other fluency disorders
TRANSCRIPT
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Cluttering (tachyphemia)Definition:“a disturbance of fluency involving
an abnormally rapid rate and erratic rhythm of
speech that impedes intelligibility. Faulty
phrasing patterns are usually present so that
there are bursts of speech consisting of groups
of words that they are not related to the
grammatical structure of the sentence. The
affected person is usually unaware of any
communication impairment.”(APA 1987)
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Rare disorder (5% of fluency
disorders)
tend to do well in scientific careers
(generally of average or above-average
intelligence…not low intelligence)
cause: unknown…thought to be
neurological
Cluttering (tachyphemia)
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Usually repetitions of 6-10 units
are usually effortless, single syllables,
short words and phrases
poor concentration, short attention
span
Characteristics:
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perceptual weakness
poorly organized thinking
speaking before clarifying thoughts
Characteristics:
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Phonemes dropped, condensed, or
distorted, especially /r/ and /l/ sounds
grammar problems
monotone speech…speech that
starts loud and trails off into a
murmur
Characteristics:
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jerky respiration
delayed speech/late talking
reading/writing disorders
Characteristics:
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poor handwriting
inability to imitate simple rhythmic
pattern
certain brain wave patterns
detectable with an EEG
Characteristics:
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late maturation
clumsiness, uncoordination
familial history
slips of the tongue, substituting
words without realizing mistakes
Characteristics:
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Stutterer: “I want to go to the
ssssssssssstore and I don’t have
muh-muh-muh-money.
Clutterer: “I want to go to the
st…uh…place where you
buy…market st-st-store and I don’t
have muh-muh ti-ti-time money”
Characteristics:
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Oral-motor coordination training
memory and attention span exercises
working on narrative structure in
story telling, emphasizing
components such as who, what,
when, where, why
Treatment:
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DAF (to slow down speech)
turn taking practice
role playing (giving directions, job
interview)
Treatment:
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Causes– strokes, head injuries can cause stuttering-
like symptoms in adults, may bring back early stuttering
– head trauma
– progressive diseases (Parkinsons, Alzheimers etc)
– brain tumor
–some drugs
Neurogenic Stuttering (Acquired)
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Two forms– persistent neurogenic stuttering
associated with bilateral damage
may last a long time
–transient neurogenic stuttering
associated with multiple lesions in one cerebral hemisphere
Onset of stuttering in a well adjusted adult may be initial
symptom of neurological disease
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Neurogenic stuttering has – repetitions, prolongations and blocks.
but lacks– facial grimaces, eye blinking and fears
and anxieties of developmental stuttering
appears to result from damage to the pyramidal, extrapyramidal, corticobulbar, and cerebellar motor systems
Onset of stuttering in a well adjusted adult may be initial
symptom of neurological disease
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Assessment of
Neurogenic
Stuttering:
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Complete case history
Assessment of Neurogenic
Stuttering:
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Complete case history
–traumatic events (physical and
emotional)
Assessment of Neurogenic
Stuttering:
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Complete case history
– traumatic events (physical and
emotional)
–drug use
Assessment of Neurogenic
Stuttering:
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Complete case history
– traumatic events (physical and
emotional)
– drug use
–other diseases
Assessment of Neurogenic
Stuttering:
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Testing for aphasia
Assessment of Neurogenic
Stuttering:
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Determining if person only stutters on certain word classes– functional words (the and but)
– substantive, informational words
(developmental stuttering usually occurs only on informational words …neurogenic stutterers will stutter on all classes)
Assessment of Neurogenic
Stuttering:
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Test adaptation
– developmental: occurs
– neurogenic: less likely to occur
Assessment of Neurogenic
Stuttering:
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Check for disfluencies in automated speech tasks
– pledge of allegiance, counting to 30
– developmental: Can,
neurogenic: can’t
Assessment of Neurogenic
Stuttering:
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Brain surgery (to improve blood flow to a restricted hemisphere
drugs (anti-seizure meds)
battery powered electrode stimulator implanted into brain (may improve fluency, reduce pain)
Neurogenic: Treatment
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Neurogenic: Treatment
transcutaneous nerve stimulator
DAF or white noise masking auditory feedback (MAF)
Electromyographic biofeedback (relax speech production muscles)
Pacing board
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WIDE VARIETY OF TREATMENTS
SHOWS THAT NEUROGENIC
STUTTERING IS NOT ONE
DISORDER, BUT A SYMPTOM OF
A VARIETY OF NEUROLOGICAL
DISORDERS
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May see– phonemes repeated and prolonged
– transient breathy voice
– strained-strangled voice
– voice stoppages
– audible inspiration
– variable rate
– prolonged intervals
– short rushes of speech
May confuse diagnosis
Dysarthria
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Often confused with stuttering
Compulsive repetition of a word, phrase or sentence
occurs typically in patients with postencephalitic parkinsonism and with pseudobulbar palsy
increased rate of speech as reiteration takes its course
vocal intensity decreases until no
sound, altho patient keeps moving lips
Palilalia
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Impairment of motor speech programming
may look “stutter-like”
struggle to form articulatory postures
groping
Apraxia of speech
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slow down in struggle
stress/prosody off
repetitions of sounds and syllables
common
change in phoneme when repeated
Apraxia of speech
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Not usually associated with
stuttering
BUT
can result in severe blocks,
repetitions, prolongations
Parkinson’s Disease
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Treatment:
maximize respiration
increase vocal fold adduction
Ex: (daily) verbalize 10-20
“ah” sounds as long and
as loud as possible
Parkinson’s Disease
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Hysterical or malingered stuttering in
adults may be unrelated to neurogenic
causes
Begins suddenly after event causing
extreme psychological stress
Psychogenic Stuttering
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Characteristics–sudden onset-rare
Psychogenic Stuttering
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Characteristics– sudden onset-rare
–repetition of initial or stressed syllables
Psychogenic Stuttering
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Characteristics– sudden onset-rare
– repetition of initial or stressed syllables
– no fluent speech, even for automatic responses
– indifferent attitude toward stuttering
–no secondary symptoms
Psychogenic Stuttering
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The maladjusted stutterer
–anxiety related symptomatology
Psychogenic Stuttering
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Treatment Considerations:
– Multidisciplinary approach
– may require increased emotional support
– may need to include stress management
techniques
– group therapy
–family therapy
Psychogenic Stuttering
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Repeated blockage of larynx only
onset in middle age
affects equal number of men and
women
Spastic Dysphonia
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Treatment: Botulism toxin
Types:
–Adductor: treatable with
botulism toxin
–Abductor: less treatable, but
responds somewhat to voice
therapy
Spastic Dysphonia
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Tourette’s syndrome:
not fluency disorder, but
similar to stuttering
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Stuttering
– abnormal breathing
pattern
– embarrassing
physical
characteristics
– can substitute more
acceptable speech
patterns
– support groups
– periods of fluency
Tourette’s
– abnormal breathing
pattern
– embarrassing tics
– can substitute more
acceptable tics
– support groups
– tic free periods
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Tourettes: believed to be caused by
abnormally high dopamine levels in some part
of brain
Stuttering: some researchers believe
stuttering caused by abnormally high
dopamine levels in another part of brain
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Both have hereditary factor
Most effective drug for both to date:
haloperidol, or haldol
subgroup of Touretters who stutter, and
stutterers with Tourette’s
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Haloperidol
– somewhat effective
– strange side effects:
halucinations
Clomipramine– improved fluency slightly
– side effects: dry mouth, urinary
hesitation, constipation and
others
Drug Treatments
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Acupuncture
JSHD, June 1995, “Results of
Traditional Acupuncture
Intervention for Stuttering”, Craig
and Kearns
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JSHD, June 1995, “Results of
Traditional Acupuncture Intervention
for Stuttering”, Craig and Kearns
Found no effect on fluency of two
adult male stutterers
Acupuncture
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The Mentally Retarded
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American Association on Mental
Deficiency (AAMD)
significantly subaverage general
intellectual functioning resulting or
associated with concurrent
impairments in adaptive behavior and
manifested during the developmental
period
Definition
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“significantly subaverage”
– IQ of 70 or below on
standardized measures of intelligence
“developmental period”
–period of time between conception and the 18th birthday
Definition
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Prevalence
– 2-3% of general population
Incidence
–125,000 births per year
Prevalence & Incidence
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Variance in studies from 0.8% -20.3%
“Stuttering…occur(s) more frequently
in this population than
in any other single identifiable group of people”
Bloodstein, 1981
Prevalence of Stuttering in MR
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Within the MR population,
prevalence of stuttering
is especially high
in mentally retarded individuals
with Down’s syndrome
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Issue in the Research
Is it stuttering or
cluttering?
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Repetitions (syllable/word/phrase)
prolongations
rarely revisions/broken words/blocks
secondary reactions
subject to same laws as nonretarded PWS with respect to adaptation,
consistency, expectancy
General Characteristics of MR
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More like cluttering?
insufficient vocabularies
hurried speech patterns
no self-consciousness
little anticipation
no avoidance
Down’s syndrome
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Is stuttering a minor annoyance compared to
other communication problems?
Many of the disfluent individuals are
unconcerned about their stuttering
Diagnostic considerations
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What is the nature of the disfluencies
observed?
– Type
– frequency
– consistency
– expectancy
–adaptation
Ask yourself these questions:
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What is the relative significance of the
disfluencies to the total communicative
competency of the individual?
What is the individual’s perception of the significance of the disfluencies?
Ask yourself these questions:
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To what extent would fluency-
enhancing strategies positively
effect other aspects of intelligibility?
What are the constraints upon
intervention?
Ask yourself these questions:
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What are the constraints upon intervention?
– time
– place
– frequency of contact
– length of sessions
– individual vs. group sessions
–continuity of services
Ask yourself these questions:
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What is the prognosis for a
sustainable enhanced fluency?
To what extent will increased fluency
enhance the individuals ability to
communicate and thereby improve
the individual’s quality of life?
Ask yourself these questions:
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Most fluency programs for the
mentally retarded are exclusively behaviorally
focused
Little or no attention to shaping and
reinforcing fluency-facilitating attitudes
and feelings
Therapy
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Example: Cooper & Cooper (STAR Process)– Structuring stage (Identification)– Targeting stage (Modification of behaviors)– Adjusting stage (Reinforcement)
–Regulating stage (develop feeling of
fluency control)
Follow program guidelines with some modifications
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allow individual to express feelings
and attitudes at their level using their
language
provide for overlearning
capitalize on supportive personnel
Examples of modifications