#65 Just Put Your Head Down and Swing!

Greetings!

My husband has golfed most of his life; I haven’t.  Three years ago at the driving range when he told me to just put my head down and swing, I thought, WHY?  My head?  How far down?  What do I do with the rest of my body?  Am I holding the club right?  Is there a wrong way?  How do I swing this thing?  When I missed the ball completely—many times—his instructions became a little more detailed (as his volume increased), but honestly, I needed a many more details.  

I started reading books, watching videos, etc.  Probably should have taken a golf class, but of course, that would have been too easy.  Armed with info, I figured out what body parts stabilize (remain still), and what body parts mobilize and how they interact.  

In addition to a ton of practice, I needed the process of part-to-whole breakdown and interaction of the components of my body’s positions and the swing.  I can now (pretty much) make it around 9 holes without holding everybody up.  

In my therapy experience, many of my speech-kids need the specification of speech sound components and how to put them together.  This is referred to as part-to-whole or part-task training.  Fortunately, some of our kids are able to correctly produce the speech sound via an independent auditory example.  In essence, this is referred to as whole-sound or whole-word training.   

Dr. Gregory Lof’s philosophy is to train speech sounds by providing the individual speech sound or the speech sound in words.  As a component of Dr. Lof’s concerns regarding oral motor and part-whole training and transfer (2017), he states:  

“Tasks that comprise highly organized or integrated movements (such as speaking) will not be enhanced by learning the constituent parts of the movement alone; training on the parts of these well-organized behaviors can actually diminish learning.” 

To support his statement (of pro whole-sound/word instruction) he references three articles:  Kleim & Jones, 2008, Wightman & Lintern, 1985, and Forrest, 2002.  I read them carefully and in their entirety.  These resources are at best moderately related or totally unrelated to the “part-whole” topic at hand.  I was disappointed, and found very little to substantiate his argument.  Instead, I found the following. 

Kleim, J.A., Jones, T.A.  (2008)  -  Principles of experience-dependent neural plasticity:  Implications for rehabilitation after brain damage 

Although the content is excellent, I could find neither a quote referencing Dr. Lof’s specified content or anything specific in the article that related to it.  This journal article does not mention “part-whole training,” however, it pertains to the plasticity of the brain and how it learns and relearns in rehabilitation.  To give Dr. Lof the benefit of the doubt, perhaps he was referencing part-whole training indirectly somewhere in the article.  Dr. Lof does not mention, however, brain plasticity in his section on Part-Whole Training and Transfer (2017).  Let’s briefly investigate plasticity. 

Kleim and Jones provided information on both new-learning and re-learning:  

“Neural plasticity is believed to be the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation.”  “…Neural plasticity is the mechanism by which the brain encodes experience and learns new behaviors.  It’s also the mechanism by which the damaged brain relearns lost behavior in response to rehabilitation.”  

The remainder of the article primarily emphasizes the “damaged brain” (their term).  It reviews ten principles of experience-dependent neural plasticity and considerations for applying them to individuals to “optimize rehabilitation.”  All are good points, for example, Use it and Improve it, Repetition, Intensity, Time, etc.  Here are two (of the ten) principles that may relate to the part-whole transfer topic. 

Principle #7, Salience Matters:  This is the only principle that specifically references “motor speech disorders.”  They state, “Saliency [the importance of the task] is already an important consideration in the treatment of many neurological disorders, including aphasia and motor speech disorders.” 

Principle #9, Transference:  “Transference refers to the ability of plasticity within one set of neural circuits to promote concurrent or subsequent plasticity.”  They cite an example, “Training on a fine digit movement task induces an increase in corticospinal excitability and an expansion of hand muscle representation in [the] primary motor cortex.”  This rather sounds like part-to-whole training and learning to me. 

Wightman, E, and Lintern, G.  (1985)  -  Part-task training of tracking for manual control 

In full disclosure, this article was researched and written for the Naval Training Equipment Center to determine the best method for in-flight training programs.  Good article, however. 

I’m unsure why Dr. Lof included this article in his argument; it’s primarily pro part-to-whole instruction.  

The authors define part-task training as

• “Practice on some set of components of a whole task as a prelude to practice of or performance of the whole task.”
• “Part-task procedures are intended to improve learning efficiency….”
• “Part-task training appears to be more effective with difficult tasks.” 

Well, speech IS a DIFFICULT task.  In addition, they cover information and research (pros and cons) about segmentation, fractionation, and simplification (see below information in Forrest’s 2002 article). 

They cite the following additional pro part-task points for instruction and learning (by Wightman and Lintern, 1985): 

• Learning capabilities: “Part-task training also appears to be more effective for low-aptitude (intellect) or inexperienced students.” (That’s many of my speech-kids.)
• Integrating parts back into the whole: “Partition the task, then reintegrate the parts during learning.”
• A fundamental assumption: “That components of a task can be identified and the improved skills on the components will help performance of the whole task.”
• Critical principle: “It is important that learners understand how the part or parts they are currently practicing are related to the whole skill.”Speech sound production and generalization is always the primary focus of oral motor therapy (and other therapies) and it’s important that we inform the client.  I’m pretty sure most SLPs do that. 

Forrest, K.  (2002)  -  Are oral-motor exercises useful in the treatment of phonological/articulatory disorders?  

Although Dr. Forrest questions oral-motor exercises, she quotes Magill (1998): “The most obvious reason for using oral-motor exercises is that speech is an extremely complex motor behavior and principles of motor learning suggest that learning is facilitated when a complex behavior is decomposed into smaller units.” (From Magill’s 1998 edition of his book, Motor Learning:  Concepts and Applications; this book is currently in its eleventh edition, 2017.)  

Dr. Lof mentions “fractionating” (in Forrest, 2002).  Fractionating is also discussed in Wightman and Lintern, 1985 (a resource Dr. Lof cites) and also in Rose, 1997 (page 256).  In fact, they indicate that there are three types of part-task practice:  1) segmentation, 2) simplification, and 3) fractionization.  In my perspective, the type of practice that best applies to speech sound therapy is segmentation.  Segmentation portions the “whole” skill into components, practiced until successful, then combined.  Within segmentation, there’s another variety called “progressive-part practice.”  One practices the first skill, then the second, then combines the two prior to practicing the third.  Actually, this sounds quite logical. 

Speech Sound Components 

The oral components of a speech sound can be categorized by points of stabilization and mobilization (Fletcher, 1992).  The production of one speech sound has multiple almost simultaneous components. 

An itemized view of speech production components goes beyond “placement” which implies stillness. As we all know, speech is movement. To generate the refined oral movements needed for intelligible coarticulation, the point(s) of stabilization must be near the moving part.   

This is not to say that the tongue interacts in the same place for each speech sound every time. There is “tongue position variability” among speakers (Rudy and Yunusava, 2013).  Lateral lingual-dental contact (stabilization) can occur on the cusps, or the sides of the teeth, or the sides of the teeth and the perimeter of the palate. Each facilitates “stabilization.” 

Take the stabilization-mobilization components of an /s/, for example:   

• The jaw rotates forward and up ever-so-slightly to generate anterior dental approximation (Dawson, 1989), and provide a stable base.
• The tongue in the area of the upper dental arch anchors to the insides of the top back teeth and sometimes the perimeter of the palate (Gick, et al., 2017; Stone, et al., 1992).
• The mid-tongue contracts (Kier, et al., 1985) (to generate front-tongue vertical movement).
• The front-tongue moves into place below and near the alveolar ridge, and
• Sustains its position while air flows between the constricted spaces of the tongue tip and alveolar ridge, and the approximated front teeth. Air between the teeth creates the hiss. 

Component, capability-based therapy “layers” and combines the elements into a correctly and functional stabilized and mobilized speech sound production.  “Correct” means:  the physiological stabilization-mobilization components smoothly blend to facilitate a clean acoustic production of the target sound. 

Please Note:  The combined stabilization-mobilization components lead to and facilitates correct production during conversational speaking. 

The component complexity increases during connected speech. It is, therefore, beneficial for speech sound stabilization-mobilization fundamentals to be in place.  These fundamentals overwhelmingly impact the generalization process.  Gick and Allen in 2013 state, 

Following are a few additional principles to keep in mind regarding this type of component, capability-based therapy: 

• Practice each component over time, according to the child’s capability level, then combine. It’s a process of building (and layering) the child’s oral capability to produce the sound correctly. 
• Component, capability-based therapy is not the same as traditional sound-stimulation (“sound-stim” therapy). Here’s what this therapy isn’t:  Ask the child to do an oral component task, repeat it, then expect an immediate correct production of the speech sound to emerge.  It’s nice when it happens, but certainly it’s the exception. 
• In this form of therapy, the child is not required to repeatedly search and figure out oral placement on his/her own. Component therapy leaves no doubt as to where the tongue stabilizes and how and where it moves. 
• During production in this type of therapy, the child received helpful intra-oral feedback from the source. He/she does not rely completely on auditory feedback after he/she has said the sound.  Intra-oral sensory feedback is immediate. 
• Some types of therapy use an all-or-nothing, right-or-wrong criteria, i.e. “Say /r/.” This can be frustrating for everyone when the child is not capable of saying the sound; this disappointment may occur for several months. On the other hand, in component, capability-based therapy, the child experiences small increments of success as he/she builds the capability to produce the speech sound.  During this process, these small increments of accomplishment motivates the child to continue working. 

It’s a win-win for everyone.  

Thank you for all you do with your therapy-kids; you are appreciated! 

Have a great week, 

Char 

P.S.  For more on Lingual Stabilization go to “Speaking Tongues are Actively Braced,“ and, for more on generating front-tongue elevation, go to, “A Remarkable Method to Lift the Front-Tongue.” 

P.P.S.  More on this part-whole topic (and other controversial topics) can be accesses at “The Perfect Oral-Motor Storm.”

Resources 

Dawson, P.E.  (1989).  Evaluation, diagnosis, and treatment of occlusal problems (second edition).  The C.V. Mosby Co. 

Fletcher, Samuel.  (1992).  Articulation:  A physiological approach.  Singular Publishing Group. 

Gick, B., and Allen, B.  (2013).  Speaking tongues are always braced.  The J of the Acoustical Soc of Amer, 134,4204.  

Gick, B., and Allen, B., Roewer-Desperes, F., Stavness, I.  (2017).  Speaking tongues are actively braced.  J Sp Lang Hear Res, Vol 60,494-506.  

Kier, W.M., Smith, K.K.  (1985).  Tongue, tentacles and trunks:  The biomechanics of movement in muscular-hydrostats.  Zoological Journal of the Linnean Society, 83,307-324. 

Kleim, J.A., Jones, T.A.  (2008).  Principles of experience-dependent neural plasticity:  Implications for rehabilitation after brain damage.  J of Sp Lang and Hear Res, Vol 51,S225-S239.  

Lof, G.L. (2017).  Tools for Skeptical Thinking, Pennsylvania Department of Education, Handout,page 15. 

Magill, R., Anderson, D. (1998).  Motor Learning and Control:  Concepts and Applications.  McGraw Hill Education, New York, NY. 

Rose, D.J.  (1997).  A Multilevel Approach to the Study of Motor Control and Learning.  Allyn and Bacon. 

Rudy, K., Yunusava, Y.  (2013).  The effect of anatomic factors on tongue position variability during consonants.  J of Sp, Lang, and Hear Research, Vol. 56,137-149. 

Stone, M., Faber, A., Raphael, L.J., and Shawker, T.H.  (1992).  Cross-sectional tongue shape and linguopalatal contact patterns in /s/, “sh”, and /l/.  Journal of phonetics, 20,253-270. 

Wightman, E., and Lintern, G.  (1985).  Part-task training of tracking for manual control.  Human Factors, 27,267-283.