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Questions from our Readers |
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What do you work on in speech therapy with those who have lost the ability to talk?
Approaches that speech therapists use to address speaking difficulties are as many as the stars above. And I'm not kidding! Approaches to therapy are as different as fingerprints; hardly ever the same. Each speech pathologist has their own way of doing things and there is a great deal of variability within the field today.
Many of the approaches, which have been used, are old and tired; and thank goodness there are the speech gurus who develop new and different approaches to address the problem of speech loss due to aphasia, head injury or developmental delays in children. There are many new and exciting approaches, which are showing great promise.
In my previous writings I have commented that most caregivers and clients/patients know whether speech therapy is working, and I have encouraged many who are in doubt to have conversations with their therapist or seek other expert speech pathologists for second or third opinions.
 The Teaching of Talking Method fits right in with the newest concepts in speech therapy today for the treatment of speech and language difficulties of those with aphasia, head injury and developmental delays. The concept deals with neuro-plasticity which is the brain's ability to reorganize itself and allow the nerve cells to compensate for an injury and disease and to adjust their activities in response to new situations or to changes in their environment. It simply means that the brain can continue to improve function with regular exercise and practice and that it may take hours per day to keep the process of learning occurring, even with a damaged brain. Our method would also concur with Constraint Induced Speech Therapy which forbids alternate methods of communication such as writing, signing, gesturing and other means
of communication and forces the concentration of therapy on speaking, and dealing with real life speaking situations and what must be said in the moment during daily activities of living. Neuro-plasticity and Constraint Induced Speech Therapy are the Foundational Principles of The Teaching of Talking Method, and forcing communicating only by talking if the person with the communication difficulty is stimulable*, and massed practice referring to speech and language stimulation which often occurs between the caregiver and individual for up to 2-4 hours per day which is what is often necessary with moderate to severe speaking difficulties. ( Stimulable means the person with the speaking difficulty can say vowels, syllables or simple words after you; example: if you say "I" and the person with the speaking difficulty can imitate that, and also say "I," he or she would be stimulable. Likewise, if you were to say numbers or letters, and simple words like "yes" or "no,"
and they could repeat them with reasonable accuracy one would say they are stimulable).
What differs about the Teaching of Talking Method is the demand placed on the speaker in the context of the relevant, communicative interchange. In simpler language our method relies on the loved one or caregiver to engage the person with the speaking difficulty in a conversation while cueing them to always answer in single words, word pairs, phrases or sentences. For many at the start of therapy, one word responses are initially stimulated until the speaking response can be expanded to more than one word, then phrases and sentences.
I had an e mail from the daughter of a stroke survivor today who stated, and I quote:
 "She was just told that her in-home Medicare covered speech therapy is finished and our family is now trying to figure out how to help her continue her rehab. When she first had the stroke (during the first 24 hours) she was not able to formulate words coherently at all, and she did not even remember her own full name. Then over the next few days, much came back to her, but she seemed to stagnate in her recovery also quite quickly. I do not believe that the speech therapy she has had over these last weeks has really helped her at all. She can sometimes get a simple thought out fairly clearly, but many of her thoughts come out in sentences that either have the words in improper order or missing correct verbs or pronouns. Sometimes it is hard to get what she is trying to convey at all. She can definitely formulate the vowels and simple words as you suggested was necessary in your video that I just watched. But we are concerned that she is sliding backwards rather than forwards in her recovery because the speech therapist she had had basically worked from packets of worksheets (crosswords, fill-in the blanks, word association, etc).
Many people who require intensive speech therapy and skilled care are not able to receive it due to insurance limitations. We are teaching speech language pathologists in the clinic or hospitals, teachers, loved ones and caregivers how to provide speech and language stimulation that is simple and fun, and could be readily learned by those caring for the person with the speaking difficulty. Speech pathologists and caregivers are educated in simple speech and language stimulation methods that they can learn and become proficient with and that free them from the confines of homework sheets, computer programs and alternative speaking devices with clients who are stimulable and imitative for sounds, single words or phrases.
Speech language pathologists and caregivers are becoming proficient stimulating words, phrases or sentences at anytime/anyplace in the clinic, out shopping, in a restaurant, or at home. The stimulation of language can be conversational, effortless and matter of fact, like everyday discourse. The person with the speaking difficulty learns to respond in single words, phrases or sentences all through the day to structured questions within the contexts of daily living.
Some examples of the language we are stimulating in the clinic with follow up at home by caregivers:
 With one of the gentlemen I work with we are constantly helping him say his favorite foods and beverages such as "Steak Lupe, Corona Beer, Veal parmesan, pizza, eggs, chicken wings, leftovers," in addition to his favorite restaurants which he and his wife often go to after numerous visits to doctors and radiation therapy: Examples are: Carrabas, Lupe Tortillas, Brooklyn Pizza, Chicken Filet, and numerous others.. Our friend with the speaking difficulty then reviews with his wife what the day was like at home and what he accomplished like: "I watched tv; I made breakfast; I made eggs and sausage; I swept the kitchen; I mopped the floor; I did laundry; I put clothes on the bed;
I raked the yard; I vacuumed." (Two months ago our friend was not speaking at all.) Finally we have helped our friend with the speaking difficulty politely request that his son "Get a haircut." and that his hair is "Too Long!"
Our mission is to help give our friends with speaking difficulties the voice and the language to speak about what interests them, and for many it is about food, and football, chilling out, eating out, and enjoying the simple pleasures of living. But there are also many who could care less about food, football, or cleaning the house. For them it may be conversations about airplanes, or hunting/fishing, or for others of differing genders foods to be prepared for Thanksgiving or Christmas, or what happens at the house on Thanksgiving or Christmas day.
One of the most important things I work on initially is to help identify what the person with the speaking difficulty needs to convey to the caregiver. Usually it has do with NEED. Like having to go pee, or poop, or wanting to change clothes, or get into bed, or take a nap, or wanting to get up, or being hungry, or thirsty, or tired, or grouchy, scared, or depressed. We get to know our friends with speaking difficulties and find out what turns them on, as well as off.
Stimulating language is about finding out what needs to be expressed and stimulating that all throughout the day and night, until the brain once again has access to these concepts and can express them in talking.
Mark
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Modeling
 For anyone to be successfully with the stimulation of speech and
language you must remember that speech therapy is all about modeling. A
person with a speaking difficulty must hear a model of speaking again,
and again and in a way that is enjoyable, safe and non-critical or
threatening.
Children who have models usually learn speech readily. Those children
who come from "silent" homes frequently are delayed in the ability to
use language.
Caregivers need to realize that for an adult with aphasia or brain
injury, the speech model may have to be very similar to the one given to
toddlers, where there are very small words repeated frequently
throughout each day.
People with aphasia and brain injury may relearn speaking by hearing
speech that is presented very slowly and simply at first very much like
the mother with an infant.
There is no substitute for a good speech model that the person with a
speaking difficulty can see and hear. Speaking is best modeled from a
human being who is warm and interactive, and who should be seen by the
listener who can watch facial mannerisms, lip and tongue movements, and
then successfully imitate them.
In todays world of high tech gadgetry and smart phones with built in
speech generating software, the traditional ways of learning to speak
are being replaced with computers and digitally synthesized speech. I
believe there is a method of communication for everyone; for some who
are unable to speak, alternative gestural or electronic methods may be
the treatment of choice. Being an oralist, I prefer natural speech
whenever possible.
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More Questions Posed by a friend of Teaching of Talking
Dear Mark,
My mother lives at home with a caregiver who is foreign born and has a
very pronounced accent. I am hesitant to ask her to learn the methods
of Teaching of Talking. What should I do?
Nan, New York
Dear Nan,
What a great question you ask, and I am sure there are many people
who have the same question when it pertains to caregivers providing
speech and language stimulation. Many foreign born speakers are
interested in improving their language, and learning The Teaching of
Talking Method would be a win/win situation for all concerned.
Since the Teaching of Talking method often starts out with very simple
language it would not be difficult for a caregiver to model one, two, or
three word questions or statements at first, and then, in time model
longer phrases and sentences. The Teaching of Talking Method also
emphasizes slow-modeled speech where the words are given to the person
with the speaking difficulty very slowly, often with a notable pause
between each spoken word. I have not had the opportunity to listen to a
sample of your mother's caregiver, however in many cases, a caregiver
can learn to model questions and statements in a very slow manner. Slow
speaking by a speech model (caregiver) is often very helpful when
helping someone with a speaking difficulty talk again. Slowly speaking
may also diminish difficulty understanding the speech of a foreign born
speaker. In fact, slowing down the speech rate of a foreign speaking
model often makes speech easier to understand and imitate. I believe
you mothers' caregiver could be of great benefit to your mother.
I hope this helps!
Mark
2.
Dear Mark,
If we saw signs of decreased cognitive function in my mother even before
she had the stroke, do you think there is still much reason to believe
that your methods will be able to benefit her? We wonder if she might
have some form of dementia in addition to the aphasia from the stroke. I
would just like to have fairly realistic expectations if we go forward
and use a totally new strategy in helping her speech.
Nan, New York
Dear Nan:
Aphasia is often accompanied by some varying degrees of dementia
especially in older people. Dementia also seems to worsen when there is
lack of stimulation, both in speaking and cognitive tasking. That is
why it is vital for anyone who has suffered from aphasia to be
stimulated with language, problem solving, sequencing, and activities of
daily living. The tendency is to circumvent or to allow disuse of a
weakened area of the brain and its subsequent function. That leads to
further wasting of muscle or matter, whether in mind or body which then
leads to worsening function. Nan you could read in our next newsletter
about neuro-plasticity and Constraint Induced Speech Therapy which are
some of the foundational principles of our new book: The Teaching of
Talking. Simply put, brain function improves with stimulation and to
address the speaking difficulty as soon as possible with the stimulation
of speech and language as long as the person can imitate simple vowels,
consonants and simple words.
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Please share with friends and institutions
The Teaching of Talking was written in order to start a movement. A way of changing the way therapy has been traditionally done for so long. Many of you know that parents and caregivers are often left out of the loop when it comes down to really knowing what to do to help their loved ones talk. Our movement invites them in and enrolls them in the conversation of really knowing what to do to stimulate speech and language with clarity. To put it simply we believe those who receive the most stimulation from the home environment will be the ones who will make the greatest improvement. It's only natural the more stimulation in one's natural environment, by someone they love, the more forthcoming the improvement!
We ask that you forward our newsletter to any of your friends, acquaintances or professionals you may know so that they may learn of our work to help parents of children who are having difficulty speaking and caregivers of those with stroke, aphasia or head injury. We thank you for that.
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Special Offer
 The Teaching of Talking, our new book which is designed for speech pathologists and care-givers, parents, and family members is available through our website. During the next 60 days we have an introductory offer. We are offering Teaching of Talking for $18. plus tax and shipping. (original $25. value) I will also autograph each copy. The methods contained within The Teaching of Talking will help you learn a conversational approach to stimulate speech and language that begins with single words and works up to phrases, and sentences. The Teaching of Talking is for those who are stimulable; ie: they can repeat a vowel, syllable, or word. Our text has a screening test which will help you identify the key components that are necessary for success with the stimulation of speech and language. It was originally intended to be used with a speech and language pathologist as a guide to follow for the caregiver interested in helping the person with the speaking difficulty improve talking However, there are thousands of people, worldwide, who do not have access to professional speech therapy. For those who do not have access to a trained speech language pathologist, this book will help them understand the principles involved in the teaching of talking, especially with those who have aphasia, speech and language loss, or those who have not developed the ability to talk. Get the best price of $18.00 for your autographed copy of Teaching of Talking on our website.
I will be available through individual telephone, video consultations, and teleconferences to help anyone learn The Teaching of Talking Method. We are also planning live seminars in Houston, Texas. Should you have any questions or comments please do not hesitate to contact me by email or scheduling of a free initial consultation from our website at www.teachingoftalking.com
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Newsletter Addition
Should any of our readers wish to pose a question regarding speech and language stimulation with The Teaching of Talking Method, we would be most happy to address your questions and publish them in the newsletter each month. | |
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New Facebook Page
We now have a teaching of talking facebook page.
Please click the facebook icon below and like us on the teachingoftalking facebook page.
Thank you
Please note: All photographs by Mark A. Ittleman
No photograph may be duplicated or copied without the expressed written permission of Mark A. Ittleman.
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