Hello!

This is the second in a series of semi-regular monthly newsletters suggesting helpful tips for remediation of articulation/phonology disorders.  If you missed the first one, it is on my website: https://satpac.com/newsletter.

This issue of the newsletter will focus on another element of my approach which involves the use of coarticulation.  The SATPAC Approach is based on the idea that when we as SLPs work to remediate sounds/phonological processes, the therapy should be as close to conversational speech as possible and to include the elements that we use in conversational speech (i.e., coarticulation, normal rate, natural prosody, etc.)  I find that there is a disconnect between the way most SLPs do therapy and conversational speech.  That is, we tend to work on sounds with either the sound in the initial or final position. Yet when we speak in conversation, the target sound is usually neither first nor last but somewhere in between. For that reason, the SATPAC Program always has the target sound embedded in the middle of the words.  Here are some examples:

1)    For /s/, I frequently use the nonword BEETSEET.  Notice how the target /s/ sound is imbedded in the word and is in the prevocalic position meaning that it is followed by a vowel.

2)    For /r/, I frequently use the nonword EERGA.  The /r/ is in the postvocalic position in this case.  In practice, it is much easier to stop with the /r/ at the end of the word than to have to transition into other sounds.  Coarticulation from the beginning makes it easier for the student to make that transition. (Note:  In this case, it is actually easier with the GA following EER because it is a facilitating context.  As the SATPAC lists progress, the GA goes away and /r/ is said in various contexts).

3)    If I’m working on s-clusters, I have the student say the word “A” before the cluster so they have to transition from an open mouth position for the “A” to a closed mouth position for the /s/ (e.g., a spoon, a stop, a sketch, etc.).  Again, it is much easier to start with the /s/ in every case but much better practice to be making the transition from the ‘A” to /s/.

To see details about /r/ and /s/ remediation and more information about my approach, I offer free ASHA CEUs on my website at https://satpac.com, or you are welcome to just watch the presentation.

If you use my techniques for /r/, you might have immediate success. However, there are 3 subtle things that often go wrong. The first relates to stabilization of the sides of the tongue against the back molars. One of the reasons I start teacher /r/ with EE in front (i.e., EERGA) is that the tongue stays wide for EE. This helps keep the tongue stabilized on the molars by keeping it wide. Because this /r/ is visible (using a flashlight), you can observe if the student is keeping the tongue on the molars as they say EERGA. This is critical as if there is no stabilization, there will not be the necessary constriction to get the /r/ sound.
Another subtle problem has to do with the height of the dorsum (mid-tongue area). Often students are doing everything correct except the dorsum is not high enough to get the /r/ sound. To remedy this, I will put an applicator stick with a cotton tip midway between the hard and soft palate. Using a mirror and flashlight, ask the student to touch the cotton ball with the dorsum. Typically they don’t get the tongue high enough to touch it but the effort to raise the dorsum higher than usual leads to a correct /r/ sound. There should be discussion about why they got a good /r/ after doing this. Another technique to raise the dorsum involves making the tongue bunchy and sliding it back and forth keeping it as high as possible.
I used to have a bunch of /r/ kids who I referred to as my “lifers”. I was not making adequate progress with them and careful examination revealed that they all had subtle problems with jaw stabilization. When I got them to stabilize their jaws consistently, they got it! I used infant tongue depressors as well as a mirror when they were removed to emphasize the consistent jaw stabilization.
Stephen Sacks SATPAC Speech
Upcoming workshops will be in Sacramento and San Jose at the end of April and Kansas City and St. Louis in October. Go to www.satpac.com to see the specifics as they will be posted soon.

I’ve always liked that word. The definition is “an aptitude for making desirable discoveries by accident”.

In November, I did a 5 day, 5 city presentation schedule for BER. It was exhilarating and exhausting. What I didn’t expect was that the more I did my presentations, the more I thought about the SATPAC Program and what could be changed to make it better. We are in the process of a major overhaul so the workshops were very helpful in being able to pinpoint ways to make the program better.

For example, there is often a breakdown for postvocalic /r/ when the student transitions from the final Practice Phase list which includes sentences like “The boy bought a new EERGA.” to the Transfer/Generalization Phase phrase list (dear Barney). I realized after one of the workshops that there needs to be a list to practice to help make this transition and that list will be part of the program soon.

On a different topic, last summer I did a couple of workshops that took place in people’s living rooms. The host attended the workshop for free and got a free SATPAC Program and the other participants received a reduced rate as I did not need to pay for an expensive conference room. I did this in my home state in Southern California last year but this year I would be willing to travel. If you are interested, let me know and we can work out the details.

Stephen SacksSATPAC Speech

Workshops:I will be doing two workshops in Houston and Dallas on Feb. 19 – 20. Details are here. Future workshops will be in Sacramento and San Jose in May and Kansas City and St. Louis in October.

In my 34 year career, I’ve done a lot of articulation mentoring of other SLPs. One of the most consistent issues I see is that practice tends to be too slow. When I first developed the SATPAC Program, I had kids complete the program and they were not transferring their correct productions into conversation. I realized that I was taking them through the program too slowly.

Because this is such an important issue, I’m repeating most of my April 2013 column.

The SATPAC Approach is based on the idea that when we as SLPs work to remediate sounds/phonological processes, the therapy should be as close to conversational speech as possible and to include the elements that we use in conversational speech (i.e., coarticulation, normal rate, natural prosody, etc.).

Early in my career I was practicing the /s/ sound with a student and we were working on sentences. He was saying them at a slow rate: I wash with sssoap. I like to sssing. The bell rang and he said at a normal rate: Thee you later Mithter Thackth–Itth time for retheth!

Realizing that it is necessary to begin at the level where the student’s skills are, we often have to begin at a slow rate. However, the goal needs to be to practice at the same conversational rate that the student speaks.

With SATPAC, I follow a 3-part approach. First the target sound is established (Establishment Phase) in one context (for /s/ I frequently use the nonword BEETSEET). It is repeated over and over until the student is 95% accurate. Then the second step uses the target sound in many different contexts. In SATPAC, this is known as the Practice Phase. The student builds up to a conversational rate practicing systematic lists (140 beats per minute using a metronome). The third step is the Generalization/Transfer Phase where the student is now using his skill to practice phrases, sentences and conversation–all at a normal conversational rate.

If you have your students practice at a conversational rate, you will be pleased by how much quicker they transfer their skills into conversation.

Stephen SacksSATPAC Speech

Workshops: I will be doing two workshops in So. Cal October 3rd and 4th. Registration will be $59 or $159 with the purchase of the SATPAC Program (Program normally $150 by itself). SATPAC is a growing company and our computer program is being used by universities, hospitals, clinics and school districts all around the world. We are looking for people to market SATPAC in their geographical areas part-time on a commission basis. Contact steve@satpac.comsteve@satpac.com if you are interested or have friends or associates who might be.

In my 34 year career, I’ve seen a certain pattern several times in highly unintelligible 4 and 5 year olds. This was their profile:

Phonological processes of fronting (t/k, d/g), stopping (t/sh,s, d/z, b/v, p/f, t,d/th), consonant cluster reduction (p/pl, p/sp), FCD (kni/knife, da/that), deaffrication (t/ch, d/j) and gliding/vowelization for /r/ (wud/rug, dee-e/deer).

Using the SATPAC Approach, I’ve had excellent success using two lists targeting different processes. The list OKKOP targets fronting and final consonant deletion. The list EESNEEP targets stopping, cluster reduction and final consonant deletion. The tricky part is figuring out what sounds to exclude. For OKKOP, you exclude all the sounds they can’t say plus /t,d/ which would interfere with the target back sounds /k,g/. For EESNEEP, you again exclude all the sounds they can’t say plus /t,d/ which would interfere with the fricatives /s,z/. In the cluster SN in EESNEEP, N is chosen because the student can say the word EESNEEP without a stop (until the end). If N were not chosen and it was EESTEEP for example, they would continue to use the stopping process and say EETEEP.

After a while, they reduce their phonological processes to deaffrication and gliding/vowelization and some inconsistency with the cluster reduction (now using s-clusters). Their speech has gone from highly unintelligible to mostly intelligible!

Stephen SacksSATPAC Speech

Workshops: I will be doing two workshops in So. Cal October 3rd and 4th. Registration will be $59 or $159 with the purchase of the SATPAC Program (Program normally $150 by itself). SATPAC is a growing company and our computer program is being used by universities, hospitals, clinics and school districts all around the world. We are looking for people to market SATPAC in their geographical areas part-time on a commission basis. Contact steve@satpac.comsteve@satpac.com if you are interested or have friends or associates who might be.

I got an email recently from a SATPAC user who wrote: SATPAC is the best program for highly unintelligible students I have ever used!

This made me think about why that might be true. There are many reasons but using systematic lists with lots of repetitions is critical. For example, there are 4 CVCV lists that can be modified to only include what the student can say. Each systematic list becomes more difficult than the previous list. So let’s say that the student can only say the following consonant sounds /p,b,m,w,t,d,n/. List one would be reduplication following the vowel circle from EE to OO like BEEBEE, MIMI, WAEWAE, etc. List two would have random vowels like BEEBI, MUHMAE, WIWOO,etc. List three would have random consonants with systematic vowels like WEETEE, PIBI, DAEPAE, etc. and list four would have everything random.

With students like these, I’ve noticed that they typically don’t talk much. I think the reason is that speech has been a failure experience so they tend to give up. Using these lists where they can say all the sounds, they experience some success. , I’ve noticed with many students, the more they use speech, the more they will spontaneously develop new consonant sounds without any direct work on those sounds.

Once a student is able to use CVCVs with various consonant and vowel combinations, they are well on their way to being understood in communication. For example, to say “Momma, I want a banana” they might say, “Momma, I wa nana.” Or looking through a book of animals to say, That’s a silly zebra” they might say, “Da tiwee deba” Having the book for context, that utterance can be understood.

Next month: Highly Unintelligible Speech-Part 2 Remediating the Phonological Processes

Stephen SacksSATPAC Speech

Workshops- I will be doing two workshops in So. Cal October 3rd and 4th. Registration will be $59 or $159 with the purchase of the SATPAC Program (normally $150) and discounts for groups of 10 or more. I’m also bringing Pam Marshalla to Texas for 2 dates in early 2015 and in St. Louis/Kansas City in the fall of 2016. Pam will be presenting on Carryover Techniques in Articulation and Phonology (details to come).

My daughter who is a Special Ed. Resource Specialist has a co-worker with a 7th grade son who was not using the /r/ sound. He had spent years in therapy in elementary school without success. She asked me if I would see this student.

Two months later after weekly 20 minute sessions, he is using /r/ in conversation. There are many reasons for the change in his behavior. In our initial session, I asked him to show me how he makes the /r/ sound. He used a retroflex /r/ and the sound was distorted. I explained to him that there are different ways to make the /r/ sound and that the most efficient is the back or bunched /r/ where a slight pull back of the tongue in the proper position leads to the correct /r/ sound. Using the SATPAC Approach (which includes the 6 elements of facilitating contexts, co-articulation, natural prosody, normal rate, non-words and many repetitions), he used a facilitating context for /r/ which was EERGA. Including a multimodality approach where he listened, felt and saw his correct/incorrect /r/ productions using a mirror and a flashlight, he was able to develop some consistency. First he used an infant tongue depressor under his tongue to move it back and bit an infant tongue depressor with his side teeth to stabilize his jaw which was moving when he made productions. Over time, he was able to say EERGA without the push stick keeping the tongue up on the top teeth and keeping his jaw stabilized just by watching it in a mirror.

We proceeded through the SATPAC Program with the Establishment Phase, using the /r/ sound in one context (EERGA). Then he did the Practice Phase using the postvocalic /r/ in many varied non-word contexts with each of the 5 lists systematically more difficult than the previous list. Finally, he moved to the Generalization/Transfer Phase using real phrases, sentences and transfer into conversation. When he was using a consistent postvocalic /r/, I had him practice prevocalic /r/ beginning with ER (e.g., ER Rat, ER Ramp, etc.). After a little bit of practice, the ER went away and he said the prevocalic words normally. He practiced faithfully a few minutes averaging 5 days a week.

To view my techniques in more detail, you can view my free CEU presentation and receive the free CEUs or just view it as you like.

Stephen SacksSATPAC Speech

Workshops- I will be doing two workshops in So. Cal October 3rd and 4th. Registration will be $59 or $159 with the purchase of the SATPAC Program (normally $150). I’m also bringing Pam Marshalla to Texas for 2 dates in early 2015 and in St. Louis/Kansas City in the fall of 2016. Pam will be presenting on Carryover Techniques in Articulation and Phonology (details to come).

I’ve always gone out of my way in my workshops to talk about how important relationships are with our students. I found as a young SLP that when I focused on developing better relationships with my students, that discipline issues that I was experiencing became almost nonexistent.

To show how important this is, I just took over a 3 day a week caseload from an SLP who went out on a maternity leave. I’m seeing 48 students-with some seen 2-3 times a week. This week I was summoned into the principal’s office and he had gotten a call from a parent of one of my students. There was a big misunderstanding between this student and I and as I reflected, I realized that I had tried to do too much with my invasive articulation techniques before I had gotten to know the student.

The moral here is that you can have the best techniques in the world but until you have the trust of the student you are working with, the techniques don’t matter. The principal suggested that I take time to develop good relationships with the students. Obviously I knew that but didn’t practice what I preached!

Stephen SacksSATPAC Speech

To see details about /r/ and /s/ remediation and more information about my approach, I offer free ASHA CEUs on my website Satpac.com or you are welcome to just watch the presentation.

Workshops- Pam Marshalla just completed two terrific workshops in So. Cal. on Carryover in Articulation for SATPAC Speech. She is going to do two more in Texas in early 2015. I will be doing two workshops in So. Cal October 3rd and 4th. I’ll give details as the dates get closer.

There is a controversy among SLPs about O-M and whether it has a place in our profession. The main person opposed is Gregory Lof who has published several articles on the worthlessness of O-M exercises. When I was at the ASHA Convention, I went to a session on /r/ therapy given by a university professor. After the presentation, a question about using O-M techniques was asked. The professor quickly dismissed the question by saying, “The research is clear that these techniques don’t work.”

Interestingly, Lof has done a survey of SLPs and 85% report using O-M techniques! I think the important question here is if these techniques are worthless, why are the vast majority of us using them? And I think this answer is clear. We use them because they work!

Does this mean all oral-motor exercises are effective? No, they must have a specific purpose for what you are remediating. So wagging the tongue left/right outside the mouth would be worthless because it does not have a specific purpose for remediating any sounds. On the other hand, I have developed a technique for remediating the /s/ sound that I call EE-POP which has worked every time on hundreds of students through the years. This techniques helps in developing the proper stabilization and differentiation needed for saying the /s/ sound correctly. You can read about this technique in the Journal of Perceptional and Motor Skills (Sacks, Flipsen, Neils-Strunjas, Volume 117, Issue 2, October 2013: pp. 559-577). Or if you want to see this technique in action, go to Satpac.com and go to the bottom of the page for free CEUs and watch the videos.

At an evidence-based practice conference in 2004, Ylivasker said that the strongest evidence for the use of a specific technique is its effectiveness with the particular client. If it works-do it; if not, try something else!

Stephen Sacks
SATPAC Speech
To see details about /r/ and /s/ remediation and more information about my approach, I offer free ASHA CEUs on my website Satpac.com or you are welcome to just watch the presentation.

Workshops- To get information about Pam Marshalla’s workshops in February in Southern California, here is the link. If you would like me to come and speak to your organization or school district, contact me at steve@satpac.comsteve@satpac.com

Hello!

Wishing you all a wonderful holiday season and hope that your 2014 will be terrific!

ASHA in Chicago was an amazing event with 15,000 professionals attending. My session with my colleague Peter Flipsen Jr. went very well with 300+ people attending. One of the attendees Kim Lewis has a blog called Activity Tailor and she wrote a review of the presentation and the SATPAC Program. If you want to read the whole review, scroll down to Dec. 17, 2013 on her blog. I took some of what she wrote to share with you here:

SATPAC (Systematic Articulation Training Program Accessing Computers)

I arrived at ASHA with my schedule more or less organized. There were a few sessions that conflicted with one another and I was going to need to make a final selection, but a few I was going to be at no matter what. The one at the top of the list was Efficacy of the SATPAC Approach for Remediating Persistent /s/ Errors. It was as game changing as I could have hoped.

SATPAC is designed to move kids through therapy quicker (while homework is a must, contact time with the therapist is kept to a minimum, often 10-15 min/week) and assist carry-over since you are immediately working with normal rate and prosody and you move to sentence level work so quickly.

The focus is on nonsense words, a recommendation that came up in several sessions, since they don’t have previously learned error patterns associated with them. It also focuses on very high trials/session-200-500 depending on the length of session time (and, yes, 200 for a 10-15 min session is possible!).

The presenter and creator, Stephen Sacks, had an hour to take us through the program and his explanations and video made compelling arguments for the protocol.

The practice phase is the most exciting. SATPAC allows you to enter the child’s name and generate lists specific to that child. So, for our example, I’ve entered myself as a student with a list, also struggling with both “th” sounds as well as “r.” I enter that in and have SATPAC make 5 practice lists specific to my abilities.

Lists 1-4 are single nonsense words with various consonant and vowel changes. List 5 contains sentences with one nonsense target word. The clinician asks questions (given to you) and the student answers with the same sentence each time, but varying the stress.

Next you move on to the generalization/transfer phase which again gives you the opportunity to print out tailored lists for students at the phrase, short sentence and sentence level.

I’ve been using the program now for a few weeks and I’m noticing much faster improvement than I frequently see. I’ll admit it’s taken me longer to get the hang of it than I expected. I sometimes feel like I’m flipping back and forth between my notes and the lists (or “winging” the pronunciation of the nonsense words) but I’m improving every day and the effort is WELL worth it! I would suggest immediately starting with the free CEU section of his website to be sure you have a good handle on both the idea behind the program and the implementation of it.

For me, the program has the most utility with elementary aged students and ideally with decent language skills.

I’ve sent home a couple lists and while I haven’t had a parent call to say “what?!” I have had to do a bit more education (why we are using “fake” words) and cheerleading (“You can do it! Don’t sweat whether or not you have the vowels quite right!”). The additional practice might not be the best fit for all families, but you could easily have a teacher, aide or carefully selected buddy run through the lists since they are so quick to do.

The program also contains list generating abilities for kiddos with apraxia that move through a hierarchy allowing reduplication, reduplication of just the consonant (varied vowel), reduplication of vowel (varied consonants) or varying both consonant and vowel. Again, you have the option to remove and sound-vowel OR consonant-that the child doesn’t yet have in their repertoire. I haven’t had the need for this yet, but it’s something that has come up for me in the past and I’m looking forward to adding this to my arsenal when it crops up again!

Stephen Sacks SATPAC Speech

To see details about /r/ and /s/ remediation and more information about my approach, I offer free ASHA CEUs on my website www.satpac.com or you are welcome to just watch the presentation.

Workshops- To get information about Pam Marshalla’s workshops in February in Southern California, here is the link. If you would like me to come and speak to your organization or school district, contact me at steve@satpac.comsteve@satpac.com . For the BER seminars, here is a link to one of my workshops. Dates are Jan. 7 in Cherry Hills, NJ, Jan. 8 in White Plains, NY, Jan 9 in Chicago and Jan. 10 in Champaign.