Chapter 5 Fluency Disorders (stuttering)

Stuttering

a high frequency or duration of repetitions, prolongations, and/or blockages that interrupt the flow of speech

Stuttering is Often combined with excessive _______ and ________ effort.

mental

physical

Most who stutter have _________ perceptions of their communication abilities

negative

Fluent (typical)

-The ability to produce effortless speech, that is smooth, and is rhythmical
-A continuous, uninterrupted forward flow of speech
-Requires oral physical maturation and language experience

Stuttering (disfluent)

-not continuous
-interrupted
-exhibit many hesitations, revisions, and interruptions in their utterances

Normal Disfluent Speech: Typical at 2 years

-whole-word repetitions: (I-I-I-want a cookie)
-interjections: (Can we-um-go now?)
-syllable repetitions: (I like ba-baseball.)

Normal Disfluent Speech: Typical at 3 years

revisions such as "He can't- he won't- play baseball," are dominant

Normal fluent speakers will frequently interrupt the flow of speech with ____________ (words or phrases) or ___________ (um, you know, etc...)

repetitions

interjections

Current Theory about the causes of stuttering

-A complex relationship between internal (neurological & cognitive)factors and external conditions(culture, parent expectations, childrearing practices, &relationships with others).
-Not all individuals stutter in the same manner or with the same frequency.

There is strong evidence for ________ influences on the development of stuttering.

genetic

Two Features of stuttering

-Within-word disfluencies
-between word disfluencies

Within Word (4 types)

-Sound/Syllable repetitions
-Sound Prolongations
-Broken Word
-Monosyllabic whole-word repetitions

Sound/Syllable repetitions

he's a b-b-b-boy

Sound Prolongations

Ssssssssee me swing!

broken word

base-(pause)-ball

Monosyllabic whole-word repetitions

"I-I-I- hit the ball. Or It's my-my-my turn."

Between Word

-Multisyllabic whole-word repetitions
-Phrase repetition interjection
-Revisions

Multisyllabic whole-word repetitions

I’m going-going home

Phrase repetition interjection

"She hit-she hit me." and "I like, uh, ya know, big boats"

Revisions

"He went, he came back."

The speaker adopts the __________ to minimize stuttering. The action or actions help _________ or avoid the stutter.

behaviors

terminate

When one movement begins to not help, then another may be _________.

added

Different Secondary Symptoms or behaviors

-Blinking of the eyes
-Facial grimacing
-Facial tension
-Exaggerated movements of the head, shoulders, and arms
-Interjected speech fragments that are unrelated to the words or sounds

Developmental Stuttering

-Occurs between the ages of 2 and 5
-Occurs mostly on content words (nouns, verbs)
-Can exhibit secondary symptoms and anxiety about speaking
-Tend to occur on the initial syllables of words

Neurogenic Stuttering

-Associated with disease or trauma (TBI, stroke)
-Occurs mostly on function words (conjunctions, prepositions)
-Do not usually exhibit secondary symptoms
-More dispersed throughout the utterance vs. on the initial syllable

Developmental Phases of Stuttering Phase 1

preschool years between ages 2 and 5

Developmental Phases of Stuttering Phase 1: Stuttering is ________ - may occur for weeks at a time between periods of normal fluency.

episodic

Developmental Phases of Stuttering Phase 1: Often occurs when ________, _________, or during communicative __________.

upset

excited

pressure

Developmental Phases of Stuttering Phase 1: Sound/syllable repetitions are the __________ feature

dominant

Developmental Phases of Stuttering Phase 1: Most __________ are unaware of the interruptions

children

Developmental Phase 2: Stuttering is _________ or _________, with few intervals of fluent speech

chronic

habitual

Developmental Phase 2: Occurs primarily on ________ words

content

Developmental Phase 2: Begin to address themselves as a "_________"

stutterer

Developmental Phase 2: Still increases under ___________/__________.

excitement/emotions

Developmental Phase 3: Stuttering occurs during specific situations such as speaking to ________, speaking in front of ________, or talking on the _________.

strangers

groups

phone

Developmental Phase 3: The stutterer can __________ the words that are more difficult than others and will avoid them

anticipate

Developmental Phase 3: Will ___________ around the word = a way of speaking to avoid words.

circumlocute

Developmental Phase 4

stuttering is in its most advanced form

Developmental Phase 4: Primary characteristic is vivid and fearful ___________ of stuttering

anticipation

Developmental Phase 4: Specific words, sounds and speaking situations are feared and avoided, circumlocutions are frequent, and there is evidence of ____________.

embarrassment

Developmental Phase 4: Stuttered words may exhibit audible vocal ________ and rising ________.

tension

pitch

When Speaking With Someone Who Stutters:

-Avoid remarks like: "slowdown, "or "relax." This can be demeaning.
-Be a patient and relaxed listener - especially on the phone.
- Maintain natural eye contact and wait until the speaker is
finished.
-Do not finish sentences or fill in words!
-Use a relaxed speech rate to slow conversational pace.

The Evaluation of Stuttering: It is the SLP's responsibility to determine if there should be a concern with the _________ _________ ___________.

child’s speech behaviors

Two part evaluation of stuttering

-Observations of child & parent
-Detailed Analysis

Observations of child & parent

-Parent interview is essential including; history, family interactions and parent perceptions
-This will help create a holistic picture

Detailed Analysis

-Using speech recordings and standardized tests
-Will determine
●Types of dysfluencies
●The # of disfluencies
●The overall %
●Secondary characteristics

stuttering treatment, Evaluation results will help to determine which approach to use:

-Indirect Therapeutic Approach
-Direct Therapeutic Approach

Indirect Therapeutic Approach

-For the beginning or mild stutterer
-Focus is on the child, parents, and the child's environment.
-Includes counseling the parents to reduce communicative pressure, provide a slow relaxed speech model and manipulate the child's environment.

Direct Therapeutic Approach

-For the moderate to severe stutterer (at least a year)
-Involves direct speech therapy tasks in attempt to modify the child's speech and behaviors.
-Usually begins by training the child to hear a difference in speech.

Two Treatment Approaches

-Stuttering Modification
-Fluency Shaping

stuttering Modification

-To teach the client to change the way he stutters
-Focus is on attitudes& beliefs
-Charles Van Riper approach
-Primary goal: to help stutterers find an acceptable speech style
-Technique examples:
*Cancellation
*Pull-out

Fluency Shaping

-Used to teach a new speech style that is free of stuttering
-Focus is on speech production
-Most procedures involve slow rate, relaxed breathing ,easy initiation, &smoother transitions between words
-Treatment example:
* Intensive 3-weekprogram

Van Riper's Stuttering modification Techniques

Cancellation Phase
Pull-Out

Cancellation Phase

client instructed to complete the stuttered word, pause for 3 seconds, then repeat word slowly

Pull-Out

client is instructed to use slow and exaggerated movements during the stutter or to "pull out"of the stutter lock

Fluency Shaping: Modify the Timing ofSpeech Movements. Prolonged SpeechDefinition

a reduced rate of speech
-prolong the duration of the syllables produced

Delayed Auditory Feedback (DAF) device

A looping system with microphone and headphones. A timer delays the speaker's own speech back to them. This naturally slows their speech and reduces disfluencies.

Fluency Shaping: Modify the Physical Tension of Speech Movements

Designed to reduce physical tension in the speech musculature before and during stuttering.
-Light articulatory contacts
-Gentle voicing onsets
-Speaking after exhalation techniques

Light articulatory contacts

will prevent the prolongation of the sound

Gentle voicing onsets

use tension-free onset of voicing

Speaking after exhalation techniques

initiate speech after the exhalation phase has started