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

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practice his motor speech skills in a distributed and random fashion, building on his ability to generalize his skills to everyday speech contexts. In this study, 3 out <strong>of</strong> the 4 speech targets indicated stable retention <strong>of</strong> learned speech motor skills as indicated by retention <strong>of</strong> target sound accuracy 2 weeks following the end <strong>of</strong> treatment. Specifically, CP’s accuracy <strong>of</strong> s-cluster phonemes /sp/, /sm/, /sn/, /st/, and /sw/ in carrier phrases rose from 0% accuracy during 4 baseline probes, to 100% and 80% accuracy in post treatment data probes. Phonemes /f/ and /v/ accuracy increased from 0% and 40% correct during baseline probes to 80% and 100% correct in post treatment data probes. CP’s accuracy <strong>of</strong> affricate sounds /ȴ/ and /ȷ/ increased in accuracy from baselines <strong>of</strong> 0% and 60% accurate to post treatment results <strong>of</strong> 60% to 100%. It should be noted that baseline data indicated a pattern <strong>of</strong> improved production prior to treatment for this sound class /ȴ/ and /ȷ/. CP had been able to accurately produce /ȴ/ and /ȷ/ in some instances (in words and phrases) prior to treatment for these sounds. It is possible that CP’s increased self-monitoring skills as well as work on other fricative word classes (/s/ clusters, and /f/, /v/) may have transferred to his motor speech skills during the treatment period. His baseline performance was stable (0 to 20% correct) over the first 9 baseline probes, then began to increase after /f/ & /v/ targets were introduced to treatment sessions. The fourth speech sound class (interdental fricatives /θ/ and /ð/) may have been introduced too late in the course <strong>of</strong> the treatment (session # 26) to have acquired stable motor learning (generalization) following the cessation <strong>of</strong> treatment. CP showed clear improvement in production <strong>of</strong> /θ/ and /ð/ sounds over the course <strong>of</strong> the treatment period. His accuracy for interdental sounds was consistently 0% over the 4 baseline data probes 66
and rose to 60% and 40% accuracy in post treatment probes. Despite clear gains in accuracy during treatment periods, the stability <strong>of</strong> his motor learning in post treatment probes indicated a pattern <strong>of</strong> decline (from 60% to 50% to 40%) for /θ/ and /ð/ sounds (see Figure 4 ). Several factors may have contributed to this decline. This phoneme set received the least amount <strong>of</strong> treatment sessions during this study as it was the final phoneme set introduced. Interdental sounds spanned only the final 3 rd <strong>of</strong> the <strong>integral</strong> <strong>stimulation</strong> <strong>therapy</strong> sessions (12 sessions in all). Although clear progress was made over the 12 sessions (performance went from 0% accuracy to up to 60 %) there may not have been adequate amounts <strong>of</strong> motor practice to have achieved motor learning (maintenance <strong>of</strong> skills after treatment for target sounds had ended) for these speech skills. By the final <strong>therapy</strong> session, CP was estimated to be only 70% accurate at word level and 40% accurate during speech activities that required him to use interdental fricatives repeatedly in a single sentence, “There’s the spider.” Unlike the other speech sound sets, mastery <strong>of</strong> /θ/ and /ð/ sounds during speech sessions at phrase levels had not been achieved by the conclusion the treatment phase. Another factor that may have negatively impacted CP’s performance <strong>of</strong> /θ/ and /ð/ sounds was that there were fewer opportunities in most speech sessions to practice interdental fricatives as sessions continued to include practice <strong>of</strong> the previous speech sound goals (/s/ clusters, labiodentals fricatives, & affricates) within a 50-minute time frame. An essential component <strong>of</strong> motor learning is frequent correct repetitions (100 to 150) <strong>of</strong> speech target sounds within a speech session. Fewer opportunities to practice speech sounds may have contributed to slower acquisition <strong>of</strong> motor performance and motor learning for bilabial fricative phonemes. 67
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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
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melodic support to overcome sound s
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Literature Review The differential
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part affect the numbers diagnosed a
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discrepancy suggests the probabilit
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neuromuscular impairment (Caruso &
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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 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 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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