Tuesday, April 22, 2014

Dysarthria: Prosody; PNC Park

This post will focus on how to manage prosody in children with dysarthria.  "Prosody" is a fancy term that reflects the degree to which speech sounds natural.  Ways to achieve natural-sounding speech include variations in loudness, pitch and duration.

To increase loudness, instruct your child to take a deep breath before each sentence.  This will allow her to have enough breath support to not only generate adequate volume for speech, but to have reserves in breath support for loud segments of speech.  Using more force when exhaling during speech will also help produce louder speech.  Practicing loud speech is an activity that most children enjoy.  Start by reviewing with your child the difference between "normal" volume and "loud" volume to emphasize a point.  For example, ask her to say her name in a normal voice and in a loud voice.  Once your child is familiar with using a loud voice appropriately, it will be time to practice using varying volume in speech.  I recommend beginning with emphasizing one word in a sentence.  Tell your child to save her loud voice for the most important word in a sentence.  For example, "I want cookies."  "Cookies" is the key word in this sentence, and thus should be said the loudest.  Practice with other sentences, such as "I like Sponge Bob," and "My brother's name is Tom." 

To have pitch sound more natural, it is essential to vary high pitch and low pitch.  Review with your child the difference between high and low pitches.  A low pitch can be demonstrated by humming, "Hmmmmmm."  Have your child touch her chest while humming "mmmm" to "feel" the low pitch/deep voice.  A high pitch is produced with more muscle tension in the throat.  It can be demonstrated by the "hmph!" noise.  Children may also conceptualize a high pitch with a "singing voice;" they can practice by singing "ah ah ah."  Have your child touch her voice box while practicing a high pitched voice so that she can "feel" the high pitch/high voice.  Once she understands the difference between a "deep voice" and a "high voice," practice saying words using different pitches.  Any words will do.  Once she is proficient in pitch alteration, it is time to practice sentences.  Again, the pitch should be varied for the most important word in a sentence.  Practice with the sentences, "I want cookies," "I like Sponge Bob," and "My brother's name is Tom."  Another good way to practice is by contrasting pitch differences in sentences that make a statement, and in sentences that ask a question.  When we ask a question, our pitch tends to be high at the end of the sentence.  Thus, practice a high pitch with sentences like, "Are you OK?" "We're going to grandma's, right?" and "Who is it?"  When we make a statement, our pitch tends to be low at the end of the sentence.  Thus, practice a low pitch with sentences like, "She lives in Florida," "It is five o'clock," and "You are nice."

Duration can be modified in speech through use of pauses.  Teach your child to pause at appropriate times in a sentence.  Syntax often dictates when it is appropriate to pause.  This may be difficult for younger children to understand.  Thus, I recommend telling them to pause after the most important part of a sentence.  Practice with sentences such as, "We went to art class...then had lunch," "I saw Joe...at school," and "Can we go now...Dad?"  Duration can also be modified by lengthening the production of sounds.  Practice with words such as "pleeeeease," "myyyyy" and "caaaaandyyyy."  In sentences, the most important word should be the one with the lengthened sound.  Practice with sentences such as, "That is mine," "It is Tuesday," and "What's on TV?"

For the most natural speech, use variations in loudness, pitch and/or duration all in the same sentence.  For example, "I like peanut butter...and jelly," "We went to McDonald's...then to the playground, didn't we?" and "I have piano lessons at four o'clock."

To practice natural sounding speech, ask your child to read aloud, have a conversation at the dinner table, or tell jokes or a story.

For practice outside the home, try going to a Pittsburgh Pirates game at PNC Park. 

Pedro goes to Pittsburgh.jpg
Image retrieved from http://en.wikipedia.org/wiki/PNC_Park.

Topics to stimulate speech may include:
How are the Pirates doing this season?
Who are our biggest rivals in baseball?
What is your favorite sport?
What do you smell at the ball park?
Why is baseball the national pass-time?
What buildings can you see from the stadium?
Who is your favorite player?
Why is a parrot the team mascot?
What position would you like to play in baseball?
When was the stadium built?
Where do the Pirates go for a rest?
What do you like to eat during the game?

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