Fluency Flashcards
Concomitant Traits
- Head jerks
- Tension (face/throat)
- Facial contortions
- Open/close eyes
- Head turns
Risk Factors
- Family Hx
- Gender (Boy)
- Age at Onset
- Type/Length of dysfluency
Severity levels
- Very Mild (1/100 or 1%): No perceptual tension
- Mild (1/50 or 2%): some tension with minimal 2ndary bx
• Moderate (1/15 or 7%): evident tension (lasts ~ 2 sec.)
o Distracting 2ndary bx
• Severe (1/7 or 15%): tension lasts ~ 2-4 sec.
o Attempts to repeat utterance
o Obvious 2ndary bx
• Very Severe (1/4 or 25%): considerable tension lasts >5 sec.
o Consistent attempts to repeat
o Vigorous 2ndary bx (lots of motor involvement)
Stuttering-like dysfluencies:
Stuttering-like Disfluencies (SLD) • Blocks • Prolongations • Single-Syllable Rep • Part-Word Rep
Other dysfluencies
- Phrase Rep
- Interjections
- Revisions
- Incomplete Utterances
Psychological Theories
- Psycho-Emotional
- Psycho-Behavioral
- Psycho-Linguistic
Psycho-Emotional Theory:
stuttering arises due to emotional trauma or personality conflict
Psycho-Behavioral:
stuttering is a learned bx that is reinforced by environmental variables (Wendel Johnson)
a) dagnosogenic: the diagnosis leads to the stuttering; stuttering occurs as avoidance od ODs
b) Conditioned anxiety response: negative reaction plus response
c) Conflict theory: competing drives to communicate and avoid stuttering
d) Stuttering as operant Bx: reinforced stuttering
e) Anticipatory struggle: expect to stutter and do
f) Demands capacity model: individual is fluent, however external demands are greater than internal capacity causing disfluency
Psycho-Linguistic
stutteringrepresents a breakdown in the underlying process for generating language
a) Covert repair: phonological encoding problem
b) Fault line: trouble with transitions within words; problem with onset coda
c) Neuropsycholinguistic: syllable frame isn’t ready for segment fillers (sounds are ready, but syllable frame is not)
Biological
1.Familial: family & twin studies
- Brain Differences: less gray and white matter
a. Overly active motor areas
b. Preparation impairments - Cerebral Dominance: states that there is not a dominant hemisphere
Assessment
- Build rapport with client & family
- Gather case history
a. Stuttering hx
b. Treatment hx (if any)
c. Identifing info
d. Quality of life
e. Onset and manner of stuttering - Attitude and awareness rating
- Child’s awareness (increased awareness b/w 4 & 5 years)
a. From parent report
b. Puppet talk (have 2 puppets; see if child recognizes the one who has bumpy speech)
c. Direct questioning - Interview about environment in which stuttering is most difficult, and impact it has on life
- Speech characteristics from various samples
a. Conversation, reading, narrative sample
b. Home, clinic, school, etc.
c. Determine duration of disfluencies
d. Frequency of disfluencies
e. Type of disfluencies
f. 2ndary bx
g. Severity
h. If >10 words stuttered/total 100 words = PWS - Give info to client about stuttering
a. Initial counseling for parents - Recommend plan of action for client
Treatment (3 approaches)
- Increased Fluency
a) Naturally fluent Speech
b) Deliberately fluent speech - Reduced Stuttering
- Improved Cognitive-Emotional Adjustment
Treatment for school-age children
1.Rules program with universal rules, primary rules, and secondary rules.
- Parent involvement for preschool-age children
a. Education, counseling, and training
Intervention with family members of CWS
Specific programs:
Tips:
a. Easy speak – use of soft voice
b. Illinois – use slow speech
c. Focus on fluency – reinforce fluent speech
d. Lidcombe – reinforce fluency and disfluency
e. Parent-Child Interaction
a. Don’t ignore the child or their disfluency speech
b. Don’t speak for the child – be patient and wait
c. Make own speaking rate slowed – limit interruption – lessen length & complexity of utterances
d. Decrease pressure (emotional excitement)
e. Promote self-confidence
f. Suggest, “That was a little bumpy, let’s try it again easy”
g. Reinforce fluency, “That was easy!”
h. Show empathy
