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31 Cards in this Set

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How do we know where to start when beginning therapy?

( 4 )
1) stimulability
2) correct production of the sound in specific context
3) sounds affecting intelligibility
4) developmentally earlier sounds
Stimulability
- can be used as a probe to find out which sounds might be somewhat easier for a cline to realize or produce
- if a client is stimluable for a particular sound, the clinician could attempt this sound in therapy for a trial period
- its not an absolute predicotr of which error sounds will imporvoe in therpay though
- stimulability means they are capable in some instances to create the sound, with help (ex: with a tongue depressor)
correct production of the sound in specific context
- some misarticulated sounds may be produced accurately in specific word contexts
- ex: use /k/ in his brother's name only
Sounds affecting intelligibility
- could be high frequ of occurence in conversation
- priority should be give to works affecting intelligibility the most
- ex: /s/
Developmentally earlier sounsd
- ex: p/b/m before th/j/l/r
Steps in Learning a Sound
- moving from imitation to spontaneous production
- see handout
5 Steps in Choosing a Sound Target
1) select your target sound
2) level
- ex: at the single sound, syllable, word, phrase, sentence or spontaneous
3) goal
- what % is correct imitated, prompted, or spontaneous
4) activity
- ex: fishing game
- what will we do to accomplish thte goal??
5) time/location
- when and where?
3 Methods of Producing a Speech Sound in Isolation
1) Auditory Stimulation/imitation
- therapist provides example and clien must imitate
- used first to try and elicit new sound
- clinician: "watch me and do exactly waht I do"

2) Phonetic placement method
- tell client how to position articulators to produce normal production

3)Sound Modification Method
- derive the target sound from a phonetically similar sound client can correctly produce, which is used as a starting point
- specific adjustment to the articulators are then suggested
Treatment of Phonemic Errors
- the treatment of phonemic errors are considerdd to be a ________ approach
- the ___ is the basic unit differentiated b/w word meaning
- intervention usually begins at the ____ level
- treatment usually focuses on _____
- the child's _____, NOT ____ is at the centre of the remediation process
- phonologically based approach
- the phoneme is the basic unit differnetiating between word meaning
- intervention usually begins at word level
- tretment usually focuses on the phonologcial system of the child (id: inventory of sounds ,error patterns,et), NOT the individual speech sound, is at the centre of remediation
What are the 3 basic principles that underlie most phonemic approaches??
1) Groups of sounds with similar patterns of errors are targeted (NOT sequential as when treating phonetic errors)
- Phonological contrasts are established b/w phonemes - often minimal pairs are used to contrast phonemes; if these distinctions can be made, one assumes that a child will generalize this knowledge to other phonemic contrasts

3) a naturalistic communicative cnotext is emphasized - work on individual sounds or nonsense syllables isn't usually a part of phonologically based therapy techniques
Two examples of Phonemic Approaches
1) Minimal Pairs Contrast Therapy
-> the theraputic use of pairs of words that differ by one phoneme only (ex: fin and pin)

2) Cycles Training
- phonological processes to be remediated are trained successivley during speicfic time periods known as cycles
- stimulates emergence (10-20%) , not mastery
- used in highly unintelligible children
- usually focuses on 2-3 sounds ex:
cycle 1 = stopping (1-3 X)
cycle 2 = fronting (1-3 X)
cycle 1, cyclec 2
Sample Therapy Session
- intro
- song
- story
- 1-3 games/activities
- craft
- closing song

- review progress w/ parent/caregiver
- record keeping

after session:
- charting
- report writing
What does SOAP stand for?
S-ubjective
O-objective
A-ssessment
P-lan
Gereral Overview of Therapy Progression (7 steps)
1) sensory-perceptual training/ ear training
2) production of sound in isolation
(thru aud stimulation/imitation, phonetic placement method, sound mod method)
3) nonsense syllables
4) words
5) structured contexts (phrases and sentences)
6) spontaneous speech
7) dismissal and re-evaluation criteria
4 stages of ear training
1) identification
2) isolation
3) stimulation
4) discrimination
How to Record Session Data
* also known as...
* trial =
* + =
* - =
* checkmark =
* NR =
- also known as online tracking of targets or data collection
- trial = each time you try and elicit a speech sound from a child is called a trial
- + is used when child achieves correct produciton on the first trial and - is used when child produces the sound correctly with a visual
clue
- checkmark used when child produces it correctly with a model (some clinicians use IM for this)
- NR refers to no response from the child
Recording Session Data guidelines
* see handout
Therapy for Phonetic Errors
- known as __ or __ approach
- phonetic errors are ____ problems
- what is involved in this approach?
- how does therapy progress?
- this approach often incldes tasks for improving auditory discrimination skills
- 'traditional' or 'motor' approaches
- phonetic errors are motor production problems
- using this approach, the client is directed to position the articulators in such a way that a spech sound is produced
- therapy progresses from 1 error sound to the next and each sound is treated individually
- this approach often includes tasks for improving auditory discrimination skills
Types of speech sound errors
* voicing/unvoicing
* substitution errors (including phonologfical errors such as stopping, fronting, etc)
* ommission errors
* distortion errors (ex: includes nasal emission - insufficient or excessive nasality, lateral or frontal /s/, whistling /s/, etc)
- cosmetic errorst (acoustically it sounds proper, but the way they produce it is wrong - usually these kids don't have therapy)
goals vs objectives
goals
- long term
- ex: Johnny will improve speech production
- not measurable
- more general

objectives
- short term
- ex: johnny will produce /k/ w/ 90% accuracy (measurable)
Substepping and Superstepping

- which is used more?
substepping = if a child has difficulty w/ a sound in word level, move down to work on the individual sound
- go back to what you know the child already knows

superstepping
- move up if child gets sound at word level, for example, them move up to sentence level

- substepping is used more than superstepping
Ecamples of speech goals
- increase or decrease rate of speech
- increase or decrease loudness
- increase tolerance to adult interference
- eye contact
- oral motor exercises
ex:
* blowing excersises
* jaw stabilization
* jaw grading
* lip rounding
* lip retraction
* tongue tip elevation
Therapy for Phonetic Errors
- known as __ or __ approach
- phonetic errors are ____ problems
- what is involved in this approach?
- how does therapy progress?
- this approach often incldes tasks for improving auditory discrimination skills
- 'traditional' or 'motor' approaches
- phonetic errors are motor production problems
- using this approach, the client is directed to position the articulators in such a way that a spech sound is produced
- therapy progresses from 1 error sound to the next and each sound is treated individually
- this approach often includes tasks for improving auditory discrimination skills
Types of speech sound errors
* voicing/unvoicing
* substitution errors (including phonologfical errors such as stopping, fronting, etc)
* ommission errors
* distortion errors (ex: includes nasal emission - insufficient or excessive nasality, lateral or frontal /s/, whistling /s/, etc)
- cosmetic errorst (acoustically it sounds proper, but the way they produce it is wrong - usually these kids don't have therapy)
goals vs objectives
goals
- long term
- ex: Johnny will improve speech production
- not measurable
- more general

objectives
- short term
- ex: johnny will produce /k/ w/ 90% accuracy (measurable)
Substepping and Superstepping

- which is used more?
substepping = if a child has difficulty w/ a sound in word level, move down to work on the individual sound
- go back to what you know the child already knows

superstepping
- move up if child gets sound at word level, for example, them move up to sentence level

- substepping is used more than superstepping
Ecamples of speech goals
- increase or decrease rate of speech
- increase or decrease loudness
- increase tolerance to adult interference
- eye contact
- oral motor exercises
ex:
* blowing excersises
* jaw stabilization
* jaw grading
* lip rounding
* lip retraction
* tongue tip elevation
Before you even work on a speech sound, child must be able to...
- hear the sound and the discriminate the sound (auditory discrimination)

- visual discrimination
ex: knowing funny bunny is /f/
4 Sound Stimulation Techniques
1) modelling
- repeat the word, then the sentence of the sounds produced incorrectly
- add stress to the corrected sound

2) labelling
- name objects correctly that have the sounds in error
(Ex: look, a Car)

3) Imitate
- if the child produces the sound correctly, repeat it back in the word they used, then in the sentence

4) prompting
- give the child choices for the correct production; however be sure they can produce the sound
- pretend you can't say the word
Eliciting /f/ and /v/
- point to upper lip
- say your voice is turned off
- smile - aski child to smile a little and bite down lightly on the lower lip and blow
- place honey on the lower ilp and ask them to scrape it off with upper teeth
- ask them to blow a feather
eliciting /k/ and /g/
- model and point out that the back of tongue goes up, and theres a sudden explosion of air
- show a picture of the back of the tongue going up
- press up under the child's chin, raising the back of the tongue and ask child to whisper 'kuh' as you release
- use tongue depressor to hold tongue behind lower teeth
- ask child to swallow
- touch child's soft palate with a cotton swab thats been rubbed over a lifesaver
- have them lie down
- use a pretzel stick to get the tongue to go back in reflex