caregivers of people with stroke and aphasia

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An open letter to clinician who has read and learned The Teaching of Talking

Posted by admin on July 10, 2012
Posted in: TOT. Tagged: , , , , , . Leave a Comment

Dear Elisa,

I awoke this morning with you on my mind; specifically the review that we discussed
In the last few visits. You have conveyed to me some of your experiences with the Teaching
of Talking Method.  You conveyed how you started out doing conventional therapy and how
that was for you.  You indicated to me an excitement when I invited you into the “Teaching of
Talking World” of mine with patients and saw what was possible; a new way of doing therapy
that required essentially no homework sheets, etc, but a style of inquiry and answer; question
and answer.  A way to stimulate thought, which then triggers language.  Interesting questions
that stimulate language.  And then making sure that the questions that are posed elicit the number
of words and complexity of language the client is capable of.  How cool is that?

What I wish for you to review is how TOT and your mentorship experience with me has impacted
the way you do therapy and the results you have been getting (with examples)

Would you also go through the book and really write about it in a few paragraphs.  What makes this
book different from the standard textbooks you had in the past.  How is the readability and the style?
What can you tell about the author of this book as compared to the authors who write speech pathology
books.  What are the distinctions made by this author and how is he different from the others?  

Is this a book you would recommend to your clients and friends?  If so, why?  What would  
happen if a caregiver you were working with in therapy showed interest in doing whatever it took
to help his or her loved one?  What would you tell them about the book, and why would you tell them
about it. What do you think would be possible if he or she were to pick up the book and study it for the
methods therein contained?  And then applied them? How about fellow colleagues or friends from
school who were working with children and adults with severe speech and language difficulties?

What do you think of the approach within The Teaching of Talking?  The chapter on Modeling and the
factors that are necessary to be a good speech model.  What do you think of the screening test that will
show the reader what a speech pathologist evaluates, and how the author helps the reader figure out if
The Teaching of Talking is the right approach for them?  What do you think of the style of instruction where
I give readers actual transcripts that are verbatim in order to help them learn the method.  And repeat them
over and over in order to get the method embedded into the mind of the reader.  What do you think of the conclusion
that not only reviews what was written in the book, but the personal viewpoints of simplicity, never making one
wrong or the philosophy of “re-stimulate” rather than making a value judgement or saying the “response was wrong?”
Or the suggestion of successive approximation?  Allowing the patient to answer in the best way that he or she can
and reinforcing that, with the thought that therapy is about a gradual movement towards improvement, and realizing
that with each and every opportunity to speak, the person with the communication difficulty (PCD)  should improve speaking
clarity and complexity of language?  What the approach is about is always ENCOURAGEMENT.  The ability to take what
the client/patient is capable of and accept and reinforce that for now, while always stimulating that response through the
model and modifying the model constantly to get the desired response from the client.  One of the essential ingredients of
The Teaching of Talking; the model and how the clinician is always modifying his or her model to get the target response
towards speaking clarity and normalcy.  By accepting what a client can do for now, and encouraging anything he can produce
the person with the speaking difficulty (PCD) has no stress or feeling of inadequacy since the clinician is constantly taking the response given and re-stimulating by changing the model of the question or the tell me phrase, until the responses are meeting the goal set by clinician (Speech Model SM) and person with the speaking difficulty (PCD).

What do you think of the stories I intersperse throughoutThe Teaching of Talking  in order to make a point?
Can you give some examples of what you found to be helpful for you?  
Is it the kind of book a speech pathologist or a caregiver could get value out of.  It’s readability or simplicity?
What do you think of this new style of doing therapy and the response patients are having when they have the
chance to talk about what is of interest to them, and what they value? (within the structure of language that they can tolerate?)

What I hope you can do dear Elisa, is put your heart into the writing of this review and really convey a message
to the audience.  Hopefully an audience who will see the value in a simple method, that is really the
one used by many parents, with children, as a child learns to talk; at home;  first simple words, word pairs, phrases
and sentences.  The child does not learn to speak with homework sheets, speech notebooks and the like.
The child learns to speak through an intimate relationship with a loved one who is always inquiring.  It is
a constant inquiry and answer, which in time gets expanded from simple answers to more complex ones, simply by the
parent or speech model who is constantly expanding and clarifying.  It is very much like the fundamental principles of
The Teaching of Talking.  

Finally how has this book impacted you as a clinician; Can you share that with others and let them know how you
think it will have a similar effect upon them as slp’s or caregivers.  How about our discussion of changing health care and the
caps that will certainly be a thing of the future.  How will that impact people with mild to profound speaking difficulties.  Can this
book have an impact for clinicians and caregivers alike who will only have a few visits to get someone started in therapy.  That
in the future, skilled, ongoing care will be a thing of the past for most people with severe speaking difficulties.  And why this book
was written by the author, who saw the future of speech pathology services, and wanted to provide people with speaking difficulties and their loved ones a way back to speaking when their health care delivery system could not?  

Reviews are the lifeblood of whether a book makes it in the marketplace or not  I hope you will write a review that
comes from your heart and soul and conveys who YOU are and what is possible within the walls of the therapy room,
and the improvement of speaking for others with this method.

I send my very best to you, as always.  Your review could have a great influence on whether others would invest their time and effort on this new approach to the improvement in talking!

Mark

Mark A. Ittleman, M.S., CCC/SLP
The Speech Therapist who can make a rock talk!
markittleman@teachingoftalking.com
http://teachingoftalking.com
Office:  713-728-9008

“Helping people speak better
through out the world!”

The Teaching of Talking: Teaching Caregivers to Do Expert Speech Therapy at Home

Posted by admin on June 4, 2012
Posted in: TOT. Tagged: , , , , , , , , . 1 comment

http://www.teachingoftalking.com

In the last few months I have been befriending people from all over the world and sharing with them the methods of The Teaching of Talking, Learn to Do Expert Speech Therapy at Home with Children and Adults. I am posting what Diane posted on her site a few days ago. She is a powerful woman with great insight and drive, and such a advocate for her husband! I would encourage you to check out her site and enjoy her inspirational and “tell it like it is” candor. How refreshing it is to read her posts at www.pinkhouseonthecorner.blogspot.com

The Purpose of Speech Therapy
I think the hardest thing for me to deal with post-stroke is aphasia and Bob’s inability to speak. That’s saying a lot, since most of you know, I have quite a bit to deal with, in fact, you would not have wanted to be at The Pink House yesterday, when there was not one, not two, but three (count them) bowel movements and the last two were complete surprises: one all over the bed and the other landing smack dab into a pair of real underwear. GAA! I tell you, right now, there is a perfectly good pair of real underwear headed to the local landfill because I could just not deal with it. You’d think my gag reflex would be better by now, but alas, it is not. But I have digressed. I was talking about speech therapy.

Since those first post-stroke months, when Bob could not utter a word, only make sounds–sort of garbles and gurgles, I knew he was trying to speak. To get the words out. As a writer, the ability to communicate is far more important to me than, say, the ability to use the bathroom. And so, since those first days, it has been a long and constant struggle to find Bob’s speech, to unlock his words.

http://www.teachingoftalking.com

For a long time, I’ve been searching for that magic key that would unlock those words. Pretty much I’ve been trying every type of therapy technique I could get my hands on. Certainly since the “professional” speech therapists have given up on Bob saying that his “prognosis was poor” or he was “functional” enough, I have been trying harder than ever to prove those saps wrong.

This morning, I woke to the sound of rain on the roof. And I thought, well, I won’t be taking the dog on a long walk in this weather, so I rolled over figuring I had bought myself a little nap time. When I heard Bob, from the next room, call to me:

“Hey? um, hey?”

That’s me he’s calling for. I am sometimes known around here as “Hey? um, hey?” But I figured I’d just ignore him, pretend to be sleeping and catch a few more winks. But then he said,

“Hey! The sun is up!”

I nearly bolted upright in bed, not because the sun was up and that meant I should have my butt out of bed by now, but because that was a very good, spontaneous sentence. And Bob’s main problem area now is saying anything spontaneous, i.e. those type of sentences which just express what’s on his mind.

I recently ordered a copy of the book “The Teaching of Talking” by Mark Ittleman, who is a speech pathologist. Though I haven’t even finished reading this book, the one thing I gleaned so far (though the author never really states it) is that the whole purpose of speech therapy is this: keep him talking. However you can, just keep him talking.

I think I’ve always known that. I know I’ve always done that. But now, it seems totally clear to me that all along this is the “magic key” I’ve been searching for and it’s been right in front of me, heck I’ve been doing it all along, and it’s really quite simple:

Just keep him talking.
And make it as easy and fun as possible.

One of the techniques to make it “easy” in Ittleman’s book is asking the “embedded question”. This is basically a question with the answer already embedded in it. For example, instead of asking, “What flavor pudding would you like tonight?”, I instead should ask, “Would you like chocolate or vanilla pudding?” That way the answer is already stated, the words are right there hanging in the air, and Bob doesn’t have to search his mind for the word “vanilla” because “vanilla” is floating in the air in front of him–he only has to grab onto it and say it.

Bob is very good at repeating things. He can and will repeat something exactly as I say it. Right down to the tone of my voice. And if I, trying to be funny, say something in a silly Chinese accent, he will repeat it back in the same silly Chinese accent. So using “embedded questions” has really helped Bob find the right words.

Another of Ittleman’s techniques is what the author calls the “Tell me” phrase. This is all about repeating, so Bob is also very good with this technique. The idea here is to get Bob to say more words than he usually does. Here’s an example:

Bob: “Up.” (which I already know means he wants to be boosted up in bed, but instead of just helping him boost up, I get him to say more words, like this:)

Me: “Do you need a boost?”

Bob: “Yes, boost.”

Me: “Tell me, I want a boost, please.”

Bob: “I want a boost.”

Me: “Please.”

Bob: “Please.”

I have been working on this technique with Bob daily now for awhile. You can pretty much do this type of thing all day long. I suppose I tend to overdo this, and I’m sure that somedays I am downright irritating to Bob, though I no longer have to give him the “tell me” phrase, I can just ask him for a sentence, as in this example from yesterday while I was giving Bob’s morning meds through the feeding tube:

Bob: “Up.”

Me: “Do you need a boost?”

Bob: “Yes, boost.”

Me: “Give me a sentence.”

Bob: “I want a boost, please.”

Me: “Good.”

Bob: “And, um…” points to his mouth and says “ow.”

Me: “You need some pain medication?”

Bob: “Medication.”

Me: “Tell me, I want a boost and some medication.”

Bob (rolls his eyes), “Oh, puh-leeease.”

OK, I tend to push it. But the nice thing about these techniques is I can sort of integrate it all through the day and not feel bad on those days we don’t have time to sit down for a proper hour of “speech therapy”. As we are now doing neck stretching exercises 3 times daily, and having regular OT visits, time is at a premium.

Recently, both my sister and Bob’s mother had an opportunity to speak on the phone with Bob and both said, afterward, that they thought his speech has definitely improved from the last time they spoke to him. Seems he’s had a bit of a breakthrough speech-wise.

Even though it’s raining here at the Pink House today and things have been mighty hard, as someone said this morning:

Hey! The sun is up!

My Comment to Diane at Pink House on the Corner

Posted by admin on June 3, 2012
Posted in: TOT. Tagged: , , , , , , , , , . Leave a Comment

Dear Diane,
I teared as I read your post about Bob, and using the technique I wrote about in Teaching of Talking. By golly, you are getting it! And you are correct in the assumption that the beauty in the method is that you don’t have to sit down to do an hour of speech therapy. (GAA!) You can just use imbedded questions and tell me phrases all day long at the right time and as the communicative situation dictates. That way you don’t have to sit down for an hour and do boring exercises that do not pertain to real life speaking needs. You stimulate speech and language when it is necessary and that will have much more meaning. Not only that but I believe that as you stimulate speech responses for important everyday events, the speech required in that event should be easier and spontaneously said in future events!
Just make sure you keep stimulating speech in almost every interaction, and making it easy and fun. If it is fun and easy, I do not think anyone with a communication difficulty, unless they are grouchy heads will mind speaking.
Thank you for sharing this inspiring story.
Mark Ittleman, The speech pathologist who can make a rock talk!

PS: There are some other cool methods in The Teaching of Talking Learn to Do Expert Speech Therapy at Home with Children and Adults. You May Want to Review: Please see the Alternative Choice method and the “I’ll tell you about me, if you tell me about you.” I think that will also be fun with Bob!

I love your writing, and dedication to Bob and sharing your voice with the world!………Mark