- Head and Neck Exercises
- 40 spm
- 60 spm
- 80 spm
- 100 spm
- 120 spm
- 140 spm
These are simple, gentle exercises designed to relax the muscles around the head and neck area. It’s helpful to begin your sessions with these calm, warm-up exercises.
These exercises are aimed at demonstrating how to relax the muscles of the vocal tract and especially the back of the throat. By yawning gently, the back of the throat is more able to relax, and this should give a sensation of free and easy speech, i.e. without any tensions blocking either the out breath or the utterance itself.
A guide to pronouncing the vowels used in these exercises is provided.
The Prolonged Speech technique uses the syllable as the basic unit of measurement. It progresses from speaking at a speed of 40 syllables per minute to a typical maximum of around 140 syllables per minute, in increments of 20 syllables per minute. It is important, therefore, that clients have a good understanding of what syllables are. In plain words, the worksheet provides a quick definition of a syllable and also provides practice in recognizing and identifying syllables.
This worksheet explains the Prolonged Speech technique. It is described in terms of four parameters:
- dividing the speech up into manageable sizes
- using only soft contacts
- keeping a similar pitch throughout
- running each word into the next one
Prolonged Speech worksheet
The clinician should demonstrate each parameter in turn using the first of the 40 spm texts. This is explained in the next section.
The method of teaching is as follows.
- Divide the text into manageable sizes. On the worksheet draw marks where you think you should take a breath. At 40 spm (40 syllables per minute), typically we need to take a breath after every 2-3 syllables.
- Identify any possible hard contacts and demonstrate how to produce these more softly. Examples of hard contacts would be the sounds /p/, /b/, /t/, /d/, /k/, /g/, /l/. These are all sounds that may be made with a little too much force and, therefore, cause unnecessary muscle tensions in the vocal tract. Encourage the client to produce these easily, almost as if he or she were blowing them out of the mouth, rather than trying to give them a full volume. When produced in a soft manner they will sound quite weak, lacking in strength – this is exactly as it should be while practicing these exercises. You may choose to mark any possible hard contacts with a highlighter pen or simply ring them with a pencil or pen.
- Demonstrate how to keep a level pitch while reading. To help fix this technique in the client’s mind, you can contrast the sound of an ongoing level pitch with the speech of a well-known TV or radio presenter who exhibits an exaggerated intonation with extreme pitch variations. Perhaps a weather reporter or a children’s presenter? During these initial reading exercises the intonation should sound quite flat, monotonous and even boring. Help the client to realize that you are not expecting his or her speech to remain like this but that it is necessary to relax everything down to begin with. As the client progresses towards higher rates of speaking the pitch typically assumes a more natural coloring and variety. It is not usually the case that you will have to work to re‑establish a more expressive pitch – pitch usually takes care of itself.
- Demonstrate how to run words into one another. Sentences should not be spoken in a clipped manner (e.g. When – it’s – cold – outside) rather the words should merge together (e.g. Whenit’scoldoutside). This can be likened to how someone might sound when they are a little drunk.
Now, practice reading aloud at 40 spm. Texts 1 and 2 already have four timing flags marked on them that should assist the client in judging how far he or she needs to be through the text at what time. It’s helpful if you break up this task initially. For example, you can demonstrate the task by reading aloud yourself at 40 spm up to the 15 seconds flag. Then have the client join in with you, repeating the text up to the first 15 seconds flag. Now you demonstrate the reading up to the 30 second flag, subsequently have the client join in with you as you say it together up to the 30 second flag…etc…until you have completed the whole text.
Next, both you and the client should begin reading the text aloud together and then, at around the 30 second flag, you should drop out (i.e. stop speaking) and allow the client to complete the text on his or her own for the final 30 seconds.
Finally, have the client read the text aloud at 40 spm for the whole minute.
The above should be practiced with texts 1 and 2. Additional materials (texts 3-20) are provided so that the client can practice these on his or her own.
Most clients can gain reasonable facility in using the prolonged speech technique at each rate of speech with about one week’s practice. However, there are no hard and fast rules as to how many times a day the client should practice. The principle is ‘little and often’. It is better to practice for 15 minutes twice-a-day than to wait until the end of the week and practice for three hours. We need to encourage the client to develop a habit of speaking at each rate – almost without thinking – so that it becomes second nature.
The above outline sets the teaching pattern to be followed for each of the faster rates of speech from 60 spm up to 120 spm, i.e.
- clarify and emphasize the four parameters of prolonged speech for each text (i.e. manageable sizes, soft contacts, level pitch and running words together)
- build up reading the text aloud by you first demonstrating and then having the client join in with you for the first 15 seconds, 30 seconds, 45 seconds and, finally, the full minute
- you and the client read the text aloud for the first 30 seconds and then you drop out and the client continues alone until the end
- the client reads aloud the whole text on his or her own
Follow the teaching pattern for Text 1, i.e.
- identify the four parameters of prolonged speech for each text
- read the text aloud in stages: first you demonstrate and then have the client join in for the first 15 seconds, 30 seconds, 45 seconds and the full minute
- read the text aloud together for the first 30 seconds and then you drop out, allowing the client to continue alone to the end
- client reads the whole text aloud on their own
Then repeat with Text 2.
Then try some simple structured conversations (see Conversations).
Texts 3-20 are provided for the client to practice on his or her own during the following week.
Same technique as described for 60 spm, including slightly more complex structured conversations (see Conversations).
Same technique as described for 80 spm. Practice some complex structured conversations and you may also wish to introduce less formal conversations in preparation for speaking at 120 spm (see Conversations).
NB: At this rate of speech, it becomes harder to maintain a level pitch contour. The pitch tends towards a more natural coloring. This is good and is to be encouraged. Point out the more natural intonation to the client, making him or her aware of the changes. It can be helpful to audio record the client reading aloud to assist their self-assessment by playing back selected stretches of speech that provide examples of progress or areas that still need attention.
This speed is a near-average speed for many speakers and it can often be difficult to speak at this rate when reading. This is because you are expected to keep a steady rate when reading the accompanying texts within a total time of one minute. In fact, when I was recording a therapist speaking at this rate each attempt was different from the previous one – it’s difficult to be consistent at this rate when one is expected to speak a long text within one minute. The point is that when we are speaking in informal conversations, we do not typically speak for one minute at a time: we tend to take a turn at talking (usually no more than about 10 words) and then the other person takes a turn at talking before the turn passes back to us to take another turn, and so on. So, don’t be overly concerned if the client finds this speed difficult when using reading materials. This is the point at which this technique should now be practiced in more typical everyday conversations (see Conversations).
140-150 spm is, arguably, an average rate of speech for many speakers. As with practice of using written texts at 120 spm, it is quite difficult to speak with consistent syllable timing at this much increased rate. It may be better, therefore, to practice speaking at 140 spm using predominantly less formal conversations (see Conversations). Nevertheless, for the sake of consistency – and for the occasional client who may enjoy the challenge of attempting reading materials at a maximal rate – 20 written texts of 140 syllables each are provided.
It is important to move away from using the support of reading materials fairly early in the process – usually when the client begins practicing at 60 spm. To begin with, it is preferable to use structured conversations. These have the advantage of
- being less predictable than a written text
- alerting the client to the topics of discussion, thereby
- relieving any undue psychological pressure to formulate a response or question in real time
You can practice these by trying some of the following suggestions.
- Tell the client that you are going to have a short conversation for just one minute and that you will be timing this. If anyone is still in the course of speaking after one minute (either you or the client) you will raise a hand to indicate that the minute is complete and that the conversation will stop.
- Tell the client that you will be asking him or her four things, e.g. (1) What is your name? (2) What is your current address? (3) Please tell me something you did yesterday, and (4) What are your hobbies or interests? Give the client sufficient time to think of relevant answers to these questions.
- Now carry out the brief conversation. The aim is for the client to use the prolonged speech technique at the rate of speech currently being practiced. At the end of the conversation ask the client how he or she thinks they did. Did they manage to control their fluency? Was this all the time? If not, which aspects were harder? Why? Etc?
- Finally, remember that the above structured conversations have largely been led by you. If you are asking all the questions this has the effect of putting the client in a respondent role. It’s important to swap these roles and allow the client opportunities to take the lead in asking you questions as well. Ultimately, of course, you hope to arrive at a situation where the conversation is informal and both parties contribute equally (see Less formal conversations).
You can now practice slightly more complex structured conversations by introducing one or two undeclared questions. For example, as before, inform the client which three or four questions you will be asking. In addition, indicate that you will also be asking an additional question (which you will not be forewarning the client about). The idea here is that, as the client does not know what you will be asking, this will put them under slightly more cognitive/psychological pressure to compose an answer in real time. The idea is that he or she should learn to continue using the prolonged speech technique even when under such moments of potential stress. Again, try role reversal where the client now leads the conversation by asking the three or four agreed questions with the inclusion of his or her own choice of an undeclared further question.
The above pattern can be repeated or varied as you both see fit. For example, you could reduce the number of declared questions to just one or two and increase the number of undeclared questions.
Less formal conversations
Eventually, you will likely arrive at a point where you will have a one-minute conversation for which you will not inform the client of any of the questions you will be asking. The client, therefore, must manage his or her speech in real time, without knowing beforehand what might be discussed. This should be the goal when speaking at around 120-140 spm. You can speak about anything. The idea is to try and make the interaction as free-flowing as a typical informal, everyday conversation. Again, it can be about hobbies, work, study interests, sports – basically anything.
As the client increases in confidence, you can increase the duration of conversations to 2 minutes, 3 minutes, and so on.
Remember: timely and accurate feedback for the client is essential in assisting him or her to gain control over any persisting dysfluency. So, don’t be afraid to gently point out any ongoing, potentially detrimental behaviors and discuss these openly.
Generalizing beyond the clinical setting
Of course, these less formal conversations do not represent what takes place in everyday life: the interactions are taking place within the safe environment of a clinical session and they may still be constrained in terms of chosen topic(s). Eventually, the client will need assistance in generalizing what they have learnt into new environments, e.g. visiting the library, making phone calls, ordering take-away food, and so on. The Prolonged Speech Pack is not designed to address these wider therapeutic issues and concerns. However, such issues will need tackling if the client is to maintain any benefits over time and reduce the possibility of relapse.
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