Module 1: Traditional Approach for Articulation (Van Riper)

Learner Objectives

1. Identify Functional Speech Sound Disorders
2. Discuss the Classification System
3. Explain the risk and educational impact of Speech Sound Disorders
4. Explain the principles of motor learning
5. Describe the treatment phase of the sequence of sensory-perceptual training and sound production training
6. Create specific goals

Speech Sound Disorders

Under Umbrella of SSD:
1. Functional
2. Organic

Functional

1. No known cause
2. Daily/ School Setting

Disorders:
---> Articulation (motor aspects)
---> Phonology (linguistic aspects)

Organic: (3 branches), what are they?

Developmental or Acquired
--Three Branches:
1. Motor / Neurological
2. Structural
3. Sensory / Perceptual

Organic: Motor / Neurological

1. Execution (Dysarthria)
2. Planning (Apraxia)

Organic: Structural

1. Cleft Palate / other Orofacial Anomalies
2. Structural deficits due to trauma or surgery

Organic: Sensory / Perceptual

1. Hearing Impairment

Classification System

Speech Sound Disorders have a classification system that provides a etiological framework:
1. Speech Delay (SD)
2. Motor Speech Disorder (MSD)
3. Speech Errors (SE)

Classification System: Speech Delay

Speech Delay (SD):
1. Genetic
2. Otis Media
3. Developmental Psychological Involvement
---> Environmental Factors, Auditory-Perception Processing, Programming & Planning

Classification System: Motor Speech Disorder (MSD)

Motor Speech Disorder (MSD):
1. Motor Speech Control

2. Lack of motor control

3. Shows significant deviations in productions aka S.O.D.A (Substitutions, Omissions, Distortions, and Additions)

Classification System: Speech Errors (SE)

Speech Errors (SE):
1. Transient or Persistent Distortions (r's)

2. Lingering past the developmental age of development or mastery (80%)

Proportion of Children with SSD's on SLPs Caseloads?

Study consisted of 14,000 children in 37 different states.
---> 1. K-3= 56%
---> 4-6= 52%
---> 7-12= 22%

What are 2 reasons to remediate children?

1. Speech Intelligibility

2. Decrease their educational demand & Social Risk (bullying, isolation)

---> Want to increase their literacy

Social & Education Risks of SSDs?

1. 1982= 44%
2. 2007= 58%
3. 2011= 77%
---> The number is consistently growing throughout the years. This is causing the social and education risks of SSDs.

Impact of SSDs on Children's Families?

1. "They think my child is stupid":
---> 50%
---> Negative Label

2. "We as parents are responsible for our child's developmental problems":
---> 30%
---> They are thinking "What did I do wrong as a parent?"

Evidence-Based Practice

1. Clinical Expertise
2. Patient Values
3. Research Evidence

Articulation

The actual (physical) production of specific speech sounds

Articulation Disorders

1. Motor speech difficulty involving the actual production (articulation) of specific speech sounds

2. Can be classified through SODA (submission, omission, distortion, addition)

---> Example: Thven / Seven (Substitution)

Clinical Techniques of Articulation Therapy Address (Primary and Secondary)

1. Articulatory movements (Primary)
2. Auditory Perception of Speech (Secondary)

Who are Appropriate Candidates for Articulation Interventions?

Children whose errors are distortions or substitutions on a single phoneme

Clinicians Should Consider the Extent to Which SSD Restricts a Child's What?

Participation in educational and extracurricular activities that rely heavily on speaking

Result of Speech Sound Production Errors?

1. Speech sound production errors are viewed to be the results of the person's inability to execute the correct placement of the articulators (Produced in timely manner)
---> Teeth, Tongue, & Lips

How does Van Riper approach target each phoneme error?

The Van Riper approach targets each phoneme individually
---> 1 sound at a time

What does this traditional motor-based approach (Van Riper) focus on?

1. This traditional motor-based approach will focus on providing instruction for the correct placement of the articulators (ex: What sound does a snake make? Ssss (metaphonological cues) in order to achieve an accurate production of speech sounds.

---> Instructions: Metaphonological, Tactile Cues

Stimuability (Secondary Assessment Task)

The ability to successfully imitate a sound, syllable, or word following an adult model and/or following instructions on articulator placement

Auditory Perceptual Assessment (Secondary Assessment Task)

Discrimination and identification of correct and incorrect forms of the sounds in error can help determine if poor auditory perception of speech contributes to client's errors.
---> Used to determine the extent to which auditory perceptual training should be included in treatment

Primary Speech Assessment Tasks

Administration of a standardized test of articulation (Goldman-Fristoe or Diagnostic Evaluation of Articulation and Phonology) and a connected speech sample to sample all speech sounds at the word and sentence levels.

Principles of Motor Learning: What is Motor Learning?

1. A set of processes associated with practice leading to a permanent change. (Permanent Placement)
---> Maximum Opportunities, Practice, Drilling, and Repetition:
These are the processes during practice to achieve permanent change!

Principles of Motor Learning: Two Levels of Performance

1. Acquisition and Learning Phase:
---> Motor performance that is demonstrated through the establishment of the ability to execute. How? Modeling / Imitation

2. Retention and Transfer Phase:
--> Ability to demonstrate the skill after the training is complete and transfer learning to untargeted sound and words.
---> Reflects the level of performance in which permanent change in articulatory movements has been demonstrated. ("Mastery" is the goal)
---> The change from incorrect to correct
---> Move articulators from one spot to the next

Articulation Therapy's Ultimate Goal?

Reduce limitations in the child's participation in social and educational activities by achieving socially acceptable speech.

Typical Goal Attack Strategy for Articulation Therapy?

1. Vertical: target phoneme is treated through a hierarchy of isolation, syllables, words, phrases, sentences, and conversation.
---> One phoneme at a time until mastery before moving on

Dr. Charles Van Riper

1. Who? Expert in Speech Pathology
--> He was a Stutter

Intervention Sequence

Overall Approach:
---> Only for clients who are unable to produce motor movement
---> Rule of thumb of Speech Based!

Intervention Sequence: Perceptual Training

1. How they receive the sound

2. Auditory Discrimination: Sets of words, ex: "Raise your hand for right one"

2. Auditory Bombarding: ex: "kid has on headphones listening to recording of L's being said over and over"

Intervention Sequence: Perceptual (Ear) Training Phase 1: Identification

1. Identification:
---> Increase the child's knowledge of the targeted sound.

---> 2 Ways:
1. Listening: What does the sound, sound like?
2. Learning: What do our articulators do to produce the sound correctly

Intervention Sequence: Perceptual (Ear) Training Phase 2: Isolation

2. Isolation:
---> Goal is for child to identify target sound in different positions [enhancing auditory model]:

1. Initial
2. Medial
3. Final

Intervention Sequence: Perceptual (Ear) Training Phase 3: Stimulation

3. Stimulation:
---> Also known as "imitation" to promote child's awareness of sound and enhances:

1. Awareness
2. Auditory Model: Bombardment & Discrimination

Intervention Sequence: Perceptual (Ear) Training Phase 4: Discrimination

4. Discrimination:
1. Error Detection: child indicates when clinician makes incorrect production (clinician says target sound wrong)

2. Error Correction: child tells you what you did/said wrong. Be able to give instructions back (child is correcting you)

Intervention Sequence: Perceptual (Ear) Training

Ear Training:
--> Metaphonological Cues are rich descriptors

Intervention Sequence: Production Training: Sound Establisment

Sound Establishment:
--> kid understanding what sound is by giving verbal and visual cues

Traditional Motor Approach is motor based meaning it is only for clients who are unable to?

Execute a motor movement

Intervention Sequence: Production Training: Sound Establisment Phase 1

1. Production in Isolation:
---> Goal is to teach correct production. Van Riper calls it "Pre-Production"

A.) Imitation: clinician says, "Repeat after me", "Watch as I go", "Watch me as I say"
---> Visual Cues

B.) Phonetic Placement: If child does not say sound in isolation, clinician must provide verbal instructions.
---> Verbal Cues: "Put your tongue here"
---> Tactile Cues: Use mirror or mouth to show the child

Intervention Sequence: Production Training: Sound Stabilization

Correct Production of whatever the target sound is.
1. Expanding the context
2. Planning for generalization
---> Includes using in sentences, conversations, stories, and self monitoring.

What is the difference between Sound Establishment and Sound Stabilization in regards to teaching?

1. Are there teaching in both of these? YES

2. Difference?:
---> Sound Establishment involves setting up the foundational aspects of a teaching environment. It's about creating the initial conditions that support effective learning.
---> Sound Stabilization focuses on maintaining and fine-tuning the teaching environment to ensure continued effectiveness and adapt to any changes or challenges that arise.


In Summary: Sound Establishment is about laying the groundwork for effective teaching, while Sound Stabilization is about maintaining and adjusting that groundwork to ensure sustained effectiveness and responsiveness to students' needs. Both are crucial for creating and sustaining a productive learning environment.

What are Linguistic Contexts?

1. Initial
2. Medial
3. Final
---> Positions of the sounds

Baseline Data

1. Starts at Sound Stabilization

2. Pre-Treatment Data: For target to be analyzed! (not associated with "pre-practice)

3. Where the child is at, % wise

4. If baseline data is below 50%, start at the level just below!

5. If baseline data is between 50%-75% start at SAME level!

Example of Baseline Data

Olari is 5, /d/ wrong on assessment.
---> Word Level: 65%
---> Phrase Level: 40%
---> Sentence Level: 35%

--> We would start at word level because it is not at 80% (mastery) and the phrase and sentence level are the highest level concepts.

Linguistic Contexts: Van Riper

7 Levels of Progression:
1. Isolation
2. Syllables
3. Words
4. Sentences
5. Stories
6. Conversation
7. Generalization

True or False: All kids start at same level.

FALSE

1. Isolation Level

Elicit target sound alone (by itself)

2. Syllable Level

1. Stabilize target sound embedded into different vowel contexts

2. Syllable Sequence:
Target Sound: F
---> Sound + Vowel= CV
----> EX: (FA) (FE) (FI) (FO) (FU)

---> Vowel + Target= VC
----> EX: (AF) (EF) (IF) (OF)( UF)

---> Vowel + Target + Vowel= VCV
----> EX: (AFA) (EFE) (IFI) (OFO)(UFU)

3. Word Level

1. Helps child maintain production accuracy of target sound!
---> If child gets below 50% on word level, go back to syllable level (go down level)
-- In some cases, go back to isolation!

2. Drill same words every session/ start at one syllable words. !!Use same words, different activity!!

4. Phrase Level

1. Maintain accurate production of target sound in phrases with carrier phrase added
---> Carrier Phrase: added phrase, same words 80% on 2 sessions

EX: I have a, I saw a , I want a, I need a, I took a, I see a

5. Sentence Level

1. Maintain accurate production of target sounds in sentences by increasing length and linguistic complexity.

---> Simple Short Sentence:
----> EX: The fox is brown
---> Sentence with increased length with one target sound
----> EX: The brow fox is sleeping in the bush
---> Simple short sentence with two or more target sounds
----> EX: The fat fury fox is fast

6. Conversational/Spontaneous Speech

1. Conversational Tasks
---> Scripted: Why? Make sure they are saying target sound. Find many paragraphs or "repeat after me" the target sound in paragraphs.
---> Structured

2. Spontaneous tasks should be:
---> Unstructured
---> Open-ended Questions

7. Generalization

1. Carryover and Transfer
---> Client demonstrates skills outside of therapy (mastery of the sound(s)