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

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welcomed from CP’s parents who were <strong>of</strong>ten the first to notice speech skills worked on in clinic being used spontaneously at home. Treatment techniques began by establishing consistent production <strong>of</strong> target sounds in single syllable productions using first established vowel sounds. As CP’s consistency increased during drill practice, the environment in which the targets were presented increased in complexity. Word shape complexity, syllable numbers, phrase lengths, and conversational contexts were increased as CP’s pr<strong>of</strong>iciency grew. A variety <strong>of</strong> visual, auditory, and tactile supports were employed by the clinician to assist CP in achieving correct productions <strong>of</strong> target sounds. Clinician models included visual and auditory productions <strong>of</strong> target sounds using a mirror and face to face interaction. CP was instructed to watch the clinician’s mouth and listen carefully. CP was directed to produce sounds first simultaneously, then imitatively, and later with delayed imitation, and with a variety <strong>of</strong> visual supports such as foam letters, written words, mouthed imitations, and pictorial depictions <strong>of</strong> oral placements. Tactile gestures were provided to indicate the location <strong>of</strong> articulator contacts. CP was encouraged to feel his throat during voiced productions and feel oral air emissions with his hand during appropriate sound productions (stops and fricatives). Signed letters were occasionally used to stimulate CP’s awareness <strong>of</strong> upcoming target sounds before producing them. Supports were faded as the accuracy <strong>of</strong> CP’s productions increased. Feedback <strong>of</strong> CP’s speech sound performance was <strong>of</strong>fered in the form <strong>of</strong> specific knowledge <strong>of</strong> results. Both correct and incorrect productions were given feedback. Correct productions would <strong>of</strong>ten be followed by statements such as; “Hey, those top teeth are touching your bottom lip!” or “I heard a hissing /s/ sound.” Incorrect productions <strong>of</strong> 44
CP’s target sounds were made known to CP and specific information on how to correct it was provided. Feedback ranged from statements such as “I heard the /s/ sound, but not the /m/ sound, I need to hear /sm/” or “Did you feel your lips come together?..... Let’s try again in the mirror and watch.” Self monitoring skills were encouraged by asking CP to rate his online productions by pointing to “thumbs up” or “thumbs down” cards, by rating others’ productions, and by teaching puppets correct oral placements by modeling sounds and manipulating their mouths for them. As soon as target sounds were able to be produced in isolation, practice began at simple word levels to ensure transfer <strong>of</strong> the skill. Practicing target sounds in words was not only more motivating to CP, but more functional for the transfer <strong>of</strong> skills to words and short phrases. Sample activity using <strong>integral</strong> <strong>stimulation</strong> techniques and rationales for use The following is an example <strong>of</strong> a 25-minute activity during which 12 target words (with initial /s/ clusters) were practiced yielding 70 productions <strong>of</strong> target sounds. Each /s/ blend was attempted an average <strong>of</strong> 5.8 times and was interspersed with short breaks. The child was presented with a motivating game such as a marble or ball run. The clinician presented the child with a pile <strong>of</strong> “tickets” that were stimulus picture cards <strong>of</strong> /s/ clusters. The clinician explained that in order to obtain a ball for the track, he must give the clinician a “ticket” and practice saying the picture on it. For many activities the clinician would discuss either before or during the activity reasons for why we are practicing our speech sounds. The clinician began by saying “Step right up! Get your ball for the ball-run!” The child handed his ticket (stimulus card) to the clinician and attempted to say the pictured word. Depending on the level <strong>of</strong> support needed, the clinician may have said the word 45
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 50 and 51: adjective, and a noun or verb (see
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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