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Speech Therapy For Fluency Disorders

admin — Fri, 06 Nov 2009 03:32:40 +0000

There are six main types of fluency disorders namely: normal developmental disfluency,stuttering, neurogenic disfluency,psychogenic disfluency, language based disfluency, and mixed fluency failures. Due to the uniqueness and difference of each case, all of them require a different kind of management approach in speech therapy.
Management For Normal Developmental Disfluency
Developmental disfluency occurs during the critical period of speech and language development. A child is considered to have this condition if 5% or less of his overall speech-sample are repetitions and 1% or less are prolongations.
Etiologies of this condition could be: excitement while speaking, demands of Language Acquisition, Speech-Motor control is lagging, environmental factors like stress in the family (e.g. separation of parents) and the situations they are in, and daily pressures of competition.
Concerned parents still make their children with this kind of disfluency undergo therapy even if this could still possibly decline. These children are taught how to: decrease the rate of their speech, relieve other pressures that the therapist and parents mutually agree to change, and simplify their language.
Management For Stuttering
The onset of stuttering may occur between ages 1-11 years old but it mostly occurs during early childhood stage, which ranges from 2-6 years old. A condition is diagnosed to be stuttering when the speech has 5% or greater repetitions and 1% or greater prolongations.
There are several approaches to therapeutic intervention for early stuttering namely: environmental manipulation, direct work with the child, psychological therapy, desensitization therapy, parent-child interaction therapy, fluency-shaping behavioral therapy, and parent and family counseling
Management For Neurogenic Disfluency
The onset of neurogenic disfluency is varied. It can occur at any age but it usually appears during adulthood or among the geriatric population. The neurological events that can trigger the onset of neurogenic disfluency are as follows: strokes, head trauma, extrapyramidal diseases, tumors, dementia, drug usage, anoxia, cryosurgery, viral meningitis and vascular disease.
Self-monitoring program is one of the most suggested modes for the management of this kind of disfluency.
Management For Psychogenic Disfluency
The onset of psychogenic disfluency is also varied. A condition is said to be under this category when 90% of the patient’s utterances have become disfluent when the emotional stimuli is present. This condition originates in the mind. The etiology could be acute or chronic psychological disturbances. Stress is another factor that may also cause the disorder.
Psychologists, psychiatrist and counselors can only provide treatment of this kind of fluency disorder. Speech pathologists prioritize treatment only of the bad speech habits, which may still be present after resolving the emotional issues of the patient.
Management For Language Based Disfluency
This kind of fluency disorder may arise in a child as soon as any newly introduced language skill emerges, specifically during the toddler to preschool stage. The fluency failure may be due to linguistic or motor immaturity. It can also be a result of the child’s struggle to acquire newly introduced and more complex language rules.
The management of this kind of disfluency usually focuses on improving the child’s language skills to increase his/her linguistic and motor maturity.
Management For Mixed Fluency Failures
The onset of this condition cannot be exactly determined, since it is an overlap pf two or more causative factors. No specific age for identification since onset may be sudden. Therapists must prioritize the most debilitating and/or the most correctable aspect of the disfluency.

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Speech Therapy For Intermediate Stuttering

admin — Sat, 17 Oct 2009 16:09:37 +0000

There are different techniques used for the treatment of intermediate Stuttering. Such techniques are a mix of fluency shaping and stuttering modification techniques. Here are some of the commonly used techniques for treating intermediate stuttering.
Flexible Rate
Flexible rate is slowing down the production of a word, especially the first syllable. This technique is thought to allow more time for language planning and motor execution. In here, only those syllables on which stuttering is expected are slowed, not the surrounding speech.
Flexible rate is taught by having the clinician model production of words in which the first syllable and the transition to the second syllable are said in a way that slows all of the sounds equally. Vowels, fricatives, nasals, sibilants, and glides are lengthened, and plosives and affricates are produced to sound more like fricatives, without stopping the sound or airflow.
After the clinician’s model, the child produces the word with flexible rate, and successive approximations of the target are reinforced.
Easy Onsets
Easy onsets refer to an easy or gentle onset of voicing. Teaching easy onsets is like teaching flexible rate. The clinician models the target behavior by the use of a lot of different sounds and then he makes the child imitate the models. After the child tries to imitate, the therapist should reinforce the child’s successive approximations.
Some children, particular younger ones, may be helped to get the concept by performing an action, such as bringing their hands together slowly, as they produce an easy onset.
Light Contacts
Producing consonants with light contacts prevents the stoppage of airlow and or voicing that can trigger stuttering. Light contacts are taught by modeling a style of producing consonants with relaxed articulators and continuous flow of air or voice, depending on the consonant.
Plosives and affricates should be slightly distorted so that they sound like fricatives but are still intelligible. Modeling a variety of words with initial consonants and reinforcing the child’s successive approximations of the target accomplish teaching a child to use light contacts. The clinician can use a variety of games to make the concept of light contact more interesting.
Proprioception
Proprioception refers to sensory feedback from mechanoreceptors in muscles of the lips, jaw, and tongue. The effectiveness of teaching proprioception may be that it promotes conscious attention to sensory information from the articulators, perhaps bypassing inefficient automatic sensory monitoring systems and thereby normalizing sensory-motor control.
Children can be taught to use proprioception by having a child first hold a raisin in his mouth and report on its taste, shape, size, and other attributes. Children can also learn proprioception by picking a word from a list and then closing their eyes and silently moving their articulators for this word and being rewarded when the clinician guesses the word.
Children can be coached to feel the movements of their lips, tongue, and jaw as they say a word. Proprioceptive awareness can also be enhanced by using masking noise or delayed auditory feedback to interfere with self-hearing. In this, the clinician must look for slightly exaggerated, slow movements to verify that a child is trying to feel the movement of his articulators.
Scaffolding
It is useful with some children to scaffold their use of superfluency by letting the listener/s know that we are working on our speech and sometimes by coaching the child in that fluency-friendly environment. This can be exhibited for example telling a stranger in a mall that the child and the clinician are working on their speech and would like to ask him some questions, another example would be when the child makes telephone calls.