Dynamic speech assessment can be a quick way to gain a lot of helpful information during an evaluation.
Free DIRECT download: Tips for dynamic speech assessment (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- What is dynamic speech assessment?
- Benefits of recording speech samples.
- First, obtain baseline speech production data.
- Steps for dynamic speech assessment.
- Common speech strategies
- Wrapping up the evaluation.
- Related Eat, Speak, & Think posts.
- What tips do you have for speech assessment?
What is dynamic speech assessment?
I learned about dynamic assessment in the context of working with children. Dynamic assessment is highly individualized and involves testing, teaching, and re-testing.
Using dynamic speech assessment, we can answer various questions about our patients:
- Can they modify their speech?
- Does their speech improve in any way?
- How easily can we shape their speech?
- Are they willing therapy partners?
- How much insight do they have into their impairments?
- Can they detect improvements in their speech?
- Are they able to describe what they did to improve their speech?
In a nutshell, dynamic assessment allows us to quickly try out different therapy strategies and levels of cueing to find what works. In the process, we gain some understanding of our patient’s insight into their impairment and their ability to participate in therapy.
Benefits of recording speech samples
Recording speech is an integral part of my practice for assessing and treating speech impairments. I find it useful for many reasons.
Recording speech samples:
- Creates a record of baseline speech abilities.
- Captures improvements with dynamic assessment.
- Educates and motivates the patient.
- Serves as an invaluable therapy tool.
- Highlights progress made from initial assessment to discharge.
- Offers a powerful tool for the patient to continue using after discharge.
Start your assessment as you normally would.
First, obtain baseline speech production data
As always, we begin by establishing our patient’s baseline speech abilities using standardized and non-standardized assessment methods.
For instance, we can record our patient producing speech during the following assessment tasks:
- Personal narrative.
- Reading the Rainbow passage or Grandfather passage.
- Procedural narrative.
- Reading the Fisher-Logemann sentences.
- Other standardized measure of speech.
Recording baseline speech measures allows us to analyze various aspects, such as:
- Rate of speech.
- Frequency of errors.
- Type of errors.
- Prosody.
- Intelligibility.
Once we’ve obtained the data we need for our assessment of baseline speech abilities, we can turn to dynamic assessment.
Steps for dynamic speech assessment
Here are the steps we can follow to dynamically assess speech.
Find a strategy that improves their speech
- Demonstrate the use of a speech strategy.
- Ask the patient to imitate.
- Give cues until they’re successful (or switch to another strategy).
- Record a short sample of improved speech.
I don’t exhaustively explore all options. Instead, I try various things until I find a strategy and cueing combination that produces a noticeable improvement in their speech. Then I move on to the next step.
Patient judges baseline speech
- Play a snippet of their baseline speech sample.
- Ask them what they notice.
- Reinforce what they say, or provide an observation of your own.
This allows us to judge their level of understanding of their impairment. Most people can only give a gross characterization of “not normal”.
I always give my impressions as well, to start teaching them how to pick out nuances in their speech. In my experience, outcomes are better when people learn to detect small improvements in their speech over the course of therapy.
Compare baseline speech to the use of a strategy
- Play a snippet from the recording of your patient using a speech strategy.
- Ask what they notice. What’s different from the baseline?
- Reinforce what they say, or provide an observation of your own.
Many people can’t hear a difference, and it’s fine to reassure them that this is normal. After all, we’ve had years of training and practice listening closely to speech.
This is a skill that they can learn over the course of therapy. Learning to detect changes in their own speech will help them use the strategies in their day-to-day life.
Describe strategy in own words
- Ask them to use the strategy again, this time paying attention to how it feels.
- Then ask them to describe it in their own words.
Finally, try to get your patient to describe the use of the strategy in their own words. This can be very helpful in promoting independent use of the strategy.
Common speech strategies
There are a number of strategies we can try with our patients. Here are the ones I use most frequently.
Talk louder
I’m certified in LSVT LOUD, and for that therapy, I only cue people to talk loudly, even though they usually have other speech impairments beyond impaired loudness.
Research shows that focusing on a therapy target of speaking loudly automatically results in a range of improvements, including articulation and prosody.
Outside of Parkinson’s disease, I’ve found that asking someone to talk a little more loudly can automatically improve intelligibility, change the rate of speech, and may improve prosody.
Most people can imitate talking more loudly, or are able to do so with direct instruction.
Here are some instructions that may help people who need more support:
- Imagine that you’re talking to someone at the other end of the house.
- Pretend that you’re on stage with a broken microphone, and the people in the back row really want to hear you.
- Imagine that I’m heard of hearing.
- Pretend that you’re angry.
- Imagine that a child is going to chase a ball into the street.
If our patient is still struggling to increase their volume (and we think it’s useful to keep assessing this strategy), we can use an app such as Bla Bla Bla which rewards louder sounds with more movement of characters.
Over-articulate
Sometimes increasing volume doesn’t improve articulation, but telling the person to “over-articulate” or “enunciate” does.
Not everyone understands these words (“articulate” or “enunciate”), so if the strategy works, we can ask them to describe in their own words what we just did. That way we can use vocabulary that makes sense to them.
We may cue people by saying:
- Be dramatic.
- Imagine that you’re over-acting.
- Make big movements with your mouth.
If necessary, we can pull out a mirror to provide visual feedback. I don’t use visual feedback for long as that’s not a natural form of feedback. Instead, I’ll ask my patient to notice what it feels like and then repeat it without the mirror.
Slow down
If our patient successfully improves their speech by speaking louder or over-articulating, then it’s likely that they will automatically slow down.
But if we want to target slowing down directly, here are some strategies to try out.
- Imagine that you’re talking to someone who is learning English.
- Pause longer at natural pause points.
- Tap your finger on your leg (or table) once for each word as you say it. Slow the pace.
- Touch the first letter of each word on an alphabet chart as you say it.
- Touch a box (in a row of boxes) as you say each word.
If these strategies don’t slow down the speech, we can ask the patient to talk in unison with us. For instance, we could recite the days of the week together while slowing the pace down. Then we can mouth the words but stop talking. Make a recording and see if we can detect any improvement in their speech.
Wrapping up the evaluation
By this point, we’ve gained a lot of knowledge about our patient. We’ve:
- Established the type and severity of the speech impairment.
- Demonstrated that we can shape our patient’s speech to improve it.
- Shown our patient that their speech responds to speech therapy.
- Gained understanding of our patient’s insight into their impairment.
- Learned at least one strategy that will be helpful.
- Started teaching our patient how to monitor and adjust their own speech.
The next step is to confirm that our patient agrees to speech therapy and is willing to put in the work necessary to improve their speech.
Finally, we discuss their specific goals for improving their speech, if this wasn’t already covered earlier in the session. Knowing our patient’s specific goals allows us to write personalized SMART goals.
Related Eat, Speak, &Think posts
- Single-use communication evaluation folders.
- Assess readiness to change for better therapy outcomes.
- Collaborative goal-setting to identify meaning cognitive goals.
What tips do you have for speech assessment?
I love learning new approaches. Please share your tips in the comments below, or contact me privately. I’d love to hear from you!
Free DIRECT download: Tips for dynamic speech assessment (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by Pexels on Pixabay.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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