The Sensory Trigger

1. The Sensory Trigger A journey of hope for speech and language recovery after stroke or head injury. By Barbara Dean Schacker

2. The Sensory Trigger What is it? How does it work? The Theory and Research Key Elements THEN: my story NOW: the challenge continues FUTURE: a vision of hope

3. What is it? • The Sensory Trigger Method is a way to make new pathways in the brain for speech, reading, writing and other mental processes after brain trauma. • It is a multisensory learning technique that emphasizes the tactile/kinesthetic sensory memory system.

4. How does it work? Compared to the auditory and visual memory systems, the kinesthetic/tactile sensory systems is the most malleable and has the most widely connected neurological channels in the brain. The area of the cortex that is devoted to the hand is many times larger than any other the area including the mouth, eyes, ears, arms, legs, feet and other sensory systems. This makes it the best channel to develop new pathways in the brain.

5. The Theory and Research We have the most touch receptors on the tips of our fingers and the tips of our tongue. There is a direct link between them in the kinesthetic sensory system. Finger Tapping Technique

6. The Mirror side of the Brain The right hand is directly connected to the left hemisphere Speech Center—even more directly than either the visual pathways and the auditory pathways.

7. The Mirror side of the Brain The left hand is directly connected to the right hemisphere Speech Center. Usually considered the non-dominant or “passive” Speech Center.

8. Pathways are blocked Depending upon the extent of the damage, the signals from the visual cortex, the auditory verbal center and the hand can be blocked from the dominant Speech Center.

9. How Touch is connected in a different way to the Speech Centers Pathways from the Wernicke’s Center, the auditory speech channel, pass through the Broca’s Speech Center before going out the Speech Motor Channel, while the pathways from the hand pass back and forth directly through or near the Speech Motor Channel.

10. The Mirror side of the Brain On the undamaged side of the brain, the “Mirror side of the Brain”, the tactile/kinesthetic signals from the left hand, the auditory signals from the mirror Wernike’s Center and visual signals from the Visual memory system pass freely into the right side speech center.

11. Yet every brain is different… Every brain is different and every brain trauma is unique. Left handed people will have to make new pathways just like right handed. In this case, the left hand can re-set its connection or dominance with Sensory Trigger techniques. Mixed dominant brains can use either hand to make new pathways. A reversed dominant brain will use the right hand to make new pathways

12. The Key Elements 1. Make a “new dominant hand” with tactile and kinesthetic imprinting and learning techniques 2. Use the hand connected to the undamaged side. 3. Make it Intensive. Repeat the same words or tasks within 48 hours if possible. Daily is best. 4. Make it Interactive. Use in different contexts, in real life with different people. 5. Plan for a long-term recovery. 6. Create a positive environment and life-style. Learn how not to “block” their speech. 7. Never give up!

13. The Key Techniques After six weeks of daily practice new neurological connections actually grow and connect in the brain. At least 6 weeks of intensive work is recommended to start. Kinesthetic and tactile techniques include: 1. Clicking the mouse, pointing with the arrow 2. Tracing with pen, pencil or finger 3. Holding the hand when talking 4. Writing and Typing 5. Manipulating materials 6. Finger or Hand tapping

14. How to Unblock Speech There are many ways that we unintentionally block speech. Learning a different manner of speaking and interactive conversation is a crucial factor to successfully “unblock” speech and enhance communication. People often tend to talk too fast, too loudly, interrupt, or talk “all at the same time”. We must avoid distractions like the TV, loud music or noise. Auditory and visual distractions can take up the mental resources needed to plan and initiate speech.

15. How to Unblock Speech • Don’t talk too fast. Leave pauses for them to respond. A damaged brain takes longer to shift processes. • Don’t talk too loud. Don’t interrupt. Don’t talk at the same time. Turn the TV off. Reduce distractions. • Be careful that you don’t talk for them or automatically finish their sentences for them. Wait first then give them a clue or “cue”. • Ask questions that have simple answers. • Talk with simplicity, melody, expression and flow.

16. THEN: How was it discovered? In 1963, my father, Vernon Keller Dean had a massive left hemisphere stroke. After 2 years of speech therapy, he was diagnosed with “untreatable global aphasia” by the Mayo Clinic. In 1972, nine years post stroke, I developed a picture communication system for him. As an artist, I was able to draw over 100 picture cards. It was the first picture card communication tool for aphasia. He was able to follow “picture commands” and string 3 or 4 picture cards together to make a sentences.

17. How was it developed? Being a librarian, I had access to information that even many college courses did not have. So I began intensive research. I studied everything related to speech disabilities, mind/brain development and language: Maria Montessori, Piaget, child language development, the evolution of language, Braille, American Sign Language, speech therapy manuals but most important—brain research. In 1972, the “split-brain” research had just come out and after reading everything I could find on this, I went to New York University at Stony Brook to meet and talk with the scientists who were working in a new field—neurolinguistic psychology.

18. Researching in New York I met with Drs.Michael Gazzaniga, Roger Sperry and Norman Geshwin. They very surprised at what I had accomplished with my father. No one before this time had tried getting a global aphasic to communicate with pictures. They were intrigued by my picture card communication tool and sent me to Boston to present the idea to a group working with Howard Gardener.

19. Coming Home Turning down an invitation to study neuro-linguistic psychology at Stony Brook, I returned home to work with my father and mall over everything I had learned. The librarian in me said, “I’d just be stuck in clinical studies, making discoveries and writing papers that would just molder on the library shelves—papers that no one reads but me anyway. I want to do something with this!” Working with my father, I decided he needed an approach that did not depend on me or the picture cards, one that he could do himself. I had also concluded that using his left hand was the key to unlock his speech. I gave him a picture command to draw. He then drew pictures with his left hand, copied words to go with them and communicated with my mother in this way.

20. Returning Home Again I moved to California to find a job while he continued working on his own. Before I left, I had noticed some changes. My father could now laugh at jokes on TV and he was beginning to read the newspaper. He was able to repeat the words said to him and started to read aloud a few words he practiced idea writing and writing everyday in his notebook. He was a very self-motivated person and worked on this everyday. For months he could only repeat a small set of words. He seemed to be stuck on a plateau. Then one day, a year later a “tipping point”. He drew a picture of the solar system and then said his first spontaneous word: “Mars”. My mother told me he was saying other new words on his own. I took a leave of absence from my job as school librarian and took the next flight home. When I arrived, I sat down next to my father. He smiled at me and said, “Amazing!”

21. My Father’s Recovery After that, my father continued to progress slowly with words coming back one at time. Before he passed away from congestive heart failure in 1984, he was able to say over 700 words. It was enough to go to the store, the bank and the post office by himself on the bus. He also became an artist with his left hand and showed his work in the state capitol building. He enjoyed this part of his life and regained his self-confidence and dignity.

22. The First Talking Software for Aphasia • Working with speech pathologists, special education teachers, and software programmers I carefully designed a multisensory software for aphasia. • The design specification for the software was evaluated at Goldwater Hospital on Roosevelt Island, NY, Speech and Hearing Lab to ensure it coincided with speech therapy practice. • The software and method was tested at U.C. Davis Medical Center. Every participant benefited. It took 5 years of research and development and testing to publish the first program. • This software program was the first program for aphasia and the first to use natural voice technology. I received an award from Johns Hopkins University in 1991 in their national search for new technology applications for the disabled.

23. Tested at U.C. Davis Medical Center

24. NOW: Strokefamily.org Today I have a web site called Stroke Family. I have written and published speech practice kits and had much success with it.

25. The Whole Speech Practice Kit Over 1600 of the most frequently spoken words “Make your own” features in the software allow for individualization and unlimited content. The Kit contains: The Let’s Talk software The Tracing Sheets set 3 “Touch” Card Sets Speech Tree sentence software 3 guides

26. Success Stories Since the beginning of my journey and throughout my career in speech recovery, I have helped thousands of adults and children regain their speech, reading and writing with the Sensory Trigger Method. Visit StrokeFamily.org to see the success Stories and to learn more. Contact me for free information and a free e-book on the Sensory Trigger.

27. The approach and content of the Kit teaches everyone how to do the Sensory Trigger Method. Expanding the parameters of speech recovery, it permeates everyday life including everyone the person interacts with. Using our approach the time frame for speech recovery is up to two years and beyond. This breaks out of the 6 month cut-off that insurance and Medicaid try to impose on survivors.

28. The Challenge Continues On April 2nd of 2008, my husband had a massive left hemisphere TBI as a result of a high risk aorta artery replacement surgery. I have worked with him with Sensory Trigger Techniques since day one, and today he is talking in fairly sophisticated short clear phrases and sentences and saying new words everyday. At Sunnyview Rehab

29. Intensive Informal Speech Practice From my experience, those with severe aphasia or apraxia do not recover speech unless they have had an “intensive” approach. By using the Sensory Trigger Program and training the family, friends and caregivers we can achieve this. Combining this with all other therapies and social interaction and activities is especially effective. The impact of a coordinated effort could be great.

30. My Vision and Hope for the Future • Our challenges are too great for individuals to face alone. • We can find ways to help each other and work together. • We can reinvent ourselves and rebuild our lives. • We can regain our skills and abilities. • We can explore new interests. • Stay positive, enjoy life and never give up!

31. For more information: • Visit Strokefamily.org • Email me from the website. • Or call me at 855-585-5350 toll free or 845-679-5364 • Outside the U.S. please email or call 001-845-679-5364