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Ax to Tx principles: typical treatment goals, goal setting (2) - Coggle…

- - - - sound production skills
      - phon skills
      - speech intelligibility
      - overall communicative effectiveness: need it to generalise
    - - at the end of everything, more broadly defined comm. behaviours
      - For XX to demonstrate age-appropriate speech production, can catch up in time: BUT X for those w oromuscular difficulty,
      - For XX to demo 80% intelligbility in connected speech, may be unds as long as speech is slowed down: only if there are no factors affecting possible achievement . X use for those w tongue thrust, hypernasality from oromuscular difficulty,
    - - Skills that can be gained in short time eg. 2 weeks, 1 month, 3 months within session goals
    - - Goals relate to client!
      - should be sth you wish client to achieve: for child to demo they can do sth
      - should be succint
      - For XX to....
      - Should include target sound, concept.
    - - will make immediate, socially difference in communicative skills of client
      - Target FCD process, then intelligibility will increase, kids like to talk to kids they can unds
      - can be produced, reinforced at home, other natural settings
      - help expand comm. skills
      - ling, culturally appropriate for indv client: involve fam in decision making, choosing targets, consider bilingual children's needs
    - - result in early success-motivates child, increases confidence, always work on structure first!
      - Are impt for child
        
        deviant, unusual
        
        contribute significantly to intelligibility
        
        Results in loss of contrast b/w 2 or more words
        
        Affect early developing sounds
        
        Affect greatest number of sound segments (complex subst based on >1 rule change)
        
        rmb apple on tree: start low first
    - - Are in child's phonological repertoire BUT X always impt
      - Are stimulable BUT X always impt
      - Improve intellgibility
      - Are freq occuring
      - Are acquired early BUT X always work
      - have max social impact eg. name
      - are relatively easy to produce: Visually easiest to work w child: tongue between teeth. Labial sounds, earlier acquired, auditory, visual, tactile cues needed for /s/ and /f/. /s/ cannot see bcos tongue is inside mouth. /f/ can feel it, you can hear it. We don't work on 'th' much bcos later acquired, hope it comes on its own.
    - - age, readiness to learn
      - intellectual skills, ability to learn
      - lang skills: do they unds the concept
      - motivation to improve
      - lvl of participation in Tx: might be indicative of early success
      - attention to task: to you, to themselves
      - Presence of any interfering behaviours: what makes it harder for child to produce sound eg. lose teeth, tongue thrust.
      - Reported history of progress: X bring back bad memories, need fresh look. If /k/, /g/ were unsuccessful, X use same approach!
  - - - Safety
      - age-appropriate think about symbolic play level
      - Expense: children X need expensive things
      - Child's interests: activities they enjoy will be better attended to. let them bring sth in to show you the next session, something they are interested in
      - type of material: pictures vs. real objects. Some children need real objects to help them w comprehension
    - - Creates positive perceptions of clinicians and therapy, they will want to come back
      - engages reluctant clients: use sth that is familiar to them
      - Sth meaningful and enjoyable facilitates long term memory
      - Expands conceptual nets
      - Facilitates generalisation
      - Fun for you too!
    - - ensure activity allows for repetition of target- needs enough dose
      - Ensure you can measure performance
      - Ensure main proportion of time is spent on Tx targets. X use targets that require too much additional time on non-Tx target
      - X waste time in games-redirect activity so that targets are the focus. Abandon the game if you X get the target
      - Try out a game before letting child play it
      - X use a full commercial game unless it directly works on your Tx goal
- - - - structural integrity of speech mechanism: is oral musculature ready to go to make that sound? can articulators be brought together?
      - child's access to visual, kinaesthetic, tactile (what they should be feeling) cues about sound
      - imitation skills
      - child's focus and motivation: is it because they can't or don't want to do it
    - - Baker (2006): Evidence for choosing non-stimulable > stimulable sounds. Generalisation is greater
      - Miccio (2005): production of stimulable sounds tends to improve regardless of Tx target
      - If stimulable--> can improve by itself. If not stimulable--> is it that it X improve unless you treat?
      - If sound is stimulable--> then maybe you shouldn't be working on it
      - stimulability, religion: it's about which sounds are stimulable in which context. There's no right or wrong! Talk to CE about what they think about stimulability.
  - - - Investigated relative effectiveness of selecting targets eg. most knowledge, earliest dev (ME) or least knowledge, late dev (LL)
      - ME: greater progress in acq of target sounds > LL group
      - LL, ME had similar wide generalisation
      - ME targets are adopted, LL targets should also be considered
  - - - investigated effects of using real vs. non-real words as stimuli in phonological therapy
      - 30 children who received Tx with each
      - Generalisation to treated sound greater cf.untreated sounds
      - Generalisation greater for non-words (kao, ga, gey) cf. real words (car, key, go).
      - Further research needed