Lecture 5 Flashcards
What are the 2 treatment care pathways?
- Phonological/ articulation
2. Motor speech
List 4 Articulation tests
> GFTA
DEAP
Arizona
Spat D
What is one standard deviation in percentile
16th percentile
1.5 SD bellow the mean is what percentile?
7th percetile
2 SD below the mean is what percentile
2nd percentile
10th percentile and below indicates severe delay and therefore child requires ______ intensity treatment
Higher
What are residual errors?
The hardest speech errors remaining after age seven (/r/,/l/,/s/, /z/, /r/ errors)
What are participation restrictions? When such factors are affected by speech impairment what does that mean for treatment
- Learning tasks
- Play/Games
- Socialization/Social relationships.
- Less enjoyment of school.
> If participation is affected, intervention is required
What are concomitant factors? If child doesn’t meet percentile cut off but these factors are present do we proceed with treatment?
Prior treatment history (unsuccessful) SSD+ Language impairments Family history of speech issues /dyslexia. Current history of Dyslexia. Poor academic or psychosocial outcomes
> Yes you should see the child if these factors are present
True or false, for residual errors (s,z,r,l,th) we do not treat children under 7
True unless error is Atypical (i.e lateral distortions)
If residual errors are present at 7 what are 3 things that would lead you to delay treatment
> If any acceptable /s,z/ production present in any context (sound is emerging)
If child is stimulable residual for errors
If Upper incisors have not erupted (can’t have interdental sounds without teeth!)
If you re check a child for residual errors at 8 you would give treatment if…
No change in past year and/or participation restrictions
If child has less than 4 indicators on the Motor speech checklist what does this mean?
They should classified with an SSD and given speech therapy (I.e. its not a motor speech problem)
What are some motor indicators?
> Lateral distortions
Retracted lip
Jaw slide
If you have more than 4 MS indictors and are b/w 8-16th %ile on GFTA-2 what will motor treatment plan be?
MSTP 1x/week for 10 weeks
If you have more than 4 MS indictors and are below 7%ile on GFTA-2 what will motor treatment plan be?
MSTP 2x/week for 10 weeks
True or false if you observe >10% atypical errors you start tretment regardless of severity
TRUE - target atypical immediately
True or false you only treat /s,z,r/ (residual) errors and slow DDK rates if child is below 16th percentile
FALSE - treat even if greater than 16th percentile
True or false functional change only begins to occur after 12-20 hours
TRue - has to be direct individual therpy
what is the treatment block leading to best changes as reported by FOCUS
45 min x 2x week /10 weeks: Ideal (best changes reported on FOCUS
Drill, play or story telling activities in which teaching episodes are delivered
is called the dose _____
Form
The Number of times a teaching episode with an active ingredient(s) occurs in 1 session is called the _____
Dose
What is the dose frequency?
Number of sessions per block of treatment
How do you calculate Cumulative intervention intensity (CII)
CII = Dose x dose frequency x total intervention duration(i.e. # of weeks)
(e.g., 50 trials x 2 sessions/week x 10 weeks = 1000 trials
What is block practice?
Repeat a target back over and over and over - hard to maintain attention. Get better fast (good for acquisition) but bad for long term retention
What is distributed practice?
Present target, move to something else, come back to bottle. Better for long term learning because i requires more recall
In a moderate phonological disorder, a minimum dose of ____ trials per session & duration of at least ___ sessions is required for a phonological intervention to be effective“ (~CII = 1500)
> 50, 30
CII = 1500 trials of target for phonological change
What is the CII (number of targets) required for change in a child with More severe SSD (phonological)
> 70 trials per session & duration of ~40 sessions (~CII = 2800)
What is the CII (number of targets) required for change in a child with SSD AND Motor speech issues
50 to 100 trials per session x 1 week (8 to 16th percentile GFTA) or 2 x per week (< 7th percentile GFTA) x 10 weeks (multiple blocks depending on severity) ~CII = 1000 (mild) to 2000 (more severe)
What is the CII (number of targets) required for change in a child with CAS
> 100 trials per session x 2 or 3 sessions a week x 10 weeks or longer duration (multiple blocks) ~CII = 2000 to 3000
What are 4 types of Input-oriented Approaches to treatment?
1. Focussed stimulation (multiple repetitions of a word/phrase multiple times; also slow rate, model, recast, expansion etc) 2. Ear training/SAILS Provide variable input Error detection Identification Discrimination etc Contrast therapies (Minimal pairs etc) 3. Dialogic Reading (child leads story telling) 4. Phonological Awareness
What are 5 types of output-oriented Approaches?
- Ear training (sensory/perceptual)
- Elicitation / Production training (e.g. Phonetic placement, Integral stimulation, Multisensory approaches)
- Drill / Practice activities
- Stabilize (hierarchy/contexts)
- Generalization.
Which therapy approach targets Phonological and language issues?
Input oriented: Emphasis on “function” of sounds.
- Internalization of phonological rules/contrasts
Which treatment approach targets lower level motor issues?
Phonetic Approach: Children have only a few errors, Each error treated one after another. Therapy relies on drill and drill-play ! Until speech sound production reaches “within normal limits”.
True or false Traditional-phonetic motor approach should be automatically used when clients exhibit 1-2 errors
FALSE - yes the phonetic approach is usually for children who only have a few errors, however if these errors are an issue with “function” of sound (i.e. phonological rules in different contexts) not the production (articulation) then phonological/ input approach should be used
True or false distortions are ALWAYS phonetic/artic (lower-level)
TRUE
Omissions and substitutions can easily be _______
phonemic
for “mixed” kids- use phonetic approach when …
When a sound is not in a child’s inventory/repertoire start with phonetic
i.e. first establish production & then integrate functionally.
True or false Producing appropriate phonetic features of a sound will increase child’s ability to understand rules/contrasts with that sound
True (e.g. /s/ [+strident, +continuant] → /t/ [-strident, -continuant].
What are the 3 steps of the treatment sequence?
- Sensory-perceptual or Ear training: Let child Identify / discriminate correct vs error sound production.
- Elicitation: Clinician elicits /corrects production in a child until it reaches criterion /acceptability. (placement/shaping/stimulation)
- Hierarchical stabilization - in all contexts and speaking situations. (isolation, syllable, stress, word, phrase etc)
When setting smart goals use __-___% in structured intervention context
80-90
When setting smart goals use ___% in spontaneous context (assuming it’s emerging
50
Define Sensory-perceptual training
Child is Not asked to produce sound, but ONLY judge its distinctiveness from other sounds. Overall, goal is recognition and discrimination.
What are the 3 steps of Sensory-perceptual training?
- Identification: Clinician describes sight/sound/feel of sound. For young child use names –e.g. call /s/ as snake sound.
-Child should indicate when a target sound is heard: - Recognition:
-Isolation: Clinician produces target in IMF, different words, phrases.
-Stimulation with variations : louder/softer, faster slower, across speakers. - Discrimination: (can use minimal pairs)
-Error detection: discriminate target and error production-
-Error correction and
self-monitoring
What are 6 techniques used in production (elicitation) training?
-Sounds in Isolation: Easily achieved with fricatives/liquids/glides (+continuant), for stops easier to use with central vowel e.g. [kᴧ].
Stimulability: Imitation, visual “watch me and do exactly what i do”
Phonetic placement method: Clinician instructs the client how to position articulators (e.g: tactile cueing, mirror, mouth puppet, hand model, tongue depressor, etc).
Sound modification (shaping): Deriving target from similar sound or non-speech movement (e.g. shape [s] from [∫] by smiling)
Using facilitating contexts: E.g. [s] is facilitated by high front retracted vowel/i/; use voiced alvelors/velars [tr,gr,dr] to facilitate [r]; g->d fronting use velar to facilitate /g/ e.g. Finger /ŋ/ facilitates /g/ etc
Nonsense syllables: Do not use-UNLESS aim is to eliminate interference of “old” error with “new” production. E.g. Child may revert to ketəl →[tetəl] – so train with non-sense [ki].
What is the hierarchy for sound stabalization
- Isolation,
- **Syllable (CV easy > VC > CVCV > CVC> harder CCVC), Word Level, ***Word level (position of word in sentence, length, syllable structure, syllable stress, coarticulation and familiarity of the word)
- ** Structured Contexts (phrases/sentences): goal to maintain accuracy of production (80-90%) in short elicited or imitated phrases / sentences. E.g. Use carrier phrase “i see a ____ {insert words starting with /s/}”.
**Spontaneous Speech (Transfer/generalization/carryover): 50% accuracy in spontaneous conversation (use focussed topics- racing cars for /r/)
What is a SMART goal
Specific, Measureable, Attainable, Relevant and Time bound
Describe the production of support from least invasive to most invasive techniques
> Begin by simply modeling the sound and see if the child can repeat after you.
Explain articulatory placement, using visual aids (puppet, diagrams, mirror)
Try shaping from mastered phonemes
Try phonetic placement techniques
Use tactile - kinesthetic cues/techniques as needed
When trying to correct fronting, what contexts will help facilitate /k/ an /g/
Facilitated by low back vowels (e.g. sock, walk, talk)
What are some therapy techniques from /k/ and /g/ fronting?
> Auditory discrimination: hear the difference between velar/alveolar sounds
try mirror feedback
What contexts facilitate the production of /s/
/s/ Facilitated by high, front, retracted vowel /i/ (e.g. see)
