WHOLE LANGUAGE MODEL FOR PROVIDING SPEECH THERAPY IN VCFS PATIENTS

1. WHOLE LANGUAGE MODEL FOR PROVIDING SPEECH THERAPY IN VCFS PATIENTS

2. CLINICAL RESEARCH IN SPEECH PATHOLOGY • EARLY SURGERY PREVENTS COMPENSATORY ARTICULATION • THE OLDER THE PATIENT IS WHEN PALATE IS REPAIRED, THE GREATER THE RISK FOR DEVELOPING COMPENSATORY ARTICULATION • THERE IS A NEGATIVE CORRELATION BETWEEN LINGUISTIC DEVELOPMENT AND THE DEVELOPMENT OF COMPENSATORY ARTICULATION DISORDER [CAD] IVF GROUP WITHOUT CAD [79%]ADEQUATE LINGUISTIC DEVELOPMENT IVF GROUP WITH CAD [62%]ADEQUATE LINGUISTIC DEVELOPMENT

3. CLINICAL RESEARCH IN SPEECH PATHOLOGY • WHOLE LANGUAGE MODEL IS EFFICIENT FOR THERAPY AIMED TO CORRECT COMPENSATORY ARTICULATION. • PHONETIC GROUP = 30 MONTHS • WHOLE LANGUAGE MODEL =14.8 MONTHS • WHEN COMPENSATORY ARTICULATION IS CORRECTED, MOTION OF VELOPHARYNGEAL SPHINCTER DURING SPEECH IS MODIFIED (INCREASES) • WHEN COMPENSATORY ARTICULATION IS PRESENT, SPEECH THERAPY SHOULD BE INDICATED BEFORE SURGERY FOR VPI.

4. ESTRATEGIES FOR ENHANCING PHONOLOGIC DEVELOPMENT • EMPHASIZE USE OF SPEECH SOUNDS WITH COMMUNICATIVE PURPOSES MORE THAN PRODUCTION AS A GOAL (FEY, 1992) • MODIFICATION OF GROUPS OF SOUNDSTREATED SIMILARLY BY THE CHILD (FEY, 1992) • MODELING : RECONSTRUCTION OF ABNORMAL EMISSIONS

5. ESTRATEGIES FOR ENHANCING PHONOLOGIC DEVELOPMENT • USE OF STRUCTURED ACTIVITIES WITHIN APPROPRIATE LINGUISTIC CONTEXT (HOFFMAN, 1992) • MODIFICATION OPHONOLOGIC PERFORMANCE IS INFLUENCED BY HIGHER LEVELS OF LINGUISTIC ORGANIZATION • CLOSING : ORGANIZATION OF EMISSIONS INCLUDING PHONOLOGIC INFORMATION • EXPANSIONS : INCREASE SEMANTIC, SINTAX & PHONOLOGIC COMPLEXITY (WARREN, 89)

6. VERBAL COMMUNICATION MODEL (LUNCH) (HOFFMAN, 1992) • MEANING(GOALS)– BE PREPARED, EAT, CLEAN • PROPOSITIONAL(ACCTIONS WITHIN THE GOAL) – EAT, DRINK • CONCEPTUAL(ACTORS, OBJECTS, ACTIONS) – JUICE, DAD, MOM • LINGUISTIC MEANING(PHRASES, RELATIONSHIPS AND CONCEPTS) – “I DRINK JUICE” • SYLLABE • PHONEME • GESTURE : PLACEMENT & MANNER – TONGUE APEX, RAISE, DECREASE

7. SPEECH ARTICULATION • MOTOR • PERIPHERAL • PHONEME BASED • EVALUATES USE OF PHONEMES • PART TO WHOLE PHONOLOGY • COGNITIVE • CENTRAL • LINGUISTIC CODE • PHONOLOGICAL PROCESSES • WHOLE TO PART

8. VCFS PATIENTS WITH VPI SPEECH : • NASAL EMISSION • HYPERNASALITY • COMPENSATORY ARTICULATION : ABNORMAL ARTICULATION PATTERNS

9. TEACHING – LEARNING CONTEX • STORY BOOKS • USEFUL AT ANY LEVEL OF DEVELOPMENT (WHEN APPROPRIATE) • PROVIDE STABLE AND REDUNDANT CONTEXT WHICH REMAINS THROUGH TIME • KEEP ACTIVITIES STABLE (PROVIDES STABILITY) • ENHANCE PARALELL WORK WITH ORAL & WRITTEN LANGUAGE

10. TEACHING – LEARNING CONTEX • EVENT REPRESENTATION • THE BASIC STRUCTURE OF KNOWLEDGE IS ORGANIZED AROUND EVENTS • PROVIDES A GUIDE FOR STRUCTURE AND CONTENT OF LINGUISTIC & NON – LINGUISTIC ASPECTS • REDUCE COGNITIVE WORK ENHANCING COMMUNICATIVE PERFORMANCE • THE MORE A SCRIPT IS PERFORMED, IT CAN BE PROCESSED MORE EFFICIENTLY

11. TEACHING – LEARNING CONTEX • EVENT REPRESENTATION (CONT.) • PHONOLOGIC FORMS WILL BE INCLUDED IN GREATER UNITS • PLAY IS AN EVENT REPRESENTATION. • THE SPEECH PATHOLOGIST MUST KEEP THE ORGANIZATION AND USE ESTRATEGIES FOR ENHANCING USE OF MORE COMPLEX LINGUISTIC – PHONOLOGIC LEVELS.

12. VPI • MECHANICAL • PLAN : SURGERY • FUNCTIONAL • ENTIRE VOCAL TRACT IS INVOLVED • PLAN : SPEECH THERAPY WITH COMPENSATORY ARTICULATION DISORDER WITHOUT COMPENSATORY ARTICULATION DISORDER

13. SPEECH THERAPY APPROACH – TREAT : • PHONOLOGICAL DISORDER • COMPENSATORY ARTICULATION • LINGUISTIC ORGANIZATION

14. COMPENSATORY ARTICULATION • STARTS AS A CONSEQUENCE OF VPI (CLEFT PALATE) • IN TIME, THE ERRORS ARE INCORPORATED INTO THE LINGUISTIC RULES SYSTEM

15. COMPENSATORY ARTICULATION GLOTTIC STOPS • ARTICULATION AT GLOTTIS LEVEL • SUSTITUTION OF : /K/, /P/, /T/ PHARYNGEAL FRICATIVE • PHARYNGEAL PLACEMENT OF ARTICULATION • SUSTITUTION OF : /S/

16. WHOLE LANGUAGE • LANGUAGE IS AN INTEGRATED SYSTEM • ALL COMPONENTS ARE SIMULTANEOUSLY PRESENT AND INTERACTING • USE OF LANGUAGE OCCURS WITHIN A CONTEXT OR SITUATION • LEARNING IS ACHIEVED FROM GENERAL TO PARTICULAR (WHOLE TO PART)

17. TEACHING – LEARNING CONTEX • GRAPHIC ORGANIZERS • PROVIDE VISUAL TOOLS FOR EFFECTIVE TEACHING • VISUAL TOOLS ARE USEFUL FOR VISUAL AND MIXED LEARNERS(MOST OF POPULATION)

21. FORGET, DISMISS, CANCEL “EXERCISES” !!!!! • THE ONLY USEFUL EXERCISE FOR SPEECH IS SPEECH • ELECTROMYOGRAPHY AND VIDEOFLUOROSCOPY DEMONSTRATES THAT VOCAL TRACT MOTION DURING SPEECH IS QUITE COMPLEX (SEVERAL STRUCTURES MOVING SIMULTANEOUSLY IN A COORDINATED FASHION). BESIDES, FREQUENCY OF MUSCLE ACTIVITY DURING SPEECH IS SIGNIFICANTLY HIGHER THAN BLOWING, SWALLOWING, ASPIRATING, ETC. THESE ACTIONS SHOW ENTIRELY AND COMPLETELY DIFFERENT PATTERNS OF ACTIVITY.

22. THERAPY MODALITIES • CONVENTIONAL (AS FREQUENT AS POSSIBLE) • “SPEECH SUMMER CAMP”

23. THERAPY MODALITIES • “SUMER CAMP” • NATURAL ENVIRONMENT • PLAY AND STORY TELLING • MORE EFFECTIVE (4 HOURS PER DAY AND FOR 3 – 4 WEEKS)

24. THERAPY MODALITIES • “SUMER CAMP” • CAREFUL PLANNING OF ACTIVIES • ADEQUATE “GROUPING” CLASSIFICATION OF PATIENTS IN GROUPS • ASSEMBLE HOMOGENEOUS GROUPS

25. THERAPY MODALITIES • “SUMER CAMP” • INCLUDE MOM & DAD (AT LEAST MOM) : • MODIFY STYLE OF INTERACTION, RECRUIT THEM AS “ALLIES” • INCLUDE VISITING SPEECH PATHOLOGISTS