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Fluency Paeds
Paediatric Fluency notes - mid sem
| Question | Answer |
|---|---|
| Name the 5 fluency disorders | Persistent developmental stuttering; Acquired Neurogenic stuttering; Acquired Psychogenic stuttering; Cluttering; Rate and general prosodic disorders. |
| Name (and describe) the 3 core stuttering behaviours | - Repetitions: of individual sounds, part words, whole words, phrases - Prolongations: stretching out a sound/syllable, commonly on fricatives/vowels - Blocking: (sounds/words) airflow physically stopped, forced audible release of sount or silent, assoc |
| Name 3 secondary behaviours (verbal) and why do they occur? | Intrusions/interjections (sounds-phrases at inappropriate point - um) Restarts (2 or more unchanged, repeated words) Revisions (2 or more changed, repeated words) Occur to give us time to think of the next word |
| Name 3 secondary behaviours (non-verbal) | word avoidance (replace with a different word) facial contortion (accompany blocking, tension around mouth/neck) loss of eye contact (while stuttering) associated body mvts (shift body position, tense mvts) |
| What are 3 emotional reactions which accompany stuttering? | Anxiety (caused by fear of inability to speak, physical feeling) Avoidance (of situations) Loss of self esteem (feeling of shame, guilt, failure |
| Define Stuttering | ... is a disorder in the rhythm, timing and coordination of speech such that the person knows exactuly what they want to say, but at the same time is unable to move forward in their speech due to involuntary repetition, blocking or prolongation of sounds |
| Describe the evolution of stuttering over time | Starts with normal dysfluencis, frequency increases, repetition of multisyllabic whole words, reactions to dysfluencies increase, repetitions of monosyllabic whole words, tension/struggle increases, duration of disfluencies increases, tension during 'norm |
| Describe Bloodsteins 1st phase of developmental stuttering | Preschool (2-6 years) episodic, sound/syllable repetition, tendency to repeat whole words, unaware |
| Describe Bloodsteins 2nd phase of developmental stuttering | early school age chronic or habitual, few intervals of fluent speech, self-concept as PWS, content words |
| Describe Bloodsteins 3rd phase of developmental stuttering | 8yrs to young adult stutter in response to fears, some words more difficult that others, word subs/circumlocutions to avoid feared words, won't avoid speaking situations |
| Describe Bloodsteins 4th phase of developmental stuttering | most advanced (adolescent/adult) anticipation of stuttering, sounds/words/situations feared, word subs/circumlocutions frequent, secondary symptoms may be present |
| When should you be concerned about stuttering? (start therapy sooner rather than later) | Male, family history, time since onset, age of onset (over 36 months), poor S/L skills, developing anxiety/blocking; higher expressive lang abilities |
| What occurs in the stuttering moment? | wiring of brain, imbalance in chemisty of brain (too much dopamine) brain computer glitches out, unable to coordinate complex mvts |
| What reduces stuttering by 90-100% ? | Lipped speech, prolonged/smooth speech, singing, slowing rate, chorus reading |
| What reduces stuttering by 50-80% ? | DAF (delayed auditory feedback), speaking alone, changing pitch/accent, whispering |
| What are the 2 types of adult acquired stuttering? | Psychogenic - late onset, begins after stress/traumatic event, absence of neurologic involvement Neurogenic - appears to be caused by neurological disease/damage, eg CVA, head trauma, parkinsons, drug toxicity |
| What are the 3 types of neurogenic stutter? | Dysarthric stutter (lack control of speech muscles) Apraxic stutter (difficulty programming/planning, lots of blocking) Dysnomic stutter (dysfluent due to language/WFD |
| Where can lesions occur for neurogenic stuttering? | either lobe, all lobes (except occipital), one or multiple lesions, cortical and/or subcortical areas |
| State 3 differences between neurogenic stuttering and developmental stuttering. | Secondary behaviours are rare in neurogenic stuttering; developmental stuttering is generally on the ititial syllable (neurogenic not restricted); developmental stutterers develop fears/anxiety about stutter, neurogenic don't |
| What does SAAND mean? | Stuttering after acquired neurogenic damage |
| What is cluttering? | speech disorder characterised by: clutter's lack of awareness of the disorder, short attention span, disturbances in perception, articulation and formation of speech processes preparatory to speech and based on hereditary disposition. Rapid rate, give imp |
| Explain the iceberg analogy | The top 10% is what you can see/hear; the bottom 90% is what you can't, If you just treat the top 10%, client will relapse |
| What is early v advanced stuttering? | early stutterers start stuttering early, are more responsive to treatment, short term stutterers, may recover without treatment, stuttering comes and goes Advanced: takes a long time to control, long term Tx, can only give strategies, always there in s |
| What is the CALMS model? | everything is interactive together Cognitive (thoughts, perceptions etc - give client knowledge re stutter) Affective (feelings, emotions) Linguistic (language skills, discourse) Motor (frequency, timing, duration etc) Social (how they react in diffe |
| Describe the Diagnosogenic theory of stuttering (non-behavioural) | caused by erroneous diagnosis by parents, begins in the ear of the parents, parents responding negatively to normal dysfluencies making it worse. |
| Explain the V model | explains S by linking onset to dvt of variable syllable stress (2-3 yrs), where stuttering starts to emerge as children put words together (3yrs), at certain age of ling dvt. Multiple syllable repetitions prominent at onset, replaced by more effortful sp |
| Why does V model work? | smooth sp reduces variability of syllable stress, which reduces stuttering |
| Name 3 treatment approaches (and their type) | Lidcombe - simple, direct, non-programmed, atheoretical, individualised. Family focussed treatment approach - reducing sstress on child... but evidence suggests othewise Fluency rules program - when simple doesn't work! |
| What are the 4 phases of therapy? | 1. assessment 2. instatement (instate fluency in clinic, at home etc) 3. Generalisation (want child to be fluent everywhere) 4. Maintenance (1. fluency in clinic; 2. durability and maintenance of this) |
| Describe the assessment phase | case and medical history; S&L devt, onset, family history, taped sample from home. -take in clinic baseline (300syll) Identify types of stutters, take measurements trial some Tx, see what works |
| What commitment is needed? | Parent must attend Tx, 10mins a day, severity ratings daily, need to do whole Tx or will relapse, |
| rating!! | SPM: syllables/time x60 %SS: stutters/syllables x 100 |
| Lidcombe | clinical and evidence based, parent based Tx, |
| Lidcombe - why does it work? | no over learning of stuttering, adults have potent reinforcers for children, uses common parenting practices, Tx occurs where problem occurs |
| Lidcombe - stage 1 | instate fluency in clinic (10 wks - 9mnths depending on severity); stutter free sp praised, stuttered corrected; reinforcement verbal/other 5:1 praise; parent has priniciple role |
| Parents (Lidcombe) |
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