Ever wondered how a deeper understanding of brain plasticity could revolutionize your language therapy sessions? Join me as I share my key takeaways from Norman Doidge’s eye-opening book, “The Brain That Changes Itself”, and how we can harness the power of brain plasticity to create more effective and efficient therapy practices. Discover how roadblocks can pave the way for new brain maps, the significance of clear signals in information retention, and why focused attention is indispensable for molding and reshaping our brain maps.

Let’s dive into the fascinating world of auditory processing and its connection to language and speech impairments. Learn how I use pictures and descriptors to aid clients in naming exercises, and a shopping activity that helps improve word retrieval. We’ll also explore the challenges language-impaired children face in perceiving the fast parts of speech and shed light on David Kilpatrick’s “Equipped for Reading Success” program, which has been a game-changer for me as a clinician. Don’t miss this enlightening episode that will transform the way you approach language therapy and help you unlock the full potential of the brain’s plasticity!

— Useful Links —

The Brian that Changes Itself  
Picnic Fun
That Thing That Isn’t APD
Equipped for Reading Success 
Phonological Awareness Tracking Tool
Whole Body Listening
Impossible R Made Possible

Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript
Welcome to the Speech Umbrella, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Denise Stratton, a pediatric speech-language pathologist of 30-plus years. I’m closer to the end of my career than the beginning and along the way I’ve worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness. Hello, welcome to The Speech Umbrella podcast. Summer is well and truly here, and what better way to celebrate summer than to kick back and relax with a good book. A few years ago, I started reading a fascinating book called “The Brain That Changes Itself by Norman Doidge. I didn’t get a chance to finish it then, but it was always in the back of my mind to finish it someday. Well, I finally did, and it was worth the wait. It’s basically a book on neurology and learning. You might be thinking that’s the last way you want to spend your free time, but it’s so well written for the everyday person and so filled with stories in hope and recovery that I found it a really great read. That also has big clinical implications for anyone who wants to teach a learner how to learn. This episode is called Three Therapy Takeaways from “The Brain That Changes Itself by Norman Doidge. One of the problems we run into as SLPs is trying to get learners to the place where they can learn, where they can actually take in what we’re offering. With some clients, I feel it’s as though what we’re trying to teach just runs off and away, and until we can find the cracks through which information can penetrate, we don’t get very far. And another problem we have is overcoming speech and language habits so ingrained that they seem set in stone. Doidge writes about both of these issues with ideas on how to overcome them. Here’s what we’re covering today; The basic premise of “The Brain That Changes Itself” book, three takeaways on the laws of learning, and clinical applications. If you structure your therapy around the laws of learning, it will make you a better therapist. The overarching idea of “The Brain It Changes Itself is that the brain is plastic, far more plastic than many scientists used to think. Not just in infancy and childhood, but the plasticity can be tapped into in old age. Now there’s a neuroscientist called Michael Merzenich who led the cochlear implant team at UCSF, and he’s done a lot of work on brain plasticity. He claims that when learning occurs in a way consistent with the laws that govern brain plasticity, the mental machinery of the brain can be improved so that we learn and proceed with greater precision, speed and retention. What are these laws that govern brain plasticity? Well, there isn’t time to cover the entire book, but the three takeaways I want to talk about today are; using roadblocks to help the brain form new maps, two, the fact that the brain needs clear signals, and three, focused attention is critical to forming new brain maps. Okay, so what does it mean to use a roadblock so the brain can learn or relearn? There’s this analogy in the book that I love. If you’re sledding down a hill and you make that first pathway in the snow and you use that pathway again and then again, pretty soon that’s going to be the only way your sled is going to want to naturally go, and that slope is going to get pretty slippery and pretty fast and you would have to really do something different to make your sled go a different way. It would take some effort, it would take a new approach, it would take blocking the old path to get your brain to take a new path, and so the whole idea of this book, of this roadblocks, is when someone has some neurological damage or if they’re born with some neurological impairment, the brain develops these pathways that are not desirable because they impair them in some way, and if you put a roadblock in the blocks the old pathway you can teach them a new pathway. It’s a really cool idea, and there’s really great research in the book about ways they experimented and proved this. Now, putting up roadblocks so the brain can take a new path and strengthening the weakest functions are two sides of the same coin. One example of using both of these ideas the roadblocks and strengthening the weakest function is what they call constraint induced therapy, and one way this has been used is when stroke patients are left with paralysis, they’re not allowed to use their stronger hand. They have to use the impaired hand over and over and over again for increasingly complex tasks, and in studies done with this constraint induced therapy, they have had astonishing success at rehabilitating the weaker side, because the brains were able to make or reconnect new maps when the weak part was exercised. And in the clinic where they study this, they use mitts and they use slings on the stronger limb, and that was their roadblock, so that the patient had to use the weaker side. And because the stronger limb was constrained, the brain couldn’t default to the old pathway, it had to make a new pathway. And Doidge writes what rewires patients’ brains is not mitts and slings, of course. The essence of the cure is the incremental training or shaping, increasing difficulty over time. Mass practice helps rewire brains by triggering plastic change. Now, as speech therapists were really really familiar with that shaping and increasing difficulty over time when taking small steps. Now here’s a study that’s a little bit more relevant to our field, using constraint induced therapy. They used it with some patients who had aphasia and the constraints weren’t physical, but they were a series of language rules which they introduced slowly, and the way it works is they play a game a little like adult go fish. These patients have to ask other patients for a matching card and at first the only rule is that they not point to the card, and that is so that they don’t reinforce learned non-use. So they have learned to not use their speech and they don’t want to reinforce that. The y can use any kind of circumlocution they want any kind of language as long as they are talking. And then from that point they move on to naming an object, correctly, and then they add the person’s name that they’re asking the card for, and so on and so on, until they gradually add more and more language. And this constraint induced aphasia therapy was used with patients who were, on average, eight years post stroke. With the control group they use what they call conventional therapy. And they said that was just repeating words, and I understand that’s not the best conventional therapy treatment, but leaving that control group therapy technique aside, what happened with the constraint induced treatment was they did have great results. After 32 hours of treatment, which took place over 10 days, they had a 30% increase in communication. And so, considering how many years post stroke these patients were, I find that remarkable. I can see using this with clients who struggle with word retrieval and moving through different levels, starting with naming, then adding a descriptor, then using a basic noun, verb phrase and adding maybe a preposition or a direct object. I can imagine a shopping activity where you built a shopping list and take your basket to the store and it could go something like this. So suppose you’ve got grapes, and so, you’re just practicing grapes and then purple grapes. Then let’s get purple grapes. Put the purple grapes in the basket, and the constraint induced therapy could be replacing pointing with words. And then you add in the shaping, and small incremental shaping to increase the difficulty, and this would not happen all in one session, of course. A way to ramp this up is to practice naming, just naming by itself, like five to seven objects in a row. Now I use pictures and then add a descriptor. I let them come up with the descriptors if they can, and after they don’t struggle with the descriptor and the noun, you can start adding words to the phrase. So I might do it like this – I might have an apple and a banana and a pineapple, and I’ll go red apple, yellow banana, sweet pineapple. Something like that. But first we would just practice apple, banana, pineapple. Until it was easy for them to name, they weren’t struggling with retrieving those three words, and then we would add the descriptors. And then it’s not so hard to say hey, let’s buy a banana, and we slap that banana on our shopping list and oh, let’s get some purple grapes. Mmmm, sweet pineapple, let’s get sweet pineapple. And once you have your shopping list built, then you go shopping in your therapy room. And, by the way, you can get food and animal pictures from my picnic fun activity available on my store at thespeechumbrella.com. And then, after you go shopping, you can go on a picnic with your stuffed animals. That’s where the animal pictures come in. Okay, moving on to the next law of brain plasticity, clear signals. A person’s memory can only be as clear as the original signal, but research suggests a lot of our clients aren’t receiving clearer speech signals, even though they have no problems with conductive hearing. The research I’m about to describe here might be somewhat controversial in our field because it suggests that nearly all speech and language impaired children have auditory processing struggles. Now, if all, or nearly all of our clients struggle with receiving clear speech signals, then should we have a separate diagnostic category called auditory processing disorder? I don’t want to go too deeply into that question today. I have a whole podcast on it. That’s Episode 44 called ‘That Thing That Isn’t APD.’ But I don’t want to ignore the elephant in the room. I prefer to look at a child’s symptoms, treat the symptoms and don’t worry about the label so much. So, if you can determine that they’re struggling with auditory processing, then treat it. Here’s a summary of the research Doidge writes about. Paula Tallal found that language impaired children had auditory processing problems with consonant – vowel combos that are spoken quickly, and she called these the fast parts of speech and that they had trouble hearing them accurately and reproducing them accurately. And has a theory about the fast parts of speech, which is that the auditory cortex neurons were firing too slowly, and this meant that; one, they couldn’t distinguish between similar sounds or be certain if two sounds occurred close together, and two, they didn’t know what order they came in, and three, they didn’t hear the beginning of syllables or sound changes within syllables. Now I just have to put a plug in for “Equipped for reading success” by David Kilpatrick. I’ve been using his program for a couple years and this is exactly what I see. The more severe the speech and or language issue is, the harder it is for those kids to hear the beginning of syllables, especially internal syllables. I mean, this is a huge struggle for some of my clients, but this is the cool thing. When they do start to hear the syllables and they can analyze these words by removing syllables or changing syllables, then I have come to expect a significant change in their language ability. It just happens every single time. Every single time they figure out the syllable analysis part of this program, they make a huge leap. Now back to the research, because, yes, there is more. After processing a sound, normally our neurons are ready to fire after a 30 millisecond rest, but 80% of language-impaired children took at least three times longer and because of this they lose large amounts of information, and also the signals aren’t clear. It’s what Merzenich called muddy in, muddy out. And this weakness in hearing led to weakness in all language tasks: vocabulary, comprehension, speech, reading and writing. I mean, that’s what we see in our field, right? We see that all the time. Also, these children used shorter sentences and didn’t exercise their memory for longer sentences. And now that I’m starting to pay attention, I see this muddy in, muddy out all the time, especially in clients who don’t really have an articulation disorder. What they have is a language disorder disguised as an articulation disorder, because while they have the motor ability to say the words, they don’t remember how to say them. It comes out sounding a little bit muddy and mushy and we think it’s a speech disorder. So what I do when this happens – I pull out my phonological awareness tracking tool, I use it to find out where they need to start and then away we go. This tracking tool has been a life changer for me as a clinician, and you can also get the phonological awareness tracking tool on thespeechumbrella.com. The third law a brain plasticity I’m covering is focus. I’m all about focus. That’s why this podcast used to be called the Mindful SLP. I love, love, love talking about focus. Doidge writes, lasting changes occur only with close attention, while you can learn when you divide your attention. Divided attention doesn’t lead to abiding change in your brain map. Isn’t that what we see when kids don’t carry over, when they don’t generalize, it’s not abiding change. Focused attention is the condition for plastic change. Anything that requires highly focused attention will help that system. Are you fans of whole body listening? I am, and this is why I love it. I see real lasting changes when my clients are paying attention with everything they have. This can take some time to teach, but I tell you it’s worth every therapy minute you spend on it. If you want lasting change, if you want carryover, focused attention is a must. Here’s another interesting tidbit. Evidence suggests that unlearning existing memories is necessary to make room for new memories in our networks. In articulation therapy I play a game which seems to help clients both learn a new path and unlearn an old path at the same time. It’s really helpful with phonemes that can be distorted, such as R, but you can really do it with any sound. I call it Mind Your R’s in my Impossible R Made Possible course, which you can find at thespeechumbrella.com/R-course. This is how the game works. I have three boxes with a one, two, three in each box and I have mini M&Ms, because that makes it fun. For a client to play this game they do need to be able to say a word, even if it’s just one word, correctly. And so what you’re going to do, is you’re going to take a word like robot. Say we’re working on the R sound robot, but they’re not really consistent with saying it correctly, and so it comes out ‘wobot”, but sometimes, or maybe their error is “raobot”, where they kind of have R but they don’t quite have it. Or maybe they’re distorting it by trying too hard “R robot, kind of like that. It can work with any of these, but what you’re going to do is you’re going to make sure that they can say it right. You say, okay, now let’s say robot. How are you going to say it the right way?” And they’ll say “Robot and then you say, how are you going to say it the wrong way? And they might go, really often go, “Lulululobt” I mean, really they’ll do that because they want to make sure they’re wrong and they just make it silly. I’m like, “no, no, that’s not how you say it wrong when you make a mistake.” And I’ll mull it for them, this is how you sound when you don’t quite get it. And we’ll practice it, we’ll practice their wrong way, the way they actually say it wrong when they’re not paying attention. Okay, and then the way the game goes is they have to say it right twice and wrong once. I’ve got three boxes. We’ve got an M&M in each box, and I’m the listener and I determine which one is the wrong one. And I get to eat that M&M. And they are so surprised when I choose their wrong one sometimes, because often the one they think is wrong is the one that sounds the best, and it’s just really weird. It’s really freaky. And we take turns with this, so I am also the speaker and they’re the listener. And they can always determine my wrong one, always. So it’s not so much a muddy in muddy out with listening to me, it’s a muddy in, muddy out listening to themselves. This game is awesome and I’ll also use recording a lot, because they’ll argue with me about which one they said wrong. But when they can hear themselves, when they play it back and have times like, oh yeah, okay. Fidelity to the process is really critical for this to work and this is gonna take some work with your hard clients. They must say it right two times and wrong once. Whatever rules you set up, they have to do that or they won’t be clear. They won’t be clear about what they’re doing and that auditory signal will be muddy. I’m often set on this podcast that neurons that fire together wire together, but it turns out that neurons that fire apart wire apart too. We can weaken links and help the unlearning process. For example, compulsive practice of a sound the wrong way, and that’s what Mind Your R, or any sound you’re working on, that’s why that game works, cause you’re helping them unlearn the proce ss and you’re helping weaken those links that have been forged. It interrupts the compulsive repeating of a phoneme the wrong way and really focuses their attention to the differences between the right and wrong way. As neurons are trained and become more efficiently process faster. This means the speed at which we think is plastic, because it can be changed, and as these changes start to occur and automaticity starts to happen, they learn to do the new skill easily and effortlessly. I hope I convinced you to pick up “The Brain That Changes Itself” by Norman Doidge. Before I go, here’s a quick recap of the rules that govern brain plasticity. A roadblock of some kind is necessary to help us change direction and form a new brain map. Faster neurons give clearer auditory signals, and a memory can only be as clear as its original signal. When working on persistent articulation errors that are not motor based, first teach them to say it once, and only once, and pay attention, and they will learn to generalize that sound. Implement the rules of brain plasticity and complex learning will take care of itself. Thank you for joining me under the speech umbrella today. I hope you learned something to help you in your therapy. If you did, please share this podcast with a fellow speech therapist and leave a five star review on Apple Tunes, Spotify or wherever you get your subscriptions. While you are online, come on over to TheSpeechUmbrella.com where you will find transcripts, links, and my free resource library. I also have some other valuable courses and therapy aids in my store. That’s all at TheSpeechUmbrella.com. Let’s connect on social media. I’m dstrattonSLP on Instagram and The Speech Umbrella on Facebook and YouTube. You can also find me on TPT. I hope to talk to you soon. Bye.