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37 Cards in this Set

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Fluency Enhancing Skills
For Factor 1
-Collection of somewhat varied treatment procedures emphasizing the learning of fluency producing skills
GOAL: natural sounding speech
Behavior Modification
Collection of approaches: cancellation, pull-out, preparatory sets
GOAL: less severe stuttering, extinction of coping behaviors, positive attitude and speech positive emotion
Cancellation
Complete the stuttered word, pause for 3 seconds, repeat the word in a relaxed way
Pull out
Reduce the tension at the onset on stuttering, pull out of the stuttering by slowing down and reducing tension at articulatory contact
Preparatory Set
Prior to saying the word on which stuttering is anticipated, the client prepares production by using soft contact and easy onset
Reality testing
Using masking, choral reading, shadowing, whispering
GOAL: show client they are capable of fluent speech, they are not able to produce perfectly fluent speech, rid of their negative empotion and false beliefs about speech
Counseling
Collection of varied approaches that provide information, change attitude, lead to rational emotional reactions
-can be used with direct TX methods
-Done with the client and the parents
Attitude change
Discuss the clients irrational beliefs that others are always fluent and that he/she will always stutter
Fluency Reinforcement
Positive reinforcement is delivered for an increase in the frequency of fluently spoken words or the duration during which speech is fluent
Fluency enhancing skills
relaxation
airflow mngmnt
gentle phonatory onset
soft artic contact
reduction in artic rate
continuous vocalization
Airflow management
PURPOSE: reduce laryngeal tension by initiating phonation at a moment when the vocal folds cannot be completely adducted.
Gentle phonatory onset
GOAL: easy, slow relaxed speech
- client learns to use as little laryngeal tension as possible when initiating voicing
Soft articulatory contact
GOAL: to reduce muscular tension during speech production
-light contact prevents the occurence of prolonged atric postures associated w/ the inability to make the transition to the artic position of the next sound
Rate reduction
reduction of articulatory rate by using within-word prolongation (extended sound and syllable duration)
Prolonged articulation
trained through instruction, modeling, differential reinforcement
Continuous Vocalization
using modeling, imitation, and reinforcement to habituate articulatory movement throughout an utterance
Response cost
client earns tokens when using the appropriate fluency enhancing skills and loses them if the skill being trianed is not used
-used when reindorecment and non/reinforcement does not produce the desired skills
Counter conditioning of targeted speech sounds and situations
sounds, words and situations that elicit negative emotions should be rank ordered (ocassion the least concern, occur most frequently, client motivation)
Transfer
*goes with maintanence
Behavior rehearsal in settings similar to real life setting; transfer clinic Tx to outside settings
Maintanence
When therapy is reduced enough to dismiss, use client follow-up, counsel the client and family, ask client to contact you if fluency decreases
Delayed Auditory Feedback (DAF)
Hearing one's own speech after a delay introduced by a mechanical device
-effect is to slow down rate of speech
Metranome-Paced Speech
speech regulated by beats of a metronome
-used to change rate of speech
-used for stuttering and cluttering
Monterey Fluency Program
Operant approach
-to establish, transfer, maintain fluency
Two methods: DAF or Increase in length and complexity of utterances (younger)
Stutter-Free speech TX program
Shames & Florance
- used DAF to induce stutter-free speech
-uses operant procedures to shape normal sounding fluency
GOAL: speech of person contains little or no stuttering
Stuttering Prevention: clinical method
Starkweather
-Early Tx program for children
-based on Demands and Capacities Model
GOAL: to reduce demands made on child's fluency and increase fluency capacities
Lidcombe Program
Tx for young children
-parent and child visit the clinic once a week
-parent does the tx every day
-two stages
Cortical dysfluency producing disorders:
Palilalia
cluttering
expressive aphasia
parkinsons
closed head injury
tumor
drug abuse
apraxia
Non-cortical dysfluency producing disorders:
encephalitis
spinal meningitis
wilson's disease
soto's disease
down syndrome
spasmodic dysphonia
tourette
Order for initial "extinction" of factor II behaviors:
1. those that are most debilitating
2. involve the largest muscle group
3. are not specific to the mouth
4. the ones the client is most motivated to reduce
Target awareness
Factor II tactic to initiate identification of a target response to move towards 95%
Target omission
DRO
Used after awareness (which will decrease some of the behavior)to stabalize and carry-over to different situations
D.R.O.
Differential Reinforcement of Other Behaviors
Negative Practice Gamma
For factor II behaviors
GOAL: to eliminate the response after successful awareness training
Non-Aversive Response Reduction
Factor II behaviors
GOAL: After successful awareness training and base-rate determination, the client is informed whenever the targeted behavior occurs
Time out from speech
Apprx. 10 seconds of stopped speech when the target response occurs
Negative practice beta
Factor II
GOAL: same as gamma, but if target repsonse occurs the client stops and then repeatedly and rapidly produce the target until it is fatigued and greatly decreased in liklihood of occuring, then return to omission training procedures
Chaining
Factor II
The target response that has been omitted must be chained to another target. The client must omit the previously worked on target while the new one is being dealt with.