interventions within broader contexts: part i speech and concomitant impairments
TRANSCRIPT
Interventions within Broader Contexts: Part I
Speech and Concomitant Impairments
Overview of 12 Interventions within a Broader Context• Psycholinguistic intervention• Metaphonological intervention• CBI• Perceptual intervention• Nonlinear phonological intervention• Dynamic systems (whole language)• Morphosyntactic intervention• Naturalistic speech intelligibility training• Parents and Children Together (PACT)• Enhanced Milieu Teaching with Phonological Emphasis• PROMPT• Family-focused interventions
Levels of Evidence (LOE)
Level Description Approach
1a Well-designed meta-analysis of >1 randomized controlled trial
MPA
1b Well-designed randomized controlled study MPA; CBI; Perc; DS; MS; NSIT; FF
2a Well-designed controlled study without randomization
MPA; Perc; NPI; MS; NSIT; PACT; EMT/PE; PROMPT; FF
2b Well-designed quasi-experimental study PLI; MPA; NPI; DS; MS; PROMPT
3 Well-designed nonexperimental studies, i.e., correlational and case studies
PSI; MPI; NPI; DS; NSIT; PACT; EMT/PE; PROMPT
4 Expert committee report, consensus conference, clinical experience of respected authorities
PSI; EMT/PE
3 Stages of Research
Stages of Research LOE Number of Studies
Exploratory Studies 3 25
Efficacy Studies 2b
2a
21
21
Effectiveness Studies 1b 19
LOE: Promising Interventions with Probable Efficacy
Stages of Research LOE Number of Studies
Exploratory Studies 3 25
Efficacy Studies 2b
2a
21
21
Effectiveness Studies 1b 19
Characteristics of InterventionsComparative Factors
Specifications
Age 3;0-6;0 • NSIT primarily for toddlers/preschoolers; MPA/PSI for school-age
Population Concomitant speech/language; speech/literacy impairments• cleft lip/palate (EMT/PE)• Down syndrome; ASD; stuttering (NSIT)
Intervention Agents SLP• Supplemental assistants: (parents/caregivers; paraprofessionals; teachers)
Key Components Varies, but can include perception, language (vocab, morphology, syntax, phono awareness, literacy)
Characteristics of Interventions: con’tComparative Factors
Specifications
Broad Goals Increase speech intelligibility and communicative competence• speech + language• speech + phonological awareness and literacy
Target Selection Primarily developmental; mismatch between perception and production or morphophonology and production
Level of Focus Speech output (perception and production of phoneme within words or conversation)
Session Type Individual and/or small group (30-60 min 2x/wk)
Technology Interactions between child and others; SCIP; PFSS; SAILS
ICF-CY Codes Primarily b320: Functions of productions of speech sounds(Others include: b330; b2304; b176; b16710; Activities and Participation emphasis: d140; d330; d350)
Psycholinguistic Intervention (Stackhouse & Pascoe)
Developmental level
Targeted stage of production
Targeted outcomes
Emerging
Developing
Elaboratng
Key components
Tech and/or materials
Specific diagnoses
Planning
Program
Execution
Spch Prod
Spch Perc
Phono awareness
Other oral Language
Literacy
X XSpeech input (e.g., auditory discrim), lexical representations (e.g., semantic, phonological, motor), speech output (e.g., programming and production of speech)
All resources can be used in a psycholinguistic way; new or specific materials not required
Speech and literacy difficulties
X X X X X X X
3 Components of PLA
1. Speech Processing Profile (series of questions; Fig 9.2)
2. Box-and-Arrow Model of Speech Processing
3. Developmental Phase Model
Simple Speech Processing Model
Box-and-Arrow Model: Speech Processing Routes
Developmental Phase Model: 5 Phases
1. Prelexical Phase (pre-words birth – 1 year)
2. Whole Word Phase (first 50 words – up to age 2)
3. Systematic Simplification Phase (consistent simplifications; 2;6-4;0)
4. Assembly Phase (mastering of connected speech; 3-4;0)
5. Metaphonological Phase (phonological awareness; age 5)
PLA Task Design
• 4 components of task designTASK = Materials + Procedure + Feedback +/- Technique
(e.g., instructions) (e.g., signs/symbols)
• 3 levels of task design:1. Design intervention tasks
2. Understand why altering any one of the 4 components, even minimally, can change the psycholinguistic nature of the tasks and therefore the demands made on the child
3. Use this knowledge to manipulate tasks at the time of delivering them to meet the needs of the child (i.e., how to make task easier or more challenging for child)
PLI: Review Case Study
• Describe the characteristics of child
• How is speech assessed?
• Describe intervention and results
Psycholinguistic Intervention: Review Questions
Metaphonological Intervention (Hesketh)
Developmental Level
Targeted stage of production
Targeted outcomes
Emerging
Develop
in
Elabor
at
Key components
Tech and/or materials
Specific diagnoses
Planni
ng
Progra
m
Executi
on
Spc
h Prod
Spch Perc
Phono aware
ness
Other
oral Language
Literac
y
X X Emphasis on phonological awareness including rhyming, syllable clapping, alliteration, blending, and segmenting activities followed by production of contrasting sounds and minimally paired words
Can include some computer-based resources (e.g., PFSS or SAILS), but not required; written letters linked to picture; standard clinical materials
SSD + PA X X X
Relationship among PA, Speech, and Literacy• PA (particularly phoneme awareness)
important in early literacy acquisition• Children with SSD have poorer PA skills• Therefore, children with SSD are at risk for
literacy difficulties• Some children with pure SSD have good
PA skills• Teaching phoneme awareness
improves phoneme awareness + literacy
• No evidence that PA should be taught separately or as a precursor to speech dev
Unique features of theMetaphonological approach
o aims to increase children’s awareness of word forms and how their own differ from the adult target, to facilitate speech change and literacy acquisition.
o MAKES CHILDREN THINK about the structure of words in ways directly related to their speech patterns
o encourages children to be agents in their own learning; helps them understand the need for change and how to achieve it
o facilitates and capitalises on literacy development
o it is integrated with speech production practice and can be adapted to any phonological goal.
MPA Activities
• Sound matching• Mispronunciation identification• Categorization from internal
representations (silent rehearsal)
MPI: Review Case Study
• Describe the characteristics of child
• How was his speech assessed?
• Describe intervention and results
Metaphonological Intervention: Review Questions
Speech Perception Intervention (Rvachew)
Developmental level
Targeted stage of
production
Targeted outcomes
Emerging
Developing
Elaborating
Key components
Tech and/or materials
Specific diagnoses
Planning
Programming
Execution
Spch Prod
Spch Perc
Phono aware
ness
Other oral
Language
Literacy
X Phonemic perception training
SAILS computer program
SSD X X X
SAILS: Speech Assessment and Interactive Learning System
• SAILS involves a two-alternative, forced-choice identification procedure involving real words– Natural recordings of words, half articulated
correctly by various child or adult speakers with typical speech and half misarticulated by various child speakers with SSD
• Visual feedback is provided for correct responses
Unique features ofspeech perception approaches
• Clarification: Phonemic perception intervention is a procedure, not an approach.
• Compatible (and tested with) linguistic and motoric approaches to the promotion of speech intelligibility.
• SAILS presents the child with highly variable natural stimuli that include actual rather than simulated misarticulations of target words produced by multiple talkers.
SPI: Review Case Study
• Describe the characteristics of each child
• How were their speech skills assessed?
• Describe intervention and results
Speech Perception Intervention: Review Questions
Nonlinear Phonological Intervention (Bernhardt)
Developmental level Targeted stage of production
Targeted outcomes
Emerging
Developin
Elaborat
Key components
Tech and/or materials
Specific diagnoses
Planning
Program
Execution
Spch Prod
Spch Perc
Phono awareness
Other oral Language
Literacy
X X Constraint-based nonlinear approach targeting prosodic structures and segments by considering individual phonological units and interactions between phonological units
Audio and video recording; creative materials, including costumes and props can be included to dramatize certain speech elements
Range of etiologies
X X X X X
Nonlinear Phonology
• Description of hierarchial representation of phonological forms from prosodic phrase to individual distinctive features
• Tiers within phonological hierarchy– Features– Segment– Larger prosodic units (syllables and feet)
Unique features of Nonlinear phonological intervention
Q: How much fun is there in nonlinear /fənɑlədʒi/?
A: The [fən] starts at the feature and ends at the prosodic phrase
Focus on multiple levels will enhance Tx outcomes....
Hola from Canadaand the GSFs.....
4 Basic Types of NL Intervention Goals
FORMS
DOMAIN New Form Existing Form in New Structures or Combinations
Prosodic Structure New word lengthsNew stress patternsNew word shapes
New word positionNew sequences
Segments and Features
New individual features (e.g.,
[+continuancy]
New simultaneous feature combinations
NPI: Review Case Study
• Describe the characteristics of the child
• How was the child’s speech skills assessed?
• Describe intervention and results
Non-linear Phonological Intervention: Review Questions
Enhanced Milieu Teaching/Phonological Emphasis (Scherer and Kaiser)
Developmental level
Targeted stage of production
Targeted outcomes
Emerging
Developin
Elaborat
Key components
Tech and/or materials
Specific diagnoses
Planning
Program
Execution
Spch Prod
Spch Perc
Phono awareness
Other oral Langu
age
Literacy
X X • Vocabulary and speech sound production simultaneously
•Phonological recasting
Materials/ toys of interest to child; occasional limited use of low resistance blowing toys (e.g., bubbles)
SSD; CLP
X X
Unique features of the Enhanced Milieu Teaching-Phonological Emphasis approach
• Supports phonological change simultaneously with language for children under 3 years of age
• Components– Target words chosen based on phonologic and
vocabulary criteria– Phonetic awareness to promote consonant
production & oral airflow– Responsive interaction and environmental
arrangement to promote engagement in play and communicative activities
– Prompting strategies provide opportunities to model, expand, request responses, and recast speech sound targets
EMT-PE Review Questions
1. EMT-PE facilitates which two communicative components?
a. Verb tenses and speech sounds
b. Vocabulary and speech sounds
c. Communicative functions and speech sounds
d. Semantic relations and speech sounds
2. Generalization of goals into routine communicative interaction is enhanced through
a. Target word selection
b. Clinician use of speech recasting
c. Parent training
d. Transcribing data
3. EMP-PE fosters speech development in children with CLPa. Expansion of consonant inventories
b. Prevention of habituation of compensatory artic errors
c. Reduction of phonological processes
d. a and b
e. All of the above
PROMPT: Prompts for Restructuring Oral Muscular Phonetic Targets (Hayden)
Developmental level
Targeted stage of production
Targeted outcomes
Emerging
Developin
Elaborat
Key components
Tech and/or materials
Specific diagnoses
Planning
Program
Execution
Spch Prod
Spch Perc
Phono awareness
Other oral Langu
age
Literacy
X X X • addresses motor phonemes (via auditory-tactual input) and lexicon within broader linguistic context
No specific materials required (toys, books, academic resources); also some PROMPT intervention materials, including computer software, stimulus cards, and web site resources (SmarTalk)
SSD; CAS
X X X X X
Unique features of thePROMPT approach• Uses Global Domain Analysis, Speech Analysis Observation and Motor
Speech Hierarchy to create, assess and devise a Communication Focus for treatment goals & objectives.
• Works across all domains (physical-sensory, cognitive-linguistic, social-emotional) and embeds motor speech actions at the appropriate level to establish functional communication.
• Uses very specific types of tactual input devised to support and activate different levels of the motor system; varies according to child profile.
• Always uses a motor-phoneme warm-up (mass practice), and implements distributed, variable practice in functional, game-like activities. Always gives clear feedback and directions e.g. “yes”, “no”, “correct”, “incorrect”.
• Co-articulation is always worked on. Beginning at the basic syllable level e.g. “be”, “bo”, “ba” , the changes (acoustically) that result from different motor movements and timing are considered
• Always includes turn-taking, choice making in age appropriate activities, routines, games.
• Parents are an essential part of the team and work with clinician to develop appropriate home program.
• Can be used with clients with cognitive impairments.• PROMPT is a motor skill; requiring extensive clinician training and practice.