I thought many of you might find some value in me breaking down what one of my therapy sessions looks like. I will give you an overview of a session I did this past week. The session was with a newly acquired private client who I did a session with at their school with her mother in attendance. It was her second session following her initial assessment which revealed fronting on her /z/ and /s/ sounds, plus misarticulation of the /l/ sound. The 6 year old client was found to be stimulable for all sounds up to the word level. The 20 minute session was timed on my iphone and went as follows:

If you are a fellow SLP, feel free to contact me with any questions regarding integrating high repetition therapy into your offerings as a clinician.

Yours in making a difference,

Marcus Little

Marcus Little

In the world of Speech Pathology, stimulability is a key concept.  It is one of the first things a Speech-Language Pathologist will look for once identifying the existence of a misarticulation.  So what is stimulability?  It is simply the client demonstrating the ability to accurately produce a target sound when given a model for that sound.  Stimulability is typically achieved at the sound level first but can be identified at each of the sound production levels leading up to conversation.  These include the syllable level, double syllable level, word and sentence levels.  Once a sound is identified as being stimulable, it signals to the SLP that this sound may be ready to be targeted specifically to be developed through the levels into conversation.  Stimulable sounds display a readiness for therapy. 

The extent to which a sound is stimulable is a key factor in target selection. I would not necessarily choose the most stimulable target as my therapy target.  For instance a sound which is stimulable in sentence level drills with multiple target sounds in multiple positions, I may choose to overlook.  A sound at this level is on the verge of emerging into conversation and I may choose to monitor this sound while choosing a lesser stimulable target to focus on. 

Early on in my career as a Speech Pathologist I imagined I would be spending the majority of my time developing stimulability in clients.  I was amazed that this simply was not the case.  Clients with multiple speech errors usually had a mix of stimulable and non stimulable sounds.  Quite often when working on the stimulable targets, the non stimulable sounds would develop stimulability on their own.  In the instances of having no sounds that are stimulable, it usually does not take multiple sessions to develop stimulability.  I have encountered sounds that were highly resistant to developing stimulability but these cases have always been the exception.    I strongly believe that once a client becomes stimulable for a sound it is simply a matter of doing the work to get the sound to ultimately emerge into conversation.  

I have put together a training video covering the concept of stimulability.  This video also provides some techniques to develop stimulability of the /s/ sound as well.  I am very pleased with the production quality considering this is our first video offering.  I encourage you to leave questions and comments.  I am here to serve you.

Marcus Little

httpvhd://www.youtube.com/watch?v=Jc8jEvC7jHs

First off,  I want to state for the record that I am not an academic.  I consider myself a problem solver.  I am someone who has worked with kids day in and day out for the past ten years to improve their articulation.  I often reflect on what I do as a clinician that makes the most impact on my clients success.  For me, the answer lies in two areas.  Firstly, effectively educating parents and support staff on how to carryout homework drills.  Secondly, what I do with my client during our sessions.  Today we will look at the latter.

During my initial case load of kids that I started in 1999, I remember one client in particular.  He was a veteran of speech therapy and had worked with a handful of Speech Pathologist over the years. We were working on his /r/ sound and he was capable of doing sentence level drills with multiple targets.  Additionally, he could produce his /r/ correctly in monitored conversation.  I was very pleased with how well he was doing until I heard him in the hallway with his friends.  It was if he had never been to speech therapy at all.  I know I am not alone with this.  Recently, I was going through my copy of Assessment and Remediation of Articulation and Phonological Disorders 2nd Edition and found the following quote by Wayne Secord (p. 150) which summed up my experience perfectly:

Consider the child who has just carried on a completely unstructured conversation in therapy and made no errors.  As he leaves the room at the end of the session, he turns to the clinician and says "Thee you friday mither Thecord" -100% correct in conversation during therapy, 100% incorrect at the door!  Unfortunately, this is not an uncommon experience.  It almost seems as if the aura of correct speech surrounds the client during therapy and disappears at the door.

Over the next few sessions with my client it became clear to me that I was overlooking some obvious clues as to why this was occurring.  My own personal bias for wanting to see my client succeed was distorting what I was perceiving as a successful productions during therapy.  I was overlooking how the targets were being produced.  For instance, during sentence drills or monitored conversation my client was "overemphasizing" his target sounds.  Additionally, he was pausing slightly before his target sounds.  So on the surface I could look at his productions in sentences and conversation and say "woohoo it is correct".  The reality was my client was only correct when monitoring his conversation and using the compensatory tactics of pausing and emphasis.  Why was this the case?  Over time, I came to my own conclusion about this.  I concluded it was the inability to transition articulators quick enough to use sound "automatically" in conversation. 

Consider the following:  When you or I speak, our tongue moves rapidly to different points of articulation.  It is an automatic process and we don't think about the movements.  Each and every client that begins working developing their speech sounds has to consciously attend to their sound production in order to be accurate.  I then view my role as an SLP is to take what has to be consciously attended to and make it automatic.  Over the past ten years it has become clear to me that the key elements to developing automaticity is number of repetitions and more importantly the speed of the repetitions. In graduate school we were taught to promote rate reduction as a method of increasing the child's intelligibility.  This works great when the child consciously monitors their conversation and works well in the moment when being prompted to slow down but I have found children resistant to adopting a slower speech rate as their automatic way of being.  For me it made sense to teach the kids to speak faster by addressing the speed of their articulator transitions.  When a child can say their targets accurately and rapidly, the carryover into conversation is much quicker.  I have experienced this hundreds of times. 

It is my intention to share with you my knowledge and expertise in using such an approach.  The free e-course that we offer is an excellent starting point.  More resources will follow in time.  Any questions and comments are greatly appreciated and encouraged.  I am here to help.

Marcus Little