A technique developed by Dr Elena Dyakova aims to increase the effectiveness of standard treatments for stammering and various other speech conditions, as Dr Michael Greenwood reports.
Speech therapists have long used massage as one of a number of techniques for patients with a variety of speech pathologies. Massage of the lips and tongue has been shown to provide some benefit to the patient, but Therapeutic Speech Massage (TSM) expands on these traditional methodologies.
TSM is not meant to replace any of the standard treatments for stammering or other speech disorders. It is meant to make the traditional forms of treatment not only more effective, but more effective over a shorter period of time. It might be helpful to think of the role of TSM in speech therapy much like the role of a catalyst in a chemical reaction.
The foundations of TSM depend upon recognizing the interactions and relationships between the muscles of the peripheral speech apparatus (namely all of the muscles of the face, head, neck and shoulders) and the primary speech muscles. Physical therapists who work with the larger muscles of the body very seldom work with only the specific muscles which have been traumatized. They usually begin their treatment somewhere else and slowly work through a series of connected muscles, thus preparing the traumatized tissue to be more receptive to direct massage. This step by step approach is the defining characteristic of TSM. Also, the type of extended massage utilized in TSM has been shown to change the physiological state of the central nervous system and the psychological mood of the patient. Both changes are helpful in preparing the patient for the work of the therapist.
In the case of stammering, spasms (cramps) in the speech apparatus will often be accompanied by vasomotor reactions in the form of general muscle tension. Rather than attack these spasms directly, the principles of TSM require that massage begin with the muscles of the related peripheral speech apparatus, beginning with the muscles furthest from the muscles in cramp. By working through the proper chain of muscles, using specialised massage techniques, the primary muscles related to the pathology being treated will be more receptive to standard treatment regimes.
An indication of the effectiveness of TSM can be seen in the case of Katya, a young woman who was about to enter university in Moscow. She had stammered most of her life and was quite worried about her ability to speak clearly in class. After 10 sessions in a two week period, combining TSM with more standard therapy, Katya's mother reported that her daughter was very happy at the university, since she had been able to talk freely in all of her classes and had no speech problems interacting with her teachers and classmates. In one class she had given a lengthy oral presentation where she displayed no signs of her previous problem with stammering.
Dr. Dyakova has written a manual on TSM. This is currently in Russian but will soon be available in English. It is most commonly used by professional therapists, but some parents have been able to use it to help in the treatment of their stammering children. English speaking participants at a seminar given in the US at the Oregon Health Science University indicated that they would find it useful even though it is in Russian, as the pictures and diagrams in the manual would be very helpful for them and some of their patients. TSM workshops in Russian for speech-language therapists are given in Moscow on a monthly basis. They last 4 days, and involve a great deal of hands on work supervised by Dr. Dyakova. She has indicated that if there were enough interest, she would be happy to present her workshops in English in the UK.
Dr. Michael Greenwood is president of the TSM Group, formed to facilitate the introduction of TSM to Europe and North America.
In addition to her private practice and her work at the Moscow Medical Academy as a senior scientific worker and speech therapist, Dr. Dyakova is currently on the faculty of the Moscow City Pedagogical University as an associate professor of speech pathology. Her website on TSM is www.tsmus.info
From the Spring 2008 issue of 'Speaking Out', page 16