June 28, 2023 • 18 mins
Ever wondered how a deeper understanding of brain plasticity could revolutionize your language therapy sessions? Join me as I share my key takeaways from Norman Doidge's eye-opening book, "The Brain That Changes Itself", and how we can harness the power of brain plasticity to create more effective and efficient therapy practices. Discover how roadblocks can pave the way for new brain maps, the significance of clear signals in information retention, and why focused attention is indispensable for molding and reshaping our brain maps.
Let's dive into the fascinating world of auditory processing and its connection to language and speech impairments. Learn how I use pictures and descriptors to aid clients in naming exercises, and a shopping activity that helps improve word retrieval. We'll also explore the challenges language-impaired children face in perceiving the fast parts of speech and shed light on David Kilpatrick's "Equipped for Reading Success" program, which has been a game-changer for me as a clinician. Don't miss this enlightening episode that will transform the way you approach language therapy and help you unlock the full potential of the brain's plasticity!
--- Useful Links ---
The Brian that Changes Itself
Picnic Fun
That Thing That Isn’t APD
Equipped for Reading Success
Phonological Awareness Tracking Tool
Whole Body Listening
Impossible R Made Possible
Music: Simple Gifts performed by Ted Yoder, used with permission
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Denise (00:06):
Welcome to the Speech Umbrella, the show that explores
simple but powerful therapytechniques for optimal outcomes.
I'm Denise Stratton, apediatric speech-language
pathologist of 30-plus years.
I'm closer to the end of mycareer than the beginning and
along the way I've worked longand hard to become a better
therapist.
Join me as we explore the manytopics that fall under our
umbrellas as SLPs.
(00:27):
I want to make your journeysmoother.
I found the best therapy comesfrom employing simple techniques
with a generous helping ofmindfulness.
Hello, welcome to The SpeechUmbrella podcast.
Summer is well and truly here,and what better way to celebrate
summer than to kick back andrelax with a good book.
A few years ago, I startedreading a fascinating book
(00:50):
called "The Brain That ChangesItself by Norman Doidge.
I didn't get a chance to finishit then, but it was always in
the back of my mind to finish itsomeday.
Well, I finally did, and it wasworth the wait.
It's basically a book onneurology and learning.
You might be thinking that'sthe last way you want to spend
your free time, but it's so wellwritten for the everyday person
and so filled with stories inhope and recovery that I found
(01:11):
it a really great read.
That also has big clinicalimplications for anyone who
wants to teach a learner how tolearn.
This episode is called ThreeTherapy Takeaways from "The
Brain That Changes Itself byNorman Doidge.
One of the problems we run intoas SLPs is trying to get
learners to the place where theycan learn, where they can
actually take in what we'reoffering.
(01:33):
With some clients, I feel it'sas though what we're trying to
teach just runs off and away,and until we can find the cracks
through which information canpenetrate, we don't get very far
.
And another problem we have isovercoming speech and language
habits so ingrained that theyseem set in stone.
Doidge writes about both ofthese issues with ideas on how
to overcome them.
Here's what we're coveringtoday; The basic premise of "The
(01:56):
Brain That Changes Itself" book, three takeaways on the laws of
learning, and clinicalapplications.
If you structure your therapyaround the laws of learning, it
will make you a better therapist.
The overarching idea of "TheBrain It Changes Itself is that
the brain is plastic, far moreplastic than many scientists
used to think.
Not just in infancy andchildhood, but the plasticity
(02:19):
can be tapped into in old age.
Now there's a neuroscientistcalled Michael Merzenich who led
the cochlear implant team atUCSF, and he's done a lot of
work on brain plasticity.
He claims that when learningoccurs in a way consistent with
the laws that govern brainplasticity, the mental machinery
of the brain can be improved sothat we learn and proceed with
(02:40):
greater precision, speed andretention.
What are these laws that governbrain plasticity?
Well, there isn't time to coverthe entire book, but the three
takeaways I want to talk abouttoday are; using roadblocks to
help the brain form new maps,two, the fact that the brain
needs clear signals, and three,focused attention is critical to
forming new brain maps.
(03:01):
Okay, so what does it mean touse a roadblock so the brain can
learn or relearn?
There's this analogy in the bookthat I love.
If you're sledding down a hilland you make that first pathway
in the snow and you use thatpathway again and then again,
pretty soon that's going to bethe only way your sled is going
to want to naturally go, andthat slope is going to get
(03:23):
pretty slippery and pretty fastand you would have to really do
something different to make yoursled go a different way.
It would take some effort, itwould take a new approach, it
would take blocking the old pathto get your brain to take a new
path, and so the whole idea ofthis book, of this roadblocks,
is when someone has someneurological damage or if
they're born with someneurological impairment, the
(03:45):
brain develops these pathwaysthat are not desirable because
they impair them in some way,and if you put a roadblock in
the blocks the old pathway youcan teach them a new pathway.
It's a really cool idea, andthere's really great research in
the book about ways theyexperimented and proved this.
Now, putting up roadblocks sothe brain can take a new path
and strengthening the weakestfunctions are two sides of the
(04:07):
same coin.
One example of using both ofthese ideas the roadblocks and
strengthening the weakestfunction is what they call
constraint induced therapy, andone way this has been used is
when stroke patients are leftwith paralysis, they're not
allowed to use their strongerhand.
They have to use the impairedhand over and over and over
again for increasingly complextasks, and in studies done with
(04:30):
this constraint induced therapy,they have had astonishing
success at rehabilitating theweaker side, because the brains
were able to make or reconnectnew maps when the weak part was
exercised.
And in the clinic where theystudy this, they use mitts and
they use slings on the strongerlimb, and that was their
roadblock, so that the patienthad to use the weaker side.
(04:50):
And because the stronger limbwas constrained, the brain
couldn't default to the oldpathway, it had to make a new
pathway.
And Doidge writes what rewirespatients' brains is not mitts
and slings, of course.
The essence of the cure is theincremental training or shaping,
increasing difficulty over time.
Mass practice helps rewirebrains by triggering plastic
(05:12):
change.
Now, as speech therapists werereally really familiar with that
shaping and increasingdifficulty over time when taking
small steps.
Now here's a study that's alittle bit more relevant to our
field, using constraint inducedtherapy.
They used it with some patientswho had aphasia and the
constraints weren't physical,but they were a series of
language rules which theyintroduced slowly, and the way
(05:34):
it works is they play a game alittle like adult go fish.
These patients have to askother patients for a matching
card and at first the only ruleis that they not point to the
card, and that is so that theydon't reinforce learned non-use.
So they have learned to not usetheir speech and they don't
want to reinforce that.
The y can use any kind ofcircumlocution they want any
(05:54):
kind of language as long as theyare talking.
And then from that point theymove on to naming an object,
correctly, and then they add theperson's name that they're
asking the card for, and so onand so on, until they gradually
add more and more language.
And this constraint inducedaphasia therapy was used with
patients who were, on average,eight years post stroke.
With the control group they usewhat they call conventional
(06:17):
therapy.
And they said that was justrepeating words, and I
understand that's not the bestconventional therapy treatment,
but leaving that control grouptherapy technique aside, what
happened with the constraintinduced treatment was they did
have great results.
After 32 hours of treatment,which took place over 10 days,
they had a 30% increase incommunication.
And so, considering how manyyears post stroke these patients
(06:41):
were, I find that remarkable.
I can see using this withclients who struggle with word
retrieval and moving throughdifferent levels, starting with
naming, then adding a descriptor, then using a basic noun, verb
phrase and adding maybe apreposition or a direct object.
I can imagine a shoppingactivity where you built a
shopping list and take yourbasket to the store and it could
(07:01):
go something like this.
So suppose you've got grapes,and so, you're just practicing
grapes and then purple grapes.
Then let's get purple grapes.
Put the purple grapes in thebasket, and the constraint
induced therapy could bereplacing pointing with words.
And then you add in the shaping, and small incremental shaping
to increase the difficulty, andthis would not happen all in one
(07:23):
session, of course.
A way to ramp this up is topractice naming, just naming by
itself, like five to sevenobjects in a row.
Now I use pictures and then adda descriptor.
I let them come up with thedescriptors if they can, and
after they don't struggle withthe descriptor and the noun, you
can start adding words to thephrase.
So I might do it like this - Imight have an apple and a banana
(07:44):
and a pineapple, and I'll gored apple, yellow banana, sweet
pineapple.
Something like that.
But first we would justpractice apple, banana,
pineapple.
Until it was easy for them toname, they weren't struggling
with retrieving those threewords, and then we would add the
descriptors.
And then it's not so hard tosay hey, let's buy a banana, and
we slap that banana on ourshopping list and oh, let's get
(08:08):
some purple grapes.
Mmmm, sweet pineapple, let'sget sweet pineapple.
And once you have your shoppinglist built, then you go
shopping in your therapy room.
And, by the way, you can getfood and animal pictures from my
picnic fun activity availableon my store at thespeechumbrella
.
com.
And then, after you go shopping, you can go on a picnic with
your stuffed animals.
(08:28):
That's where the animalpictures come in.
Okay, moving on to the next lawof brain plasticity, clear
signals.
A person's memory can only beas clear as the original signal,
but research suggests a lot ofour clients aren't receiving
clearer speech signals, eventhough they have no problems
with conductive hearing.
The research I'm about todescribe here might be somewhat
(08:50):
controversial in our fieldbecause it suggests that nearly
all speech and language impairedchildren have auditory
processing struggles.
Now, if all, or nearly all ofour clients struggle with
receiving clear speech signals,then should we have a separate
diagnostic category calledauditory processing disorder?
I don't want to go too deeplyinto that question today.
I have a whole podcast on it.
(09:11):
That's Episode 44 called 'ThatThing That Isn't APD.
' But I don't want to ignore theelephant in the room.
I prefer to look at a child'ssymptoms, treat the symptoms and
don't worry about the label somuch.
So, if you can determine thatthey're struggling with auditory
processing, then treat it.
Here's a summary of theresearch Doidge writes about.
Paula Tallal found that languageimpaired children had auditory
(09:34):
processing problems withconsonant - vowel combos that
are spoken quickly, and shecalled these the fast parts of
speech and that they had troublehearing them accurately and
reproducing them accurately.
And has a theory about the fastparts of speech, which is that
the auditory cortex neurons werefiring too slowly, and this
meant that; one, they couldn'tdistinguish between similar
(09:57):
sounds or be certain if twosounds occurred close together,
and two, they didn't know whatorder they came in, and three,
they didn't hear the beginningof syllables or sound changes
within syllables.
Now I just have to put a plugin for "Equipped for reading
success" by David Kilpatrick.
I've been using his program fora couple years and this is
exactly what I see.
(10:17):
The more severe the speech andor language issue is, the harder
it is for those kids to hearthe beginning of syllables,
especially internal syllables.
I mean, this is a huge strugglefor some of my clients, but this
is the cool thing.
When they do start to hear thesyllables and they can analyze
these words by removingsyllables or changing syllables,
then I have come to expect asignificant change in their
(10:40):
language ability.
It just happens every singletime.
Every single time they figureout the syllable analysis part
of this program, they make ahuge leap.
Now back to the research,because, yes, there is more.
After processing a sound,normally our neurons are ready
to fire after a 30 millisecondrest, but 80% of
language-impaired children tookat least three times longer and
(11:03):
because of this they lose largeamounts of information, and also
the signals aren't clear.
It's what Merzenich called muddyin, muddy out.
And this weakness in hearingled to weakness in all language
tasks (11:15):
vocabulary, comprehension , speech, reading and writing.
I mean, that's what we see inour field, right?
We see that all the time.
Also, these children usedshorter sentences and didn't
exercise their memory for longersentences.
And now that I'm starting topay attention, I see this muddy
in, muddy out all the time,especially in clients who don't
really have an articulationdisorder.
(11:35):
What they have is a languagedisorder disguised as an
articulation disorder, becausewhile they have the motor
ability to say the words, theydon't remember how to say them.
It comes out sounding a littlebit muddy and mushy and we think
it's a speech disorder.
So what I do when this happens- I pull out my phonological
awareness tracking tool, I useit to find out where they need
to start and then away we go.
(11:56):
This tracking tool has been alife changer for me as a
clinician, and you can also getthe phonological awareness
tracking tool onthespeechumbrella.
com.
The third law a brain plasticityI'm covering is focus.
I'm all about focus.
That's why this podcast used tobe called the Mindful SLP.
I love, love, love talkingabout focus.
Doidge writes, lasting changesoccur only with close attention,
(12:20):
while you can learn when youdivide your attention.
Divided attention doesn't leadto abiding change in your brain
map.
Isn't that what we see whenkids don't carry over, when they
don't generalize, it's notabiding change.
Focused attention is thecondition for plastic change.
Anything that requires highlyfocused attention will help that
system.
Are you fans of whole bodylistening?
(12:40):
I am, and this is why I love it.
I see real lasting changes whenmy clients are paying attention
with everything they have.
This can take some time toteach, but I tell you it's worth
every therapy minute you spendon it.
If you want lasting change, ifyou want carryover, focused
attention is a must.
Here's another interestingtidbit.
Evidence suggests thatunlearning existing memories is
(13:03):
necessary to make room for newmemories in our networks.
In articulation therapy I play agame which seems to help
clients both learn a new pathand unlearn an old path at the
same time.
It's really helpful withphonemes that can be distorted,
such as R, but you can really doit with any sound.
I call it Mind Your R's in myImpossible R Made Possible
(13:23):
course, which you can find atthespeechumbrella.
com/ R- course.
This is how the game works.
I have three boxes with a one,two, three in each box and I
have mini M&Ms, because thatmakes it fun.
For a client to play this gamethey do need to be able to say a
word, even if it's just oneword, correctly.
And so what you're going to do,is you're going to take a word
(13:45):
like robot.
Say we're working on the Rsound robot, but they're not
really consistent with saying itcorrectly, and so it comes out
'wobot", but sometimes, or maybetheir error is "raobot", where
they kind of have R but theydon't quite have it.
Or maybe they're distorting itby trying too hard "R robot,
kind of like that.
It can work with any of these,but what you're going to do is
(14:07):
you're going to make sure thatthey can say it right.
You say, okay, now let's sayrobot.
How are you going to say it theright way?
" And they'll say "Robot andthen you say, how are you going
to say it the wrong way?
And they might go, really oftengo, "Lulululobt" I mean, really
they'll do that because theywant to make sure they're wrong
and they just make it silly.
I'm like, "no, no, that's nothow you say it wrong when you
(14:27):
make a mistake.
" And I'll mull it for them,this is how you sound when you
don't quite get it.
And we'll practice it, we'llpractice their wrong way, the
way they actually say it wrongwhen they're not paying
attention.
Okay, and then the way the gamegoes is they have to say it
right twice and wrong once.
I've got three boxes.
We've got an M&M in each box,and I'm the listener and I
(14:49):
determine which one is the wrongone.
And I get to eat that M&M.
And they are so surprised whenI choose their wrong one
sometimes, because often the onethey think is wrong is the one
that sounds the best, and it'sjust really weird.
It's really freaky.
And we take turns with this, soI am also the speaker and
they're the listener.
And they can always determinemy wrong one, always.
(15:10):
So it's not so much a muddy inmuddy out with listening to me,
it's a muddy in, muddy outlistening to themselves.
This game is awesome and I'llalso use recording a lot,
because they'll argue with meabout which one they said wrong.
But when they can hearthemselves, when they play it
back and have times like, ohyeah, okay.
Fidelity to the process isreally critical for this to work
(15:31):
and this is gonna take somework with your hard clients.
They must say it right twotimes and wrong once.
Whatever rules you set up, theyhave to do that or they won't
be clear.
They won't be clear about whatthey're doing and that auditory
signal will be muddy.
I'm often set on this podcastthat neurons that fire together
wire together, but it turns outthat neurons that fire apart
(15:52):
wire apart too.
We can weaken links and help theunlearning process.
For example, compulsivepractice of a sound the wrong
way, and that's what Mind Your R, or any sound you're working
on, that's why that game works,cause you're helping them
unlearn the proce ss and you'rehelping weaken those links that
have been forged.
It interrupts the compulsiverepeating of a phoneme the wrong
(16:13):
way and really focuses theirattention to the differences
between the right and wrong way.
As neurons are trained andbecome more efficiently process
faster.
This means the speed at whichwe think is plastic, because it
can be changed, and as thesechanges start to occur and
automaticity starts to happen,they learn to do the new skill
easily and effortlessly.
(16:33):
I hope I convinced you to pickup "The Brain That Changes
Itself" by Norman Doidge.
Before I go, here's a quickrecap of the rules that govern
brain plasticity.
A roadblock of some kind isnecessary to help us change
direction and form a new brainmap.
Faster neurons give clearerauditory signals, and a memory
can only be as clear as itsoriginal signal.
(16:55):
When working on persistentarticulation errors that are not
motor based, first teach themto say it once, and only once,
and pay attention, and they willlearn to generalize that sound.
Implement the rules of brainplasticity and complex learning
will take care of itself.
(17:16):
Thank you for joining me underthe speech umbrella today.
I hope you learned something tohelp you in your therapy.
If you did, please share thispodcast with a fellow speech
therapist and leave a five starreview on Apple Tunes, Spotify
or wherever you get yoursubscriptions.
While you are online, come onover to TheS peechU mbrella.
com where you will findtranscripts, links, and my free
resource library.
(17:36):
I also have some other valuablecourses and therapy aids in my
store.
That's all at TheSpeechUmbrella.
com.
Let's connect on social media.
I'm dstratton SLP on Instagramand The Speech Umbrella on
Facebook and YouTube.
You can also find me on TPT.
I hope to talk to you soon.
Bye.
Announcer (17:57):
Thanks for listening to The Speech Umbrella.
We invite you to sign up forthe free resource library at
TheSpeechUmbrella.
com.
You'll get access to some ofDenise's best tracking tools,
mindfulness activities, andother great resources to take
your therapy to the next level.
All this is for free atTheSpeechUmbrella.
com.
If you've enjoyed this podcast,subscribe and please leave us a
(18:20):
review on Apple Podcasts andother podcast directories.
Welcome to the Speech Umbrella, the show that explores
simple but powerful therapytechniques for optimal outcomes.
I'm Denise Stratton, apediatric speech-language
pathologist of 30-plus years.
I'm closer to the end of mycareer than the beginning and
along the way I've worked longand hard to become a better
therapist.
Join me as we explore the manytopics that fall under our
umbrellas as SLPs.
(00:27):
I want to make your journeysmoother.
I found the best therapy comesfrom employing simple techniques
with a generous helping ofmindfulness.
Hello, welcome to The SpeechUmbrella podcast.
Summer is well and truly here,and what better way to celebrate
summer than to kick back andrelax with a good book.
A few years ago, I startedreading a fascinating book
(00:50):
called "The Brain That ChangesItself by Norman Doidge.
I didn't get a chance to finishit then, but it was always in
the back of my mind to finish itsomeday.
Well, I finally did, and it wasworth the wait.
It's basically a book onneurology and learning.
You might be thinking that'sthe last way you want to spend
your free time, but it's so wellwritten for the everyday person
and so filled with stories inhope and recovery that I found
(01:11):
it a really great read.
That also has big clinicalimplications for anyone who
wants to teach a learner how tolearn.
This episode is called ThreeTherapy Takeaways from "The
Brain That Changes Itself byNorman Doidge.
One of the problems we run intoas SLPs is trying to get
learners to the place where theycan learn, where they can
actually take in what we'reoffering.
(01:33):
With some clients, I feel it'sas though what we're trying to
teach just runs off and away,and until we can find the cracks
through which information canpenetrate, we don't get very far
.
And another problem we have isovercoming speech and language
habits so ingrained that theyseem set in stone.
Doidge writes about both ofthese issues with ideas on how
to overcome them.
Here's what we're coveringtoday; The basic premise of "The
(01:56):
Brain That Changes Itself" book, three takeaways on the laws of
learning, and clinicalapplications.
If you structure your therapyaround the laws of learning, it
will make you a better therapist.
The overarching idea of "TheBrain It Changes Itself is that
the brain is plastic, far moreplastic than many scientists
used to think.
Not just in infancy andchildhood, but the plasticity
(02:19):
can be tapped into in old age.
Now there's a neuroscientistcalled Michael Merzenich who led
the cochlear implant team atUCSF, and he's done a lot of
work on brain plasticity.
He claims that when learningoccurs in a way consistent with
the laws that govern brainplasticity, the mental machinery
of the brain can be improved sothat we learn and proceed with
(02:40):
greater precision, speed andretention.
What are these laws that governbrain plasticity?
Well, there isn't time to coverthe entire book, but the three
takeaways I want to talk abouttoday are; using roadblocks to
help the brain form new maps,two, the fact that the brain
needs clear signals, and three,focused attention is critical to
forming new brain maps.
(03:01):
Okay, so what does it mean touse a roadblock so the brain can
learn or relearn?
There's this analogy in the bookthat I love.
If you're sledding down a hilland you make that first pathway
in the snow and you use thatpathway again and then again,
pretty soon that's going to bethe only way your sled is going
to want to naturally go, andthat slope is going to get
(03:23):
pretty slippery and pretty fastand you would have to really do
something different to make yoursled go a different way.
It would take some effort, itwould take a new approach, it
would take blocking the old pathto get your brain to take a new
path, and so the whole idea ofthis book, of this roadblocks,
is when someone has someneurological damage or if
they're born with someneurological impairment, the
(03:45):
brain develops these pathwaysthat are not desirable because
they impair them in some way,and if you put a roadblock in
the blocks the old pathway youcan teach them a new pathway.
It's a really cool idea, andthere's really great research in
the book about ways theyexperimented and proved this.
Now, putting up roadblocks sothe brain can take a new path
and strengthening the weakestfunctions are two sides of the
(04:07):
same coin.
One example of using both ofthese ideas the roadblocks and
strengthening the weakestfunction is what they call
constraint induced therapy, andone way this has been used is
when stroke patients are leftwith paralysis, they're not
allowed to use their strongerhand.
They have to use the impairedhand over and over and over
again for increasingly complextasks, and in studies done with
(04:30):
this constraint induced therapy,they have had astonishing
success at rehabilitating theweaker side, because the brains
were able to make or reconnectnew maps when the weak part was
exercised.
And in the clinic where theystudy this, they use mitts and
they use slings on the strongerlimb, and that was their
roadblock, so that the patienthad to use the weaker side.
(04:50):
And because the stronger limbwas constrained, the brain
couldn't default to the oldpathway, it had to make a new
pathway.
And Doidge writes what rewirespatients' brains is not mitts
and slings, of course.
The essence of the cure is theincremental training or shaping,
increasing difficulty over time.
Mass practice helps rewirebrains by triggering plastic
(05:12):
change.
Now, as speech therapists werereally really familiar with that
shaping and increasingdifficulty over time when taking
small steps.
Now here's a study that's alittle bit more relevant to our
field, using constraint inducedtherapy.
They used it with some patientswho had aphasia and the
constraints weren't physical,but they were a series of
language rules which theyintroduced slowly, and the way
(05:34):
it works is they play a game alittle like adult go fish.
These patients have to askother patients for a matching
card and at first the only ruleis that they not point to the
card, and that is so that theydon't reinforce learned non-use.
So they have learned to not usetheir speech and they don't
want to reinforce that.
The y can use any kind ofcircumlocution they want any
(05:54):
kind of language as long as theyare talking.
And then from that point theymove on to naming an object,
correctly, and then they add theperson's name that they're
asking the card for, and so onand so on, until they gradually
add more and more language.
And this constraint inducedaphasia therapy was used with
patients who were, on average,eight years post stroke.
With the control group they usewhat they call conventional
(06:17):
therapy.
And they said that was justrepeating words, and I
understand that's not the bestconventional therapy treatment,
but leaving that control grouptherapy technique aside, what
happened with the constraintinduced treatment was they did
have great results.
After 32 hours of treatment,which took place over 10 days,
they had a 30% increase incommunication.
And so, considering how manyyears post stroke these patients
(06:41):
were, I find that remarkable.
I can see using this withclients who struggle with word
retrieval and moving throughdifferent levels, starting with
naming, then adding a descriptor, then using a basic noun, verb
phrase and adding maybe apreposition or a direct object.
I can imagine a shoppingactivity where you built a
shopping list and take yourbasket to the store and it could
(07:01):
go something like this.
So suppose you've got grapes,and so, you're just practicing
grapes and then purple grapes.
Then let's get purple grapes.
Put the purple grapes in thebasket, and the constraint
induced therapy could bereplacing pointing with words.
And then you add in the shaping, and small incremental shaping
to increase the difficulty, andthis would not happen all in one
(07:23):
session, of course.
A way to ramp this up is topractice naming, just naming by
itself, like five to sevenobjects in a row.
Now I use pictures and then adda descriptor.
I let them come up with thedescriptors if they can, and
after they don't struggle withthe descriptor and the noun, you
can start adding words to thephrase.
So I might do it like this - Imight have an apple and a banana
(07:44):
and a pineapple, and I'll gored apple, yellow banana, sweet
pineapple.
Something like that.
But first we would justpractice apple, banana,
pineapple.
Until it was easy for them toname, they weren't struggling
with retrieving those threewords, and then we would add the
descriptors.
And then it's not so hard tosay hey, let's buy a banana, and
we slap that banana on ourshopping list and oh, let's get
(08:08):
some purple grapes.
Mmmm, sweet pineapple, let'sget sweet pineapple.
And once you have your shoppinglist built, then you go
shopping in your therapy room.
And, by the way, you can getfood and animal pictures from my
picnic fun activity availableon my store at thespeechumbrella
.
com.
And then, after you go shopping, you can go on a picnic with
your stuffed animals.
(08:28):
That's where the animalpictures come in.
Okay, moving on to the next lawof brain plasticity, clear
signals.
A person's memory can only beas clear as the original signal,
but research suggests a lot ofour clients aren't receiving
clearer speech signals, eventhough they have no problems
with conductive hearing.
The research I'm about todescribe here might be somewhat
(08:50):
controversial in our fieldbecause it suggests that nearly
all speech and language impairedchildren have auditory
processing struggles.
Now, if all, or nearly all ofour clients struggle with
receiving clear speech signals,then should we have a separate
diagnostic category calledauditory processing disorder?
I don't want to go too deeplyinto that question today.
I have a whole podcast on it.
(09:11):
That's Episode 44 called 'ThatThing That Isn't APD.
' But I don't want to ignore theelephant in the room.
I prefer to look at a child'ssymptoms, treat the symptoms and
don't worry about the label somuch.
So, if you can determine thatthey're struggling with auditory
processing, then treat it.
Here's a summary of theresearch Doidge writes about.
Paula Tallal found that languageimpaired children had auditory
(09:34):
processing problems withconsonant - vowel combos that
are spoken quickly, and shecalled these the fast parts of
speech and that they had troublehearing them accurately and
reproducing them accurately.
And has a theory about the fastparts of speech, which is that
the auditory cortex neurons werefiring too slowly, and this
meant that; one, they couldn'tdistinguish between similar
(09:57):
sounds or be certain if twosounds occurred close together,
and two, they didn't know whatorder they came in, and three,
they didn't hear the beginningof syllables or sound changes
within syllables.
Now I just have to put a plugin for "Equipped for reading
success" by David Kilpatrick.
I've been using his program fora couple years and this is
exactly what I see.
(10:17):
The more severe the speech andor language issue is, the harder
it is for those kids to hearthe beginning of syllables,
especially internal syllables.
I mean, this is a huge strugglefor some of my clients, but this
is the cool thing.
When they do start to hear thesyllables and they can analyze
these words by removingsyllables or changing syllables,
then I have come to expect asignificant change in their
(10:40):
language ability.
It just happens every singletime.
Every single time they figureout the syllable analysis part
of this program, they make ahuge leap.
Now back to the research,because, yes, there is more.
After processing a sound,normally our neurons are ready
to fire after a 30 millisecondrest, but 80% of
language-impaired children tookat least three times longer and
(11:03):
because of this they lose largeamounts of information, and also
the signals aren't clear.
It's what Merzenich called muddyin, muddy out.
And this weakness in hearingled to weakness in all language
tasks (11:15):
vocabulary, comprehension , speech, reading and writing.
I mean, that's what we see inour field, right?
We see that all the time.
Also, these children usedshorter sentences and didn't
exercise their memory for longersentences.
And now that I'm starting topay attention, I see this muddy
in, muddy out all the time,especially in clients who don't
really have an articulationdisorder.
(11:35):
What they have is a languagedisorder disguised as an
articulation disorder, becausewhile they have the motor
ability to say the words, theydon't remember how to say them.
It comes out sounding a littlebit muddy and mushy and we think
it's a speech disorder.
So what I do when this happens- I pull out my phonological
awareness tracking tool, I useit to find out where they need
to start and then away we go.
(11:56):
This tracking tool has been alife changer for me as a
clinician, and you can also getthe phonological awareness
tracking tool onthespeechumbrella.
com.
The third law a brain plasticityI'm covering is focus.
I'm all about focus.
That's why this podcast used tobe called the Mindful SLP.
I love, love, love talkingabout focus.
Doidge writes, lasting changesoccur only with close attention,
(12:20):
while you can learn when youdivide your attention.
Divided attention doesn't leadto abiding change in your brain
map.
Isn't that what we see whenkids don't carry over, when they
don't generalize, it's notabiding change.
Focused attention is thecondition for plastic change.
Anything that requires highlyfocused attention will help that
system.
Are you fans of whole bodylistening?
(12:40):
I am, and this is why I love it.
I see real lasting changes whenmy clients are paying attention
with everything they have.
This can take some time toteach, but I tell you it's worth
every therapy minute you spendon it.
If you want lasting change, ifyou want carryover, focused
attention is a must.
Here's another interestingtidbit.
Evidence suggests thatunlearning existing memories is
(13:03):
necessary to make room for newmemories in our networks.
In articulation therapy I play agame which seems to help
clients both learn a new pathand unlearn an old path at the
same time.
It's really helpful withphonemes that can be distorted,
such as R, but you can really doit with any sound.
I call it Mind Your R's in myImpossible R Made Possible
(13:23):
course, which you can find atthespeechumbrella.
com/ R- course.
This is how the game works.
I have three boxes with a one,two, three in each box and I
have mini M&Ms, because thatmakes it fun.
For a client to play this gamethey do need to be able to say a
word, even if it's just oneword, correctly.
And so what you're going to do,is you're going to take a word
(13:45):
like robot.
Say we're working on the Rsound robot, but they're not
really consistent with saying itcorrectly, and so it comes out
'wobot", but sometimes, or maybetheir error is "raobot", where
they kind of have R but theydon't quite have it.
Or maybe they're distorting itby trying too hard "R robot,
kind of like that.
It can work with any of these,but what you're going to do is
(14:07):
you're going to make sure thatthey can say it right.
You say, okay, now let's sayrobot.
How are you going to say it theright way?
" And they'll say "Robot andthen you say, how are you going
to say it the wrong way?
And they might go, really oftengo, "Lulululobt" I mean, really
they'll do that because theywant to make sure they're wrong
and they just make it silly.
I'm like, "no, no, that's nothow you say it wrong when you
(14:27):
make a mistake.
" And I'll mull it for them,this is how you sound when you
don't quite get it.
And we'll practice it, we'llpractice their wrong way, the
way they actually say it wrongwhen they're not paying
attention.
Okay, and then the way the gamegoes is they have to say it
right twice and wrong once.
I've got three boxes.
We've got an M&M in each box,and I'm the listener and I
(14:49):
determine which one is the wrongone.
And I get to eat that M&M.
And they are so surprised whenI choose their wrong one
sometimes, because often the onethey think is wrong is the one
that sounds the best, and it'sjust really weird.
It's really freaky.
And we take turns with this, soI am also the speaker and
they're the listener.
And they can always determinemy wrong one, always.
(15:10):
So it's not so much a muddy inmuddy out with listening to me,
it's a muddy in, muddy outlistening to themselves.
This game is awesome and I'llalso use recording a lot,
because they'll argue with meabout which one they said wrong.
But when they can hearthemselves, when they play it
back and have times like, ohyeah, okay.
Fidelity to the process isreally critical for this to work
(15:31):
and this is gonna take somework with your hard clients.
They must say it right twotimes and wrong once.
Whatever rules you set up, theyhave to do that or they won't
be clear.
They won't be clear about whatthey're doing and that auditory
signal will be muddy.
I'm often set on this podcastthat neurons that fire together
wire together, but it turns outthat neurons that fire apart
(15:52):
wire apart too.
We can weaken links and help theunlearning process.
For example, compulsivepractice of a sound the wrong
way, and that's what Mind Your R, or any sound you're working
on, that's why that game works,cause you're helping them
unlearn the proce ss and you'rehelping weaken those links that
have been forged.
It interrupts the compulsiverepeating of a phoneme the wrong
(16:13):
way and really focuses theirattention to the differences
between the right and wrong way.
As neurons are trained andbecome more efficiently process
faster.
This means the speed at whichwe think is plastic, because it
can be changed, and as thesechanges start to occur and
automaticity starts to happen,they learn to do the new skill
easily and effortlessly.
(16:33):
I hope I convinced you to pickup "The Brain That Changes
Itself" by Norman Doidge.
Before I go, here's a quickrecap of the rules that govern
brain plasticity.
A roadblock of some kind isnecessary to help us change
direction and form a new brainmap.
Faster neurons give clearerauditory signals, and a memory
can only be as clear as itsoriginal signal.
(16:55):
When working on persistentarticulation errors that are not
motor based, first teach themto say it once, and only once,
and pay attention, and they willlearn to generalize that sound.
Implement the rules of brainplasticity and complex learning
will take care of itself.
(17:16):
Thank you for joining me underthe speech umbrella today.
I hope you learned something tohelp you in your therapy.
If you did, please share thispodcast with a fellow speech
therapist and leave a five starreview on Apple Tunes, Spotify
or wherever you get yoursubscriptions.
While you are online, come onover to TheS peechU mbrella.
com where you will findtranscripts, links, and my free
resource library.
(17:36):
I also have some other valuablecourses and therapy aids in my
store.
That's all at TheSpeechUmbrella.
com.
Let's connect on social media.
I'm dstratton SLP on Instagramand The Speech Umbrella on
Facebook and YouTube.
You can also find me on TPT.
I hope to talk to you soon.
Bye.
Announcer (17:57):
Thanks for listening to The Speech Umbrella.
We invite you to sign up forthe free resource library at
TheSpeechUmbrella.
com.
You'll get access to some ofDenise's best tracking tools,
mindfulness activities, andother great resources to take
your therapy to the next level.
All this is for free atTheSpeechUmbrella.
com.
If you've enjoyed this podcast,subscribe and please leave us a
(18:20):
review on Apple Podcasts andother podcast directories.
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