Online Gaming and Speech Therapy

I have just read this marvelous paper tweeted out by @vaughanbell: Stafford, T., & Dewar, M. (2013). Tracing the Trajectory of Skill Learning With a Very Large Sample of Online Game Players. Psychological Science. He was impressed by the very large sample size (N = 854,064) but I am impressed by the relevance of this paper for speech therapy. The researchers used “detailed records of practice activity from an on-line game” and used it to test hypotheses about learning in the game which requires “rapid perceptual decision making and motor responses”. Gratifyingly for us as speech-language pathologists, the results confirm the principles of motor learning that are currently promoted for successful treatment of childhood apraxia of speech (CAS), specifically practice intensity, distributed practice and variable practice conditions (for application of these principles to the treatment of apraxia of speech see for example Gildersleeve-Neuman in the ASHA Leader or Tricia McCabe’s ReST program).

There was one concept raised in the paper that was a little bit novel with respect to the CAS literature however: specifically, the authors talk about the “exploration/exploitation” dilemma. In the context of this simple but bizarrely fun computer game (found here at The Welcome Collection)  you can explore the axon growing environment when first learning to play or you can settle into a strategy of simply clicking on the closest protein in your circle of influence. The latter strategy will work to grow your axon which is the object of the game but you will miss out on learning how to maneuver your circle of influence so as to actively find the “power proteins” that advance the growth of your axon. Exploration has a cost in that it leads to more variable performance early on but the benefit is potentially better performance with longer experience. In fact, Stafford et al. observed a close relationship between higher early variance in performance and better performance during later attempts. This trade-off between exploration and exploitation reminded me of the importance of the expansion stage in early speech development and the implications for intervention with young children with CAS.

In Table 10-1 of Developmental Phonological Disorders: Foundations of Clinical Practice we suggest learning outcomes and therapeutic strategies to correspond to four stages of speech development as follows: 1. Expansion stage (explore possibilities of the vocal system); 2. Babbling and integrative stage (controlled variability); 3. Early speech development (expanding repertoire of phones and word shapes to achieve intelligible speech); and 4. Late speech development (ongoing refinements to achieve adultlike speech accuracy and precision). These stages are described in greater detail in Chapter 3 which covers the literature on the development of speech motor control. The expansion stage typically occurs during months 3 through 6 and is characterized by a variety of vocalizations that are not very speech-like (squeals, growls, raspberries and so on) as well as the appearance of fully resonant vowels and marginal babble. It is my experience that SLPs do not appreciate the importance of the expansion stage to normal speech development or understand its significance when planning an intervention program for children with limited if any speech capacity. Therefore I highlight this point in Chapter 10, as follows:

“The importance of the expansion stage in the laying of building blocks for later speech development is easy to forget when choosing goals for speech therapy, a topic to which we return shortly. Another important achievement during the infant period is the acquisition of canonical syllables when the child learns to control the variable parameters explored during the expansion stage, coordinating them to produce well-formed syllables in the context of babble, jargon, and early words. …Typical descriptions of speech acquisition focus on reductions in variability with age. … Therefore, it is not surprising that traditional speech therapy procedures are designed to enhance consistency and reduce variability in the production of phonemes with practice. However, variability is not always an impediment to speech learning and children with DPD often suffer from insufficient variability in their repertoire of speech behaviors. Performance variability can be viewed as facilitating, detrimental, or irrelevant to a successful outcome depending on the motor learning context (Vereijken, 2010). For example, the highly variable vocalizations of the expansion stage provide a complex foundation for the emergence of speechlike vocalizations at later stages. Infants who are described as being “quiet” during the first year of life lack sufficient variability for normal motor speech development. The normally developing infant harnesses rather than reduces this variability to coordinate the separate respiratory, phonatory, resonance, and articulatory components to produce babble in the next stage. Throughout the next 16 or so years there will be a continual interplay between adaptive variability to meet new challenges and increased stability to enhance precision. (p. 758)”

 I often talk to SLPs who are frustrated by failed efforts to teach new phones via imitation to children with severe speech sound disorders. However children with limited vocal repertoires must first be encouraged to freely explore their vocal systems. I describe procedures to encourage vocal play in detail in the book, following Dethorne, Johnson, Walder, and Mahurin-Smith (2009) and supplementing with examples of implementation from my own clinical experience. I hope that Stafford et al.’s interesting research and this amusing little game leads to more reflection about the role of exploration and variability in speech motor learning.

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