final Flashcards

(104 cards)

1
Q

modern theory - multifactorial theories

A

demands and capacities, neuropsycholinguistic model, dynamic multifactorial model

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what do all the modern theories have in common

A

genetic or other predisposition, predisposition interacts with environment, after pre-school years, stuttering tends to be lifelong condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

stuttering modification

A

teach the person to learn and understand their stuttering, and when they choose to, they can do something about their stuttering in the moment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

stuttering modification basics

A

-fluent speech is generally not altered in any great degree
-primary goal is to modify the moment of stuttering
-attitudes, speech fears and avoidances are a major focus of therapy
-client must analyze and evaluate their stuttering behaviors
-baseline and treatment data are kept in quantative manner
-emphasis is on rapport, counseling, teaching, motivation
-self-monitoring skills are emphasized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

fluency shaping

A

-the moment of stuttering is not modified
-attitudes, speech fears and avoidances are generally not dealt with in therapy
-clients do not analyze their stuttering behaviors
-baseline and treatment data are kept in a qualitative manner
-emphasis of therapy is on conditioning, reward, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when to use stuttering modification

A

-client has difficulty modifying fluency
-client shows significant fear or avoidance
-client does not seek total fluency
-poor attitude or little knowledge of stuttering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when to use fluency shaping

A

-a client can easily modify their fluency
-client seeks high levels of fluency
-client exhibits no avoidance or fear
-the client does not have the cognitive ability to use stuttering modification program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

keys to stuttering modification therapy

A

combination of: understanding, monitoring, desensitizing, accepting, modifying the moment of stuttering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

traditional van riper therapy

A

motivation, identification, desensitization, variation, stabilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

motivation

A

identifying goals, talking to others who stutter, building the therapeutic relationship to develop trust

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

identification

A

stuttering 101: education and teaching the client about stuttering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

desensitization

A

advertising, pseudostuttering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

variation

A

freezing, cancellation, pull-out, preparatory set

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

stabilization

A

support groups, self-help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

keys to fluency shaping therapy

A

-find out where fluency breaks down
-behavior modification to reinforce use of technqiue
-progress up a hierarchy of difficulty
-carryover can be difficult, so start planning for it immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

fluency shaping

A

find a method that is incompatible of stuttering and use that strategy when talking all the time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

fluency shaping treatment

A

-attitudes, speech fears and avoidances are generally not dealt with in therapy
-clients do not analyze their stuttering behaviors
-emphasis of therapy is on conditioning, reward, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when to use fluency shaping

A

-when a client can easily modify their fluency
-when a client seeks high levels of fluency
-when the client has little or no fear of avoidance
-when the client does not have the cognitive ability to use a stuttering modification program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

keys to fluency shaping

A

-find out where fluency breaks down
-assess the best method to eliminate stuttering
-behavior modification to reinforce this technique
=progress up a hierarchy of difficulty
-carryover can be difficult, so start planning for it immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

stuttering modification

A

-primary goal is to modify the moment of stuttering
-fluent speech is generally not altered in aby great degree
-teach the person to learn/understand their stuttering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

stuttering modification treatment

A

-attitudes, speech fears and avoidances are a MAJOR focus of therapy
-clients must analyze and evaluate their stuttering behaviors
-self-monitoring skills are emphasized
-emphasis on rapport, counseling, teaching, and motivation
-self-monitoring skills are emphasized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when to use stuttering modification

A

-when a client has diffculty mdifiying fluency
-when a client show significant fear or avoidance
-when a client seeks total fluency
-poor attitude or little knowledge of stuttering (for older kinds and adults)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

keys to stuttering modiication

A

-get the person to “stutter more easily”
-combo of: understanding, monitoring, desensitizing, accepting, modifying the moment of stuttering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

stuttering modification treatment steps

A

motivation, identification, desensitization, variation, stablization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
motivation
identfying goals, talking to others who stutter, building the therapuetic relationship to develop trust
26
identification
education, naming stuttering (and other behaviors) in others, naming stuttering (and other behaviors in others)
27
desensitization
advertising, pseudostuttering
28
variation
freezing, cancellation, pull-out, prepatory set
29
stabilization
support groups, self-help
30
things to keep in mind with stuttering modification
-must build the relationship, much of this is counseling in nature -get the clients to accept stuttering, then give them a technique to improve when they choose to improve -educate the client, let the assist in planning goals
31
what do we really want to know: children
does the child really stutter? is the child likely to persist or spontaneously recover? what is the best therapy for this person? what do the parents think? how does stuttering impact the child and family, etc.?
32
what do we really want to know: older children and teens
is this stuttering or something else? (child onset, psychogenic, neurogenic, other) how does this impact their life/quality of life? what do the parents/teachers thing? what is the best type of therapy for this person? what are their goals? how motivated are they to change?
33
what do we really want to know: adults
is this stuttering or something else? how does/has this impacted their life? what is the best type of therapy for this person or do they even seek therapy? and why now?
34
stuttering profile: speaking tasks
-single syllable words -multisyllablic words -phrases -sentences -connected speech (monologue w/ clinician and family) -outside of clinic tasks (telephone of friend, telephone a stranger)
35
stuttering profile: qualitative analysis
-communicative ability -ethnographic interview -avoidance/secondary behaviors -stuttering/disfluent events description -stuttering variance -speaking rate
36
stuttering profile: summary of results
-motor function -language development -articlation/phonology -feelings/attitude scales -self/assessment
37
writing goals
come up with general goals: -motivation and identification -desensitization -modification/variation of speech -modification/variation (with stuttering remaining) -carryover and maintenance
38
lidcombe program
goal: eliminate stuttering, operant with lot of reinforcement
39
before treatment LP
clinical evaluation -within clinic speech sample OR have parents play with them if shy -at home sample (300 syllables) -measure %SS at clinic and at home case history
40
case selection criteria LP
begin therapy is persisted more than 6 months after onset -does NOT begin when: - stuttering onset less than 6 months past - stuttering consists primarily of rhythmic, syllable repetitions - child and parents are NOT frustrated by the stuttering - no family history of stuttering
41
basic rules of LP
enjoy therapy, any negative reaction = stopping, parents apply with flexibility
42
clinical program LP
1. treatment procedures 2. fostering a working relationship 3. beyond-clinic speech measures 4. within-clinic speech measures 5. therapy activities 6. maintenace
43
treatment goals LP
-eliminate stuttering (maintain for 12 months) -conduct ativities sufficent enough so parent can get child to do first goal -assist parent (clinician)
44
treatment procedures LP
-weekly visits -child and parent must attend -contigent, working relationship formed with parents -maintenance
45
activities LP
-structured therapy games: praise for stutter-free speech -direct therapy: clinican uses games for 10 min then parents use technqiue with client -remaining time is used to discuss child and home training (10-15 minutes every day)
46
progress LP
-severity rating <4, online activities implemented -parents learn to use praise -structured activities at home
47
measures LP
-%SS in clinic activites -severity rating (SR) -stuttering per minute of speaking time (SMST)
48
continuation LP
3 consectuive weeks: %SS is less than 1.0 within clinic, SR is less than 2.0 outside clinic, SMST is less than 1.5 outside clinic -> child goes into maintenance phase
49
maintenance LP
parent continues with the program and child returns to clinic at intervals of: - 2 weeks (x2) – once every 2 weeks, 4 weeks (x2) – once very 4 weeks, 8 weeks (x2), 16 weeks (x1), Dismissal
50
family focused treatment program
GOAL: achieve and maintain normal fluency while developing healthy communication attitudes and effective communication skills · Age 2-6 yrs
51
fftp components
· Parent focused strategies: modify behaviors and reduce concerns · Child focused strategies: modify communication behaviors and develop healthy, appropriate communication attitudes -12 sessions
52
3 parts fftp
· Parent communication counseling: responding in supportive manner, learn about stuttering, reduce concerns, look at other aspects of childs life o Tasks: models of slowed “easy talking”, increased pause time, reduction of demands · Parent/child acceptance: o Tasks: identifying communication stressors, desensitization (talking about stuttering), understanding communication, acceptance · Child communication modifications: fluency shaping, stuttering modification
53
fftp concludes with
review and assessment
54
demands and capacities model (RESTART)
when demands exceed capacities, fluency breaks down: motoric, emotional, lingustic, cognitive
55
dcm components
1. Daily special interaction time – parent and child interact ( goal is to boost child’s confidence) 2. changing parent’s speech rate – talk more slowly, but still natural 3. substitute modeling and self-talk for demand speech – natural incentive communication
56
dcm other tasks
taught and modeled when relevant: decreasing emotional demands, decreasing cognitive linguistic demands, increasing emotional capacities
57
dcm specifics
SLP provide parent with treatment instructions · 10 min play period to begin · Target procedure is selected during play · SLP modeled target procedure, parent practice, SLP give feedback
58
palin parent-child interaction therapy
GOAL: parents trained to model helpful strategies and guide their children toward fluency Indirect approach
59
pcit evaluation
1. Child assessment: evaluation of speech, language, fluency, and questions 2. Case history · Clinician interprets the info and makes recommendation for therapy · Important to address feelings of blame or self-guilt
60
pcit therapy if
the child is considered to be at risk of persistent stuttering · if the parents are concerned and seeking support, or · if the child is reacting negatively to the stuttering
61
session 1 pcit
special time (5 min) – child and parent interact using their target o foundation of the program o parents reflect on the special time o they eventually generalize their skills and use it outside of special time
62
session 2-6
- review of special time feedback · parent child playtime is recorded and evaluated by parent · practice target in another videoed playtime
63
management strategies pcit
helping parents address issues: coping, anxiety, confidence building
64
interaction strategies pcit
· no universal or prescribed targets within the program · targets selected by parents based on child’s needs · targets not all identified at beginning of therapy because things can change
65
the consolidation period pcit
-parents continue to carry out special time at home -parents mail/e-mail feedback weekly
66
intervention programs for teens/adults
Goals include things, such as: o Reducing the frequency and form of stuttering o Reducing negative thoughts and feelings about stuttering o Decreasing avoidance o Involving the parents in altering the child’s environment o Enhancing the pleasure of communicating o Understanding stuttering and communication o Responding to stuttering and bullying
67
delayed auditory feedback - fluency induction technqiue
a device where you hear the speech playback a few seconds later
68
faf - fluency induction technqiue
69
masking - fluency induction technique
act like you don't stutter
70
choral speech - fluency induction technqiue
71
rhythmic speech - fluency induction technqiue
speak along to the beat; metronome or hand clapping/tapping
72
the successful stuttering management program (SSMP)
· GOAL: become a successful communicator and to enter all speaking situations in a person’s life · Adolescent and adult secondary stutterers · helps to improve intensive fluency, speech, stutter, communication, and language skills under a certified speech language therapist workshop.
73
precision fluency shaping
· Stuttering is treated as a behavioral problem · employs laboratory derived principles of learning in the development of new speech skills (prolonged speech).
74
therapy for precision fluency shaping
· relearn the proper means of producing the elementary sounds of speech, then rebuild their ability to correctly produce syllables, words, and ultimately, complete sentences
75
the camperdown program
· adults and adolescents · minimize stuttering through fluency technique · practice with SLP or family member · clients learn to achieve naturalness and fluency together – maintenance program after
76
american institute of stuttering
· adults and teens · intensive, residential program · emphasis on: manage and improve speech fluency, reduction or elimination of avoidance, strengthen self-confidence, develop new attitude
77
american insitute of stuttering phases
1. engaged in process of awareness and understanding (identify during sessions stuttering behaviors) 2. learns ways to reduce tension 3. learn speech restructuring techniques (easy onset, airflow management, reduced rate etc.)
78
warnings during therapy
- emotional factors require attention - individualized interventions = valued - informational support makes for better therapy - positive relationship - follow-up sessions to reinforce are important
79
stages of change (in stuttering therapy)
1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance
80
F80.81
childhood onset stuttering
81
R47.82
neurogenic stuttering
82
F98.5
psychogenic stuttering
83
F80.81 (also)
cluttering
84
developmental stuttering
· Onset in childhood · Speech disfluencies, secondary behaviors, emotions/attitudes
85
neurogenic stuttering
· Acquired stuttering: onset in adulthood · Following a neurological disease: stroke, TBI, neurodegenerative disease · Stuttering like disfluencies (repetitions, prolongations, blocks)
86
neurogenic updates
· Stroke most common etiology · Different etiologies lead to different behavioral representations · Associated with lesion in left hemispheric cortico- basal ganglia · Repetitions predominant (word initial) · SLD and OD exist in NS · Co-occurring: aphasia
87
neurogenic treatment
- Not everyone needs treatment: spontaneous recovery possible - Not everyone is bothered by the stuttering
88
psychogenic stuttering
· From emotional of psychological trauma – conversion reaction ·
89
malingering
faking
90
implication for treatment
* Stuttering modification * Fluency shaping * Cognitive therapy * Biofeedback * Speech rate changes * Pacing * Delayed auditory feedback * Voice therapy techniques * Respiration training * Relaxation techniques * Surgery & nerve stimulation * Prescription drugs
91
alternative therapies
pharmacologic and devices
92
pharmacologic
· Reduction of stuttering and anxiety · Side effects outweigh gains · Pagoclone = most successful /open label testing · No drug approved by FDA for stuttering
93
devices
· Speech easy ( like hearing aid) o Alter sounds and you hear it at slight time delay (choral effect) o Short term affect is high ( fluent for a couple months)
94
a profile is needed to determine differential diagnosis, at minimum must include:
o Speech samples at various different tasks/complexities across different settings and days o Fluency inducing tasks o Adaptation o Emotion/self-assessment o Trial therapies (finding what works) o -Singing o -Rhythmic speech
95
cluttering
(Communication problem different but related to stuttering) · Marked by 1) Excessive speech rate 2) Jerkiness in speech rhythm 3) Excessive numbers of NSD 4) Under articulation/excessive coarticulation 5) *some would also say severe expressive language difficulties
96
cluttering assessment
1. speech rate (cluttering = rapid) 2. concentration and attention span (cluttering = poor and short) 3. locus of stuttering (cluttering = pauses before vowel initial words without signs of frustration) 4. # of repetitions (cluttering = 6, 8 or 10 repetitions of syllables, words or phrases are common) 5. articulation testing (cluttering = several errors; /r/ and /l/ are common errors) 6. voice assessment (cluttering = monopitch/monotone) 7. reading assessment (cluttering = poor reading) 8. writing sample (cluttering = disorderly, poorly written, poorly integrated, uninhibited, full of repetitions and deletions)
97
qualitative cluttering assessment
1. disorganized speech 2. frequent slips of the tongue (ex. "at this plant in time,...") 3. physically immature, clumsy and uncoordinated 4. poor musical ability 5. familial evidence ("Does anyone else in the family have speech problems similar to yours?") 6. personality factors (impulsive, “figity”, hasty, hyperactive, careless, clumsy, untidy, sloppy, impatient, short tempered) 7. lack of awareness ("Do people ask you why you repeat?", "Do people ask you to slow down?")
98
new perspective of cluttering (St. Louis, 2007)
● Excessively rapid and irregular rate ● Pragmatic errors ● Word finding errors ● Hyperactive ● Reading difficulties ● Writing difficulties
99
treatment of cluttering
· motivation is the key element · Variables 1. age of the client 2. the length of time that cluttering has been a problem 3. whether cluttering and stuttering coexist 4. nature and severity of the problem
100
cluttering treatment must also include one of the following:
1. oral-motor exercises 3. work on slow deliberate/ reduce rate 6. heighten awareness of their disorder and therpuetic technqiues 7. pragmatic skills such as turn-taking 9. self-monitoring
101
stuttering vs. cluttering
- Cluttering has a faster rate of speech and lower awareness than stuttering. - Cluttering does not have prolongations, blocks, repetitions. More like phrase repetitions and interjections for cluttering. Some people who clutter also stutter.
102
demands and capacities model
each of us have innate capacity to speak fluently, when that capacity is exceeded, fluency can break down
103
neuropsycholingustic
lingustic = the words you say paralingustic = the characteristics of the speech -if these are not synchronized, then this will result in a nonfluency
104
dynamic multifacotrial model of stuttering
stuttering is dynamic and can only be described through the influence that it has on a lifetime