Tagged "Speech Clarity"


3 Presentations at NDSC 2017!

Posted by Deborah Grauzam on

TalkTools was represented in 3 presentations at this year's National Down Syndrome Congress. Thank you all for attending!

Effective Strategies For Improved Communication and Speech Clarity for Children with the Diagnosis of Down syndrome

Presenter: Jennifer Gray, MS, CCC-SLP

Age range: Birth to 8

Course description:

This presentation will focus on effective communication strategies for children, birth to
school-aged, with the diagnosis of Down syndrome. Factors that impact appropriate
communication will be presented. Strategies will be discussed that foster speech and
language and prevent communication difficulties. Sensory, motor, and oral-placement
skills will be discussed in the framework of a comprehensive language learning system.
Parents and educators will better understand how multiple strategies can be implemented
to address speech clarity and overall communication.

Learning outcomes:

  • Identify the types of communication and which to target based on the child's strengths in daily living.
  • Learn specific activities and strategies to use at home with your child/client/student to encourage speech clarity and expressive language
  • Learn specific activities and strategies to use at home with your child/client/student to encourage speech clarity and expressive language

Airway, Orthodontics, Apnea, and Oral Placement Therapy

Presenters: Brian Hockel, DDS & Heather Vukelich, MS, SLP-CCC

Age range: All ages

Course description:

Posture and function of the jaw and mouth muscles will affect speech, facial and jaw development, and even the airway. As breathing and speaking are vital to health and personal development, you will want to learn in this presentation how to optimize your child's potential through addressing the common root causes of speech, orthodontic, and sleep apnea problems.

Learning outcomes:

  • To understand the etiology of facial and airway growth, and the implications for sleep apnea.
  • To introduce therapies such as Oral Placement Therapy that help speech and facial development.
  • To show orthodontic approaches which affect speech, facial appearance, and airway health.

Understanding Sensory Differences and How It Can improve Your Child's Quality of Life

Presenter: Monica Purdy, MA, CCC-SLP

Age range: Birth to 5

Course description:

The term “Sensory Differences” has been recently added to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5®). Sensory differences can affect how each of us perform in therapy, school or their home setting. An individual’s sensory system is the foundation of his/her ability to interpret, process and react to the demands of the environment. Sensory differences affect every facet in an individual’s life – from eating, articulation, language, social and academic skills to self-care and play.

This course will allow participants to evaluate sensory differences, and gain new insights and perspectives toward your child, and even yourself. Understanding the importance of modulation, as well as under-responsive or over-responsive actions, will be the basis for guiding you and your child's therapist to have more success in every day interactions, as well as therapy sessions.

The importance of recognizing how your child may be processing information, and understanding which strategies and practices to implement will help your child both in therapy – and in life. The importance of working in conjunction with an occupational therapist will also be addressed.

Learning outcomes:

  • Define the term sensory processing disorder and determine how sensory processing affects your child
  • Identify the 8 senses and distinguish between typical and non-typical reactions to sensory input
  • Apply sensory activities to help the child/client achieve success
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A Modern Look at Van Riper's Phonetic Placement Approach

Posted by Deborah Grauzam on

by Robyn Merkel-Walsh, MA, CCC-SLP

This poster was presented at the 2016 annual ASHA Connect Convention, Poster Session #PS02.

Download the poster here  

ABSTRACT

Presentation explores 1) traditional versus phonological therapy, 2) the sensory-motor system as it relates to speech, 3) the importance of tactile and proprioception in articulation therapy, 4) shaping placement of the articulators to improve speech clarity.  

LEARNER OUTCOMES

1. Participants will be able to differentiate phonological versus traditional articulation therapy.  

2. Participants will be able to define the three stages of Van Riper’s Phonetic Placement Approach.  

3. Participants will be able to use at least three oral placement cues in order to facilitate speech movements.  

DISCUSSION

Two widely used models of articulation therapy include the traditional and phonological models (Bowen, 2005). While studies suggest that the phonological model may prove more positive results than the traditional model (Klein, 1996), Van Riper’s Phonetic Placement Approach (PPA) may be more useful for individuals who are not be able to achieve placement cues (Van Riper, 1978). In 1958, Van Riper stated:

"Every available device should be used to make the student understand clearly the positions of the tongue, jaw, and lips to be assumed."

Placement cues are based on the more traditional models of therapy, and rely on the concept that an individual can copy the motor plan suggested by the therapist, such as “place your tongue tip to the spot.” Therapists, however, often struggle with a population of individuals who do not respond well to “look at me and say what I say,” and those who require a tactile-kinesthetic approach to treatment (Bahr & Rosenfeld-Johnson, 2010). Individuals with dysarthria, dyspraxia and/or myofunctional disorders may make slow progress, or no progress at all, without the assistance of tactile cues. Even though therapists have heard the debate on oral motor therapy (Bowen, 2006; Lof, 2006; Lof, 2007; Lof, 2009), clinicians are still widely using the techniques because they yield positive treatment outcomes (Bahr, 2008).

Clinicians, who represent the Board of Directors for the Oral Motor Institute, have struggled with distinguishing “oral motor therapy” from the form of “Non Speech Oral Motor Exercises” (NSOME) presented by Gregory Lof (Lof, 2008). The term “Oral Placement Disorder” (OPD) was coined by Diane Bahr and Sara Rosenfeld-Johnson in 2010 (Bahr & Rosenfeld-Johnson, 2010). Children with OPD cannot imitate targeted speech sounds using auditory and visual stimuli (i.e., “Look, listen, and say what I say”). They also cannot follow specific instructions to produce targeted speech sounds (e.g., “Put your lips together and say m”). Although the term OPD is new, the concepts surrounding the term have been discussed by a number of authors and clinicians (Bahr, 2010; Hodge, 2012; Marshalla, 2007).

There has been question, and ongoing confusion, as to what is a NSOME, versus what is an oral placement technique (OPT) (Bahr & Rosenfeld-Johnson, 2010). Oral Placement Therapy (OPT) is a tactile teaching technique used for children and adults with Oral Placement Disorders (e.g., dysarthria), who cannot learn standard speech sound production using auditory and visual teaching methods alone. OPT facilitates the pre-requisite skills in muscle control to develop dissociation and grading in the muscles of the abdomen, velum, jaw, lips and tongue for clients who cannot approximate the standard speech sounds using the instructions. If the client can produce standard speech using adequate placement and duration using only auditory and visual cueing, OPT would not be included in that client’s program plan.

Gregory Lof’s research has even stated that the methods used in Van Riper’s Phonetic Placement Approach are not in fact considered NSOME (Lof, 2009). This is why it is important to explore current clinical techniques to determine what activities are considered unrelated to speech production, as opposed to those activities that in fact are an extension of Phonetic Placement Therapy (Marshalla, 2007).

OPT IS A MODERN EXTENSION OF PHONETIC PLACEMENT THERAPY

(Van Riper, 1954) and The Feedback Model (Mysak, 1971).

It is based on a very common sequence (Bahr, 2001; Green, Moore & Reilly, 2000; Marshalla, 2007; Young and Hawk, 1955):

1. Facilitate speech movement with the assistance of a therapy tool (ex. horn, tongue depressor) or a tactile-kinesthetic facilitation technique (ex. PROMPT facial cue); use every available device (Marshalla, 2012);

2. Facilitate speech movement without the therapy tool and/or tactile-kinesthetic technique (cue fading);

3. Immediately transition movement into speech with and without therapy tools and/or tactile kinesthetic techniques.

TalkTools | Pam Marshalla

PHONETIC PLACEMENT THERAPY TOOLS

TalkTools | Van Riper tools

MODERN ORAL PLACEMENT THERAPY TOOLS

TalkTools | Van Riper new tools

REFERENCES

Bahr, D. (2008). The oral motor debate: Where do we go from here? Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Chicago, IL. (Full handout at http://convention.asha.org/handouts.cfm)

Bahr, D. (2001). Oral motor assessment and treatment: Ages and stages. Boston: Allyn and Bacon.

Bahr, D. & Rosenfeld-Johnson, S. (2010). Treatment of Children With Speech Oral Placement Disorders (OPDs): A Paradigm Emerges. Communication Disorders Quarterly, XX(X), 108.

Bowen, C. (2005). What is the evidence for oral motor therapy? ACQuiring Knowledge in Speech, Language and Hearing, Speech Pathology Australia, 7, 3, 144-147.

Green, R., Moore, C. A., & Reilly, K. J. (2000). The sequential development of jaw and lip control for speech. Journal of Speech, Language and Hearing Research, 45, 66-79.

Hodge, M. M. (2002). Non-speech oral motor treatment approaches for dysarthria: Perspectives on a controversial clinical practices. Perspectives in Neurophysiology and Neurogenic Speech Disorders, 12 (4), 22-28.

Klein, E. S. (1996). Phonological/traditional approaches to articulation therapy. Language, Speech, and Hearing Services in Schools, Vol. 27, 314-323.

Lof, G. L. (2007). Reasons why non-speech oral motor exercises should not be used for speech sound disorders. Presentation at the ASHA Annual Convention, Boston, MA, Nov. 17.

Lof, G. L. (2009). Nonspeech oral motor exercises: an update on the controversy. Presentation at ASHA Annual Convention, New Orleans, LA.

Lof, G. L. (2006). Logic, theory and evidence against the use of non-speech oral-motor exercises to change speech sound productions. Invited presentation at the ASHA Annual Convention, Miami, FL, Nov. 17.

Lof, G. L. & Watson, M. (2005). Survey of universities’ teaching: oral motor exercises and other procedures. Poster presented at the annual meeting of the American Speech-Language-Hearing Association, San Diego, CA.

Lof, G. L. (2004). Ask the Expert: A response by Gregory L. Lof, PhD., CCC-SLP. The Apraxia-Kids Monthly, 5 (1).

Lof, G. L. & Watson, M. (2004). Speech-language pathologist’s use of non-speech oral-motor drills: National survey results. Poster presented at the annual meeting of the American Speech-Language-Hearing Association, Philadelphia, PA.

Lof, G. L. (2003). Oral motor exercises and treatment outcomes. Perspectives on Language Learning and Education, 10 (1), 7-11.

Marshalla, P. (2007). Oral motor techniques are not new. Oral Motor Institute, 1(1). Available at www.oralmotorinstitute.org.

Marshalla, P. (2012). Horns, whistles, bite blocks, and straws: A review of tools/objects used in articulation therapy by Van Riper and other traditional therapists. Oral Motor Institute, 4 (2). Available at www.oralmotorinstitute.org.

Mysak, E. (1971). Speech pathology and feedback therapy. Charles C. Thompson Publisher.

Van Riper, C. (1958, 1954, 1947). Speech Correction: Principles and Methods. Englewood Cliffs: Prentice-Hall.

Young, E. H. & Hawk, S. S. (1955). Moto-kinesthetic speech training. Stanford, CA: Stanford University Press.

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Oral Placement Therapy (OPT) vs. Non-Speech Oral Motor Exercises (NSOME): Understanding the Debate

Posted by Deborah Grauzam on

By: Robyn Merkel-Walsh, MA, CCC-SLP & Sara Rosenfeld-Johnson, MS, CCC-SLP This poster was presented at the 2015 annual ASHA Convention, Session #9333, Poster Board #602.

TalkTools | ASHA Poster 2015

INTRODUCTION

Presentation explores 1) defining Non-Speech Oral Motor Exercises, 2) defining Oral Placement Therapy, 3) understanding the difference between NSOME and OPT, 4) clinical implications for Evidenced Based Practice.

Two widely used models of articulation therapy include the traditional and phonological models (Bowen, 2005). While studies suggest that the phonological model may prove more positive results than the traditional model (Klein, 1996), Van Riper’s Phonetic Placement Approach may be more useful for individuals who are not be able to achieve placement cues (Van Riper, 1978). Many therapists supplement phonological and traditional models with oral motor activities to help achieve placement cues, especially for those individuals with muscle-based and motor-based diagnoses (Marshalla, 2007). Over the past decade, there has been an ongoing debate, through secondary research studies between those who do not support the use of Non-Speech Oral Motor Exercises (NSOME) and those who support the use of Oral Placement Therapy (OPT). Neither camp has large sampled double-blind studies to support their case; however, both sides of the debate have supported their hypothesis via literature review and surveys (Bahr & Rosenfeld-Johnson, 2010; Lof & Watson, 2005).  

LEARNER OUTCOMES

1. Participants will be able to differentiate a NSOME from an OPT technique.

2. Participants will be able to define the three stages of a phonetic placement cue.

3. Participants will be able to use at least three oral placement cues in order to facilitate speech movements.  

DISCUSSION

NSOME are movements which are not related to speech sounds, while OPT therapy only includes speech-like movements. OPT follows the principles of Van Riper’s Phonetic Placement Therapy (PPT), and uses tactile cueing to help individuals who cannot respond to visual-verbal treatment cues. Children with Oral Placement Disorder (OPD) cannot imitate targeted speech sounds using auditory and visual stimuli (ex. look, listen, and say what I say). They also cannot follow specific instructions to produce targeted speech sounds (e.g. put your lips together and say /m/). Although the term Oral Placement Disorder is new, the concepts surrounding the term have been discussed by a number of authors and clinicians (Bahr & Rosenfeld-Johnson, 2010). OPT facilitates the muscle placement to produce the targeted standard speech sound. If the client can produce standard speech using adequate placement and endurance using only auditory and visual cueing, OPT would not be included in that client’s treatment plan.

OPT is a modern extension of Phonetic Placement Therapy (PPT) as taught by Van Riper (1978) and follows The Feedback Model by Mysak (1971). It is based on a very common sequence:

1. Facilitate speech movement with the assistance of a therapy tool (ex. horn, tongue depressor);

2. Facilitate speech movement without the therapy tool and/or tactile-kinesthetic technique (cue fading);

3. Immediately transition movement into speech with and without therapy tools and/or tactile-kinesthetic techniques.  

NSOME OPT
As quoted from Dr. Gregory Lof in 2006:"No speech sound requires the tongue tip to be elevated toward the nose; no sound is produced by puffing out the cheeks; no sound is produced in the same way as blowing is produced. Oral movements that are irrelevant to speech movements will not be effective as speech therapy techniques." Puffing air in cheeks during blowing is not used in OPT.Abdominal grading for phonatory control, jaw stability and jaw-lip-tongue dissociation are important for speech sound production.The use of a therapeutic horn can help shape the articulators into the placements required for the bilabial sounds /m, b, p/. That tool is quickly faded once the individual has the muscle-memory skill to produce the correct oral placement without the tool in the mouth.TalkTools | ASHA Poster 2015 picture 1
As quoted from Dr. Gregory Lof in 2003:"There is no relevance to the end product of speaking by using an exercise of tongue wagging, because there are no speech sounds that require tongue wagging." This movement is not related to speech so should not be used in speech therapy sessions. Tongue wagging is not used in OPT.Stimulation of the lateral margins of the tongue with vibration, elicits elongation of the tongue and can assist in creating the tongue tip tension needed to elevate the tip to the incisive papillae for / n, t, d, l /.TalkTools | ASHA Poster 2015 picture 2
As quoted from Dr. Gregory Lof in 2009:"NSOME encourages gross and exaggerated range of motion, not small, coordinated movements that are required for talking." OPT only works on small, coordinated movements that are similar to speech.Blowing a bubble with appropriate placement of the articulators assists with lip rounding using the correct jaw posture for the high jaw vowels /w/, /u/ and /o/. We immediately practice those sounds without the therapy tool as per Van Riper’s PPT.TalkTools | ASHA Poster 2015 picture 2

 

Clinical data supports the relationship between OPT and speech clarity. The graph below reflects data collected from sessions with a 6 year old male with labial paresis. Lip closure on a flat-mouthed horn and bilabial production progress were monitored. When lip closure on the horn improved so did bilabial production. In sessions where lip closure was not as positive bilabial clarity decreased.

ASHA Poster 2015 graph

CONCLUSION

Dr. Gregory Lof’s research has stated that the methods used in Van Riper’s Phonetic Placement Approach, are not in fact considered NSOME (Lof, 2009). It is important to explore current clinical techniques to determine what activities are considered unrelated to speech production, as opposed to those activities that in fact are an extension of Phonetic Placement Therapy (Marshalla, 2007). If therapists understand the current debate, and that a NSOME is not the same as OPT; there would be less confusion amongst professionals in regard to evidence based practices when working towards improved speech clarity. Clinicians must use EBP to decide if they want to reject the use of a therapy technique based on the evidence, and look into the most appropriate treatment parameters based on the recipient of the treatment, and the diagnosis (ASHA, 2005). This new understanding of how OPT is used to create the standard placement for speech production would then encourage university-based researchers to explore why practicing SLPs report they use this therapy with good results. The next step would be large sample, double blind studies that would definitively address the use of OPT for clients with muscle-based speech clarity disorders.

REFERENCES

American Speech-Language-Hearing Association. (2005). Evidence-Based Practice in Communication Disorders [Position Statement]. Available from www.asha.org/policy.

Bahr, D., Rosenfeld-Johnson, S. (2010). Treatment of children with speech oral placement disorders (OPDs): a paradigm emerges. Communication Disorders Quarterly, XX(X), 108.

Bowen, C. (2013). Controversial practices and intervention for children with speech sound disorders. Retrieved from: http://www.speech-language-therapy.com/pdf/nsome2013.pdf

Klein, E.S. (1996). Phonological/traditional approaches to articulation therapy: a retrospective group comparison. Language, Speech, and Hearing Services in Schools, 27, 314-323.

Lof, G. (2003). Oral motor exercises and treatment outcomes. SIG 1 Perspectives on Language Learning and Education, Vol. 10, 7-11.

Lof, G. L., & Watson, M. (2005). Survey of universities teaching: oral motor exercises and other procedures. Poster presented at the annual meeting of the American Speech-Language-Hearing Association, San Diego, CA.

Lof, G.L. (2006). Logic, theory and evidence against the use of non-speech oral-motor exercises to change speech sound productions. Invited presentation at the ASHA Annual Convention, Miami, FL. Nov. 17.

Lof, G.L. (2009). Nonspeech oral motor exercises: an update on the controversy. Presentation at ASHA Annual Convention, New Orleans, LA.

Marshalla, P. (2007). Oral motor techniques are not new. Oral Motor Institute, 1(1). Available from www.oralmotorinstitute.org.

Mysak, E. (1971). Speech pathology and feedback therapy. Charles C. Thompson Publisher.

Van Riper, C. (1978). Speech Correction: Principles and Methods (6th Edition). Englewood Cliffs: Prentice-Hall.

Young, E. H., & Hawk, S. S. (1955). Moto-kinesthetic speech training. Stanford, CA: Stanford University Press.

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