Posted by “While a majority of the SLPs surveyed agreed that prosody is within their scope of practice, they also reported that their knowledge and clinical training on assessing, diagnosing, and treating prosodic impairments is not adequate.” -Sarah Elizabeth Fischer, 2018
This excerpt comes from a thesis project submitted to the University of Mississippi. I came across it when I was trying to figure out if I was the only one who felt uncomfortable and unsure about treating prosody. My answer: not in the slightest.
Sure, I knew what prosody was. Sure, I knew it was part of my scope. But, I wasn’t really sure how to tackle it. Or when to prioritize it. So I started digging, trying to find all I could that might support me – that might help me support my clients. All this digging inspired the new Bjorem Speech Prosody Cues.
Here’s a little snapshot of what I found (and how the Bjorem Speech Prosody cues can help!):
What is Prosody (a refresher)
Prosody refers to the suprasegmentals of speech – pitch or intonation, stress, loudness, rate including pausing and overall rhythm.
Prosody as it relates to Apraxia of Speech
Why it’s important: Often children with apraxia of speech present with unusual prosody. Speech may sound robotic-like with equal stress, prosody may be flat without variation or with unusual variation, and rate may be too fast or too slow. These irregularities often impact speech intelligibility. Check out this post for more.
How to target it: Don’t wait, start right away! Preston (2018) suggests that prosodic variation supports the motor learning principle of variable practice, in that it can increase speech motor learning for children with Childhood Apraxia of Speech. Dynamic Temporal Tactile Cueing (DTTC) includes prosodic variation in the early stages of its hierarchy for motor learning. The idea is that the variation in prosody helps to solidify the motor plan. Check out Jennie Bjorem’s visual for DTTC here and the free online course by Edythe Strand clicking here, then selecting ongoing events & more information. When a child can accurately produce a word, immediately vary its prosody. You can do this by changing its stress pattern, increasing or decreasing loudness and/or pitch, increasing or decreasing rate. A fun way to introduce this is by using silly voices (i.e. use your mouse voice, your dinosaur voice, etc.) Jennie always says start treating prosody yesterday!
Using the Bjorem Speech Prosody Cues for Motor Planning/Apraxia of Speech:
-Use cues to alter prosody when using the DTTC (Dynamic Temporal Tactile Cueing) hierarchy
-Use cues to achieve appropriate and natural movement between sounds and words
-Use cues with original Bjorem Speech Sound Cues to support speech naturalness for generalization
Prosody as it relates to Social Language
Why it’s important: Prosody often indicates meaning. We change our intonation based on our mood, an important skill for both understanding a message and conveying a message. We must make inferences based on tone of voice to figure out someone’s mood or intention. We use prosody to indicate if we are making a statement or asking a question, or even to use sarcasm and tell jokes. If we are unable to interpret and use prosody appropriately, it may lead to communication breakdowns and misunderstandings.
How to target it: A great place to start is identification. Having a child listen to variations in prosody to infer mood, or meaning of a message. Varying the stress in a sentence to differentiate meaning and identifying. Often having a word bank to select from to start and then fading those cues. After identification is successful, working on role playing and charades of emotions, statements and questions. Often sarcasm is the most challenging so contrasting statements using a sarcastic tone of voice vs. a serious tone of voice for identification to start, followed by expressive practice. Watching videos and movie clips can also be a great way to see several different models of varying intonation.
Using the Bjorem Speech Prosody Cues for Social Language:
Prosody tells a lot about what someone might be thinking or feeling. For example using the “stretched” speech visual (#28, 29) might indicate sarcasm. The different emotion cards can be paired with their pitch, rate, volume, or movement characteristics to show how we alter our voice depending on our mood, intended meaning, or our communication partner. Use the emotion cards to play “verbal charades” and practice guessing the emotion based on intonation.
Other ways to target speech prosody using the Bjorem Speech Prosody Cues:
Prosody Game
Use the character cards (# 4-15) found in the Bjorem Speech Prosody Cues to play a game that targets vocal play and prosodic control with different voices. The character cards are numbered 1-6 on the back. Flip them over and use a dice or spinner to see which character you get. The cards can be seperated into two sets of 6 to play with specific voices of your choosing. Be silly and have fun with these!
Reading Fluency
Visual cues can help with expression and fluency when reading. Different cues found in this pack can be useful in working on reading fluency. For example, use the “pause” cue to indicate commas or periods. Use emotion cues for dialogue or different punctuation. Rate visuals can serve as a reminder to speed up or slow down and stress dots can be used for appropriate intonation. Reading with expression can aid in both comprehension and fluency.
The possibilities are endless! This deck has applications for auditory verbal therapy, social language goals, apraxia of speech treatment, reading fluency, and any other area that requires use of appropriate speech prosody for using and understanding communication. Check-out this video reviewing all that is included in the deck of Bjorem Prosody Cues!.
-Kelsey Coaldrake, M.A. CCC-SLP @iowaspeechie
Sources
Fischer, Sarah E. “Speech Language Pathologists and Prosody: Knowledge and Clinical Practices.” Oxford, 0AD.
Meredith, Amy. “Prosody and Articulation.” Apraxia Kids, 28 Nov. 1970, www.apraxia-kids.org/apraxia_kids_library/prosody-and-articulation/.
Preston, Jonathan L., et al. “Variable Practice to Enhance Speech Learning in Ultrasound Biofeedback Treatment for Childhood Apraxia of Speech: A Single Case Experimental Study.” American Journal of Speech-Language Pathology, vol. 26, no. 3, 2017, pp. 840–852.
Bjorem Speech 