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Management of articulation

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Management of articulation

Publié dans : Santé & Médecine
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Management of articulation

  1. 1. 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;
  2. 2. …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
  3. 3. 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
  4. 4. 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
  5. 5. 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.
  6. 6. 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;
  7. 7. 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;
  8. 8. 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.
  9. 9. 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
  10. 10. PROBLEMS WITH INDIVIDUAL SOUNDS WHEN ARE “ORO-MOTOR” EXERCISES APPROPRIATE?
  11. 11. 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.
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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.)
  17. 17. 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.”
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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.
  22. 22. 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.
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. METAPHON THERAPY  Phase One concept level sound level phoneme level word level  Phase Two take turns in producing minimal pair words
  28. 28. 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.
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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.
  35. 35. 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

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