Saturday, June 13, 2015

A Bisl: Speech Therapy for Aphasia

Mark A. Ittleman
The Teaching of Talking
Saturday, June 6, 2015

Malka and I are in London to teach others The Teaching of Talking Method.  Yesterday we met with one of the gentlemen who helped make this trip possible.

His brother had a stroke and had great difficulty finding a speech language pathologist who spoke Yiddish.  It is a language that is combination of German and Hebrew.  In todays culture, only the very ultra-religious speak it as their native language.  Therefore there are two challenges for me as a speech language pathologist.  Learning and utilizing this language to help others.

My new friend in London bought the Teaching of Talking book over a year ago and knows the book almost almost verbatim.  He poured over every page and has a good grasp of the information, except two areas.  Do you know what they are?

The number of words to use when stimulating language. He is now helping other families and persons with aphasia and making good progress.  We discussed them one by one.  He is stimulating longer sentences and could probably get faster leanring if the phrases or utterances were simplified to an initial 2 word level.

The other critical factor as I see it, is the necessity to use a voice that is full, loud and clear.  When one gives a model that is full, loud and clear, it not only sends the message of the verbage to use, but also provides the individual sounds that make up each word.  When words are presented loudly and clearly with the sounds of each word clearly modeled, it is so much easier for those with aphasia to imitate and say accuracy.  A strong speech modeled voice also gives ENERGY.

I was speaking with some people today who equated a loud, powerful speech model as a way to "wake up the dead."  Or as a way to wake up the sleeping spirit of the individual who has been prevented from speaking, which for many of us is one of the major reasons for living.

For we all know that many with aphasia enter into somewhat of a stupor, a state of mind that often has diminished stimulation since many people at home do not know what to do to help their loved one speak.

Since those with aphasia are frequently frustrated or angry, it is often because it is like the person with aphasia is lost is the woods and there does not seem to be a way out.  The anger is often related to the frustration of not being able to speak and do everyday tasks that were always so easy to do before.  The anger is often the result in the loss of those abilities and the pain associated with the stroke and those losses.

Many with aphasia are locked into a verbal solitude where they do not know how to express the thoughts they always were able to say.  A powerful speech model is like a bugle, at revelee.  The bugle wakes up the troops like a strong speech model for those with aphsia.  That speech model is loud and clear, and awkens the spirit, so that tasks of imitation or mimicing are easier and provide for more successful talking with stimulation.

It is my belief and experience that starting out in a progression of speaking difficulty from simple to more complex is best.  Think about it.  When a child first learns to walk they first attempt to ambulate forward, and boom, they fall down!  Later they get up and the sepuence goes from one step to two, and then more as the child becomes more confident and adept with these fine motor movements.

When speech is first learned the child attempts to speak with grunts and various vocal and emotional commands for what they want.  Later they begin to learn how to say yes, no, more, and words for the names of wanted items and people:  Momma, Daddy, etc.  The progression in the development of speech and language follows a known sequence of difficulty from the single words on up.

So why shouldn't  language stimulation  follow the same  progression?

It does!

Let's  look at riding a bike.  Same principle.  Most kids have to get on a bike and go a short way and fall before they master bike riding.  We learn how to tie our shoes, put on lipstick, and catch-throw balls in a similar manner.  A slow progression of steps that must, in most cases, follow a sequence from basic or simple to more advanced.

Many new therapists and caregivers believe that since a person with aphasia once had the ability to speak, they should immediately be able to say and repeat words, phrases and sentences.  They soon find out the frustration when they learn the people with speaking difficulties can not imitate longer utterances or soon forget how to say the word or phrase soon after stimulation.

How is it they were just shown how to say words and phrases like good morning Gut Morgn! and a moment later it is no longer there!  Often those with speaking difficulties are told to repeat phrases and sentences like thank you a dank, see you later, Zay gezu’nt, or I love you, Ikh hob dikh lieb or the names of the children and sadly they are later unable to recall the name, phrase or sentence with accuracy.

Many do not understand that whenever a behavior, including speech is not forthcoming with repetition, it  must be simplified, or chunked down to a more basic level, not necessarily told they aren’t paying attention or that they need alternate ways to communicate.

So the object of  my discussion yesterday was  a Bisl; A  little.  When you are  having difficulty teaching a word, phrase or  sentence,  remember to simplify it down to where the person with the speaking difficulty can tolerate it;  like the baby who is learning to  eat table food.  You do not give it a chunk of Rib Eye steak at first.  You give it something easy to chew, swallow and digest.

Bottom line.  Start easy.  Simple short questions, that stimulate simple short answers.  A Bisl.   That's also how I'm learning to understand and speak a new language!  Gutn tog!  (Have a good day!)

For more information about the Teaching of Talking and The Teaching of Talking Video Training Course for caregivers and therapists click here.

Moshe Mark
Mark A. Ittleman, M.S., CCC/SLP
Senior Speech Langauge Pathologist
Author:  Teaching of Talking
Creator:  Teaching of Talking Training Course

Mark Ittleman, M.S., CCC/SLP  is a senior speech language pathologist who has been helping people speak with clarity for over 40 years. He has spent years in direct one on one speech therapy with those with brain injury, aphasia and children who have not developed speech and language normally. He has worked in nationally renowned rehabilitation hospitals and has developed specialized programs for those who lost their speech due to aphasia. Those programs involve training family members, caregivers and speech language pathologists who are looking for new and vibrant approaches to help others  improve speaking.  

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