CSD 418 - Fluency - Topic 1 Part 2

Van Riper (1975)

• Empathy: An authentic sensitivity for the
client.
• Warmth: A respect or positive regard for
the client.
• Genuineness: Openness, and the ability
to disclose oneself as a real person.
• Charisma: An ability to arouse hope,
appearing confident yet humble, frank
yet tactful.

Cooper & Cooper (1985)

“Devoid of dogma”

Zinker (1997)

1.Creativity that is facilitated by a childlike wonderment and excitement.

2.Patience for change without forcing.

3.A love of play.

4.A sense of humor.

5.A positive attitude about risk taking.

6.Willingness to experiment with different approaches and techniques.

7.The ability to distinguish the boundaries between the clinician and a client.

8.Willingness to push, confront, persuade, and energize another person to accomplish the work that needs to be done.

9.A lifestyle that promotes a rich background with a range of life experiences.

Clinician Attitudes About Stuttering and People Who Stutter

•You don’t have to be a person who stutters to appreciate the experience of stuttering

•But you do need to:

•Learn to not be afraid of stuttering

•Be willing to engage in challenging behaviors with your clients (e.g., pseudostuttering, making difficult phone calls, etc.)

•Seek out – and listen carefully to – stories that elaborate on the experience of stuttering.

“Remedies”

•Put pebbles in the mouth

•Dip the legs in a pail of cold water for 15 minutes every night

•Look out the window at a tree, breathing in all the “good spirits” and breathing out all the “bad spirits”—breathing in beauty and relaxation and breathing out ugliness and tension

•Read aloud while penciling a circle around each word in old magazines

•Stimulation of the head and neck muscles

•Speak while moving the right thumb from side to side in a metronomic motion (hiding the hand in the pants pocket)

•Phonate different vowels in a siren-like fashion

•Hypnosis

•Self-induced deep relaxation

•Speak while folding in the right hand fingers, one at a time for each word

•Traditional psychoanalysis

•Injections of sodium pentothal to help reach the unconsciousness

•Practice diaphragmatic breathing

•Drink water out of a snail shell

•Tongue reduction surgery

“Anti-Stuttering Devices” Samuel, 1913 (British 10,256)

Elastic Neck Band to suppress muscles

“Anti-Stuttering Devices” Monday, 1987 (US 584,696)

U-shaped clips on teeth

“Anti-Stuttering Devices” Messine, 1950 (US 2,505,056)

mouth prop - open mouth and rod - hold tongue

“Anti-Stuttering Devices” Azaretti, 1942 (Swiss, 218,761)

Pressure gauge (balloon and meter) around torso

“Anti-Stuttering Devices” Izuhura, 1939 (British 501,779)

Attached to upper palate/reed - pilot sound and sharp projections for pricking tongue

Our Role as SLPs? U.S. Dept. of Labor, Bureau of Labor Statistics

•Speech-language pathologists work with people who cannot make speech sounds, or cannot make them clearly; those with speech rhythm and fluency problems, such as stuttering, people with voice quality problems, such as inappropriate pitch or harsh voice; those with problems understanding and producing language; those who wish to improve their communication skills by modifying an accent; and those with cognitive communication impairments, such as attention, memory, and problem-solving disorders.  They also work with people who have oral motor problems causing eating and swallowing difficulties.

Our Role as SLPs? Cosumer Oriented Pediatric health web by Pfizer company (Kidspeak)

These healthcare professionals are educated and trained to help patients overcome speech, language, and swallowing disorders.  These specialists also help treat stuttering, voice, and pronunciation disorders.

From the ASHA website, under “Frequently Asked Questions about the Professions”

Speech-Language Pathologists help those who stutter to increase their fluency; help people who have had strokes or experienced brain trauma to regain lost language and speech; help children and adolescents who have language disorders to understand and give directions, ask and answer questions, convey ideas, improve the language skills that lead to better academic performance, counsel individuals and families to understand and deal with speech and language disorders.

Fluency by the numbers

•In all settings combined,

•65% of SLPs see fluency cases

•45% see voice

•37% treat dysphagia

•27% treat aphasia

•In schools, 78% of SLPs see fluency cases

•Larger than SLI, PDD, and those using AAC

•BUT if look at numbers of individual cases, fluency represents 2.4% of the caseload

Reality:  Fluency treatment is difficult

• Etiology is not clear

• No definite answers as to what helps

• Stuttering is variable

• Stigma is attached to stuttering

• Successful therapy often includes a strong psychotherapeutic  component

Making changes; making good therapies

•Percent stuttered syllables does not reflect change in quality of life

•Look for commonalities across treatments which work

•Component model:  the CLINICIAN makes the difference

•Experiment with different protocols and techniques IN RESPONSE TO the client

Clinician Intervention Skills

•Critical thinking

•Definition

•A “core skill” for SLPs and audiologists (Finn, 2011)

•Socratic Questions

•Becoming less inhibited

•About stuttering

•About working with PWS

•Avoiding dogmatic decisions

•Relates to critical thinking

•One approach doesn’t fit all!

•Opening your treatment focus

•Be flexible in your approach to treatment

•Look beyond techniques

•Calibrating to the client

•Pay attention to ALL aspects of the client’s speech, including non-verbal and anticipatory behaviors

•Pantomime the client’s speech (i.e., put their stuttering in your mouth!)

•Observing Silence