Clue into your cues: Gestural Cues

After verbal cues, I think I probably use gestural cues the most.  I’m trying to be more mindful within my sessions of the many different ways we can prompt different responses.  It’s part of our skilled service.  We use a lot of other teaching techniques as well, but cues and prompts are how we work to get our students to say the correct answer.

I talked about visual cues related to eye gaze and facial expressions last week.  Today I am going to talk about gestural cues.  I think you eye gaze and visual/facial expression cues are also gestures-but to avoid a lengthy blog post (Hahaha-most of my posts are too wordy) I broke them up into a series.  One of the most common gestural cues is pointing.  This cue usually works best when the item is close to you.  If it is too far away, you may end up in game of 20 questions as the child may not know to which item you are referring.  We can also choose how we point to vary the intensity of the cue that we are giving to the student with whom we are working.

I’m thinking about gestural cues and how I would use them to teach some common speech therapy goals.  As with other cues, some cues seem to work better with receptive vs. expressive tasks.  I’m thinking about how we could use these cues to teach the following:

• Articulation:  Saying an initial /b/ sound
• Syntax:  Using regular past tense -ed
• AAC:  Have a student tell you to “turn on” radio to listen to music.
• Pragmatic language: Greet another student
• Receptive language: Identify objects by function
• Vocabulary: Define a vocabulary word by category and function.

Pointing by tapping or touching the actual object you are asking about.  We use this cue when we physically touch the picture or object we want the child to say.  This is also how I start to teach pointing-by having my client touch the object they want to use.  

• Articulation:  Touch you lips to show them that their lips need to go together.
• Syntax:  I might touch the top of my lip to indicate /d/ in the past tense form.
• AAC:  Touch the button that you want the student to press.
• Pragmatic language: I might touch the student that I want them to greet.  I don’t know that would be particularly effective unless I was working on having them greet someone who had just walked in vs. students who were already in the classroom.
• Receptive language: Touch the picture that I want them to choose.
• Vocabulary: If we were working receptively, I might touch the pictures that they needed to use.  If we were using a semantic mapping tool like the Expanding Expression Tool, I might touch the corresponding bead to remind them what I wanted them to say.

Pointing in the general direction of the object you are asking about.  We use this cue when we circle are finger over a few pictures or towards the general area where we want the student to go but avoid directly pointing at the answer.  I could fade this by just pointing at the activity-or tapping on a worksheet to remind a student what they need to do without giving them more information about what they need to accomplish.  

• Articulation:  I might point towards my lips to remind the student to use the /b/ sound.
• Syntax:  I’d probably only use this cue if I was cuing for a receptive response.  I might point towards the row that I wanted them to use.
• AAC:  This is a great way to decrease prompting.  Instead of showing them where the button exactly is, you could point towards the correct row or area on the page where the button is.
• Pragmatic language: I might point towards the student or towards a group of students to remind the child that they can initiate a greeting.
• Receptive language: As with other receptive activities, I might point towards the area on the page where the answer is helping the child narrow down their choices.
• Vocabulary: I could use the EET tool and maybe slide my hand next to the tool without touching to see if the student remembers to define a word by category/function (without directly asking).

Other Gestural Prompts:  You could probably break these up even more-but I would include any other type of gestural or hand cue you use to stimulate the answer you want.  I LOVE pairing a physical movement or gesture with a task.  I might start with something like the category ategory with EET and make a big circle with you hands to indicate  a large group.  Eventually I could fade the verbal and just provide the gestural cue.  My younger students with speech sound production disorders quickly learn hand signal cues and may use them to cue themselves.  This is a great thing to teach your students who have diagnosis such as Down Syndrome.  If other people understand the hand signals and that can be a challenge the students can use them when people are having difficulty understanding their speech.  

• Articulation:  I might pop my fist open and shut to indicate /b/ or move my index finger forward to indicate plosiveness.  I might gesture using the PROMPT tactile cue without touching the clients face if that is part of our treatment plan.  I like to have  a big gross motor movement that we can pair with a sound (for example putting my arms in a circle above my head for O) and then eventually fading to a smaller hand or finger cue.    I don’t know that there is a right or wrong gestural prompt for articulation.  If it isn’t resulting in the response you want, try a different gestural cue.
• Syntax:  I use my sign for /d/ a lot which is moving my index finger and middle finger together like they are a ticking clock.  I might also clap my hands to provide more feedback about the /d/ at the end of the word.
• AAC:  I probably use sign language the most to cue during AAC.  I also might shrug or use the “I don’t know” gesture to see if my student will initiate language.
• Pragmatic language: This is a pretty easy one-I’m going to wave to remind the student to greet their friend/classmate.  I could vary the intensity from a big shaking my whole arm wave to a small flick of my fingers.
• Receptive language: It could be really fun to try to teach object functions using pantomime cues.
• Vocabulary: I typically teach by pairing a physical movement with my gestural and verbal cue.  I might make a big circle with my arms to indicate a category and pretend to bang a hammer for the object function piece.  Or I might use the sign for “do”.

There are a lot of great gestural cueing systems out there.  Here are a few that I have used:

Check out Pamella Marshalla’s awesome place cues on Youtube!

Judy Jelm’s cues for Apraxia.    I had a copy of these from a course I went to and find them to be very helpful.

Easy Does it for Apraxia by Linguisystems has some great cues.  If you can find the book used-it can be helpful.  I don’t know that I use it that much outside of the cues.

Visual Phonics:  This is a great tool to incorporate if your school is using visual phonics to teach reading.

I couldn’t find specific cues for vocabulary or language development-we usually make them up as we go.  Using gestures to teach vocabulary is evidence based.  I like to use a lot of pantomime.  If you are working on past tense forms have the student act out the verb as they are stating it.  What cue systems do you like to use in your speech classroom?  I’d love to hear about it below.