Teaching Foundational Speech Skills to Deaf and Hard of Hearing Young Adults JENNIFER VERBAKEL, M.S., CCC-SLP

NICOLE CHOW, M.S., CCC-SLP

NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Service Delivery Model

Overall, 1,153 Deaf and hard-of-hearing undergraduate NTID-supported students during Academic Year 2013-2014 (http://www.ntid.rit.edu/sites/default/files/annual_report_2014.pdf)

Students request services independently

Follows an adult learning model, with student-directed goals

Seen 1 or 2 times per week on a one-on-one basis

From no experience through extensive experience with speech-language therapy

Goals vary: Articulation/Intelligibility, Voice, Language, Pragmatics, Speechreading, Listening

Assessment Procedures

Background Information and Outcomes Questionnaire

Speech Intelligibility and Articulation

Voice: Qualitative and Quantitative Measures

Language: Written Samples with Optional Spoken Samples

Collect most recent Audiogram

Optional: Pronunciation Evaluation; Speechreading and/or Listening Assessments

Background and Outcomes Assessment

Student Interview and Background Questionnaire ◦ Obtain basic personal information including educational history, preferred

communication mode, and family dynamics

◦ Discuss reasons for signing up for instruction and personal goals

◦ This is a good chance to get spontaneous communication samples and impressions

Outcomes Assessment ◦ Pre-Instruction self evaluation of skills

◦ Post-Instruction self evaluation of skills for data tracking

◦ Self-confidence

Speech and Intelligibility Assessment

Articulation-Word Level ◦ Words are read from a list

◦ Modified version of an articulation test

◦ Utilizes all consonant sounds, vowel sounds, and consonant blends if desired

Intelligibility-Sentence Level ◦ 10 Sentences are read from a list and recorded

◦ Scored by a listening partner

◦ 10 sentences with 5 key words each

◦ Intelligibility is rated by percentage and rating scale

Language and Optional Assessments

Spoken and Written Language Samples ◦ May also use spoken language sample for intelligibility rating

Optional Assessments ◦ Speechreading

◦ Pronunciation

◦ Listening

Voice Assessment Quantitative Assessment: Using Kay Visi-Pitch, Real-Time Pitch Program

Assess Fundamental Frequency (F0) ◦ Sustained vowels /a, u, i/ (for 3-5 seconds)

◦ Phrase (“My name is ___.”)

◦ Counting 1 through 10

◦ Rainbow Passage

Qualitative Assessment: (Rating Scale)

Pitch: Register and Control

Respiratory Control: Loudness and Breathiness

Resonance: Nasal and Oral/Pharyngeal Resonance

Tension: Tenseness and Hard Glottal Attack image: www.rit.edu

Prosody: Rate, Stress/Inflection, and Blending/Coarticulation

http://www.rit.edu/ntid/speechlang/slpros/assessment/speechvoice/training/2

Voice Intervention Review Unaided/Aided Audiograms and Speech Banana ◦ If student is old enough, review with

her/him. Helps support awareness of potential hearing ability as well as self-advocacy skills.

◦ Determine level of gain at individual frequencies – helps to identify sounds likely within student’s auditory abilities.

◦ Helps instructor explain difference between pitch and loudness.

Voice On / Voice Off ◦ Use visual or tactile feedback

◦ App such as Bla-Bla-Bla

Image:

http://www.phonak.com/uk/b2c/en/hearing/understanding_heari

ngloss/types_of_hearing_loss.html

Average Pitch: Fundamental Frequency (F0)

Average Adult Male: ≈125 Hz

Average Adult Female: ≈225 Hz

Children Aged 6 through 7: boys and girls have similar fundamental frequencies (285 Hz – 295 Hz)

Young Adulthood: males decrease to 125 Hz and females decrease to 220 Hz

Source: Boone, D. & McFarlane, S. (2000). The Voice and Voice Therapy. Boston, MA: Allyn and Bacon. (p. 41).

Hierarchy for Facilitating Pitch Change

Phonemes /a, u, i, m/ or other

stimulable phonemes

Syllabic Patterns

Short Phrases

Consonant + Vowel Combinations

CV, VC, VCV, CVC

Using stimulable phonemes

Sentences

Conversation

Using stimulable phonemes

Moving towards generalization

Prosody Intonation – for statements, questions, conveying emotions, etc.

Multisyllabic Word Stress ◦ Typically, one syllable (vowel sound) is louder, longer and clearer, and has a

change in pitch. (Gilbert, 2008).

Chunking and Pausing

Reductions

Ideas: ◦ Play, Modeling and Imitation

◦ Books, Stories, and Music

◦ Dialogue and Script Practice

◦ Jazz Chants (by Carolyn Graham)

A Shared Code to Describe Speech Sounds Choose a tool that works for your student and use it consistently!

For Example:

◦ Cued Speech

◦ Manual/Visual Cues, Adapted Signs, or other self-developed tool

◦ Visual Phonics

◦ Written Pronunciation (e.g., a self-developed coding system or www.dictionary.com Pronunciation Guide)

**Letter Sounds versus Letter Names**

Vowel Sound Instruction A, E, I, O, U and sometimes Y = 15 vowel sounds???

All Vowel Sounds:

◦ Are voiced

◦ Are continuous

◦ Require airflow through the mouth

◦ Vary depending on jaw height, tongue placement and lip movement

Two basic kinds of vowel sounds:

◦ Monophthongs (single vowel sounds)

◦ Diphthongs (aka 2-part vowels, 2-position vowels, moving vowels, or vowels

with “off-glides”)

“Long” and “Short” Vowel Sounds “Long” and “Short” descriptors may be inadequate because: ◦ “The fact is that sounds are rarely said by themselves. In the actual context of

a word, the duration of the vowel is affected by its surrounding sounds and the stress pattern, all of which can override the intrinsic length of the vowel.” (Gilbert, 2008. (pg. 24)).

◦ “It tends to undermine the meaning of these terms when used to describe the actual duration contrasts, which are essential to the English system of stress.” (Gilbert, 2008. (pg. 24)).

**Because we do not say vowels in isolation, using the terms “long” and “short” descriptors do not make sense. These terms can thus interfere with instruction of prosodic features.**

Some alternatives: ◦ Alphabet Vowel Sounds and Relative Vowel Sounds (Gilbert, 2008)

◦ Moving Vowels and Non-Moving Vowels (http://elts.solutions/color-vowel-chart/faq/)

The Color Vowel Chart

Taylor, K., and Thompson, S. (1999, 2015).

The Color Vowel™ Chart. Santa Fe NM:

English Language Training Solutions.

http://www.colorvowelchart.org.

Picture removed for upload at author request

Consonant Sounds

3 Parameters of Consonant Sounds

◦ 1. Where do you say the sound in the mouth? (Place)

◦ 2. How do you say the sound? (Manner)

◦ 3. Is the sound Voiced or Voiceless (Voicing)

Organizing Consonant Sounds

Stop

Continuous

Nasal Oral Both Glides Liquids

p, b m

t, d n

k, g ng

th, th

f, v

s, z

sh, zh

h

ch, j

w, y l, r

Organizing Consonant Sounds

Stop

Continuous

Nasal Oral Both Glides Liquids

p, b m

t, d n

k, g ng

th, th

f, v

s, z

sh, zh

h

ch, j

w, y l, r

*Nasal Continuants - similar to a “vowel through the nose” - requires continuous voicing

*Glides - can be developed with vowels (the middle of “oo[w]ee” or “ee[y]ah”)

(FRICATIVES)

(AFFRICATES) (SEMIVOWELS)

(MOUTH) (NOSE)

Phoneme Instruction Phonetic versus Phonemic Productions / Inventory

Teaching sounds: ◦ Audition

◦ Direct Imitation/Modeling

◦ Use of Visuals ◦ Spectrograms

◦ Hand-drawn palatograms

◦ Apps (Iowa Phonetics website, Saundz app)

◦ Anatomical pictures of the mouth (inside of an open mouth, sagittal view of articulators)

◦ Mouth models

◦ Placement and Manner Instruction

◦ Verbal Descriptors (e.g., “fireworks” sound for /tʃ/)

Consonant Shortcuts (Intentional Approximations)

As the clinician, you decide if this is appropriate!

Factors: ◦ Articulation/Intelligibility Goals: Perfect productions or successful communication?

◦ Number of co-occurring goals

◦ Presenting skills

◦ Amount of time available for speech-language services

◦ Parental expectations

Example of an intentional approximation:

1st /z/ goal/ideal production

2nd /s/ manner + placement preserved

3rd (vowel) voicing + placement only

Last Omission

Examples of Hand-Drawn Palatograms (for Tongue Placement) (Can be used for consonants / vowels)

/t, d, n/ /s, z/ /l/

Syllabic Patterns: Tree Diagram

Quick, multisensory tool (Visual/Tactile)

Phonetic level speech sound instruction

Addresses syllabic (Consonant-Vowel) patterns easily

◦ CV, VC, CVC, VCV

I m

A

E

O U (oo)

Word Level

Functional Word List ◦ 100 most common words in English (search on the web)

◦ Family members,’ friends,’ or teachers’ names

◦ Restaurants / Menu items

◦ Favorite items in specific categories (sports, foods, etc.)

Curriculum-Related ◦ E.g., class vocabulary, transition words for English

Multisyllabic Words What are syllables? The number of vowel sounds in a word.

Back-Chaining or Backward Chaining ◦ Starting at the end of the word, working to the beginning, student imitates

subsequently longer chains of syllables to form a multisyllabic word.

◦ If breakdown occurs at any point, instructor can address the misarticulation revise and repeat.

◦ This technique helps to preserve within word stress patterns.

https://en.wikipedia.org/wiki/Back-chaining

Color Vowel Chart ◦ Color is associated with the stressed syllable (window silver)

◦ Supports prosodic features

Coarticulation Considerations Coarticulation Therapy (Similar to Back-Chaining for phrase and sentence levels)

Unreleased Stop Sounds (e.g., /tʃ, dʒ/, cups, Wegmans, popcorn)

Linking Examples:

◦ C-V “What’s up?” what-sup

◦ C1-C2 “This cup.” thi skup

◦ V-V “How are you?

◦ C-C “Phone number.” pho nnnumber

Resources:

◦ http://speech-language-pathology-audiology.advanceweb.com/Article/Coarticulation-Therapy.aspx

◦ http://pronuncian.com/Linking/

◦ www.rachelsenglish.com

Examples of Pronunciation Rules

The “c” Rule: ◦ ca, co, cu (or c + another consonant) c = /k/

◦ ce, ci, cy c = /s/

◦ This is consistent with “acc” words (e.g., access, account) and “sc” words (scarf, scene).

◦ **“sh” (ocean, superficial, delicious)

The “g” Rule: mostly reliable, with a few exceptions (girl, get, gift) ◦ ga, go, gu (or g + another consonant) g = /g/

◦ ge, gi, gy g = /dʒ/

Examples of Pronunciation Rules, cont. Past Tense Regular Verbs ◦ If the verb ends with “-ted” or “-ded,” add another syllable and say /tId/or

/dId/ (waited)

◦ If the verb ends with a voiced sound, “-ed” becomes /d/ (zoned)

◦ If the verb ends with a voiceless sound, “-ed” becomes /t/ (shushed)

◦ If you need to simplify: 2 options: either add a syllable or say /t/

The “s” Rule for Regular Plural Nouns and Present Tense Verbs ◦ If the noun or verb ends with a voiceless sound, “-s” sounds like /s/ (ships)

◦ If the noun or verb ends with a voiced sound, “-s” sounds like /z/ (runs)

◦ If the noun or verb ends with /s, z, tʃ, dʒ, ʃ/, say another syllable /iz/ (faces, roses, watches, edges)

◦ If you need to simplify: either add a syllable or say /s/

Examples of Pronunciation Rules, cont.

Silent Letters (thumb, sign, listen)

The “x” Rule: “x” sounds like /ks/ in the middle or end of words (more common) and /z/ at the beginning of words (less common)

Final “-e” in single syllable words: “the “e” is silent, but still has power it forces the other vowel to say its name”

“Hidden Y” or “Hidden W” (create, computer, graduate) continued voicing for the glide (semivowel) production

Conversation Play and Natural Environments

Scripts and dialogues for communicating in various places and situations

Conversations about reading materials (classroom assignments, newspaper or magazine articles)

Group Instruction

Games and Conversation Starters (e.g., Chat Pack for Kids)

Resources: ◦ Anderson, K.L. (2012). SCRIPT: Student Communication Repair Inventory and

Practical Training. Plymouth, MN: Butte Publications.

◦ www.socialthinking.com by Michelle Garcia Winner, M.A., CCC-SLP

Challenges for the School SLP

SCHEDULING DEMANDS

◦ Multiple students on caseload

◦ Multiple sites ◦ Itinerant services

◦ SLPs in 2++ buildings

◦ Restricted Service Delivery ◦ Need to group by time instead of

need

◦ Multiple needs represented in one group

◦ Inability to work 1:1

STANDARDS DEMANDS

◦ Common Core and other state/district mandated standards

◦ Educational Relevance in a Language Based World

◦ Providing ethical service

Specially Designed Instruction

Special Education Advisory, James P DeLorenzo, “The role of the committee on Special Education to the Common Core Learning Standards”

◦ “Specially designed instruction means adapting, as appropriate

to the needs of a student with a disability, the content, methodology or delivery of instruction to address the unique needs that result from that student’s disability.”

IEP Development

PRESENT LEVELS

◦ Baseline for all goal areas that matches the actual goals ◦ What can s/he do independently?

◦ What can s/he do with support?

◦ Be specific and include measurable data

◦ Describe extent of communication disability on access to the general education curriculum including both academic and social/emotional access

◦ Recommend statement of academic impact in present levels along with required areas

GOALS

◦ Speech ◦ Articulation

◦ Developmental

◦ Frequency of Occurrence

◦ Morphological

◦ Intelligibility

◦ Phonological Perspective (teach /s/-blends prior to /s/ itself)

◦ Voice ◦ Quality

◦ Pitch

◦ Communication Repair ◦ Articulation

◦ Intelligibility

Specific Goal Areas ◦ Intelligibility

◦ Does not *always* mean perfect articulation

◦ Approximations / Short cuts

◦ Manner of sound production ◦ Stops

◦ Continuants

◦ Glides/Liquids

◦ Affricates

◦ Placement of articulators ◦ Bilabial

◦ Interdental

◦ Palatal

◦ Velar

◦ Voicing ◦ On/off

◦ Cognates

◦ Vocal ◦ Pitch (Raising or Reducing Fundamental

Frequency)

◦ Pitch Control

◦ Tension Reduction

◦ Communication Repair ◦ Recognizing breakdowns

◦ Specific strategies to repair unintelligible speech

◦ SCRIPT (pg. 5 lists strategies linked to CCSS)

SMART Goals Voice

◦ When given speaking opportunities, Sammy will use a variety of relaxation techniques (deep/diaphragmatic breathing, imagery/visualization, easy onset) to reduce the amount of vocal tension present during vocalization from 0/3 relaxation techniques independently to 2/3 relaxation techniques independently as measured by the SLP.

Intelligibility

◦ When given small group conversational opportunities, Sammy will improve his intelligibility of speech from 20% intelligible independently to 50% intelligible independently as measured by the SLP over 3 consecutive data collection periods.

Articulation ◦ When given picture prompts, Sammy will produce the /th/ sound in the initial position at the word

level from 2/5 opportunities independently to 4/5 opportunities independently as measured by the SLP over 3 consecutive data collection periods.

◦ When given …, Sammy will produce stop sounds at the syllabic level from 10% accuracy independently to 60% accuracy independently over 3 consecutive data collection periods.

Resources Books:

◦ Anderson, K.L. (2012). SCRIPT: student communication repair inventory and practical training. Plymouth, MN: Butte Publications.

◦ Boone, D. (1997). Is your voice telling on you, 2nd edition. San Diego, CA: Singular Publishing Group, Inc.

◦ Ling, D. (1988). Foundations of spoken language for hearing-impaired children. The Alexander Graham Bell Association for the Deaf.

◦ Secord, W., Boyce, S., Donahue, J., Fox, R., & Shine, R. (2007). Eliciting sounds: Techniques and strategies for clinicians, 2nd edition. Clifton Park, NY: Delmar.

◦ Spears, R., Birner, B., & Kleinedler, S. (1994). NTC’s dictionary of everyday american english expressions. New York, NY: McGraw Hill.

◦ Waling, S. & Harrison, W. (1987). A Speech Guide for Teachers and Clinicians of Hearing Impaired Children. Tucson, AZ: Communication Skills Builders.

Resources

Game:

◦ Chat Pack for Kids (William Randall Publishing)

Apps:

◦ Saundz (American English Pronunciation Software) (iTunes and Windows)

◦ Sounds of Speech (The University of Iowa Research Foundation) (iTunes)

◦ Bla-Bla-Bla (Lorenzo Bravi) (iTunes)

Websites:

◦ http://pronuncian.com/Linking/

◦ http://speech-language-pathology-audiology.advanceweb.com/Article/Coarticulation-Therapy.aspx http://speech-language-pathology- audiology.advanceweb.com/Article/Coarticulation-Therapy.aspx

◦ http://soundsofspeech.uiowa.edu/

◦ http://www.rit.edu/ntid/speechlang/slpros/home

◦ www.rachelsenglish.com

◦www.socialthinking.com

References Boone, D. & McFarlane, S. (2000). The voice and voice therapy. Boston, MA: Allyn and Bacon. (p. 41).

Gilbert, J.B. (2008). Teaching Pronunciation Using the Prosody Pyramid [PDF file]. Cambridge, MA: Cambridge University Press. Retrieved from: http://www.tesol.org/docs/default-source/new-resource-library/teaching- pronunciation-using-the-prosody-pyramid.pdf?sfvrsn=0

Moreau, M., Longo, M., Padilla, E. Holding stories in the palm of your hand: Improving language and communication in students who use american sign language. ASHA Convention. 11/21/14 10:30am

Taylor, K., and Thompson, S. (1999, 2015). The Color Vowel™ Chart. Santa Fe NM: English Language Training Solutions. http://www.colorvowelchart.org.

https://en.wikipedia.org/wiki/Back-chaining

Contact Us!

Jennifer.Verbakel@rit.edu Nicole.Chow@rit.edu

Feel free to check out RIT/NTID’s SLPros Website!

http://www.rit.edu/ntid/speechlang/slpros/home