One of the Foundation Stones in Speech Therapy for those with Articulation, Voice, Rhythm, and Language Difficulties.
The subject I would like to discuss today deals with the SENTENCE. The SENTENCE is basic to the whole speech therapy process. The SENTENCE is the format that we speak in. The SENTENCE is one of the most challenging aspects of rehabilitation/speech therapy for those who do not speak, either children or adults who have a diagnosis of head injury, aphasia, and other neurological insults. Simply defined it is a collection of words which when placed together in the correct order form a complete thought or sentence. It can vary from 2 words to more than 10!The SENTENCE is one of the most critical aspects of the speech therapy process for those of us who are helping children and adults speak. I learned about the SENTENCE when first starting out as a speech language pathologist and doing articulation therapy with children. I would work on a sound in isolation, and when mastered would stimulate the correct production of the sound into single words until it could be readily said accurately, and then begin stimulating phrases and SENTENCES while assuring the new sound was correctly produced in each word. It was the production of the target sound within each target word within the SENTENCE which I believe was the crucial aspect of moving the client into Carry Over or automatic speech. Not only would I work on the stimulation of SENTENCES for those words, but my wife would craft simple books that would have pictures and SENTENCES with the target words that the child needed in his/her expressive vocabulary. The story would always be about silly characters and would have a plot and a conclusion which made a point worthy of learning. The child would circle the target sound in each word within the story with a colored marker to help cue accurate production in the sentence. We would have stories for each sound, and position within the word. We had a bunch for the (s) and (r) due to the considerable words for all positions and blends.
Then I learned voice therapy and mastered the art of (1) identifying a dysphonia, producing the dysphonia myself (one has to be very careful here….) so as to know what would be necessary to improve it. Once the habitual pitch, tone focus, breathing and intonational contours were identified it was a simple matter to find the optimum pitch, style of breathing, tone focus, resonance adjustments and intonational contours to correct. Once the client/patient could produce the specific aspects of voice that were in need of correction, we would then stimulate (yes you’ve got it!) them into vowels, syllables, multi-syllable words, word pairs, phrases, SENTENCES and then conversation. The main clinical focus was always the correct speaking behavior stimulated within the SENTENCE as the patient mastered the new adjustments necessary often following the vowel, word, phrase, SENTENCE, conversation sequence.
After meeting patients with dysarthria, it then was relatively simple to approach this speaking difficulty following the model above. One of the major thrusts of stimulation here is rate and latency in speaking. Rate as you know is the speed at which one speaks, and latency is the timing of the pause between each spoken word. Quite early in practice for dysarthria, I learned the same principle that we have been discussing. Namely the therapy in most cases is relatively easy if you can stimulate speaking. One starts out with 2 word combinations making sure that there is a pause between each spoken word. As a musician, I learned as a child to REST on the count of 1/4, 1/2, 3/4, or whole beats. To me it was teaching the person with dysarthria how to play their speaking and talking like music. and how to rest for a quarter, half, three quarter or whole BEAT between each spoken word. We started at two word combinations (Subject-Verb or Verb/Object sentences) and then gradually built up the SENTENCE in terms of the number of words, while making sure there was a quarter, half , three quarter or full beat rest between each spoken word in a SENTENCE. I would initially use written SENTENCES, but would soon tire of them since having a person read phrases and sentences to me was like watching the paint dry on a wall! Due to my boredom with the reading of SENTENCES, (which was also reported by the client-patient) I found ways to stimulate single words, word pairs, three, four, five and six word SENTENCES just by the length of the questions I would ask. And voila! We could talk about almost anything and I could stimulate SENTENCE length by the length of the question posed. Alas, freedom from prepared sentences and worksheets!!!!! However, I made myself a promise: While they were with me I would stimulate hundreds of sentences in typical question and answer format about cool stuff we liked to talk about. They were always given printed SENTENCES I would transcribe during the visit to take home and practice, esp. if a caregiver was not available. If a caregiver was available I would teach them to do what I did, and found that many became quite proficient at stimulating speech for whatever the speaking difficulty was; namely, articulation, voice, dysarthria, rhythm and rate difficulties, and especially language difficulties where the child or adult did not have the ability to string words or SENTENCES together.
The methods referenced above came about out of years of practicing speaking correction. I know that is a rather outmoded word in the speech pathologists’ lexicon today. I always have referred to myself as an oralist, always doing the very best that I could to help people talk rather than having them sign, hold up placards, or use AAC devices. I think the profession has gotten away from that in the last few years, as we have dealt with other kinds of problems such as those of the geriatric population with cognitive deficits, swallowing difficulties, reasoning, etc.
These speaking difficulties are all very responsive to The Teaching of Talking Method, if you understand the basic principles of speech correction and language stimulation which I write about in The Teaching of Talking. It is a way to engage people in speaking or talking, which addresses the specific speaking difficulty once it has been diagnosed and an approach to correct that difficulty is addressed with positive modification of speaking at the single word level. Once the client-patient can produced the desired speaking behavior at the single word level, it can readily be modified for improved speaking clarity and carry over as one works through increased SENTENCE length.
To find out more about this wonderful method of speech stimulation for therapists to learn and then teach their clients and patients, please check out our website at http://teachingoftalking.com. where you will find videos and information regarding The Teaching of Talking in either written soft cover book, Kindle edition, or Audible audio book that I have narrated with lots of vocal examples you can learn and model.
We are traveling throughout the US and Canada presenting the Teaching of Talking Method to Therapists, hospitals, schools, colleges and Universities. If you have any questions or comments please contact me at markittleman@teachingoftalking.com.
Best wishes to you all!
Mark
Mark A. Ittlman, M.S., CCC/SLP
Senior Speech Language Pathologist
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