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Artic + Oromotor Tx - Coggle Diagram
Artic + Oromotor Tx
Residual speech sound errors
Persistent
Resistant to change, Tx
Likely to be associated w /r, s, th/ productions
May impact on academic, social, peer perceptions, employment
Typical artic therapy may not be effective- they are continuing to present w errors beyond 8 y/o
Defn
Inability to produce perceptually acceptable version of particular phones either in isolation or in any phonetic context BUT attempt is variation on target sound, not a different sound. So perceptually accurate sound is not stimulable
Child may not be aware of difficulties w sounds
Problems related to motor fn, contrast is still preserved. May affect one sound only, doesn't always transfer to other sounds in same class.
But likely to be present on very similar sounds eg. if interdental lisp on /s/, will be on /z/ as well.
Take home msgs
Don't give up. It might still work despite previous failures
Intensity works
Biofeedback is useful
Auditory training is also good
Oromotor Tx defn
Non speech activities that involve both sensory stimulation, mvm of articulators (lips, jaw, tongue, soft palate, larynx, respiratory muscles), to get articulators ready, become stronger
Thought to help oropharyngeal mechanisms improve mvm, sensation
Eg. blowing, sucking through straws to improve lip seal, licking to improve tongue strength, reach. Trying DDK task also
Widespread use. BUT there is NO EVIDENCE for use of this therapy, X play part in improving speech intelligibility, X improve outcomes for motor planning
Wrong assumptions about oromotor Tx
The same structures are used for both speech and non-speech mvms. Not the case, differences in neurological organisation, structures fn quite differently in each
Oral motor exercises strengthen the articulators. We don't need that much strength. Even if required, little bit of exercise also wont make a difference
Impt to practice non-speech mvms and then put them into speech mvms. Wrong bcos speech work requires specific goals, stimulation of sensory motor system. Little integration of non-speech mvms into whole mvm required for speaking
Oral motor exercises provide a warm up for chn. Wrong because it is not a foundation for speech.
Aim
Traditional or motor based approach-lots of repetitions and drills
Knowledge of correct phonetic placement, articulation essential for success
Treat using articulation hierarchy
Maintenance (Last step)
Continued focus on transfer skills into convo- need fam to continue this
Outside of clinic, moving to use at home
Review of progress over subsq 6 months
Transfer, carryover
Use of target sound in everyday conversation
Spontaneous carryover
Generalisation: rmb those factors that affect generalisation. More difficult than it first seems. Needs to occur across range of env, contexts. Child's self-awareness (keep reminding child) may contribute to degree, speed of change
Practice
Sound in isolation:
tactile (therapist holds tongue with ice cream stick), visual cues (look at my teeth), verbal instruction (put your teeth together), SLP's model: say /s/. Imitation based on SLP's model ssssssss. Say the sound 5 times. Associate sound w name or sound. Associate with letter
Nonsense syllables:
s-ah. sssah. sah sah sah. sah/sow/see. s-aw. saw. Tell me what this is
Words
: increase length and complexity, add morpho endings, focus on sounds in blends
Sentences
: target sound in initial position in carrier phrase: repeated in the activity many time. See the (blank). Sit on the (blank). Allow transition in automatic way. Target word inserted into carrier phrase eg. look at the (sock), find a (seat)
Pre-prac instruction
Teaching child how to say the sound
Auditory cues
Phonetic placement instruction- how to describe the sound verbally, visually, tactile. What are normal variations? /r/ has diff touch points so don't need to be very accurate!
Other- metaphor, letter
Sensory perceptual ear training (First step)
Identify (saying a range of single sounds) tell me when you hear the snake sound /s/
Locating (detecting sounds in words, phrases)
Stimulation (saying the target sound a number of times)
Discrimination (auditory discrimination, judgment of correctness)
Progress through hierarchy
Assumption that child enters each stage w minimal competence
Progression to next stage when certain lvl of accuracy is met
For most stage: 80%-90% accuracy required.
At connected speech stage, 50% accuracy is ok. Convo is harder need to think about what to say, turn-taking, discourse in convo. Paraling features eg. stress, rising, falling intonaton. Rmb non-linear phonology. Progress will continue
Research
Preston & Leece (2007)
4 indv with rhotic distortions
Aged 13-22 years.
All had attended Tx at younger age
Tx: provided in uni context: consider if dosage is possible in this clinical context
2 hours in morning, 2 hours in afternoon for 5 days
Auditory training, production training, ultrasound visual feedback of tongue positions. Principles of motor learning- ways which you can get change- keeping dose high and give specific feedback
Significant increase in production accuracy at word and sentence lvl