management of stammering with pictorial programme

1. MANAGEMENT OF
STAMMERING
Presented by
Ms. Fouzia Saleemi
Speech Language Pathologist /Pediatric Psychologist
M.Phil. (Speech Language Pathology)
M.A (Special Ed), ABS (Trainer), B.ED, PGD (SLT)

2. • Stammering is not simply biological or completely psychological. It is quite
complex, and everyone stammers differently. Hence there is currently no
perfect cure for stammering . You can, however, learn to manage or
significantly overcome your stuttering with the help of speech therapy.
Speech therapy includes several stammering exercises for various age groups
depending on the intensity of stammering .

3. Stammering Exercises
1. Breathing
2. Progressive Relaxation
3. Light Articulatory Contact
4. Speaking While Exhaling
5. Pausing and Phrasing
6. Prolonged Speech
7. Pull Outs
8. Mindfulness and Meditation
9. Challenge Yourself to Approach and Overcome New Situations

4. Breathing
• Pursed lip breathing
• Coordinated breathing
• Deep breathing
• Huff cough
• Diaphragmatic breathing

5. Pursed lip breathing
• It’s been shown to reduce how hard you have to work to breathe.
• It helps release air trapped in the lungs.
• It promotes relaxation.
• It reduces shortness of breath.
• Practicing this technique 4 to 5 times daily can help. Here’s how to practice pursed lip breathing:
• While keeping your mouth closed, take a deep breath in through your nose, counting to 2. Follow this pattern by repeating
in your head “inhale, 1, 2.” The breath doesn’t have to be deep. A typical inhale will do.
• Put your lips together as if you’re starting to whistle or blow out candles on a birthday cake. This is known as “pursing”
your lips.
• While continuing to keep your lips pursed, slowly breathe out by counting to 4. Don’t try to force the air out, but instead
breathe out slowly through your mouth.

6. • Feeling short of breath can cause anxiety that makes you hold your breath. To
prevent this from occurring, you can practice coordinated breathing using these two
steps:
• Inhale through your nose before beginning an exercise.
• While pursing your lips, breathe out through your mouth during the most strenuous
part of the exercise. An example could be when curling upward on a inward curl.
• Exercise tip: Coordinated breathing can be performed when you’re exercising or
feeling anxious.
Coordinated breathing

7. Deep breathing
• Deep breathing prevents air from getting trapped in your lungs, which can cause you to feel short
of breath. As a result, you can breathe in more fresh air.
• Here’s how to practice deep breathing:
• Sit or stand with your elbows slightly back. This allows your chest to expand more fully.
• Inhale deeply through your nose.
• Hold your breath as you count to 5.
• Release the air via a slow, deep exhale, through your nose, until you feel your inhaled air has been
released.
• Exercise tip: It’s best to do this exercise with other daily breathing exercises that can be
performed for 10 minutes at a time, 3 to 4 times per day.

8. Huff cough
• Here’s how to practice the huff cough:
• Place yourself in a comfortable seated position. Inhale through your mouth,
slightly deeper than you would when taking a normal breath.
• Activate your stomach muscles to blow the air out in three even breaths
while making the sounds “ha, ha, ha.” Imagine you’re blowing onto a mirror
to cause it to steam.
• Exercise tip: A huff cough should be less tiring than a traditional cough,
and it can keep you from feeling worn out when coughing up mucus.

9. Diaphragmatic or abdominal breathing
• Diaphragmatic or abdominal breathing helps to retrain this muscle to work more effectively. Here’s how to
do it:
• While sitting or lying down with your shoulders relaxed, put a hand on your chest and place the other hand
on your stomach.
• Take a breath in through your nose for 2 seconds, feeling your stomach move outward. You’re doing the
activity correctly if your stomach moves more than your chest.
• Purse your lips and breathe out slowly through your mouth, pressing lightly on your stomach. This will
enhance your diaphragm’s ability to release air.
• Repeat the exercise as you are able to.
• Exercise tip: This technique can be more complicated than the other exercises, so it’s best for a person with
a little more practice under their belt. If you’re having difficulty, talk to your doctor or respiratory therapist.

11. Progressive Relaxation
• Stress and anxiety can worsen anyone’s stutter. You may have experienced
intense blocks and repetitions while speaking in front of your class or an
audience.
• Progressive relaxation technique helps relax your articulator muscles; it also
relieves the symptoms of anxiety, hypertension, general muscle stress, and
tension.

12. How to Practice Progressive Relaxation
Exercise to Reduce Stuttering?
• Find a quiet and comfortable place. Play some relaxing music, and remember
to breathe through your nose throughout the exercise.
• Either sit on a chair in a relaxed manner or lie down flatly on your back.
• Keep your arms relaxed, away from your body with the palms facing
upwards.
• Keep your legs slightly spread, so your feet are comfortably apart.

14. • Focus on every muscle from your toe to head. Slow your breathing down. Tense the
muscles of your feet for 5 seconds and then relax them.
• Next, do the same for your thigh muscles. Then move to your hip muscles, stomach
muscles, chest, biceps, neck, and face.
• Take a 20-second break between the tightening of the next set of muscles. Don’t
forget to breathe while successively tensing and relaxing the muscles.
• This relaxation exercise for stuttering will help you feel in control of your body
and reclaim confidence. In stuttering therapy, progressive relaxation aims to help
clients relax the muscles involved in stuttering.

15. Light Articulatory Contact(Easy Onset)
• Light articulatory contact refers to minimal contact between the lips, teeth, tongue,
and hard palate. The technique teaches people who stutter (PWS) to use light mouth
movements like tongue exercise for stuttering to allow a smooth flow of air while
talking.
• It enables the speaker to move to the next sound with a smooth movement and an
effortless voice. Consonants typically produce high articulatory pressure, which is
natural.
• Learning this particular speech exercise for stuttering will help you reduce the
articulatory pressure.

16. 3 “S”

17. Speaking While Exhaling
• It is a fluency shaping method. Speaking while you have begun exhaling can modify your
onset of phonation.
• How to Practice ‘Speak While Exhaling’ to Stop Stuttering at Home?
• You can master this technique all on your own. First, inhale with your nose and begin
speaking as you start exhaling.
• When you exhale, your vocal folds are more relaxed. They cannot come together to hold the
air back. It reduces the laryngeal muscular tension.
• The working principle of this method is quite simple, and you can keep practicing this
at home whenever you speak to your family members or friends.

18. Pausing and Phrasing
• It is another fluency shaping
technique. It lengthens the natural
pauses. Or, it can teach you to
insert additional pauses in your
speech between the words and
phrases.

19. Prolonged Speech
• This stuttering exercise can help you
achieve fluency by stretching out the
vowels.
• It combines the techniques of light
articulatory contacts along with gentle
onsets and pausing. This combinatorial
technique can enhance fluency, slow your
rate of speech, and reduce articulatory
pressure. It will give you a sense of control
while you are speaking.
•

20. Pull Outs
• The therapist will teach you how to stretch the sound you got stuck on and slide out of it
easily and blend into the next sound.
• It is a stuttering modification technique that modifies the stuttering while it’s occurring.
• You can practice it regularly on your own to get out of stubborn stutters when you speak.
• This exercise for a stuttering adult can teach you
• How to reduce muscular tension?
• How to reduce the stress of stuttering
• How to stutter more fluently?

21. Examples(pull outs)

22. Mindfulness and Meditation
• Mindfulness will reduce your mental
stress and anxiety while
communicating with others. The other
positive results might include a
decreased rate of avoidance and
improved control over the negative
emotions.
• You might be able to reduce
anticipation of stuttering by
meditating

23. Challenge Yourself to Approach and
Overcome New Situations
• Make a list of things that scare you right now.
• For example, answering phone calls, placing an order via phone, talking to a new guest,
or speaking during a Zoom meeting.
• Next, once you begin to see improvements in your speech after you practice your stuttering
exercises, breathing and yoga daily, try to face one challenge at a time.
• At first, you may find it tough to step outside your comfort zone. Joining virtual stuttering
support groups and attending moderated video calling sessions with other PWS can help
you garner the confidence you need for approaching the new situations.
• Make it a part of your exercise to challenge yourself each day while at home by stepping out
of your comfort zone.

24. What is the Lidcombe Program?
• The Lidcombe Program is a behavioral treatment for children who stutter who are
younger than 6 years. It may be suitable for some older children.
• The treatment is administered by a parent or caregiver in the child’s everyday
environment.
• The treatment is direct. This means that it involves the parent commenting directly
about the child’s speech. This parent feedback needs to be generally positive. The
parent comments primarily when the child speaks without stuttering and only
occasionally when the child stutters. The parent does not comment on the child’s
speech all the time, but chooses specific times during the day during which to give
the child feedback.

25. The Lidcombe Program has two stages.
• During Stage 1, the parent conducts the treatment each day and the parent
and child attend the speech clinic once a week. This continues until stuttering
either is gone or reaches an extremely low level.
• Stage 2 of the program – or maintenance starts at this time and lasts
around a year. The aim of Stage 2 is to keep stuttering from returning. The
use of parent feedback during Stage 2 is reduced, as is the number of clinic
visits, providing that stuttering remains at the low level it was at the start of
Stage 2. This maintenance part of the program is essential because it is well
known that stuttering may reappear after a successful treatment.

27. Indirect Approaches for Treating Stuttering
In Preschool-Aged Children
• Indirect approaches include
modifying the child’s environment.
The method avoids direct
interaction with the child. Indirect
therapy is recommended for
children who are unaware of their
stuttering or do not show any
frustration due to their speech
disfluencies.

28. • Indirect methods of the stuttering treatment target the
children's shame, fears, language, and feelings during daily
interactions.
• It also targets the parents’ speaking patterns and aims to reduce the
speaking rate of the child.
• Several clinicians prefer the indirect approach since it puts less
pressure on the child.

29. Family-Focused Treatment and Client Counseling
• Parental intervention is preferred for the treatment of stuttering of
preschool-aged children. The two major components of the parental
intervention are –
• Their feelings about stuttering, the child who stutters, and themselves.
• The parents’ behavior towards the child when they are stuttering and when
they aren’t stuttering.
• It is important that during family-focused treatment, the parents don't
criticize the child, scold them or ask them to slow down repeatedly

31. • If your child is 5 years old and still stuttering, talk to your doctor or a speech-language therapist. Check
with a speech therapist if your child:
• tries to avoid situations that require talking
• changes a word for fear of stuttering
• has facial or body movements along with the stuttering
• repeats whole words and phrases often and consistently
• repeats sounds and syllables more often
• has speech that sounds very strained
• Also talk to the therapist if:
• you notice increased facial tension or tightness in your child's speech muscles
• you notice vocal tension that causes rising pitch or loudness
• you have other concerns about your child's speech
• Most schools will offer testing and appropriate therapy if stuttering lasts for 6 months or more.

32. •Don't require your child to speak precisely or correctly at all times. Let talking be fun and enjoyable.
•Use family meals as a conversation time. Avoid distractions such as radio or TV.
•Avoid corrections or criticisms such as "slow down," "take your time," or "take a deep breath." These
comments, however well-intentioned, will only make your child feel more self-conscious.
•Avoid having your child speak or read aloud when uncomfortable or when the stuttering increases.
Instead, during these times encourage activities that do not require a lot of talking.
•Don't interrupt your child or tell them to start over.
•Don't tell your child to think before speaking.
•Provide a calm atmosphere in the home. Try to slow down the pace of family life.
•Speak slowly and clearly when talking to your child or others in their presence.
•Maintain eye contact with your child. Try not to look away or show signs of being upset.
•Let your child speak for themself and to finish thoughts and sentences. Pause before responding to
your child's questions or comments.
•Talk slowly to your child. This takes practice! Modeling a slow rate of speech will help with your child's
fluency.

33. • Yaruss, J.S. (1998), “Real-Time Analysis of Speech Fluency: Procedures and Reliability Training.” AJSLP, Vol. 7, No.@, pp25-37.
• Yaruss, J.S., Max, M., Newman, R. and Cambell, J.H. (1998). “Comparing Real-Time and Transcript-Based Techniques For
Measuring Stuttering”, Journal of Fluency Disorders, 23, pp. 137-151.
• Onslow, M., Packman, A. & Harrison, E. (2003) The Lidcombe Program of Early Stuttering Intervention: A Clinician’s Guide.
Austin, Tx. Pro-Ed.
• Peters, T.J. & Guitar, B. (1991). Stuttering: An Integrated Approach to Its nature and Treatment. Williams and Wilkins, Baltimore,
Md.
• Shapiro, D. A.,(1999), Stuttering Intervention: Collaborative Journey to Fluency Freedom. Austin, Tx. Pro-Ed.
• Quesal, R. and Yaruss, J.S. Assessment of Childs Experience of Stuttering (ACES). www.stutteringcenter.org. (2005).
• Reardon, N. and Yaruss, J.S. (2004). The Source for Stuttering: Ages 7-18. Chicago, Ill. Linguisystems.