Please enable JavaScript.
Coggle requires JavaScript to display documents.
Ax to Tx principles: typical treatment goals, goal setting (1) - Coggle…
Ax to Tx principles: typical treatment goals, goal setting (1)
Phonological analysis summary, mgm plan
Baker (2004)
Speech sound disorders mgm plan
McLeod & Baker (2017)
General objectives of Tx
Generalisation of skill to real-world env
Automaticity of skill
Capacity to self monitor
Oops that didn't sound right, let me try that again. Teacher X unds me so let me correct that
Optimum progress in available time
Sensitivity to personal, cultural needs of client
Holistic
Family centered practice
Defn
Model of care which involves family thru continuum of care from design, dev of indv healthcare for their fam member
Important aspects
recognising that fam is constant in child's life
facilitating parent, clinician collab
respect the diversity in fams
recognise fam strength, individuality
sharing w parents complete, unbiased info
encourage, facilitate fam-fam support
unds needs of children, fam, incorporating into healthcare
implementing policies, programs that provide emotional, $ support
design accessible healthcare that is flexible, culturally competent, responsive
Success in Tx client factors
1. Cognitive skills
: unds process of talking, speech sounds, conversation repair, target sounds
2. Motivation, communicative awareness
All factors are important! Doesn't just depend on one factor alone
3. Fam support, skills
4. Physical status: health, wellbeing.
Affects receptiveness in Tx. If health is poor, X retain info. If they are in hospital, don't work on speech sounds
5. Aetiology
6. Phonological processing skills:
capacity to process speech sounds more broadly
7. Severity
8. Chronological age @ presentation
: mean presentation is at 4;3 (but between 3;5-5;0)
9. Critical age hypothesis:
children who X resolve S&L difficulties by ~5;6 may have persisting difficulties in these areas and literacy.
10. Stimulability
: produce w you giving them cues
11. Inconsistency
Success in Tx, Tx factors
1. Previous therapy whether successful or not
2. Therapist knowledge, skills, attitudes
: can try new approaches but might default to what they are comfortable with, think is this the right approach for the child
3. Approaches used
: what lit says,
4. Service delivery options
: if parent only wants to come once a month, what is the best option? Is Tx going to be delivered by parent?
5. Intended goals
6. Therapy Tx, stimuli used
Notes:
need to rmb you must make their $ worth, if you neglect any of these, might not max child's success
Does client need Tx?
Relates to social, occupational, cultural, ethnic aspects of client: think abt fam, natural env, think about literacy, social, emotional, peer impacts etc
Factors w/i delay, disorder/difference. If it's speech sound difference then X need Tx
Fam considerations: attitudes, values: do they want child to have Tx?
Nature of disorder: uneven presentation, impact on activities, participation. Minor difficulty but how is impact on fning? Eg. child's name has 'r', gliding of liquids observed, so impt to start Tx. OR Is it big difficulty, small impact?
Age of child at presentation: make sure parent agrees that Tx sohuld begin, need to be ethically bound at all times.
Evidence base for Tx with clients of same presentation
Facility prioritisation needs
Occupational needs: what they need to play, learn learn and live their lives
Why fam may want Tx even though you think X need
Fam may have high expectations of child
Parents had older children, see some patterns
what to suggest: 3 monthly checks, things that parents can do to monitor
Moderate speech sound difficulties: GPs think they go away on their own bcos you dont see adults walking around w speech disorder, so they must be going away themselves. BUT THEY DO NOT.
RED FLAGS
FCD at 3;0
going to persist as speech sound difficulties
Frequent ICD
Backing: more difficult for child to be unds, intrusive to intelligibility. Atypical process.
Vowel errors
The 'wow really oh no' test. Keep other professionals (teachers, psychologists) in our circle to assist us in process.
Tx intensity
Defn: number of sessions per week, length of session, number of teaching episodes per session
Impt of quality, quantity: clinician and client must do it correctly
Baker's model
Dose form: what is the type of activity, is it repeating words, discriminating minimal pairs
Dose-number of times of listening, producing, repeating, discriminating that happen per session. How many times does a child do a certain thing?
Dose frequency: number of sessions per day/week
Total Tx duration: 12 weeks (uni sem) 45 minutes
Cumulative Tx intensity=dose X dose freq X total Tx duration
Depends on
Motor learning principles: tells us how often we should provide feedback, how often they should be trying again.
Client variables: poor attention, condition
Condition variables: type of skill the child is doing. Is it multiple repetitions, multiple productions. Is it appropriate?
Clinician variables: how freq clinician is available, alters cumulative Tx intensity
Admin factors, caseload, private vs. public service
Suggestion
Start w making front, back sounds.
Tell me a back sound. Tell me that one again, do you know another back sound?
10 or 20 at a time. I wonder if tea is a front sound. No. It is a back sound. Can you say that again? I wonder if you know another back sound.
Note down if it's identifying sound, saying sound. Do tally marking
Suggest: ~70 trials per 30 min for 40 sessions.
Providing reinforcement
To strengthen behaviour
Make feedback specific: that was a great /r/ sound
Repeat the child's accurate attempts: that's right it's a cup with a /k/
Encourage child to verbalise WHY their attempt was successful-I wonder what you did with your mouth to make that sound. Knowledge--> using those skills.
Encourage child to self-monitor-what do you think of the sound you made?
Don't forget to use your back sound in 'cup' next time.
Remember when it's a back sound, we need to put our tongue up at the back.