Speech Sound Disorders (Ideal Therapy Plan)
Speech Sound Disorders (Ideal Therapy Plan)
Speech Sound Disorders (Ideal Therapy Plan)
TH
CLINICAL
CONFERENCE OF THE
ACADEMIC SESSION
2020-2021
Management of Articulation disorders
(An ideal therapy plan)
SUPERVISED BY
MRS. VIBHA MAHAJAN
CLINICAL SUPERVISOR
AYJNISHD(D) PRESENTOR
AKSHARA SAXENA
BASLP 3RD YEAR
Speech Sound Disorders
Speech sound disorders is an umbrella term referring to any
difficulty or combination of difficulties with perception, motor
production, or phonological representation of speech sounds
and speech segments—including phono-tactic rules governing
permissible speech sound sequences in a language.
Speech sound disorders
What constitutes an Articulation and
Phonological disorder?
• Phonetic (Articulation) disorders are the result of difficulty in
producing the sounds and sound sequences of the language i.e.
difficulty in executing motoric movements for speech sound
production.
• Phonological processes are patterns of sound errors that typically developing children
use to simplify speech as they are learning to talk.
• A phonological disorder occurs when phonological processes persist beyond the age
when most typically developing children have stopped using them or when the
processes used are much different than what would be expected.
• The child has difficulty organizing their speech sounds into a system of sound
patterns (phonemic patterns).
n
Vow tio
eliza iza
tio at
n pa
l
De
Denasalization
Affric
Gliding ati on
Consonant
Redup deletion
lic ation (initial or final)
Epenthe
sis
Speech sound development
How to assess?
Oral Peripheral Formal
Case history mechanism articulation/pho
examination nological tests
Speech Connected
Stimulability
Assessment
intelligibility speech
measure sample
Auditory
Language Phonological
sensitivity
testing Awareness
Assessment
Photo Articulation Test
The Photo Articulation Test (PAT) meets the nationally recognized need for a standardized way to document
the presence of articulation errors.
The Photo Articulation Test (PAT) enables the clinician to rapidly and accurately assess and interpret
articulation errors. This test requires the patient to look at hundred and forty four pictures and speak the
corresponding word. Each word is picked with an aim to elicit a specific phone (sound) at a specific position
such as word initial, middle and ending
To administer the Photo Articulation Test (PAT), the examiner simply points to each consecutively numbered
photograph and asks the client, “What is this?" The client's response is scored on the Summary/Response Form
to indicate the presence or absence of errors. Based on H-PAT, the kind of misarticulation is decided by the SLP
and the observations are manually noted. A chart is prepared with CSODA - Correct, Substitution, Omission,
Distortion, Addition for each phoneme. Percentage consonant correct (P CC) given as
PCC = Number of consonants correctly produced /Total Number of consonants
The results from the Photo Articulation Test (PAT) provide the clinician with a straightforward comprehensive
view of each student's articulation errors.
General guidelines of Articulation and
phonological intervention
Eliminate or minimize the effect of maintaining
Keep clients actively participating
causative factors
Write behavioral objectives Provide many opportunities for the client to
practice the ‘targets’.
Specify treatment procedures
Use logically Sequenced steps in the treatment plan
Begin at appropriate level
Involve teachers, Parents, Siblings and spouses.
Elicit sounds in a simpler way
Assess the Articulation/Phonological problem and
Teach the distinction between the error sound and progress continuously
the standard production of sound
Include work on transfer and maintainence.
Use a minimum of motivational devices
Select targets that will make an immediate and
Teaching sounds that are stimulable results in more socially significant difference
accurate production than teaching sounds that are
not stimulable Conduct treatment follow-up
Phonetic treatment
Approaches
Type of tx approach Specific Approach Brief Description
Articulator placement Phonetic placement Instruction in specific placement of the articulators to produce
speech sounds
Wedge Target two or more speech sounds at a time using sounds that
have dissimilar phonetic features
Multiple phonemic Target production of all error sounds at a time with each
progression at its own rate
Tactile-kinesthetic Moto-kinesthetic Manipulation by the clinician of the articulators externally on
the face and neck to guide the articulation mechanism in
production
PROMPT Use of multidimensional tactile prompts to guide the
articulation mechanism in production
Type of tx approach Specific Approach Brief Description
Phase 2 Production
situation by enlarging
Step 2 Isolation Step 2 Stabilization in treatment
Step 3 stimulation isolation situations( activities ,
Step 4 discrimination Step 3 Nonsense syllable conversational partners,
Step 4 Words settings) with the
a error detection incorporation of self
b error correction Step 5 Sentences evaluation and
Step 5 Self hearing monitoring.
Long term Goal
Phoneme dice
For generalization and practice , we can use hair strand activity or circling the
syllable on every correct utterance.
To correct the production of / / in all positions of the words ( initial,
middle and final ) with 90% accuracy.
INITIAL: Activity - To say words that begin with the target speech sound / / for eg-
_____,______,______ etc
Clinician will take pictures of words beginning with the target speech sound / / and ask the client
to name or guess them and if the client says /tea/ instead of /sea/, then the clinician can
demonstrate it by s+ea saying the two parts separately and leaving a pause between them and
can gradually make the pause between them shorter.
For practice hair strand activity can be
Used and Clinician can ask questions
To the client such as “ can you tell me
Who gives us milk?
Do you like carrots or candies?
• MIDDLE (Activity)- To say words that contains the target speech sound / / in middle .for
e.g.,- _____,______,______ etc.
• For medial position, break the word up initially into syllables. For example, if the target is /k/ and
the word is “baker,” have the child produce each syllable individually, but in sequence. For
example, she should say “ba…ker.” Gradually, bring the two syllables closer together. The use of
visuals (e.g., a red block for the first syllable and a blue block for the second syllable) can be
helpful.
For practice hair strand activity can be
Used and Clinician can ask questions
To the client such as “ can you tell me
• Name the items blue in color?
• We can go to moon by______?
• FINAL(ACTIVITY)- to say words that end with the speech sound / / For eg-
______,_____,____ etc.
• Clinician will use set of 6 pictures having / / in the end . Clinician will take pictures of words ending
with the target speech sound / / and ask the client to name or guess them and if the client says
/tea/ instead of /sea/, then the clinician can demonstrate it by s+ea saying the two parts
separately and leaving a pause between them and can gradually make the pause between them
shorter. Introduce the final word position of the sound by first breaking up the syllable or word.
For example, if the target sound is /k/ and the work is “bake,” the child should say “baaaa…k.”
• Hair strand activity or circling
the word can be used for practice the words.
When working on the final word position combine it with a word that starts with a vowel. If the
word following the final consonant starts with a vowel, it makes the final consonant similar to an
initial sound. For example, you could have the child say “Bake it.” Have the child pause while
holding the /k/ before going on to the next sound.
To correct the production of // in sentences with 90% accuracy.
• Clinician will give the client “ the opportunities to say words in phrases by adding one
more word with not having the target sound such as if a clinician is targeting on sound /k/
then clinician will use give the /komb/. And then moving on to sentences and to practice
the words.
• Clinician can ask the client to tell a story based on pictures containing / / target sounds.
• Can you think of something that begins with / / ?
• Can you think of a color that begins with / / ?
• Can you think of a name that begins with / / ?
• Would you like to wear Skirt or a Saree?
Who’s the policeman?
Who’s the tailor? Who is Mrs. Sew?
To facilitate the production of / / in spontaneous speech
with 90% accuracy.
• Clinician will give the client opportunities to speak
• Oral reading tasks
• Question and answer – introduction, description of pictures , object etc.
• Ask the parents to bring in family pictures, including those of siblings and pets. Look at the
pictures with the child, allowing him/her to narrate the events in the pictures using slow and
easy speech patterns.
Maintenance
• Enlarging the therapy situation (school, playground, job).
• In designing a practice schedule, the practice frequency and intensity should take into consideration
the following for best results:
• Practice Frequency: Frequent, distributed practice sessions can facilitate both short-term performance and
long-term memory. In fact, it is better to have frequent, albeit short, practice sessions than infrequent, yet
longer, sessions.
• Practice Intensity: The length of a practice session is less important than the number of responses elicited
during the session. In fact, it is the number of correct responses elicited (in therapy or at home) that is
directly related to the rate of progress, not the time spent. As such, drill work is most effective in developing
motor learning and motor memory. A practice session can be as short as a minute or less, particularly if it is
done frequently throughout the day
• Use of tongue twisters and jingles can also be used.
• The best way to obtain teacher and family member involvement in the carryover stage is to engage
them as partners in the treatment process from the very beginning.
• In addition, it is important to give parents specific strategies for practicing speech sound production
at home. In this way, they will be more aware of the child’s speech goals and more helpful in
monitoring and correcting the child’s speech during the carryover stage.
ORO-MOTOR EXERCISES
• These exercises are designed to increase the range of movement in your tongue,
lips, and jaw, which will help your speech and/or swallow functioning.
• for strengthening the articulators,
• controlling the articulators, and
• controlling respiration in non-speech functions
Out of clinic Strategies
• Assignments- the clinician may put pictures or words containing the target sound in the
notebook for home practice.
• Extra clinic environments (oral reading within a limited time span (10mins) , oral
discussions, structured conversation about Pre-selected topics)
• Creating discriminative stimuli and reminders in the environment.
• During oral reading, underline difficult words and reinforce the child’s attempt at saying
them correctly.
• Follow ups
Case Presentation
Case Name: XXXXX
Case No: 264.05.2019
Age: 8 years Sex : Female
Mother tongue: Hindi
Language known: Hindi and English
Language mostly used: Hindi
Religion: Hindu
Education: Class-V
Occupation: -
General Complaint:
Appearance: Normal
Functions: Puckering- Normal
Retraction- Normal
Diadochokinetic Rate- Normal
Tongue
Appearance: Normal
Function: Protrusion- Normal
Lateral movement:- Left- Normal and Right- Normal
Elevation- Normal
Retraction- normal
Teeth
Appearance: Normal Bite
Function: Ability to chew- Normal
Hard palate
Appearance: Normal
Soft palate
Appearance: Normal
Function: Movement during the production of / ah /
- Normal
- Symmetrical
- Ability to suck through straw:- Present
- Ability to blow:- Present
Uvula: Normal
Mandible:
Appearance- Normal
Function- Normal
Vowels - /a/,/i/,/u/,/o/
Consonants- Mentioned in PAT
Blends- mentioned in PAT
• Voice- Trial 1 Trial 2
• Pitch- perceptually adequate /a/ 8s 9.4s
• Loudness-Perceptually adequate /i/ 11s 10s
• Quality- Perceptually adequate /u/ 8s 10 s
• Breath control and phonation duration-
• Supra-segmental aspects (accent, Emphasis ,Intonation ,Phrasing , Rate of speech)- Perceptually
Adequate
• Imitation Skills:
• Gross body- Good
• Speech- Fair
• Speech intelligibility- 1 ( can understand without difficulty, however feel speech is not normal)
• Formal testing- Tests Administered : Photo Articulation Test was administered.
Error analysis
a.Number of sounds correctly produced: 121
2. To correct the Stimulus Approach Clinician will assist the client in putting the target sound
production of /k/, separately from the rest of the syllable such as /s/ pause /a/ ,
/kh/, /g/, /gh/ in clinician will model the syllable with a pause and then gradually
syllable with 90% shortens the length of the pause until there is no pause.
mastery.
Sno. Short term goals Approach used Activities
3. To correct the production of Stimulus Approach Clinician will take pictures of words beginning with the
/k/, /kh/,/g/,/gh/ in all positions of target speech sound /k / and ask the client to name or
the words ( initial, middle and guess them and if the client says /tea/ instead of /sea/, then
final )with 90% accuracy. the clinician can demonstrate it by s+ea saying the two
parts separately and leaving a pause between them and
can gradually make the pause between them shorter.
For practice , client was asked to practice the target words
10 times each.
4. To correct the production of Stimulus Approach Clinician began using target words now in the sentences
/k/, /kh/,/g/,/gh/ in sentences with and then begin initially with phrases, then simple
90% accuracy. sentences (3-4 words) and gradually using complex
sentences using pictures and block of words then
introducing pauses between words and then gradually
decrease the pause between them.
Progress Report
Progress Report
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Isolation Syllables Words Sentences