Saturday, May 16, 2015

Do Speech Therapy for Aphasia or Dysarthria at Home

Mark A. Ittleman
Teaching of Talking
January 10, 2015

And then I watched her perform the speech and language stimulation and it looked like I was doing it, and noticing she had a certain confidence and was doing quite well! Then I realized it wasn’t me, it was the person I mentored.” -Ittleman 2005-

The other day I was working with a caregiver whose son had been in a motor vehicle accident. He was left with an apraxia, dysarthria, and an expressive aphasia. For the layperson or student, he had difficulty articulating accurately, even with intensive articulation stimulation. The words he was having difficulty with had to be broken down into individual syllables, and articulator placement stimulation had to be done before the actual attempt at speaking.

When I was a speech pathology student it was always a cardinal rule that placement of the articulators was a prerequisite prior to verbal production of the target sound or the phoneme. Correct articulation of a sound is often rather simple to stimulate with many clients if they have a good “eye” and “ear,” but with this young man the speech model a.k.a. therapist had to break a complex word down into syllables and assure the sounds within those syllables were said accurately.   Even though this young adult had a moderate to severe apraxia, he was stimulable to produce words accurately if the correct principles of articulation therapy were followed.

But that’s not the point of this article. This young man also had a severe expressive aphasia and receptive language component. That means he had severe trouble finding the words he wanted to express in addition to severe difficulty comprehending spoken language when it was directed to him in rapid succession; typical of the way normal speakers communicate with machine gun-like speech rate.

So what is the approach to speech and language stimulation for this person whose speech was almost completely unintelligible (apraxia), who couldn’t comprehend normal spoken language (receptive aphasia), and who had lost the ability to string simple word pairs or phrases-sentences together? (aphasia)
  1. Stimulate only single 1 or 2 syllable words (eat, drink, play, sing, go, talk) or 2 word phrases of single syllable words (drink milk, play guitar, play chess etc.) in response to very short questions.
  2. Cue speech with intensive mirroring (as outlined in The Teaching of Talking text) with very slow, over-articulated model, face to face within 3’. Speech model and the person with the communication difficulty moving their articulators in unison. (like dancing a waltz, slow dance, fox trot, or 2-step)
  3. Cue speech visually and auditorally with written-printed cues if necessary, and facial prompts by having him watch and mirror correct movement of the articulators and production of words. The speech model prolongs the vowels of each syllable in words in order to have the client see and hear each syllable, while maintaining 2-3 syllable expressive utterances.   (The client has an immediate memory for only 1-3 words.) Therefore questions posed were only in 2-3 word strings by the speech model/therapist since that was the length he could comprehend.  
  4. To deal with the dysarthria he was given models of 1-3 words with latency of about 1 second between words. This also gave him time to process and decode what was said. Many beginning clinicians and caregivers do not realize that often people who have symptoms like this need a considerable amount of time to decode or comprehend, therefore necessitating spoon-feeding language in small, bite-sized units. In this way language can be digested and realized.                  
(Here I go, off on a tangent that was not the intention of this treatise. So what’s the point?)

The point is that students, inexperienced therapists or caregivers can learn to do speech and language stimulation like an expert if they have an expert to model. An expert who can demonstrate a procedure and then immediately have the “student” do it. Speech and language stimulation can be like a round robin. The expert or therapist models the procedure that gets successful recognition, comprehension, and imitation and then immediately gives the same task to the student or caregiver. This is then repeated for each utterance stimulated in the session: therapist—>client for the first successful trial followed by caregiver–>client until trial is accomplished successfully in a similar manner.

It is amazing for the Master to see a student or caregiver after training, do speech and language stimulation with confidence, efficiency and accuracy.   He is also impressed that the complex tasks that took him so much time to acquire are easily learned by working with both the caregiver or student and the client simultaneously; Therefore the process teaches the therapist or caregiver, while improving the speaking of the client.

It’s eerie and quite impressive to watch the student therapist or caregiver and client learn the Teaching of Talking procedures and then do them automatically, while the Master then sits back and lets them do it! That’s what Masters do during training until it ends and the Master’s services are no longer indispensable, or required. New disciples emerge and then they do the work at home with their loved ones, or go on to teach others in the schools, clinics, hospitals or wherever people who have difficulty speaking are receiving therapy.

It is then time for the Master to train new therapists or caregivers, and the sequence of events is repeated. Such is the order of the universe!

Moshe Mark Ittleman is a senior speech language pathologist who has specialized in complex speech language pathology and has provided speech and language therapy to clients and patients for over 40 years. He is the author of The Teaching of Talking Learn to do Expert Speech and Language Stimulation at Home with Children and Adults, Morgan James Publishing, and is now completing a video subscription that walks the therapist or caregiver through the steps of speech and language stimulation for those who have not developed speech normally or for those who have lost the ability to speak due to neurological disease or insult. He is a guest lecturer and seminar leader who trains therapists and caregivers in group seminars and individualized one on one mentoring.

Moshe Mark Ittleman is also completing a new book entitled: The Teaching of Talking: An approach to speaking clarity for those with Dysarthria. He travels throughout the United States and beyond to bring a new message to therapists and caregivers. That message is quite simple. Caregivers, family members, and therapists can be trained in expert speech and language stimulation methods that often will become a lifetime endeavor for professionals and caregivers alike. You may contact us by e-mail: or through the Teaching of Talking website at

As a special New Years gift to subscribers I am offering a Mentoring consultation at no charge to those who purchase the Teaching of Talking Book at our website.


Moshe Mark Ittleman, M.S., CCC/SLP
Speech Language Pathologist-Author

Video Training Website:
Teaching of Talking Book:
Teaching of Talking Audio:

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