Willis/Pancamo - PowerPoint Presentation

Slide1

Willis/Pancamo

TREATMENT METHODOLOGY

FOR ARTICULATION AND PHONOLOGYSlide2

Intervention

What should be the therapy targets?

What treatment approach should I use?Slide3

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

programSlide4

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.Slide5

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 Slide6

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/educationSlide7

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/GeneralizationSlide8

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) Slide9

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 intelligibilitySlide10

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 Slide11

Influences on Intelligibility Slide12

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)

Instruct parents to respond consistently to the content of the child’s utterance before pointing out speech errors or modeling correct productionsSlide13

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 natureSlide14

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) SpeechSlide15

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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 stimulusSlide16

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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 clientSlide17

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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 doingSlide18

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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 client’s production of a correct response

Attentional, using exaggerated loudness or duration, hand cues , verbal cues , written cuesSlide19

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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 client’s 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 client’s response relative to the specific target

bxSlide20

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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 instructionsSlide21

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 structuresSlide22

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)Slide23

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)Slide24

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 tongueSlide25

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 mechanismSlide26

Hierarchy of OM Treatment

Address Postural & Positioning Issues

Normalize oral sensitivity

Increase Jaw Control

Increase Muscle Tone in Lips

Increase Muscle Tone in TongueSlide27

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 child’s ability to categorize new perceptions and improve tolerance of stimulation

Explain procedures before and during implementation