Treatment of active nasal fricatives substituting /s/ in young children with normal palatal function using motor-based intervention

Figures & data

Table I. Detailed description of the three participants in the final study group, including results from the initial assessment at the clinic.

Participants	Peter	Tom	Anna
Age at start of therapy (years:months)	6:0	3:10	4:0
Age at termination of therapy (years:months)	6:4	4:0	4:5
Phonemes substituted by active nasal fricatives	/s/	/s/ and /f/	/s/ and /f/
Type of active nasal fricatives	Anterior	Anterior and posterior (varied)	Anterior
Hypernasality	No^a	No^a	No^a
Audible nasal emission	No^a	No^a	No^a
Weak consonant pressure in words without /s/	No^a	No^a	No^a
Phonological development	Age appropriate^a	Age appropriate^a	Age appropriate^a
Language level	Age appropriate^b	Age appropriate^b	Age appropriate^b
Previous SLP contact	Yes	No	Yes
Verified VPC by nasendoscopy	Yes	–^c	Yes
Normal hearing at age 3	Yes^d	Yes^d	Yes^d
Typical psycho-motor development at age 3	Yes^d	Yes^d	Yes^d
Attending kindergarten	Yes	Yes	Yes

SLP: speech-language pathologist; VPC: velopharyngeal competence.

a According to clinical assessment at study start.

b Informally assessed by experienced SLP at study start.

c Child did not participate in nasendoscopy but VPC was verified based on clinical assessment by experienced SLP.

d Caregiver reported results from the routine examination at age 3 offered to all Swedish children by the national child health care centres.

Table II. Detailed description of the treatment steps, corresponding linguistic contexts, examples of materials and activities at each step as well as number of probe measure items and probe item examples per each linguistic context.

Treatment step: linguistic context	Treatment step description	Examples of materials and activities^a	Number of probe measure items	Probe item examples
1: Onomatopoetic expressions	onomatopoetic fricatives	Pictures depicting onomatopoetic expressions (e.g. hushing-sound, wind blowing). Imitating, gluing pictures into booklet.	–	–
2: Phoneme	isolated /s/	Toy snakes + pictures of snakes. Play with toy snakes, imitating “the snake sound”.	5	/s/
3: Syllable	/s/+vowel	Plastic letters: S + O, S + I, etc. Post box game.	5	si, so
4: Word initial	word initial /s/	Toy snakes + pictures of words with initial /s/. Play with toy snakes.	10^b	sol (sun)
5: Word final	word final /s/	Toy snakes + pictures of words with final /s/. Memory game.	^b	hus (house)
6: Word medial	word medial /s/	Toy snakes + pictures of words with medial /s/. Bingo game.	^b	läser (is reading)
7: Cluster	word initial /s/-clusters with oral consonant(s)^c	Small items + pictures of words with initial /s/-clusters. Memorising and recalling game.	10	skor (shoes), sprutar (is splashing)
8: Nasal cluster	word initial /s/- clusters with nasal consonant^d	Pictures of words with initial nasal /s/-clusters. Picking up pictures from a box and naming them.	5	snö (snow), smulor (crumbs)
9: Sentence	sentences containing words with /s/ in different positions	Depicted story with sentences containing multiple words with /s/. Reading and retelling the depicted story.	10	Sissi och Lasse sover. (Sissi and Lasse are sleeping.)

^aEvery step included a colour-coded booklet with pictures and instructions.

b Word contexts of /s/ in initial, final and medial position were grouped together in the probe measure (a total of 10 items).

c Included the following consonant clusters: /sp/, /st/, /sk/, /spr/, /str/ and /skr/.

d Included the following consonant clusters: /sm/ and /sn/.

Figure 1. Percent correct (oral) /s/-production for Peter in the six linguistic contexts probed and in the corresponding probe total score across all study phases. A: baseline, B: treatment and FU: follow-up. Dotted lines indicate treatment start of a specific linguistic context.

Figure 2. Percent correct (oral) /s/-production for Tom in the six linguistic contexts probed and in the corresponding probe total score across all study phases. A: baseline, B: treatment and FU: follow-up. Dotted lines indicate treatment start of a specific linguistic context. Hatched lines indicate a three-week treatment break.

Figure 3. Percent correct (oral) /s/-production for Anna in the six linguistic contexts probed and in the corresponding probe total score across all study phases. A: baseline, B: treatment and FU: follow-up. Dotted lines indicate treatment start of a specific linguistic context. Hatched lines indicate a five-week treatment break.

Table III. Mean probe total score across study phases, mean difference in probe total score between study phases, total number of treatment sessions, total intervention duration as well as time from treatment end to FU1 and FU2 for the three participants.

Participant	Mean probe total score, raw score (%)			Mean difference in probe total score, raw score (%)			Total number of treatment sessions	Total intervention duration, weeks	Time from treatment end to FU1 and FU2, weeks
	Phase A	Phase B	FU	Phase A to B	Phase B to FU	Phase A to FU
Peter	0.0 (0%)	30.1 (66.9%)	45.0 (100%)	30.1 (66.9%)	14.9 (33.1%)	45.0 (100%)	8	11	11 and 25^c
Tom	0.0 (0%)	14.1 (31.4%)	45.0 (100%)	14.1 (31.4%)	30.9 (68.6%)	45.0 (100%)	8	11^a	1 and 13
Anna	1.0 (2.2%)	14.7 (32.6%)	45.0 (100%)	13.7 (30.4%)	30.3 (67.4%)	44.0 (97.8%)	9	16^b	1 and 10

Phase A: baseline; phase B: treatment phase; FU: follow-up.

Maximum probe total score = 45.

a Including a three-week illness intermission with home-training only.

b Including a five-week holiday with home-training only.

c Follow-up probes were delayed due to summer holidays.