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Different modes of structuring treatment sessions....
Drill, drill play, sturctured play and play
stimulus-response mode Ex: Give me a good /g/ sound...
Define Drill Play
Using a motivator with drill
Define Structured Play
Part of play activities; optional feedback about incorrect responses Ex: /b/ phoneme, might bring blocks, bubbles, babies...
Stimulus and response activities that occur as a part of play activies. (natural) -Kids play with whatever and we model incorrect utterances
What variables should be considered when structuring treament sessions..
- 1) client
- a) modify treatment to fit client
- 2) stage of treatment
- b) begin with highly struc first
Treatment trial in which clinician presents antecedent stimuli; client is instructed to produce the sound or clinician immediately models the correct response. Then clicinician gives appropriate consequence and records accuracy. *some sounds not able to produce in this way...
Sound in Isolation level
This is the simplest response level for sounds that cannot be produced in isolation... can use vowel diagram to present target sound.
Sound in Syllable level
Treatment trial that uses carrier phrases..
Sound in word, phrase and sentence levels
In this trial the clinician presents a picture or object in front of the client then demonstrates the action or event that reps the sound in a word, asks a relevent predeterm'd question or immediatly models the correct response. Clinician then waits for client to respond following with a consequence then records response.
Sound in word, phrase and sentence levels
In this trial clinician asks open-ended questions to evoke free flow of speech. Clinician will continue to provide feedback appropriate to response, client needs to be able to self-monitor.
Sound in conversation
To find out if the treatment has resulted in generalized production, the clinician conducts a...
Data collection is necessary because and includes...
It is necessary to show accountability and includes positive changes in childs skills under treatment as well as the overall progress since the inception of treatment.
What are the different types of generalizations?
- 1) Generalization to untrained stimulus items
- 2) Generalization across word positions
- 3) Generalization across response topographies
- 4) Generalization within sound classes
- 5) Generalization across sound class
- 6) Generalization across situations
Type of generalization in which a child moves a response to a pic to response to an object.. Ex: Child learns soup in Tx and then at home says the word soup in repsonse to a bowl of soup.
Generalization to untrained stimulus items
Type of generalization in which child learns a phoneme in one position and uses it in untreated positions of a word.
Generalization across word positions
Type of generalization in which child produces /p/ in word and sentences but was only taught its production in single words.
Generalization across repsonse topographies
What is the ultimate goal of the clinician which refers to skills sustained across time?
In a nut shell selection and manipulation of antecedent stimuli is...
What we do to elicit the response
When selecting and manipulating the antecedent stimuli you need to...
- 1) Use stimuli that is from the natural environment
- 2) Use common verbal antecedents
- 3) Vary audience
- 4) Vary in physical settings
Define stimlui from natural environments..
Talking about things of clients interest or things that occur in the clients home environment... baseball, crochet,
Define common verbal antecedents..
These are words or phrases used to evoke the producion of target sounds..
Ex: Knock, knock, knock... child answers "Come in" target t/k
Varying the audience refers to..
Involving parents, siblings, friends because in the presence of the clinician is not the typical audience.
Vary the physical audience refers to...
Holding informal treatment sessions in various places like the cafeteria, playground of in the classroom...
When selecting responses...
- 1) It must be client specific
- 2) Must teach multiple exemplars
- 3) Reinforce complex resoponse topographies (generalizations)
Define multiple exemplars
This is teaching to expand the use or target. Train many words with target behavior to promote generalization.
Manipulation of treatment contingencies refers to...
The clinician reevaluating the programmed contingencies for effectiveness.
Manipulating treatment contingencies includes..
- 1) Moving away from continuous and intermittment reinforcement
- 2) Use conditioned/ natural reinforcement
- 3) delaying reinforcement
- 4) training parents and caregivers
- 5)reinforcing generalizations
- 6) Teaching self correction/ monitoring
- 7) Teaching contingency priming
What is the importance of moving away from intermittent and continuous reinforcement?
Because a client is not going to get reinforcement for each correct production in everyday life.
Verpraise, attention, and eye contact are all types of (in reference to maintenance)
When a clinician is using the 1-3-8 schedule he/she is...
When training parents and/or caregivers it is important that they give ______ not ______.
The ability of a person to catch their own incorrect production and correct it is know as...
self correct or self monitor
What is contingency priming?
This is when a client seeks reinforcement from others for their own desirable response.
ex. Mom did you hear my good /s/ sounds???
Four ways dismissal may occur are...
- 1) time restraint (third party)
- 2)Lack of interest (may need break)
- 3)Plateau effect
- 4)Ultimate goal... dismissal upon mastery
If a patient is dismissed upon mastery what needs to follow?
Follow ups or reassesments. (to check maintenance)
What is done to asses phonological/phonemic awareness?
- Phoneme isolation
- Sound and syllable blending
- Sound and syllable identification
- Phoneme manipulation
- Sound segmentation
Treatment for phonological awareness?
- 1)Articulation treatment can be changed to adapt to treatment for phonological awareness.
- 2) Activities that promote phono awareness
- 3) Important to from simple to complex
Motor skill disorder, client will have difficulty executing volotional movements in the absence of muscular weakness.
Etiologies of apraxia.
- 1) Neurological damage to the dominate speech hemi (brocca's in dom hemi).
- 2) Degenerative disorders
- 3) Tumors in left hemi
- 4) Seizure disorders
- 5) Traumatic injury
- 6) Undetermined (4% of cases)
What are the three types of apraxia?
Oral, Limb, and verbal/speech apraxia
_____ is the most common type of apraxia and ____ is the least common type of apraxia.
______ apraxia is difficulty in the volotional movements required for production of phonemes and words.
_____ apraxia may give a patient difficulty with non speech volitional movements (licking an ice cream cone)
What is the most common hemisphere damaged in apraxia?
What are the characteristics of apraxia?
- 1) awareness of problems causing frustration
- 2) imparied volotional sequencing movements
- 3) highly variable errors (hallmark of apraxia)
- 4) slower rate of speech (compensatory to produce correct speech)
What are the articulation errors of apraxia?
- 1) Subs and ommisions, some distortions
- 2) Better automatic speech
- 3) Erros of afficates and fricatives
- 4) Regressive and anticpatory substitutions
- 5) Consonant cluster error more than singleton
- 6) Metathatic errors (ask-aks)
- 7) Delayed initition
- 8) Difficulty with imitation
- 9) Searchin, trial and error or groping
- 10) Unsuccessful self correction leads to false start and searching
-monotonous voice quality and syllalble stress
-Repitions because of false starts
-Reduced rate of speech
-Multiple silent pauses
-Increased duration of syllables
-Difficulty in increasing speech or changing pitch when instructed
-may sound like foreign accent
are all prosodic problems of ______.
What are the different names of childhood apraxia of speech?
- CAS-Childhood Apraxia of Speech
- DAS-Developmental Apraxia of Speech
- DVA-Developmental Verbal Apraxia
- and Suspected Developmental Apraxia of Speech
Childhood Apraxia of Speech is a _____ descriptive and ____ known etiolgy.
Speech characteristics of CAS
- Moderate to severe intelligibility problems
- inconsitent sound errors
- unusual error patters/no pattern
- non english sound production
- prosodic problems (dysprosody and aprosody)
These are ______ and _____ problems of CAS.
1)diffi sounds in correct sequence
2)diffi sequencing sounds even though they are in the child's phonetic repertoire
3)diffi with diadochokinetic
4)increase in number of sequencing errors as incr in complexity or lenght of the utterance
5) metathetic errors
Sound and syllable sequencing
Silent posturing errors and groping errors are most notable in ________ tasks.
What is silent posturing?
Static articulatory postures withough sound production.
ex: Child may position lips for /b/ but no sound.
What are groping errors?
an active and ongoing series of movements of the articulators in an attempt to find the appropriate placement or position for the production of a sound or sounds.
List some associated problems of CAS.
- 1)Slow progress
- 2)"soft" neurological signs (problems with fine motor skills-handwriting..)
- 3) Presence of oral apraxia
- 4) Decreased oral awareness (oral asterognosis) [cant lick lollipop, puts finger on tongue to tell where it is]
What are some of the assesment obj's of CAS?
- -Assess across tasks and situations
- -Assess aspects of skills of communication
- -Describe nature and severity
- -Distinguish from other speech disorders
- -To ID treatment targets
- -To make clinical prognosis (do not set a time limit, needs to be reasonable.)
- -To ID strengths (to create a treatment plan that capitalizes on what the client can do)
What are the assessment techniques for the diagnosis of CAS?
- -Assess/Compare Non-imitative speech production and imitative speech production
- -Assess consistency and vaiability of errors
- -Assess diadochokinetic syllable rates
- -Assess intelligibility
- -Assess prosody (role play, story time, scripts)
- -Assess fluency and disfluency (repetition, false start)
This is a neromotor speech disorder affecting one or all parameters of speech production.
Dysarthria is group of _____ speech disorders resulting from ______ damage.
What is the etiology of dysarthria?
- -Lesion sites within the nervous system
- 1)lwr and hghr motor neuron systems
- 2)Cerebellar system
- 3)Extrapyramidal system (basal ganglia)
What are the respiratory problems of dysarthria?
Forced and breathy.
What are the phonotory disorders of dysarthria?
diplophonia and monoloudness
What are the resonance disorders of dysarthria?
hypo,hyper and nasal emissions
What are the articulation disorders of dysarthria?
Distortions, prolongations, and weak pressure consonants (stops, fri, affric hard to pronounce)
Prosody disorders of dysarthria?
slow or rapid rate and syllable stress
What are "other" disordesrs of dysarthria?
repetition with increased rate and decreased loudness
What are the global characteristics of communication (in reference to dysarthria)
Decreased intelligibility of speech and bizarre speech
What are the types of dysarthria?
- -Unilateral upper neuron dysarthria
Define flaccid dysarthria
"floppy" lower motor neuron damage aka bulbar palsy
Define spastic dysarthria.
Too much muscle contraction and tone. Upper motor neuron damage aka pseudobulbar palsy.
Define ataxic dysarthria.
lack of coordination, stumble around "drunkeness" Cerebellar damage
Define hypokinetic dysarthria
Damage to basal ganglia and extrapyramidal. Parkinsons
Define hyperkinetic dysarthria
movement disorders (too much movement)
Define mixed dysarthria.
Has 2 or more types of dysarthria concurrently. (flaccid/spastic)
Define unilateral upper motor neruon dysarthria.
effects only one side
Assessment objectives of dysarthria include.
- -Determine type of dysarthria
- -evaluate artic, respir, phonation and prosody
- -Plan treatment targets
- -Describe nature and severity of dys
- -Estimate prognosis
- -remember to include strengths (develop tx plan on what they can do)
When assessing connected speech in dysarthria
Are they able to produce it?
Assessing the speech production mechanism for dysarthria.
Oral-peripheral exam (tongue strength, movement etc)
Assessing Diadochokinetic syllable rates of dysarthria.
This is important... How graphically can they produce it?
Assessing respiratory system of dysarthric.
- Some may not have good breath support
- Some epend all air on one syllable
- Are the movements helpful for speech?
Assessing phonatory systems for dysarthria.
Is the breathy or intense?
Assessing resonance of dysarthria.
- Often hyponasal.
- Are they able to switch back and forth?
Assessing articulation of dysarthria
- Distortions and prolongations primarily
- Some substitutions
- No omissions
Assessing prosody of dysarthria.
Assess syllable stress, rate, rythm
- Non-progressive neuromotor disorder due to damage to the brain before, during, or shorlty after birth
- *seems progressive because of lack of advance
Etiology and nature of CP
- Actual single cause of CP unknown, about 40% unknown actual cause
- prenatal: multi causes
- perinatal: delivery complications
- postnatal: toxicity, premi, head trauma and inflammatory diseases
Paralysis categores of CP
- Quadraplegia: paralysis involving the trunk and all four extremities
- Diplegia: paralysis of corresoponding extremities on both sides of the body
- Paraplegiaa: paralysis of the lowern trunk and both lower extremities
- Hemeplegia: paralysis of one side of the body
- Monoplegia: paralysis of a single extremity
List the different types of CP
What is spastic CP?
- Most common
- Increased muscle tone (tighter muscles ---> jerky movements
What is Athetod CP?
writhing involuntary movements
What is Ataxic CP?
Balance problems (looks drunk)
What is Rigid CP?
Contraction of all muscle groups.
What is mixed CP?
- Most common is spastic and athetoid
- Combinations of palsy's
Articulatory problems of CP
- worse with athetoid (distortions and omissions)
- Slurring final positions
- Single word articulation better than connected speech
Resonance problems of CP
- Hypernasal (no velum control to shut off nasal cavity)
- Nasal emissions (stops, frics and consonants)
Phonoatory problems of CP
- weak poor control of pitch control
- pitch quality
- Pitchy, harsh and breathy
Respiratory problems of CP
- rapid breathing patterns
- excess movement of diaphragm
- (air wastage)
Prosodic problems of CP
- Dysprosody (prosody not accurate)
Associated problems of CP
- Jerky jaw
- incoordinated tongue movements
Assesment objectives of CP
- Multidisplinary: occupational therapist, classroom teacher, etc
- Assess physiologic strucs: oral motor exam for ability to move strucs
- Assess strengths
- Conduct follow-ups
- determine potential for augmen devices (sign, speaker device)
observation of neuromotor function for CP
How well do they respond to requests
Observation of motor development of CP
How will CP motor function progress and what are the current milestones?
Observation of mental development of CP
- What is their current cognitive "level"?
- Not every CP or dysarthric are cognitive impaired.
Assess speech disorder and intelligibility of CP
- Proper speech mechanism function
- Overall intelligibility?
Assess prosody problems of CP
Note stress patterns, rate, intonation, pauses etc
Assess voice and respiratory problems of CP
- Voice quality
- Breath support appropriate
Assess resonance problems of CP
Assess oromotor function of CP
General orofacial examination
Assess the need for augmen and altern comm fof CP
Good candiate based on motor and cognitive impairments
Define Cleft lip and palate. Who has the highest incidence rate?
- Occurs during embryonic
- Lip closure usually during 5&6th week
- Hard palate fusion usually 8&9th week
- *highest incedence in Native Americans
Etiology and nature of Cleft palate and lip
- genetic, environmental, toxicity, and embryonic factors
What is cleft palate often associated with?
- Ear infection
- velopharyngeal incompetence/ inability to produce intraoral pressure
Articulation and phonatory disorders of cleft palate/lip
- Difficulty with buildup and maintain intraoral pressure
- Velopharyngeal inadequacy: velum not elevating enough to close of nasal-> nasal emissions
- Compensatory errors: use of glottal stop because of inability to make regular stop
Laryngeal pathologies and phonoatory disorders
- Vocal nodules: because of incr effort to maintain intraoral pressure,
- soft or monotone
Resonance disorders of cleft palate
Assessment objs for cleft palate/lip
- presence of other disorders maybe or not
- periodic assessment of fistulae-prognosis after surdery
- Suggest tx targets if speech probs continue after surgery
- assess strengths and intact skills to make plan on what they can do
Resonance of problems of speech mechanism in cleft palate
hypo/er-nasal (nasality or denasal)
16-90 dbhl is _____ __ _______.
90> is ____.
Define hearing impairment
- refers to reduced hearing acuity
Etologies of HI
- Psychogenic: no phys reason
- Conductive: interruption of sound to cochlea
- SNHL: probs with cochlea or hair cells or aud nerve
- Mixed: combo of conductive and sensorineural
What is presbycusis?
hearing loss because of aging
Prelingual and postlingual refer to..
The age of hearing loss before acquire language and after acquire language
What are the support systems of HI?
Access to med facilities, audiologist etc.
What are some other difficulties of hearing impairment?
may be secondary to another disorder
What are articulation characteristics of those with HI?
- vowel probs (cannot see them)
- Breathy (in effort to speak orally)
Voice and resonance characteristics of those with HI
- More pronounced qualities, pitch, hyponasal, breathy and inflections
- *are not able to hear themselves
Prosody of those with HI
- Limited dysfluencies
- abnomal flow, rythm and infelctions
- slower rate
Associated language and literacy problems
- Have problems with sarcasm.
- Education level usually lower
Assessment objs of HI
- Assess intelligibility
- Assess voice, resonance and prosody
- Assess strengths and intact skills
- Assess other comm skills (auditory comprehension, verbal expression and reading and writing skills)
- Describe nature and severity of HI
- Make clinical prognosis
What is done when assessing auditory perceptin or speech discrimination of HI?
Testing for residual hearing
What is done when assessing speech mechanism of HI?
Look at high palate, because of different tongue position
Assessing for connected speech of HI
Intelligibility of somone who is familir and those wh are not
Treatment of childhood apraxia of speech
- Treat movement patterns and sound sequences
- Begin with early developing, visible, highly contrasted and easily distinguishable
- Begin with what is meaningful to child
- Begin in intial position, in order of phonetic complexity
- Take breaks or cue client to take them
- Teach slower movements
- Automatic before spontaneous
Why is it important to focus on meaningful words when treating CAS?
Child needs to learn words they are likely to use.
Why should slower movements be taught to those with CAS?
Need to give articulators time to get into place
What are some specific tx approaches?
- Progressive assimiliation
- Phonetic placement
- contrastive stress drills
What is PROMPT?
Prompt for resturucturing oral muscular phonetic targets
What is progressive assimilation?
shaping- lightly bite lower lip to begin /f/
What is phonetic placement?
Teach articulator positions
Contrasitve stress drills
to train correct prosody
Medical treatments for dysarthria in children
- Laryngeoplasty: paralyzed voal fold is moved with impland to promote phonation and better voice quality
- Teflon/collagen injections and recurrent laryngeal nerve resection
- Botox injections: spasmodic dysphonia
- Palatal lift: Prothetic device attatches to teeth and posterior portion extends to life soft palate improving resonance
Treatment principles of dys in children
- Teach appropriate prosody (pacing board, delayed auditory feedback)
- Improve intell with slower rate (pacing)
- Use of non-verbal comm if necessary
- Compensatory movements (buccal air)
- Exercises (controversial but may strength)
- Work with family (involvoe who they comm witht he most)
Treatment of CP
- Muscle strenghthening/assistive devices
- direct treatment: phonetic placement
- Increase the speech of articulatory movemtents
- Work with repiratory: sustaining airflow, breath for SP and breath for life
- Prosody (same as dysarth)
- May need augmen system
Medical treatments of Cleft palate
- Pharyngeal flap surgery: secondary procedure for hypernasality
- Fistulae repair: opening that is closed after remains open from cleft patate repair
- Speech bulb: for hypernasality, palatal retainer helps with velppharyngeal closure
Treatment of Cleft palate
- Treat visible sounds first
- Begin with vowels, move to semivowels, nasals, glides, fricatives, lingua-pals, lingua-alveols, and ling-dents
- Postpone /k/ and /g/
- Strengthen velum
- Correct airflow (after surgery may still use hypernasal airflow)
- Reduce faical grimace
- Compensatory articulation (use /h/ to produce buccal when need oral air)
- Treat proper resonance
- Reduce voal abusive behaviors
How do you work on resonance of cleft palate?
Teach oral air instead of nasal
Key apects of treatment of hearing impaired.
- Begin EARLY
- Involve family
- Use visual,tactile and kinesthetic cues
- Begin with stops-frics-affrics (because of little visual info)
- Treat initial and final consonant deletion (particularly in voiceless)
- Vowels difficult (no visual cues)
- Vocal quality (charac of deaf sp, hypo/er-nasal culdasac resonance.