Flashcards in 4- Treatment in Teens & Adults Deck (19):
What is the focus progression in long-term stuttering?
1) FIRST FOCUS ON STUTTERING
- reduce negative emotions & fears
- then change stuttering behaviours (tension/hurry)
2) SECOND FOCUS ON FLUENCY
- new ways of speaking learned when stuttering is expecting or experienced
- avoidance decreased, approach increased
What goals are appropriate for long-term stutterers?
Important to set realistic goals
- controlled fluency when fluency is important
- easy/mild stuttering when controlled fluency impossible
- little to no avoidance of speaking
- effective communication with others
What are the emotional goals of long-term stutterers?
- advertising stuttering
DECREASE NEG THOUGHTS
How does maintenance occur in long-term stutterers?
- client must become their own clinician
- therapy can continue as long as client needs it
- therapy, when faded, should be faded gradually
What is the progression of therapy in adult clients?
1) Exploring stuttering
2) Learn controlled fluency
3) Increasing approach behaviours
4) Maintaining progress
Describe explioring stuttering.
The first step of the progression of therapy in adults.
- Reduce fear of stuttering
- Increase self-awareness of what is happening to help release tension.
- Reduce fear of listener response
Describe "learning controlled fluency"
The second step of the progression of therapy in adults.
Learn fluency-shaping techniques in the clinic (slow/flexible rate, pausing, Eos)
Learning to replace stuttering with controlled fluency (using cancellations or pull-outs when unsuccessful)
Learning to use controlled fluency in outside situations
Describe "increasing approach behaviours"
The third step of the progression of therapy in adults.
work through hierarchy of easiest to most difficult speaking situations
More support at first, then fade
The fourth step of the progression of therapy in adults.
Client learns to observe, evaluate and reinforce their own behaviour
What is neurogenic acquired stuttering?
- caused/exacerbated by euro disease/damage
- etiologies include stroke/trauma
How do you distinguish neurogenic stuttering from normal stuttering?
1) Neurogenic stutterers stutter equally on all kinds of words
2) Neurogenic stutterers don’t have many secondary behaviours
3) Don’t respond to fluency-enhancing conditions
4) Little fear or anxiety about their stuttering
How do you treat neurogenic stuttering?
Depends on the etiology.
BEHAVIOURAL: slow/flexible rate, EO, masking, DAF
NEUROSURGICAL: e.g. for epilepsy
PHARMA: change/reduce doses
What is psychogenic acquired stuttering?
Stuttering which has no known cause, appearing late after prolonged stress or a traumatic event.
How do you distinguish psychogenic stuttering from normal stuttering?
1) Detailed case history, rule out neurological stuttering.
2) Dramatic improvement with trial therapy, if you tell them they will improve
3) Increased severity under fluency-inducing conditions.
4) Unusual secondary struggle behaviours.
How do you treat psychogenic stuttering?
Combination of stuttering modification, fluency-shaping, and psychiatric help
What is cluttering?
Sudden bursts of rapid speech that is difficult to understand and somewhat disfluent.
Commonly co-occurs with stuttering.
How do you distinguish cluttering from normal stuttering?
With effort/attention, speaker can speak without cluttering.
Often accompanied by language/learning difficulties
How do you treat cluttering?
Good candidates can control cluttering on demand and are motivated to improve.
Increase the client's awareness of rate (visualize slow/clear speech, use metronome)
Improve linguistic/language skills