To develop interactive spoken and signed English

To build a phonetic repertoire

To improve intelligibility of functional words and phrases

To stimulate pitch awareness and control

To reinforce correctly articulated phonemes when they occur in therapy

To explore potential contributions of tactile, proprioceptive, auditory and/or visual feedback related to pitch level and phoneme production

To stabilize habitual pitch at 250Hz or below

To increase awareness of occurrences of inappropriately high pitch and/or loudness

To stimulate awareness and correct productions of voiced vs. voiceless consonants

To stimulate correct production of vowels

Feedback: Use of Kay Visi-Pitch III for visual feedback related to pitch level/control and vowel production was effective; tactile feedback was not beneficial for pitch monitoring; auditory feedback was not used because student never brought hearing aids to therapy.

Pitch: Able to produce low vowels in isolation and cvc's at a relatively low pitch (below 250Hz) but high and front vowels were always at an inappropriately high pitch. All utterances were terminated with a pitch rise.

Articulation: Consonants /h, m, s, b, d, w/ were reinforced when they occurred correctly during therapy sessions.

Speech Intelligibility: 6% (1.2 rating) for a gain of 4% on the NTID Write-Down Test.

Feedback: Use of Kay Visi-Pitch III (Real-Time Pitch) and IBM SpeechViewer II (Waveform and Spectrograms) to reinforce pitch level and air management on /s, t, sh, m, n/; hearing aids were used for several sessions with no noticeable benefit for monitoring pitch or speech sound production

Pitch: Consistently able to maintain pitch below 300 Hz on sustained vowels, words, phrases and read sentences; unable to eliminate habituated terminal pitch rise in any context; unable to control loudness or pitch in spontaneous speech or conversations.

Articulation: Able to recognize visual differences between voiced and voiceless consonants on spectrograms; unable to produce voiceless stops; moderate success in producing voiceless fricatives /s, sh/ in cvc words in structured drills and in some functional words/phrases the student wanted to practice.

Speech Intelligibility: 22% (1.9 rating) on the NTID Write-Down Test for a gain of 16% (20% total gain since instruction began).

Prognosis for attaining intelligible speech is guarded after 20 hours of instruction. Improvements in pitch level and control were achieved quickly but no further gains were made. Student 1 is stimulable to correct on very few speech sounds. Gains were made because she more consistently produced sounds from her limited repertoire and reduced the number of deletions of final sounds in words. She may be able to achieve semi-intelligibility on a set of functional words and phrases if she learns to self-monitor pitch and carryover her best sound productions into spontaneous speech.

Case Study #2

Case Study #3

Case Study #4