Chapter 9 Flashcards
What are the two dichotomized approaches to treating SSDs?
Are these usually chosen between or combined?
Motor-Articulation
Linguistic-Phonologic
Combined
What are ASHA’s evidence levels?
Level Ia
Level Ib
Level IIa
Level IIb
Level III
Level IV
What is Level Ia?
3
Well-designed meta-analysis
More than one controlled trial
Randomized
What is Level Ib?
2
Well-designed controlled study
Randomized
What is Level IIa?
2
Well-designed controlled study
Not randomized
What is Level IIb?
Well-designed, quasi-experimental study
What is Level III?
Well-designed, nonexperimental studies
i.e., correlational and case studies
What is Level IV?
3
Expert committee report
Consensus Conference
Clinical experience of respected authorities
What is the first stage of treatment?
Establishment
eliciting and stabilizing desired client behaviors at a voluntary level
How is Establishment accomplished with a motor-based approach?
Teaching correct production
How is Establishment accomplished with a linguistic-based approach?
What does this assume?
Using contrasting sounds to teach the difference
Assumes production skill is already present
What is the second stage of treatment?
Generalization
Facilitating transfer or carryover of learned behavior across various levels
How do new skills need to be Generalized?
9
Across positions
Across contexts
Across linguistical units
Across sounds
Across syllables
Across words
Across sentences
In conversation
Across situations
What is the third stage of treatment?
Maintenance
Facilitating stabilization and retention of new skills. Responsibility transferred to client.
Do Maintenance and Generalization overlap?
Yes
What are other names for Motor-Based Treatment?
2
Traditional Approach
Traditional Articulation Approach
What are the three parts of Motor Learning Principles?
3
Prepractice Goals
Principles of Practice
Principles of Feedback
What are Prepractice Goals in Motor Learning Principles?
3
Finding out what will motivate child
Making sure child understands how to do tasks
Making sure child’s perceptual abilities are adequate
What are the Principles of Practice in Motor Learning Principles?
(5)
More frequent but shorter sessions when possible
Practice under many conditions
Present targets in a random sequence
Focus should be on target - not individual articulator movements
Better to practice entire speech target than breaking it down into steps
What are Principles of Feedback in Motor Learning Principles?
(2)
Knowledge of Performance (what is being done correctly and incorrectly)
Knowledge of Results (was target produced correctly)
Why should there be a slight delay before giving feedback?
So that the child has a chance to judge their own performance
What are four different types of Perceptual Training?
Traditional Ear Training
Perceptual Training of Sound Contrasts
Perceptual Training Software
Amplified Auditory Stimulation
What is another name for Traditional Ear Training?
Speech Sound Discrimination Training
When is Perceptual Training needed?
When child cannot discriminate target from other speech sounds
Does Perceptual Training always need to be a separate step?
No - it can be incorporated into production training
What are the four steps to Traditional Ear Training?
Identification (learning target)
Isolation (listening for target in more complex environments)
Stimulation (auditory bombardment)
Discrimination (is target produced correctly or incorrectly?)
What is Perceptual Training of Sound Contrasts?
Perception training that focuses on minimal pair contrasts
What are the two steps to Perceptual Training of Sound Contrasts?
Introduction of a minimal pair
Contrast training (practice portion)
What is Perceptual Training Software? (2)
Is it designed to be used alone?
Software designed to improve perceptual skills
Provides visual feedback an keeps track of child’s accuracy
No - child works with an adult
What is another name for Amplified Auditory Stimulation?
Auditory Bombardment
What SSD treatment uses Amplified Auditory Stimulation?
When is it used?
Cycles approach
Beginning and end of each treatment session
What is Focused Auditory Input?
When is it used
Adult plays with child while producing as many models of target sound as possible
When a child cannot or will not produce a target
What is Production Training?
3
Motor-based intervention
Teaching child to produce target
Stablizing target production
What are the four approaches to Production Training?
Imitation (client repeats model)
Phonetic Placement (client is instructed in where to place articulators)
Successive Approximation (Shaping, modifying a sound in client’s repertoire)
Contextual Utilization (isolating a sound from a particular context where it is used correctly
What are the three types of Motor-Based Treatment Approaches?
Traditional Articulation Approach
Context Utilization Approaches
Alternative Feedback Approaches
What are the four steps to the Traditional Articulation Approach?
Identifying errors
Establishing correct productions
Generalize productions
Maintainenance
What are the contexts used in the Traditional Articulation Approach?
(6)
Isolation
Nonsense Syllables
Words
Phrases
Sentences
Conversation
What does the Traditional Articulation Approach assume?
2
Speech sound errors may be due to faulty perception
Speech sound errors may be due to poor motor production
What are the strengths of Traditional Articulation Approach?
3
It is widely used and studied
Steps are logical
Useful for clients with an articulation disorder
What are the weaknesses of Traditional Articulation Approach?
(2)
The need for perceptual training is questioned
Not as effective for clients who have a linguistic disorder
Does research support the Traditional Articulation Approach?
Yes (minus perceptual training)
What are Context Utilization Approaches?
2
Sensory-motor-based approach
Stimulability tasks followed by practice using nonsense syllables -> word/word-pair practice -> rehearsal sentences ->narratives
What is the assumption behind Context Utilization Approaches?
Errors can be corrected by extensive motor practice is sound is in client’s repertoire
What is unique about Context Utilization Approaches?
They emphasize imitated repetition of productions
What are the strengths of Context Utilization Approaches?
3
Build on behaviors in the client’s repertoire
Capitalizes on syllables + auditory, tactile, and kinesthetic awareness or motor movements
Useful for clients who produce target inconsistently
What are the weaknesses of Context Utilization Approaches?
Difficult to motivate children to do this much imitation and drill
What are Alternate Feedback Approaches?
Gives child supplemental feedback about productions
What are two types of Alternate Feedback Approaches?
Tactile feedback
Visual feedback
What is a Tactile Feedback Approach?
3
Client wears removable device similar to an orthodontic retainer
Small acrylic block is built into device to give client a landmark for /r/ production
Used during therapy and practice sessions
What are four types of Visual Feedback Approaches?
Ultrasound imaging
Palatography (creating images of how tongue contacts palate during speech)
Electroplatography (EPG, artificial palate with pressure sensors is inserted and connected to computer)
Spectrograms
What are the assumptions behind Alternate Feedback Approaches?
Typical internal and external feedback does not help children with SSDs. They need something more.
What are the strengths of Alternate Feedback Approaches?
Presence of novel feedback may help with long-established incorrect pronunciations
What are the weaknesses of Alternate Feedback Approaches?
3
Cost
Most clinicians have limited experience with the technology
Most require something unnatural in oral cavity and may make speech unnatural (may impede generalization)
Are Alternate Feedback Approaches supported by research? (3)
Spectrograms?
EPGs?
Tactile approaches supported by anecdotal evidence only
Most studies support positive outcomes with visual approaches
More research needed
Spectrogram studies limited
EPG most studied - some positive evidence
What is the Core Vocabulary Approach?
5
Child learns 50 functionally-powerful words
Each week 10 of these words are randomly chosen and targeted
At end of twice-per-week sessions, child produces each word three times
Words produced consistently are removed from list
Untreated words are probed 3x every two weeks
Who does the Core Vocabulary Approach target?
Children with severe and inconsistent speech sound productions
What are Functionally-Powerful Words?
4
Names
Places
Foods
Child’s favorite things
What is the assumption behind the Core Vocabulary Approach?
If child’s productions are more consistent, they will be better understood
What are the strengths of the Core Vocabulary Approach?
Intelligibility is the overriding goal of all therapies
What are the weaknesses of the Core Vocabulary Approach?
2
Only applicable to those with inconsistent speech
No detail provided on how to achieve consistency
Is the Core Vocabulary Approach supported by research?
Few studies - seem positive
What are Nonspeech Oral-Motor Activities?
Training as a precursor for teaching speech sounds
What are three examples of Nonspeech Oral-Motor Activities?
Horn/whistle blowing
Sucking through straws
Tongue wagging
Why are Nonspeech Oral-Motor Activities controversial?
2
They were only supported philosophically originally
Research does not support their use
What sort of speech production is seen in children with CAS?
5
Difficulty with precise speech targets
Inconsistent productions
Trouble bridging all the various elements of speech
Difficulty transitioning between sounds (coarticulation, etc.)
Inappropriate prosody
What is often comorbid with CAS?
3
Neuromuscular problems like dysarthria
Other apraxias (Oral, limb, etc.)
Specific Language Impairment
Do we always know the etiology of CAS?
No
Which is usually stronger in CAS: receptive or expressive skills?
Receptive
How do we assess CAS?
7
Oral mech exam (is dysarthria or oral apraxia present)
Diadochokinetic tasks
Imitative utterances (V, CV, VC, C₁VC₁, C₁VC₂)
Connected speech sample
Phonological assessment imitating words of increasing syllables
Suprasegmental analysis
CAS-specific assessments
What must clinician keep in mind when analyzing speech performance in CAS?
(2)
There will be trouble in syllable sequencing
Movements, transitions, and timing should be observed at various linguistic levels
To whom might we refer seriously impaired children with CAS?
A neurologist to determine current status of neurological functioning
Is treatment for CAS supported by research?
Not a lot of research has been done
How do children with CAS progress in treatment?
Slowly
How do we treat CAS?
5
Short-term goals
Learning production units
Frequent drill and practice emphasizing transitions and movement timing
Possibly AAC intervention
Tactile-kinesthetic prompts and cues
What might be some short-term goals for CAS?
Functional, intelligible vocabulary
What should all production activities include with CAS?
Why?
Attention to syllable structure and combinations
To learn building blocks of words
Are more frequent, shorter sessions useful in treating CAS?
Yes
What is a tactile-kinesthetic prompt program useful for CAS?
PROMPT
Prompts for Restructuring Oral Muscular Phonemic Targets
What is a rhythmic/melodic facilitation approach useful in CAS?
Melodic Intonation Therapy
What is the most comprehensive set of instructional materials for treating clients with motor planning difficulties?
Nuffield Centre Dyspraxia Programme
What are the three stages of treatment?
Establishment
Generalization
Maintenance
When do we need to teach/establish sounds?
4
Sound is not in client’s repertoire
Sound only exists in limited phonetic contexts
Sound is not perceived in minimal pairs
Sound is not easily incorporated into syllable/word units
Is the traditional articulation method vertical or horizontal?
Vertical
