordersWhen using a phonological processes approach, teach the underlying concept in a non-speech task before introducing it in a speech taskPhonological Processes that a child uses only occasionally may be more easily modifiedIf 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 occurredParent training/educationIntervention Approaches for Articulation DisordersSingle-Phoneme TargetsPerceptual/Ear TrainingIdentification of the target soundLocation of the target soundStimulationDiscriminationProduction TrainingStabilizationCarry Over/GeneralizationIntervention Approaches for Articulation DisordersStimulability TrainingUsed to increase the number of sounds in a child with a very limited phonemic repertoire(e.g. Developmental Apraxia) Selecting GoalsDevelopmental Approach tx targets are identified based on the order of acquisition in normally developing childrenNondevelopmental approach tx targets are chosen specifically for each clientTargets that are most relevant to child or familyTargets that are most stimulableTargets that are most visible when producedTargets that will result in greatest gain in improving overall speech intelligibilityInfluences on Intelligibility ArticulatoryOmissions Substitutions DistortionsWI WM WFErrors that occur on the most frequent sounds in a languagePhonologicalWI Consonant DeletionGlottal replacement of WM consonants Influences on Intelligibility

Tx for a Functional DisorderHelpful Hints:Do not include more than one error sound in a stimulus word, phrase or sentence in the initial stages of therapyPay 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 behaviorEvaluate oral motor functionUse books that contain target sounds as immersion activities (www.speechville.com, worksheet on Moodle)Instruct parents to respond consistently to the content of the childs utterance before pointing out speech errors or modeling correct productions

Tx for Organic DisorderThe 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 natureTherapy GuidelinesHierarchyIsolation with modelIsolation without modelSyllable level with model ****Syllable level without model****Word level with modelWord level without modelWhat position in words?Carrier phrase with modelCarrier phrase without modelPhrase with modelPhrase without modelWhat position is the target word within the phrase?Sentence level with modelSentence level without modelStructured ActivitySpontaneous (Connected) Speech15Session DesignBasic Training Protocol1. Clinician presents stimulus2. Clinician waits for client to respond3. Clinician presents appropriate consequence or event.4. Clinician records response5. Clinician removes stimulus16Session DesignTask Order easy -hard-easyWork Efficiency/PaceEach session should provide the client with the maximum # of opportunities to practice target behaviorsThe pace of each session must be geared to the learning styles and rate of each client

17Session DesignMaterialsShould be client specific based on age, developmental level, language level and gender. Should be interesting to that clientAvoid time-consuming or complicated activities that result in decreased # of client responses/session.ProxemicsShould be socially/culturally acceptableSitting very close to a child can aid in reducing impulsive or distractible bxCan change depending on the specific activity you are doing18Key Teaching StrategiesDirect 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 clients production of a correct responseAttentional, using exaggerated loudness or duration, hand cues , verbal cues , written cues19Key Teaching StrategiesFading - stimulus or consequence manipulations are reduced in gradual steps while maintaining the target response.Client produces multiple imitations for each clinician modelProgressive reduction of the length of the bx modeled by the clinicianExpansion- clinician reformulates a clients utterance into a more mature or complete versionNegative practice- client is required to intentionally produce a tx bx in errorBest used on a short-term basis, only after the client demonstrates the ability to produce a given target consistently at the level of imitationTarget specific feedback clinician provides specific information regarding the accuracy or inaccuracy of a clients response relative to the specific target bx20HOMEWORKUseful after the establishment and stabilization of tx bx has occurredPromotes generalizationPurpose of HW is to provide practice of an existing skill rather than teaching a new oneShould be given only after client has demonstrated a basic ability to accurately evaluate his or her own performanceAssigned in amounts that are perceived as manageable by the client/fmlyShould be assigned on a regular basisShould be given with simple written instructionsOral Motor ConsiderationsSpeech 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 structuresOral Motor TherapyTo do or not to doProponents: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 TxTo do or not to doNay SayersLittle evidence-based research to demonstrate causal relationship rather than correlational relationship. (See handout on Moodle for additional info)

Oral Motor Tx Potential CandidatesWeak production of bilabials, droolersPoor production of sounds requiring tongue elevationPoor differential production of midrange vowelsHypernasalityForward resting posture of the tongueBasic Goals of an OM ProgramHeighten consciousness of the oral mechanismNormalize sensitivity to stimulation in the oral areaInhibit primitive or abnormal oral reflexes in order to enhance normal movement patternsIncrease differentiation and stabilization of the oral structuresRefine articulation movements by increasing the strength and ROM of the oral mechanismHierarchy of OM Treatment Address Postural & Positioning IssuesNormalize oral sensitivityIncrease Jaw ControlIncrease Muscle Tone in LipsIncrease Muscle Tone in Tongue

Oral Motor TreatmentGeneral GuidelinesApply stimulation systematically and follow the same sequence of steps each timeWork from outside-inUse firm, slow touch vs. light, quick strokesUse visual feedback (mirror) to facilitate childs ability to categorize new perceptions and improve tolerance of stimulationExplain procedures before and during implementation