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

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neuromuscular impairment (Caruso & Strand, 1999; Crary, 1993; ASHA, 2007). 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 (Chumpelik, 1984; Freed, Marshall & Frazier, 1997; Rosenbek, 1985; Rosenbek, Lemme, Ahern, Harris, & Wertz, 1973; Square, Chumpelik, Morningstar, & Adams, 1986; Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998). Among these approaches claiming beneficial effects for adults with AOS, several have indicated positive results when used as treatment methods for CAS. Treatment research employing multiple modalities <strong>of</strong> visual, auditory, and tactile feedback, such as Chumpelik and Sherman’s studies <strong>of</strong> Prompts for Restructuring Oral Muscular Phonetic Targets (1983), Edeal’s study <strong>of</strong> frequency <strong>of</strong> motor practice (2008), Jakielski et al’s., (2006), and Strand and Debertine’s study <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> (2000) have all cited increased intelligibility for children diagnosed with childhood apraxia <strong>of</strong> speech. Square highlights the most frequently used categories <strong>of</strong> treatment methods for CAS which include, “tactile-kinesthetic facilitation, rhythmic and melodic facilitation, and gestural cueing” (1999 p. 149). Among these treatment approaches is <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> which utilizes combined elements <strong>of</strong> tactile, rhythmic, and melodic treatment approaches with the addition <strong>of</strong> specific conditions <strong>of</strong> practice consistent with principles <strong>of</strong> cognitive motor learning. Tactile-kinesthetic treatment techniques (Moto-Kinesthetic Speech Training and Prompts for Restructuring Oral Muscular Phonetic Targets [PROMPT]) attempt to help children with CAS obtain better oral movement control by direct motor manipulation <strong>of</strong> the structures used for speech and tactile cues directed at appropriate locations (Bose & Square, 2001; Chumpelik, 1984). PROMPT seeks to facilitate oral-verbal feedback for 12
the client with apraxia. PROMPT uses unique hand movements as cues for English phonemes, resonance features, voicing components <strong>of</strong> speech, and various jaw movements used in speech. There are conflicting opinions on whether or not PROMPT is an efficacious treatment method for CAS that results in the generalization <strong>of</strong> speech sound productions. Although studies on two children with CAS (Chumpelik, 1984) and an adult with acquired apraxia <strong>of</strong> speech (Freed et al., 1997) all showed improvements to speech production after using the PROMPT system, there was little evidence that speech progress then generalized to non treated contexts (Freed et al., 1997; Pannbacker, 1988). Square (1999) states, “convergent information from the area <strong>of</strong> motor skill learning, language, and cognitive development as well as developmental oral physiology and neurophysiology, provides a compelling argument for the effectiveness <strong>of</strong> tactilekinesthetic approaches for establishing and modifying speech motor behaviors”(pp.150). The use <strong>of</strong> intraoral devices to direct tongue placement is used as a part <strong>of</strong> Stichfield and Young’s Moto-Kinesthetic Speech Training (Caruso & Strand, 1999). The literature reveals very little information regarding the effectiveness <strong>of</strong> such treatment methods. Another group <strong>of</strong> remediation methods used with CAS are rhythmic and melodic speech treatments, such as tapping strategies and Melodic Intonation Therapy (Helfrich- Miller, 1994). These treatments target a child’s impaired speech rhythm (coordination) or inappropriate stress through simple rhythmic repetitions <strong>of</strong> single sounds and syllables (Caruso & Strand, 1999; Dozak, McNeil & Jancosek, 1981; Hall, et al., 1993; Sparks, 2001). These methods emphasize the melodic patterns <strong>of</strong> phrases or sentences and require the client to tap, sing, use intonation and sequential speech movements to initiate and 13
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 12 and 13: melodic support to overcome sound s
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 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
Page 84 and 85:
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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