Fluency Assessment & Intervention Flashcards
What are the things you need to consider before performing the assessment?
Consistency effect - consistent distribution in repeated readings; regular and repeatable loci (e.g., I want ttttto swim–in the successive readings, with the same utterance, the same sound will have dysfluency)
Adaptation effect - stuttering decreases in frequency as over the course of several readings; flip side of consistency effect (e.g., Where the stutter occurs, it will decrease)
In adaptation effect, this is mostly evident by the
A. 3rd reading
B. 4th reading
C. 5th reading
Answer: 5th reading
True or False. In adaptation effect, roughly 50% decreases from the initial reading.
True
What is the first thing that you do in a stuttering assessment?
Case history taking
During the case history taking, what do you have to identify with regards to stuttering assessment?
- Start of the condition (is it gradual or sudden?)
- Effects of the quality of life
- Coping strategies
- Changes and fluctuations
- Feelings and attitudes regarding stuttering
What is SSI?
Stuttering Severity Instrument
SSI-4 uses multiple (2-3) speech samples of at least 200 syllables each
Norms regarding: frequency, length, and severity of stuttering moments
This assessment only assesses motor components but does not check personal and subjective aspects. Meaning primary behaviors are only checked
Stuttering Severity Instrument (SSI-4)
Can SSI be used for both children and adults?
Yes
How many standard samples should you have?
2 samples is standard: conversation and reading
Why do you assess reading?
Cannot change words, can increase or decrease stuttering frequency (to see if may avoidance na ineexhibit)
Why do we need two samples?
Compare the two speech samples
Comparisons of the amount of avoidance
According to Yair and Seery (2015), how many words or syllables should you have?
300-500 words or syllables
600-1200 for “less frequent stutterers”
Some references: minimum is 200
What is the minimum criteria to say that a person has stuttering?
2-3% stuttered syllables
What are the following information you can obtain from a fluency sample?
Stuttered syllables - %SS = SLD/total syllables x 100%
Stuttered words - %SW = SLD/total words x 100
Weighted SLD score → severity
True or False. Total number of intended words in the sample. You will not count repetitions, or word revisions.
True
True or False. Count every moment of stuttering only once. No matter how severe or complex.
True
What is the difference between SLD and NSLD?
SLD - Stuttering-like disfluencies
NSLD - Non stuttering like disfluencies
(1) interjections “uhm… err.”, ,
(2) revisions/abandoned utterances–” “Mom ate/Mom fixed dinner)
(3) multisyllable/phrase repetition–”because because”, “I want I want to go”)
What should you not count in the SSW%?
NSLD
What are the stuttering-like disfluencies?
- Part-word repetition (b-but, thi-thi-this)
- Single-syllable word repetition AKA mono-syllabic repetition (you you you)
Dysrhythmic phonation: - prolongations (“mmmmy, “coooookie”)
- blocks (#toy)
- broken words (o#pen)
True or False. Should you count phrase repetitions in getting the SSW?
What do we need to get to get the severity of the stuttering?
SLD Score
What do we need to get to say that the individual has stuttering?
SSW
How do we get the SLD score?
Part word repetitions (PWR), single syllable word repetitions (SSWR); RU = the number of times a sound, syllable, or word is repeated prior to saying a word (e.g., pppppppart - 6) divided by the number of words containing the repetitions, DP - dysrhythmic phonation
(PWR + SSWD) x RU + (2 x DP) = WSL
What is advisable to tabulate during both conversational speech and reading activities?
%SS and %SW
Both tend to be highly variable for a speaker depending on the situation and material
What is a behavioral checklist?
Checklist for the child to identify their style of coping with sounds, words, and situations
Yes/No questions
Tension
Measurement of tension using GSR, EEG, EMG
Greater tension = greater probability of a block VF occludes and airflow + voicing ceases
True and False. Avoidance can negatively impact the person’s lifestyle more than the actual stuttering
t
What are the signs of avoidance?
- Hesitations before the feared word (can be subtle)
- Thinking (similar words and circumlocutions)
- Using sounds (e.g., “ah”) or words (e.g., you know, let me see) to postpone ot assist initiation–starting tricks
How do you test loss of control–Other ABC aspects)
Identifying loss of control in another speaker has yet to be demonstrated empirically
Nevertheless, over the years authors have suggest that is possible for experienced clinicians who become calibrated to their clients to be able to accurately identify such moments
If you have a formal tool to assess primary stuttering behaviors?
SSI-4
What is A19?
Formal assessment
Measures a child’s attitudes regarding communication
Higher score = more probably of negative attitudes regarding communication
Mean score of the kinder through 4th grade stutterers → 9.07 (S.D. = 2.44)
28 matched controls → (S.D. = 1.80)
This assess affective and has 19 questions that’s why it’s calls A19–for kids
What is S-24?
For adults
Erickson (1969)’s S24 scale for attitudes regarding verbal communication
39 true-false items differentiate PWS from PWNS
What is OASES?
Overall Assessment of the Speakers Experience of Stuttering
- Evaluate the impact of stuttering on a person’s life
- Affective, behavioral, and cognitive factors of stuttering
- Adults and children
Speech reconstructing
Fluency shaping
Factors: White noise/masking
Reductions in stuttering frequency when speaking in the presence of loud noise–e.g., near ocean surf, a waterfall, or a passing train.
Stutterers were unable to hear their own speech
Inference: the inability to hear one’s own speech–rather than mere distraction–produced the effect
“Relatively free from the anxiety–producing cues involved”
Verified repeatedly and extensively
So pag di masyado naririnig ng stutterer sarili niya nawawala yung fear and anxiety niya and nababawasan yung stuttering
Factors: Delayed auditory and feedback
For many persons who stutter, speaking under DAF reduced stuttering frequency
In contrast,DAF tends to increase the frequency of disfluencies in typically fluent speakers
Whether feedback can create durable therapeutic improvements in fluency in spontaneous speech outside the research laboratory or clinic is still under investigation
Factors: Video Self Modeling
Repeated exposed to the stutterer’s **error–free, target behavior **
Editing video to select segments portraying **desired performance **
Improves
What are the low evidence interventions?
Hypnosis and suggestion
Psychotherapy
Pharmaceutical management alone
What is stuttering modification?
- Voluntary stuttering
- Fluency enhancement through a change in the stutterer’s manner of speaking
- Bring the problem out into the open and to be willing to stutter
- Discuss the stuttering freely and casually
- Willingness to enter difficult speech situations
**Increasing acceptance of dysfluency decreases breakdowns in AWS **
Refusal to use word substitutions or other tricks for avoiding stuttering
Stuttering Modification: What is Bryngelson’s Therapy?
Emphasis on “situational” work → feared situations, feared persons–that is the venue or person during therapy
Clients were taken outside the speech clinic and challenged to maintain an objective attitude in feared situations
What are preparatory sets?
(1) Begin the word with the articulators in a state of rest
(2) Say the first sound as a movement leading into the next sound
(3) initiate voice or airflow immediately on the attempt
“Easy onsets” → Preparatory sets
If the preparatory sets do not work, what is the next one?
Pull-outs
If people began to stutter: finishing the word with a smooth, controlled, gliding prolongation (there is still stutter but it will be smooth, controlled, gliding, prolongation)
No frantic struggle to escape → immediate effect of increasing fluency
When prolongations or pull outs fail, what is next?
Pausing
Study their feelings and behavior and immediately tried the word again
Not to say the word fluently on the seconds attempt but to make some change for the better in their way of stuttering
Stuttering Modification: Avoidance Reduction Therapy
- Reducing efforts to avoid showing stuttering
- Reducing efforts to conceal one’s identity as a person with stuttering
- Fluency is achieved as a byproduct of self-acceptance and letting go of efforts to control speech → modifying feelings and attitudes in an attempt to improve primary behaviors
- Role conflict - most persons with stuttering could perfectly fluent when speaking along
- Speaking fluently → expectations of continued fluency (remove the expectation)
Result: heightening anxiety and leading to increased stuttering (this is what we need to reduce)
Mas matanggap yung stuttering and wag ma anxiety and wag iavoid pag may expected kang magsstutterpara malessen ang stuttering
Stuttering Modification: Desensitization
Introducing the idea of stuttering on purpose
Voluntary, intentional, or pseudostuttering
Clear indication of the fear associated with the stuttering experience
Until the speaker is able to decrease excessive levels of fear, they will have little success in the succeeding steps of treatment
Paramg exposure therapy, magstutter ka ng sadya para ma desentisize ka and maa mabawasan fear mo
What are the fluency shaping techniques?
- Rate modification
- Continuous voicing
- Easy onset of phonation and gentle articulatory contacts
- Work to normalize breathing
What is fluency shaping?
Fluency enhancement through a change in the stutterer’s manner of speaking
Speech restructuring techniques can reduce stuttering frequency by about 50% to 60%
What is prolonged speech?
Prolong segments (continuants–vowels, liquids, and glides ) in spoken utterances
Especially voiced components such as vowels, glides, and liquids
Other sounds (stops, fricatives) are unnatural when prolonged
What is syllable timed speech?
Increased fluency when they time their speech to a rhythmic beat such as the ticking of a metronome
Control the rate
Distraction, rhythmicity, cues for the next sound
True or False. People who stutter tend to become fluent when they find themselves speaking in almost any way strange to them. When the speaker times each syllable to the beat, it is drastically reduced demands on motor planning → less tension and better fluency, which comes at the cost of speech naturalness
True
What is punishment of stuttering and time-out?
Providing a signal that a stuttering behavior occurred
- Toy/light activates during moment of stutter
In adults: can be amorphous
Aversive for some, receptive for others
Some benefited very little, while others benefited more extensively
True or False. The older the person with stuttering, what technique should you prioritize?
Modification > Shaping
Indirect therapy–parent counseling?
- Manage or decrease any factors or conditions that appear to increase disfluency
- Rather than “directly” intervening with speech and fluency
- Managing speaking when: fatigues, excited , angry, pressured, or in a competitive environment
- Some immediate improvement in fluency may be achieved
Manage yung environment ng bata na mostly nagccause ng stuttering niya (which is wit parents lol)
Common guidelines for parent counseling
(1) Slowing parental speaking rate
(2) Reducing interrupting behaviors
(3) Reducing “simultalk”
(4) Expanding waiting time between the child’s utterances and parental responses
(5) Acknowledging (rather than ignoring) the child’s speech difficulty
Lidcombre Program
Good outcomes from a treatment regimen administered by parents
What is the first stage of Lidcombe?
15 minutes daily activitiesdesigned to maximize the child’s opportunities for fluency
Under guidance of an SLP who meets with the family on a weekly basis to observe the child
What is the second stage of lidcombe?
- Defined as the maintenance stage → contingencies are fewer, and distributed throughout natural speaking situations
- Direct therapy
Fluent speech → praise, request the child’s evaluation, acknowledge
Stuttering (SLDs) → acknowledge, request self-correction
Mixed–Demands and capacities?
Components of indirect therapy, based on reducing motoric, linguistic, cognitive, and emotional stressors on children’s fluency
Following initial weekly, hour-long sessions that involve the parent only, sessions are for both parent and child so that the therapist can observe how recommendations are being implemented and the child’s response.
Therapists also employ similar strategies in direct work with children, particularly issues of the child’s response to stuttering, including desensitization strategies
