Fluency Flashcards
stuttering
specific sensorimotor disruptions of the flow of speech
disfluency
normal speech
Charles Van Riper
Father of the field of stuttering
believed stuttering as disorder of timing
Charles Van Riper
Wendell Johnson
believed stuttering was caused by anticipatory, apprehensive, avoidance reaction
Stuttering types
Overt, momentary speech event
complex disorder
fluency
coordination of respiratory, phonatory, articulatory systems
what percentage of words are stuttered in pWS:
10%
SLD
part word repetitions, single syllable word repetition, dysrhythmic phonations
complex disorder involves
overt speech characteristics
physical concomitants
physiological activity
affective and cognitive features
social dynamics
ASHA stuttering
an interruption in the flow of speaking characterized by atypical rate, rhythm, and disfluencies, which may also be accompanied by excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms
organic orientation etiology
genetics
epilepsy
motor control
listener based orientation etiology
ear of the listener
psychopathogenic etiology
psychological
related to early childhood development
psychosocial etiology
caused by fears and anxiety
learned based etiology
learned behavior due to negative communication experiences
incidence
number of cases ever; total; always the higher number (5%)
prevalence
number of cases currently identified; point in time (1%)
factors influencing incidence and prevalence:
familiarity
age (younger)
gender (males)
neurological (hearing / cognitive impairment)
Monster study
Wendell Johnson
diagnosogenic theory
Range of onset
16-60 months
mean of onset
33.4 months; 2-4 years
onset can be:
sudden, severe, different
secondary behaviors can occur at:
onset
CWS repeat:
2-4 iterations
% of PWS that will naturally recover without therapy
80%
recovery criteria
no stuttering for minimum of 12 months, maintained for 4 years
increased predictor for recovery
females
no family history
earlier onset/ time since onset
trends
patterns
CWS tend to be:
hypervigilant
less adaptable to change
more fearful/shy
no strong link, but CWS have a greater prevalence of:
phonological and language disorders
differential developmental model
Van Riper
4 tracks of progression
identification
desensitization
modification
stabilization
generally develop awareness of stuttering around ages:
5-7
“giant in chains”
stuttering is blamed for all setbacks
S Cycle
affective (negative reactions)
behavior (stuttering)
cognitive (negative thoughts)
Loci of stuttering ADULTS:
content words
long words
consonant initial
sentence initial (popsicle)
words of importance
unfamiliar words
stressed syllables/words
loci of stuttering CHILDREN
function words
short words
vowel initial
familiar words
altered sensory info
DAF
masking noise
EMG biofeedback
response contingent stimuli
altered speaking patterns
metronome timed speech
reduced speaking rate
singsong speech
part word repetitions
SLD
f-five
ba-baby
single syllable word repetitions
SLD
but-but
and-and
multiple syllable word repetitions
Normal
because - because
phrase repetitions
normal
i was - i was going
prolonged sounds
SLD
a»»»ai like to go
s»»»»ometimes
blocks & broken words
SLD
C (silence) -ake
the ta (silence)-able
tense pause
SLD
i like to (silence)—- go home
interjections
normal
um
uh
er
revisions
normal
i like - i want this ball (same thought)
incomplete utterance
normal
the baby - let’s do…. (change thought)
frequency
SLDS occur on 10% of words
duration
1 second
clustering
SLD tend to cluster together more than non stuttered disfluencies
physical concomitants
secondary or accessory behaviors
voice
vocal fry
monotone
strained
sudden pitch shifts
speaking rate
overall rate of speech with all disfluencies and pauses; slower
articulatory rate
rate of speech without disfluencies and pauses; number of fluent syllables per second/ minute
adaption
declines with successive readings of a passage
consistency
Stutter on same words; not random, but rule-governed
adjacency
stutter on adjacent words when previously stuttered words are removed
expectancy
ability to predict where stuttering event will occur
psychoemotional
emotional trauma or personality conflict/ anxiety
provide relaxation
CONS: does not occur w traumatic events
psychobehavioral
learned behavior reinforced by environmental variables; parental impact; diagnosogenic theory
CONS: onset only in children, stuttering is dynamic
psycholinguistic theory
breakdown in the process of generating language; conceptualize, formulation, articulation; covert repair theory
CONS: not always on stressed syllables, stuttering is dynamic
monologue
get a larger sample for analysis
conversation
shifting topics can increase pressure and elicit more stuttering
reading
passages must match patient’s reading ability
sample size
300-600 words or syllables
differences in preschool stuttering assessment
role of parents
time since onset is important
concomitant disorders
emotional areas
sampling issues
preschool age children: intervention must be considered if stuttering persists past:
9 months
children who stutter = _____ SLD per 100 syllables
10.37
children who do not stutter = _______ SLD per 100 syllables
1.00
stuttering is of concern when:
3-4 SLDs per 100 units, 2 or more units of repetitions, rapid tempo of repetition, presence of secondary characteristics, frequency greater than 2-3% of stuttered syllables in sample
prognosis primary factors
family history
gender (males)
trends
duration
age at onset
length/tempo
number of prolongations/ blocks
parent counsel advice
reduce excitement
use a slow pace
give time and attention
promote child’s self confidence
self congruence
authenticity
objectives of therapy
increased fluency
managed stuttering
improved cognitive-emotional adjustment
goal
who + will do what + how accurately (successfully) + how many times + under what conditions
respect for autonomy
informed and voluntary
beneficence
therapy will benefit
nonmaleficence
do not harm
justice
fairness, no favoritism
awareness
improving detection of stuttering
post block / cancellation
change the stuttering AFTER it occurs; pause; intentionally modify the tension
in block/ pullout
*after cancellation has been mastered
elimination of pause; examine/ change plan WHILE saying the word
preblock/ prepartory set
perform analysis and plan modification BEFORE word in anticipation of stutter events
school age children: introduce the speech system -
body parts involved in speaking/ explore their own speech
teasing
not intended to cause embarrassment or pain
bullying
intended to cause embarrassment or pain
GILCU
behavioral reinforcement
group therapy provides opportunities for:
desensitization and time to practice strategies within safe groups
cluttering
disorder of speech and language formulation resulting in rapid, imprecise, dysrhythmic, disorganized production of speech
disorder of central speech processes
adulthood onset
neurogenic stuttering (stroke, head injury, brain tumor)
psychogenic stuttering (psychological trauma)
malingering
faking the presence of a disorder, often for financial, legal, or vocational gain
concurrent treatment
simultaneous, cycling/rotating between disorders
sequential treatment
treat stuttering, then other disorders
