MANAGEMENT OF MANAGEMENT OF STUTTERINGSTUTTERINGThe SLP during assesment has a general The SLP during assesment has a general

therapeutic plan ,although the goals & therapeutic plan ,although the goals & strategies are different in case of young & strategies are different in case of young & older stutterers,older stutterers,

GENERAL THERAPEUTIC GENERAL THERAPEUTIC PLANPLAN

1.Identification of problem1.Identification of problem

2.Setting Goals2.Setting Goals

3.Selection of an Approach / combination 3.Selection of an Approach / combination

of Approaches.of Approaches.

4.Transfer & Maintenance.4.Transfer & Maintenance.

5.Followup5.Followup

Treatment ApproachesTreatment Approaches

1. Shaping Sttuter-free Speech1. Shaping Sttuter-free Speech 2. Modification Therapy2. Modification Therapy 3. Integrating Stutter-free Shaping & Modi-3. Integrating Stutter-free Shaping & Modi-

-fication Therapy.-fication Therapy. 4. Mechanical Intervention Devices4. Mechanical Intervention Devices 5.Counseling (adult stutterer).5.Counseling (adult stutterer). 6. Approaches for children.6. Approaches for children.

1.SHAPING STUTTER-1.SHAPING STUTTER-FREE SPEECHFREE SPEECH

1.Innitial therapy targetting stutter-free speech 1.Innitial therapy targetting stutter-free speech at one or two word level ,when stutterer is at one or two word level ,when stutterer is successful the SLP increases the complexity of successful the SLP increases the complexity of utterance.utterance.

2. Altering speaking pattern.2. Altering speaking pattern. a.Silent / whispered speech/Articula-a.Silent / whispered speech/Articula- -tory Pantomimming.-tory Pantomimming. b.Singing.b.Singing. c. Slowed & Prolonged Speech.c. Slowed & Prolonged Speech.

d. Coral Speaking & Shadowingd. Coral Speaking & Shadowing e. Easy Onset Methode. Easy Onset Method f. Light contact Methodf. Light contact Method g. Voluntary sttuteringg. Voluntary sttutering h. Imitate Stutteringh. Imitate Stuttering i. Adronian Speech.i. Adronian Speech.

MODIFICATION THERAPYMODIFICATION THERAPY

SLP modify the moments of stuttering by SLP modify the moments of stuttering by introducing RELAXATION TECHNIQUESintroducing RELAXATION TECHNIQUES

And decreasing stress,effort & struggle.And decreasing stress,effort & struggle.

INTEGRATING STUTTER-INTEGRATING STUTTER-FREE & MODIFICATION FREE & MODIFICATION THERAPYTHERAPY

The SLP benefit from both types of The SLP benefit from both types of therapies.therapies.

MECHANICAL MECHANICAL INTERVENTION DEVICESINTERVENTION DEVICES

Some of these devices resemble a normal Some of these devices resemble a normal hearing aid.Best candidate for such a hearing aid.Best candidate for such a therapy is one who hastherapy is one who has

aa.stuttered for a significant period of time.stuttered for a significant period of time bb.continue to struggle with stuttering.continue to struggle with stuttering cc. has found speech shaping & other tra-. has found speech shaping & other tra-

-ditional therapias ineffective.-ditional therapias ineffective. d.d. live where approach to a SLP is difficult live where approach to a SLP is difficult

Edinburg MaskerEdinburg Masker DAF (DELAYED AUDITORY DAF (DELAYED AUDITORY

FEEDBACK)FEEDBACK) Enhanced Vocal FeedbackEnhanced Vocal Feedback Frequency Altered FeedbackFrequency Altered Feedback Use of a Metronome(Rhythmic Speech)Use of a Metronome(Rhythmic Speech)

COUNSELINGCOUNSELING

Counseling does not mean ‘lecturing’ the Counseling does not mean ‘lecturing’ the stutterer rather it refers to providing an stutterer rather it refers to providing an opportunity to explore, verbalize & opportunity to explore, verbalize & express feelings about himself,his express feelings about himself,his problems,about his therapy about the problems,about his therapy about the process of changing ,about his process of changing ,about his expectations & fears about the future.expectations & fears about the future.

APPROACHES FOR APPROACHES FOR CHILDRENCHILDREN

1. Environmental Manipulation.1. Environmental Manipulation. 2. Direct work with the child.2. Direct work with the child. 3. Desensitization Therapy3. Desensitization Therapy 4. Parent-Child interaction therapy.4. Parent-Child interaction therapy. 5. Fluency-Shaping Behavioral Therapy.5. Fluency-Shaping Behavioral Therapy. 6. Parent & Family Counseling.6. Parent & Family Counseling.

1.Environmental 1.Environmental ManipulationManipulation

1.general excitement level in the home.1.general excitement level in the home. 2.Fast paced activity2.Fast paced activity 3.Communication stress.3.Communication stress. 4.Competition for talking time.4.Competition for talking time. 5.Social & emotional deprivation.5.Social & emotional deprivation. 6.Sibling rivalry.6.Sibling rivalry. 7.Excessive speech interruptions.7.Excessive speech interruptions. 8.Talking attempts aborted by family members.8.Talking attempts aborted by family members.

9.Standards & expectations unrealistically 9.Standards & expectations unrealistically

high or low.high or low. 10.Inconsistent discipline.10.Inconsistent discipline. 11.Lack of availability of parents 11.Lack of availability of parents 12. Excessive pressure to talk & to perfo-12. Excessive pressure to talk & to perfo-

-orm.-orm. 13. Arguing & hostility among family mem-13. Arguing & hostility among family mem-

-bers.-bers.

14. Negative verbal interaction between 14. Negative verbal interaction between

child & family.child & family.

15. Use of the child as a scapegoat,or dis-15. Use of the child as a scapegoat,or dis-

-placement of family problems onto the -placement of family problems onto the

child.child.

16. Use of a faster than normal speaking 16. Use of a faster than normal speaking

rate by one or both parents.rate by one or both parents.

2.DIRECT WORK WITH 2.DIRECT WORK WITH THE CHILDTHE CHILD

Directly working on the speech Directly working on the speech symptoms in a caring and supportive symptoms in a caring and supportive manner.manner.

3.Desensitization 3.Desensitization TherapyTherapy

This therapy attempts to increase This therapy attempts to increase gradually the child’s tolerance to gradually the child’s tolerance to stress.The SLP starts with play activity stress.The SLP starts with play activity that reduces disfluency to its lowest that reduces disfluency to its lowest level,The SLP keeps as many stress level,The SLP keeps as many stress factors as possible out of the activity.A factors as possible out of the activity.A typical desensitization session involves,typical desensitization session involves,

1.Eliminating talking altogether1.Eliminating talking altogether 2 Not asking direct questions 2 Not asking direct questions 3. Silent parallel play 3. Silent parallel play 4 Maintaining a slow pace of interaction 4 Maintaining a slow pace of interaction 5 Maintaining a low excitement level .5 Maintaining a low excitement level . 6 While not playing avoidind stressful 6 While not playing avoidind stressful

themes.themes.

4.Parent –Child Verbal 4.Parent –Child Verbal Interaction TherapyInteraction Therapy

The assumption is that childhood disfluencies The assumption is that childhood disfluencies develop in respones to parent-child verbal develop in respones to parent-child verbal interaction.The SLP will observe such behavior interaction.The SLP will observe such behavior in a non-formal setting then can mirror image in a non-formal setting then can mirror image the process doing just the opposite of what the the process doing just the opposite of what the parent did following instances of disfluency. parent did following instances of disfluency. When child’s disfluency reduced to 1% or When child’s disfluency reduced to 1% or less,parents are introduced into the therapy to less,parents are introduced into the therapy to learn more positive forms of learn more positive forms of

Of verbal interaction with their child and Of verbal interaction with their child and to use them at home.to use them at home.

5.Parent & Family 5.Parent & Family CounselingCounseling

Identifying and changing some family Identifying and changing some family behavior patterns,by making them behavior patterns,by making them understand how their behavior & feelings understand how their behavior & feelings interact with the child.interact with the child.

Sometimes the SLP feel child’s speech Sometimes the SLP feel child’s speech within boundries of normal disfluency,but within boundries of normal disfluency,but anxiety &concern of parents persists.anxiety &concern of parents persists.

TRANSFER & TRANSFER & MAINTENANCEMAINTENANCE

This is a very critical phase of therapy .In This is a very critical phase of therapy .In this regard after reducing stuttering to a this regard after reducing stuttering to a minimal level the person practices these minimal level the person practices these new skills in a non-clinical new skills in a non-clinical environment.This is called transfer and environment.This is called transfer and maintaining these new skills is called maintaining these new skills is called maintenance.maintenance.

FOLLOW - UPFOLLOW - UP

Follow up is very important to help Follow up is very important to help maintaining the new learned skill. Innitialy maintaining the new learned skill. Innitialy on alternate days,then twice aweek ,then on alternate days,then twice aweek ,then once a week, then once after every once a week, then once after every week,then once a month for few months.week,then once a month for few months.

THANK YOUTHANK YOU