Specific Treatment Programs and Approaches Flashcards
Using class room language arts books for therapy – help us help kids achieve…
common core standards
According to our text ch 8…
- most treatment approaches move from a simple to complex level of training (except the concurrent approach)
- Some approaches do contradict each other (e.g., start with stimulable vs. non stimulable sounds)
The point is to remain flexible
-and do what is best for each individual client
Non-speech oral motor exercises
- PBH do not believe that oral motor exercises are beneficial for anybody
- They say research has not proven that oral motor exercises help
- roseberrys position: these exercises are very helpful for children with oral motor problems
Kent R.D. (2015 November) Non-speech oral motor movements and disorders: a narrative review. American journal of speech language pathology
- He said that NSOMMs can be part of practice in orofacial myology
- can be used with persons with dysarthria and dysphagia (swallowing disorder)
- don’t reject NSOMMS wholesale
Traditional Approach
- around since 1920’s
- still popular and WIDELY-USED today
- however, most SLPs really don’t do ear training any more
Production Training: Sound Establishment
- establish correct sound production in ISOLATION
- use PHONETIC PLACEMENT techniques
- successive approximation
Production Training: Sound Stabilization
Stage 1: isolation Stage 2: nonsense syllables Stage 3: Words Stage 4: Phrases Stage 5: Sentences Stage 6: Conversation
Stage 1, 2,3
- Isolation: use variety of fun activities
- Nonsense syllables: I don’t really use these
- Words: begin with words that are meaningful to the child. I work on sounds:
- word-initial (Soup,See, Sun)
- word-final( buS, faCe, pieCe)
- word-medial (claSSes, Lesson)
- cluster (cruST,STop, faSTer)
Stage 4, 5
- Phrases : in-between stage -carrier phrases common –e.g., I see ____, This is ____.
- Sentences: various length and complexity
To establish sound sentences
- corrective set: SLP makes an error and kids “catch” her
- slow motion speech: SLP and ch say sentence together very slow
Stage 6
Conversation: -started with structured conv. –e.g., SLP gives a topic or specific pictures to talk about
-transition to natural conv. –open ended e.g., “Tell me what costume you wore for Halloween”
Transfer and Carryover
- vary the audience and settings
- speech assignments
Maintenance
- book: follow up sessions
- Dr. R: in schools, keep on IEP, but reduce to treatment once a week
Concurrent Approach
- said SLPs don’t have to use hierarchy we just described
- first establish sound in isolation and CV VC combos 80% accuracy
- then mix it up
CSHA Dr. Steve Skelton
-if we vary the response topography in each treatment session, ch will make increase gains than if we just go up the hierarchy like a ladder
For example in one session (dr.skelton)
- /r/ in final position of words
- /r/ in VC combos
- /r/ in sentences in word-initial position
- /r/ in word-medial position in phrases
Dr. skelton: Activities and ideas for eliciting at least 150 productions per group session
- kids take own data
- SUBVOCALIZE (say it with your voice turned off) while other students taking their turns
- tally counters –> challenge students –150+ productions
Dr.skelton acitivites cont.
- post charts –> individual/group competition
- create stations– students do something different every minute or so while practicing sounds
- e.g., one ch on white board, one putting puzzle together, one lying on floor, one using flashcards at table
- then you yell “switch”
- ask students to create cards with cerative ideas for more interesting drill
- they draw card, practice sound the way card says
activites cont.
e.g., “Say /r/ 10 times by itself while you are doing jumping jacks”
-“say at least 3 sentences with /s/ while you draw a picture on the white board”
“say ‘the’ while you are doing hopscotch”
-echo microphone
-puppets,costumes
-roll a dice or draw number from envelope to determine how many productions they have to make
other ideas for centers
- read books or stories with target sounds
- hula hoops
- jump rope
- create stories with flip books
- put stickers or stamps on a paper
- legos
- kick a ball
- blocks
- put bingo chip into a jar
- pick up sticks
- blow bubbles
Phonological Contrast Approaches
-these approaches have become popular and are supported by research
Minimal Contrast training
- use minimal pairs which only differ by ONE FEATURE such as
- voicing (to-do, pan-ban)
- place of articulation (tea-key)
Maximal contrast training
- sounds differ by at least 2 features
- cane-lane: /k/ is a voiceless linguavelar stop; /l/ is a voiced lingual-alveolar glidfe
- ten-men: /t/ is a voiceless tip-alveolar plosive; /m/ is a voiced bilabial nasal
I [roseberry] really like contrast training because
-the child sees that the sound used to makes a semantic difference
Complexity approach
- most setting research done with individual children in a university setting (not tried in schools with diverse groups)
- best for ch with individual sound errors (e.g., w/r; j/l)
- assumes that the complex sounds are AFFRICATES, FRICATIVES, AND CLUSTERS and sounds that are NOT STIMULABLE
- also assumes that LATER-DEVELOPING sounds (e.g., /tʃ/, /r/) are more complex that earlier developing sounds (e.g., /m/ and /p/)
Premise:
- START with HARDEST sounds for ch
- assumes: if train hardest sounds first, automatic GENERALIZATION to easier sounds
- e.g., ch produces /j/ 30% accuracy, /s/ 20% accuracy, /ð/ with 0% accuracy
- START WITH /ð/ and assume that /s/ and /j/ will be positively
Hodsons approach
general procedures
- STIMULATION: use of auditory, tactile, visual cues to increase awareness of target sounds
- PRODUCTION TRAINING: produce correct sound
- SEMANTIC AWARENESS CONTASTS: minimal pair training
hodsons approach cont.
- remediation program planned around a cycle
- cycle: time period required for child to focus on each deficient phonological pattern for 2-6 hours
- pattern= phonological process
- focuses on teaching STIMULABLE sounds
- early on, stick to simple CVC words
Selection of Target Patterns and phonemes
- top priority
- early developing phonological patterns:
- initial and final CONSONANT DELETION of stops, nasals, and glides
- CVC and VCV words structures
- posterior-anterior contrasts (k-g, t-d,h)
- /s/ clusters - word initial clusters /sp, st, sm, sn, sk/ and word final clusters /ts, ps, ks/
- liquids /r/ and /l/ and clusters containing these liquids
in order to move onto secondary patters the child must demo:
- appropriate syllablessness
- production of single consonants
- some emergence of velars and /s/ clusters
- production of practice words /l/ and /r/ w/o gliding (no w/r or j/l)
Secondary patterns
A: /j/, silibants /s,z/ /r/
B: consonant clusters
C: singleton stridents (e.g., /s,z,f/
D: multisyllabic words
structure of remediation cycles
- train each phoneme exemplar within a target pattern for 60 min per cycle before going to the next phoneme
- train 2 or more target phonemes in successive weeks within a patter before changing to the next target patters
(2+ hours on each pattern within a cycle)
structure of rem. cycles #3-5
- target only ONE PHONOLOGICAL PATTERN PER SESSION
- when all target patterns have been taught, a cycle is complete
- intiate second cycle. review patterns not yet corrected, intro new ones as necessaty
* * to become intelligible, most ch need 3-6 cycles of therapy
structure of therapy sessions
- review words cards from previous
- auditory bombardment (use amplification!) SLP reads list of 12 words for about 2 min. , 2x if ch paying attention
- target word CARDS - 3-5 NEW TARGET WORDS. ch draws, colors etc. and SLP writes name of pic on card
structure of therapy sessions #4-6
- production practice- games shift activities every 5-7 minutes
- stimulability probing– check if ch stimulable for phoneme planned for next session
- repeat auditory bombaredment w/ 12-item words list used at beginning of session
home program
- caretakers are asked to read the 12-item word list once a day
- child is asked to name the 3-5 pictures once a day (may also produce other target words)
Naturalistic approach
- focuses on improving childs overall intelligibility and whole-word accuracy first, then works on individual phonemes in error
- for severely involved children like preschoolers those with down syndrome, autism spectrum disorder, cerebral palsy
- approximation of sounds ok
work in the childs natural setting and have fun
- establish word and sound approximations so listener understands ch better
- use NATURAL RECASTS – corrective feedback given in naturalistic fashion- correct model given w/o ch being interrupted and asked to repeated
Speech recast
- adult feedback that immediately follows a chs utterance and provides an exact or reduced imitation of the chs words
- uses adult pronunciation
Core vocabulary approach
- designed for the 10% of children with functional SSDs characterized by INCOSSISTENT ERRORS on the same words
- these ch. don’t have childhood apraxia of speech
- been used with 2-yr olds, bilingual ch, down syndrom
inconsistent SSD: assess childs multiple productions of the same word in the same phonetic context
for ex: (25 diff pics on 3 separate trails within one session)
- child is asked to produce “cat” and 24 other pcitures
- activitiy
- asked to produce “Cat” and 24 other pictures
- activity
- asked to produce “Cat” and other 24 pictures
New slide
- “a word produced identically regardless of accuracy receives a score of zero”
- a word produced differently on at least one of the trials receives a score of 1”
Scoring
incorrect prod= 0
correct prod= 1
-total score converted to % age –40% meets criterion for inconsistent SSD
structure of intervention
- ch at least 2yrs old
- individual treatment 2x/week 30 min for 8 weeks
- goal= increase ch intelligibility
- select 70 words that are important to the indiv. ch
struct. of intervention cont
- objective= best possible production (intelligible, not perfect) consistently
- developmental errors accepted
- parents and teachers must be involved–feedback
- intended as foundation for more traditional methods
I [roseberry] love it
- gives ch immediate increase intelligibility
- words are important in chs immediate environment
- immediately decrease frustration
language treatment for phonological disorders –PBH
- pbh: research is inconclusive
- bottom line: if the ch has a lang and speech disorder, best to do both lang and speech therapy simultaneously
combining therapy for lang and speech sound disorders
- we can connect speech sound production to childrens morphosyntactic skills
- if children have final consonant deletion or cluster reduction they will have probs with some morphemes
ann tyler- ASHA the phonology morphology interface in children with SSD: development assessment and treatment considerations
- concomitant SSD and language impairment (LI) is the strongest predictor of literacy outcomes
- children with both SSD and LI have many omissions while children with just SSD have many more substitutions
tyler 2015:
-eliminating errors patterns like final consonant deletion and cluster reduction will improve production of grammatical morphemes
tyler recommends
- an integrated speech approach
- combine therapy for speech and lang
these morphemes include
- past tense -ed (jumped, scarED)
- plural -s (potS, sidewalkS)
- regular 3rd person -s (eatS, runS)
- possessive -s (grantS,bobS)
therapy suggestions
-if ch has final consonant deletion, use minimal pairs which include grammatical morphemes
for example (FCD)
- plurals : toe-toes key-keys
- possessives: joe-joe’s Ray-ray’s
- regular past tense -ed show-showed
if the child uses cluster reducation
- plural: boat- boats cup- cups
- possessives: cat- cat’s dad- dad’s
- regular past: walk-walked
- irregular past: drink-drank hold-held
we can also connect phonology semantics
- children with lang impairments often have difficulty with VERBS
- for velar fronting: tame-came; taught-caught
- stopping of fricatives: tee-see, toe-sew, tip-ship
- final consonant deletion: shoe-shott, ray-rake; say-sail
