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From: Kathy Swiney
Date: 01 Oct 2012
Time: 12:25:07 -0500
Remote Name: 99.153.185.119
Great question. I usually use only Levels 1 and 2 until the TWS (teen who stutters) is very comfortable. I watch specifically for reduced tension during reading, then for a fairly good understanding of phrasing at these two levels. It does help that stuttering tends to decrease when the same passage is read again. As the TWS experiences that improvement, tension tends to decrease naturally, and the enthusiasm for the process increases. I have TWS asking for more sets of articles to take home to practice, believe it or not. A practice session might go like this. 1) I read the first sentence or two of Level 1 making soft onsets at the beginning of each line of text. I often draw in a cloud to indicate soft start at the beginning of several lines of text as a visual reminder of easy onset. Then, at the end of each line of text, I softly tap my index finger not as a fluency “trick” but to give the TWS an indication of the length of the pause needed—about a second—to re-synch their speech/motor timing. 2) Then it’s the TWS’s turn. I ask him to re-read the two sentences I read, using phrasing, while I softly indicate the timing with two taps. I do not have TWS tap—we want to avoid creating a fluency trick that then has to be eliminated. What I find is that without that auditory cue for taking a break between sentence “chunks” the TWS just runs through the phrasing points. They tell me, they are so happy when their speech is fluent they try to get as much out as they can, as quickly as possible. This creates not only rate issues, but the practice of speaking on residual air as well. 3) The TWS then finishes the story at Level 1 and I gradually fade my quiet tapping cues. You can re-introduce the quiet taps without interrupting the reading passage if you notice the TWS running through the phrase points. 4) The TWS then reads the same story at Level 2. If he needs some cues for timing, I provided them only as needed. He adds his own phrasing in the last few sentences of text. If the TWS reads the passage sub-vocally, it is fairly easy to tell where phrase points belong based on the meaning of the sentence. I don’t worry if their phrase points aren’t in the same place as mine. The TWS then reads the section of text where he marked the phrases. 5) When these two activities are fairly easy – may take reading 4, 5, 6 stories with these two levels only – I then add Level 3 and Level 4. 6) So that would look like --- reading Level 1, Level 2 and then Level 3 with minimal assistance. The first and easiest task in Level 4 is usually the summary – same vocabulary and same sequence. If the TWS has spent some time on Levels 1 and 2 only, the summary in Level 3 is fairly fluent with little clinician support. 7) If the summary is fairly smooth, answering factual questions from the text, since answers only require short responses, are only marginally more difficult than the summary. I stay at this level (without the opinions) several sessions until the TWS is highly fluent. Then I add an opinion question without any opposition. What is your view of aliens? Are they real? Then, I ask an opinion question, and add mild, good-humored opposition. I am a bit of a ham, so I enjoy being the “not-all-that-bright-man-on-the-street” character. Some would say it’s not that much of a stretch for me. ;-). Carefully, I add opposition that is a bit more factual and realistic. This has had the unexpected benefit of TWS mentioning that they are more pro-active in discussions with friends and in standing up for themselves when comments are made about stuttering. Perhaps this practice has played a role in that. I know this is a bit more information than you probably expected, but I have had teens refer themselves for therapy specifically to learn this technique after noticing changes in the speech of their friends. Kathy