Management of Cluttering: Rational Techniques and Strategies: Management of Cluttering consists Identification, Monitoring and Self Awareness, Modification, Cluttering with Stuttering and Maintenance of Fluency.

• Identification of Cluttering
• Monitoring and Self Awareness
• Modification
  • Excessively fast speech rate
  • Speech rhythm and intonation
  • Articulation
  • Over coarticulation/Mumbling
  • Language Problems
  • Narrative and Sequencing of information
  • Pragmatics
  • Relaxation
  • Delayed Auditory Feedback
• Stuttering and Cluttering
• Maintenance of Fluency

Identification of Cluttering

• Unlike stuttering, where the vast majority of people attending assessments do so because they personally have concerns about their fluency, people who clutter may be attending because they have perhaps been coerced into doing so. This may be because of concerns raised by schoolteachers or parents, or in older clients by managers who feel that a difficulty with communication is holding their juniors back from promotion.
• The identification process can then proceed with an outline of the major symptoms of the disorder. Having the client complete the cluttering checklist.

Monitoring and Self Awareness

• Teach clients about the disorder of cluttering using Daly and Burnett-Stolnack’s (1995) checklist Predictive Cluttering Inventory (PCI)  to help the client learn which cluttering behaviors he has.
• Have the client transcribe and analyze a recording of his cluttered speech.
• Help the client become aware of his thought processes when he is talking in fast bursts of disorganized speech.
• Self-monitoring is a skill that will develop over time, there is a need, at a fundamental level at least, for the client to recognize that their speech is difficult to understand, and for them to have the confidence in your ability to help them improve the situation. When the client has come this far, therapy is underway.

Modification

Excessively Fast Speech Rate

• Simulate various speaking rates by having the client move his arm or walk at slow, medium, and fast tempos. Then, teach the client to attend to his sensory feedback while he is doing this so that he learns the feeling of these rates.
• For developing cognitive awareness about speech production system using Analogies.
• Alternate between speaking and moving various body parts or walking at various rates while attending to sensory feedback.
• Use movements and walking paced by fast and slow music.
• With children, engage in activities in which they can get speeding tickets or give speeding tickets to the clinician for speaking too fast.
• Teach clients to attend to various verbal and nonverbal cues from a listener that indicates they are speaking too quickly or cannot be understood. For example, listeners may frown or show puzzlement on their faces or repeatedly ask the speaker to repeat himself.
• For readers, put symbols at periods and commas, such as red or yellow lights, to help them slow their speech rate at relevant places in a text.
• Teach phrasing and pausing in conversational speech.
• Use the concept of a speedometer for children and ask them to speak at 75 miles per hour or at 35 miles per hour.
• Teach clients to speak with strong stress patterns by reciting poetry, for example.

Speech rhythm and intonation

• Instruct the individual to use more natural speech patterns by using feedback methods such as a Visi-Pitch.
• During practice of multisyllabic words, stressed syllables might be exaggerated so that unstressed syllables are not omitted. (Louis KO. Cluttering 2018)
• Have the individual practice using different types of intonation (e.g. making statements). (Lanouette EB.)
• Use contrastive drills to practice patterns (“Tell Me or Ask Me game”). (Ward D. Scott KS)
• The individual will increase the naturalness of his/her speech. Progression will depend on the individual’s level and might begin with single words and phrases and progress to conversation/story telling.

Articulation

• The SLP might address any speech errors (e.g. cluster reduction) that are contributing to lack of intelligibility.
• The individual might practice short sentences and multisyllabic words to achieve clear, uncluttered speech.
• The individual might practice specific sounds, sound blends or multisyllabic words in increasingly longer contexts (e.g. words, phrases, sentences)

Overcoarticulation/Mumbling

• Quite often, a mumbling type of delivery is seen together with overcoarticulation. However, they are not exactly the same thing.
• Overcoarticulation may be seen, for example, in the word television being produced as “tevision” (an example which here has actually led to weak syllable deletion), but it is still possible for this reduction to be articulated with good volume and reasonable clarity amongst the remaining syllables.

Language Problems

• The SLP can transcribe the individual’s mazes (tangential conversation), cluttered utterances so that the individual has a visual representation and can become aware of essential and nonessential information Phrases or sentences can be repeated to make them more clear.
• The individual might practice “clear” language in progressively more difficult tasks such as picture descriptions, or giving directions.

Narrative and Sequencing of information

• Teach clients to chunk and sequence their thoughts by having them write a story or narrative on cards, sequence them, and then tell the story aloud using the cards.
• Involve clients in skits and plays so that they learn to follow a script and use turn taking.
• Teach them such narrative skills as turn-taking in conversation and staying on topic in conversation.
• Teach them how to use complex sentences with subordinate clauses.

Pragmatics

• The SLP can assist the individual in using pragmatic skills such as appropriate eye gaze, turn-taking, listening to the conversational partner, checking in with the conversational partner (“Did you get that?”) and identifying the conversational partner’s level of interest in the topic.
• The SLP can assist in the individual in better recognizing signs that the listener doesn’t understand (e.g. confused look, furrowed brow)
• Instruction on the use of appropriate pausing and use of silence during conversations might be beneficial.
• Cluttering often is associated with excessive talking.
• Discourse skills might be taught in individual sessions and then practiced in group sessions.

Relaxation

• It is also true that some clients become agitated and even aggressive when they fail to be understood and are asked to repeat (Daly, 1996).
• This presents two problems:
  • one is that the listener may be surprised to find themselves on the receiving end of the person who clutter’s frustration;
  • second, attempting to improve on an unintelligible output is likely to be unsuccessful given an increasingly heightened emotional state.
• Apply relaxation techniques, whether these are muscle specific or more generalized relaxation procedures, can be helpful in dissipating unwanted tension.

Delayed Auditory Feedback

• Use Delayed Auditory Feedback (DAF) to help clients learn to speak in a slower, more fluent manner.
• Use DAF to teach proprioception, by having clients speak at a normal rate under maximal delay (i.e., 250 ms) by ignoring auditory feedback.

Stuttering and Cluttering

• Some clients have both stuttering and cluttering in their speech, but one usually predominates. It has been suggested that when stuttering is mixed with cluttering, a client’s cluttering may not be noticed until his stuttering is substantially reduced by therapy (Bakker, 2002; St. Louis et al., 2003).
• If the individual shows stuttering like disfluencies in addition to cluttering, target stuttering in therapy, preferably after components of cluttering have been addressed.
• Techniques used in the stuttering therapy, such as easy onset of voice, prolonged syllables, and correct breathing, can also assist with management of cluttering symptoms.

Maintenance of Fluency

• There are as yet no reliable data as to the efficacy of cluttering therapy, but once cluttering has become established in adulthood the emphasis will be on controlling and containing the symptoms.
• As with chronic stuttering, there is no “cure” for cluttering in adulthood. Control over an extended time period rests on the individual’s ability to self-monitor, and to put into practice the techniques and procedures learned in therapy.
• Several follow-up sessions might be necessary after the individual has finished formal therapy; generalization and maintenance are often difficult for individuals who clutter (Lanouette EB., Ward D, Scott KS, eds.)

References:

⇒ STUTTERING An Integrated Approach to Its Nature and Treatment – BARRY GUITAR, PH.D. (Book)
⇒ Stuttering and Cluttering – David Ward (Book)
⇒ Clinical Decision Making in Fluency Disorders – Walter H. Manning, Ph.D (Book)

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Management of Cluttering: Rational Techniques and Strategies