TO FORM A FLUENT SPEECH
Elena A. D'yakova
Doctor of Logopedia, Associate Professor Moscow Pedagogical University
Presently in Russia a complex approach is used to overcome stuttering. This approach is based on a system of strictly differentiated but coordinated work of different specialists: speech therapist, psychologist, physicians of different profiles, logorithmist, educator (for children), specialist of physical activity and some other specialists.
The complex approach concerns three basic issues:
The first issue is forming the habit of the stable fluent speech. It is carried out mainly by speech therapist. It involves the using of number of special techniques, mainly during the speech training lessons or logorithmic lessons.
The second issue is the upbringing of personality of the stutterer. It is mainly carried out by psychotherapist, and also by psychologist, in the course of psychotherapy, psychological training and functional training. The aim is to form the social activity of the stutterer while changing his attitude to himself as a personality and as a partner in communication as well as changing his attitude to his speech defect.
The third issue is the prevention of relapses of stuttering. It requires the general medical and health-sustaining work and the maintenance of stable fluent speech by the repeated courses of rehabilitation.
The aim of this paper is the description of the seven basic techniques used by author to form the fluent speech of stutterers.
1. SPARING SPEECH REGIME
As a rule, speech therapy begins with using so-called " sparing speech regime". This regime is directed to normalization of central nervous system and to the suppression of pathological speech stereotypes (e.g. pathological spasms of speech muscles). It includes general health-supporting measures and "speech limiting regime" or "mute regime" and helps general improvement of health. The stutterers are protected from all physical and psychical overloads. All strong and new impressions are excluded. We also try to limit the verbal production of stutterers. Concerning children, only very simple forms of speech not leading to stuttering are used: whisper, one-word questions and answers, speech conjugated with adult speech. Teenagers and adults during these regimes may practice total silence, using non-verbal means of communication (gesticulation, facial expression etc.). The different games to develop nonverbal means of communications are used. This period may have different duration according to the system of rehabilitation: from 2-3 days to 2-3 weeks. For the adult stutterers during "mute" regime intensive psychoterapy directed to the emotional restructuring and changing of the stutterer's attitude to communication is carried out.
2. REGULATION OF EMOTIONAL STATE
The basic method of regulation of the stutterer's emotional state is the method, based on arbitrary changing of muscle tension, i.e.autogenes training (AT), created by J.H. Schultz . The foundation of AT is muscule relaxation and arbitrary regulation of vegetative functions of nervous system. We use the specialized variants of AT for stutterers. As a rule the method of conducting AT essentially depends on stutterer's age. Children of a preschool age are taught only the basics of muscle relaxation; to teenagers and adults the foil course of AT is recommended. It includes the general relaxation of muscles, relaxation of speech muscles, regulation and deepening of breath etc.AT aiso includes imagining of difficult speech situations (a telephon call, a talk with boss etc.) and auto-suggestion (auto-hypnosis) of the possibility of fluent speech. At the background of AT the active speech correcting work is carried on. As a result, the bilateral connection based on reflexes, between the emotional state of relaxftion and fluent speech, is created. The habits of relaxation and fluent speech, acquired in the process of AT, are fixed by special functional training in the process of real communication.
We also use manual relaxating massage of muscles, connected with articulatory, vocal and breathing apparatuses, and massage of biological active points.
2-A. AUTOGENES TRAINING:
- muscle relaxation,
- imagining of difficult speech situations,
- auto-suggestion of the possibility of fluent speech - and training of fluent speech.
2-B. RELAXATING MASSAGE of speech muscles and biological active points.
3. FORMING OF THE CORRECT SPEECH
This includes the following stages.
1. Widening the physiological possibilities of breath apparatus, i.e. training of the diaphragmal breath. Forming of the diaphragmal breath starts when stutterer is in horizontal position, e.g. during muscle relaxation: in this position diaphragmal breath appears involuntarily. Then the training is carried in the vertical position, in sitting position and during physical exercises. Here Strelnikova's paradoxical gymnastics are effective.
2. Forming the prolonged phonic expiration. Training begins with prolonged pronouncing of vowels. This teaches the stutterers to accurately distribute the expiring air, to regulate consciously the duration of expiration. This is the first step to the forming of speech breath. Forming the prolonged phonic expiration is the basis of the development of coordinated the exalation, voice and articulation.
3. Forming of speech breathing. The exercises include specially selected syllables, words and phrases. This work is directed to the creation of coordination between breath, voice and articulation. The work on breath - forming has to be systematic and prolonged.
3-B. TRAINING OF DIAPHRAGMATIC BREATHING: STRELNIKOVA'S PARADOXICAL GYMNASTICS.
3-C. FORMATION OF SPEECH BREATHING.
4. FORMING OF RATIONAL HABITS OF VOICE - ATTACK AND VOICE-SUSTAINING
This technique is directed to the taking off local tensions in the voice apparatus and disphonic disorders and to the forming of coalescent or noninterrupted articulation.
The stutterers are taught the rational form of voice - attack, i.e. how to start "softly" using the voice. They are taught also how to use the low-breast resonator - at first in vowels and then in speech. As a result, the tension from the vocal cords is taken off, the voice becomes sonorous and resonant, rich in obertones. These exercises, combined with diaphragmatic breathing, helps to "fix" and support the voice and to liquidate tension of voice muscles. Training begins from the pronunciation of vowels, their combinations and of words, beginning with vowels.
Then the stutterers are taught the voice - bringing i. e. how to pronounce the long row of vowels in a noninterupted manner, incessantly articulating and using one expiration. This habit is further transferred into the noninterupted pronunciation of syntagma.
5. DEVELOPMENT OF PROSODIC QUALITY OF SPEECH
The stutterers learn to express different kinds of intonations. In the beginning they use only gesticulation and facial expressions, then add voice, using a gradually prolonging row of vowels. The vowels are pronounced with different modulations (soft-loud, lower-higher, imitating the intonations of question, exclamation etc.). Vocal exercises are accompanied by smooth movements of leading hand: this helps stutterers to better control the changes of voice. The different exclamations (of joy, grief ets.) are also used Then this training is transferred into words, and phrases. The next step is to teach stutterers how to divide the text into the rhythmical - intonatational groups . This division leads to forming of articulatory - breathing cycles (according to the syntagmatic division of text).
5-B, DEVELOPMENT OF PROSODIC QUALITY OF SPEECH: teach to speak with intonations.
6. DEVELOPMENT OF COORDINATION AND RHYTHMIZATION OF MOVEMENTS
This logopedic technique is devoted to the normalization of motoric functions of stutterers. It includes: l) The development of coordination and exactness in the movements of hands and legs, of fingers and articulatory movements; 2) The development of the tempo-rhythmic sense, while performing speech and non-speech movements. These movement exercises are combined with speech and musical accompaniment. Rhythmization of movements reflects positively on the rhythm of speech.
One of the important methods is working out of rhythmic speech articulations in combination with additional stimulation (by movements of hand). It is well known that rhythmization of movement changes biorithmical activity of brain, which, in its turn, positively influences the synchronizing activity of speech apparatus. Especially effective to the creation of the habit of fluent speech is to use rhythmic movements of the leading hand or fingers in combination with rhythmic pronunciation of syllables or words. Rhythmization of speech may be intensified by using acoustical and/or visual stimulation. Velocity and tempo of speech articulations have to be chosen for each stutterer individually and bring the sense of comfort.
7. DEVELOPMENT OF INTRASPEECH PLANNING
The work connected with the development of the planning function of speech, is also included in the correctional process. Such work begins with teaching the stutterers to say phrases mutely (in a silent manner, without a voice). This "inner speech" gives to the stutterers the possibility to choose the strategy of utterance, the necessary words and grammatical constructions, before they use the loud speech. They are taught not only to "hold the pauses" in sintagmatically correct places, but also at this moment actively formulate the next part of utterance.
The exercises with gradually complicating language material are used here. These are conjugated speech (i.e a speech, articulated together with speech-therapist ), reflected speech (i.e. repetition of phrases, articulated by speech-therapist); answers to the questions, connected with some pictures, descriptions of some pictures or subjects, related to some situation. The final stage is spontaneous and monologues speech of stutterer in situation of a game, and further - in the situation of a real communication.
Correcting the speech of a stutterer we take into account the logic of speech development in onthogenesis, i.e. the development of the speech from situative to contextual. Accordingly the "accompanying speech", when the stutterers describe their action in this very moment (first step) is used. Then follows "speech after the action", when the stutterers describes some action done by him (second step). In conclusion follows the "planning speech", when the stutterer describes his actions in future (third step).
7.B. DEVELOPMENT OF INTRASPEECH PLANNING: step by step complication of speech.
7.C. DEVELOPMENT OF INTRASPEECH PLANNING: different connections between speech and action.
All the enumerated logopedic techniques have one aim: to work out a fluent speech. These techniques are taught almost simultaneously, they are directed to the coordination and unifying of psycho - physiological parameters, which constitute oral speech.
In such a way, dynamics of the teaching of fluent speech consist not in a successive application of this or that technique but in a gradual complication of speech exercises: from pronouncing of isolated sounds to the context speech.
All the techniques, described above, are used in rehabilitation course with stutterers in different combinations. It is evident that there can't be one system of application of logopedic techniques with predomination of this or that techniques and the succession of their application, recommended to all stutterers. But in all cases the work with all stutterers as a rule begins with practice of sparing or mild regime, and ends with the development of the planning function of speech.
The volume of work with each technique and methodic depends on the age of a stutterer and clinical form of stuttering. We adhere to the concept of stuttering as of a systematic psycho- neurological disorder is spread. In accordance with clinical symptoms of this disorder two main forms are distinguished: neurotical and pseudo- neurotical [Beliakova, L.I.& D'yakova, E.A., 1998.]. This determines the clinical content of pathology, character of fluency disturbances, the level of speech development of the children, psycholinguistic characteristics of speech, possibility of communication, the peculiarities of personality and the specification of correctional work.
The up- to- date ideas about functional system of speech permit to select the main link of pathogenetic mechanisms, which lead to stuttering. For neurotical form of stuttering this link structurally and functionally is connected with mechanisms of emotions.
For pseudo- neurotical form of stuttering the main link is connected with disturbances of basic mechanisms of speech function formation, as a result of some organic defect in central nervous system. This concept concerning two different forms of stuttering, determines the direction, character and efficiency of each of the proposed above rehabilitation measures.
Stutterers with neurotical form of stuttering quickly master the above techniques. Switching attention on intonation essentially improves the fluency of their speech. One of the most effective techniques with neurotical stutterers is regulation of the emotional state of patients. But automatic use of new habits of speech demands from the stutterers long training and strict succession of exercises. In the opposite case the good result may quickly disappear.
When the stuttering is pseudo- neurotic, the habits of fluent speech are mastered also with difficulty. In the process of exercises it is necessary not only to explain but to show many times how to do them, using different kinds of control (acoustical, kinestethic- by hand, visual, using of computer program "Visual speech" etc.), especially when training the speech rhythms. The working out of the new speech stereotypes has to be systematic and long. As for pseudo-neurotic stutterers the most important is the development of the planning function of speech.
In such a way, we are sure that a complex approach including seven logopedic techniques, should be used in the therapy of stattering - children adolescents and adults.
Arutyunian, L.Z.,(1993). How to treat stuttering. Moscow:Aribus Publ.
Beliakova, L. I., D'yakova, E.A., (1998). Logopedia. Stattering. Moscow: Sekachov Publ.
Beliakova, L. I., D'yakova, E.A., Main trends in the rehabilitation of stutterers in Russia.(2000). Fluency disorders: theory, research, treatment and self-help. Proceedings of the Third World Congress of Fluency Disorders in Nyborg, Denmark.
Beliakova, L. I., D'yakova, E.A., (2001). Logopedia. Stattering. Moscow: Sekachov-Acsmo-press Publ.
D'yakova, E.A., Comparative analysis of number, duration and localization of pauses for stutterers and people with normal speech. (1994), 1 ORLD Congress On Fluency Disorders. Proceedings, vol.11, Germany. Ed.by С W. Starkweather Temple University and Birch Three Foundation.
Vlasova, N. A., (1983) Complex therapy of stuttering among preschool children. In Vlasova, N. A., Becker K.-P. (Eds.), Stuttering .Moscow: Medicine Publ., 106-116
Nekrasova Yu.B., (1975). Complex method of therapy of stuttering among adults. In S.S.Lyapidevsky &S.N.Shachovskaya (Eds.), Disturbances speech and voice of children., Moscow: MSPI Publ, 118-132.
Shklovsky V.M., (1994). Stuttering.Moscow: ICE Publ.
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