Fluency Flashcards
Fluent vs Dysfluent speech
fluent: smooth, relatively easy and flowing
dysfluent: halting and interrupted, increased effort
Stuttering
anticipatory, apprehensive, avoidant reactions. Stuttering is what a person does to avoid stuttering.
Major types of dysfluencies
repetitions: part word, whole word, phrase
prolongations: extension of syllables: sound and silent prolongation (posture held with no vocalization_
interjections: sound (um), word (like, okay), and phrase (you know, I mean)
pauses: silent intervals in speech
broken words: (be–fore you say it)
incomplete sentence (last summer I was….last summer….we went to Paris)
revisions (changes in wording)
% of dysfluency that is judged as stuttered/dysfluent
5% or more
incidence definition
rate of ocurrence in a specified group of people
prevalence definition
number of individuals who currently have it are counted
Adult onset of stuttering causes
in most cases, associated with neurological damage or disease. In some cases, may be psychogenic (extreme stress of psychological trauma).
Prevalence of stuttering in populations
-more common in males than females (5:1 or 3:1 depending on the study)
-familial prevalence: 3x higher than in the general population
-concordance: occurance rates in twins=identical is higher than fraternal
*data suggest both genetic factors and environmental events play a part in the etiology of stuttering.
Natural recovery/spontaneous recovery from stuttering
without professional help, some children recover. Various studies show different percentages (up to 88%)
associated motor behaviors
historically described as secondary stuttering:
facial grimacing
hand or foot movements
rapid eye blinks
lip pursin
tongue clicking
opening/closing of mouth
**may have been accidentlly reinforced (pt did ____ and stuttering did not happen so now they think it is helpful
Breathing abnormalities
in some, breathing abnormalities are associated with stuttered speech:
attempts to speak on inhalation
holding breath before talking
talking on no air
speaking without inaling first
rapid/jerky breathing during speech
Negative emotions and avoidance behaviors
fear of certain situations, sounds, words.
Loci of stuttering
refers to the locations in a speech sequence where stutterings are typically observed. more likely to occur:
consants rather than vowels
the first sound or syllable of a word, the first word in a phrase, etc
longer and less frequently used words
contant words (nouns, verbs, adj, and adv)
**preschool kids stuttering tends to occur on function words instead and also tend to have more whole word repetitions
stimulus control in stuttering
adaptation: re-reading a passage. Gets clearer by try 5
consistency effect: reread the passage after weeks of interval
audience size effect: lower with less people, nearly absent when person talks to themselves
adjacency effect: measured in oral reading. occurrence of new stuttering on words that surround previously stuttered words
Personality and stuttering
neither the personality of the person who stutters nor that of their parents seem to provide strong clues to etiology.
Theories of stuttering
genetic
neurophysiological: increased tension in laryngeal muscles, delayed onset time, etc
brain dysfunction: brain dysfunction leads to stuttering. No hypothesis entirely supported by evidence
learning, conditioning: learned behavior
mismatch: environmental demands placed on a child exceed child’s capacity for fluency
**all existing theories are hypotheses that required research. None are accepted explanations.
Assessment of Stuttering
case history
speech sample to determine frequency and types of disfluencies
assess in different situation (ask family to record at home, etc.)
reading vs conversational speech
assess motor behaviors
assess for avoidance behaviors
speech rate and artic rate: counting number of words or syllables spoken per minute in at least three 2 minute samples
negative emotions/effects of stuttering on the pt
Diagnosis Criteria for stuttering
dysfluency rate greater than 5% of spoken words
a certain frequency (at least 2% of words spoken)
excessive duration of dysfluencies (1 seconds or longer)
presence of stuttering like dysfluencies, at least at 3% of syllables produced
Treatment of stuttering
early tx of stuttering is effective. Even if spontaneous recovery might occur, better to do treatment as it increases the chance of resolution by 7.7x.
Tx should address all areas of dysluency, family education, and reducing negative feels
fluent stuttering method (van riper’s fluent stuttering approach–stutter more fluently)
teaching suttering identification
desensitizing pt to stuttering
modifying stuttering
-cancellations: pausing and saying again with more relaxed stuttering
-pull outs: change stuttering mid-course by slowing down and using soft artic contact
-using prepatory sets: changing the manner of stuttering to make is less abnormal
limitation is rare establishment of normal fluency as it only modifies.
Fluency shaping method (speak more fluently approach)
goal is to establish normal fluency.
teach airflow management
teach gentle, soft, relaxed, and easy onset
teach reduced rate of speech
**limitation is that it produces slow, deliberate and unnatural speech. Speech rate should be gradually increased.
Fluency reinforcement method
arranges a pleasant and relaxed therapy setting
evokes speech with picture books, toys, etc
positively reinforces the child for fluent utterance
frequently models a slow, relaxed speech rate
reshapes normal prosody if slower rate is an added target
**may be effective with young children
Masking and delayed auditory feedback
uses a DAF machine at lowest level smooth speech is achieved and then reduces masking. Relapse of stuttering is common.
Direct stuttering reduction methods
seek to reduce stuttering directly:
-pause and talk (time out): person is taught to puase after each dysfluency then resume talking
-response cost: for every instance of stuttering, the client takes away a token
**if client begins to use strategies (speaking slowly) the clinician discourages their use.
Neurogenic stuttering
resembles early childhood onset but is associated with neurological disorder. CVAs are the most common cause but any neurological disorder or event can be cause. It is adult onset.
assessment of neurogenic stuttering
assessment of coexisting aphasia, AOS, dysarthria, dementia
normal stuttering assessment
Treatment of neurogenic stuttering
handle treatment sympomatically by reducing rate of speech with instruction, DAF, or pacing board. When dysfluencies minimized, SLP will work on increasing speech rate or reducing DAF.
cluttering
disorder of fluency that often coexists with stuttering. c/b reduced speech intelligibility, rapid and irregular speech rate, imprecise artic, dysfluencies, disorganized language, poor prosody, and inefficient management of discourse.
CLUTTERERS DO NOT MANIFEST OBVIOUS CONCERN ABOUT THEIR SPEAKING PATTERN
Assessment and treatment of cluttering
-cluttering severity instrument
-reduced rate of speech
-Increase client’s awareness of speech problems (recordings are helpful)
malingering vs psychogenic stuttering
malingering: faked stuttering to gain advantage from the problem
psychogenic: not malingering, is adult onset, may be in conjunction with anxiety or psychiatric d/o. Dysfluencies by not be affected by adaptation.
