Author: Alyssa Banotai

Ahierarchical treatment process that incorporates elements of phonological processing and motor speech targets has evolved to become an effective tool for treating patients with apraxia of speech (AOS).

Sound Production Treatment (SPT) is a five-step approach developed by Julie Wambaugh, PhD, CCC-SLP, and colleagues at the VA Salt Lake City Healthcare System and VA Pittsburgh Healthcare System.1-3It was based on an earlier eight-step continuum developed by John Rosenbek, PhD, CCC-SLP, of the University of Florida in Gainesville and colleagues.4Dr. Wambaugh’s interest in phonological processing led her to incorporate minimal pair treatment into the hierarchy she and her colleagues developed in the early 1990s.

“We used integral stimulation, modeling and articulatory placement instructions and combined it with minimal pairs treatment,” she told ADVANCE. “At the time we still weren’t quite clear as a research discipline whether apraxia of speech was only a motor speech disorder or if there were some phonological aspects to it.”

Since that time, research has indicated that AOS is a motoric, phonetic-level disorder.

The therapy model is response-contingent, so not every patient will complete each step of the hierarchy. “You only use the steps as you need them,” said Dr. Wambaugh, an associate professor at the University of Utah in Salt Lake City and Research Career Scientist with the VA Salt Lake City Healthcare System. “You don’t use every step with every single person with every single attempt.”

The first step of the hierarchy incorporates minimal pairs contrast. If the target sound is produced incorrectly after a verbal model, then the clinician also asks the patient to produce a contrasting minimal pair word. Patients who are unable to complete the first step move onto the second step using a visual cue. The therapist uses a depiction of the written letter to facilitate the patient’s production of a target sound, again in a repetition-modeling paradigm.

The third step incorporates an integral stimulation approach of “watch me, listen to me, say it with me” that was based on Dr. Rosenbek’s research. In the fourth step articulatory placement cueing is used along with modeling. Dr. Wambaugh’s early research sought to determine whether work on one sound through the hierarchy would result in the generalization of improved sound production and articulatory skills as a whole.

“We treated just one sound at a time using single subject experimental designs so we could control the behavior, see the variability, understand what we were doing, and see if there was any generalization,” she explained. The researchers found little generalization across sounds, unless they were closely related to each other, such as /s/ and /sh/.

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