Effects of integral stimulation therapy on speech - Portland State ...

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melodic support to overcome sound sequencing difficulties. Others <strong>of</strong>fer specific feedback following motor responses so that the child’s self awareness <strong>of</strong> his/her own performance is fostered (Caruso & Strand, 1999). Integral <strong>stimulation</strong> is a treatment approach that has been used with greater frequency in treatment <strong>of</strong> motor speech disorders such as dysarthria, acquired apraxia <strong>of</strong> speech, CAS, and other severe speech disorders (Caruso & Strand, 1999). Integral <strong>stimulation</strong> <strong>therapy</strong> utilizes a multitude <strong>of</strong> strategies (gestural, tactile, and prosodic cues) in a hierarchical manner to facilitate long term learning and generalization <strong>of</strong> speech motor skills. Methods include a “bottom up” approach to learning that begins practice with simple syllable shapes and builds on speech complexity as accuracy progresses using systematic drill exercises. Motor practice during <strong>integral</strong> <strong>stimulation</strong> treatment is supported by the use <strong>of</strong> a “watch me and listen to me” strategy. Visual and auditory models <strong>of</strong> target sounds and sequences are provided to the child to provide maximal support for successful productions. Early speech success can be facilitated by simultaneous productions or imitative productions that are gradually withdrawn as competence increases. Once a criterion for success is reached, supports are faded appropriately and higher levels <strong>of</strong> complexity (word positions, sentence levels, and utterance lengths) are introduced. Central to <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> is the focus on long term motor skill retention and generalization, using the principles <strong>of</strong> cognitive motor learning. Specific attention is paid to the parameters within which motor learning best occurs; assuring precursors for motor learning exist, manipulation <strong>of</strong> conditions <strong>of</strong> practice, facilitation <strong>of</strong> knowledge <strong>of</strong> results, and influencing the rate <strong>of</strong> speech during practice (Caruso & 4
Strand, 1999; Yorkston, Beukelman, Strand, & Bell; 1999). Perhaps the most important premise <strong>of</strong> motor learning is that cognitive effort must be repeatedly stimulated through practice and/or experience in order for one’s motor planning processes to be trained well enough to allow for long term, generalized motor skill learning to occur. Ayres writes: Planning requires thinking. If one has to think about actions, one is probably motor planning. If one does not have to think about them, the actions have probably become automatic and no longer require planning….If <strong>therapy</strong> is designed to promote planning that requires thinking, then a variety <strong>of</strong> tasks that require thinking should be available. Once learned well, a task may no longer be therapeutic. (Ayres, 1985, p. 24) Determining which treatment methods for CAS are most appropriate is a difficult task even for the most well informed speech-language pathologist. The vast majority <strong>of</strong> research for treatment <strong>of</strong> apraxia has been conducted on adults with acquired apraxia <strong>of</strong> speech. Treatment efficacy results have <strong>of</strong>ten been obtained by measuring performance <strong>of</strong> speech tasks rather than the long term retention and generalization <strong>of</strong> speech skills to novel speech contexts. Integral <strong>stimulation</strong> uses the principles <strong>of</strong> cognitive motor learning, to maximize the generalization and transfer <strong>of</strong> speech skills to unfamiliar speech contexts. Research in the fields <strong>of</strong> sports training, physical <strong>therapy</strong>, and movement learning have provided a body <strong>of</strong> convincing evidence as to the effectiveness <strong>of</strong> motor movement learning. This single-subject design examines the efficacy <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> utilizing principles <strong>of</strong> cognitive motor learning on the speech intelligibility <strong>of</strong> one child diagnosed with CAS. 5
Page 1 and 2: EFFECTS OF INTEGRAL STIMULATION THE
Page 3 and 4: stimulation <stron
Page 5 and 6: Table of Contents
Page 7: List of Figures Fi
Page 10 and 11: The committee recognized that ident
Page 14 and 15: Literature Review The differential
Page 16 and 17: part affect the numbers diagnosed a
Page 18 and 19: discrepancy suggests the probabilit
Page 20 and 21: neuromuscular impairment (Caruso &
Page 22 and 23: execute smooth and accurate speech.
Page 24 and 25: Table 1. Rosenbek et al.’s Hierar
Page 26 and 27: methodologies have yielded less con
Page 28 and 29: associated with the practice or exp
Page 30 and 31: very nature of spe
Page 32 and 33: Integral Stimulation and Childhood
Page 34 and 35: stimulation <stron
Page 36 and 37: period of no treat
Page 38 and 39: diagnosis of moder
Page 40 and 41: Table 3. Summary of</strong
Page 42 and 43: Table 4. Summary of</strong
Page 44 and 45: Word Shapes Simple word shapes such
Page 46 and 47: Hearing Hearing evaluations were co
Page 48 and 49: target sounds would allow CP a mana
Page 50 and 51: adjective, and a noun or verb (see
Page 52 and 53: welcomed from CP’s parents who we
Page 54 and 55: simultaneously with the child, prov
Page 56 and 57: to restart the mental processes nee
Page 58 and 59: Analysis of speech
Page 60 and 61: Results This study examined the eff
Page 62 and 63:
Post-Treatment Results for /s/ Clus
Page 64 and 65:
Data Results for Labiodentals Frica
Page 66 and 67:
Data Results for Affricates: /ȴ/ &
Page 68 and 69:
Data Results for Interdental Fricat
Page 70 and 71:
Figure 4. Percent correct for /θ/
Page 72 and 73:
Discussion This discussion examines
Page 74 and 75:
practice his motor speech skills in
Page 76 and 77:
Indicators that motor learning had
Page 78 and 79:
Conclusion The results of</
Page 80 and 81:
A number of sessio
Page 82 and 83:
References American Speech-Language
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Delaney, A.L., & Kent, R.D. (2004,
Page 86 and 87:
Powell, T. W. (1996). Stimulability
Page 88 and 89:
Strand, E. A. (1995). Treatment <st
Page 90 and 91:
for regular treatment are determine
Page 92:
Appendix C -Data Tracking Form TX T
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