Clinics in communication disorders最新文献

ACT is a visual cuing technique designed to facilitate dyspraxic speech by highlighting the sequential production of phonemes. In using ACT, cues are presented in such a way as to suggest sequential, coarticulatory movement in an overall pattern of motion. While using ACT, the facilitator's hand moves forward and back along the side of her (or his) own face. Finger movements signal specific speech sounds in formations loosely based on the manual alphabet for the hearing impaired. The best movements suggest the flowing, interactive nature of coarticulated phonemes. The synergistic nature of speech is suggested by coordinated hand motions which tighten and relax, move quickly or slowly, reflecting the motions of the vocal tract at various points during production of phonemic sequences. General principles involved in using ACT include a primary focus on speech-in-motion, the monitoring and fading of cues, and the presentation of stimuli based on motor-task analysis of phonemic sequences. Phonemic sequences are cued along three dimensions: place, manner, and vowel-related mandibular motion. Cuing vowels is a central feature of ACT. Two parameters of vowel production, focal point of resonance and mandibular closure, are cued. The facilitator's hand motions reflect the changing shape of the vocal tract and the trajectory of the tongue that result from the coarticulation of vowels and consonants. Rigid presentation of the phonemes is secondary to the facilitator's primary focus on presenting the overall sequential movement. The facilitator's goal is to self-tailor ACT in response to the changing needs and abilities of the client.(ABSTRACT TRUNCATED AT 250 WORDS)

An experimental version of the Verbal Motor Production Assessment for Children (VMPAC) is presented. This test provides data for the differential diagnosis of children with four types of speech disorders: global motor, oromotor execution, oral and speech motor sequencing, and by exclusion of the preceding three types, phonological disorders. Rationale on which the test is based are given. The test itself, is discussed in detail as are the diagnostic indicators. Profiles for four children illustrate the integration of the VMPAC data with sensory, cognitive, language and social development data. These profiles are discussed in terms of the diagnoses and implications for intervention.

General considerations for the assessment process are presented. Then, six assessment goals are defined: (1) Determination of prerequisite behaviors for spoken language; (2) Assessment of current speech and language skills; (3) Definition of the nature and severity of the speech disability and the severity of the handicap; (4) Determination of the effects of facilitating approaches and treatment options; (5) Establishment of the child's prognosis; (6) Determination of the criteria for termination of treatment. Procedures, materials, and tests are described in relation to the assessment goals.

A rationale to guide assessment and subsequent management of children with developmental speech disorders is described. Hypotheses about the nature of praxis, the role of oral-verbal praxis in linguistic processing and speech development, and the effects of disturbances in praxis on speech behavior are presented. Implications of a diagnosis of developmental apraxia of speech (DAS) for treatment planning and expected speech, language, and social communication outcomes are discussed. Misconceptions about children diagnosed with DAS and assumptions underlying the author's approach to assessing children with DAS are identified. The desired functional outcome of the assessment approach advocated is a management plan that addresses the needs of the child and family and maximizes the child's ability to communicate.

Research on stimulability is explored and evaluated. Application of the concept of stimulability as a prognostic indicator is suggested for use in the evaluation of children who have phonological disorders. A framework for dynamic assessment, based on Vygotsky's principles and theory, is proposed as having clinical utility for determining a child's potential for learning, identifying factors that may influence the child's learning, and identifying factors that may facilitate the child's development or functioning. Eight factors are identified that may serve as antecedent cues to facilitate a child's learning of a target sound and are presented in an hierarchical order. Systematic manipulation of response complexity, in terms of linguistic complexity and interaction with language components followed by clinician manipulation of consequent events are also suggested. The approach is designed to address clinical questions such as "Who to treat?," "When to treat?," "What to treat?," "How to treat?," and "What prognosis is expected from treatment?"

Approaches to the treatment of developmental verbal dyspraxia based upon current theories about phonological development are explored. The author presents the concept of "bridging"; for example, making the transition from one sound to another or from one word to the next, as a reflection of the child's ability to generate hierarchical linguistic structures. The author suggests that children who have developmental dyspraxia must build phonological systems despite the fact that their ability to discover and use these hierarchical structures is impaired. Idiosyncratic patterns are expected, and should be used by the clinician to determine appropriate approaches to remediation for individual children. Case studies illustrate two children's shared difficulties in developing and using phonological hierarchies and the individual differences that provided a basis for appropriate remediation for each child.

Evidence for subgroups among developmental phonological disorders based on etiological origins, as opposed to the alternative linguistic view of childhood phonological disorders as a learning problem of unknown origin, is presented. A three-parameter framework that arranges relevant individual differences (mechanism, cognitive-linguistic, and psychosocial) is proposed for study and classification of the phonological disorders. The disorders are studied in relation to developmental correlates and speech-sound normalization. This permits study of these variables in relation to severity and forms of expression and interaction. Subgroups of "speech delay," each of which reflects phonological consequences, are suggested. Residual articulation errors are classified based on causal origins, possibly influenced by the developmental context in which precise articulation is an acquired skill and differentiated from genetic origins posited for speech delays and those related to specific hearing, motor-speech, and psychosocial origins. Exploration of causal origins provides advantages for both assessment and intervention as well as prevention.

This article has two purposes: to outline aspects of nonlinear phonological theory that refer to syllable, word, and phrase structure, and to provide some examples of phonological intervention techniques for development of these structures. A variety of restricted child productions of syllable, word, and phrase structures are described in nonlinear terms. Intervention targets are defined for each of the restrictions, and both general and specific interventions are suggested, the majority of which have been clinically evaluated. Clinicians are encouraged to try various alternatives to discover which techniques that facilitate syllable- and word-building strategies are most productive for an individual child. Rationales, purposes, activities, and procedures are presented to assist the clinician in developing appropriate and individualized intervention strategies.

Procedures for measuring prelinguistic vocalizations and early phonological development are described and illustrated. The prelinguistic measures indicate that production of supraglottal consonants in consonant-vowel syllables is correlated with subsequent speech and language development and that limited use of consonants can serve as a way to identify children who are at risk for speech and language disorders. Three measures of meaningful speech are discussed, two based on accuracy of production, one on error patterns. All three correlate with severity of involvement, but as yet their relationship to speech intelligibility is unclear.

Vowel misarticulations have received very little attention in our literature. The author suggests that although vowel errors occur less frequently than consonant errors, their presence may indicate increased severity of disorder and should not be ignored. As vowel misarticulations have received relatively scant attention, their assessment and remediation have not been addressed. Procedures for the analysis and interpretation of vowel errors are described. A case study is presented to illustrate approaches to vowel assessment and remediation. Clinician attention to this aspect of phonological development is urged.