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