Chapter 6: Fluency Disorders Flashcards
Definitions of stuttering falls into what three categories?
- Stuttering based on expert judgement
- Stuttering limited to certain types of disfluencies
- Stuttering based on the frequency of all types of dysfluencies
Forms of dysfluency: repetitions
Saying the same element of speech more than once
Part-word: sound or syllable repetition
- Example: S-s-s-sunday
- Whole-word: I-I-I am fine or could-could-could not do it
-Phrase: I am- I am- I am fine or could not -could not- could not do it
Form of disfluency: Prolongations
Extension of syllables and silent postures
Sound: lllllllike it or mmmmmmmommy
Silent: articulatory pressure held for a longer duration than average with no vocalization
Forms of disfluency: Pauses
Silent intervals in the speech sequence at inappropriate junctures or of unusually long duration
Forms of disfluency: interjections
Extra elements introduced into the speech sequence
Sound or syllable: um or schwa
Word: like, okay, well
Phrase: you know, I mean
Forms of disfluency: Broken Words
Silent intervals within words
Example: Be—fore you forget
Forms of disfluency: Revisions
Changes in wording that do not change the overall meaning of an utterance
Incidence vs Prevalence
Incidence: The annual rate of occurance in a speciried normally fluent group of people who are repeatedly observed over time
- Example: 10% of the population may stutter
Prevalence: The number of individuals who exhibit a disease or a disorder in a specified group at a specific time
- Ex: In the Big School District, there are 1,200 children who stutter
Natural Recovery from Stuttering
Aka Spontaneous recovery
The disappearance of stuttering without professional help
The reported rate of natural recovery of stuttering in children and adolescents range from 45% to 80%
Variables associated with the persistence of stutering in children
Family history of stuttering
Older-age onset of stuttering
Lower articulatio nand language skills
Higher frequenc y of stutter-like disfluencies
What need to be considered during a comprehensive assessment for stuttering
- Types of disfluencies
- Frequency of disfluencies
- Associate motor behaviors
- Certain breahting abnormalitieis
- Negative emotions and avoidance behaviors
Associated Motor Behaviors
Aka secondary stuttering
Examples
- various hand and foot movement
- rapid eye blinking
- knitting of the eyebrows
- lips pursing
- rapid opening and closing of the mouth
- tongue clicking
Associated breathing abnormalities
Examples
- Attempts to speak on inhalation
- Holding breath before talking
- Continued attempt to talk even when air supply runs out
- Rapid and jerky breathing during speech
- Generally tense breathing
May be more pronounced in adults with severe stuttering
Negative Emotions and Avoidance Behaviors
- Anxiety and apprehension about stuttering, fear of certain speaking situations, frustration in effort to communicate
- A sense of humiliation in certain difficult speaking situations and hostility towards certain speakers
- Avoidance of speaking with strangers, authority figures at service counters, and over the phone
- Avoid eye contact, especially during stuttering
Where does stuttering most likely to occur in adults and school-age children who stutter?
- Consonants rather than vowels
2a. The first sound or syllable of a word,
2b. The first word in a phrase, sentence, or grammatical class - Longer and less frequently used words
- Content words (nouns, verbs, adjectives, and adverbs)
Where does stuttering most likely to occur in preschool children who stutter?
Function words
Especially pronouns, conjunctions, and prepositions
Theories of Stuttering
There are environmental (learning), genetic, interactional, neurophysiological, and psychological theories of stuttering
No theory explains all aspects of stuttering
In order to diagnose stuttering in children or adults a reliable conversation speech sample contains
- A dysfluency rate higher than 5% of spoken words
- Part-word repetitions, speech sound prolongations, and broken words minimally at least 2% of word spoken
- Dration of dysfluencies that last 1 second or more
- stuttering- like disfluencies on at least 3% of syllables produced (multiple repetitions of syllables and words, prolongations of sounds, presense of schwa vowel in syllable repetitions, tension assoicadted with dsfluencies)
General Goals of Stuttering Treatment
- Counseling the client, family memebers, both about stuttering and its treatment
- Answer questions about stuttering and its personal, social, meotional, and pccupational effers
- Reduction in the amount of stuttering
- Reduce avoidance and negative feelings about speech, speaking situations, self, and others
- Training indivduals in self-monitoring techniques to maintain fluency
Psychological Methods of Treatment
Includes psychotherapy and counseling, typically offered to adults who stutter
Treatment includes
- Discussion of psychological problems associated with stuttering
- Discussion of feelings, emotions, and attitudes associated with stuttering
- Discussion and resolution of potential psychological conflicts, unconscious psychosexual conflicts, and various kinds of negative reactions
- Reduction of the client about a more realistic and rational approach to the stuttering problem
Fluent Stuttering Method
Aka Stutter-more-fluently
Modifies the severity and the visible abnormality of stuttering
The goal isn’t normal flueny, but more fluent stuttering tht may be more acceptable to the individual
Method involves the following steps
1. teaching stuttering identification: identifying stuttering and associated problems (feelings and attitudes),
2. Desenitizing the client to his or her stuttering
3. Modiftying stuttering (cancellations, pull outs, preparatory sets)
4. Stabliizing the treatment gains
5. Counseling the client
Fluency Shaping Method
Aka Speak-more-fluently approach
Goal is to establish normal fluency
Method includes
1. prolonged speech
2. Airflow management: inhalation, immdeiate slight exhalation before phonaitons, and maintenance of an even airflow throughout the production of an utterance
3. Gentle onset of phonation
4. Behavioral teaching procedures
5. Maintenance strategies
Fluency reinforcement method
Simple method that positively reinforced fluent speech in naturalistic convercational contexts
In this method the clinician
1. arranges a pleasent and relaxed theraputic setting
2. Evokes naturalistic speech with the help of poicture books, toys, and other play materials
3. Positively reinforces the child for fluent utterancees with verbal praises, tokens, or both
4. Frequently models a slightly slower and relaxed speaking rate that assures stutter-free speech
5. Reshapes normally prosody if a slower rate is an added target
Direct Stuttering Reduction Methods
Seeks to reduce stuttering directly, teaching specific fluency skills to indirectly reduce stuttering, and modifying stuttering into less abnormal forms
1. Pause and talk (time-out): pause after each disfluency and then resume talking
2. Response cost: counsel the parents, and describes the procedure and its effects. and gets their approval for using the response cost procedure
Masking and Delayed Auditory Feedback Techniques
Allows client to hear their own speech with a slight delay
This can help reduce stuttering, possibly because the speech rate is slowed down; speech tends to be monotonous
Pharmacological Treatment
No pharmacological treatment has replaced the behavioral methods of treating stuttering; all are still experimental
Neurogenic Stuttering
Aka acquired stuttering
Form of fluency disorder associated with documented neuropathology, often in older individuals without a history of childhood onset stuttering; other neurogenic speech disorders or language disorders may or may not be evident
Up to 5% of patients with stroke may experience neurogenic stuttering for varying duration of time
Several characteristics of neurogenic stuttering are unique and help distinguish it from stuttering of childhood onset
Etiology of Neurogenic Stuttering
No single brain region is exclusively associated with NS
Cerebral vascular disorders that cause strokes are the most frequent causes of lesions
Left hemisphere damage is more common, but right hemisphere damage
Extrapyramidal diseases
Drug toxicity
Bilateral brain damage
Left hemisphere strokes, parkinson’s disease, alzheimer’s disease
TBIs
Assessment and Treatment of Neurogenic Stuttering
Begins with a review of medical records to establish a neurological basis for suspeted fluency disorder
Procedure
1. Assessment of potenitally coexisiting asphas, apraxia of speech, dysarthria, and dementia
2. Treatment of NS is done in the content of other speech or language disorders that coexist
3. Most clinicians handle treatment symptomatically
What is cluttering?
A disorder of fluency characterized by reduced speech intelligibility, rapid and irregular speech rate, imprecise articulation, disfluencies, disorganized language, poor prosody, and inefficient management of discourse
Often coexists with stuttering
Cause of Cluttering
Cause is unknown
Genetic transmission and subtle brain damage have been suggested factors
Malingered stuttering
Faked stuttering exhibited to gain an advantage from the problem
Symptoms are well-planned (researched by the individual)
The individual knows they are faking
Psychogenic stuttering
Individuals may be unaware of the origin of the problem
