Neurogenic Stuttering: Successful Case Studies - MemberClicks
2/10/2020 TIM MACKESEY, C CC-SLP, B CS-F & KIM E. O NO, PH.D. NEUROGENIC STUTTERING: SUCCESSFUL CASE STUDIES FEBRUARY 13, 2020 12:00-2:30PM LAUREL AMPHITHEATER TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com Introductions/Course Description The sudden onset of stuttering following a neurological event can be devastating to the patient and the family. The pws can quickly develop negative emotions and thoughts associated with their speech impediment. An integration of behavioral speech control techniques and cognitive therapy is often necessary to make significant and lasting improvements. This course will include video of therapy in action, demonstration of techniques, and live testimony from an adult recovering from neurogenic stuttering. TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 1
2/10/2020 Today’s Agenda 12:00-12:05 Introduction with overview of today’s agenda and learning objectives 12:05-12:15 Introductions to our guest speaker who is recovering from neurogenic stuttering 12:15-1:05 Neuroimaging and diagnostics of TBI and concussion- Dr. Kim E. Ono, Ph.D. 1:05-1:20 Diagnostics and needs assessment for Sara post TBI 1:20-2:05 Fluency shaping and stuttering modification adapted for neurogenic stuttering 2:05-2:15 Concomitant issues: visual deficits, fine motor, right sided weakness 2:15-2:25 CBT for neurogenic stuttering 2:25-2:30 Closing statements and farewell www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F Learning Objectives 1) Identify 3 common cognitive distortions that result from sudden onset stuttering 2) List 3 speech production steps in a hierarchy from phoneme production to carrier phrases 3) Identify 2 ways to utilize phrasing to increase fluency TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 2
2/10/2020 Tim Mackesey, CCC-SLP, BCS-F Tim Mackesey, CCC-SLP, BCS-F has a full-time private practice dedicated to stuttering. He is a Board Certified Specialist in Fluency Disorders and a Specialist Mentor per ASHA. Tim had a severe stutter well into his 20s. He has been an SLP since 1992. Tim taught the graduate level Fluency Disorders course at Georgia State University. Tim is a past president of Georgia Speech and Hearing Association. He is a Master Practitioner of NLP and Neurosemantics. He integrates leading-edge CBT into stuttering therapy. Tim has published several articles in peer-reviewed professional journals. Tim Mackesey, CCC-SLP, BCS-F www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F Kim E. Ono, Ph.D. Kimie Ono is a neuropsychologist at the Children’s Healthcare of Atlanta (CHOA). She completed her undergraduate work at Harvard University, concentrating in neuroscience. She went on to complete her graduate studies at the University of Miami, and her internship and fellowship in pediatric neuropsychology at Emory. Kimie has extensive research and clinical background in various imaging and brain monitoring modalities, including fMRI and EEG. Her current research and clinical interests include concussion and epilepsy. Kim E. Ono, Ph.D. TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 3
2/10/2020 Sara Propes Sara is a 38 year-old female with a doctorate degree in Occupational Therapy. Prior to her accident, she was employed as a pediatric occupational therapist. Sara and her husband, Cameron, enjoy an active lifestyle. Sara was struck hard under her left eye at work on November 15, 2017. Right sided weakness, headaches, visual impairment, and a severe stutter resulted. Prior to receiving stuttering therapy, previous documentation reported that Sara was “barely able to utter words” following very light activity. On the date of Sara’s evaluation, (October 15, 2018), Sara’s conversational speech was 73% disfluent. Oral reading was deferred due to Sara’s stuttering severity- this caused her sample unable to be standardized. Sara used a communication board and ASL to supplement verbal output. Cameron reported that Sara looks away when she has trouble talking. Sara stated that her stuttering has drawn attention from listeners and she wonders what people think about her speech. Sara began speech therapy in October 2018. www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F We dedicate this day to Sara Video Content Here TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 4
2/10/2020 Neuroimaging- Kim E. Ono, Ph.D. Kim E. Ono, Ph.D. www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F Speech Pathology for Neurogenic Stuttering CBT TIM MACKESEY, CCC-SLP, BCS-F Speech Mechanics www.stuttering-specialist.com 5
2/10/2020 Spousal support & training see Tactile helpers Speaking on an exhale Spelling & oral reading Melodic intonation therapy Integrated & Holistic Therapy hear Multisensory feel phoneme Eye contact word phrase sentence CBT phrasing TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com FLUENCY SHAPING & STUTTERING MODIFICATION FOR NEUROGENIC STUTTERING TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 6
2/10/2020 Speech Anatomy Essentials Lips: Tongue: . Voice: p, b, f, v, m, w th, t, d, s, z, n, l, r, sh, ch, j, y, r, k, g h, vowels TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com Filler “bopsy” to /m/- Isolation & CV Evaluation- “bopsy” filler to compensate for /m/ Video Content Here TIM MACKESEY, CCC-SLP, BCS-F /m/ in isolation and in CV words Video Content Here www.stuttering-specialist.com 7
2/10/2020 /m/ - “My name is Sara” Continuous voicing and tactile support Video Content Here TIM MACKESEY, CCC-SLP, BCS-F Sara “My name is Sara.” Video Content Here www.stuttering-specialist.com Sara- Oral Reading Strategies CBT and initial reading- trial therapy Video Content Here TIM MACKESEY, CCC-SLP, BCS-F Reading /m/ sentences using oral reading strategies Video Content Here www.stuttering-specialist.com 8
2/10/2020 Phrasing in Oral Reading www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F Sara Propes Video Content Here o Panic Signing, spelling board, blocking, ‘bopsy’ o Had to begin with phonemes word phrases o Right-sided weakness and visual deficit o Projecting o Cameron’s role o ‘Conversion disorder?’ TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 9
2/10/2020 Crossing Midline Sara’s findings when crossing midline with her right hand Video Content Here What would you do? Video Content Here www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F Crossing Midline- vowels Using strategies when crossing midline to produce vowels Video Content Here TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 10
2/10/2020 Visual Deficits Video Content Here www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F CBT in SLP “Freedom is to speak. And I fear to form what is air and may be made in a minute.” -M. McClure TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 11
2/10/2020 Logical Levels o Environment- The “Where, When, and With Whom” o Behavior- The “What” o Capabilities- The “How” o Beliefs- The “Why” o Identity- The “Who” www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F When Attempted Solutions Become the Problem Sudden onset of neurogenic stuttering identity of a “stutterer” oAvoid talking oWord changing oEnabling oAvoid introductions oPhone tricks oPoint to menu for server to say it oBackwards speech oEye aversion oFillers TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 12
2/10/2020 Cognitive Distortions- Top Four 1) Projecting- Imagining what others think when you stutter o i.e., “They will think I’m special needs because I stutter.” 2) Black and White Thinking- Either/or thinking o i.e., “If I stutter on a phone call, my coworkers will be mad and blame me.” 3) Personalization- Blaming yourself for something you weren’t entirely responsible for or blaming other people. o i.e., “If I stutter, I failed I’ve started speech therapy.” 4) Should statements- Criticizing yourself with shoulds or shouldn’ts. o i.e., “I should be able to say my name everyone else can.” *David D. Burns- The Top 10 Forms of Twisted Thinking www.stuttering-specialist.com TIM MACKESEY, CCC-SLP, BCS-F Projecting Stuttering burden, frustrating, tense Video Content Here TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 13
2/10/2020 Black and White Thinking Realizing old thoughts were “all or nothing” Video Content Here TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com CLOSING STATEMENTS TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com 14
NEUROGENIC STUTTERING: SUCCESSFUL CASE STUDIES FEBRUARY 13, 2020 12:00-2:30PM LAUREL AMPHITHEATER . TIM MACKESEY, CCC-SLP, BCS-F www.stuttering-specialist.com Learning Objectives 1) Identify 3 common cognitive distortions that result from sudden onset stuttering 2) List 3 speech production steps in a hierarchy from phoneme production to .
Stuttering: Two Definitions 1) Stuttering behaviorsare speech disfluencies that include repetitions, prolongations, and other interruptions (such as blocks) in the forward flow of speech. 1) The entire experience a speaker has due to stuttering behaviors is the stuttering disorder. "Stuttering is more than just stuttering." J. Scott Yaruss
Learning Objectives . By the end of this course, learners will be able to: Distinguish between common terminology related to stuttering Recognize influences of genetics, neurology, and environment on stuttering Recall the CALMS multifactorial model of stuttering, and its importance in assessing and treating childhood stuttering.
Disclosures uFinancial uStuttering Therapy Resources, Inc. (Nina: Royalties, Ownership; Lee, Salary) uOverall Assessment of the Speaker's Experience of Stuttering (OASES) uSchool-Age Stuttering Therapy: A Practical Guide uEarly Childhood Stuttering Therapy: A Practical Guide uEarly Childhood Stuttering Therapy: Information & Support for Parents uStuttering: How Teachers Can Help
Our Job Is Not to ure Stuttering Most natural recovery from developmental stuttering occurs before age 7. Most children who are stuttering at age 7 and above, have been stuttering for more than 3 or 4 years (with onset between 2 and 4 years). Stuttering is natural for most of the school-age students we see. 6 (Yairi & Ambrose, 2013)
how to start stuttering treatment for school age who stutter in the span of 3 totalhours (Parts 1 and 2) So, I will attempt to address the major . 2013 School -Age Stuttering Therapy: A Practical Guide, Stuttering Therapy Resources, Inc: McKinney, TX Sheehan, J. (1970).
A. Stuttering Is Genetic 1. Stuttering runs in families – if you have one person in a family who stutters, chances are 60-70% that you will find another person in the family who also stutters. a) If the child has a positive family history of stuttering, this counts as a risk factor! 2. Girls are more likely to recover than boys.File Size: 1017KB
Stuttering Mod Fluency Shaping Attitudes, speech fears, avoidances major interest/focus little/no attention Client analysis/eval. of stuttering behavior major interest/focus little/no attention Modification of stuttering spasms primary tx goal not dealt with Stuttering Modification vs. Fluency Shaping Therapy
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