CSD 405: Final exam

Single-syllable word repetition

" I-I-I-I want to go home"

Interjection

"I um, well, um, want to go home"

Phrase Repetition

"I want-I want-I want to go home"

Dis-rythmic phonation (sound prolongation)

"MMMMMMMy tooth hurts"

Part word repetition

"My t-t-t-tooth hurts"

Revision-Incomplete

"My too...my molar hurts"

Multisyllabic word repition

"The ba-ba-ba-baby is crying"

Francis Bacon

(1561-1626) Etiology, an English philosopher, recommended that a stiff and frozen tongue should be thawed with hot wine. Suggested hot wine to loosen the tongue of stutterers. Less invasive

Different Diagnosis Neurogenic

- Acquired and no previous history of stuttering usual adult onset - Confirmed neurological lesion/ problem - stutter event locations anywhere in sentences all words - stuttering frequency varies little across situations - Adaptation effect less common - Secondary behaviors less common - No habits related to word type content and function words - Occurs on highly neurogenic stutter less responsive

What are the clinical impliactions of current research on BWS?

- Assessment and treatment of stuttering - Dual-task conditions and attention training: the diagnosis of stuttering is typically confined to collection of speech samples to determine amount of disfluencies however, executive functionings may help diagnosis

Visual Hemifield Paradigm

- BWS perform faster and with fewer errors compared to MWS - No performance difference between BWS and BWNS

Dual-Task Paradigm

- BWS show less dual-task interference compared to MWS - No performance difference between BWS and BWNS

Behavioral Tests

- Dichotic listening paradigm, visual hemifield paradigm, dual-task paradigm - Simon Task, Flanker Task

Physical components/ movements

- Distracting sounds - Facial Grimaces - Head movements - Movements of extremities

What questions do current fMRI research studies hope to answer about BWS?

- Does bilingualism provide cognitive reserve and brain reserve in BWS? - Is stuttering severity less in BWS compared to MWS

What is stuttering linked to?

- Family history link - Genetic - Environment - Neurogenic: changes in brain function

Neuroscience research relative to stuttering

- Hemispheric asymmetry difference - Decreased gray matter density - Decreased white matter density - Decreased executive functions

Atypical Cerebral Lateralization

- Increased right hemisphere activity and production during language tasks However, a more typical left activation pattern can be achieved through fluency therapy

Demands may include

- Internal Demands - External demands

What are some research questions that have yet to be answered regarding bilinguals who stutter?

- Is stuttering more prevalent in bilinguals than in monolinguals? - Does stuttering in bilinguals always manifest in both languages? - Is an accurate diagnosis possible when listening to a language that is foreign? - Should treatment be given in both languages or in one language? - Is outcome of therapy in bilinguals worse than in monolinguals? WHAT IS THE CAUSE OF STUTTERING??

Capacities may include

- Neurological development - Speech articulation development - Language stage - Temperament (disposition/mood)

Possible Therapy Outcomes for Bilinguals who Stutter

- No generalization to the untreated language - A similar improvement in both languages - Less improvement in untreated language - More improvement in untreated language

Cause of stuttering

- Not necessarily related to one pathway - Motor, speech, and language production areas show differences in levels of brain activation in PWS - Stuttering is most notably associated with hemispheric symmetry for language. - More specifically PWS shows overactivity in the right hemisphere centered on the right inferior frontal gyrus. - Underactivity activity of auditory areas in the temporal lobe - Atypical activity of subcortical structures both in the control of movements (basal ganglia, cerebellum) - Structural abnormalities in the frontal and temporal lobes and the white matter connections between them

Atypical Auditory-Motor Interactions

- Overactivation of motor areas in the right hemisphere (frontal lobe, Broca's area) - Under activation of the auditory areas in both temporal hemispheres

Function Brain differences in PWS

- Overactivity: in the right hemisphere; Area's that connect speech areas in the left hemisphere - Underactivity: in the left hemisphere; Auditory areas of brain in which we need to monitor our speech

What does both cognitive and brain reserve do?

- Protective mechanism - Increases the brains ability to cope with aging and various brain pathologies (alzhimers) - Close relationship with executive control system: - superior executive functions which enhances cognitive reserve which strengthens brain reserve

Manner of talking that decreases stuttering

- Singing - In rhythm (metronome in background) - Imitating a dialect - Whispering - Speaking slowly

Other variables when assessing stuttering

- Speaking rate: Helpful with cluttering and to differentiate between stuttering - Phonology - Language abilities

Are speech disfluencies present?

- Speech samples: Take minimum of 300 words, Identify and tally disfluencies in each sample then convert into percentage of disfluency. Make sure sample is large enough to evaluate great presence of natural speaking behavior - Disfluency count: 21 disfluencies 21/300= 7% of disfluencies

Different Diagnosis Developmental

- Usual childhood onset - No neurological lesion - Stutter event locations mainly on first 3 words of sentences - Stuttering frequency varies across situations - Adaptation effect more common - Secondary behaviors more common - Automated tasks prove easier

Different Diagnosis Psychogenic

- Usually adult onset - Diagnosed psychological trauma - Often apathetic towards stuttering (indifferent) - Stuttering occurs in singing, unison, delayed auditory feedback (no improvement) - Rapid remission with reduced emotional stress - Leaves as soon as psychological issue is gone

Context of talking that decreases stuttering

- alone - in unison - to animals and infants (low risk situation) - with delayed auditory feedback - with masking noise

Frequency of disfluencies

-How often do disfluencies occur in a sample -Typically represented as the percentage (out of 100) of disfluent words or syllables

U.S. Prevalence for stuttering

.7% about 339 million overall

7- Point scale

0- no stutter 1- very mild (less than 1% of words) 2- Mild (1% to 2% of words) 3-Mild to moderate (2% to 5% of words) 4- Moderate (5% to 8% of words) 5- Moderate to severe (8% to 12% of words) 6- Severe (12% to 25% of words) 7- Very severe (more than 25% of words)

Iowa Scale for Rating the Severity of Stuttering

0- no stutter 1- very mild (less than 1% of words) 2- Mild (1% to 2% of words) 3-Mild to moderate (2% to 5% of words) 4- Moderate (5% to 8% of words) 5- Moderate to severe (8% to 12% of words) 6- Severe (12% to 25% of words) 7- Very severe (more than 25% of words)

What is the prevalence of stuttering worldwide?

1% of words population - Every country/culture - All class of society - At all age levels

Components of Assessment

1. Background info/case history 2. Observe the client 3. Interview 4. Diagnose 5. Meet with client or family to review options for treatment (Trial therapy: test out different treatment options to see which ones fit best)

Three goals for therapy

1. Change speaking behavior 2. Change the way the person feels 3. Change the way the person interacts (speaking environment) ALL EQUALLY IMPORTANT

Methods of evaluation of Brain

1. Neuroimaging Tests 2. Behavioral Tests Or a combination

Two types of fluency disorders

1. Stuttering 2. Cluttering

Three possible manifestations of stuttering in bilinguals

1. Stuttering occurs in one language and not in the other 2. Stuttering occurs in both languages with similar stuttering behavior in each language 3. Stuttering occurs in both languages but varies from one language to the other

Two treatment approaches

1. Traditional Therapy 2. Non-Traditional Therapy

What is the approximate administration time for the SSI-4?

15-20 minutes

Disfluency Clusters

2 or more disfluencies on words following each other Example: B-b-b-boy fffffffollowed

What is the average age of onset for stuttering?

2-5 years old; 3 years old is the most common because they start using connected speech

Duration of longest disfluency or block

3 longest stutters averaged together

Conversational speech that is _______ disfluent or higher is usually a rough indication of a fluency disorder.

3%

Family history of stuttering in PWS

30-60% suggests genetic predisposition

Stuttering is estimated to be a problem in about.

5% of the preschool population

What percentage of the worlds population is Bilingual?

50% Most people speak more than one language and it's more common to speak more than one language than not

Neuropsycholingustic theory

90's; Fluent speech involves specific demanding timing for formulation and exclusion Fluent speech: needs correct timing between the internal formulation of language and motor execution of speech movements Stuttering: disruption in timing linguistic information and speech movement PWS: experience "loss of control" when producing speech and worsens stutter. timing between form and production is off

Psychogenic stuttering

A condition referring to people in whom a psychological disturbance is clearly diagnosed - Speech disfluencies are strongly linked to psychological distress; some psych issue and disfluencies are less constant (If patient improves psychologically they may return to complete fluency)

Disfluency

A disruption or breakdown in the flow of speech *Dysfluency is normal in everyone's speech; doesn't mean they have a stutter

Stroop Task

A task invented in which a subject sees a list of words (color terms) printed in an ink color that differs from the word named. The subject is asked to name the ink colors of the words in the list and demonstrates great difficulty in doing so, relative to a condition in which non-color words form the stimuli. 2 hemispheres are competing with eachother

An example of a famous person who stutters is:

All of the above

How may stuttering manifest in a bilingual person?

All of the above

Within-word disfluencies

Always there for PWS, Needed to diagnose, the more within-word disfluencies the more severe the stutter is 1. Part word repetition 2. Single syllable word repetition 3. Multisyllabic word repetition 4. Dis-rhythmic phonation (sound prolongation) 5. Tense pause (silent prolongation or "block")

Heredity in stuttering

Appears to be inherited Family studies: What is the pattern of stuttering in members of one family? Genetics are involved and it's not the patients fault but most likely it's a combination of environment and supporting a child while decreasing stressors help

Conditions where stuttering may increase in developmental stuttering

As development progresses repetition of phrases and disfluencies increase with age - word-initial - consonants - long words - content words - sentence-initial words

What two primary methods are used to evaluate bilinguals who stutter?

Assess cognitive abilities of MWS and BWS/ MWNS and BWNS - Visual Hemifield Paradigm - Dual-Task Paradigm

SLP career with bilinguals who stutter

At some point in SLP career everyone will encounter biligual who stutters however, there are mixed views in the way PWS that are bilinguals stutter. Person typically stutters in both languages however they're more likely to stutter in L2 language

What have researchers found in general with PWS Brain functions?

Atypical activation of brain structures that are involved in the control of movements for both fluent and disfluent speech

Brain Function: Cerebellum and Basal Ganglia

Atypical cerebellum and basal ganglia functions in PWS: - Increased activation in the cerebellum - Decreased activation in the basal ganglia (cordite nucleus)

It helps to tell a person to "take a deep breath before talking" or "think about what you want to say first" Myth

BAD ADVICE. Makes a stutter more conscious, it's better to listen and slow your own speech

Stuttering worsting on word initial

Beginning of words vs. the end

What seems to offset the deficits in executive functions associated with stuttering?

Bilingualism seems to offset deficits in executive functioning associated with stuttering; Bilingualism may seem to provide some kind of neural reserve

Characteristics in Bilinguals who stutter (as found in past research)

Bilinguals who stutter are likely to stuttering both language: - Not necessarily the same pattern of stuttering in both languages - Less proficient language will usually show a high percentage of stuttering (they may be using avoidance behavior/switching between two languages)

People who stutter have been found to have

Both A and C

The Iceberg Analogy

Both overt (can see, primary characteristics) and covert (can't observe, secondary characteristics, emotions, more influential) behaviors

Stuttering is more likely to occur in:

Boys

The child Dr. Gorman discussed was often teased by his

Brothers

King Louis II of France

Called le Begue... the stammerer

Johnson System (1960)

Categorized disfluency by within-word disfluencies and between word disfluencies

In childhood stuttering how does the brain's grey matter differ from fluent speakers?

Childhood stuttering has been linked to a bilateral reduced grey matter volume in speech-related areas *However, adults also show decreased grey matter but in a right to left asymmetry

Background info/case history

Children (get info with parents) Adults (alone)

Electronic devices for stutters

Closely resemble hearing aids that provide an auditory distraction to help alter the individuals overall speaking behavior - Speech Easy Device

What is the most consistent brain difference associated with developmental stuttering?

Decreased White Matter

How does diagnosis of a bilingual stutterer depend of SLP?

Depends on SLPs proficiency and patients language preferences. Comes down to SLP being versitile

Which statement about developmental stuttering is true?

Developmental Stuttering is the most common form of stuttering

Primary Characteristics (Overt)

Different disfluencies most often assosiated with chronic stuttering, helpful in diagnosis and assessment - Interjections - Sound/syllable repetition - Word repetition - Phrase repetition - Audible sound prolongation - Inaudible sound prolongation - Revision COMBO of any of the above

Nature vs. Nurture theory

Different factors that contribute to stuttering: - genetics - physchology - language complexity - CNS issues - Environment - General motor

Difference between disfluency and dysfluency

Disfluencys: latin for to form words opposite of word "honor" "dishonor" Dysfluency: Greek for bad/harsh

World Health Organization (WHO) Defines stuttering as...

Disorders in the rhythm of speech in which the individual knows precisely what she/he wishes to say but at the same time is unable to say because of an involuntary repetition prolongation or cessation of a sound

The drug Pagoclone, which may provide relief to some PWS, targets which neurotransmitter?

Dopamine

Which of the following artifacts tells us that people have stuttered throughout history?

Egyptian hieroglyphics

What is the significance of brain differences in PWS relative to cause and effect?

Evidence of brain differences in MWS (monolinguals who stutter) compared to MWNS (fluent speaking control group); Overall, it has been found that the neural system of underlying speech is different in PWS vs. PWOS Differences found in: 1. Brain structure 2. Brain function

A popular approach to describe covert stuttering behaviors is to differentiate the different types of disfluencies.

False

Cluttering typically involves awareness of disfluencies and developmental stuttering does not.

False

Psychosocial Behaviors

Feelings experienced by PWS; Result of speech behavior, often negative as stutter worsens psychosocial behavior will get worse, may lead to stopping speech - Fear - Frustration - Embarrassment - Anger - Word avoidence

What kind of fluency therapy treatment did Dr. Gorman's client receive when he was in the school system?

Fluency Shaping

Stuttering Brain Connectivity

Fluent Speech Production: - Auditory processing: Posterior auditory cortex - Motor planning and Execution: anterior motor cortex Need both for success need the connection

OASES

Form of assessment for psycho assessment Overall assessment of the speakers experience of stuttering, Questions based tool to eval everyday impact on patients life

What is the nature of the speech disfluencies?

Further analysis looks in detail to see disfluencies - Increased occurrence of within-word disfluencies (SLD) - Increased stuttering severity scales (directly related to SLD increase) - Occurrence of secondary characteristics: Bodily movements, psychosocial behaviors

Treatment for demands vs. capacities theory

Goal is to decrease demands and increase the capacity; try to make communication easier for the child (Slower speech rate, more parent time, decrease complexity of language used with them)

Brain Structure: Grey Matter in Stutterers

Grey matter is the hard ware Decreased grey matter volume in speech related areas - Children: this decrease is bilateral - Adults: this decrease has a right to left asymmetry

Structural brain differences in PWS

Grey matter volume reduced: temporal lobes (bilaterally), Brocas area/speech output(motor control) White matter connectivity reduced: Premotor and motor and auditory systems; wide spread WMC deficit in children's left hemisphere

Proficiency and usage of languages

How often they use the language, the individual's comprehension skills, speech skills, and written skills

Methodology assessing stuttering and bilingualism

How stuttering and bilingualism is assessed

A psychologically-based approach to the treatment of stuttering is called

Hypnotherapy

Stuttering occurs...

IN ALL LANGUAGES in 1 out of every 100 individuals

What are some important factors to consider when providing speech therapy to a bilingual who stutters?

If treatment in both language is possible: - Should both languages be treated simultaneously or not? - If not, which language should be treated first and for what reason? - For children, the Lidcombe program would be a good option to treat both languages simultaneously (parents help, important feedback can be given, and no frequent check ins) TYPICALLY, treat L1 over L2

Historic Aspects of Stuttering

If we don't know how stuttering was treated in the past then we may make faults and can't learn from the past. There has been a lot of research on stuttering because of the unusual pattern

Tense pause (silent prolongation or "block")

Inaudible prolongation "... the baby is crying"

Increase in within-word disfluencies=

Increased severity of stuttering

What is Cognitive reserve?

Individual differences in brain function Example: task performance

What is Brain reserve?

Individual differences in brain structure Example: motor neurons or sollapsis

For the SSI-4, non-readers are considered:

Individuals with a reading level below 3rd grade

Stress cause stuttering Myth

It may aggravate however, it's not a cause

Which statement is true about the SpeechEasy device?

It may stop working once the patient gets used to the feedback

Between-word disfluencies

Johnson suggested these were common in general, might be shown in regular speech, and can't solely diagnose someone off on these characteristics: - Phrase repetition - Interjection - Revision-Incomplete

L2

Language 2

L1

Language one

Pre motor area

Leads to auditory deficits in communication between left and right hemisphere and subcortex and cortex; basal ganglia

Early Bilinguals

Learning the two languages at the time in an early age (approx. before age of 12)

Late Bilinguals

Learning the two languages sequentially, usually the second language after adolescence; L2 learned later

Covert Repair Theory

Links production and internal programing/coding; Problem with language planning - Internally disordered phonological system: while planning we form sounds internally then produce speech - Frequent planning errors in speech organization: stutters have planning errors internally that need to be prepared - Interruption of ongoing speech to repair errors: frequent repetitions and pauses, repairs don't occur at a conscious level

Rebecca states that some people misattribute her stutter to:

Low intelligence

Sex differences in brain function of PWS

Males: positive correlation between stuttering and cerebellum activity Females: positive correlation between stuttering and basal ganglia activity

Executive Functions

Management and control of complex cognitive processes - Updating of information (working memory) - Cognitive shifting (attention) - Inhibitory control (interfering responses)

Criticism of stuttering modification

Moments of stuttering, it doesn't completely eliminate the stutter

Secondary characteristics (Covert)

More difficult to classify because they develop over time and only will develop when CWS is older and becomes adult - Bodily movements - Psychosocial Behaviors

Case studies vs. Group studies

More favorited is group studies

Stuttering

Most common fluency disorder Catagorized by: - Developmental Stuttering - Acquired (Non-developmental) stuttering - Neurogenic stuttering - Psychogenic Stutting

Neuroimaging Tests

Most direct way - Structural: CT, MRI (views the cross sections of brain and anatomy) - Functional: PET, fMRI (views of brain activity during language)

Sample size and age of subjects

Mostly small sample sizes Not the same age group

Right side of the brain controls...

Music, art, colors

Severity rating scale for parents

NOT AN ASSESSMENT; records the personal experience of the stutterers; mark an X at the end of each day, home eval on how stuttering changes overtime

Yairi and Ambrose System

Need both within-word disfluencies and between word disfluencies to diagnose. Changed to simplify diagnosis - Within-word disfluencies: stuttering like disfluencies (SLD) - Between-word disfluencies: Other word disfluencies (OD)

Age of acquisition of the second language

Need subjects with the same years of experience - Early Biligualism - Late Biligualism

Language combinations involved

Need subjects with the sample languages (English and French/ English and Spanish)

Is there a cure for stuttering?

No cure for stuttering but it can be helped, there's no unified approach towards treatment

Is the cause of stuttering know?

No it's still unknown

Non-Traditional Treatment

Not as often used because they're not applicable to most stutters 1. Hypnotherapy 2. Drug therapy 3. Electronic Devices

Criticism of Fluency shaping speech

Not natural

Language Proficiency

Not necessarily equal in proficiency can be different in speech, writing and comprehension

Which test would you use to assess psychosocial behaviors?

OASES

Observe client

Observe parent-child interaction and record speech sample (SSI)- phonological and language assessment (child only, but collect SSI if you suspect adult of cluttering) Phonological and language assessment

Fluency disorders Treatment

Once a diagnosis is made treatment program is the next step. In some circumstances may just suggest monitering (especially helpful in children) 2 Forms: Direct: involves patient as recipient Indirect: working with parents

Lidcombe Program

Parents provide direct feedback to child during conversational settings about stuttered (only occasionally) and non stuttered speech (points out the most) 2 Stages: 1. check-in: Child and parent comes once a week and the parents learn to measure the child's stutter 2. fluency follow up: Once stutter is gone make sure it stays away

According to the Johnson System, what would be classified as a within-word disfluency?

Part-word repetition

Past Research on Prevalence of Bilinguals who stutter

Past research has found stuttering is more prevalent among bilinguals, however, this is viewed with caution because... - Single assessments - Internet Surveys - Researchers not familiar with the second language - Outdated studies Most only compare to monolinguals and are not alone

How does white matter in the brains of people with persistent stuttering differ from fluent speakers?

Persistent stuttering has been linked to decreased white matter underlying the sensory motor cortex in the left hemisphere

Emotional reactions

Prior to stuttering: fear, dread, anxiety, panic During stuttering: blankness, being trapped, panic, frustration After stuttering: shame, humiliation, anger, resentment, embarrassed/ashamed

Stuttering Severity Instrument (SSI)

Provides 3 scores based on a speech sample analysis. Looks at - frequency of disfluencies - duration of longest disfluency or block - count of secondary symptoms and associated motor behaviors

9-Point Scale

Rating scale- contrasts to SSI; much more subjective; no formal measures of disfluencies; Value after sampling of conversational speech; not much info on the type of disfluency

Bilingualism Effecting brain connectivity

Recent research has found connections between bilingualism and functional connectivity: - Control regions: cingulate cortex, left caudate nucleus - Language regions: left superior temporal gryus Anatomical Connectivity (areas associated with language processing and monitering activity changes) - Left frontal and temporal/parietal regions - Left occipital and temporal/parietal regions

Bodily Movements

Related to facial activity seen as coping strategy and moving may help at first to get out of a stutter and coping strategy becomes uncontrollable movement/reaction - Facial Grimaces - Head movement - Loss of eye contact - Torso/lip movement/ recaction

Brain structure anatomy and function...

Relies on each other and influences e/o. The way we use our brain changes the elasticity and creates other functions

A type of disfluency that is most characteristic of stuttering is

Repetition of syllables

Characteristics of Neurological stuttering

Repetitions Excessive phonations

Developmental stuttering research with brain matter

Researchers found the most consistent differences that are associated with developmental stuttering are the white matter microstructures

Research Difficulties in Bilinguals who stutter

Researchers often fail to consider bilingualism (1/2 of people diagnosed with a stutter should be bilingual) Researchers need to control: - Language combinations involved (English and French/ English and Spanish) - Age of acquisition of the second language (early/late) - Proficiency and usage of the languages (how often they use the language, the individual's comprehension skills, speech skills, and written skills) - Sample size and age of subjects (mostly small sample sizes, not the same age group) - Methodology assessing stuttering and bilingualism (how this is assessed) - Case studies vs. Group studies

What factors make a diagnosis of stuttering easier when working with a bilingual?

Should SLPs working with a bilingual speak both languages? - Easier to identify stutter in a familiar language - Easier to identify a severe stutter - Easier to identify language close to the native language

Conditions where stuttering decreases

Situations with high anxiety may increase stutter (class, phone calls) Manner of talking and context of talking can help decrease stutter

left himsphere

Speech production

Stuttering=

Stammering

Demands vs. Capacities Theory

Stockweather 1990's Views stutters as intrinsic and extrinsic effects on child exceed child ability to meet expectations put on a child Stuttering may occur when capacities for producing fluent speech are not equal to the demands on the child's fluent speech Too demanding of an environment and a genetic predisposition may cause a mismatch between own current capacity and demands of the environment/others

What is the cerebral dominance theory?

Stuttering is caused by a lack of hemispheric dominance for language - "Competing hemispheres" (Speech centers in both hemispheres instead of just the left) - As a result, he argued that there was a Breakdown in the flow of speech due to competition LH= right side of the body RH= left side of the body however, this isn't the case for language (LH controls most speech decisions)

Parent directed therapy

Taught to play a key role in the redirection of Childs stuttering. Parents reinforce the techniques taught in therapy. They direct attention to praising desirable behaviors and concentrate on fluency. Creates awareness of what makes speech easy and difficult for the child. Looks at the physical aspects of awareness such as speaking patterns

Which of the following is not an area of speech that the SSI-4 measures?

The SSI-4 measures all of the above.

Anticipation

The ability of PWS to predict which words they will stutter on; They know what they struggle with

Questions for stuttering assessments

The answer according to age; children the emphasis is working with parents 1. Are speech disfluencies present? 2. What is the nature of the speech disfluencies?

Fluency

The effortless flow of speech makes speech sound normal/natural Pleasant sing-song pattern of speaking

Adaptation

The tendency for stuttering to decrease in frequency and severity when a passage is read several times, familiarity overtime

Clinically, adaptation refers to

The tendency for stuttering to decrease when a passage is read several times

Consistency

The tendency to stutter on the same words when a passage is read several times; same sounds

PWS are not smart myth

There's no link between stuttering and intelligence

Assessment Goal

To determine if the atypical/typical in what we would see in people on an everyday basis

Who proposed the cerebral dominance theory?

Travis 1931

A criticism of the Fluency Shaping Approach is that the patient's speech sounds somewhat unnatural as a result of the modification in overall speaking behavior

True

An example of a non-traditional treatment approach to decrease stuttering is an electronic device, which closely resembles a hearing aid, that provides an auditory distraction to help alter a patient's overall speaking behavior.

True

Cluttering is associated with a fast speaking rate.

True

Neuroscience research relative to Bilingualism

Typically it has shown advantages - Hemispheric asymmetry differences - Increased gray matter density - Increased white matter connections - Increased executive functioning

Drug therapy for stutters

Use of anti-anxiety medications to reduce moments of stuttering. Pagolclone: Selective receptive neurotransmitters treats dopamine in the brain and produces positive effects such as relaxation. Research has been discontinued and results were disappointing. Very little patients responses were long lasting and modest reduction

Traditional Treatment

Uses behavioral modification to help stutter, often try both to see which fits best 1. Fluency Shaping: designed to modify all aspects of the clients speaking behavior 2. Stuttering Modification: designed to address individual moments of stuttering, as opposed to changing the entire pattern of speaking behavior Could develop hybrid combining both together

The Speech Easy device

Uses white noise to aid in blocking auditory feedback. They're unable to hear their own voice and decreases the stutter. Prolonged use can negatively affect stutter

Brain Structure: White Matter in Stutterers

White matter is seen as the software that wires the brain together Decreased white matter (children and adults) affects: - Corpus callosum: myelinated nerve fibers that connect the two brain hemispheres, permitting communication between the right and left sides of the brain. - Tracts that link auditory and motor areas

Which of the following is an example of covert stuttering behavior?

Word avoidance

Stuttering can be "caught" through imitation or by hearing another person stutter Myth

You can't catch stuttering

Hypnotherapy

a psychologically based approach to the treatment of stuttering. Controversial and is aimed towards mild stutter. Works by decreasing anxiety and increasing confidence

Adults and School aged children with developmental stutter Prevalence

about 1%

Preschoolers with developmental stutter Prevalence

about 5% (worldwide) higher; lowers to 1% when entering school; 3x more likely in boys and more often occurs in twins

Stuttering Modification

address individual moments of stuttering, as opposed to changing the entire pattern of speaking behavior - Reduction of tension - Use of light articulatory contacts (light tongue and lip movements) - Address situational fears and negative attitudes (secondary characteristics) PRODUCES SPEECH THAT'S MUCH MORE NATURAL

Bilinguals who don't stutter vs. monolinguals who don't stutter

advantages in executive control

The sentence "I can - I can - I can pick you up at 5pm." is an example of

all of the above

Bilingualism stuttering

bilinguals are more fluent in secondary language than primary language

Monolinguals with stutter vs. Monolinguals who don't stutter

deficits in executive control

Left side of the brain controls...

language, math, logic

Fluency Shaping

modify all aspects of the clients speaking behavior in order to develop a new speaking pattern. Syllables, words, sentences - Reduction of speech rate - Prolongation of Vowels - Slow and smooth speech initiation CONTINUOUS PHONATION: constant vocal fold vibration, same principles of phonation used with singing trying to replicate that GOAL: completely stutter free

Stuttering worsting on consonants

more likely than on vowels

Stuttering worsting on Long words

more on long words than short words

Stuttering worsting on Initial words

more than later words

Stuttering worsting on Content words

more than on function words

According to the Yairi and Ambrose System, what would be classified as a stuttering-like disfluency?

multisyllabic word repetition

As a general rule, the greater the occurrence of within-word disfluencies, the greater the severity of the stuttering disorder

true

Parkinson's disease may cause neurogenic stuttering

true

Stuttering disappears when a person begins to sing

true

What is the general goal of stuttering treatment?

All of the above

World population Prevalence for stuttering

8 billion people overall; .7% more than 50million world wide

Cluttering

A disorder of speaking rate - Speech and language formulation affected - Very fast speaking/ irregular/ or both Treatment: Decrease speaking rate to increase general fluency and clarity of speech

Jean-Marc Gaspard Itard

(1774-1838) First to view stuttering as pathological Thought that stuttering was caused by a spasm induced by a weakness of the motor organs of the larynx and tongue; Dysfunction of the tongue and larynx was believed to be the etiology, small plate was placed under tongue for support

Lee Edward Travis

*Founding father of SLP 1896-1987 Strong research intrest in stuttering. He thought that PWS have speech centers in both cerebral hemispheres of their brain instead of just the left hemisphere (less invasive but still strange) - Stuttering resulted in brain dominance in speech and 2 sides competed for dominance and this fight results in stutter breakdowns in flow of speech - Worked with charles riper and wendell johnson and observed that Left handed people were forced to use right hand were more likely to stutter. Took left handed people and forced them to write with their right hands.

Famous people who stutter

- Charles darwin - Marilyn Monroe - Issac Newton - Ed Sheeran - Bruce willis - Moses - Joe Biden - King George the 6th

Comparing Cluttering

- Late talker - Repetition of phrases - Never very fluent; choppy - Poor articulation - Poor reading and writing - Poor prosody and musicality - Unaware of disfluency - Speech improves with pressure

Developmental Stuttering

- Most common fluency disorder - Born with this condition and not apparent until connected speech occurs - Condition waxes and wains and there will be periods where child is completely disfluent and times where they're completely fluent - Stuttering is found to occur in all languages of the world - Family history of stuttering in 30-60% of PWS - Stuttering occurs more often in boys than girls (3:1)

Comparing Stuttering

- Precocious talkers (good) - Repetition of sounds and syllables - Fluent episodes - Good articulation - Good reading and writing - Good musical abilities - Aware of disfluency - Speech gets worse under pressure

Etiologies of Neurogenic Stuttering

- Stroke - Traumatic Brain Injuries (TBI) - Brain tumor - Neurological diseases (parkinsons disease) - Drug toxicity May be caused by and undiagnosed neurological disorder

Comparing Neurogenic stuttering

- Usual adult onset - Confirmed neurological lesion (somewhere in the brain) - Stutter event locations anywhere in sentences - Stuttering frequency varies little across situations - Adaptation effect less common (reading out-loud less likely to decrease stutter)

Comparing Developmental Stuttering

- Usual childhood onset - No psychological trauma - No neurological lesions (etiology is unknown) - Stutter event locations typically mainly on first 3 words of sentences - often anxious about stuttering and aware of stutter - Stuttering less in singing, unison, delayed auditory feedback - Remission at adult age is rare - Stuttering frequency varies across situations (There may be different situations where the stutter increases and decreases) - Adaptation effect more common (stutter gets less frequent because they get used tp reading a statement)

Comparing Psychogenic Stuttering

- Usually adult onset - Diagnosed psychological trauma - Often apathetic towards stuttering (indifferent) - Stuttering occurs in singing, unison, delayed auditory feedback (no improvement) - Rapid remission with reduced emotional stress - Leaves as soon as psychological issue is gone

Aspects of Disfluency

1. Fast speaking affects vowels and consonants 2. Interjections are seen as disfluency (Um)

Myths about stuttering

1. PWS are not smart 2. Nervousness causes stuttering 3. Stress causes stuttering 4. Stuttering can be "caught" through imitation or by hearing another person stutter 5. It helps to tell a person to "take a deep breath before talking" or "think about what you want to say first"

Aspects of Flow

1. Rate/quickness 2. Pauses that may occur within or in between words 3. Stress placed on syllables/words 4. Intonation someone uses

Stuttering when one sings

1. Strings of words are heard and repeated 2. Vocal folds in constant state of vibration and constant phonation decreases stutter

Johann Friedrich Dieffenbach

1792-1847 A german surgeon who recommended cutting out portions of the tongue (because it sticks to roof of the mouth) to treat stuttering Treatment: cutting tongue with scissors in triangles, did over 250 surgeries without patient being asleep

Rudolf Schulthess

1802-1833; Suggested using the terms phonophobia or lalophobia to describe condition related to voice and motions

Charles Van Riper

1905-1994 Developed the "Stuttering Modification Therapy", which is still used today by clinicians all around the world. Goal: not to eliminate stuttering 1. Reduce fear and avoidance 2. Modify normalcy of stuttering so it's less severe Well know for treatment of speech sound disorders too

Cognitive reserve refers to individual differences in brain structure, and brain reserve refers to individual differences in brain function

False

Fluency Shaping was designed to address individual moments of stuttering, as opposed to changing the entire pattern of speaking behavior.

False

The SSI-4 cannot be administered to non-readers

False

Who recommended cutting out portions of the tongue to treat stuttering?

Johann Friedrich Dieffenbach

What is the aim of stage 2 in the Lidcombe Program?

Make sure stutter doesn't return

Wendell Johnson

Monster Study 1906-1965 Believed that the development of stuttering had a strong environmental influence. - Issues with stuttering don't begin with a child's mouth but parents ears - Mistook Childs dysphonia as stutter and forced children to speak weirdly developed stutter

In general, ____________________ are considered low-risk disfluencies, whereas ____________________ are considered high-risk disfluencies

Phrase repetitions, sound prolongations

What did Dr. Gorman's client create to teach his family about his stuttering?

PowerPoint Presentation

Neurogenic Stuttering

Results from conditions affecting various areas of the brain (neurological lesions); Increased number of involuntary speech thats caused by psychological factors and neurons Neurological condition

Dr. Gorman discussed that when her bilingual client arrived at her clinic, his disfluencies were more commonly observed in...

Spanish

Characteristics of Cluttering

Speaking rate: really fast typical rate for fluent speech, difficult to follow Speech articulation: Slurred and/or omissions and substitutions Speech disfluencies: primarily other disfluencies Self-perception/anxiety may be unaware of disfluent speech/ no anxiety Expressive Language: disorganized

Characteristics of Stuttering

Speaking rate: regular 240 syllables per min Speech Articulation: Normal Speech Disfluencies: Primarily stuttering-like disfluencies Self-perception/anxiety: aware of disfluent speech/anxious Expressive language: Organized

What does SSI stand for?

Stuttering Severity Instrument

Nervousness Causes stuttering myth

Stuttering doesn't mean they're nervous/shy

Charles Van Riper described stuttering as

Stuttering occurs when the "forward flow of speech is interrupted by a motorically disrupted sound, syllable, or word or the speakers reaction therto"

Cluttering differs from stuttering in that:

Stuttering typically involves awareness of disfluencies and cluttering does not

PWS (People who Stutter)

This preferred to stutters

Developmental stuttering is not perceptually apparent until a child begins using connected speech

True

Researchers have suggested that bilingualism may increase the brain's ability to cope with various brain pathologies, such as Alzheimer's disease

True

Some researchers speculate that right hemisphere activation might reflect a compensatory mechanism of long-term stuttering, rather than bilateral or right hemisphere language dominance

True

The SSI-4 can be administered to children and adults.

True

James Yearsley

VERY INVASIVE 1805-1869 a British surgeon who advocated the removal of tonsils as a form of treatment for stuttering *Both tonsil removal and tongue removal became banned because these surgeries didn't work and led to excessive bleeding

For the treatment of stuttering, the English philosopher Francis Bacon (1561-1626) recommended

drinking hot wine to loosen up a stiff & frozen tongue

Cluttering is associated with a fast speaking rate

true