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Transcript of Cycles Approach
Melonie Coghill and Sarah Sprague
Who, What, When
Created by Barbara Hodson in 1991
It is a phonological therapy approach used for severely unintelligible children who have several phonological processes.
What Is It All About
The General Procedures
Use of auditory, tactile, and visual stimulation cues, the child is made aware of the auditory, tactile and visual characteristics of target sound.
Offered to evoke sound productions that are incompatible with the occurrence of the phonological process selected for remediation, so that the operation of the process is reduced to child's speech
Semantic Awareness Contrasts
Training with minimal pairs is conducted to increase the client's awareness of the semantic contrast between his or her typical production and the target production.
Eight Underlying Concepts of Cycles Approach
1. Children with normal hearing typically acquire the adult sound system primarily by listening
2. Phonological acquisition is a gradual process
3. Phonetic environment in words can facilitate or inhibit correct sound productions.
4. Children associate auditory and kinesthetic sensations that enable later self-monitoring
5. Children generalize new speech production skills to other targets
6. An optimal 'match' facilitates learning.
7. Children learn best when they are actively involved/engaged in phonological remediation
8. Enhancing a child's metaphonological skills facilitates enhances the child's speech
(Pena-Brooks & Hedge, 2007)
The remediation program is planned around cycles.
Each cycle is a period of time during which all phonological patterns in need of remediation are facilitated in succession
Hodson emphasized that the treatment cycles should range from five or six weeks to fifteen or sixteen weeks.
Why Is It Called Cycles Approach?
Structure of Remediation Cycles
Each phoneme within a target pattern should be worked for 60 minutes.
Stimulation should be provided for two or more target phonemes within pattern before changing to next.
Only one phonological pattern should be targeted during a session.
A cycle is complete when all target phonological patterns have been taught.
After one cycle is complete, another is initiated covering the patterns that need further instruction.
At least 3 to 6 cycles of remediation are usually required before a child becomes intelligible.
Identification and Selection of Target Patterns and Phonemes
1. Assess the phonological performance to identify the patterns affecting the child's intelligibility.
2. Select the target patterns and phonemes
Clinician arranges hierarchy of phonological patterns the child demonstrates at least 40% of the time.
Remediation begins with the most stimulable item.
Primary Target Patterns and Phonemes
Early Developing Phonological Patterns
word initial and word final singletons, utterances containing two or more syllables, CVC and VCV word structures
Posterior and Anterior Contrasts
velar stops /k/ and /g/, alveolar stops /t/ and /d/, glottal fricative /h/.
word initial /sp/, /st/, /sm/, /sn/, /sk,/ and word final /ts/, /ps/, /ks/
/l/ and /r/ phonemes, velar liquid clusters /kl/, /gl/, /kr/, /gr/, alveolar liquid clusters /tr/, /dr/, /sl/, labial-liquid clusters /pl/, /bl/, /fl/, /pr/, /br/, /fr/ and postvocalic.
Secondary Target Patterns
other consonant clusters
residual context-related processes
Advanced Target Patterns
Appropriate for upper-elementary school age children
complex consonant sequences
Instructional Sequence For Remediation Sessions
Review of Previous Session
Target Word Cards
Review of Previous Session
The prior weeks practice words are reviewed, unless a new pattern is being initiated
If the target patterns are changed, the previous sessions cards are put aside until the next cycle.
Provided through slight amplification for about two minutes.
The child puts on headphones and listens to the clinician read slowly 12 words containing the target sound.
The list of words is repeated twice
At no point is the child allowed to repeat the target words.
At the end of the auditory bombardment the child is allow to repeat one or two words into the microphone from a different list containing possible production practice words
Target Word Cards
The child draws, colors or pastes pictures of three to five target words on large index cards
The name of the picture is written on each card
The child participates in game-based production practice activities
Shifting experimental play every 5-7 minutes helps maintain child's interest in repetition of target phonemes.
Production practice includes
auditory, tactile and visual stimulation at the word level.
The child is instructed to produce five words per target sound in a single session.
The target phoneme for a specific pattern to be addressed in the next session is selected
The selection is based on the child's performance on stimulability testing.
Modeling, slight amplification and cueing may be provided during this testing.
Auditory Bombardment (Repeated)
Slightly amplified auditory bombardment with no opportunity to produce words is repeated using the 12 item word list from the beginning of the sessions.
Parents or guardians are instructed to read the 12 item word list used in auditory bombardment once a day.
Child is instructed to review the target word list by naming the picture cards at least once daily.
Who Is A Good Candidate for
Cycles Approach Therapy
Those patients who are highly unintelligible.
Those patients, who after completing a phonological assessment such as the Khan-Lewis or HAPP-3, have several phonological processes.
Some Things To Remember
Each sound in a pattern is targeted for 60 minutes.
Each pattern is targeted for 2-6 hours.
Auditory bombardment is essential for this therapy treatment.
For quickest results, the child should be in therapy more than once a week.
Carry over at home is an important aspect.
Sample of Cycles Approach
Glides- initial /j/
consonant singletons -final /f/
velars - final /k/ and initial /k/ and /g/ targeted together.
liquid /r/ - initial /r/
Sessions for Cycle One
1. Initial /j/ 5 words with initial /j/
2. Initial /j/ 5 words with initial /j/
3. Final /f/ 5 words with final /f/
4. Final /f/ 5 words with final /f/
5. Final /k/ 5 words in final /k/
6. Final /k/ 5 words in final /k/
7. Initial /k/ and /g/ 3 words with /k/ three words with /g/.
8. Initial /r/ 5 words with initial /r/
9. Initial /r/ 5 words with initial /r/
Glides - initial /j/
Velars - final /k/, initial /k/ and /g/
Liquid /r/ - initial /r/
Sessions for Cycle Two
1. Initial /j/ - 5 words with initial /j/
2. Initial /j/ - 5 words with initial /j/
3. Final /k/ - 5 words with final /k/
4. Final /k/ - 5 words with final /k/
5. Initial /k/ and /g/ - 3 words with initial /k/ and 3 words with initial /g/
6. Initial /k/ and /g/ - 3 words with initial /k/ and 3 words with initial /g/
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