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fluency Flashcards

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1
Q

what are the forms of dysfluency

A
  1. repetitions
  2. prolongations
  3. interjections
  4. pauses
  5. broken words
  6. incomplete sentences
  7. revisions
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2
Q

what are the different types of repetitions

A
  1. part word (sound or syllable repetitions). s-s-s-ssaturday
  2. whole word repetitions. I I I am fine
  3. phrase repetitions: repetition of more than one word
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3
Q

what are the different types of prolongations

A
  1. sound prolongations: lllllikeit

2. silent prolongations: articulatory posture held with no vocalization (block)

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4
Q

what are interjections

A
  1. sound or syllable. um
  2. word interjections: like, okay, well
  3. phrase interctions: you know, I mean
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5
Q

what are broken words

A

pauses between syllables or intralexical pauses

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6
Q

revisions

A

changing in wording that does not change the overall meaning

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7
Q

what is concordance

A

occurrence of the same clinical condition in both twins

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8
Q

what populations have higher prevalence of stuttering

A
  1. ID especially Downs

2. brain injury

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9
Q

what population has a lower prevalence

A

hearing loss

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10
Q

where are repetitions most common

A

beginning of sentences and phrases

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11
Q

what words do children mostly stutter on

A

function words such as pronouns, conjunctions, and articles as well as content words

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12
Q

what words do adults mostly stutter on

A

content words

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13
Q

what are typical secondary behaviors

A
  1. excessive muscular effort
  2. facial grimaces
  3. hand and foot movements (wringing, tapping)
  4. rapid eye blinking
  5. knitting eyebrows
  6. lip pursing
  7. rapid opening and closing mouth
  8. tongue clicking
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14
Q

what is needed for a diagnosis of stuttering

A

excessive frequency and duration of dysfluencies

secondary behaviors not crucial but assure a diagnosis

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15
Q

what breathing abnormalities are associated with stuttering

A
  1. speaking on inhalation
  2. holding breath before talking
  3. attempts to speak when air supply gone
  4. interruption of inhalations by exhalations
  5. speaking without first inhaling enough air
  6. rapid and jerk breathing during speech
  7. exhaling puffs of air during stuttered speech
  8. tensed breathing
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16
Q

what is the loci of stuttering

A

the location in a speech sequence where stuttering typically observed

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17
Q

what is the loci of stuttering for adults and school aged children

A
  1. consonants rather than vowels
  2. first sound or syllable of a word, first word in a phrase, sentence or grammatical class
  3. on longer less frequently used words
  4. content words
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18
Q

what is the loci of stuttering for preschoolers

A

same as adult except on function words which are often at the beginning of phrases
children also have more whole word repetitions

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19
Q

when is adaptation greatest

A

during first few oral readings
by 5th time the most reduction will have occurrred
there is no transfer from one passage to the next

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20
Q

what is the consistency effect

A

when a passage is reread after 6 weeks and the stuttering remains
indicator f the strength of the stuttering stimuli

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21
Q

what is the adjacency effect

A

measured in oral reading

occurrence of new stuttering on words surrounding stuttered words

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22
Q

what is the audience size effect

A

frequency of stuttering increases with increase in audience size
stuttering may be absent when they talk to themselves

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23
Q

what is the genetic hypothesis of stuttering

A

genetic basis to stuttering

currently no genetic transmission theory is universally accepted

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24
Q

what is the neurophysiological hypothesis of stuttering

A

differences in the neurophysiological organization

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25
Q

what is the laryngeal dysfunction hypothesis

A

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

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26
Q

what is the brain dysfunction hypothesis

A

lack of dominant hemisphere

  1. impaired cerebral blood flow
  2. aberrant brain waves
  3. CNS dysfunction
  4. auditory feedback issues
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27
Q

what is the learning, conditining and related hypotheses

A

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

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28
Q

what is the mismatch hypotheses

A

capacities and demands model

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29
Q

what is the leading edge hypothesis

A

speech disruptions of typically developing children tend to occur on more advanced sentence structures

30
Q

what is necessary in a case history for fluency

A
  1. specific behaviors at onset
  2. development over the years
  3. variability
  4. family prevalene
  5. prior treatment
  6. education and occupation aspirations
  7. general health, language and speech development
31
Q

what needs to be assessed for fluency

A
  1. frequency and types of dysfluencies through a sample
  2. variability of stuttering in different environments, assessed through verbal reports from family
  3. associated motor behaviors and avoidance behavior
  4. speech and artic rate
  5. negative emotional reactions
  6. stuttering severity
  7. QOL
32
Q

how are associated motor behaviors assessed

A
  1. note during assessment
  2. family member describe
  3. administer a behavior assessment battery
33
Q

how are avoidance behaviors assessed

A
  1. have client list sounds, words, situations and audiences he avoids
  2. take note of words and sounds avoided during interview
  3. family members list
  4. behavior assessment battery
34
Q

how is speech rate assessed

A

count number of words or syllables spoken per minute for 3 two minute samples

35
Q

how are negative emotions assessed

A
  1. have client describe her emotions about speech
  2. ask family or friends
  3. administer behavior assessment battery
36
Q

what are some behavior assessment batteries

A
  1. Behavior Assessment Battery for Adults who Stutter
  2. Behavior Assessent Battery for School-Age Children Who Stutter
  3. Communication Attitude Test for Preschol and Kindergarten Children Who Stutter
37
Q

what is the diagnostic criteria for stuttering

A
  1. 5% of spoken words
  2. frequency of part-word repetitions, speech-sound repetitions and broken words at least 2%
  3. excessive duration. 1 second or longer
  4. dysfluencies on at least 3% of syllables, prolongations, schwa vowel in syllable repetitions and associated tension
38
Q

what is the fluent stuttering method

A
  1. Van Ripers approach

2. stutter more fluently approach

39
Q

what is included in the fluent stuttering method

A
  1. desensitize: voluntary stuttering

2. modify through cancellations, pullouts, and preparatory sets

40
Q

what is the fluency shaping method

A
  1. goal is to establish normal fluency through management of airflow, slower rate through syllable prolongation and gentle onset of phonation
41
Q

what are the targets for the fluency shaping method

A
  1. airflow management: inhale and immediate slight exhale before phonation. Maintain airflow through utterance
  2. easy onset
  3. reduced rate through syllable prolongation. No breaks in phonation. The vowel following the initial consoant is prolonged
42
Q

what is Camperdown

A

fluency shaping program that includes only prolonged speech at a reduced rate as a target.

  1. clients practice with prolonged speech with a model video
  2. rate gradually increased
43
Q

what is the limitation of fluency shaping

A

generates slow, unnatural speech

relapse common when rate increased

44
Q

what is the fluency reinforcement method

A

positive reinforcement of fluent speech in naturalistic conversational contexts

  1. used for young children
  2. speech evoked with books, toys etc
  3. positve reinforcement for fluent utterances
  4. modeled slow, relaxed speaking rate
  5. Lidcombe Program
45
Q

what are direct stuttering reduction methods

A

reduce stuttering directly, without specific fluency or modifying skills
2. methods include time-out and response cost

46
Q

what is pause-and-talk or time out

A
  1. person taught to pause after each stutter and then resume talking
  2. clinician says stop or gives another signal when dysfluency observed
  3. avoids eye contact with client for 5 seconds
  4. re-establishes eye contace and lets client continue
  5. socially reinforces fluent speech (smiles etc)
  6. preferred for older children and adults
47
Q

what is the response cost method

A

clinician takes away a token which is awarded for every fluent production

  1. progress from words and phrases to conversational speech
  2. fade tokens when fluency is susained at 98% or better across 4 sessions then maintain with verbal praise alone
  3. preferred for young children
48
Q

what should be considered when treating preschool children

A
  1. parent counseling and consultation
  2. counseling about bullying
  3. select effective reinforcers for the child
  4. fluency reinforcement in naturalistic play often effective
  5. child should enjoy therapy. Generously reinforce fluency, minimizing corrective feedback
49
Q

what should be considered when treating older students and adolescents

A
  1. teach self monitoring skills; child counts stutters
  2. fluency shaping and time out are good choices
  3. oral reading reinforces reading rate
  4. teach child to talk frankly about their stuttering to reduce teasing
  5. parent counseling and patient training important
  6. train teachers to prompt and reinforce fluency, be patient, and support clinicians effort
50
Q

what should be considered when treating adults

A
  1. teach self monitoring skills
  2. explain treatment and the evidence for it
  3. fluency shaping and time out good choices
  4. counsel spouse to reinforce fluency
51
Q

how do you generalize the treatment

A
  1. when a certain level is reached, have unfamiliar people come to the session for conversation
  2. take client out of clinic into other settings to reinforce fluency
  3. reinforce fluency in various settings
  4. teach self monitoring skills
52
Q

What is the etiology of neurogenic stuttering

A
  1. Cerebral vascular disorders that cause stroke
  2. Right hemisphere disorder
  3. Extrapyramidsl disorders such as Parkinson’s
  4. Drug toxicity
  5. Bilateral brain damage
  6. TBI
  7. MS
53
Q

What are chacteristics if neurogenic stuttering

A
  1. Evidence of neuropathologies
  2. Increased rate of dysfluencies
  3. No adaptation effect
  4. Minimal variability
  5. Few associated behaviors
  6. Minimal effects if delayed feedback, choral reading, singing
  7. No anxiety or associated behaviors
54
Q

What do you assess for neurogenic stuttering

A

. Coexisting aphasia, apraxia, dysarthria, or dementia

2. Rule iut preexisting developmental stuttering

55
Q

How do you trest neurogenic stuttering

A

Symptomatically by reducing rste, delayed auditory feedback, pacing board

56
Q

What is cluttering

A

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

57
Q

How do you treat cluttering

A

Reduce rate of speech

Increase clients awareness of problem through video

58
Q

what are Van Der Merwe’s 5 origins of stuttering

A
  1. frontoimbic: intent to speak
  2. Linguistic-planning: choosing words
  3. Motor Planning: establishing temporal and spacial specifications
  4. motor programing: instructions to muscles
  5. Execution
59
Q

what is a preperatory set

A

prolongation that is used in expectation of upcoming difficult word
creates a change in segmental duration which is a change in motor planning

60
Q

what are the Van Riper’s 4 stages of stuttering modification

A
  1. identification
  2. desensitization
  3. modification: cancellation, pullouts, preparatory set
  4. stabilization: patient becomes own therapist
61
Q

what is cancellation

A

after a stuttered word, pause and say it again before going on

62
Q

what is Webster’s theory on the Disorder of Brain Organization

A
  1. PWS have normal localization of speech in left hemisphere but the supplementary motor area is vulnerable to disruption by activities in other areas
63
Q

what is the covert repair hypothesis

A

stuttering is the repair of phonological errors

64
Q

what are normal dysfluencies

A

revisions: where are….can I go with you
interjections: uh
repetitions of 2 extra units or less: he… he is my friend

65
Q

what is borderline stutterine

A 
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
66
Q

what is beginning stuttering

A

repetitions more hurried
characterized by neutral vowel: muh muh Mike
blocks appear
tension exhibited but no strong negative feelings
older preschool age

67
Q

what is intermediate stuttering

A

most notable behavior is block
child begins to fear stuttering
age 6-13

68
Q

what is advanced stuttering

A

tension, escape, avoidance
longer blocks
affects school, work and social lives

69
Q

how do you identify covert behaviors in the classroom

A

disparity between written and oral performance

70
Q

what are ways to bring about fluency

A
  1. prolongations
  2. chorale speech
  3. shadow speech: spoken directly after
71
Q

describe the Lidcombe Program

A

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

72
Q

how do you teach fluency skills

A
  1. flexible rate: slowing
  2. pause: preparatory set
  3. easy onsets:
  4. light contacts
  5. proprioception: conscious attention to movements of articulators

Praxis (20 decks)

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