Fluency Final Flashcards
Differences in clinical management of stuttering due to
-Changing the nature of the disorders of stuttering
-Effect of age itself
Key phrases of IDEA
“aversely affects educational performance”
“educationally relevant”
Therapy can apply to variety of goals for school-age treatment such as
-Improving communication attitudes
-reducing negative reactions to stuttering
-educating people in the child’s environment
-minimizing the overall impact of the child’s stuttering in many domains
what might affect school performance
-Decreased participation in classroom interactions
-Difficulty giving oral presentations
-Trouble reading aloud
-Hesitant to participate in group projects
Goals of stuttering treatment in school-age
-Use a broad-based definition of the entire disorder, taking into account the child’s overall communication experience, then we can be much more successful
-Treat disorder not just behavior
-Stuttering is something child does not something that he or she is
We need to treat the
entire disorder
adressing impairment
change speech production to improve fluency
addressing child reactions
improve speech attitudes, acceptance of stuttering, reduce avoidance, tension, struggle
addressing negative consequences
focus on communication skills, not just fluency
addressing environmental reactions
educate others, help child handle teasing, etc.
beneath the service
negative reactions to stuttering can increase the severity
A
affective
affectice
child experiences embarrassment, shame, isolation, fear, guilt, anxiety
b
behavioralb
behavioral
stuttering event
c
cognitive
cognitive
child evaluates himself negatively as a communicator; does not understand stutter
directions for school age tx
- parent counseling
- Learn about speech and stuttering
- facilitate fluency
- identification/analysis
- modification of stuttering
- transfer
parent counseling
-Give information about stuttering
-Help parents explain feelings of concern, frustration, etc.
-Explore child’s relationship with parents and siblings
-Identify factors which complicate the problem or those interfering with progress
speech system
- air from lungs
- vf vibrate
- tensing
- timing
- sounds (smooth, continuous)
link stuttering to general learning of skills such as
tying a shoe, coloring, free throws
facilitate fluency
-Slow speaking rate
-Gentle voice onset
-Light articulatory contact
-Continued movement and airflow
-Prosody
identification/analysis
-clinician can model stuttering
-locate bumpy speech; differentiate between easy and hard speech
- modification of stuttering
-Show they can change speech in variety of ways
-Physically feel what they do
-Release tension
-Move speech helpers instead of trying to push against them
techniques for treating the entire disorder
timing, tension, or both
timing
rate, pausing, phrasing paragraphs, pace
tension
light contact, pull outs, post blocks
timing and tension
easy onset/start
techniques for modifying stuttering
help children stutter more easy we need to modify tension while stuttering and reduce child’s discomfort with stuttering
catching the stuttering
identify moments of stuttering as they occur
rationale for catching the stutter
*Increases awareness
*Provides opportunity to modify stuttering
*Develops self-monitoring skills
*Encourages openness and acceptance
*Begins process of desensitization
relaxing the stuttering
purposefully stutter on a word with 100% tension, observe the disfluency, then repeat word with decreased tension
rationale for relaxing the stutter
-Identify, analyze, and change stuttering
-Students see they can stutter in an easier way
-Reduces sensitivity
-Increases feelings of control
-Develops ability to work with stuttering
sliding out of the stuttering
Students catch themselves during a moment of stuttering and then gradually “slide out” of the stuttering by identifying and stabilizing the tension, slowing down their articulation, and stretching out transitions
rationale for sliding out of the stuttering
*Stabilizes and decreases tension
*Increases speech control
*Keeps speech moving forward
easy stuttering
-Intentionally produce relaxed, controlled repetitions of sounds, syllables, or words
-Can be used before or during a moment of stuttering or at times when stuttering is not anticipated or occurring
rationale for easy stuttering
*Helps children learn they can change the way they stutter
*Also reduces tendency to hide stuttering
*Recues tension and counter conditions struggle behaviors
Cancellation
-Students pause for a couple of seconds after a moment of stuttering (to acknowledge / analyze disfluency) and then they say stuttered word again with less tension
Cancellation Rationale
-Increases feeling of control
-Desensitizes concerns about stuttering
-Reduces tension
what could be included in portfolio
-Reflective writing and drawings
-Journal entries
-Questionnaires
-Checklists
-Transcripts of conversations with the child
-Documentation of behaviors observed by SLP, parent, teacher, and peers
example of goal for environment
-Child will demonstrate ability to
*Educate his peers about stuttering
*By giving 1 classroom presentation
*During a report on ISA day
*With support from teacher and clinician
example of goal for attitudes
-Child will demonstrate the ability to use pseudo-stuttering in a familiar situation when promoted by the clinician
-Child will demonstrate the ability to minimize avoidance strategies during an oral reading task in the classroom
REBT stands for
Rational Emotive Behavioral Therapy
what is REBT
-Based on the idea that individuals can “think” themselves into being upset because of irrational belief systems
-Get them to change belief system
-Teach acceptance -> model acceptance
to decrease emotional reactions we need to find balance between
-Developing and/or maintaining positive attitudes associated with communication and self
-Developing the ability to understand and use speech modifications techniques
what teachers need to know
-Knowledge
-The FACTS
-The goals and the therapy process
-To know that you are willing to collaborate
-Empowerment
-Connection with resources
-Ongoing contact with us/support from us
-Acceptance
teachers need to reinforce
small victories (open stuttering, open discussion, non-avoidance)
Goals contain
-What the child is to do
-How often
-What task and setting the child will do it in
-How much support will the child have
treatment types in adult stuttering
-stuttering modification (traditional)
-fluency generating/shaping
-group therapy
Traditional program wants to change _____________ of adults
belief system
how to change negative thinking in adults
-Show they have ability to be fluent (use devices)
-Show even “normal” speakers can be disfluent
identification
*In normal speakers
*In clinician’s pseudo-stuttering
*In client’s recorded speech
*In client’s conversation
Analysis
*What is happening when you stutter? (ex: tension)
*Freeze in moment; magnify the situation; explain how they felt before, during, and after moment
*Use descriptive language to discuss interfering behaviors
*Gives client specific goals for change
desensitization
Reducing emotion or anxiety that may accompany stuttering
steps of modication
*Modify stuttering after you have done it (post-block)
Pause, go back, repeat word
Pay attention where tension was and plan for next time
-Stuttering modified as it occurs (in-block, pull out)
Reduce tension midstream and pull out
-Modify stuttering before it happens (pre-block)
post-block
Ask client to pause after a stuttered word and say the word again with easy, more relaxed stuttering
In-block
Teach client to change stuttering in its mid-course; let client pull out by slowing down and using soft articulatory contacts
Pre-block
Teach preparatory sets by asking the client to use the techniques of modifying stuttering as he/she anticipates difficulty on a word
fluency generating/shaping is achieved by using
-Delayed auditory feedback
-Metronome-paced speech
-Prolonged/rate reduced speech
-Masking noise
-Shadow reading
Advantages of fluency shaping
-Client can see that they can be fluent
-Goal is clear = fluency
-Steps are clearly outlined, defined, and structured
Disadvantages of Fluency shaping
Relapse is a big problem
No techniques taught in case of relapse
Speech may be unnatural
No direct work on emotions or feelings
