The Role of Speech Perception Training in Phonological Intervention

1
The Role of Speech Perception Training in
Phonological Intervention

• Bronwyn Carrigg Elise Baker on behalf of EBP
  Paediatric Speech Group 2011
• NSW Speech Pathology EBP Network

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• What is Speech Perception? Where does it fit?
• Phonological Processing broader term describing
  the use
• of phonological information to process spoken and
  written
• language (incl PA, Phon Working Memory, Phon
  Retrieval)
• Speech Perception and Phonological Awareness
  comprise
• different aspects of phonological processing. In
  speech
• perception tasks (such as mispronunciation
  detection),
• child does not have to segment words into smaller
  units,
• as required in PA tasks.

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• Speech Perception
• continuous acoustic signal -gt discrete
  linguistic unit
• most models assume a multistage process by which
• Acoustic Signal -gt Phonetic Units -gt
  Phonological Rep
• depends on detailed acoustic-phonetic
  representations
• word/sound identification tasks (point to shoe
  or X)
• Phonological Awareness (PA)
• depends on segmented phonological representations
• conscious awareness of sound structure of words
• matching manipulating sound structures eg
  syllables
• appears to be core deficit in SLI, SSD, Dyslexia
• (Rvachew Grawburg, 2006 Snowling et al 2000
  cited in Rvachew.S. 2006)

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• Speech Perception Phonological Awareness are
  related
• half sample with SSD had poor speech perception
  PA
• speech perception is pivotal in PA emergence
• speech perception receptive vocab jointly
  predicted PA
• speech perception receptive
  vocab-gtPA-gtemergent lit
• articulation accuracy did not predict PA
• reciprocal relationship (PAlt-gtvocab PAlt-gtemerg
  literacy
• Cautionhalf sample had adequate speech
  perception PA
• (Rvachew Grawburg, 2006, 95 preschoolers with
  SSD with normal comp)

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Development of clinical question

• Decided to focus on
• Role of speech perception tasks rather than PA
  tasks in Rx
• Studies comparing Perception Production vs
  Production Rx
• Studies using SAILS speech perception program
  (multiple speakers producing normal and
  misarticulated versions of tgt)
• PICO Clinical Question

In children with phonological impairment does the
SAILS speech perception program plus production
training compared with production training alone
lead to better speech production outcomes? (x4
studies)
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Rvachew, S (1994) Speech perception training can
facilitate sound production learning. JSHR, 37,
2, p.347

• Speech Perception Production vs Production
  only
• 27 children mod-severe SSD, 3 groups, 6 sessions,
  unstimulable /sh/
• 60 production trials/session. 60 speech
  perception trials/session
• Group 1 perception task correct/incorrect
  versions of shoe
• Group 2 perception task listened to shoe vs
  moo
• Group 3 control group, no perception task but
  computer game.
• Conclusion Overall, children receiving
  Perception Production Rx
• made greater speech improvement than Production
  Only group on
• non-stimulable sounds

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Rvachew, Rafaat, Martin (1999) Stimulability,
speech perception skills and the treatment of
phonological disorders AJSLP, 8, 33-43

• Speech Perception Production vs Production
  only
• Group 1 n10, 9 group Rx sessions cycles
  (incl audit bombardment)
• Group 2 n13, 6 group Rx sessions cycles
  (incl audit bombardment)
• plus 3 individual Rx
  (stimulability perception SAILS)
• Conclusion Group who received speech perception
  stimulability
• production training made more gains than
  production only group,
• especially on non-stimulable or poorly perceived
  sounds

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Wolfe, Presley, Mesaris (2003) The importance of
Sound Identification Training in Phonological
intervention, AJSLP,

• Speech Perception Production vs Production only
• 2 treatment groups (n4, n5), PSK severe SSD,
  11 sessions
• Group 1 Production only Rx
• Group 2 Production Speech Perception Rx
• Conclusion on speech error sounds that were
  stimulable pre-Rx
• Well identified/perceived errors (pre-Rx) No
  difference
• Poorly identified/perceived errors (pre-Rx)
  Mixed better
• Production only training improved perception

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Rvachew, Nowak et al (2004) Effect of phonemic
perception training on speech production and
phonological awareness skills of children with
expressive phonological delay. AJSLP, 13, 250-263

• Speech Perception PA Production vs Production
  only
• n34, PSK, mod-severe SSD, mean Rx 12 sessions,
  variability in Rx
• Group 1 Production and Perception (16x15 min
  sessions SAILS)
• Group 2 Production only (16x15 min sessions
  computerised book)
• Perception Rx included generic phonemic
  perception, plus letter
• recognition, sound symbol ass, onset/rime
  matching (ie PA)
• Conclusion Mixed Rx (PerceptionPAProduction)
  led to greater
• gains in speech production and perception than
  production only group
• No differences in PA between groups.

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• Clinical Bottom Line
• In preschool children with SSD with speech
  perception difficulties
• the evidence suggests that speech perception
  training, specifically
• the SAILS program, plus production training is
  more effective at
• improving production of stimulable and non
  stimulable speech
• sounds than production only training.

• Production Only treatment also improves
  speech perception

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• Guidelines for combining speech perception
  training with
• production practise Authors caution that
• perception Rx should always be concurrent with
  production Rx
• production training should be explicit, ie
  including cues/prompts
• speech perception contrasts match contrasts
  for production Rx
• speech perception exercises based on childs
  sound errors may
• start with maximum distinctions later
  moving to finer distinctions
• Speech perception, like stimulability, may
  provide information about
• underlying phonological knowledge and may be
  useful to consider in
• selecting targets, predicting progress, as well
  as in treatment.

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Problem SAILS is for North-American speakers...

• POSSIBLE WAYS FORWARD...
• Australian adaptation of SAILS being investigated
  with Australian speakers of different ages,
  genders (contact Elise Baker if interested).
• Alternate suggestion in the meantime provided
  modified SAILS, using various people in the
  childs environment clinician, parents,
  siblings, grandparents
• The variety of speakers would provide the child
  with opportunities to better refine the childs
  underlying representation.
• Need to collected INTERNAL clinical evidence from
  everyday practice, to determine whether this
  modification would still be beneficial.

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• Current Topic Treatment in CAS
• Question 1 In children with Childhood Apraxia
• of Speech does Dynamic Temporal and Tactile
• Cueing (DTTC) lead to an improvement in
• speech production.

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References

• Rvachew, S (1994) Speech perception training can
  facilitate sound production
• learning. JSHR, 37, 2, p.347
• Rvachew, S (1994) Speech Assessment and
  Interactive Learning System SAILS
• AVAAZ Innovations
• Rvachew, Rafaat, Martin (1999) Stimulability,
  speech perception skills and the
• treatment of phonological disorders. AJSLP, 8,
  33-43
• Wolfe, Presley, Mesaris (2003) The importance of
  Sound Identification Training in
• Phonological intervention, AJSLP, 282-288
• Rvachew, Nowak et al (2004) Effect of phonemic
  perception training on speech
• production and phonological awareness skills of
  children with expressive
• phonological delay. AJSLP, 13, 250-263
• Rvachew, S (2006) Longitudinal Predictors of
  Implicit Phonological Awareness
• Skills, AJSLP, 15, 165176

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• Thank you to EBP Paed Speech members
• SWAHS, SSWAHS, HNEAHS, SESIAHS, NSCCAHS
• University of Sydney, Private SPs, Learning Links
  
• To join contact
• bronwyn.carrigg_at_sesiahs.health.nsw.gov.au