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adjective, and a noun or verb (see Appendix). CP was allowed to look at a book or hold a small manipulative during speech probes as he was <strong>of</strong>ten non-compliant without them. CP was instructed to, “Listen carefully and repeat after me.” During data collection, the clinician (trained in phonetic transcription using IPA) transcribed online the imitated utterances <strong>of</strong> CP. CP was instructed to repeat each <strong>of</strong> the 20 sentences in imitation <strong>of</strong> the clinician. Occasionally, the clinician <strong>of</strong>fered general encouragements such as “I can tell you’re listening carefully,” or “Thanks for speaking clearly” to maintain CP’s participation in the task. Baseline Phase. Baseline measures were established in the clinic rooms <strong>of</strong> PSU Speech-Language Clinic, at the Scottish Rite Speech Clinic, and at the client’s place <strong>of</strong> residence. CP’s production attempts <strong>of</strong> stimulus probe carrier phrases were video and audio recorded over a period <strong>of</strong> 4 data collection events. Resulting data were phonetically transcribed, recorded, and graphed by the clinician to determine levels <strong>of</strong> stability. Criterion for baseline data stability was consistent with this study’s guidelines for stability (Schiavetti & Metz, 2002). No intervention for target speech sounds and behaviors using <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> was implemented during the baseline period. Treatment Phase. Treatment sessions were conducted by the examiner at the PSU Child Speech-Language Clinic, The Scottish Rite Speech Clinic, and at CP’s place <strong>of</strong> residence when university facilities were closed. Methods for treatment <strong>of</strong> CP’s articulation disorder included the application <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> techniques in activities with games, books, conversations, self-analysis, and speech production feedback. The eight-step continuum Treatment Program for Apraxia <strong>of</strong> Speech developed by Rosenbek et al. (1973) as presented in Caruso and Strand in their text, Clinical 42
Management <strong>of</strong> Motor Speech Disorders in Children (1999), was used as the basis for treatment. In this study, <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> for target speech sounds remained consistent with principles <strong>of</strong> motor learning to maximize long term retention and generalization <strong>of</strong> speech skills. Target sound practice was brief in duration and frequent (treatment twice per week at PSU clinic and twice per week at a private speech practice). Treatment activities consisted <strong>of</strong> multiple activities, 5 to 10 minutes in length, that stimulated target productions in a variety <strong>of</strong> contexts (repetitive drills, mirror imitation, book reading, turn taking games, conversation, rhymes, and songs). Within these activities, the clinician encouraged as much practice <strong>of</strong> target sounds as CP would tolerate while <strong>of</strong>fering feedback on his productions. Discussions <strong>of</strong> oral structures, placements, and reasons for working toward improved speech were used to clarify session goals and motivate CP to focus his attention on learning tasks. A prize in the form <strong>of</strong> an activity, plush toy, or card was <strong>of</strong>ten <strong>of</strong>fered to CP at the end <strong>of</strong> sessions as reinforcement for his hard work. Short play breaks were <strong>of</strong>fered to CP when his focus on tasks waned. Play breaks allowed CP time to redirect his attention from repetitious and imitative tasks to opportunities to use practiced skills in a conversational context with supportive feedback. Repeated breaks <strong>of</strong>fered CP consistent practice in relearning the motor programming steps necessary for long term retention <strong>of</strong> motor skills. The practice schedules for target sounds were randomized in order and frequency throughout the course <strong>of</strong> the sessions. Throughout the 30 sessions, adjustments were made to activities and treatment objectives that failed to stimulate CP’s interests, speech progress, and/or abilities to self-monitor his speech. Suggestions and feedback were 43
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 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 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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