AOS management Flashcards
1
Q
Goals of AOS management
A
- Improve effectiveness, efficiency and naturalness of speech
- Restore impaired functions
- Adjusting to loss of speech
- Focus on reestablishing motor plans
2
Q
Experience dependent neural plasticity
A
- Use it or lose it
- Use it and improve it
- Specificity (brain training)
- Repetition matters
- Intensity matters
- Time matter
- Saliency
- Age matters
3
Q
PMLs for AOS
A
- Variable > constant practice: alter target sound’s phonetic environment, contrast target sound with others that gradually become more similar to target sound
- Complex > simple targets: later acquired sounds and sequences
- Random > blocked practice: AAAA, BBBB vs ACBA, CBBA, forces retrieval and organisation of a different response on every trial rather than practicing only execution
Feedback: knowledge of results, low frequency, delayed
4
Q
Treatment approaches for AOS
A
Impairment-based
- Articulatory-kinematic
- Rate and/or rhythm
Activity and participation
- AAC
5
Q
Articulatory kinematic therapy for AOS
A
- Impairment-based
- Increase accuracy through improving movement/positioning of artics
Different approaches
1. Integral stimulation - 8 step continuum
2. PROMPT
3. Structure oral reading
4. Sound Production Treatment (SPT)
6
Q
Integral stimulation (articulatory-kinematic therapy)
A
- Cycles of modelling/repetition
- Process of “watch me/listen to me/say it with me”
- Structured hierarchy with fade cues and increased difficulty
1. Integral stimulation with simultaneous production
2. Integral stimulation with delayed production and simultaneous visual cue/miming
3. Integral stimulation with delayed production without simultaneous cues
4. Successive productions without intervening or simultaneous cues
5. Written stimuli with simultaneous production
6. Written stimuli with delayed production
7. Appropriate response elicited with a question
8. Response elicited through a role-play situation
7
Q
PROMPT (articulatory-kinematic therapy)
A
- Prompts for Restructuring Oral Muscular Phonetic Tasks
- Uses tactile cues to provide touch pressure, kinesthetic and proprioceptive cues for how to move the articulators
- Tactile cues paired with auditory and visual stimulation
- Word is repeated to client in a fun activity, SLP then uses their hands to support motor movements, home practice required
8
Q
Structured oral reading
A
- Preserved visual processing of orthography and conversion to phonology might facilitate motor planning
- Provides context to rehearse production of words
- Multisyllabic words broken down to syllables
- Self detection of errors is important for home practice
9
Q
Sound Production Treatment (SPT)
A
- Has the most efficacy data
Step 1: modelling/imitation - Clinician produces minimal pair and client repeats
- Choose stimuli based on error patterns
- If correct, give feedback and elicit again then move on to next pair
- If incorrect, move on to step 2
Step 2: modelling and written word cue/imitation - Clinician points to letters while modelling
- Client repeats
- If either sound incorrect, go to step 3
Step 3: integral stimulation - Focus on target or contrast sound, whichever was incorrect
- “Watch me, listen to me, say it with me”
- If incorrect, go to step 4
Step 4: articulatory placement/modelling - Clinician provides verbal articulatory placement instructions and models word
- Client repeats
- If correct or incorrect move to step 5
Step 5: Production in isolation - Clinician models the sound in isolation
- Client repeats
Evidence:
- Generalisation of results to connected speech and untrained words
- Best effects when multiple sounds are trained in parallel
- 15 prods per target per session
10
Q
Rate/rhythm therapy for AOS
A
- Impairment-based
- Focus on timing of speech production
- Re-establish temporal patterning
- Reducing rate allows time for motoric planning and processing sensory feedback
11
Q
Metrical pacing therapy: rate/rhythm
A
- Tones represent syllable onset
- Reduced rate
- Rate gradually increased
- Feedback on timing but not segmental accuracy
- Evidence suggests this can improve both artic and timing
12
Q
Autonomy-supportive treatment for AOS
A
Most treatments for acquired apraxia of speech (AOS) rely on clinician-controlled practice conditions and repeated exposure to unimpaired speaker models. Recent motor learning research indicates that autonomy-support, expectation of competence, and external attentional focus may be more beneficial for motivation and skill learning.
13
Q
AAC for AOS
A
- Replace or supplement verbal comm
- Used when there is a perceived need to improve communication
- Must be individualised
- Focus on training optimal use and inform/educate communication partners
- Eg. text to speech, supported communication, communication boards/cards, gesture, writing
- Consider: limb function, motivation, visual-perceptual skills, language, cognition, communication partners, social networks
13
Q
AAC for AOS
A
- Replace or supplement verbal comm
- Used when there is a perceived need to improve communication
- Must be individualised
- Focus on training optimal use and inform/educate communication partners
- Eg. text to speech, supported communication, communication boards/cards, gesture, writing
- Consider: limb function, motivation, visual-perceptual skills, language, cognition, communication partners, social networks
