COMD_700_Final_Study_Guide

Vowel Interventions

• Principles of Vowel Interventions:

  • Target vowel errors with individualized strategies.

  • Use a structured approach for assessment and monitoring progress.

  • Incorporate consonant therapy principles where applicable.

• Individualized Protocol for Vowel Errors:

  • Tailor interventions to specific vowel errors identified during speech assessments.

• Calculating Percentage of Vowels Correct:

  • Divide the number of correctly produced vowels by the total vowel targets, then multiply by 100.

• Summarizing Vowel Knowledge & Designing Vowel Inventory:

  • Document correctly produced vowels.

  • Identify vowels that are in error.

  • Create a targeted vowel inventory for intervention.

• Importance of Diphthongs:

  • Diphthongs are complex and require precise coordination, improving overall vowel production and speech intelligibility when addressed.

• Applying Consonant Intervention Principles to Vowel Interventions:

  • Use structured practice, feedback, and meaningful communication tasks.

• Adapting Consonant-Focused Therapy Techniques:

  • Implement techniques such as minimal pairs, motor-based articulation, and auditory training for vowel production errors.

• Minimal Pair Therapy:

  • Utilizes word pairs differing by a single vowel sound (e.g., bat vs. bite) to clarify and improve target vowel production.

• Motor-Based Articulation and Ear Training:

  • Focuses on teaching physical movements of vowel production while training the ear to discern correct and incorrect productions.

• Use of Facilitative Contexts:

  • Pair back vowels with back consonants, and front vowels with front consonants for easier production.

• Incorporating Hand Cues:

  • Visual representation of tongue movement and placement for accurate vowel production.

Childhood Apraxia of Speech (CAS)

• Definition:

  • CAS is defined by ASHA as a neurological disorder affecting the precision of speech movements without neuromuscular deficits.

• Difference from Other Speech Disorders:

  • CAS involves planning and programming difficulties without abnormal reflexes or muscle tone.

• Core Impairment in CAS:

  • Focused on planning and programming spatiotemporal movement sequences, resulting in speech production errors and prosody issues.

• Neurological Basis of CAS:

  • Originates in the brain, affecting processes required for precise movements.

• Perception of CAS:

  • Considered a disorder rather than developmental; requires intervention.

• Impact on Planning and Prosody:

  • Disrupts planning of speech movements, leading to slow, choppy speech.

• Segmental Characteristics of CAS:

  • Inconsistent consonant and vowel errors, motor planning difficulties, and challenges in syllable and word articulation.

• Errors in Production:

  • Errors are inconsistent; they worsen in longer or complex words.

• Syllable/Word Transitions:

  • Difficulty with articulatory sequencing leads to inappropriate pauses and groping behaviors.

• Suprasegmental Difficulties:

  • Challenges regulating rate, loudness, nasality, and pitch effects.

• Advice on Diagnosing CAS in Young Children:

  • Diagnosis should be deferred in children under three due to limited speech.

• Diagnostic Therapy Duration:

  • Recommended 6 months before a definite CAS diagnosis.

Motor-Speech Evaluation for CAS

• Purpose:

  • To assess the child’s current phonetic inventory and motor-speech abilities.

• Phonetic Inventory Characteristics:

  • Examine inconsistent errors in consonant production and variety of sounds.

• Inconsistent Errors:

  • Variability across repeated productions of sounds or words.

• Assessing Articulatory Transitions:

  • Difficulty during transitions called lengthened or disrupted movements.

• Prosodic Difficulties:

  • Problems with regulating speech characteristics (rate, loudness, pitch).

Complexity of Assessing CAS

• Syllable Complexity:

  • Important for identifying articulation and sequencing difficulties.

• Imitation vs. Non-Imitation:

  • Spontaneous speech difficulties may not be evident in imitation tasks.

• Single Words vs. Phrases Assessment:

  • Identify worsening difficulties with increased complexity.

• Utterance Length Assessment:

  • Increased demands revealing potential CAS characteristics.

• Diadochokinesis:

  • Ability to produce rapid, alternating movements; assessed to check motor planning.

• Formal Assessments for CAS:

  • Kaufmann Speech Praxis Test for Children (KSPT)

  • Dynamic Evaluation of Motor Speech Skill (DEMSS)

Developmental Coordination Disorder (DCD)

• Type of Disorder:

  • Neurological disorder affecting motor coordination.

• Impact on Learning New Motor Tasks:

  • Difficulty in learning indicates potential DCD.

• Affected Life Areas:

  • Daily living activities, academics, and play impacted.

• Associated Populations:

  • Commonly affects school-aged children, especially with early motor milestone issues.

PROMPT Therapy

• Objectives:

  • Utilize tactile-kinesthetic-proprioceptive inputs to reorganize motor speech systems.

• Sensory Input in PROMPT:

  • Formulation of accurate speech sound representations.

• Specialized Myokinesthetic Cueing Techniques:

  • Provide physical guidance and sensory feedback for articulatory movement.

Rapid Syllable Transition Treatment (ReST)

• Target Age Group:

  • Designed for children aged 4-12 with CAS.

• Core Characteristics Requirement:

  • Inconsistent errors, disrupted transitions, and inappropriate prosody must be present.

• Approach with Nonsense Words:

  • Helps in developing motor sequences free from past influence.

• Practice Intensity:

  • High intensity recommended: 1 hour, 4 times a week.

• Random vs. Blocked Practice:

  • Random practice enhances learning and adaptability.

• Motor Learning Principles:

  • High intensity, random schedules, focus on execution, and feedback for retention.

Cleft Palate Disorders

• Types of Cleft Palates:

  • Isolated cleft lip, cleft palate, combined cleft, unilateral/bilateral, complete/incomplete.

• Velopharyngeal Dysfunction:

  • Issues affecting closure leading to hypernasality.

• Speech Characteristic Observations:

  • Assess speech errors, including nasality-related issues and specific sound difficulties.

• Dental Abnormalities and Related Issues:

  • Commonly associated with cleft palate include missing or misaligned teeth.

Myofunctional Disorders and Tethered Tissues

• Definition of OMDs:

  • Abnormal orofacial muscle posture affecting speech, feeding, and chewing.

• Diagnostic Role of SLPs:

  • Distinction of OMDs from SSDs focusing on muscle function.

• Implications of Tethered Tissues:

  • Decisions around treatment should be made by medical professionals.

Interventions for Speech Sound Disorders (SSDs)

• Types of Interventions:

  • Motor-based interventions are recommended across various SSD contexts.

• Core Vocabulary Approach:

  • Aimed at improving the consistency of sound production in children with unintelligible speech.

• Minimal Pairs Therapy:

  • Utilizes contrasting words to improve phoneme distinctions.

• Multiple Oppositions Approach:

  • Addresses phoneme collapse in severe SSDs.

• Complexity Approach:

  • Focuses on treating more complex sounds to improve simpler ones.

• Feedback and Practice Strategy:

  • Emphasizes the necessity for ongoing feedback and adjustment in therapies.

Application-Based Questions and Answers with Example Case Studies

Case Study 1: Vowel Errors in a Five-Year-Old

Question: How would you individually tailor a vowel intervention plan for a 5-year-old boy, Tommy, who struggles with the production of back vowels?

Answer: For Tommy, I would first assess which specific back vowels he is struggling with using a structured assessment. Then, I'd design a personalized intervention plan that includes:

• Structured Practice: Use structured vowel games focusing on back vowels such as oo in food and aw in paw.

• Feedback Mechanisms: Provide immediate feedback during sessions, using visual cues like mirrors to help him understand tongue placement.

• Progress Monitoring: Track his progress weekly by calculating the percentage of correct vowel productions. For instance, if Tommy produced 12 out of 15 back vowel targets correctly in a session, he would have an 80% success rate.

Case Study 2: Childhood Apraxia of Speech (CAS) in a Seven-Year-Old

Question: A 7-year-old girl named Sarah has been diagnosed with CAS. How would you conduct a motor-speech evaluation to assess her capabilities?

Answer: To evaluate Sarah's motor-speech abilities, I would:

• Perform a Phonetic Inventory Assessment: Note the variety of sounds she can produce and identify inconsistencies in her consonant and vowel sounds.

• Imitation vs. Spontaneous Speech: Compare her ability to imitate sounds in a controlled environment versus her spontaneous speech during play.

• Assess Prosodic Features: Observe her speech for rate and loudness control by asking her to read a simple passage and note any disruptions or inconsistencies.

• Diadochokinesis Testing: Test her ability to produce rapid, alternating movements with syllables like ‘papapa’ and ‘tatata’ to assess her motor planning.

Case Study 3: Cleft Palate and Hypernasality in an Eight-Year-Old

Question: How would you assess and address hypernasality in an 8-year-old boy, Jake, who has a diagnosed cleft palate?

Answer: To assess Jake's hypernasality:

• Speech Characteristic Observations: Conduct a speech analysis by recording his speech in a controlled setting and listening for nasality-related errors.

• Dental Examination: Evaluate any oral structural anomalies that may be contributing to his speech difficulties.

To address Jake's hypernasality:

• Targeted Speech Exercises: Incorporate exercises that focus on velopharyngeal closure, such as blowing into a tissue to feel the airflow.

• Use of Facilitative Contexts: Practice words that pair back consonants with back vowels, making it easier for him to produce sounds accurately.

• Feedback and Practice: Provide frequent feedback during practice to help him understand which adjustments to make.