Other fluency disorders: SAAND, cluttering, cluttering treatment Flashcards
What is SAAND?
Stuttering after acquired neurological damage
- when the stuttering behaviour first occurs, noticeably worsens or re-occurs in the presence of acquired neurological problems
What is neurogenic stuttering, and some potential aetiologies?
- stuttering cause or exacerbated by neurological disease/damage: typically acquired after childhood
Aetiology may be: - stroke
- head trauma
- tumour
- Parkinson’s
- drug toxicity
What are the steps involved in the diagnosis and evaluation of neurogenic stuttering?
- Complete case history
- Direct assessment of speech
How could you directly assess speech of a neurogenic PWS?
- SSI-4
- analysis of speech sample
- proportion of stuttering function vs. content words
- presence of stuttering on non-initial syllables
- absence of secondary behaviours
- passage reading to be read 6 times to determine if stuttering is reduced through repeated readings
- speaking in a variety of fluency-inducing conditions (DAF 250-ms delay, listening to loud masking noise)
Compare and contrast the speech behaviours of neurogenic and developmental stuttering?
Neurogenic:
- stuttering on function and content words - equally affected
- not restricted to initial syllables in words
- rarely are there are secondary non-verbal behaviours
- no adaptation effect occurs with repeated readings
- less responsive to fluency-enhancing conditions
- individuals may appear annoyed or frustrated
Developmental:
- stuttering more frequent on content words
- primarily on initial syllables
- usually escape and avoidance behaviours which are at times severe
- sudden decrease in stuttering frequency with successive readings (5th reading = 50% reduction)
- noticeable reductions in stuttering - speaking to rhythm, masking noise, DAF
- have already developed fears and anxiety about stuttering and speaking
List, and briefly describe, some treatment approaches for treating neurogenic stuttering.
- Behavioural treatments
- pacing: speaking 1 syllable at a time, regular staccato rhythm
- tapping of thigh rhythmically to produce fluent speech
- slow rate and easy onset
- stuttering modification: light contacts, pull outs, cancellations and preparatory sets
EMG biofeedback - Neurosurgery
- can resolve or improve stuttering; implantations of electrodes to stimulate thalamus - Medications
- NOT CURRENTLY TRIALLED
Describe psychogenic acquired stuttering
- later onset
- typically begins after prolonged period or stress after a traumatic event
- conversion symptom - physical or behavioural expression of psychological conflict
- involuntary
- resembles developmental stuttering in terms of core behaviours
- may occur alone or together with other signs of psychological or neurological involvement
Discuss the diagnosis and evaluation of psychogenic acquired stuttering
(multi-disciplinary approach needed: neurology, psychiatry and SP)
- complete case history
- motor speech exam (rule out apraxia or PD)
- assess language and cognition if indicated
- ask client to speak under fluency enhancing conditions
- trial therapy
- analysis of stuttering (SSI-4)
What is the nature of the speech of someone who clutters?
- rapid speaking
- difficult to understand
- words may be collapsed
- sounds may sound slurred
- word repetitions
- revision and restarts
- hesitations
- all usually without tension
- speaking rate is not continuously rapid - sudden bursts filled with misarticulations and disfluencies
-can become more fluent, slower and intelligible when they control their disorder BUT rarely happens because
PEOPLE WHO CLUTTER ARE UNAWARE OF THE DISORDER
What is ‘mazing’?
- repeated false starts, hesitations, revisions that leave listeners puzzled about a speaker’s verbal destination
- rambling, run-on verbalisations that add nothing to the content of the message
What are some features of cluttering?
- lack of effective self-monitoring skills
- lack of pauses between words
- lack of awareness
- imprecise articulation
- compulsive talkers
- language disorganised
- poor attention span
- perceptual weakness
- excessive repetitions
What are some associated symptoms with cluttering?
- articulation and motor difficulties
- syntactic difficulties
- vocal monotony
- reading disorders
- writing disorders
- distractibility
- lack of rhythm and musicality
- restlessness and hyperactivity
-hereditary links - learning difficulties
List how you would directly assess the speech of someone who clutters.
- recording of speech (reading passage situational recording, produce multisyllabic words, words with differing stress patterns)
- analysis of rate (SPM)
- analysis of stuttering vs. cluttering
- meaningful vs. extraneous syllables
- analysis of intelligibility
Compare and contrast features of i)stuttering and ii) cluttering
Thought planning and language:
i) knows exactly what they are saying
ii) disorganised thoughts and verbal clarity
Fluency behaviours:
i) all core behaviours + revisions, interjections
ii) repetitions (word) dominate + interjections, restarts, revision. Blocks rare
Secondary behaviours:
i) common
ii) rare
Speech clarity:
i) clear intelligible and consistent
ii) distorted, telescopic, unintelligible patches
Anxiety:
i) can be high
ii) minimal
Learning problems:
i) occasional
ii) usual
Pragmatics:
i) not typically impaired
ii) verbose, impulsive, unable to consider communication partner. Difficulty ‘reading’ social cues
Compare and contrast features of i)stuttering and ii) cluttering
Thought planning and language:
i) knows exactly what they are saying
ii) disorganised thoughts and verbal clarity
Fluency behaviours:
i) all core behaviours + revisions, interjections
ii) repetitions (word) dominate + interjections, restarts, revision. Blocks rare
Secondary behaviours:
i) common
ii) rare
Speech clarity:
i) clear intelligible and consistent
ii) distorted, telescopic, unintelligible patches
Anxiety:
i) can be high
ii) minimal
Learning problems:
i) occasional
ii) usual
Pragmatics:
i) not typically impaired
ii) verbose, impulsive, unable to consider communication partner. Difficulty ‘reading’ social cues
What are features of cluttering treatment?
- tailored to client’s unique difficulties
- minimal evidence suggesting standard procedures
- number of strategies shown effective
- aim to include speech, language and other skills that may impact communication skills
- need to remember that stuttering reduction is also important and should be prioritised if dominant feature
- can incorporate fluency shaping strategies
What are features of cluttering treatment?
- tailored to client’s unique difficulties
- minimal evidence suggesting standard procedures
- number of strategies shown effective
- aim to include speech, language and other skills that may impact communication skills
- need to remember that stuttering reduction is also important and should be prioritised if dominant feature
- can incorporate fluency shaping strategies
Why is slowing rate useful in cluttering treatment? List some strategies
- effective in ameliorating range of cluttering symptoms
- more difficult to achieve and maintain slow rate for a PWC
- Operant conditioning
- Biofeedback
- ‘speeding tickets’
- DAF and other assistive devices helpful
Paced reading tasks are useful
Why is heightening monitoring a good treatment for PWC? List some strategies
- need to learn to monitor their speech (many are unable to)
- difficult to teach
- ask them to imagine speaking clearly prior to communication and use self-talk, affirmation to strengthen those images
- SS or PS
Why is using clear articulation a useful treatment for PWC? List some strategies
- slowing the rate or learning to monitor more effectively = clearer speech
- use conventional articulation treatment strategies
Why is verbal planning a useful treatment for PWC? List some strategies
- language treatment recommended if previous strategies have not been effective
- begin with simple, short sentences and progress to longer, more complex
Why is ‘interacting with listeners’ a useful strategy for PWC? What does this treatment look like?
- training in anticipating, perceiving, and responding to standard conversation cues
- turn-taking
- learning how to respond using facial cues
- ‘checking in’ with the listener
Why is ‘speaking naturally’ a useful treatment for PWC?
- rapid, irregular, slow and robotic rates are unnatural
- need to vary both syllable durations (especially of stressed syllables) and intonation - done during Mater SS
- provide immediate feedback for strange sounding speech
- combined with clarity treatment
Why is ‘reducing excessive dysfluencies’ a useful treatment for PWC?
- many PWC also stutter
- excessive stuttering dysfluencies or cluttering dysfluencies should be the last speech aspect treated - for those PWC with minimal stuttering
- if stuttering is dominant = fluency shaping strategies are recommended
Why is ‘relaxation’ treatment useful for PWC?
- general relaxation/meditation, breath control (deep diaphragmatic breathing), PMR and visual imagery exercises may help to decrease impulsivity and distractibility
- attention deficits are also common so sustaining relaxation will be a challenge initially
