I.M. is doing fantastic in therapy. His accuracy rates have been improving throughout the semester. Therefore, I have been able to increase his goals mostly to the sentence and conversational level. Besides being such a hard little worker, I.M’s parents are very involved. On the days the I.M. doesn’t receive speech therapy his parents work with him on his homework assignments.
Looking back on the semester, I am really proud of how far I.M has come. However, producing the /sh/ phoneme is still a great challenge not only for I.M. but for me. I started by occluding the nostrils. However, this technique is not working due to the placement of tubes into his ears. I.M. could feel the tubes rolling in his ears which caused him to be scared. (Note: I freaked out as well, but Mrs. Haines said there was nothing to be concerned about).
In Dr. Ruscello’s cleft lip and palate class he provided us with a handout discussing treatments of various types of errors such as developmental, obligatory, or compensatory errors. I.M. displays compensatory errors like glottal stops, and nasal snorts. The article suggests the use of a mirror to provide feedback to see whether air is coming out of the mouth or nose. Another feedback technique is the listening tube. I.M. and I are working on the listening tube right now. The listening tube is actually in the shape of a phone where he can hear if he is displaying nasal omission on the /sh/ phoneme.
We only have used the listening tube once in clinic, but I feel this will be more beneficial to do with I.M. to provide feedback as to whether air comes out of his nose or mouth. I.M. got very frustrated with the nasal occlusion, and this type of technique is more like a game for him. We will see how it goes!
References:
Kummer, A. W., Strife,J L., Grau, W. H., Greaghead, N.A. & Lee, L. (1989). The effects of Le Fort I osteotomy with maxillary advancement on articulation, resonance, and velopharyngeal function, Cleft Palate Journal, 26, 193-199.
Trost-Cardamone, J.E. (1990) Speech: Anatomy, physiology, and pathology. In D.A. Kerhnahan & S.W. Rosenstein (Eds), Cleft Lip and Palate (pp. 91-103). Baltimore, MD: Williams & Wilkins.
