Showing posts with label Stuttering. Show all posts
Showing posts with label Stuttering. Show all posts

Monday, April 28, 2014

Stuttering; Fluency Shaping/Speech Modification

This post will focus on "fluency shaping," also known as "speech modification," as a treatment for stuttering.  This therapy seeks to teach behaviors that will lead to "normal" speech.

One component is management of airflow.  A child should have relaxed inhalations and exhalations, thus reducing tension in the body (specifically, the vocal tract).  Cue your child to take slow, deep breaths.  If she has labored inhalations, cue her to inhale through her nose as if she was sniffing a flower.  Provide her with a flower or other pleasant scent to sniff for practice in the initial stage.  If your child has labored exhalations, cue her to exhale through her mouth, as if she was blowing out a candle.

Additionally, a child should use an "easy onset" when speaking.  An easy onset is when one exhales a little bit before saying a sentence or before saying each individual word.  It is a way to encourage relaxation and a decreased rate of speaking, which have been shown to promote better speech.  A good way to begin teaching easy onset is to say words that begin with "H."  Words such as "hat" and "help" naturally occur with easy onsets since the "H" sound lets air flow freely.

Another component is to speak with "light articulartory contact."  This means that the child should produce gentle speech movements that are slow and deliberate.  For example, when making the /m/ sound, she should let her lips meet together lightly rather than pressing them together in a hard fashion; when making the /t/ sound, she should lightly tap her tongue on the roof of her mouth.  This is a way to reduce tension.

Reduced rate of speech is a key component in fluency shaping.  A child should speak slowly.  This can be accomplished by prolonging syllables.  For example, ask your child to say "father" by making sure that each syllable is said clearly, as in "fa-ther."  Another way to speak more slowly is to encourage prolongation of vowel sounds.  For example, cue your child to say "faaaaather;" in this case, the "ah" sound is prolonged so that rate of speech is slower.  It is also important for pauses to be used within and between sentences.

It is recommended that these strategies be trained individually.  Once a child has mastered the strategies, then it is time to practice using all of them together in speech.  Direct instruction, modeling of behaviors and positive reinforcement are all helpful in learning.  Also, encourage your child to monitor her own speech so that she will be independent.

One criticism of this treatment is that speech may sound unnatural or monotonous.  If this is the case, additional training may be incorporated to slightly increase rate, volume and intonation.

In order to habituate these strategies, practice will be essential - especially in a variety of environments.  One place to practice speech modification outside the home is at the Consol Energy Center while watching the Penguins play.

 
Image retrieved from http://en.wikipedia.org/wiki/Pittsburgh_Penguins.

Practice saying words first.  Cue your child as needed to "breathe easy," "speak slow," "speak gently," and use "easy onset."
One syllable words include: Goal, net, ref, skate, puck, ice, rink, win, lose, snack, pass, stick
Two syllable words include: Hockey, player, Penguins, Pittsburgh, defense, offense, helmet, trophy, award
Three syllable words include: Referee, goaltender, energy, national, injury, concussions, uniform, sportsmanship.

Next, move onto phrases.
Phrases include: Stanley Cup, Consol Energy Center, National Hockey League, Metropolitan Division, Eastern Conference, ice hockey, Pittsburgh Penguin, entry draft, Hall of Fame.

To stimulate sentences, as your child open-ended questions.  Examples include, "Who is your favorite player and why?" "What is your favorite part of the rink?" "What do you think is the hardest part about playing hockey?" "What concession foods do you like best?" "What's better: hockey or football?"  Cue your child to speak in full sentences.

To stimulate conversation, you may use the same questions as above but I recommend offering up your own opinion in order to generate a back-and-forth exchange.

Sunday, April 13, 2014

Pittsburgh Jokes

Although April Fools' Day has come and gone, I think it's important to use jokes frequently...even in speech therapy.  Joke telling is a great way to practice turn-taking and social skills.  Telling jokes is also a great way to practice articulation, stuttering strategies, language, voice strategies, abstract reasoning, reading...just about anything!  Here are a few Pittsburgh-themed jokes:

1. Why did the panther cross the road?  Because it was the chicken's day off!

2. What's black and white, black and blue, black and white, black and blue?  A Pittsburgh penguin slipping on the ice!

3. What did the Eat'n Park Smiley Cookie say when he felt sick?  I feel crummy.  I'm about to crumble!

4. Where do Pittsburghers keep their money?  In a river bank!

5. What did the frozen vegetables at Giant Eagle say?  Lettuce out, it's cold in here!

6. How can there be an Upper Saint Clair if there isn't a Lower Saint Clair?!

7. What is the nicest town in Pittsburgh?  Friendship!

8. Knock knock.  Who's there?  Pierogi.  Pierogi who?  Knock knock.  Who's there?  Pierogi.  Pierogi who?  Knock knock.  Who's there?  Pierogi who?  Knock knock.  Who's there?  Orange.  Orange who?  Orange you glad I didn't say Pierogi?!

9. What do lawyers wear to the Allegheny Courthouse?  Lawsuits!

10. Why did the computer go to UPMC?  Because it had a virus!

Please post below any Pittsburgh-themed jokes that are appropriate for children.

Thursday, March 20, 2014

Stuttering; Van Riper Approach Continued

In my last post, I highlighted one component of Charles Van Riper's approach to stuttering treatment.  It involved modifying stuttering and included the strategies of cancellation, pull-out and preparatory set techniques.  Now, I would like to address the other components of Van Riper's stuttering modification program, often referred to by the acronym MIDVAS.

Motivation:  The child should be motivated to seek therapy and participate in it.  Caregivers should help children understand the therapy process and share positive information.

Identification: The child should identify her individual stuttering moments in order to build awareness.

Desensitization: The child's "negative" emotions regarding stuttering are addressed to reduce the stress associated with stuttering.  Techniques may include relaxation and stuttering on purpose.

Variation: The child will modify her stuttering.  This may involve using a word repetition ("book-book") instead of a sound repetition ("b-b-b-book").  This is meant to increase a child's control over stuttering/speech.

Approximation: Modifying the child's speech in order to decrease stuttering and increase fluency.  The strategies of cancellation, pull-out and preparatory set techniques are discussed in the previous posting.

Stabilization: The child gains self-confidence and the ability to monitor her own speech/use therapy strategies independently.

Next, I would like to address how parents and other caregivers in the Pittsburgh area can work on these components.  In terms of motivation, J. Scott Yaruss (a Ph.D. level SLP) notes that we should envision goals more broadly, and explain to children that the purpose of speech therapy is to increase communication (not simply to eliminate stuttering).  Here is a link to the piece Yaruss wrote, "Why School-age Children Who Stutter Aren't Motivated for Therapy": http://www.speechandlanguage.com/stories-from-the-field/why-school-age-children-who-stutter-arent-motivated-for-therapy.  One way to increase motivation would be to find out from your child what they are having trouble with in terms of communication.  Is it talking on the phone?  Reading aloud?  Speaking with friends at recess?  Whatever it is, that should be used as a target in therapy.  So, if your child finds that she stutters more on the phone and this then decreases her ability to communicate, target having her speak on the phone.  She can start by calling a family member, and then progress to more complex calls to friends, acquaintances, and institutions.  Here are some tips for people who stutter regarding telephone usage from The Stuttering Foundation: http://www.stutteringhelp.org/using-telephone

Since cell phones are probably most popular, I recommend having your child practice phone usage at a location she feels comfortable in.  This may be her bedroom, on school grounds, at a quiet cafe, etc.  Once she is ready to broaden her horizons, a great Pittsburgh place to practice would be in a phone booth.  The Citizens Bank Building at 525 William Penn Place has some old-fashioned telephone booths much like the one pictured below.
Image retrieved from http://dougdawg.blogspot.com/2009_06_01_archive.html.

In terms of identification, have your child identify moments of stuttering during a task she is invested in.  If your child wants to have more fluent speech when reading aloud, ask her to read something she is interested in, then discuss with her the particular types of stuttering she encounter (allow her to lead the conversation).

"Pittsburgh Magazine" is an excellent source of news and human interest that may provide a good starting point for children of middle school and high school age.  Magazines are great for oral reading because their stories are often concise and are filled with a lot of visually interesting pictures.

 
Image retrieved from http://slickdeals.net/localdeals/pittsburgh/.

For desensitization, the goal is to reduce anxiety about speech.  One technique is relaxation, whereby you may instruct your child to pretend her body is a melting ice cube; the idea is to let her body ease out of tension.  Practice this with her regularly so that it comes naturally; the body and mind should be relaxed.  Another technique is to ask your child to stutter on purpose.  Stuttering on purpose can signal to her that she can be in control of her speech, and can also demonstrate that even when she stutters, nothing "bad" will happen.

To encourage your child to engage in relaxation techniques while out in the real-world with all of its distractions, pick a public place that is welcoming.  According to Pittsburgh Magazine, "Knit One" is the best yarn store to visit if you enjoy crafts and talking with friendly people, or just sitting down and soaking up the scenery.  I recommend visiting the Buhl Planetarium at the Carnegie Science Center. 


Image retrieved from http://www.carnegiesciencecenter.org/planetarium/buhl-planetarium-skywatch/

To practice variation, review with your child different ways to stutter.  There are part word repetitions ("wh-wh-where"), sound prolongations ("sssssister") and interjections ("I, um, you know, want to see a movie") to name a few.  Try these out at home during preferred activities so that your child will continue to be motivated throughout the whole process.

You can help your child with the approximation stage by cueing her to use cancellations, pull-outs and preparatory set techniques.  (See previous post for detail.)

Finally, aid your child with the stabilization phase by praising her for monitoring her speech, whether she is successful or not.  Also, try to keep her motivated by reminding her of the big picture and reinforcing positive self-esteem.

Monday, March 17, 2014

Stuttering; Van Riper Approach/Stuttering Modification

There are varying treatments available for stuttering, each with their own advantages and disadvantages.  As this blog grows, I hope to touch on the treatments more in-depth.  At the core of many stuttering treatments, though, are behavioral principles.  One of the first steps is for children to monitor, and eventually control, the rate at which they speak.  The goal is to have children initially speak more slowly, and with less physical tension.  The idea is that in the beginning, children should speak more slowly than usual, using light articulation and relaxed muscle movements so that they gain better awareness and control of their speech (not mention gain confidence!).  Speaking in shorter sentences also helps.  Over time, children will then learn to speak at a more appropriate rate, and speech will sound more "natural."

One approach that is used is the "Van Riper Approach" or "stuttering modification,"  which seeks to modify stuttering movements so that stuttering is less severe and fear/avoidance behaviors of stuttering are decreased/eliminated.  There are several components to this method, but for the purposes of this post I would like to highlight Charles Van Riper's techniques for specifically modifying the act of stuttering itself.  One method is known as "cancellation."  In this method, once the child stutters, she is encouraged to pause and say the word again.  Another method is known as "pull out."  In this method, once a child begins to stutter she should continue saying the word, but with more ease; in other words, once she begins to stutter she should try to gain control over the movement and then "smooth it out" as she is saying the word.  The final Van Riper strategy is known as "preparatory set" techniques.  In this method, a child is encouraged to anticipate when a word will be difficult to say, and work though the speech sounds gently, slowly and calmly.

As children that stutter often experience anxiety when speaking, I recommend practicing the above in a quiet environment.  I also recommend choosing a setting that will stimulate your child's speech, so please pick something that they are interested in so that they will be more likely to talk.  Review the techniques with your child at home, then go somewhere your child feels comfortable speaking to start. 

Some ideas for locations include:

Pennsylvania Trolley Museum

 

 Image retrieved from http://commons.wikimedia.org/wiki/File:PA_Trolley_Museum.jpg

One syllable target words: ride, seat, car, track, trip
Two syllable target words: trolley, engine, streetcar
Three syllable target words: collection, education, history, Washington, museum.

North Shore Riverfront Park; Water Steps

Picture of North Shore Riverfront Park
Image retrieved from http://www.pps.org/great_public_spaces/one?public_place_id=587.

One syllable target words: park, north, shore, bridge, lawn, steps
Two syllable target words: water, river, level, fountain
Three syllable target words: riverwall, riverwalk, riverfront, bicycle, rollerblade.

Round Hill Park and Exhibit Farm

Image retrieved from: https://southhillsmomblog.wordpress.com/tag/round-hill-park/

One syllable target words: farm, park, hill, sheep, pond, rounf
Two syllable target words: silo, turkey, chicken, greenhouse, garden
Three syllable target words: animal, exhibit, family, attraction, vegetables

*Tip: Visit these areas when it is quiet - my guess is in the morning.
**Extra tip: Customize the practice to your child's level: words, phrases, sentences, conversation.

Tuesday, March 11, 2014

Multi-syllabic Words at Phipps Conservatory

Phipps Conservatory is filled with multi-syllabic words.  These are great for practicing speech sounds at more complex levels, practicing stuttering strategies, acquiring vocabulary, spelling, language, etc.  Customize the use of the words to your child's goals.  If a breakdown occurs, it is often helpful to segment  multi-syllabic words.  For example, break up the word "waterfall" into the words "water" and "fall;" or, break up the word "conservatory" into the syllables "con-serv-a-to-ry."

Some words include:

1. conservatory

 

2. banana
 

3. serpentine


4. waterfall

 

5. rainforest

 

6. foliage

 

7. Madagascar

 

8. butterfly

 

9. dinosaur

 

10. topiary

 

11. irrigation

 

12. gazebo

 

13. organic

 

14. Japanese

 

15. pedestal

 

16. burrito

 Photo of Curritos - Burritos without borders

17. directions

 

18. canopy

 

19. agave

 

20. chandelier

 
 
21. elevator

 

22. latticework

 

23. succulent


Images retrieved from: 1. http://en.wikipedia.org/wiki/Phipps_Conservatory_and_Botanical_Gardens 2. http://wifemothergardener.blogspot.com/2013/02/phipps-conservatory-orchid-bonsai-show.html 3. http://www.panoramio.com/photo/43156329 4. http://pittsburgh.about.com/od/pictures/ig/phipps_spring/waterfall.htm 5. http://phipps.conservatory.org/exhibits-and-events/featured-event.aspx?eventid=907 6. http://phipps.conservatory.org/project-green-heart/green-heart-resources/top-ten-sustainable-plants.aspx 7. http://www.flickr.com/photos/silencia/3296210243/ 8. http://phipps.conservatory.org/exhibits-and-events/featured-event.aspx?eventid=168 9. http://phipps.conservatory.org/exhibits-and-events/featured-event.aspx?eventID=371 10. http://pittsburghmommyblog.com/category/pittsburgh-green/phipps-conservatory-and-botanical-garden/ 11.
http://www.van-wingerden.com/home/Products/GHSEStructures/MX.aspx 12. http://www.flickr.com/photos/49240985@N07/5346414564/ 13. http://phipps.conservatory.org/exhibits-and-events/featured-event.aspx?eventid=324 14. http://www.examiner.com/article/phipps-conservatory-japanese-courtyard 15. http://casacamisas.wordpress.com/2008/03/ 16. http://www.tripadvisor.com/Restaurant_Review-g53449-d4137637-Reviews-Curritos_Burritos_without_borders-Pittsburgh_Pennsylvania.html 17. http://phipps.conservatory.org/visit-phipps/directions-and-parking.aspx 18.
http://forums.gardenweb.com/forums/load/palms/msg0806360010476.html?8 19. http://milliverstravels.com/2012/04/postcards-from-pittsburgh-no-3-phipps-conservatory/ 20.  http://www.fullhdwal.com/blown-glass-chandeliers-rosemarys-sampler-phipps-conservatory-chihuly-glass/
21. https://www.youtube.com/watch?v=K9SSYbYWpu4
22. http://www.flickr.com/groups/phippsconservatory/ 23. housetrends.com