Management of stuttering


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Management of stuttering

  1. 1. MANAGEMENT OF STUTTERING The SLP during assesment has a general therapeutic plan ,although the goals & strategies are different in case of young & older stutterers,
  2. 2. GENERAL THERAPEUTIC PLAN 1.Identification of problem 2.Setting Goals 3.Selection of an Approach / combination of Approaches. 4.Transfer & Maintenance. 5.Followup
  3. 3. Treatment Approaches 1. Shaping Sttuter-free Speech 2. Modification Therapy 3. Integrating Stutter-free Shaping & Modi-fication Therapy.  4. Mechanical Intervention Devices  5.Counseling (adult stutterer).  6. Approaches for children.   
  4. 4. 1.SHAPING STUTTERFREE SPEECH  1.Innitial therapy targetting stutter-free speech at one or two word level ,when stutterer is successful the SLP increases the complexity of utterance.  2. Altering speaking pattern. a.Silent / whispered speech/Articula-tory Pantomimming. b.Singing. c. Slowed & Prolonged Speech.
  5. 5.       d. Coral Speaking & Shadowing e. Easy Onset Method f. Light contact Method g. Voluntary sttutering h. Imitate Stuttering i. Adronian Speech.
  6. 6. MODIFICATION THERAPY  SLP modify the moments of stuttering by introducing RELAXATION TECHNIQUES  And decreasing stress,effort & struggle.
  7. 7. INTEGRATING STUTTERFREE & MODIFICATION THERAPY  The SLP benefit from both types of therapies.
  8. 8. MECHANICAL INTERVENTION DEVICES  Some of these devices resemble a normal hearing aid.Best candidate for such a therapy is one who has  a.stuttered for a significant period of time  b.continue to struggle with stuttering  c. has found speech shaping & other tra-ditional therapias ineffective.
  9. 9.  Edinburg Masker  DAF (DELAYED AUDITORY FEEDBACK)  Enhanced Vocal Feedback  Frequency Altered Feedback  Use of a Metronome(Rhythmic Speech)
  10. 10. COUNSELING  Counseling does not mean ‘lecturing’ the stutterer rather it refers to providing an opportunity to explore, verbalize & express feelings about himself,his problems,about his therapy about the process of changing ,about his expectations & fears about the future.
  11. 11. APPROACHES FOR CHILDREN       1. 2. 3. 4. 5. 6. Environmental Manipulation. Direct work with the child. Desensitization Therapy Parent-Child interaction therapy. Fluency-Shaping Behavioral Therapy. Parent & Family Counseling.
  12. 12. 1.Environmental Manipulation         1.general excitement level in the home. 2.Fast paced activity 3.Communication stress. 4.Competition for talking time. 5.Social & emotional deprivation. 6.Sibling rivalry. 7.Excessive speech interruptions. 8.Talking attempts aborted by family members.
  13. 13.  9.Standards & expectations unrealistically high or low.  10.Inconsistent discipline.  11.Lack of availability of parents  12. Excessive pressure to talk & to perfo-orm.  13. Arguing & hostility among family mem-bers.
  14. 14. 14. Negative verbal interaction between child & family. 15. Use of the child as a scapegoat,or dis-placement of family problems onto the child. 16. Use of a faster than normal speaking rate by one or both parents.
  15. 15. 2.DIRECT WORK WITH THE CHILD  Directly working on the speech symptoms in a caring and supportive manner.
  16. 16. 3.Desensitization Therapy  This therapy attempts to increase gradually the child’s tolerance to stress.The SLP starts with play activity that reduces disfluency to its lowest level,The SLP keeps as many stress factors as possible out of the activity.A typical desensitization session involves,
  17. 17.       1.Eliminating talking altogether 2 Not asking direct questions 3. Silent parallel play 4 Maintaining a slow pace of interaction 5 Maintaining a low excitement level . 6 While not playing avoidind stressful themes.
  18. 18. 4.Parent –Child Verbal Interaction Therapy  The assumption is that childhood disfluencies develop in respones to parent-child verbal interaction.The SLP will observe such behavior in a non-formal setting then can mirror image the process doing just the opposite of what the parent did following instances of disfluency. When child’s disfluency reduced to 1% or less,parents are introduced into the therapy to learn more positive forms of
  19. 19.  Of verbal interaction with their child and to use them at home.
  20. 20. 5.Parent & Family Counseling  Identifying and changing some family behavior patterns,by making them understand how their behavior & feelings interact with the child.  Sometimes the SLP feel child’s speech within boundries of normal disfluency,but anxiety &concern of parents persists.
  21. 21. TRANSFER & MAINTENANCE  This is a very critical phase of therapy .In this regard after reducing stuttering to a minimal level the person practices these new skills in a non-clinical environment.This is called transfer and maintaining these new skills is called maintenance.
  22. 22. FOLLOW - UP  Follow up is very important to help maintaining the new learned skill. Innitialy on alternate days,then twice aweek ,then once a week, then once after every week,then once a month for few months.
  23. 23.  THANK YOU