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

al., 1999). A clinician’s sense <strong>of</strong> what level <strong>of</strong> feedback support their client needs and
when to allow pause times for reflection on performance to occur is a refined skill that
varies according to the individual cognitive capacities, motivational levels, and
impairment severity <strong>of</strong> individual speakers.
Knowledge <strong>of</strong> results has been shown to be most effective during the acquisition
phase <strong>of</strong> cognitive motor learning (Ballard, 2001). Feedback is most helpful when it is
slowly withdrawn over time with the goal that the speaker will learn to assume more <strong>of</strong>
the responsibility for self judgment <strong>of</strong> speech performance.
Influence <strong>of</strong> reduced rate on speech intelligibility has been shown to facilitate
proprioceptive feedback for the speaker when rate is slowed (Caruso & Strand, 1999;
Yorkston et al., 1999).
Integral <strong>stimulation</strong> utilizes the four principles <strong>of</strong> cognitive motor learning:
precursors to motor learning, conditions <strong>of</strong> practice, knowledge <strong>of</strong> results, and the
influence <strong>of</strong> rate <strong>of</strong> speech. These four parameters frame an environment in which
specific treatment approaches such as <strong>integral</strong> <strong>stimulation</strong> can be implemented with
efficacious results. The “bottom up” approach to treatment begins with accurate
production <strong>of</strong> the simplest syllable shapes and gradually introduces more complex forms
as client pr<strong>of</strong>iciency increases. Multimodal cues in the form <strong>of</strong> visual, auditory, and
tactile models provide individuals with apraxia <strong>of</strong> speech a hierarchical system <strong>of</strong>
support. Modeled support is carefully withdrawn, requiring more independence, as
practice and self monitoring skills increase.
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