Innovative Tools for Treating Stuttering

Transcription

1 Innovative Tools for Treating Stuttering Elyse Lambeth, M.S., CCC-SLP October 9, 2015 Fluency Lanes Ideally clients have the opportunity to choose between various options for managing their stuttering including stuttering freely, utilizing tools, utilizing a pattern, and not talking The goal is freely communicating or saying what you want to say when you want to say it Provides platform to discuss the advantages and disadvantages of the various lanes and empower clients to make choices about managing their stuttering Speech Helpers/Speech Mechanism Education is an important step that we cannot afford to skip and should be revisited often Clear understanding of the speech mechanism is the foundation upon which all other tools are built Understanding how the speech mechanism works demystifies stuttering Have the client tell you what parts of the body are used for talking Lips, tongue, teeth, vocal folds/voice box, lungs, jaw, diaphragm Discuss sounds that are made with each speech helper Discuss placement of the speech helpers on sounds 1

2 Speech Helpers/Speech Mechanism Discuss tension in speech helpers Model first with hand Attempt loose, medium, tight levels of tension on a variety of sounds and words Ensure that the sounds are made with less tension of the muscles rather than simply loud, medium, and soft Try to avoid atypical placement of the articulators during this exercise Attempt easy sounds and words first and feared words or sounds after the client is comfortable Good jumping off point for pullouts or let it go Speech Helpers/Speech Mechanism TIPS: Vocal fold tension is often the most difficult for clients to consciously tighten and loosen. Try having the client pretend to lift something heavy for tense. Breathing like Darth Vader is a lesser amount of tension. Finally have them attempt to visualize an open throat or wind. Videos of vocal fold movement are helpful for some clients When a client begins experiencing new types of tension or tools that were helpful are no longer helpful, return to the speech mechanism and talk about what is happening and problem solve tools that would be helpful Let them take the picture of the speech helpers home with them for practice and to educate other family members Speech Helpers/Speech Mechanism TIPS: If a client is avoiding words and talking, playing around with how they utilize their speech helpers is a good desensitization activity and does not have to lead to work on tools Going over speech helpers may be useful even with children as young as 3 years old depending on their awareness of and reaction to their stuttering Keep it fun for kids with lots of praise for participation 2

3 Scaling Based on Solution-Focused Brief Therapy & the Camperdown Program Solution-Focused Brief Therapy (SFBT) has its origins in the Brief Family Therapy Center in Milwaukee with Steve de Shazer and Insoo Kim Berg The Stuttering Foundation has a wonderful DVD that outlines SFBT within the context of working on stuttering: Cook, F., & Botterill, W. (2009). Tools for Success: Solution-Focused Brief Therapy Taster (DVD). Memphis, TN: Stuttering Foundation of America. Camperdown Program is from the Australian Stuttering Research Center and the manual is online: Scaling Appropriate for students 7 years and up Helpful for identifying what the client s best hope for therapy would be and creating functional goals with those hopes in mind Increases buy in and carry over of goals Helps everyone focus on skills and what is going well rather than solely on the amount of stuttering Clients determine how they would like to move towards their goals Helps set criteria for dismissal from therapy Alleviates fear of sounding weird Scaling-First Session Ask the clients to rate their stuttering on a scale of 1 to 10 with 1 being no stuttering and 10 being as much as they can imagine Ask what they are doing to get themselves to their current rating and keep themselves from being a 10 Ask What else? questions to get more strategies Ask What do you mean?, What does that look like?, How often? to get more information about a strategy they currently use 3

4 Scaling-First Session Ask additional questions to get a better understanding of what they are doing now in terms of stuttering and communication Ask questions in several different ways to see if answers differ (e.g. Do you ever not talk to avoid stuttering?, When you re in a group of friends, do you ever think of something funny or interesting but not say it because you think you might stutter? ) Ask them where they would like to be on the scale Ask them what will be different at their desired number Scaling-First Session Ask how they will know they reached their goal and What else? to get more topics of things they would like to be different Ask What difference will that make?, What will others notice is different? to go more in depth into a topic If teens say they want to be a 1, ask if they will only be happy if they are at a 1 Work to get specific and measurable goals (e.g. I will raise my hand in class 3 times per day versus I will stutter less. ) Scaling-First Session Introduce a weirdness/naturalness scale so that the client knows that tools or patterns of talking may feel weird now, but you are working to make it less effortful, more natural, and sound more like their own voice. 1 is their own voice and 10 is as weird as they can imagine (e.g., singing like a musical or talking like Mickey Mouse). Discuss weirdness versus smoothness to allow the client to feel in control of the level of weirdness that they are willing to tolerate for smoother talking 4

5 Scaling 1 10 No Stuttering Severe Stuttering 1 10 Own Voice Super Weird Scaling-Each Session Start by asking the client what went well this week Ask what went well with the goal from the previous week Ask them to rate their stuttering/communication for the week Video practice with various levels of smoothness and weirdness and then watch and rate smoothness and weirdness Set weekly goals wherein you ask what small step the clients can take towards their goals (e.g., I will notice when I avoid a word three times this week. ) Ensure they are 80% sure they will reach the goal Scaling TIPS: Scaling can be utilized for clients with language disorders, articulation disorders, social-pragmatic language disorders and more Write down everything that the client says and reflect back to ensure understanding (e.g. So it sounds like you re saying that you sometimes scan forward in a sentence and change words that you think will have stuttering. ) Abandon asking for rating of stuttering/communication every week if it stops being productive, but continue to work towards goals 5

6 Name It, Claim It, Tame It Identify the dysfluency Give it a name Find a tool to reduce the dysfluency Give the tool a name that is personalized, descriptive, and easy to remember Explore how the tool is helpful to the client Work on the tool in a hierarchy of difficulty and naturalness (e.g., words, sentences, reading conversation, etc.) If progress stalls, attempt to use a different tool or give the same tool a new name Name It, Claim It, Tame It TIPS: Draw pictures of tools for younger children or visual learners Honor when clients tell you that a tool does not work for them and include them in problem solving to determine what would be helpful If a client does not like a tool, it will not carryover into their natural environment! Keep coming back to what the clients are feeling in their speech mechanism and how they visualize releasing tension and utilizing tools Often you will build up the hierarchy of speaking situations, and then suddenly the tool will stop being effective and you begin the process again. Model helpful thinking patterns when this happens. Be optimistic! There is always something that can be done that will help. Name It, Claim It, Tame It Fluency-Enhancing Tools Easy Onset/Light Articulatory Contact Continuous Phonation Prolonged Speech Pattern Pauses Phrasing Slow, Even Rate 6

7 Name It, Claim It, Tame it Stuttering Modification Tools Cancellations Pull-Outs Preparatory Sets Easy Bounces Name It, Claim It, Tame It Resources 7

8 Websites The Stuttering Foundation of America This site offers insightful pamphlets, videos, and other resources regarding stuttering. The National Stuttering Association Along with useful information including help with insurance coverage, this website helps kids connect with support groups in their area. The Stuttering Home Page There is a wealth of information on this site for both parents and professionals. The American Speech-Language and Hearing Association The speech-language pathologist association offers basic information on stuttering as well as helping parents connect with local speech-language pathologists. FRIENDS: The National Association of Young People Who Stutter Empowers kids and connects them with other kids who stutter. StutterTalk Podcast that covers a wide variety of topics with regard to stuttering. Local Resources Consider joining the NW SLP Stuttering Group on Facebook Have teens join the mailing list for the teen stuttering social group in Seattle by ing elyse.lambeth@seattlechildrens.org University of Washington and Seattle Children s Hospital partner to sponsor the Summer Intensive Stuttering Workshop for Teens. Applications are typically due in April and are available online at: r-treatment-children.shtml Questions 8

9 References Cook, F., & Botterill, W. (2009). Tools for Success: Solution-Focused Brief Therapy Taster (DVD). Memphis, TN: Stuttering Foundation of America. O Brian, S., Packman, A. & Onslow, M. (2009). The Camperdown Program. In B. Guitar and R. McCauley (Eds.), Treatment in Stuttering: Established and emerging approaches. Baltimore, MD: Lippincott Williams & Wilkins. 9