Severe speech sound disorders: an integrated multimodal intervention.

PURPOSE: This study introduces an integrated multimodal intervention (IMI) and examines its effectiveness for the treatment of persistent and severe speech sound disorders (SSD) in young children. The IMI is an activity-based intervention that focuses simultaneously on increasing the quantity of a child's meaningful productions of target words and providing supports to shape the quality of natural speech productions of target sounds by systematically incorporating the full range of each child's communicative repertoire, including augmentative and alternative communication (AAC) systems and natural speech and language. METHOD: A multiple-probe single-subject research design was used to assess the effectiveness of the IMI for 3 boys (ages 4 to 8) with moderate to severe SSD, all of whom used speech-generating AAC. RESULTS: All 3 participants demonstrated an increase in the amount of speech they produced (i.e., quantity) and an increase in the production accuracy of their target speech sounds (i.e., quality). CONCLUSION: This study demonstrated that simultaneously targeting natural speech and AAC speech using an integrated multimodal approach was effective in producing positive changes in both communication and speech production goals. These findings strongly suggest that integrating multimodal speech-generating AAC with traditional speech intervention was effective at supporting natural speech production for these children.

Coordinating voicing onset with articulation: a potential role for sensory cues in shaping phonological distinctions.

In the typical speech of any language, voicing onset and offset are effortlessly coordinated with articulation as part of the intrinsic coordination of sound production. In this paper, we argue that voicing-articulatory coordination patterns could be shaped by sensory feedback during early speech learning and these patterns persist in mature syllable productions. Our experimental results show that voicing onset is closely associated with the peak velocity and peak amplitude of jaw and upper lip movements for VC syllables in adults. This robust coordination in the onset position may function to increase the salience of VC syllables and provide a phonetically natural explanation for vowels to undergo phonological lengthening and to avoid phonological reduction in word-initial onset position.

Treatment of complex regional pain syndrome: functional restoration.

In this review, the authors discuss the development of consensus-based treatment guidelines in 1997. They also synthesize the recommendations of a closed workshop held in Budapest in late 2004 that reexamined these treatment guidelines and made further and more detailed recommendations. They explore and develop the rationale for making functional restoration the pivotal treatment algorithm in the management of complex regional pain syndrome, around which all other treatments, such as psychotherapy, drugs, and interventions, revolve. The authors discuss in detail the process of functional restoration and the modalities appropriate to accomplishing that--specifically, the role of the occupational therapist, physical therapist, recreational therapist, and vocational rehabilitation specialist. Medications, interventions, and psychotherapy will be covered in other sections of this series.