Looking for a way to remediate speech disorders more quickly? Here is an honest review of a new speech remediation technique by an SLP.
This blog was written by guest blogger Pat Mervine, M.A., CCC-SLP. Pat is a speech/language pathologist and assistive technology consultant who has worked for twenty years with students who have significant disabilities. She is the creator of the popular websites, www.speakingofspeech.com and www.patmervine.com, and her blog, www.speakingofspeech.blog.com. She is the author of the illustrated children's book, "How Katie Got a Voice (and a cool new nickname)."
I had the opportunity to use the SmartPalate from CompleteSpeech with eight second- and third-grade students. Two students had lateral /ch, sh, j/, four had vocalic /r/ distortions, one had a distorted /s/ due to significant malocclusion and asymmetrical muscle tone in cheeks, lips, and tongue, and one student with severe apraxia had previously improved all but vocalic /r/ and interdental /s/.
Most students were seen individually for 10-15 minute sessions, 2-3 times per week. Almost immediately, the two students with lateral production had their “aha!” moment. The visual feedback from the palatometer showed the students exactly where the air was leaking. Their tongue tip was sealing against the front of the palate and dropping off the molars on one side. Within a few sessions, which also included giving a little tactile feedback with a coffee stirrer placed and pushed down medially on the tongue tip, they were able to use the visual feedback to maintain the seal against their molars to plug up the leaks. It took a few more sessions to achieve automaticity with the palatometer, and a few sessions beyond that for the students to develop fluent carryover. Both have met their goals and are dismissed from therapy.
The students who had the /r/ distortions also learned a lot about their tongue position from the visual display. One student, who produced /r/ with a cul-de-sac resonance, was able to see that his mid-tongue was making contact with the palate. Once he learned to lower that portion of his tongue, his resonance noticeably improved. The other /r/ students worked hard to “fill up the triangles” on the screen by achieving the “butterfly” position, with the lateral margins firmly anchored on the molars. All students improved in their production; two have been dismissed, and two will be dismissed soon, once they improve their self-monitoring skills.
The student who was working on /s/ was able to see what adjustments he needed to make, but was resistant to using the SmartPalate for more than a few minutes at time, due to significant sensory issues. We tried having him wear his practice at palate for a short period every day at home, but he was resistant to that as well. This student continued in traditional therapy after the trial with the palatometer ended. We still use the imagery of the palatometer screen to improve production; I draw a facsimile of the screen on a whiteboard and draw where his tongue is and where it should be. This has been helpful, as he can recall how correct production looks on the screen and feels in the mouth. This student will likely be going on “speech vacation” soon when significant orthodontia work begins, as we anticipate sensory issues will be problematic for at least a little while.
The student, with whom I really wanted to try the palatometer, has a history of severe apraxia. He was completely unintelligible in kindergarten. He would chatter away with good prosody, but even his vowels were distorted. Through years of intensive therapy (individual, 3 times per week in school, 1 time per week at the local hospital clinic), he had corrected all sounds but /r/ and /s/. Those sounds simply weren’t responding to traditional therapy techniques. Unlike the other students, who received their 30 minutes per week of therapy in short, frequent sessions, this student continued to receive two individual 30-minute session per week when the palatometer was introduced. I was frankly amazed that he was able to improve his vocalic /r/ with the SmartPalate. It took six months, but every vocalic /r/ in every position in sentences is now acceptable. Compare this to the full year it took for him to learn /k, g/ without the palatometer. This student was also able to control his /s/ production when reading or repeating sentences. However, he hadn’t fully achieve carryover to conversation when he moved out of district.
My experience with the SmartPalate was very positive. The students were motivated by the timed warm-up game of chasing dots on the screen with their tongue ; as one student said, “it’s like the Wii for the tongue!” Parents and teachers were pleased with the students’ progress as therapy time, in many cases, was shortened. Obviously, my students made progress because they could see and learn from the visual feedback. I have to add, though, that I also learned a lot from this experience. I have a much better understanding of what the tongue is doing when students mispronounce those sounds that you can’t really see, and am better able to explain to students exactly what they should be doing and feeling to achieve correct production. It was a sad day for all when the palatometer trial ended, and I am hoping that I can find a way to permanently add this amazing technology to my bag of therapy tricks.
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