Management of Neurogenic Stuttering: Rational, Techniques and Strategies

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Management of Neurogenic Stuttering: Rational, Techniques and Strategies: Many conditions can cause SAAND (Stuttering Associated with Acquired Neurogenic Disorder) and affect the frequency with which it coexists with other communication impairments, there is no single treatment approach that is effective in alleviating its symptoms.

Some therapy techniques that help reduce the symptoms of developmental stuttering may also be effective with Neurogenic Stuttering. These include:

  • Slowing speech rate (saying fewer words on each breath by increasing the duration of the sounds and word).
  • Emphasizing a gentle onset of the start of each phrase (starting from a relaxed posture of the speech muscles, beginning with adequate respiratory support; a slow initiation of the exhalation and gentle onset of the first sound).
  • Emphasizing a smooth flow of speech production and use of relaxed posture, both in terms of general body postures and for specific speech production muscles.
  • Identifying the disruptions in the speech patterns and instructing the client in the use of more appropriate patterns.

It has also been suggested that teaching a delay strategy to provide more time for word retrieval maybe one way to reduce disfluencies (Linebaugh, 1984).

Management of Neurogenic Stuttering:

Self monitoring

Whitney & Goldstein (1989) described a self monitoring program they found successful in reducing the disfluencies of 3 mild aphasics.

Step 1: Clients listen to tape recordings of their own speech while their clinician points out instance of the target behaviors to them. The purpose is to make them aware of the behaviors they are to self monitor.

Step 2: Clients listen other tape samples similar to their own and signal each time they hear the target behavior. If they do not signal an instance within 3 seconds after it occurs, the clinician stops the tape and points it out to them.

Step 3: Clients self monitor while performing a speaking task (such as describing a picture). They are told to signal each time they produce a target behavior, the same way they did in STEP2. If they do not do so, the clinician stops them and points out the target behavior using a recording.

Step 4: Clients self monitor while performing the speaking tasks used in STEP 3 without the clinician providing feedback and reinforcement. Their performance is recorded and the amount the evince is compared to that in a recording they made before beginning the training program. If there is less of the target behavior in the post than in the pre intervention recording, his would suggest that self monitoring could help decreasing the dysfluencies. They would be then encouraged to use it outside the clinical set up.

To determine whether a client would be likely to benefit from the use of this strategy, have him/her speak at very slow rate. If doing so results in slow rate in increased fluency, it is likely that he/she would be befitted from this program.

Delayed auditory feedback

There is some evidence to suggest that patients with SAAND may show positive response to auditory masking. In 1984, Rentscheker & Colleagues described a 41 yr old man who developed stuttering following drug over dose with chlorazepate dipottasium. Marshall & Starch (1984) used DAF to successfully treat a 32 year old man who developed SAAND after a closed head injury. The DAF was introduced 4 years after the injury occurred. For detailed information about Delayed Auditory Feedback (DAF)  please go through this article ⇒ Different Techniques and Strategies used in Management of Stuttering

Auditory Masking

Cherry (1956) Found that masking noise can reduce stuttering with using loud masking noise. Masking noise generator unit: hearing aids – tune if/ when blocking or anticipating block. Binaural  noise masking at 95dB resulted in fluent speech. With reduced levels of noise intensity, stuttering returned. For detailed information about Auditory Masking please go through this article ⇒ Different Techniques and Strategies used in Management of Stuttering

Biofeedback

  • Another approach is based on the work of kalotkin (1978), who experienced some success in treating 10 developmental stutterers by using biofeedback and relaxation.
  • In this method electrodes are placed over the masseter muscle bundles, and baseline tension levels are computed for 10 to 20 minutes of conversation and oral reading.
  • The patient then is instructed in relaxation procedures while provided with visual (lights) and/or auditory (beeps or squeaks) feedback. By lowering the masseter tension levels while talking the patient can turn off the red light and/or sounds.

Pacing techniques

  • Some patients with SAAND may respond to pacing techniques that involve slowing the speech rate and speaking one syllable at a time.
  • Often however, patients do not respond to instructions for producing slower, paced speech because of an underlying neurological drive to speak at faster rate.
  • For such patients a pacing device, Helm (1979) first described had six multi colored squares with raised dividers.
  • The patient was encouraged to tap his/her fore finger from square to square while speaking in a syllable to syllable manner.

Pharmacological treatment

  • There is evidence to suggest that drugs may have either a negative or positive effect on speech disfluency.
  • A patient was reported by Bartz & Mesulam (1981) in which stuttering associated with head injury and seizures diminished when seizures were brought down under control with phenytocin.
  • McClean & McClean (1985) reported that their patient with post head injury seizures stuttered when treated with phenytocin but reduced his disfluencies when switched to carbamazepine. These cases suggest that when stuttering occurs in patients with documented or suspected seizures, the choice of antiepileptic agents should be carefully explored.
  • Drugs that affect the basal ganglia may affect the speech fluency in either a positive or negative direction. Careful, controlled drug trial may establish the correct levels for maintaining fluent speech in some patients.

Thalamic stimulation

Bhatnagar & Andy (1989) described a 61 yr old man with stuttering associated with a long history of trigeminal pain. A surgical procedure was used to implant a chronic stimulation electrode in left centromedian thalamic muscles for relief of chronic pain through a battery operator stimulator. The patient could self stimulate 3 or 4 times a day for 20 minutes. This resulted in remarkable improvement in speech fluency as well as considerable pain reduction.

Transcutaneous nerve stimulation

Butler and Curlee (1977) reported the case of a 68 years old woman who experienced a series of minor strokes to both cerebral hemispheres. Severe stuttering occurred after the 5th stroke with a transient left hemiparesis. Trials with a speech pacing board increased her fluency but when an electro-larynx was vibrated against her left hand, movements of stuttering during an oral reading task decreased from 38 to 8.

References:

⇒ STUTTERING An Integrated Approach to Its Nature and Treatment – BARRY GUITAR, PH.D. (Book)
⇒ Stuttering and other fluency disorders – Silverman F.H (Book)
⇒ Stuttering and related disorders of fluency – Curlee F. Richard (Book)

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Management of Neurogenic Stuttering: Rational, Techniques and Strategies

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