SPECIFIC TREATMENT PROGRAMS AND APPROACHES

1

• SPECIFIC TREATMENT PROGRAMS AND APPROACHES

2
I. INTRODUCTION

• traditional and pattern-based approaches (p.
  395)
• Textbook philosophy all programs contain
  elements of both regardless of what we call an
  approach, we are teaching motor production of
  phonemes
• P. 396 Children learn to produce speech sounds,
  not rules.
• All approaches use behavioral tx techniques

3
II. TRADITIONAL APPROACH

• A. Background

4
B. Part One Ear Training (pp. 399-400)

• Phase 1 identification
• Phase 2 isolation
• Phase 3 stimulation
• Phase 4 discrimination

5
(p. 400)

• There are two forms of discrimination
• In error detection, the child has to tell when
  the SLP produces the sound in error
• In error correction, the child must explain why
  the sound was in error and how it can be corrected

6

• C. Part 2 Production TrainingSound
  Establishment
• D. Part 3 Production TrainingSound
  Stabilization
• (begin at the most complex level possible)
• Stage 1 Isolation
• Stage 2 Nonsense syllables (not functional)
• Stage 3 Words
• Stage 4 phrases (2-4 word phrases)
• Stage 5 sentences
• Stage 6 conversation

7

• To help establish the production of sentences
  (p. 404)
• 1. Slow-motion speech SLP and Ch say target at
  the same time, using a very slow rate of speech
• 2. Shadowing SLP says the sentence first, then
  Ch says it immediately

8
E. Part 4 Transfer/Carryover

• (dont worry about definitionsuse them
  interchangeably)
• Vary settings, interlocutors/audience, stimuli
• Speech assignments
• Follow-up (maintenance) sessions

9
CSHA Dr. Steve Skelton
10
(No Transcript)
11
ACTIVITIES AND IDEAS FOR ELICITING AT LEAST 150
PRODUCTIONS PER GROUP SESSION
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
OTHER IDEAS FOR CENTERS

• Read books or stories with target sound
• Hula hoops
• Jump rope

17
(No Transcript)
18
(No Transcript)
19
III. MULTIPLE PHONEME APPROACH (test 4 just
lecture notes and summary on pp. 416-417)

• A. Introduction (McCabe Bradley)
• For children with 6 errors
• Highly structured
• Use multimodal cues to teach multiple phonemes
  simultaneously

20

• B. Phase 1 Establishment
• Step 1 Establishment of sound production
• Step 2 Holding procedure (all sounds in
  isolation in each tx session)

21

• C. Phase 2 Transfer
• Syllables?Words ?Phrases and sentences?reading/sto
  ry/conversation
• D. Phase 3 Maintenance
• 90 accuracy across speaking situations with no
  external modeling

22
IV. MCDONALDS SENSORIMOTOR APPROACH

• A. IntroductionAssumptions

23
B. Part 1 Heighten Childs Responsiveness

• Practice syllables with nonerror sounds
• Begin with CVCV syllables
• Then go to trisyllables
• Vary vocal emphasis on syllables

24
Bauman-Waengler CSHA
25
C. Part 2 Reinforce Correct Articulation of
Error Sound

• Use facilitative contexts e.g. watch-sun

26
McDonalds (Part 2 continued)

• 1. Slo-mo
• 2. Equal stress on both syllables
• 3. Primary stress on first syllable
• 4. Primary stress on second syllable
• 5. Child prolongs target until clinician signals
  to go on (e.g., watchsssssssssun)
• 6. Practice in short sentences

27

• D. Part 3 Facilitate Correct Articulation of
  the Target Sound in Various Contexts

28
Beach-seal
29

• V. Shine Prousts Sensorimotor Approach
• Based on McDonald, but more structured
• Emphasizes orientation to the speech helpers
  (articulators)

30
V. DISTINCTIVE FEATURE APPROACH (lecture only!)

• Based on distinctive feature analysis
• Teach a relevant sound that is missing the
  feature, hope for generalization
• E.g., for feature of stridency, teach /f/ and
  hope it will generalize to /s, z, sh/

31
VI. PAIRED-STIMULI APPROACH

• A. Introduction
• Developed by Irwin Weston, 1971
• Good for children with a few sound errors
• Capitalizes on a key word

32
B. Step 1 Word Level

• Select a target sound for tx
• Identify 4 key words 2 with target in
  word-initial position and 2 with target in
  word-final position

33
C. Step 2 Sentence Level

• Use Key Word 1 with 10 training words, only
  evoke the target in a sentence
• FR3 schedule of reinforcement (3 responses for 1
  token)
• Do 2nd, 3rd, 4th key words and then do some
  alternations

34
D. Step 3 Conversational Level

• Clinician and child converse
• Clinician stops the conversation immediately if
  the child produces a sound incorrectly

35
VII. CONTRAST THERAPY APPROACH/PHONOLOGICAL
CONTRAST APPROACHES (pp. 432 on)

• Minimal contrast training use minimal pairs
  which only differ by one feature (tea-key)
• Maximal pair training sounds differ by at least
  2 features (cane-lane ten-men)

36
(pp. 436-437)

• Multiple oppositions/multiple contrasts approach
• Not on exam

37

• Begin with perceptual training
• Then, go to production training where the child
  has to produce minimal pairs
• Good for use with adults also

38
VIII. HODSONS CYCLES APPROACH (on exam!)

• A. Introduction
• General Procedures
• 1. Stimulation (multimodal cues)
• 2. Production training
• 3. Semantic awareness contrasts

39
(No Transcript)
40
B. Selection of Target Patterns and Phonemes

• Top Priority
• 1. Early-developing phonological patterns
• Initial and final consonant deletion of stops,
  nasals, and glides
• CVC and VCV word 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

41
2. Secondary Patterns

• A. Voicing contrasts, vowel contrasts
• B. Singleton stridents
• C. Other consonant clusters
• D. Other (metathesis, reduplication,
  multisyllabic words, complex consonant sequences)

42
C. Structure of Remediation Cycles

• 1. Train each phoneme exemplar within a target
  pattern for 60 min per cycle before going to the
  next phoneme
• 2. Train 2 or more target phonemes in successive
  weeks within a pattern before changing to the
  next target pattern
• (2 hours on each pattern within a cycle)

43

• 3. Target only one phonological pattern per
  session
• 4. When all target patterns have been taught, a
  cycle is complete
• 5. Initiate the second cycle. Review patterns
  not yet corrected, introduce new ones as
  necessary
• to become intelligible, most children need 3- 6
  cycles of therapy

44
D. Structure of Therapy Sessions

• 1

45
E. 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)

46
IX. 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

47
X. Language Treatment for Phonological Disorders

• PBH research is inconclusive re the question
  Can language therapy improve childrens
  artic/phono skills?
• Bottom line If the child has a language and
  phonological disorder, best to do both language
  and artic/phonology therapy simultaneously.
• In other words, dont just do language therapy
  and hope that somehow artic/phonological skills
  will magically improve too ?

48
Anthony et al. 2011 American Journal of
Speech-Language Pathology (4/11 issue)
49
XI. Combining Therapy for Language and
Articulatory-Phonological Disorders

• We can connect phonology to childrens
  morphosyntactic skills
• If children have final consonant deletion or
  cluster reduction, they will have problems with
  some morphemes

50
These morphemes include

• Past tense ed (jumped, scared)
• Plural s (pots, sidewalks)
• Regular 3rd person s (eats, runs)
• Possessive s (Grants, Bobs)

51
Therapy suggestions

• If the child has final consonant deletion, use
  minimal pairs which include grammatical morphemes

52
For example (FCD)

• Plurals toe-toes key-keys
• Possessives Joe-Joes Ray-Rays
• Regular past tense ed show- showed

53
If the child uses cluster reduction

• Plurals boat-boats cup-cups
• Possessives cat-cats Dad-Dads
• Regular past walk-walked
• Irregular past drink-drank hold-held

54
We can also connect phonology to semantics

• Children with language 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-shoot, ray-rake
  say-sail

55
XII. Developing a Lexicon for Young Highly
Unintelligible Children with Accompanying
Language Disorders

• Use early-developing consonants with words that
  are key in childrens environments
• For example, we can teach
• No, puppy, baby, bye-bye, yes, happy, mama, dada,
  baba (bottle), more (?), mine, please (peez), kay
  (okay), potty, pee, kitty, why, go, wawa, eat

56
If the child only says a few words
57
DeThorne et al. 5/09 American Journal of
Speech-Language Pathology

• Looked at alternatives to imitation for
  facilitating early speech development
• Premise when little kids wont talk, trying to
  have them imitate us often does not work
• Focused on kids who dont have any underlying
  problems like CAS or dysarthria

58
Ideas for therapy
59
(No Transcript)
60
Another idea was

• Imitate child
• Research has found that the extent to which
  mothers imitated their 13-month old children
  predicted the timing of the childrens later
  language milestones

61

• For example, if the child said ba! the mother
  said Ball!
• This predicted the timing of things like the
  childs development of her first 50 words and
  using two-word combinations
• We can even imitate non-speech movements (e.g.,
  smiling, yawning)

62
Another therapy idea from DeThorne et al. 2009
63
We can also

• Use headphones for slight amplification
• Use an echo microphone or other device
• Use mirrors, puppets

64
XIII. TEACHING /K/ AND /G/

• The dorsum of the tongue must raise to contact
  the soft palate and form a seal which completely
  blocks the air stream
• The back of the tongue must suddenly pull away
  from the velum to create a burst of air

65
Strategies for eliciting these phonemes
66

• Tell the child to hold his tongue against his
  lower teeth and hold his hand in front of his
  mouth to feel the burst of air as he imitates
  youtell him to raise the back of his tongue
• Use a mirror, and have the client imitate you
• Use a tongue depressor to push the tongue upward
  and backward in the oral cavity

67
(No Transcript)
68
(No Transcript)
69
XIV. TEACHING /S/ AND /Z/

• I like to refer to these sounds with animal
  analogies
• /s/ is the snake sound, and /z/ is the bee sound

70
Types of Lisps

• Type 1 the frontal lisp

71
Type 2 The interdental lisp
72
Type 3 the lateral lisp
73
However, we can

• Have the child strongly aspirate a /t/
• Use a bite block to stabilize production
• A bite block helps the jaw to not move around
• Have the child say /t t t t t t ssssss/
• Eventually you can get away from the bite block

74

• Shape /s/ from words that end in /ts/ (like
  boats or cats)
• Tell Ch to drop her tongue after she says /t/
• Try having Ch strongly aspirate /t/ ?German
  affricate /ts/. Have Ch prolong second part of
  this affricate.

75
Try this yourself

• And notice that when you make a really strong
  /t/, your tongue tip drops into perfect position
  for a predorsal /s/ ?
• Tell the child that when her tongue drops down,
  hold it there and produce an /s/

76
Other techniques for /s/ include
77
To develop a central airstream
78
Other techniques

• Tell Ch to make a smile and hide his tongue
  behind the white gate (teeth) while resting his
  tongue along his upper back teeth
• Tell him to blow out a straight, fine stream of
  air
• Place your finger in the center of his lips/teeth
  for an additional cue

79
Also
80
XV. TECHNIQUES FOR /l/

• One of the most common errors in children is y/l
  (I yike that yamp.)
• I like to tell kids about the magic spot (the
  alveolar ridge)
• It is very important for kids to have perfect
  awareness of the alveolar ridge and know exactly
  where their tongue is to be placed

81
(No Transcript)
82
One of my very favorite techniques
83
Be sure
84
Other tx ideas for /l/
85
Use the ribbon technique

• Place a ½ ribbon across the front of the
  clients tongue so that the ends hang down to her
  chin.
• Then, tell her to put her tongue tip on her
  alveolar ridge.
• Have her say /l/ while you gently pull down on
  the sides of the ribbon, which allows lateral
  airflow.

86
I do like

• Using /t, d, n/ as coarticulatory contexts
• E.g., ch can say na-la, na-la or da-la, da-la

87
XVI. TECHNIQUES FOR /th/

• One of the very most common errors is f/th
• Mark did this until he had artic therapy in first
  grade
• His SLP called /th/ a lip cooler (could also be
  called tongue cooler or angry goose sound)

88
To teach /th/ production

• Use a mirror
• Mr. Mouth is very helpful for children
• Tell the client to open his teeth slightly
• The tongue tip must protrude between the upper
  and lower central incisors

89
I have found that

• Many adult accent clients are not comfortable
  with their tongue protruding
• They feel like the whole world is staring at them
• I do a lot of desensitization and do the
  exercises in the mirror along with them
• The mirror is super helpful, because they can see
  that they do not look like idiots

90
If the client sticks her tongue out too far

• Hold a tongue depressor about ¼ in front of her
  teeth
• If she can feel the tongue depressor when she
  produces /th/, her tongue is coming out too far

91
/th/ can be shaped from several phonemes

• /h/ techniquehave client prolong /h/, slowly
  stick her tongue out while gradually closing her
  mouth
• Good /th/ and /h/ both voiceless fricatives

92
To direct airflow through the oral cavity

• Place straw where tongue tip contacts upper and
  lower front teeth, have client direct air into
  straw
• Put clients finger in front of his lips, have
  him repeat procedure by himself
• Hold a strip of paper in front of clients mouth,
  near tongue tip, ask him to blow out air to make
  paper move

93
XVII. I HATE /r/!
94
A. INTRODUCTIONORAL MOTOR EXERCISES

• Remediating /r/ is one of the most frustrating
  jobs that SLPs have
• It is a very complex sound that requires
  precision and muscle strength
• The use of oral motor techniques for helping
  clients with /r/ problems is hotly debated
• Some say that there is no research to support the
  efficacy of oral motor exercisesthis is true

95
However

• Clinically, I and many of my friends in the
  profession have found them to be extremely
  beneficial
• I have a hypothesis that because so many children
  were bottle fed and/or used pacifiers, tongue
  strength did not develop adequately
• Remember, for a baby, nursing requires far more
  work than drinking from a bottle!

96
There are many oral motor exercises
97
Other fun oral motor exercises

• Put cake sprinkle at corner of Chs mouth, have
  her move her tongue laterally to get it
• Ch can stick her tongue forward and lick cake gel
  off of a tongue depressor
• Squeeze soft cheese or frosting on her hard
  palate, have her lick it off

98
(No Transcript)
99
One SLP I know

• Tells all parents of her /r/ kids that all
  liquids have to be drunk through a
  strawbeginning today!
• NO MORE SIPPY CUPS
• One child had pudding races with her little
  brother

100
Have the client practice
101
B. /r/ WITH SMALL CHILDREN

• Hodson believes that we can begin working on /r/
  when children are as young as 3 or 4
• With these little ones, we dont drill to
  precisionbut we get it on their radar

102
How do we do this with young kids?
103
For example, when they are reading books with
their children

• Point out /r/
• Oh, there is your special tiger sound!
• I ask parents to model correct /r/ productions
  regularly
• BUTdo not push the child too hard to produce it

104
C. SPECIFIC TECHNIQUES
105
It is best to start each session
106
(No Transcript)
107
We need to be sure

• Children are sitting up straight with their feet
  on the floor
• Their bodies need to be stable

108
It is very important
109
(No Transcript)
110

• I like shaping /r/ from /i/--eeeeeeeerrrr
• Helpful to smile cant make a /w/

111

• A great technique is from PROMPTthe SLP puts
  her fist under the clients chin and pushes
  upwardthis elevates the tongue
• We can use a tongue depressor to push the
  clients tongue back in her mouth

112
The biggest thing with /r/

• Is PRACTICE
• /r/ is hard strong lingual muscles are needed
• If the client doesnt practice, no progress!

113
Remember that the foundation of all
articulation therapy is

• PRACTICE
• Retraining the muscles
• Repetitions!!