Stammering Flashcards
Difference between dysfluency and disfluency
Dis- normal non fluency
Dys- disorder
Male to female ratio of stammering
4:1
What model is often used to look at the personal factors, activity limitation, participation and environmental factors of stammering
Yaruss and Queasal 2006
Name 3 forms stammering can take
Repetitions
Prolongations
Blocks
What is a block?
Stoppage of air/voice or articulators
Name some behaviours that are not considered to be stammering
Repetition of multisyllabic word eg “mummy mummy mummy”
Pauses
Revisions
Name some escape and avoidance behaviours
Fillers eg- well actually
Eye blinks
Head jerks
Avoidance of sounds/ words/ situations
Who’s model is the ice burg
Sheehan 1970
Describe the overt and covert parts of the iceberg
Overt- what we can hear and see
Stammered speech
Some secondary behaviours
Covert- thoughts about stammering and self
Feelings
Some secondary behaviours eg avoiding words
Describe the macro and micro environmental factors
Macro- support and relationships
Professionals eg teachers
Attitude of society
Micro- specific speaking situations eg phone calls
With reference to literature describe participation restriction in schools
Daniels et al 2012- more likely to be rejected by peers
What is the conflict theory?
Sheehan 1970
Conflict between identifying as a fluent speaker and identifying as a person who stammers
Describe the genetic theory of stammering with literature
Runs in families
Males more at risk
Yairi 1992- 66.3% participants had positive history
Describe the brain structure and function theory of stammering
Some changes in brain imaging
Impairment of left hemisphere
Some children have the ability to switch speech to right side of brain
Describe the basal ganglia theory of stammering
Basal ganglia is processing unit
Causes movement of speech to be triggered
Disorder- motor initiation problem
BG sends pulse to cortex to release mvmt if the pulse is weak- stammer?
Noisy background - cluttering?
Describe sensorimotor deficits theory of stammering
PWS impaired on speech and non speech motor tasks
Articulatory discoordination during fluent speech- eg more slowly
Affected by syntactic complexity - more complex task puts more demand on individual
Describe Levelts monitoring loops
Internal loop- before preverbal plan generated
After phonetic plan
External loop- after speech articulated
Describe the vicious circle hypotheses
Vasic and Wijnen 2005
PWS do so because they are trying to avoid it
What environmental factors could affect stammering?
rapid speech rate
Competition for speaking
Frequent interruptions
Complex syntax
What are the linguistic and physiological aspects of Palins multifactorial model
Linguistic- syntactic complexity - language and phonology skills Physiological- genetics - basal ganglia - gender
Describe the demands and capacities model
Starkweather (1987)
Capacities- what the system can offer
Demands- what tasks the system needs to perform
Stammering occurs when demands exceed capacities
With reference to literature describe the features of normal dysfluency, borderline stammering and beginning stammering
Guitar 1998,2006 Normal- <10/100 words stammered Borderline - 10/100 Beginning - rapid/ irregular blocks Some secondary behaviours Aware
Describe intermediate and advanced stammering
Intermediate- blocks in which sound and airflow are cut off Escape and avoidance behaviours Fear/ frustration Advanced- long tense block Escape and avoidance Negative self concept
What are some risk factors for persistent stammering
Being male 12> since onset Relative who stammers Anxious temperament Phonological problems
Name some assessment tools in children
Case history
Observation
Pre appointment questionnaire
Audio/ video recording
Describe single syllable whole word repetitions
And-and- and
How would you draw a sound prolongation
M:ummy
How would you draw a block
(B)all
What is the calculation for percentage syllables stammered
Total number of syllables stammered / total number of syllables x 100
What should you ask in a case history for a child
Age of onset >12 months? Awareness How does it present Temperament Life events Parents concerns S&L milestones
Name some indirect and direct interventions
Indirect- change environment - demands and capacities PCI Direct- lidcombe <6 - fluency shaping - gradually increase length of childs utterance
What advice could you give to parents?
Modelling pauses
1:1 quality time
Avoid interrupting and asking lots of questions
Encourage them to observe fluency environments
Name some potential fluency disrupters
Direct questions Complex speech Competitive speaking environments Rushed speaking Negative comments
Describe PCI
Take video
Follow childs lead in play using commenting
Special time- 5 mins 1:1 undevided attention with child picked activity
1 hour sessions- 6 weeks
Describe lidcombe
Based on operant conditioning Aims to make speech fluent Praise and acknowledge ‘smooth’ speech - ‘was that smooth?’ Only when fluent Acknowledge ‘I heard a bump’ Comment more on smooth speech
What else would you need to gather in a case history for adults
Whether they had any previous SLT input Developmental stammering? Has there been a change in the stammer Tension behaviours in speech Feelings? Self concept?
Name 4 tools for assessment
WASSP- looks at covert features of stammering
OASES- yaruss 2006- likely scale, agree or disagree with statement 7+
ACES- similar to OASES but for children
CAT- children’s attitude test
What would you look for when assessing PWS speech
Frequency of stammer Type Duration Secondary behaviours Rate Pitch
What are the 5 principles of ‘stammer more fluently’
Variation Identification Desensitisation Avoidance reduction Voluntary stammering
What is variation
Change around speech/ non speech items
Broaden self construct
Stammer in different way?
What is identification
What happens when they stammer?
Map out stammer on to iceberg
Thoughts/ feeling
What is desensitisation
Van riper
View it in less scary way
Broaden construct of what stammering is
Confronting disorder
What is avoidance reduction
Sheehan
Reducing avoiding words/situations/feelings/ relationships
What is voluntary stammering
Stammering modification
Gaining control
Theory behind stammering modification
Van riper 1973
Fear of stammering- increased stammering
Replace stammer with less difficult stammer - reduce fear and avoidance
Name the three stages of block modification
Post block modification -ask client to stammer, think about stammer, do it again but easier
In block modification- do something in the moment
Pre block modification- know you may stammer so make it easier beforehand
Describe soft contacts
Hearing difference between hard and soft contrasts
Experiment with softness
What is easy onset
Taught in context of breathing
Exhale first - gradual onset of phonation
What is the camper down programme
Used for older children
Aim- not stammering
Very slow exaggerated talking
What packs can be used with children to represent slowing etc
Swindon fluency packs
What is cluttering
Uncontrolled speed of utterance Rapid, dysrhythmic Speech sounds jumbled Handwriting affected? Difficulty planning sentences Word finding difficulties
Discuss attention and disinhibition in cluttering
Insufficient attention to listener
Poor self monitoring of speech
Impulsive/ impatient/ excess talking
What would you look for in assessment of cluttering
Dysfluency types
Rate
Festinating (speeding up)
Grammatical error
Describe the scores for cluttering/not cluttering on the predictive cluttering inventory
> 120 cluttering
<80 not cluttering
Intervention for cluttering
Increased monitoring (recording themselves?)
Modify rate
Improve attention span
Over articulation
Name the 5 types of acquired stammering
Neurogenic Psychogenic Drug induced Aggravated developmental Idiopathic
Describe neurogenic stammering
Following neurogenic disease/event eg stroke/ TBI (75%) disease (16-18%)
Not related to function words
Speaker annoyed not anxious
Absence of secondary behaviours
Describe psychogenic stammering
As a result of emotional trauma or stressful event
History of mental health problems?
Presence of primary and secondary gain
(Primary- benefit eg more attention, time off work)
(Secondary- changes to interactions?)
Can be intermittent
What is aggravated developmental stammering
Late onset- developmental but reoccurring?
What is drug induced stammering
Can be side effect of some medications
What is idiopathic stammering?
No history
No neuropathology
No medication
No trauma
