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

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Results This study examined the effectiveness <strong>of</strong> the <strong>integral</strong> <strong>stimulation</strong> articulation treatment on a child with childhood apraxia <strong>of</strong> speech. It was hypothesized that the participant’s (CP) percentage <strong>of</strong> correctly produced target phonemes would increase over the course <strong>of</strong> <strong>integral</strong> <strong>stimulation</strong> treatment and be retained after a 2-week treatment withdrawal period. Speech probes with phrases containing target sounds were administered before each session, throughout baseline, treatment, and post-treatment phases <strong>of</strong> this study. Data from the speech probes were charted over the course <strong>of</strong> this study to monitor treatment effectiveness. Baseline results tracked the generalization <strong>of</strong> skills to non-trained single-syllable words in phrases containing target speech sounds. Baseline measures were conducted over four sessions to determine stability <strong>of</strong> performance for CP’s initial target phoneme set /sm, sn, sp, st, sw/. Baseline data for proceeding target sounds were tracked over longer periods <strong>of</strong> time as phoneme sets were introduced one at a time. Treatment sessions following the initial baseline sessions included short games that familiarized child with sound-to-letter associations, naming mouth parts, and practicing turn-taking skills, but direct instruction <strong>of</strong> target speech sounds using <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> was not used. The treatment periods for each phoneme set varied as only one phoneme set was introduced at a time. Once treatments began, the treatment continued in each set throughout the duration <strong>of</strong> this study’s treatment phase. Integral <strong>stimulation</strong> <strong>therapy</strong> included 33 treatment sessions. Post treatment data were collected 16 days after the subject’s last <strong>integral</strong> <strong>stimulation</strong> treatment session. In order to avoid interruptions in treatment sessions, treatment and baseline data were 52
gathered in the PSU Speech Clinic as well as at CP’s residence. This was due to school closures during vacation periods and schedule changes for the participating family. Data collected at CP’s residence are indicated by session number below each Figure. Data Results for /s/ Clusters: /sp, sm, sn, st, sw/ Figure 1 illustrates CP’s performance during speech probes as the percent <strong>of</strong> /s/ consonant clusters /sp, sm, sn, st, & sw/ correctly produced. Data were charted over time during baseline, treatment, and post-treatment phases. Baseline data probes indicated that CP consistently omitted or distorted /s/ consonant cluster phonemes within carrier phrases. Substitution errors were varied (a hallmark <strong>of</strong> apraxic speech), ranging from omissions <strong>of</strong> first or second consonant, to substitutions with sounds sharing neither place nor manner characteristics with its intended production. CP’s percent accuracy <strong>of</strong> /s/ consonant clusters was 0% over the 4 pre-treatment sessions. In instances when the subject made multiple productions <strong>of</strong> a target sound (self-corrections), CP’s last attempt was recorded as his response. After 3 treatment sessions, CP’s accuracy <strong>of</strong> /s/ cluster phonemes moved from 0% correct to 40% correct in carrier phrases. His accuracy continued to fluctuate between 0% correct and 40% correct over the course <strong>of</strong> treatment sessions 6 through 15. In session 16, CP’s percent <strong>of</strong> correctly produced /s/ cluster phonemes showed a marked increase to 60% accuracy. Figure 6 shows an increase in slope throughout the treatment sessions and following session number 16, the slope did not move below 60% accuracy for all target phonemes (/sp, sm, sn, st, sw/). Following session 24, CP’s percent consonant correct for /s/ cluster phonemes in carrier phrases alternated between 80% to 100% accuracy over the course <strong>of</strong> sessions 25 through 37. 53
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EFFECTS OF INTEGRAL STIMULATION THE
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stimulation <stron
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Table of Contents
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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 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 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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