Cluttering, etc

B. Neurogenic Disfluency

The result of an IDENTIFIABLE neuropathology in a speaker with no history of fluency problems prior to the occurrence of the pathology. • Stuttering appears at the onset or soon after neurological trauma or progressive disease, such as: o CVA (stroke) o Head trauma o Tumor o Dementia o Drug abuse o Anoxia o Surgery

A. Cluttering

The segments of irregular speech rate must further be accompanied by one or more of the following: • excessive 'normal' disfluencies • excessive collapsing or deletion of syllables, and/or • abnormal pauses, syllable stress, or speech rhythm. -- St. Louis & Schulle (2011)

G. Linguistic Disfluency

There appears to be a relationship between language delay/disorder and stuttering. The form of disfluency reflecting LINGUISTIC EMERGENCE is somewhat different from stuttering, consisting primarily of: o Part-word repetitions (mi milk), o Prolongations, and o Dysrhythmic phonation (normal devl. disfluencies are rhythmic) • Disfluency increases with new challenges to the child's communication system -- imposed by new grammatical rules. • Consider the DEMANDS & CAPACITIES model.

Seven Qualitative Symptoms of cluttering: (Daly, 1993) 7: Various levels of awareness --

o Younger clients may not see cluttering as an issue - may be defensive to "save face." o Adults may tell you they have been asked to frequently repeat themselves, so are more aware there is a problem.. o Most clients don't specifically know what they are doing to interfere with normal speech.

Assessment of Cluttering

• Obtain a language sample of approximately 500 words, e.g., explain a sport or how to do something... o Listen to overall connected speech sample for rate and irregular rhythm (jerky/spirty). o Determine percentage of normal disfluencies and stuttering-like disfluencies, and unintelligible words/phrases. • In comparison, administer a normal articulation test - there should be no problem with isolated words.

Treatment of Cluttering

• Point out "communication breakdowns" in client's speech when s/he is ready to face her/his own speech. • Teach client to pay attention to listener's non-verbal signs/signals of not understanding...SLP can role play facial gestures, etc. • SLP can give hand gestures + facial cues, then fade hand gestures as clients begins to pay attention to facial expressions. • Bring other listeners in to treatment room to give non-verbal feedback as client speaks about a subject.

Characteristics of neurogenic disfluency include:

• Repetitions and prolongations on initial, medial, and final syllables • Disfluency not related to grammatical function (e.g., function and content words may be equally troublesome). • No direct relationship between linguistic complexity and disfluency (e.g., self-formulated speech may be easier than automatic speech). • Fluency does not improve with repeated readings (adaptation effect) • Speaker is not anxious (although may be annoyed) • Secondary features are not observed.

Treatment of Cluttering

• Target FIXING the BREAKDOWN - • Teach the client what s/he needs to do to repair the breakdown. • Teach client to a) monitor her/his own speech using listener's reactions/signals; and b) repair the breakdown by repeating her/himself using natural pauses, over-articulating syllables, etc. • For clients who present with Cluttering + language issues, work on cluttering first....once the SLP has a system in place to "cue" client to her/his comm. breakdowns the SLP can move to treating other problems, while incorporating signals to repair communication breakdowns. • See Figures 4.2 and 4.3 (pg. 100-101) Cluttering Checklist and Planning Profile.

Treatment of Cluttering

• Work on EFFECTIVE COMMUNICATION (instead of "slowing down", focus on pauses) • Work on exploration of ways people might not understand someone's speech • Make a LIST (e.g., how many audible breaths they're taking; pauses; syllables; enunciate; elongating words) • Ask client if s/he presents with any of these... • For resistant clients, explore COMM. BREAKDOWNS o SLP might need to work away from the client first -using examples from her/himself and others before client is willing to work on her/his own speech.... (refer to spider analogy in intermediate stuttering notes).

F. Tourette Syndrome

Neurological disorder characterized by chronic tics (repetitive, rapid, sudden, involuntary movements or utterances). • May be caused by abnormal metabolism of the neurotransmitter, DOPAMINE. • Treatment includes medication, behavioral modification, relaxation • 3:1 MALE to female ratio • Approximately 1/3rd of patents with Tourette also stutter. • See Figure 4.4 (pg. 112) TEACHER'S CHECKLIST for symptoms. • Associated problems commonly seen include: o Attention Deficit/Hyperactivity Disorder (AD/HD) o Learning disabilities o Dyslexia o Conduct disorder o Sleep disorder

E. Acquired Disfluency following Laryngectomy

Some individuals who stutter prior to laryngectomy may continue to do so following laryngectomy. • Patients who are in the early stages of relearning speech may be highly disfluent. • Reports of patients CONTINUING to stutter are RARE.

D. Adductor Spasmodic (i.e., spastic) Dysphonia

Spastic dysphonia is characterized by spasms of the adductor laryngeal Muscles. • Results in sounds that are intermittently STRAINED & STRANGLED • This is a VOICE condition • Onset: middle age • More typically seen in FEMALES • Normal fluency with choral reading, singing, repeating memorized verses, speaking to children, animals, or while alone.

Making the diagnosis of cluttering:

1. One MUST first have the perception that the speaker's rate is too fast or irregular. • If you measure rate, it may not really be so rapid, but it's the perception that is the key....so don't measure rate, just listen. (listen first; if a problem more of reading & writing -- then it's a language problem)

Seven Qualitative Symptoms of cluttering: (Daly, 1993)

1• Disorganized speech (abrupt topic shifts, incomplete phrases, word-retrieval problems) 2• Verbal transpositions without awareness 3• Physical immaturity, clumsiness, incoordination 4• Rhythm and musical deficits 5• Familiar pattern of cluttering 6• Impulsive, hasty, restless, hyperactive, careless, impatient, short-tempered (AD/HD characteristics) 7• Various levels of awareness

Cluttering -- If the speaker's rate is perceived too fast or irregular, then determine if the following also occurs:

2. Excessive normal disfluencies (may include some stuttering behaviors, but these are not as excessive as a person who stutters). • Normal disfluencies - phrase or multi-syllabic whole word repetitions, interjections/fillers, revisions • Stuttering behaviors - part-word repetitions, prolongations, blocks/tense pauses, broken words (pause between syllables)

Cluttering -- If the speaker's rate is perceived too fast or irregular, then determine if the following also occurs:

3. Over co-articulation (collapsing of syllables -sounds are excessively flowing together), mumbled/mushy speech, and/or decreased intelligibility -- due to excessive dropping of the sounds. 4. Abnormal rhythm, less amount of pauses (speech sounds more rapid), jerky speech, and/or spurts of rapid rate interspersed with speech of normal rate (tachylalia).

C. Psychogenic Disfluency

Cases have been reported of adults who begin to stutter following psychological disturbances or as a reaction to emotionally traumatic events. In these cases: • Onset is SUDDEN and is related to a significant EVENT of extreme psychological stress • Disfluencies mainly consist of REPETITIONS of initial or stressed SYLLABLES • Disfluency pattern is affected LITTLE by choral reading, white noise, DAF, singing, or different communication situations. • May be no periods of fluency • Attitude toward stuttering is INDIFFERENCE • No secondary characteristics

A. Cluttering

Cluttering is a fluency disorder wherein segments of conversation in the speaker's native (or mastered and habitual non-native) language are typically perceived as: • too fast overall, • too irregular, • or both.

Additional behaviors that accompany cluttering:

Cluttering may also affect language processing -- grammar, reading, writing, and handwriting. o Reading errors: skipping small words, revising text, poor concentration o Writing errors: poor integration of ideas and motor incoordination o Poor concentration, or short attention span

Where must cluttering occur?

Cluttering must occur in naturalistic conversation, but it need not occur even a majority of the time. Clear but isolated examples that exceed those observed in normal speakers are sufficient for a diagnosis. Underlying cause: Persons who clutter are speaking faster than their own motor systems can handle. Cluttering usually begins during early childhood and may be genetic