Stuttering Lec 4

essential program components

improve speech flow control (motor strats)

reduce speaking related fears and improve attitudes

enhance pt independence

positive speech outcomes

acceptable stuttering

controlled fluency

spontaneous fluency

usual steps for therapy

identification phase

modification phase

transfer phase

maintenance phase

identification phase

find when they stutter and what they do when stut

relates to physical feeling of speech mvmts and muscular tension

modification phase

clinician teach strategies

point out disruptive aspects of speech

signal the client

transfer phase

generalizing from therapy to outside therapy

maintenance phase

follow up therapy

skills to maintain fluency

factors to consider for discharge

client satisfaction w/speech

client independence

score on modified erikson

availability of self help groups

stuttering modification: 2 major goals

1. eliminate habitual avoidances and struggle responses; respond in less abnormal ways

2. reduce strength of emotional responses

6 phases of stuttering modification approach

motivation

identification

densensitization

variation

modification/approximation

stabilization

motivation phase

goal = assess motiv for theraoy

needed to change behaviours and attitudes

identification phase of SMA

goal = combat denial, discriminate among behaviours

fluent speehc

expectancy reactions and cues

core behaviorus

post stuttering rxns

desensitization phase

goal = reduce speech anxieties

tell pt to pseudostutter (voluntary or pretend)

helps to take pressure off

focus on listener reactions

variation phase

goal = change way of stutter and rxn to it

modification/approximation phase

goal = learn strats to minimize dysfluencies

cancellation - say stuttered word, stop, repeat fluently after dysfluency

pull outs - slow motion stuttering; smooth out dysfluency as it's happening; control of moment

preparatory sets - slow motion; anticipate and glide thru smoothly before stutter

stabilization phase

goal = consolidate gains and increase automaticity

stutterer takes more control than guidance

voluntarily stutter; seek sits previously avoided

done thru practice, buffering, reconfiguring fluency

fluency shaping

teaching pt to speak so stuttering doesn't occur

very defined goals, small steps in therapy

strategies of fluency shaping

stretch out syllables

blending

soft contacts

full breath

easy onset

stretching out syllables

slow = focus on learning other techs and gain control

60spm --> 90, 120, 150, 180 (slow-normal rate), 220 (normal)

practice w/single words, phrase, sentence, para

how do you accomplish slowed speech

insert pauses

stretch out voiced sounds, esp vowels (emphasis)

blending

eliminate breaks bn words

blur transitions bn words --> slurred speech

read phrases as if one word

soft contacts

addresses hard artic contacts

only to consonants

taught basic vocab to see each POA and MOA and work thru them systematically

full breath

be aware of breathing and coordinate w/speech

full breath before speech, say utterance, exhale rest of air

easy onset (easy voice onset)

focuses voiced sounds esp words starting w/vowels

start breath stream before start to phonate

can use initial /h/ with words starting w/vowels

work at rate theyre speaking at

transfers

speak to ppl outside clinic

start easy w/fam and friends

w/ppl they know less well

in person and phone

intensive fluency programs

1.5 wks - learn techs and work thru slow speech rates

mid 2nd week - speak at moderate rate, transfers

cog focus - talk abt stutter, how it affects them, how their fluent speech feels, how self concept is changing

maintenance

continue to practice and get feedback

monthly meetings, courses, phone calls to SLP

high relapse rate

other fluency disorders

acquired neurogenic stuttering

acquired psychogenic stuttering

cluttering

palilalia

spasmodic dysphonia

acquired neurological stuttering

aka acquired or neurogenic stuttering

resembles developmental stutering after neurological event

repeat sounds and syllables, not only initial

function & content words difficult

more frustration than anxiety

how does speech sound for ANS

automatic

no secondary behaviours

not unitary disorder - everyone's diff

may accompany aphasia

persistent symp - bilateral neurological damage; transient - multiple lesions of one hemi

cause of ANS

stroke, head trauma, seizures

brain tumours

neurological disease - PD, dementia, drug use

acquired psychogenic stuttering

onset adulthood w/o neurological findings

emotional stress or other psych condition

can co occur w/ other existing neurological findings

conversion rxn

cluttering

separate or co occur w/other comm disorders

fast, uncontrolled speech rate --> truncated, dysrhythmic and unintelligible

omit pauses, phoentic units, final syllables

need to repeat themselves

speaker unaware of difficulty

palilalia

rare

compulsive and pathological reiteration of utterances of words and phrases

spasmodic dysphonia

voice disorder

to listens, sounds like stuttering

spasms and may use pre phonatory posturing to try get voice out

complain of lack of control when speaking

tips for speaking w/ppl who stutter

dont say slow down, take breath, relax

show you're interested in convo

dont look embarassed

maintain natural eye contact

wait patiently and naturally until they're done

don't finish their sentence/words

adjust your own speed to be slower

be esp patient on phone

don't show stress or impatience

if comofrtable, ask iif there's anything they want you to do

don't ignore person or speak to caregiver