Chapter 12

Question 1

Some key principles of therapy for adults include:

Answer 1

• design the treatment according to individual needs
• focus on analyzing and proprioceptive aspects of speaking
  -compensations and adjustments are a lifelong learning process

Question 2

Therapy approach that addresses speech directly

Answer 2

Stuttering management

Question 3

Stuttering management was commonly seen in the years ____, but still used by many clinicians today

Answer 3

1940s-1970s

Question 4

The focal point for stuttering management is _____

Answer 4

Stutter events

Question 5

The client and the clinician need stuttering event to occur to pursuer therapy objects. This is known as

Answer 5

Stuttering management

Question 6

Many clinician’s programs “management” is a stage that follows ______, aka “_______”

Answer 6

Desensitization; modification

Question 7

The traditional approach to stuttering treatment was introduced by

Answer 7

Van riper

Question 8

Van riper introduced a program to address stuttering in 4 major stages:

Answer 8

1. Indenitification
2. Desensitization
3. Modification
4. Stabilization

Question 9

Raise the clients level of cognition about all the details of their abnormal speech characteristics so they can modify them. Which of van ripers stage does this fall under?

Answer 9

Identification

Question 10

Two main phrases used in identification are

Answer 10

Awareness & analysis

Question 11

Develop thorough familiarity with all features of stutter events. Which of van ripers stage does this fall under?

Answer 11

Identification

Question 12

Develop thorough familiarity with all features of stutter events such as:

Answer 12

A. Occurrence of stuttering – frequency
B. Specifics of how you stutter
C. Identification reveals the behaviors that should be targeted.

Question 13

Develop a sense of responsibility for speech movements. Which of van ripers stages does this fall under?

Answer 13

Identification

Question 14

Examples of developing a sense of responsibility for speech movements

Answer 14

Ex. Outside force makes him or her stutter
Ex. “Words get stuck in my throat” as if words are small objects not sounds resulting from muscle movement.

Question 15

Identification aims for developing a sense for responsibility of speech movements

Answer 15

A. Describes what you do in during each instance of stuttering
B. “I tensed my jaw.” instead of “My jaw got stuck.”
- Gain objectivity; reduce emotional reactions to stuttering
C. Stuttering is discussed more objectively and openly.
D. Associated emotional reactions are lessened.

Question 16

Client engages in self- observation only; no behavior changes yet. This is an example of ___

Answer 16

Awareness/detection activities

Question 17

Describes and explores behaviors/ attitudes/ feelings to identify future targets of change. This is can example of __

Answer 17

Awareness/detection activities

Question 18

Increase accuracy in recognizing his/her stutter events. This is an example of ____

Answer 18

Awareness/ detection activities

Question 19

Client is instructed to talk, pause after each stutter event, and describe what he/she was doing while stuttering. This known as

Answer 19

Analysis

Question 20

Uses language of responsibility (e.g., “I tensed my tongue”). This is an example of ___

Answer 20

Analysis

Question 21

In awareness and analysis, Typically not all steps in these phases are covered in a single session. True or false

Answer 21

True

Question 22

In awareness and analysis, Extensive practice brings about change in habituated beliefs and attitudes. True or false

Answer 22

True

Question 23

To develop the client’s skills for changing the habitual stuttering into easier, relaxed, less interrupted, more continuous speech movements.

Answer 23

Modification

Question 24

Post-block modification is also known as

Answer 24

Cancellation

Question 25

_____ occurs when Changing the stuttering after the stutter has occured

Answer 25

Post-block modification

Question 26

Finish word, stop, examine/analyze, reduce tension, plan change, re-say. This is an example of ____

Answer 26

Post-block modification

Question 27

In-block modification is also known as

Answer 27

Pull-out

Question 28

____ occurs while saying the word, examine, reduces the tension, plan change, finish the word in an easier way

Answer 28

In-block modification

Question 29

Without pausing or stopping the client “pulls out” of the block. This is an example of ___

Answer 29

In-block modification

Question 30

Pre-block modification is also known as

Answer 30

Preparatory Set

Question 31

_____ occurs before saying the word, examine, reduce tension, plan change, produce the word more easily throughout

Answer 31

Pre-block modification

Question 32

Fluency shaping:n key principles

Answer 32

Establish fluency with new speech pattern Reinforce and gradually shape to near-normal Self-monitoring (high level) Practice progresses from shorter to longer speech segments; establish criteria before advancing to next level Transfer to outside situations (hierarchy) Intensive schedule for treatment

Question 33

Fluency shaping techniques

Answer 33

Fluency Facilitating Speaking Behaviors (FFSBs) slowed rate by stretching or enlongating the speech sounds gentle voice onset (vowels) light articulatory contact (consonants) breathstream management continuous phonation & articulatory movement (connecting across boundaries) intonation & phrasing management

Question 34

Possible treatment hierarchies

Answer 34

Utterance length (sound-syllable-word-etc.) Utterance complexity (syntax) Cues/support by the clinician Situational hierarchy (easy to difficult) Rate of speech (slower to faster) Other – topics, pragmatics (easy to difficult) Schedules of reinforcement Listeners (#, age, types)

Question 35

Fluency inducing instruments include

Answer 35

Metronome pacer Auditory masking Altered auditory feedback Computer Software for biofeedback

Question 36

Use of a _____ to help regulate the length of the desired speech intervals

Answer 36

Metronome

Question 37

1960s- surge when a miniature electric metronome that fit behind the ear was introduced. True or false

Answer 37

True

Question 38

Because of this instrument, several therapeutic programs were developed and studies of clinical applications of rhythm were published.

Answer 38

Metronome pacer

Question 39

In 1971, Brady described the systematic therapy program with accompanying results.

Answer 39

Metronome Conditioned Speech Retraining (MCSR)

Question 40

_____ is one of the most extensive metronome-paced treatment programs to date.

Answer 40

Metronome Conditioned Speech Retraining (MCSR)

Question 41

Metronome Conditioned Speech Retraining (MCSR) Consists of ____ phrases

Answer 41

5

Question 42

Obtain nearly 100% accuracy using a desk metronome in the clinic. This occurs in ____ of MCSR

Answer 42

Phase 1

Question 43

Client determines most comfortable rate for fluency when reading aloud east materials. (40 bpm another may choose 80 bpm). This occurs in ____ MCSR

Answer 43

Phase 1

Question 44

The client is meant to practice speaking with the desk metronome at least 45 min./day, first alone, then in the presence of others. This occurs in ____ MCSR

Answer 44

Phase 1

Question 45

Using the desk metronome, the speaking rate is gradually increased by: Changing the frequency of the metronome beats and by pacing longer speech units per beat moving from one syllable per beat to words, longer words and even three to four words per beat This occurs in ____ MCSR

Answer 45

Phase 2

Question 46

In phase 2 MCSR, Using the desk metronome, the speaking rate is gradually increased by:

Answer 46

- Changing the frequency of the metronome beats and -by pacing longer speech units per beat moving from one syllable per beat to words, longer words and even three to four words per beat

Question 47

In MCSR _____, natural pauses are added

Answer 47

Phase 2

Question 48

Home practice continues varying the listeners and their numbers. this occurs in _____ MSCR

Answer 48

Phase 2

Question 49

MCSR phase takes 2-3 weeks. True or false

Answer 49

True

Question 50

Phase II ends when:

Answer 50

- the client is able to speak fluently with the metronome at a normal rate of 100 to 160 words per minute - Exhibits no more than 20% of the original disfluency level when speaking without the metronome

Question 51

____ MCSR occurs when switch over to the miniature metronome.

Answer 51

Phase 3

Question 52

May result in partial setback, so the speaking rate is reduced until fluency is reached again. This occurs in ___ MCSR

Answer 52

Phase 3

Question 53

The client is to construct a hierarchy of speaking situations and practice them in that order. This occurs in _____ MCSR

Answer 53

Phase 3

Question 54

If difficulties occur, the rate is lowered and then gradually increased. This occurs in _____MCSR

Answer 54

Phase 3

Question 55

Maintaining fluency without the metronome. This occurs in ____ MCSR

Answer 55

Phase 4

Question 56

Metronome is turned off in less stressful situations and gradually removed from more stressful situations. This occurs in ___ MCSR

Answer 56

Phase 4

Question 57

Should difficulties continue the metronome is turned back on. This occurs in _____ MCSR

Answer 57

Phase 4

Question 58

Continuation of training based on responses in phase IV. This occurs in ____ MCSR

Answer 58

Phase 5

Question 59

Use masking/white noise for clinical management of stuttering. This is known as

Answer 59

Auditory masking

Question 60

In auditory masking, A continuous sound is delivered ______

Answer 60

Binaurally

Question 61

In auditory masking, start with complete masking of the patient’s voice. True or false

Answer 61

Treu

Question 62

In auditory masking, When fluency is achieved, the noise is _____ to a level that covers conversational speech.

Answer 62

Lowered

Question 63

In auditory masking, Obtain normal intensity and _____.

Answer 63

Intonation

Question 64

In auditory masking, turn off white noise while talking is known as

Answer 64

Generalization

Question 65

Use Delayed Auditory Feedback (DAF) device to aid in speech fluency- worn in or around the ear, usually in one ear

Answer 65

Altered auditory feeedback

Question 66

Device which is custom-made to fit in the speaker’s ear canal and transforms speech in two ways: Time delay (DAF) Pitch shift (FAF= frequency altered feedback)

Answer 66

Altered auditory feedback

Question 67

Altered auditory feedback is a Device which is custom-made to fit in the speaker’s ear canal and transforms speech in two ways:

Answer 67

Time delay (DAF) pitch shift (FAF= frequency altered feedback)

Question 68

In altered auditory feedback, Delay is often set to either ___ ms or ___ ms

Answer 68

50ms or 75ms

Question 69

quarter, half, or one octave below the speaker’s voice is known as

Answer 69

Octave

Question 70

Train them to listen to their altered feedback, adjust their sensorimotor responses and move past their stuttering blocks.

Answer 70

Altered auditory feedback

Question 71

Taught to use “umm” or “ahh” to prolong their initial sounds so they can start to hear themselves with altered feedback.

Answer 71

Altered auditory feedback

Question 72

Unison or shadowed speech is commonly known to induce fluency.

Answer 72

Altered auditory feedback

Question 73

Speaker hears themselves and altered speech, the condition is considered to be talking along in unison/choral (or shadowing) with another speaker.

Answer 73

Altered auditory feedback

Question 74

In altered auditory feedback, _____% reduction rates have not been verified

Answer 74

80 to 90%

Question 75

In altered auditory feeedback,___ reduction rates in stuttered syllables

Answer 75

40%

Question 76

In altered auditory feedback, _____, the outcome was not a typical normal level (Ritto, et. Al, 2016)

Answer 76

Reduced stutering

Question 77

the delivery of information about the status of the function of one’s biological system through an analogous sensory signal

Answer 77

Biofeedback

Question 78

_____ biofeedback involves the placement of sensory electrodes on the skin over muscle areas of interest.

Answer 78

EMG (electro graphic)

Question 79

_____ stated that electrodes placed on upper lip, jaw and neck with instructions to speak with almost resting level activity.

Answer 79

guitar (1975)

Question 80

integrated approaches include:

Answer 80

1. Identification and facing stuttering (bringing it out in the open) 2. Desensitization 3. Fluency- facilitating strategies (breath management, slow, rate, easy voice onsets, exc.) 4. Stuttering modification (cancellation, pull out, preparatory- set)