General Information Flashcards
What is an impairment?
Impairment: “…any loss or abnormality of psycho-logical, physiological, or anatomical structure or function.”
What is a disability?
Disability: “…any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.”
What is a handicap?
Handicap: “ …a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual.”
Give an example of an impairment
Impairment: Complete tear of medial collateral ligament
(MCL), torn medial meniscus, and partial tear of the left
quadriceps muscle
Give an example of a disability
Disability: Functional difficulties included standing, walking, running, playing sports, lifting weights, pushing, balancing, transferring, dressing, etc
Give an example of a handicap
Handicap: Difficulty with job tasks and overall independence; additional economic impact
What does ABC stand for?
A = Affective reactions (feelings & emotions associated with stuttering)
B = Behavioral reactions (tension, struggle, avoidances)
C = Cognitive reactions (thought processes associated with stuttering)
What are the 4 domains of fluency?
- Motoric skills
- Linguistic skills
- Cognitive abilities
- Socio-emotional skills
What does CALMS stand for?
Cognitive (Thoughts, Perceptions, Awareness, Understanding)
Affective (Feelings, Emotions, Attitudes)
Linguistic (Language skills, Language formulation demands, Discourse complexity)
Motor (Sensorimotor control of speech movements)
Social (Effects of type of listener and speaking situation)
Are there periods of decreased transition
smoothness?
YES
Normal disfluency (1.5-6 years):
- Core behaviors- easy, clonic repetitions 10 or fewer disfluencies per 100 words, interjections and revisions due to language learning
- Secondary Behaviors- none
- Feelings and Attitudes- no awareness or concern from the child
- Underlying Processes- stresses of speech, language and psychosocial development
Borderline Stuttering 1.5-6 years:
- Core behaviors- 11% or more disfluencies per 100 words, more iterations 2+ sound/syllable repetitions, 3+ whole word repetitions, more prolongations, will see revisions, interjections, not too many blocks/tonic stuttering, not struggling
- Secondary Behaviors- not many, if any
- Feelings and Attitudes- may be momentary surprise or mild frustration, does not last long
- Underlying Processes- still stresses of speech, language and psychosocial development, may now see interaction with constitutional predisposition (the environment is blending with genetics/nature)
Beginning Stuttering: ages 2-8
Beginning Stuttering: ages 2-8
* Core behaviors- instead of clonic it is more tense, rapid, irregular, and tense repetitions seen, fixed articulatory posturing and blocks
* Secondary Behaviors- escape behaviors, eye blinks, increasing pitch and loudness, more reactions and manifestation of struggle with stuttering
* Feelings and Attitudes- greater awareness of disfluencies, more frustration, conditioned emotional reactions that cause tension,
* Underlying Processes- classical and instrumental condition leading to escape behaviors
Intermediate Stuttering (6-13 years)
Intermediate Stuttering (6-13 years)
* Core behaviors- more blocks where sound and airflow is disrupted
* Secondary Behaviors- avoidance behaviors as a result of cognitive awareness and escape behaviors
* Feelings and Attitudes- fear before stuttering, frustration and embarrassment during stuttering, shame and embarrassment after stuttering
* Underlying Processes- avoidance conditioning
Advanced Stuttering (14+)
Advanced Stuttering (14+)
* Core behaviors- long, tense blocks with tremor of lip, tongue, jaw, more overt stuttering or less overt stuttering, increased covert stuttering,
* Secondary Behaviors- become better at hiding it
* Feelings and Attitudes- negative self-concept, growth in the subsurface
* Underlying Processes- cognitive learning and recognition of communication difficulties
What are Bloodstein’s 4 phases?
Incipient
Transitional Phase
Confirmed
Advanced Phase
Describe the incipient phase (phase 1) of stuttering?
a. Between 2-6 years of age (preschool age)
b. Episodic in nature, when upset/tired/excited, presentation of lengthy info
c. Dominant symptom is repetitions syllables and words
d. Beginning of sentences disfluencies most common
e. Both on content and non-content words
f. Very little concern for speech disfluencies
g. Typically clonic
h. Increasing tonic aspects (tension/squeezing and muscular effort)
i. Fluctuation widely varies
j. Stuttering increases with communication pressure
Describe the 2nd phase (transitional phase) of stuttering?
a. Early elementary school
b. Becoming more chronic in nature
c. Identify themselves as children/people who stutter
d. Disfluencies are more common on content words
e. Not too much concern for their speech still
f. Repetitions increase
g. Rapid rate of speech/excitement increases disfluencies
h. Harder contacts, more tonic aspects
Describe phase 3 (confirmed phase) of stuttering?
a. Late childhood/early adolescence
b. Disfluencies become aligned with specific situations
c. Specific sounds and words that are difficult to say
d. More covert and avoidance tendencies, word substitutions and circumlocutions to avoid the words
e. Increasing fear, embarrassment, avoidance of certain speaking situations
f. Fully developed stuttering
g. More difficulty in specific situations
Describe phase 4 (advanced) of stuttering?
a. Later adolescence/adulthood
b. Anticipation of disfluencies, vivid fear
c. Identification of feared sounds, words, speaking situations as a result of cognitive learning and instrumental conditioning
d. Circumlocutions
e. Chronic awareness and avoidance
f. Fear, anxiety, embarrassment
g. Continual anticipation
What are capacities in the DCM?
Capacities (i.e., intrinsic skills and abilities)… ❖ to move articulators ❖ to select intended words ❖ to formulate sentences ❖ to employ appropriate pragmatic skills ❖ to coordinate speech motor system
What are the demands in the DCM?
Demands (internal and external) encountered… ❖ by the child ❖ by other speakers ❖ by the topic being discussed or ❖ by the complexity of the language/vocabulary ❖ by the pace of or competition for talking ❖ by the awareness level
Internal and external demands (environmental factors resulting in reduced fluency) placed on the child (e.g., elevated speaking rates, complex language structures, time demands, questioning behavior, etc.)
What are the components of stuttering?
- Neurological system: Brain process and transmission of messages via the motor units.
- Respiratory system: Air is requisite for sound and speech. (* Stuttering perturbs breathing, not the opposite. *)
- Laryngeal Function: a. Voiced and Voiceless phoneme production b. Appropriate air pressures and translaryngeal airflow
-most sensitive element - Articulatory system: Production of specific speech sounds.
- Resonatory System
- Psychological component
What is cluttering?
Cluttering- the message gets stuck, intelligibility is impacted, rapid rate of speech, festination
what are the 3 distinct types of stuttering?
1.Early childhood stuttering (majority of the cases)
2. Psychogenic stuttering (infrequent clinically; onset in adulthood) trauma/emotional insult
3. Neurogenic stuttering (subsequent to brain lesion [e.g., CVA] or disease)
Clonic Stuttering
Easy; relatively tension-free; little muscular effort or involvement
Tonic Stuttering
Tension-filled disfluencies; muscular effort; struggle
What are the types of Secondaries?
- Escape Behaviors: ways to stop stuttering and get the word out (intra-stuttering or during stuttering) - Eye blinks, head nods, interjections, loss of eye contact
- Avoidance Behaviors: speaker knows stuttering is coming; attempts to stall or stop stuttering from occurring (pre-stuttering or before stuttering); person rewarded and feels at ease when stuttering does not occur.
What is stridor?
Audible inspiration
- Avoidances- avoiding words, avoiding sounds, changing order of words, waiting for help on the word, pretending to think, using condensed/telegraphic speech
- Postponements – stalling, delaying onset of stuttering, pausing, filling pauses with vocalizations, repeating preceding words, sounds, phrases, prolonging last part of preceding words, slowing down rate of speech
- Starters – initiate speech, using a starter word/phrase/sound, using a stereotypical movement before the word is attempted (eye blink, body jerk), repeating a preceding phrase, changing rate of speech, changing pitch and intensity, increasing or decreasing tension in speech
- Anti-Expectancies – attempts to destroy the fear of the approaching word, using a kind of speech where nothing stands out and it monotonous, may be slow, deliberate, rapid or slurred speech, thinking about other things that are not about stuttering, assuming an attitude of self-confidence, humor, whispering
- Releases – letting out a starter, trying again,
All kinds of secondaries
What is REL?
37% of vital capacity (residual air)
People who stutter may speak on residual air to hold onto their fluent speech
What is the 4-factor definition of stuttering?
Factor 1: Stuttering is a developmental disorder of childhood. - 90% of cases begin between ages of 2-5 years (Andrews et al., 1983) - 70% of cases begin by 3½ years of age (Yairi & Ambrose, 2005) - Usually does not begin later in age unless acquired
Factor 2: The cause of stuttering is unknown. - Research has identified that children have a genetically transmitted neurological predisposition to stuttering (Felsenfeld, 2002; Ambrose et al., 1993) which interacts with environmental conditions, external factors (others’ reactions to stuttering), intrinsic child factors (child’s reactions, sensitivity, perfectionistic tendencies, or temperament), and communicative stressors (Yaruss, 2007; Ramig & Dodge, 2005), serving to influence stuttering development. - Research has identified noted differences in the neurophysiologic systems of individuals who stutter.
Factor 3: Individuals who stutter view communication differently from speakers who do not stutter. - person’s expectations are different
Factor 4: Clients have abnormal overt and covert communication behaviors. - primary stuttering characteristics - secondary stuttering characteristics
What does VOT stand for?
-voice onset time- glottal vibration, people who stutter demonstrated longer voice onset times
What does VIT stand for?
Voice initiation time
What does SIT stand for?
Speech initiation time
What are 3 areas we may assess?
- Anticipation: Expectation to stutter on a word resulting from experience, sound and word fears, etc.
- Adaptation: Decrease in stuttering given repeated readings of a written piece.
- Consistency: The amount that the same words are stuttered on consistently during the course of repeated readings
ACCESSing Communication acronym?
Affective
Cognitive
Concomitant Disorders
Environment
Social Skills
Speech/Motor skills
