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

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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. ________________________________________________________________________ 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 16
producing the target sound/word simultaneously (Yorkston et. al., 1999). Next, (depending on the client’s level <strong>of</strong> success) the clinician whispers or mouths the oral movements while the child produces the target sound/word. With success, the auditory and visual support cues are faded further until the child begins the next stage <strong>of</strong> immediate repetition <strong>of</strong> targets. Repetition <strong>of</strong> modeled targets gives way to successive repetitions <strong>of</strong> target sounds/words. Delayed repetition decreases the level <strong>of</strong> support by distancing the provided auditory model from the point <strong>of</strong> client production. For instance, the clinician may instruct the client to listen, wait 1 to 5 seconds, then imitate what he/she has heard. By varying the temporal relationship, a gradual autonomy is achieved for motor speech movements. The intended effects <strong>of</strong> temporal variance methods are that holding motor plans for sequential speech movements in one’s memory results in better long term retention <strong>of</strong> speech skills. It should be noted that for young children with short attention spans, longer delay <strong>of</strong> repetitions may cause them to lose focus on their speech tasks (Caruso & Strand, 1999). It is necessary to adapt treatment procedures to the specific abilities and attention needs <strong>of</strong> clients. Incorporating activities such as games into treatment sessions may provide children with enough motivation to maintain attention when asked to perform delayed responses. The hierarchy <strong>of</strong> cueing options continues to include reading, writing, responding to questions, and role playing or conversation as appropriate for individual needs and abilities. If at any point in the treatment process, a client fails to respond correctly, the level <strong>of</strong> support is increased to ensure correct production and awareness <strong>of</strong> performance. Integral <strong>stimulation</strong> operates from a motor processing/programming impairment perspective using the theories <strong>of</strong> cognitive motor learning as a basis for treatment. Other 17
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 20 and 21: neuromuscular impairment (Caruso &
Page 22 and 23: execute smooth and accurate speech.
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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