Tuesday, October 13, 1998

Sign languages can improve reading and give lift to stroke patients

By Joan Whitely

      Certain hospital patients, toddlers and one local second-grader are using their hands to talk. Not a one has a hearing impairment, but each has a factor that is making communication otherwise difficult.
      The second-grader, Brianne Khoury of Henderson, is using signed English -- a different sign language than American Sign Language -- to help her read.
      Brianne's parents and teachers at Galloway Elementary School are using a multisensory approach that includes the tactile activity of signing each word that's read. Two California teachers developed the system for children, such as Brianne, who have Down syndrome.
      Toddlers in several Las Vegas Valley families are signing, too. Their parents have taken Christian parenting courses that encourage simple signing as a way for pre-verbal children to make their needs and wants clear.
      Stroke and head-injury patients at rehab facilities such as Rehabilitation Hospital of Nevada-Las Vegas also may use signing in their recovery process, depending on which areas of the brain have been affected.
      More. All done. Thank you. Please. No.
      These signs were the first vocabulary of toddler Micaela Steenblock, who is not yet 2 years old. Recently she has begun shedding some of her hand signs, replacing them with conventional spoken words.
      But the signs came in handy when she was just over 1 year old, and couldn't speak. The signs involved use of broad motor skills, not fine positioning of individual fingers.
      Until Micaela's parents took the class, "I personally wasn't aware they had the cognitive ability" to sign at such early ages, admits her dad, Paul Steenblock, who works in the legal department of Caesars Palace.
      The theory is that signing helps toddlers avoid feeling frustrated. As a result, they may whine less, throw fewer tantrums and commit fewer etiquette infractions.
      Instead of pushing unwanted food off her highchair tray, for example, Micaela learned to sign "all done."
      "It's such a disservice to the child" to permit whining as the way to request things, explains Micaela's mom, Sue Steenblock. "Especially if the parent gives in to the child. They see it's OK to act out inappropriately to get their way."
      Since signing is a low-key, low-decibel way to communicate, Paul Steenblock says it fits in well with their Christian view of family life, which includes running a household that is orderly rather than chaotic.
      In public as well, fewer tantrums are evidence of what he calls "the test of parenting ... not whether you enjoy your kids, but whether other people enjoy your (well-behaved) kids."
      A Henderson family underwent a similar Christian-based parenting class . Though their children -- now 5 and 9 -- are already past the toddler stage, Joe and Letty Sunderman still find the signing to be useful.
      "Say a waiter brings them something. If they forget and we say, `Say thank you,' it takes all the value away. ... They're just following instructions (to express gratitude). It doesn't come across as a beautiful thing," Joe Sunderman says. Instead, he or his wife uses signing to prompt them on their etiquette.
      Signing also works when a parent wants to communicate to a child across a room, without disturbing others, he adds.
      "Say if your kid is up on the stage (with classmates) and she is talking, you can give them that sign (to stop) from the audience. They know they need to stop doing that."
      Sunderman and his wife are the Nevada directors of one Christian parenting program, Growing Families International. They also head a parenting ministry at their church, Central Christian Church.
      Brianne Khoury can speak, but she was not having success with her reading last year, in first grade. Over the summer, Lois Khoury, her mother, went to Texas for a convention of the National Down Syndrome Society. There she and Brianne's second-grade teacher, Krystal Bitsko, learned of the multisensory approach.
      To read, children don't just look at letters and words on a page. As they say each word, they also sign it. As they master a written word, they tend to unconsciously phase out of signing it.
      "The multisensory approach works because signs illustrate or mimic, words. For example, in order to sign the word `up,' you simply point your finger up. Or in order to sign the word `car,' you use your hands to pantomime moving a steering wheel. Thus students physically illustrate a word as they say it, and form a mental picture," explains California teacher Laura Felzer, interviewed over the Internet. "Another reason why signing works is that we tend to remember motor skills such as riding a bike and typing."
      Felzer, who led a workshop at the Texas convention, also published an article about the approach in the January 1998 issue of Teaching and Change. She and a colleague have been using the approach with children who have Down syndrome for six years, and for about three years with other elementary students.
      "I don't really have a basis for comparison because the only other approach I used (for students with Down syndrome) worked for about half the children, and they only learned about half as much," Felzer says.
      Bitsko, who teaches at Galloway Elementary, says that in only three weeks, Brianne clearly mastered 15 reading words. She can read them aloud and rearrange them into new sentences.
      "It's really working," says Bitsko, who also taught Brianne in first grade, without reading success. "I don't know if we're going to hit a stalemate, but it's just been this wonderful experience."
      The method has worked as well with children who don't have Down syndrome, a genetically caused form of mental retardation, but do have reading difficulties, Bitsko notes.
      Lisa Schultz is a speech pathologist who manages inpatient clinical services at Rehabilitation Hospital in Las Vegas.
      Signing is invaluable with patients who, because of stroke or head injury, have suffered damage to centers of the brain that control speech.
      Not only does it help them communicate without words. Signing also seems to help them regain their speech.
      "There's been no research done (to explain why) a lot of times, when you pair physical movements with speech (during rehab), there's a little bit better facilitation of speech," says Schultz.
      But Schultz doesn't usually tell patients what they're doing is signing. She just calls it "gestural communication," to avoid patient resistance to the notion that they, who have hearing, could benefit from a language designed for people with hearing impairments.
      Without signing, patients unable to speak clearly would have to resort to more cumbersome kinds of equipment such as picture boards. "The nice thing about sign language," Schultz says, "you're never going to forget (to bring it along). It doesn't need batteries. It's more natural."
      In her work, the speech pathologist says she uses a combination of formal signs, improvised gestures, pointing to props, facial expressions and intonation of sounds, made by the mouth, that are not words.