Are you too old, sick, or set-in-your-ways to improve your speech? Did your speaking skills plateau in your twenties when you were young, strong and beautiful? Are your skills “fossilised” like a peat-bogged dinosaur?
Speech is a motor skill. Regardless of your excuse – even allegedly good ones like neurological conditions, major illnesses, strokes or long-term bad habits – you can improve your speech.
A. Why am I so confident?
Humans – old, young, sick, well, flexible and stubborn – can learn new tricks. Specifically, we can learn (or re-learn) to do skilled motor tasks; and we can adapt to set-backs like injuries and illnesses.
- Motor learning: with practice, we can effect a semi-permanent change in our ability to execute a skilled motor task (Magill, 2004). Examples include piano tinkling, golf-swinging, shoelace tying – and, you guessed it – speaking.
- Neural plasticity refers to the capacity of the central nervous system to change and adapt, e.g. in response to a brain injury (e.g. Ludlow et al., 2008). Unfortunately, the term has been hijacked by a lot of charlatans peddling quick fixes with exaggerated claims. But, pushing the neuro-peddlers to one side, the evidence is clear: the adult brain – though less plastic than a child’s – can reorganise itself with the right treatment (e.g. Doyon & Bernali, 2005; Johansen-Berg et al., 2002).
B. What’s the catch?
Lots of hard work! Simply wishing for change and practising in your “comfort zone”, when you feel well enough or “up for it” is not going to cut it. If you’re not up for a challenge, save yourself the time and money and look at other options.
C. So how do treatments based on principles of motor learning work?
Behavioural treatments are known to promote brain reorganisation (Maas et al. 2008). If you want to improve your speech using principles of motor speech, you first need:
- proper motivation to learn;
- to understand what, exactly, you are trying to achieve – a clear target; and
- treatment based on principles of:
- motor learning; and
- experience-dependent neural plasticity.
Oh, and remember I mentioned hard work? I wasn’t joking. Principles of motor learning include lots of practice with feedback from someone who knows what they are doing.
(a) What kind of practice?
- lots and lots;
- distributed practice: lots of sessions over a long period of time;
- variable practice: practising different targets in different places;
- random practice: different targets intermixed, rather than one at a time;
- external focus: focus on the results (did you get it right or wrong?), not on what your tongue, teeth, lips and soft palate are doing; and
- complex targets: difficult, complicated targets, rather than simple, easy to achieve targets.
(b) What kind of feedback?
Following principles of motor learning, feedback:
- focuses on the results – did you hit the target: yes or no? – not whether you are trying your best or were close;
- is irregular and infrequent – we don’t hold your hand for every attempt; and
- is delayed – we want you to learn to self-monitor your own performance before we give you our views.
Call it tough love!
D. What about brain plasticity principles?
Motor treatments designed to help the brain reorganise itself, e.g. after an injury, incorporate 10 principles. When it comes to speech goals, many of these principles overlap with principles of motor learning:
- Use it or lose it. Use the skill or it will degrade.
- Use it and improve it. Build on strengths through practice.
- Be specific. Train the skills you want to improve. If you want to speak better, speak! This is why non-speech mouth and tongue exercises don’t improve speech.
- Repeat, repeat, repeat. Plasticity requires lots of practice.
- Intensity. Change requires intense practice.
- Time matters. Some motor skills take time to consolidate.
- Salience matters. Motivating tasks and rewards promote engagement.
- Age matters. Yes, young kids’ brains are more plastic than older brains.
- Transference. Plasticity in response to one experience can enhance similar behaviours, e.g. learning in a challenging clinical environment might lead to better outcomes in the real world than learning in a room with no distractions.
- Interference. Plasticity in response to one experience can interfere with the acquisition of other behaviours, e.g. using your left hand to compensate for weaknesses in your right hand, might help you cope with activities of daily living, but may interfere with the recovery of your injured right hand.
(Kleim & Jones, 2008.)
Probably the best documented speech treatment based on principles of motor learning and brain plasticity is LSVT Loud. Designed originally for people with Parkinson’s Disease, it’s now used to treat a range of speech disorders, including non-progressive dysarthrias (e.g Wenke et al., 2011).
As my LSVT Loud-graduates will tell you, LSVT is:
- intense (for both the client and the speech pathologist!);
- features high frequency, repetitive drills for a solid hour;
- carried out in the clinic four times a week, over a period of four weeks come rain or shine;
- requires clients to complete daily additional homework and challenging carryover tasks between sessions in a range of different contexts;
- includes personalised, high frequency phrases and speech drills on topics of particular personal or professional interest to the client;
- has a clear, results-driven target: increased volume; and
- challenging: it does not change to accommodate fluctuations in health, mood or motivation.
LSVT rewards clients for using their loud voice and helps them to recalibrate their volume for themselves. The positive feedback they receive on their voice from friends, family and others increases the saliency of the loud vocal behaviour, which may lead to an increase in experience-dependent plasticity (e.g. Fox et al., 2006).
Another example of a highly programmed motor speech program is the ReST treatment for Childhood Apraxia of Speech.
As an example of a less structured application, I’ve been using principles of motor learning when working with some school-aged children with residual speech sound issues. For motivated clients, I’ve had good results with randomised, intense, drill-based practice on complex targets involving topics of interest to them, with low frequency feedback on their results. Although it can take more work, the results seem to generalise better for some clients compared to their previous results with traditional hierarchical articulation therapy.
We’ve also been using principles of motor learning when working with adults who would like to eliminate their lisps.
F. Clinical bottom line
For highly motivated people with speech disorders, principles of motor speech and brain plasticity provide an excellent – though challenging! – framework around which to design an evidence-based treatment plan. Just add motivation, clear treatment goals and lots of hard work.
Of course, principles of motor learning and brain plasticity are relevant to everyone – not just people with motor speech disorders. The principles can also be used to design training plans for adults looking to improve their professional communication skills or increase their intelligibility.
- Maas, E., et al. (2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of Speech-Language Pathology, 17, 277-298.
- Kleim, J.A., & Jones, T.A. (2008). Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation after Brain Damage. Journal of Speech, Language, and Hearing Research, 51, S225-239.
- Wenke, R., Theodoros, D., & Cornwell, P. (2011). A Comparison of the Effects of the Lee Silverman Voice Treatment and Traditional Therapy on Intelligibility, Perceptual Speech Features, and Everyday Communication in Nonprogressive Dysarthria. Journal of Medical Speech-Language Pathology, 19(4), 1-24.