MOTORBASED APPROACHES TO INTERVENTION I INTRODUCTION Intervention for
• MOTOR-BASED APPROACHES TO INTERVENTION
I. INTRODUCTION** • Intervention for speech sound disorders is very exciting • There is nothing in the world like the feeling you get when a child first says a sound correctly!!
The point is to remain flexible…** • And do what is best for each individual client
A. Motor Learning Principles** • 1. Establishment of a sound: Elicit target behaviors from the client and then stabilize such behaviors at a voluntary level. You teach correct production of individual sounds. • 2. Generalization: transfer/carryover to untrained contexts. • 3. Maintenance: stabilize and facilitate retention of sounds learned
• 4. Many shorter tx sessions are more** • productive than fewer but longer tx sessions • 5. Amplified auditory stimulation can help. Auditory bombardment: Use a mild gain amplification device at beginning and end of session. Read a list of up to 20 words with the target sound.
Optimal challenge point: (p. 313)
B. Non-Speech Oral-Motor Exercises** • Your book authors do not believe that oral motor exercises are beneficial for anybody • They say research has not proven that oral motor exercises help
• **Kent, R. D. Nonspeech oral motor movements and disorders: A narrative review. American Journal of Speech-Language Pathology. • He said that NSOMMs can be part of practice in orofacial myology • Can be used with persons with dysarthria and dysphagia • Don’t just reject NSOMMs wholesale
II. TRADITIONAL APPROACH (Van Riper)** • Around since 1920 s • Still popular and widely-used today • Motor-based approaches stem from Van Riper’s traditional approach
Perceptual (ear) training…** • Most SLPs today don’t emphasize it, but I think it can’t hurt to do a little bit of this • Ear training is useful when the child is tired of producing the sound but you need to still keep working and maximizing therapy time
Ear/Perceptual Training:
Perceptual Training continued: ** • 3. Stimulation —provide the ch with auditory examples of the sound in contexts—slight amplification helps. Ch just listens and doesn’t have to produce. • 4. Discrimination —ch judges correct/incorrect production in increasingly complex contexts. They love to catch the SLP being wrong!
A. Production Training: Sound Establishment
Successive approximation: ** • Uses a sound the child already makes correctly • Build from there—e. g. ggggggrrrrrrr
In this youtube video… • The SLP uses the direct technique of Mr. Mouth for phonetic placement • Articulation Disorder Teaching /r/ • Ashley Mcgeehon’s channel
B. Production Training: Sound Stabilization** • Stage 6 Conversation • ↑ • Stage 5 Sentences • ↑ • Stage 4 Phrases • ↑ • Stage 3 Words • ↑ • Stage 2 Nonsense syllables • ↑ • Stage 1 Isolation
• 1. Isolation—use variety of fun activities** • 2. Nonsense syllables —I don’t really use these • 3. Words —begin with words that are meaningful to the child. I work on sounds: • 1. word-initial • 2. word-final • 3. word-medial • 4. Clusters
For example, with /s/: ** • Begin with soup, see, sun (word-initial) • Next: bus, face, piece (word-final) • Then: Classes, lesson (word-medial) • Last: Crust, stop, faster (clusters)
• **4. Phrases – in-between stage—carrier phrases common—e. g. : • I see ____ • This is___ • 5. Sentences – various length and complexity
• 6. Conversation** • Start with structured conv. —e. g. , SLP gives a topic or specific pictures to talk about • Transition to natural conv. —open ended. E. g. , “Tell me what costume you wore for Halloween. ’
C. Transfer and Carryover** • Vary the audience and settings • Speech assignments • In small groups—what are some practical strategies for implementing these ideas in a school setting?
D. Maintenance
III. MODIFICATIONS TO THE TRADITIONAL APPROACH: CONTEXT UTILIZATION APPROACHES** (not emphasized on test) • Assume that speech sounds are not produced in isolation but rather in syllable-based contexts • Assume that certain phonetic contexts can facilitate correct sound usage • Assumes you can find a context where the error sound is produced correctly
For example, a child has a th/s substitution…** • But you find that she can produce /s/ correctly in watch -sun • You have her say watch-sun with various stress patterns, and then move to sequences such as watchsea, watch-sat, etc.
In sum, contextually-based approaches assume:
SATPAC (pp. 332 -333): ** • Uses this approach • Uses nonsense words to establish accurate sound production; uses nonwords up to the sentence level to establish and automatize new motor habits. Then, real words are introduced. • Uses computer software • Very structured and uses extensive drill
IV. MODIFICATIONS TO THE TRADITIONAL APPROACH: CONCURRENT APPROACH** • Said SLPs don’t have to use hierarchy • First establish sound in isolation and CV, VC combinations— 80% accuracy • Then, mix it up in tx! • Generalization is built into this approach
Concurrent approach:
For example, in one session (See example on p. 331): ** • 1. /r/ in final position of words • 2. /r/ in VC combos • 3. /r/ in sentences in word-initial position • 4. /r/ in word-medial position in phrases
Dr. Skelton: ACTIVITIES AND IDEAS FOR ELICITING AT LEAST 150 PRODUCTIONS PER GROUP SESSION** • Kids take own data • Subvocalize (“say it with your voice turned off”) while other students taking their turns • Tally counters challenge students--150+ productions
Max made 335 good /r/ productions in 30 minutes using the clicker! He loves it! • He has fine motor problems so I had him say /r/ in isolation and CV combinations while he used these paint dots
• Post charts individual/group competition** • Create stations--students do something different every minute or so while practicing sounds • E. g. , one ch on whiteboard, one putting puzzle together, one lying on floor, one using flashcards at table
• E. g. , “Say /r/ 10 times by itself while you are doing jumping jacks. ”** • “Say at least 3 sentences with /s/ while you draw a picture on the whiteboard. ” • “Say ‘the’ while you are doing hopscotch”
• Echo microphone** • Puppets, costumes • Roll a dice or draw a number from an envelope to determine how many productions they have to make
OTHER IDEAS FOR CENTERS** • Read books or stories with target sound • Hula hoops • Jump rope
• Blocks ** • Put Bingo chips into jar • Pick up sticks • Blow bubbles
V. MODIFICATIONS TO THE TRADITIONAL APPROACH: SPEECH MOTOR CHAINING (SMC)** • A. Basic Principles • Highly structured approach that is good for children with Childhood Apraxia of Speech (CAS) and also older children with persistent or residual speech sound errors • Combines core movements with principles of motor learning to help the child generate complex speech • Helps therapy move faster—condenses it • Works with and without ultrasound feedback
Complexity is built up with a chain: (. 328)
For example, if working on /r/: ** • /ru/ →room →bedroom →my bedroom →My bedroom is down the hall. • /rei/ →rainbow →colorful rainbow →The colorful rainbow was beautiful.
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