COMD 4200- Treatment for Fluency

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Dec 6, 2023

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Terissa Tryon (Heeringa) COMD 4200 Treatment for Fluency 1. Define core and secondary stuttering behaviors. Compare the two. Provide examples of each in your answers. (2 points) Core stuttering behaviors are involuntary. Some core stuttering behaviors are repetition of sounds, syllables, or whole words, prolongation of single sounds, and blocks of airflow or voicing during speech. Secondary stuttering behaviors are learned and developed over time to "escape" or "avoid" stuttering instances. Escape behaviors could include head nods, eye blinks, foot taps, and jaw tremors. Avoidance behaviors could include substituting words that a person commonly stutters with a word they do not struggle with or using interjections to postpone speaking. 2. Watch the video about Easy Onset and Light Contacts (provided in the module). In this video, you watch two students role-playing these strategies. Write a summary (1-2 paragraphs) of each of the techniques. (2 points) In this video, the student explained that easy onset techniques are done by turning on your voice before making a voiced sound. She then demonstrated what this looks like with paint and described that easy onset in making the paintbrush glide both controlled and slowly across

the paper, just like you want to control and glide your voice slowly into making a sound after turning it on. The student explained that light contact is used when making a labial sound and barely allowing your lips to touch to make the sound. The student demonstrated light contact with paint by barely touching the brush to the paper to draw a line, just as a person would barely touch their lips together. 3. Read the information about Delayed Auditory Feedback and provide a brief (1-2 paragraph) summary of this fluency-shaping technique. (2 points) Delayed Auditory Feedback is a fluency-shaping technique for stuttering. Auditory feedback is collected through a device and reflected back to a speaker using headphones after a delay. Delayed Auditory Feedback helps an individual who stutters by slowing down their speech rate and reducing disfluencies by allowing a speaker to reflect on their own speech feedback. Some experts disagree with this technique as it is hard to wean a client off the device, and they can develop monotone speech patterns. 4. Select TWO of the profiles from the back of the chapter (there are 4 total). Provide a summary of the profiles and explain how the sample activities relate to the selected targets. (4 points) 1. Kate is a 3-year-old with hesitations in her speech pattern and produces whole- word/phrase repetitions and interjections of syllables/words. Kate produces some word-initial

syllable repetitions, accompanied by some secondary behaviors of eye blinks and head nods. Under evaluation, it was found that 23% of the syllables Kate uttered were disfluent, and she is frustrated by these disfluencies. Targets include; Fluency shaping in the form of decreasing speech rate and implementing easy onset of phonation. And implementation of stuttering modification and management techniques to help Kate become desensitized to her own disfluencies. Activity one incorporates the goals of slowing the speech rate and implementing easy onset together in one activity. This activity compares the pretend voices of a slow animal with those of a fast animal. Start the activity by introducing a carrier phrase that starts with a vowel, then demonstrate what a fast animal voice and a slow animal sound like using the easy onset of phonation. The child then chooses an animal, says the animal's name, and then repeats the carrier phrase using the animal's fast or slow voice. If the child's utterances are too fast, the clinician demonstrates a slow/easy onset voice and has the child repeat. This activity relates to the target slowing the speech rate and implementing easy onset by allowing the child to hear the difference between a fast voice and a slow voice and ralate the fast and slow voices to the child's fluency. Activity two targets decreased speaking rate. The clinician prepares this activity by making a yarn-pull toy by punching holes in the lid of a container and stringing yarn through the holes for the child to pull slowly. The clinician looks at a book with the client that contains

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pictures of familiar objects and activities. The clinician starts this activity by demonstrating a simple three- to five-word observation from the book's picture while pulling a string slowly in the yarn pull toy and using a slow/easy speaking voice. The child will imitate the clinician's original sentence using the same slow/easy speaking voice while pulling a new string to match their steady, slow speaking. This activity relates to the target because it gives the child a tactile example of matching their speaking rate by pulling the string slowly. Desensitization activities: Activity one uses a card deck depicting different agent + action relationships. The clinician will pretend to be disfluent in the same manner as the client during this game. Each person will take turns choosing and then describing a card. If bumpy speech is detected, players must slap the card when they hear the disfluency. The clinician will provide feedback about the smoothness or bumpiness of every production. This activity relates to the target because it models the client's disfluency to them and allows the client to recognize and talk about their disfluency. Activity two utilizes puppets and a repetitive storybook. The idea of this activity is to use the puppets to model different types of bumpy/dysfluent types of speech. One of the voices should be modeled after the client's own disfluencies and secondary behaviors. The clinician will model each puppet voice to the client and then read the story using the puppets and their voices. The child will produce the repetitive line of the story using their own puppet but

modeling the voice of the puppet that the clinician used on the line before. This activity relates to the target because it draws awareness to the disfluencies. 2. Susan is nine years old, and her speech is characterized by part-word and whole-word repetitions, prolongations of initial sounds, and phrase revisions. Susan demonstrated several secondary behaviors she did not seem aware of, such as leg movements, lip tremors, and eye gaze aversion. A 200-syllable spontaneous speech sample analysis was performed and indicated that 29% of the syllables Susan uttered were disfluent. Susan is anxious about her speech disfluencies. Targets include: Fluency-shaping approaches, such as easy onset of phonation, light articulatory contacts, and decreased speaking rate. And stuttering modification and management that addresses her secondary stuttering behaviors of prolongations and part-word repetitions. Activity one targets easy onset of phonation and light articulatory contacts. Before this activity, the clinician must demonstrate an easy onset of phonation and light articulatory contacts by instructing the child to release some air before starting her voice and gently moving her tongue and lips during speech. The clinician will start the I-spy game by describing an item in the room. The child will try to guess the item using both fluency techniques. The child then takes a turn to be "it," still using both fluency techniques. This activity relates to the target because they actively practice both techniques throughout the activity.

Activity two targets decreasing the client's speech rate. The clinician prepares a few "mad libs" stories to fill out with the client. The client must respond with ideas to fill out the mad libs using a slow speech rate for each blank in the story. When the blanks are filled, the client will then read the story out loud using a slower rate of speech. The clinician will then take a turn filling in blanks to a mad lib while the child is responsible for writing and asking questions. The clinician will use a slow rate of speech during their turn. Then, the child will read the new story aloud with a slowed speech rate. This activity relates to the target because they actively practice decreasing their speech rate throughout. Stuttering modification and management activities: Activity one is a self-analysis activity that utilizes a 30-minute video of the child speaking. Explain secondary stuttering behaviors to the client, and choose one the client does involuntarily to watch for during the video. When the client and clinician spot the behavior, they must raise their hand. Whoever correctly identifies most instances of secondary stuttering behaviors during the video wins. This activity relates to the target because it helps the client identify and recognize her secondary stuttering behaviors. Activity two focuses on cancellations by having the client repeat the stuttered word no matter what. This is done by preparing a list of animal riddles and answers. The clinician will randomly underline a word in the riddle question and then have the child deliberately stutter on the underlined word. The client will then work on canceling this stuttering disfluency and any

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other spontaneous disfluencies that occur while reading the riddle. Canceling is done by following through with saying the stuttered word, then pausing to think about what went wrong, and then silently rehearsing a correction to the word fluently. Then, the child should repeat the word out loud in a smooth, prolonged manner. The clinician should model this technique back to the client. This activity relates to the target of prolongations and part-word repetitions through the client reflecting on the disfluency and then correcting it.

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