Adult Flashcards
Explain in what types of situations stuttering tends to go up or down and which are stuttering inducing, and which are fluency enhancing?
- Fluency enhancing: singing, delayed aud feedback, swearing, masking noise, talking to child/pet, rhythmic speech, slow speech, while writing
- stuttering inducing: unfamiliar places, talking on the phone, talking to unfamiliar people, talking in front of a crowd, rapid speech rate, complex syntax, polysyllabic vocab, use of two languages at home
How/why do fluency enhacing conditions affect the brain
- slower rate of speech
- facilitation of prosody and external cues to prompt and initiate speech
- more attention to speech because less formulation demands
- external cues use right side of brain or other compensatory parts of brain
- concentrating on auditory feedback to help activate the auditory processing part of the brain
How/why do stuttering inducing conditions affect the brain?
- stress the speech and language system in the brain
- situational fears/anxiety
- reduce available capacities for the demands of the situation
Explain how this information about what is fluency enhancing and what is stuttering inducing can be used to plan treatment hierarchies and transfers.
- start with using fluency enhancing techniques in a controlled, fluency enhancing environment
- as these skills develop, start moving up the speech hierarchy in the controlled environment
- start to transfer strategies into stuttering indicuing environments with speech elements that are lower in the hierarchy
- move up the hierarchy in stuttering indicuing environments as client becomes more successful in applying strategies
- transition to be own therapist
Name three things related to Svetlana as a whole person in a social context you would measure as part of her assessment.
CAMP
- Concomitant
- Attitudes, anxiety, avoidance
- Motivation/availability
- Previous therapy
OASES (overall assessment of the speaker’s experience of stuttering)
Name 3 things you could do to make certain that your assessment measures were reliable and valid (reflecting what Svetlana’s stuttering was really like)
- ask her if her sample is representative
- Self-rated severity
- at least two samples in different situations
- at least 200 words/syllables or 3 min
How would you be sensitive to her cultural identity during assessment?
- Ask if she stutters in multiple languages
- Ask if her stutter is worse in one language vs another
- Ask her how stuttering is perceived in her cultural communities
- Ask how stuttering impacts her in reference to her cultural community
- Understand what her goals are/what is functionally most important to work towards
Guitar superfluency goals, techniques, expected outcome
Goals:
Reduce fear surrounding stuttering
Addressing avoidance
Become your own clinician
Use and transfer fluency techniques
Techniques: 8 main techniques
Outcome: stuttering is more acceptable, less anxiety around stuttering(?)
Essential Pause/Fluency Plus goals, techniques, outcomes
Goals:
Teaching correct and necessary movements for fluent speech
Effective communication
Building confidence in communication
Address negative behaviours and thoughts, common obstacles
Techniques: 8 main techniques
Outcomes: Speech that looks and sounds like normal speech
Based on what you know about Svetlana, which type/s of treatment would you recommend (e.g., where on the ‘continuum’ would she fit?).
You find in your evaluation that she has many anxieties about stuttering and avoids many situations. She also reports that she needs to give presentations for her new job and she would like to be as fluent as possible in many job situations.
- Essential Pause
> she wants to address attitudes and fluency shaping
> improves confidence and communication
> “speech that looks and sounds like normal speech” is a priority
> give more realistic goal instead of as fluent as possible (as natural as possible) - Guitar superfluency
> addresses avoidance behaviours and does some fluency shaping
> big emphasis on self-monitoring which is helpful when in new environments and increases the generalizability of techniques
> long-term maintenance plans - overall - falls more on attitude adjustment side of continuum
> Even if only working on attitude, it would be easier to cope with anxiety that would come with presenting in front of people → focusing more on fluency shaping techniques will not help in dealing w anxiety and avoidance behaviors
Camperdown goals, techniques, outcomes
Goal: eliminate/improve stuttering
Using prolonged speech - copying exemplar speech
Rating scales for naturalness and severity
Rating before and after using fluency techniques - monitoring progress
Problem solving for generalization
Practice outside of clinic
Help client develop plans for maintenance
What analogy could you use (for expectations of therapy)?
Piano teacher analogy:
you can come to class but if you don’t practice on your own you cannot expect to see progress
it’s up to you to reinforce the learning on your own
What suggestions would you provide for care when weekly treatment was over?
Schedule follow-up
Create videos during treatment of how to use the strategies to refer to as refreshers
Connect to peer groups for PWS?
3 strategies for accepting stuttering (Guitar’s Superfluency)
- Voluntary stuttering in clinic and transfers
> Fake stutter in public, show that you are not bothered by stutter so it should not bother the other person either - Holding on to stutter
> Learn to remain calm when you block/stuck in a repitition
> Maintain eye contact while stuttering
> Increase tolerance for stuttering → reduce fear → become more relaxed while stuttering - Discussing stuttering openly
> To address negative stigma & fears, talk about stuttering with friends and family
> Let friends & family know what to do when you are stuttering, what helps & what doesn’t help → create stuttering friendly environment
How would you facilitate transfer of these skills? (Guitar’s Superfluency)
Move away from clinic setting as soon as possible
Move away from single words as soon as possible
Use hierarchy to manage anxiety
Do what is slightly uncomfortable
Clinician can go with and demonstrate stuttering outside the clinic
After stuttering outside the clinic, talk about reactions and feelings? - Desensitization practice?
Write a SMART goal (short term or sessional) for therapy addressing attitudes, avoidance and anxiety.
- Client will independently order a coffee from a coffee shop using sentences, monitored by clinician in a public setting.
- Within 6 weeks, the client will demonstrate the ability to voluntarily stutter at the conversational level in real-life speaking situations (outside the clinic), as monitored by a self-recorded log, and will achieve 3 consecutive instances of voluntary stuttering rated as low anxiety (a 1 or 2 on a 5-point scale).
- Within 6 weeks, the client will demonstrate a positive shift in attitudes toward stuttering by identifying and challenging negative thoughts in at least 3 different speaking situations per week, using a self-monitoring log to record the situation, initial thought, and a more constructive reframe. The client will achieve 3 consecutive instances of successfully reframing negative thoughts with low anxiety (a score of 1 or 2 on a 1-5 scale). [this one generated by chatgpt based on the previous goal i wrote]
Write a SMART goal (short term or sessional) for therapy addressing attitudes, avoidance and anxiety.
Within 6 weeks, the client will demonstrate the ability to voluntarily stutter at the conversational level in real-life speaking situations (outside the clinic), as monitored by a self-recorded log, and will achieve 3 consecutive instances of voluntary stuttering rated as low anxiety (a 1 or 2 on a 5-point scale).
Write a SMART goal (short term or sessional) for fluency shaping.
Clients will independently integrate ‘pausing for normal speech’ in semi-structured, sentence level tasks while maintaining a relaxed and open airway in 8 out of 10 trials as monitored by clinician in the clinical setting.
Explain in detail 3 fluency shaping techniques that you would teach as part of “essential pause” or “fluency plus” treatment.
- 2-second pause
> Breathe right before speaking
> Maintain open airway
> No tension
> Think of techniques you will use when speaking - Easy speech
> Light touch consonants
> prolonged speech
> gentle onset - Repetition
> mimicking natural disfluencies
> eye contact, no tension
> repeat at the word or syllable level in natural places
How would you ensure transfer of these skills? (essential pause)
- move away from the same reading material as soon as possible
- move away from communicating in the same setting wit hthe same person as soon as possible
- role-play
- jointly plan goals (client and clinician) = better transfer of skills when goals are important to client
how would you check if she was transferring skills successfully? (essential pause)
- feedback from her, friends, family
- self-monitoring logs
- video samples of transfer
- rating scales and questionnaires
Explain 3 specific techniques/methods you can use to decrease avoidance, negative attitudes, fear and anxiety of speaking.
- modelling acceptance (Children can learn to love and accept themselves with a stutter if parents model acceptance)
- densensitization (talk about why stuttering bothers you)
- Acceptable stuttering (changes should not result in reduction of naturalness - use techniques slightly and only when they want to enhance fluency)
-positive self-talk
> attack (confront situation)
> remind yourself of your strengths
> turn problems into opportunities (think of speaking/stuttering as a chance to practice techniques and educate others)
How would you consider and address the individual’s culture and identity during treatment
- what language does the client/parents prefer to speak in (get interpreter if necessary)
- make note of cultural differences in communication style (eye contact, physical touch)
- be mindful of scheduling around holidays/other important times of day
- be aware of using culturally relevant and appropriate therapy materials
