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Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Possibilities in
Neurogenic Stuttering Treatment
An empirical study on
therapists` experiences
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
„Stuttering is more than a riddle. It is at least a complicated,
multidimensioned jigsaw puzzle, with many pieces still missing”
(Van Riper, 1982, 1).
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Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Presentation agenda
1. Definition and etiology
2. State of research in literature
3. Research questions
4. Empirical study and methodology
5. Findings
6. Conclusion
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Presentation agenda
1. Definition and etiology
2. State of research in literature
3. Research questions
4. Empirical study and methodology
5. Findings
6. Conclusion
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Definition
Speech dysfluencies in the form of
repetitions, prolongations and/or
blocks
Direct correlation
between the
neurological
disturbance and
the onset of speech
dysfluencies
Diagnosis of a neurological
disturbance or underlying disease
Neurogenic
Stuttering
Possible onset at
any age
Occurence of
symptoms for the first
time in life
or
massive change or
aggravation of existing
stuttering pattern
According to: Van Borsel et al. (1997) Grant et al. (1999), Leder (1996), Helm-Estabrooks (1986)
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Etiology
▪
▪
▪
▪
▪
▪
▪
▪
Cerebrovascular disease
Head trauma/ traumatic brain injury
Neurodegenerative disease
Tumor
Epilepsy
Intoxication
Neurosurgery
Other diseases of the central nervous system
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Presentation agenda
1. Definition and etiology
2. State of research in literature
3. Research questions
4. Empirical study and methodology
5. Findings
6. Conclusion
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
State of research
„Acquired stuttering in adults has received little
attention relative to that given developmental stuttering“
(Marshall & Starch, 1984, 87).
„Extensive research has been conducted in the field of
developmental stuttering, and many facts about this
disorder are well documented in the developmental
stuttering literature. An equivalent body of knowledge is
not available in the area of neurogenic stuttering [...]“
(Ringo & Dietrich, 1995, 117f.).
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
State of research
▪ Limited number of publications
▪ Single case studies
▪ Lack of empirical (group) studies
Critique:
▪
lack of objectivity of studies
▪
lack of comparability of data
▪
inaccurate sampling procedure
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
State of research
▪ Increased demand for research in the area of neurogenic stuttering
treatment
▪ Highly discrepant hypothesis
„Our therapy experience with adults with neurogenic
stuttering has been very encouraging. [...] in a good many
cases we have seen the stuttering problem completely
eradicated” (Canter, 1971,143).
„Results have rarely been dramatic and not always
encouraging“ (Rosenbek, 1984, zit. n. Baumgartner & Duffy,
1997, 91).
„The call for more systematically collected data is long overdue“
(Curlee, 1995, 125).
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Presentation agenda
1. Definition and etiology
2. State of research in literature
3. Research questions
4. Empirical study and methodology
5. Findings
6. Conclusion
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Research questions
▪
How is neurogenic stuttering currently treated in Germany?
▪
Is neurogenic stuttering treatable?
▪
Which factors evoke a good prognosis?
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Presentation agenda
1. Definition and etiology
2. State of research in literature
3. Research questions
4. Empirical study and methodology
5. Findings
6. Conclusion
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Empirical study and methodology
§ Research method:
§ Sampling procedure:
Written survey of 700 speech
language pathologists in Germany
Random sample
Two-stage sampling procedure:
Stage 1: Therapists (cluster)
Stage 2: Clients
§ Research tool:
§ Period of examination:
Structured questionnaire
(30 questions: 178 items)
4 years (1.08.2004 – 1.08.2008)
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Questionnaire – subject matters
Demographic data
Age, gender, handedness
Symptoms
Core symptoms, secondary behaviors etc.
Etiology
Medical history, neurological disturbance etc.
Therapy targets
Individual aims
Type of treatment
Stuttering therapy, general speech therapy etc.
Focus of treatment
Fluency shaping or modification techniques
Response to treatment
Learning, adopting and transferring techniques
Treatment outcome
Improvement, aggravation, difficulties etc.
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Pretest
Two stage Pretesting (Prüfer & Rexroth, 2000)
Phase 1: cognitive pretest
§ Cognitive interviews
§ n = 7 therapists
different occupational groups
different therapy setting
Phase 2: field pretest (pilotstudy)
§ Written survey
§ n = 100 therapists
§ Split-ballot procedure
assure manageability of the questionnaire and
correct understanding of questions
avoid ambiguity
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Data collection
Contacting the
non-responders
by phone
Information
letter on the
upcoming
survey
Pre-information
Questionnaire
Follow-up
added by:
▪ correspondence letter
▪ letter of recommendation
from the faculty
▪ stamped self-addressed
envelope
Data
analysis
Data collection
and
data preraration
with SPSS 17.0
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Return rate
Return rate (n = 700)
66,0%
53,3%
34,0%
12,7%
Response
No Response
Neurogenic stuttering clients among the clientele
No neurogenic stuttering clients among the clientele
89 therapists (12,7%)
have treated one or
more clients with
neurogenic stuttering
68 case descriptions
(9,7%)
after plausibility check:
61 data sets (8,7 %)
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Presentation agenda
1. Definition and etiology
2. State of research in literature
3. Research questions
4. Empirical study and methodology
5. Findings
6. Conclusion
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – age
Bar chart – age (n = 52)
range: 8-87 years
mean: 55.4 years
n
standard deviation: 17. 4
years.
age (years)
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – accompanying speech problems
Accompanying speech disorders (n = 60)
21,7%
20,0%
3,3%
51,7%
30,0%
21,7%
24,6%
Aphasia solely or in combination with other speech problems
No accompanying speech problems
Apraxia of speech
Dysarthria
Other speech problems
Aphasia (solely)
Aphasia and other speech problems
In three fourths
of all cases
neurogenic
stuttering
clients showed
accompanying
speech
disorders.
In every
second case
the client had
aphasia.
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – secondary behaviors
Secondary behaviors (n = 61)
80%
60%
40%
20%
70,5%
60,7%
47,5%
47,5%
32,8%
27,9%
13,3%
0%
Irritation
Difficulties in handling communication situations
Linguistic avoidance behavior
Situational avoidance behavior
Accessory movements
Anxiety
Others
95.1% of all patients
showed secondary
behaviors
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Chosen type of treatment
Type of treatment (n = 61)
100%
80%
60%
40%
20%
0%
90,2%
59,0% 52,5%
49,2%
Huge variety of different
types of treatment
45,9%
18,0%
4,9%
Specific stuttering therapy
Breathing exercises
Motor speech therapy/facial exercises
Aphasia therapy/word finding exercises
Relaxation techniques
Other types of treatment
Medical treatment
Average: use of 3.21
types of treatment
(sd = 1.07)
Specific stuttering
therapy as the most
used type of treatment
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Specific stuttering therapy
Type of stuttering treatment (n = 54)
Stuttering
modification
n
Fluency Shaping
n
Speech devices
n
Easy onset
30
Slowing speech rate
37
Metronome
11
Easy syllable
repetitions
21
Rhythmical speech
37
Chorus speaking
9
Easy articulatory
contacts
15
Continous phonation
5
Shadowing
7
Cancellation
14
Prolonged speech
5
Pacing Board
5
Use of starting sounds
9
Biofeedback
1
Pull-out
8
Delayed auditory
feedback
1
Other modification
techniques
2
Other speech
devices
3
Other fluency
shaping techniques
3
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Core techniques
Focus of stuttering therapy (n = 42)
Stuttering
modfication
Cancellation
2
Easy onset
9
2
Use of starting sounds
Easy syllable repetitions
1
Other modification technique
1
Speech
Othersdevices
Fluency
Shaping
Rhythmical speech
10
11
Slowing speech rate
Continous speech
1
Prolonged speech
1
Metronom
1
Pacing Board
1
2
0
2
4
6
8
10
12
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Psycho-social methods
Psycho-social methods (n = 56)
Information on stuttering
90,9%
Anxiety reduction
70,4%
Counseling of relatives
58,2%
In-vivo training
Other psycho-social methods
55,4%
14,0%
0% 20% 40% 60% 80% 100
%
94,9% of all therapists used psycho-social methods
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – „Success“ of treatment
C
R
I
T
E
R
I
A
O
F
S
U
C
C
E
S
S
Achievment of therapy target
Improvement of speech (improvement of body
functioning)
Improvement of psycho-social factors (activity and
participation, positive affect on context factors)
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Achievement of therapy target
)
en
t ir
el
y
(3
ly
de
y
(4
)
)
wi
ta
en
ru
di
m
rtl
(0
d
ve
no
ta
ch
ie
appropriate handling of stuttering
7,1%
(2
)
reduction of core symptoms
improvement of general linguistic skills
8,9%
5,4%
pa
27,1%
42,9%
35,7%
)
37,3%
50%
40%
30%
20%
10%
0%
(1
35,6%
Degree of target achievement
ry
Overall target of treatment
No significant difference between the 3 superordinate targets of treatment with
regard to the degree of target achievement (χ2 = 1,429; p = 0,489).
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Improvement of speech
Acquisition of the chosen speech
technique (n = 44)
21,3%
29,5%
Use of the chosen technique in
spontaneous speech (n = 42)
16,7%
0,0%
7,1%
21,3%
31,0%
not possible
conditionally possible
good
excellent
45,2%
not possible
conditionally possible
good
excellent
Comparison of speech techniques:
Easy onset, rhythmical speech, slow speech rate
No significant difference between the 3 techniques with regard to
acquisition (χ2 = 0,421; p = 0,814)
and use in spontaneous speech (χ2 = 1,668; p = 0,434)
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Improvement of speech
The speech technique was
acquired best, in cases of
Correlation matrix – Acquisition and use in
spontaneous speech
Acquisition
Use in
spontaneous
speech
1,000
,635**
r
Acquisition
State of health
Sig. (2sided)
n
44
42
r
-,308*
-,143
,045
,372
43
,542 **
41
,519 **
Sig. (2sided)
,000
,000
n
44
42
Sig. (2sided)
n
r
Motivation
* sig. 0,05 level
,000
**sig. 0,01 level
▪ good state of health
▪ high therapy motivation (of the
patient)
The use in spontaneous
speech was best, in cases of
▪ an excellent acquired
technique
▪ high therapy motivation (of the
patient)
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Improvement of speech
Improvement in different speech situations
excellent
improvement
No significant
differences
between speech
techniques
good
improvement
slight
improvement
no
improvement
improvement in
therapy setting
improvement in
everyday life
improvement in
stressful situations
Comparison of speech techniques:
Easy onset, rhythmical speech, slow speech rate
▪ Improvement in therapy setting: χ2 = 0,391; p = 0,572
▪ Improvement in everyday life: χ2 = 1,395; p = 0,238
▪ Improvement in stressful situations: χ2 = 0,043; p = 0,836
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Improvement of speech
therapy setting
acquisition
everyday life
stressfull
situations
r
0,632**
0,515**
0,425*
Sig. (2-sided)
<0,001
0,003
0,015
n
32
32
32
r
0,461**
0,545
0,487**
0,009
0,002
0,005
31
use in
spontaneous
speech
Sig. (2-sided)
n
31
31
motivation
r
0,347*
0,576**
0,513**
0,019
<0,001
<0,001
45
45
44
Sig. (2-sided)
n
Improvement of speech in different speech situations is correlated with
▪ the factor „acquisition“
▪ the factor „use in spontaneous speech“
▪ the factor „therapy motivation“
**sig. 0,01 level * sig. 0,05 level
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Improvement of speech
Transferring practiced skills
M
O
T
I
V
A
T
I
O
N
A
C
Q
U
I
S
I
T
I
O
improvement in therapy setting
U
S
E
improvement in everyday life
improvement in stressfull situations
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Improvement of psycho-social factors
More participation in
communication situations
Reduction of psychological
strain
81,5%
83,6%
16,4%
Self-confident handling of
stuttering
81,5%
18,5%
Yes
No
18,5%
Reduction of negative impact
of stuttering on everyday life
25,5%
74,5%
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – Improvement of psycho-social factors
Reciprocal conditionality of psycho social improvement
Reduction of
psychological
strain
Reduction of
negative impact
of stuttering on
everyday life
More participation
in communication
situations
Selfconfident
handling of
stuttering
significant
correlation
between different
apsects of
psycho-social
improvement.
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – treament outcome
Improvement of speech and psycho-social
factors (n = 56)
19,6%
75,0%
1,8%
3,6%
improvement of speech and psycho-social
factors
improvement of psycho social factors (solely)
improvement of speech (solely)
no improvement
inhibiting factors:
▪ bad state of health
▪ lack of motivation
▪ irregular attendance of therapy
i sessions
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Results – treament outcome
initial condition
final condition
negativ
significant
improvement
over the period
of treatment:
▪ psycho-social
..improvement
▪ speech
..improvement
positiv
state
of
health
severity
of
stuttestuttering
severity
of
psychopsychological
strain
negative
impact
on
everyday
life
state
of
health
severity
of
stuttestuttering
severity
of
psychopsychological
strain
negative
impact
on
everyday
life
▪ better state of
..health
(p < 0,001)
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Presentation agenda
1. Definition and etiology
2. State of research in literature
3. Research questions
4. Empirical study and methodology
5. Findings
6. Conclusion
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Conclusion
▪
Similar methods as in developmental stuttering therapy can be used
▪
Specific stuttering therapy is often supplemented by other approaches
▪
A combination of multiple speech techniques is most often used
Easy onset
Rhythmical speech
Slowing speech rate
most
frequently
used
techniques
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Conclusion
▪
▪
Demand: treatment has to be based on the patients` indiviudal needs
Practicing
Learning and using an exact speech technique
Transfer
Supporting transfer into various speech situations
Motivation
Strengthening the patient`s motivation
Improvement of speech and psycho-social factors in the majority of
cases
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Prospect
Research desideratum
„Patients with acquired stuttering – just as those
with developmental stuttering – deserve to receive
the best evidence-based fluency intervention“
(De Nil, Jokel, Rochon, 2007, 327).
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Thank you very much for your attention!
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Acknowledgement
Special thanks go to:
My parents Heinrich Ulrich König und Ursula König
Univ.-Prof. Dr. Gregor Dupuis
Univ.-Prof. Dr. Nitza Katz-Bernstein
Marcus Beckmann, Friedhelm Därmann, Anika Förster, Claudia Gerrlich,
Maren Gezemba, Stefan Göthel, Robert Hammelmann, Stefani Holland,
Matthew Kishinami, Jürgen Lamberti, Karolin Schäfer, Kathrin Sundermann,
Alexander Sommer, the statistical center of the University of Dortmund and to
all participants in the survey of this study.
Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
References
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Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
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Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
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Dr. Kathrin König ▪ Speech language pathologist ▪ Bochum ▪ Germany ▪ [email protected]
Discussion
I`d be happy to send you the bibliography. Please feel free to contact
contact me at my email address.
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