Possibilities in Neurogenic Stuttering Treatment - …

1 Dr. Kathrin K nig Speech language pathologist Bochum Germany inNeurogenic Stuttering TreatmentAn empirical study on therapists` experiencesDr. Kathrin K nig Speech language pathologist Bochum Germany Stuttering is more than a riddle. It is at least a complicated, multidimensioned jigsaw puzzle, with many pieces still missing (Van Riper, 1982, 1). Certain images and/or photos on this page are the copyrighted prCertain images and/or photos on this page are the copyrighted property of 123RF Limited, their Contributors or Licensed Partnersoperty of 123RF Limited, their Contributors or Licensed Partnersand are being used and are being used with permission under license. These images and/or photos may nowith permission under license. These images and/or photos may not be copied or downloaded without permission from 123RF be copied or downloaded without permission from 123RF Limited.

2 CcccDr. Kathrin K nig Speech language pathologist Bochum Germany Definition and etiologyPresentation agenda2. State of research in literature3. Research questions4. Empirical study and methodology5. Findings6. ConclusionDr. Kathrin K nig Speech language pathologist Bochum Germany Definition and etiology2. State of research in literature3. Research questions4. Empirical study and methodology5. Findings6. ConclusionPresentation agendaDr. Kathrin K nig Speech language pathologist Bochum Germany of symptoms for the first time in life ormassive change or aggravation of existing Stuttering patternDiagnosis of a neurological disturbance or underlying diseaseSpeech dysfluencies in the form of repetitions, prolongations and/or blocksDirect correlation between the neurological disturbance and the onset of speech dysfluencies Possible onset at any ageNeurogenic StutteringAccording to: Van Borsel et al.

3 (1997) Grant et al. (1999), Leder (1996), Helm-Estabrooks (1986)DefinitionDr. Kathrin K nig Speech language pathologist Bochum Germany Cerebrovascular disease Head trauma/ traumatic brain injury Neurodegenerative disease Tumor Epilepsy Intoxication Neurosurgery Other diseases of the central nervous systemEtiologyDr. Kathrin K nig Speech language pathologist Bochum Germany Definition and etiology2. State of research in literature3. Research questions4. Empirical study and methodology5. Findings6. ConclusionPresentation agendaDr. Kathrin K nig Speech language pathologist Bochum Germany Acquired Stuttering in adults has received little attention relative to that given developmental Stuttering (Marshall & Starch, 1984, 87). Extensive research has been conducted in the field of developmental Stuttering , and many facts about this disorder are well documented in the developmental Stuttering literature.

4 An equivalent body of knowledge is not available in the area of Neurogenic Stuttering [..] (Ringo & Dietrich, 1995, 117f.).State of researchDr. Kathrin K nig Speech language pathologist Bochum Germany Limited number of publications Single case studies Lack of empirical (group) studiesCritique: lack of objectivity of studies lack of comparability of data inaccurate sampling procedureState of researchDr. Kathrin K nig Speech language pathologist Bochum Germany Increased demand for research in the area of Neurogenic Stuttering Treatment Highly discrepant hypothesis Our therapy experience with adults with Neurogenic Stuttering has been very encouraging. [..] in a good many cases we have seen the Stuttering problem completely eradicated (Canter, 1971,143). Results have rarely been dramatic and not always encouraging (Rosenbek, 1984, zit.)

5 N. Baumgartner & Duffy, 1997, 91). The call for more systematically collected data is long overdue (Curlee, 1995, 125).State of researchDr. Kathrin K nig Speech language pathologist Bochum Germany Definition and etiology2. State of research in literature3. Research questions4. Empirical study and methodology5. Findings6. ConclusionPresentation agendaDr. Kathrin K nig Speech language pathologist Bochum Germany Which factors evoke a good prognosis? Is Neurogenic Stuttering treatable? Research questions How is Neurogenic Stuttering currently treated in Germany?Dr. Kathrin K nig Speech language pathologist Bochum Germany Definition and etiology2. State of research in literature3. Research questions4. Empirical study and methodology5. Findings6. ConclusionPresentation agendaDr.

6 Kathrin K nig Speech language pathologist Bochum Germany Sampling procedure:Random sampleTwo-stage sampling procedure:Stage 1: Therapists (cluster)Stage 2: Clients Period of examination:4 years ( ) Research tool:Structured questionnaire (30 questions: 178 items) Research method:Written survey of 700 speech language pathologists in GermanyEmpirical study and methodologyDr. Kathrin K nig Speech language pathologist Bochum Germany symptoms, secondary behaviors , gender, handednessDemographic dataSymptomsIndividual aimsMedical history, neurological disturbance targetsFluency shaping or modification techniquesStuttering therapy, general speech therapy of treatmentFocus of treatmentImprovement, aggravation, difficulties , adopting and transferring techniquesResponse to treatmentTreatment outcomeQuestionnaire subject matters Dr.

7 Kathrin K nig Speech language pathologist Bochum Germany Cognitive interviews n = 7 therapists different occupational groupsdifferent therapy settingPhase 1: cognitive pretest Written survey n = 100 therapists Split-ballot procedure Phase 2: field pretest (pilotstudy)assuremanageability of the questionnaire andcorrect understanding of questionsavoid ambiguityTwo stage Pretesting (Pr fer & Rexroth, 2000)PretestDr. Kathrin K nig Speech language pathologist Bochum Germany Informationletter on the upcoming surveyadded by: correspondence letter letter of recommendation from the faculty stamped self-addressed envelope Contacting the non-respondersby phoneData collection and data preraration with SPSS collectionDr. Kathrin K nig Speech language pathologist Bochum Germany rate (n = 700)89 therapists (12,7%) have treated one or more clients with Neurogenic stuttering68 case descriptions (9,7%) after plausibility check: 61 data sets (8,7 %)34,0%53,3%66,0%12,7%ResponseNo ResponseNeurogenic Stuttering clients among the clienteleNo Neurogenic Stuttering clients among the clienteleReturn rateDr.

8 Kathrin K nig Speech language pathologist Bochum Germany Definition and etiology2. State of research in literature3. Research questions4. Empirical study and methodology5. Findings6. ConclusionPresentation agendaDr. Kathrin K nig Speech language pathologist Bochum Germany chart age (n = 52)range: 8-87 yearsmean: yearsstandard deviation: 17. 4 ageage (years)nDr. Kathrin K nig Speech language pathologist Bochum Germany speech disorders (n = 60)In three fourths of all cases Neurogenic Stuttering clients showed accompanying speech every second case the client had aphasia. 20,0%51,7%30,0%21,7%21,7%3,3%24,6%Aphasi a solely or in combination with other speech problemsNo accompanying speech problemsApraxia of speechDysarthriaOther speech problemsAphasia (solely)Aphasia and other speech problemsResults accompanying speech problemsDr.

9 Kathrin K nig Speech language pathologist Bochum Germany in handling communication situationsLinguistic avoidance behaviorSituational avoidance behaviorAccessory movementsAnxietyOthersSecondary behaviors (n = 61) of all patients showed secondary behaviorsResults secondary behaviors Dr. Kathrin K nig Speech language pathologist Bochum Germany variety of different types of treatmentAverage: use of types of Treatment (sd = )Specific Stuttering therapy as the most used type of Treatment Type of Treatment (n = 61)18,0%90,2%59,0%52,5%49,2%45,9%4,9%0%2 0%40%60%80%100%Specific Stuttering therapyBreathing exercisesMotor speech therapy/facial exercisesAphasia therapy/word finding exercisesRelaxation techniquesOther types of treatmentMedical treatmentResults Chosen type of treatmentDr.

10 Kathrin K nig Speech language pathologist Bochum Germany modificationnFluency ShapingnSpeech devicesnEasy onset30 Slowing speech rate37 Metronome11 Easy syllable repetitions21 Rhythmical speech37 Chorus speaking9 Easy articulatory contacts15 Continous phonation5 Shadowing7 Cancellation14 Prolonged speech5 Pacing Board5 Use of starting sounds 9 Biofeedback1 Pull-out8 Other fluency shaping techniques3 Delayed auditory feedback1 Other modification techniques2 Other speech devices3 Type of Stuttering Treatment (n = 54)Results Specific Stuttering therapyDr. Kathrin K nig Speech language pathologist Bochum Germany BoardMetronomProlonged speechContinous speechSlowing speech rateRhythmical speechOther modification techniqueEasy syllable repetitionsUse of starting soundsEasy onsetCancellationOthersSpeechdevicesFlue ncyShapingStutteringmodficationResults Core techniquesFocus of Stuttering therapy (n = 42)Dr.