Fluency Final Study Set: Stuttering Therapy Terms & Definitions

2 types of therapy techniques

1. fluency enhancing

2. stuttering modification

fluency enhancing technique

increase fluent speech (ex: easy onset)

stuttering modification

target the stuttering behavior (ex: cancellation, pull out)

what are the specific goals for advanced stuttering?

1. controlled fluency - conscious monitoring of speech

2. acceptable stuttering - noticeable stuttering, but speaker is comfortable despite it

What are the 5 phases in treating stuttering?

1. education

2. identification (self awareness)

3. desensitization

4. modification

5. maintenance

education phase

-teaching clients about the basics of speech production

-dispelling myths about stuttering

-information about stuttering (ex: prevalence, factors associated)

-make sure you and your client are on the same page (ex: using same vocabulary to describe the same concepts)

identification phase

-client recognize and examines the core behaviors, secondary behaviors, and feelings and attitudes associated with their individual nature of stuttering

What are therapy strategies used to identify behaviors?

-oral reading

-discussion

-modeling stuttered behaviors

-self observation

what does identification help clients with?

1. explore the physiology of speech

2. explore what happens during stuttering (types of stuttering, pseudostuttering, identify moments of stuttering and what happens during stuttering)

for advanced stuttering clients, what is a discussion to have during identification phase?

name 5 difficult and easy speaking situations, and 3 difficult and easy people to talk to

for early stuttering clients, what is important during identification phase?

-clients may assume all types of disfluency are stuttering

-less direct than in advanced stuttering

Desensitization phase

-the client learns strategies to reduce negative feelings and anxiety associated with stuttering

-therapy strategies are to confront the disorder and desensitize the individual to stutter behaviors and listener reactions

Van ripers adult stuttering therapy

1. time pressure (plan scenarios where clients feel rushed but have to resist the urge to rush through speech)

2. stuttered speech (pseudostuttering)

3. negative emotion (discuss worse case scenarios and how to deal with the emotions)

4. eye contact

general guidelines for teaching techniques

1. clinicians model and client observes

2. clinician and client practice together

3. client practices technique with clinician feedback

4. client tried to teach the clinician how to use the technique

5. client practices and rates own production with clinician guidance

6. client practices the behavior and self-monitors

modification phase - controlled fluency techniques

1. slow rate

2 soft starts/easy onset

3. soft contact/light articulatory contact

speech rate goals

goals

1. overall slower speech (fewer words per minute)

2. smooth connected speech

3. increase fluency (stretching sounds, pausing, over articulation)

soft starts (easy onset- before stutter)

includes:

1. slower physically-relaxed speech starts (stretch)

2. relaxed speech muscle

3. smooth airflow and voicing

usually used at the beginning of words, phrases, or phrase boundaries

practice with single words, two words and then spontaneous speech

light contact (before stutter)

1. light tongue and lip movement

2. continuous airflow

3. smooth airflow and voicing

usually used at the beginning of words, phrases, or phrase boundaries

practice with single words, two words, and then spontaneous speech

stuttering modification types (acceptable stuttering)

1. voluntary/pseudostuttering

2. holding and tolerating a moment of stuttering

3. in block corrections/pullouts

4. post-block corrections/cancellations

5. bounce

6. slides

voluntary stuttering

creates:

1. sense of control

2. increase awareness

3. decreases fear and avoidance behaviors

4. increases desensitization to stuttering

practice with single words and then spontaneous speech

holding a moment of stuttering

helps to:

-increase awareness of stuttering and areas of tension

-increase desensitization

-decreases avoidance behavior

requires clients to:

-stay in a moment of stuttering

-keep the disfluency going

pulls outs (during stutter; aka slide out)

1. identify and focus on the moment of stuttering

2. then decrease the tension (prolong the sound) and ease themselves out of the moment of stuttering

helps to:

reinforce acceptable stuttering with decrease tension, increase sense of loss of control

-practice with single words and then spontaneous speech

cancellations (during/after stutter)

typically only used in the clinic

-finish the stuttered word

-pause to plan

-pseduostutter (with any technique) on the previously stuttered word

helps to decrease avoidance behavior

bounce (during)

-repeat the initial syllable of words (so the general struggle behaviors evident during stuttering are reduced)

-clients are told to vary the number of repetitions of a syllable so that they do not create a habit of the pattern

preparatory set (before stutter)

1. anticipate the moment of stuttering

2. modify the tension before it builds up or reduce the tension

helps to

-increase airflow

-changes articulatory posture/reduces tension

practice with single words and then spontaneous speech

group therapy for stuttering

-not the same as a support group

-led by slp

-treatment plan

-goal and objectives for each client (individual goals, group goal)

-reduces isolation

-place to practice strategies

-community

counseling people who stutter

-informative

-persuasive

-listening and valuing

examples of counseling questions to ask

a) What do you hope to achieve as a result of our meeting?

b) When you use the word "stuttering" what do you mean ?

c) Describe when and how your stuttering began)

d) What do you think caused your stuttering?

e) Have you had therapy for stuttering?f) Does anyone else in your family stutter? Or have other communication challenges?

When do you stop therapy?

1. when they can communicate effectively

2. when they can successfully transfer and maintain their skills in situations outside of the clinic

3. when they become their "own" clinicians

4. elimination of feared words and situations

van ripers definitions of success

therapy is considered successful when the client changes from a person who stutters to a person who is in control and speaks fluently with occasional moments of mild stuttering

therapy goals

ultimate goal is to become an effective communicator regardless of stuttering; motivation determines eventual success of therapy

treatment for children

1. education for parents and children

2. identification (remember the puppet - "do you know someone who talks like me")

3. desensitization (modeling normal disfluency, normalizing disfluencies)

4. modification

5. maintenance

considerations for attitudes and emotions

-make sure children know that it is okay to stutter

-consider how you are interacting with that child (make sure the child knows they are valued regardless of stuttering. ask the child how they feel about the session/technique)

-empower children (listen to them and allow them to make some choices in therapy; books, types of play, length of practice)

direct therapy for children

-easy relaxed speech

-turn taking

-delayed response

-stuttering modification

easy relaxed speech

can also be used with kids

-easy onset/light contact

-stretching vowels

turn taking

1. prompts (whose turn is it?)

2. target behaviors (child responds with words or gestures)

3. reinforcement

turn taking should be integrated into activities and use in conjunction with easy relaxed speech

delayed response

includes:

-visual and verbal prompts

-use thinking time

-target behavior

-reinforcement

stuttering modification in children

1. identification of bumpy and smooth speech

2. visual examples

3. practice turning bumpy into smooth speech

4. model how to modify stuttering

5. reinforcement ("good talking")

fluency hierarchy

for all techniques begin with the easies task and progress to more challenging ones

some considerations for preschool children:

-treatment can be direct or indirect

-traditionally indirect therapy has been used but direct therapy is gaining favor

-desensitization in preschool children is mainly modeling disfluency and normalizing disfluencies (reactions to the disfluencies)

indirect therapy for preschool children

-there is an assumption that the interactions between the child's speaking abilities and the environment that he or she is in affects speech

-consists of parent education, parent training for making communication changes at home or a combo of both

parents in preschool therapy (indirect)

-initially, you model interaction for parents, then have them participate and discuss with them some positive changes that can take place at home

-parent-child interactions are not the source of stuttering but modifications in behavior can help bring out more positive changes

when to use indirect therapy?

-child is not aware of or frustrated by, his stuttering

-no tension

when to use direct therapy?

-child is aware of and/or frustrated by his stuttering

-tension is present

-secondary behavior is present

positive changes - listening time

1. listening time

-encourages parents to listen more and make less speech demands (turn taking with parents and siblings)

-parents can also set up a listening time session everyday for 15-20 min where they just listen and refrain from giving instructions or making demands

positive changes - slow rate

simplify and slow down their speech rate and other daily activities (ex: time pressure)

positive changes - pauses

this slows down the speech rate and also helps to prevent interruptions to the child's speech

positive changes - positive comments

teach parents to respond/interact to the child without drawing attention to the disfluency (ex: praise good speech)

positive changes - fewer speech demads

it is a good idea for parents to make fewer demands and give fewer speech instructions

additional components when working with preschool children

1. create a healthy environment

2. create a predictable routine

3. slowly increase challenges

4. reinforce communication (ensure that they don't stop talking because they are afraid of stuttering)

5. careful monitoring

how many children who stutter face bullying in school?

81% of CWS reported bullying in a 1995 study

how to approach multicultural intervention

-approach each family and client as an individual entity

-look at factors that may perpetuate stuttering

-consider child-rearing practices, reactions to stuttering, etiological views, other special cultural factors that might interfere with fluency intervention

ways to encourage spontaneous speech in children

some ideas:

-books

-dvds

-sports

-music

-cartoon

-family pictures

-game

-barrier games

-fluency games

what is cluttering?

-the essence of cluttering is rapid speaking that is difficult to understand

-regarded as a speech and language disorder that results in a rapid, imprecise, dysrhythmic and disorganized production of speech

characteristics of cluttering

-either too fast, too jerky, or both

-run their words or sentences together

-more fillers, hesitations, revisions or other breaks in their speech

prevalence of cluttering

-less common than stuttering

-cluttering without other concomitant disorders (such as stuttering) is rate)

in other words, cluttering usually co-exists with other disorders

estimates of pure cluttering

-becker and grundmann (1971) reported 1.5% prevalence of pure cluttering in a german school with 7-8 year olds

-estimates of pure cluttering range from 1.5%-7% of children with fluency disorders

why is cluttering under-diagnosed?

1. relatively few clinicians are as knowledgable about cluttering as they are about stuttering

2. there is a lack of self-awareness of cluttering thus,

3. few clutterers self-refer for services

when is the onset of cluttering?

7 years old - when a child begins to produce longer and more complex utterances

spontaneous recovery?

research suggests that rates of recovery are poorer in children who clutter compared to CWS

in adulthood, the likelihood of recovery is related to the degree of self-awareness

causes of cluttering

1. cerebral dysfunction (including brain damage)

2. genetics

common characteristics of cluttering

1) Excessive repetitions and other types of disfluencies

2) Rapid speech rate

3) Poor use of pauses

4) Imprecise articulation

5) Short attention span

6) Poor organized thinking

7) Lack of awareness of cluttering

assessment

-family history

-history of learned or behavioral issues

-speech language samples

-reading

-spontaneous speech

-articulation (ex: Goldman fristoe, arizona)

-language (maze) - tell a story

-writing

what are you looking for in the speech language samples

-rate (fast)

-rhythm and pacing (pausing)

-fluency (co-occur with stuttering)

-articulation (imprecise)