Stimulus- response, repeating the same thing over and over. 10 good /g/ responses.
Drill
Stimulus- response, repeating the same thing over and over. 10 good /g/ responses, but with a motivator.
Drill Play
Training is part of play activities; optional feedback about incorrect responses.
Structured play
Stimulus and response activities occur as part of play activites (natural), one of the more effective ones we use for younger children.
Play
Structuring Treatment Sessions:
Varibles-Client and stage of treatment
Modify treatment to fit the client
___________ structured treatment is often used in the beginning
Highly
Move *gradually* from __________ structured to __________ structured in treatment sessions.
more, less
Final goal of treatment is _____________.
conversation
In a _______________ trial, you arrange opportunity for the production of a particular behavior.
discrete
What are the 4 Discrete Treatment Trials?
1. Isolation
2. Syllable
3. Wood, phase, sentence
4. Conversation
__________ _____________ evoke the sound.
Antecedent stimuli
Instruction, pictures, phonetic placement, visual and verbal prompts, modeling, or a combination of techniques are examples of ____________ _____________.
antecedent stimuli
What is the steps in treatment trial in isolation?
- client is instruced to produce the sound
- Clinician models the correct response
- Reinforce if response is acceptable or provide corrective feedback
- Record accuracy of response
- use graphemes unless client is able to understand
What are the phonemes that are difficult to produce without the schwa?
/r/, /l/, /j/(yah), /w/
When thinking about Discrete Trials:
What is the simplest response level for sounds that cannot be produced in isoloation without a schwa?
Syllable
When thinking about Discrete Trials:
At the syllable level you may use a ___________ stimulus.
visual
When thinking about Discrete Trials:
At the syllable level, client familar with _______ can use a ________ or other method. (like the snake video observation)
letter, chart
When thinking about Discrete Trials:
At this level you are looking for ____________ level from 80%-90% in at least ___ sessions...maybe even _____ sessions.
The level is Word, Phrases, and Sentences
the answers to the blanks are accuracy, 2, 3
When thinking about Discrete Trials:
At this level you may need to use carrier phrases- "slot fillers" (one hat, one cat, one rat)
Word, phrases, Sentences
When thinking about Discrete Trials:
At the word, phrase, sentence level of treatment, you may need to use _____ _______ or ______ ______?
carrier pharses or slot fillers
When thinking about Discrete Trials:
At the word, phrase, sentence level: What are the steps to do in treatment?
- may use carrier phrases- slot fillers
- use a picture to demonstate movement (may use visual phonic here)
- Ask a relevant predetermined question - needs to make sense- "functional prompts" for purposes of generalizations it will work better.
- Immediately model the correct response
- Allow time for a response
- Reinforce or provide corrective feedback- at least reward the effort.. "almost there"... good try.
- remove the stimulus and wait 2-3 seconds before providing the next- works to enhance the auditory memory.
- these are fairly structured.
When thinking about Discrete Trials:
At this level, open ended questions are used?
Conversation
When thinking about Discrete Trials:
At the conversation level avoid ________ and ______ questions?
What, do
When thinking about Discrete Trials:
At the conversation level you have to use a series of questions?
False
It doesn't have to be an interrogation.
Think about how real world works outside of a clinic setting.
When thinking about Discrete Trials:
What is an example of something you could say at the conversation level to elicit a non interrogative conversation?
I wonder if we'll go outside for recess today... can you tell me why not... how could we help going outside to be fun. Ask them to describe something (for example Dr. Barker has never seen a soccer game) Ask them how their last soccer game went?
When thinking about Discrete Trials:
At the Conversation level, what are some of the key points to do in treatment?
- Use open-ended questions-- that cannot be answered in just one word.
- Avoid what and Do questions
- do not turn it into an interrogation- doesn't have to be a series of questions.
- Listen for natural occurrences- listen for what they say in the waiting room or when coming in with their parents.
- Give intermittent verbal praise
- Continue to provide corrective feedback- that was a really nice sentence.. I would really like to hear that /s/ sound a little clearer-
- Train self-montoring- client can give themselves a token every time they notice they made the sound correctly- actually this should be done before you get to the conversation level.
A sound is __________ only if its production generalizes to __________ words, phases etc.
mastered, untrained
When thinking of Treatment Sequence:
What is used to determine gerealizations?
Probes
__________ assesses accuracy of untrained responses and is used to determine generalization.
Probes
Probing is particularly crucial at the __________ and _____________ level?
sentence and conversation level
What are some examples you could use to probe?
Using 3 picture cards that they've never seen before.
Keep track of the words that have been used before
- she would rather us use 10 cards with really good responses than 30 cards with and not get as good of responses.
Some kids have low tolerance for repetition?
T or F
True
What are some things that data collection is used for?
- accountability
- Document performance in Tx
- Requirements for documentation have increased- if you don't document it, it didn't happen. (need documentation for fed. gove. or insurance to reimburse.)
- Documentation is easier when objective are clearly specified.
Probing for Generalized Responses:
When moving from responses to pictures to response to the object, checkin to see if they can make distinctions, this is called?
Probing for Generalized Response:
If you were probing across word positions, you would be looking at????
initial, medial, final
Probing for Generalized Response:
A client that moves from trained response at word level to spontaneous (untrained response) in phrases and sentences, this is called?
Response Topographies aks intraverbal generalization.
Probing for Generalized Response:
If you were training within a ________ ________ and you've trained one stop or process you may not need to train another?
sound class
Probing for Generalized Response:
manner, place, voice, word position, distinctive features, phonological processes would be probed in _________________.
situations
bad question, sorry!!
Probing for Generalized Response:
In Situations if a client has it in onel pair(bilabial) you may not need to train another?
True or False
True
Probing for Generalized Response:
5 things to know about Situations are:
-if a client has it in onel pair(bilabial) you may not need to train another?
- Distinctive feature may generalize
- Individual variations
- across sound classes - occurs when a Tx generalized to a sound that does not appear to be phonetically related (trained /m/ and all of a sudden we get a /g/- idea of a consonant sound needing to be at the end)
- across situations: generalizes to other physical settings, other people... sometimes just our physical presence in the classroom will be a reminder to use correct sounds.
Probing for Generalized Responses:
Assessing Gereralization you should:
Train /f/ in 10 words, then probe:
- untrained words
- untrained phonemes, especially a cognate
- untrained word position
- untrained linguistic level (phrases, sentences)
In Maintenance you need to:
- make a selection and manipulation of antecedent stimuli. - have them do things they are really going to need to do (knock on door, sports, crocheting)
- Selection of responses- how they need to respond
Maintenance:
When thinking about selection and manipulation of antecedent stimuli, you should consider:
- common stimuli from natural environments
- commom verbal antecedents (words used to evoke the target)
- vary the audience
- vary the physical setting
Maintenance:
In selection of response you should:
- select client- specific objectives (have individual differences in Tx appraoches)
- teach multiple exemplars - give them lots of opportunities to respond in a variety of situational contexts
- reinforce complex responses
Manipulation of Tx Contingencies:
You should move from ____________ to ______________ reinforcement.
continuous, intermittent
because it's more successful when thinking about transferring into the real world
Manipulation of Tx Contingencies:
You should use __________ or ____________ ____________ reinforcers?
conditioned or naturally occurring
Manipulation of Tx Contingencies:
Things you should know about this:
- move from continuous to intermittent reinforcement
- use conditioned or natually occurring reinforcers
- delay reinforcement - no one is going to tell them good job in everyday life.
- train parents and caregivers - generally, don't instruct them on correct speech
- Reinforce generalized responses
- Teach self monitoring and self correcting
- Teach contingency priming ( actively seek reinforcement from others)
Manipulation of Tx Contingencies:
When you train parents and caregivers, you instruct them on correct speech?
True or False
False
instruct them in general, but not in correct speech.
Self monitoring and self correcting is a should not be reinforced?
True or False
False
It should be reinforced- it is a good thing to reinforce
Working with Family and Others consider what?
another bad question, but oh well.
-Peer tutor- need to be trained
- Classroom teachers - play a significant role in maintenance
- parents and others- skills and interest may vary.
When do you dismiss a client?
- after a certain period of time (may be required by third party)
- Ideally, client hs achieved the goals
- Plateau of skills - they might not be doing what we ask or even want to
- Poor motivation
- Under ideal circumstances do a follow-up assessment
Phonological/Phonemic Awarenss:
Assessment consists of 7 things.
1. rhyming
2. Alliteration
3. Phoneme Isolation
4. Phoneme Manipulation
5. Sound and Syllable blending
6. Syllable and sound identification
7. Sound Segmetation
When dealing with phonological/Phonemic Awareness, in treatment you should use activities.............
designed to promote develpment of phonological awareness skills.
In treatment of Phonological/Phonemic Awareness:
-Articulation Tx steps can be adaptd to Tx of phonological awarenss
-Reinforcement prodecures apply
- Move from simple to complex
-Train phonological awarenss to address literacy issues because it is so directly correlated to academic success.
Organic and Neurogenic Speech Disorders:
A motor programming disorder characterized by difficulty executing volitional(purposeful) movements, in the absence of muscular weakness, paralysis or incoordination.
Apraxia
Non speech movements like licking an ice cream cone
Oral apraxia
Difficulty moving arms and legs?
Limb Apraxia
inability to program and excute voilitional movements for production of phonemes and words.
Apraxia of speech or verbal apraxia
Apraxia's can occur together or separately?
True or False
True
Speech Apraxia is the ______ common, where as ___________ apraxia is the __________ common.
most, limb, least
Causes of Apraxia are: (7things)
Neurological damage - in the dominate hemisphere for speech, usually Broca's area, most common - single left hemisphere stoke.
Degenerative diseases
TBI
Surgical trauma - neurosurgery
Tumors
Seizure disorder
Undetermined
What is the most common type of neurological damage when talking about etiologies of apraxia.
singe left hemisphere stoke
Characteristics of Apraxia
- awarness of the problems - frustration - saying no when they actually mean yes, they know they are not saying what they mean.
- Impaired volitional sequencing
- Better automatic speech - (ex in class, telling them to say telephone, and they can't, but then they say I can't say the word telephone, and they said it.
- Variable errors- if you ask them to repeat a word 3 times it comes out differently everytime.
- Reduced rate of speech- may use compensatory behavior- they can move their articulators they just can't sequence them.
-
Articulation errors in Apraxia
Substitutions, Omissions, Distortions
Fricative and affricates
consonant cluster errors
Anticipatory substitutions
Regressive substiutions - they have already said the sound and they say it the same way again.
Metathetic errors - switching two sounds that go together
Increased error with increased complexity
Delayed initiation - have trouble even starting to speak
Trial and error - groping or searching- stumbling around because they know they didn't say the word correclty
Initial sound position errors- likely beause they have trouble with initiation
False starts and attempts at self correction
Occasional difficulty with imitation - Tx best used in a finctional disorder not organic.
Prosodic Problems with Apraxia
Reduced rate of Speech
Pauses between words - they are giving themselves time to formulate
Increased duration of syllables - especially the medial vowels
Monotone stress and speech quality- flat, monotone, syllable stress absent
Restricted range and intensity of pitch
Repetitions like stuttering
May sound like they are speaking with a foreign accent.
these kids stand out, highly unintelligible, inconsitency and searching behaviors?
Childhood Apraxia of speech
Childhood Apraxia of Speech have no know etiology?
True or False
True
For people that don't believe it exists, they believe it to be a severe phonological process disorder?
True or False
True
What is the descriptive diagnostic label would be worded how, when talking about Childhood Apraxia?
Johnny presents characteristics not unlike childhood apraxia of speech.
What are the characteristics of Childhood Apraxia?
- moderate to severe intelligiblity problems
inconsistent sound errors
Unusual errors- that don't seem to follow a pattern and aren't typicaly seen.
- Additions, prolongations, repetitions - so its like a fluency disorder
- Primarily omissions and substitutions errors
- Vowel errors- why they sound like they are speaking a different language.
- intelligibility - overall with and without context
- Prosody- are they able to make changes (can they do a big deep voice like goldilocks)
- Fluency and disfluency- ability to produce words accutately without multiple substitutions, false starts.
A neuromotor speech disorder affecting one, various or all parameters of speech productions. A group of motor speech disorders resulting from neurological damage.
Dysarthria
What does Dysarthria effect?
Respiratory and Phonatory
What are two sources of Phonation called?
diplophonia
What is it called when a person cannot control their intensity?
Monoloudness
What are the lesion sites in Dysarhria?
lower motor neuron
Upper motor neuron
Cerebellar
Extrapyramidal (basil ganglia)
What will your respiration be like with Dysarthria?
breathy, forced
What types of problems will you have with Dysarthria in terms of resonance?
Hyper, Hypo, nasal emission
What types of Articulation problems will you have with Dysarthria?
