- Most often used on individuals w/nonfluent aphasia
- Exploits melodic abilities of right hemisphere in persons w/nonfluent aphasia
- Incorporates integral stimulation, repetition, gradual fading of cues, and enforced delays.
Melodic Intonation Therapy (MIT)
*Need relatively preserved comprehension & self-monitoring skills
- For acquired AOS
- Goal: to help reestablish the appropriate placement, manner, voicing, and sequencing of movements required for production of sounds.
- Articulatory-kinetic treatment that combines modeling-repetition, minimal contrast practice, integral stimulation, articulatory placement cueing, repeated practice, and verbal feedback
Sound Production Treatment/ Minimal Contrast Treatment
Four Steps in this approach:
- Ask client to imitate clinician w/target sound
- Present orthographic symbol, say target word, and then ask client to repeat target word.
- Use integral stimulation to elicit target word up to three times.
- Offer articulatory placement cues, and then request production of target word.
Sound Production Treatment (minimal contrast treatment)
- For patients who perseverate.
- Used for patients with aphasia with nonfluent speech.
- Uses “key word technique” - uses words that a patent can say accurately & automatically and has them repeat those words in hopes of the patient gaining volitional control.
- Focuses on words the patient produces involuntarily in hopes to bring them under voluntary control.
a. Identify any real words used.
b. Use word in an oral reading task.
c. Create list of words used voluntarily, even those based on errors.
d. use emotionally laden words.
Voluntary Control of Involuntary Utterances (VCIU)
- A multi-sensory approach in which visual, auditory, tactile, and movement cues are given.
- In order to administer this approach, the clinician must be certified as well as submit a video to the __ Institute; there can also be no modifications to the approach.
- Populations: AOS, aphasia, ASD, CP, speech sound disorders, CAS, artic disorders, phonological disorders, voice and fluency disorders, mild-mod hearing loss, feeding disorders, dysarthria, & Down Syndrome.
PROMPT Approach
- Used for AOS
- Uses nonspeech activities to facilitate speech; takes nonspeech behavior & pairs it with a speech act.
- Theory: use nonspeech activities to reorganize cortical processes associated w/the programming and execution of speech movement. Hopes that programming a certain activity in the brain may “spread out” in the cerebral space & affect other movements being programmed.
- Pairs speech w/gestures, rate/rhythm techniques (e.g., pacing boards), and vibrotactile stimulation.
- Attempts to provide guidance for speech movements in terms of accuracy and pacing.
Intersystemic Reorganization
- A form of oral motor/placement therapy
- Hierarchy of 12 or 14 horns, each identified to target specific muscles and production of specific phonemes.
- Can be used w/clients of all ages & different disorders.
- Artic disorders, phonological disorders, mild-mod hearing loss, feeding disorders, apraxia, dysarthria, CP, & Down Syndrome.
Horn Therapy
- Heavily involves integral stimulation
- For people with AOS
- Highlights visual and auditory models of treatment, along with imitation (“listen to me, watch me, do what I do”)
- Targeted words & phrases should be functional to the client.
- employ integral stimulation
- integral stim is employed + delayed production from client (clinician provides verbal model and then clinician mouths the utterance but fades the auditory cue)
- integral stim & delayed production occur; client repeats utterance with no visual cues this time.
- integral stim is employed along with successive productions from the client; clinician provides an utterance once and the client must repeat it multiple times without any cues.
- written stimuli of the utterance are given and simultaneous production occurs.
- written stimuli of utterance are given w/delayed production of utterance.
- Appropriate utterance is elicited through question; clinician now provides conditions so the target utterance is used volitionally as the appropriate response to a question.
- 8. The clinician targets the appropriate response through a role-playing situation to which the client responds accordingly.
Eight-step continuum
- For people with Parkinson’s disease and aphasia
- Based on the theory that singing is a multimodal activity that involves the integration of auditory and sensorimotor processes.
- Singing & speaking share the common elements of frequency, frequency range, rhythm or rate, intensity, & diction.
- Social support and building community improves QOL and enhances mood.
Therapeutic Singing
-For people with hypokinetic dysarthria (affects motor speech control, respiration, phonation, articulation, & esp. voice and prosody)
- Four distinctive elements:
1. Intensity (4 times a week for 1 month)
2. Requirement of high physical effort to increase loudness & vocal fold adduction
3. Focus on respiratory-phonatory effort
4. Focus on increasing sensory awareness of loudness and effort.
Lee Silverman Voice Training (LSVT LOUD)
GOAL: to teach patients with PD to improve functional intelligible oral communication by increasing vocal loudness, accomplished through phonatory effort tasks and respiratory support.
Lee Silverman Voice Training (LSVT LOUD)
-Hopes that the therapeutic application of singing may help to improve the communication potential of persons w/impaired speech.
Therapeutic Singing
A form of oral motor/placement therapy
Horn therapy
Targeted: improved respiratory support and phonation.
Respiratory issues: inconsistent patterning during longer utterances - problems coordinating language planning w/respiratory support
Phonatory issues: reduced conversational loudness; voice tremors in varying percentages of speakers w/PD
Lee Silverman Voice Training (LSVT LOUD)
-Exploits melodic abilities of right hemisphere in persons w/nonfluent aphasia
Melodic Intonation Therapy (MIT)
-Articulatory-kinetic treatment that combines modeling-repetition, minimal contrast practice, integral stimulation, articulatory placement cueing, repeated practice, and verbal feedback
Sound Production Treatment/ Minimal Contrast Treatment
-Goal: to help reestablish the appropriate placement, manner, voicing, and sequencing of movements required for production of sounds.
Sound Production Treatment/ Minimal Contrast Treatment
-For patients who perseverate.
Voluntary Control of Involuntary Utterances (VCIU)
-Focuses on words the patient produces involuntarily in hopes to bring them under voluntary control.
Voluntary Control of Involuntary Utterances (VCIU)
-A multi-sensory approach in which visual, auditory, tactile, and movement cues are given.
PROMPT Approach
Which approaches are used primarily for AOS?
- Sound Production Treatment/ Minimal Contrast Treatment
- Intersystemic Reorganization
- Eight-step continuum
- PROMPT approach
Which approach was made for clients with CAS
The Kaufman Approach
Which approach was made for clients with PD?
- Lee Silverman Voice Training (LSVT LOUD)
2. Therapeutic Singing
Which approach was made for clients with aphasia?
- Melodic Intonation Therapy (MIT)
- Voluntary Control of Involuntary Utterances
- PROMPT approach
- Therapeutic singing
