Traditional Articulation Therapy Research Articles

Comparison of Traditional Articulation Therapy and Picture Articulation Test in Children with Articulation Disorders

Background: Articulation disorders in children can impede communication and social interaction. Traditional Articulation Therapy (TAT) and the Picture Articulation Test (PAT) are two contrasting approaches employed to address these disorders. While TAT is a conventional method focusing on sensory-perceptual training and sound stabilization, PAT uses visual aids to assess and encourage correct speech sound production. Objective: The study aimed to evaluate and compare the efficacy of TAT and PAT in treating substitution errors in children with articulation disorders. Methods: Employing a randomized sampling technique, the study included 10 children with functional articulation disorders, aged 8 to 18 years, from both genders. Exclusion criteria included organic articulation disorders. Participants were divided into two groups at REX Medical Center, Lahore, and treated over a six-month period, with two sessions per week lasting 30-40 minutes. Pre- and post-intervention assessments were conducted using the Articulation Assessment Test and the Articulation Severity Rating Scale. Data analysis was performed using SPSS 24, with paired and independent sample t-tests. Results: TAT showed a significant reduction in substitution error scores from pre- to post-intervention across all error types (initial, middle, and final), with significant p-values indicating improvement (p ≤ 0.05). PAT did not demonstrate a significant reduction in error scores, with p-values exceeding the threshold of significance. Conclusion: TAT was found to be more effective than PAT in decreasing substitution errors in children with articulation disorders. The findings advocate for the application of TAT in clinical settings, while recognizing the potential for integrating traditional methods with newer technologies to optimize treatment outcomes.

Introduction: Innovations in Treatment for Children With Speech Sound Disorders.

There is a clear need for effective and efficient interventions for children with speech sound disorder (SSD) that can be implemented in both clinical and school-based settings. This forum was created for any clinician who treats SSDs. We asked the invited authors to include immediately actionable information, such as therapy activities, tips for goal writing or progress monitoring, assessment processes, and frameworks for conversations with parents. We have curated nine scientifically based articles that highlight the heterogeneity of SSDs and how various subpopulations require uniquely tailored interventions. Some children with SSDs require treatment approaches that are more heavily embedded in phonological theories (e.g., maximal or multiple oppositions) or that extend beyond speech production and include speech perception and phonological awareness skills. Clinicians also need to be mindful of not only which sounds are affected, but which kinds of errors a child is making. For instance, lateral lisps and residual speech sound errors should be evaluated and treated differently from other kinds of speech sound errors. There are certainly subpopulations of children with SSDs for whom there is extremely limited data upon which speech-language pathologists can base clinical decisions, such as children under the age of 3 years or children who are multilingual. Finally, there is a crucial need to better understand the social-emotional impacts of SSDs. Tools to aid in including social-emotional data within assessment and intervention outcomes are also included in this forum. The traditional articulation approach is the most commonly used approach in school-based settings; however, there are many children for whom this approach is not appropriate. We hope to provide a robust resource for busy school-based speech-language pathologists who treat children with SSD-specifically, we hope clinicians embrace the opportunity to "think outside the box" of traditional articulation therapy.

Speech Sound Disorder Treatment Approaches Used by School-Based Clinicians: An Application of the Experience Sampling Method.

Children with speech sound disorders (SSDs) comprise a large portion of caseloads for school-based speech-language pathologists (SLPs). Despite the existence of several evidence-based SSD intervention approaches, the translation from research to practice is often limited by ecological validity because of various factors unique to school settings (e.g., scheduling constraints, caseload size, child availability). The purpose of this study was to use the experience sampling method (ESM) to examine the current practices of school-based SLPs when treating children with SSDs on their caseloads. SLPs (N = 106) from 42 different states working full-time in school-based K-12 settings participated in this study. At the beginning of the study, each SLP completed a one-time demographic survey about treatment practices for children with SSDs. The SLPs then participated in a series of brief surveys every day for one workweek using a specialized ESM phone application that randomly alerted participants to report on their treatment practices for children with SSDs. Findings revealed that although most SLPs reported using a variety of SSD intervention approaches in a one-time survey, the majority of SLPs reported using one of three approaches in situ: the traditional articulation therapy approach, cycles, and minimal pairs. We also report a significant negative relationship between the years of experience of an SLP and the number of different approaches used. This study is the first to use the ESM to determine which approaches school-based SLPs use to treat children with SSDs. Findings demonstrate that SLPs have knowledge of many different SSD approaches but tend to utilize only a few in school-based settings.

A survey of interventions used by speech-language pathologists for children with speech sound disorders in the Middle East

Purpose While many examples of speech pathology intervention approaches for children with speech sound disorders (SSDs) exist in English and some other European languages, approaches with children in other languages are largely unknown. The aim was to determine current speech-language pathologists (SLPs) intervention practices with children with SSDs in the ME, and to then compare these with international practices. Methods Data were collected by online questionnaire using Qualtrics. One hundred and eighty-nine SLPs completed the survey. Participants were required to be Arabic first language speaking SLPs practicing in the ME (e.g. Kuwait, Saudi Arabia, UAE, and Egypt), working with children with SSDs. Results The respondents reported a frequent use of phonological awareness, traditional articulation therapy, auditory discrimination, minimal pairs, and whole language therapy approaches in the treatment of children with SSDs, like their counterparts in Australia, the USA, UK, and Portugal. Gaps between research recommendations for evidence-based practice and actual clinical practice are identified, and discussed. Conclusions Future research should investigate the efficacy of speech-therapy approaches to improve service delivery for Arabic-speaking children with SSDs in the ME.

Intervention for children with phonological impairment: Knowledge, practices and intervention intensity in the UK.

Across the world, research has shown that intervention for children with phonological impairment can be both effective and efficient. However, it has also raised concerns about the translation of this evidence to practice, highlighting questions around clinician knowledge and the understanding of approaches, and the intensity of intervention provided within real-life clinical contexts. To investigate the clinical management of phonological impairment by speech and language therapists (SLTs) in the United Kingdom (UK). An anonymous, UK-wide, online survey was developed using Qualtrics. The target audience were UK-based SLTs who worked with children with phonological impairment. The following topics were explored: (1) SLTs' understanding of intervention approaches; (2) SLTs' use of intervention approaches to treat phonological impairment; and (3) SLTs' provision of intervention intensity for children with phonological impairment. A total of 166 responses were analyzed. To remediate phonological impairment, SLTs most commonly used speech discrimination (79.5%), conventional minimal pairs (77.3%), phonological awareness therapy (75.6%) and traditional articulation therapy (48.4%). Participants least frequently used the complexity approaches targeting the empty set (82.9%) and two- to three-element clusters (75%) as well as the cycles approach (75.6%). Results also showed that some SLTs were uncertain of what the empty set and two- to three-element clusters approaches entailed. In terms of intervention intensity, participants predominantly provided intervention once per week (69%) for a total of 9-12 sessions (ranging from five to 30 sessions, 71.5%) and elicited targets 10-30 times in single words per session (59.4%) in sessions lasting 21-30 min (41.4%). The most commonly used intervention approaches identified in the current survey (i.e., speech discrimination, conventional minimal pairs and phonological awareness therapy) may be used eclectically by SLTs, which could impact upon the effectiveness and efficiency of treatment for phonological impairment. The current study also highlighted that almost half the participants always/often used traditional articulation therapy to remediate phonological impairment, even though this approach has been found to be less effective for this difficulty. Additionally, it appears that the currently provided intervention intensity for phonological impairment in the UK is significantly lower than what is indicated in the literature. Therefore, a research-practice gap exists for SLTs in the UK working with children with phonological impairment.

The effects of the Lee Silverman Voice Treatment program and traditional dysarthria therapy in flaccid dysarthria

Objective The aim of this study was to investigate the short-term and long-term speech effects of the Lee Silverman Voice Treatment (LSVT) program in a group of individuals with flaccid dysarthria and compare its effectiveness with traditional dysarthria therapy (TDT) methods. Design This study was designed as a randomized controlled trial. Patients and methods The study included 22 patients with flaccid dysarthria who were randomized into two groups and received either the LSVT or the TDT. Both interventions were administered at the same frequency, for 1 h a day, 4 days a week, for 4 weeks. Participants underwent a three-phase assessment: (a) before treatment, (b) immediately after treatment, and (c) 6 months after treatment or follow-up. Outcome measures included auditory perceptual analysis, acoustic and spectral analysis, aerodynamic analysis, nasometry, and Communication Partner questionnaire. Results There was significant improvement in most auditory perceptual analysis and instrumental variables in both treatment groups but most of these improvements were not maintained during follow-up in either group. Comparative statistical analysis revealed no significant differences between the two groups in the three assessment phases in most studied variables. Conclusion The apparent equity between LSVT and TDT in flaccid dysarthria highlights the clinical value of teaching the LSVT method and the potential for this treatment to yield improvements comparable to traditional articulation therapy methods through a technique that is cognitively less demanding. Thus the advantage of LSVT is not the amount of improvement but the less-demanding nature, cognitive-wise, of the technique.

Using a Multimodal Approach to Facilitate Articulation, Phonemic Awareness, and Literacy in Young Children

The primary focus of this research study was to examine the benefit of a using a multimodal approach to speech sound correction with preschool children. The approach uses the auditory, tactile, and kinesthetic modalities and includes a unique, interactive visual focus that attempts to provide a visual representation of a phonemic category. The research compared the effectiveness of traditional articulation therapy with this multimodal approach to articulation therapy for each of two 4-year-old children. Participants demonstrated severe articulation deficiencies in the presence of two very different receptive-expressive language profiles. The findings indicated that the multimodal intervention not only directly improved both participants’ articulation abilities, but also enhanced their developing phonemic awareness and literacy skills. The analysis suggests that early speech sound intervention using a multimodal approach that emphasizes symbols may be more beneficial than a traditional articulation therapy approach for some children, because it promotes phonemic awareness and sound–symbol correspondence.

Speech-language pathologists’ practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders

A survey of 231 Australian speech-language pathologists (SLPs) was undertaken to describe practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders (SSD). The participants typically worked in private practice, education, or community health settings and 67.6% had a waiting list for services. For each child, most of the SLPs spent 10–40 min in pre-assessment activities, 30–60 min undertaking face-to-face assessments, and 30–60 min completing paperwork after assessments. During an assessment SLPs typically conducted a parent interview, single-word speech sampling, collected a connected speech sample, and used informal tests. They also determined children’s stimulability and estimated intelligibility. With multilingual children, informal assessment procedures and English-only tests were commonly used and SLPs relied on family members or interpreters to assist. Common analysis techniques included determination of phonological processes, substitutions–omissions–distortions–additions (SODA), and phonetic inventory. Participants placed high priority on selecting target sounds that were stimulable, early developing, and in error across all word positions and 60.3% felt very confident or confident selecting an appropriate intervention approach. Eight intervention approaches were frequently used: auditory discrimination, minimal pairs, cued articulation, phonological awareness, traditional articulation therapy, auditory bombardment, Nuffield Centre Dyspraxia Programme, and core vocabulary. Children typically received individual therapy with an SLP in a clinic setting. Parents often observed and participated in sessions and SLPs typically included siblings and grandparents in intervention sessions. Parent training and home programs were more frequently used than the group therapy. Two-thirds kept up-to-date by reading journal articles monthly or every 6 months. There were many similarities with previously reported practices for children with SSD in the US, UK, and the Netherlands, with some (but not all) practices aligning with current research evidence.

A multi-modal approach to intervention for one adolescent's frontal lisp

An adolescent with a persistent frontal lisp participated in a two-part 11-session intervention case study. The first phase used ultrasound imagery and acoustic, phonetic and voice education to provide information about articulatory setting (AS) and general awareness of the speech production process. The second phase used traditional articulation therapy, online visual–acoustic biofeedback and fluency strategies to target the frontal lisp directly (specifically /s/, /z/, /ʃ/ and /ʧ/). Trained listener evaluations of pre-intervention, post-phase 1 and post-phase 2 assessments showed no improvement after phase 1, but notable improvement in all treatment targets immediately after phase 2. These improvements were substantially maintained at assessment 4 months post-intervention. The outcomes suggest that direct training was more effective than the AS approach; however, the client's ability to self-monitor in phase 2, rapid acquisition of the targets and maintenance at 4 months post-intervention possibly reflected the knowledge gained in phase 1 about AS.

Horns, whistles, bite blocks, and straws: A review of tools/objects used in articulation therapy by van Riper and other traditional therapists

The use of tools and other objects in articulation therapy has been bundled into new groups of activities called “nonspeech oral motor exercises” (NSOME) and ‘nonspeech oral motor treatments’ (NSOMT) by some authors. The purveyors of these new terms suggest that there is no proof that such objects aid speech learning, and they have cautioned students and professionals about their use. Speech-language pathologists are trying to reconcile these cautions with basic Van Riper type therapy routines. The purpose of this literature review was to summarize the ways in which tools/objects were used by Van Riper and other speech professionals between 1939 and 1968. Fourteen textbooks were selected for review. Van Riper and other developers of traditional articulation therapy regularly used a wide variety of tools/objects in articulation therapy. Tools/objects were used when other auditory, linguistic, and cognitive means failed to stimulate correct phoneme productions. To call these activities “non-speech” methods seems to misrepresent the historic purpose objects have served in articulation therapy. More empirical research is required in this area.

Sensory articulation speech system: SASSy – a 3D animation based therapeutic application for motor speech disorders

PurposeThis paper aims to describe the development of a multimedia 3D animation based resource for speech sound training.Design/methodology/approachSpeech sound training is historically auditory in nature and speech sound disorders often prove intractable. Sensory articulation speech system (SASSy) combines auditory and visual stimuli as a novel multimedia resource to enhance learning.FindingsThe advantages of the visual presentation of information have been described by the authors of various studies using instrumental analysis of speech as a training resource. With the further integration of a speech analysis and biofeedback mechanism, SASSy is designed to be used as a non‐invasive diagnostic and therapeutic tool.Practical implicationsIntended users are speech and language therapy clients with motor speech sound disorders (MSDs). At any one time, up to 20 per cent of the population – adults and children – have a speech disorder arising from a difficulty in producing perceptually acceptable speech sounds. Therapy is very time and resource intensive and the consultative role that speech and language therapists are now assuming means they have less capacity to deliver and assess traditional articulation therapy. Training and feedback can only be on a 1:1 basis and relies on the therapist providing an explanation and description of the speech mechanism to facilitate correct speech.Originality/valueMSDs often prove resistant to change which is frustrating for clients and therapists alike. It is anticipated that a new, non‐intrusive instrumental analytic and therapeutic tool will improve the treatment and management of motor speech disorders. Animations of speech sounds were derived from the instrumental analysis of real speech to provide a real‐time visual sequence for users to match.

The impact of contextual, conversational, and affective factors on a child's speech intelligibility

In this study, we discuss how the intelligibility of a 5-year old with disordered articulation changes with contextual and conversational factors in a speech-therapy setting, and with the client’s affective response to these factors. Using Conversation Analysis and Systemic-Functional Linguistics to obtain detailed analyses of the sequential unfolding of the interaction, we show that the client’s efforts to be intelligible or unintelligible vary with the informativity of the client’s productions as they are enabled by the clinician. Variations in the client’s intelligibility function in the same way as conventional conversational contributions, and can be viewed as insights into the client’s understanding of the ongoing interaction. We conclude that there are cases of disordered articulation for which traditional articulation therapy (motor drills and highly structured speech tasks) are contraindicated. Interactional and conversational context should receive more attention in articulation therapy and research into speech sound disorders.

Addition of contingency management to increase home practice in young children with a speech sound disorder

Background: Along with the severity of the disorder, the motivation of the children and their parents is an important element in explaining the extensive variance in therapeutic success. There is consensus that parental cooperation and homework are important for successful therapy. Systematic investigation into the effects of including homework in therapy is lacking, as are methodological approaches to increasing parental involvement.Aims: The aim was to determine whether the efficiency of traditional articulation therapy for children with speech‐sound disorders can be improved by adding a behavioural treatment approach (contingency management) to treatment in order to increase the time that patients spend doing homework.Methods & Procedures: A total of 91 children between the ages of four and six with articulation impairments participated in the study. They were divided into three groups: 32 children were treated with traditional articulation therapy (eight sessions of 45 minutes each), 33 children received a combination of contingency management and traditional therapy, and 26 children received no therapy at all. A picture‐labelling test measuring the treated target sound at different levels was used before and after therapy to quantify therapy‐induced improvement.Outcomes & Results: The results confirm the fact that the traditional articulation therapy approach is effective for children with articulation impairments. However, adding contingency management significantly increased the frequency of homework sessions and improved the efficiency of treatment by decreasing the variance in therapeutic success.Conclusions & Implications: Contingency management has a positive impact on therapeutic success and leads to an increase in the number of homework sessions.

The use of facilitative vowel contexts in the treatment of post‐alveolar fronting: a case study

School-aged children with persisting speech sound disorders (SSDs) may show little improvement in speech accuracy following phonological or articulation therapy. To determine the effects of establishing consonant production in facilitative vowel contexts for a 7-year-old boy (CD) with persisting post-alveolar fronting. CD had received phonological awareness therapy and traditional articulation therapy as part of a community caseload. However, his post-alveolar fronting showed resistance to therapy. CD received individual therapy for nine 45-55-min sessions. A checklist of quality indicators for single-subject research was used to explore the likelihood that a community clinic could meet quality indicators. Fifteen test words in each of target, generalization and control sets were measured at five times pre-, during and post-therapy. A trend analysis was used to measure the statistical significance of the results and to demonstrate the efficacy of therapy. Therapy was successful. Gains on treatment and generalization test items were rapid and significantly higher than gains on control test items. Only three of 21 single-subject research quality indicators were not met in this research. Targeting facilitative vowel contexts was successful for this 7-year-old boy with persisting post-alveolar fronting which had been resistant to other therapy techniques. Speech and language therapists are encouraged to ensure that quality indicators for single-subject interventions are built into regular practice.

Addition of contingency management to increase home practice in young children with a speech sound disorder

Along with the severity of the disorder, the motivation of the children and their parents is an important element in explaining the extensive variance in therapeutic success. There is consensus that parental cooperation and homework are important for successful therapy. Systematic investigation into the effects of including homework in therapy is lacking, as are methodological approaches to increasing parental involvement. The aim was to determine whether the efficiency of traditional articulation therapy for children with speech-sound disorders can be improved by adding a behavioural treatment approach (contingency management) to treatment in order to increase the time that patients spend doing homework. A total of 91 children between the ages of four and six with articulation impairments participated in the study. They were divided into three groups: 32 children were treated with traditional articulation therapy (eight sessions of 45 minutes each), 33 children received a combination of contingency management and traditional therapy, and 26 children received no therapy at all. A picture-labelling test measuring the treated target sound at different levels was used before and after therapy to quantify therapy-induced improvement. The results confirm the fact that the traditional articulation therapy approach is effective for children with articulation impairments. However, adding contingency management significantly increased the frequency of homework sessions and improved the efficiency of treatment by decreasing the variance in therapeutic success. Contingency management has a positive impact on therapeutic success and leads to an increase in the number of homework sessions.

Simultaneous treatment of grammatical and speech-comprehensibility deficits in children with Down syndrome

Children with Down syndrome often display speech-comprehensibility and grammatical deficits beyond what would be predicted based upon general mental age. Historically, speech-comprehensibility has often been treated using traditional articulation therapy and oral-motor training so there may be little or no coordination of grammatical and speech-comprehensibility treatment. The purpose of this paper is to provide the rationale for and preliminary evidence in support of integrating speech and grammatical intervention using a type of recast treatment in six children with Down syndrome. Speech-comprehensibility and MLU growth in generalisation sessions occurred in 4/6 and 5/6 participants, respectively. Using multiple baseline design logic, two of these participants showed evidence of treatment effects on speech-comprehensibility and two in MLU in generalisation sessions, respectively. The study constitutes a conservative test of the intervention effects for reasons that are discussed. The theoretical and applied significance of these findings are discussed.

The efficacy of speech and language therapy for cleft palate speech disorders

ABSTRACT The incidence of cleft palate is approximately 1 in 600 live births, and when velopharyngeal disorders (sub‐mucous cleft, pharyngeal disproportion, neurological disorders affecting the velopharynx) are added, most speech and language therapists will treat one or more of this client group in their career. There is a dearth of research literature on the efficacy of therapy, but evidence will be considered related to (1) Type of therapy (neither traditional articulation therapy nor phonological therapy is appropriate in isolation, they need to work hand in hand for maximum efficacy — how is this achieved?). (2) Timing of therapy (more speech and language therapists are working in a preventative role with the parents of infants and toddlers to encourage good feeding, language and phonological development — is this justified by the research literature in terms of outcome and time spent? Controversy exists over whether to correct articulation pre‐ or post‐pharyngoplasty — do we have enough evidence to say which is more ?ffective?). (3) Frequency of therapy — are intensive courses more effective long‐term than conventional weekly therapy?

Treating 'cleft palate speech': combining phonological techniques with traditional articulation therapy

The relative merits of traditional articulation therapy and phonological approaches to the treatment of 'cleft palate speech' are discussed. It is suggested that contrary to customary clinical practice, phonological therapy is an appropriate and in some instances essential procedure in such cases. Two case studies are described in support of this proposal.

Mass generalised learning applied to the problem of carry-over in articulation therapy

This study was designed to investigate Morehead and Johnson's hypothesis that mass generalised learning experience in therapy will eliminate carry-over problems. Four subjects who consistently misarticulated the /S/phoneme participated in an intensive six week therapy programme. Two experimental subjects were trained in the production of the entire category of sounds of which the target phoneme is a member. Two matched control subjects received traditional articulation therapy. Pre- and post-therapy measures included an articulation test, competence tests and spectrographic analysis. Sound production tasks and carry-over tasks were administered at regular intervals during therapy to assess generalisation to untrained contexts. Complete carry-over was evidenced by one experimental subject at the end of the sentence phase of therapy. The remaining three subjects demonstrated inconsistent carry-over at the conclusion of the therapy programme. It is suggested that a mass generalised learning procedure may offer an efficient approach to articulation therapy.