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like europe or k. i'm very pleased that i can
00:00:06
share with you some ideas about uh speech therapy
00:00:11
and uh the day i will focus a little bit more
00:00:15
on articulation therapy because that is one of the topics
00:00:21
are we included in that that pas project and we we're
00:00:24
happy that we can develop some ideas in the uh
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future years i a speaker on behalf of might collect
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cap was uh apologised for today when from different
00:00:37
and vehement also new new researcher in this project that we will uh that we
00:00:43
hope to continue successfully in collaboration with the context of the university of kent
00:00:51
a speech is um is a key feature in your life
00:00:57
and i used to start with a quote it's our place a little bits of to
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use quotes maybe for engineers not common but i found this very an impressive
00:01:10
uh it's a quote from george orwell who set who wrote
00:01:14
in his book nineteen eighty four perhaps one did not
00:01:17
want to be loved so much has to be understood
00:01:21
so nothing is worse than to be not understood
00:01:25
if you lose the capacity to communicate your dependent on others
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you have a worse health care you have worse services
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it is known to it is very hard to live without being understood and it's our um
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mission to try to help uh the people that cannot be understood
00:01:53
i have here another uh image so what can we
00:01:57
do with people that don't have the capacity to
00:02:01
be understood by others what are the possibilities and
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we and number of collects here addressed already
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a number of of problems um but what do we understand
00:02:16
in for speech speech is uh that that combination
00:02:21
off is what we use for the output and speech is voice
00:02:28
resonance and articulation it's not line which languages
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selecting works making sentences it's a brain more brain process which
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is their realisation of what we want to say
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so in that speech there are a lot of that mentions that
00:02:49
we can address and that we can try to modify
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and the question we always have is can we modify speech
00:03:00
you know speech is quite consistent in your life i
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have recordings from the beginning of my carrier
00:03:09
um because i do a lot of recordings um for clinical activities
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and i'm surprised when i hear things from the eighties that my voice my speech
00:03:21
is almost identical nothing changed maybe to fundamental
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frequency lowers a little bit with age
00:03:29
speech is going a little bit slower be 'cause we used to speak
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slow because we know people don't understand the spell that speech
00:03:39
is stable and you know how difficult it is to change the
00:03:44
speech of others if you make a recommendation to someone
00:03:50
they accept it may be great for they try to do it two minutes but later date change to the
00:03:57
to the form that they use it so if you ever learn to use of a french yeah
00:04:03
so i don't know how to do it it takes a lot of effort not of time the opposite manner french speaking
00:04:10
person wants to use the like the spanish they have a lot of problems it's not easy and it's very
00:04:18
have to do and i'll bet already addressed yesterday
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the problem of developmental a speech disorders and
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you see in that they put it in the right that on the horizontal uh
00:04:36
axes u. c. d. h.'s and the different sounds that are
00:04:41
coming with h. u. c. b. between zero and five
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a child is learning a complete set of sounds in an appropriate way
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normal children or completely understandable at the age of five for any person
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if you start to learn chinese of another language you never will get the level of
00:05:07
like it a five it would be very difficult even be very intelligent person so
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for children there is a critical period we have to use haven't not uh
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does it today but it means this set of what we use
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is composed in that h. and the question is how can we
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modify weight exercises with recommendations to make a person more intelligible
00:05:37
so speech therapists use to work of it with communication i
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took here um uh a number of up ideas
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from the i shot but okay you now we address
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speech aunts but not on the the articulation
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we address line which literacy does the capacity to ripen to read
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pragmatics how we use communication daily life voice problems
00:06:05
like uh one yep this phone yeah
00:06:08
fluency disorders stuttering or a well known all these problems are addressed in
00:06:14
the question is can how can be modified this it's it
00:06:18
uh just uh trying to do with our own is there's some evidence that that kind of things are
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and we look to brain damage light white
00:06:32
uh i hope this i did it for a long time to instill i would be be very it's my feeling that one
00:06:39
day i lose my speech or lose my capacities because i know
00:06:42
how hard it is to survive how dependent you are
00:06:46
and how difficult it is to improve but we look a little bit hopeless
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to this patients like the damage is there so what you better try
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to live with it however uh as drawbacks as the brain is not the static or can
00:07:06
it's dynamic system even when there is damage or some damage
00:07:11
it is continuously changing instructor function that's why
00:07:15
we are able to cope with defects during our live when you get older you
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can walk worse or you can use a bike in another way
00:07:24
but you will learn it be still learn being all
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so there is a a cat and blasts city
00:07:33
even that much and that plus the city we have a we have
00:07:38
to use and to develop it at as good as possible
00:07:43
that if we want to help but someone and it that idea deep on the is is helping
00:07:51
uh the two to construct programs for this kind of page
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a good idea how what about how we have to how open to treat patients changed a lot
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even in the uh at times that i'm working with changed a lot in addressing that problems
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and since ninety seventy nine been no quite good what
00:08:15
kind of this order the tar and it
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um literature was mainly from a diagnostic our point of view
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classification um markers of sort of the speech that kind of thing so
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more pages or more energy spent in developing diagnostic tools and descriptors
00:08:38
then in finding solutions for this kind of patients so there are very
00:08:42
few solutions and a lot of that i just have to them
00:08:45
do a lot of improvisations daily to to continue uh with these patients
00:08:51
on the other side the the way we think about their opinion three eating and healing
00:08:57
is ah was developing with the with the years
00:09:02
and i remember when i started working without okay we can uh he'll the patient one day he will be
00:09:09
a better when we do we never fronts it's not like that because sometimes you have damaged for life
00:09:16
meanwhile you're getting older so it will never be as yesterday that is something
00:09:21
that you have to tell the patience to but anyway you can continue
00:09:27
and ah out in that context we have to realise that from the medical side
00:09:33
that there is not any um a thing that can help the patient not animate this in
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uh almost not an intervention can out the patience to we have to focus on
00:09:46
how the patient behaves and how we can have modified this behaviour
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and one of the first that put the finger on the wind was sort of the big things that this archetype is the real
00:09:58
or systematic brecht is of specially selected then ordered excessive
00:10:03
you focused already on the real repetitive uh exercises to
00:10:08
improve uh this the speech of that patients
00:10:13
meanwhile the concepts of payless and healing changed and
00:10:18
we use now well being quality of time
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um ah and that compensation and that kind of things
00:10:27
or more important within the context of the workout association
00:10:33
definition of how it's so out this how
00:10:36
you feel with all the uh meanings in in daily life
00:10:41
we use no more limitations not that this is um we
00:10:45
don't like to or handicapped we speak about participation
00:10:50
its semantic but it reflects also the way we think
00:10:54
about helping patients it's more managing then healing
00:11:00
have a look for optimal quality of life take into account the limitations
00:11:07
and we tried to give the patient as much chance as possible
00:11:12
to participate in they live in the job in family life um consortia life
00:11:19
hockey so on the other hand we have more health services to the to improve the lot
00:11:25
and we come back to the issue speech therapy is change of behaviour and
00:11:30
how we can relies that if there's some a question on that too
00:11:36
i do believe that it can help or just wishful thinking sometimes i thought that
00:11:41
when i was six months busy with the patient that was not better
00:11:45
in speech you think okay what am i doing it is a it is hopeless but anyway
00:11:52
uh we have to keep in mind the brain is dynamic whole
00:11:56
small that uh yeah it's the capacity is and um
00:12:03
you will develop your own adaptation what the muscle activity that is an important concept so
00:12:10
we are kept about to recover and reorganise damage in uh in some proportion
00:12:18
and motor reorganisation speaking is a function of motor function
00:12:23
implies that you use that system a problem of a lot
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of patient that are but low intelligibility is that
00:12:31
after a while they don't speak anymore they just to men and they're sitting in the chair and
00:12:38
move to had but they don't speak anymore and you have an act kind of a depreciation
00:12:45
and that becomes speechless persons if you don't activated so to speak
00:12:50
better you have to speak you have to do the activity
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and to support the systems that uh um uh uh compose that capacity
00:13:01
so did compensation implies that the use of speech is also
00:13:05
conscious patient has to be aware of that and the
00:13:08
risk is that one day he will uh let it go and then it's very difficult to pick it up
00:13:15
let me save now something about the concept of more per learning because
00:13:19
that concept is very important in the development of exercises for page
00:13:25
mulder learning pace it change i said the speech
00:13:31
is develop between z. around five years
00:13:34
but it's not finished so we we have skills like cycling swimming playing
00:13:40
the um no even if you didn't do with for many years
00:13:45
you can pick up it again it's you can drop a using
00:13:50
uh by getting ten years you take a biking you will
00:13:54
be capable to do it so it is there an internal it's killed that
00:13:59
programming is existed so motor learning is it change resulting from brecht is
00:14:06
our novel experience and it improves the smoothness and accuracy of movements you have to do it a lot
00:14:13
if you see cook getting on is on the television is going fast because he's doing that they really
00:14:18
and it is a on this can be they can develop with doing that many many times
00:14:25
so that motor learning is yeah important for speaking the playing instruments
00:14:31
even for climbing trees and it depends on variables that
00:14:37
contribute to motor programming a sensitivity of other
00:14:42
detection a strength of movement schemas
00:14:46
and the change you can really lies in this way is quite permanent
00:14:51
what is important because you try a couple of times
00:14:55
it's not enough to change that permanently and
00:15:01
the main components underlying the behavioural approach our structure of practised and
00:15:06
feed back that is important that important issues for developing
00:15:11
uh i'm a program that to to help patients sort on an a device like we hope to do
00:15:19
so what are these principles in a small list you can use to develop exercise so
00:15:24
to improve speech you have to speak to improve swimming you have to swing not speak about swimming
00:15:31
you have to jump into the water and do it is the only way
00:15:35
it's to specifically specificity of the task is important so you cannot
00:15:41
change that if you don't speak so the more the patients speaks the
00:15:45
better it is even if it is not really always correct speech
00:15:50
drill is essential so it has to be a lot and repetitive
00:15:56
an instruction and demonstration are very important issues so
00:16:01
that the one who teach it has to show all to demonstrate to make
00:16:06
it all the bow and to make it visual to support the production
00:16:13
we have to stress the capacity on self learning so you have
00:16:18
to do with a lot then it has to be integrated
00:16:22
we have to support with feedback feedback in many ways uh you can
00:16:27
give a commons but they can have a school or they can have that
00:16:32
um i kind of a judgement but it's very important that you're now in all
00:16:37
the trainings how you did it that is important because it will support
00:16:42
um the exercise and as i said already it has to be specific so it it it
00:16:48
is best be relevant for speech you don't have to do anything else than speech
00:16:53
or you have to do a anything else than swallowing when you want to improve swallowing
00:16:59
and you need consistency so you need to continue for a
00:17:02
while in that task but with enough variation sounds
00:17:07
in combination of sounds gives a lot of possibilities and the power of that exercise has to be increased
00:17:15
but always we have to take into account the phenomenon we did this
00:17:20
call speed it curiously trade off so if you really speed
00:17:24
uh of speech you diminished accuracy you notice when someone is
00:17:29
speaking fast you miss the part of the message
00:17:33
because the cost the speech the less clear is the speech just lower the speech
00:17:40
uh so if you still have to get the accuracy speech will be
00:17:44
slower so that is a phenomenon you have to keep it happens
00:17:49
so in this r. t. and we have to take into account the brain damage to capacities
00:17:55
and patience are very different that would explain how would that be patient is quite unique
00:18:01
and that it be is always a combination of actions uh and
00:18:05
and the continuum of interventions so you don't have to
00:18:09
start with one package it has to be an meaningful for the page
00:18:15
under globally to approach is one approach as you have to make an intervention for the patient has about
00:18:21
that big relation train the articulation the voices but during the voice to focus on the problem
00:18:29
and that is trying to um manage that problem another approaches
00:18:34
the participation oriented approach that's it's okay you have to
00:18:38
to try to find a solution for the daily communication and maybe speaking is not that
00:18:44
important articulation is that an important if the patient has another two to make himself
00:18:51
understandable for other so it's another view it's the first is more exercising on that
00:18:58
and the capacities of speech the fourth one is from finding solutions strategies to
00:19:06
how to make it possible that there is communication in some way and
00:19:12
in that choice the continuum the it eulogy at the
00:19:17
the therapy approach a play an important role to have patience to work
00:19:22
who have regrets it is out here that means it's in terms will be calm better
00:19:27
and your whole harder is uh and and found it hope
00:19:31
that the patient can uh improves that patients you can
00:19:38
go from an intervention the two compensatory strategies you can choose what
00:19:44
is at that moment the most of the best possible
00:19:47
you have patients were going down all the time degenerative and
00:19:52
you have to take into account when dave maybe
00:19:54
this person will not be able to make any sound a possible so you have to think about solutions
00:20:01
add that will be available at the time he will do speech and
00:20:05
and we know the kind of this is that are going burst
00:20:09
so when the patient is getting worse you look more for compensatory strategies
00:20:15
what we call a see this month that and alternative communication
00:20:19
it is communicating with all that means than speech
00:20:25
and you have patients with chronic diseases are quite stable dislike parkinson can patients can be
00:20:32
four years in in almost the same level when when they are like to
00:20:36
so but even for that patient it's important to develop a program and two main things skills with to a
00:20:43
specific set of that exercises and keeping compensation i'm behind
00:20:50
the corner to help when it is necessary
00:20:54
walking another important issue is the intelligibility incomprehensible eighty intelligibility
00:21:00
is what you pick up from the speech
00:21:04
from the speech only when you hear me while comprehensible you see is what you peek at
00:21:11
from the context so that some people will use um
00:21:16
uh admit makes or make a signs with
00:21:19
the hands and that helps you to understand what is going about it's more then intelligibility
00:21:27
as important because the most important is to communicate
00:21:32
and you see internationally it ran to work in a more
00:21:36
functional a way in favour of compress abilities
00:21:41
a lot of people say it's not that important that you see it correctly as long as
00:21:46
you understand it he is stupid as a feed and the importance is that the listener
00:21:54
it makes an effort to should he has to try to understand and when
00:21:58
you know the limitations of a patient you can understand him really better
00:22:03
so maybe you have to do something with the family and the caregivers to improve the communication
00:22:11
hockey so if you want to use compensatory strategies you have to take a it to see
00:22:18
to the patients where we'll have a minimum need to have very few for compensation
00:22:24
additionally the substantial amount of compensation and not just
00:22:28
missed a complete uh a different system um
00:22:33
i give some examples are like people with that minimum need
00:22:37
uh sometimes it is sufficient to say okay a a
00:22:41
delay your speech you speak slower eleven understand you and often it is like that and you see that
00:22:48
speech rate diminishing speech rate
00:22:52
always almost always helps
00:22:56
you to better understand any other person
00:22:59
that you don't understand even when they speak another language and they have normal capacities spec ops always
00:23:08
another technique is the clear speech is using exaggerated articulation you know
00:23:13
this way of speaking it's a little bit us tentative but anyway you can understand an addition
00:23:20
on that just doing that can improve intelligibility with fifteen percent which is a lot
00:23:28
hockey the one who has a neat requests need for comp and moderate support
00:23:35
sometimes need in a system that house uh
00:23:41
to understand like making a and natural movement like eating
00:23:46
when i do this you know c. p. u.
00:23:49
will understand on a what i mean because you supported
00:23:52
with uh with some um but some movements
00:23:57
but patients uh who do what train it's efficient motor controls often it's not
00:24:03
the case they need some confirmation to know what they have to do
00:24:07
and they have to they need a capacity to combine hands and speech
00:24:13
another technique is topics implementation if you're not liable speak about foot
00:24:18
like it is here the case in that image that we speak
00:24:22
about foot it's easier to understand one of these words uh
00:24:27
so you indicate the topic it's about out here it's about
00:24:32
a physical needs it's about that and you know in that direction we have
00:24:37
to think so you supported with the communication chocolate sentences icons photos
00:24:43
and the speaker first indicates the topic and at that little speech it's not
00:24:47
the reason to say nothing you always use the speech as support
00:24:51
and they say okay this can help you ten percent
00:24:55
in the disability uh and communication i got past
00:25:00
another technique is the alphabet complement the us implementation in that
00:25:06
and chase you use natural speech and you always
00:25:12
put the thing it on the first lot of the next word say hi and mike double
00:25:19
and you put the first letters to the patient that the listener will understand better with that
00:25:25
help what you want uh to say a four that's because it
00:25:29
can help like for twenty five percent in in the disability
00:25:34
but that patients need some mental capacity is a good vision
00:25:40
uh kept us motor skills so they're always limitations in that kind of patience you
00:25:46
don't expect that uh make it difficult here you have like a system for
00:25:52
alpha but with the quite deal with that's not your uh in the traditional a. b.
00:25:57
c. and even some of them with the protector in i don't have to
00:26:03
for to protect it for saliva so that are all possibilities i'm
00:26:09
there are a lot of technical devices like uh the the speech you
00:26:14
for instance that with the display where you can prepare messages
00:26:18
and show with patient and read it from your side to the other possibilities
00:26:24
that for people with its e. v. it needs that can be
00:26:30
okay
00:26:31
on the other side we have already the intervention and that's what we want to do
00:26:36
within the type of project we want to make an intervention to try to
00:26:39
make it that and in that uh intervention we try to we change
00:26:46
that different parts of the speech production and of course you have
00:26:51
to select your candidates that has to be some stimuli ability
00:26:56
the the good behaving good corporation but that patients exceed
00:27:01
exist so you have to select a little bit
00:27:04
the condition and the criteria of the patient and in that case
00:27:09
uh to radically you have the possibility to train speech making and you
00:27:13
can think okay maybe don't movements fail we have to train that
00:27:18
question is is that file that we have during uh uh the speech of before yes ah or whatever
00:27:26
first about the speech mechanisms in the past people that did a lot to try to make the move once more
00:27:32
to bring them up under better control and to do
00:27:35
movements with the song do movements with joe
00:27:39
without speaking a lot of studies have been reported and it's
00:27:44
hard to prove that they make any sense so i
00:27:48
stopped for a long time doing this because i think they
00:27:52
they don't bring the patient it to better speech
00:27:57
um i think it can all be harmful to do it but it doesn't bring it to better communication
00:28:03
and at this moment it is generally accepted that there is no no or few relation
00:28:09
between nonspeech movements speech a movement should do without sound
00:28:14
and the speech movement because the control is working different from the brain
00:28:20
and you better focus on speech and skip that uh excess
00:28:24
the day we're done for a long time and still a lot of comics try to improve it
00:28:29
so in the past that were like a lot of hierarchical programs that
00:28:34
try to speed up the movements hoping that that would be helpful for speech
00:28:42
um you can focus on respiration i'm i'm improving supported pressured
00:28:50
the pressure that is necessary to keep to make forays
00:28:53
you can train speech breathing putting more syllables in one bread
00:28:59
you can train before not to re system of famous one is the looser than voice treatment
00:29:04
not the does it because it's it's uh not the system that it's making patients
00:29:09
to speak louder and slower and and a lot of you speak the better
00:29:14
you open them out and the more clear is the speech or you have
00:29:18
a lot of benefits with speaking louder and all putting them out but
00:29:24
oh okay but remains the articulation where we try to focus on what this
00:29:32
for this project we now that articulation and it's the capacity
00:29:38
to make the phonemes distinctive enough that you'd can
00:29:43
i hear another sound then um the the the
00:29:48
alternative sounds with the almost the same characteristic
00:29:52
we know it has a major impact if you uh can improve uh the articulation it will
00:29:58
help a lot frontage but it together with prosody process is strong one to um
00:30:05
there is a direct approach to try to train that and you focus on the
00:30:10
articulatory movements what you have to do to produce the sound
00:30:15
you try to use indications for phonetic positioning how you have to
00:30:22
put the lips put it down and you use for
00:30:26
that it could stimulation present that uh this sound
00:30:33
and you present the image and you try to give that encourage
00:30:39
the patient to do that uh uh with a little bit
00:30:44
um uh stressing a little bit sound with the with the exact right
00:30:50
we use that kind of images there are a lot of that images and
00:30:55
this is a a view from top unilateral view and um
00:31:02
there are a lot of systems uh i saw the next speaker will
00:31:05
use it i i'd that now make yeah interface or at least
00:31:09
i'm the airfare really is seduced by dynamic uh
00:31:14
a presentation they have very suggestive to understand what happens
00:31:19
ah inside the mouth in the feedback is very powerful so
00:31:25
what you see is what you will try to imitate
00:31:28
in some way or at least to think about all i have to do with which is very important for
00:31:34
for patients so um about technology using
00:31:40
for patient with brain damage we always have to
00:31:44
think twice because patients are slow in accepting
00:31:48
uh that kind of but the facilities and
00:31:50
sometimes more possibilities make them more confused
00:31:56
i remember that in the hospital in the past operations had only
00:32:00
one button to call another person to use the button
00:32:04
to call the nurse or two or something like this it okay the nurses had a lot of job so they brought a like kind of
00:32:12
remote control you can the no it call the nurse for emergency you can look for them
00:32:17
you knew when the television you can ask it uh it's something with different choices
00:32:23
and the patients became in big problem because they pushed all the buttons as possible
00:32:29
uh consecutively and the nurses had more work like coming to see to
00:32:34
check what the patient need then with the simple buttons so about
00:32:39
that tools then the possibilities we have to think from that point of
00:32:45
view of a person with brain damage per person that is all
00:32:49
here you have another uh the image for do but the other one was for the for the object
00:32:57
so what is uh what do we want to put in inside the the top boss project then i i
00:33:03
saw a lot of uh uh excellent uh id send
00:33:07
and haynes from people who was or developing
00:33:11
uh to us but we want at what we call a virtual articulation tina someone was
00:33:17
doing the same as a speech therapist is doing in front of the patient
00:33:22
and we want to implement that principles of multiple learning
00:33:27
that they are very important to make a real
00:33:31
a permanent change possible and it is uh multimodal stimulation auditory and
00:33:37
visual feedback uh repetitive system and with it the real
00:33:44
and we're looking for the optimal those all many exercises
00:33:49
you have to do to improve it you
00:33:52
people who go to fitness and and all the other exercise programs and you have to do
00:33:58
so money minutes every day to improve your heart greater your condition so in
00:34:04
physical therapy is quite a noun one in speech therapy we are
00:34:09
trying to do something good but we never know this is good enough
00:34:14
of course patients are getting tired patients will complain but
00:34:18
it's uh our problem to manage to to have a better control in
00:34:24
what do we need daily it's better to exercise twice or three times
00:34:28
in a day ten minutes or to do it thirty minutes
00:34:32
eh in one period so it's something we have to learn about the dos and that you ration
00:34:38
how to do it but i uh and a digital assistant can be helpful uh to find it out
00:34:46
so i present we composed uh and number of exercises during the past months that for
00:34:53
two packages one is the articulatory to real um
00:34:58
it's sound by sound phoneme by phoneme
00:35:02
position by position show you go put their sound in the beginning at the end than in the middle of a word
00:35:08
that we limit it to more no i'm a syllabic words by syllabic words because
00:35:14
we don't want to make it too complicated because that will be hopefully to b. c.
00:35:20
and we excluded nonsense because in the past to be included nonsense for that
00:35:25
intelligibility assessment uh we developed in the late nineties and
00:35:31
it's good because you can address all the phonemes in all the
00:35:35
positions that you want but some patients are confused with nonsense
00:35:41
and even when you get instruction really really disagreed what is on the paper they will say something
00:35:47
what they think oh it must be three and not be so they say something different you
00:35:53
ah will look to that like a mistake so it's we skip it
00:35:58
now it is better for this kind of patients we exclude nonsense
00:36:04
and the other package are the minimal pierce and minimal pairs are excellent
00:36:09
to improve the distinctiveness it like then then
00:36:13
it's voiced unvoiced too it's uh they're excellent exercises to do that
00:36:19
i'm up to make the distinct but related forms
00:36:25
okay um i got packaged already know and we see a
00:36:30
number of chances first b. c. a lot of
00:36:33
possibilities to it will increase a facilitated training time we
00:36:39
we have some to like that it patients will have more um possibility to train
00:36:45
you can use it as a therapy supplements or it doesn't have to replace the speech therapist
00:36:50
they can use it on other moments than in the real uh in the real therapy
00:36:56
we can use it to maintain a result because sometimes you see it the training effect when you stopped
00:37:03
raining basins are going worse a little bit and that this a set to to to find out
00:37:10
it can work as a standalone system in the house of the patient or it can be
00:37:15
uh on the control system of for the speech
00:37:18
therapist a remote control or anything else
00:37:24
an important issue is how to make the interface attractive it's
00:37:28
is boring material to is boring to repeat sounds
00:37:33
uh maybe you have to repeat to more of the same sound that
00:37:36
is boring it's very hard to make it a funny or interesting
00:37:41
and um it's boring in in in real therapy too but i'll keep patients do it
00:37:47
in real therapy for that that this was looking into their eyes and say okay
00:37:51
i will do it it's not the worst men so they do it for you but with a machine it will be different
00:37:58
and how can be work within the capacities of a brain damaged patient with that
00:38:04
settings to shows that have to be more or less manageable
00:38:09
okay so to take home just we can improve intelligibility and competence
00:38:16
ability and that is the primary goal whatever the method this
00:38:20
and you can do that by compensation are you giving compliments
00:38:27
a functional communication is has to be addressed directly you have
00:38:31
to work on it taking into account motor learning principles
00:38:35
and you have to use speech not speaking about speech but doing speech
00:38:41
it allergen prognosis are important variables affects the for
00:38:46
but we and and don't give up the
00:38:49
patient too early look for the go to it i hope the day but be patient
00:38:54
ah someone will be patient with me to continue for
00:38:59
a while because that can make a difference
00:39:02
thank you replace your standing to encourage me to stop so i do it now thank you
00:39:15
mm
00:39:23
yeah
00:39:58
it is and it's it's a radical question i i think so i think i
00:40:04
even i believe the more the patients speaks the better he is if you
00:40:08
if he's reading aloud in a newspaper it will be helpful to but
00:40:13
and to make a change i think you need is specific yet
00:40:18
a structure than a specific program and in fact at present
00:40:22
from the the peace sign the form that being a point of view we we don't have inside
00:40:29
the what is it really necessary to relies that changes we we hope
00:40:34
and we looked with but i'm confident that uh keeping in
00:40:40
to uh i count this eh id is it
00:40:44
can be better because in the past we there was a lot in prophecy a lot of improvisation
00:40:50
trying to do something good and some patients okay with it so
00:40:54
it it it is possible but we we we really don't
00:40:58
have a enough experience to judge that at this moment

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