SKILL: Clear Speech
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 into 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 unavailable without speech recognition technology.
FOR THE CLINICIAN:
The treatment, Using Speech Strategies, targets speech production subsystems by encouraging the use of strategies. 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/