L7 Fluency Disorders

Introduction to Human Communication and Speech-Language-Hearing Sciences

Course and Authors

• Course Date: 07/03/2025

• Authors: P. Kan & T. Law, PhD

• Affiliation: Division of Speech Therapy, The Chinese University of Hong Kong

• Copyright © 2017. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong

Communication Chain

溝通過程

• Stages of Communication:

• 溝通階段：

  • Prelinguistic

  • 前語言

  • Language Encoding

  • 語言編碼

  • Motor Programming

  • 動作編程

  • Program Execution

  • 程序執行

  • Transmission

  • 傳輸

  • Reception

  • 接收

  • Perception / Recognition

  • 感知／識別

  • Language Decoding

  • 語言解碼

  • Message Interpretation

  • 訊息理解

Outline of the Course

課程大綱

• Part I: Understanding Stuttering

• 第一部分：了解口吃

  • Definition

  • 定義

  • Features of Stuttering

  • 口吃特徵

  • Epidemiology

  • 流行病學

  • Theories of Stuttering

  • 口吃理論

• Part II: Assessment of Stuttering

• 第二部分：口吃評估

• Part III: Treatment of Stuttering

• 第三部分：口吃治療

• Part IV: Other Fluency Disorders

• 第四部分：其他流暢障礙

Part I: Understanding Stuttering

第一部分：了解口吃

Fluency Disorders

流暢障礙

• Definition:

• 定義：

  • Interruption in the flow of speaking characterized by atypical:

  • 口語流暢性中斷，其特徵為非典型：

  • Atypical rate rhythm

  • 非典型語速節奏

  • Repetitions in sounds, syllables, words, and phrases

  • 聲音、音節、詞語和短語重複

  • Excessive tension and struggle behavior

  • 過度緊張和掙扎行為

  • Secondary mannerisms

  • 繼發性行為

  • Reference: ASHA, 2013

  • 參考資料：ASHA, 2013

Types of Fluency Disorders

流暢障礙的類型

• Stuttering:

• 口吃：

  • Also known as:

  • 又稱：

  • Stammering

  • 結巴

  • Disfluency

  • 不流暢

  • Dysfluency

  • 語流障礙

• Origins:

• 起源：

  • Developmental

  • 發展性

  • Neurogenic

  • 神經源性

  • Psychogenic

  • 心理源性

• Cluttering

• 語速過快綜合症

Definition of Stuttering

口吃的定義

1. Disruption in fluency characterized by:

2. 流暢性受損，其特徵為：

   • (a) Involuntary, audible or silent repetitions or prolongations in the utterance of speech elements

   • (a) 在語音要素發聲時出現不自主的、可聽或無聲的重複或延長

   • (b) Frequent disruptions that are marked in character

   • (b) 頻繁且顯著的中斷

   • (c) Disruptions not readily controllable

   • (c) 不易受控制的中斷

3. Accompanied by:

4. 伴隨：

   • (e) Accessory activities involving the speech apparatus or body structures

   • (e) 涉及言語器官或身體結構的附帶活動

   • (f) Emotional states ranging from excitement to negative feelings (fear, embarrassment)

   • (f) 從興奮到負面情緒（恐懼、尷尬）的情緒狀態

   • (g) Immediate incoordination in speech mechanism; ultimate cause is complex or unknown.

   • (g) 言語機制立即出現不協調；最終原因複雜或未知。

   • Reference: Wingate, 1964, pp 498

   • 參考資料：Wingate, 1964, pp 498

Features of Stuttering

口吃特徵

• Johnson’s Disfluency Categories

• 約翰遜的不流暢類別

  • Clonic and tonic

  • 陣攣性和強直性

  • Primary and secondary stuttering

  • 原發性和繼發性口吃

  • Stuttering-like disfluencies (SLD)

  • 類口吃不流暢 (SLD)

  • Lidcombe Behavioral Data Language (LBDL)

  • Lidcombe行為數據語言 (LBDL)

• References include multiple authors (Johnson & Associates 1959; Wingate 1976; van Riper 1982; etc.)

• 參考資料包括多位作者（Johnson & Associates 1959；Wingate 1976；van Riper 1982；等）

Johnson’s Disfluency Categories

約翰遜的不流暢類別

• Eight Categories:

• 八個類別：

  • Word repetition

  • 詞語重複

  • Sound/syllable repetition

  • 聲音／音節重複

  • Phrase repetition

  • 短語重複

  • Interjection

  • 插話

  • Revision

  • 修改

  • Incomplete phrase

  • 不完整短語

  • Broken word

  • 斷裂詞

  • Prolongation

  • 延長

  • Applicability: Stuttering and non-stuttering children

  • 適用性：口吃和非口吃兒童

  • Reference: Johnson & Associates 1959

  • 參考資料：Johnson & Associates 1959

Stuttering-Like Disfluencies (SLD)

類口吃不流暢 (SLD)

• Types include:

• 類型包括：

  • Part-word repetition (e.g., 今-今日)

  • 部分詞語重複（例如，今-今日）

  • Single-syllable word repetition (e.g., 我我想)

  • 單音節詞語重複（例如，我我想）

  • Disrhythmic phonation:

  • 語音節律失常：

  • Prolongations (e.g., f - 飛機)

  • 延長（例如，f - 飛機）

  • Blocks (e.g., …波)

  • 語塞（例如，…波）

  • Broken words (e.g., 火…車)

  • 斷裂詞（例如，火…車）

  • Reference: Ambrose & Yairi 1999

  • 參考資料：Ambrose & Yairi 1999

Other Disfluencies (OD)

其他不流暢 (OD)

• Types include:

• 類型包括：

  • Interjection (e.g., um, er)

  • 插話（例如，嗯，呃）

  • Revision or abandoned utterances (e.g., 妹妹倒瀉 …打瀉杯水)

  • 修改或放棄的語句（例如，妹妹倒瀉 …打瀉杯水）

  • Multisyllable / phrase repetition (e.g., 佢地佢地好曳)

  • 多音節／短語重複（例如，佢哋佢哋好曳）

  • Reference: Ambrose & Yairi 1999

  • 參考資料：Ambrose & Yairi 1999

Lidcombe Behavioral Data Language (LBDL)

Lidcombe行為數據語言 (LBDL)

• Describes the moment of stuttering

• 描述口吃發生的瞬間

  • Reference: Packman & Onslow 1998 & Teesson; Packman & Onslow 2003

  • 參考資料：Packman & Onslow 1998 & Teesson; Packman & Onslow 2003

Repeated Movements in LBDL

LBDL中的重複動作

• Includes:

• 包括：

  • Syllable repetition, incomplete syllable repetition

  • 音節重複，不完整音節重複

  • Multisyllabic unit repetition (group of words, multisyllabic word)

  • 多音節單位重複（詞組，多音節詞）

Fixed Postures in LBDL

LBDL中的固定姿勢

• Attempts to speak where phonatory structures are stopped

• 嘗試說話時發音結構停頓

• Observable fixed postures with audible airflow

• 可觀察到的固定姿勢，伴隨可聽見的氣流聲

• May involve arrest in phonation with or without sounds

• 可能涉及發音中斷，無論是否有聲音

Superfluous Behaviors in LBDL

LBDL中的冗餘行為

• Verbal (e.g., interjections, incomplete phrases)

• 言語（例如，插話，不完整短語）

• Nonverbal (e.g., facial gestures, body movements)

• 非言語（例如，面部表情，身體動作）

Co-occurring Stuttering Behaviors

口吃行為的共現

• Stutters can co-occur

• 口吃可能同時發生

• Example: Syllable repetition combined with fixed postures

• 例子：音節重複與固定姿勢結合

Normal Disfluency

正常不流暢

• Frequency and types of behaviors:

• 行為的頻率和類型：

  • Less than 7 disfluencies per 100 words

  • 每100個詞語中少於7次不流暢

  • Mainly interjections, revisions, or easy whole word repetitions

  • 主要為插話、修改或輕鬆的整體詞語重複

• Developmental patterns in children’s disfluencies

• 兒童不流暢的發展模式

  • Reference: Guitar 2014

  • 參考資料：Guitar 2014

Epidemiology of Stuttering

口吃的流行病學

Onset

發病

• Mean Age of Onset: 30 – 36 months

• 平均發病年齡：30 – 36個月

• Types of Onset:

• 發病類型：

  • Sudden onset: within 1 week

  • 突然發病：在一周內

  • Gradual onset: over 1 week

  • 逐漸發病：超過一周

  • Prevalence of sudden onset: 33-53%

  • 突然發病的流行率：33-53%

Prevalence

患病率

• Preschool-age children: 5.0 – 5.7%

• 學齡前兒童：5.0 – 5.7%

• School-age and young adults:

• 學齡兒童和年輕成人：

  • Ages 6-10: 0.33 – 1.44%

  • 6-10歲：0.33 – 1.44%

  • Ages 11-20: 0.47 – 1.15%

  • 11-20歲：0.47 – 1.15%

• General population: 0.72%

• 一般人口：0.72%

Incidence

發病率

• Rate of occurrence of stuttering

• 口吃發生率

  • By age 3: 5.0 – 8.5%

  • 到3歲時：5.0 – 8.5%

  • By age 4: 11.2%

  • 到4歲時：11.2%

Gender Ratio

性別比例

• Near onset: Boys to Girls = 1.58:1 to 2.1:1

• 發病附近：男孩與女孩 = 1.58:1 至 2.1:1

• Older years: Boys to Girls = 2.8:1 to 7.5:1

• 較大年齡：男孩與女孩 = 2.8:1 至 7.5:1

Natural Recovery

自然康復

• More common in younger children shortly after onset: 71.4% - 85.0%

• 在發病後不久的幼兒中更常見：71.4% - 85.0%

• Factors influencing recovery:

• 影響康復的因素：

  • Most reliable: Female gender

  • 最可靠：女性

Stuttering and Genetics

口吃與遺傳

• Genetic predisposition for stuttering

• 口吃的遺傳傾向

• Family incidence method shows 30-71% prevalence in family history

• 家族發病法顯示家族史中有30-71%的患病率

• Associated Chromosomes: 2, 3, 5, 7, 9, 12, 13, 18, 21

• 相關染色體：2、3、5、7、9、12、13、18、21

Theories and Models of Stuttering

口吃理論與模型

Historical View

歷史觀點

Diagnosogenic Theory

診斷致病理論

• Labeling of normal dysfluencies worsens stuttering

• 將正常不流暢標籤化會加重口吃

  • Reference: Johnson 1956, 1957, 1961

  • 參考資料：Johnson 1956, 1957, 1961

Current Theories of Stuttering

當前口吃理論

The Brain Factor

大腦因素

• Brain activity

• 大腦活動

  • Increased right hemisphere activation, decreased temporal lobe activity

  • 右半球活動增加，顳葉活動減少

  • Unusual cerebellar activation

  • 小腦活動異常

  • Positive correlations in basal ganglia related to stuttering severity

  • 基底核與口吃嚴重程度呈正相關

  • Reference: Giraud et al, 2008; Ingham et al, 2012; Brown et al, 2005

  • 參考資料：Giraud et al, 2008；Ingham et al, 2012；Brown et al, 2005

Structural Anomalies

結構異常

• Changes in brain structures including size and white matter abnormalities

• 大腦結構變化，包括大小和白質異常

  • Reference: Foundas et al 2001; Jancke et al 2004; Sommer et al 2002; etc.

  • 參考資料：Foundas et al 2001；Jancke et al 2004；Sommer et al 2002；等

Linguistic Factors

語言因素

• Linguistic stress and complexity affect stuttering

• 語言壓力與複雜性影響口吃

  • Higher complexity leads to more disfluencies

  • 複雜性越高導致越多的不流暢

  • Reference: Dworzynski & Howell 2004; Kleinow & Smith 2000; etc.

  • 參考資料：Dworzynski & Howell 2004；Kleinow & Smith 2000；等

Demand and Capacity Model

需求與能力模型

• Demand for fluency exceeds capacity for production

• 流暢性需求超出產生能力

  • Factors include social, emotional, and cognitive development

  • 因素包括社會、情感和認知發展

  • Reference: Starkweather (1987); Adams (1990)

  • 參考資料：Starkweather (1987)；Adams (1990)

EXPLAN Model

EXPLAN模型

• Fluency failures occur due to slow linguistic planning

• 流暢性故障因語言規劃緩慢而發生

  • Reference: Howell & Au-Yeung 2002

  • 參考資料：Howell & Au-Yeung 2002

P&A 3-Factor Model

P&A三因素模型

• Multifactorial explanation includes a deficit in neural processing, a trigger of stuttering, and modulating factors

• 多因素解釋包括神經處理缺陷、口吃觸發因素和調節因素

  • Reference: Packman (2012)

  • 參考資料：Packman (2012)

Part II: Assessment of Stuttering

第二部分：口吃評估

Case History

病史

• Information gathered includes:

• 收集的資料包括：

  • Age of onset

  • 發病年齡

  • Severity and types of stuttering

  • 口吃的嚴重程度和類型

  • Family history

  • 家族史

  • Reactions from parents & child

  • 父母和兒童的反應

Equipment and Software

設備與軟件

Equipment

設備

• Speech fluency rating machines

• 語音流暢度評估儀器

• Stopwatch and traditional materials

• 秒錶和傳統材料

Software

軟件

• Stuttering Measurement System (SMS)

• 口吃測量系統 (SMS)

Speech Samples

語音樣本

Sampling Method

採樣方法

• Online and beyond-clinic recordings

• 線上和非臨床錄音

Length of Sample

樣本長度

• Time-based and Word/Syllable-based samples: 600 and 1000 syllables

• 基於時間和基於詞語／音節的樣本：600和1000個音節

Percentage of Syllable Stuttered (%SS)

口吃音節百分比 (%SS)

• Calculation method:

• 計算方法：

  
  

Severity Rating

嚴重程度評級

• Scale rating for assessment

• 評估量表評級

  • 0 = normal speech; up to 8/9 = extremely severe stuttering

  • 0 = 正常言語；最高8/9 = 極度嚴重口吃

  • Reference: Eve, Onslow, Andrews & Adam (1995)

  • 參考資料：Eve, Onslow, Andrews & Adam (1995)

Stuttering Severity Instrument (SSI-4)

口吃嚴重程度量表 (SSI-4)

• A behavioral assessment tool measuring:

• 一種行為評估工具，測量：

  • Frequency, Duration, Physical Concomitants, Naturalness of Speech

  • 頻率、持續時間、身體伴隨動作、言語的自然度

  • Reference: Riley 1994

  • 參考資料：Riley 1994

Part III: Treatment of Stuttering

第三部分：口吃治療

Treatment Targets

治療目標

• Focus on aspects targeting:

• 專注於針對以下方面：

  • Neurophysiology: Pharmacological or behavioral interventions

  • 神經生理：藥物或行為干預

  • Communication skills development

  • 溝通技能發展

  • Quality of life improvements

  • 生活質量改善

Preschool-Age Children

學齡前兒童

• Goals: Achieving normal fluency through various programs

• 目標：通過各種課程實現正常流暢

  • Included:

  • 包括：

  • A Multidimensional Approach

  • 多維度方法

  • Lidcombe Program

  • Lidcombe計畫

  • The Westmead Program

  • Westmead計畫

School-Age Children

學齡兒童

• More complicated treatment demographic

• 更複雜的治療人群

• Goals: Treatment for normal fluency versus controlled fluency

• 目標：針對正常流暢的治療與針對受控流暢的治療

Adolescents and Adults

青少年和成人

• Goals: Achieve normal or near-normal fluency with support

• 目標：在支持下實現正常或接近正常的流暢

  • Treatment approaches may include:

  • 治療方法可能包括：

  • Time-out

  • 暫停

  • Altered Auditory Feedback

  • 改變聽覺回饋

  • Camperdown Program

  • Camperdown計畫

Part IV: Other Fluency Disorders

第四部分：其他流暢障礙

Neurogenic Stuttering

神經源性口吃

• Acquired disorder linked to neurological diseases

• 與神經系統疾病相關的後天性疾病

  • Example causes: Stroke or traumatic brain injury

  • 例子原因：中風或創傷性腦損傷

• Characterized by similar frequency across speech tasks

• 特徵是所有言語任務中出現類似的頻率

Psychogenic Stuttering

心理源性口吃

• Late onset linked to stress or traumatic events

• 晚期發病與壓力和創傷事件相關

  • Behaviors: repetitions, fixed postures, and secondary actions

  • 行為：重複、固定姿勢和繼發性動作

Cluttering

語速過快綜合症

• Characterized by

• 特徵是

  • Rapid and/or irregular articulation rate

  • 快速和／或不規則的發音速度

  • High frequency of disfluencies, reduced intelligibility

  • 高頻率的不流暢，可理解性降低

  • Language organization deficits

  • 語言組織缺陷

• May co-occur with stuttering

• 可能與口吃同時發生

Conclusion

結論

• Comprehensive understanding of fluency disorders essential for effective assessment and treatment strategies in speech-language therapy.

• 全面了解流暢障礙對於言語治療中有效的評估和治療策略至關重要。