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Dysfluency secondary to CNS damage

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Dysfluency secondary to CNS damage

  1. 1. Dysfluency secondary to CNS damage
  2. 2. Subgroups of acquired fluency disorders <ul><li>True neurogenic stuttering is also known as “acquired” or “cortical” stuttering. </li></ul><ul><ul><li>However, it must be distinguished from other fluency disturbances following CNS damage that share few features with classic stuttering </li></ul></ul><ul><ul><li>Subgroups include: </li></ul></ul><ul><ul><ul><li>Dysarthric disfluency </li></ul></ul></ul><ul><ul><ul><li>Apraxic disfluency </li></ul></ul></ul><ul><ul><ul><li>Disfluency stemming from anomia </li></ul></ul></ul><ul><ul><ul><li>Palilalia </li></ul></ul></ul>
  3. 3. Dysarthric disfluency <ul><li>This category includes Parkinsonian patients, who often demonstrate </li></ul><ul><ul><li>Frequent prolongations </li></ul></ul><ul><ul><li>Rapid sound, syllable and word repetitions </li></ul></ul><ul><ul><li>“ blocking” associated with failure to progress to the next articulatory target </li></ul></ul><ul><li>Symptoms worsen as the disease progresses (Benke, et al., 2000); levodopa treatment may further aggravate fluency (Louis, et al., 2001) </li></ul>
  4. 4. Dysarthria (continued) <ul><li>PD may prompt re-emergence of developmental stuttering (Shahed & Jonkovic, 2001). </li></ul><ul><li>Ataxic dysarthrics may show: </li></ul><ul><ul><li>Long prolongations </li></ul></ul><ul><ul><li>Easy repetitions </li></ul></ul>
  5. 5. Other subgroups <ul><li>Apraxic dysfluency: apraxic patients often repeat initial segments while groping for the appropriate target; this needs to be distinguished from the stuttering behavior of perseverative repetitions of the correct target, as in true stuttering. Both may be seen in apraxia. </li></ul><ul><li>Some people have suggested that the two disorders share a common neurological basis. </li></ul>
  6. 6. Dysfluency stemming from anomia <ul><li>Dysfluencies are characterized primarily by pausing, articulatory groping, and the interjection of filled pauses and/or phrase repetitions while searching for lexical targets. </li></ul><ul><li>Usually, other additional aphasic symptoms are present </li></ul><ul><li>Wernicke’s patients may be more prone to this pattern of dysfluency than other aphasic syndromes. </li></ul>
  7. 7. Palilalia <ul><li>Found in a number of neurological conditions (including Parkinson’s), speech is characterized primarily by: </li></ul><ul><ul><li>word and phrase repetitions (NOT) sound or syllable repetitions) that may become increasingly more rapid, and progressively more unintelligible. </li></ul></ul>
  8. 8. True “cortical stuttering” <ul><li>Quite rare </li></ul><ul><li>Typically documented in the literature through isolated case studies </li></ul><ul><li>Patients show true stutter-like symptoms which cannot be attributed to neuromotor or language planning disturbance </li></ul>
  9. 9. Causes of cortical stuttering <ul><li>Stroke, typically multiple and bilateral events </li></ul><ul><ul><li>However, site of lesion has been reported to be extremely variable (Franco, et al., 2000; including subcortical regions [Ciabarra, et al., 2000]) and occasionally subtle enough to be detected only using very sophisticated measures (e.g., SPECT, Heuer, et al., 1996). </li></ul></ul><ul><ul><li>This variability has impeded the use of acquired stuttering cases to shed light on the underlying defect in developmental stuttering. </li></ul></ul><ul><ul><li>Stroke sometimes prompts return of resolved developmental stuttering (Mouradian, et al., 2000) </li></ul></ul>
  10. 10. Causes (continued) <ul><li>Penetrating objects and tumors </li></ul><ul><ul><li>Occasionally, there are reports of stuttering caused/cured by removal of tumors or invasive objects </li></ul></ul><ul><li>CHI: these cases typically show </li></ul><ul><ul><li>bilateral involvement </li></ul></ul><ul><ul><li>loss of consciousness after injury </li></ul></ul><ul><ul><li>Development of seizure disorder </li></ul></ul><ul><ul><li>Emergence of stuttering following establishment of seizure disorder </li></ul></ul><ul><li>Senile and dialysis dementia </li></ul>
  11. 11. Drug-induced stuttering <ul><li>A wide number of medications have been reported to induce disfluency, including some that have been shown to marginally increase fluency in developmental stuttering (Brady, 1998). </li></ul><ul><li>Similarly, while trials continue to explore the use of medication in alleviating stuttering (e.g., resperidone, Maguire, et al., 2000)), there is some consensus that medications will best augment, rather than replace, conventional therapy in stuttering treatment. </li></ul>
  12. 12. Overlap: Neurogenic and psychogenic stuttering <ul><li>Psychogenic stuttering, while rare, typically shows some symptom overlap with neurogenic dysfluency: </li></ul><ul><ul><li>Patients often show evidence of some degree of neurological insult or disease state </li></ul></ul><ul><ul><li>Differential diagnosis is important, and focuses on ruling out potential alternative explanations for the dysfluency, while gauging pt. profile similarity to known neurogenic subgroups (see Helm-Estabrooks & Hotz (1998) for case study example.) </li></ul></ul>
  13. 13. Features of neurogenic and psychogenic stuttering (from Manning, 2001) <ul><li>NEUROGENIC: </li></ul><ul><ul><li>Disfluencies on function as well as content words </li></ul></ul><ul><ul><li>Speaker annoyed but not usually anxious </li></ul></ul><ul><ul><li>Behaviors not solely on initial syllables </li></ul></ul><ul><ul><li>Secondary symptoms not linked to disfluencies </li></ul></ul><ul><ul><li>Lack of adaptation effect </li></ul></ul><ul><ul><li>lack of variability across speaking tasks and situations </li></ul></ul><ul><li>PSYCHOGENIC: </li></ul><ul><ul><li>Rapid and favorable response to limited treatment </li></ul></ul><ul><ul><li>Bizarre struggle and other signs of anxiety </li></ul></ul><ul><ul><li>Stuttering may be episodic </li></ul></ul><ul><ul><li>Stuttering pattern differs from both developmental and neurogenic stuttering </li></ul></ul>
  14. 14. Treatment <ul><li>If stuttering is accompanied by seizure disorder, medications to control seizures often ameliorate dysfluency </li></ul><ul><li>Remission most often occurs within three months; persistent cases have less favorable prognosis </li></ul><ul><li>Combination of fluency shaping (emphasis on rate and pacing) and stuttering modification (to reduce struggle) is most often recommended. Limited efficacy data are available. </li></ul>

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