Prosody Treatment:

Pausing
Portfolio Project Part IV: Treatment
Megan Brey, BS

Breath-Group Theory of Phonation

Suprasegmentals of speech can be characterized by two activities

Grouping words into units based on breath groups
Marking the breath groups for intonation and stress
*Both may be compromised in individuals with dysarthria

Occurrence of pauses in normal speech appears to be more dependent on

syntactic structure than on the physiological requirements of respiration.
In spontaneous speech, pauses may occupy as much as 50% of the
total time.
Distribution of pauses is related to planning and organization
Speech naturalness- Garden Path effect
(Lieberman, 1967)

This theory states that suprasegmentals can be characterized by two activitiesgrouping words into units based on breath groups, and marking the breath groups for
intonation and stress. It is important to note that BOTH of these may be compromised
in individuals with dysarthria.
Therefore, pauses play a key role in our prosody. The occurrence of pauses in normal
speech appears to be more dependent on syntactic structure than on the
physiological requirements of respiration. In fact, in spontaneous speech, pauses may
occupy as much as 50% of the total time. As a result, the distribution of pauses is
highly related to planning and organization.
In dysarthric speakers, speech naturalness may suffer as well as speech intelligibility.
This results in the Garden path effect- the listener is mislead, perhaps because the
total utterance is not divided into the appropriate syntactic units.

Assessment
A complete assessment must provide information
about both habitual and potential maximum
performance for breath patterning.
Must ensure that the patient has the motor and
respiratory support to modify their habitual
breath patterning
Conversational speech sample
Paragraph reading

(Lieberman, 1967; Swigert, 1997)

In contrast to non-impaired speakers, the physiological capabilities of dysarthric speakers are

compromised. Because of this limitation, pauses may be more frequent and may be a
response to physiological rather than to syntactic demands.
So, in order to ensure that a patient would benefit from pausing as a treatment technique, a
complete assessment must be conducted to provide information about both habitual and
potential maximum performance for breath patterning.
An understanding of both aspects is necessary for the planning of appropriate intervention in
order to ensure that the patient has the motor and respiratory support to modify their habitual
breath patterning.
This can consist of reading of paragraph length passages, conversational samples, and data
from respiratory support. During reading, pauses typically account for 30-50% of the total time
and almost always come at the end of sentences. The length of breath groups in speech is
highly variably as a result of syntactic requirements of the material.
Rates affect intelligibility and varies depending on the task. Normal paragraph reading rates
range from 160-170 wpm. Conversation rates vary from 150-170 wpm. (p. 120)
Dworkin (1991) describes a method for determining speaking rate. Record several one-minute
samples of reading, monologue, and conversation. Count the number of words the patient said
during each sample, and take an average of the number of words.

Pausing as a treatment technique

Who would benefit from this:
Individuals with mild dysarthria

Pauses may be more important in modifying

rate than slowing down articulation time.
Monotonous tone was the result of...
(1) short uniform breath groups
(2) inhalation during every pause
(Swigert, 1997)

The basic premise behind pausing as a treatment technique is that, in these

individuals, frequent inhalations were a learned behavior and that pauses may be
more important in modifying rate than slowing down articulation time.
If you think about how you speak, you do not inhale every time you pause in your
speech. According to Swigert, the monotonous nature of the dysarthric speakers
voice was the result of short uniform breath groups and inhalation during every pause.

Treatment Goal/Objective
Goal: Will vary length of breath groups and use pausing as a strategy
to separate speech into meaningful units.
Objective: Will produce utterances of __ words per breath group with 90% accuracy in
structured activities.
Task: Will reduce rate by inserting pauses when answering questions requiring phrase/sentence level
responses.

Objective: Will demonstrate a frequency ratio of __ pauses without inhalation to pauses

with inhalation, when reading passages of increasing length and complexity.
Task: Will reduce rate by inserting pauses at premarked locations with when reading paragraphs.
(Swigert, 1997)

Scoring/Criteria
Binary: +/*Note level and type of cueing required

The scoring and criteria would be binary, plus or minus. Denote whether cueing was
needed and what type, with the goal of fading cueing.

Conditions of Practice
Feedback
Immediate feedback from the clinician
Delayed feedback through video recording (if
possible)
Knowledge of results & performance

Distributed/random practice (multiple stimuli)

Feedback:
Knowledge of results
Clinician provides feedback about overall goodness of the utterance
This type of feedback is given immediately
Knowledge of performance
Specific feedback regarding the error
Distributed practice has been shown to be a better facilitator for the development of
motor learning.

Stimulus Design
10-20 stimuli depending on the level of the
objective/task
Linguistic nature:
Sentence or paragraph level
Increasing length and complexity
Number of words
Length of sentence
(Swigert, 1997)

Both sources mentioned using pausing as a treatment technique for 15-20 minutes.
Use this as a basis for the number of stimuli to prepare. Example: 10 paragraph level
stimuli for a 15 minute period targeting pausing/prosody. Sentence or paragraph level
material may also be used, depending on the level of the client. Regardless, as a
clinician you highlight the punctuation marks. Ask the patient to pause at these marks.
Facilitate the pause by giving a visual signal, such as holding up your hand when the
patient reaches one of the natural pause marks.
In a lengthy utterance, you may also want to insert another pause for the patient
between syntactic boundaries (e.g.,...). (p. 129)

Example stimuli: sentence level

The phone wouldnt stop ringing, so she took
the receiver off the hook.
Put the butter and garlic salt on the bread
before broiling it.
*Vary number of words in sentence depending on clients level
(Swigert, 1997)

10+ word level

Example stimuli: paragraph level

A person may get a stitch in his side when running.
This stitch causes a sharp pain because the diaphragm
has become tired. The function of the diaphragm is to
help the muscles between the ribs pump air in and out of
ones lungs. Because a person breathes faster when
running, the diaphragm has to work harder. This causes
his side to hurt. The pain subsides after the person has
rested.
(Swigert, 1997)

Demonstration
Set-Up
Room set-up
Stimuli
Coaching

Recommendations: sit across or next to the person, within sight of the stimuli that the
patient will be reading from. Have a copy of the stimuli for yourself, in a more compact
version, to take data on.
You will want to provide visual coaching, if needed, when pauses are needed in the
material.
Clinician: I would like you to read this paragraph out loud as you would normally.
Every time you see the highlighted period, I want you to take a short, one second
pause, before continuing on. I will give you a cue to pause, if needed, by placing my
hand up, like this. Does that make sense?
*Consider recording the sample for the patient to hear themselves back.

References/Resources
Bellaire, K., Yorkston, K. M., & Beukelman, D. R. (1986). Modification of breath patterning to
increase naturalness of a mildly dysarthric speaker. Journal of communication disorders,
19(4), 271-280.
Swigert, N. (1997). The source for dysarthria (2nd ed.). East Moline, IL: LinguiSystems.
Tomlin, K. J. (1994). The source for apraxia therapy. East Moline, IL: LinguiSystems.