9/19/11

Coarticulation and Timing

     One-hour speech therapy sessions pale in comparison to the many hours of dysfluency children experience in demanding, daily communication. This has always been a challenge for speech therapy. In 2011, I have been experimenting with my e-mail newsletter "Helping At Home", Skype, telephone calls, and digital recordings of speech therapy as ways to place 'new speech' in the home.

     After receiving permission from LinguiSystems, I burned CDs of myself demonstrating how to practice several of the activities in Easy Does It for Fluency: Intermediate (1) and gave these to my students who also purchased the workbook. My speech is very slow and my demonstration of the speech tools a bit exaggerated on this CD. I hope my model - as comical as it may sound - is a reminder of what speech therapy practice is. It is not speech as usual. It begins as a somewhat awkward sounding, very self-aware way of speaking. Only with practice and problem solving does it become more automatic and natural sounding.

     This past weekend, I recorded a CD of activities based on the picture book Friends by Helme Heine. (2) This CD, also free for my students, demonstrates how you can adapt your own books, games, and schoolwork to practice more fluent speech at home. Literature is educationally rich and a golden opportunity for carryover practice. Children apply multiple speech and language skills when working with fiction and nonfiction. In addition to books, I will be making speech homework CDs based on the lessons in Flash Skills Reading Comprehension books. These children's workbooks are available at any Barnes and Noble and, at $4 each, are quite affordable. Let me know your child's favorite literature and I'll add it to my CD collection.

     Children who stutter (CWS) are coping with a speech-language-motor system that is different from their fluent peers. Their speech is more sensitive to disruption and stuttering. We know that the fluent speech of young CWS is different from their fluent peers. Yes, the fluent speech. Children who stutter "have difficulties regulating the temporal/spatial programs of speaking, whether at a peripheral motor execution level or at a more central level before motor execution." (3) Speech therapy teaches "slow easy speech" to help CWS with motor planning, and motor execution. Now research indicates this may also contribute to more typical brain development.

     Please print this article and give it to your children's doctors, tutors, teachers, and counselors: "Using Brain Imaging to Unravel the Mysteries of Stuttering" by Soo-Eun Chang, Ph.D. This article, published 8/23/11, is a review of past research and a summary of "the only published study to date on the neuroanatomical bases of childhood stuttering."

     [Have you ever listened to a toddler babbling while lying in her crib before a nap? As the very young child chatters to herself, she plays with sound combinations she can feel and hear. I love listening to preschoolers learn new words as they try to match their own immature sound productions with adult models. An adult asks, "Can you say spaghetti?" and the very young child's first response may be, "eti!" Later, with improved coarticulation and timing skills, she may say three syllables, "ageti!" Eventually, she can pronounce the /sp/ with precision, "spaghetti!" The developmental sequence of speech and language is just plain fascinating to me.]

     A child's "fluid, effortless speech production is possible because of well-established connections among brain regions that support auditory processing, motor planning, and motor execution." (p. 3) There is a neurological 'superhighway' of white brain matter that connects the auditory processing, motor planning, and motor execution areas of our brains. It goes by the abbreviation SLF. This highway looks different in both children and adults who stutter compared to fluent speakers, primarily on the left side of the brain. (p. 4 & 6) Dr. Chang suggests that this may be related to an inherited predisposition for stuttering.

       This difference in the [SLF] "may mean that signals among the movement planning, execution, and sensory brain areas may not be transmitted in a sufficiently rapid manner to allow for fluent speech production." (p. 6, bold is mine)

     The brain is also made up of gray matter. (4) This is where the auditory processing, motor planning, and motor execution areas are located. Typical brain development shows more gray matter on the left side of the brain than the right side. Children who stutter show this typical gray matter distribution. However, brain scans of adults who stutter reveal more gray matter on the right side. Researchers speculate that this is the result of an adult brain that has been compensating for a weaker SLF on the left side. "The functional brain differences in stuttering children, when sustained, could result in structural brain changes, in turn resulting in abnormal laterality of auditory-motor interaction for speech processing - which is reported in stuttering adults." (p.10)

      Helping children become more fluent may nurture more typical brain maturation. The ongoing challenge of speech therapy for CWS is how to increase the amount of time they practice more fluent speech outside of the 'clinic.' The Lidcombe Program (5) requires that parents do the speech therapy at home. There are many issues to consider with respect to the Lidcombe method, but that is the topic of another newsletter. The point is, all speech therapy for stuttering must find ways to gradually transfer new, more fluent speech skills to daily life. I hope that home practice with Skype, telephone conversations, and homework CDs, as a supplement to other verbal recommendations, will help make this happen. I'll write about apps for speech therapy in a future newsletter.

(1) http://www.linguisystems.com/products/product/display?itemid=10044

(2) http://www.amazon.com/Friends-Helme-Heine/dp/0689710836/ref=sr_1_1?s=books&ie=UTF8&qid=1316393162&sr=1-1

(3) Soo-Eun Chang et al (2002) Coarticulation and Formant Transition Rate in Young Children Who Stutter, Journal of Speech, Language and Hearing Research, 45, 676-688.

(4) gray matter stained blue: http://www.sciencephoto.com/media/118722/enlarge

(5) http://www.stammering.org/lidcombe_info.html

(6) Olander, L. (2010) Evidence That a Motor Timing Deficit is a Factor in the Development of Stuttering, Journal of Speech Language Hearing Research, 53, 876-886

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.