Technique to increase self-monitoring skills

Many children with articulation problems have an underdeveloped auditory feedback mechanism thus it makes it hard for them to "hear" the difference in their speech to know correct from incorrect (distortions).

The palatometer provides another modality "the visual" modality to facilitate the underdeveloped self-monitoring process.

Here is a simple technique.

1. Record the child or adult saying a word three times in a row. Save the recording.

2. Play back the recording and have the client listen to each word again and judge each word by putting a mark on a written visual acoustic arrow as to how close to the correct target they were or how far from the correct target sound they were.

3, Then go back find the worst sound display and click through the visual display/target sound to see what went on, do the same clicking process of the display with the correct target sound.

4. Let the child tell you what happened. One mother said "I really don't believe HE can hear the difference" and the child said, " I sound the same as all the other kids not in speech." After going through the visual check of each sound, he said "I didn't get to a correct /s/ placement and it went into a different position which was incorrect placement for 3 msec., while the other good /s was held in the correct placement for 4 msec." He liked to use numbers. Wow, he was totally accurate with the description after visually seeing the difference once. After this process, he self-corrected incorrect /s/ words two times in a row in his connected speech. His mom just smiled big at him and he smiled back. He realized he made the correct adjustment and carryover from what he had just learned.

A video display of this techniques is coming soon.

correct Swallow palatogram video

One of the major goals for correcting tongue thrust is to

establish and maintain correct swallow with liquids and foods.

Here is a new demonstration video of using the palatometer

system to teach tongue placement for correct swallowing pattern.

EVIDENCE-BASED THERAPY

Therapists often want to provide the best evidence based therapy possible, but does it always translate into evidence based-results across all therapists?

There is no doubt that using the palatometer system provides such evidence based-results. Further more, using the palatomater system, could even -out the playing field for most therapists.

I'm kicking myself because I should have taken photos of before and after results of several tongue thrust clients that came in with occlusion gaps, ( even after two years of braces because of their tongue thrust problem.) This is a good lesson to be learned; take the time to snap a before and after client photo with dates.

The results were truly amazing. Only after ten sessions (5 weeks) the client's occlusion was beautifully fixed as well as his tongue thrust and speech. It's hard to put into words the sheer joy that comes over you, when your clients make tremendous progress. It's that kind of progress that all therapists dream of for their clients, but was made into reality with the palatometer technology.

PALATOGRAM DISPLAY

                 "agah"                                       "akah"

Notice the back two lines of the mouth, the /g/ has more contact points than /k/, that is really the only difference.

These are rough samples, not perfect samples.

Children who front their /k, g/ sounds often substitute /t, d/ for the back sounds. I have noticed that they often have very strong tongue tips, but somewhat uncoordinated muscles in regards to separating out tongue movement from jaw, lip or head movements.  There are many strong opinions in the speech profession about whether this disorder would fall under articulation or phonological processes.  I will take the stand on this situation as being a placement issues from my observations.  If you want to read up on both sides of the issue go to ASHA.org website.

This brings us to HOW do therapists teach young clients to separate each mouth part yet teach the correct target sounds.  Try having the client say a few words like " take, cat, mac,  mickey,"  if all the Ks sound like /t/,  most therapists cringe because they know they have their work cut out for them. Another hot debate is whether or not to use some oral motor exercises when teaching correct articulation.  I'm with the mindset that you can use simple oral motor exercises briefly to help with placement and manner,  but not to use them beyond their scope of utility.

I discovered a few good simple steps from close observation of clients and the assistance of the great palatometer displays. The amazing part was that I was able to see a client's progress from incorrect to correct placement in just three visits, (translated into two weeks) for isolated "K" and in word level. Most therapists without the palatomer technology work on velar sounds for months and months if not up to years.

Here are the steps for teaching correct /K, G/ placement with the palatometer.

1. Teach the client to keep their mouth open by saying "ah"  (***watch out for jaw closure of any degree)

2. Now press a tongue depressor on their tongue tip as they keep their mouth open and say "kah or gah".  (*** watch out that s/he doesn't push the depressor out, because they will).  This simple exercise can be sent home with the depressor, so the child can practice the "kkkkah" sound with the parent as many times as they need to with and without the tongue depressor.

3. Next, have the client make a fricative /k/  like "kkkkah" sound with their mouth open, without moving their jaw closed, or moving their tongue tip up. (***Use a mirror, and s/he may have to hold their jaw still while keeping their mouth wide open)

4. Remember at first, the palatometer display  showed that the client used his tongue tip to make the "kah"  later as they can make the fricative "kkkah" the display will show no contact at all because they will try to make the "kkkah" very far back in the throat where the sensors do not touch. (this is all good !).  When you see no sensors displays, this is great, it also means no tongue tip is being used to get the "kkkah" sound. (Cheer, this is progress)

5. Now you will start shaping that "kkkah"  with k at the end of the word or middle of the word. (like (VCV in sack, or  "ickey"),  notice that their "k" dots will show on the display now, the "K" comes more forward producing a correct "k" sound, with no tongue tip display.  This is the best  because the client can now "see" they are producing the "K" correctly!

If you need to, you can go back through steps 1 to 3 again till the client can say "ickey", or "ick"  or kick"  or  "ake,  or "cake"  use assimilation principle to help facilitate the two "k" sounds.   later you can use font and back sounds in the word like pick, tick, pack, tack,  but don't do this right away since they may revert back to fronting the /k, g/ to  /t, d/.  Wait on proceeding to harder words till the "K, G' is will established. 

 Three cheers for the Palatometer Technology!!! 

 

 

Progress from word, phrase, to sentences

Client E: Practicing /S/ sentences

Client E, came in three times per week, total 10 sessions

Came in with lisp, and strong tongue thrust

causing a gap between her teeth.

She is practicing /s/ production in sentence

level. She is in her third week and re mediated

all target sounds, established and maintained correct tongue

rest position and swallow with all liquids and foods

ARTICULATION THERAPY WITH THE PALATOMETER SYSTEM

5-minute practice on

word and phrase level

Therapy session in action

with split-screen display.

Denture Paste Use, and more Aug 2009 lesson

Denture Paste Use

I used denture grip paste to keep smartpalate in place with a child who had nubs for teeth. Don't use too much or too little denture paste, it can cause problems. If it falls out after 10 or 20 seconds, just put it back in the mouth and gently hold for another 10 seconds. Usually it take hold. The client can practice chasing dots with the "Tongue Coordination" game while the paste is setting up.

Children with tongue tied issues, should get it resolved first before working with the palatometer system. For others who have tongue tip weakness, You can also work on tongue tip coordination and strengthening for a week or two. This greatly supports therapy production.

Tongue Thrust
The palatometer system has proven to be helpful to remediate tongue thrust of all kinds within 5 + weeks, if seen minimally 10 sessions. If they have tongue thrust and sound errors, therapy time will vary and most likely take up to 20 sessions or so.

Getting placement of sounds is the easy part with the palatometer, getting it to carry over with clients who have apraxia is another matter. Neuro-typical clients do well with catching on to placement and generalizing new skills from word to phrase to sentence level. It still takes time to generalize to conversation.

Optimal Therapy schedule
The optimal therapy amount for success seems to be meeting three times per week for seven weeks, or 2 times per week for ten weeks.

For next summer intensive therapy session, try holding therapy 4 times per week over 5 weeks, this will be better, providing one more week for progress, than what we did this last summer which was 5 days per 4 weeks. Some clients that had multiple issues needed more time.

Hard of Hearing clients
Hard of hearing clients needed to work on more than just palacement, they have resonance issues, and voice issues.
Still work on placement first, then work on " forward focus" (forward airflow)- maybe using the vowel formant software, then work on oral/nasal resonance with the nasometer and visi- pitch for the prosody.

Voice Issues
One voice client improved his articulation and vocal quality with a variety of voice therapy such as Lee Silverman Voice Treatment for clean vocal fold adduction, Many Stemple voice exercises, breathing techniques, and talking through a straw (Titsa Method), which unloaded tension off their vocal folds, and direct digital manipulation of the voice box to increase relaxation around his throat.