Abstract
The purpose of this study is to discuss the process that an almost non-speaking cerebral palsied child has been increased the variety of articulations by means of operant conditioning procedures and the muscle relaxation training. The case was a twelve years old girl who was able to understand instructions and to imitate actions to some extent. Only four verbalizations were, however, reported; "a" "o" "hai" "haiku". She was in non-speaking, seemingly due to high tension and poor control of her speech and utterance organs. In order to make up her speech, muscle relaxation training and operant conditioning were introduced. Muscle training were constructed as follows; relaxation of her shoulder, neck and breast, and then controlling with breathing and with movement of tongue, lower jaw, etc. Verbal praise or encouragement and token were used as the reinforcer on the process of operant conditioning. On its treatment, the training process was followed on the basis of the developmental steps of normal children. The 19 training sessions have been done for 8 months in individual setting. The results were demonstrated that she learnt the relaxation of her shoulder, neck and breast, and was able to have effective utterance for speech. She has also been able to control tongue and lower jaw, and has acquired 31 kinds of sounds and 20 words, including "mama" "papa", etc. These results are discussed with following three points. 1) The effect and problem of reinforcer: It was apparent that token and social reinforcement activated her motivation for training. Another reason to increase her motivation appears to be that her possible articulation sound was connected with the word, as possible. It also seemed to be efficient and effective that her family worked as a mediator to learn her speech with picture card and repeating the words which had learned in the training sessions, particularly in the early stage of learning. 2) The effect of muscle relaxation training: It is seemed that the relaxation of her shoulder, neck and breast promoted control of breathing, and then became to set an adequate posture for verbalization. Controlling of tongue was able to product many sounds in the first step. It is necessary, however, to control lower jaw in order to connect some plural sounds with to make some words up. 3) The acquisition order of the articulations in vowels and consonants: The training were based on the developmental steps of normal children. It is necessary, however, to take into account of disturbed parts of the subject.
