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55 Cards in this Set
- Front
- Back
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Speech Rate
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Calc'd as SPM
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Why impt to measure rate?
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Stuttering affects rate
Goal of trmt = speaking more normal - may want to bring rate back to normal rate (where it was at beg of trmt) Some trmt methods slow down Some trmts do not slow PWS down, but they do slow down on own because of trmt effects |
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Avoidance - 2 types
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Situational
Word |
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Situational Avoidance
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Find out about SA from client interview (usu. adult client) by asking "do you avoid situations due to your disorder?"
Child - may want to interview child's parents and/or teacher With avoidance, all information is qualitative |
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When would you use questionnaires or surveys?
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To make information quantifiable
Asks questions about attitudes about speaking Many surveys are free (on internet) |
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Surveys
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E.g., Inventory of Comm Attitudes
Uses Likert scale to rate comm Rates how speech skills are in various situations E.g., OASIS - provides detailed information |
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Another consideration to keep in mind regarding surveys
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Ask "Why do I need to ask this?"
May or may not want to administer questionnaires Some surveys are directed at children, others for adults |
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Word avoidance
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Particular word
Must know the word to avoid Children gen. not good at this Adults tend to be good at doing this Can sound funny/odd - unable to pinpoint what is wrong Very difficult to measure - can ask, but still may need to measure Client MAY NOT BE AWARE One indication = come to clinic and do not stutter |
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How measure WA?
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Can collect speech sample
Want them to read a passage See if difference btwn spontaneous and non-spontaneous and reading a passage = may indicate WA Need multiple speech samples that are spontaneous & reading passages |
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How do we measure Attitudes about speech?
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Collect 2 types of samples
Single sample (should collect more) Speech samples should be of CONNECTED speech wherever possible Want to measure speech as it occurs |
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3 Types of Connected Speech Samples to collect
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1) Conversational
2) Monologue 3) Reading Important that all samples are NOT taken in clinic |
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How many to collect outside of clinic?
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For child = at home, at school
For Rsh = have to convince - so need more information As clinician want to be sure that you have captured as many as will give you an idea of actual speech |
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Method for obtaining speech samples
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Take tape recording for child, parent will be asked to record
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Does reactivity of the situation matter?
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Post-cohort study to see if better speech when subject knew they were being recorded - conclusion = did not matter if they knew
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What to do with speech samples
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Calculate frequency & speech rate
May calc other information - like 2ndy beh |
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Data collection includes
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Obtaining speech samples
Interview Survey SSI Any test |
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Data analysis
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Is different than data collection
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Conversational speech sample
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In clinic = engage in conversation - may use topic cards or picture cards with younger child
* Reading = give them something to read at their grade level - but don't use same passage over again due to adaptation effect |
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Length of samples
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Between 3-5 mins
May measure # of syllables With child, usu. assess lang/artic as well |
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Two general approaches to Treatment
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Stuttering Modification SM
Fluency Shaping FS |
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First, define terms
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Complete fluency = normal
Spontaneous fluency = don't have to concentrate to speak Controlled fluency = takes effort on part of speaker Acceptable stuttering = ok to have some stuttering where short in duration, not as many 2ndy behs, and no increase in frequency - can be different from person to person Goal = make it non-handicapping |
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Goals with FS
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Preschoolers = spont fluency
Older children/adults = spont fluency or controlled fluency |
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Goals with SM
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Preschooler = spont fluency
Older child/adults = Controlled fluency, or acceptable stuttering; reduced fears & anxiety and avoidance SM does NOT aim for controlled fluency (only controlled or acceptable stuttering) |
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Names associated with SM
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All methods teach to lesson severity, decrease fear, anxiety & avoidance; specific techs differ from rshr to rshr
Charles Van Riper VR approach, includes cancellation, pull-outs & prep sets |
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Fluency Shaping
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All approaches are BEHAVIORAL based on Operant Conditioning
Data collection is stressed bef, during and post-trmt All have empirical evid to support their efficacy (although not all techniques have empirical support) |
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Operant Conditioning with regard to FS
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Main belief: All behs are controlled by their consequences
OC says all operant behs are controlled by their consequences Can take non-operant behs & modify or change them using operant beh principles Q: nature of language - is it operant? Q: is stuttering an operant beh? NO - not in terms of its origin, but it can be modified by using OC |
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Stimulus in OC models
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Sr+ = positive reinforcer
Here, the stimulus is separate from the procedure A - B - C = antecedent, beh, consequence When you present a stimulus, beh either increases, decreases or remains neutral |
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Sr+
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Positive reinforcer
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Sr-
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Negative reinforcer/punisher
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Stimulus can be . . . .
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Presented or withdrawn
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S triangle
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Neutral - does nota
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In FS are interested in two models
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Sr+ and Sr-
Can present or withdraw in 4 different procedures |
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Present Sr+
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Beh increases (PR)
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Withdraw Sr+
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Beh decreases (punishment by contingent withdrawal via RC or TO, e.g.)
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Present Sr-
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Behavior decreases (punishment by contingent presentation)
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Withdraw Sr-
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Behavior increases (NR)
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Sr+ withdrawal is different than . .
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Extinction - something that's maintained thru PR - not doing or giving or withdrawing; cessation of either one of procedures
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Programmed Instruction PI
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Based on Operant conditioning
Series of steps In order to use PR, beh must be already in repertoire Increase beh gradually |
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PI - overview
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Series of steps
A (what person can do) B (what you want them to do = goal) Success at each step required Increased difficulty Components |
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PI - How to increase difficulty?
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Removal of supportive cues/prompts (Antecedent)
Harder stimulus (Antecedent) More complex beh/response req'd (behavior) More intermittent consequences (consequence - e.g., change schedule) |
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PI - components
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Stimuli/Antecedent
Response/Beh Consequences Criteria |
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How to use PI
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Do over and over to point where criterion met; idea is that when met, can/able to go on to next step
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PI criteria?
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Pass/Fail
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Structure of Tx = SM v. FS
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SM = Loosely structured; not based on beh principles
FS = Highly structured; beh principles followed (cons - can be boring) |
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Measurement of Tx success - SM v. FS
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SM = indirect; client reported self-satisfaction & clinical intuition
FS = Direct; measures speech beh incl - %SS, speech rate, naturalness, etc. |
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Evidence of Tx efficacy - SM v. FS
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SM = not much and not usu based on data
FS = Empirical studies |
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Example of PI - Step 1 of 3
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Step 1
STIMULI - 10 pics of single syllable words w/releasing /s/ + model word, instructions & repeat BEH = correct production of /s/ in modeled word CONSEQ = Correct - verbal and token Sr+ (1:1) Incorrect - Verbal feedback CRITERIA - Pass - 9/10 |
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Example of PI - Step 2 of 3
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Step 2
STIMULI - 10 pics of single syllable words w/releasing + instrs to name pics BEH = correct production of /s/ in pic word CONSEQ = Correct - same as 1 - verbal and token Sr+ (1:1) Incorrect - Verbal feedback + model word and instr to repeat (1:1) CRITERIA - Pass - 9/10 Fail: 5 consec incorrect |
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Example of PI - Step 3 of 3
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Step 3
STIMULI - 10 pics of single syllable words w/releasing /s/ + instrs to use in sentance BEH = correct production of /s/ in pic word in a sentance CONSEQ = Correct - verbal and token Sr+ (1:1) Incorrect - Verbal feedback; + model & instr to "try again" CRITERIA - Pass - 9/10 Fail = 5 consec incorrect |
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Types of FS programs
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1) No altered speech & PI
2) No altered speech & no PI 3) Alt speech & PI 4) Alt speech & no PI [no known trmts fall under this category] |
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Stages of all FS programs
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Establishment
Generalization (or Transfer), and Maintenance |
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Establishment Stage
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Normal-sounding, stutter-free speech is established; at end of Estab. stage, speech is stutter-free and normal sounding
NOTE: Not ready for dismissal |
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Generalization or Transfer Stage
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Teach to use normal-sounding, stutter-free speech in other setting
End of Gen/Transf stage = doesn't matter where you are, your speech is stutter-free |
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Maintenance Stage
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Usually, with Cdisorder not fluency, would dismiss at this point; with fluency disorder clients, relapse is common
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Where is the main difference in all treatment approaches?
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At the Establishment stage - other stages are usually very similar if not the same
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