Progress Report Spring 20XX

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1 Progress Report Spring 20XX Client: XX C.A.: 7 years Date of Birth: January 1, 19XX Address: Somewhere Phone Referral Source: UUUU Graduate Clinician: XX, B.A. Clinical Faculty: XX, M.S., CCC-SLP Diagnosis and Code: 15.9 Other Articulation Disorder Background XX is a 7-year-old woman who works at UUU. She was born in city, country and moved to the United States in 199. XX s native languages are L and LL, and she also speaks English and LL. XX currently lives in Somewhere, USA, with her husband. XX s speech and language skills were evaluated in April 20XX at the Eleanor M. Luse Center. A diagnostic assessment was carried out to examine her English communication skills. Speech and language samples were evaluated for pronunciation, prosody, and grammar. The Compton Phonological Assessment of Foreign Accent was administered as a formal assessment to supplement informal assessments of XX s speech. The results of this test indicated difficulties with production of voiced and voiceless interdental fricatives /θ/ ( think ) and /ð/ ( that ), substitution of /v/ for /w/, and challenges with short and long vowel use. It was also noted that she frequently omits articles and pronouns. Therapy was recommended as a result of this diagnostic evaluation. Since the spring of 20XX, XX has undergone three semesters of therapy at the Eleanor M. Luse Center. Goals and objectives for treatment targeted overall intelligibility and increased communicative effectiveness of spoken language through increased grammatical forms (articles, interdentals fricatives, and verbs) and employment of self-monitoring and self-correction strategies. Goals and Objectives: The following goals and objectives were established for XX s upcoming course of treatment.! Long Term Goal 1: XX will increase her intelligibility to unfamiliar listeners by using Standard American English intonation and stress patterns in spontaneous speech by September 20XX.

2 " Short Term Objective 1.1: XX will increase her awareness of Standard American English stress and intonational patterns and her self-monitoring skills during the production of a monologue in a structured setting with minimal prompting from the clinician with 80% accuracy by December " Short Term Objective 1.2: XX will increase her awareness and use of Standard American English stress and intonational patterns by reading and memorizing portions of a prepared dialogue or passage, and using a recorded model provided by the clinician with 80% accuracy by December 2014.! Long Term Goal 2: XX will increase her intelligibility to unfamiliar listeners by using Standard American English pronunciation in spontaneous speech by September 20XX. " Short Term Objective 2.1: XX will increase her awareness of vowel differences in commonly spoken phrases in Standard American English through the use of minimal pair activities when provided with a verbal model from the clinician. " Short Term Objective 2.2: XX will increase the accuracy of her pronunciation of the phonemes /w/ and /v/ through memorized dialogues and structured reading activities when provided with a verbal model from the clinician with 80% accuracy by December 20XX.! Long Term Goal : XX will increase her intelligibility by appropriately using articles, prepositions, and auxiliary verbs in spontaneous speech by September 20XX. " Short Term Objective.1: XX will appropriately use prepositions when presented with structured and unstructured monologue tasks, and self-rate her use with 80% accuracy with minimal verbal prompting from the clinician by December 20XX. " Short Term Objective.2: XX will appropriately use prepositions when presented with structured and unstructured monologue tasks, and self-rate her use with 80% accuracy with minimal verbal prompting from the clinician by December 20XX. Course of Treatment: XX s speech is characterized by difficulties with production of voiced and voiceless interdental fricatives /θ/ ( think ) and /ð/ ( that ), substitution of /v/ for /w/, and challenges with short and long vowel use. She frequently omits articles and pronouns. During her course of treatment, it became apparent that XX also confuses or omits prepositions in spontaneous speech, particularly the preposition of. Over twelve sessions, XX was encouraged to work on her speaking skills in the clinic and at home through the use of conversation, auditory models, dialogues, and grammatical exercises provided by the clinician. Each session began with an Oral Proficiency Interview (OPI), where the clinician provided a prompt or discussion topic for the XX to respond to, and she was asked to speak on that topic for 10 minutes. The clinician asked questions relating to the topic, to XX: Page 2 of 8

3 increase communicative pressure. XX was then subjectively judged based on criteria from the American Council on The Teaching of Foreign Language (ACTFL). To target articulation, XX and the clinician addressed vowels by teaching phonetics and the International Phonetic Alphabet (IPA). Initially, XX was asked to discriminate between two vowels, and eventually she progressed towards vowel identification and production using a vowel quadrilateral and basic IPA transcriptions. The clinician also worked on identifying vowel environments that change pronunciation of certain words. XX s language and pronunciation goals were targeted through the use of Oral Drills, which were multimodal (written, verbal) linguistic exercises requiring her to provide grammatically correct answers with Standard American English pronunciation and intonation. Exercises changed from week-to-week, and involved irregular verb conjugations, sentence constructions, comparatives, opposites, imperatives, and pronunciation drills. The clinician modeled the appropriate responses with XX before beginning each activity. VisiPitch software was used in conjunction with Oral Drills during pronunciation activities to provide a visual and auditory aid for XX. XX was also presented with dialogues for the first half of the semester, to practice oral reading skills, and later for intonation, stress, and prosody work. Phrases and words from these dialogues were also analyzed on VisiPitch. During her sessions, the clinician instituted a translation activity using personal narrative material that XX provided. The passage was edited for grammar as well as style, and the clinician provided a corrected version of each passage for comparison. Present Status: An intelligibility rating was given based off of a speech sample taken from two activities of 100 utterances from two therapy sessions on 10/1/14 and 12/1/14. These samples were rated by an unfamiliar listener, and judged based on speech intelligibility and oral proficiency. Table 1. Intelligibility and Oral Proficiency Ratings 10/1/14 12/1/14 Intelligibility 98% 100% Oral Proficiency.5.5 The unfamiliar listener judged XX s speech to be highly intelligible. It appears that most of her consonant articulation errors do not affect her intelligibility. The unfamiliar listener noted most confusion around vowel errors in XX s speech. In terms of language comprehension and production, the unfamiliar listener rated XX.5 out of 4, mostly due to syntax, phrasing, and missing articles. The criteria for XX s OPI scores are as follows: 1. The speaker made no grammatical errors and effectively conveyed her message. Appropriate stress, prosody and articulation were demonstrated. The listener understood the message clearly, and proficiency is functionally equivalent to a native speaker. XX: Page of 8

4 2. The speaker has mostly accurate pronunciation, and no grammatical errors. The speaker is able to use the language fluently. Some evidence of non-native prosody is apparent. The accent is noticeable, but does not hinder communication.. The speaker s utterances contained awkward or inaccurate phrasing. The speaker is still able to convey the message effectively, although there is some evidence of hesitancy, errors, or effort that limits language use. Errors in articulation were noticeable and required clarification from the listener. Errors in prosody were noticeable, but did not affect the intended message. 4. Misunderstandings are frequent, and the listener does not understand the speaker s intended message, even after clarification. Vocabulary is inaccurate and speech contains numerous grammatical errors. Pronunciation is poor, and they demonstrate inappropriate stress and prosody in connected speech that affects the intended message. Graph 1. Monologue/Oral Proficiency Interview Scores (OPI) Oral Proficiency Interview Scores OPI score XX s scores remained relatively the same throughout the course of the semester. Her scores became higher at the end of the semester because the topics of conversation were more challenging and there was higher communicative pressure. XX s scores were primarily related to her non-native phrasing, article and preposition omission, and pronoun usage. At this time, XX demonstrates awkward or inaccurate phrasing, although she is fluent in her delivery and rarely has word-finding issues. She continues to demonstrate errors with /v/ and /w/, but is showing a remarkable ability to self-monitor her production of those phonemes. XX also has difficulty with the voiced and voiceless th phonemes, and will often over-generalize and insert these sounds for /t/ (e.g., thu for two ). XX: Page 4 of 8

5 Graph 2. Oral Drills (Average Score/) Oral Drills Percent Correct Oral drill activities included imitation tasks (targeting prosody), pronunciation drills, spontaneous sentence generation (comparatives, superlatives, opposites), and sentence correction. Overall, XX performed very well, averaging over 50% accuracy for nearly every session. s where XX scored higher in her oral drills was because the oral drills targeted pronunciation and prosody. In session nine, her oral drills focused on grammar and sentence generation, which resulted in lower scores. Correcting grammatical errors and generating sentences are higher-level language tasks, which explains why this was more difficult for her. Graph. Vowel Discrimination and Identification Vowel and Vowel Vowel Over the course of twelve sessions, XX was able to successfully discriminate between each vowel minimal pair presented, progressing to 100% accuracy. To increase the level of challenge, XX was asked to say a word and identify the placement and vowel in terms of tongue position and height, with direct instruction from the clinician. XX showed great improvement in the awareness of her tongue and was able to correctly identify numerous vowels with the use of a vowel quadrilateral. XX made tremendous progress in this domain, and eventually had to XX: Page 5 of 8

6 identify -4 different vowels at a time, as they were presented orally by the clinician. The words and tasks increased in complexity and number of vowels being identified, which correlate with lower vowel identification scores in the second half of the semester. Dialogue: Memorizing dialogues and practicing speaking were introduced to improve her pronunciation of English. These activities were designed to help her learn common speech sequences and encourage the development of self-monitoring skills for linguistic details (such as articles and prepositions) in natural language contexts. Dialogues were also introduced to target fluency while reading aloud in English, and to provide XX with a standardized script of easily accessible, grammatically correct phrases she could use in everyday conversation. They were not done consistently each session due to time and client interest. Reading the dialogues without practice proved difficult for XX, but when she was allowed to practice them for homework, her reading became more fluent and intelligible, as seen by the improvement in her scores. Table 2. Dialogue Reading Scores (Scale from 1-5) Dialogue Reading Score Graph 4. Editing a Narrative Passage Results Personal Edits Percent Errors Over the course of nine sessions, XX made revisions to journal entries/letters addressed to her grandson. This was an incredibly meaningful and successful activity for XX, and it targeted her written and spoken language skills. Allowing her to proof-read her own writing allowed the clinician to show her consistent errors and also allowed XX to see the progress she has made as an English speaker, since these entries are from over a year ago. Towards the end of the semester, XX was asked to read these journal entries out loud, to help her find more errors in her writing. While not always able to correct the error, she showed increasing awareness of errors and had great success identifying things that sounded wrong. XX: Page 6 of 8

7 Summary: XX was a highly motivated participant during each session, and this led to progress towards all of her goals this semester. XX s baseline intelligibility and intelligibility ratings provided by an unfamiliar listener show that XX s speech is highly intelligible. The data show that overall, XX made progress in her awareness and production of Standard American English in structured activities, particularly in tasks involving prosody, stress, intonation, and articulation. Areas of difficulty for her were unstructured speech activities involving complex spontaneous language generation. Identifying her own mistakes independently proved the most difficult, because that is how [XX] would normally say it. Of the four domains of accentedness (baseline intelligibility, speech production, speech perception, and language), areas for improvement continue to be language and speech production. Intelligibility and speech perception are strengths for XX. Intelligibility is extremely high, and she has made incredible progress in both identifying and producing different English vowels. Overall, XX s progress across different goals is a positive indicator for improvement in her speech production. Continued improvement will require continued support from a speechlanguage pathologist. Recommendations: Based on XX s progress this semester, the results of assessments and discussions with the clinical supervisor, the following recommendations are made: 1. Continue speech therapy for one, one-hour session per week. XX s goals should focus on spontaneous speech and intonation at the word and phrase level. 2. Emphasize syntax and self-monitoring her speech in conversation rather than articulation.. Direct instruction for vowels, with indirect instruction for consonants in isolation. 4. Utilize native English-speaking friends and family members over the winter vacation to reinforce XX s speech and language goals to minimize skill regression over break. 5. Continue to edit passages from XX s journal over break to help maintain skills, and in the following semester to provide a functional and meaningful activity for XX. Prognosis: XX s prognosis for increased intelligibility and syntactic skills is excellent given her enthusiasm and motivation during speech therapy sessions. XX s drive and motivation to make progress will also be an important component in her success. XX: Page 7 of 8

8 It has been a pleasure to work with XX this semester. If you have any questions regarding this report, please call the Eleanor M. Luse center at (802) XX, B.A. Graduate Student Clinician Cc: XX, M.S., CCC-SLP Speech-Language Pathologist Clinical Assistant Professor Appendix: Amee Shah, PhD, CCC-SLP XX: Page 8 of 8

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