Coombes

Map Branches

• whole system approach
  • intervention targets:
    • multiple speech subsystems
      • breathing
      • Nasal resonance
      • Articulation
      • Pitch control
  • examples of aims
    • breathing control
    • maintain pressure across utterance
      • teach:
        • start speaking at start of exhalation
        • split utterances into smaller phrases
          • maintain
    • slow speech rate
      • rationale:
        • allow oral muscle movement precision
    • Strand/Yorkston
      • respiratory effort
      • jaw movement in speech
        • oral cavity size
      • speech/non speech exercises
        • practice closing nasal airway during speech
  • Evidence?
    • Yorkston 1996
      • Not systematic
• other therapy approaches
  • treatment packages
    • Oral mm. 
    • PROMPT
      • combination
        • tactile stimulation
        • cueing
      • "fiddling about"
        • periphery
    • TalkTools
      • originator
        • S.Rosenfeld-Johnson
      • rationale
        • assumption:
          • strong
            • sucking/blowing
            • Speech
      • format
        • hierarchies:
          • bubble blowing
          • Horn blowing
          • straw drinking
      • controversy
        • parental demand
    • M.O.R.E
      • RATIONALE
        • sensory integration therapy
          • Ayres 1972
        • focus
          • synchrony
            • suck
            • Swallow
            • Breath
          • NOT AIMED AT DYSARTHRIA
    • Myofunctional Therapy
      • USA
      • aims
        • correction:
          • malocclusion
          • Lisps
      • format
        • OM exercises
  • Oro-motor approaches...
    • summary
      • assume
        • vegetative functions
        • Speech
      • theoretical basis
        • unclear
      • approach
        • mix
          • stimulation
          • cueing
      • evidence
        • zero
      • LOOK PRETTY!
• physiological approaches
  • alternative physical approaches
    • Hydrotherapy
    • Riding
    • Alexander technique
  • proprioceptive neuromuscular facilitation
    • format
      • oropharyngeal reflexology
    • aim
    • disadvantages
      • congenital disorders
        • effectiveness
      • ? dangerous
      • adult approach
  • oral facial stimulation
    • disadvantages
      • impact
        • temporary
    • advantages
      • hypersensitivity
        • (untitled branch)
        • (untitled branch)
  • Facial Oral Tract Therapy
    • approach
      • physical contact/manipulation
      • facilitate normal movement patterns
        • "speech precursors"
          • teeth cleaning
          • drinking
          • eating
    • Base
      • Coombes
      • Neuro-development Theory

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