Wambaugh, Julie-Acquired Apraxia of Speech

5/28/2018 Wambaugh, Julie-Acquired Apraxia of Speech

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Management of Acquired Apraxia of Speech

J.L. Wambaugh

SOUNDPRODUCTION TREATMENTHIERARCHY

Step 1 Modeling/Imitation: The therapist produces the minimal contrast pair* and instructs the speakerto repeat the pair (e.g., say piebuy). If the speaker cannot repeat the paired words together, each

member of the pair is presented separately. If the target sound and contrasting sound are correct,

knowledge of results (KR) is provided, another production of the target word is elicited, and the next pair ispresented. If either sound is incorrect, KR is provided, and the next step is employed.

Step 2 Modeling + Written Letter Cue/Imitation: The therapist points to printed letters representing

the target sound and contrasting sound while modeling production of the minimal pair items. The speakeris asked to repeat each item. If both sounds are correct, feedback is provided, another repetition is elicited,

and the next pair is presented. If either sound is incorrect, the next step is employed.

Step 3 Integral Stimulation: If only the target sound or both sounds are incorrect in Step 2, then the

target sound onlyis focused upon at this step. If only the contrasting sound is incorrect, then that sound isfocused upon. Using the single item (i.e., non-paired item), the therapist instructs the speaker to watch

me, listen to me, and say it with me. If correct, then feedback is provided, another production is elicited,and the next pair is presented. If the contrasting sound is incorrect, feedback is provided and the next pair

is presented. If the target sound is incorrect, the therapist provides feedback and moves to the next step.

Step 4 Articulatory Placement & Modeling: The therapist provides verbal articulatory placementinstructions specific to the speakers perceived error, models the word, and asks the speaker to repeat the

word. If correct, feedback is provided, another production is elicited, and the next pair is presented. If

incorrect, the therapist provides feedback and moves to the next step.

Step 5 - Production of Sound in Isolation: The therapist models the target sound in isolation and asksthe speaker to repeat the sound. If correct, feedback is provided and another production is elicited. If

incorrect, feedback is provided and the next minimal pair is presented.

*Modifications to the Minimal Pair Presentation:

A. 80%-100% correct production in a single trial (10 items), use hierarchy exactly as above.B. 50%-79% correct production in a single trial, use single items in alternate trials instead of contrast

pairs every trial

C. 0%-49% correct production in a single trial, use two single item trials alternately with one minimalpair trial

Notes:

10 exemplars of the target sound presented in random order constitute one trial As many productions as possible should be attempted per session (attempt to complete a minimum of

seven 10-item trials) Continue treatment until at least 90% of trained items are produced correctly inPROBESin 3 of 4

consecutive sessions


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SPT(MODIFIED)APPLIED TOMORE THAN ONE SOUNDAT A TIME

Treatment Log: /l/, /m/, & /n/

A. Target Words Trial 1:

B or R

Trial 2:

B or R

Trial 3:

B or R

Trial 4:

B or R

Trial 5

B or Rl m n l m n l m n l m n l m

1. Lit mitt knit (bit)

2. Lee me knee (thee)

3. Low mow know (though)

4. Late mate Nate (date)

5. Lie my nigh (thy)

6. Lead mead need (bead)

7. Lou moo knew (boo)

8. Light might night (bite)

Total Correct

% Correct

one trial = one presentation of each of the 24 words in the group. First trial = blocked presentation (all 8 words of the 1stsound, all 8 words of the 2ndsound, all 8 words

of the 3rdsound)

Randomize the order of the sounds across first trials of tx. sessions (i.e., tx.1 s, p, f; tx.2 - p, f, s;tx.3 f, p, s; etc.)

Blocked trial will continue until 6/8 items are correct during treatment trials for all three sounds. Second trial = randomized presentation (all exemplars for all three sounds are randomized). Additional trials alternate between blocked and randomized.

Treatment Hierarchy:

1)

Say wordand request repetitiona) if correct, request additional repetitions (5 times*) and go to 5.b) if incorrect, give feedback and say: Now, lets try a different word and present minimal pair

word.

if correct, say: Now, lets go back to the other word & go to step 2 with the target word if incorrect, give feedback, attempt with integral stim. X3 and go to 2 with target word

2) Show letter representing sound, say word, and request repetitiona) if correct, request additional repetitions (5 times*)

b) if incorrect, go to 33) Integral stimulation watch me, listen to me, and say it with me 3 times

a) If correct, request additional repetitions (5 times*)b) If incorrect, go to 4

4) give Articulatory Placement Cues, attempt word again after cueing using integral stimulationa) if correct, request additional repetitions (5 times*)

b) if incorrect, go to 55) go to the next item* give feedback on only 60% of attempts.


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Possible Sentence Completion Items

Group 1:

A. /s/1. (see) Before I can read the newspaper, I need to put on my glasses because I cant ________________.2.

(set) A track and field runner always gets ready when he or she hears the phrase: On your marks, get_____________.

3. (seal) In order for a passport to be legal, the immigration department has to stamp a ____________.4. (Sue) My best friends name is Susan but I call her by the nicknames of Susie or ___________.5. (sigh) Everybody knows when my father is extremely tired and ready to go to sleep because he tends to

yawn and ___________.

B. /p/1. (pie) Julie usually makes desserts when she has company. Last Saturday, her parents came and she

baked a delicious apple ________________.

2. (pail) The little boy wanted to build a sandcastle, so his mom bought him a shovel and a_____________.

3. (pet) We have a goldfish, a hamster, and a dog in my house. Im responsible for the hamster becauseshe is my _____________.

4. (pat) Every time I get home, my dog wants me to play with him and give him a friendly_________________.

5. (peer) I tied my boat up at the dock or the _____________.C. /v/1. (vi) The little boy learned today to write words such as violin, van, and vase, which are words that

begin with the letter ____________.2. (veil) A bride bought her wedding gown, shoes, and accessories. But later she realized that she did not

buy a _______________.

3. (view) If you live on the mountain and look over the city, you have a beautiful ____________.4. (vet) My dog has been very sick for the last two days, I need to take her to the ___________.5. (veal) Instead of making my beef stew with beef, I prefer to use the meat of a calf, which is better

known as ___________.

Group 2:

A. /k/1. (key) I was frustrated because I locked myself out. Fortunately, I remembered that I was carrying an

extra _____________.

2. (cut) My hair is too long. I need to go to my hairdresser and get a new hair __________.3. (cot) Grandpa came to visit. Mom said to my brother: Grandpa can sleep in your bed and you can

unfold the _________________.

4. (coo) When I went to New York, I visited Central Park. I loved to feed the pigeons and hear their________________.

5. (car) Ive been riding the bus for many years. I finally saved enough money to buy a good___________.

B. //1. (shoe) The little boy is almost ready to go outside and play. Hell be ready once he ties his left

______________.

2. (shot) The flu can be deadly in older people. Thats why older people have been encouraged to have aflu _____________.

3. (shut) The little boy was so tired that when his mom finished reading the story, his eyes were already_________.

4. (share) At the beginning of the school semester, the teacher did not have enough books for all thechildren so she said: Well have to _________.


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5. (she) We saw a beautiful dog at the pet shop. We wanted to get a he so we asked: Is it a he or a________?

C. //1.

(jail) A man committed a crime and was caught. He was sentenced to 15 years in ________________.2. (Jew) Even though my friend is American, he believes in Judaism, so everyone considers him a

________________.

3. (jaw) The boxer threw a punch near his opponents mouth and broke his ____________.4. (jar) The little boy was so hungry that he couldnt wait for his lunch and grabbed some cookies from

the cookie ___________.5. (gee) The little girl learned in class today that the words girl, game, goat, and guitar begin with the

letter ___________.

Group 3:

A. /l/1) (light) I was reading a book and all of the sudden the room became dark. I told my husband to turn on

the ___________________.2) (late) Tim is never on time. He usually gets to school ten to fifteen minutes _______________.3) (lit) Julie doesnt like to live in a dark house. When she was looking for a home, she made sure that it

was well-________________.4) (low) Ted wants to apply for medical school but he needs to retake the test because he scored too

_______________.

5) (lie) I tried to believe what they said but it was very hard for me because they always__________________.

B. /m/1) (mitt) Tim was ready to play baseball. He brought a ball and a bat, but then he realized that he forgot

to bring his baseball __________________.2) (me) Julies mom told her to call home as soon as possible. So when Julie was leaving, mom said:

Dont forget to call ____________________.

3) (mate) Ted is always dating but never seems to find the right person. Hes still searching for the perfect_________________.

4) (mow) The big kids share the yard work with their dad. The grass is tall and dad asked: Who is goingto _______________?

5) (moo) I would like to live in a farm. I love to hear the horses neigh, the ducks quack, the pigs oink,and the cows ____________________.

C. /n/

1) (knit) I know how to cross-stitch, sew, and crochet, but I dont know how to _______________.2) (know) The teacher asked a question about what the children were studying in class. A kid raised his

hand and said I _______________.

3) (night) The mom put her son in his bed, covered him with a blanket, gave him a kiss, and said: Good

______________!4) (need) The boy scouts were knocking on every door, asking for donations for families in

_______________.5) (knee) The boy was running and tripped over a rock. He was crying because he scraped his left

____________


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Story Completion Treatment

1. Sentence completion(my dog is very sick, so Ill take her to the.)

2. Sentence completion delayed repetition modeling whole sentence with response

(not quite, listen and then you try itmy dog is very sick, so Ill take her to the vet. My dog is very sick, soIll take her to the .)

3. Sentence completion with letter cue

(not quite, lets try using the first letter of the word. My dog is very sick, so Ill take her to the [show letter

V])

4. Model word target sentence completion again(not quite, the word is VET. My dog is very sick, do Ill take her to the .)

5. Repeat word target sentence completion again

(say the word after me and then well try it with the sentence. Say VET. My dog is very sick so Ill take her

to the.)

6. Integral stim. of word sentence completion again(watch and listen and say the word with me and then well try it with the sentence. Say it with me VET.

My dog is very sick so Ill take her to the.)

7. Sentence completion with integral stim. of word(not quite. Ill say the sentence and when I get to the word, you try it with memy dog is sick so Ill take

her to the[cue to say together] VET.

8. Word only integral stimulation

(not quite. Say vet with meVET)


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SOUND GROUP TREATMENT-SENTENCELEVEL

1. The speaker is shown a printed copy of the target sentence. The examiner models a relatively slow

production of the entire sentence and instructs the speaker to repeat the sentence.

A. If all target sounds are correct, positive feedback is provided and the speaker is required to repeat

the entire sentence with integral stimulation.

B. If any target sounds are incorrect, feedback is provided, the word(s) containing the target are

modeled and the speaker repeats the word(s) only.

1) If sounds are correct, positive feedback is given and the speaker is required to repeat the entire

sentence with integral stimulation.

2) If sounds are still incorrect, the word with the problematic target sound is attempted with

integral stimulation, up to a maximum of 3 attempts. Upon a correct production, the entire

sentence is produced with integral stimulation.

2. When all words in the sentence are not attempted, feedback is provided, the examiner models the

sentence again while pointing to each word. Then, the speaker is required to produce the sentence while

the examiner points to each word. The preceding steps are then followed.

3. Following a correct production, or failure at all steps, then the next item is presented.

Notes:

10 sentences presented in random order constitute a single trial. As many trials as possible should be attempted. Continue treatment until at least 90% of trained items are produced correctly inPROBESin 3 of 4

consecutive sessions

Examples of Target Sentences:

Fricatives StopsSusan is shy. The boat docks today.

The shell is thin. Dad packs the bag.

Something falls off. Bobbys key is gold.

Glides & Liquids Mixed ConsonantsRain ruins her wig. Sue eats cheese.

Young lions roar. You choose the first one.

We hear yelling. Toast is good for lunch.


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MODIFIEDRESPONSEELABORATION TRAINING (AFTERKEARNS AND COLLEAGUES)

Treatment Steps

1. The clinician presents a picture and elicits a response (e.g., Tell me about this picture., What does

this remind you of?, Tell me whats happening.)A. If the response is correct*, the clinician moves to Step 2.

B. If there is no or an incorrect response, the clinician models two response options (e.g., Youcould say something likenoun phrase [NP] or verb phrase [VP].) If the response is correct, the

clinician moves to Step 2.

C. If there is no or an incorrect response, the clinician models a one-word response and requests a

repetition (e.g., Say noun. or Say verb.) If the response is correct, the clinician moves to Step 2.D. If there is no or an incorrect response, the clinician uses integral stimulation, with a maximum of

4 attempts, to elicit the noun or verb production. If the response is correct, the clinician moves to Step

2. In the event of an incorrect or no response, the next item is presented.

2. The clinician models and reinforces the participants production from Step 1 (e.g., Shoe. Great.

Thats a shoe.)

3. The clinician requests an elaboration of the response from Step #1 (e.g., Whats happening with the

shoe?)

A. If the response is correct, the clinician moves to Step 4.

B. If there is no or an incorrect response, the clinician models two response options (e.g., Youcould say something likenoun phrase [NP] or verb phrase [VP].) and requested a response. If the

response is correct, the clinician moves to Step 4.

C. If there is no or an incorrect response, the clinician models a one-word response and requests arepetition (e.g., Say noun. or Say verb.) If the response is correct, the clinician moves to Step 4.

D. If there is no or an incorrect response, the clinician uses integral stimulation, with a maximum of

4 attempts, to elicit the noun or verb production. If the response is correct, the clinician moves to Step4. In the event of an incorrect or no response, the next item is presented.

4. The clinician reinforces the production from Step 3 and models a phrase/sentence that combines the

participants productions from Steps 1 and 3 (e.g., Right, tie. Tie shoe.)

5. The clinician models the combined production again and requests a repetition.A. If the response is correct, the clinician requests 3 more productions, using integral stimulation as

needed. The clinician moves to Step 6.

B. If there is an incorrect or no response, the clinician attempts to elicit 4 productions of the target,using integral stimulation. The clinician moves to Step 6.

6. The clinician removes the picture, waits for at least 5 seconds, returns the picture and requests that theparticipant again describe the picture.

A. If the entire** elaborated response is produced, the clinician reinforces the production and moves

to the next item.

B. If a partial elaborated response is produced, the clinician reinforces the production, models the

entire elaboration, and requests a production with integral stimulation. The clinician then moves tothe next item.

C. If no response, the clinician reinforces the production, models the entire elaboration, and requestsa production with integral stimulation. The clinician then moves to the next item.D. If an alternate correct response is produced, the clinician reinforces the production and moves to

the next item.

* any appropriate, intelligible, noun, pronoun, verb, adjective, adverb, or preposition; not perseverative,

stereotypic, or reiterative utterances

** omission of functors is not considered incorrect


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Acknowledgement:

All of the preceding research was supported by Rehabilitation Research and Development, Department of

Veterans Affairs

Correspondence:

Julie Wambaugh, Ph.D.151 A500 Foothill Blvd.

SLC, UT 84148

[email protected]

References

Wambaugh, J.L. (2006). Treatment guidelines for apraxia of speech: Lessons for future research.Journal of

Medical Speech-Language Pathology, 14(4), 317-321.Mauszycki, S. & Wambaugh, J.L. (2006). Perceptual analysis of consonant production in multisyllabic

words in apraxia of speech: A comparison across repeated sampling times.Journal of Medical

Speech-Language Pathology, 14(4), 263-267.Wambaugh, J.L., Duffy, J.R., McNeil, M.R., Robin, D.A., & Rogers, M.(2006). Treatment guidelines for

acquired apraxia of speech: A synthesis and evaluation of the evidence.Journal of Medical SpeechLanguage Pathology, 14(2), xv-xxxiii.

Wambaugh, J.L., Duffy, J.R., McNeil, M.R., Robin, D.A., & Rogers, M.(2006). Treatment guidelines for

acquired apraxia of speech: Treatment descriptions and recommendations.Journal of Medical Speech

Language Pathology, 14(2),xxxv-ixvii.

Wambaugh, J.L. (2004). Stimulus generalization effects of sound production treatment for apraxia of

speech.Medical Journal of Speech Language Pathology, 12(2), 77-97.

Wambaugh, J.L., & Nessler, C. (2004). Modification of Sound Production Treatment for aphasia:Generalization effects.Aphasiology, 18(5//6/7), 407-427.

Wambaugh, J.L. (2002). A summary of treatments for apraxia of speech and review of replicated

approaches. Seminars in Speech and Language, 23(4), 293-308.Wambaugh, J.L. (2001). Sound production treatment for apraxia of speech.ASHA SID-2 Newsletter, 11(4),

9-13.

Wambaugh, J.L., Martinez, A.L., & Alegre, M. (2001). Qualitative changes following application ofmodified response elaboration training with apraxic-aphasic speakers.Aphasiology, 15(10/11), 965-976.

McNeil, M.R., Doyle, P.J., & Wambaugh, J.L. (2000). Apraxia of speech: A treatable disorder of motor

planning and programming. In L.Gonzalez-Rothi, L.Crosson, and S. Nadeau (Eds.)Aphasia and

language: Theory to practice. Guilford Pub., Inc.Wambaugh, J.L., & Martinez, A.L. (2000). Effects of rate and rhythm control treatment on consonant

production accuracy in apraxia of speech.Aphasiology, 14, 851-871.

Wambaugh, J.L., & Martinez, A.L. (2000). Effects of modified response elaboration training with apraxicand aphasic speakers. Aphasiology, 5/6, 603-617.

Wambaugh, J.L., Martinez, A.L., McNeil, M.R., & Rogers, M. (1999). Sound production treatment for

apraxia of speech: Overgeneralization and maintenance effects.Aphasiology, 9-11, 821-837.

Wambaugh, J.L., Kalinyak-Fliszar, M.M., West, J.E., & Doyle, P.J. (1998). Effects of treatment for sound

errors in apraxia of speech. Journal of Speech, Language, and Hearing Research, 41, 725-743.Wambaugh, J.L., West, J.E., & Doyle, P.J. (1998). Treatment for apraxia of speech: Effects of targeting

sound groups.Aphasiology, 12, 731-743.

Wambaugh, J.L., & Doyle, P.J. (1994). Treatment for acquired apraxia of speech: A review of efficacy

reports. Clinical Aphasiology, 22, 231-243.

Documents

Wambaugh, Julie-Acquired Apraxia of Speech