1
Q
Diagnostic
–Requires at least a 4-stage assessment of
A) ______
B) ______
C) ______
–perceived “loss of control” will be conducted
A
–Requires at least a 4-stage assessment of
A) affective- attitudes, feelings emotions about stuttering,
B) behavior - speech behavior,
C) cognitive - cognitions, thinking, beliefs about stuttering, and
–perceived “loss of control” will be conducted
2
Q
Diagnosis
- Defined:
- Differential Diagnosis
A
- Defined: “the identification of a specific condition usually not apparent at the beginning” (p. 199)
- Differential Diagnosis - discerning the nature of a disorder as different from other possible clinical entities
3
Q
Differential Diagnosis – Examples
- Stuttering vs. __ ___
- __ Stuttering vs. ___ Stuttering
- Stuttering that will ___ vs. Stuttering that will ___
- Stuttering vs. ____
- Stuttering (Developmental) vs. ____ Stuttering
A
Differential Diagnosis – Examples
- Stuttering vs. Normal Disfluencies
- Early Stuttering vs. Advanced Stuttering
- Stuttering that will Recover vs. Stuttering that will Persist
- Stuttering vs. Cluttering
- Stuttering (Developmental) vs. Neurogenic Stuttering
4
Q
Assessment Objectives
- Establish ___
- Obtain ___/____
- Describe __ ___
- Consider __ ___ ___environments
- Note __ ___ ___
- Understand the ____ on the client’s life
- Provide info. about ___ and ____
- Recommend a __ __ ___
A
- Establish rapport
- Obtain background/case history
- Describe speech characteristics
- Consider home/social/work environments
- Note conditions affecting speech
- Understand the impact on the client’s life
- Provide info. about stuttering and therapy
- Recommend a plan of action
5
Q
Case History Areas
- Stuttering ____
- ___History
- ___ ___Description
- ___ Variables Affecting Speech
- Impact of Stuttering on ____
- Other Relevant __ ___
- ____ Perspective
- _____ Information
all happens before you hear their speech- hear their story and their perceptions
A
- Stuttering (including family) History
- Treatment History (results of previous treatment)
- Current Speech Description
- Environmental Variables Affecting Speech (hardest/easiest thing)
- Impact of Stuttering on Quality of Life (social life)
- Other Relevant Case History (medications)
- Client’s Perspective (feeling and mood and their effects)
- Identifying Information (who referred and technical info)
6
Q
Interviewing School-Age Children
- What ___ in school?
- Which ____ liked most? Least?
- _____activities? Skills/Hobbies?
- What do you like to do best? Why?
- Tell me about things you do ___
- Like ____? When/Where/How much?
- ___ response? Teachers’ response?
A
- What grade in school?
- Which subjects liked most? Least?
- After-school activities? Skills/Hobbies?
- What do you like to do best? Why?
- Tell me about things you do well.
- Like talking? When/Where/How much?
- Peers’ response? Teachers’ response?
7
Q
Interviewing Parents
- Does stuttering affect the child in ___?
- Is it the same at __ and at ___?
- Describe the child’s __- ___.
- Besides speech, any other trouble areas?
- Is ___ or ___affected?
- Any other ____ on the family?
- Is speech____ to your child?
A
- Does stuttering affect the child in school?
- Is it the same at school and at home?
- Describe the child’s typical day.
- Besides speech, any other trouble areas?
- Is playing or socializing affected?
- Any other impact on the family?
- Is speech important to your child?
8
Q
Speech Analysis Decisions
-After sample collection, determine:
1.__ _ ___:
~Examples: ___ types? Stuttering ___? Fluent ___?
2. __ __ __ ___:
~Examples: Syllables? Words? Time intervals?
A
-After sample collection, determine:
1. behaviors of interest:
~Examples: Disfluency types? Stuttering events? Fluent words?
2. units to be analyzed:
~Examples: Syllables? Words? Time intervals?
9
Q
Metrics of stuttering / disfluency counts
- Percent of __ ___
- Percent of ___ ___
- Number of ____ or ____
- ____ Units
A
-Percent of words stuttered
-Percent of syllables stuttered
-Number of disfluencies per 100 words
or per 100 syllables
-Repetition Units
10
Q
Also important to measure…
- ____ concomitants
- __ ___
1. overall __ ___ (words spoken/talking time) X 60
2. __ ___ (per second) - Communication skills in general
- other ____ conditions
A
- physical concomitants
- speaking rate
1. overall speech rate (words spoken/talking time) X 60
2. Articulatory rate (per second) - Communication skills in general
- other speaking conditions
11
Q
Analyzing the Speech Sample
- SSI-4: __ __ __– Fourth Edition is a reliable and valid norm-referenced stuttering assessment that can be used for both ____.
- It measures stuttering ___ in both __ & __ in the four areas of speech behavior:
(1) ___,
(2) ____,
(3) ___ ___, and
(4) ____of the individual’s speech
A
- SSI-4: Stuttering Severity Instrument – Fourth Edition is a reliable and valid norm-referenced stuttering assessment that can be used for both clinical and search purposes.
- It measures stuttering severity in both children and adults in the four areas of speech behavior:
(1) frequency,
(2) duration,
(3) physical concomitants, and
(4) naturalness of the individual’s speech
12
Q
Analyzing the Speech Sample
__ ___of the 3 longest stuttering behaviors
A
Mean Duration of the 3 longest stuttering behaviors
13
Q
Analyzing the Speech Sample
- For instance, the client says
1. buh-buh-buh-aseball with tension. - This would be evaluated as a ___ (part-word) and ____ (tense pause).
1. The coding procedure consists of ____ the word(s) where the disfluency occurred, and then placing the letters from the __ __ above the word in a transcript. In this case, it is a cluster.
A
- For instance, the client says
1. buh-buh-buh-aseball with tension. - This would be evaluated as a sound syllable repetition (part-word) and block (tense pause).
1. The coding procedure consists of underlining the word(s) where the disfluency occurred, and then placing the letters from the disfluency categories above the word in a transcript. In this case, it is a cluster.
14
Q
Analyzing the Speech Sample
- In this example the letters Rss and B would be placed above the word “baseball” in the transcription.
- CL [Rss(2) + B]
- This is a baseball. It is really easy to throw.
1. This means that two types of disfluencies (This would be evaluated as a sound syllable repetition (part-word) and block (tense pause) occurred on that one word. You would record this as a cluster.
A
- In this example the letters Rss and B would be placed above the word “baseball” in the transcription.
- CL [Rss(2) + B]
- This is a baseball. It is really easy to throw.
1. This means that two types of disfluencies (This would be evaluated as a sound syllable repetition (part-word) and block (tense pause) occurred on that one word. You would record this as a cluster.
15
Q
Stuttering Severity
- “the level of ___ in the delivery of __ ___”
- ___ may not correspond to the __ or ___ of the disorder
- Stuttering can be ___, but cause minimal ___ or __ __
- tuttering can be mild, but cause deep concern and negative social impact
A
- “the level of disruption in the delivery of continuous speech” (p.219)
- Severity may not correspond to the impact or experience of the disorder
- Stuttering can be severe, but cause minimal concern or social impact
- Stuttering can be mild, but cause deep concern and negative social impact
16
Q
Severity rating Scale (Wingate, 1976)
Very mild = mild= moderate= severe= very severe=
A
Very mild = 3% mild= 5% moderate= 10% severe= 20% very severe= 25%
17
Q
Situational Rating Protocols
- Stutterer’s _____(SSR)
- Southern Illinois University ___
- ___ to Selected Speaking Situations
- ______(SESAS & SEA Scale)
- ________
A
- Stutterer’s Self-Ratings of Reactions to Speech Situations (SSR)
- Southern Illinois University Speech Situation Checklist
- Reactions to Selected Speaking Situations
- Self-Efficacy Scales (SESAS & SEA Scale)
- Individualized situation hierarchy
18
Q
Attitude Rating Scales
- _____(S-24)
- Communication Attitude Test (CAT-R)
- Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
- ________(4S)
- Individualized interview regarding attitudes and emotional reactions
A
- Modified Erickson Scale (S-24)
- Communication Attitude Test (CAT-R)
- Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
- Self-Stigma of Stuttering Scale (4S)
- Individualized interview regarding attitudes and emotional reactions
19
Q
Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
important slide
- Yaruss & Quesal adapted the World Health Organization’s (2001)_____ (ICF)
- The ICF model describes disorders in terms of:
a) impairment of ___ or ___(observable stuttering behavior)
b) ____ Factors (personal and environmental reactions to stuttering)
c) ___ or ____in ability to participate in daily activities
A
- Yaruss & Quesal adapted the World Health Organization’s (2001) International Classification of Functioning, Disability, Health (ICF)
- The ICF model describes disorders in terms of:
a) Impairment in body function or structure (observable stuttering behavior)
b) Contextual Factors (personal and environmental reactions to stuttering)
c) Limitations or restrictions in ability to participate in daily activities
20
Q
Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
- -“The scope of practice in speech-language pathology encompasses all____ identified in the ___ framework…That is, speech-language pathologists work to improve ____by reducing impairments in body ___ and ___, activity ____, ___ restrictions, and ___ barriers…”
- ASHA (2007) Scope of Practice
A
- -“The scope of practice in speech-language pathology encompasses all components and factors identified in the WHO framework…That is, speech-language pathologists work to improve quality of life by reducing impairments in body functions and structures, activity limitations, participation restrictions, and environmental barriers…”
- ASHA (2007) Scope of Practice
21
Q
Overall Assessment of the Speaker’s Experienceof Stuttering (OASES)
- 100 items in 4 sections, each on a 5-point scale
- Sections are closely related to the ICF Model
1. Section I: __ ___ about Stuttering
a. __ __of the Impairment and general knowledge and perception of the stuttering disorder
2. Section II: ___, ___, ___Reactions
3. Section III: Communication in __ ___
a. ___ Limitation /___ Factors
4. Section IV: Impact of Stuttering on ____a. a. ____ Environmental Factors
A
- 100 items in 4 sections, each on a 5-point scale
- Sections are closely related to the ICF Model
1. Section I: General Information about Stuttering
a. Speaker’s perception of the Impairment and general knowledge and perception of the stuttering disorder
2. Section II: Affective, Behavioral, Cognitive Reactions
3. Section III: Communication in Daily Situations
a. Activity Limitation / Environmental Factors
4. Section IV: Impact of Stuttering on Quality of Life
a. Participation Restriction Environmental Factors
22
Q
ANALYSIS of ASSESSMENT TOOLS
- Age
- Administration Time
- Manual
- Case History Obtained
- Audio recording required
- Video recording required
- Verbatim Transcript required
A
- Age
- Administration Time
- Manual
- Case History Obtained
- Audio recording required
- Video recording required
- Verbatim Transcript required
23
Q
So, back to diagnosis…
- Even more important to __, __,___aspects of it
- Remember to consider “__ ___”
1. There is often “more than meets the eye” - Importance of multiple samples
A
- Even more important to describe, quantify and assess aspects of it
- Remember to consider “life impact”
1. There is often “more than meets the eye” - Importance of multiple samples
24
Q
Tx Recommendations
- Need tx?
- What type?
- __- ___?
- What kind of __ ___ needed?
- Deal with __/____, coping mechanisms, etc.?
- Work on basic communication skills?
- Deal with __ ___?
A
- Need tx?
- What type?
- Client’s goals?
- What kind of speech change needed?
- Deal with attitudes/avoidances, coping mechanisms, etc.?
- Work on basic communication skills?
- Deal with secondary behaviors?
Fluency
flashcards
Decks in class (9)
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