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Other types of stuttering - Coggle Diagram

- - - - SSI-4
      - Analysis of speech sample
      - Proportion of stut function vs. content words
      - Presence of $ on non initial sylalbles-more freq in neurogenic $
      - Absence of secondary behaviours
      - Passage reading-but need to see if this is even possible. Get them to read it a couple of times to see if $ reduces after period of reading
      - Speaking in variety of fluency inducing conditions
    - - Aphasia diagnostic profiles Ax
      - need for further neurological testing
      - testing for other disorder-need to do differential diagnosis, impacting on comm or Tx eg. dysarthria, aphasia, motor disorders, cognitive disorders
      - Erikson scale S-24
      - Locus of control
      - Apraxia is the primary cause but it can become an apraxic type of stutter groping around, unable to plan and program
  - - - Pacing: speaking 1 syllable at a time, regular staccato rhythm. Pacing board-moves finger from place to place, timing each syllable/word with mvm. Tapping of thigh rhythmically to produce fluent speech
      - Slow rate and easy onset, increased success together w fluency shaping techniques
      - Stut modification: light contacts, pull outs, cancellations and preparatory sets
      - EMG biofeedback
- - - - Onset of stut-circumstances surrounding onset
      - Changes in stut since onset
      - Pattern of stut-situational variability, impact on life
      - If client has stuttered previously, ask about recovery
      - Family Hx of stut, other S&L, learning problems
    - - Diagnosis is usually tentative, conclusive diagnosis can never be reached
      - Need to weigh multiple factors
      - Evidence: Adult onset during psychological stress, absence of neurological factors, dramatic impv w trial therapy, unusual or bizarre struggle behaviours
- - - - General lang testing-all modalities
      - oromotor exam-if muscular weakness is suspected, low tone is observed, or if speech is slurred
      - Articulation probing and/or formal Ax
      - DDK tasks ptk
      - Copying rhythms
      - Pragmatic skills
      - Erikson scale, OASES- someone who clutters will have diff looking profile from someone who stutters bcos PWC has poor awareness of their speech difficulties so not anxious about it
  - - - Slowing rate
        
        Can be effective in ameliorating entire range of clut symptoms, more difficult to achieve, maintain slow rate for PWC. SLP to persevere until they find effective strategy. Speech rate often increases as degree of emotion increases.
        
        Strategies: Operant rate control programs, biofeedback, point out rapid spurts of speech. Use speeding tickets. DAF, assistive devices. Paced reading tasks-read word by word. Use of pre-recorded material for PWC to match rate and duration-device that demonstrates freq and intensity
      - Smooth speech, prolonged speech-slow rate, reduce dysfluencies. Impv in self-monitoring, clarity and lang planning abilities
      - Heighten monitoring
        
        Many are currently unable to monitor their own speech. Teaching this is challenging-need imagination, observation to create optimal strategies
        
        Strategies: rate reduction strategies need increased monitoring, analysis of video/audiotaped conversations to determine where breakdown occurs, show them samples of their worst, questionable and best speech. Ask them to imagine speaking clearly prior to comm and use self-talk, affirmation to strengthen those images
      - Using clear articulation
        
        Slow rate or learn to monitor more effectively often=clearer speech.
        
        Strategies: use conventional articulation strategies, when multisyllabic words are telescoped by cluster reductions, WSD, reading multisyllabic words can help PWC learn to include all sounds
      - Acceptable, organised language
        
        Verbal planning
        
        Lang Tx is recommended if above strategies have not been effective
        
        Strategies: Begin w simple, short sentences and progress to longer, more complex ones. Pauses, phrasing or chunking. SLP transcribes cluttered utterances to demo mazes-then asked to repeat only impt info. PWC asked to outline what, how, use of narrative frames. Prac telling a story logically, sequentially. Aphasia, high level concurrent lang resources targetting planning, sequencing, predictions
      - Interacting w listeners: training in anticipating, perceiving, responding to standard conversation cues, turn taking, slowing things down. Learning how to respond using facial expressions Learn to check in with listener. "Did you get that, should I repeat that?"
      - Speaking naturally: Rapid irregular, slow and robotic rates are unnatural but saying things quickly is also unnatural. Need to vary both syllable durations esp of stressed syllables, intonation, done during Mater SS, provide immediate feedback for strange speech. Use of Visipitch for intensity, freq. Teach PWC to vary pitch, loudness in an effort to sound more natural, combined w clarity Tx
      - Reduce excessive dysfluencies: Many PWC also stutter, excessive stut dysfluencies or clut dysfluencies should be the last speech aspect treated for minimal stut. If stut is dominant, fluency shaping strategies are recommended
      - Relaxation: general relaxation/mediation, breath control (deep diaphragmatic breathing), progressive muscle relaxation Tx and visual imagery exercises may help to decrease impulse, distractions. Attention deficits are also common so sustaining relaxation will be a challenge at the start! PWC have problem maintaining stillness. Referral info: best if it came from a workplace, building a rapport and work w them