CDO 338 12

  1. By 2020 50% of our children attending
    public schools will come from culturally and linguistically different (CLD)

    By 2050 50% of the total population will
    be from culturally and linguistically different (CLD) backgrounds.
  2. TREATMENT STRATEGIES for clients with a sound system disorder concomitant with a language, fluency or voice impairment
    • Simultaneous
    • Concurrent
    • Cyclic
    • Sequential
  3. 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. 
  4. Should I use a  phonetic or phonological treatment approach ?
    Select the approach that best matches the client’s diagnosis: phonetic, phonological, mixed or apraxia. 
  5. 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.
  6. Phonological Approaches
    These approaches are for clients who are unintelligible and have multiple misarticulated sounds.
  7. 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
  8. 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.
  9. Evidence Based Triangle – Evidence Based Practice – Research, Experience, and Client Values
  10. 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.
  11. Treatment Approaches for Phonetic Errors
    Phonetic Placement Approach-placement of articulators
    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.
  12. Treatment Approaches for Phonetic Disorders
    —Phonetic Placement is still used:
     particularly in early phases of articulation intervention to demonstrate how a phoneme is produced.
  13. 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
  14. 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).
  15. 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
  16. 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.
  17. 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.
  18. 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
  19. 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.
  20. There is lots of evidence to support using literature for language therapy.
    Book: Books are for Talking Too.
  21. 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.
  22. 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.
  23. 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.
Card Set
CDO 338 12
Intervention of Articulation / Phono Disorders