Fluency Flashcards

Question

What is cluttering?

Answer 1

Rapid speech with high rates of disfluency and irregular prosody. Decreased intelligibility. Characterized by a perceived rapid and/or irregular speech rate (i.e. talks too fast, sounds jerky), atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency.

Answer 2

Causes: research is not far enough along to identify causes of cluttering Predisposing factors: potential factors include: ○ Age - more often occurs in school-age children. ○ Sex of child - appears to be more common in males ○ Family history - anecdotal reports indicating presence of cluttering in more than one family member suggest that family history may be a risk factor ○ Presence of co-occurring disorders - features of cluttering are sometimes observed in conjunction with other neurological disorders (e.g. ASD, Tourette’s, and ADHD). However, not all individuals with these disorders also exhibit cluttering. ○ Presence of stuttering - an estimated one third of people who stutter also present at least some components of cluttering

Answer 3

A general term referring to a type of fluency impairment that arises secondary to a specific causal event such as stroke, head trauma, neurodegenerative disease, introduction of a pharmacological agent, or significant psycho-emotional stress

Answer 4

Similarities: involves primary/core behaviours and are associated with behavioural symptoms Differences: Lesion: unknown but includes left perisylvian areas (develop) vs. cortical or subcortical in either hemisphere (acquired) Cause: unknown vs. physical trauma, vascular, metabolic, tumour Duration: 80% grow out of vs. good prognosis if unilateral, bad if bilateral Dysfluency: beginning of sentence or phrase vs. scattered throughout sentence Singing: induces fluency v.s. may minimally improve fluency Onset: sub-acute vs. sub-acute or acture Reaction: anxious vs. not anxious

Answer 5

(i) roughly equal occurrence of dysfluencies on both content and function words (ii) lack of anxiety about disfluencies; (iii) stuttering instances not restricted to initial syllables; (iv) rare occurrence of secondary behaviors; (v) absence of adaptation effect; and (vi) occurrence of dysfluencies on all speech tasks.

Answer 6

Shows frequency, duration, types, and secondary behaviours Should be between 200-500 syllables Sample a variety of communicative contexts and across environments

Answer 7

Variability is one of the hallmarks of stuttering. Things that can impact the sample include: The speaking task (i.e. the activity in which the speaker is engaged) - E.g. reading, describing a picture, retelling a story, describing a job The conversational setting (i.e. the location in which the seaking is taking place) - E.g. in the clinic, at home, in the classroom/workplace, on the playground The conversational partner (i.e. the person with whom the client is speaking) - E.g. clinician, peers, parents, siblings, spouses, co-workers

Answer 8

Social/pragmatic skills; Verbal interactions in familiar and unfamiliar situations; Number of opportunities for the client to use new skills in realistic speaking activities; Strategies for dealing with bullying; Self-advocacy strategies, Expressing wants and needs, Having conversations or telling stories, Forming relationships, regulating emotions, showing confidence and conveying truthfulness Assess: case history, comparison of speech samples, self-report

Answer 9

Linguistic complexity,MLU, presence/absence of word avoidance, reading aloud and answering short questions Assess: classroom observation, interview, self-report measures.

Answer 10

Feedback technology Cognitive interventions Behavioural interventions Speech motor intervention Speech motor + cognitive Multiple component Fluency shapping Stuttering modification Pharmacological options

Answer 11

Technologies that aim to reduce frequency or severity of stuttering but altering the way a person with stuttering hears their own speech Two types: frequency altered feedback (FAF) and delayed auditory feedback (DAF) Some devices also combine these two Advantages: all have a positive effect on fluency, no adverse outcomes Limitations: most participants are adults, results are variable across individuals.

Answer 12

Aim to lead to psychological change and may be used alone or to support, optimize or prepare for other interventions Anticipated outcomes: direct speech gains, psychological wellbeing gains which lead to improved speech, gains which aim for living successfully Pro: positive impact on measured outcomes, reduced stuttering severity, positive communication attitude, improved speech fluency, self-efficacy beliefs, coping, and attitudes towards speech situations Con: evidence for adults only, certain tools to measure outcomes have significant limitations.

Answer 13

Focuses on changing the behaviour of child or family Lidcombe program: teaches parents to provide verbal contingencies on the child’s fluent and stuttered speech Parent-child interaction therapy: focus on changing behaviours within family, predominantly parent behaviour and interactions Direct child behaviour modification: working exclusively and directly to change approach Pros: used with all ages, lidcombe has shown good improvements, benefits post-intervention, positive effects on %SS and severity of stutter. Cons: requires involvement and persistence of parent/caregiver

Answer 14

Clinical administered direct therapy approach that aims to reduce stuttering by altering speech motor patterns (eg. easy onset, measured rate) Focuses on the mechanism of speech and includes fluency shaping techniques that aim to establish fluent speech by altering it significantly and then shaping it to sound more natural Pros: all studies reports positive benefits, reduced %SS Con: most with adults or older children

Answer 15

Combines cognitive techniques with speech motor/fluency shaping techniques Elements: EMG feedback, smooth speech, relaxation, airflow training, social support, self-management components, elements to prevent relapse. Pros: all report positive impacts, some reduction in %SS, positive effects on reducing avoidance behaviours and anxiety surrounding speech Cons: some fading after intervention, change in attitudes towards speech after technique sessions.

Answer 16

Incorporate multiple components of components of different fluency interventions Elements: EMG feedback, smooth speech, relaxation, airflow training, cognitive aspects, self-management components, social support, particular elements to prevent relapse Pros: any age, positive impact on avoidance behaviours and attitudes, reduction in self-judgement, reduction of #SS and %SS Cons: complex to implement

Answer 17

Techniques that alter breathing, speech rate, voice production, and articulation in ways that facilitate more fluent speech Maintenance of fluency by modifying the manner of speaking and contingencies for stuttering and fluency Include skills such as: relaxed breathing, belly breathing, slow stretched speech, smooth movement, easy voice, light contact/soft touch Therapy is characterized by conditioning and programming principles Advantages: explains systems of speech and which element is being targeted, motivating from start of program, almost all can become highly fluent quickly Cons: may require abnormal speech patterns, can sound unnatural, some difficulty with maintenance and fear of stutter returning, does not address underlying fears and concerns, requires use of contingent reinforcements

Answer 18

Work directly with stuttering to help client increase awareness of stuttered speech, examine and reduce physical tensions, and ultimately change moments of stuttering. Help reduced struggle behaviours and stutter in a more relaxed way. Can also help decrease sensitivity, negative reactions, and increase feelings of control, openness, and acceptance. Techniques: catching the stutter, relaxing the stutter, slide, easy stuttering, cancellation Pros: no abnormal pattern, therapy is more spontaneous and enjoyable, helps understand the nature of their concerns and become less anxious, more natural speech, flexible approach Cons: non-structures and more difficult decisions beed to be made, high degree of clinical skill, may not be the best for more severe

Answer 19

Excess levels of dopamine in the BG may lead to stuttering Some drugs block DA to improve fluency Pros: reduced by 50% Cons: limited reduction, does not address other issues, other factors (side effects, interactions with other drugs, risk to health and safety)

Answer 20

Parent training/counselling: can set minds at ease, educate and clear conceptions, answer questions, provide strategies Parent training: slow speech/turtle talk Home/school programming: fluency shaping programs (lidcombe, syllable-timed speech, palin parent-child interaction) Individual therapy: Stuttering modification programs - Cancellation technique (post-block correction) Pull-out technique (In-block correction), Preparatory set technique (pre-block correction) Group therapy: stuttering modification programs, support, share ideas and resources

Answer 21

Follow your child’s lead in play Make more comments and ask less questions Keep the complexity of questions at the child’s level Use language appropriate to the child’s level - Use language that is contingent on the child’s focus Repeat, expand, and rephrase often Allow child time to initiate, respond, and finish their statements (don’t complete sentences for them) Maintain eye contact, position, touch Provide constant praise and encouragement

Answer 22

Reducing rate of speech Stretching out speech Regulating and controlling breathing Establishing light articulatory contact Facilitation of oral-motor planning coordination Modifications of the stuttering moment Self-monitoring Transfer and generalization

Answer 23

Genetic predisposition o Prevalence x3 higher in families who stutter o Family prevalence increases in families with daughter who stutters (inherited stronger predisposition) o Males more at risk to develop persistent stuttering o Females tend to recover from stuttering more easily TWIN STUDIES o Monozygotic (identical twins) have more concordance than fraternal o Not 100% in identical twins à only 1 twin stutters o Environmental factors play a role

Answer 24

When a child’s family includes stutterers whose stuttering persisted (lack of family history) o Boys have a greater risk of persistence, but girls typically recover more quickly o Children who begin to stutter “later” (after 3.5 years) o Children whose stuttering frequency/severity is not decreasing over a year after onset o Longer the child stutters beyond a year after onset, the greater the risk of persistence (especially for girls) o If prolongations + blocks do not decrease as stuttering goes on o Children whose phonological skills below norms

Answer 25

Demands of language acquisition o Ineffcient speech-motor control skills o Interpersonal stress associated with growing up in a typical family o Threats to security (divorce, hospitalization, relocation) o Under normal daily pressures of competition + excitement while speaking

Answer 26

Parents are NOT the cause of stuttering - there's no difference in communication/interaction - If parent is a fast talker = speaking rate may maintain stutter - SLP could work with parents on their communication style to help with therapy success - Some parents have unrealistic standards of fluency = normal disfluency misdiagnosed - Parents find it difficult to cope with having a child who stutters