Abstracts for Seminars
It is the author’s belief that stammering cannot be considered as a speech-only disorder. Rather, therapy that acknowledges the impact and lived experience of stammering is thought to have greater and more relevant outcomes for each client. This seminar draws on the available literature to argue for therapy methods that consider the whole ‘stammering iceberg’. Autobiographical evidence presented by a client who stammers further supports a holistic, client-centred approach and adds weight to the principle of practice-based evidence.
An explanatory model is proposed: the dual premotor systems theory of stuttering. A core premise is that the timing of speech motor segments may be cued by either of two parallel premotor systems, the lateral and the medial. Stuttering is suggested to be related to impaired "go-signals" from the medial system (including the basal ganglia). Recent findings suggest the possibility that impaired input from the motor cortex to the basal ganglia might be an important factor, leaving the basal ganglia out of control and subject to disproportionate strong emotional influence from the limbic system. Most fluency inducing conditions are proposed to shift speech timing from the medial to the lateral system.
This session will present two independently developed but compatible models of stuttering that propose aberrant self-monitoring as a critical feature in the precipitation of stuttered events. We will begin with comparisons between normal and stuttered disfluency and features of stuttering that are not well accommodated within most current models of the disorder. We will then present two complementary, testable models that link language, fluency and self-monitoring abilities in CWS and AWS, data to support these models, and suggestions for future research.
This seminar will present relevant theory about the role of parents in
therapy with children who stutter from a Cognitive Therapy perspective (Beck,
1976). It is proposed that there is a relationship between children’s and their
parents’ thoughts, feelings and behavioural responses
to stuttering. Clinical examples will be used to demonstrate this
inter-relationship. The process of developing a shared understanding of these
dynamics with families, and of negotiating changes in the management of
stuttering will be explored.
Traditional stuttering therapy often focuses on behavioral skills without considering individual differences or the broader context of the problem. For some clients, these approaches are only minimally effective; for others, there is relapse. This seminar presents a systems-based approach that considers the whole person. Three contexts are examined: the overall speech-language system, emotional/psychological framework and the even broader perspective of family, community and culture. The importance of this approach will be discussed, with implications for differential diagnosis, therapy, maintenance and preschool stuttering.
Virtual Reality Job Interviews (VRJI) and Virtual Reality Audiences (VRA) were tested to see if the speech patterns of persons who stutter (PWS) would react in ways similar to those seen in the real world. Subjects were assigned to challenging and facilitative VRJI’s. In mild-to-moderately severe PWS, the challenging VRJI environments led to more stuttering. To date, similar effects on frequency of stuttering have been observed during speeches to challenging and facilitative virtual audiences. Data from several studies will be presented that suggested VR offered a safe, reliable, repeatable and confidential alternative to obtaining speech samples in the real world.
Many speech-language pathologists assess people who stutter by counting dysfluencies and determining severity solely on the basis of the frequency of these dysfluencies. It is our contention that assessment of individuals who stutter must include physiological, attitudinal and environmental elements in order to plan a holistic treatment program. This presentation will include a description of the evidence-based, multi-dimensional battery of formal and informal assessment techniques and tools that we use for children and adults. Participants will be provided with an explanation of a variety of protocols to expand their repertoire when assessing individuals who stutter.
Neurogenic
stuttering has long been recognized as a clinical disorder following acquired
or degenerative lesions of the brain. Many clinical case reports and a few
studies involving larger patient populations have been reported in the
literature. Despite this interest, little is know about its prevalence and
incidence and only a few planned experimental studies have been published aimed
at addressing the underlying etiology, behavioural
characteristics or clinical intervention strategies for this disorder. The
intent of the presentation is to provide a comprehensive overview of the
literature and clinical guidelines useful in intervention. Future research
needs will be outlined as well.
The Speak Easy Association of
Western Australia undertook 3 workshops engaging women who stutter to establish
the needs of women who stutter seeking self help. A questionnaire was designed
to elicit information on their needs, including:
The results indicate that the current resources available are not well publicized and not well known, stuttering affects women much the same as men and most women are happy to attend a mixed sexes support group.
The purpose of this study is to determine if
there are differences in temperamental characteristics of children who stutter
(CWS), children who do not stutter (CWNS) and children with vocal nodules
(CWVN). The temperament structure is assessed by using the Flemish version of
the Children’s Behaviour Questionnaire, a caregiver report measure.
Participants consist of 69 CWS, 146 CWNS and 41 CWVN with ages ranging from 3;0 to 8;11 years. The results will be interpreted within
existing frameworks of temperament development in young children, as well as
previous studies of temperament in CWS.
In this study we evaluated the
effect of three speech therapy programs on the speech of adult stuttering
persons (N=65). Speech characteristics were assessed pre-therapy, post-therapy,
and at one and two years follow-up on three levels of dysfluency:
a) speech quality (e.g. perceptual evaluation of speech fragments; percentages
stuttered syllables); b) speech physiological processes; c) emotions and
cognitions that are related to stuttering (self-evaluation questionnaires). We
found substantial progress immediately after therapy but also some relapse at
the long term. Based on these results participants were classified into groups.
Short- and long-term differences between these groups are discussed.
One of the key clinical judgements that need to be made in the treatment of young
children who stammer is that of persistence or transience. In other words,
which children are likely ‘to grow out of it’ and which ones are likely not
too. The presentation will describe the authors attempt to risk profile young
children who stammer within a busy speech and language therapy department.
Children are divided into low, medium and high risk in an attempt to provide a
highly client centred, clinically effective service,
that is also cost and time efficient.
The International Stuttering
Association, the umbrella group for national and international stuttering
associations, has been particularly active in recent times in its outreach
efforts in
This eight-day intensive residential group course (and three-day follow-up) offers a new departure in adult stammering therapy. Continuously evolving since its inception in 1998, PATMAR holds that only through reducing sensitivity to and gaining acceptance of the stammer, can control of the stammer be maintained in the long-term. Tenets from Sheehan (1972) and Van Riper (1973) form underlying principles. The complex interplay of personality, life experience and family dynamics for each individual is a key consideration within the group. Family involvement is central in this therapy process, as individuals learn coping strategies for long-term acceptance and control of their stammers.
This symposium will bring together a panel of experts from
Narrative therapy prioritises personal
experience by drawing on ‘insider-knowledge’. This paper will demonstrate how
narrative ideas and practices can be helpfully transferred to adult stammering
therapy. The rationale will be given and the process of developing
‘outsider-witness’ practices (M. White, 1995) described. Involving clients in
the process of co-authoring new and preferred identities as people who stammer
will be illustrated and the issues discussed. The experience of involvement in
this project will be shared from the perspective of client and therapist.
Videos will be used.
Stuttering is classified in the psychiatric nomenclature of DSM-IV. In spite of such, relatively little research has been conducted into possible psychopharmacologic treatments. Clinical trials utilizing double-blind, placebo-controlled designs have found that novel dopamine blocking agents are effective in reducing the severity of stuttering but are associated with significant side-effects. The most comprehensive pharmacologic trial to date in stuttering has recently been completed and evaluated the efficacy and safety of pagoclone, a novel nonbenzodiazepine GABA partial agonist with a unique mechanism and the potential to provide a favorable safety profile. Data from this multi-center, double-blind, placebo-controlled trial will be presented.
Few representative
longitudinal studies have been conducted based directly on the stuttering of
small children and on the child's immediate surroundings. The most well-known
and comprehensive of these studies is Andrews and Harris' study, The Syndrome
of Stuttering, published in 1964. On the Danish
When asked why they want to speak more fluently, a universal theme I hear
from my clients is that they want to gain a sense of freedom: to no longer have
the stuttering rule their lives, feel helpless, victimized or ashamed. Many of
us were taught that the client’s acquisition of good speech management tools
was the means to that end. Now we know that working through the emotional
layers along with the physical skills is the means toward true empowerment.
This session will focus on practical strategies that help us help our clients
toward that emotional freedom.
We have long proposed adaptive sensory-motor modelling as a basis for understanding human movement control and its disorders, in particular stuttering. Several computational theories of movement now take this approach. To be viable, any account of motor behaviour, speech production included, must address three well-known problems: redundancy, limited central resources, and nonlinear interactions. Using state-of-the-art neural adaptive filters we have developed an integrated solution to these difficulties. We discuss this with respect to speech, pointing to how neural models of the interrelationships between efference copy signals and auditory and kinaesthetic feedback signals may pertain to processes of fluency and disfluency.
Patient resistances can present
a significant obstacle to the efficacy of stuttering therapy and a confounding
variable in evidence-based practice. Viewed as defense mechanisms, mapping
resistances helps the clinician to understand the patient’s belief system and
provides essential guideposts in designing an effective treatment program. Understanding
the patient’s unconscious motivations enables the clinician to educate the
client and help shape his or her attitudes and behaviors. This paper discusses
resistances using case examples and proposes approaches toward minimizing or
overcoming the impact of the patient’s defense mechanisms in stuttering
therapy.
This film is an intimate journey into the lives of seven people who stutter, as they travel from the darkness of fear and isolation to the light of courage and freedom of speech. The inspiring message sent by the brave individuals featured in this film is that it is never too late to triumph over our own personal challenges. This movie serves as an innovative therapy tool which opens dialogue about the often unspoken aspects of the stuttering syndrome. It is also a teaching resource for educating PWS, students, professionals, loved ones and the general public.
English
and French speaking adults from
The self-report measures that make up the Behavior Assessment Battery (BAB) for children have been internationally investigated and shown to be reliable and valid test procedures. The cross-cultural data relative to emotional reaction to and speech disruption in speech situations (Speech Situation Checklist), coping behaviors used (Behavior Checklist) and speech-associated attitude (Communication Attitude Test and KiddyCAT) are in overwhelming agreement. They indicate higher scores for CWS than CWNS on each of the BAB test procedures. The BAB tests are useful as an aid in differential diagnostic decision making and allow for identification of treatment targets.
The purpose of this longitudinal study is to examine the relationship between changes in stuttering and changes in lexical diversity/rarity over time in young children who stutter. Eleven children, ages 2;1 to 4;11, participated in the study. All children performed within the average range on standardized language testing. For each child, two conversational samples, 10 months apart, were analyzed for percent change in stuttering and percent change in measures of lexical diversity and lexical rarity. Results are interpreted within the context of each child's age, vocabulary knowledge at the beginning of the study, and the change in disfluency over time.
The purpose of the workshop is to discuss how the Internet could best be used to help researchers and to do meta-analysis of research. The author will briefly review the different tools available or possible, and discuss potential issues: like PubMedline abstract archive, on-line conference, on-line material, email, discussion forum, blogs, backtracks, mailing lists and more. Then all participants are invited to contribute to a discussion.