Module 12: Fluency Disorders

Stuttering

____ is a speech disorder that disrupts the flow of words with part-word repetitions, speech sound prolongations, and broken words (involuntary pauses).

It is the most common fluency disorder.

1. repetitions

2. prolongations

3. Blocks

4. interjections

Core Behaviors of stuttering:

1. ___ of sounds, syllables, whole words, unit of speech; often the meaningful part of what is said

2. ___ of single sounds, speech segments, or syllable that is longer than expected

3. ___ of airflow/voicing during speech

4. ___, intruded elements of speech; don’t add to the meaning, can be sound, whole-word, phrases (um, like)

1. Escape

2. Avoidance

Secondary Behaviors of stuttering are learned reactions to the core behaviors, 2 types:

1. ___: head nods, eye blinks, foot taps, jaw tremors

2. ___: circumlocutions, unfilled pauses, interjections

1. Motor

2. negative

3. airflow

4. avoidance

Even though the stuttering frequency is below the overall accepted criterion of 5% dysfluency of words spoken, the differential diagnosis of stuttering consists of:

1. Associated ___ Behaviors

2. ___ emotions and feelings

3. mismanagement of ___

4. ___ behaviors

1. eye blinks

2. nose

3. pursing, quivering, tensing

4. neck

5. forehead

6. jaw

7. leg, arm

8. hand

9. hitting

Associated motor behaviors of stuttering includes:

1. rapid, tense ___ ___

2. ___ wrinkling

3. ___, ___, ___ of lips

4. tension in ___ area

5. wrinkling ___

6. clenched ___

7. head, ___, and/or ___ movements

8. ___ clenching

9. ___ themselves

1. anxiety, fear

2. frustration

3. self

4. helplessness

5. embarrassed, impatient

Negative emotions of stuttering include:

1. ___ or ___ about speaking situations

2. feelings of ___

3. negative statements about ___

4. sense of ___

5. belief or impression listeners are ___ or ___

1. shallow

2. exhalation

3. breathing

4. dysrhythmic

5. inhalations, exhalations

Management of airflow for stuttering includes:

1. Speaking upon/with ___ inhalations

2. speaking during ____, may run out of air or talk on their reserve vital capacity

3. sudden cessations (stopping) of ____ while speaking

4. ___ respiration

5. audible ___ and ___

1. speaking
2.conversational
3. words
4. emotional
5. eye
6. talking

Avoidance behaviors of stuttering due to negative reinforcement:

1. Avoid ___ situations
2. Avoid certain ___ partners
3. Avoid certain ___
4. Avoid talking about their stuttering and ____ experiences with it (it's important we talk with them about it)
5. Avoid ___ contact
6. Avoid ___ as much as possible (we can encourage them to as much as possible)

1. whisper, impersonate

2. postures

3. ignorance

4. thinking

5. hear

When avoiding speaking situations, stutters may:

1. ___ or ___ a character

2. carry an unusual physical ___

3. pretend ___ for words that are more difficult for them

4. pretend to be ___ of an answer

5. pretend not to ___ a question

1. neurological, trauma

2. function

3. secondary

4. improvement

Neurogenic stuttering characteristics

1. Typically associated with ___ disease or ___
2. Usually occurs on ___ words, widely dispersed through utterance
3. No ___ characteristics
4. No ____ with repeated readings or singing

easily, avoidance

The primary goals of stuttering modification for those who stutter more fluently are to modify each dysfluent moment by stuttering more ___ and to eliminate struggle and ___ behaviors.

1. Cancellations

2. Desensitization

3. hierarchy

4. Preparatory Sets

5. Pull-outs

6. Relaxation

7. Self-analysis

List 7 Stuttering Modification for those who stutter more fluently (cdhpprs):

Self-analysis

Stuttering Modification for those who stutter more fluently:

___ -____ is to have the client examine moments of stuttering and secondary behaviors

Relaxation

Stuttering Modification for those who stutter more fluently:

____ is to have the client sit comfortably, loosen and contract muscles beginning at the level of the abdomen moving upward toward the face

Desensitization

Stuttering Modification for those who stutter more fluently:

____ is to have the client stutter in front of people

hierarchy

Stuttering Modification for those who stutter more fluently:

Have the client develop a ____ of feared speaking situations (where, who, what, when)

Cancellation

Stuttering Modification for those who stutter more fluently:

____ is having the client repeat words more fluent after completing the stutter, Stick with the stutter, think about it, rehearse it, repeat the word

Pull-outs

Stuttering Modification for those who stutter more fluently:

___-___ is to have the client stop in the middle of stutter, rehearse, then repeat it

Preparatory

Stuttering Modification for those who stutter more fluently:

____ sets is to have the client anticipate dysfluent moments and rehearse them before using the word

eliminating

Fluency Shaping of stuttering focuses on ____ dis-fluencies by practicing fluent speech.

Doesn’t address secondary behaviors or feelings/attitudes

1. onset, exhalation

2. rate

3. articulatory

4. phonation

5. Delayed

Fluency Shaping of stuttering includes:

1. Easy ___ and prevoice ___
2. Decrease speaking ___ (prolonged speech)
3. Light ___ contacts
4. Continuous ___
5. ___ auditory feedback (DAF)- begin at 250ms and reduce in 50ms intervals; the delayed feedback helps slow speech

Cluttering

_____ affects the speech rate, but may involve language and thought process.

1. rapid, irregular

2. intelligibility

3. relaxed, reading

4. thought

5. Reading, writing

6. Motor

7. improve, slowed

8. Syntactic

9. unconcerned

Differential Diagnosis & characteristics of cluttering:

1.___ and ___ speech rate
2.Articulatory breakdowns cause reduced ___, sounds like mumbling
3.Dysfluencies worsen when ___ or ___ well known text

4. disorganized ____ process
5. ___ and ___ difficulty
6. ___ incoordination

7. Artic & speech intelligibility ____ when rate is ____ down

8. ____ problems w/prosodic variations

9. ____ about his/her speech problems

stuttering

Cluttering May coexist with __1_

A person who __1__ is unlikely clutter, but a person who clutters is likely to __1__.

negative

Cluttering is NOT associated with ___ feelings about his/her speech problems. That would be stuttering.

Malingering

____ is when someone is feigned stuttering for the purpose of receiving some type of external benefit.

1. work

2. service, jail

3. lawsuits

4. scams

Examples of Malingering:

1. Getting out of ___
2. Avoiding ___ or ___ time
3. ___, court

4. ___, fake phone calls