Older info (2) Flashcards
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Cerebral Palsy
congenital disorder from brain damage before, during, or after birth; several
types: spastic, athetoid, rigid, ataxic, mixed
Treatment of CP
with some children who may have a language delay, a home-based early language stimulation program may be necessary-Sooner Start
if a home language treatment does not produce the desired effects, formal language treatment may be necessary; periodic assessment is needed to make this determination
some SLPs recommend muscle strengthening exercises or methods to control interfering movements of the head, neck, jaw, and other body parts….may consider chin strap to stabilize jaw, steady an arm
a child’s articulation problems may be limited to a few sounds or they may be extensive;
direct treatment targets include bilabial, linguavelar, lingua-alveolar, linguadental, articulatory contacts needed for various speech sound productions
increasing the speed of the child’s articulatory movements once they have been established becomes the next goal
if the assessment reveals specific errors or patterns, the clinician can use the procedures described in the basic unit
may need an AAC
treatment should target prosodic features including speech rate, rhythm, stress patterns, and pitch variations
in some children, speech does not become a functional mode of communication
Treatment of CAS
Need lots of repetition of the same motor sequence.
Large amounts of practice facilitate retention.
Activities need to facilitate repetition.
Start treatment by explaining what you expect and what you are targeting.
Have them focus on your mouth (look and listen)
If severe case, only have 4-5 targets
If less severe, can do 10-15 targets
Talking about motor sequence not specific error sounds
Trying to build a core vocab with the child (difference between kid with artic and kid with CAS)
Good starter words are yes and no.
Talk to the parents to figure out what they want their child to be able to say.
Mirror neurons-same when watching and doing. Why they need to watch your mouth.
They need to be seen 3-5 times per week for shorter sessions (1/2 hour sessions)
Hour sessions are not appropriate.
Kids with CAS need 5x the number of sessions to achieve the same success as a child with a normal artic disorder.
Important to slow speaking rate initially in therapy and fade that as they have success.
Also want to have block practice rather than randomizing the words. Stay on one word for a time and then move on. Once they get the criterion level, then you can start randomly practicing those words each session.
Initially, practice with same intonation, rate and stress. Can start changing those as they gain success.
Provide movement based feedback (talk about what you want the articulators to do.)
Provide feedback right away (initially) and then face
Primary focus is motor, not sounds. Focus more on syllable level. First core words will be very simple and then gradually increase the complexity.
• Contrastive Stress drills
used to promote articulatory proficiency and natural prosody
especially suited to teach appropriate stresses and rhythm of spoken language
Dynamic Temporal and Tactile Cueing (DTTC):
- Simultaneous production
- Immediate repetition
- Delayed repetition
- Spontaneous
Allows for use of other cueing discussed earlier as needed
Positives: allows high level of success and good gradual building blocks. Get a lot of repetition. Allows for all the cueing mentioned above.
Instructional method
1.Simultaneous production without cues
- Slow model simultaneous
- Verbal cue & slow model simultaneous
- Tactile cue
- Once child has mastered back off cueing from step 4-step 1
- Once the child can produce 25 accurate responses simultaneously without cues move to the next level: Direct Imitation
- Direct Imitation
a. SLP provides auditory model while child watches the clinician’s face and child repeats; SLP made mouth the gesture during the response if additional support is needed; then fade - Delayed Imitation
a. SLP says target utterance
b. Insert a delay of 1-3 seconds before the child imitates the reponse - Spontaneous Production
a. Child repeats the target several times without intervening stimuli - Once target is mastered, continue to add it into the mix in functional practice
- Review learned targets at beginning of each session.
PROMPT:
Prompts for Restructuring Oral Muscular Phonetic Targets-uses touch pressure, kinesthetic, and proprioceptive cues to facilitate speech production
otrains finger placements on the client’s face and neck to prompt the place of articulation and manner of production for the articulatory target
ofinger placements also provide information about the degree of jaw movement needed and appropriate duration of the syllable
omost appropriate for chronic severe clients in which other tx have failed
ohave to be certified $650-$700
Cleft Palate
target right away- feeding, swallowing
treatment may begin in infancy including parent education and counseling, and addressing feeding problems
part of the craniofacial team or Cleft Palate Team
general behavioral treatment principles discussed previously in the basic unit would be appropriate in addressing articulation and phonological disorders
should educate the parents
consider an early language intervention program to stimulate language skills
train the parents to withhold reinforcement for undesirable compensatory behaviors when the need for them has been eliminated by medical management i.e., pharyngeal fricatives
begin treatment with …vowels and semi-vowels (w, j, l, r)
teach …fricatives before stops
Teach more visible sounds first. After vowels and semi vowels move on to nasals, glides and then aspirate consonants.
teach accurate production of consonants that are produced with weak articulatory force as this is a unique problem of children with cleft palate
avoid or postpone training on /k/ and /g/ if the child’s …
teach lingua-palatal sounds, lingua-alveolars and linguadentals in that order
structure therapy so that it progresses from …basic to more advanced syllable structures.
use cueing as needed
avoid oral-motor exercises to strengthen the velum or tongue as there is no evidence that such exercises are beneficial
teach the child to articulate with …less effort and facial grimacing
train compensatory articulatory productions if structural distortions are present that prevent normal articulation
don’t target resonance problems unless the child has the ability to achieve…unless they can’t get VP closure
oral resonance may be achieved by occluding the nares while making the target production, increasing loudness or sudden bursts of loudness, or increasing mouth opening
treat phonation also since there is a …vocal nodules and bad vocal behaviors. Voice therapy. Easy onsets, etc
identify
Want immediate success
What to target:
1. easier to teach
2.stimulable
3.visible
4. Sounds that are produced inconsistently
Want generalization
What to target?
Complex
Nonexistent in their repertoire
Processes that affect a greater number of sounds.
Processes that are idiosyncratic
Processes that reduce homonymy
Processes that are exhibited in 100% of opportunities.
Words that contain maximal phoneme feature contrast (different in placement, manner, etc)
Words that contain multiple phoneme feature oppositions.
Either way you want to always what?
- ethnoculturally appropriate
- sounds that are in the child’s dialect
- sounds most frequently used in language/home environment
- probe other sounds that are in error- always be probing as they are getting success with a sound.
Regardless of the target behavior selection strategy chosen, you should assess the effects of just completed treatment on
untreated but potential targets
o Hegde & Davis (2005) make the following recommendations:
First, select behaviors that will make an immediate and socially significant difference in the communicative skills of the client
~Target things that improve social communication, academic achievement, and/or occupational performance. Includes sounds used often in their vocabulary first to help improve speech intelligibility faster.
Second, select the most useful behaviors that may be produced and reinforced at home and in other natural settings
~Things that are beneficial and will be reinforced in the home setting.
Third, select behaviors that help expand the communicative skills
~ pick vocab words that can be expanded into sentences, phrases, story-telling.
Lastly, select behaviors that are linguistically and culturally appropriate for the individual client
~what vocab is used, language structures, pragmatics, dialects. Make sure it is culturally appropriate – talk to family to get idea of what is used.
Hodson & Paden (1991) recommend that if the frequency of a phonological process is less than 40%, it should not be treated
What do you do after you assess them?
Get baseline have to have it for charting progress. Means measured baseline behaviors in the absence of treatment. Percentages, level, etc) Helps as a clinician to establish accountability for self and for third-party payers.
What should you do once per month?
Probe for generalization (To new words, to a new level of complexity, other sounds in the same process, to a different setting)
Discrete trial probes:
Conversational probe:
no feedback on specific sounds, no imitation, new things
collecting a speech sample and simply listening during conversation for generalization
4 methods commonly employed to establish production:
- Imitation: initial instruction method for production training. Look at you and do what you do. Think about the way the sound feels, looks, etc. Use all cues you can. Using a mirror is helpful. Maybe use an FM system and tape recorder (to play back for the client- judge for themselves)
2 phonetic placement: getting in their mouth and using a lot of tactile cues. Explain to them where to place their articulators in their mouth. May use moth model to show tongue placement. straws- lateral lisp- shows them where air is leaking. Straw can be used to stabilize the jaw. Tongue depressors. Lemon swabs-gives tart taste to see if tongue is in the right place. Kool-aid or fun-dip. Holding cheerio up on alveolar ridge.
3successive approximation: shaping a new sound from one that they can already produce (that is similar). T and s do graded steps until you get to an /s/
- contextual utilization: Can do after assessment- do to see if there is any context in which they can accurately produce the sound.
Reinforcement In maintenance phase
Only use naturally occurring
Less frequent
Delayed Teach them to self-monitor Contingency priming? Ask others if they sound okay?
Implementing a Maintenance Program:
move from continuous to intermittent reinforcements, delay reinforcement in maintenance phase, use more natural reinforcement (social), train the parents in how to give appropriate feedback, teach them to self-monitor (self-correct), reinforced generalized targets, teach contingency priming (child is more responsible for asking teacher/mom if she is saying sound correctly) child take on more responsibility in maintenance phase. Make sure you are picking naturally occurring
stimulus items. Change setting, vary the audience. Reinforce more complex productions
positive reinforcers:
negative reinforcers:
events that increase the future probability of that response.
responses that remove, postpone, or reduce or prevent aversive behavior.
Primary Reinforcers:
do not rely on past learning. (snacks) good to use initially but not preferred for long term use (or by family) but does weork well for those who are in the beginning stages of therapy, who are young, or who are intellectually disabled. Not natural (not a natural consequence) won’t get it outside of the treatment room. They should be accompanied with a social reinforcer (verbal feedback). Talk to their parents prior to therapy and make sure they do not have allergies or what the parents prefer they have/not have. Fade away into secondary
Secondary reinforcers:
events/actions that increase behavior because of social or prior learning. Eye contact, facial expression, verbal feedback. Condition-generalized reinforcrse. Stickers, check marks, beads. They learn that tokens have meaning. Need to be immediate initially in therapy. Make sure reinforcement is quick and effective but don’t spend too much time on them. Use free time to probe and listen to the child’s speech at conversation level. Informative feedback for competitive kids-show them their chart so they can see how they are doing.
continuous reinforcement:
interval schedule:
o every time they have a correct production- reinforce. 1:1 reinforcement.
Move to fixed ratio
time period that goes by before they get a reinforcement. Better for when you are targeting vocal quality, speaking rate, etc (not really speech sounds)
Fixed ratio (FR) schedule:
Variable ratio (VR) schedule:
every two/three/four productions, they get a token.
variable number of correct productions before they get a token. Later in therapy
time-out:
non-exclusion time-out:
more for behavior rather than incorrect production. Need to be removed from what you’re doing. Or a period where they cannot win any tokens.
Cease therapy for a second to let them realize they are being unacceptable. Important for child to know you are in charge. (try not to use parents as leverage)
