On Golf and Speech Therapy

Last weekend I didn’t write a blog post because the weather was spectacular and I was having too much fun enjoying the new deck at my cabin and playing golf. This weekend it is raining so I have plenty of time to reflect on the decline in my golf skills since I gave it up three years ago to devote my weekends to writing a book. My daughter says I should go get a lesson but I am too embarrassed to do that because I am in such poor physical shape. I am not convinced it would help in any case because my husband and I used to go get tune up lessons in the spring and I was never convinced that these were a good investment. The instructors would give me a bucket of balls and leave me by myself while concentrating on my husband. This used to annoy me no end – I thought it was some sort of sex discrimination thing until I complained one time and the instructor says, “no, no – you really don’t need my help, you have a perfect swing, just keep practicing as you are”. Imagine my surprise! If I had a perfect swing, why was my score so awful (even before I gave up golf to write a book my scores were pretty awful but I had a terrific 200 yard drive so my score didn’t bother me so much). Anyway, when I was writing chapter three, I had to study up on theories of speech motor control and I figured out why my perfect swing wasn’t much good to me.

Practice Conditions

The problem is related to the vast difference in the practice conditions for golf relative to the actual playing conditions. Golf lessons and most practice sessions occur at a driving range or a golf dome as illustrated here: the terrain is perfectly flat and the practice mats are positioned to ensure that your body is aligned square to the target line. During practice it is common to hit many balls with the same club, concentrating on executing the same motor plan with a high degree of precision.

Play Conditions

Play Conditions

Our playing conditions are vastly different since our cabin is located 5 minutes from a course where, for $1500 a year the whole family can play as often as we have time for, with carts and no tee times – just show up and play nine holes when we feel like it, it’s wonderful. There is a hitch though and that is that it’s pretty much the worse golf course in the world except for the scenery. There isn’t a flat spot on it and that includes the tee boxes. Every time you hit your ball you are likely to end up with a bad lie like this one (ball below feet, basically hitting off gravel). All the precision in the world with my perfect swing is not going to help me hit this ball. What I need to do is process the initial conditions accurately and select a motor plan that is going to get the club to the ball given those conditions. Looking at the picture I can tell that my ball is too far back in my stance but at the time I was quite unaware that I had positioned myself incorrectly relative to the ball – often my problem is one of poor information processing that leads me to essentially select the wrong initial conditions for the purpose of predicting which motor plan will have the desired effect.  Poor execution of my swing is not the problem. Unfortunately when I achieve the inevitable bad result I start to adjust my swing which just makes everything worse. Instead, I need to focus on processing aspects of the context so that I can adapt my set-up to the initial conditions: First, what is the gradient of the slope between my feet and the ball? How much of an incline is there in the lie of the ball? Where is the target relative to the ball? And then, where are my feet relative to the ball? How wide is my stance? How bent are my knees? Where is my centre of gravity? Are my shoulders aligned with the slope of the hill?

So what has golf got to do with speech therapy? Given that speech is also a motor learning problem, the same principles of motor learning that apply to golf apply to speech learning. I have spent a bit of time this summer watching therapy videos as part of the treatment fidelity process in the randomized control trial that Françoise and I recently completed. I see student clinicians and sometimes the experienced SLPs conducting therapy sessions like practice at the golf dome – aiming for precision rather than dynamic stability. I think the students should know better because I taught them the principles of motor learning using Maas et al.’s (2008) excellent Tutorial http://bit.ly/Ta9STv in which the authors stress the distinction between learning and performance. Performance during practice may or may not transfer to untrained movements in nonpractice contexts. Maas et al. discuss a number of different strategies to enhance transfer of training to similar but unpracticed movements. Although the research findings are complex and often difficult to interpret, it appears that overall it is best to practice under conditions that afford a wide range of experience with varying initial conditions and movement outcomes. At the golf dome the best one can do is switch clubs and targets often. In speech therapy, practicing the target phoneme in many different words so as to vary phonetic context is often a good strategy. I think that novice and experienced SLPs know that variable practice conditions are important but it is not always easy to implement this principle for two reasons. The first is that performance levels are higher under constant than variable practice conditions and it is reinforcing to both clinician and patient to achieve high levels of accuracy during therapy sessions (the distinction between practice performance and actual learning is hard to keep in mind). The second is more fundamental: the goal of the therapy exercise is not itself clear to SLP or patient. In some ways, Maas et al.’s Tutorial contributes to this confusion of aims by focusing on motor programming and motor programs. Therapy sessions are conducted as if the goal is to perfect the specification and execution of a particular motor program. I prefer Wolpert’s approach to motor learning http://bit.ly/OE8VT5 (take a look at this if only for the Calvin and Hobbe’s cartoons). Wolpert and colleagues (2001) describe motor control “as the process of transforming sensory inputs into consequent motor outputs. The problem of motor learning is one of mastering and adapting such sensorimotor transformations” (p.488). We can think of speech therapy as the process of helping the patient to process the sensory input so as to transform them into the desired motor outputs. An approach to motor learning that takes into account information theory and information processing is the “challenge point framework”, described by Guadagnoli, M. A. and T. D. Lee (2004) http://www.tandfonline.com/doi/abs/10.3200/JMBR.36.2.212-224#preview. Françoise and I are going to teach a seminar about how to apply this framework to speech therapy at ASHA 2012 in Atlanta this fall:

Topic Area: Speech Sound Disorders in Children (SLP)
Session Number: 1530

Title: Application of the Challenge Point Concept to Developmental Phonological Disorders

Session Format: Oral Session (Seminar 2-Hours)
Day/Time: Saturday, Nov 17 — 03:00 PM – 05:00 PM

Authors: Susan Rvachew, McGill U; Francoise Brosseau-Lapre, McGill U