I adore fluency therapy

26 Sep

This semester I have a fluency client. I am LOVING it and I thought I’d share some of what is working and what isn’t with you.

Let me preface this by saying my client is a teenager and getting them to do ANYTHING is a chore but I love being able to say “Nanny nanny naaaanny” when something works that they didn’t want to do because it was “stupid” or embarrassing.

Okay so we start our sessions with some facilitating techniques – systemic relaxation, rote speech (ABCs, 123s), and discussing techniques we’re going to use. This kind of gets the ball rolling on the “feeling” of fluency. If your client can do something fluently, start the session with it. That way you’re getting a kind of errorless learning – the client can be successful right away and if they can’t do something you can always take a few steps backwards.

My goals for the semester are to establish fluency in structured speech tasks but my client has already surpassed that so I’m going to have to start working on fluency in connected speech/conversation.

Anyway, so I use word lists for one word, two word, three word, four word phrases and then sentences. Usually I use those right after we do rote speech tasks to keep up the fluent speech. We quickly practice the techniques we’ve seen success with on these word lists (thoracic breathing, reduced rate, low pitch, easy onset). Then we read an article from Missouri Conservationist for Kids, and I parse the article before the session so I know how many syllables my client will be reading (makes for easier tracking later). Each paragraph we read we use a different technique and record it so that my client can listen to them and count the stuttering moments for themself (not a word but I don’t want to say he or she).

The techniques we use: first we use DAF – not because it is a technique but because my client thinks it is cool and I use it as a reward. Also, my client does BETTER with fluency when using targeted techniques so I can say “Hey you know what – DAF is cool but you got this on your own, you can physically be fluent without any technology.” I think with teenagers who stutter this is a big deal – it’d be soooo nice to just have some earbuds in that look like an iPod that would make them fluent, but it doesn’t work that way, and even if it did – they can do better without them.

Then we read with thoracic breathing and practice inspiratory checking and conversational breathing. This is a hard one to monitor but I’ve seen a lot of progress with some coaching prior to speech acts.

Usually then we work on reducing rate. To reduce rate I taped a tongue depressor to the table and the client is prompted to read each word but not finish the word before finishing running his hand over the length of the depressor. Now we’re working on staying slow without the tactile cue (usually there’s a lot of me making  crazy “slow down” hand motions). Reducing rate has a HUGE effect on my client’s fluency – which is likely why the DAF works.

To target disfluent moments, we do easy onset and cancellation. My client really seems to hate easy onset, but it works. If you’re working with a teenager, expect a lot of ‘splainin – they want to know what they’re doing, why they’re doing it, and when they can leave. At least once a session I have to say “This isn’t something you would do in real life, I just want you to feel control over your speech.” Sometimes we’ll do things like negative practice or speaking at a ridiculously low pitch and my client HATES it but, it works (that’s when the “nanny nannying” comes in).

If you’re working with a teen, be relaxed and really make them feel like this is a team effort. Being different is not cool, so make sure they know they aren’t alone. Before you make them do something, do it yourself! At least then if they think what they’re doing is stupid they’ll feel like you both look stupid rather than them looking stupid alone.

If anyone has any tips for working on stuttering at the connected speech level please let me know! I’ve noticed with my client that when reading or speaking at a reduced rate, the naturalness of speech goes out the window. It becomes very robotic, but when prompted to add intonation to a reduced rate the dysfluency comes right back. We do a lot of modeling right now, any input is appreciated.

NP: The Rascals – Good Lovin

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