Introduction
In this paper, a recorded session conducted by a speech-language therapist for a young girl will be scrutinized. The patient’s data will be summarized; after that, the session itself will be analyzed. In the analysis, some information about the patient will be provided, and the objectives of the session will be stated; further, the materials, methods, and the client’s response will be examined. After that, it will be assessed whether the clinician was able to achieve the goals of the session. Some reflections regarding the session will also be provided.
Summary of the Patient’s Data
The patient, Penelope, was a 4.5-year-old girl at the time of the recorded session of therapy (February 19, 2015). Her problem was that she experienced stuttering and tension while attempting to speak. According to the information provided with the video (Master Clinician Network, 2015), the girl had started stuttering approximately half a year to a year before the therapy was initiated. The speech disorders that Penny was suffering from consisted mainly of sound-syllable repetitions, as well as occasional blocks and the repetitions of some words or phrases (such as “and also, and also…” or “it, it…”). Penelope had family members who also had experienced stuttering, but had been able to recover from it. The therapy was also initiated because Penny’s stuttering had been gradually becoming tenser over some time. Therefore, the therapy was aimed at addressing both the problems of stuttering and the tension of speech.
During the sessions the therapist focused on 1) explaining to Penelope that both smooth and stuttering speech are OK; 2) saying words only once and lowering the rate of repetitions; 3) speaking at a slower pace to decrease the tension. It is also pointed out that the program entitled “Fluency Rules” was implemented during the therapy sessions; it included the use of visual signals when the girl started stuttering or speaking too quickly. The girl was taught to “catch” the therapist when the latter demonstrated the respective manner of speech, so that Penelope would also correct her speech on her own, and would feel more comfortable when the clinician “caught” her.
As for the made progress, the stuttering of the girl significantly decreased as a result of the sessions, which had been taking place for four weeks before the recorded one. Also, it is highlighted that because fluency may be fragile, more sessions were to take place after the one shown in the video to ensure that the skills learned by the girl become stable.
Analysis of the Session
Name, age and diagnosis of the child
The name of the patient is Penelope; she was 4.5-year-old at the time of the session. Her diagnosis was stuttering. It is also mentioned that she had “tension” of speech (Master Clinician Network, 2015); this probably refers to muscle tension dysphonia.
The objectives of the session
The therapy, on the whole, was aimed at helping Penny overcome her stuttering problem, as well as the tension of speech. The girl had been making progress, and the goal of the recorded session was to revise the use of fluency rules and practice the methods of its achievement to make the girl more accustomed to their utilization. In particular, it was an aim to have Penelope use the method of inhaling deeply and lowering the pace of her speech as a response to stuttering. The patient was also supposed to practice speaking normally.
The materials and activities used by the SLP during the therapy session
During the session, the therapist utilized a set of colored pencils and chalks for drawing on paper, several sheets of paper (A4 format), and a book with pictures.
At the beginning of the session, the SLP talked about the kinds of speech, stating that both “smooth” and “bumpy” were “OK.” Then, the technique of addressing “bumping” was practiced; the girl was to inhale deeply and say numbers while exhaling.
After that, the therapist drew pictures and explained that people do not speak slowly, but can speak slower than usual and that it is possible to do this when the speech becomes “bumpy” or tense.
Geometric shapes were also drawn; the SLP proceeded to color the shapes, making an analogy between how the shapes were colored, and the speech was carried out.
At the end of the session, the therapist took the book with pictures and asked Penelope to find unicorns in the pictures. This exercise was aimed at making the girl talk; while searching for unicorns, the girl was speaking constantly.
The clinical techniques/methods/procedures that the clinician used
The SLP employed the techniques aimed at changing the timing of speech and reducing the physical tension, as well as the comprehensive approach (Conture & Yaruss, n.d.). In other words, the girl was taught to slow down when she started experiencing stuttering, and to start speaking gently. She was also told that “bumpy” (stuttering) speech is “OK,” which is important to promote a better attitude to stammering and decrease the psychological problems and anxiety which may result from it.
The methods included providing analogies and metaphors to make the girl better understand the techniques. Penelope was also encouraged to gesture to the clinician when the latter started repeating words so that the girl would learn to avoid repetitions herself.
The client’s response
The responses of Penelope to the SLP’s actions were usually somewhat shy; nonetheless, the girl appeared to be interested and engaged in the offered activities. Shyness was mostly demonstrated when the girl was asked to say something or answer a question; during the activities, the girl was too engaged to be shy. In particular, Penny talked the most when she was looking through the book with pictures and describing it. Therefore, the activities helped get the desired results of the session.
Did the clinician accomplish the objectives for the observed session?
During the observed session, the therapist was able to achieve the aim that had been set. The girl revised the techniques aimed at correcting her speech and practiced their use. She also talked rather much during the session, which, undoubtedly, allowed her to stabilize the skills that she learned during the intervention.
Reflection on what has been learned from observing the session
The observation of the session of speech-language therapy provided us with some examples of how to make a session more effective.
First, it may be effective to imitate the language disorders and to ask the patient to correct them. This helps the client to detect the cases of impaired behaviors and correct them.
Second, the use of metaphors and analogies may be helpful while working with small children. This creates additional associations in their memory and lets them remember the materials and/or techniques better.
Third, the use of additional activities in which a young child is engaged significantly helps to achieve the objectives of the session, because the patient is concentrated on the activity and, as a result, the speaking occurs almost automatically, without additional consideration. It also helps to address the problem of shyness. Noteworthy, the activities in which the patient is completely engaged should be used in cases when the client can already speak rather well so that the skill of talking properly becomes a habit.
Conclusion
To sum up, it should be stressed that the techniques utilized by the SLP were aimed at changing the timing of speech and reducing the tension; the comprehensive approach, aimed at making the patient more psychologically comfortable with stuttering, was also employed. During the session, the clinician conducted several activities; their use was successful, and the patient responded well to the activities. Important conclusions from the video are that the use of such activities may be effective while dealing with children of young age; that metaphors and analogies may be useful while working with young children; and that imitating language disorders and asking the patient to correct them may also prove helpful during the sessions.
Observation Notes
Notes
The session started with talking about kinds of speech (smooth and bumpy); both are OK. “But when things get bumpy,” it is possible to inhale and speak slowly. The girl practices inhaling and speaking slowly while exhaling.
The clinician draws a turtle and snail; states that we don’t talk slowly, but we can talk slower; they practice.
The SLP makes the girl use gestures when the SLP speaks too fast or repeats words on purpose.
The SLP engages Penelope in coloring activities; they color shapes. The clinician makes analogies between coloring slowly and fast and speaking slowly and fast. The activity takes a lot of time.
Final activity: Penny finds unicorns in the pictures in a book. While doing this, the girl talks much; a good method to practice good speech.
Final Comments from the Clinician
Penny has been demonstrating stuttering and tension of speech; they have been worsening over six months. Her family has a history of stuttering and recovery. Penelope is recovering, but because of history, the therapist wanted to intervene.
The SLP stresses that “bumpy” speech is OK and tries to be “judgment-free.”
Fluency rules and modeling are employed; the girl corrects problematic speech of the SLP; this will be turned around on the girl. Slow breath and keeping the speech at a slow pace helps address the problems.
The girl has been on therapy for four weeks and is making progress.
References
Conture, E. G., & Yaruss, J. S. (n.d.). Treatment efficacy summary: Stuttering. Web.
Master Clinician Network. (2015). Clinical videos. Web.