Fluency for the Praxis

Question 1

What do the terms incidence and prevalence mean? Describe.

Answer 1

Incidence is the rate of occurrence of a disease in a specified group of people. Usually measured through longitudinal studies. It is a predictive statement.

Prevalence is the number of individuals who currently have the disorder. It is a head count. Does not make predictive statement. Usually measured through cross sectional studies.

Question 2

Describe the various forms of dysfluencies

Answer 2

Repetition- saying the same element of speech more than once (part word, whole word, phrase)
Sound prolongations- sounds produced for longer than typical (“MMMMommy)
Silent prolongations- articulatory posture held for longer than average (posture for /p/ in “pot” held for longer than normal)
Pauses- pausing at inappropriate moments
Broken words or intralexical pauses- silent intervals within words
Incomplete sentences- grammatically incomplete productions (“Last summer I was…we went to Paris this time.”)
Revisions- changes in wording that do not change the overall meaning of the sentence (“Let me have coffee, maybe tea.”)

Question 3

Sometimes people who stutter have associated motor behaviors and breathing abnormalities. List three associated motor behaviors and three breathing abnormalities that a person who stutters might manifest.

Answer 3

Motor behaviors:
Excessive muscular effort
Facial grimaces
Hand and foot movements (wringing hands, tapping the foot.)

Breathing behaviors:
Attempts to speak on inhalation
Holding breathing before talking
Speaking on an exhausted air supply

Question 4

Describe a direct stuttering reduction method. What are the specific procedures and how are they implemented?

Answer 4

Time out (pause and talk)-
Staying “stop” or giving other signals as soon as dysfluency is observed
Avoiding eye contact with the client for about 5 seconds
Reestablishing eye contact after the time out duration and letting the client continue his or her speech
Maintaining eye contact, smiling, and employing other social reinforcement for fluent speech
Good for older children and adults
Response cost- giving and taking away tokens
Good for very young children

Question 5

Distinguish stuttering of early childhood onset from neurogenic stuttering

Answer 5

Neurogenic stuttering is a form of fluency disorder associated with documented neuro patholology. Can be persistent or transient. Shares many symptoms with early childhood stuttering except for a few diagnostic features:

• Evidence of neuropathology and symptoms associated with neurologic disease
• Adult onset
• Repetition of medial and final syllables in words
• Dysfluent production of function words
• dysfluencies in imitated speech
• rapid speech rate
• lack of adaptation effect
• fewer associated motor behaviors
• minimal or no effects of DAF
• few attempts at speech avoidance

Question 6

The position that stuttering indicates a social role conflict was taken by

Answer 6

Sheehan

Question 7

Research on the prevalence of stuttering has shown that

Answer 7

• Familial incidence is higher than in the general population
• Sons of stuttering mothers run a greater risk than the sons of stuttering fathers
• Blood relatives of stuttering women run a greater risk than those of a stuttering man

Question 8

Stuttering in preschool children is more likely on

Answer 8

function words (pronouns, conjunctions, prepositions)

Question 9

Name some facts about stuttering adaptation when reading

Answer 9

Most of the reduction in stuttering occurs by the fifth reading.

Question 10

Brutten and Shoemaker proposed that:

Answer 10

• Stuttering is limited to part word repetitions and sound prolongations
• Stuttering is due to classically conditioned negative emotion
• Some dysfluencies are operantly conditioned

Question 11

Bloodstein advocated that stuttering may be caused by

Answer 11

Any belief that speech is a difficult task

Question 12

Describe the fluent stuttering treatment approach

Answer 12

-Developed by Van Riper
- Goal is not normal fluency, but more fluent stuttering
Steps:
-Teaching stuttering identification
- Desensitizing client to his/her stuttering (voluntarily stutter in many speaking situations)
- Modifying stuttering using different techniques

Question 13

Describe different stuttering modification techniques

Answer 13

• Facing difficult speaking situations
• Using cancellations (pausing after a stuttered word, then saying the word again with easy, more relaxed stuttering)
• Using pull outs (slowing down and using soft articulatory contacts instead of blocking sounds
• Preparatory sets (changing the manner of stuttering so client produced less abnormal stuttering)

Question 14

Cancellations, pull outs, and preparatory sets are taught in the ____ approach

Answer 14

Fluent stuttering

Question 15

Such skills as airflow management, gentle phonatory onset, and reduced rate of speech are targets in the ____ technique

Answer 15

Fluency shaping

Question 16

Name some characteristics of cluttering

Answer 16

Impaired fluency with excessive amounts of dysfluencies, rapid repetitions of syllables, rapid but disordered articulation resulting in indistinct (unintelligible) speech, clearer articulation and improved intelligibility at slower rate of speech, imission and compression of sounds and syllables, jerky or stumbling rhythm, monotonous tone, spoonerisms (“many thinkle peep so”), lack of concern about speech problem

Question 17

What are two good approaches to treating cluttering?

Answer 17

Reducing speech rate and increasing awareness of speech rate through audio and video recordings

Question 18

The theory that stuttering is caused by lack of a unilateral dominant hemisphere is the ….

Answer 18

cerebral dominance theory

Question 19

Best treatment approach for a child who has been stuttering since 3 years old whose parents are concerned about teasing, etc.

Answer 19

Response cost

Question 20

You have been asked to assess Rudy, a 65 year old man, for suspected neurogenic stuttering. Your assessment plan would include:

Answer 20

• Examination of medical charts to see if a neurological disease or trauma has been diagnosed.
• Assessing the possible coexistence of apraxia of speech, dysarthria, or aphasia
• Assessing symptoms of potential traumatic brain injury or degenerative neurological diseases
• Assessing the frequency and types of dysfluencies

Question 21

To distinguish neurogenic stuttering from that of early onset stuttering, you will assess the effects of….

Answer 21

DAF and the adaptation effect

Question 22

Common etiologic factors of neurogenic stuttering

Answer 22

CVA, Extrapyrimidal diseases (Parkinson’s), drug toxicity (asthma, depression, schizophrenia)

Question 23

Describe how you would use DAF to treat stuttering

Answer 23

• Use a DAF machine that allows for variable delays
• Determines a client specific duration of delay that assures stutter free speech
• Have client practice stutter free speech for varying lengths of time to eliminate stuttering
• Fade the delay while reshaping normal prosody and fluency

Question 24

How would you use masking to treat stuttering

Answer 24

• Determine a minimal level of masking that induces stutter free speech
• Have the client practice stutter free speech for variable lengths of time
• Fade the masking noise to reshape normal prosody while maintaining fluency

Question 25

Describe the fluency reinforcement method. Who would you use it for?

Answer 25

Young children

• Arrange a pleasant therapeutic environment
• Evoke speech with the help of picture books, toys, and other play materials
• Positively reinforce the child for fluent utterances
• Frequently model a slow, relaxed speaking rate
• Reshape normal prosody if a slower rate is an added target

Question 26

Goal of fluency shaping is…

Answer 26

fluent speech

Question 27

How would you implement fluency shaping as a treatment?

Answer 27

• Teach airflow management, gentle onset, and rate reduction to achieve stutter free speech, then shape prosodic features
• Start at the word, phrase, or sentence level depending on what the client can handle
• Use direct instruction, modeling, and corrective feedback for mismanaged skills and use similar techniques to shape prosodic features

Question 28

Using a psychological method of treatment for stuttering might include

Answer 28

• Discussion of psychological problems associated with stuttering
• Discussion of feelings and emotions associated with stuttering