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By 2020 50% of our children attending
public schools will come from culturally and linguistically different (CLD)
backgrounds.
By 2050 50% of the total population will
be from culturally and linguistically different (CLD) backgrounds.
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TREATMENT STRATEGIES for clients with a sound system disorder concomitant with a language, fluency or voice impairment
- Simultaneous
- Concurrent
- Cyclic
- Sequential
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Question: How do we treat children with an artic/phono disorder concomitant (at the same time) with one or more other speech and/or language disorders?
If the goal is to improve in both domains, the cyclic and concurrent approaches seem to be the most appropriate.
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Should I use a phonetic or phonological treatment approach ?
Select the approach that best matches the client’s diagnosis: phonetic, phonological, mixed or apraxia.
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Use Phonetic (motor) Approaches if...
- If the individual does not articulate sounds correctly because of:
- 1.Inappropriate placement of the articulators
- Interdentalized /s/
- 2.Inappropriate modification of the airstream
- lateralized /tS/
- The client is intelligible, uses a few misarticulated sounds, or distorts speech sounds.
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Phonological Approaches
These approaches are for clients who are unintelligible and have multiple misarticulated sounds.
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Treatment Approaches for Phonetic Disorders
- Emphasis is on motor or movement components of sounds in terms of visual, auditory, and kinesthetic changes.
- Major approaches:
- Phonetic
- placement
- Moto-Kinesthetic
- Stimulus
- Sensory-Motor
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Treatment Approaches for Phonetic Disorders
Criteria for Target Selection
Most People agree--begin with a misarticulated phoneme(s) that are relatively easy for clients to produce.
- Variables to Consider:
- Earlier vs. Later developing phoneme
- Stimulable vs. nonstimulable phoneme
- Phoneme produced correctly in Key word
- Frequently Occurring Phoneme
- Visible Phoneme
- Consistently misarticulated phoneme
- Phoneme that the Client/others desire to target
- Phoneme for which a Client has been criticized or penalized
- Phoneme that is omitted or an atypical substitution
- Phoneme least affected by physical limitations
- Same phoneme for client group
Probably 80% of the time we will choose the stimuable sound over the nonstimulable.
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Evidence Based Triangle – Evidence Based Practice – Research, Experience, and Client Values
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Treatment Approaches for Phonetic Errors
Phonetic Placement Approach emphasizes:
- 1.Placement of the articulators
- 2.Modification of the airstream
Premise is that an individual does not articulate sounds because of faulty articulatory placement or modification of the airstream.
- You may choose this approach because you
- know that the articulator needs to be in a specific place and it isn’t,
- The Late Eight by Ken Bleile.
- Working on things when they are destabilized because we aren’t stable on a regular basis. So that they generalize.
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Treatment Approaches for Phonetic Errors
Phonetic Placement Approach-placement of articulators
Intervention:
Teach appropriate placement by physically assisting placement
- Tongue: touching the alveolar ridge with a tongue depressor
- Teaching appropriate modification of the airstream by using a straw.
- Diagrams
- Demonstrations
- Use considerable repetitive practice.
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Treatment Approaches for Phonetic Disorders
Phonetic Placement is still used:
particularly in early phases of articulation intervention to demonstrate how a phoneme is produced.
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Treatment Approaches for Phonetic Errors
Moto-Kinesthetic Approach
- Premise: speech is not a series of static positions, but a dynamic event.
- Sound productions rely on a motor process of shaping or obstructing exhaled air
- This approach involves external manipulation of the articulators.
- Movement must be “felt” and developed as a muscle sense of kinesthetic image
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PROMPT – Prompts for Restructuring Oral Muscular Phonetic Targets
- most widely used moto-kinesthetic approach. These teaches clients for positions for the sounds and how to move from one sound to another.
- Speech isn’t static (stationary, non-moving) it is dynamic (moving).
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Moto-Kinesthetic Approach continued
- Focus on the feelings of where sounds occur and the movement between sounds.
- Association is made between the feeling of the movement and the simultaneously produced
- auditory model.
- Feel movement as sound is produced first in syllables with schwa) then
- -Reduplicated syllables
- -Multisyllablc words,
- -Phrases,
- -Sentences.
- Tactile cuing is part of M-K approach
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Sometimes we get caught up on having them watch how we pronounce it when we should be helping them to make the sound and see/know the sound themselves.
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Treatment Approaches for Phonetic Disorders
Stimulus Approach
- Van Riper’s—referred to as the traditional approach.
- Van Riper viewed misarticulations as more than placement or Production errors.
- -He viewed poor auditory sensory perception as a contributing factor in misarticulations.
- -Advocated auditory or ear training prior to production practice of individual sounds to stimulate the sensory perception of the phoneme.
- -Targeted 1 phoneme at a time
- Speech Correctionists used this in the 1970s.
- This is the correct approach for some kids with articulation disorders, but not for kids with phonological disorders.
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Stimulus Approach (Traditional)
3 Phases:
- Phase 1: Auditory Training
- Phase 2: Production
- Phase 3: Transfer of the sound production to other settings and Carryover and Maintenance of the sound in conversational speaking
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Phase 1: Auditory Training
- 1.Identification: Naming of the target sound using a descriptive cue
- /s/=snake sound /f/=mad kitty sound
- 2. Isolation- identifying the sound of the position of the sound in a word phrase or sentence (beginning middle or end).
- 3.Auditory stimulation using the target sound in a variety of activities, tongue twisters and sound-loaded sentences.
- She sells sea shells by the seashore
- 4.Discrimination of the “new” target sound from the client’s errors.
- 5.Self-hearing where the client identifies own errors.
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There is lots of evidence to support using literature for language therapy.
Book: Books are for Talking Too.
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Phase 2: Production
- Sound elicitation established by:
- isolation
- stabilization in isolation
- nonsense syllable
- words
- sentences
- Very methodical and you must meet your 80% accuracy until you move to the next thing.
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Phase 3: Transfer of the sound production to other settings and Carryover and Maintenance of the sound in conversational speaking:
- Facilitated through speech assignments at home, school, or in the community
- Self monitoring
- Practice with various conversational partners in various settings.
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Treatment Approaches for Phonetic Disorders
Sensory Motor Approach (McDonald, 1964)
- Follows this sequence:
- Heightened awareness of the speech movement patterns through bi-syllable and tri-syllable productions
- Correct production of sound sequences in syllables
- Correct production in varied phonetic contexts
- Primary goal of the program is to increase the child’s auditory, tactile, and proprioceptive awareness of the motor patterns involved in speech sound production through motor tasks.
- This is an old approach. It starts in syllables, teaching client how to move from sound to sound.
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