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54 Cards in this Set
- Front
- Back
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Sequence of Speech Instruction for Remediation Procedures:
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1. Antecedent events-stimulus events presented by the clinician
2. Responses-production of a target behavior 3. Consequent events-reinforcement or feedback that follows a response |
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Best Remediation for Client and Diagnosis?
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*Individual vs group vs class
*Length of session *Length of treatment *Intervention style -drill -drill play -structured play -play |
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Establishing Goals
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*Using the analysis of formal and informal measures, the clinician determines what sound or process will be targeted first. (dev. norms, standardized norms, freq. of occurance, stimulability)
*Write long term goals *Write short term goals |
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Measuring Progress
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*Pre-test and post-test (do initial, medial, final position)
*Record responses quantitatively and qualitiatively (video, audio, paper/pen) each session! (Need numbers for insurance purposes, prove progress) *Chart progress each date to determine if criterion has been met across 2-3 sessions. (IQ focus, physical movement (ie jaw data need 90% accuracy accross 2-3 sessions so client doesn't regress. prove client is ready to move to next step, set consistant goals) |
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Reinforcement
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*Tangible
-sticker, check mark/star, token, privilege -Careful of food (allergies), and too many can make you broke, and kids will become dependent *Verbal -Great/good job, wow, hurray, not quite your getting closer -What you do for one, do for all. -Verbal reinforcement is best. |
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Three Stages of Treatment
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*Establishment-eliciting the target behavior and then stabilizing it
*Generalization-facilitating transfter and carryover of a behavior accross different speaking situations and environments (ask them where to put things. Make the client the teacher-helps to generalize) *Maintenance-stabilizing the behavior as a habitual or automatic speech pattern, Involves self-regulation and correction |
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Stage One: Establishment
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*Perceptual Training-ear train or sound discrimination. Have two words-same or different? change one phoneme
*Production Training-eliciting the sound |
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Levels of Linguistic Complexity
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*Isolated sound
*Syllable *Word *Phrase *Sentence *Conversation |
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Articulation Positions
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*Initial-prevocalic
*Medial-intervocalic *Final-postvocalic (you can change the order in which you work on these) |
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Phonological Processes Treatment
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Start with the processs that either
-most effects intelligibility -occurs most frequently -one that is easiest to resolve based on age and ability (ie gliding of liquids in an older child is easy to resolve, postvocalic r hardest to resolve. stopping is difficult, and fricatives affect so much) |
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Teaching Strategies
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*Imitation-say like me
*Phonetic Placement-voice/manner/place *Chunking-break down word *Contextual/Bridging-start and end with word that has the same phoneme (dig-go) *Shaping-hold /t/ out and get an /s/ *Imagery-blowing sounds = fricatives, popping = stops |
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Stage Two: Generalization
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The learning process where by the client uses the target sound/pattern with some ease in other linguistic contexts. Then they transfer use to non-clinical settings
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Five Types of Generalization
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*Across position-prevocalic, intervocalic, final position, get sound in any part of the word
*Across phonetic context-say phoneme in blends /s/ blends, /l/ blends *Across linguistic unit-syllables to words, words to sen., to conv. *Across sound and feature-make sure all cognates are good. Turn voice on! /s/ to /z/ *Across situation-conversational practice ~See pg 285~ |
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Stage Three-Maintenence
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*The new speech behavior becomes automatic and retained
*Dismissal criteria is met through monitoring over time *Maintenence phase is the final opportunity for the clinician to monitor, reinforce, and encourage the client to assume responsibility for habituation of the new speech patterns (kids forget over breaks, adults are invested in change) ~See pg. 276~ |
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Oral Facial Exam
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*Use universal precautions
*Have adaquate materials and lighting *Record findings |
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Oral Exercises
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*Oral aerobics
*Can do oral exercises *Pamella Marshella's programs for eliminating habits and facilitating sounds *Charlotte Boschart's sensory normalization techniques and excersises *Sara Rosenfeld-Johnson's hierarchies *Other resources |
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Myofunctional Programs
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*Taming the Tongue Thrust
*Swallow Right *Swallow Work *Other resources, programs avalible at the clinic |
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Evidence for Oral Motor Training
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*Controversial in treatment of articulation in children with no motor control problems
*Is there evidence to support the need to use oral-motor training as part of artic/phonological instruction? *Procedures and efficacy? ~See oral motor article on BB~ |
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Traditional Treatment Approach
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*Formulated in early 1900's
*Published by 1930's formally by Charles Van Riper (takes clients up the latter-syllables, words, convo/initial medial final. Riper also published on stuttering) *Motor based and comprised of perceptual training, produciton training and strategies. |
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Secord (1989) Substages of Word Level of Production (Traditional Approach)
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*Initial prevocalic words (1 syllable)
*Final postvocalic (1 syllable) *Medial intervocalic (2 syllable) *All word positions (1-2 syllables) *All words all positions *All words, all positions, multiple sounds -Stages are goal levels for clients. Adapt to IEP, modify to suit client, for typical artic kids-substitution / deletion / omission |
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Multiple Phoneme Approach
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*Motor based approach allows the client to work on several sounds in the same session across levels of production (like initial /f/ and final /k/, work on multiple sounds)
*Includes specific criterion levels to be achieved across several sessions |
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Motokinesthetic Approach
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*Involves traditional therapy (initial, medial, final posit) with tactile cues on the face and upper body to elicit sound productions
*Jelms cues, MK cues (very specific hand postures, hard to remember) -Like the prompt method, not good for sensory patients, need phonetic placement cues and artic ~Watched video "it takes two to talk" in library based on approach |
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Contextual or Sensory-Motor Based Approach
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*Focuses on producing speech sounds in phonetic (syllable based) contexts, rather than in isolation (McDonald 1964)
*Uses sequential phonetic context with varying stress patterns (lala, lalala, LAlala) (vary stress patterns to generate sounds and suprasegmentals) *Hoffmen et al 1989 had a variation of approach that facilitated automatization of new behavior-sequenced production tasks *Clinician focus on stimulability to find target, then imitation and sequential phoneme productions from isolation to short sent *Watchsun, watch-sun, watchsss-un (doesn't relate to most kids, SLP's had to create their own) *Client and clinician work to gether to match production *Client assumes responsibility on word level to self-monitor |
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Linguistic Based Approach
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*Involve the relationship between rules of phonology and how sounds interact
*Whearas motor based approaches focus primarily on the remediation of individual sounds (articulation) |
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Examples of Linguistic Approaches
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*Distinctive Feature Approach
*Minimal Pair Contrast Approach *Cycles Approach |
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Distinctive Features Approach (Linguistic)
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*Focus is to establish a feature that is lacking in the clients' repertoire
*Features established in one sound will generalize to other sound segments in which the target feature is absent (1972) -ie teach /s/ to generalize /z/, obstruent, strident, cognates, continuant +/-(fa-pa, fi-pi, fo-po) nasal +/- (meat-beat, bat-mat) front/back +/- (tea-key) |
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Minimal Pair Contrast Training Approach
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*Uses pairs of words that differ by a single phoneme (production) in order for the client to differentiate one word from another (perceptual).
-Also called minimal pairs -Word games use /s/ vs /sh/ memory games -final consonant deletion (bee-> beet, beef, beak, bean) -Velar fronting (tea-key, take-cake, done-gun) -Minial opposition (sun-ton = manner) (thumb-sum = place) -Maximal opposition (chain-main = manner nasality place) (gear-fear = manner, place, voicing) |
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Paired Stimuli
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*Find a word the kid can say, such as /k/ey.
*Use the word as a training word for other words in the inital position (kite, cup, kick) *What child can do translates to what child couldn't do (more of strategy than approach) |
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Cycles Approach
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*Designed for highly unintelligible children with deficient phonological patterns (1991)
*Focuses on helping children acquire appropriate phonological patterns based on stimulability and at least 40% of occurance during pre-testing (Barbara Hodsen who developed this is great according to Michelle) |
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Instructional Sequence for Cycles Approach
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*Review of previous session
*Auditory bombardment *Target word cards created *Production practice *Stimulability probing *Auditory bomardment *Home program Ex: week one work on /sp/, week two /sm/ and /sp/, week three /sp/ /sm/ and /sn/ etc. after 7-14 weeks of therapy you can clear up /s/ blends |
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Broader Based Language Approaches
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*For children with severe phonological and other language imparements
*Norris and Hoffman (1990) developed a storytelling language-based approach based on narrative construction to also address phonology, semantics, and syntax -narratives can arise from spontaneous events / routine / planned instruction -Scaffolding strategies in the form of prompts, questions, restatements, and offering information to support utterances are utilized (ie focus on plurals to stop final consonant deletion) |
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Approaches for Developmental Verbal Dyspraxia / Childhood Apraxia of Speech
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*DVD/CAS involves
-motor (articulation) -linguistic (phonology, morphology, syntax, prosody) -social and behavioral deficits(1984/89) -consider this when we have a kid with apraxia. mostly descriptive, no numeric testing. -oral exam, automatic and volitional movement use Apraxia Profile Test (popular) or Kauffman Speech Praxis Test |
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Goals for Therapy with CAS or DVD Children
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*Build a functional and meaningful vocabulary for the client by attending to the syllable structures and combinations of these syllables to form intelligible words (book rec. "moving accross syllables" start CVC bilabials, then interdentals, then alveolars. motor planning. Also Speech Praxis Kit is similar)
*Emphasizing speech and language motor planning to shift between syllables and increase linguistic complexity |
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Programs for DVD / CAS
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*Tactile-kinesthetic (Prompt, Jelm's cues/MK cues)
*Rhythmic and melodic facilitation (Melodic Intonation Therapy) *Shaping (Kaufman Speech Praxis Kits) *Gestural Cueing (Signed English, ASL) *Augmentative Communication Systems |
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English Dialects
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Speech difference not a disorder
-general American English, Southern White Standard, Appalachian English, Carribean English, African American English etc. ~ pg. 238 ~ |
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Register
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Form of speech that varies based on participants, setting and topic.
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Pidgen
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Form of language adapted to bridge between two languages. Creates a third language that uses the two. Also called trade languages.
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Creole
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When pidgen stays and creates a whole new language with rules.
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Spanish Phonology
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When compared to English...
*5 vowels, two front, three back (i,e,u,o,a) *18 phonemes (p,b,t,d,k,g,f,x,s,ts,w,j,l,m,n,ng,trill r,and flap) ~ pg. 258 ~ |
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Asian Languages
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*Many, but not all Asian languages are tone languages. The difference in word meaning are the result of changes in pitch
*Cantonese, Mandarin Chinese, Korean, Hawiian, Hmong *Japanese is not a tone language *Vary widely in phonology *When compared to English, the similarities among Asian languages are limited number of final consonants in syllables and few consonant clusters *Register tones and contour tones signal difference in word meaning ~ pg. 266~ |
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Dialect Assessment Considerations
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*Asha's position paper on social dialects officially acknowledges the distinction between a speech-language difference and a speech-language disorder
*Become aware of your own dialectical influences as well as attitudes and biases regarding other cultures *Use culturally sensitive assessment tools *Include formal measures (instrument stamdardized on speakers from the particular language) and informal measures (spontaneous language sample) *Consider collaborating with a billingual consultant or diagnostician *Consider training a billingual aide or a professional interpreter to assist with testing *Consult with ASHA's network of billingual SLP's (parents can be hard, interpreters are good resources) |
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Intervention Considerations (Dialect)
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*Become trained through further educational opportunities (phonological patterns of the language, accent modification, adaption of English based treatment approaches)
*Treat the disorder. Treat the difference only if "elected" by the client |
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Definition of Phonological Awareness
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*The ability to identify specific linguistic units (phonemes, syllables, words, etc.)
*This awareness is "sublexical"-at a level apart from meaning, and "metalinguistic"-language as an object of thought *Synonymous terms include phonological processing, phonemeic awareness, phonetic awareness (PA), and phonological sensitivity ~ pg. 187-188 / pg. 511-517 ~ |
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Shallow Levels of Phonological Awareness
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*Where a child recognizes similarities between word pairs such as rhyming (mall-ball)
*Similar initial consonant (me-moon) *Child cannot explain why or how these words share the same phonological elements *Child is becoming sensitive to larger units such as words and syllables (toddler skills, sound fun) |
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Deep Levels of Awareness PA
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*The child has more conscious awareness of phonological elements and can manipulate, compare and contrast across phonemes, syllables, and words
*Generating rhyming chains *Segmentation of sounds, words, sentences *Deletion of segments "track/ rack" *Substitution "mop to map" (asking a kid to change vowel or consonant is a deep cog. ability) *Sound blending and decoding |
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Development of PA
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*Occurs along a continum of shallow to deep
*Generally ages 2-9 years *Facilitates -emergent (prerequisite, involves rhyming) and -conventional (actual reading and writing) literacy development *Skill level I. identify hard words to say II. rhyming words III. blending sounds together to read words, make jokes, word play |
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Earliest Sensitivity to Words
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*Awareness of rhyme (2 yrs)
*Awareness of alliteration (3 yrs) *Awareness of syllables (4 yrs) *Awareness of phonemes (6 yrs) Initial, Final, Medial (easiest to hardest) |
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Reading and PA
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*A child's phonological awareness skills have show through research to be a predictor of reading achievement
*Two critical areas of knoweldge for the beginning reader are letter name knowledge and phonemic awareness. (1987) * Beginning readers who are deficient in grapheme/phoneme relationships, onset/rime and isolation of beginning or ending sounds have a more difficult time learnign to read (1994) |
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"Phonological Recoding" or "Grapheme/ phoneme relationships"
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In order to decode a new word, a reader must know sounds, letters, and be able to bridge the two together.
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Relationship of PA with Speech Production Disorders
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*Children with early speech and language disorders are at greater risk for difficulty with phonological awareness (and later spelling and reading), especially if they present phonological rule-based disorders (1995).
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Assessment of PA
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Use of standardized (norm-referenced) measures:
1. Comprehensive Test of phonological processing CTOPP ages 5-24 years 2. The Phonological Awareness Test ages 5-9 years 3. Test of Phonological Awareness for ages 5-8. |
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Intervention for PA
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*Goals are for the child to learn
-alphabet letter names and corresponding sound -sentences are comprised of words -words consist of sounds *Activities for phonological awareness should be embedded into therapy for children who have speech and language disorders. Ex: write words on all stimulus cards with pictures, create stories with target sound, alphabet strip to assist with rhyming chains, books and games that incorperate rhyme and alliteration, draw childs attenciton to phonological structures such as rhyme, beginning sound, ending sound |
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Classroom Bassed Collaboration of PA
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*Opportunity for teacher and SLP to work together to instruct all children
*PreK and kindergarden classes are an ideal starting point because kids are learning to read and phonological awareness is key |
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Direct Instruction of PA
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*Older children, 2nd grade and beyond benefit from direct instruction to address specific areas of need in reading, writing, spelling, and phonological awareness.
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