Showing posts with label Voice. Show all posts
Showing posts with label Voice. Show all posts

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?

Monday, April 21, 2014

Hyponasality; Soergel Orchards

Resonance is defined as the modification of sound through the bodily structures that the sound passes through.  Disorders of resonance can be classified into two categories: hypernasality (covered in the previous post) and hyponasality.  What is an acceptable amount of nasality is often culturally defined.

Hyponasality is caused when too little air passes through the nose on nasal sounds like /m/, /n/ and /ng/ as in "sing."  Children often sound hyponasal when they experience a cold or allergies; this is temporary and does not require treatment.  Other children may experience persisting hyponasality.  This may be due to obstructions in the nasal cavity, enlargement of the tonsils and adenoids, or a deviated septum; in such cases, medical intervention may be required and one should consult an ear, nose and throat doctor.

There are behavioral treatments, though, to decrease hyponasality.  The first involves using a visual aid.  Place a tissue or mirror under your child's nose so that she can see appropriate nasal airflow while speaking.  The tissue should move and the mirror should fog up during nasal airflow.  An alternate method is for her to put her finger under her nose while she is speaking so that she can feel the air coming out of her nose.  You may demonstrate proper nasal air flow for her by letting her feel the air coming out of your nose, or by seeing the tissue moving/mirror fogging while you are speaking.  Nasal airflow is best taught with nasal sounds.  Practice saying the sounds /m/, /n/ and /ng/ in isolation.  Then, practice them in syllables.  Words with nasal sounds should then be practiced, such as "mom," "no" and "none."  Finally, move onto phrases, then sentences and finally conversation.  Humming can also help children reach the target amount of nasality, and therefore help them understand what their voice should sound like.  Children may start with a hum, then change the hum into a word.  For example, "Hmmmm, mmmmm, mmmmm, mom."

Another treatment is known as nasal-glide stimulation.  Children are prompted to say words with many nasal sounds and many "glide" sounds (/w/ and the "yuh" sound) in varying combinations.  This helps to direct airflow into the nasal cavity.  Some words with nasal sounds include, "meal," "knee," and "sing."  Words with glide sounds include "water," "yogurt" and "wheel."   Words that contain nasal and glide sounds include "swing," "yummy," "yam," and "lawnmower."

The final treatment option is known by a few different names, including "focusing," "masking" and "resonant voice therapy."  The idea is that one should increase vibration of the nasal and facial bones in order to facilitate increased resonance.  Prompt your child to exaggerate production of nasal sounds, and to feel the vibrations in her face/nasal area.  Once this is accomplished and you have identified an appropriate amount of resonance, use this strategy to practice nasality in words, phrases, sentences then conversation.  This treatment may be hard to conceptualize.  Here is a link for more specific instruction: http://www.everythingspeech.com/articles/resonant-voice-therapy/.  It also may be helpful to view YouTube videos so that one can see and hear exactly what this therapy is all about.  Please post below if you find an especially helpful video.  (I did a quick search and haven't found the perfect one yet.)

You may practice the above treatments anywhere.  A good starting point may be at Soergel Orchards (a family farm and country store) in Wexford.  It is a fun place in the springtime, and there are plenty of words with nasal sounds. 


Image retrieved from http://www.topworkplaces.com/frontend.php/regional-list/company/post-gazette/soergel-orchards

Nasal words to practice include:
country
home
garden
barn
family
farm
plant
planting
business
market
manage
growing
picking
plum
run
greenhouse
natural
landscape
indoor
Amish
corn
pumpkin
menu
tomatoes
lamb
riding
rent
furniture.

To practice nasal resonance at the phrase level, ask your child to describe some of the scenery or items at the orchard.  Targets may include, "big greenhouse," "red barn," and "pretty farm."  Another task is to ask your child what she would like to see more of, since "more" has a nasal sound.  Targets may include, "more horses," "more apples," and "more gardens."

To practice nasal resonance at the sentence level, ask your child what she wants to do at the orchard.  The target word "want" also has a nasal sound in it, so this will provide extra practice.  Targets may include, "I want to see the horses," "I want to smell the tomatoes," and "I want to shop at the gift barn."

To practice conversation, ask your child what she enjoyed doing at the orchard.  Any verb ending with "ing" provides practice since it has a nasal sound in it.  Targets may include, "I liked picking apples.  I also liked seeing the horses.  The barn was neat.  It was so giant.  Can we come back again?"

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.

Monday, April 7, 2014

Dysarthria: Phonation; Loews Movie Theater at the Waterfront

This post will focus on how to manage phonation (the vibration of the vocal cords, also known as "voicing") in children with dysarthria.  Behavioral strategies for managing phonation are similar to strategies for respiration because better breath support leads to a stronger voice.  This is because when one takes a deeper breath, it creates more pressure underneath the vocal cords which makes them vibrate better, giving the speaker a louder and stronger voice; it also provides more air to speak on for longer sentences.  Thus, cueing for better phonation is often the same as cueing for better respiration.  Instruct your child to "Take a deep breath before each sentence."  This will allow her to speak louder, and to speak longer on one breath.  (See the previous post "Dysarthria: Respiration" for more detail.)

If your child still has deficits in phonation, there are other behavioral strategies.  The first is to known as a "vocal cord adduction" technique.  Have your child sit upright on a chair with armrests, and put her arms on the armrests.  Then, tell her to push down on the armrests with her hands while she is speaking (starting with a deep breath, of course).  This is known as "bearing down" and it will help push the vocal cords together in order to get better vibration.  To be on the safe side, I recommend speaking with your child's doctor before implementing this strategy.

Another behavioral strategy for improved phonation is to instruct your child to begin speaking at the beginning of the exhalation.   It is true that we speak during exhalation, but many of use exhale for a little bit before starting to speak.  This can be detrimental to children with dysarthria because it can lead to air wastage.

If behavioral interventions fail, you may wish to speak with your SLP about the appropriateness of a speech amplifier.  There are also medical interventions available.  I recommend consulting with a specialized voice team including an ENT and SLP.  Here is a link for the UPMC Voice Center: http://www.upmc.com/services/ear-nose-throat/services/voice/pages/default.aspx.

I think a great place to practice phonation is at the movie theater...don't worry because you can talk during the previews!  Loews Movie Theater at the Waterfront is a good one to stimulate speech because it is so interesting looking inside and out.

 
 Image retrieved from http://www.cbre.us/o/pittsburgh/properties/the-waterfront/Pages/tenants.aspx.

Plus, the movie seats have armrests which allow your child to practice "bearing down."

Image retrieved from http://pittsburgh.cbslocal.com/top-lists/free-and-affordable-pittsburgh-129-music-movies-and-family-fun/.

A good way for your child to practice is to start by imitating short sentences, then longer sentences.  Remember to cue her to "Take a deep breath before each sentence," and maintain upright positioning; instruct her to "bear down" or begin talking at the start of the exhalation as needed.  Finally, let her move onto making up her own sentences, then participating in conversation all while monitoring her own speech.

Short sentences for repetition may include:
"It smells like popcorn,"
"I like movies,"
"There is a line."

Long sentences for repetition may include:
"I like to get popcorn and a soda when I go to the movies,"
"I wish I had a big movie screen at home,"
"I like funny movies because I like to laugh."

To stimulate your child to make up her own sentences, ask her questions.  Some may include:
"What is your favorite movie?"
"What is your least favorite movie?"
"Who is your favorite actor?"

Some topics for conversation may include discussing your favorite snacks at the movies, comparing movies, and talking about other things to do at the Waterfront.

Tuesday, March 4, 2014

Word List: Walnut Street/Shadyside

Word lists containing nouns, verbs, adjectives and adverbs are useful for many goals.  They can be used to target reading, spelling, writing, stuttering, voice strategies, articulation, phonological processes, vocabulary building, sentence structure, etc.  Thus, I have decided to post word lists relating to Pittsburgh.  This one is centered on Walnut Street/Shadyside.  Obviously there are many, many words that pertain to this area so I have tried to limit my lists to 25-50 words.  If there is a word that you would like to be included, please post below!

Image retrieved from http://imaginepittsburgh.com/explore/girasole.

I think this list is especially relevant to the tween/teen population.  Bring the list with you on your next trip to Shadyside and use it to practice goals, or ask your child to brainstorm words that pertain to Shadyside and her speech goals.  For example, if your child needs to practice vocabulary building, ask her to think of synonyms for purses (handbags, clutch, tote, etc.) and then spend some time looking at the purses for sale.  If your child needs to practice the /r/ sound, ask her to say words with the letter "R" in them as you walk around Walnut Street (dinner, jewelry, parking spot, etc.).

Alley
Apparel
ATM/MAC machine
Bistro
Breakfast/lunch/dinner
Bus
Bus stop
Café
Cards
Cash
Checks
Clothing
Coffee
Convenience store
Credit card
Dining
Dressing room
Electronics
Entertainment
Fashion
Florist
Food (American, French, Thai, Chinese)
Furnishings
Gallery
Gifts
Grill
Gym (exercise, workout, strength, nutrition, fitness)
Hair salon
Jewelry (rings, bracelets, cuffs, solitaire, gems, silver, gold, platinum, choker, chain, band)
Lingerie
Music
Parking garage
Parking meter
Pharmacy
Purse (handbag, clutch, tote)
Reservations
Restaurant
Sales associate
Shadyside
Shoes (stilettos, high heels, sandals, wedges, mules, clogs, sneakers, boots)
Shopping (browse, purchase, return)
Side street
Stationery
Style
Tea
Technology
Ticket
Toys
Variety store
Walnut street

Monday, March 3, 2014

Word List: Station Square

Word lists containing nouns, verbs, adjectives and adverbs are useful for many goals.  They can be used to target reading, spelling, writing, stuttering, voice strategies, articulation, phonological processes, vocabulary building, sentence structure, etc.  Thus, I have decided to post word lists relating to Pittsburgh.  This one is centered on Station Square.  Obviously there are many, many words that pertain to this area so I have tried to limit my lists to 25-50 words.  If there is a word that you would like to be included, please post below!

 
Image retrieved from http://www.schellgames.com/schell-games-expands-into-station-square-property/.

Customize the words for her particular goals; if you need some suggestions on ways to hit the targets, please post below or e-mail me.  Explain any unfamiliar words to your child.  As with each of my lists, I suggest bringing it with you while you are out and about at any location.  Feel free to give this list directly to your child (if she can read) and have her check off each of the words that she encounters.
Bench
Bessemer
Bridge
Candy
Carriage
Court
Dance
Dining
Dinner
Downtown
Entertainment
Fountain
Freight
Gateway clipper fleet
Hear
Horse
Incline
Landing
Landmark
Listen
Look
Marina
Mountain
Music
Parking
Railroad
Restaurants
River
See
Shopping
Skyline
Station
Steel
Stores
Toys
Tracks
Train
View
Water
Whistle

Word List: South Park

Word lists containing nouns, verbs, adjectives and adverbs are useful for many goals.  They can be used to target reading, spelling, writing, stuttering, voice strategies, articulation, phonological processes, vocabulary building, sentence structure, etc.  Thus, I have decided to post word lists relating to Pittsburgh.  This one is centered on South Park.  Obviously there are many, many words that pertain to this area so I have tried to limit my lists to 25-50 words.  If there is a word that you would like to be included, please post below!  I haven't been to North Park, so if anyone has special words pertaining to that park, please post below.

P4260004(1).JPG
Image retrieved from http://www.examiner.com/article/pittsburgh-trails-hiking-south-park-s-bison-ridge-trail-slide-show; credit Jason Elliot.

As with each of my lists, I suggest bringing it with you while you are out and about at any location.  Feel free to give this list directly to your child (if she can read) and have her check off each of the words that she encounters.  Or, customize the words for her particular goals; if you need some suggestions on ways to hit the targets, please post below or e-mail me.  Explain any unfamiliar words to her.

Baseball
Bicycle
Bird
Birdhouse
BMX track
Branches
Bridge
Cat
Deer
Dogs
Ducks
Exercise
Field
Fish
Gold course
Grass
Ice skate
Jog
Jungle gym
Martial arts
Park
Pavilion
Picnic
Playground
Pond
Restroom
Run
Sky
Soccer field
South
Squirrel
Swings
Tennis court
Trail
Trees
Walk
Wave pool
Weeds
Wildlife
Woods

Word List: St. Patrick's Day Parade

Word lists containing nouns, verbs, adjectives and adverbs are useful for many goals.  They can be used to target reading, spelling, writing, stuttering, voice strategies, articulation, phonological processes, vocabulary building, sentence structure, etc.  Thus, I have decided to post word lists relating to Pittsburgh.  This one is centered on the St. Patrick's Day Parade, which will be held March 15th.  Obviously there are many, many words that pertain to this area so I have tried to limit my lists to 25-50 words.  If there is a word that you would like to be included, please post below!


Image retrieved from http://www.examiner.com/article/st-patrick-s-day-parade-downtown-pittsburgh; photo credit Seth Rosenberg.

As with each of my lists, I suggest bringing it with you while you are out and about at any location.  Feel free to give this list directly to your child (if she can read) and have her check off each of the words that she encounters; customize the words and use of the words for her particular goals.  (If you need some suggestions, please post below or e-mail me.)  Explain any unfamiliar words to her.
Bagpipes
Band
Banner
Cabbage
Celebrate
Clover
Confetti
Corned beef
Costumes
Dancing
Downtown
Float
Green
Holiday
Instruments
Irish
Joke
Kilt
Leprechaun
March
Music
Parade
Party
Pot pf gold
Potatoes
Route
Shamrock
Sing
Song
St. Patrick
Stand
Streamers
Street
Watch

Tuesday, February 25, 2014

"Green Eggs and Ham" Re-imagined

"Green Eggs and Ham" by Dr. Seuss is one of my favorite contemporary picture books.  I just can't get it out of my head...which is why I re-imagined it in a Pittsburgh setting, with pierogies replacing the green eggs and ham.  Read this out loud to your child, because reading stories and hearing rhymes are helpful for children because it helps promote early literacy and attention.  Or, have your child read this to you to practice reading skills, articulation, stuttering strategies, voice strategies, etc.  I would love to add some pictures to this when I have more time.


Pierogies, National Pierogi Day

Image retrieved from http://www.roadtripsrus.com/2013/10/09/pedaling-pierogies-national-pierogi-day/.

I am Suzy Zees.

I am Suzy Zees.
Suzy Zees – that’s me.

That Suzy Zees
That Suzy Zees!
I do not like
that Suzy Zees!

Do you like
pierogies?

I do not like them,
Suzy Zees.
I do not like
pierogies.

Would you like them
outside or in?

I would not like them
outside or in.
I would not like them
for breakfast, lunch or din-din.
I do not like
pierogies.
I do not like them,
Suzy Zees.

Would you like them
in Station Square?
Would you like them
with a bear?

I do not like them
in Station Square.
I do not like them
with a bear.
I do not like them
outside or in.
I do not like them
for breakfast, lunch or din-din.
I do not like peirogies.
I do not like them, Suzy Zees.

Would you eat them
in Schenley Park?
Would you eat them
with a shark?

Not in Schenley Park
Not with a shark.
Not in Station Square.
Not with a bear.
I would not eat them outside or in.
I would not eat them for breakfast, lunch, or din-din.
I would not eat pierogies.
I do not like them, Suzy Zees.

Would you? Could you?
On a cruise?
Taste them! Taste them!
You can’t lose!

I would not ,
could not,
on a cruise.

You may enjoy them.
You will see.
You may like them
on the T?

I would not, could not on the T.
Not on a cruise! You leave me be.

I do not like them in Schenley Park.
I do not like them with a shark.
I do not like them in Station Square.
I do not like them with a bear.
I do not like them outside or in.
I do not like them for breakfast, lunch or din-din.
I do not like piergoies.
I do not like them, Suzy Zees.

A run! A run!
A run! A run!
Could you, would you
while on a run?

Not on a run! Not on the T!
Not on a cruise! Suzy! Leave me be!
I would not, could not, in Schenley Park.
I could not, would not, with a shark.
I will not eat them with a bear.
I will not eat them in Station Square.
I will not eat them outside or in.
I will not eat them for breakfast, lunch or din-din.
I do not like them, Suzy Zees.

Hey!
In the river?
Here in the river?
Would you, could you, in the river?

I would not, could not,
in the river.

Would you, could you,
in the sun?

I would not, could not, in the sun.
Not in the river.  Not on a run,
Not in on a cruise.  Not on the T.
I do not like them, Suzy, you see.
Not in Station Square.  Not in Schenley Park.
Not with a bear.  Not with a shark.
I will not eat them outside or in.
I do not like them for breakfast, lunch or din-din!

You do not like
pierogies?

I do not
like them,
Suzy Zees.

Could you, would you,
with a feline?

I would not,
could not.
with a feline!

Would you, could you,
on the incline?

I could not, would not, on the incline.
I will not, will not, with a feline
I will not eat them in the sun.
I will not eat them on a run.
Not in the river! Not on the T!
Not on a cruise! You leave me be!
I do not like them in Schenley Park.
I do not like them with a shark.
I will not eat them in Station Square.
I do not like them with a bear.
I do not like them outside or in.
I do not like them for BREAKFAST, LUNCH or DIN-DIN!

I do not like
pierogies!

I do not like them,
Suzy-Zees.

You do not like them.
SO you yell.
Taste them! Taste them!
And you may tell.
Taste them and you may tell I yell.

Suzy!
If you will let me go,
I will taste them.
You will know.

Hey!
I like pierogies!
I do!! I like them, Suzy Zees!
And I would eat them on the incline!
And I would eat them with a feline.
And I will eat them in the sun.
And in the river.  And on a run.
And on a cruise.  And on the T.
They are so yummy, so yummy you see!

So I will eat them in Schenley Park.
And I will eat them with a shark.
And I will eat them in Station Square.
And I will eat them with a bear.
And I will eat them outside and in.
Hey! I will eat them for breakfast, lunch and din-din!

I do so enjoy
pierogies!
Thank you!
Thank you,
Suzy Zees!