WHOLE LANGUAGE MODEL FOR PROVIDING SPEECH THERAPY IN VCFS PATIENTS

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

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.

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 SOUNDS TREATED SIMILARLY BY THE CHILD ( FEY, 1992 )  MODELING : RECONSTRUCTION OF ABNORMAL EMISSIONS

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 )

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

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

VCFS PATIENTS WITH VPI SPEECH :  NASAL EMISSION  HYPERNASALITY  COMPENSATORY ARTICULATION : ABNORMAL ARTICULATION PATTERNS

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

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

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.

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

SPEECH THERAPY APPROACH – TREAT :  PHONOLOGICAL DISORDER  COMPENSATORY ARTICULATION  LINGUISTIC ORGANIZATION

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

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

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 )

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

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.

THERAPY MODALITIES  CONVENTIONAL ( AS FREQUENT AS POSSIBLE )  “SPEECH SUMMER CAMP”

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

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

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