Evidence Based Practice And Speech Restructuring Flashcards
What is bottom up vs top down
Bottom-Up = is the piecing together of systems to give rise to a bigger system, thus making the original system sub-systems of the emergent system. • This approach often resembles a ‘seed’ model whereby the beginnings are small but eventually grow in complexity.
• Top Down = aka stepwise design is essentially the breaking down of a system to gain insight into its sub-systems
What does evidence based practice say about speech restructuring?
Good evidence for Smooth Speech, Prolonged Speech, Camperdown Program
• Research has shown these to be ‘best practise’ treatments for AWS.
What are some bottom up approaches?
Smooth speech = Latrobe and mater
Prolonged speech
Better for more severe cases
What is a top down approach?
Camperdown program
What is the neuroscience model?
Says that instability in the speech system is caused by a mismatch between the selection, programming of speech sounds and the production of these sounds.
Mismatch between inner production loop and outer cognition loop.
What are the current findings in terms of structural and functional abnormalities?
Stuttering is a disorder related primarily to disruption in the cortical and subcortical neural systems supporting the selection, initiation and execution of motor sequences necessary for fluent speech production
What is smooth speech?
Incorporates speech restructuring and cognitive aspects.
Basic premise – elimination of muscle tension and control over all muscular components of speech and the emotional aspects associated with stuttering creates a physiological environment that is incompatible with stuttering
What is the overall treatment program for smooth speech?
- Pre-Course Treatment – smooth speech is taught individually. Pre-practice skills
2. Instatement of fluency within the clinic through mass practice
3. Transfer of fluency outside the clinic SPM, intense environment learning - Maintenance of fluency following transfer phase. Once able to use the skills in the outside world need to learn how to maintain
What does smooth speech promote during speech?
Relaxation Breathing Gentle onsets Gentle contacts Continuous airflow Continuous smooth movements - linking words Natural sounding voice and prosody
What are the 8 steps in the smooth speech program?
- Relaxation
- Mechanics of smooth speech
- breathing
- gentle onsets
- gentle contacts
- continuous smooth movement
- continuous airflow
- normal intonation, stress patterns, voice quality. - Planning - using short phrases in chunking
- Rate control
- Attitude change - anxiety control and cognitive restructuring
- Rehearsal
- High level communication skills
- Consideration of environmental factors
What are some critical points in teaching each part of smooth speech?
Facilitate self-monitoring:
- teaching and identification of normal function and what stuttering does to this.
- stringent teaching on error - identification of incorrect breathing, hard onsets or contacts, breaks in airflow, prosody violations etc.
What in the Latrobe speech program?
Widely used program with best evidence for short and long term.
Intensive Program : 5 days for 9 hours/day • Maintenance: once weekly follow up sessions for 2 hours per week for 7 weeks
What is prolonged speech?
• Microstructural approach that teaches the behaviours of: ▫ Continuous vocalization (voiceless voiced)
▫ Soft contacts ( very loose slushy)
▫ Gentle onsets ( aspirated vowels)
… in order to acheive continuous airflow
“Naturalness” (voice and prosody) taught as a later layer, rather than at the outset.
No formal cognitive restructuring or anxiety management aspects in most Australian Prolonged Speech programs
What is the Camperdown program?
Macrostructural approach
Teaches Prolonged Speech (PS) without making reference to terms of traditional speech targets such as “gentle onsets” and “soft contacts”
Clients are encouraged to use whatever features of the PS pattern they desire to control stuttering and are free to individualize their own behaviours.
Rate is slow at start, but set by the individual in accordance with fluency level
Helps people who stutter feel more positive about themselves as communicators
Immediate shift of monitoring and control on to the individual, for them to work out “what aspects assist them most”
How is the Camperdown program taught?
Individual teaching sessions - learn smooth speech and to rate naturalness and severity.
Group practice day
Individual problem solving sessions
Maintenance schedule
