Efficacy of the SATPAC Approach for remediating

persistent /s/ errors

Stephen Sacks, M.A., CCC-SLP SATPAC Speech, Fresno, CA

&

Peter Flipsen Jr., Ph.D., S-LP(C), CCC-SLP Pacific University, Forest Grove, OR

Disclosure-Stephen Sacks

Financial:

• Owner and Developer of SATPAC Speech and receives royalty payments.

• Receives royalty payments from Marshalla Speech & Language.

• Consultant for the Bureau of Education & Research and receives honorarium compensation.

Nonfinancial:

• Board Member of the Oral Motor Institute

Disclosure – Peter Flipsen Jr.

• No financial or non-financial conflicts to report

Outline

• What are persistent speech errors?

• Current approaches to treatment

• The SATPAC Approach

• Study design and results

• Discussion

• Questions

Persistent Speech Errors

• Frequently encountered on school caseloads

• Mild distortions of /s, z, r, l/.

• Hard to justify more than limited treatment.

• Minimal impact on intelligibility?

• Usually little impact on academics?

• Have proven difficult to correct with traditional methods

• Ingrained bad habits?

Management Options?

• Traditional therapy but more Tx time?

• Unlikely; no more time available

• Ignore?

• Probably not a good idea.

• Negative peer reactions

• See Crowe Hall (1991), Madison & Gerlitz (1991), & Silverman & Paulus (1989).

• Reduced adult expectations

• See Overby et al. (2007) & Lass et al. (1988)

• Possible increased risk of emotional and behavioral problems

• See Beitchman et al. (1986)

Management Options?

• Modify the therapy sequence?

• Concurrent task sequencing (Skelton, 2004).

• Relatively unstudied so far.

• Modify feedback?

• Electropalatography?

• Still somewhat expensive and requires considerable training

• Spectrograms? Ultrasound? Speech Buddies?

• All relatively unstudied.

The SATPAC Approach• Systematic Articulation Training Program Accessing Computers.

• www.satpac.com

• Combines the use of:

• 1. Non-words based on facilitating contexts (with transition to real words)

• Helps get around ingrained bad habits, and

• Takes advantage of coarticulation

• 2. Computer generated stimulus lists

• Progressively move through ever more challenging contexts, and

• Avoid other error sounds that may interfere or are not in the student’s repertoire.

• 3. Practice at normal (or near-normal) speaking rate

• Avoids odd prosody, and

• Promotes normal motor planning, and

• Promotes generalization from an early stage

Multimodality Approach

to /s/ Remediation

Use of /t/ Sound (and other unusual things)

• /s/ is not mentioned

• Mouth is open which is not normal for /t/ (but only temporarily)

Use of an Auditory Visual Model to Contrast

Correct/Incorrect “EET”Production

Use an Applicator Stick for Visual Tactile

Feedback(EE-point)

Tongue Tip Pointing forVisual, Tactile-Kinesthetic

Feedback

page 33

Tongue Pops forVisual, Tactile-Kinesthetic

Feedback

EE Point Tip forVisual, Tactile-Kinesthetic

Feedback

Tongue, Lips and Jaw Differentiation

EET for Auditory, Tactile-Kinesthetic

Feedback

KF Second Session

EETS for Auditory, Tactile-Kinesthetic

Feedback

The French/t/

page35

Systematic Articulation Training Program Accessing Computers

SATPAC Procedure Checklist-Establishment Phase

Practice Phase-Criteria for Completion

80%+ accuracy on the first 4 lists @ 140 BPM

80%+ accuracy on List 5 at a normal conversational rate with no slowing down on the target sound

Practice Phase-Lists 1 and 2

Practice Phase Lists 1 and 2

Practice Phase-Lists 3 and 4

Practice Phase Lists 3 and 4

Practice Phase-List 5

Practice Phase List 5Contrastive Stress

Generalization/Transfer Phase

Generalization/Transfer Phase

TALLY COUNTER

Generalization/Transfer Phase Phrases

Generalization/Transfer Phase Short Sentences

Generalization/Transfer Phase Sentences

Generalization/Transfer Phase Short Contrasts

Generalization/Transfer Phase Contrasts

Current Study

• Sacks, Flipsen, & Neils-Strunjas (in press) revealed significant improvement in persistent /s/ with the SATPAC approach when administered by the first author (who is also the program designer).

• Attempting to replicate using other clinicians trained in the approach.

• Between groups alternating treatments design

• Measure baseline performance, treat group 1 while group 2 waits.

• Then measure performance on both and treat group 2 while group 1 waits

• Measure both groups again and re-measure after an additional 12 weeks to check for maintenance.

Participants• 13 children recruited from two public schools.

• 7 males; 6 females – initial age 6;11 to 8;8 (Mean = 7;11)

• No previous speech or language treatment rec’d.

• 8/13 monolingual English speakers; 5/13 bilingual but English dominant.

• All presented with either dentalized or interdental versions of /s,z/

• Dentalized = sounds distorted

• Interdental = may or may not sound distorted but looks atypical

Progress Measures

• Measured production accuracy of /s/ in:

• 1. CPAC /s/ probe (words and sentences; Secord & Shine), and

• 2. conversational speech

• Allowed for measurement of performance in the structured context of therapy and to monitor generalization.

CPAC /s/ Probe

Treatment Plan

• Participants randomly assigned to two groups

• Group 1 (n=7) included 5M; 2 F; ranged in age from 6;11 to 8;8

• Group 2 (n=6) included 2M; 4 F; ranged in age from 7;5 to 8;3

• No significant age difference

• Individual treatment sessions by 2 clinicians who were trained on the approach

• Focus only on /s/

• Each clinician saw about half the children in each group

• 12 weeks of treatment; 1 X 15 minute session per week = 180 minutes of total treatment.

• 180 total minutes of therapy.

Observations about Treatment

• Variation between SLPs

• One SLP administered the program more faithfully than the other and consequently showed significantly better results (7/8 90%+ in conversation vs. 2/5 90%+ when study was completed).

• All completed Tx but 3 (2 from Group 1) moved at the end of the school year and were no longer available at follow-up.

• Net result: missing any follow-up data for 1 participant.

Group Results (CPAC probe)

Time periodTx Group

432121212121

90

80

70

60

50

40

30

20

10

0

CPA

C M

n %

12

Tx Group

Change in CPAC / s/ Accuracy over Time

Group Results (Conversational Speech)

Time periodTx Group

432121212121

70

60

50

40

30

20

10

0

Conv

Mn %

12

Tx Group

Change in Conversational / s/ Accuracy over Time

Individual Results• Not all participants achieved the same results

• 6/12 (3 from each group) followed an “ideal” pattern.

• Saw change on both measures immediately after therapy and it was maintained at follow-up.

time

Y-D

ata

% Correct / s/ over TimeParticipant = AG

time

Y-D

ata

% Correct / s/ over TimeParticipant = JH

Individual Results• “Delayed” generalization?

• 1/12 showed immediate change after treatment on CPAC probe but no generalization to conversation until follow-up.

• 1/12 showed gradual change over time on CPAC probe but no change in conversation until 24 weeks post-treatment.

time

Y-D

ata

% Correct / s/ over TimeParticipant = PJ

time

Y-D

ata

% Correct / s/ over TimeParticipant = AS

Individual Results

• At least one participant showed gradual improvement to acceptable levels by initial follow-up but regressed at 24 week follow-up

time

Y-D

ata

% Correct / s/ over TimeParticipant = TT

Individual Results• 3/12 participants showed little or no change in one or both

measures.

time

Y-D

ata

% Correct / s/ over TimeParticipant = EL

time

Y-D

ata

% Correct / s/ over TimeParticipant = SL

time

Y-D

ata

% Correct / s/ over TimeParticipant = EP

Overall Results and Conclusions

• Group results show obvious effects for both the CPAC probe and conversational speech.

• Individual results showed obvious signs of improvement for 8/12 participants to acceptable levels of performance on both measures.

• Doesn’t work for everyone.

• With a relatively short treatment period (12 weeks) and relatively brief sessions (15 minutes per week), the SATPAC Approach appeared to be effective at correcting persistent /s/ errors.

Future Directions• Need to determine efficacy with other errors (/r/, /l/).

• Need to evaluate whether each component is absolutely necessary.

• E.g., are the specific “establishment” procedures necessary or can any technique to establish good /s/ work?

• E.g., how crucial are the nonsense stimuli?

• Need to determine why some don’t respond to the therapy.

Questions?