In Speech and Language Therapy
GUIDANCE FOR PROFESSIONALS
How you introduce and use Cued Speech will depend greatly on the ages of the person receiving Cued Speech, their level of hearing loss, their background, and the quantity and quality of your interactions. No doubt a deaf child who is cued to at home starting at age 1 will have a different experience from a 17-year-old young adult who was raised with BSL and receives cued English twice a week at school. These variables will have an impact on the results and timeline you can expect. This guide is intended to assist you toward making informed, deliberate choices when applying Cued Speech. Keep in mind there is no one way to apply Cued Speech. We hope that in presenting this information you find useful bits to answer your questions and to help you gain momentum in your pursuit of communication, language, literacy, and social interaction.
We choose to look at Cued Speech in the context of the Bloom and Lahey Model of Language of form, content, and use (for a summary see: http://www.slc.cambridgeshire.nhs.uk/default.asp?id=11) By using this model it incorporates much more than just the words, or the content, of language.
This guide is intended to assist you toward making informed, deliberate choices when applying Cued Speech. We hope that you will find comfort in the fact that there is no one right way. The ideas and advice presented here should be adjusted to suit your goals and the needs of the deaf person with whom you will cue. Many of the principles are general and may be applied broadly, however, you will want to adjust to the language level and interests of the person with whom you are communicating.
We would like to expand this section. If you have a story to tell about Cued Speech use in Speech and Language Therapy sessions please contact us here.
CUED SPEECH AND CUED LANGUAGE
Cued Speech is a system devised to make the building blocks of language (phonemes) clear through vision alone. The hand shape and placement cues for English can be displayed on a single sheet of paper and learned in a relatively short period of time. However, the use of Cued Speech is a very variable. To say that someone “uses Cued Speech” presents an insufficient picture. A speech therapist might “use Cued Speech” to make a clear distinction between the [s] and [z] sounds of English. In this way, the therapist is using Cued Speech as a tool to elicit speech sounds. This example is one way that Cued Speech is used around the world.
Remember that Cued Speech is not a method. There is no single way to apply Cued Speech. Cued Speech is actually best described as a modality for language. It is a way of sending and receiving language. Cued Speech is visual and used for languages that have traditionally been spoken (e.g. Chinese, English, Russian). For this reason, Cued Speech particularly benefits deaf individuals who have struggled to learn spoken languages.
Cued language is the term for a complete language conveyed through Cued Speech. Since Cued Speech has no prescription for how it should be administered, professionals often use the term cued language to make an important distinction. Families who cue to their deaf child use cued language at home in the language of the home. In this country, most use cued English – a term that describes both the specific language and the mode through which it is conveyed. It is vital that parents, teachers, and administrators establish clear and realistic goals for deaf children and design appropriate programmes incorporating Cued Speech to support those goals.
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LANGUAGE FORM
Language form includes phonology, morphology, and syntax. Cued Speech can be readily and directly applied to each of these aspects of language in speech therapy. The child's individual language ability will vary depending on the quality and quantity of their previous language exposure through Cued Speech. In homes where English through Cued Speech is the first language, therapists can expect a typical sequence of language acquisition milestones depending on the child's linguistic background, provided that no other language or cognitive disorders are present.
Phonology
Cued Speech not only shows individual phonemes, it also shows how sounds are put together. Children who have benefited from early and consistent exposure to Cued Speech demonstrate knowledge of the sound system and the skills that support phonemic awareness. Cued Speech provides some articulatory information (since the lip patterns of English are an essential component of the cued message). It does not, in general, show how sounds are pronounced.
For example, a deaf child who has naturally acquired English through Cued Speech will know that that /s/ and /z/ are two different sounds, where they are found in the language (e.g. niece and music), and where they are not found (e.g. pressure, abrasion). The child may need to be taught that /z/ is produced with vocal cord vibration, and /s/ is not. Her actual awareness of sound quality will depend on her level of hearing, use of amplification or cochlear implant, and amount of listening training. A deaf child who cues has an advantage over children who use other methods in that if they are taught to how to make a sound, they know where that sound occurs, within which words, and the rules for combining it with other sounds. Conversely a deaf child who has not been exposed to Cued Speech can be taught to pronounce a sound but this will be of limited use since they will then have little or no knowledge of where the sound occurs in the language.
Morphology
Language is not limited to single sounds. Sounds are built into syllables and words. The hand shapes and placements of Cued Speech also build into meaningful pieces and retain essential components of the English language. English affixes (like pre-, re-, -ism, -ology, and bio-) are important clues to the meanings of words. These affixes are preserved when cued. Speech lessons can capitalize on these segments to help deaf children unpack the meanings of tough words, even a word like "antidisestablishmentarianism". The rules for assembling meaningful bits of language (morphology) are passively acquired by deaf children who grow up using Cued Speech.
Syntax
The rules for combining words is called syntax. In English, word order is not only for making sentences "sound right", it also impacts the meaning of some sentences. For example, in the sentence, "Sarah hit Sam" we know that Sarah did the hitting, while Sam was the victim. If we re-arrange the sentence, "Sam hit Sarah" now the opposite meaning is true. But English is not that simple; in “Sam was hit by Sarah” Sarah is again the aggressor. It is exactly this complexity of language which is so hard to teach by rote and where sign-language-using children often flounder.
Children who use Cued Speech acquire syntax naturally. For children who come to Cued Speech later for language remediation, Cued Speech can be used to provide clear, unambiguous access to the syntactic rules of English
LANGUAGE CONTENT
The content of language refers to our internal dictionary, or the words we know and use. Cued Speech is relatively easy for hearing parents to learn because unlike learning a language, no new vocabulary needs to be memorised. For those who already know a spoken language, learning to cue requires learning how to combine handshapes and placements and gaining fluency in their production.
The richness and diversity of English words is conveyed easily through Cued Speech. Therapists can introduce in groups words such as nouns (e.g. bear, snake, gorilla, giraffe, etc.), function verbs (go, stop, eat, drink, play, wait), and prepositions (in, out, aboard, about, through). These words, their usage, and their associations are preserved when cued. Further, based on the child's language level, therapists can introduce subtle differences between words (e.g. tell, inform, explain, admit, advise, notify, etc.) based on the child's language level.
LANGUAGE USE
Learning how to interact with others through language is an important skill. The rules for how to use language are also sometimes referred to as pragmatics. For deaf children, goals for appropriate use may include learning appropriate ways to get someone's attention or how to take turns in a conversation. Traditionally, speech and language therapy for deaf children has focused heavily or form and content (pronounciation, language rules, and vocaulary). For children who cue, goals will be structured with consideration of the child's internalized understanding of English. For children who receive consistent exposire to Cued Speech at home, they may not need much work on vocabulary (or in some cases, their vocabulary may exceed hearing norms). It is important to consider all three domains form, content, and use when determining an appropriate course of intervention for the child.
SAMPLE LESSON PLANS
Two example lesson plans follow which can be adjusted to the language levels of the child with whom you are communicating.
Form Lesson Plans 1.
Pural Marker Endings for Cued Speech Users
Content Lesson Plans 2.
Teaching “go” for Cued Speech User
1. Teaching Form- Plural Endings: /s/ and /z/
Target Age(s): Can be adapted for children aged 3-7.
Objective: The child will correctly produce the sound /s/ and /z/ for pluralisation rules.
Rationale: When selecting goals and objectives for your client, keep in mind the sounds that they have in their phonetic repertoire. Choose words that use phonemes that your client uses or approximates. Incorporate words that are both functional and motivating for the client (e.g. a desirable toy or a favorite food).
Procedure:
Receptive portion
Have available a number of identical small items (small toys or sweets). Get parents approval before offering sweets!
1. Have client seated in comfortable chair. Sit across from them
2. Bring one small toy/sweet to your face to gain client’s attention and cue the singular name.
3. Give client toy/sweet.
4. Repeat several times.
5. Bring handful of toys/sweets to face and cue the name in plural
6. Repeat several times alternating between singular and plural.
Expressive portion
1. Ask client would you like sweet or sweets?
2. Give them what they ask for. If they cued sweet and were unhappy with the one sweet, cue “oh, you meant sweets, sweets, there you are”. And give them multiple sweets.
3. Repeat several times.
4. Try a variety of objects so that client can see the generalization patterns. Use some items that have /z/ endings (pencils, m&m’s), /ez/ endings (goldfishes) and /s/ endings (chips).
2. Teaching Content “go”
Objective: Client will understand and use cue for “go” for when he wants something to go.
Rationale Considerations: This lesson plan idea would be geared towards a first words client, one who currently does not use language. Take into consideration what gestures the child uses communicatively. Does he show frustration when he is trying to make a favorite toy go? Does he frequently hand things to you with the anticipation that you will make it go for him? Choose a gesture the child currently uses and pair it with a cued word (quote research).
Procedure:
- Have the child seated at a table in a comfortable position in which he can easily view your face.
- Bring out a fun windup toy one that the child is interested in.
- Bring the toy to your face and say and cue "go, go, go, go".
- Wind the toy up and show excitement when it goes. If the child looks back at you, say and cue "go".
- Repeat again- frequently gaining the child’s attention by bringing the toy to your face and/ or using gestures.
- When the toy stops going, put it down and say "go, go, go, go". Use hand over hand to cue "go" for the child. When they cue "go", have the toy go immediately.
- If he looks at your face, share affect and say and cue "go".
- Repeat as many times as the child is interested. Use hand over hand if needed working up and down your scaffolding ladder.
These resources were largely developed by a team of Speech and Language Therapy students as part of a project for the Language Disorders class at the Massachusetts General Hospital Institute of Health Professions.
We would like to thank the team of Janine Pedro (Team Leader), Caroline Shannon, Ashley Schuler, Ramya Shyam, Caitlin Schlauch and Tom Shull for their time and dedication. Special thanks go to Cued Speech Transliterator Tom Shull who inspired the other students to pick Cued Speech as their project.