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Passage Reading is a contextual speech task used to obtain samples of connected speech which allows for holistic evaluation of the respiratory, phonatory, articulatory, resonatory and prosodic domains of speech production (Weismer et al., as cited in van Brenk et al., 2022).
"The Caterpillar” is a famous novel reading passage designed to provide a contemporary, easily read, and contextual speech sample with specific tasks, including prosodic contrasts and words of increasing lengths and complexity to target any indication of motor speech disorders (Patel et al., 2013).
Who benefits from Passage Reading therapy?
Individuals diagnosed with neurodegenerative diseases including Amyotrophic lateral sclerosis (ALS), Kennedy’s disease, brainstem stroke, Guillain-Barre syndrome, myotonic dystrophy & progressive bulbar palsy (Duffy, 2013) can benefit from the passage reading therapy as part of their treatment plan to increase prosodic elements in speech such as intonation, stress and rhythm. Speech characteristics associated with these etiologies include hypernasality, imprecise consonants, breathy and strained voice quality, nasal emission, audible inspirations, short phrases and abnormal prosody (Duffy, 2013).
Motor Speech Impairment Target
Flaccid Dysarthria is associated with disorders in the lower motor neuron and/or muscle. Muscle weakness and reduced muscle tone as a result of the damage to the LMN significantly affect the speed, range and accuracy of speech movement (Duffy, 2013).
Therapy Goal: In 3 months, given the printed material of "The Caterpillar" passage, the client will read the entire passage while maintaining the correct intonation and pitch range in 8/10 trials at 80% accuracy across 3 sessions as measured by SLP data collection.
"The Caterpillar"
Do you like amusement parks? Well, I sure do. To amuse myself, I went twice last spring. My most MEMORABLE moment was riding on the Caterpillar, which is a gigantic roller coaster high above the ground. When I saw how high the Caterpillar rose into the bright blue sky I knew it was for me. After waiting in line for thirty minutes, I made it to the front where the man measured my height to see if I was tall enough. I gave the man my coins, asked for change, and jumped on the cart. Tick, tick, tick, the Caterpillar climbed slowly up the tracks. It went SO high I could see the parking lot. Boy was I SCARED! I thought to myself, “There’s no turning back now.” People were so scared they screamed as we swiftly zoomed fast, fast, and faster along the tracks. As quickly as it started, the Caterpillar came to a stop. Unfortunately, it was time to pack the car and drive home. That night I dreamt of the wild ride on the Caterpillar. Taking a trip to the amusement park and riding on the Caterpillar was my MOST memorable moment ever! (Patel et al., 2013)
Activity breakdown (45-minute session 2x a week)
Clinician will initially read the entire passage to model the correct intonation, pitch range, and rhythm of the reading pattern.
Client will read the entire passage aloud while being audio-recorded. The recording gives the client feedback on how he performed during the task. Based on this, the clinician will underline the words, phrases, or sentences the client will work on to target correct intonation, stress, and rhythm.
Client will read the entire passage for the second time. The clinician will provide appropriate verbal prompts and let the client repeat the word, phrase, or sentence that the client will produce with errors.
Clinician will provide additional verbal prompts for the client to pause at the end of sentences, increase voice volume, over-articulate words, and use appropriate stress to indicate a question or exclamation.
End of session.
Hierarchical Cueing:
Modeling: Clinician will read entire passage targeting correct intonation, stress and rhythm.
Direct verbal prompt: Clinician will provide direct feedback to client when error is produced.
Scaffolding with the use of non-verbal prompt: Use of hand gestures to indicate high or low pitch, and fast or slow rhythm.
Fade verbal prompt: Client is able to read the passage with minimal to no verbal or non-verbal prompts
An Evidence-based Approach
Reading a passage out loud is a commonly used strategy to assess dysarthria (van Brenk et al., 2022). Passage reading closely approximates spontaneous speech versus isolated, single sentences and therefore can be considered as a helpful approach for understanding intelligibility variation during typical speech and communication. (van Brenk et al., 2022).
Data Collection Tools
Audio recording device
Notepad and pen for written observations
References:
Duffy, J. R. (2013). Motor speech disorders: Substrates , differential diagnosis, and management. St. Louis, MO: Elsevier.
Patel, R., Connaghan, K., Franco, D., Edsall, E., Forgit, D., Olsen, L., Ramage, L., Tyler, E., & Russell, S. (2013). The caterpillar: A novel reading passage for assessment of motor speech disorders. American Journal Speech-Language Pathology, 22(1), 1-9. doi: 10.1044/1058-0360(2012/11-0134).
Van Brenk, F., , Stipancic, K., Kain, A., & Tjaden, K. (2022). Intelligibility across a reading passage: The effect of dysarthria and cued speaking styles (Vol. 31). American Journal of Speech-Language Pathology, 31(1), 390-408. doi: 10.1044/2021_AJSLP-21-00151
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