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fluency > final > Flashcards

final Flashcards

1
Q

modern theory - multifactorial theories

A

demands and capacities, neuropsycholinguistic model, dynamic multifactorial model

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2
Q

what do all the modern theories have in common

A

genetic or other predisposition, predisposition interacts with environment, after pre-school years, stuttering tends to be lifelong condition

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3
Q

stuttering modification

A

teach the person to learn and understand their stuttering, and when they choose to, they can do something about their stuttering in the moment

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4
Q

stuttering modification basics

A

-fluent speech is generally not altered in any great degree
-primary goal is to modify the moment of stuttering
-attitudes, speech fears and avoidances are a major focus of therapy
-client must analyze and evaluate their stuttering behaviors
-baseline and treatment data are kept in quantative manner
-emphasis is on rapport, counseling, teaching, motivation
-self-monitoring skills are emphasized

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5
Q

fluency shaping

A

-the moment of stuttering is not modified
-attitudes, speech fears and avoidances are generally not dealt with in therapy
-clients do not analyze their stuttering behaviors
-baseline and treatment data are kept in a qualitative manner
-emphasis of therapy is on conditioning, reward, etc.

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6
Q

when to use stuttering modification

A

-client has difficulty modifying fluency
-client shows significant fear or avoidance
-client does not seek total fluency
-poor attitude or little knowledge of stuttering

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7
Q

when to use fluency shaping

A

-a client can easily modify their fluency
-client seeks high levels of fluency
-client exhibits no avoidance or fear
-the client does not have the cognitive ability to use stuttering modification program

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8
Q

keys to stuttering modification therapy

A

combination of: understanding, monitoring, desensitizing, accepting, modifying the moment of stuttering

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9
Q

traditional van riper therapy

A

motivation, identification, desensitization, variation, stabilization

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10
Q

motivation

A

identifying goals, talking to others who stutter, building the therapeutic relationship to develop trust

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11
Q

identification

A

stuttering 101: education and teaching the client about stuttering

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12
Q

desensitization

A

advertising, pseudostuttering

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13
Q

variation

A

freezing, cancellation, pull-out, preparatory set

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14
Q

stabilization

A

support groups, self-help

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15
Q

keys to fluency shaping therapy

A

-find out where fluency breaks down
-behavior modification to reinforce use of technqiue
-progress up a hierarchy of difficulty
-carryover can be difficult, so start planning for it immediately

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16
Q

fluency shaping

A

find a method that is incompatible of stuttering and use that strategy when talking all the time

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17
Q

fluency shaping treatment

A

-attitudes, speech fears and avoidances are generally not dealt with in therapy
-clients do not analyze their stuttering behaviors
-emphasis of therapy is on conditioning, reward, etc.

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18
Q

when to use fluency shaping

A

-when a client can easily modify their fluency
-when a client seeks high levels of fluency
-when the client has little or no fear of avoidance
-when the client does not have the cognitive ability to use a stuttering modification program

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19
Q

keys to fluency shaping

A

-find out where fluency breaks down
-assess the best method to eliminate stuttering
-behavior modification to reinforce this technique
=progress up a hierarchy of difficulty
-carryover can be difficult, so start planning for it immediately

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20
Q

stuttering modification

A

-primary goal is to modify the moment of stuttering
-fluent speech is generally not altered in aby great degree
-teach the person to learn/understand their stuttering

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21
Q

stuttering modification treatment

A

-attitudes, speech fears and avoidances are a MAJOR focus of therapy
-clients must analyze and evaluate their stuttering behaviors
-self-monitoring skills are emphasized
-emphasis on rapport, counseling, teaching, and motivation
-self-monitoring skills are emphasized

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22
Q

when to use stuttering modification

A

-when a client has diffculty mdifiying fluency
-when a client show significant fear or avoidance
-when a client seeks total fluency
-poor attitude or little knowledge of stuttering (for older kinds and adults)

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23
Q

keys to stuttering modiication

A

-get the person to “stutter more easily”
-combo of: understanding, monitoring, desensitizing, accepting, modifying the moment of stuttering

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24
Q

stuttering modification treatment steps

A

motivation, identification, desensitization, variation, stablization

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25
Q

motivation

A

identfying goals, talking to others who stutter, building the therapuetic relationship to develop trust

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26
Q

identification

A

education, naming stuttering (and other behaviors) in others, naming stuttering (and other behaviors in others)

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27
Q

desensitization

A

advertising, pseudostuttering

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28
Q

variation

A

freezing, cancellation, pull-out, prepatory set

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29
Q

stabilization

A

support groups, self-help

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30
Q

things to keep in mind with stuttering modification

A

-must build the relationship, much of this is counseling in nature
-get the clients to accept stuttering, then give them a technique to improve when they choose to improve
-educate the client, let the assist in planning goals

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31
Q

what do we really want to know: children

A

does the child really stutter? is the child likely to persist or spontaneously recover? what is the best therapy for this person? what do the parents think? how does stuttering impact the child and family, etc.?

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32
Q

what do we really want to know: older children and teens

A

is this stuttering or something else? (child onset, psychogenic, neurogenic, other) how does this impact their life/quality of life? what do the parents/teachers thing? what is the best type of therapy for this person? what are their goals? how motivated are they to change?

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33
Q

what do we really want to know: adults

A

is this stuttering or something else? how does/has this impacted their life? what is the best type of therapy for this person or do they even seek therapy? and why now?

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34
Q

stuttering profile: speaking tasks

A

-single syllable words
-multisyllablic words
-phrases
-sentences
-connected speech (monologue w/ clinician and family)
-outside of clinic tasks (telephone of friend, telephone a stranger)

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35
Q

stuttering profile: qualitative analysis

A

-communicative ability
-ethnographic interview
-avoidance/secondary behaviors
-stuttering/disfluent events description
-stuttering variance
-speaking rate

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36
Q

stuttering profile: summary of results

A

-motor function
-language development
-articlation/phonology
-feelings/attitude scales
-self/assessment

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37
Q

writing goals

A

come up with general goals:
-motivation and identification
-desensitization
-modification/variation of speech
-modification/variation (with stuttering remaining)
-carryover and maintenance

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38
Q

lidcombe program

A

goal: eliminate stuttering, operant with lot of reinforcement

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39
Q

before treatment LP

A

clinical evaluation
-within clinic speech sample OR have parents play with them if shy
-at home sample (300 syllables)
-measure %SS at clinic and at home
case history

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40
Q

case selection criteria LP

A

begin therapy is persisted more than 6 months after onset
-does NOT begin when:
- stuttering onset less than 6 months past
- stuttering consists primarily of rhythmic, syllable repetitions
- child and parents are NOT frustrated by the stuttering
- no family history of stuttering

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41
Q

basic rules of LP

A

enjoy therapy, any negative reaction = stopping, parents apply with flexibility

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42
Q

clinical program LP

A
  1. treatment procedures
  2. fostering a working relationship
  3. beyond-clinic speech measures
  4. within-clinic speech measures
  5. therapy activities
  6. maintenace
43
Q

treatment goals LP

A

-eliminate stuttering (maintain for 12 months)
-conduct ativities sufficent enough so parent can get child to do first goal
-assist parent (clinician)

44
Q

treatment procedures LP

A

-weekly visits
-child and parent must attend
-contigent, working relationship formed with parents
-maintenance

45
Q

activities LP

A

-structured therapy games: praise for stutter-free speech
-direct therapy: clinican uses games for 10 min then parents use technqiue with client
-remaining time is used to discuss child and home training (10-15 minutes every day)

46
Q

progress LP

A

-severity rating <4, online activities implemented
-parents learn to use praise
-structured activities at home

47
Q

measures LP

A

-%SS in clinic activites
-severity rating (SR)
-stuttering per minute of speaking time (SMST)

48
Q

continuation LP

A

3 consectuive weeks: %SS is less than 1.0 within clinic, SR is less than 2.0 outside clinic, SMST is less than 1.5 outside clinic -> child goes into maintenance phase

49
Q

maintenance LP

A

parent continues with the program and child returns to clinic at intervals of:
- 2 weeks (x2) – once every 2 weeks, 4 weeks (x2) – once very 4 weeks, 8 weeks (x2), 16 weeks (x1), Dismissal

50
Q

family focused treatment program

A

GOAL: achieve and maintain normal fluency while developing healthy communication attitudes and effective communication skills
· Age 2-6 yrs

51
Q

fftp components

A

· Parent focused strategies: modify behaviors and reduce concerns
· Child focused strategies: modify communication behaviors and develop healthy, appropriate communication attitudes
-12 sessions

52
Q

3 parts fftp

A

· Parent communication counseling: responding in supportive manner, learn about stuttering, reduce concerns, look at other aspects of childs life
o Tasks: models of slowed “easy talking”, increased pause time, reduction of demands
· Parent/child acceptance:
o Tasks: identifying communication stressors, desensitization (talking about stuttering), understanding communication, acceptance
· Child communication modifications: fluency shaping, stuttering modification

53
Q

fftp concludes with

A

review and assessment

54
Q

demands and capacities model (RESTART)

A

when demands exceed capacities, fluency breaks down: motoric, emotional, lingustic, cognitive

55
Q

dcm components

A
  1. Daily special interaction time – parent and child interact ( goal is to boost child’s confidence)
  2. changing parent’s speech rate – talk more slowly, but still natural
  3. substitute modeling and self-talk for demand speech – natural incentive communication
56
Q

dcm other tasks

A

taught and modeled when relevant: decreasing emotional demands, decreasing cognitive linguistic demands, increasing emotional capacities

57
Q

dcm specifics

A

SLP provide parent with treatment instructions
· 10 min play period to begin
· Target procedure is selected during play
· SLP modeled target procedure, parent practice, SLP give feedback

58
Q

palin parent-child interaction therapy

A

GOAL: parents trained to model helpful strategies and guide their children toward fluency
Indirect approach

59
Q

pcit evaluation

A
  1. Child assessment: evaluation of speech, language, fluency, and questions
  2. Case history
    · Clinician interprets the info and makes recommendation for therapy
    · Important to address feelings of blame or self-guilt
60
Q

pcit therapy if

A

the child is considered to be at risk of persistent stuttering
· if the parents are concerned and seeking support, or
· if the child is reacting negatively to the stuttering

61
Q

session 1 pcit

A

special time (5 min) – child and parent interact using their target
o foundation of the program
o parents reflect on the special time
o they eventually generalize their skills and use it outside of special time

62
Q

session 2-6

A
  • review of special time feedback
    · parent child playtime is recorded and evaluated by parent
    · practice target in another videoed playtime
63
Q

management strategies pcit

A

helping parents address issues: coping, anxiety, confidence building

64
Q

interaction strategies pcit

A

· no universal or prescribed targets within the program
· targets selected by parents based on child’s needs
· targets not all identified at beginning of therapy because things can change

65
Q

the consolidation period pcit

A

-parents continue to carry out special time at home
-parents mail/e-mail feedback weekly

66
Q

intervention programs for teens/adults

A

Goals include things, such as:
o Reducing the frequency and form of stuttering
o Reducing negative thoughts and feelings about stuttering
o Decreasing avoidance
o Involving the parents in altering the child’s environment
o Enhancing the pleasure of communicating
o Understanding stuttering and communication
o Responding to stuttering and bullying

67
Q

delayed auditory feedback - fluency induction technqiue

A

a device where you hear the speech playback a few seconds later

68
Q

faf - fluency induction technqiue

A
69
Q

masking - fluency induction technique

A

act like you don’t stutter

70
Q

choral speech - fluency induction technqiue

A
71
Q

rhythmic speech - fluency induction technqiue

A

speak along to the beat; metronome or hand clapping/tapping

72
Q

the successful stuttering management program (SSMP)

A

· GOAL: become a successful communicator and to enter all speaking situations in a person’s life
· Adolescent and adult secondary stutterers
· helps to improve intensive fluency, speech, stutter, communication, and language skills under a certified speech language therapist workshop.

73
Q

precision fluency shaping

A

· Stuttering is treated as a behavioral problem
· employs laboratory derived principles of learning in the development of new speech skills (prolonged speech).

74
Q

therapy for precision fluency shaping

A

· relearn the proper means of producing the elementary sounds of speech, then rebuild their ability to correctly produce syllables, words, and ultimately, complete sentences

75
Q

the camperdown program

A

· adults and adolescents
· minimize stuttering through fluency technique
· practice with SLP or family member
· clients learn to achieve naturalness and fluency together – maintenance program after

76
Q

american institute of stuttering

A

· adults and teens
· intensive, residential program
· emphasis on: manage and improve speech fluency, reduction or elimination of avoidance, strengthen self-confidence, develop new attitude

77
Q

american insitute of stuttering phases

A
  1. engaged in process of awareness and understanding (identify during sessions stuttering behaviors)
  2. learns ways to reduce tension
  3. learn speech restructuring techniques (easy onset, airflow management, reduced rate etc.)
78
Q

warnings during therapy

A
  • emotional factors require attention
  • individualized interventions = valued
  • informational support makes for better therapy
  • positive relationship
  • follow-up sessions to reinforce are important
79
Q

stages of change (in stuttering therapy)

A
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
80
Q

F80.81

A

childhood onset stuttering

81
Q

R47.82

A

neurogenic stuttering

82
Q

F98.5

A

psychogenic stuttering

83
Q

F80.81 (also)

A

cluttering

84
Q

developmental stuttering

A

· Onset in childhood
· Speech disfluencies, secondary behaviors, emotions/attitudes

85
Q

neurogenic stuttering

A

· Acquired stuttering: onset in adulthood
· Following a neurological disease: stroke, TBI, neurodegenerative disease
· Stuttering like disfluencies (repetitions, prolongations, blocks)

86
Q

neurogenic updates

A

· Stroke most common etiology
· Different etiologies lead to different behavioral representations
· Associated with lesion in left hemispheric cortico- basal ganglia
· Repetitions predominant (word initial)
· SLD and OD exist in NS
· Co-occurring: aphasia

87
Q

neurogenic treatment

A
  • Not everyone needs treatment: spontaneous recovery possible
  • Not everyone is bothered by the stuttering
88
Q

psychogenic stuttering

A

· From emotional of psychological trauma – conversion reaction
·

89
Q

malingering

A

faking

90
Q

implication for treatment

A
  • Stuttering modification
  • Fluency shaping
  • Cognitive therapy
  • Biofeedback
  • Speech rate changes
  • Pacing
  • Delayed auditory feedback
  • Voice therapy techniques
  • Respiration training
  • Relaxation techniques
  • Surgery & nerve stimulation
  • Prescription drugs
91
Q

alternative therapies

A

pharmacologic and devices

92
Q

pharmacologic

A

· Reduction of stuttering and anxiety
· Side effects outweigh gains
· Pagoclone = most successful /open label testing
· No drug approved by FDA for stuttering

93
Q

devices

A

· Speech easy ( like hearing aid)
o Alter sounds and you hear it at slight time delay (choral effect)
o Short term affect is high ( fluent for a couple months)

94
Q

a profile is needed to determine differential diagnosis, at minimum must include:

A

o Speech samples at various different tasks/complexities across different settings and days
o Fluency inducing tasks
o Adaptation
o Emotion/self-assessment
o Trial therapies (finding what works)
o -Singing
o -Rhythmic speech

95
Q

cluttering

A

(Communication problem different but related to stuttering)
· Marked by
1) Excessive speech rate
2) Jerkiness in speech rhythm
3) Excessive numbers of NSD
4) Under articulation/excessive coarticulation
5) *some would also say severe expressive language difficulties

96
Q

cluttering assessment

A
  1. speech rate (cluttering = rapid)
  2. concentration and attention span (cluttering = poor and short)
  3. locus of stuttering (cluttering = pauses before vowel initial words without signs of frustration)
  4. # of repetitions (cluttering = 6, 8 or 10 repetitions of syllables, words or phrases are common)
  5. articulation testing (cluttering = several errors; /r/ and /l/ are common errors)
  6. voice assessment (cluttering = monopitch/monotone)
  7. reading assessment (cluttering = poor reading)
  8. writing sample (cluttering = disorderly, poorly written, poorly integrated, uninhibited, full of repetitions and deletions)
97
Q

qualitative cluttering assessment

A
  1. disorganized speech
  2. frequent slips of the tongue (ex. “at this plant in time,…”)
  3. physically immature, clumsy and uncoordinated
  4. poor musical ability
  5. familial evidence (“Does anyone else in the family have speech problems similar to yours?”)
  6. personality factors (impulsive, “figity”, hasty, hyperactive, careless, clumsy, untidy, sloppy, impatient, short tempered)
  7. lack of awareness (“Do people ask you why you repeat?”, “Do people ask you to slow down?”)
98
Q

new perspective of cluttering (St. Louis, 2007)

A

● Excessively rapid and irregular rate
● Pragmatic errors
● Word finding errors
● Hyperactive
● Reading difficulties
● Writing difficulties

99
Q

treatment of cluttering

A

· motivation is the key element
· Variables
1. age of the client
2. the length of time that cluttering has been a problem
3. whether cluttering and stuttering coexist
4. nature and severity of the problem

100
Q

cluttering treatment must also include one of the following:

A
  1. oral-motor exercises
  2. work on slow deliberate/ reduce rate
  3. heighten awareness of their disorder and therpuetic technqiues
  4. pragmatic skills such as turn-taking
  5. self-monitoring
101
Q

stuttering vs. cluttering

A
  • Cluttering has a faster rate of speech and lower awareness than stuttering.
  • Cluttering does not have prolongations, blocks, repetitions. More like phrase repetitions and interjections for cluttering. Some people who clutter also stutter.
102
Q

demands and capacities model

A

each of us have innate capacity to speak fluently, when that capacity is exceeded, fluency can break down

103
Q

neuropsycholingustic

A

lingustic = the words you say
paralingustic = the characteristics of the speech
-if these are not synchronized, then this will result in a nonfluency

104
Q

dynamic multifacotrial model of stuttering

A

stuttering is dynamic and can only be described through the influence that it has on a lifetime

fluency (2 decks)

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