Sound Production Treatment: 4-Step Protocol

In this article, you’ll learn how to do Sound Production Treatment, an evidence-based treatment for apraxia of speech.

Let’s dive in!

What is Sound Production Treatment? 

Sound Production Treatment (SPT) is an apraxia of speech treatment that targets specific sound errors. It was developed by Julie Wambaugh and colleagues.

SPT uses integral stimulation, the principles of motor learning, and a cueing hierarchy to improve sound production (Wambaugh et al., 1998; Wambaugh & Mauszycki, 2010).

Here’s the cueing hierarchy:

• visual & verbal cues
• written cues
• integral stimulation (“Watch me, listen to me, say it with me”)
• articulatory placement cues
• gestural cues (as needed throughout)

(Wambaugh et al., 1998; Wambaugh & Mauszycki, 2010)

Take Wambaugh’s Medbridge course to learn more about SPT, including helpful how-to videos.

Sound Production Treatment is an articulatory–kinematic treatment, an approach based on the principles of motor learning.

The articulatory-kinematic approach focuses on:

• Accurate speech movements
• Sensory cues
• Frequent and intensive repetitions
• Being intentional about the type and frequency of your feedback
• Being intentional about the order of treatment

(ASHA, n.d.)

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When to Use Sound Production Treatment

Use Sound Production Treatment to treat apraxia of speech.

Research shows that SPT improves the production of trained sounds in people with apraxia of speech. This includes severe AOS, chronic AOS, and/or verbal perseverations (Wambaugh et al, 2010; Mauszycki & Wambaugh, 2020).

How To Do Sound Production Treatment

Sound production treatment targets each patient’s specific sound errors. These can be in words, phrases, or sentences.

You’ll start by giving minimal cues. Then add on more cues, as needed.

Here’s how.

Preparation

• Choose 2-3 target sounds. Prepare a list of at least 50 words that focus on your patient’s sound errors.
• Consider minimal pairs. For monosyllabic target words, you may need to use a ‘minimal pair’ during treatment. The pair will be based on a phoneme your patient has difficulty producing. The minimal pair may change as the patient improves. Go with it!

Sound Production Treatment Steps

• Step 1: Model the target word. Ask for repetition
  • After any response, give feedback
  • If the patient is correct at any point: Ask for 5 repetitions. Then move on to the next target word
  • If incorrect, choose a word that sounds like what they just said (the minimal pair). Model the minimal pair
  • If still incorrect, say, ‘Watch me, listen to me, say it with me.” Then say the minimal pair with the patient up to 3 times
  • If still incorrect, go to step 2
• Step 2: Write down the target sound. Then model the target word. Ask for repetition
  • After every response, give feedback
  • If the patient is correct at any point: Ask for 5 repetitions. Then move on to the next target word.
  • If incorrect, go to step 3
• Step 3: Say, “Watch me, listen to me, and say with me.” Then say the target word with the patients up to 3 times 
  • After any response, give feedback
  • If the patient is correct at any point: Ask for 5 repetitions. Then move on to the next target word. 
  • If incorrect, go to step 4
• Step 4: Give error-specific articulatory placement cues for the target word. Say, “Watch me, listen to me, and say with me,” then say the target word with the patient
  • After any response, give feedback
  • If the patient is correct at any point: Ask for 5 repetitions. Then move on to the next target word.
  • If incorrect, start over at step 1 with a new word

(Wambaugh, n.d.)

Improve Motor Learning

Here are tips for improving your Sound Production Treatment sessions using the principles of motor learning (Wambaugh, n.d.):

Lots of practice. Prepare 50+ target words per session. On average, patients achieve mastery after around 12-14 SPT sessions (Wambaugh et al, 2021).

See the Motor Speech Pack for phonemic lists made for adult patients with apraxia of speech.

Decrease feedback. As the patient gets the hang of Sound Production Treatment, give feedback less often. For example, give feedback every 3 attempts to say the target word.

Start with blocked practice. During a session, practice one sound first. Then move on to the next sound. For example, focus only on /t/ initial words for the first 10 minutes of the session before moving on to other phonemes in other word positions.

Move on to random practice. Once your patient can say a target sound in 75% of trials, move on to random practice for that sound. For example, once your patient is at 75% accuracy with /t/ medial, you can present target words with /t/ in any word position.

Move on. Once your patient has hit a target goal (e.g. 90% accuracy across 3 trials), move on to the next sound. Or, if your patient hasn’t made progress, consider discontinuing SPT and trying a different approach.

Minimal Pairs for Sound Production Treatment

Ten/Hen	Nose/Note	Hope/Pope	Wise/Wine
Name/Lame	Let/Less	Sip/Tip	Bin/Fin
Lane/Lake	Zone/Bone	Deal/Steal	Feel/Feed
Cut/Cup	Bad/Bag	Guess/Mess	Got/Goth
Knit/Sit	Dock/Rock	Jest/Rest	Van/Ban

Example of Sound Production Treatment

Target sound: /t/

Target word: ten

Minimal pair: hen

In this example, our patient says the target word incorrectly every time. This is for you to see the full Sound Production Treatment hierarchy.

But! If a patient says the sound correctly at any point in treatment, do this:

1. Ask them to say the target word 5 more times
2. Then move on to the next target word 

• Step 1: Model
  1. Clinician: “Say this word after me: ten”
  2. Patient: Watches then repeats incorrectly by saying “hen”
  3. Clinician: “That’s not quite it. Let’s try to say a different word that sounds like what you just said. Say this word: hen.” This is the minimal pair. 
  4. Patient: Watches, then repeats incorrectly
  5. Clinician: Gives feedback. “Watch me, listen to me, and say it with me: hen.” Says “hen” with the patient two times
  6. Patient: Watches and listens and says the word incorrectly both times
  7. Move on to Step 2

• Step 2: Write and model
  1. Clinician: Writes down the target sound. The target sound is /t/ so you write down the letter ‘t’. Or, write ‘ten’, underlying the t. “This is the sound that we’re focusing on. Try it again: ten” 
  2. Patient: Looks at the word, watches, then repeats incorrectly
  3. Clinical: Gives feedback. Moves on to Step 3

• Step 3: “Watch me, listen to me, say it with me”
  1. Clinician: “Watch me, listen to me, and say it with me: ten.”  
  2. Patient: Watches, listens, then says the word incorrectly
  3. Gives feedback. Move on to Step 4

• Step 4: Articulatory placement cue, “Watch me, listen to me, say it with me”
  1. Clinician: Give error-specific articulatory placement cues. “Place the tip of your tongue behind your teeth and say /t/.” Then say, “Watch me, listen to me, and say with me: ten.”
  2. Patient: Watches, listens, then says the word incorrectly
  3. Gives feedback. Move on to a new target word. Back to step 1

More Apraxia of Speech Materials

For ready-made apraxia treatment materials, check out the Adult Speech Therapy Starter Pack!

References

• American Speech-Language-Hearing Association. (n.d.). Acquired Apraxia of Speech. (Practice Portal). Retrieved April 10, 2024 from www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/.
• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Duffy, J. R. (2020). Motor speech disorders: Substrates, differential diagnosis, and management (4th ed.). Elsevier.
• Mauszycki, S. C., & Wambaugh, J. L. (2020). Acquired Apraxia of Speech: Comparison of Electropalatography Treatment and Sound Production Treatment. American journal of speech-language pathology, 29(1S), 511–529. https://doi.org/10.1044/2019_AJSLP-CAC48-18-0223
• Wambaugh, J.L. (n.d.) Sound Production Treatment: Clinical Application. [Online course]. https://www.medbridge.com/course-catalog/details/sound-production-treatment-clinical-application/
• Wambaugh, J. L., Kallhoff, L., & Nessler, C. (2021). Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance. American journal of speech-language pathology, 30(1S), 425–440. https://doi.org/10.1044/2020_AJSLP-19-00110
• Wambaugh, J. L., Kalinyak-Fliszar, M. M., West, J. E., & Doyle, P. J. (1998). Effects of treatment for sound errors in apraxia of speech and aphasia. Journal of Speech, Language, and Hearing Research, 41(4), 725–743. https://doi.org/10.1044/jslhr.4104.725
• Wambaugh, J. L., & Mauszycki, S. C. (2010). Sound production treatment: Application with severe apraxia of speech. Aphasiology, 24(6-8), 814–825. https://doi.org/10.1080/02687030903422494