Study Guide for Exam1 in SLP 664 Fluency Disorders

What are some fluency-inducing behaviors and conditions?

1. Choral reading

2. Delayed auditory feedback (DAF)

3. Rhythmic Stimulation (metronome effect)

4. Loud Noise (white noise effect)

1. Choral reading

Reading it together

Delayed Auditory Feedback (DAF)

Hearing your own voice being played back via a device, a fraction of a second late to encourage self-monitoring and slows speech rate.

Rhythmic Stimulation (Metronome Effect)

Syncing/timing one's speech to the beat of a metronome which typically results in slower, less typical sounding speech pattern.

Loud Noise (White Noise Effect)

Noise in the environment while a person who stutters is speaking to increase the loudness of speech; speaking loud appears to decrease stuttering to some degree.

Consistency of Stuttering

Tendency to stutter on the same words when repeatedly reading the same text aloud.

Adaptation of Stuttering

Decreases in stuttering frequency during successive oral readings of the same material aloud.

Sound Repetition

M-m-my ice cream.

Single Syllable Word Repetition

I-I-I-I like vanilla ice cream.

Audible Sound Prolongation

Mmmm-more ice cream please.

Blocks (Inaudible Sound Prolongation)

T- (silence while the pt holds artic posture) -oday is Monday.

Interjections

I will be uh uh uh late.

Revisions

She is- she was here.

Phrase Repetitions

I was- I was here.

Classical Conditioning

Consistently pairing two unrelated stimuli together until one stimuli is associated with the other.

Link Stuttering

A form of classical conditioning. Negative emotion becomes paired with speaking.

Operant conditioning (Skinner)

A behavior gets stronger or weaker because of its consequences: reinforcement or punishment. The learning comes after the behavior.

What are the four operant conditioning?

1. Positive reinforcement → Giving Penn a treat when he sits on command

2. Negative reinforcement → Turning off a beeping sound when you put on your car seatbelt.

3. Positive Punishment → Giving a kid extra chores b/c they missed curfew.

4.Negative Punishment → Taking a kid's cellphone b/c they missed curfew.

Two-Factor theory:

Operant conditioning produces the secondary/associated behaviors (head jerks, eye closing, looking away). These are learned through escape and avoidance.

EX: A child gets through stuttering by closing their eyes, so now they start doing that

Demands and Capacities Model

Stuttering occurs when the "demands" (social or otherwise) exceed the speech capabilities (social-emotional maturity, language formulation, cog skills, speech motor).

According to the diagnosogenic theory, how did the disfluencies of children who stutter compare to those of children who don't, near onset?

They were the same; what differed was the parents' reactions

The children's disfluencies were assumed to be normal: brief, "effortless" repetitions. Some parents "diagnosed" those normal disfluencies as stuttering.

In the diagnosogenic theory, what turns a normal disfluency into stuttering?

Parents react with concern, worry, or upset, so the child tries harder not to be disfluent to avoid disapproval, and that struggle becomes stuttering

What happens, according to the theory, if parents perceive the disfluency as normal?

The child develops normal, fluent speech

No negative reaction means no struggle, so the normal disfluency stays normal and the child develops typical fluency.

Which quote summarizes the diagnosogenic theory?

Stuttering begins in the ear of the parent rather than the mouth of the child

What is the clinical application of the Anticipatory Struggle Hypothesis?

As SLP's we should reduce communicative pressure, build the child's confidence, and treat the anticipation struggle so speech becomes less difficult.

What is the main criticism of the diagnosogenic theory?

It can't easily be tested (it isn't falsifiable), and genetic findings show nature plays an important role

What are the DIVA family of models?

Neurocomputational models of speech production by Guenther and colleagues

They model normal speech motor control. They are NOT theories of stuttering in themselves, but have been applied to studying stuttering.

What does DIVA stand for, and what is it?

Directions Into Velocities of Articulators: a computational and neuroanatomical model of speech production with feedforward and feedback control

In DIVA, what is FEEDBACK control?

Monitoring what you just said (auditory feedback) and felt (somatosensory feedback) and correcting errors

In DIVA, what is FEEDFORWARD control?

Anticipating and correcting errors before they occur

What does GODIVA add to the original DIVA model?

Neural processes for initiating (starting) and sequencing speech sounds

What is SimpleDIVA?

The newest, "streamlined" neural network model of speech motor development and production, built to better describe people with speech disorders

According to DIVA/GODIVA-based research, what may be impaired in stuttering?

The basal ganglia, cortex-basal ganglia-thalamus connections, and cortical processing, making it hard to start the next speech movement

What is the clinical application of the Covert Repair Hypothesis?

As SLP's we should cue slow the speech rate to give encoding more time, and target phonological accuracy.

Covert repair hypothesis (Postma & Kolk, 1991) defines that

PWS have difficulty with phonological encoding and are given opportunities to correct frequent errors, however, byproduct are more dysfluent.

Triggered by errors in phonological plan caught by internal monitoring

Studies found children who stutter has delay in transitioning to more complex verbal expressions

Clinical Application of Diagnosogenic Theory

This was DISPROVED. Do not blame the parents.

Transcranial Magnetic Stimulation

magnetic fields are used to stimulate brain activity

Event-Related Potentials

using electrode caps, stimuli such as semantically anomalous sentences "We sleep the floor with a....rake" can be presented to tongue children to evoke

Diffuse Tremor Imaging

fractional anisotropies of the white matter pathways in the brain can be measured

Positron Emission Tomography

radioactive drug (tracer) shows colorful brain activity

Functional Magnetic Resonance Imaging

cerebral blood flow is shown with high spatial resolution in a magnetic field that produces three-dimensional detailed anatomical images of brain structure

Basal Ganglia Location

Deep within white matter of the cerebral hemispheres near the base of the forebrain and the top of the midbrain.

Putamen Function

Selection and initiation of movement sequences

Supplementary Motor Area Location

It's the dorsomedial frontal cortex, sitting on the medial surface of the superior frontal gyrus

Thalamus Location

subcortical gray matter

Thalamus Function

A relay station for signaling between the cortex and the basal ganglia associated with motor control

Iatrogenic

Negative effects resulting from treatment, product, or service that was intended to provide a health benefit (meds that cause acquired stuttering or worsening stuttering).

Putamen Location

Deep at the base of the forebrain, sitting at the outermost part of the basal ganglia

Frontal aslant tract function

Plays a role in planning, timing, and coordinating sequential motor movements

Cerebellum Functions

Coordinates voluntary movements, balance, posture, and motor learning

Frontal aslant tract location

frontal lobe of the brain

Cerebellum Location

Lower back of the brain, directly beneath the occipital and temporal lobes and behind the brainstem

Basal Ganglia Function

It helps initiation and fine-tune voluntary motor movements.

Gray Matter

neuronal cell body, dendrites, and unmyelinated axons that analyzes incoming sensory information and transmits voluntary muscle movements.

White Matter

neuronal somas, axons with myelinated sheaths for increased signal transmission speeds, works to connect different cortical areas in the brain

Transcranial Electrical Stimulation

a low intensity electrical current (direct or alternating) stimulates the brain through electrodes placed on the scalp

Chromosome

structure made up of DNA and proteins that carry genetic instructions for any living organisms

What is an agnoist?

an agonist allows actions to happen by activating receptors

what is an antagonist?

Antagonists inhibit actions by binding to receptors before the agonist would bind.

why is a dopamine blocker / dopamine antagonist type of medication often effective in reducing stuttering?

PWS have excess dopamine, so dopamine blockers/antagonists help because it regulates the dopamine.

Dopamine is a highly important neurotransmitter for motor speech planning.

DNA

deoxyribonucleic acid - instruction manual found in every cell

2/3s Rule

1. 2/3s of children who stutter have a positive family history for current or past stuttering

2. 2/3s heritability which was calculated between monozygotic and dizygotic twins

3. 2/3s of variance3 in twins who stutter can be attributed to genetic affects

Anticipatory Struggle Hypothesis (Bloodstein, 1987) defines that

The source stuttering is the tension and struggle a child produces in anticipation of speech difficulty.

Child is thinking "they wont hear me" or "they wont understand what I say."

Difficulty → anticipation → struggle → stuttering

How many adults who stutter are likely to be "accepting" of medications that might alleviate stuttering symptoms?

16% were accepting

27% were indifferent, 24% ambivalent, 33% skeptical

Gene

Basic physical and functional unit of heredity made of a specific sequence of DNA

Heritability

Measure of how much of the variation in a trait within specific population is due to genetic differences rather than environmental factors

RNA

ribonucleic acid - single strand molecule that carries instructions from DNA to build proteins

Off-label" use of medications

Using medications to treat a disorder or a potential symptom that does not have regulations through the FDA.

Aka putting yourself at risk

Dyskinesia

movement disorder that is characterized by uncontrolled, involuntary, and erratic muscle movement

Dopamine

neurotransmitter that helps control movement, motivation, and the reward system

Etiology

why or how a health problem starts; study of the cause of a disease or condition

Operant Conditioning → Stuttering itself

EX: Child's repetition gets the parent's attention, and that attention acts as positive reinforcement, so repetitions increase.

Approach-Avoidance Conflict Theory

Stuttering results from opposing drives/tendencies to speak (positive) and refrain from speaking (negative). If tendencies are equal in strength, it will result in stuttering.

Systematic Desensitization

A therapeutic technique in which the client is deeply relaxed and images feared speaking situations. The idea is that fear and relaxation can't happen together.

A student fears speaking with a teacher so they will be more disfluent when speaking to them is an example of.....

Links stuttering, classical conditioning