Willis/Pancamo TREATMENT METHODOLOGY FOR ARTICULATION AND
PHONOLOGY
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Intervention What should be the therapy targets? What treatment
approach should I use?
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Training Approaches Vertical/Deep intense practice on a limited
# of targets. Tx moves through a hierarchy of difficulty. Tends to
be most appropriate for kids with relatively few errors. Horizontal
attacks goals broadly; assumes that simultaneous exposure to a wide
range of targets will facilitate production of phonemes or sd.
patterns. Tends to be most appropriate for client with multiple
errors Cyclical - client practices given target for predetermined
amount of time, then moves on to another target. Focus on the
original target resumes later on in the tx program
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Articulation Model vs. Phonological Model Articulation Model
emphasizes the motor component of speech. Focuses on the incorrect
production of individual phonemes. Phonological Model emphasizes
the linguistic component of speech. Focuses on rule-governed errors
that affect multiple speech sounds and follow a predictable
pattern.
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Intervention Approaches for Phonological Disorders Phonological
Process Targets Used for children with phonological disorders who
exhibit multiple phonemic errors with poor intelligibility Cycles
approach Very structured Begins with the sound the child is most
stimulable for Utilizes auditory bombardment Metaphon Approach
Incorporates the child as an active cognitive participant So, the
child must be aware of his incorrect productions, want to modify
it, and have the neuromotor capability of accurately producing the
target sound
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Intervention Approaches for Phonological Disorders When using a
phonological processes approach, teach the underlying concept in a
non-speech task before introducing it in a speech task Phonological
Processes that a child uses only occasionally may be more easily
modified If using distinctive feature approach, early targets
should only differ by one feature to increase success Distinctive
feature approach predicts generalization based on phonemes with
common features. So, probe ahead to see if spontaneous acquisition
has occurred Parent training/education
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Intervention Approaches for Articulation Disorders
Single-Phoneme Targets Perceptual/Ear Training Identification of
the target sound Location of the target sound Stimulation
Discrimination Production Training Stabilization Carry
Over/Generalization
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Intervention Approaches for Articulation Disorders
Stimulability Training Used to increase the number of sounds in a
child with a very limited phonemic repertoire (e.g. Developmental
Apraxia)
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Selecting Goals Developmental Approach tx targets are
identified based on the order of acquisition in normally developing
children Nondevelopmental approach tx targets are chosen
specifically for each client Targets that are most relevant to
child or family Targets that are most stimulable Targets that are
most visible when produced Targets that will result in greatest
gain in improving overall speech intelligibility
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Influences on Intelligibility Articulatory Omissions
Substitutions Distortions W I W M W F Errors that occur on the most
frequent sounds in a language Phonological W I Consonant Deletion
Glottal replacement of W M consonants
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Influences on Intelligibility
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Tx for a Functional Disorder Helpful Hints: Do not include more
than one error sound in a stimulus word, phrase or sentence in the
initial stages of therapy Pay attention to phonetic context of
words that contain the target phoneme. Tx sessions that elicit the
greatest # of sound productions will be most effective in
establishing correct production as an automatic behavior Evaluate
oral motor function Use books that contain target sounds as
immersion activities (www.speechville.com, worksheet on
Moodle)www.speechville.com Instruct parents to respond consistently
to the content of the childs utterance before pointing out speech
errors or modeling correct productions
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Tx for Organic Disorder The selection of initial therapy
targets for organic disorders is based on developmental approach
b/c the accompanying articulation deficits are the direct result of
structural/neurologic anomalies and are not developmental in
nature
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Therapy Guidelines Hierarchy Isolation with model Isolation
without model Syllable level with model **** Syllable level without
model**** Word level with model Word level without model What
position in words? Carrier phrase with model Carrier phrase without
model Phrase with model Phrase without model What position is the
target word within the phrase? Sentence level with model Sentence
level without model Structured Activity Spontaneous (Connected)
Speech
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15 Session Design Basic Training Protocol 1. Clinician presents
stimulus 2. Clinician waits for client to respond 3. Clinician
presents appropriate consequence or event. 4. Clinician records
response 5. Clinician removes stimulus
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16 Session Design Task Order easy -hard-easy Work
Efficiency/Pace Each session should provide the client with the
maximum # of opportunities to practice target behaviors The pace of
each session must be geared to the learning styles and rate of each
client
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17 Session Design Materials Should be client specific based on
age, developmental level, language level and gender. Should be
interesting to that client Avoid time-consuming or complicated
activities that result in decreased # of client responses/session.
Proxemics Should be socially/culturally acceptable Sitting very
close to a child can aid in reducing impulsive or distractible bx
Can change depending on the specific activity you are doing
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18 Key Teaching Strategies Direct modeling- clinician
demonstrates a specific bx to provide an example for the client to
imitate. Used in early stages of tx (establishment) or when tx bx
shifts to higher level of difficulty Indirect modeling- clinician
demonstrates a specific bx frequently to expose the client to
numerous well-formed examples of the tx bx. Shaping by successive
approximation tx bx is broken down into small components and taught
in an ascending sequence of difficulty. Prompts clinician provided
additional verbal or nonverbal cues to facilitate a clients
production of a correct response Attentional, using exaggerated
loudness or duration, hand cues, verbal cues, written cues
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19 Key Teaching Strategies Fading - stimulus or consequence
manipulations are reduced in gradual steps while maintaining the
target response. Client produces multiple imitations for each
clinician model Progressive reduction of the length of the bx
modeled by the clinician Expansion- clinician reformulates a
clients utterance into a more mature or complete version Negative
practice- client is required to intentionally produce a tx bx in
error Best used on a short-term basis, only after the client
demonstrates the ability to produce a given target consistently at
the level of imitation Target specific feedback clinician provides
specific information regarding the accuracy or inaccuracy of a
clients response relative to the specific target bx
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20 HOMEWORK Useful after the establishment and stabilization of
tx bx has occurred Promotes generalization Purpose of HW is to
provide practice of an existing skill rather than teaching a new
one Should be given only after client has demonstrated a basic
ability to accurately evaluate his or her own performance Assigned
in amounts that are perceived as manageable by the client/fmly
Should be assigned on a regular basis Should be given with simple
written instructions
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Oral Motor Considerations Speech is not an isolated act but the
product of a highly complex and synchronized oral motor system.
Oral Motor function affects neuromuscular control and organization
needed for the production of intelligible speech. OM deficits
include: hypersensitivity, hyposensitivity, weakness, and
incoordination of oral structures
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Oral Motor Therapy To do or not to do Proponents: Speech is
founded on earlier developing non-speech motor patterns. Reduced
muscle tone in the oral-facial area results in limited strength of
the articulators used for speech. Normal movement and sensation
significantly influence motor learning. (Piaget) Speech is highly
complex and is more easily learned when it is broken into smaller
components (when you have to teach it that way)
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Oral Motor Tx To do or not to do Nay Sayers Little
evidence-based research to demonstrate causal relationship rather
than correlational relationship. (See handout on Moodle for
additional info)
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Oral Motor Tx Potential Candidates Weak production of
bilabials, droolers Poor production of sounds requiring tongue
elevation Poor differential production of midrange vowels
Hypernasality Forward resting posture of the tongue
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Basic Goals of an OM Program Heighten consciousness of the oral
mechanism Normalize sensitivity to stimulation in the oral area
Inhibit primitive or abnormal oral reflexes in order to enhance
normal movement patterns Increase differentiation and stabilization
of the oral structures Refine articulation movements by increasing
the strength and ROM of the oral mechanism
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Hierarchy of OM Treatment 1. Address Postural & Positioning
Issues 2. Normalize oral sensitivity 3. Increase Jaw Control 4.
Increase Muscle Tone in Lips 5. Increase Muscle Tone in Tongue
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Oral Motor Treatment General Guidelines Apply stimulation
systematically and follow the same sequence of steps each time Work
from outside-in Use firm, slow touch vs. light, quick strokes Use
visual feedback (mirror) to facilitate childs ability to categorize
new perceptions and improve tolerance of stimulation Explain
procedures before and during implementation