Lecture 11 Flashcards
What is the prevalence?
implications re: under diagnosis
What is the prevalence under diagnosis due to?
- Relatively few clinicians are knowledgeable re: cluttering
- few clutterers self refer
- clutterers awareness of issue
what are considered Nature of cluttering
- fluency disorders: categorized by fluency issues (disfluency)
- stuttering: cluttering can co-occure with stuttering; stutterers know what they want to say; clutterers do not know what they want to say
- Articulation: deletion of sounds in multisyllabic words; deletion and neutralizing of syllables (e.g., “explation” for “explanation” or “inbitity” for “inability”; sometimes difficulties with /s/, /r/ and /l/
what are considered Nature of cluttering part 2
- language disorder:common co-exisiting issue; studies have shown MLU may be the same but clutterers seemed to exhibit less complete or less complex sentences; may have pragmatic issues
- Attention deficit/hyperactive:may coexist with cluttering
- specific learning disability: learning disabilities (LD) has been reported to coexist with cluttering; especially with problems in expression, reading and writing, handwriting
- other possible co-existing disorder: central auditory processing disorders; executive function/ organization problems, developmental apraxia
Cluttering Evaluation
- Primary focus of evaluation: rate; fluency, articulation, language and awareness
- Case history: information re: onset, course, co-existing, past current treatment; natal history; general language/motordevelopment; family history of fluency issues; medical issues; school/social issues
- Audio/video taping (to get samples)
- Speech/Language sampling: rote tasks ( days of week etc..); imitation (single syllables, multisyllabic words, and sentences) (where is the break down); oral reading;
monologue; conversation (small talk and topics of interest, including “letting down guard opportunities”, MLU, Language sampling analysis - Self Awareness: possibly Self Awareness Questionaire; Perceptions of Speech
Communication; St. Louis Inventory of Life Perspectives and Speech/Language Difficulty - Other: Oral motor exam; audiological/tympanography exam; central
auditory ; if suspected: LD assessment to include psychoeducational testing of reading, comprehension, spelling, writing, math, and other academic areas; psychological assessments of attention/distractibility
Treatment of cluttering
- Increase awareness and self monitoring skills
Improve: - Improve rate (articulation/speech intelligibility) (use machine to slow down speech)
- Linguistic and narrative skills (teach clients grammars, sequencing, use visual cues to organize lang)
- Fluency skills (using any type of previous activities using rate, overall video and audio taping)
- Meta-cluttering skills (increase awareness)
- Phonatory and respiratory behaviors
- Family, friend, employer support ( how cluttering is affecting them in life)
- Collaboration with other team members
SAAND?
Stuttering Associated with acquired Neurological disorders
SAAND causes?
- Cerebral Vascular Accident (CVA- Stroke)
- Traumatic Brain Injury (TBI)
- Persistent stuttering- associated with bilateral (both) pathology
- Transient stuttering- associated with unilateral pathology
SAAND Evaluation focus:
Evaluation focus: need to differentiate between stuttering that is
developmental, neurological, and psychogenic in nature
SAAND case history::
interview components should include information
concerning onset, precipitating events including psychological or
neurological in nature; other medical and family history; current status of
disfluencies; awareness of stuttering and secondary behaviors if any
What are SAANDs 2 basic questions?
- Is the stuttering developmental stuttering in nature?
(Was theres tuttering before) or neurogenic (something that happened prior to stuttering i.e. cba, tbi) - Is the stuttering neurogenic or psychogenic (emotional trauma before stuttering)?
Nuerogenic stuttering
exists if there is a “… clear neurological event
preceding onset of stuttering”, and there exists a “… reasonable
link between the event and the speech difficulties and no evidence of
pre-morbid (pre event of stuttering) stuttering”…;
Developmental stuttering
-may exist if the trauma “….may have
triggered co-occurrence or aggravation of pre-existing stuttering
disorder.”
Mahr and Leith (1992) define the diagnosis criteria of psychogenic stuttering as follows
(1) a change in speech pattern suggesting stuttering
(2) a relationship to psychological factors as evidenced by an onset associated with emotional conflict and or secondary gain
(3) the lack of evidence of organic (neurological disease) etiology
(4) a past history of mental health problems
(5) atypical disfluencies…. (no stereotypical repetitions or secondary behaviors)
(6) …. lack of emotional responses to the disfluencies
(7) interpersonal interactions of somewhat unusual or bizarre quality
SAAND Evaluation continued:
Need to rule out aphasia, word finding difficulties or motor speech issues
- Assessments that can be used:
- Boston Diagnostic Aphasia Battery
- Aphasia Diagnostic Profile
Other Evaluation Components:
Fluency evaluation: reading single words, short sentences, paragraph
monologue, and conversation
-Automatized tasks: ( e.g., counting, days, months, singing, pledge of allegiance, choral reading, etc..)
- Speech variability situations
Other evaluation factors:
- need to rule out aphasia/word finding issues
- neurogenic vs developmental; consider where disfluencies occur;
- in most cases developmental stuttering occurs more at the beginning of utterances, word- initial; phrase-initial, sentence-initial
- SAAND Stuttering can occur in word- medial; word- final positions **
- in most cases SAAND stuttering occurs on small grammatical words (such a determiners: the, an, a; prepositions: in, on; pronouns: his, their. SAAND Stuttering can occur in word-medial; word- final positions
- concomitant/ secondary behaviors are rare in SAAND; no eye blinking etc…
- look for adaptation effect- 70% of Developmental Stuttering client show adaptation effect. Repeated readings become more and more fluent. SAAND has no adaptation effect.
- automatized tasks such as counting, days of week, pledge of allegiance, singing, choir reading are not more fluent with SAAND
SAAND Intervention possibilities:
- Surgical intervention: endarterectomy: clearing of carotids; opening of carotid stenosis; thalamic electrical stimulation: implanted electrodes in thalamus
- Pharmacology: antiseizure medication; controlling seizures may reduce stuttering
- DAF (Delayed Auditory Feedback): some success reported; as well as
using white noise machine - Biofeedback and relaxation techniques
- Speech pacing: slow rate; speak one syllable at a time; pacing board/visual cues, work sheet with square boxes, other visual cues.
California Code of Regulations;
Chapter 3: Section 56333
Fluency Disorders. A pupil has a fluency disorder
when the flow of verbal expression including rate and
rhythm affects communication between the pupil and
listener.
