final exam Flashcards
What is included in a full assessment?
- Interview
- Talking logs
- standard talking tasks
- may need to do a covert assessment
- Data analysis
- Speech change probes
Interview
-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?
Talking logs (adult)
(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
talking logs (children)
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.
Covert assessment
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.
Data analysis
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.
How do you interpret assessment results?
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.
What are the measures of overt behaviors?
These are the measures of the speech sample that are taken when the client knows they are being recorded
What are the measures of covert behaviors?
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.
How do we gather samples of speaking behaviors from our clients?
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.
How are the procedures different for children and adults?
-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
How are the speech change probes administered?
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).
What are the procedures for each probe?Instructional control/minimal management:
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”
Operant management speech-change probes:
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.
Verbal punishment:
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.
Time-out:
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.
Reinforcement of fluency:
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.
Self-monitor:
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.
Modification of speech production speech-change probes:
Modification of speech production speech-change probes: Make sure you go in order down the list when administering these probes.
Reduced rate of speech:
Reduced rate of speech: Have the client talk slower, don’t make their speech choppy, just slower rate
Prolonged speech:
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.
Rhythmic speech:
Rhythmic speech: have a metronome and set it to 90 beats per minute and have them speak one syllable per beep.
Chorus reading or shadowing:
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.
What if none of these probes reduce their stuttering?
*If nothing has reduced their stuttering out of all the speech change probes then you may be looking at some kind of neurogenic stuttering.
