u MOTORBASED APPROACHES TO INTERVENTION Working with Isaac
u MOTOR-BASED APPROACHES TO INTERVENTION
Working with Isaac to MOOSE-open and stretch—really increases intelligibility!
I. INTRODUCTION** u Intervention for speech sound disorders is very exciting u There is nothing in the world like the feeling you get when a child first says a sound correctly!!
These are ideas I use as an SLP in my job in the schools:
Using classroom language arts books for therapy—helps us help kids achieve Common Core State Standards:
Vincent—highly unintelligible, working on /f/ and language
The point is to remain flexible…** u And do what is best for each individual client
Non-Speech Oral-Motor Exercises** u Your book authors do not believe that oral motor exercises are beneficial for anybody u They say research has not proven that oral motor exercises help u Roseberry’s position: these exercises are very helpful for children with oral motor problems
u **Kent, R. D. (2015 November ). Nonspeech oral motor movements and disorders: A narrative review. American Journal of Speech-Language Pathology. u He said that NSOMMs can be part of practice in orofacial myology u Can be used with persons with dysarthria and dysphagia u 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: • 1. Identification —label and describe the sound, have a picture or object to go with it (e. g. , /s/ is the snake sound) • 2. Isolation —have the ch id the sound in increasingly complex environments—e. g. , raise your hand when you hear a word with /s/ in it
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 • Establish correct sound production in isolation • Use phonetic placement techniques • Successive approximation/shaping
Successive approximation: • Uses a sound the ch already makes correctly • Build from there—e. g. ggggggrrrrrrr
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** (p. 404 has some) • 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 (wordinitial) • Next: bus, face, piece (word-final) • Then: Classes, lesson (word-medial) • Last: Crust, stop, faster (clusters)
Working with Emma on post-vocalic /r/
• **4. Phrases – in-between stage—carrier phrases common—e. g. : • I see ____ • This is___ • 5. Sentences – various length and complexity (examples bottom of p. 405)
• 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?
Had Max say “orrrrange” to work on /r/ on his way back to the classrom
Walking back to class with Jake and Max and finding /l/
D. Maintenance • Follow-up sessions • Dr. R. : in schools, keep on IEP, but reduce to tx once a week
III. CONTEXT UTILIZATION APPROACHES** (not emphasized on test) • Assume that speech sounds are not produced in isolation but rather in syllablebased 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 watch-sea, watch-sat, etc.
In sum, contextually-based approaches assume: • The ch can make the sound correctly in some context • Extensive motor practice of articulatory behaviors at the syllable level works to correct the sound
IV. CONCURRENT APPROACH** • Said SLPs don’t have to use hierarchy • First establish sound in isolation and CV, VC combos— 80% accuracy • Then, mix it up in tx!
CSHA Dr. Steve Skelton • If we vary the response topography in each tx session, Ch will make gains than if we just go up the hierarchy like a ladder
For example, in one session: ** • 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
Working with Kiyah on /l/
• 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
• Then you yell “switch!” • Ask students to create cards with creative ideas for more interesting drill • They draw card, practice sound the way card says
• 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
• Create stories with flip books • Put stickers or stamps on a paper • Legos • Kick a ball
• Blocks • Put Bingo chips into jar • Pick up sticks • Blow bubbles
True-False • You are working with Candace, a 5 -year old, in a group of 4 children. All have th/s substitutions. You are having Candace subvocalize during the other children’s turns, meaning that she is silently writing down the words that the other children are saying.
Playing Pigmania
V. CORE VOCABULARY APPROACH (a fave )** (uses both motor and linguistic principles) A. Introduction Designed for the 10% of children with functional SSDs characterized by inconsistent errors on the same words These children don’t have childhood apraxia of speech Been used with 2 -year olds, bilingual children, Down Syndrome
B. Structure of Intervention Goal= increase ch’s intelligibility Select 50 words— functional for individual ch Each week, select 10 words to tx SLP teaches ch best production of each word; goal is consistency
For example: ** • If the child needs to use the bathroom, it’s hard if he says this differently every time • So the goal might be for him to say “potty” • If he can’t, we can teach him to say /a-i/ every single time he needs to go • Much easier on him and his caregivers!
• Objective = best possible production (intelligible, not perfect) consistently • Developmental errors accepted • Parents and teachers must be involved— feedback • Intended as foundation for more traditional methods
I love it!! Gives ch immediate ↑intelligibility Words that are important in ch’s immediate environment Immediately ↓s frustration
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