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Treatment of Articulation Disorders

The goal is to obtain an accurate production of speech sounds

Traditional Motor Approach

Aka phonetic approach

  • treats each sound error individually 

Multiple-sound approach: attempts to influence several sound errors at the same time

General Overview of Therapy Progression

​

  1. Sensory-Perceptual Training

    • consider: age of client and whether specific auditory discrimination difficulties are noted​

      • clients' ability to differentiate between their error production and the target sound

    • Step 1: Identification

      • recognition and discrimination of sound in isolation when contrasted to other similar and dissimilar sounds

    • Step 2: Isolation

      • client identifies sound in word-initial, -medial, and -final positions​

    • Step 3: Stimulation

      • client identifies sound among variations of the sound​

    • Step 4: Discrimination

      • client detects and describes error productions of the sound​

  2. Production of the Sound in Isolation

    • goal: to elicit a standard production of the target sound alone​

    • Auditory Stimulation/Imitation

      • clinician models and client imitates​

    • Phonetic Placement Method

      • clinician instructs client how to position the articulators​

    • Sound Modification Method

      • start at a phonetically similar sound and clinician instructs how to adjust the articulators to achieve target sound​

  3. Sounds in Context

    • Use of Facilitating Contexts​​

      • coarticulatory conditions to aid production

      • key words: words in which the target sound is produced correctly​

    • Nonsense Syllables

      • goal: to maintain accuracy in varying vowel contexts​

      • order the nonsense syllables from easiest to more difficult

  4. Words

    • goal: maintain accuracy in words​

    • words with fewer syllables, contain the target sound only once, initial-word position, open syllables, and stressed syllables are typically easier

  5. Structured Contexts - Phrases and Sentences

    • goal: maintain accuracy in phrases and sentences​

    • should not be spontaneous, yet structured and elicited

    • continue to work at the word level

    • use a carrier phrase with a target word at the end

    • move from highly structured to less structured tasks

  6. Spontaneous Speech

    • goal: maintain accuracy as the target appears spontaneously in conversation​

    • first, achieve a high level of accuracy in the therapy setting

    • then, work outside the therapy setting

  7. Dismissal and Re-evaluation Criteria

    • 50% accuracy during normal spontaneous speech​

      • with the assumption that the​ client will continue to improve

    • rev-evaluation is the only way to ensure therapy was successful and the client continued to generalize across situations

If client produces less than 50% in two or three practice sessions, the word level is too difficult. Could work on nonsense syllables or CV words

Typically client must reach 80-90% accuracy before moving on to next stage

Principles of Motor Learning

  • A set of complex processes associated with either experience or practice that leads to permanent changes

  • Basic framework includes:

    • performance during acquisition of a specific skill should me measured separately from performance after the completion of acquisition​

    • pre-practice portion of intervention

      • information on what constitutes correct response​

      • taught how to produce correct response

    • practice phase of intervention

      • includes conditions of practice and feedback​

Conditions of Practice

  • Practice Amount: large or small

    • higher frequency of practice generally leads to more rapid acquisition, better performance, and better generalization

  • Practice Distribution: massed or distributed

    • children who completed home practice, increasing mass distribution, finished intervention in a much shorter time​

  • Practice Variability: constant or variable

    • constant practice: practice in the saw way and same context​

      • more beneficial when first acquiring a new motor skill​

    • variable practice: practicing same skill with variations

      • ex. in varying linguistic contexts​

      • promotes permanent retention of a skill

  • Practice Schedule: blocked or random

    • blocked: practicing several times before moving on to next target​

      • may be more beneficial at beginning of therapy​

    • random: different sequences or patterns with no perceptible pattern

    • combination or blocked and random may be beneficial​

  • Practice Task: complex or simple

    • simple example: sound in isolation​

    • complex example: sound in consonant cluster

  •  Practice Fraction: whole or part

    • use both: practice whole or and at time, divide it into its component parts​

  • Practice Accuracy: errorless or learning with errors

    • errorless: discourage errors to strengthen accurate acquisition​

    • learning with errors: allows learner to refine and further define motor skill

  • Attentional Focus: external or internal

    • internal: asking child to focus on mouth movements​

      • use during pre-practice​

    • external: child asked to judge perceptual quality of a sound

Conditions of Feedback

  • Feedback Type: knowledge of results or knowledge of performance

    • knowledge of results: correct or incorrect​

    • knowledge of performance: why it was correct or incorrect

    • both used during pre-practice, but knowledge of performance use primarily in practice phase

  • Feedback Frequency: high or low

    • high​: feedback on more than 50% of productions

      • more advantageous during beginning of therapy/pre-practice​

    • low: feedback on 50% or fewer

      • encourages child to rely on their own feedback and self-monitoring​

  • Feedback Timing: immediate or delayed

    • immediate: follows a response directly​

    • delayed: occurs after 3 or more seconds

      • encourages the child to self-correct​

The Traditional Motor Approach and the Most Frequently Misarticulated Speech Sounds

Misarticulations of [s] and [z]

  • Phonetic Description

    • apico-alveolar​

      • tongue tip up​

      • advantages: most common way to produce [s] (parents and teachers may reinforce this method).

      • disadvantages: the tongue tip is hovering and must be maintained through the whole production of [s], the tongue tip is forward (more likely to dentalize the sound).

    • predorsal-alveolar

      • tongue tip down behind lower incisors​

      • advantages: easily identifiable spot for the tongue tip, easier to keep it in that location, tongue tip is further away from their previous attempts (easier to do a new production than a slight adjustment to a previous production), can be beneficial for children with a flat palate.

      • disadvantages: new production placement that the child may not have done before.

  • They have high-frequency components, so check for hearing loss

  • Where to begin?

    • Can begin with [z] because it is voiced and [s] is voiceless, so [z] will be produced with less air pressure, possibly making the articulation easier. Also because the voicing of [z] may mask some productional differences. Productional differences are more noticeable and less acceptable for [s]. It will hopefully allow the child to be successful with the sound earlier. Also, it is more difficult to change voicing halfway through an utterance. So changing from a voiceless [s] to a voiced vowel would be more difficult for a child than producing [z] and a vowel. Once the child can correctly produce [z], [s] should come relatively easily because he can “whisper” [z].

Misarticulations of [ʃ] and [ʒ]

  • Phonetic Description

    • [s] and [ʃ] are closely related, but the sagittal grove is wider for [ʃ] than [s].

      • [ʃ] is slightly posterior, at the anterior part of the palate, the postalveolar area​

      • [ʃ] has lip rounding

      • [Ê’] is voiced [ʃ]

    • [ʃ] can also be produced with tongue tip down behind lower incisors​

Misarticulations of [k] and [g]

  • Phonetic Description

    • back of the tongue is raised

    • complete blockage of airflow at the anterior portion of the velum

    • buildup of air pressure occurs until tongue suddenly moves away from velum

    • [k] is produced with more pressure and tension then [g]

  • usually target [k] first, then [g]

Misarticulations of [l]

  • Phonetic Description

    • tip of tongue touches alveolar ridge

    • air escapes laterally

    • lateral edges of tongue are relaxed

    • visibility is helpful

    • light [l]: has an [I] quality, convex shape of tongue, especially the frontal portion near the palatal or prepalatal area

      • typically in initial position where [l] precedes vowel or ​follows initial consonant

        • ex. "like," "leap," "play," "sleep"​

    • dark [l]: has an [ÊŠ] or [o] quality, tongues posterior portion is elevated

      • word-final positions, as syllabics, and preceding a consonant​

        • ex. "full," "kettle," "cold"​

        • tongue tip may not be contacting alveolar ridge

Misarticulations of [r]

  • Phonetic Description

    • extremely variable

    • bunched

      • voiced alveolar central approximant​

      • corpus of the tongue is elevated toward the palate 

      • tongue tip points slightly downward

      • air passes sagittally

      • sides of tongue touches bicuspids and molars

    • retroflexed

      • voiced retroflexed central approximant​

      • tip of tongue to alveolar ridge or neighboring palatal areas

      • air channeled sagittally

      • lateral edges of tongue raised

      • often the tongue tip can be slightly bent backward or curled up

      • often can be easier to explain the features

Misarticulations of [θ] and [ð]

  • Phonetic Description

    • dental fricatives

    • can be produced with the tongue tip slightly behind the front teeth or with tongue tip coming close to the inner surface of the front incisors

    • restrict the breath stream between the tip of the tongue and the backside of the upper front teeth

    • tongue remains relatively flat

Misarticulations of [f] and [v]

  • Phonetic Description

    • labiodental fricatives

    • inner edge of the lower lip is in close contact with the edge of the upper incisors 

    • breath stream can pass between

    • upper lip remains inactive

Bauman-Wängler, J. A. (2020). Articulation and phonology in speech sound disorders: a clinical focus (6th ed.). Hoboken: Pearson Education.

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