The use of strategies for treating compensatory articulation errors in ...

SCALE FOR THE SEVERITY OF CAD• APROPRIATE ARTICULATION. Patient is ableto produce adequate placement and mannerof articulation during spontaneous speech,including non-present situations.

SCALE FOR THE SEVERITY OF CAD• INCONSTANT. The patient showscompensatory articulation errorsinconstantly during spontaneous speech.Intelligibility is not significantly affected

SCALE FOR THE SEVERITY OF CAD• ARTICULATION WITHIN CONTEXT. The patientself-corrects when using speech within aspecific context. For example during telling astory from a story book which the patientalready knows well. Nonetheless he showsfrequent compensatory errors duringspontaneous speech.

SCALE FOR THE SEVERITY OF CAD• ARTICULATION OF ISOLATED PHONEMES.The patient is able to correct articulationonly with isolated phonemes through directinstruction

SCALE FOR THE SEVERITY OF CAD• CONSTANT CAD. The patient is not able tocorrect articulation not even in isolatedphonemes and despite direct instruction

STRATEGIES (DIRECT INSTRUCTION)• phonetic changes• think aloud in phonemic awareness• cloze procedure with phonemic cues

STRATEGIES (INDIRECT)• Modeling• Modeling with Stress

MODELING• The adult models the language.• Behavior is modeled bur do not normallyrequest an imitation.• It seems preferable, since it is more similarto normal language learning than elicitedimitation.

MODELING WITH STRESS• Model the targeted sounds of speech butincludes a light pause before the sound anda stress on the phonemes the clinicianwants to model.• Child: “cut the cake” ; The adult says: “yes,__please, __cut the __cake and give me a__piece.

CLOZE PROCEDURE WITHPHONEMIC CUES• Clinician prompts the child’s communicativeturn by supplying part of the utterance andletting the child fill in the rest. If necessary,the clinician can provide the initial sound ofthe target word.• “Yes, she was hungry, and she foundthree-------(bowls) of -------(soup) on the----------(table)

PHONETIC CHANGES• Indicate that the message would be moreeasily interpreted with a modification inspeech production.• “the pen”…remember to put your lipstogether and make an explosion—ppppen”• The information would directly contribute torefining the phonemic distinction beingmisarticulated.

THINK ALOUD IN PHONEMICAWARENESS• Think aloud is a metacognitive strategywhere the clinician verbalizes thoughts whilereading a selection, thus modeling theprocess of comprehension.• Enables to demonstrate for the patient howto select an appropriate articulation processat a specific point in a particularcommunicative message.

THINK ALOUD IN PHONEMICAWARENESS• The clinician verbalizes specific think-aloud aboutdifferent levels of language organization, includingphonologic information.• Before looking at a story book: “think which sounds wewill be focusing on. We have to consider that thesesounds are short and explosive (/k/, /p/, /t/). We willwrite the letters for reminding you to use your bestspeech. Besides, we have other sounds that are long andcontinuous, like /s/ (write in another paper).While lookingat the story book, the clinician is focusing on the targetsounds and explaining the characteristics of eachphoneme and how changing the sounds can modify thecharacteristics of the word increasing intelligibility .

RESULTS• There was a significant relationship betweenthe success of all strategies and the degreeof severity of CAD in VCFS patients

RESULTS• Strategies which involve direct instruction onarticulation appear to be more effective inmore severe levels of CAD.

RESULTS• Strategies which do not involve directinstruction are equally effective in milderlevels of CAD.

CONCLUSIONS• STRATEGIES WHICH DO NOT INVOLVEDIRECT INSTRUCTION ON ARTICULATION AREEQUALLY EFFECTIVE IN MILDER LEVELS OFCOMPENSATORY ARTICULATION DISORDER

CONCLUSIONS• When speech intervention for a VCFS patientwith CAD is being planned, it is essential toassess the severity of the CAD. Furthermore,some strategies should be selectedaccording to the level of severity of thisdisorder.