Stimulability Therapy


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Bowen, C. (2011). Stimulability Therapy. Retrieved from http://www.speech-language-therapy.com/ on [insert the date that you retrieved the file here].


Stimulability


Traditionally, ‘stimulable’ has meant that a consonant or vowel can be produced in isolation by a child, in direct imitation of an auditory and visual model with or without instructions, cues, imagery, feedback and encouragement. We know that if a child is not stimulable for a sound there is poor probability of short-term progress with that sound. That is, the sound is unlikely to ‘spontaneously correct’ or magically ‘become stimulable’.


Research


Since the late 1990s the child phonology literature has encouraged clinicians to target non-stimulable sounds, because if a non-stimulable sound is made stimulable to two syllable positions, using our unique clinical skills, it is likely to be added to the child’s inventory, even without direct treatment (Miccio, Elbert & Forrest, 1999).


Stimulability Intervention


Miccio and Elbert (1996) proposed teaching all consonants (stimulable and non-stimulable) at once in every session. Because the primary goal is to enhance stimulability speech sounds are taught in isolation (s::::::) or in a variation of the approach, in CVs (soo, see, sie, saw…).

Each consonant is associated with an interesting, alliterative character depicted on "Character Cards" and a hand or body motion.In this therapy the targets become the focus of joint attention. Direct imitation is not required, but ‘vocal practice’ and ‘requests’ (for Character Cards), in simple turn-taking games, are encouraged. The emphasis is on ensuring ‘successful communications’.


Case Example


When Fiona (Miccio, 2009) produced [d] in a therapy session,but mimed zipping up her coat, the clinician knew the intended sound was [z], and gave her Zippy Zebra. At the same time, the clinician provided feedback about how to produce [z] while miming zipping her coat: ‘Let me see, do I have Zippy Zebra?  Zippy Zebra says [z::::::::::].’ Fiona chose characters to ask for, and when it was the clinician’s turn to ask for a character, she always chose non-stimulable sounds.

At 4;3 Fiona’s phonetic inventory was [m n p b t d w j h]. She was seen twice weekly for 50 minutes, for 12 weeks (24 treatments; 20 hours of intervention). All consonants were worked on, including those in Fiona’s phonetic inventory. Motions were always used concurrently with speech production. By the end of this therapy she was stimulable for all targeted sounds. She produced many of them in simple words or used typical developmental substitutions in more difficult contexts. She had 4 weeks break from therapy attendance. She then received a minimal pair treatment (maximal oppositions) to encourage generalisationof her ‘new sounds’ across her phonological system.


Stimulability Assessment Form and Miccio's Character Cards


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Stimulability Assessment Form
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Character Cards (22 page pdf) LARGE FILE download from the phono-tx Files area
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Character Cards (7 page pdf) download from this site
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References


Miccio, A.W. (2002). Clinical problem solving: Assessment of phonological disorders. American Journal of Speech-Language Pathology. 11, 221-229.

Miccio, A. W. (2005). A treatment program for enhancing stimulability. In Kamhi, A. G., & Pollock, K.E., (Eds.). (2005). Phonological disorders in children: Clinical decision making in assessment and intervention (pp. 163-173). Baltimore, MD: Paul H Brookes.

Miccio, A. W. (2009). First things first: Stimulability therapy for children with small phonetic repertoires. In C. Bowen, Children's speech sound disorders. Oxford: Wiley-Blackwell, 96-101.

Miccio, A. W. (2015). First things first: Stimulability therapy for children with small phonetic repertoires. In C. Bowen, Children's speech sound disorders, Second Edition. Oxford: Wiley-Blackwell, pp. 177-182.

Miccio, A.W, & Elbert, M. (1996). Enhancing stimulability: a treatment program. Journal of Communication Disorders, 29, 335-352.

Miccio, A. W., Elbert, M., & Forrest, K. (1999). The relationship between stimulability and phonological acquisition in children with normally developing and disordered phonologies. American Journal of Speech-Language Pathology, 8, 347-363.

Miccio, A. W, & Williams, A. L. (2010). Stimulability treatment. In A. L. Williams, S. McLeod, & R. J. McCauley (Eds.), Interventions for speech sound disorders in children. Baltimore, MD: Paul H. Brookes.

Powell, T. W., & Miccio, A. W. (1996). Stimulability: A useful clinical tool. Journal of Communication Disorders, 29, 237-253.

Rvachew, S. (2005). Stimulability and treatment success. Topics in Language Disorders, 25(3), 207-219.