Fluency Final Flashcards
(82 cards)
1
Q
Primary Typologies of Stuttering: Within words SLD
A
Sound repititions, syllable repitions, blocks, broken words, prolongations
2
Q
Primary Typologies of Stuttering: Between word normal disfluency
A
Interjections, Revisions, Phrase repetitions, multisyllabic word repetitions, monosyllabic word repititions
3
Q
Secondary Typologies of stuttering
A
Frustration, Tremor, Reactions to perseveration, vocal fry, interruptor reactions, speaking on complemental air, gasps and speech on inhalation
4
Q
Socondary Typologies of Stuttering: Responses to the fear of the basic behaviors
A
Word substitutions and circomlocutions, refusal and odd speaking, postponement, Abulia, timing devies, trigger postures, disguise reactions
5
Q
Clonic
A
Repetition, Rythmic, Oscillatory
6
Q
Tonic
A
Prolongation, Tense, Sustained
7
Q
Tonoclonus
A
Predominantly clonic
8
Q
Clonotonus
A
Predominantly tonic
9
Q
Overt
A
Observable, measurable
10
Q
Covert
A
Feeling, attitude
11
Q
Trigger
A
Internal, posture
12
Q
Cue
A
External, situation
13
Q
Accessory
A
Struggle, tension
14
Q
Associated
A
Feeling, attitude
15
Q
Speaking rate
A
Average # syllables/min - stuttered and non stuttered speech
16
Q
Articulatory rate
A
Average # syllables/min - nonstuttered speech
17
Q
What is “too fast” speaking rate?
A
180-200 syllables/min
18
Q
What is “just right” speaking rate?
A
120-180 syllables/min
19
Q
Stuttering Modification
A
Van Riper-Modify stuttering moment Voluntary/Fake stuttering Cancellation Pullouts Bounce Preparatory set
20
Q
Fluency Shaping
A
Wingate, Webster, Ryan, & Perkins-Replace stuttered speech with fluency…not just modifying the stuttering
22
Q
Quick Fluency
A
Suggestion, relaxation, and unusual modes of speaking
23
Q
Psychotherapy
A
Anxiety, guilt, frustration, hostility, self-confidence, and fear
24
Q
Iowa Therapy
A
Fake or voluntary stuttering, cancellation, pullouts, bouce, and preparatory sets
25
Q
DAF and FAF
A
-Delayed Auditory Feedback-Frequency Altered Feedback
26
AAF
Altered Auditory Feedback-Corrects auditory processing abnormality in brain imaging
27
Medications for stuttering
tranquilizers and dopamine antagonist-haloperidol
- resperidone
- olanzapine
28
ABC's of Stuttering
- Affective-Behavior
| - Cognitive
29
Affective (ABC's)
-Feeling of embarrassment, anxiety, shame, and guilt-emotional reactions to stuttering for client or listener, not always negative
30
Behavior (ABC's)
- Tension or struggle, avoidance, or circumlocution-stuttered speech, describe what they are doing
- secondary characteristics, happen at time of sttering moment (eye blink, tensing, fist clench)
31
Cognition (ABC's)
- negative thoughts, low self esteem, reduced self-confidence-anticipation of stuttering, predict when to stutter
- avoidance behaviors, may be debilitation
- negative self-regard as a communicator, not at root of stuttering, stereotypical view that is not necessarily true
32
Fluency Disorders in Children:Type 1
-Normally fluent, but parents are excessively concerned-Normally fluent with pareny concer, domo therapy with parents
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Fluency Disorders in Children:Type 2
Excessive time speaking discontinuously, not aware of speaking difficulty, secondary bx (tremors, facial contortions) Younger than 3.5 years-Excessivy disfluency and no awareness, modeling and rate reduction
34
Fluency Disorders in Children:Type 3
Child aware of difficulty and is imposing internal demands. over 3.5 years old-Excessive sifluency with internal demands, comprehensive program to ID, desensitize, and modify
35
What does research tell us about stuttering and disordered phonology?
- not much!does occur in an unknown proportion of kids
- 30-40% is an overestimate
- no evidence that disorder phonology causes stuttering
- stuttering not more likely to occur on more phonologically complex sounds
- no difference b/tthose who do stutter and those who don't
- co-occuring may change over time
- may or may not differ in kids whose stuttering persists
36
Loci of stuttering:Consistency Effect
Person whos stuttered words being the same upon repeated readings of the same passage
37
Loci of Stuttering:Congruity
Not all who stutter will stutter on the same word in a passage (?)
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Loci of Stuttering:Adjaceny Effect
Stuttered words occurring next to previously stuttered words that have been blotted out upon repeated readings of the same passage
39
Loic of Stuttering:Cycles
There is no evidence of a tendency for stuttering during oral reading to appear in periodic waves
40
Loci of Stuttering:Clusters/Clustering
Tendency for moments of stuttering to occur in clusters where by stuttered words are flollowed immediately by more blocks
41
Loci of Stuttering;Expectancy (anticipation) phenomenon
The ability of people who stutter to predict the words on which they are going to stutter with greater than chance accuracy
42
Loci of Stuttering:Adaptation Effect
Progressive decline in the number of stuttering moments upon repeated readings of the same passage
43
Facts and stats:Onset
Developmental stuttering first appearing in preschool period2-5 years
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14 fluency inducing conditions 1-7
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1 alone2 in unison with another speaker
3 to an animal
4 to an infant
5 in time to a rhythmic stimulus
6 when relaxed
7 in a different dialect
```
45
14 fluency inducing conditions 8-14
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8 while simultaneously writing9 when singing
10 swearing
11 slow prolonged manner
12 loud masking noise
13 Delayed Aud feedback
14 showdowing another speaker
```
47
WWR
Whole word rep
48
A-SP
Audible sound prolongation
49
I-SP
Inaudible sound prolongation
50
PR
phrase rep
51
INTJ
Interjection
52
REV
Revision
53
CL
Cluster
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UP
Unfinished Phrase
55
UW
Unfinished word
56
Criteria for Direct Therapy 1-5
1 negative statements about their talking2 struggle bx
3 3+ types of disfluencies are demoed
4 vowel interruptions are notes in speech or there are phonatory arrests
5 When parents show distress when child is disfluent
57
Criteria for Direct therapy 6-10
6 disfluency rate exceeds 8% of the words uttered7 disfluencies occur on ind phonemes or syllables as opposed to whole words
8 fluent periods are shorter in duration
9 father, mother, or sibling also stuttered
10 child also has an artic or lang delay as well
58
After the eval, the child can be in 1 of 4 categories:
| Child is fine, no stuttering bx
- affirm patients' concern
- say we aren't concerned about disfluencies at this time
- pay them off for bring the child in early
- if anything changes have them call right away
59
After the eval, the child can be in 1 of 4 categories:
| We're not sure, not real concerned, but more concerned than #1
- Ask parents to track disfluencies
- affirm parent's concern
- note any changes
- have parents make contact in 2 months
- contact sooner if things change
60
After the eval, the child can be in 1 of 4 categories: Child is at risk, not stuttering yet, but has red flags
- enroll in treatment
- goal of tx is to find situations that increase/decrease disfluency
- parents track
- look for ways to increase fluent time
- look for ways to decrease disfluent time
- lots of positive reinforcement
- parents are NOT asked to DO anything until be determine what seems to work best
61
After the eval, the child can be in 1 of 4 categories: Child stutters
- Enroll and treat stuttering directly
| - parents MUST be actively involved in all phases of treatment
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Cluttering
- excessive rate
- periods of fast and slow rate
- rushes
- may be telescopic
- may have errors in artic
- may worse when relaxed
- disorganized thoughts
- prosody issues
poor syntax
-rhythm issues
63
SAAND
Stuttering Associated with Acquired Neurogenic Disorder
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Neurogenic
- usually no history of stuttering, secondary to a neuro event
- Can be persistent or transient
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Neurogenic Characteristics
- initial phonemes (always)
- Medial (often)
-substantive words (always)
66
Persistent neurogenic
may be bilateral
| -associate with both hemi damage
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Transient Neurogenic
unilateral
| -associated with damage on one hemi
68
Neurological disorders that can cause stuttering:
Parkinson's (degenerative) strokes, Head trauma, tumor,TBI, etc.
69
```
Fluency Enhancing Procedures:
Direct Therapy (8)
```
1: very slow/stretched speech,
2: simple/short sentences,
3: many silent pauses,
4: elim of ?'s/interruptions/demands,
5: slow convo turn taking
6: self-talk, parallel play, modeling, expansion
7: follow kids play
8: you having a stuttering moment
70
Easy Onset
1: light artic contacts for initial sounds
2: smooth artic movements from sound to sound, word to word
3: unrestricted air flow
71
DIMES Approach
```
Describe what happened
Identify when it occurs
Modify
Evaluate
Self Correct
```
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How does motivation effect therapy?
If the client isn't ready to actively participate in therapy, even the best approach will fail.
73
What do parents need to be aware of?
they need to understand the nature of stuttering, recognize bx changes can be slow, and commit to reinforce, NOT enforce.
74
Evaluation Phase
1: Family Play Session (15 min, caps and demands are noted)
2: Direct Observation and manipulation of fluency skills (explore awareness, fluency enhance bx's are used,
3; Parent Interview (case history, info about stuttering history, emotional support)
75
Intervention Phase
1: family play session
2: parent counseling edu and skill dev
3: Direct Therapy with child
4: Parent's Group
5: Children's Group
76
Phases of a Stuttering Program
1: Describe speech pattern (explanation, exploration)
2: Bring down intensity, struggle, and fear (desensitization, P-scale)
3: Detect bx during moments (signal, interrupt)
4: Replace old reaction with new action (smooth, voluntary)
5: Produce speech that moves forward fluently (structured/unstructured, inside/outside)
77
Procedures and Terms of stuttering program
1: Fundamental concept (stimuli: sounds, words, physical, people, etc)
2: Selected bx principle
3: Organization of individual therapy session
4: learning to change stuttering to a Smooth Voluntary Response (SVR)
5: General sequence for obtaining and habituating a new response
78
Demands and Capacities model
Capacity: motoric skill, linguistic skills, affective and cog dev, ractin time, self-conf, neurological maturation
Demands: speech rate of other, turn taking, parent reactions, questioning, demanding,
79
Hierarchy: Length of utterance
```
1: monosyllabic words
2; 2 syllable words
3: Multisyllablic words
4; Phrases
5: Sentences
6: Conversation
```
80
Hierarchy: Topic
1: Rote "lists" 9days of week, counting)
2: Picture naming
3: Short answers to ?s
4: Descript of concrete things
5: Descript of abstract things
6: Likes and dislikes
7: solving a problem
81
Hierarchy: Environment
1: clinic room
2: clinc door open
3: In hallway
4: walking around
5: Another room/bldg
6: Restaurant
7: Telephone
82
Hierarchy: Listeners Present
1: clinician only
2: clinician and another client
3: clinician and family member
4: clinician and multiple listeners
5: clinician and teacher
6: listeners other than the clinician (clinician not present)
83
Hierarchy: listener reaction
1: attentive
2: inconsistent eye contact
3: Challenging questions
4: placing time pressure
5: feigning misunderstanding
84
Why is it important to use a Hierarchy?
to build them up to real world situations to help them maintain fluency in all situations.
