Background: The client, T, has been attending speech therapy here at WVU for about three years. She is an 8 year old girl. She has been seen for articulation difficulties. Originally she was mostly unintelligible. Most recently she was working on /tS/, /k/, /g/ and /d3/. When I began treatment she was working on carry-over skills and had graduated from her speech therapy at her school.

Treatment: After some initial base rating it was determined that T had well established carry-over of her sounds and that we should focus solely on maintenance. We see T once a week for fifty minutes. In that time the assistant and I listen for correct articulation of all sounds while focusing on other activities. When we originally focused on her sounds she was 100% over 4 sessions so now we get her conversation in as natural settings as possible and see how her carry over is maintained. In the article, Programming Rapid Generalization of Correct Articulation through Self-Monitoring Procedures by Lynn Kern Koegel , Robert L. Koegel , and Janis Costello Ingham , they discuss the importance of self-monitoring in situations outside of the clinic for generalization and maintenance. This is why we try to use different situations with T, like going outside, or talking on the phone. The above mentioned article was in the Journal of Speech and Hearing Disorders Vol.51 24-32 February 1986.

Semester 2- interesting case

Background: The client, M, has been attending speech therapy here at WVU since last summer. He is a 23 year old graduate student. He complained of not being able to remember how to say multisyllabic words. He was first diagnosed with cluttering because of his fast rate and mumbling words together. After working on his rate and passing several cluttering diagnostic examinations, he was diagnosed with pure apraxia of speech. M will sometimes be able to tell if he is coming up on a word that he will not be able to say it, other times he just struggles with it. He will pronounce the word incorrectly but differently with each try. Sometimes when the word is modeled it can be easier for him to say. He also seems to struggle on where to put the stress on words. This is really giving him difficulty the further along in his academic career he goes.

Treatment: My supervisor and the past clinician were working on repetition of multisyllabic words, both modeled and un-modeled. We try to incorporate words that are relevant to him, such as words that he has to use often when presenting and teaching. This approach is based on the basic principals of neuroplasticity, stating that repetition can help in developing speech in motor disorders. The latest issue of the Journal of Speech Language and Hearing has an excellent article: Translating Principles of Neural Plasticity Into Research on Speech Motor Control Recovery and Rehabilitation. By: Ludlow, Christy L.; Hoit, Jeannette; Kent, Raymond; Ramig, Lorraine O.; Shrivastav, Rahul; Strand, Edythe; Yorkston, Kathryn; Sapienza, Christine M.. Journal of Speech, Language & Hearing Research, Feb2008, Vol. 51 Issue 1, pS240-S258, 19p; (AN 28774003). This article describes neroplasticity and specifically applies it to motor disorders. It can be a bit monotonous, but it is proven to work.

Effectiveness: I am only in my second session with M. He is optimistic and very willing to put forth the effort to make a difference in his speech.