Adult+-+Stuttering

= //__Adult Stutter__// =

...  .   .  __**What is a stutter?**__

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 According to ASHA, "Stuttered speech ﻿often includes repetitions of words or parts of words, as well as prolongations of speech sounds. These disfluencies occur more often in persons who stutter than they do in the general population. Some people who stutter appear very tense or "out of breath" when talking. Speech may become completely stopped or blocked . Blocked is when the mouth is positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming. After some effort, the person may complete the word. Interjections such as "um" or "like" can occur, as well, particularly when they contain repeated ("u- um- um") or prolonged ("uuuum") speech sounds or when they are used intentionally to delay the initiation of a word the speaker expects to "get stuck on." An evaluation consists of tests, observations, and interviews that are designed to assess the overall severity of the disorder are used during intervention. . ======   .  media type="youtube" key="Lj2IsxxCSS8?version=3" height="343" width="610" align="center"

.. **__How is a stutter diagnosed?__** = // Stuttering Severity Instrument, Fourth Edition (SSI-4) // =

= __ Author __ : Glyndon D. Riley  = = __ Price __ : $155. 00 = =  This test can be purchased through Pearson’s Assessments Website (PearsonsAssessments.com)  = = &  = = // Overall Assessment of the Speaker's Experience of Stuttering (OASES™) // =

= __ Authors: __ J. Scott Yaruss, PhD & Robert Quesal, PhD  =

__ Price __ : $125.10  . This test can be purchased through ASHA online. . .. ..__**What goals are set for treatment?**__  __.__  <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal;">A general goal is to increase self-confidence and reduce fear by being able to have a conversation without dysfluency being present. <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: auto 0in;">. <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal;">An example of a behavior goal is: Given a topic by the clinician, the client will speak for three minutes with less than 5% dysfluencies. <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal;">. <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal;">. <span style="color: #ffcc99; font-family: Georgia,serif; font-size: 18pt; font-weight: normal; margin: auto 0in;">__**What theoretical approaches are used for treatment?**__ <span style="color: #ffffff; font-family: Georgia,serif; font-size: large; font-weight: normal; margin: auto 0in;">__**.**__  <span style="color: #ffffff; font-family: Georgia,serif; font-size: large; margin: auto 0in;"><span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: auto 0in;">**__.__** <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: auto 0in;">Walter Manning developed an approach that helps his clients increase their options and choices in their lives because he felt that an adult who stutters has limitations socially, academically and occupationally. He wrote a book about a therapy approach that begins with the client describing what happens when they stutter and what they do because of their stutter. Manning and the client work to modify the client's behaviors and choices, learning how to feel comfortable with their stuttering and to modify the sound of their stutter to that of normal speech. The client then goes through fluency shaping to help enhance their speech to normal. The fluency shaping helps severe stutterers who are unable to modify their speech. <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: auto 0in;">. <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: auto 0in;">David Daly developed a treatment program based on his own personal experience with stuttering and the successful treatment that he recieved. Daly uses fluency shaping followed by a cognitive therapy program. The cognitive therapy helps aid in the long term success rate. His approach "establishes fluency using three 'targets' that are taught through the clinician's models and instructions and then overlearned using highly structured practice in increasing realistic contexts." The first target is called deliberate phonation. Daly asks his clients to use a monotone drone and keep phonation going throughout a phrase, even during segments that are normally voiceless. This also teaches the clients to produce speech slowly. The second target is called normal breath, which is exactly as it sounds: the client learns a "relaxed breathing pattern that ensures adequate air for normal volume without straining." The third and final target is called easy stretch. This target teaches the client to "use an easy onset of phonation and light articulatory contacts rather than a hard vocal attack and a high level of intraoral air pressure at the beginnings of utterances." <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: auto 0in;">. <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: auto 0in;">After these targets are mastered through extensive drills, clients use self-monitoring techniques to maintain the targets to generate newly fluent speech. Three hand signals are taught to the client to "remind themselves to monitor these targets and to gradually fade out self-monitoring once an utterance is underway." The hand signals are clenching their firsts, touching their thumb and finger and pressing a finger on a surface. Daly then reinforces the monitoring of fluency targets by having the client speak freely, without thinking, after self-monitoring has been successful for a period of time in each speaking situation. This follows an approach developed by Shames and Florance (1980). After accomplishing speakign freely, Daly's next phase of therapy is called cognitive and self-instructional strategies. This phase consists of "guided relaxation, mental imagery, and positive self-talk to help clients move through more challenging activities to maintain fluency." <span style="color: #ffffff; display: block; font-family: Georgia,serif; font-size: large; font-weight: normal; margin: auto 0in; text-align: center;">... media type="youtube" key="buZ3brbn8Q0?version=3" height="353" width="600" align="center" = <span style="color: #ffcc99; font-family: Georgia,serif; font-size: 18pt; margin: auto 0in;">__W__ <span style="color: #ffcc99; font-family: Georgia,serif; font-size: 24px; line-height: 36px;">__hat kinds of techniques/activities might be observed in a typical treatment session?__ =

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. <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 12pt 0.25in;">Increasing verbal interaction with the client is a technique that can be used in a treatment session with an adult stutterer. Working on communication skills is important because the client needs to be reassured that talking is better than not talking at all. When they are familiar with a topic they will have input on the subject and, therefore, talk about it. Just having a conversation with the client can improve their stuttering problem. <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 12pt 0.25in;">Many adults that seek an SLP for their stutter address that their stutter becomes worse when they are stressed. Relaxation techniques may be observed in a treatment session with an adult stutterer. These techniques include proper breathing to reduce stress and improve the stutter. If one is about to speak to their boss or someone of importance, they may want to take slow, deep breaths beforehand so that they are less stressed and able to speak more efficiently. Oral visualization can also be helpful; saying it in your mind before saying it out loud, or visualizing saying the words. Yoga, pilates or other forms of meditation may also be helpful for someone with a stuttering problem. <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 12pt 0.25in;">. <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 12pt 0.25in;">One stutterer states, "I enrolled for Yoga classes to help de-stress my mind (and in the process, my body too). The more I took the classes the more in check I was with my breathing patterns and could control my speaking pace too, even in stress filled times." <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 12pt 0.25in;">. <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 12pt 0.25in;">There are also anti-stuttering devices that are now available for stutterers. One of the many devices that are used on adults is the altered auditory feedback device, which is usually used with an electronic device. This device corrects the auditory processing underactivity seen in adult stutterer's brain scans. More importantly, there are three different types of altered auditory feedback devices: Delayed Auditory Feedback (DAF), Frequency-Shifted Auditory Feedback (FAF), and Masking Auditory Feedback (MAF). The DAF device delays the user's voice to his/her ear a fraction of a second. This can be combined with fluency shaping therapy for more results. The FAF changes the pitch of the user's voice in his/her ear. The FAF produces a synthesized sine wave in the user's ear at the frequency at which the user's vocal folds are vibrating. ====== <span style="color: #ff00ff; display: block; font-family: Georgia,serif; font-size: 12pt; margin: 0in 0in 12pt 0.25in; text-align: center;">Fluency shaping therapy is found to be an effective method for stuttering therapy. This therapy trains the stutterer to speak fluently with relaxed breathing, vocal folds, and articulation. This is when stutterers are trained to breathe with their diaphragms, gently increase vocal fold tension at the beginnin of words, slow their speaking rate by stretching vowels, and reduce articulatory pressure. This creates fluent, but monotonic speech. However, this abnormal-sounding speech is only used in the speech clinic. After this is mastered, speaking rate and prosody (emotional intonation) are increased. This speech is then used in a daily life style. <span style="color: #ff00ff; display: block; font-family: Georgia,serif; font-size: 12pt; margin: 0in 0in 12pt 0.25in; text-align: center;">A study followed 42 stutterers through the three-week fluency shaping program. The program included psychological treatment to reduce fears and avoidances, discussing stuttering openly, and changing social habits to increase speaking. The therapy program reduced stuttering from about 15-20% stuttered syllables to 1-2% stuttered syllables. 12 to 24 months after therapy, about 70% of the stutterers had satisfactory fluency. About 5% were marginally successful. About 25% had unsatisfactory fluency.

**__What we observed of Stuttering:__** <span style="color: #ff00ff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 0pt;">Alison Sheedy: "The dysfluent client that I was able to observe while doing my field observations was the in-class video of a stuttering evaluation. The video featured a young man having trouble with his fluency. He commented that he often avoided the words that he had trouble with, attempting to find a way around the stuttering. He also found that he stuttered more when he became anxious or when he had already stuttered in a previous sentence. I believe that this approach is common for someone that has a stutter - trying to avoid the problem and work around it. The relaxation technique explained above may be a good way for this client, and others like him, to calm themself enough while speaking to aid in the fluency of their speech. The techniques provided above, in addition to countless techniques currently being used, can not only improve ones speech, but also their overall quality of life." <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 0pt;">. <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 0pt;">. <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 0pt;">include component="comments" page="Adult - Stuttering" limit="10". <span style="color: #ffffff; font-family: Georgia,serif; font-size: 12pt; font-weight: normal; margin: 0in 0in 0pt;">. <span style="color: #30cf62; font-family: Georgia,serif; font-size: 12pt;">**__Sources:__**

<span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">ASHA definition of a stutter: ([]) <span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">SSI-4 Test: ([]) <span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">OASES Test: ([+of+the+Speaker%e2%80%99s+Experience+of+Stuttering+(OASES+%e2%84%a2]) <span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">Increased Verbal Interaction Technique: ([]) <span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">Relaxation Testimony: ([]) <span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">Relaxation Technique: ([]) <span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">Anti-Stuttering Devices: ([]) <span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">General Goal: ([]) <span style="color: #30cf62; font-family: Georgia,serif; font-size: 10pt;">Guitar, B. (1998). Stuttering. An Integrated Approach to its Nature and Treatment. Maryland: Williams and Wilkins.