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Adult stuttering Tx (2) - Coggle Diagram
Adult stuttering Tx (2)
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Smooth speech
Demo to them, warn them that it is going to sound diff. Don't know what it is like to be fluent, have only felt stutter
Defn
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Systematic retraining of speech mechanism via modifying the way in which one usually breathes, voices, articulates of phrases to produce smooth speech
Mater speech program
Pre-course therapy
Unds impact of stress, relaxation principles
Mental relaxation (contracts adrenaline fight and flight response- anxiety, fear, threat), exclusion of distracting thoughts eg. meditation
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Basic skills for fluency control, empowerment: facilitates ability to monitor muscle tension, ease heavy weight around chest area. Dev into anxiety control, specific speech situations, once practiced they become good at it. Fosters a general sense of wellbeing
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Progressive muscle relaxation: reduces overall body tension by tensing, relaxing all muscle groups in your body
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- Mechanics of smooth speech
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Gentle onsets, slow smooth transitions into phrases
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Continuous airflow-talk thru how we obtain diaphragmatic breathing- need to lie down sometimes for more visual, before you sleep, need to do diaphragmatic instead of clavicular breathing
Normal intonation, stress patterns, voice quality
Instatement
Use short phrases chunking, longer pause times strategically.
Need to consider where it happens in reading passage, where to pause and breathe
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Allow time for planning, monitoring
Easier to articulate, more predictable in length=less respiratory control demand
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Facilitates better thought planning, thinking time
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Client needs to master control, monitoring of their speech rate
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Transfer
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Direct back to hierarchy of speech situations: phone call, script it, do it, take them to order lunch, coffee.
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How to get them up to that confidence, making him work thru a maze to build cognitive load, see if he is able to maintain smooth speech
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Maintenance
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- Consideration of env factors
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La Trobe program
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Intensive phase
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Day 1-3 instatment: learning SS 60-170-comfortable rate- how much time is needed varies across clients
Key concepts: easy onsets, linking, elongating vowels
Clinician modelling as main teaching method, w audio exemplars
Start w single vowels (VC, CVC)- multisyllabic words, phrases, sentences, reading conversation
At 60spm, clinician provides feedback every 15 seconds, at 120spm feedback is given every 1-2min
At 120spm, +ve feedback given every 1-2min
Encouraged to use natural sounding speech at 120spm, higher while remaining stutter free using SS
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Indv hierarchy of speech situations: for them to rmb how confident they felt. "Let's think about the time you did it"- first w guidance, next time on their own
Prepare those speaking situations-rehearse, plan, role play, actually implement those tasks
Maintenance phase
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Review home prac activities, SS techniques
Problem solving around generalisation, maintenance issues
Last 0.5 hour, group interaction and practice
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Results of Tx
3.5-5 years after Tx, adults have maintained 70% reduction in stut
1 year after Tx, adults have maintained a 95% reduction in stut
1 y 4 months after Tx, 74% reduction in stut maintained
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Normalises muscle tension levels, provides a speech env where airflow, speech are continuous so stutters X creep in
General components
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Gentle onsets, soft contacts, linking words
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Feedback
Provide feedback on technique and rate for every 15-20s, shaping technique during prac
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If there is breach in technique or rate but next few phrases are ok, continue on
If there is a breach in technique 2 times in a row, stop client, identify what they did, demonstrate the breach if necessary, see if they can self correct- model the correct technique-START exercise again
Assistive devices
Form part of speech restructuring program, other fluency training programs
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EMG feedback, breathing monitors, metronome
Devices for DAF, Speech Easy
Change pitch, chorale effect
Not eliminating stut completely, can decrease the severity of stut, somewhat when they are used by some ppl, effects can wear off
Decreased anxiety for ppl using these devices, BUT dangerous to be over-reliant on these devices
Speech motor control
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SLP is the external prompt for fluency but client must move towards self-prompt, internal control
Other techniques
Benson technique
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Decide how long you are going to practise the technique, have means of telling when time has passed
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As you breathe out, say simple word or phrase to yourself eg. relax, stay calm
If you become aware of distracting thoughts, put them aside
Silva technique
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Establish relaxed breathing pattern by breathing in and out slowly and abdominally, becoming aware of breathing pattern
Think about in-breath, as you breathe out, say number 10 in your mind, in smooth speech. Try to visualise the number.
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Stuttering feedback
Need to discuss moments of stut to increase awareness, reduce stigma. If there is a stutter, ask them to change specific comments, stop client and ask what happened then start exercise again.
Did you feel that stutter? What happened there? What could you have done there? Let them know you were aware of the stut. Problem solve thru it- give them positive reinforcement
Operant therapies
Operant conditioning eg. rewarding fluency, timeout for stut.
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Pharmacotherapy
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underactivity in left striatum of basal ganglia-impaired function, eg. excess amounts of dopamine present in brain of many PWS
Excess lvls of dopamine are also present in ppl w Tourette's Syndrome and schizo, same type of drugs have been trialled (but in smaller doses w PWS)
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Some drug names
Haliperidol
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Blocks receptors for neurotransmitter dopamine, diminishes uptake of dopamine in excess
Worked but side effects of drowsiness, sexual dysfunction, excess limb mvm, risk of permanent neurologically based mvm disorder
Olanzapine
Dopamine antagonist: medication to reduce uptake of dopamine can be effective in reducing stuttering
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Pagoclone
Has best effects, least side effects
After trial all patients offered, decrease in 40% stuttering after use for 1 year, BUT headache!
Is not a miracle cure but may be a helpful adjunct w traditional forms of Speech Tx. WE CANNOT PRESCRIBE!