final exam

Question 1

What is included in a full assessment?

Answer 1

1. Interview
2. Talking logs
3. standard talking tasks
4. may need to do a covert assessment
5. Data analysis
6. Speech change probes

Question 2

Interview

Answer 2

-Their perception of the problem
-when and under what conditions the problem started
-how the problem has changed since onset
-consequences of the problem
-how the client/family has coped with the problem
-if other family members have had same problem
-expectation for assessmet
Most importantly: do they even stutter? what type? and previous therapy?

Question 3

Talking logs (adult)

Answer 3

(adult) client records time, duration of episode, conversational partners, rating.. this will give you an idea over a period of time of the trends in stuttering..tells you which situations need a speech sample.
You want a speech sample within clinic during oral reading, conversations with clinician, and monologue
-Beyond clinic you want a sample with clinician outside of clinic, with client & spouse, telephone with friend, and conversations in daily setting.
**all samples should be 10 minutes in length

Question 4

talking logs (children)

Answer 4

speech sample in a minimum of two different contexts (e.g. clinic and beyond clinic).
In clinic speech samples needed when child is speaking with clinician, parent & child. Beyond clinic, you’ll want samples with child & parent, child & sibling, and child in typical daily acitivies
Older children, have them do oral reading, monologue, or conversations. You wan an over view of what kind of difluencies and how often they are occuring.

Question 5

Covert assessment

Answer 5

recommendation is at least one covert assessment, using osmeone the client knows (must have informed permission). There is good evidence that PWS will change their rate when they know they are being watched. So it is sometimes necessary to arrange a covert assessment in their natural settings. You do the same assessment on recording and look at if there is a difference between your two samples (reliability check). Sometimes there is a difference, sometimes not.

Question 6

Data analysis

Answer 6

Calculate:

• percent syllables/words stuttered
• types of stutters
• duration of stutters
• rate of speech
• length of stutter free utterances
• naturalness rating
• • seperate your data by settings/conditions. gives you a baseline for treatment.

Question 7

How do you interpret assessment results?

Answer 7

Most important to look at percent syllables/words stuttered and the type of stutters. You will also be looking at duration of stutters, rate of speech, length of stutter-free utterance, naturalness rating, and you want to make sure that you have separate samples in different settings and under different conditions.

Question 8

What are the measures of overt behaviors?

Answer 8

These are the measures of the speech sample that are taken when the client knows they are being recorded

Question 9

What are the measures of covert behaviors?

Answer 9

These are the measures of the speech sample that are taken when the client is unaware they are being recorded
C. May need a covert assessment→ recommendation is at least one covert assessment, using someone they client knows ( must have informed permission). There is good evidence that PWS will change their rate when they know they are being watched. So it is sometimes necessary to arrange a covert assessment in their natural setting. You do the same assessment on recording and look at if there’s a difference between your two samples (reliability check). Sometimes there’s a difference, sometimes not.

Question 10

How do we gather samples of speaking behaviors from our clients?

Answer 10

a. Gathering data: 1. taking logs(adults): client records time, duration, conversational partners, Self rating
b. Standard talking tasks (children)→ speech sample in a minimum of two different contexts (e.g. in clinic and beyond clinic). In clinic speech samples need in which the child is speaking (e.g. child & parent, child & clinician). Beyond Clinic you’ll want speech samples with child & parent, child & sibling (or frequent play mate) and child in typical daily activity.
- With older children→ have them do oral reading, monologue, or conversation. You want an over view of what kind of disfluencies and how often they are occurring.
- With adults, you want a speech sample within clinic during oral reading, conversations with clinician, and monologue. Beyond clinic you want a sample with clinician outside of clinic, with client & spouse (or close friend), telephone with friend, and conversation in daily setting (work).
* *all samples should be at least 10 minutes in length.

Question 11

How are the procedures different for children and adults?

Answer 11

-Speech sample child will include the parent & child, child & clinician. Outside of clinic speech sample will contain child & parent, child & sibling (or frequent play mate), and the child in their typical daily activity. -With adults, in clinic your speech sample will contain oral reading, conversations with the clinician, and a monologue. Beyond clinic it will include a sample with the client & clinician, client & spouse (or close friend), on the telephone, and in daily work environment

Question 12

How are the speech change probes administered?

Answer 12

Each probe lasts 4 minutes, with each phase of the probe 1 minute long. The client speaks in monologue for a total of 4 minutes, during the first minute the client is speaking as they would normally with no intervention in place, the 2nd minute the speech change probe is implemented, the 3rd minute the speech change probe is withdrawn and the client speaks as they would normally, and finally the last 4th minute the speech change probe is implemented again. Do not apply the procedure to interjections, only provide intervention during speech-change probes to the Stuttering-like dysfluencies (SLDs).

Question 13

What are the procedures for each probe?Instructional control/minimal management:

Answer 13

Instructional control/minimal management: This probe tests to see that if you do the very minimum can the person change their stuttering. Tell the client: “I want you to talk and then when I signal I want you to do whatever you can to not stutter. Then when I signal again after that I want you to stop doing that…etc”

Question 14

Operant management speech-change probes:

Answer 14

Operant management speech-change probes: these probes don’t require the person to change their speech pattern, they’re not having to learn a new speech pattern to change their stuttering. If the person can increase their fluency through operant management it’s preferred because they’re not having to distort their speech or make it unnatural.

Question 15

Verbal punishment:

Answer 15

Verbal punishment: During the intervention phases (the B phases), the clinician provides some sort of verbal punishment every time the client stutters. Ex: “After you’ve been talking for a minute, whenever you stutter I’m going to say ‘no’”. Say “no” every time the client stutters.

Question 16

Time-out:

Answer 16

Time-out: During the intervention phases, every time the client stutters you tell them to “stop”, hold up your hand and look down for 5-10 seconds. Once the 5-10 seconds has passed, then tell them to resume talking.

Question 17

Reinforcement of fluency:

Answer 17

Reinforcement of fluency: For adults, tokens can be a powerful reinforcer as a method of feedback. You can provide feedback without disrupting the flow of conversation. You want to use plain tokens and explain what you’ll be doing, ex: “For every 10 seconds that you speak without stuttering I’m going to put a token down.”
If you have a severe stutterer you can adjust the time if you know they can’t make it 10 seconds without stuttering.

Question 18

Self-monitor:

Answer 18

Self-monitor: During the “B” phases, somehow have the client keep track of every time they stutter. They can mark on a paper, use a counter, or anything.

Question 19

Modification of speech production speech-change probes:

Answer 19

Modification of speech production speech-change probes: Make sure you go in order down the list when administering these probes.

Question 20

Reduced rate of speech:

Answer 20

Reduced rate of speech: Have the client talk slower, don’t make their speech choppy, just slower rate

Question 21

Prolonged speech:

Answer 21

Prolonged speech: With this probe, have the client practice it and then do the probe. To perform this have the client reduce the rate of speech significantly but also lengthen syllable duration by lengthening the vowel, maintain phonation across phonetic transitions with breaks in phonation only at voiceless phonemes (no pauses in between words or syllables. It is helpful to tell them to do this all on one breath but make sure they’re not speaking on residual air, have them take a breath at unnatural places, and have light articulatory contact). These behaviors will almost always be incompatible with the behavior of stuttering.
Watch in yourself and in your client, there will be a tendency to make the speech choppy and put a lot of pauses in, you want to make sure every word flows into the others, don’t exaggerate the movements or make harder articulatory contacts because that can cause stuttering.

Question 22

Rhythmic speech:

Answer 22

Rhythmic speech: have a metronome and set it to 90 beats per minute and have them speak one syllable per beep.

Question 23

Chorus reading or shadowing:

Answer 23

Chorus reading or shadowing: Perform shadowing for kids or adults that can’t read. Have a passage that takes 4 minutes to read, during the “B” phases you come in and read it with them.
There’s no treatment program that comes from chorus reading, this and rhythmic speech are more of diagnostic significance. At the very least one or both of these should reduce stuttering.

Question 24

What if none of these probes reduce their stuttering?

Answer 24

*If nothing has reduced their stuttering out of all the speech change probes then you may be looking at some kind of neurogenic stuttering.

Question 25

How are they interpreted?

Answer 25

Did one of them reduce or eliminate stuttering, look at which one or ones reduce stuttering the most.

Question 26

Why do we administer them?

Answer 26

Speech change probes help us identify which of these fluency strategies would work best for the client. They help give ideas on where to begin treatment and which treatment program would be the best fit for that client.

Question 27

Stuttering Modification (Iowa Therapy):

Answer 27

• The two goals of Iowa therapy (1) Reduce feelings of shame and anxiety, (2) Teach stutterers to modify the way they stuttered. The goal is NOT to not stutter (be completely fluent), the goal is to avoid dysfluency, make the moments of stuttering less severe or shorter in duration, to help them manage stuttering.
• The main goal of Iowa Therapy was to reduce the person’s fears. This treatment was based on the theory that avoidance techniques make it worse, so clients were instructed not to use avoidance techniques. The goal was to stutter without fear or avoidance. One of the assignments of this therapy is to go out and stutter openly, if the client felt that they weren’t going to stutter in a particular situation then they were told to “pseudo-stutter”. Then they were to watch the reaction of the person they stuttered to and also that person’s reaction to other people. This helped PWS realize that not every reaction someone has is a reaction to them or their stuttering. This helped the clients reduce their anxiety, fear, and social isolation.
• The goal is not fluency, though it might develop. Since fluency isn’t the goal then relapses aren’t such an awful experience for the PWS. The stutterer must analyze what he does when stuttering and then modify it. Van Riper’s modification techniques: “fluent stuttering”. These techniques are only used when the person stutters or anticipates stuttering compared to Fluency Modification where fluency techniques are used all the time when the person speaks.

Cancellation: First the client is taught cancellation. In this technique, after they stutter they have to repeat the stutter with a smooth prolongation (ex: if they said b-b-ball, they have to make it smooth “baaaaalllll”)
Pull-outs: Next clients were taught pull-outs. In a pull-out, if a person blocked (had a silent prolongation), they were told to initiate a smooth, prolongation of the word. The idea is that they pull out of the block/stutter. Here the person is aware they’re in the middle of a stutter so they need to pull out of the stutter and make the stutter less severe and shorter in duration so they can move on with their speech.
As people mastered the pull-out they started to use the technique earlier and earlier in a stutter and were prepared to use it whenever they thought they were going to stutter, so in that way it turned into preparatory sets.
Preparatory sets: Preparatory sets are based on the knowledge that the person who stutters is aware they’re going to stutter before it happens so they prepare themselves for the stuttering based on that anticipation.
There are 3 behaviors during preparatory sets that they need to change: (1) look for tension in the speech musculature, (2) if they fear their inability to initiate a particular word they start to fix in place the position of the articulators, (3) placing the articulators into position before initiating voice (the timing between phonation and articulation is off).
The client needs to be aware of what they do during stuttering, not all clients will do all of these 3 things.
Once the client is aware of what behaviors to look for during stuttering, they can put their articulators in the resting position; start to say the first sound and then flow that sound into the next one, similar to prolonged speech. Make sure they start phonation and the breath stream the same time as articulation. If they do these things they either won’t stutter or stutter less severely.

Question 28

Fluency Modification:

Answer 28

Treating stuttering by increasing fluent speech, typically through the use of Prolonged Speech. The goal is 0% stuttering/dysfluencies.
Prolonged speech= lengthen syllable duration, maintain phonation across phonetic transitions with breaks in phonation only at voiceless phonemes, pauses between phrases or air intake; rate reduced to a set level (70 syllables per minute), gentle onset of phonation, light articulatory contacts.
A good candidate for this type of treatment should have a strong motivation to achieve fluency (not to please others). They should have personal goals because this therapy is a lot of work. Just doing this because a significant other, boss, etc wants them to isn’t a good motivator.
In various research studies, there have been several ways in which treatment practice has been organized. One way is to increase the length of production and usually that is done by syllables GILCU=gradual increase in length and complexity of utterances. Or practice is done entirely in conversational speech but the rate of speech is altered, first starting out very slow then gradually increase rate of speech while remaining stutter-free.
The main focus in Fluency modification is learning to use Prolonged Speech in order to be completely fluent at all times. Once the client learns how to perform prolonged speech, their speech is shaped up to sound more natural while still maintaining stutter-free speech.

What makes these two treatments different from each other:
In stuttering modification therapy the goal is NOT to not stutter (be completely fluent), the goal is to avoid dysfluency, make the moments of stuttering less severe or shorter in duration, to help them manage stuttering. In Fluency modification therapy the goal IS to be completely fluent, 0% stutters.
Stuttering modification helps stutterers feel less shame and anxiety about their stuttering whereas fluency modification focuses on making the stutters go away completely.