The Carryover Challenge: Why Speech Doesn't Transfer—and How to Change That

We've all experienced it. A client produces the target sound during therapy in words, phrases, sentences and even during controlled conversations. Yet when they walk out the door, it's gone. Poof. We spend a great deal of time and effort getting to the finish-line but crossing it? That can be a whole other challenge.

It's tempting to say the child isn't motivated or they don't devote adequate time or effort. While that may be true to some degree, I believe there can be other potential contributors.

So why does this happen and what can we do about it? After studying the subject and a few decades of therapy, following are findings, suggestions, and three sure-fire treatment phases to help you and your clients win the race.

The Two Phases of Motor Learning

The motor learning research makes a clear distinction between Acquisition (learning) vs Transfer (retention). This distinction is emphasized in most motor learning books that I've read, as well as Maas's excellent 2008 article (that's based on Schmidt's Motor Learning and Performance book):

"Speech production is a motor skill, governed by similar principles of motor learning…. It is important to consider the distinction between performance during acquisition and performance during transfer…. Transfer [generalization and carryover] refers to whether practice on one movement affects related but untrained movement," (Maas, et al., 2008).

And that's what we all want: THE TRANSFER.

This sounds similar to "get the sound in isolation, then words, phrases, sentences, then do generalization and carryover tasks." But the breakdown, however, is slightly different and more distinct. While all of the following is not in speech literature, it is based on motor learning theories and principles. After all, speech IS movement.

Seven Suggestions to Implement During the Acquisition Phase

In our field Carryover has often been described as the final stage of speech therapy, but perhaps it's more accurate to think of it as the natural outcome of everything that came before it. Before clients can successfully transfer a new speech pattern into conversation, they must first develop a comfortable, automatic motor pattern that is easily replicated. The Acquisition phase lays that foundation. Here are summaries of seven strategies to help prepare your clients for successful speech Transfer.

• Emphasize "Carryover" From the Beginning—not just as a Separate Final Stage: This flies in the face of the two phases, Acquisition and Transfer. It is a great distinction for us as therapists, but clients need to recognize the final goal from the beginning. They are more likely to transfer new skills when they understand why change is important from the start.
• Emphasize the Production Components of the Speech Sound: Apply the stabilization-mobilization components of the speech targets you are working on. Ensure the production of the single-sound has all the components it needs to easily and consistently move into and among other speech sound productions. This is huge piece of establishing carryover.

  "Results indicate that tongue bracing [the anchorage of the tongue-side on the top side teeth] is both pervasive and active in running speech and essential in understanding tongue movement control," (Gick, at al., 2017, p. 494).

• Emphasize Early Self-Monitoring: Encourage them to become active analysts of their productions. Urge them to self-monitor not only the acoustic result of their productions, "How did that one sound to you?" but direct them intra-orally, "Close your eyes and focus and feel" so they can better recognize and discern their stabilization-mobilization.
• Include and Emphasize the Oral Resting Posture (ORP): The ORP is where the tongue, lips, and jaw rest when they're not in use. Basically, the tongue is up, the lips are closed and the jaw is gently relaxed. The ORP is home-base for the tongue to come from and go to.

  "Helping an individual optimize their static oral resting posture facilitates achievement of fluid, efficient and economic movement patterns needed for accurate and fluent speech," (Landis, 1998, p. 42).

  The ORP is the integrating center of speech movement. Given most other elements are in place, a comfortable and consistent ORP all but ensures speech automaticity success.
• Investigate for Any Oral-Nasal Obstacles: The ideal ORP and appropriate speech production stabilization-mobilization are dependent on the "normality" of numerous cranio-facial-oral-respiratory factors. Investigate for any obstacles or deterrents that might restrict your client from achieving these positions, postures, and movements.
• Emphasize Repetition and Why it's Important for Them to Do It: I like to use the phrase "drill-and-instill." We know that all motor learning tasks requires replication; but I'm not so sure the kids do. Draw comparisons to learning sports (perhaps they play soccer), or talk about handwriting, or learning to play a musical instrument. Practice is how movement develops patterns that leads to automaticity.
• Emphasize that There is an End to Speech Therapy; set up a Graduation Date: "Speech" not a life sentence! Set a potential graduate date—complete with a graduation party. Emphasize the ice cream and make it a big deal. Both you and your client decide how much time they need to work on their speech and finish. Gotta be realistic here; most clients take many months. Give them criteria: "Here's what your mouth must be able to do to graduate and have the party. Your new speech target must sound just as good as all the other speech sounds (pick out a few) you say when you talk."

Three Progressive Transfer Steps

The acquisition approach you use is up to you. However, if you use a strictly auditory approach, e.g., traditional stimulation methods, the complexity approach, etc., the oral-piece must be emphasized during the process of transitioning to automaticity. Transfer is a motor process that happens over time.

I caution you to only advance into the Transfer Phase when your client's isolated speech target is motorically accurate, and at least 90% consistent. If they proceed into words, etc., too quickly and you have to frequently correct their productions—stay in Acquisition. They must be able to correctly produce appropriate stabilization-mobilization of the target production.

Step One: Solidification

Many years ago I coined the term Solidification as well as its practice regimen. It certainly fits within the motor learning schema. In essence, Stabilization is quality, deliberate drill-and-instill of the production in isolation and within non-sense syllables: CV, VC, CVC, VCV. Only practice the combinations they're capable of doing correctly; that's key.

Solidification is the bridge between being able to say a speech sound and, producing it effortlessly. Focus on establishing a stable movement pattern through repetitive, quality practice.

First, initiate a simple, to-and-from movement. Introduce tongue movement from the ORP to the speech sound placement, say the sound, and move back to the ORP home-base. Ask them to close their eyes, focus and feel, and do this many times until this trajectory feels comfortable and familiar. The tongue begins to initiate refined lingual movement and control. Emphasize that speech movements are small; they have to be to eventually fit into coarticulated speech.

Then move into non-sense syllables. There are three practice-types. Take inventory and only practice the one(s) they can do. As skills improve, gradually introduce greater variability from blocked practice to alternating practice, then to random practice:

• Blocked – e.g., /ri/, /ri/, /ri/; /ra/, /ra/, /ra/, etc.
• Alternating – e.g., /ri/ /ra/, /ri/ /ra/, /ri/ /ra/, etc.
• Random – e.g., /ri, re, ra, ro, rʊ/, etc.

Random practice is more challenging. But it often advances movement agility because it more closely resembles the variability of real-life connected speech. Advance slowly according to what they're able to do successfully. They are in the early stages of developing automaticity. If I had to suggest a timeline, I'd say, stay at this level for at least one to two months, but it's up to you and your client's capabilities.

Step Two: Generalization

The Generalization practice-level increases their phonemic load and thus ups their ante toward building movement consistency. This information is no doubt familiar to you. But, only advance to this level if they have mastered random syllable production. That's a good indicator they're ready for the rigors of producing word contexts that escalate:

• single syllable words, to
• multi-syllable words, to
• short sentences/phrases, to
• longer sentences containing 2 or 3 target words.

Again, at this level, only practice what they can successfully do. Take inventory and administer it frequently to determine what to practice. Use any tool you want, but here's what I use: The Deep Screening Probe.

With that said, it's not just what they practice, it's how they practice. Emphasize self-monitoring. Their brain is the "production police."

Also, endeavor to keep their productions clean. Meaning, make sure they say the target accurately with no additions or distortions. For example, some clients over-emphasize their target sound when practicing words, etc. Therefore, say, "Your new sound is important, but do not emphasize it. It gets the same weight as all of the other sounds in the word." If they have difficulty with this, record their productions and analyze. What they practice at this level is how they will produce the sound during connected speaking.

Step Three: Carryover

Carryover is the final Transfer Phase that brings together the hard and effective work you both have done during Acquisition and the accomplishments made during Solidification and Generalization. You have carefully and deliberately developed the foundational movement patterns. This Carryover step merely polishes the diamond to make to shine. It's the part that everyone sees.

The Carryover goal isn't just repeating correct productions (as we did in the previous levels). It's learning to apply the speech pattern that will become automatic under increasingly complex speaking conditions.

As a prerequisite to advancing into this level, I suggest you should hear close to 100% consistency of accurate and effortless productions at the controlled sentence level. No pausing to try to find the placement. No incorrect productions that they didn't notice. If all is going as expected, you may hear them say a correct production when you know they weren't thinking about it. That's good news.

As you move them forward, keep in mind that both forms of production focus—intra-oral and auditory—are needed and encouraged. During early learning, internal awareness helped them establish accurate productions. But as productions becomes more stable and consistent, attention can gradually shift toward the acoustic result.

Now. We want to provide tasks and activities for them to incrementally integrate their good productions inside and outside the therapy room. So how do we do this? Think of Carryover tasks and assignments as a hierarchy of practice situations.

And here's the secret: Early in the Carryover phase, assign a similar speaking task to do outside of therapy that you did during therapy. Also, ensure you have support from parents, teachers, etc., to reinforce the outside activity—no matter where it's done, e.g., home, in the car, in the classroom, on the soccer field, etc.

And, here's the sequence; I recommend a progressive approach. As much as possible:

• They begin by reading out loud or repeating narrative text (record and critique). Read school assignments, pleasure books, or articles out loud. Ask them to bring a classroom book to therapy that they also read at home.
• Ask them to retell or summarize what they just heard or read.
• Then, have them create their own narrative spontaneously (use wordless books, for example); make up stories using funny voices (bring in puppets), etc.
• In the advanced Carryover phase, assign "real-life" spontaneous, unscripted situations outside of therapy.

This progression is meant to mirror the gradual increase in cognitive and linguistic demands. Following are ten Carryover opportunities to spark your creativity:

1. Choose a "Word of the Week" that contains their target sound. Write the word on a wrist band and put the band on their dominant hand; make sure they feel it and it reminds them as their arm moves. Talk with the teacher, let them know what the word is and to monitor. (Amazon.com, search either Tyvek wristbands or reminder wristbands.)
2. Ask them to read a poem out loud or say each line and have them repeat. Find poems online that they would enjoy and that have appropriate line-length and vocabulary; print it out. Read it in therapy; send it home.
3. Sing songs they know and like. Again, go online and print the lyrics for them to read, if needed. Send it home.
4. Do round-robin story-making tasks.
5. Ask them to bring an item into therapy; do show and tell.
6. Do "reader's theatre" with those that read. Checkout this amazing series by Mary Ann Hoberman. My favorite book in the series (I have most of them!) is You Read to Me, I'll Read to You, Very Short Stories to Read Together. It has a bear reading a book on the cover. Print out a couple of the stories, do them in therapy, and send them home. (Kids love these!)
7. Ask them to share experiences they've had, places they've gone, stories about their pets, their favorite movie or video game, etc., etc.
8. Engage in role-play; for example when they ask for help in class. Role-play greetings and interactions with friends, family members, teachers, a waitress, store clerk, etc. Go online and pull up menus from their favorite restaurants; practice ordering food, etc.
9. Do role-switching play (teachers, family members, someone they know/admire), etc.
10. Create a weekly conversation group with those at the carryover level, or close. Either specify the conversation topic or use topic-cards they pull from a "hat." Discuss the subject; encourage everyone to join in with back and forth conversation and questions.

Here is a specific assignment for those with high-level production consistently. It is not a starting task but perhaps you may want to include it after a month or so of Carryover tasks. To reinforce consistent outside-of-therapy productions, designate a conversation partner (CP). It can be anyone they come in contact with fairly often, such as a teacher, their best friend, a parent/caregiver, grandparent, etc.

Every time they have an opportunity to speak/interact with the CP, they're expected to use their good speech productions. To close the accountability loop, let the CP know about the task and what you expect from them and the client. Talk and work with the parent about monitoring their child's productions and setting up speaking situations.

Carryover is not something we hope will happen toward the end of therapy. It is something we intentionally design into therapy from the very beginning.

No doubt, you've discovered strategies that have helped your clients successfully transfer their speech into everyday communication, I'd love to hear about them!

Here's to therapy that truly makes a difference,
Char Boshart
Char@SpeechDynamics.com

References

Aman, J.E., Elangovan, N., Yeh, IL, Konczak, J. (2014). The effectiveness of proprioceptive training for improving motor function: A systematic review. Frontiers in Human Neuroscience, January 2015, Vol. B, Article 1075.

Boshart, C., Jutila, M. (2020). Speech Practice Audio Series (r, s, sh & ch, k & g, th, l). Speech Dynamics, Inc., Ellijay, GA.

Gick, B., Allen, B., Roewer-Desperes, F, Stavness, I. (2017). Speaking tongues are actively braced. Journal Speech, Language and Hearing Research, Vol. 60, 494-506.

Landis, C.F. (1998). Preliminary observation of rest posture habituation time. International Journal of Orofacial Myology and Myofunctional Therapy, Vol. 24 (1), 42-44.

Maas E, Farinella KA. (2012). Random versus blocked practice in treatment for childhood apraxia of speech. Journal of Speech, Language, and Hearing Research. Vol. 55, 561–578.

Maas, E., Robin, D.A., Austermann Hula, S.N., Wulf, G., Ballard, K.J., Schmidt, R.A. (2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of Speech-Language Pathology, Vol. 17, 277-298.

Wulf, G. (2007). Attentional focus and motor learning: A review of 10 years of research. E-Journal Bewegung und Training, Vol. 1, 4-14.

©Char Boshart, M.A., CCC-SLP · SpeechDynamics.com

About the Author

Char Boshart, MA, CCC-SLP

Char Boshart is a therapist, seminar presenter, president of Speech Dynamics, and a published author of several practical programs and books on speech and swallowing from a physiological perspective. She has presented numerous well-received on-site and online seminars through SpeechTherapypd.com, state associations, school-districts, and the Bureau of Education and Research (BER). In addition, she writes an information- and idea-oriented blog called Therapy Matters and is host of the popular podcast, The Speech Link. She graduated with her Masters in Speech-Language Pathology from Western Michigan University. Since that time, she worked several years in the public schools and in private practice and was an Assistant Professor and Department Chair at Loma Linda University. Char can be reached at SpeechDynamics.com, MySwalloworks.com and at Char@SpeechDynamics.com.

Disclosures:

Financial Disclosures: Char Boshart is the author and owner of Swalloworks and MySwalloworks.com, and she receives an honorarium from TalkTools for this course.

Non-Financial Disclosures: No relevant non-financial disclosures.