Different Approaches to Facilitation of Speech/Communication

Different Approaches to Facilitation of Speech/Communication:

PROMPT
- the systematic manipulation of tactual-kinesthetic-proprioceptive input to oral-motor structures
-muscle movement simulation for speech sounds and timing
-planes of movement for co-articulation and how they coordinate to create speech
-speech, language and social goals considered
-Research continues with subjects with ASD
- physical-sensory aspects of motor performance, cognitive-linguistic and social-emotional aspects

NSOME
-any technique to influence speaking without requiring sound production
-warm-ups to increase blood flow for ease of muscle control, not needed prior to speaking
-influence tongue, lip and jaw resting postures, strength, tone, ROM, and muscle control
-oral motor exercises: sensory stimulation of lips, jaw, soft palate, larynx, and respiratory muscles
-blowing, tongue push-ups, pucker-smile, tongue wags, big smile, tongue-to-nose-to-chin, cheek puffing, blowing kisses, tongue curling
-benefits: tongue elevation, awareness of articulators, tongue and lip strength, lateral tongue movements, jaw stabilization, lip/tongue protrusion, drooling control, VP competence, sucking ability
-not strong research, claimed effectiveness in catalogs selling materials
-teaching the parts does not help the whole/ doesn’t assist in speech development, more effective to train the whole
-strength/force measurement not always objective although there are several objective measures
-may not strengthen articulator strength, to improve articulation stimulation must be done with pertinent actions, an end goal expectation and integration of abilities
-articulatory strength is very low compared to the oral motor strength for feeding, swallowing, sucking, breathing (same structures/different functions);breathing for speech is different than for any other activity as one example
-context is important for possible skill transference
-teaching isolated motions may not lead to speech according to evidence, speech is improved through practicing speaking in the context
-studies show motions activate different parts of the brain than speech movements

The Denver Model
-developmental
-intensive teaching, specific teaching approach
-develop social-communication skills
-skill building
-affective connection, relationship building, understanding emotional exchanges
-understanding communication
-inclusive setting in a group, used to be center based, recommended one-on-one for the ASD population
-start early to prevent confounding effects of ASD
-family based, families choose objectives
-individualized
-will consider using other techniques in addition such as ABA, PROMPT, imitation/symbolic play, pragmatics,
-teach peer play, imitation- nonverbal communication, receptive language/understanding, games, pretend play for social interaction
-use of puppets and dolls
-dialogs/play scripts so they know what to do when playing, ex. turn taking
-verbal

ABA/Verbal Behavior
-analyzing the function of the behavior: to get something or avoid something, behavior analysis-antecedent, behavior, consequence, function
-direct instruction, DTT, precision teaching, verbal behavior (uses student motivation to teach language skills, determine the function of language based upon the student’s use of words, signs, or pictures)
-teach basic communication and language skills
-immediate feedback
-positive reinforcement
-team based
-data collection
-Verbal Behavior can be used with sign, devices nonverbal and verbal communication
-requests, vocabulary and intraverbals are important

Augmentative and Assistive Technology
- high and low tech/aided and unaided (PECS, objects and voice output devices)
-consider developmental level, fine motor abilities
-objects, photographs or line drawings
-purpose or goals of communication
-to support communication, reduce frustration, encourage speech
-total communication- combing several modes of communication such as speech and sign language

PECS (Picture Exchange Communication System)
-modify communication demands making it effective
-exchange pictures for a desired item, answer/respond, comment
-to increase functional communication between a listener and a speaker
-may increase speech

Sign Language
-using gestures of hand signals to communicate
-need to consider the audience, many people may not understand
-family and educational professionals would also need to learn the same gestures, ASL or ESL that are used by the child
-can eliminate frustration
-paired with speech = Total Communication
-need finger isolation/fine motor ability

Facilitated Communication
-for non-speaking population that cannot use sign language or access devices
-a facilitator provides support to the arm, wrist or hand to support their ability to type, point, or use devices
-controversy- typed data may be facilitator driven
-support is faded back as pointing increases
-goal independent communication
-may have an extensive duration

Integral Stimulation Method
-to improve motor planning and processing as speech is acquired
-visual and auditory models
-visual attentions to instructor’s face (“listen to me, watch me, do what I do”)
-bottom up approach
-tactile, gestural and prosodic cueing which is constantly added or faded dependent on progress
-Dynamic Temporal and Tactile cueing (a variation)

Note: not all approaches have been covered.

ABA Forum (2010). Sally Rogers: Intensive Autism Treatment the Denver Way. http://www.abaforum.dk/artikler/2003/sally_rogers.php

Autism-Resources.com(2010)Severe Communication Impairment, Facilitated Communication, and Disclosures of Abuse. http://www.autism-resources.com/papers/severe_communications_impairment

Burkaba, C. (2010). What is Applied Verbal Behavior> http://www.christinaburkaba.com/AVB.htm

Lof, G. (2008). Evidence-Driven Speech Sound Intervention: Alternatives to Nonspeech Motor Exercises. 2008 ASHA Convention, p.1-9.

Miller-Kuhaneck, H. (2004). Autism: A comprehensive Occupational Therapy Approach. 2nd ed. Bethesda, MD: American Occupational Therapy Association, Inc.

Mirenda, P. (July 2003).Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids. Language, Speech, and hearing Services in Schools, V 34, p. 203–216.

Pennsylvania Department of Education.(September 2005). An Introduction to Applied Behavior Analysis. Pennsylvania Depart of Education: bureau of Special Education: Pennsylvania Training and Technical Assistance Association. P. 1-6

The Prompt Institute (2010). History, Mission and Goals. https://promptinstitute.com/index.php?page=history-mission-goals

The PROMPT Institute. (2010). PROPMPT Research. https://promptinstitute.com/index.php?page=prompt-research

Strand, E. (2005). What is the Integral Stimulation Method? How is it used for treating apraxia speech in children? Apraxia-KIDS – A program of the childhood Apraxia of Speech Association (CASNA)

Wikipedia. (2010). Facilitated Communication. http://en.wikipedia.org/wiki/Facilitated_communication

Autism-Resources.com (2010).Severe Communication Impairment, Facilitated Communication, and Disclosures of Abuse. http://www.autism-resources.com/papers/severe_communications_impairment