上次分享過treatment 嘅structure，有興趣可以碌返去C004睇下。今次想講下點揀stimuli。
揀stimuli 比CAS 仔係一件好重要嘅事，亦係一門學問。揀得太易，就challenge 唔到個小朋友；揀得太難，就學極都學唔到。唔同嘅treatment approach 揀stimuli 嘅criteria 都有啲唔同。今次講其中一個approach。
Dynamic Temporal Tactile Cueing (DTTC; Strand, Stoeckel, & Baas, 2006) 係一個functional approach，係會應用Principle of Motor Learning 嘅。佢揀嘅stimuli，都係一啲日常生活用量較高嘅字。即係functional vocabularies/phrases。咁當然唔係咁簡單啦，仲會因應小朋友本身嘅能力。所謂「能力」，拆到好細嚟講，就係佢嘅phonetic 同phonotactic inventory喇。Strand and Skinder (1999) 曾經舉過一個例子： 如果小朋友只有differentiated vowels (e.g., /i/, /u/)，咁我地可以揀一啲CV 或者 VC structure，然後設計一啲二至三個CV/VC字嘅短句 (e.g., me too)。套用落廣東話到，如果小朋友有/a/同/i/，你就可以試下揀/ba si/（巴士）。
不過講係咁講，試過咁樣揀，你就知道好有限制。第一，如果小朋友嘅inventory 好少野，你實際上揀到嘅字唔會好多。第二，由講一個 single vowel 跳到去講一個咁長嘅disyllabic words，對小朋友嚟講難度有啲高。我個人覺得，CAS小朋友嘅sequencing skills，真係應該一步一步咁上。
我喺我份MPhil thesis (Wong, 2017) 入面，定咗一個槪念，叫 simple-but-beyond-inventory phonotactic structure。其實都係zone of proximal development 嘅槪念。喺揀stimuli 嘅時候考慮stimuli 嘅phonotactic structure。如果小朋友有CV，simple-but-beyond-inventory structure 就係VV同CVV喇。呢個structure 嘅level of difficulty，係參考Stoke (2002) 同developmental data (Tse, 1993) 而訂嘅。有咗難度提升嘅hierarchy，再根據phonetic inventory 入面有嘅野，砌一個functional word，小朋友學起上嚟就會易好多。Thesis入面都報告咗有一個小朋友成功用呢種方法擴充咗佢嘅phonotactic structure inventory。
其實CAS 仔嘅phonetic inventory 都唔係咁簡單。Spontaneous speech 入面有嘅唔代表imitation 可以做到，亦唔代表佢可以用喺唔同phonotactic structure 入面，咁又算唔算係phonetic inventory呢？另外，咁inventory 無嘅音點算？都要教架？下次講下先。
References: Stokes, S. F. (2002). Levels of complexity in phonological disorders: Evidence from Cantonese. Clinical Linguistics and Phonetics, 16(1), 35–57.
Strand, E. A., Stoeckel, R. E., & Baas, B. S. (2006). Treatment of severe childhood apraxia of speech: A treatment efficacy study. Journal of Medical Speech-Language Pathology, 14(4), 297–307.
Strand, E. A., & Skinder, A. (1999). Treatment of developmental apraxia of speech: Integral stimulation methods. In A. J. Caruso & E. A. Strand (Eds.), Clinical management of motor speech disorders in children (pp. 109–148). New York: Thieme.
Tse, C. A. (1993). The development of a phonological system in Cantonese: A case report. In E. V. Clark (Ed.), The proceedings of the 25th annual child language research forum (pp. 287–296). US: Centre for the Study of Language Information, Leland Stanford Junior University.
Wong, E. C. H. (2017). Development of a treatment protocol for Cantonese-speaking children with childhood apraxia of speech. (Unpublished master’s thesis). The Chinese University of Hong Kong, HKSAR, China.
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