10/14/13-Lecture 10

Question 1

What if the definition of cluttering?

Answer 1

• 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

Question 2

Why is cluttering under diagnosed?

Answer 2

1. Relatively few clinicians are knowledgeable re: cluttering
2. Few clutterers self refer
3. Clutterers awareness of issue

Question 3

What is the onset of cluttering?

Answer 3

• Around 7 years old

- Maybe related to use of more complex and longer utterances

Question 4

What is the nature of cluttering?

** Need help breaking this card down!!!!*****

Answer 4

• 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

Question 5

What is Tachylalia?

Answer 5

• Excessive and rapid speech

Question 6

T/F: Sometimes people who clutter might have problems in pragmatics?

Answer 6

TRUE

Question 7

What is the primary focus of evaluation for cluttering?

Answer 7

• rate
• fluency
• articulation
• language and awareness

Question 8

What are some things we will notice about the articulation of a person who clutters?

Answer 8

• 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/

Question 9

What are the areas that we want to focus on for cluttering?

Answer 9

• 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

Question 10

What else should we consider to evaluate besides rate?

Answer 10

• Intonation

Question 11

What is a good way to approach treatment of cluttering?

Answer 11

• Increase their awareness

- Teach self monitoring skills

Question 12

What do you want to improve for cluttering

Answer 12

• 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

Question 13

What does SAAND stand for?

Answer 13

Stuttering Associated with Acquired Neurological Disorders

Question 14

T/F: According to Ch. 16 cluttering has been variously described as the “orphan” of speech-language pathology.

Answer 14

TRUE

Question 15

According to the book, what are the two crucial questions that need to be asked when dealing with neurogenic stuttering?

Answer 15

• Is the stuttering developmental or neurogenic stuttering in nature?
• Is the stuttering neurogenic or psychogenic?

Question 16

T/F: The first term cluttering, in 1877 have been attributed to Adolph Kussmaul, a German lexicographer

Answer 16

True

Question 17

T/F: Cluttering, just like stuttering should be considered primarily a fluency disorder?

Answer 17

True

Question 18

What are the co-existing symptoms of cluttering? (p 302 & 303)

Answer 18

• fluency disorder
• rate deviations
• stuttering
• articulation disorders
• language disorders
• ADHD
• specific learning disabilities

Question 19

What is another name for SAAND?

Answer 19

Cortical stuttering or acquired stuttering

Question 20

What are some causes of SAAND?

Answer 20

• CVA

- TBI

Question 21

What are the two types of stuttering in SAAND?

Answer 21

• persistent stuttering

- transient stuttering

Question 22

What is the evaluation focus in SAAND?

Answer 22

• 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

Question 23

Neurogenic stuttering exists in SAAND if there is what?

Answer 23

“… 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”

Question 24

Developmental stuttering may exist if what?

Answer 24

• exist if the trauma “…. may have triggered co-occurrence or aggravation of pre-existing stuttering disorder.”

Question 25

How does Mahr and Leith (1992) define the diagnosis criteria of psychogenic stuttering?

Answer 25

• 1. a change in speech pattern suggesting stuttering
• 2. a relationship to psychological factors as evidenced by an onset associated with emotional conflict and or secondary gain
• 3. the lack of evidence of organic etiology
• 4. a past history of mental health problems
• 5. atypical disfluencies…. (no stereotypical repetitions or secondary behaviors)
• 6. …. lack of emotional responses to the disfluencies
• 7. interpersonal interactions of somewhat unusual or bizarre quality

Question 26

What are some other evaluation factors during the SAAND evaluation?
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Answer 26

• 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

Question 27

What are some intervention possibilities for SAAND?

Answer 27

1. Surgical intervention: endarterectomy: clearing of carotids; opening of carotid stenosis; thalamic electrical stimulation: implanted electrodes in thalamus
2. Pharmacology: antiseizure medication; controlling seizures may reduce stuttering
3. DAF (Delayed Auditory Feedback): some success reported; as well as using white noise machine
4. Biofeedback and relaxation techniques
5. Speech pacing: slow rate; speak one syllable at a time; pacing board/visual cues, work sheet with square boxes, other visual cues.