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OTHER FLUENCY DISORDERS. Cluttering (tachyphemia).

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Other fluency disorders

OTHER

FLUENCY

DISORDERS


Cluttering tachyphemia
Cluttering(tachyphemia)

  • Definition:“a disturbance of fluency involving an abnormally rapid rate and erratic rhythm of speech that impedes intelligibility. Faulty phrasing patterns are usually present so that there are bursts of speech consisting of groups of words that they are not related to the grammatical structure of the sentence. The affected person is usually unaware of any communication impairment.”(APA 1987)


Cluttering tachyphemia1
Cluttering (tachyphemia)

  • Rare disorder (5% of fluency disorders)

  • tend to do well in scientific careers (generally of average or above-average intelligence…not low intelligence)

  • cause: unknown…thought to be neurological


Characteristics
Characteristics:

  • Usually repetitions of 6-10 units

  • are usually effortless, single syllables, short words and phrases

  • poor concentration, short attention span


Characteristics1
Characteristics:

  • perceptual weakness

  • poorly organized thinking

  • speaking before clarifying thoughts


Characteristics2
Characteristics:

  • Phonemes dropped, condensed, or distorted, especially /r/ and /l/ sounds

  • grammar problems

  • monotone speech…speech that starts loud and trails off into a murmur


Characteristics3
Characteristics:

  • jerky respiration

  • delayed speech/late talking

  • reading/writing disorders


Characteristics4
Characteristics:

  • poor handwriting

  • inability to imitate simple rhythmic pattern

  • certain brain wave patterns detectable with an EEG


Characteristics5
Characteristics:

  • late maturation

  • clumsiness, uncoordination

  • familial history

  • slips of the tongue, substituting words without realizing mistakes


Characteristics6
Characteristics:

  • Stutterer: “I want to go to the ssssssssssstore and I don’t have muh-muh-muh-money.

  • Clutterer: “I want to go to the st…uh…place where you buy…market st-st-store and I don’t have muh-muh ti-ti-time money”


Treatment
Treatment:

  • Oral-motor coordination training

  • memory and attention span exercises

  • working on narrative structure in story telling, emphasizing components such as who, what, when, where, why


Treatment1
Treatment:

  • DAF (to slow down speech)

  • turn taking practice

  • role playing (giving directions, job interview)


Neurogenic stuttering acquired
Neurogenic Stuttering (Acquired)

  • Causes

    • strokes, head injuries can cause stuttering-like symptoms in adults, may bring back early stuttering

    • head trauma

    • progressive diseases (Parkinsons, Alzheimers etc)

    • brain tumor

    • some drugs


Onset of stuttering in a well adjusted adult may be initial symptom of neurological disease
Onset of stuttering in a well adjusted adult may be initial symptom of neurological disease

  • Two forms

    • persistent neurogenic stuttering

      • associated with bilateral damage

      • may last a long time

    • transient neurogenic stuttering

      • associated with multiple lesions in one cerebral hemisphere


Onset of stuttering in a well adjusted adult may be initial symptom of neurological disease1
Onset of stuttering in a well adjusted adult may be initial symptom of neurological disease

  • Neurogenic stuttering has

    • repetitions, prolongations and blocks.

      but lacks

    • facial grimaces, eye blinking and fears and anxieties of developmental stuttering

  • appears to result from damage to the pyramidal, extrapyramidal, corticobulbar, and cerebellar motor systems


Assessment of neurogenic stuttering
Assessment of symptom of neurological diseaseNeurogenic Stuttering:

5 Steps


Assessment of neurogenic stuttering1
Assessment of Neurogenic symptom of neurological diseaseStuttering:

  • Complete case history

Step 1


Assessment of neurogenic stuttering2
Assessment of Neurogenic symptom of neurological diseaseStuttering:

  • Complete case history

    • traumatic events (physical and emotional)

Step 1


Assessment of neurogenic stuttering3
Assessment of Neurogenic symptom of neurological diseaseStuttering:

  • Complete case history

    • traumatic events (physical and emotional)

    • drug use

Step 1


Assessment of neurogenic stuttering4
Assessment of Neurogenic symptom of neurological diseaseStuttering:

  • Complete case history

    • traumatic events (physical and emotional)

    • drug use

    • other diseases

Step 1


Assessment of neurogenic stuttering5
Assessment of Neurogenic symptom of neurological diseaseStuttering:

  • Testing for aphasia

Step 2


Assessment of neurogenic stuttering6
Assessment of Neurogenic symptom of neurological diseaseStuttering:

Step 3

  • Determining if person only stutters on certain word classes

    • functional words (the and but)

    • substantive, informational words

      (developmental stuttering usually occurs only on informational words …neurogenic stutterers will stutter on all classes)


Assessment of neurogenic stuttering7
Assessment of Neurogenic symptom of neurological diseaseStuttering:

  • Test adaptation

    • developmental: occurs

    • neurogenic: less likely to occur

Step 4


Assessment of neurogenic stuttering8
Assessment of Neurogenic symptom of neurological diseaseStuttering:

Step 5

  • Check for disfluencies in automated speech tasks

    • pledge of allegiance, counting to 30

    • developmental: Can,

      neurogenic: can’t


Neurogenic treatment
Neurogenic: Treatment symptom of neurological disease

  • Brain surgery (to improve blood flow to a restricted hemisphere

  • drugs (anti-seizure meds)

  • battery powered electrode stimulator implanted into brain (may improve fluency, reduce pain)


Neurogenic treatment1
Neurogenic: Treatment symptom of neurological disease

  • transcutaneous nerve stimulator

  • DAF or white noise masking auditory feedback (MAF)

  • Electromyographic biofeedback (relax speech production muscles)

  • Pacing board


Other fluency disorders

WIDE VARIETY OF TREATMENTS SHOWS THAT NEUROGENIC STUTTERING IS NOT ONE DISORDER, BUT A SYMPTOM OF

A VARIETY OF NEUROLOGICAL DISORDERS


Dysarthria
Dysarthria IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • May see

    • phonemes repeated and prolonged

    • transient breathy voice

    • strained-strangled voice

    • voice stoppages

    • audible inspiration

    • variable rate

    • prolonged intervals

    • short rushes of speech

  • May confuse diagnosis


Palilalia
Palilalia IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Often confused with stuttering

  • Compulsive repetition of a word, phrase or sentence

  • occurs typically in patients with postencephalitic parkinsonism and with pseudobulbar palsy

  • increased rate of speech as reiteration takes its course

  • vocal intensity decreases until no sound, altho patient keeps moving lips


Apraxia of speech
Apraxia of speech IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Impairment of motor speech programming

  • may look “stutter-like”

  • struggle to form articulatory postures

  • groping


Apraxia of speech1
Apraxia of speech IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • slow down in struggle

  • stress/prosody off

  • repetitions of sounds and syllables common

  • change in phoneme when repeated


Parkinson s disease
Parkinson’s Disease IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Not usually associated with

    stuttering

    BUT

    can result in severe blocks,

    repetitions, prolongations


Parkinson s disease1
Parkinson’s Disease IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Treatment:

    maximize respiration

    increase vocal fold adduction

    Ex: (daily) verbalize 10-20

    “ah” sounds as long and

    as loud as possible


Psychogenic stuttering
Psychogenic Stuttering IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Hysterical or malingered stuttering in adults may be unrelated to neurogenic causes

  • Begins suddenly after event causing extreme psychological stress


Psychogenic stuttering1
Psychogenic Stuttering IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Characteristics

    • sudden onset-rare


Psychogenic stuttering2
Psychogenic Stuttering IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Characteristics

    • sudden onset-rare

    • repetition of initial or stressed syllables


Psychogenic stuttering3
Psychogenic Stuttering IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Characteristics

    • sudden onset-rare

    • repetition of initial or stressed syllables

    • no fluent speech, even for automatic responses

    • indifferent attitude toward stuttering

    • no secondary symptoms


Psychogenic stuttering4
Psychogenic Stuttering IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • The maladjusted stutterer

    • anxiety related symptomatology


Psychogenic stuttering5
Psychogenic Stuttering IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Treatment Considerations:

    • Multidisciplinary approach

    • may require increased emotional support

    • may need to include stress management techniques

    • group therapy

    • family therapy


Spastic dysphonia
Spastic Dysphonia IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Repeated blockage of larynx only

  • onset in middle age

  • affects equal number of men and women


Spastic dysphonia1
Spastic Dysphonia IS NOT ONE DISORDER, BUT A SYMPTOM OF

  • Treatment: Botulism toxin

  • Types:

    • Adductor: treatable with botulism toxin

    • Abductor: less treatable, but responds somewhat to voice therapy


Tourette s syndrome not fluency disorder but similar to stuttering
Tourette’s syndrome: IS NOT ONE DISORDER, BUT A SYMPTOM OF not fluency disorder, but similar to stuttering


Other fluency disorders

Stuttering IS NOT ONE DISORDER, BUT A SYMPTOM OF

abnormal breathing pattern

embarrassing physical characteristics

can substitute more acceptable speech patterns

support groups

periods of fluency

Tourette’s

abnormal breathing pattern

embarrassing tics

can substitute more acceptable tics

support groups

tic free periods


Other fluency disorders


Other fluency disorders

  • Both have hereditary factor levels in some part of brain

  • Most effective drug for both to date: haloperidol, or haldol

  • subgroup of Touretters who stutter, and stutterers with Tourette’s


Drug treatments
Drug Treatments levels in some part of brain

  • Haloperidol

    • somewhat effective

    • strange side effects:

      halucinations

  • Clomipramine

    • improved fluency slightly

    • side effects: dry mouth, urinary

      hesitation, constipation and

      others


  • Acupuncture
    Acupuncture levels in some part of brain

    • JSHD, June 1995, “Results of Traditional Acupuncture Intervention for Stuttering”, Craig and Kearns


    Acupuncture1
    Acupuncture levels in some part of brain

    • JSHD, June 1995, “Results of Traditional Acupuncture Intervention for Stuttering”, Craig and Kearns

    • Found no effect on fluency of two adult male stutterers


    The mentally retarded

    The Mentally Retarded levels in some part of brain


    Definition
    Definition levels in some part of brain

    • American Association on Mental Deficiency (AAMD)

    • significantly subaverage general intellectual functioning resulting or associated with concurrent impairments in adaptive behavior and manifested during the developmental period


    Definition1
    Definition levels in some part of brain

    • “significantly subaverage”

      • IQ of 70 or below on

        standardized measures of intelligence

    • “developmental period”

      • period of time between conception and the 18th birthday


    Prevalence incidence
    Prevalence & Incidence levels in some part of brain

    • Prevalence

      • 2-3% of general population

    • Incidence

      • 125,000 births per year


    Prevalence of stuttering in mr
    Prevalence of Stuttering in MR levels in some part of brain

    • Variance in studies from 0.8% -20.3%

    • “Stuttering…occur(s) more frequently in this population than

      in any other single identifiable group of people”

      Bloodstein, 1981


    Other fluency disorders

    Within the MR population, prevalence of stuttering levels in some part of brainis especially high in mentally retarded individuals with Down’s syndrome


    Issue in the research

    Issue in the Research levels in some part of brain

    Is it stuttering orcluttering?


    General characteristics of mr
    General Characteristics of levels in some part of brainMR

    • Repetitions (syllable/word/phrase)

    • prolongations

    • rarely revisions/broken words/blocks

    • secondary reactions

    • subject to same laws as nonretarded PWS with respect to adaptation,

      consistency, expectancy


    Down s syndrome
    Down’s syndrome levels in some part of brain

    • More like cluttering?

    • insufficient vocabularies

    • hurried speech patterns

    • no self-consciousness

    • little anticipation

    • no avoidance


    Diagnostic considerations
    Diagnostic considerations levels in some part of brain

    • Is stuttering a minor annoyance compared to other communication problems?

    • Many of the disfluent individuals are unconcerned about their stuttering


    Ask yourself these questions
    Ask yourself these questions: levels in some part of brain

    • What is the nature of the disfluencies observed?

      • Type

      • frequency

      • consistency

      • expectancy

      • adaptation


    Ask yourself these questions1
    Ask yourself these questions: levels in some part of brain

    • What is the relative significance of the disfluencies to the total communicative competency of the individual?

    • What is the individual’s perception of the significance of the disfluencies?


    Ask yourself these questions2
    Ask yourself these questions: levels in some part of brain

    • To what extent would fluency-enhancing strategies positively

      effect other aspects of intelligibility?

    • What are the constraints upon intervention?


    Ask yourself these questions3
    Ask yourself these questions: levels in some part of brain

    • What are the constraints upon intervention?

      • time

      • place

      • frequency of contact

      • length of sessions

      • individual vs. group sessions

      • continuity of services


    Ask yourself these questions4
    Ask yourself these questions: levels in some part of brain

    • What is the prognosis for a sustainable enhanced fluency?

    • To what extent will increased fluency enhance the individuals ability to communicate and thereby improve the individual’s quality of life?


    Therapy
    Therapy levels in some part of brain

    • Most fluency programs for the

      mentally retarded are exclusively behaviorally focused

    • Little or no attention to shaping and reinforcing fluency-facilitating attitudes and feelings


    Follow program guidelines with some modifications
    Follow program guidelines with some modifications levels in some part of brain

    • Example: Cooper & Cooper (STAR Process)

      • Structuring stage (Identification)

      • Targeting stage (Modification of behaviors)

      • Adjusting stage (Reinforcement)

      • Regulating stage (develop feeling of fluency control)


    Examples of modifications
    Examples of modifications levels in some part of brain

    • allow individual to express feelings and attitudes at their level usingtheirlanguage

    • provide for overlearning

    • capitalize on supportive personnel