3.01 - Treatment for Fluency Disorders Flashcards
What are the four fluency disorders?
Stuttering
Cluttering
Neurogenic Stuttering
Psychogenic Stuttering
What four things does fluent speech contain?
Rate
Continuity
Rhythm
Effort
Over ________ Americans stutter.
3 Million
The male to female ratio for stuttering is __:__.
4:1
What is the cause of stuttering?
2
Unknown
Neuro-motor basis seems influenced by genetic & environmental factors
What are the three core behaviors of stuttering?
Repetitions
Prolongations
Blocks
What are secondary behaviors to stuttering?
Those that develop as a reaction to the core stuttering behavior
What are the two categories of secondary behaviors to stuttering?
Escape
Avoidance
What are escape behaviors to stuttering?
3
Head nods
Blinks
Jaw tremors
What are avoidance behaviors to stuttering?
3
Substitutions
Tension
Pauses
What is another important element to stuttering therapy?
The client’s attitudes and emotions towards stuttering
Stuttering is a ______ speech disorder wherein there are _____ or _____ speech/language networks in the brain.
Neural Motor
Slow developing
Inefficient
Some children persist in stuttering because of what two things?
Factors within the child
Factors within the environment
What factors within the child can contribute to stuttering?
4
Family history
Sensitive temperment
Male gender
Presence of other speech/language disorders
What factors within the child’s environment can contribute to stuttering?
(4)
Rapid-fire, high-pressure, high-level conversation
Impatience or anxiety about the child’s stuttering
“Traumatic” events in the child’s life
High expectations
What are normal nonfluencies?
Effortless disfluencies associated with linguistic developement
What are normal nonfluencies experienced by many children between 2-8 years?
(5)
Phrase repetitions
Interjections (um)
Revisions
Normal rhythm and stress is maintained
No tension or tremors
What three things may signal an “abnormal” disfluency in young children?
Frequent (More than 10%)
Occurs in several situations
Occurs over longer periods of time
Dysfluencies primarily occur on ______.
The first sound/syllable
What types of disfluencies tend to not be normal?
4
Repetitions of sounds or syllables
Repetitions of short words
Prolongations
Blocks
When dealing with preschool stuttering, we need to distinguish between ____________.
Normal nonfluencies and stuttering
When dealing with preschool stuttering, it is important to address _________.
Parental concern
What four things can parents of stuttering preschoolers do?
Give the child more time to talk (1 second pause)
Talk more slowly
Use shorter, simpler sentences and ask fewer questions
Don’t correct or tell the child to slow down (adds pressure)
What two things does direct intervention for stuttering preschoolers contain?
Exploring speech and stuttering
Helping a child to modify speech
When working with older children and adults who stutter, what is the focus not on? What is it on?
Not on whether or not the person is stuttering
On what they can do when they are disfluent to become more fluent
When working with older children and adults who stutter, what two types of assessment do we do?
(2)
Measure core stuttering behaviors, secondary behaviors, and attitudes/emotions
Dynamic assessment to identify strategies to help them be more fluent
When working with older children and adults who stutter, what sorts of treatment can we offer?
(4)
Using fluency shaping techniques to establish fluent speech
Stuttering modification techniques to help in moments of stuttering
Helping to generalize skills to spontaneous speech
Helping the client carryover skills to environment outside the clinic
How do we measure the frequency & type of disfluency?
2
Count each disfluency one time (1 pt per word)
Divide the number of disfluencies by the total number of syllables
When might we measure the length of a stutter?
In severe stuttering moments
Are there scales to measure each type of disfluency: repetitions, prolongations, & blocks?
Yes
Are there scales to measure attitudes and emotions?
Yes
Should we assess situations & explore techniques that can increase or decrease fluency?
Yes
What is fluency shaping?
3
Goal is to increase fluent speech
You teach the client techniques to produce fluent speech
You gradually shape the techniques to sound as normal as possible
What is stuttering modification?
3
Goal is to teach the client to stutter more easily
You help the client identify what to do when they stutter
You teach strategies to modify speech during stuttering moments
Do you have to chose a fluency shaping or a stuttering modification technique?
No. You can combine them
What are six Fluency Shaping/Enhancing techniques?
Easy onsets
Decrease speaking rate
Light articulatory contact
Continuous phonation
Change the overall speech pattern
Delayed auditory feedback
What are the two treatment techniques for stuttering?
Modifying stuttering making episodes acceptable
Focusing on the moment of stuttering
What are the six ways we can focus on the moment of stuttering?
Identification
Desensitization
Relaxation
Pull-Outs/In-Block Corrections
Post-Block Corrections
Preparatory Sets (rehearse fluent speech)
Who came up with the Techniques to Treating the Entire Disorder (Stuttering)?
J. Scott Yaruss, Ph.D.
What are the main points of the Techniques to Treating the Entire Disorder (Stuttering)?
(5)
Addressing Impairment: Improving Fluency
Addressing Impairment in Body Function: Techniques to Modify Stuttering Behaviors
Reducing Physical Tension
Easy Stuttering - Voluntary Behaviors
Addressing the Rest of the Disorder
How do we address the impairment and improve fluency?
Focus on changing timing or tension
Learning guidelines to reduce speaking rate
Changing timing through pausing
Changing timing through pacing
Changing tension through light contact
Changing timing & tension through easy starts
How do you focus on changing timing? (stuttering)
3
Reducing rate & pace
Pausing & phrasing
Easy starts
How do you focus on changing tension? (stuttering)
4
Light contact
Easy starts/easing in
Pulling/easing out
Cancelation
How do you learn guidelines for reducing speaking rates? (stuttering)
(4)
Practice learning the slow rate before you try it for real
Use natural intonation and rhythm
Do not use choppy/robot speech or stretch out all the words
Slower, natural rates can be incorporated into all activities
How can you change timing through pausing? (stuttering)
3
Increase the length of time between words and phrases
Put pauses in natural locations
Pauses should not be too long (uncomfortable silence)
How can you changing timing through pacing? (stuttering)
2
Manage the pace
Goal is effective and successful speech
How can you change tension through light contact? (stuttering)
(2)
Try to reduce physical tension as articulators touch
Practice
More tension means more ______.
Stuttering
How can you change timing & tension through easy starts?
2
Reduce the pace and physical tension at the beginning of phrases
Use when the individual knows they are about to stutter
How can you address impairment in body function: techniques to modify stuttering behaviors?
(2)
Explore stuttering
Learn what they are doing when they stutter
How do you explore stuttering?
5
Learn about the speech mechanism
Learn how articulators move during stuttered and fluent speech
Stay in the block to learn how to move articulators to change stuttering
Develop self-monitoring skills & desensitize stuttering
Pretend to stutter (pseudostuttering)
How can you reduce physical tension? (stuttering)
3
Tension & struggle are normal reactions
Physical tension during stuttering is a learned reaction
Reduce tension during pseudostuttering (cancellation, pull outs) and practice with real stutters
What is easy stuttering: voluntary behaviors?
2
Learning that the way you stutter can change
Reduces the tendency to hide stuttering
How can you change the way you stutter?
Bouncing
Gliding
Stretching
Why is hiding stuttering bad?
The more it is hidden, the more likely it is to occur
Comfort with stuttering releases muscular tension and prevents bigger blocks
What is addressing the rest of the disorder? (stuttering)
Techniques for addressing the individual’s ABC reactions
What are the ABC reactions to stuttering?
Affective
Behavioral
Cognitive
What are the Affective reactions to stuttering?
The experience of embarrassment, shame, isolation, fear, and/or anxiety about speaking
What are the Behavioral reactions to stuttering?
2
Physical tension and struggles when speaking
Avoiding speaking situations
What are Cognitive reactions to stuttering?
Evaluating oneself negatively as a communicator due to stuttering
How do you address stuttering reactions directly?
3
Explore stuttering to learn more about stuttering and to reduce anxiety
Easy stuttering teaches that they have control of the speech musculature
Easing out helps to reduce behavioral reactions
What do we do when dealing with affective reactions to stuttering?
(5)
Talk about the stuttering in a safe environment
Provide a vocabulary & analogies
Be open and honest
Express emotions
Reduce shame
What do we do when dealing with behavioral reactions to stuttering?
(2)
Use techniques to unlearn physical tension, struggle, & avoidance
Reduce the underlying causes of these reactions (emotions, lack of understanding, etc.)
What do we do when dealing with cognitive reactions to stuttering?
(4)
Understanding (learn about stuttering)
Perception (disfluencies are a normal part of speech)
Tolerance (it’s ok to stutter)
Support (meet other stutterers)
What are the four general treatment guidelines for stuttering?
Systematically increase the difficulty of the linguistic task and environment
Work towards increasing the naturalness of the speaking task
Move the client towards self-monitoring
Support groups can help deal with negative attitudes and emotions
