To improve respiration for phonation.

To eliminate vocal tension during speech.

To expand her phonetic repertoire.

To improve her functional communication skills with people who do not know sign language.

To improve respiration for phonation by using quick appropriate inhalations followed by controlled exhalations.

To distinguish between a tense and relaxed voice production using tactile feedback.

To explore the use of amplification for feedback.

To stabilize relaxed voice during sustained phonation.

To develop acceptable productions of vowels, including diphthongs.

To expand phonetic repertoire [b, w, d, p] while maintaining relaxed phonation.

To gradually increase length of utterances (3 syllables) while maintaining relaxed voice.

4th ten weeks of therapy (two hours per week)

To continue to expand phonetic repertoire [l, f, t, s] with relaxed phonation.

To continue to increase length of utterance while maintaining relaxed phonation (4-5 syllables).

5th ten weeks of therapy (two hours per week)

To gradually increase length of utterances (3 syllables) while maintaining relaxed voice.

To increase use of speech and voice outside of speech instruction.

Student 2 is currently in her 5th ten-week quarter of instruction. The "Training Program for Correction of Tense Voice Production" (Spector [Brown], P., et.al. (1979) Description and evaluation of a training program to reduce vocal tension in adult deaf speakers. The Volta Review, 81, 81-90) has been used quarterly as a guide for developing relaxed phonation and expanding phonetic repertoire. The results of the first 4 quarters of instruction are summarized below.

Feedback: Since Student 2 was unaided during the first quarter of instruction, visual feedback was used to augment tactile awareness of tense vs. relaxed phonation. The Real-Time Pitch program on the Kay Computerized Speech Lab (CSL) was utilized because it provided a trace pattern during relaxed phonation that was markedly distinct from the pattern during tense voice. The Real-Time Spectrogram program on the CSL was also used because it facilitated correct phoneme production. At the start of the 2nd quarter of instruction Student 2 started using a hearing aid which introduced auditory feedback, but she expressed the need to continue using the CSL for reinforcement of voice and articulation.

Voice: Qualitative judgments indicate that this student is able to produce a relaxed voice production in controlled speaking situations (single words, 2 to 3-word utterances, etc.) and has developed a functional phonetic repertoire. However, rate of speech is far too slow for effective communication and she still has not mastered prosodic features of blending, co-articulation, stress, and inflection. (Pre and post recordings of this student's speech and voice are included on this site.)

Articulation: Steady gains have been accomplished. At the end of the 4th quarter of instruction her Fisher-Logemann Test results were as follows: 56.72% consonant error (28.35% improvement); 31.25% vowel error (50% improvement); 51.81% total error (32.53% improvement). Of the consonant errors, 34% were omissions, 42% were substitutions, and 24% were distortions (9 distortions: 2 severe and 7 mild). Compared to the error patterns on the intake exam, Student 2 has made significant gains. The highest percent of errors on the intake evaluation were omissions. Recent testing revealed substitutions were most prevalent. On closer examination most of these errors were cognate substitutions which often do not impact on functional intelligibility.

Speech Intelligibility: NTID Write-Down scores have slowly improved:

This indicates that over the course of instruction, speech intelligibility has improved from unintelligible (1.3) to semi-intelligible (2.9) on read sentences with experienced listeners. However, Student 2's speech is not intelligible to naive listeners in unstructured situations.

Speech samples following 4th 10-week quarter of instruction:

Intake score: 1.3

Audio Sample # 1 "On first base"
Audio Sample # 2 "A dish fell"
Audio Sample # 3 "We bought fish"
Audio Sample # 4 "Fill a bowl"

Achieving functional speech intelligibility with relaxed phonation is possible but the prognosis remains guarded. Although Student 2 has made steady gains (reducing vocal tension and improving phoneme production), she does not consistently use speech outside of instruction. She is dependent on visual feedback (CSL) and without it, she is not consistently able to maintain relaxed phonation. She has reported using voice with somme friends and classmates on a limited basis (one or two-word utterances) and has been reinforced by experiencing some success. She is currently in her 5th quarter of speech instruction and wants to remain enrolled. If she continues to make this slow and steady improvement and increases her use of speech in her daily life, limited funcational intelligibility is a realistic goal.

Case Study #1

Case Study #3

Case Study #4