10/14/13-Lecture 10 Flashcards
What if the definition of cluttering?
- Disorder of fluency and there isn’t that awareness
- Excessive breaks in their normal fluency
- Rate is faster than normal
- They have difficulty putting it all together
Why is cluttering under diagnosed?
- Relatively few clinicians are knowledgeable re: cluttering
- Few clutterers self refer
- Clutterers awareness of issue
What is the onset of cluttering?
- Around 7 years old
- Maybe related to use of more complex and longer utterances
What is the nature of cluttering?
** Need help breaking this card down!!!!*****
- Fluency disorders
- Rate deviations: tachylalia and excessive rapid rate (ERS) versus excessive rate along with irregular rate that is not associated with pauses that do not coincide with thought or linguistic juncture
- Stuttering: cluttering can co-occur with stuttering; stutterers
- clutterers do not know what they want to say
- Articulation: This is minor – it is more related to sequencing
- Language disorders: common co-existing issue; studies have shown MLU may be the same but clutterers seemed to exhibit less complete or less complex sentences; may have pragmatic issues
- Attention deficit/hyperactive: may co-exist with cluttering
- Specific learning disabilities: Learning disabilities (LD) has been reported to co-exist with cluttering; especially with problems in expression, reading, and writing; handwriting
- Other possible co-existing disorder: Central auditory processing disorders; executive function/organization problems; developmental apraxia
What is Tachylalia?
- Excessive and rapid speech
T/F: Sometimes people who clutter might have problems in pragmatics?
TRUE
What is the primary focus of evaluation for cluttering?
- rate
- fluency
- articulation
- language and awareness
What are some things we will notice about the articulation of a person who clutters?
- deletion of sounds in multisyllabic words
- deletion and neutralizing of syllables (e.g., “explation” for “explanation” or “inbi-ity” for “inability)
- sometimes difficulties with /s/, /r/ and /l/
What are the areas that we want to focus on for cluttering?
- Rate, fluency, articulation, language and awareness
- Case history
- Audio/video taping: good for referencing & provide us with a baseline
- Speech/language sampling: Rote tasks, imitation, oral reading, monologue and conversation
- Self awareness: questionnaire
- Other: oral motor exam, audiological exam
What else should we consider to evaluate besides rate?
- Intonation
What is a good way to approach treatment of cluttering?
- Increase their awareness
- Teach self monitoring skills
What do you want to improve for cluttering
- Rate (articulation/speech intelligibility)
- Linguistic and narrative skills
- Fluency skills
- Meta-cluttering skills
- Phonatory and respiratory behaviors
- Family, friend, employer support
- Collaboration with other team members
What does SAAND stand for?
Stuttering Associated with Acquired Neurological Disorders
T/F: According to Ch. 16 cluttering has been variously described as the “orphan” of speech-language pathology.
TRUE
According to the book, what are the two crucial questions that need to be asked when dealing with neurogenic stuttering?
- Is the stuttering developmental or neurogenic stuttering in nature?
- Is the stuttering neurogenic or psychogenic?
T/F: The first term cluttering, in 1877 have been attributed to Adolph Kussmaul, a German lexicographer
True
T/F: Cluttering, just like stuttering should be considered primarily a fluency disorder?
True
What are the co-existing symptoms of cluttering? (p 302 & 303)
- fluency disorder
- rate deviations
- stuttering
- articulation disorders
- language disorders
- ADHD
- specific learning disabilities
What is another name for SAAND?
Cortical stuttering or acquired stuttering
What are some causes of SAAND?
- CVA
- TBI
What are the two types of stuttering in SAAND?
- persistent stuttering
- transient stuttering
What is the evaluation focus in SAAND?
- need to differentiate between stuttering that is developmental, neurological, and psychogenic in nature
- Need to rule out aphasia or word finding difficulties or motor speech issues
- Boston Diagnostic Aphasia Battery, Aphasia Diagnostic Profile
- Fluency evaluation
- Automatized tasks ( e.g., counting, days, months, singing, pledge of allegiance, choral reading, etc..)
- Speech variability situations
Neurogenic stuttering exists in SAAND if there is what?
“… clear neurological event preceding onset of stuttering”, and there exists a “… reasonable link between the event and the speech difficulties and no evidence of pre-morbid stuttering”
Developmental stuttering may exist if what?
- exist if the trauma “…. may have triggered co-occurrence or aggravation of pre-existing stuttering disorder.”
How does Mahr and Leith (1992) define the diagnosis criteria of psychogenic stuttering?
- a change in speech pattern suggesting stuttering
- a relationship to psychological factors as evidenced by an onset associated with emotional conflict and or secondary gain
- the lack of evidence of organic etiology
- a past history of mental health problems
- atypical disfluencies…. (no stereotypical repetitions or secondary behaviors)
- …. lack of emotional responses to the disfluencies
- interpersonal interactions of somewhat unusual or bizarre quality
What are some other evaluation factors during the SAAND evaluation?
** HELP SIMPLIFYING THIS
- Need to rule out aphasia/word finding issues
- Neurogenic vs developmental; consider where disfluencies occur;
- In most cases developmental stuttering occurs more at the beginning of utterances, word- initial, phrase- initial, sentence- initial
- In most cases SAAND stuttering occurs on small grammatical words (determiners: the, an, a; prepositions: in, on; pronouns: his, their. Stuttering can occur in word-medial; word- final positions
- Concomitant/ secondary behaviors are rare in SAAND; no eye blinking etc…
- Look for adaptation effect- 70% of Developmental Stuttering client show adaptation effect. Repeated readings become more and more fluent. SAAND has no adaptation effect.
- Automatized tasks such as counting, days of week, pledge of allegiance, singing, choir reading are not more fluent with SAAND
What are some intervention possibilities for SAAND?
- Surgical intervention: endarterectomy: clearing of carotids; opening of carotid stenosis; thalamic electrical stimulation: implanted electrodes in thalamus
- Pharmacology: antiseizure medication; controlling seizures may reduce stuttering
- DAF (Delayed Auditory Feedback): some success reported; as well as using white noise machine
- Biofeedback and relaxation techniques
- Speech pacing: slow rate; speak one syllable at a time; pacing board/visual cues, work sheet with square boxes, other visual cues.
