Understanding Stuttering: Definitions, Behaviors, Prevalence, and Therapies - Prof. Helen , Study notes of Speech-Language Pathology

Download Understanding Stuttering: Definitions, Behaviors, Prevalence, and Therapies - Prof. Helen and more Study notes Speech-Language Pathology in PDF only on Docsity! Hanley 2008 1 DEFINITIONS OF STUTTERING BEHAVIORAL CRITERIA THE CONTROVERCY People have, and will continue, to argue about the definition of stuttering. The argument centers around the various types of disfluencies, whether feelings and emotional responses should be included, and whether the speaker or the listener is the appropriate identifier. This has led to difficulty in research/diagnosis/treatment areas FLUENCY Fluency is the aspect of speech production which refers to the continuity, smoothness, rhythm, rate, and/or effort with which phonologic, lexical, morphologic, and/or syntactical units are spoken. If any or all of these are effected, disfluency occurs!
Task Force on Terminology, SID IV Van Riper Stuttering occurs when the forward flow of speech is interrupted by a motorically disrupted sound, sylable or word…or by the listener’s reaction thereto. Later, Van Riper included avoidance and struggle behaviors in his definition Core Behaviors REPETITIONS: Sounds, syllables or single syllable words repeated several times PROLONGATIONS: Of voiced or voiceless sounds. Sound or airflow continues but articulator movement is stopped SECONDARY BEHAVIORS ESCAPES Terminate or end the stuttering AVOIDANCES Prevent the stuttering from occurring Hanley 2008 2 Secondary, contd. BEHAVIORAL EXAMPLES eye blinks head movement tension and struggle hesitation or stalling substitution of synonyms for feared words avoidance of topics or situations JOHNSON’S DISFLUENCY TYPES Repetition -sound
p,p,p,p,p,people are funny -syllable Par,par,part of a word -word
He, he, he, he wants to go -phrase
I will, I will, I will, I will go home now Types, contd. Prolongation Interjection Intrusion of Sound
be hecause he’s myhi brohuther Types, contd. Tense Pause (Block
-a silent period accompanied by excessive tension
Revision
Sound (“I p, t, put it in the jar.”)
Syllable (“I wi-wa-wish you were here”)
Word (“He came—arrived last nnight.”)
Phrase (“I was—I am—I will be going.”) PREVALENCE/INCIDENCE
PREVALENCE: The number of cases that exist within a population at a given time, divided by the total number in the population. 1% INCIDENCE: The number of new cases arising in a population during a given time period, usually over a year, although a full lifetime is sometimes used. 4.5% PREVALENCE, CONTD. TREATED PREVALENCE: The number of cases in treatment divided by the toal number of the population. Hanley 2008 5 Disturbed Feedback “The Closed Feedback Loop” Delayed Auditory Feedback (Lee, 1951; Black, 1951) Normal
A delay imposed on a person’s speech signal (200 ms.) causes a breakdown
usually characterized by vowel prolongation
slower rate
females adapt more readily
younger children more vulnerable but longer latencies are needed APPROACH AVOIDANCE CONFLICT (SHEEHAN) The degree of an approach drive and the degree of an avoidance drive reach a level that introduces conflict. As applied to stuttering by Sheehan, the drive to speak (gregarious) and the drive to be silent (because of disfluency) cause conflict (emotional) leading to struggle Persons who stutter
Fluency increases
in reading
in spontaneous speech Covert Repair Kolk (1985) Adaptation theory (agrammatic aphasia)
Window for processing reduces
adapt-simplify syntactic planning
“corrective” attempts to repair poor programming Covert Repair Hypothesis (CRH) of stuttering (Postma & Kolk, 1993)
Stutterers have more errors in phonological encoding PARAMETERS FOR MEASUREMENT Frequency of Stuttering Intensity of Stuttering (Tension/Struggle) Duration of Stuttering SITUATIONAL ASSESSMENT Fear and avoidance will vary across different speech situations. Thus, a “hierarchy” of difficult situations must be established, and the therapy activities will follow that hierarchy. Hanley 2008 6 PHYSIOLOGICAL TARGETS OF MEASUREMENT Airflow/Air Pressure Voicing Rate of Speech Muscle Tension Movement (stoppage, choppiness) Effort SPEECH SAMPLES SPONTANEOUS SPEECH SAMPLE READING PASSAGE ADAPTATION (reduced stuttering over repeated readings) CONSISTENCY MEASUREMENT ATTITUDE MEASUREMENT The measurement of attitudes and attitude change are essential parts of successful treatment!! Brown’s Factors LOCI OF STUTTERING
Vowels vs. Consonants
Polysyllabic vs. monosyllabic
Content words vs. Functional Words
First Words
Streesed Syllables vs. Unstressed Syllables Browns Factors, contd. The observation by Brown that stuttering occurs more on consonants than vowels needs to be interpreted with caution, While the repetition or prolongation may be on a consonant, the difficulty may be with the transition to the subsequent vowel. DISFLUENCY TYPES 1. SOUND, SYLLABLE, WORD, PHRASE REPETITION 2. INTERJECTION 3. PROLONGATION 4. TENSE PAUSE (BLOCK) Hanley 2008 7 THERAPY TARGETS AND ACTIVITIES Hurried vs. Unhurried Initiations. Excited and emotional onsets of speech are usually hurried (maximum acceleration of movement). Quick inhalations are often noted. Pitch elevation is not unusual. Exaggerated head and neck movements are often observed. VOICE ONSET Onset of voicing is the most commonly observed difficulty. The most typical pattern involves an adducted, tense vocal fold posture.The child may report “getting stuck.” Excessive subglottal air pressure is often involved. The therapy target is initiation with vocal folds abducted. “Easy Eddie” “Hard Harry” are good “Fluency Friends” to be used during therapy activities. AIR/VOICE COMBOS! It is important to observe the characteristics of the disfluent phoneme. Is it voiced? Voiceless? Oftentimes, a voiceless repetition is evidence of difficulty with voice onset (related to a subsequent sound) VOICE ONSET, CONTD. Start with vowel initiated words, gradually extending the complexity of the utterance to phrases, clauses, sentences, and combinations of sentences. THE /h/ AID If the child is having difficulty initiating voice from an abducted (open fold) position, initiation of airflow with an /h/ sound insures an open airway. Then the vibration for voicing can be initiated gradually. Later, the audible /h/ phoneme can be changed to an inaudible airflow. VOICED VS. VOICELESS PHONEMES 1. VOICELESS PHONEMES (EG. /P/,/T/,/K/) Drills should focus on the initiation of controlled airflow following the explosion of air. Then, the voiced signal (for the subsequent vowel) must be gradually turned on. Thus, the rule for the tool is AIR + VOICE This is the control target!!