Shuffle and place the deck face-down on the table. Go one-by-one, asking the patient to say the word out loud. Don’t stop as you go through, but each time pronunciation is strained, difficult, or incorrect, place the card in a different discard pile. You may simply use these as practice words, or you may also ask the patient to use those cards to tell a story, playing them face-up in front of them; you may throw in some blank cards so they can “fill in the gaps” to complete their stories, and/or you may also wish to give the other discard pile (with words they said correctly) to the patient and have them choose 5 or so words that they can say confidently to be added to the mix. At the end, read the story aloud, going through each word at least once. Take the words that are the hardest to manage, and repeat this process however many times are manageable for the patient. Ideally, you should incorporate some words that are challenges for the patient so that they can rest between challenge words and rebuild their confidence and engagement; this is particularly important for young patients.

In your practice or at home, ask your patient to stand in front of a mirror with a deck face-down in front of them. Ask them to go through one-by-one (either with the full deck or just a pile of words that have already been identified as challenging), flipping the cards over and saying them in front of the mirror. As they do so, they should watch their mouths, saying the words slowly, and observing how they make different kinds of sounds using their mouths. You may ask them to also consider how their tongues and lips are moving particularly to make different kinds of sounds. For added challenge, you may ask patients to put cards in front of the mirror and ask them to and the word For example, the word “bat” could be read as “tab.” This may get complicated pretty quickly. For some patients, this will be a fun and engaging exercise, while others may find it overly challenging or intimidating.

This exercise is ideally for elementary-aged kids or younger. Pick six or more cards that are good practice words for this patient, then place them in clear zip-lock bags and put the bags on the ground spaced evenly apart (a couple feet at least). You may draw lily pads on the baggies if you wish. Ask the patient to hop to each word (“lily pad”), saying the word each time. For some extra fun and practice, you might ask that they “ribbit” each time they reach a new lily pad.

Gather a pile of cards with images on them (nouns, some verbs, and some adjectives) and place them face-down on the table. Flip the cards over, covering everything except for the picture. Ask your patients to say the word that matches the image on the card. As an additional challenge, you might go through the whole pile, then ask your patient to choose a subject for a story from within the pile. Take out that word and place it face-up on the table, then shuffle the remaining cards back into the deck. Now, draw and play cards until you’ve told a story of at least 7 words using that card as a starting point, speaking each word out loud with every placement. You may play cards before or after that card. At the end, you may wish to read the entire story out loud together.