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. What would you like to do?
A stimulus-response/ stimulus-response/stimulus-response
Uses a motivator with a drill
ex: roll a die and client will produce sound that many times
training is part of play activities; optional feedback
ex: for /b/- bring a box with a lot of toys that being with /b/ sound....baby, ball, blocks
Stimulus and response activies occur as part of play activities. It is more natural. Used often with lower functioning cognitive level.
For treatment it is best to move from ________ structured to _________ structured.
Final goal for treatment is?
A structured opportunity for the production of a particular behavior.
What evokes the sound? It can be pictures, visual and verbal prompts, modeling, instructions, phonetic placement, or a combination of techniques.
In treatment you sould use ______ unless the client is able to understand phonetic symbols.
The simplest response level for sounds that can't be produced in isolation without a schwa.
In what level of treatment do you look for 80-90% accuracy level from in at least 2 sessions or possibly 3?
Word, phrase, sentence level
In which treatment level would you might need to ue carrier phrases or "slot fillers"
Word, phrase, sentence
After the removal of a stimulus it is good to wait 2-3 seconds before providing the next one to enhance ________ .
In conversation level it is best to ask ________ questions.
It is important to avoid which kind of questions in the conversation level?
What and Do
In the conversation level it is important to train ______.
(Dr. Barker said you should actually work on it before the conversation level)
When is a sound mastered?
When its production generalizes to untrained words, phrases, etc.
What are used to determine generalization?
Probes are crucial at what level?
Sentence and conversation
Moving from responses to pictures to response to the object
untrained stimulus item (physical stimulus generalization)
Generalization across word positions would be...
initial, medial, and final
if client moves from trained response at word level to spontaneous in phrases and sentences.
response topographies (intraverbal generalization)
Generalization within a sound class?
manner, place, voice, word position, distinctive feature, phonological processes
occurs when a treatment generalized to a sound that doesn't appear to be phonetically related?
generalization across sound classes
selction and manipulation of antecedent stimuli.
Stimuli- have them do things that they are going to really need to do!!
maintaining the skill after treatment is finished
actively seeking reinforcement from others?
Assessment of Phonological/phonemic awareness....
- phonemic isolation
- phonemic manipulation
- sound and syllable blending
- syllable and sound identification
- sound segmentation
Train phonological awareness to _______?
A motor programming disorder characterized by difficulty executing volitional movements, in the absence of weakness, paralysis, or incoordination?
the client has problems executing volitional non-speech movements of the oral muslces.
difficulty moving the arms and legs?
inability to program and execute volitional movements for production of phonemes and words?
Apraxia of speech or verbal apraxia
The most common type of apraxia?
Apraxia of speech
The least common type of apraxia?
Most common type of neurological damage for individuals with apraxia?
single left himisphere stroke
For apraxia the cause is undetermined ____% of the time.
Characteristics of Apraxia?
- better automatic speech
- reduced rate of speech
- variable errors
- frustration for clients because of their speech problems
Articualtion errors for Apraxia
- substitutions, omissions
- more errors on fricatives and affricates
- consonant cluster errors
- regressive substitutions
- anticipatory substitutions
- trial and error
- initial sound position error
- difficulty with imitation
Apraxias prosodic problems...
- reduced rate of speech
- pauses between words
- increased duration of syllables
- repetitions (stuttering)
- restricted range and intensity of pitch
- sometimes sounds like foreign accent
What disorder sometimes sounds like they have a foreign accent?
kids are highly unintelligible, the term is not used very often. It is essentially a childhood articulation disorder of unknown etiology.
Chidlhood apraxia of speech or developmental apraxia of speech or developmental apraxia of speech
The term CAS could be used most often as a _____.
Descriptive diagnostic label
Childhood Apraxia of speech characteristics:
- They defy phonetic transcription
- unusual errors
- vowel errors
- aprosody (flat prosody)
- dyprosody (inappropraite pitch variations)
- omission and substittion errors
don't know what their articulators are doing. They have to use their hand to realize what their tongue is doing.
For treatment of CAS you should focus on _____?
sensorimotor: movement patterns and sound sequences.
a neuromotor speech disorder affecting one, various, or all parameters of speech productions
lower motor neuron damage to te cranial or spinal nerves that supply the speech muscles. It is usually floppy. Aka bulbar palsy.
a bilateral upper motor neuron damage. Aka pseudobulbar palsy.
results from neuropathological damage to the cerebellum or the cerebellar control circuits that regulate and coordinate muscular movements. lack of coordination....looks like they're drunk.
a neuromotor speech disorder associated with basal ganglia(extrapyramidal system). Includes parkison's disease or alzheimers disease.
an inclusive diagnostic label for a variety of speech disoder resulting from damage to the basal ganglia (extrapyramidal system) Deals with a lot of movement disorders.
a combination of two or more pure types of dysarthria.
a motor speech disorder caused by a unilateral lesion to the upper motor neurons that supply the cranial and spinal nerves involved in speech. Affected on one side only.
Unilateral upper motor neuron dysarthria
Major symptomsof unilateral upper motor neuron are:
- unilateral lower facial weakness
- unilateral tongue weakness
- unilateral palatal weakness
- hemiplegia/ hemiparesis
Dysarthria is characterized by:
- imprecise productin of sounds
- irrefular articulatory breakdowns
- harsh voice
- reduced loudness
paralyzed vocal fold is moved with implants to promote phonation and better voice quality. Paralyzed vocal fold is brought to midline and implant may be used so there can be better approximation.
When the voice cuts out they cannot consistently phonate.
prosthetic device that attaches to the teeth wit a posterior portion extending to lift the soft palate- improving resonance.
A congenital, non-progressive, neuromotor disorder resulting from brain damage before, during, or shortly after birth.
before birth; trauma, lack of oxyygen to the brain
during birth; complications during delivery
after birth; prematurity, head trauma, inflammatroy diseases, blood toxicity
After 2 years they will call cerebral palsy ______?
In cerebral palsy _____% of the time etiology is unknown.
Categories of cerebral palsy: trunk and all extremities
Categories of cerebral palsy: corresponding extremities on both sides.
Categories of cerebral palsy: lower trunk and lower extremities
Categories of cerebral palsy: one side
Categories of cerebral palsy: single extemity
Types of cerebral palsy: most common, increased muscle tone causing jerky movements
Types of cerebral palsy: writhing involuntary movements
Types of cerebral palsy: balance problems (look drunk)
Types of cerebral palsy: simultaneous contraction of all muscle groups
Types of cerebral palsy: combination, most common is a combination of spastic and athetoid
Articulation is worse with what type of cerebral palsy?
The resonance is most often _______ with individuals with cerebral palsy.
hypernasal- because velum isn't able to close off nasal cavity effectively
Cleft lip and palate has the highest incidence in ___________.
Cleft lip and palate occurs during ________?
Lip closure usually occurs during the _______ week of gestation?
hard and soft palate fusion occurs during the ______ week of gestation?
children with cleft lip and palate may have associated problems with:
- ear infections
- hearing loss (50% of the time)
- mental retardation
- velopharyngeal incompetence
Compensatory errors for individuals with cleft lip and palate:
secondary procedure for hypernasality assuming that the cleft palate correction has already been done. Flap is cut from pharyngeal wayy and attached to the velum.
Pharyngeal flap surgery
close opening after surgery, if unrepaired affects speech and eating, the suturing doesn't quite close in some patients so this procedure is done. If not done there can be nasal emissions.
cleft palates can cause?
device designed to eliminate hypernasality in children with velopharyngeal insufficiency. It is a palatal retainer and pharyngeal extensions
Treatment for individuals with cleft lip and palate:
- strengthen velum
- work on visible sound (bilaials, labiodentals)
- correct airflow
- reduce facial grimace
- Postpone working on /k/ and /g/
Hearing impairment chart:
- hard of hearing- 16-90db
- slight- 16-25db
- mild- 26-40
- moderate- 41-70
- severe- 71-90
- profound- 90+db
- deaf- 90db or greater
Hearing impairment: no idea why it happens just suddenly loses hearing
Hearing impairment: interruption of sound to the cochlea
Hearing impairment: cochlea hair cells or fibers of acoustic nerve are damaged
Hearing impairment: hearing loss associated with aging
Hearing impairment: combined conductive and sensorineural
Hearing impairment: production of velar consonants sound distorted because:
a higher hard palate
Most difficult for hearing impaired to produce because there's no auditory information or enough visual information
stops, fricatives, and affricates
a phonator used to help client feel the sound. Can put on their hand
What would you like to do?
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