She’s talking at a million miles an hour. She’s so excited to regale you with her every juicy detail of the latest terrible scandal to befall her BFF that you can’t understand a single word she’s saying.
Usually a quick smile, polite hand gesture and a “whoa” are enough to cue your friend to stop sounding like a retro FedEx commercial:
To take a deep breath. And to slow. Down.
But not everyone is so lucky. Some people with Parkinson’s Disease, a traumatic brain injury, Cerebral Palsy, anoxia, ALS, and/or hyperkinetic, mixed, ataxic or spastic dysarthria struggle to control their rate of speech. And a fast rate of speech seriously reduces their intelligibility – especially when speaking with strangers.
Rate control is a long-standing global strategy to improve speech intelligibility. But which specific treatments are supported by research evidence? Here are 4:
- Pacing boards: these humble low-tech devices have proved particularly helpful in helping people with Parkinson’s Disease control palilalia (e.g. Helm, 1979) and, more recently, in combination with LSVT Voice Therapy focusing on increasing loudness.
- Metronomes: although better known in speech pathology as a tool to assist people who stutter, e.g. in some early forms of syllable timed speech, the metronome has been used as a method to help people who speak too quickly to regulate their rate of speech and to increase their intelligibility (e.g. Pilon et al., 1998). The main draw-back with metronomes is that they cause people to place equal stress on each syllable, which is not the way we speak in real life. While it can increase intelligibility, it can give your speech a slightly robotic quality.
- Computer-games: the now defunct IBM-owned SpeechViewer Program, showed early promise in modifying rate (e.g. Thomas Stonell et al).
- Deliberate Pause insertions: speaker-implemented interword pauses have been shown to increase speech intelligibility in the clinic (e.g. Hustad & Sasano, 2002), though it can be a challenge for some people to learn how to cue themselves.
Most of the studies cited above record Phase I experiments, which suggest a potential benefit of rate control in improving intelligibility – but no more than that. There is very little evidence about whether the improvements achieved with these treatments transfer (or ‘generalise’) to people’s speech in their everyday lives – a major gap in the research.
Recently, more sophisticated computer rate control programs, such as Speech Pacer and (cheaper) apps like Speech Pace Setter have come onto the market. They seem to have overcome the problem with metronomes by allowing people to set their pace based on words (rather than syllables) per minute. They also allow people to choose their own reading material. In the clinic, some of my clients have used Speech Pace Setter and achieved good improvements in the clarity of their speech. But, again, the key question is whether these improvements transfer to real life activities, e.g. in conversations. In the absence of quality research, this is something speech pathologists need to monitor closely when working with people on their speech rate.
Related articles:
Key source: Yorkston, K.M., Hakel, M., Beukelman, D.R. & Fager, S. (2007). Evidence for Effectiveness of Treatment of Loudness, Rate, or Prosody in Dysarthria: A Systematic Review. Journal of Medical Speech-Language Pathology, 15(2), xi-xxxvi.
Hi there, I’m David Kinnane.
Principal Speech Pathologist, Banter Speech & Language
Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.
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