Deck 14: Articulatory and Motor Speech Intervention Approaches

Question 1

List five cues for eliciting /s/.

Answer 1

To elicit the /s/ sound in speech therapy or during language development exercises, the following five cues can be used:

1. **Visual Cues**: Show the child how to place their tongue behind their top front teeth. You can use a mirror so they can see the correct tongue placement and try to imitate it. Sometimes, therapists use diagrams or pictures to illustrate where the tongue should go.

2. **Tactile Cues**: Encourage the child to feel the airflow by placing their hand in front of their mouth while producing the /s/ sound. This helps them understand the concept of a stream of air that is necessary for the correct production of /s/.

3. **Auditory Cues**: Exaggerate the /s/ sound yourself, making it longer and more pronounced so the child can hear it clearly. This helps them to understand what the target sound is. You can also use recordings of the /s/ sound for them to listen to and then imitate.

4. **Verbal Cues**: Use simple instructions like "Put your teeth together and hiss like a snake," or "Blow air out of your mouth while keeping your teeth close together." These instructions give the child a clear idea of what they need to do to produce the /s/ sound.

5. **Phonetic Placement Cues**: Guide the child to place the tip of their tongue close to the ridge behind their upper front teeth without touching them. This is known as the alveolar ridge. Instruct them to keep their tongue tense and to direct the airflow over the center of their tongue.

Using these cues consistently can help children learn to articulate the /s/ sound more clearly. It's important to be patient and practice regularly, as mastering speech sounds can take time.

Question 2

List five cues for eliciting consonantal /ɹ/.

Answer 2

To elicit the consonantal /ɹ/ sound, which is the "r" sound as in the English word "red," speech-language pathologists or educators might use a variety of cues and techniques. Here are five cues that can be used to help an individual produce the /ɹ/ sound:

1. **Visual Cues**: Use a mirror to show the tongue's position. The individual can watch themselves or the therapist to see the correct tongue placement, which is usually bunched or retroflexed (curled back) in the mouth without touching the alveolar ridge.

2. **Tactile Cues**: Guide the individual to feel the sides of their tongue touching their upper back teeth. This can be done by gently touching the sides of the tongue or using a tool like a tongue depressor to guide the tongue into the correct position.

3. **Auditory Cues**: Provide a model of the /ɹ/ sound for the individual to imitate. This can be done by exaggerating the sound and breaking down words into smaller parts, starting with the /ɹ/ sound, then adding a vowel (e.g., "rrr-ed").

4. **Verbal Cues**: Use descriptive language to explain the tongue's position. For example, you might say, "Curl your tongue back like a hook," or "Make your tongue strong and tight in the back of your mouth."

5. **Phonetic Placement Cues**: Instruct the individual to start with a sound that they can produce correctly, such as /l/, and then modify it to produce the /ɹ/ sound. For example, you can ask them to say /l/ and then pull the tongue back into the /ɹ/ position while maintaining voicing.

These cues can be used in isolation or in combination, depending on the individual's needs and responsiveness. It's important to note that eliciting speech sounds can be a complex process, and what works for one person may not work for another. Consistent practice and positive reinforcement are key to helping individuals improve their articulation of the /ɹ/ sound.

Question 3

What is the main difference between traditional articulation intervention and Skelton's (2004) concurrent treatment approach?

Answer 3

The main difference between traditional articulation intervention and Skelton's (2004) concurrent treatment approach lies in the methodology and focus of the therapy.

Traditional articulation intervention typically involves a step-by-step approach where the speech-language pathologist (SLP) focuses on correcting individual speech sounds in a hierarchical manner. This process often starts at a very basic level, such as working on the production of the sound in isolation, then gradually moving to syllables, words, phrases, sentences, and eventually conversational speech. The therapy is often segmented, with each session dedicated to practicing and mastering a specific sound or set of sounds before moving on to the next. The goal is to establish correct production of speech sounds and then generalize this to spontaneous speech.

Skelton's concurrent treatment approach, on the other hand, is a more integrated method that addresses multiple speech sounds or error patterns simultaneously. Instead of isolating sounds and working on them individually, this approach encourages the practice of several target sounds within the context of meaningful language activities. The rationale behind this method is that it more closely resembles natural speech and language learning processes, potentially leading to more efficient generalization and transfer of skills to everyday communication.

Skelton's approach is based on the idea that working on multiple sounds at once can help the child learn the rule-based nature of speech sounds more effectively, as it provides opportunities to compare and contrast different sounds and their articulatory features within a language context. This can be particularly beneficial for children with multiple speech sound errors, as it allows for a more holistic and functional approach to intervention.

In summary, the main difference is that traditional articulation intervention is a linear, segmented approach focusing on one sound at a time, while Skelton's concurrent treatment approach is a more integrated, simultaneous method that addresses multiple speech sounds within the context of language activities.

Question 4

Ultrasound and electropalatography (EPG) are useful for providing what type of information about articulation?

Question 5

What does DTTC stand for, and what do each of the terms mean?

Question 6

List the five levels of the verbal imitation hierarchy proposed by Rosenbek, Lemme, Ahern, Harris, and Wertz (1973).

Question 7

What does ReST stand for, and what type of word stimuli are used in ReST intervention?

Question 8

Name the three skills that ReST focuses on.

Question 9

What are the three components of integrated phonological awareness intervention?

Question 10

Briefly describe the systems approach to intervention for children with childhood dysarthria.

Question 11

Compare and contrast traditional articulation intervention with the principles of motor learning.

Question 12

Choose one speech subsystem and prepare a critical review of research evidence on interventions for children with childhood dysarthria on that subsystem.

Question 13

Discuss the role of augmentative and alternative communication (AAC) in conjunction with intervention targeting speech production for toddlers with severe childhood apraxia of speech or childhood dysarthria.

Question 14

Compare and contrast integrated phonological awareness intervention and ReST for a young school-aged children with moderate-severe childhood apraxia of speech primarily characterized by dysprosody.

Question 15

Why are generalization probes so important when conducting intervention for children with motor speech disorders?

Question 16

Discuss how you would encourage attention and motivation during intervention for young children with motor speech disorders.

Question 17

Technology or no technology for children with residual errors involving /s/ and /ɹ/? As part of your response, critique the intervention research associated with using no technology, electropalatography, ultrasound, spectrography.

Question 18

Discuss the role of movement sequences in intervention for children with childhood apraxia of speech.

Question 19

Examine the evidence on strategies for reducing nasal air emission and hypernasality in children with childhood dysarthria.

Question 20

Read about two approaches for children with childhood apraxia of speech mentioned (but not covered) in McLeod and Baker (2017), such as Nuffield Centre Dyspraxia Programme-3 (NDP-3) (Williams & Stephens, 2004) and Melodic intonation therapy (e.g., Helfrich-Miller, 1994). Prepare a document for SLPs outlining the history of each approach, the theoretical basis, general procedure, research evidence and resources.

Question 21

Zoe (8;3 years) is a monolingual English-speaking girl. She has an interdental lisp. You have decided to trial a period of traditional articulation intervention to improve the clarity of her production of /s, z/. During the first intervention session you start with:

A) auditory stimulation and lexical judgment tasks.
B) pre-practice instructions on how to articulate a clear /s, z/.
C) sensory-perceptual (ear) training including identifying, locating, stimulation, and discrimination.
D) production of /s/ in isolation with a model.

Question 22

You have begun pre-practice instruction with Zoe (8;3 years) to improve her production of /s, z/. During pre-practice instruction you:

A) teach Zoe how to articulate /s/ with cues as necessary.
B) talk with Zoe about the structure of the intervention sessions and provide her with instructions for home practice.
C) teach Zoe how to perceive the difference between /s/ and /z/ in syllables and words.
D) explain to Zoe how /s/ is articulated and have her imitate /s/ in CV syllables with knowledge of results feedback only.

Question 23

As part of traditional articulation intervention, transfer and carryover would involve Zoe (8;3 years):

A) practicing /s/ in word-initial, within word, and word final positions with other speakers in the clinic.
B) practicing the /s, z/ in phrases then sentences.
C) learning to use /s, z/ in conversational speech in everyday situations.
D) learning to use /s, z/ in conversational speech with the clinician in the clinic.

Question 24

The production practice sequence in Van Riper's traditional articulation intervention approach includes:

A) nonsense syllables, phrases, words, conversational speech.
B) isolation, words, alliterative phrases, sentences.
C) isolation, words, phrases, sentences, tongue twisters and alliterative phrases.
D) isolation, nonsense syllables, words, sentences.

Question 25

You are going to use Skelton's (2004) concurrent treatment approach with Susie (7;4 years), to address her lateralization of /s, z/. As part of your first session with Susie, you include:

A) orientation training followed by a period of pre-practice, then (depending on her progress), randomized variable practice.
B) pre-practice for a time-based criterion of 15 minutes, followed by orientation training, then randomized variable practice.
C) orientation then pre-practice until a performance criteria of 50% accuracy in 50 trials is met, then randomized variable practice.
D) pre-practice for 2 to 3 minutes followed by orientation training, then randomized variable practice.

Question 26

When preparing your picture resources for the practice phase of concurrent treatment with Susie (7;4 years) you could have your picture-based resources for the different exemplar types:

A) sorted into a hierarchical manner, ready to begin with word-initial singleton syllables.
B) arranged so that all exemplar types focused on word-initial (e.g., syllables, words phrases, sentences, conversation topics) are practiced before within word or word-final positions.
C) randomly shuffled into one pile then have Susie work through the pile.
D) organized so that all exemplar types focused on word-final (e.g., syllables, words phrases, sentences, conversation topics) are practiced before within word or word-initial positions.

Question 27

The focus of Dynamic Temporal and Tactile Cueing (DTTC) for children with childhood apraxia of speech is on:

A) movement sequences rather than individual phonemes.
B) individual phonemes rather than movement sequences.
C) sounds in isolation before syllables and words.
D) intonation and loudness variations with vowels before combining vowels with syllables.

Question 28

Paige (2;11 years) is a monolingual English-speaking girl. She has a limited phonetic inventory and is struggling to sequence consonants and vowels in simple syllable shapes such as CV, VC and CVCV. You suspect she has childhood apraxia of speech. You have decided to use Dynamic Temporal and Tactile Cueing (DTTC), which means that you will:

A) progressively fade cues from one trial to the next so as to improve her production of consonants and vowels.
B) focus on Paige's ability to plan and program movement sequences in simple syllables through the back-and-forth use of different types of imitation, a slowed speech rate, multiple cues (particularly tactile-phonetic cues, motokinesthetic cues, and gestural cues), and changing in the amount of time between your model and when Paige imitates the model, as needed.
C) focus on intensive practice of monosyllabic and multisyllabic pseudo-words.
D) guide Paige's ability to sequence sounds in syllables through manual guidance rather than using verbal-phonetic cues.

Question 29

To encourage smooth transitions between syllables:

A) practice consonants and vowels in isolation first.
B) insert a brief breath between consonants and vowels.
C) avoid pausing during a syllable and avoid segregating the movement.
D) use fractionation rather than additive segmentation.

Question 30

When conducting Rapid Syllable Transition Treatment (ReST), McCabe and Ballard (2015) recommend that clinicians use:

A) multisyllabic pseudo-words (nonwords) to ensure that children imitate clinicians' motor plans rather than use their own established motor plans for real words.
B) multisyllabic real words so that children can focus on refining motor plans and programs for known phonological plans, rather than having to create new representations for nonwords.
C) multisyllabic pseudo-words to avoid the interference of ingrained errors from real words.
D) multisyllabic real words to reduce the demands on children's processing capacities.

Question 31

When conducting Rapid Syllable Transition Treatment (ReST) instruction cues and feedback primarily focus on:

A) accurate phonetic targets and syllable stress.
B) articulatory transitions and consonant accuracy.
C) appropriate loudness and breath control.
D) appropriate syllable stress emphasis, fluency, and appropriate loudness.

Question 32

Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) is:

A) an intervention approach for children with motor speech disorders that requires specific training and certification.
B) a prosodic intervention approach treating motor speech disorders in children and adults.
C) a visual-verbal method for assessing and treating motor speech disorders in children and adults.
D) an intervention suitable for children with mild articulation impairments characterized by distortion errors.

Question 33

Integrated phonological awareness for CAS uses:

A) metalinguistic instruction and feedback with children rather than relying on models for imitation, to encourage children to make their own phonological and motor plans.
B) manual guidance.
C) metronomes to ensure that all syllables are included in polysyllabic words.
D) feedback focused primarily on prosodic elements of children's speech such as fluency, smooth transitions, and appropriate loudness.

Question 34

Cody (7;7 years) is a monolingual English-speaking boy. He has moderate-severe childhood dysarthria. His speech intelligibility is better in single words than connected speech, partly because he has difficulty regulating breath control during speech. You have decided to use a systems approach to improve his speech intelligibility, by focusing on his:

A) laryngeal (phonation) system.
B) velopharyngeal (resonance) system.
C) respiratory system.
D) articulatory system.

Question 35

As part of your intervention with Cody (7;7 years) which of the following strategies would you not use, to improve his awareness of and ability to regulate breath control during speech:

A) speech production exercises at phrase level to practice breath control while ensuring adequate intensity and stress.
B) increasing Cody's awareness about breathing and its importance for speech.
C) talking with Cody and his family about the importance of correct seating and posture for speech.
D) EPG feedback for alveolar consonants [t, d, n, s].

Question 36

When used in conjunction with speech-language pathology intervention, the surgical technique that might reduce nasal air escape in children with reduced speech intelligibility associated with childhood dysarthria is:

A) pharyngoplasty.
B) cheiloplasty.
C) palatoplasty.
D) rhinoplasty.

Question 37

Samantha (8;8 years) has childhood dysarthria because of traumatic brain injury (TBI). Her speech is highly unintelligible. You have decided to trial an aided form of communication. A suitable aided form of communication for Samantha would be:

A) sign language.
B) a simple digitized speech output device.
C) using her face to communicate facial expression.
D) using basic vocalizations for attention.

Question 38

Gillan (7;5 years) has an articulation impairment characterized by /?/ distortion. You have decided to help Gillan produce /?/ by successive approximation from another consonant. This would most likely involve:

A) shaping // from [l].
B) shaping /11ee98bf_542e_25d8_a6de_1b80c8003dcb_TB9704_11/ from [ $\theta$ ].
C) shaping /11ee98bf_542e_25d8_a6de_1b80c8003dcb_TB9704_11/ from [w].
D) shaping /11ee98bf_542e_25d8_a6de_1b80c8003dcb_TB9704_11/ from [].

Question 39

A facilitating phonetic environment that would not be helpful for eliciting // with a school-aged child with /11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11/ distortion would be:

A) /11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11/ before a high front vowel [i].
B) in a syllable-initial velar plosive cluster /k11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11, g11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11 / for a bunched /11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11/.
C) in an alveolar plosive clusters /t11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11, d11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11 / for a retroflex /11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11/.
D) /11ee98bf_8946_864a_a6de_ad3a42e6130d_TB9704_11/ before a high back rounded vowel [u].

Question 40

Compared with traditional articulation therapy, concurrent treatment uses:

A) randomized-variable practice.
B) massed practice.
C) blocked-constant practice.
D) a period of instruction on how to articulate a distorted consonant.