CSD 2072: Fluency Disorders
Practice Assignment #1: Stuttering in Public (Due 2/6/06)
(1) To give you a sense of what it would be like to be a person who stutters so you can begin to understand what your clients experience on a day-to-day basis.
(2) To give you an opportunity to practice a primary technique used in stuttering treatment
(3) To begin to desensitize you to stuttering so you will not react negatively to you clients’ stuttering or shy away from desensitization activities your clients may need in treatment.
First, practice stuttering with some from the class to make sure your pseudostuttering behaviors are representative of real stuttering and to help you feel more comfortable with pseudostuttering. Next, stutter openly in public in at least 10 situations. Be sure to vary your stuttering behaviors so they appear realistic. You should do this with a partner, in part to make the assignment easier, and in part so your partner can provide feedback to you about how well you stuttered. Your partner can also watch carefully for the reactions of the people you interact with during the assignment.
Examples of situations where you can do pseudostuttering include the following:
· ordering at a coffee bar · asking for directions to a building on campus
· calling information for a phone number · buying clothing at a department store
· buying a book at the bookstore · ordering pizza over the phone
· ordering lunch in a restaurant · calling a radio talk show
Try to make this assignment as real as possible. Don’t just stutter once during the conversation and then be done with it. Try to become a person who stutters so you can begin to understand what our clients face on a daily basis.
Post a summary of your experiences under the thread created for this assignment on the BlackBoard website. In your summary, be sure to answer the following questions:
· In what situations did you pseudostutter and what types of stuttering behaviors did you exhibit (severity, secondary characteristics, etc.)?
· What were the reactions of the people you were talking to? What were your own reactions?
· How did stuttering affect your ability to communicate?
· Were some situations easier or harder than others? Why do you think that was?
· Did pseudostuttering become easier or harder as you progressed through the assignment?
Finally, you should also include in your documentation a comparison between your experiences and the experiences of two or three of the students who posted their summaries before you.
This assignment is worth a total of 30 points, as follows: For the pseudostuttering, you will receive up to 20 points (up to 2 points for each of 10 situations): 1 pointfor entering the situation and pseudostuttering and 1 point for continuing to exhibit pseudostuttering throughout the entire interaction (You will need your partner to help with the scoring.) For the write-up, you will receive up to 10 points: up to 4 points for your description of your reaction and the reactions of others, up to 4 points for your description of how stuttering affected your communication in different situations, and up to 2 points assigned by me for excellent write-ups.
CSD 2072: Fluency Disorders:
Practice Assignment #2: Evaluating and Measuring Speech Fluency (Due 2/27/06)
(1) To give you experience evaluating and measuring observable aspects of speech fluency
(2) To help you develop intra- and inter-judge reliability in identifying disfluencies
You will work in pairs or small groups for this assignment. First, each member of your group should work individually to review a videotape of a child who stutters (available in class) and determine:
· The frequency of disfluency
· The types of disfluencies
· The average duration of stuttered disfluencies
· The overall severity of stuttering according to the SSI
· The child’s rate of speech in syllables per second
Second, after a few days, each member of the group should again review the tape individually and complete the calculation of stuttering frequency again in order to assess intrajudge agreement.
Finally, group members should compare their individual judgments of the videotape to assess interjudge agreement. In cases where interjudge agreement is poor, you
Yaruss, J.S. (1998). Real-time analysis of speech fluency: Procedures and reliability training. American Journal of Speech-Language Pathology, 7(2), 25-37.
Yaruss, J.S. (1997). Clinical measurement of stuttering behaviors. Contemporary Issues in Communication Science
and Disorders, 24, 33-44.
CSD 2072: Fluency Disorders
Practice Assignment #3:What would it be like to be in stuttering therapy? (Due 3/27/06)
(1) To help you practice speech and stuttering modifications commonly used in treatment.
(2) To help you understand the difficulties clients often face when use these techniques in the real world.
First, practice using the primary speech modifications we discussed in class until you are able to do them comfortably and accurately. The speech modifications you should practice include:
· Slow speech (with pausing and phrasing) · Easy Starts · Light Contact
Next, use these three techniques in 15 different speaking situations. Make sure you get experience with all three techniques, not just the ones you find easier to do. In order to do this, you will first have to pretend to be a person who stutters (as in Assignment #1). Try to use the modification consistently like you want your clients to do. As with Assignment #1, you should do this in pairs so your partner can provide feedback about your stuttering, your modifications, and listeners’ reactions.
Assignment – Part II
First, practice using the primary stuttering modifications we discussed in class until you are able to do them comfortably and accurately. The speech modifications you should practice include:
· Preparatory Set · Cancellation · Pull-out
Next, use these three techniques in 15 different speaking situations. Make sure you should review the tape with your group to reach consensus agreement on the behaviors in the sample.
Each group should post a brief summary of their experience with this practice assignment on the Blackboard website. Specific questions to address include:
· What stuttering behaviors were observed in the tape?
· What difficulties did you run into in counting stuttering behaviors?
· How reliable were your judgments and what factors appeared to influence that reliability?
· How could you improve your measurements?
This practice assignment, which consists of 3 components (frequency count, reliability check, and write-up) is worth up to 30 points. For the frequency count, you will receive up to 10 points for calculating measures of disfluency (2 points each for frequency, duration, type, speaking rate, and severity). For the reliability check, you will receive up to 10 points for achieving and demonstrating intrajudge and interjudge reliability (5 points each). For the write-up, you will receive up to 10 points (up to 2 points for each of the 4 questions outlined above, plus 2 additional points for citing novel literature on stuttering measurement.)
There is a huge literature on the reliability of stuttering measurements. I have prepared two tutorial articles outlining procedures for measuring stuttering; however, there is more literature you may wish to consider. For starters, here are references for the two articles I have written. get experience with all three techniques, not just the ones you find easier to do. In order to do this, you will first have to pretend to be a person who stutters (as in Assignment #1). Try to use the modification consistently like you want your clients to do. As with Assignment #1, you should do this in pairs so your partner can provide feedback about your stuttering, your modifications, and listeners’ reactions.
Post a brief summary under the thread created for your small group on the BlackBoard website. For each part of the assignment, address the following questions in your write-up:
· What was it like to try to change your speech?
· Did the modifications come naturally?
· Would you like to talk this way all the time? Do you think you would be able to do so if you tried?
· How do you think a person who stutters feels when we ask them to do use such modifications?
You should also include in your documentation a comparison between your experiences and the experiences of two or three of the students who posted their summaries before you.
This assignment is worth a total of 40 points, as follows: For the speech modifications, you will receive up to 15 points (1 points for each of 15 situations). The same is true for the stuttering modifications (1 point for each of 15 situations). For the write-up, you will receive up to 10 points: up to 2 points for answering each of the 4 questions above, and up to 2 points assigned by me for excellent write-ups.
CSD 2072: Fluency Disorders: Group Project and Poster Presentation
(To be presented in class 4/17/06 and 4/24/06)
(1) To help you evaluate new information about stuttering that might arise during you career.
(2) To support the development of specific areas of interest in stuttering.
(3) To encourage you to develop your own opinions about various topics in stuttering.
You will work in small groups for this assignment. Each group will select a topic of mutual interest and prepare a poster presentation on the topic. Examples of topics that would be appropriate include:
· Reading several personal stories of people who stutter and presenting a comprehensive review
· Interviewing people about their knowledge and opinions about stuttering and presenting a review of your findings, including a comparison with existing literature
· Interviewing practicing SLPs about their knowledge and opinions about stuttering and presenting a review of your findings, including a comparison with existing literature
· Critically reviewing online resources for stuttering
· Actively participating in the Stutt-L listserv and critically reviewing the contents
· Attending several NSA meetings and conducting interviews with people who stutter
· Critically reviewing material available for SLPs from the National Stuttering Association or Stuttering Foundation of America
Groups should select their topics by March 15 and get approval for the topic before proceeding. One topic that should be avoided is “reviewing movies about stuttering or people who stutter.” (That can be done for extra credit but not as a main project.)
The poster presentation can be created either as a single large poster (several examples are available in the halls of Forbes Tower) or as a series of pages (PowerPoint slides) that will be printed and pinned to the wall individually. Half of the groups will present their posters on 4/17 and the other half will present their posters on 4/24. Students will have the opportunity to view other posters, ask questions, and discuss the content of the posters during each class.
Posters should reflect the work and participation of all members of the group; however, it will be left up to you to determine each members’ contributions. Specific topics to be addressed in your presentation will vary depending upon your project.
Each group should prepare a brief handout outlining the group project, summarizing the important “take home” messages from the poster, and citing the appropriate references used in the project.
The project and presentation will be worth up to 50 points, as follows: For the Project, you will receive up to 5 points for creativity in selecting the topic and up to 15 points for successfully completing the project. For the Poster, you will receive up to 10 points for coverage of your topic and up to 10 points for the quality of your poster. For the Handout, you will receive up to 10 points for including relevant details and citing appropriate literature. A final 5 points will be assigned for particularly excellent presentations.
Fluency last test- ppt & handouts
2) Keep them SIMPLE and ATTAINABLE
3) Set them up to be TRANSFERABLE to out-of-therapy situations.
2.Broadcasting: public revelation of stuttering
3.Decreased severity tolerated in various speech situations
4.Public use of speech techniques
For many school-aged children, areas to focus on may include
-How they feel about themselves and stuttering (affective).
-How they formulate messages as speech demands change (linguistic).
-How they manage the speech process (motor).
-How stuttering impacts interactions with various people in various situations (social).
Children: Sometimes I Just Stutter (SFA)
Adolescents: A Guide for Teens (SFA)
Main website: www.stutteringhomepage.com
What does the client believe "causes" his/her stuttering?
2.Lungs as bellows to drive air, vocal cords as rubber bands that are vibrated, vocal tract modifications like different bottle size resonators, tongue and lips as "sound shapers and poppers".
3.Knowing what and how sounds are made helps de-mystify the speaking process. Teach understanding of the "speech machine."
4.Focus on positive aspects of client's speech. Help client achieve a feeling that he/she can be successful. Increase focus on what client CAN DO instead of what he CAN'T DO. Reduce mental effort involved in talking.
2.Listen to "self-talk" and change the semantics to positive lexicons.
3.Enhance positive self-talk.
4.Have others present during speaking experiences and match perceptions of the experience.
5.Record (tape or video) and review successful speaking experiences.
6.Generate daily "I did it" lists: five things that make you proud.
7.Accept mistakes...everyone makes them. Decrease assigning blame.
8.Get "hooked into" self-help organizations.
Identify tricks (starters like "uh", "well um", sucked "tch") and eliminate or find balance in their use.
Identify sound, word, situation, people fears and practice desensitization, direct confrontation, or other modification techniques to manage them.
about stuttering. Draw, model, or design with clay figures, balloons,
paper activities. Help them manage their creations as they manage their speech.
performances. Teach teachers, parents, other students to stutter.
-Learn about famous people who have stuttered.
-Role playing how to deal with teasing responses.
-Interviews and surveys of other school children regarding stuttering.
-Develop stutter groups to share thoughts, feelings, experiences.
-Develop internet projects to learn more or communicate with others.
Our job is to explore with the child stutterer, the bases of attitudes about or affecting the stuttering. These bases will include not only why he has the attitudes, but how he came to hold these attitudes.
This activity requires a lot of effort from both parties. Still, we can help a child explore and analyze a belief system while he is learning a more effective way of talking.
There are four processes involved in attitude change:
the ability to change and overcome the past by focusing on the present
the power to choose and implement satisfying alternatives to current patterns."
The stutterer's perspective on his speech, or other things towards which he holds some attitude, is derived from his thinking processes. A change in thinking should result in a change in affect.
B is the client's belief about A
C the upsetting emotional consequences
D is disputing of irrational ideas
E is emotional change
The idea is to manipulate speech fluency and/or language variables in one or more areas to enhance the child's level of success in each area. The strategy also allows a framework through which one may move a child to greater levels of communicative functioning.
2.Description-"Tell me what you do when you stutter"
3.Attribution-"Tell me three different ways a person can stutter"
4.Interpretation-"Why is slowing down helpful?"
5.Inference-"What might happen if you stuttered when answering a question in class?
6.Evaluation-"Why do you think it is hard to talk on the telephone?
7.Analogies-"How is stuttering like a clog in a pipe?"
With the CALMS model, you can treat language integratively as a component of the communication deficit
The demands for speech and/or language functioning compete with the resources available for fluency functioning. Clinical decisions regarding children with multiple impairments will be based on child's particular capacities for learning and responses to communicative demands
Demonstrate (show) what happens during fluency and stuttering.
Drill (practice) skills that promote fluency. When a stuttered moment occurs, have child explore what needs to change. Make technique sound natural
Teach fluency enhancing skills that match the disruptions in the client's speech system (e.g., easy onsets for phonatory disruptions, light contacts for tense blocks).
Teach pullouts, preparatory sets, and cancellations for those who are good at catching or feel comfortable working slowly through stuttered moments
-Mountains or slide for easy onsets of phonation.
-Stretched words and hooked words for continuous phonation.
-Four wheel drive out of mud or gradual opening of clinched fist
-Butterfly landing on flower or any light touch for light articulatory contacts.
Generalize strategy use to a variety of speech situations and with a variety of listeners. Vary performance of strategies, from extreme to minimal use.
Sometimes teaching "belly breathing" in supine, standing, and sitting positions with variants on depth and rate of breathing is useful. Sometimes drawing wave-like lines with the breathing in and out motions increases awareness of breath control.
For older children, simple diagramming of anatomy and physiology in speech respiration may be useful.
B. Not interrupting someone else.
C. Contributing to the topic of discussion.
D. Being sensitive to conversational turns.
E. Being willing to talk to anyone at anytime, anywhere.
-Move systematically through easy to difficult speaking situations.
-Help the client become more comfortable using a technique in public
-Help create positive communicative interactions with the family.
-Reduce the impact of "fluency disruptors" (time pressure, people interrupting, loss of listener, etc).
-Help provide new insights, perspectives, methods of implementing change.
-Aid in transfer, generalization, and maintenance of learned skills.
-Breaking down situations from easiest to hardest for speaking in academic or nonacademic situations.
-Helping teachers identify/reinforce verbal attempts and successes.
-Managing distractors, increasing time for responses, managing teacher feelings and responses.
-Helping teachers manage linguistic complexity or length requirements of response requirements in class.
-Teaching others about stuttering or self with regard to stuttering.
-Demonstrating and encouraging speech modification techniques.
-Keeping open acceptance of the stutter and focusing on the "what" of utterances versus the "how" of utterances.
-Learning and following appropriate turn-taking rules.
-Using appropriate eye contact.
-Resisting time pressures...internal or external. Injecting pause time.
-Practicing strategies to "jump into" conversations.
2) Teaching children who stutter to be assertive
3) Increasing children's self-esteem
4) Educating classmates about stuttering and bullying behaviors
"I can see you're well educated!"
"Careful! It's contagious!"
"No, no, no....you're doing it all wrong. It's done like this (demonstrating a pseudostutter with exaggeration)."
"Did you have to go to school to figure that out?"
There isn't one approach that will work for all children who stutter. Tailor the therapy to the needs of the child through decision making and problem solving.
Attitudes and emotions about self and stuttering have improved.
Perceptions of stuttering by client, parents, and teachers have improved.
A client understands that fluctuations in fluency will occur
but through therapy, they know WHY.
The client is able to convey message in an efficient manner, recognize listener needs, and maintain topic of discussion, and manage stuttering the best way possible.
Fluency in all communicative conditions.
Questions to ask yourself:
1.how confident am I in treating stuttering?
2. what is the long-term goal of treatment?
3. which philosophical approach will i adopt?
4. how will i document changes
5.are there external factors that may influence treatment
6. what is a realistic short-term goal?
7.why is the child making slow progress?
8.have i been an advocate for educating others?
9. if goal has been met, have behaviors been stabilized?
10. should i dismiss child?
-For preschool clients- Onslow's Lidcombe Program, Starkweather's parent home prevention program
-For school age children-Ryan's monterey GILCU program
-For adolescents and adults-stutter free speech program
Stabilization- intensive drill and practice
transfer- 8 week phase one-hour-long session where there is therapy outside the therapy room,journaling has been successful to heighten our awareness.
maintenance-prepare clients for more independent monitoring of their speech. practice and reinforced skills.
2. carrier phrase, slow & easy speech
3. aid & have child instruct adult on slow on easy speech
4.sentence responses with slow speech
5. phrase length with slightly faster speech
6. phrase length with "natural" speech
7. conversation with natural spa.
8. convo involving others
IT- might be warranted for children who are borderline disfluent or are in a "watch and wait period". Best approach is both therapy.
2. making changes in how child stutters or created a more fluency
3. learn about stuttering
4. focus on becoming a good communicator rather than being a fluent speaker
2.not easy to change the way one talks, do handwriting tasks
3. have parents journal
4.help parents get comfy with stuttering & look at positive things
5. be a good listener
6. parents should use encouraging praise
7. communication improves on: use "i" instead of "you". example: i see instead of you should & not interrupting each other
discourse complexity: lowest degree occurs when discussing disconnected events & greatest degree is required when asked to coordinate multiple subjects
2.try to make talking fun and speech is not on display
3. avoid competition to speak among family members
4. realize child will stutter more when: tired, excited, talking to strangers, asked to tell an adult something, talking to an impatient listener
5. don't suggest "to slow down" "think before u speak". only listen to what and not how its being said
6. model a slow, easy, relaxed speaking style with short simple phrases
7. its ok to talk to child as long as its a non threatening manner. its okay to make mistakes
2. show a chart with different types of stuttering and have child imitate stuttering patterns
3. stuttering is no ones fault
4. practice voluntary stuttering
5. describe feelings towards stuttering
6. draw stuttering monster & destroy it!
7. use play-doh and have it represent negative emotions. Smash it!
8. have child teach others how to stutter and have the child grade performance
9. talk about how to handle teasing
10. keep a journal
SLOW: a reduction in speech rate through prolongation technique-prolong each syllable
EASY: gentle onset phonation-yawn approach
DEEP: consciously controlled inhalation prior to initiation of phonation
LOUD: conscious and sustained increase/decrease in vocal intensity
BEAT: change in prosody of speech by randomly altering loudness, rate, pitch, stress
SMOOTH: reduction of phonatory adjustments and the use of light articulatory contacts. continuous phonation