Chapter 9

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Fluency

_____ is an important part of oral communication that is essential to the listener's ability to understand a spoken message.

Rhythm, Rate, Fluency

Components of fluent speech include ___, ___, and ____.

Rhythm

The timing of speech units

Rate

the speed with which successive speech units are produced

Fluency

The smoothness with which speech units flow together

Fluent

Speech is considered ____ when it is produced in a seemingly easy, smooth, effortless, and forward manner.

Fluency

The American Speech-Language-Hearing Associations (ASHA) defines _______ as the "aspect of speech production that refers to the continuity, smoothness, rate, and/or effort with which phonologic, lexical morphological, and/or syntactic language units are spoken".

Sequence, Duration, Rate, Rhythm, Fluency

There are five elements that make up speech flow that is considered fluent speech: ____, ____, ___, ____, and ____.

Sequence

_____ has to do with the order of speech sounds necessary for meaning.

Duration

_____ is the length of time that phonetic elements are articulated together

Rate

_____ has to do with the speed in which phonetic elements are articulated together.

Rhythm

____ is the phonetic pattern of language and how it continues to flow when spoken.

Fluency

_____ is the smooth pattern of sounds as they are articulated together.

any of these elements is compromised or disrupted, causing stuttering

However, fluency problems arise when _____.

Rhythm, Rate, Fluency

Speech dysfluencies are times when speech production contains disruptions in the ______,
____ or _____ for the speaker.

Dysfluencies

Specifically, _____ are "breaks in the continuity of producing phonologic, lexical, morphologic, and/or syntactic units in oral speech", when one word does not appear to flow into the next quickly and smoothly.

Repetitions

______ may include part-word, whole-word, or phrase repetitions.

Prolongations

____ may be sound extensions of an additional sound or syllable, word, or phrase within an utterance.

Interjections

_____ may include the inclusion of an additional sound or syllable, word or phrase within an utterance.

Hesitations

______ are periods of silence within an utterance.

Initial, first, consonants, longer, less

Typically, dysfluencies occur in the _____ word of a phrase, the ___ word or ___ few words of a sentence, or with ____, ___ words, and ____ frequently used words.

Stuttering and Cluttering

There are two major categories of fluency disorders: ____ and ____.

3

Approximately ____ million Americans stutter.

4-5%, 1%

Overall, stuttering occurs in ___ of the general population, with a less than _____ percent occurrence rate in school- age children.

2 and 4-6

Children usually develop stuttering patterns between the ages of _____ years of age.

9

More than half of children who stutter recover spontaneously by ___ years of age.

3:1

Typically, more male than female children develop stuttering patterns at a ratio of ____.

developmental, neurogenic, psychogenic

There are three subtypes of stuttering: ___ stuttering, ___ stuttering and ___ stuttering.

Developmental

____ stuttering is a disorder that affects the rhythm of speech as a result of abnormal timing and movement of muscles in the respiratory, laryngeal, and peripheral organs of articulation, thereby interrupting the flow of speech.

repetitions, prolongations, interjections

Individuals who stutter have difficulty producing speech due to involuntary ____ of word parts or whole words, sound ____, excessive amounts of _____ (uh, um), or cessations of sound.

loss of speech production

Stuttering is a _______ rather than a language formulation problem.

Muscular Tensions and Dysfluencies

Individuals experiencing oral production difficulty often become increasingly aware of their dysfluencies, thereby increasing ____ ___ and the ____ in spoken language.

Simple

____ stuttering may be characterized by single-syllable or first-syllable-of-mullti-syllabic word dysfluencies, of which the child does not struggle or have an awareness or concern.

content words, nouns, verbs, adjectives, adverbs

Early stutterers are more likely to have problems with ____, ____, ____, ____, _____.

meaningful or more difficult

Established stutterers tend to have greater difficulty and are more likely to stutter with situations that are perceived as being more ____ or more _____ in terms of topic.

Facial Behaviors

Rapid eye blinking, wrinkle of nose and forehead, knitted eyebrow, tightly shut eyes, pursed or puckered lips, lips tremble, open and close mouth without sound

Hand and Feet Behaviors

Flap arms and hands, wring hands, tap on a surface, clench fists, rub foot on floor, wriggle legs, move feet, tense thighs

Breathing Behaviors

Speak while inhaling, breath in the middle of an utterance, continued talking until the last bit of air is used up

Situations more likely to cause stuttering

Speaker thinks he will stutter, speaker thinks he is saying something important, speaker thinks he will have speaking difficulties, speaker feels and enormous responsibility as the communicator, speaker feels subject to pressures that make him believe speaking will be more difficult, speaker feels fatigued

Situations less likely to cause stuttering

Speaker concentrates on something other than the content of the message, speaker is saying something that is meaningless, speaker is talking to someone that he sees as being unimportant or nonthreatening, speaker believes the speaking task will be easy, speaker is extraordinarily confident as a communicator, speaker is not viewing himself as a stutterer

Stressful Communication Situations

When listeners appear as losing interest in speaker, interruptions to speaker, competition for speaking opportunity, communication is cross-examination type questioning, demand is made for speech putting the speaker on display, request for speech when the speaker is under strong emotions, speaking under fatigued conditions, speaking when highly distracted

Neurogenic

____ stuttering typically has a sudden onset of stuttering symptoms that begin after individuals experience damage to the central nervous system.

History

Individuals diagnosed with neurogenic injury have no ____ of stuttering prior to the sustained neurogenic injury.

any time in an individuals life

Neurogenic stuttering may occur at ____.

Stroke, TBI, drug reaction, tumor, other diseases

Many times this type of stuttering occurs after a____, ___, ____, ____, _____ affecting the central nervous system.

throughout, initial, medial, final

Sound production (neurogenic stuttering) problems may occur ___ words, ___, ___ and ___ sound positions.

articles, conjunctions, prepositions

Individuals with neurologic stuttering are more likely to have problems with function words, such as ___, ____ and ____.

Psychogenic

______ stuttering onset tends to be sudden and is typically attributable to a specific, identifiable psychological trauma.

initial, stressed, prolongations

The most common symptoms experienced by individuals psychogenic stuttering include repetitions of ____ syllables or ____ syllables of words and unvoiced ______.

Circumlocution

A strategy used by stutters to avoid or reduce the amount of dysfluency is to talk around the target word and not use it at all, also known as ______.

Anticipation or Expectancy

A second common strategy used by stutterers is _____ or _____. Stutterers look ahead to see if there are any problematic words.

Fluent Speech

Speech-language professionals often prescribe teaching _____ ______ for individuals who stutter.

instructional classroom

Fluent speech techniques, although generally taught by a speech-language professional, can be carried out or extended into the ____ _____.

Modified Airflow

______ is a technique in which the individual is taught to inhale a sufficient amount of air and slightly exhale before speaking and then continue to exhale throughout the utterance.

Gentle Initiation

______ of sound is a technique in which the individual starts the sound gently, softly, and in a relaxed manner.

Slower Rate of Speaking

Individuals who stutter are taught to stretch syllables or prolong their pronunciation. This type of speech tends to sound monotonous at first, but is gradually sped up to abnormal rate without dysfluencies.

Soft Contact of Articulators

The final fluent speech technique is ____. This technique has individuals lightly or gently articulate with the lips, tongue, and palate, reducing sound productions stops or hesitations.

Pause-Talk and Response Cost

Two of the most successful therapies used for stuttering correction are ______ and ____ technique.

Pause talk

_____ requires the speech-language to stop the stutterer immediately following a stutter. The individual is allowed to resume speaking after five seconds.

Response Cost

_____ uses an external reward system to provide reinforcement for fluent speech and consequence for dysfluent speech.

Cluttering

_____ is a "complex disorder of communication with impaired fluency, rapid but disordered articulation, possibly with disorganized thoughts and language production.

Cluttering

____ is a "disorder of both speech and language processing that frequently results in rapid, disrhythmic, sporadic unorganized and often unintelligible speech."

false starts, sound sequence error, and word retrieval difficulties, repeat words, interjections

Characteristics of Clutterers

Spoonerisms

____ are the unintentional interchanging of sounds within a sentence.

perceptual, organized thinking, attention span

Separate from the specific utterance characteristics, individuals who clutter appear to have ____ weaknesses, poorly ____, and a short _____.

Clutterers

These individuals often appear to speak at an excessively rapid rate and have articulation and motor disabilities. Many individuals with these problems also experience reading and writing disorders, have a lack of rhythm and musical ability, and appear restless and hyperactive.

Clutter

Individuals who ____ appear to be unaware of the dysfluencies in communications and tend to be social communicators.

Cluttering, Stuttering

A second distinction is with treatment. ____ can be affected by drawing attention to it. If an individual is asked to slow his or her speech, the utterance can be spoken in a more understandable form. An individual who ____ will be more likely to increase the amount of stuttering if attention is drawn to it.

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