This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Cerebral Palsy and Intelligibility
By Pam Marshalla
Q: My 12-year-old grandson has cerebral palsy. He understands everything at age level but he is very hard to understand. He is getting very little speech help. How can we help him at home?
Expressive speech is divided into Consonants, Vowels, Syllables, and Intonation Patterns. Most SLP’s focus on Consonants. I would suggest that you focus on Vowels, Syllables and Inflection instead.
In other words, have your grandson practice important words, and instead of focusing on getting the consonants correct, focus on having him say the vowels, the right number of syllables, and an inflection that sound like he is making a statement, or asking a question, and so forth.
For example, if his favorite word is “computer” have him say the word with three syllables and big round vowels – “Uh-Ooo-uh.” Tell him not to worry about the consonants – C, M, P, T, and R.
Teach him that the consonants will be the hardest for him to learn, and he will get better at them over the next 10 years. Tell him that the most important thing he can do now is to say the words with the best possible vowels, the right number of syllables, and the best inflection he can achieve.
My experience is that if a child with cerebral palsy tries to hard to make the consonants, his speech gets choppy, the vowels get very distorted, and the prosody that should hold up the intelligibility gets altered dramatically. Trying too hard to make the consonants correctly will make the words unintelligible to others. The vowels, the syllables, and the musical intonations are what will help more people understand him.
When he does work periodically on a consonant or two, teach him to make them softly, without much force. Most children with cerebral palsy who are smart try too hard to make the consonants. This distorts the rest of his speech. Teach him soft control.
Also teach him to help his listener get on the right topic before he speaks a whole phrase or sentence. The speaker who knows the topic can understand quite a bit more than one who doesn’t. He can use words or his augmentative communication system to get the listener on topic.
Thank you for this. I am a new graduate Speech-Language Pathologist and I don’t think anyone said I should focus on vowels before consonants with kids who are CP. I have a hard working client who cannot get clusters together. Especially when he has to go from back to front like /kl/ He always adds the schwa in between and the harder he tries the worst it gets. I don’t know why I didn’t realize his intelligibility can be enhanced when just focusing on making sure to keep the right number of syllables and the intonation right. This will really help him! I also like the suggestion about soft control I’m going to work on this with him the next time I see him. Thank you for this fabulous website I have learned a lot!
You are welcome. Don’t worry about the schwa between the two consonants of clusters. Clients ADD the cluster to help them make the sequence. Let him use the schwa as long as he needs it.