Clinical application of usage-based phonology: Treatment of cleft palate speech using usage-based electropalotography

PURPOSE

To investigate whether a novel electropalatography (EPG) therapy, underpinned by usage-based phonology theory, can improve the accuracy of target speech sounds for school-aged children and adults with persistent speech sound disorder (SSD) secondary to cleft palate +/- lip.

METHOD

Six consecutively treated participants (7-27 years) with long-standing speech disorders associated with cleft palate enrolled in a multiple baseline (ABA) within-participant case series. The usage-based EPG therapy technique involved high-volume production of words. Speech was assessed on three baselines prior to therapy, during weekly therapy, at completion of therapy, and 3 months post-therapy. Percent correct of target phonemes in untreated words and continuously connected speech were assessed through acoustic phonetic transcription. Intra- and inter-transcriber agreement was determined.

RESULT

Large to medium treatment effect sizes were shown for all participants following therapy (15-33 sessions). Percentage of targets correct for untreated words improved from near 0% pre-therapy, to near 100% for most target sounds post-therapy. Generalisation of target sounds to spontaneous connected speech occurred for all participants and ranged from 78.95-100% (M = 90.66; SD = 10.14) 3 months post-therapy.

CONCLUSION

Clinically significant speech change occurred for all participants following therapy. Response to the novel therapeutic technique is encouraging and further research is indicated.

The impact of age on the treatment of late-acquired sounds in children with speech sound disorders

The question of 'when' to treat speech sounds is often posed in the context of normative data. The new normative data suggest that speech sounds such as /ɹ/ and /l/ are acquired earlier than previously thought. The present study compared the treatment of late-acquired sounds between two age groups of English-speaking children: Young children (4-5) and Old children (7-8). Eight monolingual children with speech sound disorder (SSD) participated in the study. Each child received a criterion-based, standardised, two-phase therapy protocol. Treatment efficacy was measured by examining children's accuracy on real world speech probes. Treatment efficiency was measured by calculating the number of sessions required to meet the exit criterion and the mean session duration. For treatment efficacy, young children learned treated sounds as effectively as oldchildren did. For treatment efficiency, both groups required a comparable number of sessions, but young children required longer sessions than old children. The results suggest that delaying treatment of individual speech sounds is unnecessary and that a range of sounds should be considered as potential treatment targets.

Word-final complexity in speech sound intervention: two case studies

In speech sound intervention, consonant clusters promote generalisation (i.e. improvement in untreated sounds and words), ostensibly due to their relative complexity compared to other phonological targets. However, our understanding of clusters as intervention targets is largely restricted to those in word-initial position (e.g. [fl-], flip). The present study extends available work to consider the effects of word-final consonant cluster targets (e.g. [-ks]). Phonologically complex word-final clusters may be morphologically simple (e.g. mix) or morphologically complex (e.g. packs, inflected with third-person singular) - yet this cross-domain complexity remains an understudied phenomenon. Presently, two case studies provide an initial investigation of word-final cluster intervention targets for children with phonologically based speech sound disorders. Intervention targets for both Anna (3;7 [years;months]) and David (4;1) featured the phonologically complex word-final cluster [-ks], with Anna's target being morphologically simple and David's being morphologically complex. Intervention was provided in 45-minute, individual sessions three times per week for a maximum of 18 sessions. Both children demonstrated high target accuracy by intervention's end. Following intervention, both children demonstrated progress in intelligibility and ability to produce word-final consonant clusters; David further demonstrated generalisation across multiple measures. Results are interpreted with consideration of individual differences and existing research on complexity in phonological intervention. Overall, present findings motivate continued research, as manipulation of word-final complexity allows for emphasis on a context that is relevant for children with speech sound disorders, for peers with difficulties in morphology (including word-final grammatical morphemes) and for the substantial proportion of children demonstrating weaknesses in both domains.

Creencias y actitud hacia la Práctica Basada en la Evidencia de fonoaudiólogos latinoamericanos dedicados exclusivamente a la práctica clínica y educativa

La Práctica Clínica Basada en la Evidencia (PBE) sugiere al fonoaudiólogo/a la incorporación de acciones orientadas a dar respuesta a las necesidades de los usuarios en contextos específicos. Dichas acciones incluyen planteamiento de interrogantes, revisión crítica de evidencia disponible y toma de decisiones integrando la experiencia clínica, la evidencia y las preferencias del usuario. Si bien este paradigma se ha posicionado en la disciplina en la última década, resulta compleja su implementación para los profesionales que se encuentran completamente dedicados a la práctica clínica y/o educativa. El objetivo de este estudio es analizar las creencias y actitud hacia la PBE de fonoaudiólogos/as dedicados a labores clínicas y/o educativas a tiempo completo en diferentes países de Latinoamérica. Se trata de un estudio cualitativo, fenomenológico. Se realizaron entrevistas semiestructuradas a fonoaudiólogos/as residentes en Argentina, Paraguay, Chile, Perú, Colombia, Uruguay y Costa Rica. Para los análisis de resultados se contó con entrevistas a 9 profesionales. La mayoría de los encuestados considera que la PBE se limita a las publicaciones científicas y que se dificulta la implementación en su contexto laboral, principalmente por la falta de tiempo asociada a la revisión de literatura científica actualizada. Como conclusión cabe indicarse que existe una creencia errada en términos conceptuales sobre el significado de la PBE, generando actitudes ambiguas hacia dicho paradigma. En Latinoamérica se hace necesaria la reflexión respecto a la formación de fonoaudiólogos/as para que desde el pregrado puedan manejar mayores recursos para la toma de decisiones en la evaluación e intervención; y así disminuir la brecha entre los investigadores y quienes se dedican eminentemente a la práctica clínica.

Minimal, Maximal, or Multiple: Which Contrastive Intervention Approach to Use With Children With Speech Sound Disorders?

PURPOSE

This tutorial contrasts a familiar and frequently used speech sound disorder (SSD) intervention approach, conventional minimal pair, with newer but less familiar and less frequently used variants that may be more effective: (a) maximal opposition and (b) multiple oppositions.

METHOD

This tutorial provides a general description of each contrastive approach, focusing on the evidence base and a small number of critical elements that define the approach and make it unique from all other approaches. Hypothetical cases are used to illustrate how the approaches can be tailored to child needs and speech-language pathologist (SLP) expertise. Supplemental materials enhance the reader's skill in using these approaches in their practice with a minimal initial investment.

RESULTS

The reader will be able to identify which children with SSD are appropriate for conventional minimal pair, maximal opposition, or multiple oppositions approaches and will be able to plan intervention (i.e., select target sounds and contrasting words or nonwords, develop intervention activities, write goals, and determine intervention intensity) for each of these approaches.

CONCLUSIONS

This tutorial highlights that using the conventional minimal pair approach should be restricted to children with a small number of errors (i.e., older children or children with mild SSD). There is an opportunity for SLPs to use newer, more efficacious approaches with younger children and children with more severe SSDs. The maximal opposition approach is well suited to children with multiple errors across multiple sound classes. The multiple oppositions approach specifically targets global phoneme collapses that impact intelligibility.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19178783.

The Challenge of Rich Vocabulary Instruction for Children With Developmental Language Disorder

Purpose The aims of the study were to explore responses of children with developmental language disorder (DLD) to rich vocabulary instruction and to identify potential factors that contribute to outcomes. Method Children with DLD participated in a language intervention embedded within a science camp. Using parent and clinician reports, standardized tests, probes, notes, and video, we derived descriptions of seven of the campers who received a vocabulary intervention that incorporated principles of rich instruction. We present them here as a case series. Results Five cases responded to the intervention with modest gains in Tier 2 science vocabulary and science knowledge. One case demonstrated no response, and another was unable to complete the intervention. The latter two cases presented with triple risks: DLD, executive function deficits, and stressors associated with poverty. In comparison, the best responder also lived in poverty and had DLD, but he had intact executive function, strengths in extant vocabulary, stronger knowledge of science, better engagement in the science and language intervention activities, and was older. Other factors that seemed to contribute to outcomes included the complexity of the word forms and dosage. Conclusions Translating research on rich instruction to clinical practice is challenging. This case series motivated hypotheses about the nature of the challenge and what to do about it, the primary one being that the modest success of rich vocabulary instruction for children with DLD is not a limitation of the approach itself but rather a reflection of the difficulty of delivering the intervention while tailoring the targets, approach, and dosage to the needs of individual children with DLD. Supplemental Material https://doi.org/10.23641/asha.13667699.

A Phonomotor Approach to Apraxia of Speech Treatment

Purpose This study continued Phase I investigation of a modified Phonomotor Treatment (PMT) Program on motor planning in two individuals with apraxia of speech (AOS) and aphasia and, with support from prior work, refined Phase I methodology for treatment intensity and duration, a measure of communicative participation, and the use of effect size benchmarks specific to AOS. Method A single-case experimental design with multiple baselines across behaviors and participants was used to examine acquisition, generalization, and maintenance of treatment effects 8-10 weeks posttreatment. Treatment was distributed 3 days a week, and duration of treatment was specific to each participant (criterion based). Experimental stimuli consisted of target sounds or clusters embedded nonwords and real words, specific to each participants' deficit. Results Findings show improved repetition accuracy for targets in trained nonwords, generalization to targets in untrained nonwords and real words, and maintenance of treatment effects at 10 weeks posttreatment for one participant and more variable outcomes for the other participant. Conclusions Results indicate that a modified version of PMT can promote generalization and maintenance of treatment gains for trained speech targets via a multimodal approach emphasizing repeated exposure and practice. While these results are promising, the frequent co-occurrence of AOS and aphasia warrants a treatment that addresses both motor planning and linguistic deficits. Thus, the application of traditional PMT with participant-specific modifications for AOS embedded into the treatment program may be a more effective approach. Future work will continue to examine and maximize improvements in motor planning, while also treating anomia in aphasia.

Treatment Targets for Co-Occurring Speech-Language Impairment: A Case Study

PURPOSE

The intersection of speech and language impairments is severely understudied. Despite repeatedly documented overlap and co-occurrence, treatment research for children with combined phonological and morphosyntactic deficits is limited. Especially little is known about optimal treatment targets for combined phonological-morphosyntactic intervention. We offer a clinically focused discussion of the existing literature pertaining to interventions for children with combined deficits and present a case study exploring the utility of a complex treatment target in word-final position for co-occurring speech and language impairment.

METHOD

Within a school setting, a kindergarten child (age 5;2) with co-occurring phonological disorder and developmental language disorder received treatment targeting a complex consonant cluster in word-final position inflected with third-person singular morphology.

RESULTS

For this child, training a complex consonant cluster in word-final position resulted in generalized learning to untreated consonants and clusters across word positions. However, morphological generalization was not demonstrated consistently across measures.

CONCLUSION

These preliminary findings suggest that training complex phonology in word-final position can result in generalized learning to untreated phonological targets. However, limited improvement in morphology and word-final phonology highlights the need for careful monitoring of cross-domain treatment outcomes and additional research to identify the characteristics of treatment approaches, techniques, and targets that induce cross-domain generalization learning in children with co-occurring speech-language impairment.

How Mixed-Effects Modeling Can Advance Our Understanding of Learning and Memory and Improve Clinical and Educational Practice

Purpose A key goal of researchers, clinicians, and educators within the fields of speech, language, and hearing sciences is to support the learning and memory of others. To do so, they consider factors relevant to the individual, the material to be learned, and the training strategy that can maximize learning and retention. Statistical methods typically used within these fields are inadequate for identifying the complex relationships between these factors and are ill equipped to account for variability across individuals when identifying these relationships. Specifically, traditional statistical methods are often inadequate for answering questions about special populations because samples drawn from these populations are usually small, highly variable, and skewed in distribution. Mixed-effects modeling provides advantages over traditional statistical techniques to answer complex questions while taking into account these common characteristics of special populations. Method and Results Through 2 examples, I illustrate advantages of mixed-effects modeling in answering questions about learning and memory and in supporting better translation of research to practice. I also demonstrate key similarities and differences between analysis of variance, regression analyses, and mixed-effects modeling. Finally, I explain 3 additional advantages of using mixed-effects modeling to understand the processes of learning and memory: the means to account for missing data, assess the contribution of variations in delay intervals, and model nonlinear relationships between factors. Conclusions Through mixed-effects modeling, researchers can disseminate accurate information about learning and memory to clinicians and educators. In turn, through enhanced statistical literacy, clinicians and educators can apply research findings to practice with confidence. Overall, mixed-effects modeling is a powerful tool to improve the outcomes of the individuals that researchers and practitioners serve within the fields of speech, language, and hearing sciences.

Speech Intervention Outcomes Associated With Word Lexicality and Intervention Intensity

Purpose This study examined how lexical representations and intervention intensity affect phonological acquisition and generalization in children with speech sound disorders. Method Using a single-subject multiple baseline design, 24 children with speech sound disorders (3;6 to 6;10 [years;months]) were split into 3 word lexicality types targeting word-initial complex singleton phonemes: /ɹ l ʧ θ/. Specifically, academic vocabulary words, nonwords (NWs), and high-frequency (HF) words were contrasted. Intervention intensity was examined by comparing the performance of 12 children who completed eleven 50-min sessions (4 children/word type) to the performance of 12 who completed 19 sessions (4 children/word type). Children's production accuracy of their treated phonemes and overall percent consonants correct values were used to measure phonological generalization via percentage accuracy scores and d scores. Results All word lexicality conditions elicited phonological change, suggesting that academic vocabulary words, NWs, and HF words are viable intervention targets. Group mean averages were similarly high for the NWs and HF words, although children in the NW condition demonstrated more consistent phonological gains. Children who received 19 intervention sessions achieved 6 times more gains in treated sound accuracy than did children who received 11 sessions. Conclusions Word lexicality did not significantly influence children's intervention outcomes. More intensive intervention, as characterized by the number sessions, resulted in greater phonological change than did a shorter intervention program. Intervention intensity outcomes should be considered when establishing best practices for speech intervention scheduling. Supplemental Material https://doi.org/10.23641/asha.7336055.