Management of articulation

4. CONSIDERATIONS BEFORE STARTING...
 sounds that are functional for the child;
 sounds that are stimulable;
 sounds that occur in key words/contexts;
 sounds that are more visible;
 sounds that occur more frequently;
 sounds that affect intelligibility the most;
 sounds least affected by physical deviations;

5. …MORE CONSIDERATIONS...
 sounds inconsistently mispronounced;
 sounds that are acquired earlier;
 sounds that are part of child’s inventory;
 sounds that may generalize to others
 exemplars that are part of a rule pattern, e.g., P-V-M,
Distinctive features, Phonoloigcal processes

6. Edwards (1983)
Principles for selection of target sounds
•Choose target sounds that are in the child’s phonetic
repertoire
•Choose sounds for which the child is stimulable.
•Choose sounds that should improve intelligibility
•Choose frequently occurring sounds
•Choose sounds that are acquired early
•Choose high-value sounds
•Choose sounds that should be relatively easy to produce

7. Weiss, Gordon and Lillywhite (1987)
Select the error phoneme that:
•is the earliest to develop
•is the most stimulable
•is produced correctly in a key word
•occurs most frequently in speech
•is most consistent
•is visible
•has resulted in criticism
•the client most desires to correct
•is least likely to be affected by physical deviations
•is the same for a group of clients

8. Hegde and Davis (1995)
Guidelines for selection of potential target behaviors:
• select behaviors that will make an immediate and socially
significant difference (improves intelligibility the most);
• select the most useful behaviors that may be produced and
reinforced at home and in other natural settings (easily
understood and reinforced by family);
• select behaviors that help expand communicative skills;
practice words should be meaningful and appropriate.
4. select behaviors that are linguistically and culturally
appropriate for the individual client; practice words and
materials, suggested follow-up activities must be appropriate.

9. PREDICTIONS REGARDING
GENERALIZATION
(ELBERT AND GIERUT, 1986)
 teaching one members of a cognate sounds pair will
result in the use of the other sound in the pair;
 teaching one allophone will result in the production
of other related allophones;
 teaching a distinctive feature in the context of one
sound will result in the use of that feature in other
untreated sounds;
 teaching sounds in final position of morphemes will
result in more accurate production of the sounds in
inflected intervocalic contexts;

10. PREDICTIONS (CONTINUED)
teaching stops in word-final position will lead to
more accurate production in word-initial position;
teaching fricatives in word-initial position will
result in more accurate production of fricatives in
word-final position;
teaching fricatives will result in more accurate
production of stops;
teaching voiced obstruents (stops, fricatives,
affricates) will result in accurate production of
voiceless obstruents;

11. MORE PREDICTIONS ABOUT GENERALIZATION
teaching sounds that are stimulable results in
more accurate production than teaching sounds
that are not stimulable;
sounds that are phonologically “known” will be
produced more accurately than sounds that are
phonologically “unknown;”
teaching sounds of which a child has least
phonological knowledge will result in changes
across untreated aspects of the sound system.

13. TRADITIONAL APPROACH
Sensory-Perceptual (ear) Training:
identification, isolation, stimulation, discrimination
Production Training – Sound Establishment
Production Training – Sound Stabilization
isolation, nonsense syllable, words, phrases, sentences, conversation
Transfer and Carryover
Maintenance

14. PROBLEMS WITH INDIVIDUAL
SOUNDS
WHEN ARE “ORO-MOTOR”
EXERCISES APPROPRIATE?

15. MCDONALD’S SENSORI-MOTOR
APPROACH
I. Heighten child’s responsiveness to the patterns of auditory,
proprioceptive and tactile sensations associated with the
overlapping ballistic movements of articulation
II. Reinforce the child’s correct articulation of his error sound
III. Facilitate the correct articulation of the error sound in
systematically varied phonetic contexts.

16. I. Heighten awareness….
a) auditory stimuli for imitation and
description
b) exercises for overlapping movements
c) ear training
d) simple to complex
e) listen, feel, hear
f) practice with bisyllables
g) practice with trisyllables

17. II.REINFORCE CORRECT ARTICULATION
OF ERROR SOUND
 select a sound for reinforcement
 select a context in which error sound is correctly
articulated slow motion speech, alter
stress, etc.
 practice in short sentences

18. III. FACILITATE CORRECT ARTICULATION...
 change the vowel following it
 use other words ending in target + vowel; change the
vowel preceding target
 vary the stress
 practice in sentences
 if not continuant: slow motion speech/arrested
production
 practice with varied stress
VARY THE FACILITATING CONSONANT
SYSTEMATICALLY

19. UNIQUE FEATURES OF PHONOLOGICAL
THERAPY
 Works on groups or classes of sounds, not one sound
 Aim is to establish phonological contrasts which have been
neutralized
 Works in a naturalistic context

20. Edwards (1983)
Principles for selection of target processes
• Choose processes that result in early success or that would be relatively
easy to remediate. For example, select processes that occur only in
certain phonetic environments; or processes that affect sounds that are
within the child’s phonetic inventory; or select processes that affect
sounds for which the child is stimulable.
• Choose processes that are crucial for the child, i.e., those that draw
considerable attention to the child’s speech (e.g., velarization,
lateralization, frication of stops, glottal replacement).
• Choose early processes or processes that affect early sounds (e.g.,
gliding of stops).
4. Choose processes that interact, i.e., involve more than one rule (e.g.,
stopping of fricatives in final word position, which impacts plurals,
possessives, 3rd
person singular.)

21. CYCLES APPROACH
(HODSON AND PADEN (1983,1991)
 designed for severely unintelligible children
 uses auditory, tectile, visual stimulation cues to facilitate
awareness of targets
 a cycle is “a period of time during which all
phonological patterns in need of remediation are
facilitated in succession…
 the time period required for the child to successively
focus for 2 to 6 hr on each of his or her basic deficient
patterns.”

22. CYCLES APPROACH (CONTINUED)
SELECTION OF TARGET PATTERNS
Administer APP-R or HAPP-3
determine which phonological patterns are seen
at least 40% of the time
determine which one is most stimulable, next
most stimulable, etc. This determines hierarchy of
tx.
Primary target patterns or phonemes: early
developing phonological patterns
posterior/anterior contrasts /s/ clusters
liquids

23. CYCLES CONTINUED
Secondary target patterns voicing
contrasts vowel contrasts singleton stridents
consonant clusters residual context-related
processes (e.g., assimilation)
Advanced targets multisyllabic
words complex consonant sequences
Inappropriate primary targets voiced-
final obstruents final // weak-syllable deletion“th”
phonemes

24. CYCLES CONTINUED:
STRUCTURE OF REMEDIATION CYCLES
 Each phoneme exemplar within a target patterns should be
trained for approx 60 min per cycle before shifting to the next
phoneme in that pattern; one 60-min session or two 30 min
session or three 20-min session.
 Stimulation should be provided for two or more target
phonemes within a pattern before changing to the next target
pattern = two hours
 only one phonological pattern should be targeted during any
one session
 a cycle is complete when all targets have been taught
 a second cycle is initiated
 3-6 cycles (30-40 hrs), 40-60 min per week, usually required for
a child to become intelligible

25. CYCLES CONTINUED:
INSTRUCTIONAL SEQUENCE FOR REMEDIATION
SESSIONS
1. Review previous session: previous week’s production practice
word cards are reviewed
2.Auditory bombardment: slight amplification, two minutes;
child only listens to 12 words, perhaps twice
3.Target word cards: child draws, colors or pastes pictures of 3-5
target words on large index cards,with printed word.
4. Production practice: game based repetition; practice includes
auditory, tactile, visual stimulation at word level;
5. Stimulability probing: next session’s potential targets are probed.
6.Auditory bombardment - same as #2
7. Home program- read words to child;child imitates; 1/day.

26. USE OF MINIMAL PAIRS
 Highlights child’s error and correct production.
 Target selection is crucial
 Train perceptual discrimination
 Train productive discrimination
 Child takes on role of ‘teacher’ and must signal
knowledge of difference between pairs.

27. DISTINCTIVE FEATURE THERAPY
 Select the target
 select a sound pair contrasting this binary feature one
sound has to contain the feature and the other must not;
one sound is typically in the child’s inventory and one is not
 earlier developing sounds have priority

28. MINIMAL OPPOSITION CONTRAST
THERAPY
 Select two sounds with as many articulatory similarities as
possible;
 earlier sounds have priority;
 substitutions with greater impact on intelligibility have
priority
 stimulable sounds have priority

29. MAXIMAL OPPOSITION THERAPY
 Choose sounds that are productionally very different in
terms of P-M-V or distinctive features
 sounds should not be in inventory and should be maximally
different
 discrimination is not trained - only imitation and
spontaneous production

30. MULTIPLE OPPOSITION THERAPY
 Used with children who are typically unintelligible and who
neutralize several consonants into one;
 Aims at impacting system across rule set;
 Choose pairs (often will result in nonsense syllable pairings)
that cut across PMV
 Two, three of four pairings recommended

31. METAPHON THERAPY
 Phase One concept level
sound level
phoneme level
word level
 Phase Two
take turns in producing minimal pair words

32. COGNITIVE LEARNING AS BASIS FOR
PHONOLOGICAL INTERVENTION
In contrast to traditional modes of articulation therapy, the goal
of therapy from a phonological perspective is not production of
target sounds, but instead involves a conceptualization or under-
standing of the system or rules and regulations underlying
american english phonology…once the child understands the
rule-bound contrast between his production and the correct
production, it will be easy to facilitate improvement.

33. UNDERLYING PRINCIPLES:
 Emphasis is not the sound, but the rule
 rule is always taught in context of contrast
 no correct/incorrect value judgements
 no instructions about phonetic placement
 avoid direct imitation
 work on one rule at a time
 deemphasize auditory discrimination

34. USE OF IMAGERY
 Stopping of fricatives: running vs. dripping;
popping vs. blowing
 fronting of velars: front vs. back; tippy vs.
throaty
 deletion of final consonants: open vs. closed; tail
vs. no tail
 cluster reduction: friendly vs. lonely

35. THERAPY REGIMEN
 STEP 1 - semantic identification
 STEP 2 - production in nonsense syllables
 STEP 3 - semantic ID in words
 STEP 4 - production in words
 STEP 5 - semantic ID in phrases
 STEP 6 - production in phrases
 STEP 7 - production in conversation

36. PRIORITIES FOR INTERVENTION:
 Syllable structures rules first (DFC.WSD)
 assimilation rules
 manner rules (SF, gliding of liquids)
 placement rules (FV, backing of alveolars)
 late disappearing rules (CR, gliding of /r/,
stopping of “th”)
 voicing rules

37. ASSORTED ISSUES:
 Age to begin: data on individual sounds does not apply. Not
enough data
 Well-suited for group work
 Exclude parents
 Single out a sound for state/school data
 Number of errors is insignificant
 Can be used with adults, especially FAR

38. ASSORTED ISSUES, CONTINUED
 To cycle or not to cycle
 choose your first client carefully
 bypass the child’s learned phonological helplessness
 avoid wasting time on unsuccessful activities
 believe that the child isn’t producing, rather than can’t
produce, some sounds.

39. CHILD WITH AN EMERGING
PHONOLOGICAL SYSTEM
 Teach words that begin with sounds in inventory
 select words with syllable shapes that child uses and
expand to new shapes
 use normal developmental sequence of consonants as
a guide
 introduce new consonants in a babbling activity
 introduction new words
 vary their grammatical category
 reinforce all productions, even approximations