347: Principles of Motor Learning in Articulation Intervention

Show Notes:

Tired of reaching for the same generic drills no matter what speech sound error walks through your door? In this episode, Hallie chats with Laura Rinella, MA, CCC-SLP, creator of Laura Teaches Speech and a pediatric specialist in speech sound disorders. Laura breaks down how she builds targeted, individualized treatment plans that move the needle on intelligibility, offers her take on telling articulation and phonological disorders apart in real sessions, and explains why she sees every kid's progress as a step toward letting their voice come through.

Here's what we learned:

  • Motor learning principles matter for every kid with a speech sound error, not just those with residual/lingering errors
  • Mastering a sound in the therapy room isn't the same as mastering it in real life — that's the performance trap
  • Variation in rate, intonation, and loudness is what drives carryover to real conversation
  • Speech motor chaining builds from syllables to self-generated sentences, leveling up as accuracy improves
  • Buy-in matters as much as biomechanics — kids need to believe change is possible before the movement work sticks

RESOURCES

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Learn more about Laura Rinella

JOKE OF THE WEEK:

Q: Why did the pencil get sent to the principal's office?

A: It couldn't stop drawing attention to itself.

Where We Can Connect: 

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TRANSCRIPT

00:00:00 Hallie: Hey there SLP working with grades four through 12. New school year,  new you. Let's not go into this school year feeling overwhelmed and behind on paperwork. Let's not worry about students asking why they are coming to speech. Let's not have students shrug in their shoulders and looking at you saying, why am I here? I don't wanna be here. Let's instead have your students excited to come to speech, ready to take on the challenges you provide and make massive progress towards their goals. 

00:00:31 Hallie: If you are ready to make this school year the year that you leave work promptly at the end of the day, plan in an hour or less a week, and go into every session confident that your students will grasp the session objectives, then SLP Elevate is just what you need to make this school year a successful one. Either go to slpelevate.com or send me a DM on Instagram with the word club, C-U-L-B and we can discuss if SLP Elevate is right for you and your students. Now is the time to get your time back, and now is the time to get your students excited to come to speech. SLP Elevate is perfect for you.

00:01:14 Hallie: Welcome to SLP Coffee Talk, the podcast designed exclusively for speech language pathologists who work with older students, grades 4 through 12. I am your host, Hallie Sherman, your SLP behind Speech Time Fun, the Speech Retreat Conference, and the SLP Elevate Membership. And I'm thrilled to bring you conversations,  strategies, and insights that will give you the jolt of inspiration that you need.  Whether you're tuning in during your morning commute,  on a break in between sessions, or even during a well-deserved relaxation time. I am here for you each and every week.  Let's do this SLPs.

00:01:55 Hallie: Hey, hey, and welcome to another episode of SLP Coffee Talk. I know you guys are gonna love this conversation that I'm having here today with Laura Rinella, who is also gonna be joining us at the November speech retreat. If you have not purchased a ticket yet, what are you waiting for? Go to speechretreat.com or message me the word retreat on Instagram.  But Laura, welcome to the show. 

00:02:16 Laura: Hey, hey, happy to be here. 

00:02:18 Hallie: Tell everyone listening a little bit about yourself and your SLP journey to what you are doing these days that make you so passionate about what you like to talk about.  

00:02:28 Laura: All right. Yes. So I've been in SLP for 18 years. I started out in the schools. I was in very small rural school districts. I worked there for six years and I genuinely enjoyed working on IEP teams to help students with their communication where they spent most of their days, most of the time. In 2013, I started my private practice, ARCH Speech Therapy. And at first, just like I was in the schools, just like I know many of you are, I was a generalist seeing just a little bit of everything ages three to 18. And then about five years ago, I decided to focus solely on speech sound disorders because for me, all roads have always led back to that part of our field. I naively got into this field thinking like, that's what SLPs do. They help kids talk better and that's what I'm gonna do. 

00:03:10 Laura: And then I went to undergrad and graduate school and I was like, oh wow, there's a lot more that we can do. And again, I genuinely enjoy treating other types of communication disorders. I just felt my God-given gifts aligned with this area of our field. I know that all of us have kind of that one part of our field that clicks. And for me, that is SSDs. And then four years ago, I started teaching introduction to speech sound disorders and man, having conversations with those seniors and their interest in the field, their questions really led me to start Laura teaches speech on Instagram and then also on Substack. 

00:03:44 Laura: So my Substack is a place of what I hope is ongoing learning, a learning community. So for subscribers, can be free subscribers or $5 a month, they can come and get courses,  one monthly downloadable resource. And then also what I really like is what we're calling office hours, which is a live Q&A via Zoom once a month where I'm just available for an hour and anyone who has questions can pop in and out and get their questions about SSDs answered. I don't promise to have all of the answers, but I will try as best I can because I felt like I was missing that when I first started working. You know, we're in graduate school, we have all this support. You can ask all these questions to professors and to supervisors. 

00:04:24 Laura: And then all of a sudden, my clinical fellowship supervisor was wonderful, but her specialty was AAC. And I was working in the school, seeing just a little bit of everything. I was like, “Ah, I have more questions.” And I could have, I met other SLPs, but you know, they've been working for 20 years and I felt like I had a really basic question. And that is exactly what those live Q&A's are for. Like come to me with. Any question at all and I will try to support you in the best way that I can.  So that's and now here we are.

00:04:49 Hallie: I love that. And especially when it comes to speech sound disorders, every sound is different.  Every case is different. So what advice would you give to someone who's like, “Okay, where do I begin?” Like I have–

00:05:22 Laura: That is a great question. Well, and working with speech sound disorders, particularly if you're in the schools, that comprises a great majority oftentimes of our case loads and sometimes they linger and it's just like after year after year and it gets tricky. The thing is, is when it comes to SSDs, speech sound disorders that umbrella term. So we had this specific diagnoses within that umbrella. And so my advice would be to get really good at that differential diagnosis and know pretty clearly, I looking at something that's motor-based and I need to be looking at how the articulators are moving or is it more phonologically based and I need to be thinking about the rules and if you can seek out some type of continuing education in differential diagnosis, I think that's going to be your best bet because everything stems from that. 

00:05:48 Laura: And if you know what the diagnosis is, and oftentimes it's mixed, it's motor and it's phonology, if you know that, then you can kind of slowly over time learn different treatment approaches and try not to learn everything at once. When I was in the schools, I was like, okay, this year I'm focused on, I look at my caseload and I would see what I had the most of. And then I'd be like, okay, I really need to learn more about this because I seem to have 10 kids with this type of diagnosis. And that's probably my best advice is to get really good at dynamic speech assessment if you can ask those questions about assessment. 

00:06:17 Hallie: All right. So say they have a student in front of them.  They've determined it's definitely motor speech. Now what? How one? 

00:06:24 Laura: Great question.  So we're looking at mother's motor difficulty. So that's how I like to think of SSDs. We've got that umbrella term and then we've got phonology and we have different types of phonological impairments. And then we have motor and it can be motor difficulty. And that's what we think of as our articulation disorder. And then we have motor speech disorder, childhood apraxia, speech dysarthria, and then that speech motor delay, which is a newer diagnostic category. So it's looking at what treatment approach matches each of those diagnoses, which we can get into those things. 

00:06:55 Hallie: And that just from my experience especially like those older students it's typically that pesky R sound that is still there and a lot of motor planning that needs to be like that habit that needs to be reconfigured. So like yes let's start there since a lot of people are like, yeah–

00:07:15 Laura: What do do with this student? So those sound distortions seem to linger, right? So whether it's an R distortion or a lateral list with that side airflow on a variety of different sounds or a frontal or an interdental list, those are the kids too that when I was in the schools and even here that I will at my practice that I'll get those referrals for a 12, 13 year old. And it's like they've been in speech for a really, really long time. And more than anything, I want us to really be thinking about what we're addressing as a generalized motor program, right? They already have this plan or this program that is incorrect. It's a sound distortion. And we want to create a new generalized motor planner program. words can kind of be, you see it used in a literature.  

00:07:52 Laura: So how do we do that? If it's a movement and we want to teach them this new movement, then if you've been to my Instagram page, you know that I'm crazy about principles in motor learning and articulation intervention and addressing our making sure we're mindful of what type of practice we're doing and then what type of feedback we're providing. And the student I think that you're thinking of is one who has those residual errors and they've been in speech therapy for a long time. So they've mastered that acquisition, right? They can, they're in our rooms and they're like, they're doing sound loaded sentences and sound loaded reading and you've got a headbands and five second rule. And you're like, I'm thinking graduation. 

00:08:29 Laura: And then you see them in the cafeteria and you see them out at recess and it is not the same. Like you run into them out in public and you're like, wow, that conversation went very differently than it did in my speech therapy room. And that's when I think we really need to take a look at what type of practice that we're doing and making sure that practice is complex and that we're getting variation into our practice. Because those students are going outside of our speech therapy room and they're not able to meet the conditions that are in the environment because they practice maybe in their constant speech therapy voice. 

00:09:00 Laura: Maybe they are doing complex targets, but they're always practicing in the same way then they go to whisper to their friend at the chess tournament, or they go to shout across the baseball field, and they lose it, and they don't have it. So inviting those–

00:09:22 Hallie: Excited at something. 

00:09:13 Laura: Yeah, they're not thinking about it. It's not automatic. And we need to invite some of those conditions into our speech therapy room. So really, I'm big on variation, varied practice. We have complex targets, but varying them, vary the rate and then intonation and the loudness and really lean into those. I found that really for those kids who have residual errors to make the biggest difference. That was something I wasn't always doing. And when I started varying targets with rate, intonation, and loudness, that's when I saw that carryover, that generalization to conversation. 

00:09:43 Hallie: So interesting. All right, what about the students that are not those residual students that are newer onto the caseload?  And now what? 

00:09:52 Laura: Yeah, so that's great question too. I use principles of motor learning with all of those students. if you look at Preston and colleagues, 2020, their tutorial, their art tutorial, they talk about those kids with those residual errors and really speak about principles of motor learning with those students. But if you think about what you're wanting to do, even with maybe a five-year-old who is on your caseload or a six-year-old and they have a lateral lisp or an art distortion, well, what are we wanting to do? It goes back to like, what is the depth that we're wanting to address? It's the movement piece, right? We want to create this new generalized motor program. How do we do that?

00:10:22 Laura: It's principles of motor learning and I love speech motor chaining. So if you have a lot of kids who have sound distortions on your caseload looking at Preston's speech motor chaining is a great approach to be using with with those students.

00:10:36 Hallie: So in like a clip note version, what would you say are like some things that someone should be thinking about when they're doing that chaining and.

00:10:44 Laura: Oh, the chaining. Okay. So what I like about Cliff Notes, oh man, you know me so well already in a few minutes. don't do well with Cliff Notes. have to do it. It's like, oh, it's for me. Though it's long story short, it's a story long. So, okay, I'll try.  What I like about speech motor chaining is that it takes advantage of a strategy we all know really well, right? So it starts at syllables, something like read, and then you get a monosyllabic word. It's read, reading.

00:11:07 Laura: It's a multisyllabic word that you do. I'm forgetting now it's a phrase or then a self-generated sentence. Yeah, phrase and then a self-generated sentence. So you have to get five out of six correct at each level to move on. And if we have kids in our case, well, they love video games. So if they enjoy this level up concept, I love talking to them about, hey, this is how we're going to practice. We're going to practice this re and oh, you got five out of six level up. You can even have a sound effect or something. And then we get it level up to the next word and kind of make it more game-like, but it builds in that blocked practice, that consecutive practice as we're trying to help that child acquire to stabilize what they're doing, to be more consistent with less support from us. 

00:11:48 Laura: And then once you start to get that consistency,  make those targets more complex. Go to two, three, four syllable words and recurring R, refrigerator and river, and they can do those, then get some variation in there. Have them say it as a question, have them shout it, have them shout a question, just really layer in the variation. Cause that's what they have to do outside of our speech therapy rooms. 

00:12:08 Hallie: What about those kids that no matter what you try, either they are hesitant, or still just, have you had those kids that just like really struggling to get it?

00:12:21 Laura: Yeah, absolutely. And then we're not really to this point, right? Like, don't talk to me about block practice. I can't even get there. We're not even past elicitation. Or perhaps we're not even like pre-practice is when you're just trying to get them to be stimulable. Maybe you're not even on the board with acquisition and motor learning. You're just up here in pre-practice. I would say for me, that depends on the age of a student. I know that a lot of your listeners may be like, I think it's a fourth grade and older if I'm right on that. 

00:12:46 Hallie: Mystery to work with the younger. So..

00:12:48 Laura: Yeah. So I just, find that… you know, sometimes I get students who they can't get there in terms of stim ability.  And I first sometimes have a conversation with them about whether they believe that they can do it.  Because listen, if they're in fourth or fifth grade, they probably cycled through a lot of us. They don't believe in us anymore. They don't actually think that they can do it. And they don't think that we can help them. In my experience, I've had a few of these kids who just I don't actually care. They'll tell you, like, I don't care if I can say it.

00:13:18 Laura: Well, do they not care or do they not believe that they can actually do it? And I think that I found that to be like once I built that relationship and built the rapport and acknowledging how hard it is, like I see you, I see that this really stinks. That this is, this isn't fair. That all of your friends can say it really easily and that you're sitting here fighting for your life, trying to say, er, and you can't do it. And so I think that that acknowledgement of how hard it is building that relationship, but to really answer your question….

00:13:45 Laura: For those students who can't get it, for me, in my experience, I find that those are the kids that have poor proprioception. They don't have any idea where their tongue and their lips are. And they may have been told different things that they don't know. So going back to basics with anatomy, but I find that tongue jaw differentiation, like they just cannot isolate that movement of their tongue from their jaw. And so looking at it at a really granular level. So I'd say building relationship, acknowledging how hard it is, validating how they feel.

00:14:14 Laura: Well, also just really, like if you've been doing words and the words just aren't really that accurate, like you've kind of been accepting it. We've all been there before where you're like, eh, this is close. It's close enough. And I would say it's within normal limits, but it's not truly an urk that I would really back up and try to get more granular with it, is what I would say. Like look at their mouth, what can they do, what can't they do? I just find that they can't separate that movement for ur their tongue in their jaw, then it's not going to happen. This is hard. This is really hard. It's not an easy business. 

00:14:49 Hallie: I love having that conversation with them and recognizing that it's their own beliefs in themselves and beliefs in us and recognize where they come from. We're not their first stop, most likely.  

00:15:00 Laura: No, definitely not.  also then too, I find that once they believe in themselves and then I'll have them like start to take data, even if it's just, we got urr today, we ER at one time. And then remember, then we look at it. And then like this time we got a session, we got it three times. You're doing it. You're making the baby steps. Like you're getting there. I think it's important to acknowledge those super small wins because it's going to be a journey. It's going to take a while, but I mean, it's hard for these kids for sure. 

00:15:28 Hallie: And I've even told kids that it's like going to the gym. If I go to the gym and lift up that 100 pound weight, I'm going to hurt myself. I have to build up to it. So like your mouth, your tongue, those are muscles.  It builds up. You're coming here, it's like going to the gym.  

00:15:43 Laura: Yeah, absolutely.  It's pieces of a puzzle, right? It's hard to learn new things. And I'll try to, you know, I'll tell them about things that I'm terrible at doing. I'm terrible at bowling and just kind of trying to relate to them in a way of like, not everybody's good at everything. This is like your thing that's hard. I find too that once they start to make some of those baby steps, you can almost see that they start to believe in themselves and then you have buy-in. Because a lot of times with these older kids, then we don't have buy-in. They don't believe they can do it. They don't want to be there. Mom's making them come. They don't even, mom cares about me saying, oh, I don't care. And it's like, we have to flip that script a little bit and try to help them to have ownership over. can't make them have ownership. And I think sometimes breaks are good. If you take a break, come back in six months, have that accountability. We are going to come back to it. know in schools we can't always do that.

00:16:31 Laura: But I do think there's something to that. And then trying again and seeing if they're ready then. Because they do have to. I mean, once they're older, it's like you are going to have to practice at home. But if they believe they can do it and they're seeing the progress, then I've seen kids be more likely to kind of get on board. 

00:16:47 Hallie: Have you made mouth movement exercises cool enough for older kids? 

00:16:26 Laura: Oh, I would say, you know what? I have some of the most fun with my students who are older because it's not necessarily about games, although sometimes they'll see a game in my game closet and like, oh, I've seen Pop-Up Pig before on TV and they'll like want to play it at the very end or something. But I love getting to know them and I love investing in them and making sure that I'm asking about how their band concert was and what Pokemon thing they're into or did they sell that card and did they buy a new pack or they're into basketball card, whatever it is. I think that I always try to just really build up that relationship, because I want them to know,  like, I'm here for you. 

00:18:08 Laura: Like, this actually stinks. This is not fun. This is terribly boring.  But we can do this together. And then I also tell kids, it's kind of like reading. Like, once you get it, you get it. So you're not going to have work on this forever. Like, once you get there, once you can say, er, you can say, er, you're not practicing it for the rest of your life. I think sometimes they need to know, too, there's like a finish line. 

00:18:27 Hallie: It's not like we don't want you to be a lifer. Like, that's OK. 

00:18:30 Laura: No. No, you kind of are, but I don't want you to be.  

00:18:32 Hallie: Like, we'll miss you, but it's really like I always say, like, my job is for you not to need me anymore. Like, it's really–

00:18:39 Laura: 100 percent. 100 percent. You do. You don't want to be coming here. And I really love you. But I don't want you to come here either. I you know–

00:18:46 Hallie: I'm going to to assume that once you're spot, I'm just kidding.  

00:18:48 Laura: No, I won't. Well, and I would tell kids do like I don't actually care how well you do here in this room. I care how well you do outside of here. And they were always like, whenever I say like, oh, I don't care. Just like… It matters more outside of here than it does in this room.  

00:19:03 Hallie: Is there any last bit of advice that we have not covered yet that you feel like new and veteran SLPs working with SSDs students should know? 

00:19:12 Laura: Great question.  think more than anything, just,  man, variation has been the secret sauce for me. It really has. I think you're probably doing complex targets. I think you're probably already doing maybe two, three, four syllable words and you're already recurring our words… probably all have lists of those. But making sure that they're never saying anyone target more than once, randomizing the practice to make that motor plan nimble and have that dynamic stability. And then just they have to shout it. And kids don't always love that. There's kids that they won't love. They have to shout it. You have to whisper it. You have to have a question. Saying it in different ways has really made a huge difference for me. 

00:19:43 Laura: And I do have a Principles of Motor Learning, like a cheat sheet that's on my Laura Teaches Speech Substack, and that's available for free. So I don't know, we can put a link in something if you–

00:19:54 Hallie: We will have a link to everything.  So where can everyone learn more about you and everything gets–

00:19:59 Laura: Oh yeah, so come find me please. I would love for you to join us on Instagram, Laura Teaches Speech, and then it's Laura Teaches Speech on Substack. Again, there's the free subscription, and then there's the $5 a month and my hope is just, you a tagline is make SSC's easy. Let's be honest, it's really complex and it's hard, but I would love for just one practical tip that I shared to be helpful. Like if that, one thing helped you, if you start having kids shout words or say it as a question, and then all of a sudden you're noticing some generalization, then like all efforts have been worth it. So. 

00:20:29 Hallie: And you've loved listening to Laura here today. Make sure you join us on November 7th at the speech tree so you can learn more about it. Head to speechtreattreat.com and I always end my episodes with a joke since jokes build rapport. There are tons of funs so I tried to find one that had some R in it. Why did the pencil get sent to the principal's office? 

00:20:48 Laura: Tell me why. 

00:20:49 Hallie: It couldn't stop drawing attention to itself.  

00:20:53 Laura: Nice but a bunch. 

00:20:55 Hallie: Watching guys, these corny jokes will be here every week.  I not missed one or two in like the six years I've had my podcast so it's not too bad. Well, thank you, Laura, so, much. Everyone go check out our Substack or check out our Instagram and make sure you join us on November 7th. That's speech retreat. Laura, thank you so much. And our show next week everyone. Stay out of trouble. See ya.

00:21:23 Hallie: Thanks so much for tuning in to another episode of SLP Coffee Talk. It means the world to me that you're tuning in each and every week and getting the jolt of inspiration you need.  You can find all of the links and information mentioned in this episode at my website,  speechtimefun.com.  Don't forget to follow the show so you don't miss any future episodes.  And while you're there, it would mean the world to me if you would take a few seconds and leave me an honest review.  See you next week with another episode full of fun and inspiration from one SLP to another. Have fun guys!

00:22:04 H : Hey there SLP friends, it is Hallie here, pumping in with the best news ever. My new book,  Secondary SLP Roadmap is officially available. If you've ever wished for a clear,  practical guide for working with middle and high school students, this is it. It is packed with real stories,  ready to use strategies and tools you can use right away. Grab your copy now, check the link in the show notes or search Secondary SLP Roadmap on Amazon, and then of course, please do me a favor. When you are reading it, snap a picture and tag me on Instagram at speechtimefun. I love seeing where you're diving in. The speech room, the couch, waiting in a doctor's waiting room, all the places. All right, ready? Go grab your copy and let's make secondary speech feel doable and fun.

 

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