An excellent clinical feature of the Facilitator is its solid-state looping auditory playback. With looping feedback, it is possible for the patient to hear back immediately what was just said.
Delayed tapeloops became an important part of speech-language-voice therapy in the 1960s and 1970s, enabling patients to hear back what they had just said. Tapeloop instruments that were commercially available included the Phonic Mirror and the Echorder (cited in Section 2 of this manual). Auditory feedback of patient productions was an important part of language therapy for patients with aphasia; perhaps the best known auditory feedback instrument for use with aphasic patients was the Language Master (1).
Present-day use of auditory feedback is generally limited to recording what the patient says, rewinding the recorder, and then replaying the tape back to the patient. Many computer-assisted programs include the spoken model coupled with a visual presentation on the computer screen; no program seems to include a way for the patient to hear back immediately his or her spoken response. Modern electronics now permits use of a solid-state looping device that can capture client spoken response and provide an immediate feedback of that response.
Client-patient response can now be shaped and expanded by using immediate auditory looping on the Facilitator. For example, in articulation training, the SLP may present a phonemic target, asking the child to repeat it. With looping, the child can hear back exactly what he or she just said. The clinician can then react to the child’s production and perhaps repeat the playback again. The looping feedback would then be compared once more. The clinician controls the number of playbacks of the same loop by pressing the STOP/PLAY switch each time another replay is wanted.
In both diagnostic and therapy settings, the use of looping may be used to differentiate whether or not such immediate auditory feedback facilitates improved patient response. As was shown in Table 2-1, loop feedback has been found helpful in therapy for articulation disorders, voice problems, dysarthria, and for language disorders in both children and adults. The Facilitator’s looping capability has been, also, especially helpful in studio work, correcting articulation, altering accent, and establishing normal prosodic patterns of phrases and short sentences.
When using this feature, you will see the word LOOPING on the Facilitator display window. Loop feedback tokens (e.g., words, phrases, or sentences) can last up to 6 secs; the length of the recording can be controlled by client or the clinician by simply pressing STOP/PLAY as soon as the target utterance has been spoken. By pressing STOP/PLAY again, you can listen to the utterance. This can be done repeatedly. Later in this section, we will give greater details for using looping feedback.
Examples of Cases Using Looping Playback
Dianna, age 6, was found in first grade to have a moderately severe articulation problem, primarily centered on /r/ and /l/ (with /w/ substitutions in the initial position and distorted vowelization of the target sounds in the final position). Subsequent stimulability by her school SLP found that with repeated visual and auditory modeling of /r/, she could on occasion make a correct initial and medial /r/. Solid-state looping was then used with Dianna wearing headphones and speaking her responses after the SLP’s model into the microphone. The time of the loop playback was approximately 4 to 5 secs. After each of her responses, Dianna listened critically to the loop playback. If she heard an error, she would attempt immediate correction of the error. Looping facilitated her acquisition of a normal /r/ in two therapy sessions. Subsequent speech therapy focused on her /l/ and production in general of final consonants. In carryover practice, she wore a portable Facilitator in the provided wearable carry case with the system set on the amplification mode; with real-time amplification, she quickly became aware of using correct productions of her /r/ and /l/.
Mrs. K was a 73-year old woman with a moderately severe fluent aphasia some 17 months after a left-hemisphere CVA. Using the Western Aphasia Battery (WAB), she was found to have an overall WAB function of 68% with a diagnosis of "transcortical (sensory) aphasia". It was found soon in therapy that the patient was able to repeat two-word combinations after the clinician. We then had Mrs. K. use a loop device that made it possible to hear back immediately what she had just repeated after the SLP. She began to show amazing repetition skills. Soon she was able to repeat 12-word sentences and about this time, she began to formulate sentences on her own. Once we found that she could repeat 14-word sentences in our therapy sessions, we discontinued further use of auditory looping. She continues, however, to use real-time amplification wearing headphones in her therapy sessions. Her oral language is so improved that she recently (over two years after the onset of the aphasia) taped a greeting-announcement on her home telephone answering machine.
Recommended Procedures for Using Looping
Auditory looping is available on the Facilitator when the instrument is plugged into an outlet in the clinic. The looping jacks are also plugged into the Facilitator in the jack openings marked LOOP. While using the loop controls on the Facilitator, the clinician is equipped with his or her own microphone and headset (which must be plugged into the instrument). Looping occurs when the clinician presses the RECORD button, stopping it at any time by pressing the STOP/PLAY button. By clicking the STOP/PLAY button again, the loop will begin playback, automatically stopping when the recorded utterance stops. For two or more playbacks of the same utterance, the clinician merely clicks the STOP/PLAY button again for each playback.
1. Looping instructions are explained to the patient, such as "Please say what I ask you to say, and then you’ll hear back on the phones what you just said."
2. The amplification level of the loop playback is the same VOLUME setting that was last used for the amplification mode of the Facilitator. Some adjustment in loudness may be necessary before beginning the loop feedback. Generally, however, loudness levels are kept at the same level for both amplification and looping.
3. The patient says the verbal stimulus and then listens to the auditory feedback of what was just said. The clinician may present a list of words, phrases, or sentences for the patient to read aloud, stopping after each utterance to listen critically to the feedback. Or the patient may initiate the spoken response. The loop feedback can be repeated as much as needed while the patient attempts to correct what he or she says to match the feedback. Or a new patient utterance can be recorded and then played back.
4. Loop feedback may be turned off at any time by pressing the mode button, so it no longer appears in the instrument window.
5. When loop playback is no longer being used, the loop jacks should be removed from the Facilitator body.
(1) The Language Master (1971). New York: Bell and Howell.