How can our clients better incorporate new skills into their speech in their daily lives? It seems that they are often limited by their social interactions with caregivers, parents or spouses, so that they can’t practice or complete speech homework between sessions.
Some of my adult clients will avoid practice sessions with their spouses altogether. How can we encourage use of newly acquired skills between visits? Wouldn’t the duration of therapy be reduced and functional communication improved? Research has supported more intensive therapy approaches to promote a more efficient, complete healing process. Because time and funding often limits therapy frequency, we send patients home with work for practice. Follow-through with homework generally rests on the motivation of the client or the client’s family. We need to find ways to make the therapy process efficient and functional.
In Pam Marshalla’s 2010 book “Carryover Techniques (in Articulation and Phonological Therapy),” she defines the term carryover are referring to “a client’s ability to take an individual speech skill learned in the therapy room and to apply it broadly in all speaking situations.”
Getting our students and clients to use their articulation and communication skills outside the therapy environment requires that we begin the process of carryover as soon as the skill is demonstrated in a variety of environments. For children, it might mean saying a fluent word or phrase during a game to get to the next square, or using the correct production of /r/ and /l/ during a short conversation about sports. For adults, the rules of learning after a stroke or traumatic brain injury still may require learning a new skill, like writing the first letter for phonemic placement or using cognitive-semantic linking to ask for coffee.
We need to get more creative to promote carryover across all our clients because of additional sensory, physical, psychological or cognitive difficulties that may impede the process. Charles Van Riper in 1947 wrote that while we cannot rush carryover, we must facilitate its progress.
Pam Marshalla listed some functional ways to promote carryover in children and adolescents, including use of:
- Fill-in sentences or fill-in stories to stimulate spontaneity.
- Idioms to stimulate spontaneity.
- Negative practice to help break the incorrect speech habit.
- Nonsense syllables and words to strengthen the carryover process.
- Over practice to cause a hyper-awareness of the goals of therapy.
- Rapid-fire questions and answers to promote naturalness.
- Reading aloud as a step between word productions and conversational speech.
- Rhyming to capture a client’s attention and encourage practice outside of therapy.
- Riddles because they cause a client to combine practice material with creative thinking.
- Shortening productions to encourage naturalness.
- Singing to help children remember their speech work and to encourages effortless practice.
- Spelling out errors to help the client think about what she is saying and how she is saying it.
- Story-telling and re-telling to cause stimulate spontaneity and to cause a breakthrough in carryover.
- Tongue twisters to teach children how to control their articulation.
Many of these techniques are useful for adults as well as children. Here are some additional carryover ideas for adults:
- Create a script to practice at a favorite restaurant.
- Use the carryover phrases and substitute other items at a counter deli or a department store.
- Make a to-do list (or grocery list) each day. Practice writing and reading.
- Talk about the programs you will watch.
- Use carryover phrases for conversation, such as, “Hi. How are______?” “What is____?” “I’m _____.” “Who is____?”
- Use a calendar and an 8 by 10 dry-erase board to practice drawing,writing and gesturing.
- Use your smart pad, apps, whiteboard, AAC, text-to-speech, and speech-to-text to send emails and do alphabet board, speech tutor and naming practice.
- Play your favorite brain games daily. They will help you with focus, learning, word-finding and memory.
If you encourage your clients to engage in games and functional activities daily, the overall quality of your clients’ understanding and speech production will improve because you are encouraging the growth of new neural connections. Your clients are naturally acquiring and using the new skills in their daily lives because they are using them. Becoming more functional can be the most motivating effect of carryover.
Betsy C. Schreiber, MMS, CCC-SLP, is a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders, and 18, Telepractice.