A shift of treatment approach in speech language pathology services for children with speech sound disorders – a single case study of an intense intervention based on non-linear phonology and motor-learning principles

Figures & data

Table 1. The Swedish vowel inventory.

	Front	Central	Back
High	iː yː	uː	uː
	ʏ ɪ		ʊ
Mid-high	eː øː	ɵ	o:
Mid	ɛ œ		ɔ
	ɛː
Low	a		ɑː

Table 2. The Swedish consonants.

	Place of articulation
		Labial		Coronal		Dorsal		Laryngeal
		Labial	Labiodental	Dental	Post- alveolar*	Palatal	Velar	Glottal
Manner of articulation	Stops	p b		t d	ʈ ɖ		k ɡ
	Nasals	m		n	ɳ		ŋ
	Trill				r
	Fricatives		f v	s	ʂ	ɕ j	ɧ	h
	Laterals			l	ɭ

* the retroflexes, ʈ ɖ ɳ ʂ and ɭ are often the result of assimilations between/r/and a coronal in Central Swedish, but are often regarded as separate consonant phonemes since they are used contrastively in word medial and word final position.

Table 3. Time table of the study.

December-January	February	March-April	May	June
Base-line assessments	Therapy block I	Intervening break	Therapy block II	Post therapy assessment

Table 4. Chosen target words and phrases and matched probes, with target pronunciations used in the two blocks of therapy

Therapy block I		Therapy block II
Target words	Probes	Target words	Probes
tupp* [tɵp] (rooster)	topp [tɔp] (top)	Klocka [ˈklɔka] (watch)	plocka [ˈplɔka] (pick)
napp [nap] (pacifier)	nål [noːl] (needle)	Blomma [ˈblʊma] (flower)	blöda [ˈbløːda] (bleed)
tåg* [toɡ] (train)	tak [tɑːk] (roof)	Pannkaka [ˈpaŋˌkɑːka] (pancake)	badanka [ˈbɑːdˌaŋka] (rubber duck)
docka [ˈdɔka] (doll)	data [ˈdɑːta] (data)	Sommarlov** [ˈsɔma(ɾ)ˌloːv] (summer holiday)
ballong* [baˈlɔŋ] (balloon)	giraffe [ɧɪˈraf] (giraffe)	iIpad [ˈajpæd]	Adam [ˈɑːdam] (Adam)
delfin [dɛlˈfiːn] (dolphin)	gitarr [jɪˈtar] (guitar)	Igelkott** [ˈiːɡɛ(l)kɔt] (hedgehog)
kanin [kaˈniːn] (rabbit)	orange [ʊˈraɳʂ] (orange)	jag vill ha [jɑː vɪl hɑː] (I want)	han är fin [han ɛ: fiːn] (he is nice)
polis [pʊˈliːs] (police)	fåtölj [fɔˈtølj] (armchair)	jag vill sova**[jɑː vɪl ˈsoːva] (I want to sleep)
		jag är fem år [jɑː ɛː fɛm oːr] (I’m 5 years)	hon är ett år [hɵn ɛː ɛt oːr] (she is 1 years)
		jag ska bada** [jɑː skɑː ˈbɑːda] (I’m going fora swim)

*were replaced by three words with iambic stress pattern (polis, ballong and kanin) **replaced the word/phrase immediate above. Replacements were done when the participant managed to say the target correctly in 90% of the trials.

Table 5. The participating boy’s phonological strengths and needs before therapy divided by word structure, single consonants by word positions* and features.

	Word structure	Word positions, single consonants	Features & segments
Strenghts	2 syllabic words, trochaic stress pattern and the following CV word shapes: CV, CVC, CVCV, CVCVC, (VC)	WI:/p b m f l j k ɡ h/	Manner: Plosive, nasal, fricative
		WM:/b ŋ/	Place: labial (labiodental), palatal, dorsal
		WF:/f/	Laryngeal often matches
Inconsistent or often used as substitution or in assimilation		WI:/d/	Manner: lateral
		WM:/p b f n l ɕ j k g/	Place
		WF:/p t n l ɕ j k g/	laryngeal
Needs	≥3 syllables, iambic stress pattern and all with CC	WI:/t d s (n l)/	Manner: Trill
		WM:/p f t d r s l ɳ ʂ j/	Place: Coronal: dental
		WF:/v t d r n s l ɳ ʈ/	Laryngeal: Voicing precision need

*Word-initial:WI, Word-medial: WM, Word-final:WF

Table 6. The participating boy’s phonological strengths* and remaining needs** after therapy divided by word structure, single consonants by word positions.

	Word structure	Word positions, single consonants	Features & segments
Strenghts	3 syllabic words, both trochaic and iambic stress pattern and the following CV word shapes: CV, CVC, CVCV, CVCVC, VC, CCV	WI:/ p b m t d n f v l j k ɡ h ɕ /	Manner: Plosive, nasal, fricative
		WM: / p b v k g ŋ/	Place: labial labiodental, palatal, dorsal, Coronal: dental
		WF: /p f t n l s g /	Laryngeal often matches
Inconsistent or not elicited		WI: /s/	Manner: lateral
		WM: / d l /	Place (coronal:dental)
		WF: /d l /	Laryngeal: Voicing precision
Remaining needs	/s/+C, C+/v/ and CCC	WI: / r ɧ /	Manner: Trill
		WM: / r ʂ ʈ ɖ ɳ /	Place: retroflex
		WF: / r ʂ ʈ ɖ ɳ /	Laryngeal

*gains in bold ** not all sounds in all positions were elicited

Figure 1. Percentage of whole word match, word shape match, CCV-match, PCC and coronal match at baseline and one week after therapy.