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8 Step intergral stimulation

"Watch me, listen, do as I do."

Samantha Gay Julia Miller Elanie van Schalkwyk Elani Matthee

Introduction

1

Definition of the approach

The Eight-Step

(Integral Stimulation) Continuum

for treating Apraxia of Speech

Definition of the approach

  • In 1973, Rosenbek and his colleagues described t...
  • In 1973, Rosenbek and his colleagues described the 8-step task continuum in an article, A Treatment for Apraxia of Speech in Adults.

  • The 8 step-continuum is effective for improving word, phrase, or sentence production in severely impaired patients.

  • For decades this treatment approach has been successfully used as a method for treatment of AOS.
  • The eight-step continuum is a sequence of structured ...
  • The eight-step continuum is a sequence of structured of activities which moves the patient from repeating target phonemes with the clinician to independent productions of utterances in role-playing situations (Freed, 2011).

Definition of apraxia

  • Apraxia is a motor speech disorder.
  • The formulation of messages in the brain are disrupted, and the person cannot move his or her lips or tongue to the right place to say sounds correctly, even though the muscles are not weak.
  • The severity of apraxia depends on the nature of the brain damage. (American Speech Language Hearing Association, 2005)

Definition of apraxia

Integral Stimulation

Video

Retrieved from

https://www.youtube.com/watch?v=W22lucjT6go

Principles

2

General Principles

The eight step continuum is based on the fundamental principal, integral stimulation.

General Principles

  • Integral stimulation was introduced in 19...
  • Integral stimulation was introduced in 1954 (Milisen) and was used as a program for treating articulatory disorders.
  • It was based on cognitive motor learning neccesary for speech production.
  • The “bottom-up” approach is used.
  • Various modalities are used but mainly auditory and visual modes (Baker & Nquist, 2008).

  • A procedure which requires the patient to carefully wat...
  • A procedure which requires the patient to carefully watch the therapist's face while listening to her/him verbally produce a target word.
  • The verbal and visual model enhances an apraxic patients own attempt of verbal production.
  • The therapist should cue the patient before the stimulus: “Watch and listen to me…” (Freed, 2011).

Specific Principles

The 8-step continuum emphasizes the following principals:

  • The importance of task continua to ensure high levels of success.
  • The importance of intensive and extensive drill.
  • The need to work on meaningful communication as soon as possible.
  • Self-correction.
  • The importance of selecting and ordering stimuli as a function.

(Duffy, 2013)

Specific Principles

Theoretical Approaches

Treatment can fall into 4 different categories:

1. Articulatory-kinematic treatment:

  • Focus is on improving temporal and spatial aspects of speech production.
  • The outcome measure is articulatory accuracy and is part of the “articulatory function” in the ICF.

2. Rate/Rhythm control treatment:

  • Manipulation of rate to improve speech production.
  • Also considered an articulatory function in the ICF.

3. Reorganization treatment.

4. AAC approaches.

Theoretical Assumptions

Steps

The Eight-Steps (Integral Stimulation) Continuum for Treating Apraxia of Speech

What is integral stimulation?

Where the clinician asks the patient "Watch as I say the word" and then demonstrates the word. It can be helpful to also show a photo and a printed word.

3

1

Step 1 : Integral Stimulation

The target stimulus is produced by the clinician.

  • The patient looks at the clinician while listening to the target stimulus.
  • The patient will then imitate the target stimulus along with the clinician.

2

Step 2

The same as step one, BUT….

  • The patients response is delayed.
  • The clinician mimes the patient’s response (without sound) in unison with the patient.

Therefore, the patient only has a visual cue as the auditory cue is faded.

3

Step 3

Integral stimulation followed by imitation.

  • No simultaneous visual or auditory cues are provided by the clinician.

4

Step 4

Integral stimulation with several successive productions.

  • No intervening stimuli and no simultaneous visual or auditory cues from the clinician.

Example:

Therapist: "Sam"

*The patient must say ‘Sam’ three times with no simultaneous or visual cues from the clinician*

Patient: "Sam, Sam, Sam"

5

Step 5

Written stimuli is presented without any visual or auditory cues followed by patients production

  • The patient will look at the written stimuli while producing the target stimuli.

6

Step 6

Written stimuli with delayed response.

  • The written stimuli is taken away, this therefore leads to a delayed response.

7

Step 7

A response is elicited with an appropriate question.

Example: Let the patient answer the question.

Clinician: “Would you like anything?”

Instead of imitating the clinician the patient is expected to respond with the appropriate response.

Patient: “I would like a cup of tea”

*It is important to use appropriate and functional utterances that relate to the patients everyday life*

8

Step 8

The therapist is to elicit an appropriate response from the patient in a roleplay situation.

“Step 9” – Generalization:

This refers to the generalization of what has been targeted in therapy to everyday situations. It is important to note that this is not directly targeted in therapy (Rosenbek et al, 1973.)

PLEASE NOTE

  • Not all patients have to complete/ go through all of the steps.

  • Some steps can be carried over, if they are too difficult.

  • If integral stimulation fails revert to phonetic placement techniques.

!

Voordele en Nadele

4

Voordele

  • ‘n Buigsame ontwerp wat aangepas kan word vir verskillende grade van gestremdheid, sowel as verskillende populasies.

  • Terapie kan op enige stap begin en alle stappe hoef nie gevolg te word nie.

  • Die benadering kan funksioneel gemaak word.

  • Die benadering maak gebruik van verskeie modaliteite, veral visueel en ouditief.

Voordele

Nadele

  • Kinders mag verveeld raak met die wag periodes tussen herhalings.

  • Die benadering maak gebruik van baie herhaling en drilwerk wat kan lei tot moegheid.

  • Sommige stappe vereis die pasiënt om te lees en vereis dus voldoende visie en geletterdheid.

  • Latere stadia vereis self-monitering strategieë wat nie moontlik is vir kognitief laer funksionerende pasiënte nie.

Nadele

Opsomming

5

Wat is dit?

  • 'n 8 Stap kontinuum ontwerp deur Rosenbek et al. (1973) vir die verbetering van woord- , frase- en sinsproduksie in pasiënte met AVS.

  • Die benadering maak gebruik van ‘n hiërargie wat begin met ‘n hoë vlak van ondersteuning en verminder soos terapie vorder (Duffy, 2013).

  • Die benadering fokus op die gebruik van verskeie modaliteite, maar beklemtoon ouditiewe en visuele modules (Baker & Nyquist , 2008).

Wat?

Vir wie is dit?

Die model kan gemodifiseer word om in verskillende omgewings en met verskillende populasies gebruik te word:

  • AVS in volwassenes /verworwe AVS (Rosenbek et al., 1973)
  • AVS in kinders/ontwikkelings AVS (Strand & Debertine, 2000)
  • Disartrie
  • Funksionele artikulasie afwykings

(Strand & Debertine, 2000)

Wie?

Good to know

Good to know

6

Resources

Retrieved from

https://www.youtube.com/watch?v=tAGnfss5oBA

Retrieved from

https://www.youtube.com/watch?list=PLXTouG6eNRKzh0nmCSOq4Y6HXwclcmIeE&v=9JgH2_nXneY

References

References

American Speech Language Hearing Association. 2005. Apraxia in Adults.

Retrieved from http://www.asha.org/public/speech/disorders/apraxia_adults.htm.

.

Baker, J., & Nyquist, B. (2008). Integral Stimulation Treatment for Children with

Childhood Apraxia of Speech (CAS). Retrieved from http://people.umass.edu/ mva/pdf/ComDis%20624%20Student%20Pres_08/ Baker_Nyquist_Integral_Stimulation_08.pdf]

.

Code, C, Petheram, B 2011. Delivering for aphasia. International Journal of

Speech-Language Pathology, 13(1), Pp. 3--10.

.

Duffy, J. R. (2013). Motor Speech Disorders: Substrates, Differential Diagnosis,

and Management (3rd edition). Philidelphia: Elsevier Mosby.

.

Freed, D. B. (2011). Motor Speech Disorders: Diagnosis and Treatment (2nd

edition). New York: Delmar Cengage Learning.

Moses, J. [jmoses09]. (2012, April 24). Apraxia Therapy- Eight Step Continuum

[Video file]. Retrieved from https://www.youtube.com/watch?v=tAGnfss5oBA

.

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.

.

SpeechTherapyOnline. (2015, February 12). APRAXIA treatment in

MoreSpeech.com [Video file]. Retrieved from https://www.youtube.com/watch?list=PLXTouG6eNRKzh0nmCSOq4Y6HXwclcmIeE&v=9JgH2_nXneY

.

Strand, E. A., & Debertine, P. (2000). The efficacy of integral stimulation i

intervention with developmental apraxia of speech. Journal of Medical Speech-Language Pathology, 8, 295–300.

.

Tenbe100. (2014, June 30). Integral Stimulation [Video file]. Retrieved from

https://www.youtube.com/watch?v=W22lucjT6go

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