What are some examples of aural rehabilitation activities that focus on articulation?
Adult aural rehabilitation activities for articulation will be similar to typical speech therapy articulation, with some additional considerations. In aural rehab, we will spend more time to ensure people are hearing the sounds (such as discrimination and identification of minimal pairs), and more time teaching the sound through audition instead of via tactile and visual cues. We may also consider using their FM or DM system.
When targeting articulation, the first question to ask is whether or not the adult has access to the articulation sound that we're targeting. The way we answer this question is by reviewing the aided audiogram. If they are not using amplification, then the unaided audiogram will give us that information. There are reference charts available at www.supportforkidswithhearingloss.com (access may require a membership) that give information about where you need to be able to hear for particular vowels and consonant sounds.
If someone can hear a sound, then they're more likely to be able to produce it and to be able to hear the features to make it correctly. If the adult does not have access to the sound, then consider using their FM system, especially when you're introducing the sound. Start with discrimination activities and listening activities to make sure the adult is hearing differences in manner, voicing, and place cues. When targeting a whole class of sounds, for example, all fricatives, then make sure they hear the difference between stops and fricatives. You can also then look at the error sound that someone is using for a specific sound, and make sure they're able to discriminate the difference between the error sound and the target sound via audition. Resist the urge to teach solely through visual and tactile cues. We're used to doing that in the pediatric population, but with adults, often if they're not producing the sound, it's because they're either no longer hearing themselves clearly, or they never heard that sound clearly. When communicating at a conversational level, it's challenging to try and think about what something feels like and where to place our tongue, rather than to hear it and correct it via audition.
Remember that overexaggerating when producing speech sounds tends to make it more difficult for the listener to comprehend what's being said, so use very natural productions of the sound.
Refer to Adult Aural Rehabilitation: Therapy and Goals for more information on evidence-based best practices and considerations for doing aural rehabilitation with adults with cochlear implants, including therapy goals and target selection.