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

Table 1.
Rosenbek et al.’s Hierarchical Eight-Step Continuum Treatment Program for AOS (1973)
1. The client is instructed to watch and listen to the clinician. The clinician and client
produce the target utterance simultaneously. Meanwhile, the clinician encourages the
client to attend carefully to the auditory and visual cues <strong>of</strong> the correct production.
2. The client repeats the target utterance, after the clinician models the production, while
the clinician mouths the utterance (simultaneous auditory cues faded while visual
supports remain).
3. The clinician produces the target utterance and the client repeats it. No other visual or
auditory clues are given during client’s production.
4. The clinician produces the target utterance and client repeats it several times
(correctly) with no intervening cues.
5. The client reads/names the target utterance written/pictured on a card.
6. Similar to step 5, but the client responds after the target card (stimulus) has been
removed.
7. Client uses the target utterance spontaneously when asked an appropriate question by
the clinician. The imitative model is no longer in use. This allows the client to produce
the target utterance volitionally.
8. The target utterance is incorporated into role-playing situations. The clinician, staff,
parents, and friends assume roles appropriate to the target utterance and the client
responds appropriately. (With children target utterances can be practiced in the context
<strong>of</strong> games and theme-based role-plays.
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Following the successful treatment <strong>of</strong> adults with acquired apraxia <strong>of</strong> speech, the
method has been applied to children diagnosed with non-acquired apraxia <strong>of</strong> speech
(CAS), and is producing positive treatment results as well (Edeal, 2008; Jakielski, et al.,
2006; Jensen, 2005; Strand & Debertine, 2000). Integral <strong>stimulation</strong> employs multiple
modalities <strong>of</strong> cueing systems for the <strong>stimulation</strong> <strong>of</strong> speech. Clinicians using this approach
draw from a wide range <strong>of</strong> visual, auditory, and tactile cues to model for the child. The
child is instructed to “watch me and listen to me.” The speech movement is then
explicitly modeled for the child who then attempts the production. Depending on the
level <strong>of</strong> need, a child is provided with a hierarchy <strong>of</strong> supportive cues. Maximal support
starts with tactile cues and visual and auditory models, with both child and clinician
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