Establishment of Fluency

ESTABLISHMENT OF FLUENCY THROUGH INCREASINGLY LONG AND COMPLEX LINGUISTIC STIMULI

Rationale: To provide a hierarchically based framework of application of principles for breathstream management, decreased speaking rate, oral motor planning, light loose articulatory contacts and self-monitoring.

As the child increases the length and complexity of his/her utterances they also increase the motor planning required to say these utterances. The motor planning required to coordinate the respiratory, phonatory, and articulatory systems becomes increasingly complex. As the length of the sentences increase, we also see an increase in the semantic and syntactic complexity, as well as an increase in cognitive activity.

For the beginning speaker, language is a part of a complex array of developing skills, including linguistic and speech motor, which are essential to the production of fluent speech.

Activities/Techniques:

Word Level:
1. Memory games are useful in eliciting single word responses. The child names each picture upon turning it over. The clinician models the same behavior, reinforcing the child's fluency.
2. Go Fish games, using pictures or words, will elicit single word responses which can be modeled and reinforced by the clinician.
3. Bingo Games
4. Secret Grab Bag games utilizing objects or picture cards, drawn from a box or a bag, are fun ways to elicit single word responses.
5. Classification games (where the child is asked to classify a number of different pictures or words) provides a more cognitively stimulating activity at the single word level. The clinician chooses a number of different categories, selected according to the child's age, and asks the child to put each response item into the correct category. Peabody language cards are helpful for this type of activity.
6. Naming opposites - The client is presented with picture cards and responds by naming the opposite.
7. Animal Farm - The clinician and the client take turns taking animals out of a box and putting them on a farm. The client names the animals as he/she puts them on the farm.
8. Sentence completion - The clinician presents incomplete sentences which the child completes using one word. For example:
```
         1)  The leaves fall from the _________
         2)  Turn the light ____________
         3)  Please tie my ____________
         4)  Open the ____________
         5)  The time is 6 o' ______________
```
Phrase Level:
1. Carrier phrases are easily elicited with games such as "Chutes and Ladders" and "Candy Land". The child is instructed to respond at each turn with "I have a ______" The clinician models this response throughout the game and reinforces the child for easy, fluent phrase responses.
2. Memory games - Modify the child's response to include a carrier phrase such as "I have a _______" "I have a match." "There is a ______" or "This is a _______" may be substituted or used in addition to "I have a _______"
3. Picture cards - (e.g. Winitz verb cards, Peabody Language Cards, activity pictures) can be used to elicit a wide variety of phrase level responses. For example, the clinician may have the client use the cards in a drill activity where a phrase response is required describing the activity in the picture. The level of difficulty may be increased by having the clinician ask questions such as "What is the boy doing?" to elicit a response.
4. Guessing games - The clinician and client can play guessing games using pictures or ideas, where clues are given describing a person, place or thing. For example, "It's an animal" or "It's something you eat." The other person must guess the secret thought.
5. "Tell me what you do with it" games - By utilizing pictures or words, the clinician can have the client describe what a variety of things are used for.
6. "Simon Says" can be modified to be used at a two-phrase level inserting a pause between "Simon Says" and "touch your toes". This activity is also helpful in modeling reduced linguistic complexity and appropriate pauses.
Sentence Level: Complex multi-sentence level
1. Verb cards - These can be used in several ways; the client can describe the action taking place in the picture, or two pictures can be placed side by side and a complex sentence may be elicited.
2. Picture books - The client is requested to provide a sentence about each picture. Clinician modeling during this task my be necessary to obtain the desired response. This task may be introduced initially where the child simply repeats back a sentence produced by the clinician.
3. Sequence pictures - The child is presented with sequence pictures and is asked to arrange them in the proper order while providing a sentence for each picture.
4. Fokes Sentence Builder - An excellent tool which can be utilized to gradually increase the length and complexity of the client's sentences while providing visual stimuli. This may also be utilized to elicit nonsyntactic word strings of increasing length.
5. Description activities - Using picture cards, the child is asked to describe a variety of attributes of the picture. "What does it look like", "What is it used for?", or "Where can it be found?" are questions which may elicit sentence length responses.
6. Jobs/occupations - Provide the child with pictures of individuals depicting different occupations and instruct the child to explain what each does.
7. Sentence transformations - Instruct the child to form one sentence from two; e.g. "I have a coat. The coat is blue;" to, "I have a blue coat."
8. Giving directions - Obtain a variety of shapes or small objects, two of each. One set is for the child and one set is for the clinician. A barrier is needed to put between the clinician and the client. The clinician will ask the client to describe, in detail, sentence by sentence how to place the shapes or objects. Either a time limit or a certain number of sentences should be used. The clinician can make it more difficult for the client by shortening the time, increasing the number of sentences, or creating other fluency disrupters that would help the client use his tools for modification. For instance:
```
  
            Clinician:  "You need to make a picture with your objects.
            Now you need to tell me, step by step, how to put my shapes
            so that I can have a picture that looks exactly like yours."
            Client:  "Okay.  First, put the circle at the top."
            The client is expected to use his/her techniques throughout
            the game (i.e., stretching, easy onset of voicing, soft
            contacts).  Response will be elicited through positive
            reinforcement by the clinician when the client uses his
            techniques.
```
Story Level:
1. Recount past events:
  - "What happened on your last birthday?"
  - "What did you do in school today?"
  - "Tell me about Christmas?", etc......use a topic that requires sequencing and specific people/experiences.
2. "All About Me Books"
3. Books with no words
4. Felt board stories (make up story from picture)
5. "Retell the Story"
6. Sequence cards
7. Continuous stories
Conversational Level:
1. Role playing
2. Problem solving
3. Opinions
4. General conversation about favorite activities, television shows, the family, what happened in school
Storyline:
1. When presented aloud with the first sentence or two of a story, the child will appropriately complete the storyline generating a story of several more fluent utterances.

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