On Target Practice and Speech Therapy

Research Digest (http://bps-research-digest.blogspot.ca/2012/08/targets-look-bigger-after-shot-that.html ) posted a rather curious article about the relationship between perceived target size and shooting accuracy. In the context of archery, larger targets are easier to hit; at the same time, when the target is successfully hit the archer retrospectively perceives the target to be bigger than it was. Apparently this works for golf too in the context of putting and perceived cup size. The authors of the golf research suggest a reciprocal relationship between perception and performance. I don’t recall ever noticing the retrospective relationship in my own life but I do know that prospective perception of the target is a critical factor and that my golf game has always been hampered by poor representation of target location. It is very annoying how often my husband tells me “that ball went right where you aimed it” just as it is disappearing into the forest far from what I thought was my target.

Last week I spent more time in the lab watching some of the 1000 hours of video we recorded as part of the ECRIP trial (Essai Clinique Randomisé sur les Interventions Phonologiques; a randomized control trial of phonological interventions for francophone children). It was a great pleasure to watch one of our most talented students teaching two delightful children to articulate the /ʃ/ phoneme using one of the more popular games in the Output Oriented treatment arm. The game is called ‘course des animaux” (animal race): it provides opportunities to practice animal names that include the /ʃ/ phoneme in different word positions such as “chat” (cat) → [ʃa], “cheval” (horse) → [ʃəval], “cochon” (pig) → [kɔʃɔn], and “vache” (cow) → [vaʃ]. One child in particular was having a lot of trouble with “vache”, producing [vas] or [ʃvas] on each spontaneous trial although achieving it with pictogram support to help him sequence the head and coda of the word appropriately. The student clinician was providing excellent feedback and prompting the child to use the pictographic cues at appropriate intervals. What was clear from the child’s face however is that he had no idea of the target; he had to look to the student clinician on each trial to verify if he had achieved it. Whether he said [vas] or [vaʃ] he would produce the trial with the same frown of concentration and then look to the clinician for feedback; if she indicated that he had produced the word with “un beau rond” (a good circle), only then would he break into a smile. Even more interesting, another student arrived in the lab while we were watching the video and informed us that this child was related to her and that he was still misarticulating “vache” in spontaneous conversation, now two years after the videorecorded therapy session (it takes us a long time to analyze our data!).

We can contrast this exchange with another one that is reproduced (as a hypothetical English version of the original French session) in Chapter 9 of Developmental Phonological Disorders: Foundations of Clinical Practice. The exchange involves a child who was assigned to the Input Oriented treatment arm of the ECRIP trial. All the Input Oriented treatment procedures were directed at strengthening the child’s acoustic-phonetic or underlying phonological representations of the target form. The sessions are markedly different from those conducted in the Output Oriented intervention in which the child is practicing speech all the time; in the Input Oriented sessions the focus is on the therapist providing input while the child listens. The procedures that were used in the Input Oriented intervention were as follows: In the first session the student therapist would identify the target for the child. Then the therapist would proceed to auditory bombardment in a meaningful context such as a story. For example, when /ʃ/ was the target, Michel, le mouton qui n’avait pas de chance (Sylvain Victor)was a favourite for our student therapists to read since it is a delightful story that provides at least one /ʃ/ exemplar approximately every three seconds of reading. Auditory bombardment would be followed by activities in which the child actively judged words to be correctly or incorrectly pronounced. This is the specific exchange that I want to contrast with the “course des animaux” activity. Rather than asking the child to name animals as they participated in a race to the farm, the therapist essentially asks the child’s permission to put the animals in the barn – he has control of the animals but they cannot go in unless the therapist pronounces the words correctly. While he holds the horse, she says to the child “J’aimerais faire entrer le [sival] (I would like to make enter/let in the horse (pronounced incorrectly)”. The child tells her he won’t let in the horse because she must say it “like it should be said”. So she tries again, “J’aimerais faire entrer le [səval]”. Now the child gets impatient. He explains that he can’t let in the horse unless she says [ʃəval]. “Oh”, exclaims the therapist, “J’aimerais faire entrer le [ʃəval]”. Without wasting any time the child gallops the horse into the barn. At this moment the child has shown us that he has achieved perceptual and productive knowledge of the target form. Now we know that he is ready to progress to expressive minimal pairs therapy activities and the focus will switch to speech production activities. Up until this time there has been no explicit expectation that the child produce speech unless he wished to. If the child attempted a target word the therapist would respond with recasts, imitations and expansions but no explicit information about the child’s production accuracy. We haven’t finished our data analysis yet but we know that the Input Oriented intervention was at least as effective as the Output Oriented intervention on our single word picture naming test even though the children in this treatment arm received very little direct speech practice during their therapy sessions. Our preliminary results mirror those reported by Hesketh and colleagues in which they found that standard articulation therapy and a phonological awareness intervention had similar outcomes in the short-term but the phonological awareness program appeared to provide a better basis for spontaneous generalization by the children over the long term (http://onlinelibrary.wiley.com/doi/10.1080/136828200410618/abstract).

We think that Input Oriented therapy has the advantage, for all children, of providing them with a clear sense of the target so that they can determine for themselves whether they are achieving it or not. Children who receive standard articulation therapy tend to be very reliant on their therapist for information about their own speech accuracy which deprives them of hours of speech practice every day. Children who know what the target is can practice independently. This approach to therapy is also especially appropriate for children who cannot or will not engage in structured speech therapy activities due to their age or cognitive level or temperament. Finally we found that it was an excellent choice for children who had “bottomed out” with standard therapy and were in no mood to continue cooperating with speech practice after a long period of failure to succeed with a given target.

Francoise and I will teach a workshop at ASHA this year on how to implement Input Oriented therapy.

Topic Area: Speech Sound Disorders in Children (SLP)
Session Number: 1420

Title: Input-Oriented Approaches to Intervention for Children With Developmental Phonological Disorders

Session Format: Oral Session (Seminar 2-Hours)
Day/Time: Saturday, Nov 17 — 08:00 AM – 10:00 AM

Authors: Francoise Brosseau-Lapre, McGill U; Susan Rvachew, McGill U

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6 Comments

  1. Phonological disorders can be resolved with help of speech therapy however it removes all although if anybody want to do this therapy then they should have to go through this site.

    Reply
    • I’m not sure I catch the meaning of your comment. would you care to elaborate? Thank you for reading my blog.

      Reply
  2. Lisa S-H

     /  September 5, 2012

    This is a fantastic reminder- perceptual activities and minimal pairs are not done enough in regular clinical therapy. I attended Françoise’s presentation at CASLPA in Montréal and it was extremely interesting and I’ve been re-incorporating my perceptual and minimal pairs activities (as well as some of her suggestions) since. It’s been a great boon, and many parents have actually enjoyed the more ‘receptive’ approach as it’s ‘easier’ on the child and can be much less frustrating for all involved during home practice.

    Reply
  3. A well written article regarding to headline of Target Practice and Speech Therapy. I especially like the link to Phonological awareness therapy. I’ll keep follow your post here.

    Have a nice day
    Anne samtaleterapi

    Reply
    • Thank you for your comment Anne. We are still sort of amazed at how much progress we see for speech accuracy when using a treatment approach that doesn’t pressure the child to practice speech at all!

      Reply

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