Title: Visual feedback in speech habilitation: focus on treating r with ultrasound
1Visual feedback in speech habilitation focus on
treating r with ultrasound
- P. Bacsfalvi, PhD, CCC-SLP(C)
- Registered Speech Language Pathologist and
Consultant for Deaf and Hard of Hearing - Washington Speech Language Hearing Association
Convention, - October 11, 2008 Spokane, WA
2My clinical background
- Work history
- Types of clients to date (pilot work and
clinical) - cleft palate, Down syndrome, deaf, persistent
speech disorders, oral motor, ESL - Current work place UBC
- PRP-AO and ultrasound
3Why visual feedback?
4My research background
- Began research 2001
- Pilot study with the collaboration of the Burnaby
School District and UBC - Provincial Oral Prog.- housed at Burnaby South
Secondary - All students were on my caseload and oral deaf
with severe-to-profound hearing loss - Presented our pilot data at Canadian Hard of
Hearing Association Annual Conference in 2001
(CHHA BC) - Student spoke to an audience of over 100
5So why do we care about visual feedback.?
- Cost effective
- Motivating
- Preferred method?
6Motivating for students with persistent speech
disorders
7Motivating for students with severe hearing loss
8Clinical research at UBC
- Main researchers at SASS
- Dr. Penelope Bacsfalvi, SLP (my doctoral
research) - Dr. B. May Bernhardt, SLP, School of Audiology
and Speech Sciences, UBC (my doctoral supervisor) - Masters students Marcy Adler-Bock, Geeta Modha,
Benjamin Perry, Bosko Radanov (all working SLPs
in B.C.) - Community collaborators Susan Fawcett, SLP from
Down Syndrome Research Foundation
9Visual feedback therapy projects to date
- Pilot projects studies have included
- people who are deaf or hard of hearing
- cochlear implant users
- ESL learners
- Cleft palate
- Persistent speech disorders
- Clinical model consultative model
- People with Down Syndrome
- Both adults and children
10A brief history of visual feedback in speech
pathology therapy
11A brief history
- Effective for establishing new phones
- Visual information useful
- Technologies have been used successfully
- Acoustic displays, electropalatography,
glossometry - Dagenais Ertmer Fletcher Gibbon, Hardcastle
Maki, Ruscello, Rvachew Shuster, Ruscello, Toth,
Smith
12History of visual feedback as an intervention tool
- OUTLINE
- Visual feedback has been around a long time
- Abbreviated history to be presented
- Focus on visual feedback used with persons with
hearing loss
13The pitch meter
- Boone (1966)advocated for the use of a pitch
meter - Pitch meter could help the child explore vocal
range - Simple, but effective
14Voiscope
- The Voiscope was studied by Wirz et al. (1979)
- suprasegmental aspects of speech of children with
profound hearing impairments. - displayed pitch patterns (fundamental
frequencies) - compare and copy the teachers productions
- helpful in the modification of air-stream
control, pitch control, pitch movement and rhythm
within an utterance (Wirz et al. 1979).
15First ultrasound investigation for speech (that
we know of)
- Shawker Sonies(1985)used ultrasound biofeedback
in a case study - Do not know if 1-D or 2-D ultrasound was used.
- Success /r/ in single words and in open-ended
sentences with 88 accuracy. - This case study was the beginning to signal
further exploration
16Electropalatography(EPG)
- Another case study targeted a lateral /s/
- Often resistant to traditional speech therapy
treatments - (Gibbon Hardcastle, 1987).
- A programme of four-one hour weekly sessions
- Great success
- a 12-year-old hearing child boy
- mastered /s/ in four weeks after years of
traditional therapy that had not been successful.
17Exploratory study with ultrasound
- Klajman et al. (1988) investigated the
articulatory setting of vowels - majority able to improve their tongue shapes
- Sixteen out of the 21 children partially or
completely matched the teachers target vowels in
one session. - The researchers commented that it was very
important for the instructor to have specific
knowledge of phonetics, and the ability to give
precise help based on this knowledge.
18EPG children with profound hearing impairment
- Fletcher et al. (1991) used EPG to teach
consonants - Following the brief 3-4 week period of daily
therapy, these participants all produced many
more consonants - The authors reported that their training
principles followed some traditional procedures
19US exploratory study of adults tongue movements
with dysarthria
- Keller (1987) used ultrasound to investigate
vertical tongue dorsum movements in several cases
of motor disturbance - identify the control and impairment variables.
- Useful in collecting quantitative information for
speech motor disturbances. -
- important findings included
- variability in movement amplitude and duration
- insufficient coordination in his participants
20EPG adult with unrepaired palatal cleft
- Fletcher (1985) explored the uses of
electropalatography (EPG) for speech production - explored the articulator roles in stops and
fricatives - his findings revealed the speakers compensatory
strategies - gave insight into lingua-palatal contacts of
speech.
21Glossometry Palatometry
- Dagenais(1992) used both glossometry and
palatometry as an adjunct to traditional speech
training - His past studies with visual biofeedback had
resulted in a lack of generalization to
spontaneous speech. - The participants improved on all targeted speech
sounds - The results revealed that visually based speech
training was a viable adjunct to traditional
auditorily based training.
22EPG CleftNet, Scotland
- Gibbon, Stewart, Hardcastle, Crampin(1999)
initiated an EPG network - Four clinic centres across Scotland were set up
with EPG systems and each centre was provided
with a number of portable training units (PTU)
that could be loaned out to clinicians. - At the hub was an EPG specialist, and the PTUs
could be loaned out to the communities where they
were most needed. - The role of the specialists declined
- Extremely successful for children with cleft
palate across the U.K.-see website for more info.
23Visual feedback by the late 1990s
- many speech and language specialists had found
visual biofeedback devices to be useful adjuncts
in speech habilitation - outcomes of investigations were all positive
- most small centres, or centres without a research
institute usually did not have access to these
technologies or therapeutic techniques - goal in the current decade to increase access to
speech technologies in habilitation settings.
24Speech production outcomes case study for a child
with a CI
- One child, long term CI user
- Speech difficult to understand
- Worked with SLP for habilitation on EPG
- Worked primarily on fricatives
- Improvement seen
- Bernhardt, B, Loyst, D., Pichora-Fuller, K.
Williams, R. (2000)
25BALDI
- newer software such as Baldi (Massaro Light,
2004) - based on info. incorporated from various visual
biofeedback devices - Baldi offers all the acoustic information
available in programmes like Speech Viewer,
Dr. Speech and The Rosetta Stone as well as
additional articulatory information from
ultrasound, electropalatography or other such
high-tech instrumentation - allows observation of dynamic articulatory
movements.
26Effectiveness of Baldi
- seven students ages 8 to 13.
- aided hearing threshold levels were all within
the mild-to-moderate range. - Their programme consisted of a computer-animated
talking head (Baldi) - students can view what is happening on the inside
of the mouth and neck. - range of information
27Effectiveness of Baldi 2
- Training was over 21 weeks at twice a week for 45
minutes. - The students worked mostly on their own with
Baldi as their trainer - gains from 23 to 76 accuracy.
- weakness of programme- inability of students to
see what they were doing in comparison to the
model
28Phonological disorders and intervention
29Speech assessment and intervention
- Differences in phonology (speech perception,
representation and production) - The impact of phonological differences (Delay,
Impairment) on life activity and participation - Signs and sources
- Comparison with typically developing norms
30Phonological disorders
- What is it?
- Articulation/speech that is developmentally
different or delayed - Anything else?
31Stats on the impaired comprehension of the sound
system of language
- For 80 of children with phonological disorders,
the disorders are sufficiently severe to require
clinical treatment. - Relationship b/t early phonological disorders and
subsequent reading, writing, spelling and
mathematical abilities - In 2006, 90 of SLPs in schools indicated that
they served individuals with phonolgical/articualt
ion disorders. - From ASHA website, 2008
32Definition of Phonological disorder
- World Health Organization Intl. Classification of
Function - Body Structure anatomical parts of body
- Function- physiological functions of body systems
- Activity- execution of a task by an individual
- Participation in life involvement in life
situation
33Limitations-
- Structure or function limitations in
- Representation of phonetic, handshape form
- Processing of phonetic, handshape form
- Actual articulation of phonetic, handshape form
34Apparent everyday.
- Demonstrated by
- Phonological awareness, literacy delays
(activity) - Speech or sign thats difficult to understand for
age - Withdrawal, difficulty in peer interaction
(participation)
35Age and frequency in hearing population
- 50 of caseloads in health system, schools
- Children with speech impairment- one of the
largest groups with communication difficulty
(Harasty Reed, 1994) - Not just children
- Residual differences can persist into adulthood
- Sibilants, /l/, /r/, flaps, multisyllabic words
(case) - Difficulties as preschoolers may impact
subsequent educational, occupational and social
opportunities throughout life for many people. - Learning new multisyllabic words is challenging
for everyone!
36Frequency of hearing loss
- In the U.S. 31.5 million USers had hearing loss
in 2004 (ASHA) - Of the 1,200,000 hearing impaired individuals in
Canada, 40,000 are profoundly deaf. (BCASLPA)
37Speech issues in children who are DHH
- Many of these children have speech issues
- Most have speech issues due to hearing loss
- Some have concomitant phonological disorders
- Production errors include vowels as well as
consonants
38Treatment for disordered speech
- What do we do about it?
- Behavioural intervention
- Complex, multicomponential process
- Intervention by trained professionals
- Training
- Phonetics
- Phonology
- Neuroanatomy Physiology
- Disordered speech
- Voice Therapy
39ICF incorporates both impairment and social
factors.
- when working with children with speech impairment
- Goals set for these children and their families
must consider life-long communication and
literacy needs
40ICF meta theory
- Assists us in considering all the possibilities
of speech intervention - Correct production of speech sounds
- Intelligible conversational speech
- Enhance childs participation in social
interaction - Increase self-esteem
- Decrease negative societal attitudes
41Persons with structural or functional limitations
in phonology
- Often show signs of difficulty at all
componential levels to some degree!
42Frequently correlated factors?
- Auditory perception issues
- sensorineural loss, (otitis media)
- Oral motor skills for speech movements
- General language deficits, particularly
production - Psychosocial issues chicken or egg
43More severe limitations signs
- Language, oral-motor, hearing, social factors
- Impoverished syllable and word structure
- Chronological mismatch CV, but has /l/ or /r/
- Greater within-word variability than is typical
- More uncommon substitutions or defaults
- nasal snort, dorsal default, continuant WI
default (st), lateral emission, glottal stop
default, ungrooved sibilants beyond second
dentition, clicks for sibilants - Prosody aberrations speech breathing, rate,
rhythm, stress - Limitations in vowel system
- Lack of imitative skills (or for toddlers,
babbling)
44More factors.
- Environmental input
- Word familiarity
- Preference/interests
- Physiological and motor development
- Complexity of sound productions
- Perception
45Case Example Its not that easy to tell.
- Problem or not?
- Therapy or not?
- Parent/Assistant intervention or SLP
intervention? - Challenging goals or less challenging goals?
- In the end efficacy or maturation.
46Red flags for impairment?
- Processes at later stages
- Need to know what is typical to know what is
impaired - Need to know hearing loss profile
- Unusual processes
47And on a related note.Societal attitudes
towards children with speech impairments
- One study noted that a child with a mild speech
impairment (a child who uses /w/ for /r/ was
considered to be - Less talkative
- Can hear less well
- Dysfluent
- Unpleasant to listen to
- Soft
- Boring
- Dull
- More tense
- Nervous
- Afraid
- Handicapped
- Isolated
- Uncomfortable
48Studies from SASS ISRL, University of
British Columbia, Canada
School of Audiology Speech ScienceInterdiscipl
inary Speech Research Lab
49Pilot study Everyday listener study
- In everyday life
- speakers need to communicate with unfamiliar
listeners who have no phonetic training. - through the ears of everyday listeners who were
familiar neither with the speakers nor with
speech disorders.
50Pilot study Background
- Mostly acoustic displays
- Somewhat successful
- Have to infer articulatory and movement patterns
from the display
51Evaluation
- How do we evaluate success/change?
- Severely disordered speech takes more time to
change. - One way is through listener studies
52Method
- 4 high school students (grades 10-12)
- Ages 16-18
- Have had years of speech therapy and training
from TDHH and SLPs - Bilateral severe-to-profound sloping
sensorineural hearing loss - All oral deaf
53Speech profile summary
- Typical of those with significant sensorineural
hearing loss - All had mild hypernasality
- Difficulty with loudness regulation
- 2 had difficulty regulating pitch and
coordinating breath support for speech - Sibilants and liquids were least established
- Tense-lax distinction for vowels was not well
established - Obstruents showed devoicing, particularly word
finally - Often deaspirated initial stops
- Fricatives sometimes produced as stops and vice
versa - Difficulty with sibilants in terms of placement
and air flow - Diphthongs reduced to monophthongs
- And moretypical of speakers with congenital
hearing impairment
54Treatment
- 4 weeks with no technology
- 15 weeks with visual feedback tech.
- Part with EPG and part with U/S
- All student received treatment with both
technologies - Intervention twice a week
- Once with technology
- Once without technology
55Goals included
- Sibilant place contrast
- Liquid place contrast
- Tense-lax vowel contrast with high vowels
56Results Pamela
- Sibilants
- S- improvement word I
- SH- improvement word I/F
- Liquids
- L- improvement word F (had I)
- R- improvement word I/F
- Vowels
- Improvement on two vowels
57Results Purdy
- Sibilants
- S- improvement word I/F
- SH- had alrady
- Liquids
- L- improvement word F (had I)
- R- improvement word I/F
- Vowels
- Improvement on 3/4 vowels
58Results Palmer
- Sibilants
- S- improvement word I/F
- SH- improvement word I/F
- Liquids
- L- improvement word F (had I)
- R- improvement word I/F
- Vowels
- Improvement on 4/4 vowels
59Results Peran
- Sibilants
- S- improvement word I/F
- SH- improvement word I/F
- Liquids
- L- improvement word I/F
- R- improvement word I/F
- Vowels
- Improvement on 1/4 vowels
60Overall
- All demonstrated significant improvement
- Very short term as each goal was worked on for a
few weeks - Need for further studies
- This leads us to.
61My doctoral research
- Focus on visual feedback technologies
- Focus on speech science
- (SLPs you need all your physiology and speech
science training!) - Acoustic correlates of vowels and consonants
- Formant data as corresponds to speech sounds
- Tongue palate contact analysis
- Tongue shape patterns
- Dynamic tongue movement patterns
- Gestural components of speech sounds
- Focus on quality of life issues
- Focus on experiences during and after intervention
62Study 1 Vowel remediation for adolescents with
hearing impairment
- Background
- 8 month olds with HI produce fewer vowel
distinctions than age-matched hearing babies - Dagenais and Critz-Crosby (1992)
- tongue movements and positions for vowels
differed significantly - Less studies on vowel intervention
63Method
- Three 18 year olds
- Oral programme
- Severe-to-profound sensorineural hearing loss
before the age of 26 - Pre-post intervention pilot study
- 6 weeks of treatment
64Treatment
- Twice a week for 6 weeks
- Treatment conducted by 2 SLPs
- One session with ultrasound
- One session without
- Required weekly practice schedule
- Treatment was with both EPG and Ultrasound
65Analysis
- How do objectively measure change?
- Acoustic analysis
- EPG contact target analysis
- Phonetic transcription (fine, not broad)
66Results
- Overall reduced variability for productions in
all three participants - Variability is a hallmark of speech of people who
are DHH - 8 of the 15 vowels showed gains
- All of these students had high frequency loss so
improvement for /i/ for all three is noteworthy - Results revealed that contact pattern changes do
not necessarily imply a change in the acoustic
signal.
67Study 2 Attaining the lingual components of /r/
for three adolescents with cochlear implants
- Background
- Many older children who are recipients of CIs
continue to require speech habilitation - Even years after receiving CIs difficulties with
speech production continues - /r/ is a very challenging speech sound to learn
for hearing and hearing impaired speakers
68Method
- 3 participants
- Severe-to-profound sensorineural hearing loss
- Early onset of hearing loss
- Use of unilateral CI for more than 3 months
- Desire and motivation to improve speech
production - Educational environment with emphasis on oral
approach - Access to speech therapy
69Research design
- Non-concurrent multiple baseline across
participants - Single subject design with
- (a) baseline,
- (b) intervention,
- (c) follow-up
- Componential approach to therapy
70Intervention process
- All students attended weekly 45-60 minute
treatment sessions - All students also received Auditory training to
develop listening skills with a trained SLP or
AUD - Parts of /r/ were trained
71Results
- All three students were able to learn the
gestural components of /r/ - Component level vs. Word level
- more rhotic quality by the end of this study
72Study 3 Long-term outcomes of speech therapy
for seven adolescents with visual feedback
technologies
- Background
- Short term outcomes have been successful
- Need for longer term outcomes
- Evidence based practice is needed to maximize
treatment effectiveness - Need for clinical intervention studies
73Method
- 7 young men and women who had participated in
past studies - All have severe-to-profound sensorineural hearing
loss - Follow-up was 2 to 4 years post intervention
74Study design
- Within subject evaluation
- 7 expert listeners evaluated the speech of one
speaker - Listener evaluation study
- Three sets of data evaluated
- 1. before treatment with visual feedback
- 2. immediately post treatment
- 3. long term follow up post
75Results
- Overall, listeners rated six out of seven
speakers maintained or improved - Goal maintenance or improvement since last
therapy session
76Study 4 A qualitative follow-up of long term
outcomes
- Background
- Long term negative impacts of unintelligible
speech in the life of people with hearing loss
(Takala and Seppala, 1994 Skelton and Valentine,
2003 Blackorby and Wagner, 2007). - Negative effects on
- Interpersonal relationships with family and
friends - Performance in school
- Ability to get jobs
- Ability to participate in society in general
77Beneficial change from treatment
- WHO requirement
- Beneficial change from treatment
- One ultimate goal
- Enhanced social participation
- Increased self esteem
78Understanding the impact of speech therapy
- Past focused only on quantitative results
- Less know about lived experiences
- Qualitative analysis able to illustrate benefits
unavailable from quantitative analysis alone
79Method
- 5 past participants
- 4 stake holders in their lives
- Semi-structured interviews
- Interviews were between 1 and 2 hours
- All interviews conducted in auditory-oral
modality - Questions designed to generate candid
descriptions of experiences
80Analysis method
- Interviews collected over 6 months
- Transcribed verbatim
- Each transcript read several times
- Data were open coded and recoded
- Data were placed into categories and themes
- Constant comparison and contrasting of codes
81Findings
- Most prominent themes
- Good experience
- Therapy method
- New information
- Benefits
- Outcomes Generalization
82Quotes good experience
- I like itit help to talk clearand it helps me
to practice with that (the US). - Another participant explained how unfamiliar
listeners could understand him now.and added-
now I can know how to talk.
83Findings Therapy Method
- A few participants indicated now it had been hard
work, but worth it. - Yes, it was hard before, in the beginning, it
was hard (work)and then it got better and
better, and now it is easy- I like it. - A couple of students also indicated that they
felt this method was more informative than
traditional methods.
84Quotes New Information
- It was helpful to see what happen(s), whats
happeningto show how to do it the right way.
85Findings Benefits
- at the university, that was really important
for me- because this way I could talk with
peoplemake people understand me, like most of
the time- otherwise people dont have time to
(have you) repeat, and try to understand what you
sayagain, againthey get tired. So thats why it
was very important for me, for my life too.
86Quote from a stakeholder
- And now , now he knows it- hes learned it. So,
I think its been really effective, and Im
positive that if you hadnt had this visual
stimulus there for him to see, he would have
given up long before he would have never got
where he got.
87Stakeholder perspective on practice
- Well, I think if it was in, especially at his
school, for an oral deaf person, who is really
working on speech and who really is, you know,
youre really trying to use (speech).I mean,its
not just schooling, its part of their life.
88Parker Age 16 Sensorineural hearing loss,
cochlear implant user
- Severe-to-profound sensorineural hearing loss
since birth. CHARGE syndrome. Attending signing
programme, grade 10. - Slight language delay School SLP, Hearing
Resource Teacher - Participant in ultrasound therapy studies over
the past year - CI 1.5 years ago Understands all conversations
in Aud. only - Difficulty discriminating /r/ - /w/
- Since CI Listening therapy (AVT) and ultrasound
- Current speech status intelligible speech to
naïve listeners - This term /r/ with ultrasound, pitch control,
coordinating voice and speech onset (acoustic
software). Excellent results. - Continued work in pitch control generalization is
needed.
89Speech Therapy process for work with people with
hearing loss
- Most SLPs on the team are offering a combination
speech and listening therapy while using auditory
verbal techniques. - Must be constantly aware of frequency and formant
information - Remember vowels are louder than consonants and
only two consonants approach the mean peak power
of a vowel- r and l, and these sounds develop
later in speech production (Pollack, 1997).
90Other studies on r completed by our lab.
91Study 5 Rural ultrasound project
- Background
- Rural clients have limited access to technology
- Could a consultative model work?
92Rural project
- Thirteen 7 to 15 year olds
- All needed /r/
- All had previous SLP therapy
- Three phases
- No U/S
- 1-3 sessions
- No U/S
- Training of local SLPs on new knowledge
93Results of study
- The group that received 2-3 hours of U/S in
therapy over 3-4 sessions over 2 days improved
more than the group who received 1 tx. with U/S
in a half day session
94Quotes from community SLPs
- Some students had years of unsuccessful therapy
for /r/. Some of these students got a good /r/ in
15 minutes with the ultrasound and an experienced
therapist SLP consultant. - The children in this study really improved- they
are not great at monitoring their speech but Im
very pleased with their ability to make good /r/
sounds when they are focued (good placement).
95Study 6 pilot revealed success for people with
Down Syndrome
- Background
- Most people with D.S. experience some degree of
reduced speech intelligibility - Few speech studies in people with D.S.
- Research has shown learning through the visual
modality is a strength - Effective tool for people in general
- EPG has been shown to be effective for people
with D.S.
96Study design
- Three adult participants
- Teach components of /r/
- Single subject repeated withdrawals design
- Withdrawal of ultrasound
- Revealed rapid loss of newly acquired skills
97Results of study
- Success
- All participants could produce /r/ at the word
level post intervention
98Perspectives to Date
- VF technology Useful adjunct
- New targets established
- A bargain over time
- Easy to interpret
- New phonetics knowledge used now in regular
therapy
99General Discussion
- Visual feedback cannot take the place of
instruction based on knowledge of phonology,
phonetics, voice, anatomy and physiology, etc.
(SLP training)- but it is a tool that will
greatly change the way we practice
100Challenges and questions
- Acoustic or other visual feedback equally useful?
- Need regular therapy for continued generalization
- Cost in the short-term
- Accessibility?
- Need knowledge and equipment!
- Need bigger studies for conclusive evidence based
practice
101Home practice- invaluable
- An important part of therapy- a collaborative
team approach and/or involvement of the family. - A parent, grandparent or older sibling can be
involved. - We have found home practice of achievable targets
without ultrasound invaluable to making progress.
For example one gestural component, such as
tongue root retraction, can be practiced at home.
Practice needs to happen at least every other
day.
102School based practice- invaluable
- What about those families that just cannot seem
to practice? - We found success with the school based team-
- CDAs, OIs, EAs, TDHH, CT
- Team pulled together in the school
- Great success for the student
103Valuable practice in school
- The school team can also be very valuable
- practice with the EA at the school for even 15
minutes a day is a great help. - We have trained teachers, oral interpreters and
education assistants to help with the carry-over
practice sessions - without ultrasound
104Reading the ultrasound
- How to read the ultrasound image
- Is it safe?
105Reading the ultrasound image
- Ultrasound transducer (probe) placed under the
chin - Two perspectives
- Sagittal- tongue root to tip
- Coronal- height of sides or raising in midline
- Two dimensional ultrasound reveal 2-D perspective
- Ultrasound waves collide with the air in the
mouth above the tongues surface and reflect back
to the probe- these digital image are translated
onto the screen
106How safe is ultrasound?
107About r
108What happens in the process-an example with /r/
- Knowledge change
- Clients learn to describe the components of the
target segment. - Acoustics e.g. Lowering of third formant in /r/.
(Another useful tool is Praat). - Tongue shape change (max target) as displayed on
ultrasound - Tongue tip raising
- Tongue body lowering
- Root retraction
- Groove
109A volunteer please.
- Demonstration of ultrasound for therapy
110Additional techniques
- Clay models
- Drawing the tongue shapes
- Facilitation by use of known target
- Velars
- High back vowel
111Therapy Procedure with sample /r/
- Single gt combined movements
- Tip Retroflexed gt bunched Sagittal view
- Tongue root retraction into pharynx
- Sagittal view
- Lateral tongue margins/molar contact
- for bracing, groove Coronal view
- Inhibition of non-target movement
- Excessive labialization Mirror
- Tongue back raising (from w) Sagittal
- Relative advancement of tongue Sagittal
112Clinical cases Lower Mainland School Board
clinical pilots
113MartinCase 1
- Hearing within normal limit
- Above average student in academics
- Now in grade 7
- Artic. Therapy in grade 3 and group therapy in
grades 4 5 - Gave up in grade 6
114(No Transcript)
115Martin Tx. with U/S as adjunct
- -One group tx. session
- -5 individual tx. sessions
- -3.5 months to complete generalisation
- -needed bunched r
- -practiced at home regularly with dad
116RubyCase 2
- Hearing within normal limits
- O.T. ax. inconclusive, mild fine motor delay
- In grade 3 and 4 mild delays in literacy and
phonological awareness - Had received SLP intervention
- Now in grade 6, functioning WNL
117Ruby Tx. with U/S as adjunct
- One group therapy session
- 14 individual sessions
- Timeline
- 2 months to achieve r at word level
- Using r in connected speech after 5 months
- 2 months to achieve k in connected speech
118References P. 1
- BCASLPA (2008). Statistics from Website
www.bcaslpa.ca - ASHA. (2006). 2006 Schools Survey report
Caseload characteristics. Rockville, MD Author. - Bacsfalvi, P. Bernhardt, B.M. Phonology and
Speech Therapy (2008). Guest lecture- March 25,
2008 AUDI 451 School of Audiology and Speech
Science, UBC, Canada - Bacsfalvi, P. Bernhardt, B.M. (2001). The new
speech therapy for people with a hearing loss.
Presentation at CHHA-BC, Richmond, BC. - Bacsfalvi, P., Bernhardt, B.M. and Gick, B.
(2007). Electropalatography and ultrasound in
vowel remediation for adolescents with hearing
impairment. Advances in Speech Language
Pathology, 9(1), 36-45. - Bernhardt, B.M., Bacsfalvi, P, Adler-Bock, M.,
Shimizu, R. Cheney, A., Giesbrecht, N.,
OConnell, M., Sirianni, J., Radanov, B.
(2008). Ultrasound as a visual feedback in speech
habilitation Exploring consultative use in rural
British Columbia, Canada
119References P.2
- Bernhardt, B., Fuller, K., Loyst, D., Williams,
R. (2000). Speech production outcomes before and
after palatometry for a child with a cochlear
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