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Attempts to personalize aphasia treatment to the extent where it is possible to reliably predict individual response to a particular treatment have yielded inconclusive results. The current study aimed to (i) compare the effects of phonologically versus semantically focussed naming treatment and (ii) examine biographical and neuropsychological baseline factors predictive of response to each treatment. One hundred and four individuals with chronic post-stroke aphasia underwent 3 weeks of phonologically focussed treatment and 3 weeks of semantically focussed treatment in an unblinded cross-over design. A linear mixed-effects model was used to compare the effects of treatment type on proportional change in correct naming across groups. Correlational analysis and stepwise regression models were used to examine biographical and neuropsychological predictors of response to phonological and semantic treatment across all participants. Last, chi-square tests were used to explore the association between treatment response and phonological and semantic deficit profiles. Semantically focussed treatment was found to be more effective at the group-level, independently of treatment order (P = 0.041). Overall, milder speech and language impairment predicted good response to semantic treatment (r range: 0.256–0.373) across neuropsychological tasks. The Western Aphasia Battery-Revised Spontaneous Speech score emerged as the strongest predictor of semantic treatment response (R2 = 0.188). Severity of stroke symptoms emerged as the strongest predictor of phonological treatment response (R2 = 0.103). Participants who showed a good response to semantic treatment were more likely to present with fluent speech compared to poor responders (P = 0.005), whereas participants who showed a good response to phonological treatment were more likely to present with apraxia of speech (P = 0.020). These results suggest that semantic treatment may be more beneficial to the improvement of naming performance in aphasia than phonological treatment, at the group-level. In terms of personalized predictors, participants with relatively mild impairments and fluent speech responded better to semantic treatment, while phonological treatment benefitted participants with more severe impairments and apraxia of speech., Kristinsson et al. found superior effects of semantic versus phonological therapy in a group of 104 participants with chronic aphasia. Personalized predictors of semantic therapy response included mild language impairment and fluent speech, whereas more severe language impairment and presence of apraxia of speech predicted response to phonological therapy., Graphical Abstract Graphical Abstract

Attempts to personalize aphasia treatment to the extent where it is possible to reliably predict individual response to a particular treatment have yielded inconclusive results. The current study aimed to (i) compare the effects of phonologically versus semantically focussed naming treatment and (ii) examine biographical and neuropsychological baseline factors predictive of response to each treatment. One hundred and four individuals with chronic post-stroke aphasia underwent 3 weeks of phonologically focussed treatment and 3 weeks of semantically focussed treatment in an unblinded cross-over design. A linear mixed-effects model was used to compare the effects of treatment type on proportional change in correct naming across groups. Correlational analysis and stepwise regression models were used to examine biographical and neuropsychological predictors of response to phonological and semantic treatment across all participants. Last, chi-square tests were used to explore the association between treatment response and phonological and semantic deficit profiles. Semantically focussed treatment was found to be more effective at the group-level, independently of treatment order (P = 0.041). Overall, milder speech and language impairment predicted good response to semantic treatment (r range: 0.256-0.373) across neuropsychological tasks. The Western Aphasia Battery-Revised Spontaneous Speech score emerged as the strongest predictor of semantic treatment response (R 2 = 0.188). Severity of stroke symptoms emerged as the strongest predictor of phonological treatment response (R 2 = 0.103). Participants who showed a good response to semantic treatment were more likely to present with fluent speech compared to poor responders (P = 0.005), whereas participants who showed a good response to phonological treatment were more likely to present with apraxia of speech (P = 0.020). These results suggest that semantic treatment may be more beneficial to the improvement of naming performance in aphasia than phonological treatment, at the group-level. In terms of personalized predictors, participants with relatively mild impairments and fluent speech responded better to semantic treatment, while phonological treatment benefitted participants with more severe impairments and apraxia of speech.

There is a lack of clarity in the field regarding how to best predict which naming treatment will be most beneficial for a particular individual with aphasia. The purpose of this study was to elucidate whether or not semantic or phonological therapy differentially impacts on outcomes for people with a range of different aphasic profiles when given both therapies. A single-participant design, with multiple repeated baselines for naming, replicated across four participants, was used. Participants were provided with a counterbalanced order of Semantic Feature Analysis (SFA) and Phonological Components Analysis (PCA) treatment. Findings demonstrated differential effects across participants. This seemed to be influenced by factors such as severity of anomia, order of treatment presentation, and capacity limits. Clinical implications of these findings highlight the importance of expanding our picture of a participant's behaviours to consider what other important factors can inform intervention decisions.

RESUMO As pseudopalavras são um recurso pouco utilizado na prática clínica, mas podem representar uma excelente opção para a terapia fonológica. O objetivo deste estudo foi verificar o progresso terapêutico de crianças com desvio fonológico tratadas a partir de uma nova abordagem terapêutica, considerando o ambiente linguístico favorecedor em pseudopalavras e palavras com significado. A amostra foi composta por 3 crianças, com idades entre 4 e 8 anos, submetidas a uma nova abordagem terapêutica com base fonológica. As crianças foram tratadas com diferentes alvos envolvendo pseudopalavras e palavras reais, em ambiente linguístico favorecedor e neutro. Nos resultados, pode-se observar que a terapia envolvendo ambiente linguístico favorecedor apresentou melhores resultados quando comparada com a realizada em ambiente neutro. Em relação às palavras-alvo, os sujeitos tratados simultaneamente com pseudopalavras e palavras reais apresentaram resultados satisfatórios, indicando que os alvos foram adequados à terapia. A nova abordagem terapêutica envolvendo pseudopalavras e palavras reais em ambientes favorecedores mostrou-se eficaz para o tratamento dos desvios fonológicos.

Based on findings for overlapping representations of bilingual people's first (L1) and second (L2) languages, unilingual therapies of bilingual aphasia have been proposed to benefit the untrained language. However, the generalisation patterns of intra- and cross-language and phonological therapy and their neural bases remain unclear. We tested whether the effects of an intensive lexical-phonological training (LPT) in L2 transferred to L1 word production in a Persian-French bilingual stroke patient with Broca's aphasia. Language performance was assessed using the Bilingual Aphasia Test, a 144-item picture naming (PN) task and a word–picture verification (WPV) task. Electroencephalography (EEG) was recorded during PN and WPV in both languages before and after an LPT in French on a wordlist from the PN task. After the therapy, naming improved only for the treated L2 items. The naming performance improved neither in the untrained L2 items nor in the corresponding items in L1. EEG analyses revealed a Language x Session topographic interaction at 540 ms post-stimulus, driven by a modification of the electrophysiological response to the treated L2 but not L1 items. These results indicate that LPT modified the brain networks engaged in the phonological-phonetic processing during naming only in the trained language for the trained items.

Two 6-year-old male fraternal twins each received 8 weeks of morphosyntactic and phonological intervention in counterbalanced order. Progress occurred for most targets and measures, with each child making greater progress for either phonology or morphosyntax during the corresponding unitary-domain block. Gains were maintained during the subsequent alternate treatment block. Possible indirect changes in the non-treated domain were also observed in global measures. The data suggest that at least some school-aged children with concomitant difficulties in morphosyntax and phonology, perhaps those with significant constraints in each domain, can benefit from sequences of unitary-domain intervention. This study invites further research concerning many unresolved clinical issues for school-aged children with protracted development in both phonology and morphosyntax.

The effectiveness of two treatment approaches (phonological therapy and articulation therapy) for treatment of 14 children, aged 4;0-6;7 years, with phonologically based speech-sound disorder (SSD) has been previously analysed with severity outcome measures (percentage of consonants correct score, percentage occurrence of phonological processes and phonetic inventory). Considering that the ultimate goal of intervention for children with phonologically based SSD is to improve intelligibility, it is curious that intervention studies focusing on children's phonology do not routinely use intelligibility as an outcome measure. It is therefore important that the impact of interventions on speech intelligibility is explored.

The studies of phonological therapy for patients with both phonemic planning and articulatory implementation deficits report the related dichotomy of anterior and posterior syndrome with psycholinguistic model. However, there must be some investigation on segmental errors as input of rehabilitation within phonological framework. This study investigates whether the errors-based rehabilitation model can encourage two Balinese individuals with Broca's aphasia (KW and NS) to reduce the phonological errors. The results showed that KW and NS performed different segmental errors and types of the phonological process even though they suffered from identical non-fluent symptom. KW, in pre-intervention tended to present phonemes substitution, omission and insertion errors which mostly occurred in the initial position of words and he transposed the onset of the second syllable to the onset of the first syllable. Meanwhile, NS in some cases, tended to transpose the phonemes randomly, inserted other segments – especially [nasal] and [lateral] between two vowels (hiatuses) and altered the high complex segments with less complex ones. The phonological error-based rehabilitation was effective to reduce the errors and the phonetic relaxation helped them exhibit minor errors. This indicated that phonetic based training can stimulate the articulatory processing deficit as anterior syndrome.

Purpose Clinicians do not have an evidence base they can use to recommend optimum intervention intensity for preschool children who present with speech sound disorder (SSD). This study examined the effect of dose frequency on phonological performance and the efficacy of the multiple oppositions approach. Method Fifty-four preschool children with SSD were randomly assigned to one of three intervention conditions. Two intervention conditions received the multiple oppositions approach either 3 times per week for 8 weeks (P3) or once weekly for 24 weeks (P1). A control (C) condition received a storybook intervention. Percentage of consonants correct (PCC) was evaluated at 8 weeks and after 24 sessions. PCC gain was examined after a 6-week maintenance period. Results The P3 condition had a significantly better phonological outcome than the P1 and C conditions at 8 weeks and than the P1 condition after 24 weeks. There were no significant differences between the P1 and C conditions. There was no significant difference between the P1 and P3 conditions in PCC gain during the maintenance period. Conclusion Preschool children with SSD who received the multiple oppositions approach made significantly greater gains when they were provided with a more intensive dose frequency and when cumulative intervention intensity was held constant.

PURPOSE: To verify the changes in the deviant phonological system regarding phonemes acquisition and in the severity level of phonological disorders in subjects submitted to phonological therapy using the contrastive approach, in comparison to a group of subjects not submitted to intervention. METHODS: Participants were 18 subjects aged between 4 years and 10 months and 7 years and 4 months, of both genders, with diagnosis of phonological disorder. Nine subjects treated by contrastive approach constituted the Experimental Group, and the other nine subjects, the Control Group (on the waiting list for phonological therapy). All subjects were assessed before and after the period of contrastive therapy applied only to the Experimental Group. Subjects in both groups were matched by age, severity level of the phonological disorder, number of absent sounds in the first phonological assessment, and period of time between the first and the second phonological assessment. In both assessments, the number of acquired sounds in the general phonological system was verified and the Percentage of Consonants Correct - Revised was calculated to determine the severity level of the phonological disorder. Data were statistically analyzed. RESULTS: The Experimental Group acquired more sounds, which determined changes in the severity level of the phonological disorder. The differences found between groups were significant. CONCLUSION: The phonological therapy using the contrastive approach promotes changes in the phonological system that significantly influence the acquisition of sounds and the change of the severity level.

This study aimed to analyze the phonological awareness skills and progress (phonetic and phonological inventory and generalizations) in phonological therapy. The research group consisted of five children presenting speech disorders, aged 5:0 and 6:11, subjected to phonological therapy. The results of the phonological awareness assessment were analyzed before the treatment in order to verify the performance of children and their phonological knowledge. The evaluation was performed before and after the treatment. It was possible to obtain the phonetic and phonological inventories of the subjects and, after that, the generalizations obtained with phonological therapy were analyzed (considering lexical items that were not used during treatment, other positions in word, within one sound class or another class of sounds). The results showed that there is no relation between the performance in phonological awareness tasks and the evolution of the phonological therapy. On the other hand, the results agree with the research findings from the literature, reinforcing the idea that, children with phonological disorder can be able to react properly to metalinguistic tasks such as phonological awareness without being able to correct their speech problems. Finally, it can be conclude that this research subject should be investigated deeper and another analysis should be carried out involving a higher number of subjects, including the phonological awareness evaluation before and after therapy. By doing this, it will be possible to obtain other important data to improve the treatment of phonological disorder.

TEMA: percursos de aquisição fonológica de crianças tratadas com ambientes favoráveis em oposição aos ambientes pouco favoráveis e neutros para a produção de /z/, /∫/e /ℑ/na terapia fonológica. PROCEDIMENTOS: foram selecionadas seis crianças com desvio fonológico e idades entre 4:7 e 7:8 para participarem do estudo. As mesmas estavam devidamente autorizadas por seus responsáveis. Foram realizadas avaliações fonoaudiológicas e complementares para diagnóstico do desvio fonológico. Os sujeitos foram pareados de acordo com a gravidade do desvio fonológico, sexo, faixa etária e aspectos do sistema fonológico em relação aos fonemas alterados. Metade das crianças foi tratada com palavras em que os fonemas /z/, /∫/e /ℑ/encontravam-se em ambientes favoráveis e a outra metade com ambientes pouco favoráveis e neutros. Foram realizadas oito sessões e, após estas, novas avaliações foram realizadas para descrever e comparar qualitativamente os percursos de aquisição fonológica dos sujeitos por meio do Modelo Implicacional de Complexidade de Traços. RESULTADOS: os resultados indicaram discreta vantagem na evolução terapêutica de dois sujeitos tratados com ambientes favoráveis, em relação a seus pares. Porém, uma criança tratada com ambientes pouco-favoráveis e neutros, obteve resultados mais positivos do que seu par. CONCUSÃO: os ambientes favoráveis à produção das fricativas /z/, /∫/e /ℑ/ não determinaram o sucesso terapêutico, porém influenciaram positivamente a evolução fonológica dos sujeitos do estudo. BACKGROUND: routes of phonological acquisition in children treated with favorable environments in contrast with unfavorable and neutral environments for production of /z/, /∫/and /ℑ/in phonological therapy. PROCEDURES: six children with phonological disorder aged between 4:7 and 7:8 were selected to take part in the study. They were properly authorized by their parents. There were speech-language and complementary evaluations in order to diagnose the phonological disorder. The subjects were matched according to the severity of the phonological disorder, gender, age and aspects of the phonological system in relation to the altered phonemes. Half of the children were treated with words in which the phonemes /z/, /∫/and /ℑ/ were in favorable environments and the other half with unfavorable and neutral environments. There were eight sessions and, after that, new evaluations were made in order to describe and qualitatively compare the routes of phonological acquisition in the said subjects through the Implicational Model of Features Complexity. RESULTS: the results indicated a small advantage in the therapeutic evolution of two subjects treated with favorable environments, in relation to their matches. However, children treated with unfavorable and neutral environments obtained more positive results than their matches. CONCLUSION: the favorable environments for production of fricatives /z/, /∫/and /ℑ/ did not determine the therapeutic success, but positively influenced the phonological evolution in the subjects in the study.

This study had the aim to analyze both the phonological changes and the generalization obtained in the treatment with rothics in two models of phonological treatment. The sample consisted of four subjects diagnosed with phonological disorder, with ages between four and six years. All of them were assessed before and after the phonological therapy. Two groups were established for the treatment with rothics. One group was treated with ABAB - Withdrawal and Multiple Probes Model, and the other group with the Maximal Opposition Model. The phonological system and the occurrence of generalizations before and after the treatment were analyzed. It was found that none of the subjects acquired the rothics that were practiced in the treatment, however, the occurrence of generalization to untreated items was observed only in the subjects treated by the ABAB - Withdrawal and Multiple Probes model. The other types of generalization occurred in both models. The Maximal Opposition Model provided greatest changes in the phonological system of the subjects, which can have been favored by the other target-sound of the pair

PURPOSE: To examine the occurrence of complex onset pre- and post-treatment in children treated with three different models of phonological therapy. METHODS: Twenty-one subjects with phonological disorder participated in the study, 16 boys and five girls, with ages varying between four years and seven years and eleven months. The children were divided into three groups of seven subjects, according to the therapy models used: Modified Cycles Model, Maximum Opposition Model and ABAB-Withdrawal and Multiple Probes Model. Data from initial and final evaluations of the phonological system were analyzed, regarding the total production of complex onsets and of production of complex onsets with /l/ and /r/. These were classified as: not acquired, from 0 to 39%; partially acquired, from 40 to 69%; and acquired, from 70 to 100%. Statistical analyses were carried out. RESULTS: Regarding the total number of occurences of complex onsets, there was a difference between pre- and post-therapy means of not acquired and acquired complex onsets in the Modified Cycles Model and in the Maximum Opposition Model; in the ABAB-Withdrawal and Multiple Probes Model, this difference was found only for acquired complex onsets. The same was veryfied for complex onsets with /r/. With regards to complex onsets with /l/, differences were found only in the Modified Cycles Model, between not acquired and acquired complex onsets. A different classification of not acquired and acquired complex onsets was observed, in all models, between pre- and post-treatment. CONCLUSION: The three models of phonological therapy were effective for the treatment of complex syllabic onset structure.

This study compared a semantic and a phonological/orthographic approach to the treatment of word-finding difficulties in a case-series of ten individuals with aphasia, using a cross-over design. The study aims to investigate whether one approach is generally more effective than the other or whether the effectiveness of the two treatments relates systematically to the nature of the underlying functional impairment within the framework of a modular single-word processing model. In both treatments, the main task was spoken naming of pictured objects with different types of cues. In the semantic approach, different aspects of the target semantic concept were used as a cue in picture naming, while in the word-form method, both phonological and orthographic information were provided as a cue. Treatment effects were assessed in terms of both short- and long-lasting effects on spoken picture naming accuracy in each participant after the end of each treatment phase. Here, both item-specific effects and a possible generalisation to untreated pictures were considered. In addition, the immediate effects of the phonological and the semantic prompts were analysed. With regard to the cue effects on immediate naming, the word-form specific cues proved stronger than the semantic cues. The semantic treatment phase on the other hand, produced more stable effects than the word-form specific phase in some participants. A direct relationship between specific treatment effects and underlying functional deficit pattern was not confirmed for all subjects, i.e. participants with post-semantic anomia benefited from the semantic approach and participants with semantic anomia benefited from the phonological/orthographic approach. In the discussion of the results different explanations are considered, including the importance of preserved functions which aphasic participants bring into the treatment, the possible acquisition of a conscious strategy, and the possible influence of order of treatment. The effects of the two treatments are interpreted with regard to their underlying functional mechanisms in a single-word processing model.

PURPOSE: to describe the phonological systems of monozygotic twins both having phonological disorders and to analyze the gradual development of the speech therapy after applying Modified Maximal Opposition Model in order to investigate the influence of genetic and environmental factors on the outset and continuity (maintenance) of phonological disorders. METHODS: the initial phonological assessments were compared as well as the target-sounds used in therapeutic plan, and the final phonological assessments at the end of each year of treatment for both monozygotic male twins who were six years and five months of age at the beginning of the research, and diagnosed as having phonological disorders. The boys were treated from August 2002 to December 2004 according to the Modified Maximal Opposition Model. All the material was obtained from the database of a project developed in the speech/language clinic of the Federal University of Santa Maria. RESULTS: great similarities were found in the phonological systems of both subjects in the beginning, during the therapeutic evolution and at the end of the phonological therapy, even though the target sounds were not necessarily the same throughout therapy. The boys acquired the absent and partially acquired sounds, presenting generalization in the various possible situations, confirming the efficiency of the therapeutic model employed. CONCLUSION: the genetic influence induces the onset and continuity of phonological disorders; nevertheless environmental factors cannot be disregarded.

PACT (parents and children together) is a broad-based intervention approach for children with phonological impairment, which involves the participation of caregivers in therapy. Its components are: Parent Education; Metalinguistic Training; Phonetic Production Training; Multiple Exemplar Training (minimal pair therapy and auditory bombardment); and Homework. Accommodating to the gradual nature of phonological change in typical development, PACT therapy is delivered in planned therapy blocks and breaks from therapy attendance, during which parents continue aspects of the therapy. A review of literature relevant to the theoretical underpinning, development and evaluation of PACT is provided, and unique features of the approach are highlighted. The processes of speech assessment using parent-observed screening, independent and relational analyses, treatment planning and scheduling, and target selection and goal-setting are presented and discussed in the context of Jarrod, a 7 year old boy with a severe, inco...

Developed in Australia, Parents and Children Together (PACT) is a broadbased, family-centred phonological therapy. It is a treatment approach for developmental phonological disorders in the course of whose implementation speech and language therapists enlist the active participation of parents and significant others. It requires family members to learn technical information and develop novel skills to use, with professional guidance, in relation to their own child and his or her specific speech clarity issues. In this paper we review the ‘family education’ and ‘homework’ aspects of PACT and explore, with brief case illustrations, the participation of 13 families involved in its administration. In preschool-aged and younger school-aged children, developmental phonological disorders are manifested as difficult-to-understand speech. They affect the organization of children’s speech sound systems, and have been argued to occur at the (underlying) phonological level (for example, Grunwell, 1987; Ingram, 1989). Developmental phonological disorders are obvious to the listener because of the use, by children, of abnormal (surface) speech patterns, which impair general intelligibility. Provided that children with the disorder receive effective therapy, the prognosis for normal speech intelligibility is good (Gierut, 1998).

Background: Treatments for word-finding difficulties in aphasia using semantic techniques have been shown to be effective (e. g., Marshall, Pound, White-Thomson, & Pring, 1990). The evidence with regard to phonological treatment is more equivocal, however, with some studies reporting only short-term improvement in word retrieval (e. g., Howard, Patterson, Franklin, Orchard-Lisle, & Morton, 1985a) and other studies reporting lasting effects (e. g., Miceli, Amitrano, Capasso, & Caramazza, 1996). There is also little in the literature on the use of orthographic cues in treatment (Howard & Harding, 1998). Additionally, whereas several studies have reported the results of using cues in facilitation of word-finding difficulties (e. g., Patterson, Purrell, & Morton, 1983), none so far has attempted to relate response to facilitation and response to treatment using similar techniques in the same individuals.Aims: This study set out to investigate whether the use of phonological and orthographic cues in the treatment of word-finding difficulties could produce lasting improvements in word retrieval. The response of the participants to phonological and orthographic cues in a facilitation study was also related to their response to treatment using similar cues.Methods & Procedures: The study used a case series design. The participants were eight people with acquired aphasia who were all at least 1 year post-onset, had a single left CVA, and had word-finding difficulties as a significant aspect of their aphasia. Detailed assessment of each participant was carried out to identify the nature of their word-finding difficulties and this was related to response to treatment.Outcomes & Results: Results are given for the eight participants, seven of whom benefited overall from treatment. Both phonological and orthographic cues were effective in improving word retrieval. For the group as a whole there was a significant correlation between the overall outcome of facilitation and response to treatment.Conclusions: The theoretical and clinical implications of the relationship between the individual's level of language impairment and their response to therapy are discussed. It is also suggested that the results from facilitation appear to have potential in predicting the outcome of phonological/orthographic therapy with aphasic participants. Finally, it is concluded that phonological and orthographic treatments for word-finding difficulties can be highly effective and that they represent an under-utilised and under-researched tool in the clinician's armoury.

Pattern-based approaches to phonological disorders emerged in the 1970s and 1980s after researchers realized that phonological "rules" used to describe speech patterns of adults could be used in the analysis of children's speech. In this article, a pattern-based approach to assessment and treatment of phonological disorders is described, based on identification and treatment of phonological processes. Means of identifying and quantifying phonological processes are provided and assessment tests are described. Principles underlying the use of phonological processes in intervention programs are presented and decisions regarding target selection are discussed. A case study of the treatment program for one child illustrates the application of phonological processes within a cycles approach.

Children with speech difficulties often have delayed phonological awareness development and associated literacy problems. Speech-language pathologists (S-LPs) typically use phonological and articulatory approaches in their treatment of such children. However, it is unclear to what extent phonological awareness training, originally designed to promote literacy skills, might also improve children's speech output. This article adopts a psycholinguistic approach to examine the nature and development of phonological awareness and to explore the relationship between phonological awareness training and phonological therapy. The role of phonological awareness in predicting literacy development in children is discussed, and principles for analyzing the psycholinguistic properties of therapy tasks are presented. Phonological awareness cannot be dealt with independently as it is an integral part of articulation and phonological intervention. Further, phonological awareness is a necessary "on-line" skill in the dynamic communication process between therapist and child. Failure to take this into account will result in inappropriately targeted therapy and pragmatic breakdown between the child and S-LP.

A multiple opposition approach to phonological intervention is described as an alternative contrastive approach for the treatment of severe speech disorders in children. The development and theoretical constructs of this approach are presented within the context of a clinical case study. The multiple opposition approach is based on the premise that the systemic level of phonological organization is essential in the description and intervention of disordered sound systems. Phonological descriptions identify phoneme collapses, which are viewed as phonologic strategies developed by the child to accommodate a limited sound system relative to the full adult system of the ambient language. Intervention is then directed systemically across the child’s entire rule, or collapse, by using larger treatment sets of multiple oppositions rather than by one contrast at a time.

Thirty-one children with isolated phonological disorders participated in a speech and language therapy programme targeted at improving metaphono-logical ability. Assessments were designed that were sensitive to the potential changes made in metaphonological awareness and speech output as a result of therapy. Metaphonological abilities improved significantly as a result of therapy (in comparison with non-treated control children). Post-therapy measures demonstrated that speech and language therapy was highly effective in improving the speech output of children with isolated phonological disorders after controlling for maturational effects. Consideration is given to whether initial metaphonological status influences outcome and whether having good or poor initial metaphonological skills indicates a child’s readiness to benefit from phonological therapy.

A bilingual Punjabi-English-speaking child, whose speech was characterized by inconsistent errors in both languages, participated in an intervention programme. A core vocabulary therapy approach was used targeting consistency of production. The accuracy and intelligibility of the child’s speech improved in both languages, even though therapy had only been provided in English. The results of the study contrast with a previous study targeting consistent phonological errors in a bilingual child. While the results of single case studies should be interpreted with caution, the findings suggest that phonological therapy targeting the deficit underlying speech disorder is effective in remediating the errors in both of the child’s languages. However, therapy simply correcting specific surface speech patterns is only effective in the language targeted in therapy. These data have theoretical implications regarding the nature of phonological disorders, and the separateness of bilingual children’s phonological systems. There are also clinical implications regarding intervention for bilingual children with disordered speech.

(1999). Phonological therapy: a collaborative approach. International Journal of Language & Communication Disorders: Vol. 34, No. 1, pp. 62-65.

The focus here is a detailed case description of a broad-based model for treat ing developmental phonological disorders. Successful treatment comprising 27 consultations over 17 months, of a girl aged 4;4 at the outset, with a mod erate phonological disability, is examined in detail. The model’s strength is in its combination of family education, metalinguistic tasks, phonetic produc tion procedures, multiple exemplar techniques and homework. Treatment is administered in planned alternating therapy blocks and breaks from therapy attendance.

The efficacy of teaching sounds in developmental sequence as defined by age norms was evaluated in two independent investigations. Study I was a within-subject evaluation using an alternating treatments design, with three children each receiving treatment on one early-acquired and one later-acquired phoneme relative to chronological age. Study II was an across-subject evaluation involving six children in a staggered multiple baseline paradigm, whereby three subjects were each taught one early-acquired sound and three other subjects were taught one later-acquired sound relative to chronological age. Phonological change was measured on probes of sounds excluded from each child's phonemic inventory. General results indicated that: (a) quantitatively, change in treated phonemes and manner classes was equivocal following treatment of early-acquired and later-acquired phonemes; (b) qualitatively, the onset of change was immediate following treatment of later-acquired phonemes, but delayed following treatment of early-acquired phonemes; and (c) treatment of later-acquired phonemes led to system-wide changes in untreated sound classes, whereas treatment of early-acquired phonemes did not. These findings were considered relative to clinical intervention and theories of phonological acquisition.

Although the naming disorders given much attention in clinical practice, the researchers still search for effective approaches to the treatment and understanding nature of word-finding deficits in the aphasics. This paper presents the results of the phonological and semantic strategies on the capabilities of the naming in patients with Broca's and in patients Wernicke's aphasia. The results showed that phonological strategy contributes to the increasing capabilities in patients with Broca's aphasia, while in the patients with Wernicke's aphasia, the semantic strategy have a greater effect than phonological strategy. . Iako se poremećaju imenovanja poklanja dosta pažnje u kliničkoj praksi, još uvek se traga za efikasnim pristupima u tretmanu. U ovom radu su prikazani rezultati efekta fonološke i semantičke podrške na sposobnost imenovanja kod pacijenata sa Brokinom i Vernikeovom afazijom. Rezultati su pokazali da fonološka podrška doprinosi povećanju sposobnosti imenovanja kod Brokine afazije, dok je kod Vernikeove afazije utvrđen veći efekat semantičke nego fonološke podrške. .

The incidence of cleft palate is approximately 1 in 600 live births, and when velopharyngeal disorders (sub-mucous cleft, pharyngeal disproportion, neurological disorders affecting the velopharynx) are added, most speech and language therapists will treat one or more of this client group in their career. There is a dearth of research literature on the efficacy of therapy, but evidence will be considered related to (1) Type of therapy (neither traditional articulation therapy nor phonological therapy is appropriate in isolation, they need to work hand in hand for maximum efficacy — how is this achieved?). (2) Timing of therapy (more speech and language therapists are working in a preventative role with the parents of infants and toddlers to encourage good feeding, language and phonological development — is this justified by the research literature in terms of outcome and time spent? Controversy exists over whether to correct articulation pre- or post-pharyngoplasty — do we have enough evidence to say which is more ?ffective?). (3) Frequency of therapy — are intensive courses more effective long-term than conventional weekly therapy?

(1995). The Metaphon approach to phonological therapy from a Swedish perspective. Clinical Linguistics & Phonetics: Vol. 9, No. 1, pp. 42-49.

Dinnsen, Chin, Elbert, and Powell (1990) described an implicational hierarchy of feature distinctions that characterized five inventory types for a group of phonologically disordered children. The presence of a feature associated with a more complex phonetic inventory implied the presence of all the distinctive features from less complex levels. In the present study two phonologically impaired subjects, ages 2;8 and 2; 10, with limited phonetic inventories, received treatment to add phonetic distinctions based on this implicational hierarchy. One subject was treated on a distinction from a more complex level in the hierarchy and the other on a less complex distinction. Treatment was applied in two 9-week blocks separated by 5-week withdrawal periods in which generalization probes were administered. Both children learned their target sounds; however, only the child treated on the complex distinction added sounds reflecting less complex distinctions without direct treatment. This subject added 12 sounds com...

In this addendum to my lead article for this forum, I will resist the temptation to reply to each point of disagreement raised by my colleagues in their commentaries or to emphasize crucial points of agreement. Instead, I will update and clarify my comments on the application of phonological principles to the treatment of children with phonological disorders, responding to their comments only where appropriate to reach these objectives.

Two analytical frameworks for identifying and measuring the processes of phonological change in the speech of children with developmental speech disorders are described. The frameworks are illustrated by an examination and evaluation of longitudinal data from children with this type of disorder. The ways in which clinicians can use the two frameworks to guide treatment planning are discussed.

Assumptions basic to the whole language philosophy of education are enumerated and exemplified with regard to facilitation of spelling and phonological abilities. It is suggested that development of spelling and phonological knowledge progress through similar stages and are enhanced by whole language experiences. Inasmuch as speech-language pathologists are the school-based professionals who are most knowledgeable regarding phonological development, they are encouraged to: (a) serve as a resource to teachers in the instruction of spelling, (b) be aware of potential problems in spelling development in phonologically delayed children, and (c) utilize whole language strategies that relate speech production to reading and writing within their phonological therapy.

A review of software was carried out to evaluate to what extent particular titles could be used within a phonological therapy programme using a psycholinguistic approach for children aged between four and seven years. Some of the software had been developed specifically for speech and language therapists working with children's phonological impairments. Other titles were from the education market and aimed at developing children's literacy skills. This paper describes how these software programmes could be used to address phonological impairments through developing the sub-skills described within the psycholinguistic framework.

This two-part study continued the evaluation of minimal pair treatment in phonological change (Gierut, 1989, 1990, 1991a; Gierut & Neumann, 1992). Three linguistic variables relevant to change were experimentally manipulated within an alternating treatments design to determine specifically the interplay of a maximal number of feature distinctions, feature class, and relationship of treated phonemes to a child's grammar in inducing sound change. The conditions of treatment that were shown to facilitate optimal phonological change in previous research were again experimentally replicated. Specifically, minimal pairs comparing two phonemes previously unknown to a child that also differed by maximal and major class features were found to be the preferred context motivating change. Important individual differences emerged and underscored the role of a child's pretreatment grammar in phonological change. These differences contributed to descriptions of possible courses of change followed by children with phonological disorders and bear upon the predictability of change and the effectiveness of treatments that may condition change.

The purpose of this paper was to evaluate a phonological treatment program of maximal rather than minimal feature contrasts by charting the course of learning in a child displaying a systematic error pattern involving the nonoccurrence of word-initial consonants. Generalization data indicated that the child learned 16 word-initial consonants following treatment of only three sets of maximal opposition contrasts. Overgeneralization data indicated that the child restructured his phonological system based on a larger concept of "word initialness." Basic components of and differences between various forms of contrast treatment are discussed.

The results of a treatment procedure using meaningful minimal contrasts are reported. The procedure was successful in reducing the frequency of the following processes: final consonant deletion, stopping of fricatives, and fronting of velars, which were exhibited in the speech of two children with phonological disability. Generalization of response to non-treatment words was also evidenced.

Two phonological process-based treatment procedures were applied in an ongoing clinical program. Subjects were 4 children aged 3:1, 3:8, 4:1, and 5:1. Two subjects were assigned to a minimal pairs contrasting procedure, and 2 were assigned to a modified cycles procedure based on results of a detailed phonological analysis. All children demonstrated marked changes in their phonological systems as shown by the results of pretreatment and follow-up generalization probes. Correct production generalized to sounds affected by the treatment process that were not a focus of training. Correct production of untrained sounds lagged behind that of trained sounds for all subjects. Results support the hypothesis that articulation remediation is enhanced by treating phonological processes as well as the notion that the acquisition of phonology is a gradual process. Both treatment procedures used in this study were found to be effective and efficient, as evidenced by the elimination of up to three phonological processes within 2 ½ months for each subject.