1. family and parenting
2. children

Effects of Ar9cula9on Therapy, Such As PROMPT And Minimal Pair Interven9on On Intelligibility For Children With Down Syndrome. Lynzie Thorpe, B.S. & Abbie Olszewski, Ph.D., CCC-­‐SLP University of Nevada, Reno CASE SCENARIO •  I am a graduate student clinician at the University
Nevada, Reno in the field of speech pathology. I am
currently seeing a seven year old client with Down
syndrome. Her goal is to improve speech intelligibility.
I would like to determine the best therapy approach to
implement.
•  I took an articulation class and learned about PROMPT
(Prompts for restructuring oral muscular phonetic
targets) therapy and minimal pair therapy.
•  PROMPT therapy is an approach were clinicians
stimulate their patients’ muscles to produce a phoneme
through touch. Minimal pair therapy, when using it for
articulation strategies, contrasts words that differ by
only one sound to using speech sound discrimination.
•  I am pondering which approach is better for my client.
The purpose of this study is to examine the effects of
articulation intervention on intelligibility in individuals with
Down syndrome.
INTRODUCTION Communication allows human beings to share knowledge, ideas,
and develop meaningful relationships. To be accurately
understood, speech sounds must be appropriately and
developmentally acquired. Individuals with Down syndrome
experience a delay when acquiring speech sounds. If intelligibility
is poor, it may be harder to understand the conveyed message.
Some treatments attempt to increase intelligibility by working on
articulation. One therapy approach is called minimal pair therapy.
Another treatment is prompts for restructuring oral muscular
phonetic targets (PROMPT) therapy, which attempts to increase
intelligibility by physically manipulating the body to articulate the
correct sound.
PICO:
Does Prompts for restructuring oral
muscular phonetic targets (PROMPT)
intervention (I) result in significantly
increased intelligibility, as measured by
increased articulation skills (O), for children
with Down syndrome (P) as compared with
minimal pair therapy (C)?
METHODS Search Terms: Down syndrome, PROMPT therapy, minimal
pair therapy, intelligibility, articulation and speech sound
disorders and speech.
Databases: ERIC, PubMed, PsychInfo, Google Scholar
Rating System: Critical Appraisal of Treatment Evidence
(CATE form) was used to appraise validity and clinical
significance with interrater reliability,15 point rating scale, 10
articles.
Articles: 5 articles were chosen to help with EBP decision used
and each study had an average score of 88% for interrater
reliability. Limited research was found on the Down syndrome
population with PROMPT and minimal pair interventions,
however, enough research was gathered to make an informed
decision based on the PICO question.
DISCUSSION External Evidence:
•  PROMPT therapy was successful in generalizing increased
correct productions in individuals with speech sound disorders
(Kadis et al., 2014), while minimal pair therapy lead to increased
performance in discrimination (Mildner, Sindja, & Zrinski, 2006).
§  Both therapies lead to increased intelligibility.
§  Children with Down syndrome had significant improvement in
speech articulation (Bysterveldt, Gillon, & Foster-Cohen, 2009)
of single words after short intervention so this population would
benefit from speech therapy.
Evidence internal to the client: My client is easily frustrated when
she is not understood and desires to improve her communication. As
a graduate clinician, I feel like she would most benefit from
PROMPT therapy.
Evidence internal to clinical practice: While both therapies lead to
significant improvement, PROMPT shows the most efficient effects
for correcting speech sound errors and increasing intelligibility. With
correct training, I would feel comfortable implementing this therapy
to my client with low intelligibility due to speech sound errors.
Bysterveldt, K.A., Gillon, G., & Foster-Cohen, S. (2009). Integrated speech and
children with Down Syndrome.
phonological awareness intervention for pre-school
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Kadis, D., Goshulak, D., Namasivyam A.,Pukonen, M., Kroll, R., Nil, L…Lerch, J. (2013).
Cortical thickness in children receiving intensive therapy for idiopathic apraxia of speech.
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RESULTS Study Research Design Purpose Par9cipants Dependent Variable Results Integrated speech and phonological awareness interven9on for pre-­‐school children with Down syndrome Bysterveldt, Gillon, & Cohen (2010). MulMple single-­‐subject InvesMgate the effecMveness of an integrated intervenMon approach which included: Speech, leTer knowledge and phonological awareness development of 10 pre-­‐school children with Down syndrome. N=10 •  Children with Down Syndrome •  Ages 4;4-­‐5;5 •  Gender was not revealed Speech Significant treatment effects on all 10 parMcipants: Speech •  StaMsMcal differences were found on trained but did not generalize to untrained targets (p > 0.1). Significant improvements in the speech arMculaMon of single-­‐words. LeNer Knowledge •  StaMsMcally significant relaMonships between iniMal phoneme idenMty (p < 0.001) and iniMal phoneme idenMty with words (p = 0.05). N=72 •  Children with SSD (n=36) and TDS (n=36) •  Ages 3, 4, & 5 •  Gender was not disclosed Intelligibility Correct ProducMons of minimally contrasMve words Intelligibility •  Significantly lower for SSD group compared with TDS group (p < 0.001). N=28 •  Children with idiopathic apraxia of speech (n=14) and typically developing children (n=14): CorMcal thickness changes Speech Assessments Cor9cal thickness changes •  Significant thinning in the posterior temporal gyrus (Wernicke’s) (p < 0.05). Speech Assessments •  Significant gains were made on all speech measures (p < 0.05). •  Decreasing thickness in Wernicke’s not correlated to speech measures (p > 0.05). Vowels •  CI children performed significantly beTer than HA children (p < .05). Consonants •  CI children performed significantly beTer than HA group ( p < .01). This study seeks to answer two quesMons: •  How successful are young children with typically developing speech (TDS) and children with speech sound disorders (SSD) at making monosyllabic words that are minimally contrasMve? •  Does relaMve success in making these words idenMfiable predict children’s intelligibility scores on a speech sample? Cor9cal thickness in children Assess corMcal thickness receiving intensive therapy for correlates of idiopathic verbal idiopathic apraxia of speech apraxia in childhood and characterize changes in corMcal Kadis, Goshulak, Namasivayam, thickness associated with Pukonen, Kroll, Nil, Pang & parMcipaMon in PROMPT Lerch (2014). therapy. Quasi-­‐Experimental Minimal pair dis9nc9ons and intelligibility in preschool children with and without speech sound disorders Hodge & Gotzke (2011). Quasi-­‐Experimental Speech percep9on of children with cochlear implants and children with tradi9onal hearing aids Mildner, Singija & Zrinski (2006). The aim of the study was to analyze the percepMon of speech in children with cochlear implants (CI) and compare it with the percepMon of children using tradiMonal hearing aids (HA). A minimal-­‐pair discriminaMon task was used as sMmuli. LeTer knowledge and phonological awareness •  Ages 3.9-­‐6.6 •  17 males and 11 females N=49 •  Children with cochlear implants (n=29) and children with hearing aids (n=20) •  Age not disclosed Quasi-­‐Experimental •  29 girls and 20 boys Rela9onship between speech InvesMgate the impact of speech N=12 motor control and speech motor issues on the speech •  Children with moderate intelligibility in children with intelligibility of children with to profound speech speech sound disorders moderate to severe SSDs within sound disorders the context of the PROMPT Narasivayam, Pukonen, intervenMon approach. •  Ages 3;11-­‐ 6;7 Goshulak, Yu, Kadis, Kroll, Pang & Nil (2013). •  9 boys and 3 girls Quasi-­‐Experimental Vowels Consonants Verbal Motor ProducMon Assessment for Children (VMPAC): •  Focal Oro-­‐Motor Control (FOC) •  Sequencing (SEQ) Goldman Fristoe Test of ArMc (GFTA-­‐2) Children’s Speech Intelligibility Measure (CSIM) Correct Produc9on •  SSD group had significantly lower producMons than TDS group (p < 0.001). FOC VMPAC-­‐FOC: p = 0.0001 SEQ •  VMPAC-­‐SEQ: p = 0.011 Goldman Fristoe Test of Ar9c •  No significant changes despite large effect size (d > 0.8) CSIM •  p = 0001