Fluency Final Flashcards

Question

Concomitant Disorders

Answer 1

Language * how might stuttering impact the various components of language? * assess language when assessing fluency? why or why not? ▪ Word finding ▪ confrontation naming ▪ word association

Answer 2

while we no longer blame parents for causing their children to stutter, there are certain parental behaviors that are conducive to stuttering while yet others are conducive to fluency

Answer 3

you must learn new strategies and behaviors in order to become fluent; how you learn is largely related to the learning style of your community

Answer 4

who displays what behavior around which people is cultural also; eye contact which we think might be important for a PWS, may not be important if you are from a culture that does not value that behavior

Answer 5

the feeling(s) people have about their problem may to a large extent be related to their culture and to the reactions of friends and people with whom they interact regularly – especially if that society places great importance on fluent speech; how you display emotions is largely cultural in nature

Answer 6

There is unequivocal evidence that more males than females stutter, regardless of the society or national origin.

Answer 7

Glasner (1949) identified harsh discipline, humiliation, and indulgence as directly affecting the occurrence of stuttering

Answer 8

Stuttering is more prevalent in urban, rather than rural areas, according to Brady and Hall (1976), Yet, Dykes (1995) found that rural areas had a greater prevalence of stuttering (49%) than urban areas did (34%)

Answer 9

Bilingual children are more likely to stutter than monolingual speakers, according to Bloodstein (1995) and Borsel et al (2001) who cites a prevalence rate of 2.8% among bilinguals versus the nearly 1% in the general population. In contrast, Montes and Erickson (1990) found no significant differences in the occurrence of stuttered speech behaviors in English and Spanish bilingual children. They also noted that the types of disfluencies associated with second language learning are often misindentified as stuttering.

Answer 10

Morgenstern (1956) found more stuttering in the middle and upper-middle classes than in the lower classes.

Answer 11

Dated studies examined stuttering among the Eskimos and native Americans; however no current research is available on these groups nor on Asian Americans. Leavitt (1974) found the prevalence of stuttering among Puerto Ricans living in New York City to be 0.84%, a value similar to that of whites; by comparison the prevalence among of Puerto Ricans living in San Juan was 1.5%.

Answer 12

Is there a problem with the patient’s speech? – If there is a problem, what is the best way to describe it? – Does the problem seem to be the result of a neurologic disorder? – If it seems to be neurologic in origin, did it appear suddenly or slowly? – Is the problem related strictly to speech production, or is it more of a problem with language, such as aphasia? – If it is a problem of speech production, do most of the problems seem to be related to the sequencing of phonemes? – If there are no phoneme sequencing errors, what are the characteristics of the patient's speech errors and any associated motor problems?

Answer 13

Excessive number of simple repetitions of sounds or syllables, same tempo as other syllables Then repetitions per word increase and become swifter or irregular The schwa vowel appears (bc it completely changes the word being spoken) Next prolongations of sounds occur and then silent articulatory (blocks) postures and then we find evidence of tension and tremors accompanying the repetitions and prolongations Shortly thereafter, the child demonstrates awareness of his fluency breaks and becomes frustrated.... Then after this, the child begins to show signs of fearing to speak (unfinished sentences (escape), unduly silent, refusing to answer, withdrawn) When stuttering does occur, he now tries to interrupt it by various devices or explosive struggle resulting in facial contortions, gasping or tongue protrusions Then after struggle, avoidance devices (synonyms, postponing, interjections, pretending to think) May also see other strategies for timing the speech attempt, such as tapping a finger or leg, using head, finger or leg, head jerk,......

Answer 14

Revisions Interjections Repetitions (part word, single syllable word, multi-syllabic word, phrase) Prolongation Tense pause ….but just because it’s normal, doesn’t mean it’s normal.

Answer 15

1. The population of persons who stutter is heterogeneous. 2. The speech of children who stutter appears to be different from the speech of normally fluent speakers, right from the onset of stuttering. 3. Stuttering runs in families, although the exact method for genetic transmission remains unknown. It is more common in males. 4. Stuttering onset may be gradual or sudden. 5. Stuttering is a disorder of children with the largest onset occurring prior to age 5. 6. Stuttering often begins as sound/syllable repetitions although some children clearly produce (in)audible sound prolongations at stuttering onset. 7. Nonspeech Associated Behaviors (secondary characteristics) are often present from stuttering onset. 8. A large percentage of children (between 70% - 80%) spontaneously recover from the problem. 9. The greatest amount of recovery occurs within 1 year post stuttering onset. 10. Early stuttering is often characterized by higher frequencies of stuttering that decline within the first 2 years post onset. 11. Lack of positive change (decrease in frequency) in stuttering by 7 months post stuttering onset suggests the need for evaluation and possible treatment. 12. While sponta neous recovery can occur for some children beyond 1-year post onset, intervention is encouraged by 1 year post onset. 13. The development of stuttering occurs as a result of the clients’ speech skills, the communicative environment, and the clients’ awareness of, and reactions to, stuttering and the environment. 14. Stuttering is bidirectional. 15. The relatively fast changes in the state of communicative processes precipitate or cause stuttering. The relatively slow changes in the state of extracommunicative processes (e.g. psychological excitement, temperament) tend to aggravate, exacerbate, or maintain stuttering. 16. Certain conditions will make stuttering decrease, at least temporarily. 17. The power of suggestion, as with the treatment of most human problems, is very much involved with the treatment of stuttering.

Answer 16

to determine whether the client has a fluency disorder or is at risk for developing one to determine the type of fluency disorder to identify the set of behaviors that define the client’s fluency problem to assess the severity of the problem for funding eligibility, litigation and other purposes

Answer 17

speaking in a nonhabitual manner reading in chorus (if reading something simultaneously, you don’t stutter if you typically stutter & vice versa) shadowing or delayed-auditory-feedback (DAF) singing using a metronome or pacer speaking in the presence of loud masking noise reducing speaking rate speaking while alone, with children or with animals speaking in a monotone trying to stutter not thinking about or attending to stuttering playing a role

Answer 18

speaking on the telephone saying one’s name telling jokes repeating a misunderstood message waiting to speak speaking to authority figures speaking to relatively large audience failing to bring stuttering out in the open desiring to avoid stuttering experiencing positive emotional arousal (excitement about birthday)

Answer 19

total percent of syllables stuttered is 5% or greater duration of dysfluencies is1 second or longer (you might see 2 seconds in some literature) presence of associated motor behaviors client or caregiver's degree of concern

Answer 20

length of time of stuttering age at evaluation (<4 years old often means much greater chance of recovery without treatment) child's reaction parent's reaction prolongations evident or obvious family history (aunt, uncle, sibling, etc. stuttering; anyone recover from stuttering?) concomitant disorders stuttering severity hx (usually but not always but often the more severe, the less likely recovery)

Answer 21

No record of unsuccessful treatment A cooperative and supportive family system Cooperative interdisciplinary team members More severe stuttering pattern (more motivated?) No other significant, concomitant problems Other available resources (and interests, hobbies, etc.) Positive pretreatment motivation and attitude Significant timing and voluntary enrollment Commitment to a jointly determined treatment plan and schedule Personality variables Positive, yet realistic expectations regarding the commitment required for fluency intervention Clinician’s attitudes and expectations Providing information (written report, cover letters, etc.)

Answer 22

play, role play, simulations

Answer 23

Video/audio recorder, stopwatch/timer

Answer 24

Thinking about the class definition (developmental, unknown origin, person feels different, overt & covert characteristics), which can be treated?

Answer 25

continuity - smoothness rate - rapid rhythm - stress patterns effort - physical and mental

Answer 26

we don’t want our clients to sound like they have had therapy

Answer 27

getting the message out whenever, wherever and to whomever

Answer 28

spontaneous fluency - the fluency of normal speakers controlled fluency - the fluency achieved by PWS by monitoring and changing behavior acceptable stuttering - speech produced PWS but without their negative reactions to it Attention to feelings and attitudes Maintenance procedure

Answer 29

hides or disguises his/her stuttering avoids speaking perceives personal penalty as a consequence of stuttering feels poorly about himself/herself as a communicator demonstrates a more positive response to stuttering modification trial management

Answer 30

Consider FST when the person who stutters: stutters openly does not avoid speaking perceives annoyance or interference but no personal penalty from stuttering feels positive about himself/herself as a communicator demonstrates a positive response to fluency shaping trial management

Answer 31

stutters openly, but may demonstrate some avoidance perceives some sense of personal penalty and negative feelings from stuttering, but not to an extreme or handicapping degree feels relatively positive about himself/herself as a communicator, but wishes for personal change demonstrates a positive response both to stuttering modification and fluency shaping trial management

Answer 32

SM: Stuttering results from avoiding or struggling with dysfluencies, fears, and negative attitudes. FS: Stuttering is learned.

Answer 33

SM: In decreasing order of desirability, goals include spontaneous fluency, controlled fluency, or acceptable stuttering. FS: Only spontaneous or controlled fluency are acceptable goals. Any evidence of noticeable stuttering is regarded as a program failure.

Answer 34

SM: Fears and avoidances related to stuttering are reduced by identifying, studying, and understanding thoughts, feelings, and attitudes about communication and oneself as a communicator. Positive social and vocational adjustments are targeted directly. FS: No attempt is made to reduce communication-related fears and avoidances or impact the attitudes of the person who stutters. As a result of improved fluency, however, fears often reduce and positive social and vocational adjustments occur indirectly.

Answer 35

SM: Much attention is given to reducing speech fears and avoidance behaviors. The client is taught to be more fluent by various techniques to modify stuttering. Fluency is maintained by reduction of fears and avoidance behaviors. FS: Little attention is given to reduction of speech fears and avoidance behaviors. The client is “programmed” for stutter-free speech via specific contingencies. Fluency is maintained by modifying the manner of speaking and, if necessary, reinstatement of fluency by recycling through the original program.

Answer 36

SM: A less structured format (such as teaching or counseling interaction) is used. FS: In contrast, the format is highly structured (which is typical of behavioral conditioning and programming). Note. From Stuttering: An Integration of Contemporary Therapies (pp. 13-23), by Guitar and T.J. Peters, 1980, Memphis, TN: Stuttering Foundation of America.

Answer 37

reduce the frequency of stuttering reduce the abnormality of stuttering reduce negative feelings about stuttering and about speaking reduce negative thoughts and attitudes about stuttering and about speaking reduce avoidance increase overall communication abilities create environment that facilitates fluency increase the freedom to speak

Answer 38

help clients deal with emotions reduce the frequency of stuttering reduce the abnormality of stuttering reduce negative thoughts and attitudes about stuttering and speaking reduce avoidance increase overall communication abilities create an environment that facilitates fluency engage motor learning principles

Answer 39

MIDVAS: MOTIVATION - The person who stutters needs to assess her/his motivation for seeking therapy and the SLP needs to help the person build and maintain the motivation necessary for successfully changing speech behaviors and attitudes. Facing one's weaknesses squarely enough and long enough to change them is not easy for humans to do. Therapy for stuttering is not something to enter into lightly; it takes a large investment of time, physical energy, emotional energy, and money. Motivation gets addressed throughout therapy. IDENTIFICATION - The client and clinician identify all of the behaviors, feelings, and attitudes that go along with the person's stuttering. This is like picking the stuttering apart. They identify the core stuttering behaviors, any secondary behaviors, physiological components, such as changes in heart rate, feelings of fear, anxiety, shame, guilt and hostility, and avoidances. Identification can be very difficult for people who stutter because it exposes their shame and feelings of inadequacy. Motivation can appear to change (most likely decrease) during this stage. DESENSITIZATION - The person who stutters moves into the desensitization stage. Van Riper designed this stage to help drain away the negative emotions, the fears, and the anxieties associated with the act of stuttering. These negative emotions give stuttering its power over the individual. In order for the individual to have control over the stuttering, he or she must drain away these emotions from the act of stuttering so that stuttering becomes a neutral event, sort of a "no big deal." The most common strategy used in the desensitization phase is called voluntary stuttering, in which the person stutters on purpose. By choosing when and how to stutter, the individual begins to gain control over the stuttering and the fear and anxiety begin to diminish. VARIATION - Once some of the negative emotions have been removed from the act of stuttering, the individual can change not only how he or she stutter but change his or her reactions to the stuttering. Actual work on changing stuttering behaviors does not happen until the fourth stage of therapy because much groundwork needs to get done first. Many PWS find the initial tasks (or targets) more difficulty than they had anticipated and drop out of therapy before reaching this stage. Much of the person’s behaviors and reactions become ingrained to the point of being stereotyped. The same stimulus (e.g. ringing telephone) will set off the same chain reaction of feelings and behaviors in the person. Varying these stereotyped responses weakens their power over the individual and helps the individual continue gaining control over the fears and the stuttering. Van Riper suggested having individuals change their reactions to word fears, situation fears, communicative stresses, and frustration and penalty. In addition, the individual learns how to stutter differently in this phase. For example, if the person usually prolongs the initial "s" in "sister," have him or her repeat the sound or stutter on a different sound in the word. APPROXIMATION - Once the stereotyped pattern of the stuttering has been ‘conquered’, the individual can learn specific strategies to smooth out and minimize the moments of stuttering. The three most common strategies for altering the stuttering are: cancellation: in which the person stutters all the way through a word, stops immediately, and then repeats the word stuttering a different way pull-out: in which the person gains control over a moment of stuttering while it is happening and smooths it out preparatory set: in which the person prepares for a moment of stuttering before it happens, starts it gently and glides through it smoothly. STABILIZATION - After successfully moving through the previous phases of therapy (with the close guidance of a clinician), the PWS should become his or her own clinician. In the stabilization phase, the individual uses the new stuttering controls in more and more situations of daily life. The individual also continues to stutter voluntarily and to seek out communication situations that he or she previously avoided.

Answer 40

Approx. Age: 2-3.5 Characteristics: Speech may be characterized by multiple part-word and single syllable whole word repetitions. There is little to no tension or awareness. Suggested Approach:Fluency Shaping: Indirect Use pauses, reduce Q’s and make more comments; have dedicated listening time–first thing in the morning.

Answer 41

Approx. Age: 2.5-6 Characteristics: The child may have been stuttering for several months. The common stuttering behaviors may be part-word repetitions that are produced rapidly, often with irregular rhythm. Some prolongations maybe present. There may be excessive tension. Blocks may be present. Secondary behaviors are typically escape devices such as eye blinks and head nods. Avoidance maneuvers such as starting sentences with extra sounds like “uh” or changing words when a stutter is anticipated may be observed. Frustration may be present but not typically a strong fear of talking. Suggested Approach: Fluency Shaping but you will likely infuse some Stuttering Modification SLP – Indirect Parent – Direct Parents are w/ child more often, to generalize to everyday life;

Answer 42

Approx. Age: 6-13 Characteristics: The stuttering characteristics maybe tense part-word and monosyllabic whole word repetitions, tense prolongations; some blocks with tension and struggle may be evident. The child may use escape behaviors such as body movements or brief verbalizations (e.g. interjections) to break free of stutters. He may also use various avoidance strategies such as starters, word substitutions, circumlocutions, and evasion of difficulty speaking situations. He experiences more frustration and embarrassment than beginning stutterers do and has distinct anticipation of stuttering on specific sounds, words, and many speaking situations, his major fear is the moment of stuttering and he has a definite concept of himself as a stutterer. Suggested Approach: Stuttering Modification but you will likely infuse some Fluency Shaping Direct

Answer 43

Approx. Age: Adolescents to Adults Characteristics: Characteristics at this stage are typically well entrenched and consist of blocks, repetitions, and prolongations that are usually accompanied by tension and struggle. Typically, these individuals have developed negative anticipations about speaking situations and listener reactions. Suggested Approach: Stuttering Modification Direct

Answer 44

onset after age 10 or 11 an event occurred immediately before the onset of the disorder resulting in damage to CNS few if any situations in which client is completely fluent (like reading in unison) client is aware and concerned repetitions and prolongations occur on final as well as initial and medial syllables phonemic foci of disfluency may differ from (developmental) stuttering dysfluency is not related to grammatical function no direct relationship between linguistic complexity and dysfluency (self-formulated speech may be easier than automatic speech) the adaption effect is not observed (fluency does not improve with repeated readings) the speaker may be annoyed but does not appear anxious secondary features are not always observed

Answer 45

onset after age 10 or 11 no event occurred immediately prior to the onset of the disorder that could have resulted in damage to CNS onset is sudden; an event occurred immediately before the onset of the disorder that could have resulted in severe psychological trauma few if any situations in which client is completely fluent (affected little by choral reading, white noise, DAF, singing or different speaking contexts) client is aware but not overly concerned; indifference secondary symptoms are not observed dysfluency is primarily repetition of initial or stressed syllables May also see this referred to as Conversion Speech Disorder

Answer 46

a) spastic dysarthria: tension may be too great at the beginning of an utterance. Shallow respiration can affect motor control. b) athetoid dysarthria: involuntary movements of the larynx or tongue can cause dysfluency. c) chorea-like dysarthria: rapid, jerky movements of the articulators may not allow normal fluency. d) flaccid dysarthria: slow, labored speech; muscles tire easily and fluency deteriorates. e) ataxic dysarthria: muscle tone is reduced and incoordination of the articulators can take place.

Answer 47

struggle to produce speech and thus may sound like PWS when their fluency breaks down. know what they want to say, but cannot execute the appropriate movements necessary to produce the target utterance. The flow of speech and normal intonation patterns are affected, and since these individuals are aware of their problem, they struggle to correct errors and generally become very disfluent with a lot of whole word and phrase repetitions.

Answer 48

Confusion of ideas will frequently lead to speech characterized by hesitations, whole word repetitions, revisions and filled and unfilled pauses. Word retrieval deficits will also result in long pauses and word/phrase repetitions as well. The most common site of lesion in aphasics with fluency deficits are caused by frontal lesions associated with stroke or brain trauma.

Answer 49

1) Standardized Tests: a) Aphasia Diagnostic Profiles b) Boston Naming test 2) Standard Speech Passages (repeated readings): a) "The Rainbow Passage” b) "The Grandfather Passage" 3) Automatic Recitations: a) Counting to 30 b) Months of the Year c) "The Pledge of Allegiance” 4) Singing Familiar Songs

Answer 50

case history – include setting and perspective; ask about events that may have occurred history and current pattern of disfluency motor speech exam evaluation across multiple speaking contexts stimulability or trial therapy Consult with other service providers for the client.

Answer 51

Malingering is faking a disorder to receive some benefit. Malingering has been reported in criminal cases and civil lawsuits. Assessment – complete a fluency assessment as usual including case history, screenings and stuttering evaluation (including procedures and analysis). In the analysis, use the information from table 15.3 to help distinguish what you’re seeing and hearing from stuttering (or psychogenic or neurogenic disfluency).

Answer 52

is a fluency disorder characterized by a rapid and/or irregular speaking rate, excessive dysfluencies, and often other symptoms such as language or phonological errors and attention deficits. To identify cluttering, you must listen to nonstuttered speech of the speaker. Evidence for a fluency disorder (one that is not stuttering) and excessive dysfluencies, would be present in a speaker who meets all of the following: Does not sound "fluent," that is, does not seem to be clear about what he or she wants to say or how to say it. Has excessive levels of "normal dysfluencies," such as interjections and revisions. Has little or no apparent physical struggle in speaking. Has few if any accessory (secondary) behaviors. A rapid and/or irregular speaking rate would be present in a speaker who has any or all of the following: Talks "too fast" based on an overall impression or actual syllable per minute counts. Sounds "jerky." Has pauses that are too short, too long, or improperly placed. These fluency and rate deviations are the essential symptoms of cluttering. In addition, however, there are a number of symptoms suggested in the latter part of the above definition that may or may not be present but add support to the impression that a person is cluttering. Accordingly, the clinical picture of a typical cluttering problem would be enhanced if the person in question had any of the following: Confusing, disorganized language or conversational skills. Limited awareness of his or her fluency and rate problems. Temporary improvement when asked to "slow down" or "pay attention" to speech (or when being tape recorded). Mispronunciation or slurrring of speech sounds or deleting non-stressed syllables in longer words (e.g., "ferchly" for "fortunately"). Speech that is difficult to understand. Several blood relatives who stutter or clutter. Social or vocational problems resulting from cluttering symptoms. Learning disability not related to reduced intelligence. Sloppy handwriting. Distractibility, hyperactivity, or a limited attention span. Auditory perceptual difficulties.

Answer 53

should include different tasks to include oral reading, spontaneous speech, retelling a memorized story, a test of oral motor coordination and questionnaires. Cluttering severity may vary depending on the nature of the speaking task. Cluttering behaviors are more likely to surface as the speaking task is more extemporaneous and informal, less structured, more emotional, and linguistically more complex.

Answer 54

The nature of the oral reading task will limit the possibilities for language formulation difficulties in the clutterer; however, omission of syllables and words (particularly pronouns and articles) may occur. Take note of errors in syllable and word structure such as telescoping of syllables or semantic paraphasias. Because the level of reading material may influence degree of cluttering, present clients with appropriate reading material that vary in reading difficulty. The more difficult passages, containing more multisyllabic words and linguistically more complex sentences, may produce more cluttering behaviors compared to the less difficult passages. It is also suggested that the client read a passage with and one without preparation, to compare the results of the prepared and unprepared reading.

Answer 55

Engage the client in a more relaxed exchange on a subject that is of high interest to the client. This can include explaining a videogame, telling about his favorite sport or leisure activity, or telling a story about a recent exciting event that the client experienced. Record at least 10 minutes of of this language sample. The language sample should consist of a narrative rather than iterations of events as in a list. We have found that cluttering behaviors become more evident the more informal, spontaneous and extensive the talk. When the client is not aware of the recording you will have the highest chance of recording “uncontrolled” cluttering speech. Such speech may also be observed when recording the interaction between, for instance, the parent and the child, or the adult and partner while you leave the room for a while.

Answer 56

Assessment of articulation should include tasks that range from short and structured tasks, to longer and less structured tasks. Examples of the former include rote tasks such as counting or reciting memorized material. Be aware of errors in syllable- and word structure and take measures of articulatory rate. Some clutterers have phoneme-specific misarticulations. Most clutterers exhibit reduced (non-phoneme-specific) speech intelligibility as the talk becomes more informal and extended. Speech intelligibility arises from elisions of sounds and syllables, neutralization of vowels, cluster reductions. Ask the client to count backwards: 100-97-94-91…. Ask the client to count from 20 to 29 Older clutterers should read some words that are difficult to pronounce (e.g., “statistical,” “chrysanthemum,” “possibilities,” “tyrannosaurus”) and produce these words three times in succession first at their comfortable rate and then at a faster speech rate. Older clutterers should read some words with changing stress pattern sequences such as "apply, application, applicable" (a_ply’ / a_pli_ca’_tion / a_pli’_ca_ble). OMAS (Riley and Riley, 1985): Although the norms for adolescents and adults are lacking, the diadochokinetic tasks of the oral motor assessment scale (OMAS) provide clear guidelines for observation of oral motor coordination. Imitation of numbers (forward and backward) provides information of auditory memory and flexibility.

Answer 57

People who clutter commonly experience language deficits besides their articulatory problems. It is, therefore, important to assess the language skills of the client. Language difficulties include word-finding problems, poor syntactic structure, lack of coherence and cohesion in discourse and narratives, and compromised pragmatics (e.g., poor presuppositional skills such as not taking into account the listener’s viewpoint or knowledge; frequent interruption of conversational partner’s turn) in individuals who clutter. We speculate that a number of the clutterer’s disfluencies are motivated by linguistic rather than motoric difficulties; these disfluencies are often called “linguistic maze” behaviors. Ask the client to retell a story you told them. Observe the following as the client retells you the story: ability to paraphrase the story with the major points of the narrative in logical sequence, and with intact story grammar, maintaining syllable-, word- and sentence structure, appropriate pausing, adequate speech intelligibility, appropriate pragmatics. Imitation of sentences of increasing length (up to 20 word-sentences) for adults and adolescents. This task provides information on auditory memory skills and on the amount of language complexity the client can handle.

Answer 58

Predictive Cluttering Inventory (Daly and Cantrell, 2006), also translated in Dutch (by van Zaalen, 2007) and in German (by Abbink, 2007). Checklist of Cluttering Behaviours (Ward, 2006) The Perceptions of Stuttering Inventory (Woolfe, 1967) WASSP (Wright and Ayre, 2000) The S-24 (Andrews and Cutler, 1974) Where there are questions relating to cluttering behaviors (for example, some questions on the WASSP and PSI relate to the physical aspects of disfluencies), comparisons can be made between the clinician’s observations and those of the client. For instruments tapping feelings and attitudes (such as the S-24, subsections of the WASSP and the “expectancy“ and “avoidance” statements on the PSI), the clinician can go through the responses together with the client once the client has completed the assessment and use the client’s responses as springboard for subsequent therapy. Ask the client to critique his own speech during various recorded tasks, compared to the clinician’s critique. A 5-point rating scale is often useful to judge the recorded samples on each of the major dimensions of the client’s speech and language.

Answer 59

Cluttering usually co-exists with other disorders such as stuttering, articulation disorders, attention-deficit disorders/hyperactivity disorders and learning disabilities. The available literature as a whole suggests that an essential difference between cluttering and stuttering lies on the speaker’s level of preparedness for saying intended utterances. Stutterers know what they intend to say but are interfered at the motoric level in their attempts to produce various words, whereas clutterers do not necessarily know all of what they want to say (or how to say it) but continue talking anyway. Part-word repetitions, prolongations and blocks are typically produced by stutterers, whereas excessive but normal disfluencies often characterize the speech of clutterers. The latter include interjections, incomplete phrases/words, revisions. Persons who clutter exceed the normal qualitative and quantitative limits of changes in phonemes and tend to delete or neutralize syllables that standard speakers do not neutralize, especially in fast speech. Although symptoms of ADD/ADHD are mentioned as cluttering, individuals diagnosed with ADHD do not necessarily clutter. Specific Learning Difficulties have been reported to co-exist with cluttering, especially difficulties in oral expression, reading, writing, handwriting and music; however, corroborating data for these observations are anecdotal.

Answer 60

Rate reduction Rhythm (such as MIT) Prolongation During a conversation, baselines of target behaviors are obtained for comparison in Step 4. Step 1. To help the patient learn to self-monitor, the patient should listen to audio-recordings of his/her own speech while the SLP points out instances of the target behavior to them. Step 2. Patients listen to audio-recordings of their speech and use a counter to monitor the target behavior. If there is no signal within 3 seconds of the occurrence of the behavior, the SLP stops the tape and identifies the behavior. Step 3. Patients self-monitor during a speaking task (like describing a picture). Repeat strategy for identification used in Step 2. Step 4. Patients self-monitor while performing the speaking task used in Step 3 but without SLP feedback and reinforcement. Compared to baseline data. Compare their needs to that of a person diagnosed with aphasia or a motor speech disorder like dysarthria. Use appropriate evidence-based strategies from those clinical areas.

Answer 61

Person shows good signs of psychological adjustment; can decrease stuttering in trial tx? good candidate for tx so start speech services right away Person is unable to decrease stuttering in trial tx or continues to have some indications of dysfunction? good candidate for tx if it’s provided in conjunction with psychotherapy Person is unable to decrease stuttering in trial tx or denies that the stuttering might be stress related? poor candidate for tx (perhaps extended treatment might be considered) Once it’s determined that therapy is appropriate, fluency shaping strategies have been effective. Those include: ● light contact ● easy onset ● easy repetitions Techniques from Duffy (2005) that address what he calls ‘symptomatic therapy’ 1. Identify for the patient the behaviors that represent the disorder (eg. tight and effortful voice, whispering, facial grimacing, neck extension; eye blinking, etc.) 2. After the behaviors are identified, tell the patient that they reflect a well-intentioned effort to speak but are actually physically exhausting and acting as a barrier to more normal speech. 3. Have the patient do something with speech that approximates a normal or at least different response. This can range from a grunt to a sigh to a prolonged sound to a single syllable. 4. Talk to the patient about what has and is going on during symptomatic efforts. 5. Laryngeal manipulation and massage can be effective in reducing tension. Touch can be a valuable tool both physically and psychologically. 6. With improvement, it is appropriate to accelerate enthusiasm about the patient’s progress. Gradually begin to withdraw touch with expectations that the patient can modify speech without physical assistance. 7. With continued improvement, ask patients to read a paragraph and get a feel for the their improved speech. The SLP can interrupt to ask some general questions; the patient’s improved speech during such responses should be noted. Duffy (2005) provides guidelines for addressing services beyond the steps listed. Those include how to handle it if the speech problems return, don’t resolve, or if they continue to do well (in or out of the presence of the contributing psychogenic issue).

Answer 62

It’s not typically treated; the SLP may work with others (psychiatrists, law enforcement, social workers, attorneys, etc) to help identify malingerers. Should the person’s malingering manifest secondary to a larger psychiatric or emotional challenge, the SLP may be called upon to consult with those professionals in patient support.

Answer 63

Procedures · administer a standardized test (all employers will not require) · obtain speaking samples from at least 3 or 4 contexts · assess feelings, emotions, attitudes, reactions MAY BE CONSIDERED INCOMPLETE IF OMITTED · observe/document any secondary characteristics or physiological factors · screen language, voice, and articulation · assess stimulability Analysis · frequency of stuttering per stuttered syllables · pattern of dysfluencies (types, like blocks, ect…) · duration of the longest stuttering moments · impact of secondary behaviors · severity rating · rate of speech (words or syllables per minute)

Answer 64

Dimensions of fluency Speech Naturalness Effective Communication Types of Fluency spontaneous fluency - the fluency of normal speakers controlled fluency - the fluency achieved by PWS by monitoring and changing behavior (FST) acceptable stuttering - speech produced PWS but without their negative reactions to it (SMT) Attention to feelings and attitudes Maintenance procedures

Answer 65

Physiological adjustments Rate reduction Operant conditioning Length and complexity of utterance Attitude adjustments Maintenance, movement, and monitoring

Answer 66

Use audio and video recordings of speech to monitor and self-correct. ● Record client’s speech and play it back: (1) at a fast speed to show how cluttering sounds; and (2) at a slow speed to show how it might be improved (reorder wherein these functions preserve the vocal frequency). ● Heighten client’s sensory awareness of movement first during nonspeech motor acts such as rate of moving arms or hands or when walking, then during speech motor acts. ● Use various types of computer-generated visual feedback of speech rate (e.g. comparing client’s tracing with clinician’s model on a Visi-Pitch screen ● Give “speeding tickets” (for children) following episodes of rapid speech. ● Use feedback from listener (e.g. facial expressions, verbal indications of communication breakdown due to clutterer’s poor speech, and linguistic coherence). ● Provide opportunities to monitor and provide feedback to other clutterers in group sessions.

Answer 67

Slow overall rate using delayed auditory feedback (DAF). ● Use syllable-timed speech (e.g., metronome) as an intermediary technique (this approach alone would not facilitate natural sounding speech.) ● Prolong vowels because they are easy focal points to prolong, thereby reducing rate. ● Attend to word endings and unstressed vowels and syllables. ● Use more distinct and more deliberate articulatory gestures (e.g., wide excursion of articulators). ● Impose pauses for breath groups. ● Mark reading passages with “stop signs” wherever there are periods and commas. ● Use analogy of speedometer to regulate rate. ● Use self-imposed phrasing to help with organization of speech and language or though. ● Aim for greater prosodic variations (assuming that greater prosodic variations will slow the rate and produce more natural-sounding speech). ● Give added stress to accented syllables. ● Read and/or recite poetry with “interpretation” to increase prosodic variations and pauses and to increase overall effectiveness of speech delivery. ● Use skits and plays to: (1) increase awareness of partner’s turn in conversation; and (2) highlight pauses imposed by lines from different speakers to automatically stop the clutterer from perseverating and festinating (i.e., going faster and faster). ● Use music to impose slower and/or more varied prosody (e.g., smooth, easy, and slow lullabies vs fast staccato beat of a march). ● If group therapy, have clients take turns “conducing” speech and/or singing depending on their “composition” (legato, allegro, pianissimo); have children sing or recite a lullaby for softer, gentler , slower speech or a march for more rhythmic and deliberate cadence. ● Shadow the speech of slow and effective speakers.

Answer 68

Teach clients elements of story grammar (i.e., episodes, problem resolution). ● Help clients to sequence thoughts if they report several thoughts coming at once. ● Increase turn-taking skills to reduce tendency to interrupt and improve skills for appropriate adjacency and contingency. ● Increase semantic classification and categorization skills for word-finding difficulties. ● Increase speed and accuracy of word retrieval (e.g., naming drills). ● Formulate ideas using appropriate syntactic structures. ● Increase cohesion of extended talk (e.g., through appropriate use of relational terms such as “although” and “however”).

Answer 69

● Review audio and video recordings for use of fillers, revisions, incomplete phrases, and other disfluencies. ● Have client transcribe his or her own maze behaviors (e.g., use the systematic disfluency analysis (SDA) [Campbell & Hill, 1994] system and point out inefficiencies in clients information output due to excessive maze behaviors). ● Use aforementioned strategies for rate and language to decrease disfluencies as well.

Answer 70

● Point out specific attributes of client’s cluttering behaviors (e.g., difficult to understand, dropping of sounds and syllables). ● Differentiate reactions of self and others to the client’s cluttering. ● Compare the nature of thought and language organization after moments of clarity with moments of incoherence. ● Compare sensory feedback associated with fast rate, irregular rate, and slower rate. ● Discuss with client the relative effectiveness of different therapy approaches. ● For clutterers who also stutter, talk about behaviors associated with one’s moments of cluttering compared with stuttering. ● Identify effects of speaking rapidly on general body state (e.g., “Do you feel more tense when you talk fast?”). ● Compare effects on clutterer when others speak rapidly versus more slowly. ● Explore jointly client’s reactions when speaking to someone who is difficult to follow because of poor speech intelligibility or poor narrative and pragmatic skills. ● Use analogies from animal kingdom (e.g., stride of a racehorse vs hippopotamus or penguin) or engines (e.g., car skidding on ice, derailment of speeding train, or the synergism of a Porsche engine).

Answer 71

● Mark passages with pauses for breath intake. ● Heighten client’s awareness when exceeding optimum number of words per breath group.

Answer 72

● Obtain feedback, during moments of clear speech and poor communication, from family and friends. ● Recommend participation in group speaking activities (e.g., oral presentations at school, Toast-master ([www.toastmasters.org]), or other monitored activities at home or school).

Answer 73

● Consult with-or refer to-ECE specialist if school-age clutterers have significant attention, activity, distractibility, or academic problems; coordinate treatment plans around other ECE goals if relevant. ● Consult with-or refer to-psychologist if adult clutterers have significant problems (e.g. ADHD). ● Consult with –or refer to- mental health specialist if clutterers manifest problems in social adjustment. ● Consult with-or refer to-pediatric or general neurologist if clutterers have pharmacological issues.

Answer 74

It is one matter to help the clutterer become a slower, more fluent, and more intelligible speak while speaking in an ideal situation such as with the clinician. It is quite another for the person to make those changes permanent in all communicative situations. To foster transfer and/or maintenance, the clinician should program specific activities and assignment designed specifically for each client’s needs. Following are a few suggestions that may assist in this process. Daly (1992) outlined a procedure for preparing “anchor” recordings for clients - short samples of the person’s seriously cluttered speech, slightly clutterered speech, and noncluttered speech are recorded. The client is asked to listen to the tape every day or even several times a day, to: ● help maintain awareness of what goes wrong in cluttering ● serve to “recalibrate” the targets of good speech ● provide consistent reminders to practice. Whether or not “anchor” recordings are used, activities to promise daily speaking practice in a new and controlled way can be useful. Some clutterers have found that self-help groups for stuttering, such as National Stuttering Association chapters, are good places to practice and feel the support of others. It is likely that clutterers who might benefit from attending a stuttering support group will need to educate the group members about cluttering and how its treatment and maintenance challenges may be different from those faced by those who stutter.

Fluency Final Flashcards

(98 cards)