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

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simultaneously with the child, provided an imitative model for the child, pointed to the printed word under the stimulus picture, mouthed the /s/ blend sounds, or provided any combination <strong>of</strong> mirrors and other supportive visuals for the child. The child was given specific feedback in response to his correct and incorrect productions <strong>of</strong> target sounds (extrinsic feedback). Feedback such as “I heard the /s/ sound but not the /n/. Let’s try again with both sounds.” Clinician gave the child pictures <strong>of</strong> /s/ and /n/ with oral placements and letters below to stick on a mirror. The child ordered the cards mouthing each /s/ and /n/ oral placement as pictured. The clinician and the child repeatedly practiced the sound simultaneously, <strong>of</strong>ten lengthening the sounds for emphasis. They monitored their own oral placements in the mirror until the sound could be produced correctly and consistently. The clinician gave the child feedback as to the accuracy <strong>of</strong> his production, and also provided the child with specific feedback so that he could make the minute adjustments needed for improved productions. This feedback is at the core <strong>of</strong> what makes <strong>integral</strong> <strong>stimulation</strong> so effective. Individuals with motor speech disorders are first given the tools to monitor specific speech movements by way <strong>of</strong> clinician feedback. As they become more pr<strong>of</strong>icient with their sound productions, they begin to develop the skills needed to monitor their own speech productions. The child was encouraged to develop familiarity with how a particular target feels, looks, and sounds (intrinsic feedback). Tactile feedback included questions such as: Does it create wind when it flows out <strong>of</strong> the mouth (putting hands in front <strong>of</strong> clinician’s and child’s mouth to feel air flow)? Is it voiced or unvoiced (feeling for vibrations <strong>of</strong> voiced sounds on the throat for differentiating /v/ from /f/ sounds)? Can the child feel his tongue touching his upper teeth when attempting the “th” sound? 46
CP was encouraged to create a mental picture <strong>of</strong> what target sounds look like; first by using mirrors, clinician examples, and pictorial supports, then by linking those visuals with tactile and auditory information. For children who are developing literacy skills, printed letters can serve as cues for the child to include all sounds in target productions. Auditory information was used first by providing the child with a model for a stimulus sound, then by asking the child to judge the accuracy <strong>of</strong> his own and others’ productions using auditory information (“thumbs up or down?”). Teaching a child how to self monitor his speech using normal auditory feedback is what allows a child to make corrections when misarticulations do occur. When CP had produced the target sound at syllable level (eg., [snæ]) with repeated success, then this hierarchical process <strong>of</strong> practice and feedback began again at the word level (eg., /snæp/). CP was given the maximum opportunity for practice without the adverse effects <strong>of</strong> fatigue and disinterest. One way <strong>of</strong> maintaining CP’s interest was to create short “breaks” in the form <strong>of</strong> motivating activities (rolling several balls down a track, hammering pegs, looking for hidden cards). The short activity served two purposes that are consistent with the principles <strong>of</strong> motor learning. First, it provided frequent reinforcement (through play) which may have increased the child’s motivation to continue practicing their target sounds. CP needed to be able to maintain focused attention to feedback given to him and apply that feedback to his speech sound attempts. Next, short breaks in speech target practice may increase the number <strong>of</strong> times a child may have to re-learn the patterns for specific (speech) movements (Magill, 1998; Schmidt & Wrisberg, 2004). In other words, it prevented the over habituation <strong>of</strong> practiced sounds/words by interrupting the practicing <strong>of</strong> motor speech enough to require the child 47
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 52 and 53: welcomed from CP’s parents who we
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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