Historical Perspective on Tactile Approaches to Speech Therapy

Recently Caroline Bowen on Twitter (@speech_woman) alerted us to a new fad, therapeutic massage. Of course, the therapy techniques being promoted on the website that Caroline linked to and in the workshops offered by the person in question are not new at all. I recognized them immediately as being very very old and the historical basis for other techniques that are in current use such as tactile cueing and PROMPT. The description of therapeutic massage that was offered (I’m sorry, I refuse to link to the site) put me in mind of Charles Van Riper’s brilliant response to the Motokinesthetic Method which I reproduce here for your edification and enjoyment:

“We have previously mentioned the Motokinesthetic Method invented by Edna Hill Young as one of the approaches used in teaching a child with delayed speech to talk. It has also been used in the elimination of misarticulations. Essentially, this method is based upon intensive stimulation; however, the stimulation is not confined to sound alone but to tactile and kinesthetic sensations as well. The therapist, by manipulation and stroking and pressing the child’s face and body as she utters the stimulus syllable, helps him recognize the place of articulation, the direction of movements, the amount of air pressure, and so on. Watching an expert motokinesthetic therapist at work on a lisper is like attending a show put on by a magician. The case lies on a table with the therapist bending over him. First she presses on his abdomen to initiate breathing as she strongly makes the s sound; then to produce a syllable from the patient, her fingers fly swiftly to close his jaws, spread the lips, and tap a front tooth, thereby signaling a narrow groove of the tongue or the focus of the airstream. Then her magical fingers squeeze together to draw out the sibilant hiss as a continuant.

One therapist, when working with a child,  used to “draw out” the s, wind it around the child’s head three times then insert it into her ear, thus insuring that it would be prolonged enough to be felt. Each sound has its own unique set of deft manipulations, and considerable skill is required to administer motokinesthetic therapy effectively. Viewed by the cold eye of the modern speech scientist, many of the motokinesthetic cues seem inappropriate; and a therapist would need sixty fingers and thirty arms to provide sufficient cues to take care of the necessary integration and coarticulation. Moreover, much of our research has indicated that standard sounds are produced in different ways by different people, and that their positioning vary widely with differing phonetic contexts. We suspect that much of the effectiveness of this method is due to its powerful suggestion (the laying on of hands), to its accompanying auditory stimulation, or to the novelty to the situation, which may free the case to try new articulatory patterns. We have used it successfully with some very refractory cases, but we always have felt a bit uncomfortable when doing so, as though we were the Magical Monarch of Mo in the Land of Hocus Pocus. (p. 198-201).”

This is just one of many delightful passages from Van Riper’s book “Speech Correction: Principles and Methods” (1978 Prentice-Hall edition but first published in 1939). Characteristically, this passage shows Van Riper to be far ahead of his time. Tactile approaches to speech therapy just seem to make sense because, as I heard numerous times at the ASHA conference last week, “speech comes from movement”. However, a point I make repeatedly in our book Development Phonological Disorders , I believe that this perspective is subtly backwards. Speech movements are learned through practice. The practice is motivated by the desire to achieve functional goals. Learning involves linking knowledge of the goal with the movements used to achieve the goals. The movements are learned through the process of achieving goals which are phonetic, phonological and ultimately linguistic in nature. In another post I will talk more about the issues with trying to shape those movements articulator-by-articulator.

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