Therapeutic Methods & Developing Therapy Activities

Therapeutic Process: Overview

• Speech-language pathology (SLP) intervention follows a predictable workflow that moves from information gathering all the way to documenting client change.
  • Pre-Treatment (Pre-Tx) Tasks
  • Gather data (case history, formal/informal assessments, caregiver interviews).
  • Choose treatment (Tx) targets based on assessment data, stimulability, impact on intelligibility/communication, and client-family priorities.
  • Write measurable long-term goals and short-term objectives.
  • Determine baseline performance for each target (initial probes without clinical assistance).
  • Session Planning & Implementation
  • Determine teaching methods (e.g., drill, hybrid, naturalistic).
  • Develop scaffolding strategies (hierarchy of cues/prompts to raise or lower task difficulty).
  • Create generalization plan (transfer new skills across settings, partners, materials, and linguistic contexts).
  • Design therapy activities (select stimuli, decide on number of repetitions, embed reinforcement, sequence tasks for optimal challenge).
  • Session Documentation
  • Collect data (quantitative accuracy, qualitative observations, level of cueing).
  • Write SOAP note immediately post-session.
  • Write periodic progress notes summarizing growth and recommending next steps.

Session Planning & Implementation: Key Decisions

• Determine Teaching Method
  • Select the global intervention style (drill, hybrid, or naturalistic) based on:
  • Client age, interests, temperament.
  • Target complexity.
  • Need for maximal practice versus functional relevance.
  • Select modality/modalities you will train or leverage: verbal, written, gestural, AAC, multimodal combination.
• Create Treatment Activities
  • Select or design session stimuli that effectively elicit the target behavior.
  • Plan for high repetition to solidify skill acquisition (motor, linguistic, cognitive).
  • Embed opportunities to measure accuracy and generalization.

Selecting Your Session Stimuli

• Definition: Stimuli are the concrete components that prompt the client to produce the target (e.g., picture of a “sun” to prompt /s/ in initial position).
• "Not all stimuli are created equally"—their linguistic and cognitive properties influence ease or difficulty.
  • High- vs. Low-Frequency Words
  • High-frequency words are encountered often (e.g., “dog”); typically easier and more meaningful.
  • Low-frequency words (e.g., “suds”) increase phonological or lexical challenge and may foster generalization once mastered.
  • Minimal Pairs vs. Maximal Opposition
  • Minimal pairs differ by a single feature (/t/\, /d/) and highlight subtle contrasts.
  • Maximal opposition pairs differ across multiple features (/m/\, /s/) and can accelerate reorganization of the phonological system.
  • Lexical Properties (Lexical Density)
  • Dense neighborhoods (many phonological neighbors) can facilitate or hinder learning depending on target selection strategy.
  • Complexity
  • Starting with more complex phonemes or syntactic structures may yield greater system-wide change (complexity approach).
  • Functional Target Selection
  • Select items relevant to daily life communication (names, routines) to boost motivation and carryover.
• Helpful Resources
  • Caroline Bowen’s phonological therapy materials.
  • VNeST (Verb Network Strengthening Treatment) verb lists for aphasia therapy.

4 Characteristics of a Great Therapy Activity

1. Enhances rather than hinders target practice (directly elicits the behavior without excessive cognitive load).
2. Functional and meaningful to the client—engaging, age-appropriate, culturally relevant.
3. Adjustable for progress or struggle (built-in scaffolding: prompts, cues, task modifications).
4. Allows numerous attempts in the allotted time—repetition drives neuroplastic change.

Activity Structure: Continuum of Naturalness

• Research (Paul & Cascella, 2007) supports both highly structured and naturalistic approaches; clinicians strategically position themselves on a continuum:
  • Drill (Highly Structured)
  • Hybrid (Moderately Structured)
  • Naturalistic (Least Structured)

Drill

• Core Features
  • Massed practice of discrete targets; clinician controls stimuli, cueing, and response expectations.
• Benefits
  • Maximizes number of attempts in a session.
  • Typically yields high in-session accuracy.
• Limitations
  • Generalization outside the therapy room is often poor unless systematically addressed later.
  • Engagement can wane; may feel monotonous.
• Activity Examples
  • Picture card naming with immediate feedback.
  • Articulation worksheets (circle and say each word 5 times).
  • Phonological “exercises” or syllable drills.

Hybrid Therapy Activities

• Blend of clinician structure and client-initiated interaction.
• Benefits
  • Maintains partial control over number of target attempts.
  • Improves generalization relative to pure drill.
• Limitations
  • Fewer total elicitation opportunities compared with drill.
• Activity Examples
  • Integrated board games where each turn requires using the target.
  • Simulated role-plays (e.g., ordering in a restaurant for fluency targets).
  • Literacy tasks: dialogic reading with pre-planned wh- questions for language targets.
  • Play-based sequences with embedded cues (e.g., dollhouse describing verbs, syntax).

Naturalistic Therapy Activities

• Least structured; therapy embedded in real-life or spontaneous interactions.
• Benefits
  • Strongest outcomes for generalization and maintenance.
  • Highly functional and motivating; mirrors authentic communication.
• Limitations
  • Minimal clinician control over number and type of attempts—data collection is more complex.
• Activity Examples
  • Child-led play therapy focusing on expansion and recasting.
  • Wordless picture books prompting narrative generation.
  • Community-based intervention: ordering coffee, navigating public transit with AAC.
  • Push-in classroom services or lunch-table conversation groups.

Scaffolding & Cueing Hierarchy

• Verbal Cues
  • General ("Remember your /s/ sound") to specific ("Keep your tongue behind your teeth, blow the air").
• Visual Cues
  • Mouth pictures, written models, gestural prompts.
• Tactile/Kinesthetic Cues
  • Hand-over-hand, tactile placement, touch cues.
• Prompt Fading
  • Systematically reduce cue intensity or frequency to foster independence.

Generalization Planning

• Across Settings: clinic → classroom → home → community.
• Across Partners: clinician → parent → peer → unfamiliar listener.
• Across Linguistic Contexts: single words → phrases → sentences → conversation.
• Across Modalities: spoken → written → AAC output, etc.

Data Collection & Documentation Essentials

• Objective Data: percent accuracy, number of prompts, latency, frequency counts.
• Subjective Observations: effort, frustration, attention, strategy use.
• SOAP Note Structure
  • Subjective: client mood, parent report.
  • Objective: session data (e.g., 85\% accuracy on /k/ in final position in 20 trials).
  • Assessment: clinician interpretation (progress, barriers).
  • Plan: next targets, homework, carryover tasks.
• Progress Notes summarize trajectory, adjust goals, and justify continued therapy.

Assignment: Reverse Session Plan (Course Requirement)

• Select one of the demonstration videos (Drill, Hybrid, or Naturalistic).
• Create a fully detailed session plan that another SLP could implement "as is."
  1. Identifying Information: client initials, age, diagnosis, date.
  2. Long-Term Goals: broad functional outcomes (e.g., "Increase intelligibility to 90\% in conversation").
  3. Session Objectives: specific, measurable (e.g., "Produce /r/ accurately in initial position with 70\% accuracy given moderate verbal cueing").
  4. Teaching Methods & Materials: specify activity type, stimuli list, reinforcement schedule.
  5. Cues/Prompts: explicit hierarchy, criteria for fading.
  6. Adjustments/Scaffolding: how to increase or decrease difficulty on the fly.
• The document is worth 50 pre-class points.
• Collaboration allowed; list group members as "clinicians."

Practical & Ethical Considerations

• Functional relevance honors client autonomy and increases ethical service delivery.
• Over-reliance on drill without generalization may inflate performance data and misrepresent functional change.
• Cultural & Linguistic Responsiveness: choose stimuli that respect client’s background and linguistic norms.
• Confidentiality: ensure session plans and notes protect identifying information (HIPAA, FERPA compliance).

Connections to Foundational Principles

• Motor Learning Theory: high-frequency, variable practice → consolidation of motor patterns.
• Zone of Proximal Development (Vygotsky): scaffolding keeps tasks just above current skill level.
• Behavioral Principles: reinforcement, shaping, prompt fading reflect operant conditioning.
• Evidence-Based Practice: integrating best research (Paul & Cascella, 2007), clinical expertise, and client values.