Using Speech Strategies

SKILL: Talking

DIFFICULTY: 3/5

LEVELS: 6 based on number of syllables

BRIEF RATIONALE: This treatment works on speech clarity using compensatory strategies.

In Using Speech Strategies, you will learn about speech strategies and select at least one to focus on during the session. Strategies include:

Take a deep breath
Speak slowly
Speak louder
Exaggerate sounds

Then, you will see a common phrase. Press the record button. Say the phrase loud and clear. Press the button again to end the recording.

Listen to your own production and then rate yourself from 1-5 before receiving sound-level feedback. This feedback can improve awareness of your speech intelligibility (how easily others can understand you).

Next, you will receive sound-level feedback using our speech recognition technology. You will be marked correct if 80-100% of the sounds are detected clearly, partially correct if 50-79% of sounds are detected clearly, and incorrect if less than half of the sounds are detected clearly. The treatment auto-adjusts in difficulty based on your performance.

If you are marked as partially correct or incorrect, you will try saying the phrase again using speech strategies. Select the strategies you want to use. Record the phrase again and repeat the self-rating. Then, you will see a comparison of your first attempt and second attempt to gain insight on how effective the strategies were.

SELF-RATING OPTION: If speech recognition is not right for you or your patient (e. g. due to accent, background noise, or lack of a microphone), you may choose the self-rating version of this treatment. Levels will be adjusted based on your self-rating, since accuracy data is not available without the speech recognition technology.

FOR THE CLINICIAN:

The treatment, Using Speech Strategies targets speech production subsystems by encouraging strategy usage. We educate patients on:

Upright posture
Initiating phonation at the top of inhalation to coordinate breathing and phonation
Vowel stretching to reduce speech rate while maintaining natural-sounding prosody
Increased intensity to indirectly reduce speech rate
Exaggerated articulation to promote phonetic placement and precision

Biofeedback has been shown to increase volume, decrease speech rate, and improve intelligibility in stroke patients (Jayaraman & Das, 2023). The treatment provides biofeedback by including recordings of patients' productions, visual feedback of sound-level errors, and comparisons between productions to improve awareness.

When the patient is ready to practice learned speech strategies outside of the Virtual Rehab Center, you can educate them on additional compensatory strategies including:

Introducing the topic
Maintaining eye contact with the listener
Using non-verbal communication (e.g. gestures, pointing, writing) to help convey the message
Using low-tech AAC (e.g. alphabet board) to help convey the message
Checking in with the listener to see if they understand
Rephrasing the message as needed

Selected References:

American Speech-Language-Hearing Association. (n.d.). Dysarthria in adults [Practice portal]. https://www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/
Jayaraman, D. K., & Das, J. M. (2023, June 5). Dysarthria. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK592453/