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.

Devoicing and Voicing; Ice skating rinks; PPG Place

"Devoicing" occurs when a "voiced" sound (a sound that is made with the vocal cords vibrating) is made into a "voiceless" sound (a sound that is made without the vocal cords vibrating).  For example, a /b/ sound may turn into a /p/ sound; the sounds are made in similar ways, except that when we say /b/ our vocal cords vibrate and when we say /p/ our vocal cords don't vibrate.  Thus, when saying "tub," a child may say "tup" in error.  The error often occurs with the last consonant sound in a word.

"Voicing" occurs when a "voiceless" sound (a sound that is made without the vocal cords vibrating) is made into a "voiced" sound (a sound that is made with the vocal cords vibrating).  For example, a /p/ sound may turn into a /b/ sound; the sounds are made in similar ways, except that when we say /p/ our vocal cords don't vibrate and when we say /b/ our vocal cords vibrate.  Thus, when saying "potty," a child may say "botty" in error.  The error often occurs with the first consonant sound in a word.

It is important to note that a child can produce all the sounds in the word correctly, so this is not an articulation problem per se.  Rather, this what experts call a "phonological process" whereby a child produces a different "rule" when saying words.  In the case of devoicing, the "rule" the child is applying is to make the sounds without vibrating the vocal cords.  In the case of voicing, the "rule" the child is applying is to make the sounds while vibrating the vocal cords.

To reduce devoicing, it is helpful to model production of the word correctly for your child.  For example, say "tub" and emphasize the /b/ sound; say this over and over.  Then, prompt your child to say "tub" correctly.  If it is still in error, a good cue is, "Turn on your voice."  Explain to your child that some sounds are made with our voice on, like with /b/; other sounds are made with our voice off, like with /p/.  Review this notion with other sounds, like the difference between "zzzzzz" and "ssssss;" have your child feel her throat (or yours) when making these sounds to sense/understand the concept of voicing/vibration.  You may find it helpful to practice the sounds alone at first so that your child gets used to responding to the cue "Turn on your voice."  Good sounds to practice include b/p, d/t, z/s, g/k.  Also, try breaking up the word.  In the case of "tub," prompt her to say "buh;" then "-ub;" then "tub."  Breaking up the word can help build awareness of the sounds in the word.  It is also highlights to your child that she can make all the sounds in the word successfully.  In addition, the slow pace allows her time to produce the correct sounds.  

To reduce voicing, it is helpful to model production of the word correctly for your child.  For example, say "potty" and emphasize the /p/ sound; say this over and over.  Then, prompt your child to say "potty" correctly.  If it is still in error, a good cue is, "Turn off your voice."  Explain to your child that some sounds are made with our voice off, like with /p/; other sounds are made with our voice on, like with /b/.  Review this notion with other sounds, like the difference between "ssssss" and "zzzzzz;" have your child feel her throat (or yours) when making these sounds to sense/understand the concept of voicing/vibration.  You may find it helpful to practice the sounds alone at first so that your child gets used to responding to the cue "Turn off your voice."  Good sounds to practice include p/b, t/d, s/z, k/g.  Also, try breaking up the word.  In the case of "potty," prompt her to say "puh;" then "pott-;" then "potty."  Breaking up the word can help build awareness of the sounds in the word.  It is also highlights to your child that she can make all the sounds in the word successfully.  In addition, the slow pace allows her time to produce the correct sounds.

I thought it might be fun to practice elimination of voicing and devoicing at an ice skating rink, since the days of coldness are (hopefully!) numbered.  Unfortunately the Cal U Ice Rink at PPG Place is closed for the season, as are Allegheny County outdoor ice skating rinks.  However, there are plenty of indoor ice skating rinks in Pittsburgh.  A few I know of include: the Iceoplex at Southpointe, the Ice Castle Arena, and the Mt. Lebanon Ice Center.

 

Image retrieved from http://www.achildgrows.com/ice-skating-best-excuse-drink-hot-chocolate/.

Words to practice eliminating devoicing while at the rink include:
freeze
glide
blade
slide
pad
slid
kid

Words to practice eliminating voicing while at the rink include:
cold
fall
pay
coach
pad
fun
ticket
bend
seat
kid
parent.

If ice skating isn't your cup of tea, but you are still keen on visiting PPG Place, there are some target words for that location that will be relevant this spring.  PPG Place will soon be opening up its plaza to include the water feature.

 Image retrieved from http://www.waymarking.com/waymarks/WM4WM8_PPG_Plaza_Pittsburgh_Pennsylvania.

Words to practice eliminating devoicing include:
trees
arcade
PPG Industries
Blvd of the Allies
tables

Words to practice eliminating voicing include:
sit
food court
column
fountain
Pittsburgh Plate Glass
tower
solar
tables.