fluency Flashcards
what are the forms of dysfluency
- repetitions
- prolongations
- interjections
- pauses
- broken words
- incomplete sentences
- revisions
what are the different types of repetitions
- part word (sound or syllable repetitions). s-s-s-ssaturday
- whole word repetitions. I I I am fine
- phrase repetitions: repetition of more than one word
what are the different types of prolongations
- sound prolongations: lllllikeit
2. silent prolongations: articulatory posture held with no vocalization (block)
what are interjections
- sound or syllable. um
- word interjections: like, okay, well
- phrase interctions: you know, I mean
what are broken words
pauses between syllables or intralexical pauses
revisions
changing in wording that does not change the overall meaning
what is concordance
occurrence of the same clinical condition in both twins
what populations have higher prevalence of stuttering
- ID especially Downs
2. brain injury
what population has a lower prevalence
hearing loss
where are repetitions most common
beginning of sentences and phrases
what words do children mostly stutter on
function words such as pronouns, conjunctions, and articles as well as content words
what words do adults mostly stutter on
content words
what are typical secondary behaviors
- excessive muscular effort
- facial grimaces
- hand and foot movements (wringing, tapping)
- rapid eye blinking
- knitting eyebrows
- lip pursing
- rapid opening and closing mouth
- tongue clicking
what is needed for a diagnosis of stuttering
excessive frequency and duration of dysfluencies
secondary behaviors not crucial but assure a diagnosis
what breathing abnormalities are associated with stuttering
- speaking on inhalation
- holding breath before talking
- attempts to speak when air supply gone
- interruption of inhalations by exhalations
- speaking without first inhaling enough air
- rapid and jerk breathing during speech
- exhaling puffs of air during stuttered speech
- tensed breathing
what is the loci of stuttering
the location in a speech sequence where stuttering typically observed
what is the loci of stuttering for adults and school aged children
- consonants rather than vowels
- first sound or syllable of a word, first word in a phrase, sentence or grammatical class
- on longer less frequently used words
- content words
what is the loci of stuttering for preschoolers
same as adult except on function words which are often at the beginning of phrases
children also have more whole word repetitions
when is adaptation greatest
during first few oral readings
by 5th time the most reduction will have occurrred
there is no transfer from one passage to the next
what is the consistency effect
when a passage is reread after 6 weeks and the stuttering remains
indicator f the strength of the stuttering stimuli
what is the adjacency effect
measured in oral reading
occurrence of new stuttering on words surrounding stuttered words
what is the audience size effect
frequency of stuttering increases with increase in audience size
stuttering may be absent when they talk to themselves
what is the genetic hypothesis of stuttering
genetic basis to stuttering
currently no genetic transmission theory is universally accepted
what is the neurophysiological hypothesis of stuttering
differences in the neurophysiological organization
what is the laryngeal dysfunction hypothesis
stuttering aused by slightly delayed VOT
may be associated with increased tension in laryngeal muscles, simultaneous activation of abductors and adductors and excessive laryngeal muscle activity during stuttered speech
what is the brain dysfunction hypothesis
lack of dominant hemisphere
- impaired cerebral blood flow
- aberrant brain waves
- CNS dysfunction
- auditory feedback issues
what is the learning, conditining and related hypotheses
stuttering is a learned behavior
stuttering is an avoidance behavior due to parental punishment
stuttering is a cultural phenomenon that exists in some societies
stuttering is a social role conflict
what is the mismatch hypotheses
capacities and demands model
what is the leading edge hypothesis
speech disruptions of typically developing children tend to occur on more advanced sentence structures
what is necessary in a case history for fluency
- specific behaviors at onset
- development over the years
- variability
- family prevalene
- prior treatment
- education and occupation aspirations
- general health, language and speech development
what needs to be assessed for fluency
- frequency and types of dysfluencies through a sample
- variability of stuttering in different environments, assessed through verbal reports from family
- associated motor behaviors and avoidance behavior
- speech and artic rate
- negative emotional reactions
- stuttering severity
- QOL
how are associated motor behaviors assessed
- note during assessment
- family member describe
- administer a behavior assessment battery
how are avoidance behaviors assessed
- have client list sounds, words, situations and audiences he avoids
- take note of words and sounds avoided during interview
- family members list
- behavior assessment battery
how is speech rate assessed
count number of words or syllables spoken per minute for 3 two minute samples
how are negative emotions assessed
- have client describe her emotions about speech
- ask family or friends
- administer behavior assessment battery
what are some behavior assessment batteries
- Behavior Assessment Battery for Adults who Stutter
- Behavior Assessent Battery for School-Age Children Who Stutter
- Communication Attitude Test for Preschol and Kindergarten Children Who Stutter
what is the diagnostic criteria for stuttering
- 5% of spoken words
- frequency of part-word repetitions, speech-sound repetitions and broken words at least 2%
- excessive duration. 1 second or longer
- dysfluencies on at least 3% of syllables, prolongations, schwa vowel in syllable repetitions and associated tension
what is the fluent stuttering method
- Van Ripers approach
2. stutter more fluently approach
what is included in the fluent stuttering method
- desensitize: voluntary stuttering
2. modify through cancellations, pullouts, and preparatory sets
what is the fluency shaping method
- goal is to establish normal fluency through management of airflow, slower rate through syllable prolongation and gentle onset of phonation
what are the targets for the fluency shaping method
- airflow management: inhale and immediate slight exhale before phonation. Maintain airflow through utterance
- easy onset
- reduced rate through syllable prolongation. No breaks in phonation. The vowel following the initial consoant is prolonged
what is Camperdown
fluency shaping program that includes only prolonged speech at a reduced rate as a target.
- clients practice with prolonged speech with a model video
- rate gradually increased
what is the limitation of fluency shaping
generates slow, unnatural speech
relapse common when rate increased
what is the fluency reinforcement method
positive reinforcement of fluent speech in naturalistic conversational contexts
- used for young children
- speech evoked with books, toys etc
- positve reinforcement for fluent utterances
- modeled slow, relaxed speaking rate
- Lidcombe Program
what are direct stuttering reduction methods
reduce stuttering directly, without specific fluency or modifying skills
2. methods include time-out and response cost
what is pause-and-talk or time out
- person taught to pause after each stutter and then resume talking
- clinician says stop or gives another signal when dysfluency observed
- avoids eye contact with client for 5 seconds
- re-establishes eye contace and lets client continue
- socially reinforces fluent speech (smiles etc)
- preferred for older children and adults
what is the response cost method
clinician takes away a token which is awarded for every fluent production
- progress from words and phrases to conversational speech
- fade tokens when fluency is susained at 98% or better across 4 sessions then maintain with verbal praise alone
- preferred for young children
what should be considered when treating preschool children
- parent counseling and consultation
- counseling about bullying
- select effective reinforcers for the child
- fluency reinforcement in naturalistic play often effective
- child should enjoy therapy. Generously reinforce fluency, minimizing corrective feedback
what should be considered when treating older students and adolescents
- teach self monitoring skills; child counts stutters
- fluency shaping and time out are good choices
- oral reading reinforces reading rate
- teach child to talk frankly about their stuttering to reduce teasing
- parent counseling and patient training important
- train teachers to prompt and reinforce fluency, be patient, and support clinicians effort
what should be considered when treating adults
- teach self monitoring skills
- explain treatment and the evidence for it
- fluency shaping and time out good choices
- counsel spouse to reinforce fluency
how do you generalize the treatment
- when a certain level is reached, have unfamiliar people come to the session for conversation
- take client out of clinic into other settings to reinforce fluency
- reinforce fluency in various settings
- teach self monitoring skills
What is the etiology of neurogenic stuttering
- Cerebral vascular disorders that cause stroke
- Right hemisphere disorder
- Extrapyramidsl disorders such as Parkinson’s
- Drug toxicity
- Bilateral brain damage
- TBI
- MS
What are chacteristics if neurogenic stuttering
- Evidence of neuropathologies
- Increased rate of dysfluencies
- No adaptation effect
- Minimal variability
- Few associated behaviors
- Minimal effects if delayed feedback, choral reading, singing
- No anxiety or associated behaviors
What do you assess for neurogenic stuttering
. Coexisting aphasia, apraxia, dysarthria, or dementia
2. Rule iut preexisting developmental stuttering
How do you trest neurogenic stuttering
Symptomatically by reducing rste, delayed auditory feedback, pacing board
What is cluttering
Fluency disorder that coexists with stuttering
2. Characterized by reduced intelligibility, rapid and irregular speech, imprecise artic, disorganized language, poor prosody and discourse
3. No obvious concern about problem
4. Rate variations
5 frequent pauses
6. Omission and compression of sounds
7 jerky or stumbling rhythm
8. Spoonerisms: interchanging sounds in a sentence ( many thinkle peep vs many people think
How do you treat cluttering
Reduce rate of speech
Increase clients awareness of problem through video
what are Van Der Merwe’s 5 origins of stuttering
- frontoimbic: intent to speak
- Linguistic-planning: choosing words
- Motor Planning: establishing temporal and spacial specifications
- motor programing: instructions to muscles
- Execution
what is a preperatory set
prolongation that is used in expectation of upcoming difficult word
creates a change in segmental duration which is a change in motor planning
what are the Van Riper’s 4 stages of stuttering modification
- identification
- desensitization
- modification: cancellation, pullouts, preparatory set
- stabilization: patient becomes own therapist
what is cancellation
after a stuttered word, pause and say it again before going on
what is Webster’s theory on the Disorder of Brain Organization
- PWS have normal localization of speech in left hemisphere but the supplementary motor area is vulnerable to disruption by activities in other areas
what is the covert repair hypothesis
stuttering is the repair of phonological errors
what are normal dysfluencies
revisions: where are….can I go with you
interjections: uh
repetitions of 2 extra units or less: he… he is my friend
what is borderline stutterine
more than 7 stuttered words per 100 part word repetitions and prolongations frequent repetitions of more than one extra sound age: 1.5-3.5 no tension or struggle
what is beginning stuttering
repetitions more hurried
characterized by neutral vowel: muh muh Mike
blocks appear
tension exhibited but no strong negative feelings
older preschool age
what is intermediate stuttering
most notable behavior is block
child begins to fear stuttering
age 6-13
what is advanced stuttering
tension, escape, avoidance
longer blocks
affects school, work and social lives
how do you identify covert behaviors in the classroom
disparity between written and oral performance
what are ways to bring about fluency
- prolongations
- chorale speech
- shadow speech: spoken directly after
describe the Lidcombe Program
Stage 1:
1. assess severity, explain rating to parents, teach parent to conduct daily treatment conversations
2. structured treatment: sit with child 15 minutes a day, read with them to bring about speech, start at their linguistic level
3. after progress for 2-3 weeks begin unstructured treatment and fade structured treatments
Stage 2:
1. when parent and clinician ratings are all 1-2 for 3 weeks in a row2. reduced verbal contingencies
takes about 1 year
how do you teach fluency skills
- flexible rate: slowing
- pause: preparatory set
- easy onsets:
- light contacts
- proprioception: conscious attention to movements of articulators
