Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Copy of The Eight-Step Continuum for Treating Apraxia of Speech

No description
by

Nora Knijf

on 19 October 2012

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Copy of The Eight-Step Continuum for Treating Apraxia of Speech

Nora Knijf
Chevonne du Plessis
Natalie Diedericks
Elzeth van der Westhuizen The Eight-Step Continuum
for Treating Apraxia of Speech Definition Theoretical
Assumptions Pros
and
Cons Steps Definition:
The eight-step continuum for the treatment of apraxia of speech was described in the article “A Treatment for Apraxia of Speech in Adults" by Rosenbek et al. (1973).
It is a treatment continuum that has been found effective for teaching words, phrases, or sentences to severely impaired apraxic patients.
(Duffy, 2005) Definition continued:
The eight-step continuum is based on the principles of integral stimulation:
Integral stimulation was first introduced in 1954 by Milisen, who utilized it as a program for treating articulatory disorders.
It is based on cognitive motor learning with emphasis on cognitive-motor programming necessary for speech production.
Involves “bottom-up” approach.
Often referred to as the “watch me, listen, do as I do” approach.
Focuses on the use of various modalities of presentation, but stress auditory and visual modes.
(Baker & Nyquist , 2008) Definition continued: Definition continued: The eight-step continuum is a sequence of structured activities that moves the patient from repeating target phonemes with the clinician to independent productions of utterances in role-playing situations.
The key element of this treatment is integral stimulation – a procedure that requires the patient to carefully watch the clinician’s face while listening to him/her verbally produce a target word.
The combined presentation of a verbal and visual model can significantly enhance an apraxic patient’s own attempts at verbal production.
The clinician cues the patient : “Watch me and listen to me” before presenting stimulus
(Freed, 2011) Emphasis is placed on:
the importance of task continua in order to ensure high levels of success
the importance of intensive and extensive drill
the need to work on meaningful and useful communication as soon as possible and
self-correction
(Duffy, 2005) Die algemene tema van die benadering is waar die:
Stimulus aanbiedinge inisiëel maksimaal is
Daarna word dit geleidelik verminder
Vereistes vir response neem dan geleidelik toe

Duffy, 2005) Stappe van die “Eight-Step Continuum” In ‘n geval waar Rosenbek et al. (1973) die stappe toegepas het, was hierdie 8 stappe toegepas op ‘n 58-jarige vrou wat reeds vir 6 jaar lank met apraksie van spraak gepresenteer het.
Die doel van die stappe was om die vrou te help om eenvoudige frases, opdragte en sosiale uitinge, soos byvoorbeeld “I want to eat”, te programmeer en te gebruik.
(Rosenbek et al., 1973) Stappe van die “Eight-Step Continuum” vervolg Integrale stimulasie sluit in die proses waar:
Teikenstimulus deur die klinikus geproduseer word
Pasiënt kyk na die klinikus
Pasiënt luister na die teikenstimulus
Nabootsing deur pasiënt van die teikenstimulus saam met die klinikus
(Duffy, 2005) Stap 1: Integrale stimulasie Dieselfde as stap 1, MAAR:
Pasiënt se respons is vertraag
Klinikus „mime” die respons (sonder klank) gedurende die pasiënt se respons
Dus: die gelyktydige ouditiewe leidraad (van die klinikus) word verminder
Slegs visuele leidraad van die klinikus
(Duffy, 2005) Stap 2: Integrale stimulasie GEEN gelyktydige leidrade van die klinikus ni
Vertraagde respons
Geen ouditiewe en visuele leidrade nie
(Duffy, 2005) Stap 3: Integrale stimulasie gevolg deur immitasie Sonder enige betrokke stimuli
Sonder gelyktydige leidrade (van die klinikus)
(Duffy, 2005) Stap 4: Integrale stimulasie met verskeie opeenvolgende produksies Word voorgedra SONDER enige visuele of ouditiewe leidrade
Gevolg deur pasiënt se produksie
Pasiënt KYK na geskrewe stimuli tydens produksie
(Duffy, 2005) Stap 5: Geskrewe Stimuli Geskrewe stimuli word weggeneem
Lei tot ‘n vertraagde respons
(Duffy, 2005) Stap 6: Geskrewe Stimuli met vertraagde respons ‘n Respons word by die pasiënt ontlok deur ’n gepaste vraag te vra
Bv: Laat die pasiënt eerder die vraag beantwoord:
”Wil jy iets hê?”
INSTEDE daarvan om die verwagte respons na te boots: ”Ek wil ’n koppie tee hê.”
Gebruik dus toepaslike en funksionele uitinge in die alledaagse lewe.
(Duffy, 2005) Stap 7: Respons op 'n gepaste vraag Ontlok respons deur rolspel
Bv. Klinikus is aangetrek as ‘n verpleegster
Pasiënt lewer toepaslike respons
(Duffy, 2005) Stap 8: Toepaslike respons in ‘n rolspel-situasie Die 9de stap (wat nie direk in terapie geteiken word nie) is veralgemening van response tot alledaagse situasies.
Nie alle pasiënte hoef deur al die stappe te gaan nie
Sommige stappe kan oorgeslaan word
Dit kan te moeilik wees
Indien integrale stimulasie misluk:
Gebruik fonetiese plasingstegnieke
Om spraak te verbeter kan verskillende veranderinge aangebring word soos:
Die stimulusaanbieding
Volg van stappe
En die kriteria om van en stap na ’n ander aan te beweeg
(Rosenbek et al., 1973) Stappe van die “Eight-Step Continuum” vervolg Indien integrale stimulasie misluk:
Fonetiese plasingstegnieke:
Die klinikus moet dus veelsydig wees in sy/haar aanbieding
Bied stimuli aan deur bv. instruksies te gee aan die pasiënt hoe om artikulators te plaas om bv. /f/ te produseer
Herhaalde oefening veroorsaak dat die /f/ klank geprogrammeer en ontlok kan word
(Rosenbek et al., 1973) Stappe van die “Eight-Step Continuum” vervolg The integral stimulation method should be tried first.
As therapy progresses in accordance with the different steps, first auditory THEN visual cues should be gradually faded.
Only if the integration method failed, should the clinician use modifications, such as phonetic placement.
Emphasis should be placed FROM THE FIRST SESSION on developing a strong visual memory of the correct form of the word.
(Rosenbek et al., 1973) Principles for therapy in treating apraxia of speech Voordele Nadele Die 8 Stap Kontinuum maak gebruik van ‘n hiërargie wat begin met ‘n hoë vlak van ondersteuning en verminder soos terapie vorder.
Integral stimulasie waarop die model gebasseer is kan gemodifiseer word om in verskillende omgewings en met verskillende populasies gebruik te word. Onder andere, persone met: disartrie, volwasse en kinder apraksie sowel as funksionele artikulasie afwykings.
Kan funksioneel gemaak word
Baie modaliteite word gebruik tydens terapie, visueel en ouditief
Kan op enige punt begin en nie alle stappe hoef gedoen te word nie Kinders mag verveeld raak met die wag periodes tussen herhalings.
Daar is baie herhaling en dus mag enige persoon moeg raak vir die eentonige drilwerk
In die latere stadia van die benadering word daar van die pasiënt vereis om staretegieë soos self monitering toe te pas, dit kan wees dat ‘n pasiënt kognitief laer funksionerend is en nie kan nie.
Sommige stappe vereis van die pasiënt om te lees dus moet die pasiënt beide voldoende visie hê en instaat daartoe wees om te kan lees. References Baker, J., & Nyquist, B. (2008). Integral Stimulation Treatment for Children with Childhood Apraxia of Speech (CAS). Retrieved October 17, 2012, from http://people.umass.edu/mva/pdf/ComDis%20624%20Student%20Pres_08/Baker_Nyquist_Integral_Stimulation_08.pdf

Duffy, J. R. (2005). Motor Speech Disorders: Substrates, Differential Diagnosis, and Management (2nd edition). Philidelphia: Elsevier Mosby.

Freed, D. B. (2011). Motor Speech Disorders: Diagnosis and Treatment (2nd edition). New York: Delmar Cengage Learning.

Rosenbek, J. C., Lemme, M. L., Harris, E. H., & Wertz, R. T. (1973). A Treatment for Apraxia of Speech in Adults. Journal of Speech and Hearing Disorders, 38, 462-472.

Strand, E. A., & Skinder, A. (1999). Treatment of Developmental Apraxia of Speech: Integral Stimulation Methods. In A. Caruso, & E. Strand (Eds.), Clinical Mangement of Motor Speech Disorders in Children (pp. 109-146). New York: Thieme Medical Publishers. Theoretical Assumptions Theoretical Assumptions Continued Theoretical Assumptions Continued Theoretical Assumptions Continued Theoretical Assumptions Continued Theoretical Assumptions Continued Treatment can generally fall into 1 of 4 categories:
Articulatory-kinematic treatment
Focus is on improving temporal and spatial aspects of speech production
Rate/rhythm control treatment
Manipulation of rate to improve speech production
Reorganization treatment
AAC approaches
Articulatory-Kinematic Treatments Articulatory-Kinematic Treatments continued Usually include a combination of techniques (such as Sound Production Treatment), and no one technique is superior to the next
Since the outcome measure is articulatory accuracy, it is considered to be part of the “articulatory function” in the ICF framework Rate/Rhythm Control Treatment Rate/Rhythm Control Treatment continued Also addresses articulatory, or body function in the ICF.
Rate and rhythm treatments may also provide extra benefits beyond articulatory-kinematic treatment Specific Principles for therapy Non-linguistic factors
Relearning sequencing of articulatory gestures
Phonetic conditions
Easiest phonemes first; control for length
Articulatory accuracy
Integral stimulation method
Strong visual memory Theoretical Assumptions Continued Theoretical Assumptions Continued General Principles for treating Apraxia Activities should follow a task continua
Patient should work on a high level of success and not struggle during the session
Articulatory drills should be both intensive and extensive
This is because the patient will take longer to respond and will have to work harder to regain lost function General Principles for treating Apraxia continued Therapy should focus on meaningful and functional verbal communication
This is because the patient may have had normal speech before. Oral, non-verbal movements may be necessary before verbal movements
Compensatory strategies may help
Includes prolongation and even stress
Self-correction should be encouraged Questions????
Full transcript