Soma Mukhopadhay: Speech as a Procedural Skill

This talk was on Soma's new pink book. I have read 3/4 of it and feel like I should start it again. As there is so many good things in it. 

I took most of the information straight from Soma's slides. She had so much information from her pink book that I couldn't write fast enough. I would be open to discussing the information if anyone wants to. It is so very interesting to continue to work on speech for those that do not have speech where so many have given up the hope that speech would come. 

I love that she answers the why and how; the science behind the method. 

The primary motor cortex sends signals to the spinal cord-to alert which part of the body to focus on. 

Premotor cortex- integration of sensory information to procedural abilities and application of self regulatory plans. 

The basal ganglia is a group of nuclei involved in the initiation of movement regulation. The dysfunction can lead to speech initiation disorders affecting speech. CSTC(cortico-striato-thalamus-cortico) can lead to a 'tic' movement or speech.

The cerebellum coordinates precision and timings of movements. The role it has in speech is to fine tune motor activity initiated by the motor cortex and maintains fluidity of speech in word production and pauses in the syllables. 

Neural Pathways are involved in speech. The corticobular tract controls the movement of face, neck, tongue, lips and vocal cords. It helps the lower jaw's movements to coordinate with other organs. 

Cranial nerves involved in speech production are:  trigeminal nerve which controls the jaw movements. The facial nerve which controls lips and expressions and the hypoglossal nerve which controls the tongue movements. 

So when you look at all that goes into the movement of the jaws it is easy to see that it is complex and requires specialized control of the face . It requires: protrusion, elevation, depression, retraction and lateral motion. 

Let's look at how we begin in RPM, we will use the acquired skills of spelling to begin. It is in the spelling that the language output will guide the speech. 

It is modifying the procedure of spelling to communicate into the spelling to speech and continuing to communicate.  Slowly we wean out the letter-board dependency and move to allowing the student a 'speech' experience. To do this is not about a speech perfection but it is about the speech experience. She added the note that communication in the absence of speech can happen using the letter board. 

There can be some pre existing stimulatory speech such as humming or scripting.  You don't want to unmute a student instead the replacement techniques would include things such as delaying, diluting or scrambling.

She discussed delaying as when there is hyper-imitation or echolalia we use written choices. Visual choices slow the student and stimulates the student's reasoning(which we know engages the communication)

When diluting it is using the student's own language and helping him to grow a thought around it. 

Scrambling is when you change the OCD speech pattern. ( an example of this would be stopping and redirecting the student to list 4 words that begin with f and have at least 5 letters) It changes the dynamic. One of the things Soma said is that when it comes to obsessive speech , you would really want to dilute it. 

Replacing impulsive speech with purposeful speech by scrambling the procedure of performance. Interrupting and replacing a vocal habit can be successful if the student is not distressed by it. 

If there is stress or fear it should not be interfered with. 

Sometimes a student will use social speech to distract. This is where using the rhythm and scrambling. Putting back in the spelling slows down the  rush of nervous speech. 

Now for the non speaking student:  When pairing the jaw movements with existing skills of spelling. And then synchronization of the breathing happens with the rhythm of spelling.  She had a lovely video where when spelling she touched the lower jaw for him to open and worked on the breathing out at the same time.  The student may need the help of the letterboard at the beginning. The student may still need to the help of the prompt to get the language around the thoughts. 

Soma discussed what she called tennis. The first being syllable tennis. You have a sentence where you say a syllable and the student finished or adds the next syllable. It is a back and forth. As always in RPM it is about the rhythm and the back and forth.

That would graduate to word tennis. You say a word , I say a word. to create the sentence. 

She discussed word board; evolving spelling for the purpose of communication into reading and communication.