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Approaches to treating articulation and phonological disorders

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are oral motor exercises considered EBP by ASHA?
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NO!
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Who would benefit most from maximal oppositions?
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-those with 6 or more sounds missing -moderate-severe phonological processes
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multiple oppositions approach
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a set of words differ by a single phoneme (for simultaneous errors) -for severe disorders -example set: tip–>sip, kip, chip, tip -minimal pairs are used as targets
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minimal contrast approach
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like minimal pairs
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minimal pairs approach
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uses a set of words that differ by a single phoneme
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maximal oppositions/maximal contrast
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uses a set of words that differ by more than one feature (place, manner, voice) -uses 8-10 pairs -“comparison sound” should be mastered by the child already
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what is the aspiration trick?
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-helps child produce voiceless phonemes by adding a voiced /h/ after an initial voiceless sound -/f//heat/, (eventually /h/ will get phased out)
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cycles approach is designed for
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severely unintelligible children
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cycles approach: do you use real or nonsense syllables?
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real
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cycles approach: a cycle can last how long?
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5-16 weeks
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Cycle approach: what are the cycles (7)
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1. review 2. auditory bombardment 3. target word cards 4. production practice 5. stimulability probing 6. auditory bombardment 7. Home program
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cycles approach” appropriate target pattern is one that is present:
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at least 40% of the time during assessment
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Multiple phoneme approach phases:
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5 or more sounds worked on simultaneously: 1. establishment (produces consonant sounds when shown phonetic symbols) –uses visual, auditory and tactile stimulation to do this –holding procedure 2. transfer to a) syllable, b) words, c) phrase, sentence, d) reading/story, e) conversation *need 80% accuracy over two consecutive sessions, or 90% accuracy over 1 session 3. maintenance (goal is 90% WWA (whole word accuracy) in conversational speech across various speaking situations; *skills should be monitored for 3 months after cessation of treatment
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paired stimuli approach: 3 levels:
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*for teaching one sound at a time 1. word level –choose 4 key words w/target sounds (initial and final) –need 80% target sounds in words over two successive trials 2. sentence level –pair key words with 10 training words 3. conversational level –engage child in conversation –conversation stops when child correctly produces a target sound in 4 words, or when she incorrectly produces it in 1 word -training stops when target word is correct in 15 opportunities, 2 times in a row
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which approach de-emphasizes auditory discrimination training?
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multiple phoneme approach
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when is multiple oppositions approach used?
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on severe disorders; collapsed phonemes –deals with child’s mental representation, not the motor act
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sensory motor approach
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utilized coarticulatory effects structured on syllables -makes use of the facilitative context of correctly produced sounds
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How many targets does the “Traditional Approach” use at a time?
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1-2
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What are the phases of the Traditional Approach?
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1. sensory-perceptual training (ear training) -identification -isolation -stimulation -discrimination 2. Production Training (sound establishment) (imitation, phonetic placement, contextual cues, motor-kinesthetic cues, sound approximation) 3. Production Training (Sound stabilization) (isolation, nonsense syllables, words, phrases, sentences, conversation)
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3 types of oral-motor exercises
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1. active (strength training with or w/o resistance) 2. passive (massage, tapping, stretching, etc.) 3. external stimulation (vibrations, heat, cold, e-stem)
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Cycles approach: What is the big deal about it?
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it uses tactile, auditory and visual stimulation
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WHo would benefit most from the multiple phoneme approach?
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-kids with 6 or more sounds lacking
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What’s the big deal about multiple phonemes approach?
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-teaches multiple phonemes at once -uses behavioral principles -analyze conversational speech -also uses auditory and tactile and visual cueing -HIGHLY structured
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is Van Riper’s Traditional Approach still relevant today?
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yes, it still offers a foundation for many of the therapeutic strategies that are performed today
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Traditional Approach: what are the 4 parts of the sensory perceptual (ear training) phase?
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1. Identification 2. Isolation 3. Stimulation 4. Discrimination
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Traditional Approach: perceptual (ear training) phase: What is the goal of Step 1: Identification?
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goal is to teach the child auditory, visual and tactile-kinesthetic properties of the target sound -child learns to recognize the sound from among several possible sounds composed of similar and dissimilar properties -ex. The SLP describes the target sound and gives it a label /t/ is the ticking sound, /s/ is the snake sound, etc.
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Traditional Approach: perceptual ear-training phase: What happens in step 2: isolation?
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the child must be able to identify words, phrases, and sentences that contain the sound -complexity gradually increases
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Traditional Approach: perceptual ear-training phase: What happens in phase 3: stimulation?
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-SLP presents the sound by varying degrees of loudness and duration in sentences loaded with the sound (auditory bombardment)
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Traditional Approach: perceptual ear-training phase: Step 4: Discrimination:
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-child tells the SLP if he hears the sound being produced correctly or incorrectly (when produced by the SLP)–this is “error detection” –error correction involves the child telling why a sound is in error and how it can be corrected
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What is the goal of the production training phase (sound establishment) in the traditional approach?
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to evoke and establish a new sound pattern that will replace the error pattern includes: 1. imitation–auditory stimulation–child imitates/receives auditory stimuli 2. phonetic placement: assumes the child can’t produce the sound correctly, so the SLP employs facilitative techniques to show appropriate placement 3. contextual cues: use of other sounds in which the error sound is made correctly 4. moto-kinesthetic cues 5. sound approximation–capitalizes on a sound the child can already make, to make another
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Traditional Approach: Production training phase (sound establishment): Steps
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1. isolation (not everyone begins at this level. some begin with syllables or words due to the link in meangin) (goal=to stabilize the production at the lowest level at which the child has difficulty) 2. nonsense syllables (use to help child develop stronger and more consistent production of nonsense syllables) 3. words (use of true words when child easily and consistently produces the target in nonsense syllables; move from mono-multi syllablic) 4. phrases (shift from 2-4 word phrases (may contain carrier phrases initially) 5. sentences (produce the sounds in sentences of varying and heirarchical complexity) 6. conversation (moves from structured and planned to unstructured)
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Techniques for establishing sounds in sentences
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1. slow-motion (slp and child say sentence at same time in slow motion) 2. shadowing (echo speech) 3. unison speech (hand tapping or rhythmic activity are used in sentences, child follows slps movements and prosody as he/she repeats) 4. corrective set (child identifies and corrects the slp (sometimes children who can’t normally say the sentence can do when correcting someone) 5. role-playing (dramatic theatrical roles used to assist with production that isn’t usually performed)