Three Therapy Takeaways from "The Brain That Changes Itself" by Norman Doidge

Join me as we explore the many topics that fall under our umbrellas as SLPs . I want to make your journey smoother . I found the best therapy comes from employing simple techniques with a generous helping of mindfulness . Hello , welcome to The Speech Umbrella podcast .

Summer is well and truly here , and what better way to celebrate summer than to kick back and relax with a good book . A few years ago , I started reading a fascinating book called "The Brain That Changes Itself by Norman Doidge . I didn't get a chance to finish it then , but it was always in the back of my mind to finish it someday .

Well , I finally did , and it was worth the wait . It's basically a book on neurology and learning . You might be thinking that's the last way you want to spend your free time , but it's so well written for the everyday person and so filled with stories in hope and recovery that I found it a really great read .

That also has big clinical implications for anyone who wants to teach a learner how to learn . This episode is called Three Therapy Takeaways from "The Brain That Changes Itself by Norman Doidge . One of the problems we run into as SLPs is trying to get learners to the place where they can learn , where they can actually take in what we're offering .

With some clients , I feel it's as though what we're trying to teach just runs off and away , and until we can find the cracks through which information can penetrate , we don't get very far . And another problem we have is overcoming speech and language habits so ingrained that they seem set in stone .

Doidge writes about both of these issues with ideas on how to overcome them . Here's what we're covering today; The basic premise of "The Brain That Changes Itself" book , three takeaways on the laws of learning, and clinical applications . If you structure your therapy around the laws of learning , it will make you a better therapist .

The overarching idea of "The Brain It Changes Itself is that the brain is plastic , far more plastic than many scientists used to think . Not just in infancy and childhood , but the plasticity can be tapped into in old age .

Now there's a neuroscientist called Michael Merzenich who led the cochlear implant team at UCSF , and he's done a lot of work on brain plasticity . He claims that when learning occurs in a way consistent with the laws that govern brain plasticity , the mental machinery of the brain can be improved so that we learn and proceed with greater precision , speed and retention .

What are these laws that govern brain plasticity ? Well , there isn't time to cover the entire book , but the three takeaways I want to talk about today are; using roadblocks to help the brain form new maps, two, the fact that the brain needs clear signals , and three, focused attention is critical to forming new brain maps .

Okay , so what does it mean to use a roadblock so the brain can learn or relearn ? There's this analogy in the book that I love .

If you're sledding down a hill and you make that first pathway in the snow and you use that pathway again and then again , pretty soon that's going to be the only way your sled is going to want to naturally go , and that slope is going to get pretty slippery and pretty fast and you would have to really do something different to make your sled go a different

way .

It would take some effort , it would take a new approach , it would take blocking the old path to get your brain to take a new path , and so the whole idea of this book , of this roadblocks , is when someone has some neurological damage or if they're born with some neurological impairment , the brain develops these pathways that are not desirable because they impair

them in some way , and if you put a roadblock in the blocks the old pathway you can teach them a new pathway . It's a really cool idea, and there's really great research in the book about ways they experimented and proved this . Now , putting up roadblocks so the brain can take a new path and strengthening the weakest functions are two sides of the same coin .

One example of using both of these ideas the roadblocks and strengthening the weakest function is what they call constraint induced therapy , and one way this has been used is when stroke patients are left with paralysis , they're not allowed to use their stronger hand .

They have to use the impaired hand over and over and over again for increasingly complex tasks , and in studies done with this constraint induced therapy , they have had astonishing success at rehabilitating the weaker side , because the brains were able to make or reconnect new maps when the weak part was exercised .

And in the clinic where they study this , they use mitts and they use slings on the stronger limb , and that was their roadblock , so that the patient had to use the weaker side . And because the stronger limb was constrained , the brain couldn't default to the old pathway , it had to make a new pathway .

And Doidge writes what rewires patients' brains is not mitts and slings , of course . The essence of the cure is the incremental training or shaping , increasing difficulty over time . Mass practice helps rewire brains by triggering plastic change .

Now , as speech therapists were really really familiar with that shaping and increasing difficulty over time when taking small steps . Now here's a study that's a little bit more relevant to our field , using constraint induced therapy .

They used it with some patients who had aphasia and the constraints weren't physical , but they were a series of language rules which they introduced slowly , and the way it works is they play a game a little like adult go fish .

These patients have to ask other patients for a matching card and at first the only rule is that they not point to the card , and that is so that they don't reinforce learned non-use . So they have learned to not use their speech and they don't want to reinforce that .

The y can use any kind of circumlocution they want any kind of language as long as they are talking . And then from that point they move on to naming an object, correctly, and then they add the person's name that they're asking the card for , and so on and so on , until they gradually add more and more language .

And this constraint induced aphasia therapy was used with patients who were , on average , eight years post stroke . With the control group they use what they call conventional therapy .

And they said that was just repeating words, and I understand that's not the best conventional therapy treatment, but leaving that control group therapy technique aside , what happened with the constraint induced treatment was they did have great results . After 32 hours of treatment , which took place over 10 days , they had a 30% increase in communication .

And so , considering how many years post stroke these patients were , I find that remarkable .

I can see using this with clients who struggle with word retrieval and moving through different levels , starting with naming , then adding a descriptor , then using a basic noun , verb phrase and adding maybe a preposition or a direct object .

I can imagine a shopping activity where you built a shopping list and take your basket to the store and it could go something like this . So suppose you've got grapes, and so , you're just practicing grapes and then purple grapes . Then let's get purple grapes .

Put the purple grapes in the basket, and the constraint induced therapy could be replacing pointing with words . And then you add in the shaping , and small incremental shaping to increase the difficulty , and this would not happen all in one session , of course .

A way to ramp this up is to practice naming , just naming by itself , like five to seven objects in a row . Now I use pictures and then add a descriptor . I let them come up with the descriptors if they can , and after they don't struggle with the descriptor and the noun , you can start adding words to the phrase .

So I might do it like this - I might have an apple and a banana and a pineapple, and I'll go red apple , yellow banana , sweet pineapple . Something like that . But first we would just practice apple , banana , pineapple . Until it was easy for them to name , they weren't struggling with retrieving those three words , and then we would add the descriptors .

And then it's not so hard to say hey , let's buy a banana , and we slap that banana on our shopping list and oh , let's get some purple grapes . Mmmm , sweet pineapple , let's get sweet pineapple . And once you have your shopping list built , then you go shopping in your therapy room .

And , by the way , you can get food and animal pictures from my picnic fun activity available on my store at thespeechumbrella . com . And then , after you go shopping , you can go on a picnic with your stuffed animals . That's where the animal pictures come in . Okay , moving on to the next law of brain plasticity, clear signals .

A person's memory can only be as clear as the original signal , but research suggests a lot of our clients aren't receiving clearer speech signals , even though they have no problems with conductive hearing .

The research I'm about to describe here might be somewhat controversial in our field because it suggests that nearly all speech and language impaired children have auditory processing struggles . Now, if all , or nearly all of our clients struggle with receiving clear speech signals , then should we have a separate diagnostic category called auditory processing disorder ?

I don't want to go too deeply into that question today . I have a whole podcast on it . That's Episode 44 called 'That Thing That Isn't APD . ' But I don't want to ignore the elephant in the room . I prefer to look at a child's symptoms , treat the symptoms and don't worry about the label so much .

So, if you can determine that they're struggling with auditory processing , then treat it . Here's a summary of the research Doidge writes about .

Paula Tallal found that language impaired children had auditory processing problems with consonant - vowel combos that are spoken quickly, and she called these the fast parts of speech and that they had trouble hearing them accurately and reproducing them accurately .

And has a theory about the fast parts of speech , which is that the auditory cortex neurons were firing too slowly, and this meant that; one , they couldn't distinguish between similar sounds or be certain if two sounds occurred close together , and two , they didn't know what order they came in, and three , they didn't hear the beginning of syllables or sound changes

within syllables . Now I just have to put a plug in for "Equipped for reading success" by David Kilpatrick . I've been using his program for a couple years and this is exactly what I see . The more severe the speech and or language issue is , the harder it is for those kids to hear the beginning of syllables , especially internal syllables .

I mean , this is a huge struggle for some of my clients , but this is the cool thing . When they do start to hear the syllables and they can analyze these words by removing syllables or changing syllables , then I have come to expect a significant change in their language ability . It just happens every single time .

Every single time they figure out the syllable analysis part of this program , they make a huge leap . Now back to the research , because , yes , there is more .

After processing a sound , normally our neurons are ready to fire after a 30 millisecond rest , but 80% of language-impaired children took at least three times longer and because of this they lose large amounts of information, and also the signals aren't clear . It's what Merzenich called muddy in , muddy out .

And this weakness in hearing led to weakness in all language tasks: vocabulary, comprehension , speech , reading and writing . I mean , that's what we see in our field , right ? We see that all the time . Also , these children used shorter sentences and didn't exercise their memory for longer sentences .

And now that I'm starting to pay attention , I see this muddy in , muddy out all the time , especially in clients who don't really have an articulation disorder . What they have is a language disorder disguised as an articulation disorder , because while they have the motor ability to say the words , they don't remember how to say them .

It comes out sounding a little bit muddy and mushy and we think it's a speech disorder . So what I do when this happens - I pull out my phonological awareness tracking tool , I use it to find out where they need to start and then away we go .

This tracking tool has been a life changer for me as a clinician , and you can also get the phonological awareness tracking tool on thespeechumbrella . com . The third law a brain plasticity I'm covering is focus . I'm all about focus . That's why this podcast used to be called the Mindful SLP . I love , love , love talking about focus .

Doidge writes, lasting changes occur only with close attention , while you can learn when you divide your attention . Divided attention doesn't lead to abiding change in your brain map . Isn't that what we see when kids don't carry over , when they don't generalize , it's not abiding change . Focused attention is the condition for plastic change .

Anything that requires highly focused attention will help that system . Are you fans of whole body listening ? I am , and this is why I love it . I see real lasting changes when my clients are paying attention with everything they have . This can take some time to teach , but I tell you it's worth every therapy minute you spend on it .

If you want lasting change , if you want carryover , focused attention is a must . Here's another interesting tidbit . Evidence suggests that unlearning existing memories is necessary to make room for new memories in our networks . In articulation therapy I play a game which seems to help clients both learn a new path and unlearn an old path at the same time .

It's really helpful with phonemes that can be distorted , such as R , but you can really do it with any sound . I call it Mind Your R's in my Impossible R Made Possible course , which you can find at thespeechumbrella . com/ R- course . This is how the game works .

I have three boxes with a one , two , three in each box and I have mini M&Ms , because that makes it fun . For a client to play this game they do need to be able to say a word , even if it's just one word , correctly . And so what you're going to do, is you're going to take a word like robot .

Say we're working on the R sound robot, but they're not really consistent with saying it correctly , and so it comes out 'wobot" , but sometimes , or maybe their error is "raobot" , where they kind of have R but they don't quite have it . Or maybe they're distorting it by trying too hard "R robot , kind of like that .

It can work with any of these , but what you're going to do is you're going to make sure that they can say it right . You say , okay , now let's say robot . How are you going to say it the right way ? " And they'll say "Robot and then you say , how are you going to say it the wrong way ?

And they might go, really often go, "Lulululobt" I mean , really they'll do that because they want to make sure they're wrong and they just make it silly . I'm like , "no , no , that's not how you say it wrong when you make a mistake . " And I'll mull it for them, this is how you sound when you don't quite get it .

And we'll practice it, we'll practice their wrong way , the way they actually say it wrong when they're not paying attention . Okay , and then the way the game goes is they have to say it right twice and wrong once . I've got three boxes . We've got an M&M in each box, and I'm the listener and I determine which one is the wrong one .

And I get to eat that M&M . And they are so surprised when I choose their wrong one sometimes , because often the one they think is wrong is the one that sounds the best , and it's just really weird . It's really freaky . And we take turns with this, so I am also the speaker and they're the listener . And they can always determine my wrong one , always .

So it's not so much a muddy in muddy out with listening to me , it's a muddy in , muddy out listening to themselves . This game is awesome and I'll also use recording a lot , because they'll argue with me about which one they said wrong . But when they can hear themselves, when they play it back and have times like , oh yeah , okay .

Fidelity to the process is really critical for this to work and this is gonna take some work with your hard clients . They must say it right two times and wrong once . Whatever rules you set up , they have to do that or they won't be clear . They won't be clear about what they're doing and that auditory signal will be muddy .

I'm often set on this podcast that neurons that fire together wire together , but it turns out that neurons that fire apart wire apart too . We can weaken links and help the unlearning process .

For example , compulsive practice of a sound the wrong way , and that's what Mind Your R , or any sound you're working on, that's why that game works , cause you're helping them unlearn the proce ss and you're helping weaken those links that have been forged .

It interrupts the compulsive repeating of a phoneme the wrong way and really focuses their attention to the differences between the right and wrong way . As neurons are trained and become more efficiently process faster .

This means the speed at which we think is plastic , because it can be changed , and as these changes start to occur and automaticity starts to happen , they learn to do the new skill easily and effortlessly . I hope I convinced you to pick up "The Brain That Changes Itself" by Norman Doidge .

Before I go , here's a quick recap of the rules that govern brain plasticity . A roadblock of some kind is necessary to help us change direction and form a new brain map . Faster neurons give clearer auditory signals , and a memory can only be as clear as its original signal .

When working on persistent articulation errors that are not motor based , first teach them to say it once, and only once, and pay attention , and they will learn to generalize that sound . Implement the rules of brain plasticity and complex learning will take care of itself . Thank you for joining me under the speech umbrella today .

I hope you learned something to help you in your therapy . If you did , please share this podcast with a fellow speech therapist and leave a five star review on Apple Tunes , Spotify or wherever you get your subscriptions . While you are online , come on over to TheS peechU mbrella . com where you will find transcripts , links, and my free resource library .

I also have some other valuable courses and therapy aids in my store . That's all at TheSpeechUmbrella . com . Let's connect on social media . I'm dstratton SLP on Instagram and The Speech Umbrella on Facebook and YouTube . You can also find me on TPT . I hope to talk to you soon . Bye .

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