PREVENTION OF STUTTERING & RELAPSE
INFANCY
• One of the
temperament characteristics children are born with is the tendency toward assertiveness
or timidity.
• If the tendency is toward
shyness, the need for careful nurturance from birth is of special importance if
he is to feel secure as he develops.
• A child who grows up feeling
secure & important is a child who will not be vulnerable to stuttering,
regardless of how timid he may be inherently.
• Any child can be insecure.
• Children are born with
temperaments from timid to aggressive, but they are not predestined to be
insecure.
• Insecurity is the product of
how they are parented (Inadequate parents attention when child demands)
• To cope, insecure children
are likely to develop protective fantasies, which stuttering can help
preserve.
• But protection of these
fantasies with stuttering does not begin until children begin to think
themselves as stutterers.
• It is when they have the
self-image of handicapped stutterer that the actual stuttering becomes
protective of that image.
• Research proves that the key
to giving children security is being responsive to their needs
from birth.
• The foundation of security is the
child’s knowledge that he can control his world.
• With security comes reduced risk of stuttering.
OLDER CHILDHOOD
• Stuttering,however,can also
begin in later childhood.
• In older children, shyness
is predominantly considered as the cause of stuttering.
• It is natural reticence, a “people phobia,” which feeds on fear :-
Fear of evaluation.
Fear of social failure.
Fear of rejection.
Fear of intimacy.
Shy people are likely to feel :-
• More sensitive
• Introspective
• Guilty
• Inadequate
• Moody
They are less likely to feel :-
• Likable
• Expressive
• Interesting
• Attractive
• Charming
• Satisfied
• Having said all above about how shy people feel, many do not wear their shyness for all the world to see. They can hide it and play the role of extrovert- in adult years as actors,teachers,lecturers. This includes such celebrities as Jimmy Carter, John Travolta, Carol Burnett, & Johnny Carton.
• But when the spotlight on
their public self goes off, they revert to their shy private world
• Another strong parallel to
stuttering is the type of condition which triggers it :-
- Strangers
- Authorities
- Parents
- Large groups
- Giving a speech
- Low status
- Being evaluated
- New situations
- Needing help.
DO’s :-
- Listen closely when your child talks. Pay attention to what your child says rather than the way it is said.
- Keep the child interested in talking by making speech fun & rewarding (use songs,rhymes,games involving speech,etc).
- Use a slow rate in your
speech and pause frequently. Model a calm, slow manner of talking and try to
convey reassuring, unhurried manner when talking with the child. It also gives
your child more time to understand what you are saying and formulate thoughts.
- Provide opportunities for
your child to talk to you without distractions or competition from other family
members.
- Reduce pressure to
communicate.
- Eg:Limit the number of
questions you ask your child since questions demand that your child make an
immediate response.
- Give your child enough time
to talk,limit time pressure.
- Eg: Give your child time to
answer a question before asking another one.
- Observe situations that
increase or decrease fluent behavior. Increase his experience of situations
when your child tends to be more fluent.
- Recognize that certain
language factors may have an effect on fluency
- Eg: Dysfluency may increase
if topic is unfamiliar, difficult to understand, or refers to something in the
past.Dysfluency may also be greater when complex language is used.
- Recognize that certain
environmental factors may have a negative effect on fluency: competition to
speak, excitement, arguing, fatigue, new situations & unfamiliar listeners.
- Convey understanding,
acceptance & reassurance if the child expresses concern about his
stuttering.
- Make it a habit to read out
from a book at least 10minutes everyday. Use a slow, unhurried tone and good
inflection.
- Make him recite poems with the appropriate gestures and narrate short stories. Once again even this should be in a slow rate. There is a tendency to go fast in this activity as they over learn all the poems and stories.
DO NOT :-
- Finish a sentence or word for him because you know what he is trying to say.
- Give the impression that you are alarmed or disappointed because of his stuttering.
- Force a child to speak or recite before stranger or visitors.
- Give suggestions that require the child to do something before he speaks, such as “Stop and think about what you want to say before you say it,”or “Take a deep breath and try it again.”Do not tell your child to speak differently.Dont say “Relax” , “Take your time”,”Slow down” or “Think before you talk”.
- Suggest that the child substitute an “easy” word for the word he is having trouble saying.
- Let stuttering become an excuse to avoid responsibilities.
- Alow anyone to tease or mock a child about his stuttering.
- Make negative comparisons.
- Expose him to many languages.
- Correct him often for any behavior you wish to change.
- Have heated arguments in the presence of the child.
- Ask him questions where the formulation of the answer is likely to be long and complex.
- Force him to enter a situation he is fearful or reluctant to.
- Insist on confessing a wrong he has done.
RELAPS
Relapse is the biggest factor that limits the effectiveness of therapy. In 1979, the problem of relapse in current programs of therapy was formally recognised by an international conference on the subject in Banff, Canada.
Achieving out-clinic performance that parallels in-clinic learning and practice is the major goal of all therapies, fluency included. This target is called Transfer. Successful transfer of improved fluency to more and more types of verbal interactions and situations lays the foundation of Maintenance of these fluency skills. Maintenance refers to the continuation or persistence of speech & attitudinal changes over time. If the phases of Transfer and Maintenance are not carried out appropriately, there is a significant possibility of return of the old attitudes and feelings which in turn will bring about an increase in the stuttering. Thus an effective transfer program along with a program for post-treatment maintenance of fluency which focuses on individual’s speech and also the affective, behavioural and cognitive aspects can minimize or even prevent relapse.
Defination :- Relapse may be defined as “the recurrence of stuttering symptoms that are perceived as personally unacceptable after a time of improvement” (Craig, 1998)
Richard E. Ham defined “relapse as a return of undesired symptoms that therapy either had replaced or brought under control”
The Possibility of Relapse :-
Many authors have recognized relapse as a common event following treatment for individuals who stutter (Bloodstein ,1987; Craig,1998; Perkins,1979; Silverman,1981; Van Riper,1973).
Prins (1970) found that 40 % of the clients taking part in an intensive residential program experienced some regression following treatment. Although he noted that clients believed that maximum regression occurred within 6 months of termination of formal treatment, other writers have suggested that clients should be followed at least 2-5 yrs following termination of formal treatment (Bloodstein, 1995; Conture and Guitar, 1992).
Van Riper states, “Relapses and remissions are the rule, not the exception, for the adult stutterer if long term follow-up investigations are conducted” (1973,p.178).
A review of studies by Bloodstein (1975) showed that relapse or regression is a common experience for adult stutterers. Fewer than 50% of older children and adults who acquire normal fluency during treatment are able to maintain it permanently (Bloodstein,1987; perkins,1989; Starkweather,1990). Relapse in the post treatment environment is present whether or not maintenance activities are carried out.
Ryan (1974) analysed the relationship between completion of his transfer maintenance program and long-term outcome for 17 stutterers. He reported the data in terms of whether clients skipped the program, did a part of it, or completed the program. He concluded that transfer and maintenance programs are necessary to prevent relapse.
Coleman (1977) has suggested that relapse is a part of “human condition...regression occurs almost invariably after cessation of treatment for most if not all behavioural problems”.
Martin (1981) reviewed the literature and estimated relapse at approx 30%.
Silverman (1981) suggests that relapse is likely to occur with a 40%-90% probability.
Craig and Hancock (1995) found that 71.7% of the 152 adults surveyed experienced relapse but that the majority found that they subsequently regained fluency. They also found that relapse tended to be cyclical, occurring upto 3 times a year.
Bloodstein (1995) maintains, although we are adept at making people who stutter fluent, we know little about how to keep them that way.
Craig and Hancock (1995) found that adults with significantly raised levels of trait anxiety were 3 times more likely to experience relapse
Relatively little is known about relapse in children or adolescents. Craig at al (1996) followed 97 children (aged 9-14 yrs) for 1 year post treatment and found that 3 out of 10 children experienced relapse (2% SS). In a subsequent study Hancock and Craig (1998) followed 77 of these same children in order to identify possible predictors of relapse (2% SS). A regression analysis indicated that only pre-treatment % SS and immediate post treatment trait anxiety were significant predictors (accounting for 14.4 % and 8% of the variance, respectively). That is, children who stuttered to a greater degree pre-treatment were more likely to relapse. Surprisingly, children who indicated higher immediate post treatment measures of trait anxiety (within the normal range) were less likely to relapse. The authors concluded that the normal yet heightened anxiety resulted in the children to be more willing to work on their fluency skills. A variety of other variables (age and gender of the child, no. of years stuttered, family history of stuttering etc) had little predictive value.
An increasing no. of behaviour therapy programs in recent years have incorporated so called maintenance procedures ( eg periodic clinical contacts after termination of treatment, self-therapy assignments, and work on speech attitudes) in an effort to cope with the possibility of relapse following treatment.
CAUSE OF RELAPSE :-
1. False fluency: This form of fluent experience is quite common to PWSs. False fluency may be defined as any fluency that results from the successful use of avoidance devices, such as assumed foreign accent, or clowning behaviour. Listeners and sometimes even PWSs delude themselves that such false roles constitute improvement. Relapse in such cases is so certain that the term is hardly applicable. When there has been no real improvement, based on some basic alteration of the stuttering or speaking patterns, the return to the previous state is automatic.
2. Suppressively based fluency: It is similar to false fluency, but in this obvious distracters are not used. In this, the outward expression of blocking is suppressed for atleast brief periods of time. When the stimulus complexity builds up beyond threshold, a reversion is seen. A reversion to baseline frequency or usual rate of stuttering is so inevitable that relapse must be viewed as an integral part of the process.
3. Return
of older attitudes and habits (Jost’s law): The
basic statement of Jost’s law is that when 2 habits are of approximately equal
strength, but unequal in age, at any given time in the future the older will be
stronger, provided that neither is practised in the meantime. The newer
attitudes and learned behaviours acquired during any type of therapy tend to be
much younger than the handicapping learned behaviour that they have at the
moment eclipsed. All the PWS has to do to relapse is to stop practising. The
fact that the new habit is dropping at a much faster rate will ensure that he
will have a relapse. That is why some overlearning is typically necessary with
any kind of speech therapy, usually; a period of return to the therapy setting
for renewal and support is required to strengthen the newer and more fragile
patterns. The process is similar to what Van Riper calls ‘Stabilisation’.
4. The
strangeness of new fluency: New roles typically require
some adjustment before they replace previously existing patterns of action. The
new patterns of speaking are not accepted automatically or with ease. They come
with a feeling of strangeness and alienation. That which is familiar will feel
‘right’ even though it is objectively wrong, whereas that which is unfamiliar
will feel ‘wrong’ even though it is objectively correct. Such a period of
familiarisation invites relapse for sometime after acquisition of any new
response pattern. The relapse may masquerade as a return of naturalness.
5. Role change and adjustment to improvement: Even after assimilation of new sound into the self-concept, there are further adjustments to improvement. Improvement in speaking brings about a new set of expectations. The stutterer may have over attributed all his problems to his dysfluency. Recovery of fluency may bring about reactions of disappointment. The stutterer must now face other problems.
6. The assumption that PWSs will easily grasp and hold fluency if it is given to them often turns out to be incredibly naive. Yet that assumption, unrecognized, pervades the maintenance and outcome claims in current literature. That’s why often the claims don’t hold up when subjected to independent examination or follow-up.
7. It is misleading to treat stuttering simply as a problem in behavioural frequency rather than primarily as the problem of a person. The recovery of fluency would mean loss of secondary gain component of the stuttering handicap. Despite the heavy primary loss of the ability to communicate, stuttering can be so woven into the lifestyle of the person that change can bring new problems.
8. Return to successful avoidance: The reinforcement situation is such that the stutterer is immediately rewarded for doing the wrong thing, namely pretending or avoiding, while he is immediately punished for doing the right thing, namely speaking up and taking part in life. The sheer success of avoidance manoeuvres probably is the central perpetuating factor in the problem, and overwhelmingly accounts for the commonness of relapse in the treatment of the disorder.
9. Tragedy, Illness and Life stress events: Recovery is not a permanent condition. A certain amount of morale seems necessary to maintain forward motion to recovering or improving stutterer, to serve as a countering force to avoidance tendencies that have been bred into a life time of stuttering behaviour. When physical illness or some major disappointments strikes, it would be improbable that some regression in morale and speaking behaviour wouldn’t occur. Though there is little a clinician can do to prevent tragedies, we must expect that they will affect the speech fluency.
10. Entropy: the tendency of things to break down or fall apart. Applied to humans who are attempting to change, this may be thought of as a tendency to give up actions that have been initiated. As we are beginning the process of change, the actions that we undertake seem reasonable, even exciting. But, with the hard work of daily routine, enthusiasm fades, and lack of time and other priorities soon interfere.
11. Self Efficacy doubts: Clients may be over depended on the clinician and the therapy program, rather than developing confidence in their own capacities. Clients who rely too much on their clinician and the clinical environment as a source of reinforcement of fluent speech, and who do not assume self responsibility for their fluency, are said to be more likely to relapse once therapy is terminated (Boberg, Howie and Woods,1979)
12. Residual dysfluency that was not anticipated by the client or planned for by the clinician: This occurs particularly when there is some small regression early in post dismissal, and the client is not prepared for it.
13. Failure to develop or more likely to use self-monitoring adequately: It can also be clinician failure to monitor accurately the client’s effort at transfer stage. Kher & Rustin (1985) found evidence of minor depression in several fluent speakers, maintenance following normal treatment.
14. Role change and adjustment to improvement:
Client’s Adjustment to New Role:-
Listener’s Adjustment to New Role:-
The speaker is not the only one adjusting to new role even the listener too. If other people in clients life fail to understand and recognize the nature of changes that have occurred, they will be less likely to reinforce these changes, if this is the case then long term progress is less likely to occur.
15. Premature termination of therapy: Lack of financial support to continue therapy, time availability etc can lead to premature termination of therapy. A stutterer is quite likely to relapse if he is discharged before he has learned to do what is necessary to maintain the fluency level he achieved while in therapy. In addition he may be more likely to relapse if contact with his clinician is terminated abruptly rather than being gradually reduced in frequency over a relatively long period of time.
16. Ineffective transfer program: This can be viewed as a lack of responsibility from clinician’s part as to not fully indulging the client in transfer activities.
17. Failure to follow Maintenance Procedures: Client fail to do what was prescribed by the clinician when therapy was terminated. It could be quite specific or general.
18. Lack of support :- Significant others may fail to support maintenance and transfer all along as they might not have accepted the changes that have happened in the client during therapy.
19. Emotions, Stress, Social Situations & Fluency Outcome
§ Craig and Hancock (1995), in their survey on 150 stutterers revealed that 109 had relapsed long term out of which 92% believed that relapse was associated with moderate to severe levels of stress and 60% also believed that negative emotions were associated with relapse. Over half believed that relapse was associated with feelings of helplessness. Those who had relapsed were also shown to have raised trait anxiety levels compared to those who believed they had not relapsed.
20. Onslow and Ingham, 1987, have suggested that a fluency product which is unnatural sounding will result in poor treatment outcome in the long run and thus place the person at a higher risk of relapse. Craig and Hancock, 1995, found that 40% of the people they surveyed believed that their relapse experience was related to feeling embarrassed about their fluency skills such as pronounced airflow or prolongation. The majority (79%) believed that feeling under pressure to speak faster was related to their relapse. Speech modification treatments that alter naturalness and slow speech rate may need to make provision for ensuring that participants complete the program with natural sounding speech and appropriate rate.
21. Acceptance: - Some PWS should be able to accept the limited potential they have been endowed with to maintain 100% fluency all the time. He should be motivated to accept the three fluency goals given by Perkins as the long term goal viz spontaneous fluency, Acceptable stuttering and Controlled stuttering.
RELAPSE INTRODUCTION & RECOVERY :-
During therapy the responsibility gradually should shift to the client. He must begin to inform himself and take action appropriate to the therapy principles or program. Ultimately, if he is to succeed, the stutterer must become his own clinician.
Many PWSs who have improved dread the thought of relapse, for relapse to any degree seems catastrophic to them. However, it is better for the PWS to experience some relapse, to analyse the factors or inactions produced by it, and to learn how to pull out of it.
It may be clinically advisable to induce relapse, either thru direct suggestions or thru ‘therapy reversal’. For eg, a PWS may deliberately go back to avoiding a certain person or a particular speaking situation. The effect is most likely to be a dramatic increase in fear of the avoided situation. He may also experience a general increase in fear and struggle behaviours. After such an experience, going back to the therapy principles may be relief for the patient. He can feel a greater pride in his accomplishment of pulling out of relapse. The PWS learns that an occasional fear of a situation or a word is not a catastrophic, and that an increase in the frequency of blocking need not be taken as a sign of failure. It is better for the PWS to learn that he need not be perfectly fluent at all times, that speech within a acceptable range is enough.
There are several other things that can be done while the clients are in therapy that have been reported to decreases likelihood of relapse. One is to train the PWS’s to be their own therapists. Another is modifying their self-concepts and attitudes toward speaking. One can desensitise them to feeling pressured to speak faster if the strategy they are using to reduce stuttering severity results in a reduction in speaking rate.
What the PWS needs is not speech that is stutter-free, but speech that is avoidance free. It should require no special effort. Without avoidance, the PWS should aim for acceptable and not ‘perfect’ speech. The ultimate aim of therapy should be to produce an independence of the therapist.
Craig (1998) summarizes the suggestions for preventing relapse and achieving long term success following treatment. At the centre of the issue is the concept of self-control. Constant effort and continued practice will most likely be the basic requirements for continued change. Craig suggests that success involves such things as practice of treatment activities and objectives that are achievable; using positive (self) reinforcement; practising self monitoring skills; scheduling follow-up treatment; and emphasis of self responsibility. Understanding and overcoming probable relapses are complex and-just as stuttering itself- requires a multidimensional approach.
IMPORTANCE of SUPPORT GROUP :-
- One of the important influence on long term maintenance of treatment gains may be the client’s in self help groups.
- It is referred to as self help, support or advocacy groups.
- It provides information & motivation to stutter as well as their family members & also for the stutter who has isolated themselves as a result of stuttering. Although an empathetic clinician & successful treatment may promote dramatic decrease in isolation for a client, there is probably nothing as effective as a good support group for increasing a person’s social involvement.
- It gives opportunities to practice techniques & stabilize cognitive changes following formal treatment.
- Group members also provide as an important social function for some of the members, foresting interaction in an accepting, penalty free environment.
- Due to variety of cultural & economic reasons, many members of society & people with disabilities are hesitant about seeking professional help. In these cases coming together with other people who have similar problems can be an empowering & exciting experience.
- Hunt (1987) describes support groups are volunteers who come together for mutual assistance with common problems or handicaps. They provide face to face contact among members & stress members personal responsibility.
-The group provide a variety of members needs including the facilitation of personal change, fostering of personal responsibility by members, provision of information & advice, discussion of alternative treatment, fund raising & political activities relating to the goals of the group.
- In order for a local to continue for any length of time, strong leadership is essential. In addition from time to time, the group needs to elicit the support of local speech language pathologists for referrals as well as advice.
- The group must discipline itself so that it will be more that a social group. It must have specific guidelines & objectives that focus on self management of fluency disorders.
TRANSFER & MAINTENACE ACTIVITIES :-
- Basic theme- individual must gradually take the major responsibilities for identifying & modifying his own behavior & attitude concerning his situation .
- Speaker must recognize errors & assign activities for changing mistakes & also majority of practice should take place outside the context of treatment setting.
- Formal training takes place for only a few hours each week & changes won’t occur unless individual is disciplined enough to practice his own
SUGGESTION :-
-Clinician should not be naïve or surprised when client experiences a relapse.
- Clinician can stress that its natural & client can taught to think relapse as a temporary “lapse” & with cognitive & behavioral techniques ha can be fluent.
- Counseling regarding continuous consultation & support are available following the termination of therapy & its not only acceptable but expected.
- Treatment intensity can vary & decrease gradually & sessions will be supplemented by group sessions.
- Treatment will be transformed from face to face meeting to contact via telephone. Audio & video recording of self practice session will be done.
- Prior to dismissal from formal treatment, clinician & client can discuss reasons of relapse & plan specific client responses at the first indication of relapse.
- Following formal treatment , client can seek new assertive speaking situations where the envelope of comfort can be expanded.
- Client may contact local groups & organizations to talk about his interest & professional experiences.
- Client can continue to reassess opportunities for changes in his lifestyle including vocational, social roles.
- Client can continue to expand & to improve on a variety of non speaking skills that are likely to enhance his participation in life & interaction with others.
- Client can join & take active part in a local self-help group.
- Client can continue to moniter & evaluate his positive-negative self talk.
- Client can be taught to identify potentially high risk situations regarding lifestyle, negative moods or threatening environments & develop methods to cope with these situations.
- Client can practice the use of positive affirmations on a regular basis.
RELATED STUDIES :-
- Guitar (1976) found a weak but significant relationship between abnormal pretreatment speech attitudes and long term negative outcome. Thus those who reported of avoiding situations and with high negative reactions are more likely to relapse.
- Guitar (1976) also investigated the relationship between multiple pretreatment factors and outcome and found that the ability to predict relapse was greater if a combination of pretreatment factors (speech attitudes, personality factors, %SS).
- On various studies done on the relationship of immediate post treatment factors to relapse found no significant relationship (Gregory, 1969; Guitar, 1976).
- Guitar and Bass (1978) showed that persons treated for stuttering who normalized their attitudes toward speech had lower risks of relapse than those who did not normalize their speech attitudes ( normalization was defined as falling below or equal to a score of 9 on S 24 scale following treatment.
- The work of Guitar and Bass (1978) was replicated by Andrews and Craig (1988).
- They classified their subjects in three ways at the end of the treatment according to (1) speech attitude (2) locus of control (3) stuttering.
- Speech attitude was measured using S24 scale.
- Locus of control was measured using LCB( locus of control of behavior scale).
- Locus of control theory predicts the internalization is related to successful long term outcome. It suggests that a person becomes aware that treatment gains are due more to self rather than external sources. This theory enhances performance and lowers the risk of relapse.
- Stuttering measure estimated smooth speech mastery.
- All three classification measures were shown to be significant predictors of relapse by analyzing the relationship between the classification measures and long term relapse outcome after 10 months.
- For instance, people who did not attain any of the 3 classification measures had all relapsed.
- Subjects who attained one classification measure had a risk of relapse of 50%.
- If 2 measures were achieved, the relapse rate fell to about 30% to 40%.
- If all classification measures were attained then relapse rate fell to 10 %.
- Thus Andrews and Craig believed that actual mastery (%SS reduction) over stuttering was probably the most initial factor with speech attitude and perceived mastery factors acting to maintain fluency.
- The research by Andrews and Craig was criticized by Finn and Gow (1989)on the following points:
1. They believed that the single assessment of stuttering upon which relapse status was based was inappropriate. The variability of stuttering across context needs multiple assessments especially for relapse studies.
2. They questioned the 2% SS criteria. This perhaps reflects the lack of an acceptable relapse criterion.
They suggested that attendance at a self help group following treatment was a possibly confounding factor, in that the success of those who maintained might be explained by self help group rather than the 3 treatment goals.
- This concern suggests that further research needs to be done in relapse considering above methodological issues.
EMOTIONS, STRESS, SOCIAL SITUATIONS & FLUENCY OUTCOME :-
- Craig and Hancock (1995), in their survey on 150 stutterers revealed that 109 had relapsed long term out of which 92% believed that relapse was associated with moderate to severe levels of stress and 60% also believed that negative emotions were associated with relapse. Over half believed that relapse was associated with feelings of helplessness.
- Those who had relapsed were also shown to have raised trait anxiety levels compared to those who believed they had not relapsed.
- Points to remember from our knowledge on relapse :- Even though behavioral technology was considered of importance in 1980’s and has produced advances in maintenance of behavior, it is crucial that self management “anti- relapse” type strategies be further explored.
- Clinicians should be aware of continuing struggles and difficulties that may have in management of stuttering. They should attempt to enhance motivation by discussing relapse- stuttering cycle and offer self management and cognitive behavioral strategies to maintain fluency.
- Cognitive behavior techniques could be applied to overcome attitudinal barriers to success. Self management Skills are worthwhile in this regard as they emphasize the importance of self responsibility, self evaluation, self effort and motivation in the achievement of self set goals.
- Skills for dealing with failure when it occurs can also be taught and applied to prevent reductions in fluency and externalization of locus of control.
- Failure better called “lapse” can be viewed as an opportunity to employ more successful strategies in future.
ARTICLES:-
- Fluency disorder and life quality: Subjective wellbeing V/Shealth related quality of life.
- Journal of fluency disorders 35 (2010) 161-172.
- Abstract-It seems intuitive that people with fluency disorder,such a stuttering ,must must experience a low quality life.Yet it is not necessary so.Whether measured life quality is lower depends on several factors,the most importantof these being methodological.This is because the decipline of medicineand social sciences utilze quite different technologies to measure the construct. Within medicine HRQOL is measurethrough constellations of perceived symptoms.Thus ,if the symptoms chosen to represent HRQOL match the pathological characteristics of the fluency disorder, the relationship is self – fulfilling.Psychology on the other hand use subjective wellbeing to represent life quality. Here the relationship between symptom and perceived life quality is much less certain. It is proposed that this partial disconnection is due to the presence of a homeostatic symptom which manages subjective wellbeing in an attempt to keep it positive.The paper that follow examines the construct of life quality from both disciplinary perspectives, and then reports on the finding from each discipline in relation to fluency disorder .It is cocluded that there is no necessary link between fluency disorders and life quality provided subjective wellbeing is used as the indicator variable.
- The impact of stuttering on the quality of life in adults who stutter .
- Journal of fluency 34 ( 2009) 61-71
Abstract :-
Stuttering is an involuntary fluency disorder that is not uncommon in society.However the impact of stuttering on a composite manner such a quality of life has rarely been estimated .QOL assess the well-being of a person from the multidimensional perspective, and valid and reliable general QOL measures are available that can be used to estimate the impact of stuttering on QOL. This studu involved the use of general measures of QOL called the medical outcomes study SF 36 in order to assess the impact of stuttering on 200 adult who stutter .Comparison of 200 adult of similar age and sex ratio donot stutter were made so that the unique contribution on QOL could be estimated .Findings indicate that the stuttering does negatively impact QOL in the vitality,social function,emotional function and mental health status domains.Results also tentatively suggest that people who stutter with increased level of severity may have a higher risk of poor emotional functioning . These findings have implications for treatment such as the necessity to address the emotional and psychological aspects of QOL in AWS and the need for additional clinical resources to be invested in stuttering treatment.
Post treatment speech naturalness of comprehensive stuttering program clients and differences in rating among listener groups.
Journal of fluency disorders 35 (2010)44-58
Abstract-
The purpose of this study were to investigate the natural ness of post-treatment speech of comprehensive stuttering program client and differences in naturalness rating by these listener group LIstner were 21 student speech speech language pathologist, 9 community members and 15 who stutter . Listner rated perceptually fluent speech samples of CSP clients obtained immediately post treatment and at 5 yrs follow up and speech sample of matched typically fluent TF speaker.A 9 point interval rating scale was used.A 3 listner group *2 time * 2 speaker mixed Anova was used to test for differences among mean ratings. The difference between CSP post and F5 mean rating was statistical significant. The F5 mean rating was within the range reported for typical fluent speaker Student speech language pathologist were found to be less critical than community member and listener who stutter.Result indicate that the naturalness of the post treatment speech of CSP clients improves in the post treatment period and that is possible for client to achieve level of naturalness that appears to be acceptable to adult who stutter and that are within the range of naturalness rating given to typical fluent speakers.
- Relapse following treatment for stuttering : a ctitical review and correlative data
- Jouranal of fluency disorders volume 23,1998 ( 1-30)
Scientific research into relapse following treatment for stuttering in the speech and stuttering modification literature has been scare. A crtical review of data based research revealed two method of relapse.In one approach , attempt are made to isolate predictors of relapse, in the second, the effectiveness of strategies that reduce the risk of relapse are evaluated. In addition to the critical review,orginal data are presented to illustrate the relative and combined importance of several predictors of long term fluency in four group of adults who stutter. Independent variables included demographics, frequency of stuttering , speech rate personality, locus of control,speech attitude and participation in anti-relapse activities . The data reveals few factor that could be considered reliable determinats of relapse, although the results are in agreement with findings reported elsewhere,namely that several factors in combination may provide a reasonably valid prediction of relapse.
Predictors of stuttering one year following treatment for children aged 9 to 14 years
- Jouranal of fluency disorders volume 23,1998 (31- 48)
Controlled trials have shown treatment to be successfull in reducing stuttering and inhancing fluency in the short –term for most children and adolscents Regrettably upto 30% have been found to experience significant loss of fluency after 12 months. While this rate of relapse occurs in a significant minority, research should should be investigating determinates of this process. However research into relapse following treatment for stuttering in children has been scarce.To date anecdotal material predominates. Another problem with this research lies in the difficulty in objectively defining relapse. In order to enhanse our understanding of the relapse process, the present study”s purpose was to investigate predictors of relapse in older children . Subjected included 77 children and adolescents aged 9-14 years who were diagnosed as having stuttered for atleast 1 year . All successfully participated in treatment and were assessed 12 month later. Possible determinants investigated consisted of pre and post treatment factors, including demographic variables, severity of stuttering and anxiety levels.A standard regression analysis was performed to isolate factors that predicted the likelyhood of relapse. Only pretreatment stuttering frequency measured by percentage syllables stuttered and trait anxiety post- treatment significantly predicted stuttering frequency1 years post-treatment. Those having a severe stutter before treatment and those who were less anxious immediately post therapy were those susceptible to higher level of stuttering in the long term.Although frequency of stuttering is not an exhaustive measure of relapse, the present study offers an elementary ability to predict those children at risk of relapse following successful treatment.
References : -
1. A Handbook of Stuttering, 5th edition, Bloodstein
2. Clinical Management of Stuttering, Richard Ham
3. Nature and treatment of stuttering. Perkins
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