FLUENCY MASLP
- 1. UNIT 4 A. FLUENCY DISORDERS: (Theoretical issues in measurement of stuttering. Treatment outcomes in stuttering – relapse, Prognosis and maintenance. The nature of recovery. Prevention of stuttering) Submitted to Submitted by DR. ROHILA SHETTY HIMANI BANSAL MVSCOSH MASLP 1st year
- 2. Theoretical Issues in Measurement of Stuttering Stuttering measurement adhere more or less to the principles of behavioural psychology preferring the quantification of overt speech behaviours rather than emotional or psychological aspect of the disorder Assessment of stuttering involves a number of aspects including neurological psychological, emotional and linguistic aspects
- 3. Shine 1980: Used transcription to identify the stuttered word including whole word repetition prolongations and visible struggle behaviour with all other dysfluencies considered normal. Conture 1990 & Kellyu 1991: Within the word disfluency are stuttering instances and between words disfluencies are normal Gregory and Hill 1993: Presence of a typical disfluency in up to 2% of the spoken syllable is not necessarily stuttering and that the presence of typical disfluency is not particularly normal if they occur at 10% of the spoken syllable Curlee 1993: The fluency problem may be suspected on the basis of all disfluencies in stutterers and non- stutterers and the presence of stuttered disfluencies on up to 2% in 35 words or syllables may not be labelled as stuttering
- 4. Treatment Outcomes in Stuttering Bloodstein & Gregory, 1979: It seems unlikely that clinical researchers in stuttering will ever arrive at a consensus regarding which treatment approaches are most appropriate or most effective To recommend that treatment be restricted only to approaches that have been proven to be effective, through scientifically valid research methodologies 1.The importance of documentation with broad range of options for treating stuttering, it would provide way for documenting outcomes of the treatment.
- 5. Defining Success Success of treatment is determined by: Complaint as the stuttering event: The focus is on frequent disruptions in speech fluency that are characterised by overt features such as physical tension and struggle Complaint as the stuttering disorder by: the treatment programs view not only the speech disruptions, but also the complex minimum of negative feelings and emotions that often accompany the production of stuttering events
- 6. Measures that need to be included % SS: syllable stuttered Syllables/min (SPM) Naturalness of speech Type of stuttering behaviours to be measured Stuttering severity measures Covert measures
- 7. Criteria for Efficacy of Treatment Reports of therapeutic success must be based on repeated evaluation and adequate samples of speech Improvement must be shown to carry over to speaking situations outside the clinical setting Bloodstein (1987): presented criteria that have generally accepted as a way to determine whether a treatment for stuttering has been successful or not
- 8. Studies on Efficacy of Stuttering Therapy Ryan (1983): compared four programs (i.e., programmed traditional, delayed auditory feedback, time out, contingency and GILU) for effectiveness in sixteen school children with a stuttering disorder. Although all four treatments were reported to be effective in reducing stuttering, only four of the sixteen children completed follow up stages. This large dropout rate and the lack of a control group raise questions about the success of these treatments Hanna & Owen 1977: stutterers have a tendency to seek help only when stuttering appears to be at its worst. After treatment is sought and before it begins, there appears to be a spontaneous return of symptoms to their average level, which are non-specific benefits of having sought help
- 9. Relapse Relapse covers all forms of client regression from occasionally stuttered words to the resumption of speaking patterns to pre therapy patterns Craig and Calver (1991): The majority of those who had suffered relapse related to feeling under pressure to talk faster while others reported it due to embarrassment to use the new speech patterns Silverman (1981): Clients who are especially likely to relapse are those who, following treatment, believe themselves to be cured. Other clients may regress as they come to lose confidence in the treatment program
- 10. Possible Causes of Relapse Client adjustme nt to a new role Speaking in non- habitual manner Failure to practice Slow decay due to similar stimuli Failure to follow maintenan ce procedure Neurophy siological loading Listener adjustme nt to a new speaker The cyclic nature of fluency Client’s assumption of responsibili ty
- 11. Factors Related to Relapse Chronicity and severity of the problem Achievement of false fluency Lack of motivation and interest Attitude change Genetic factors Poor self- monitoring Jost’s law- when two responses of approximately equal strength compete, the older one will replace the newer one, over time Dissatisfaction with the new methods of speaking
- 12. The Possibility of Relapse Prins (1970) found that about 40% of clients taking part in an intense residential program experienced some regression following treatment Silverman (1992) reports fewer than 50% of older children and adults who acquire normal sounding fluency during treatment are able to maintain fluency permanently Craig and Hancock (1995) found that 71.7% of 152 adults surveyed experienced relapse but that the majority found that they subsequently regained fluency. They also found that relapse tended to be cyclic, occurring up to 3 times a year
- 13. Helping Events Manage Relapse Client’s first experience with relapse is traumatizing Re-evaluation of the problem with respect to frequency and severity Cognitive behaviour therapy is particularly very helpful
- 14. Maintenance Establishment and Transfer: first two of the required three steps in a complete fluency management program Maintenance: third step is to maintain a satisfactory level of fluency in the client’s natural environment after clinical treatment has been terminated The research reviewed indicates the presence of relapse in the post treatment environment whether or not maintenance activities are carried out
- 15. Activities for Maintenance Regular clinical contact following treatment Emphasis on the need for changes in attitudes to speech, self- concepts, etc. Intensive ‘refresher programs’ or recycling through the initial program Emphasis on client self-responsibility
- 16. Recovery from Stuttering Total Recovery Kalinowski & Saltuklaroglu (2006): Complete removal of the overt (e.g., Syllabic repetitions, part-word prolongation of speech sounds) and covert (e.g., avoidances, substitutions and circumlocutions) stuttering events Finn et al. (1997): It also entails producing speech that is natural sounding, and therefore, indistinguishable from speech of those who do not stutter, as perceived by both the child and listeners Spontaneous Recovery Cordes & Ingham (1996): Recovery as an often-gradual process with knowable factors underlying the process. This alternative is based on the notion that recovery occurs without treatment It is an example of the wonders of Mother Nature. Mother Nature does seem to have a time schedule for recovery. For example, Andrews et al. (1983) reported that 75% of 4-yr old, 50% of 6-yr old and only 25% of 10-yr old will recover from stuttering
- 17. Model of Recovery Recovery WITHOUT Treatment Traditional View: SR is the result of maturation process, especially among preschool and early school age children. Perkins (1992): One possibility is that child’s stuttering is the result of an immature speech and language system that, with time, sufficiently matures to overcome the disability. Yairi, Ambrose & Cox (1996): Genetic factors; children who spontaneously recover are more likely to have a family history of recovery than children who continue to stutter. Alternative Model: SR is the result of informal corrective factors that were either parent-directed among children or self-directed among adults. Onslow and colleagues’ clinician-guided, parent-directed program for young children who stutter was developed from this model. Ingham (1984): Fluency-inducing techniques; adults have reported modifying their speech behavior by slowing down or by stopping and thinking before speaking.
- 18. Model of Recovery Recovery WITH Treatment When cognitive/behavioral techniques are used to bring fears under control and to counter tendencies to avoid social and speaking situations, inevitably right hemisphere activation is being kept under control. As clients practice their skills and become more proficient in an ever- broadening range of social and speaking situations, the skills become more automatic and require less concentration. With the maintenance of this skill altered state of brain activation will also become more automatic. Neural plasticity: There are well documented evidences of reorganization of the neural system in response to developmental and environmental demands
- 19. Studies CITATION RESULT Ambrose, N. G., Cox, N. J., & Yairi, E. (1997). The genetic basis of persistence and recovery in stuttering. Journal of Speech, Language, and Hearing Research, 40(3), 567-580. Results indicated sharply different sex ratios of persistent versus recovered stutterers in that recovery among females is more frequent than among males. It was found that recovery or persistence is indeed transmitted, and further, that recovery does not appear to be a genetically milder form of stuttering, nor do the two types of stuttering appear to be genetically independent disorders. Sheehan, J. G., & Martyn, M. M. (1966). Spontaneous recovery from stuttering. Journal of Speech and Hearing Research, 9(1), 121-135. Thirty-two spontaneously recovered stutterers were compared with 32 active stutterers and the normal controls, and a computer bivariate association analysis showed: (1) four out of five recover from stuttering spontaneously; (2) fewer of those who had received public school speech therapy recovered from stuttering; (3) fewer of those who had ever been severe recovered spontaneously; (4) no familial incidence pattern with either group of stutterers as compared to controls; (5) no differences in reported handedness in stutterers or their families; (6) improvement attributed to self-acceptance and role acceptance; (7) there appear to be many different paths to recovery. Arya, P., & YV, G. (2012). Speech Naturalness of Recovered and Relapsed Persons with Stuttering Following Treatment. Language in India, 12(12). Results of the present study showed a significant difference between recovered and relapsed group of persons with stuttering following treatment across different speech parameters. The present study concludes that recovered persons with stuttering showed a perceptually more natural sounding speech across all the parameters as compared to relapsed persons with stuttering following treatment.
- 20. Prevention of Stuttering CITATION RESULT Gottwald, S. R., Goldbach, P., & Isack, A. H. (1985). Stuttering: Prevention and detection. Young Children. Teachers of young children are in a good position to make early detections of potential stuttering problems. Negative reactions to a child's stuttering may make stuttering worse. Adults are encouraged to develop an unemotional, matter-of-fact reaction to dysfluencies. Parents and teachers can alter their speaking style and the classroom environment to enhance children's speech fluency by, for example, slowing their own rate of speech; simplifying their grammar and vocabulary; reducing use of direct questions; responding to the meaning of a child's speech, not the way it is said; eliminating interruptions; allowing plenty of time for all activities, especially those that involve talking; and avoiding requests for verbal performance.
- 21. REFERENCES: 1. Stuttering and Related Disorders of Fluency- Richard F. Curlee 2. Clinical decision making in fluency disorders – Manning 3. Stuttering and other Fluency Disorders- Franklin H Silverman 4. http://kunnampallilgejo.blogspot.com/2012/09/efficacy-of-fluency- therapy.html?q=stuttering 5. https://ahn.mnsu.edu/departments/center-for-communication-sciences-and- disorders/services/stuttering/speech-and-language-disorders/support-for- parents/stuttering-prevention-a-manual-for-parents/ Questions asked in previous years: 1. Short note on objectives measures in evaluation of stuttering. (4 marks) (2013)