THEORETICAL PERSPECTIVES IN CLUTTERING, FAST RATE OF SPEECH.pdf / KUNNAMPALLIL GEJO JOHN

7/27/2019 THEORETICAL PERSPECTIVES IN CLUTTERING, FAST RATE OF SPEECH.pdf / KUNNAMPALLIL GEJO JOHN

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FLUENCY AND ITS

DISORDERS

THEORETICAL PERSPECTIVES IN

CLUTTERING, FAST RATE OFSPEECH

KUNNAMPALLIL GEJO JOHN,

BASLP,MASLP


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KUNNAMPALLIL GEJO JOHN 2

Skills in the timing and integration of speech

and language functions are basic to the fluent

output of oral communication

Froeschels, Freund, Luchsinger and Weiss

have not only outlined the disorder in detail

but less fortunately, contrasted the

cluttering and the stuttering in terms ofpersonality and behavior


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The definition, by American speech language

hearing association :

Cluttering is a fluency disorder characterized

by rapid and/or irregular speaking rate,

excessive disfluencies, and often other

symptoms such as language or phonological

errors and attention deficits


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An analysis by Weiss 1964, Luchsinger and Arnold 1965, Wow1970, Van Riper 1971, Dalton and Hardcastle 1977, Daly 1986

found at least 65 different symptoms or descriptions of thisdisorder.

Rapid sequence rates were reported by 5 out of 6 authors andthere by reflected the highest level of agreement.

4 out of 5 authors reported articulatory symptoms.

Single author listed 28 different factors, including such as:congenital dyspraxia, enhanced musical ability, inability to singon key, short temper or causal acceptance of life.


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Definition of Cluttering

NSHS (national Speech and Hearing Survey) working definition of clutteringis as follows

Cluttering is a speech & language disorder and its chief characteristics Abnormal fluency which is not stuttering

Rapid and irregular speech rate

Van Riper (1954) descried cluttering as characterized by slurred andomitted syllables, by improper phrasing and pauses, due to excessivespeed.

Luchsinger (1970) says that repetition of syllables and word as the mostimportant feature and remarks on an imperfection in finding words amongstthese speakers and a striking monotomy of speech melody.


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Weiss (1964) outline the speech symptoms ingreater detail. Excessive speed (tachylalia) has

always been considered the maintains

Froeschels (1946)said that they only speak

relatively too quick for their inability to find wordsand formulate sentences

Drawling and interjection are seen as resulting fromthis difficulty


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The unintelligibility of the speech of many

clutterers is caused by

Omissions of sounds, syllables and whole words Displacement of sounds

Inversions of the order of sounds

Anticipation of sounds

Post position of sounds

Repetition of initial sounds

Telescoping of several syllables of a word

Many of features seem to be an exaggeration of co articulation and

elision of normal speech


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All these articulatory deviations improve when speed is reducedand, indeed, many disappear altogether.

Weiss also noted the clutterers jerky respiration and short

respiratory span and the monotony of the speech-melody pattern(presumably referring to intonation and pitch range)

Wohl (1970) described the prominent feature of cluttering as

festination (i.e. becoming faster and faster as speech proceeds)which leads to elision articulation disorder of an erratic andunstructured type, omission and subsequent spelling and writingerrors.


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Liebmann (1900,1930) proposed 2 groups, one being motor inform and having lack of attention to kinesthetic and somato-motor performance as its basis, while the second was said to bereceptive in nature, with the disorders of audition, and attention

predominating

Froesches (1946) was one of the earliest to relate cluttering to adisturbance of thinking.

He described the sequence of preparatory steps before a phraseor sentence is uttered.

There is a psychic urge or attitude toward expressing a thought.

This is followed by a planning of the sequences and choice ofwords to be expressed


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Weiss declared that the clutterers thoughts are

poorly integrated and incomplete.

Wohl, however found more often that it is the speed

of speech which disturbed the flow of thought and,when speed is reduced, the thought of most seem to

be as well order as those of normally fluent

speakers.

This suggests some impairment of the normal neural

pacemaker.


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SYMPTOMS

REPETITION

EXCESSIVE SPEED

DRAWING & INTERJENCTION

VOWEL STOP

ARTICULATION AND MOTOR DIASABILITY

RESPIRATION

MONOTONY

LACK OF RHYTHM AND MUSICAL ABILITY

CONCENTRATION AND ATTENTION

POORLY INTEGRATED THOUGHT PROCESS

INNER LANGUAGE

READING DISORDER

WRITING DISORDER

GRAMMATICAL DIFFICULTIES

UNAWARENESS OF SYMPTOMS

RESTLESSNESS AND HYPERACTIVITY

DELAYED SPEECHAND LANGUAGE DEVELOPMENT

ELECTROENCEPHLOGRAPHIC FINDINGS

HEREDITY

PSYCHOLOGY OF CLUTTERER


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REPETITION

Repetition of one-syllable words or the first

syllable of polysyllabic words is an important

symptom of cluttering.

These repetitions may occur occasionally in

normal speech also; most frequently when

the speaker is under pressure.


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Repetition of syllables is common especially in thechildren between the ages 2-5yrs.

During these yrs substance of what the childwhishes to communicate is too complex forexpression in his limited vocabulary.

During these yrs the inception of cluttering, if it isuncomplicated by stammering or other disorders,may be over looked.

Diagnosis cannot be confirmed until othersymptoms such as excessive speed anddisorderliness, become apparent.


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The rate of speed of clutters repetition is the exact syllabicspeed of his non repetitive (or free-following) speech.

This is also true of the repetition of normals under stress and isan important factor in differential diagnosis.

A faster or slower rate indicates that the individual has becomeaware of his repeating and attempting to correct it: correctiveawareness of disorder rules out clutteringas defined.

The clutters characteristic unawareness of his speech deviation

accounts for his continuing to make syllabic noise (repetition ofsyllables) instead of stopping the speech process while hedecides on the words to follow.


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EXCESSIVE SPEED

Excessive speed was considered the most significant symptomof cluttering, and some investigators even considered it the basicelement.

However there are somenorm alswho speak too rapidly but withperfect order and articulation.

And there are some clutterers who speak at the normal rate.

Therefore excessive speed must be ruled out as the one of theprimary indicator of cluttering.


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In cluttering, on the other hand, there isexcessive speed, is accomplished by poor

formulation and delivery, and is therefore anindicator that the speech mechanism cannotcope with its function of communication.

A clutterer will sometimes begin polysyllabicwords at an acceptable rate, but his speed

increases as he progresses, resulting in atelescopingof the words.


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He spells as he pronounces, omitting the same letters.

This is also occurs in some speech disorders that are a result ofbrain lesions (e.g. postencephalitic speech).

Seeman called it interverbal acceleration. Luchsinger added theconcept of intraverbal acceleration in cluttering.

The first indicates the shortening or omission of the essential pausebetween words.

Bradford says that silence is just as much a part of speech as

articulation.


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Gerstmann and Schilder and, Seemanattempted to localize the anatomical site of

this speed drive and concluded that it is in thestriopallidar system, especially inencephalitis, but there are no availablehistological findings at this time for clutterers.

The hereditary factor in typical cluttering,however is not anticipated that structural

changes in the brain will have found to causeexcessive speed


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Normal conscious action is constantly controlled bythe feed back mechanism.

That is, the brain constantly receives tactile, visualand auditory information and signals indicating themovement or position of the limbs or otherstructures.

The clutterers feedback mechanism seems toprovide less than normal conscious control.

If a typical clutterer, for instance reads a short text orperforms a simple task, only a few mins later hemight be unable to recall the context of what he hasread or the nature of what he has done.


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Unfortunately, determination of the normal rate of

speed presents considerable difficulties.

When the calculation is made, several factors will

have to be considered.

First, people in the south countries generally speak

at a faster rate than those in northern countries.

Second, the rural population generally speaks at aslower rate than the urban population.


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DRAWING & INTERJENCTION

The clutterers inability to find the words heneeds in sufficient time to maintain a smooth

flow of speech causes him to prolong vowels,

most often at the ends of words.


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Occasionally a clutterer will prolong a vowel at beginning of aword, in which case it would appear that the cause ofprolongation cannot be the quest for the same word.

On questioning clutterers, however, they find that when theyprolong the vowel at the beginning of word, they are in theprocess of searching for the next word before completingverbalization of the word they have begun.

This is consistent with the clutterers over acceleration of speechand disharmony of reading and verbalization rates when readingaloud.

He reads much faster than he verbalizes. The clutterers complainthat they often seemed to be ahead of themselves


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The frantic quest for the next word also causesclutters to interject single vowels as ah, consonantsuch as mm, articulatory combinations often thanahem, and words such as well and you know moreoften than normal speakers

Clutterers some times prolong the interjections(ah or mm) and remains unaware of theirpresence in his speech although his listeners findthem utterly tiresome.

As the Germans call these prolonged interjections.Gaxen or Staxen; the French liken them to thebraying of donkey; duer or dnonner.


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VOWEL STOP

Vowel stop consist of a stop before pronunciation ofthe initial vowel with the mouth open as if frightened.Early therapists considered vowel stop appearing in

conjuction with unimpaired ability to pronounce theinitial consonant to be one of the importantsymptoms of cluttering.

Liebmann considers it a decisive symptom in thedifferential diagnosis. It is especially common at thebeginning of a new phrase or sentence


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The essential difference between the stammerersspasmodic blocking and the clutterers simple vowelstop is the fact that the clutterer is that unaware ofhesitation and consequently does not develop afearful attitude toward the sound.

The stammerer stops as a result of phobic reaction

to a particular sound, whereas the clutterer stops asa result of his inability to find the necessary word,the clutterer rushes on his needless way.

Vowel stop is particularly common among mentallyretarded clutterers and is particularly a characteristicin speech of mongoloids.


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ARTICULATION AND MOTORDIASABILITY

Every investigator has noted the clutterers

poor articulation. It is characterized bysuperficiality and lack of precision, evenwhen the pacing of syllables is correct.Blandness and lack of expressiveness

characterize pronunciation paralleling, wemight say, the monotony of delivery.


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Many clutterers come for consultation with the

complaint: people say that they cannot understand

me and I dont know why.

Alber Liebmann specifies these deviations as: Omission of sounds, syllables and whole words (ellipsis)

Displacement of sounds (heterotopy)

Inversion of the order of sounds (metathesis)

Anticipation of sounds

Post position of sounds

Repetition of initial sounds and Telescoping of several syllables of a word


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Arnold and DeHirsch both noted that the clutterers poorarticulation is paralleled by poor motor performance in general,suggesting dyspraxia.

Seeman & Novak tested the articulatory ability of 52clutterers and 52 individuals whose speech was

normal. Age gender and intelligence were held consonant. The test

consisted of quick repetition of syllables pah and tah. Theperformance of the youngest subjects (ages 7-11) in each groupdid not differ. Clutterers over age 11 performed better thannormals over age 11. The investigator concluded that poor motor

skill is not the cause of poor articulation in cluttering.


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RESPIRATION

The clutterers jerky respiration and short

respiration span is to be noted.

Arnold says that respiratory dysrhythmia is

the cause for the clutterers jerky and

explosive speech


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Froeschels reported that before we speak we

automatically inhale an amount of air sufficient for

the length of sentences or phrase that we intend topronounce.

Clutterers attempt only short phrases and hence

must inhale more frequently.

Then often find them in embarrassing situation

because of inability to find the appropriate word,loss of the track of their thought,


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Jerkiness of delivery is the cause not seems to be

proved when they have succeeded in slowing the

clutterers delivery and inducing him to speak inlonger sentences, because they then noticed neither

dysrhythmia nor polypnea in their respiration.

Respiratory exercise fall into the category of

nonspecific measure that may form a favorable

foundation for the specific therapy for cluttering


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MONOTONY

Many therapists have recommended on themonotony and uniformity of the clutterers speechmelody pattern.

Scripture was the original investigator who reportedon the cause of this monotony, first in epileptics andthen in stammerers. He concluded that monotony ofspeech melody is related primarily to lack of musicalsense.

Arnold, Pearson, roman-Goldziener concurred


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Analysis of the clutterers speech melody andexamination of their speech curves by Arnold and byLuchsinger and Dubois indicated that in fact they donot lack variability in pitch.

There is a short melodic pattern confined to a rangeof only several notes of the scale. This pattern

repeated continually.

The clutterers speech, therefore, is notcharacterized by monotony in the strict sense of theword (one tone), but by continual repetition of short

melodic pattern. It is stereotype but not monotony inthe sense of unchanging pitch


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LACK OF RHYTHM AND MUSICAL ABILITY

Lack of rhythm in speech is one of the most readilynoticeable symptoms of cluttering.

(Colombat, Serre, Pearson, and others consideredit the very basis of cluttering).

The majority of the clutterers have difficulty both inperceiving and reproducing rhythmic.

However, there are clutterers with excellent sense ofrhythm and dysrhythymicspeech.


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L.Pearson administered the Drake Test forrhythmic ability and musical memory and the

seaslore test for recognition of rhythmicpattern to 36 clutterers.

The results indicated that expressivedysrhythymia is marked than receptivedysrhythymia.

She suggested that clutterers performexercises in rhythm.


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There are 2 categories of symptoms in cluttering:

a) symptoms which are always manifested and in

which diagnosis is made,

b) symptoms which sometimes manifested(faculatative symptoms).

There may be impairment of a facultative function

with excellent performance of closely relatedfacultative function.


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CONCENTRATION AND ATTENTION SPAN

Poor attention and concentration are the basic

symptomatic elements of cluttering (Hermann,

Gutzmann, 1893).

Attention span appears to be a function of

concentration and together they constitute the basis

of other symptoms of cluttering such as reading and

writing disorders because of this their memory isseverely limited


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POORLY INTEGRATED THOUGHT

PROCESS

Think ing too quick ly

Think ing too s low ly

Unorganized th ink ing

Inner language


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Thinking too quickly

The supposition that a clutterer thinks faster than heis able to speak.

Interpreting clutterer who has reached anarticulatory dead end because of what appears to

be an attempt to speak as quickly as he is thinking,and asking him to state his thought slowly andclearly found that he is still unable to proceed withfacility.

Either he has no clear thoughts to express, or hehas several indefinite and amorphous ideas.


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There fore it is not so much an accumulation

of thoughts that speeds him on, but vague

and tentative ideas.

Froschels calls these thoughts that are

unripe for speech.

Thesegerms of thoughtoccur to the

clutterer and he is driven to express theminstantaneously


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Thinking too slowly

If thought in preparation for verbalcommunication is conceived of as an orderlyprocess of clarifying ideas, then clutterers

think too slowly for a normal speed ofspeech.

In addition to the pause in search of concrete

thought for expression there are gaps whilethe clutterers search for a particular word.


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His limited knowledge of grammar also slow

his thinking, lack of accentuation, leaves long

words without integration, and these wordsare then misaccented, mispronounced,

misspelled, and often even misunderstood by

the clutterer himself.

The tachylalia rapidity of verbal utterance

manifested by many clutterers worsens theeffect of slow preparatory thought,


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Unorganized thinking

Poor intergrated and incomplete thought process,rather than the rate of speed of thought, is a factorin cluttering.

The clutterers haphazard and tentative thinking inperception for speech reflects his general approachto all understanding.

This is the basic characteristic of cluttering andhence one of the prime target of therapy.


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Inner language

The clutterer speech lacks this inner harmony one

of the basic characteristic of cluttering is a lack of

clarity of inner formulation and as a result delivery is

haphazard and studded with moment when the

clutterer seems to lose the thread of thoughtcompletely or forgets what he said or the next word

to be spoken.

Normal speech reflects inner order and cluttering in

the minor of inner disorder.


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The clutterers speech process however, is rather automaticperformance.

Clutterers seem to need to exert mental effort even to formulatethe idea of the sentence they are about to verbalize, where asnormal apparently perform this inner formulation withoutconscious effort, as a function of their predominant type ofimagery.

Even the most intelligent clutterers are apt to remarkspontaneously that they are often surprised by something theysay, being unaware of having entertained the thought beforesaying it in speech performed without the stabilizing effect

rendered by previous imagery of the act can be called abstractaction, as opposed to concrete action in which imagery isinvolved


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READING DISORDERS

One of the characteristic symptoms of

cluttering is reading disability.

Virtually all clutterers manifest a reading

problem and, such difficulties may occur as a

pathognomonic indication when certain othercircumstances make the diagnosis uncertain.


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The dyslexia of the clutterer may appear at all age levels.

In young clutterers, poor reading is a result of having learned toguess at the text; the root of the problem here is that certainletters of the alphabet have not been learned.

Speaking problems in reading and writing may persist throughand beyond the highest grade of school attended.

This is closely related to the clutterers lack of attention andresult in his ignorance of many words with high frequency usage.

In addition the clutterers read longer sentences in the very samemanner as they speak i.e. in short phrases. This causes him tolose the trend of thought.


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The clutterer, as a rule, does not actually read, heskips.

When he reads we may observe him trying toglimpse the end of the sentence before he hasreached the middle, or looking back at the beginning

because he has lost trend of thought.

There is generally not much repetition, even in oralreading; rather there are misreading in the sense ofprolepsis (anticipating a sound before it turns), postposition, and other seemingly pure articulationdeviations.


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WRITING DISORDER

The clutterers hand writing is a characteristic

of his generally reduced motor skill, his rather

formless imagination, and his disregard for

the reader.

Occasionally repetitions of his speech areseen in writing as well.


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Klara Roman-Goldzieher discusses the general

characteristics of the clutterers handwriting -

repetitiveness, frequent transposition or omissionsof letters and frequent revisions.

Cluttering errors in handwriting and even in

typewriting are pervasive enough to suggest thatthey are symptomatic of dysgraphia.

The clutterer is capable of much better performancewhen he focuses his attention upon the task.


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GRAMMATICAL DIFFICULTIES

The clutterers spoken grammar is also notoriously poor such as

confusion of him and her and the use of the singular when theplural is indicated.

total confusion in the structure of long sentences.

Clutterers lack of attention to speech results in poor memory ofcorrect grammatical usage.

Clutterer may forget how he started and so the grammaticalstructure of his sentence suffers.

The rather fuzzy thinking of the clutterer leads to a less thansatisfactory structuring of his sentences.


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UNAWARENESS OF SYMPTOMS

The typical clutterer is unaware of his speech disorder and may

even react with surprise when his attention is brought to theproblem. The clutterers unawareness of his speech difficulty is aspecific case of his general lack of self awareness

Speech as in action, the clutterer proceeds with suddenimpulsive spurts, uncontrolled by the smoothing influence of selfawareness or an appreciation of the needs of others.

Libermann suggested delimiting a subgroup of clutterers basedon perceptual difficulties. Froeschels suspected sensory aphasiain some cluttering children. Arnold considers the poor perceptiona severe aphasia like symptom which he calls perceptualdysgnosia


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RESTLESSNESS AND HYPERACTIVITY

The typical clutterer fidgets by day and is restless even while sleepingaccording to Seeman. Clutterer seems to be alert and interested in hissurroundings, but only fora short time, since his focus of interestchanges continually.

During interview they are apt to squirm in their chair, occasionallyassuming odd positions, to play with objects on the desk.

This activity appears to be the outcome of a motor drive, which wouldalso account for the tachylalia and compulsive talkativeness.

There are many cases of proven lesions of the basal ganglia withrestlessness of this sort.


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The Seeman School assumes that

submicroscopical lesion in this area the

cause of the clutterers hyperactivity.

The clutterers are not aware of his

restlessness, but if it is brought to his

attention, he will exert effort to control it.


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PSYCHOLOGY OF THE CLUTTERER

Klencke characterizes clutterers as carefree,careless, and lacking in persistence and sense ofresponsibility

Pleasant temperament

Lifes problem very seriously

Short attention span

Overactive Change their mind frequently

Child like behavior reactions

Th P li f h Cl


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The Personal i ty o f the Clutterer

Pure s tutterers Pure clu t tererstimed aggressive

restricted expansive

regressed extroverts

introspective impulsive

compulsive uncontrolled

over inhibited hasty

hesitant over productive

retarded


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Weiss generalized typical differences between

clutterers and stutterers

CLUTTERING STUTTERING


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CLUTTERING STUTTERING

Awareness of disorder

Speaking under stress

In relaxed position

Calling attention to

speech

Speaking after

interruption

Short answer

Foreign language

Reading well known text

Reading unknown text

Hand writing

Attitude toward own

speech, psychological

attitude

Goal of therapy

Absent

Better

Worse

Better

Better

Better

Worse

Better

Better, hasty, repetitionsCareless, outgoing

Directing attention to

speech details

Present

Worse

Better

Worse

Worse

Worse

Better

Worse

contracted, forcedFearful, rather withdrawn

Directing attention from

details


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Differential diagnosis between cluttering

& stuttering

l t t i t t t i


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clut ter ing stut ter ing

Client is unaware of the dysfluencies

Fluent when concentrating on the fluency

Spontaneous speech less fluent

Strangers more fluent

Verbalization are less diff to control

Fear of specific sound or situation is not

present

Relaxed situation more pblm

Prognosis is better never relapse Prognosis is better but relapse

seen

Occurs only at childhood Childhood or adulthood

Taking chloropromazine drug improves

speech

Becomes worse

ASSESSMENT OF CLUTTERING


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ASSESSMENT OF CLUTTERING

Several principles are held to be particularly helpful in theassessment of clutterers

They should be assessed for entire communication systemincluding language, rate, articulation and fluency

Need to assess the nature of the reaction between the variouscomponent of communication system is important.

Since some clutterers may also exhibit perceptual motor andlearning difficulties assessment should be broadly based to

include neuro psychological testing


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Strategies for assessment

Language sample and formal testing

Analysis of language sample should seek to answer a

number of question regarding aspects of the clients

fluency, language, rate and articulation.

There should be notations regarding non verbal speech

behavior

Based on the information from the language sample, theclinician selects assessment tools which provides a more

structured and standardized means of evaluation.


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Some diagnost ic quest ions to consider

Selected diagnostic questions will be organizedaround the major components of speech andlanguage system, each query attempts to tap acomponent from a slightly different point to extractadditional insight regarding therapy implication

Fluency

Rate and rhythm

Articulation

Language Neuropsychological testing

Self awareness


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Case history and interview

Some important information can be extracted from the

case history and interview with the client and family

Other members of the family have speech and

language problem similar to those of the client

Interaction between client and family members,

how it is at home, work, school etc. Attempt to compensate for the problem


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According to Jayaram and Savithri 1993assessment for cluttering includes collection of aspeech sample of about 4min talking time andaudiotape recorded at the clinic.

A suitable picture storage chart can be used tocollect the required sample.

The speech sample should be analyzed for thefollowing.

Speaking rate in terms of syllables per minute.


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A majority of the normal speakers speak at a

rate of about 260 to 320 syllables per minute

their first language (speech reduce by 10-15percentage from their level while speaking in

foreign language) and the fastest speakers

among them speak about 350-400 syllablesper minute.

The utterance speed of clutterers should bemore than this.(ISHA Monograph)


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Variation in speaking rate from the initial sentence to the finalsentence of the discourse.

2 types of measures can be made for this

Within a sentence where successive three word group can beused for memory speaking rate in 4 sentences selected atrandom.

For ex: in a sentence of ten words like there (1) are(2)many(3)varying(4)approaches(5)to(6)the(7)treatment(8)of(9)cluttering(10), rate of utterances of word groups 1-3,2-4,3-6etccan be computed.

Festination if present should be evident in the rate ofutterances in the succeeding sequences in comparison to theearlier word groups.


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Between the sentences - where rate of

utterance is compared with the rate of

utterance of the succeeding sentence and iffestination is present, it should be reflected in

an increased rate from sentence to sentence.

A speech sample of five sentences of 10 to

15 words can be analyzed for this.


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The spontaneous speech sample should be analyzed forarticulatory deviation and particularly for omission ofsyllables and whole words.

Darley and Burnet 1996: their standard evaluation forassessing cluterrer includes measures of

Persons automatic speech (such as counting andnaming days of the week)

Echoic speech (repeating monosyllabic and polysyllabicwords phrases and sentences).

Oral reading and spontaneous speech

Oral diadochokinetic skills Written expression


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Stimulus/task used

Procedures and stimulus material used for theassessment of cluttering are

Articulation test

Reading passages

Speech and language sampling comparison

Sound errors from an articulation test and connectedspeech

Evaluating rate of speech

Determining intelligibility

Diadochokinetic syllable rate work sheet


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Dalys checklist for possible cluttering

Dally 1981 gave a checklist which includes 33 items

This 33 item check list presents features that numerous clinicalresearches believe as indicative of cluttering.

The interviewer questions client or parent and then records the extentto which each statement is judged to be true for the client. Each item istreated thoroughly. A total of 99 points possible on the checklist.

A score of 60 or above is usually sufficient to support a diagnosis ofcluttering. Scores between 39 and 60 maybe indicative of a clutterer-

stutterer.


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Several items on the checklist appear to be more criticalfor diagnosing.

Repetition (syllables, word, phrases) Onset of speech (word and sentences)

Fluency disruptions (more emissions, never very fluent)

Disorganized speech (confused wording)

Silent gaps or hesitations, interjections Stops before saying initial vowel, no tension drawn out

vowel.

Rate of speech (tachylalia, speaking spurts)

Extrovert

Jerky breathing pattern, respiratory disrhytmia Slurred articulation, mispronunciation of r, l and sibilants


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Speech better under pressure and during short periodsof heightened attention

Difficulty following directions

Distractible, attention span problems poor concentration

Story telling difficulty

Demonstrates word finding difficulties

Inappropriate reference

Improper language structure

Clumsy and uncoordinated

Reading disability

Poor motor control


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Transposition of letters and words in writing

Left right confusion

Initial loud voice Seems to think faster than he can talk or write

Above average in mathematical and abstract reasoningabilities

Poor rhythm

Improper stress pattern of speech

Peers younger than age: small or immature

Other family members with same problem

Careless

Untidy

Hasty

Lack of self awareness


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Rating

0 - not at all

1 - Just a little

2 - Pretty much

3 - Very much


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Computer Aided Assessment of ClutteringSeverity*

By Klaas Bakker (Missouri, USA), Kenneth O. St. Louis(West Virginia, USA) and Florence Myers and LawrenceJ. Raphael (New York, USA)

It is a software tool for the perceptual assessment ofaspects of cluttering severity. While immediately helpfulin assessing cluttering severity in one's clients, the tool isalso stated to be researched in the light of possible

adoption as an assessment instrument in support ofevidence based practice.


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The Program :

The quant i f ied assessment po rt ion:

This tool consists of a dual event-duration counter/timer designed for

the assessment of frequency and duration related aspects of

cluttering severity.

It helps determine how often one clutters, and to what degree one's

speech is affected by cluttering in a durational sense.

In addition to these counter/timers is a third timer which works like a

stopwatch and reflects overall sample duration.


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The middle counter/timer (controlled with the left mouse button)tracks number and duration of speaking intervals (regardless ifcluttering is present or absent from the sample).

A third counter/timer (right mouse button) is used for trackingnumber and durations of intervals during which cluttering isperceived by the clinician.

If the cluttering counter/timer is pressed by itself by mistake, withoutalso pressing the speech counter/timer, this will be automaticallyconsidered speaking time in the calculations as well.

Computed results are available each time when a session isstopped, or paused.


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The quali tat ive assessm ent port ion

The visual analog scoring portion of the program allowsa user to provide ratings on the following dimensions ofcluttering: speaking rate, rate regularity, disfluency,syllable production integrity, overall articulation accuracy,naturalness, pragmatic language appropriateness,

language coherence, and thought organization. As canbe seen in Figure the procedure expects the user tomark a rating by clicking at the appropriate part of ascoring bar.

This leaves a mark that may still be adjusted by clickingat a new location if so desired.


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After a rating is provided the computer calculates thepercentage that corresponds with the relative location ofthe mark on the scoring bar.

At the same time this score is recalculated to match the9-point rating procedure such as typically used in speechnaturalness ratings (That is, perceptual rating scales with

1 as the most natural and 9 as the least naturallysounding speech).

Figure 1. Example of the quantified scoring tool, withonline cluttering severity ratings, among which thepercent talking time cluttered discussed in the text.


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THERAPY


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Treatment

Clutterer is inattentive to the details of speech

process and heedless of their speech ingeneral.

S f C


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Suggestions for Treating Cluttering

A handout by David A. Daly, University of Michigan, froma workshop on Cluttering, reproduced below withpermission, May 6, 1997.

Weiss (1964) contends that cluttering is the "motherload" of stuttering. He believes that in most cases, thechild's stuttering began with cluttering.

Early literature reports a poor prognosis for clutterers,however, success has been reported using varioustechniques and strategies.

F lf M t l tt f th i


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1. Focus on self-awareness. Most clutterers are unaware of theirrepetitions deletions, and transpositions. Audiotape and videotapethem to teach self monitoring. A patient, but direct clinician isneeded.

2. Tachylalia is not obligatory for cluttering diagnosis, but it iscommon. Instructions to "slow down" are worthless. Try fingertapping to teach syllable stress. Model desired behavior. Clinicianmust slow rate too.

3. Froeschels (1946) recommended reading aloud one word at atime. Placing a cover sheet with a hole over the page to revealone word at a time is suggested to help the clutterer focus.

4. Test for articulation errors and dyslalia is common. We have useda delayed feedback machine to help cluttering clients "over-articulate" their slower rate of speech. Encourage client to "feel"tactile cues.

Poor memory abilities are common in cluttering. Practice telling andretelling stories trying to include more and more details. Use


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retelling stories trying to include more and more details. Usesequence picture cards if necessary. Such abilities can beenhanced.

Relaxation and visual imagery exercises may be useful for reducingimpulsivity and distractibility. Attention deficits are common.Auditory comprehension activities found useful for learningdisabled students or aphasic adults may be most appropriate forcluttering clients.

Some clutterers have motor coordination, rhythm, and speech melodyimpairments. Exaggerating various rhythmic patterns and speechprosodic patterns may be helpful. E.g., some clutterers show verymonotonous voice patterns-vary their prosody-change the stresspattern. We use exaggeration as auditory imperceptiveness isusually present.

Reading and writing difficulties are typical. Authorities recommendteaching cursive writing not printing. Help clients write a oneparagraph story. Assistance may be needed to follow a train ofthought. Reinforce generously. Read and discuss the "story."


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Then try for a one page story. Patience and persistence

are needed. Examination of written work will help

clinicians understand the clutterer's language confusion.

Cluttering therapy according to Weiss 1964 should

focus on

Speed

Reading

Vocabulary and formulation

Attention span and concentration

Treatment of concurrent problems

S


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Speed

Syllabication:it consists of requiring the patient tospeak in slowly pronounced syllables, giving eachsyllable an equal time allotment.

The disadvantage of this method is that it results in alifeless manner of speech. However it a usefuldemonstration to the patient of the degree to which hedeviates from the normal speed of speaking.

Therefore it is a practical way of beginning treatmentwhen excessive speed of delivery is the prime difficulty.

Rh thmical taping


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Rhythmical taping

It is a reinforcement of the syllabication exercise, allowing the

patient greater control of his speed of delivery.

There maybe difficulty at first in co coordinating this spoken syllablewith the tapping exemplifying the typical clutterers difficulty inintegrating various simultaneous activities.

When co ordination of syllabised speaking and simultaneoustapping has been achieved, then reading aloud maybe attempted.

Following this we proceed to spontaneous speaking, first in shortsentences, in answer to simple question and then longerconversational sequences.

R di


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Reading

Poor speech habits seem to be primary cause of poorreading

Letter reading Froschels (1931) proposed this technique the clutterers

is made to read through a paper shield in which there isa hole, the size of a single letter to the patient moves thepaper slowly access the line, he sees one letter at a timeand in forced to concentrate his full attention on it.

Ph ti iti


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Phonetic writing

Froschels advocated the use of simple and ingeniousform of phonetic writing.

It can be learned speedily but cannot be read quickly.

The alphabet is based on the anatomical positions ofthe articulatory organs during the pronunciation of thevarious sounds.

Due to its naturalness and simplicity, patient consideredit a game and recites it with enthusiasm.

Reading backwards: the patient reads a text backwards


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Reading backwards:the patient reads a text backwardsnot omitting any letter or word. Depending upon theparticular language, he may read literally as syllabically,

but he must omit nothing.

Copying and reading aloud

The patient is required to copy a text and to pronounceeach syllable simultaneously while writing it. This

procedure may appear to be clumsy, but it has severaladvantages.

First the patient must sit attentively or he will not be ableto copy the text

Second the process of writing makes him more aware of

correct spelling Third speech is considerably slowed.


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Rhythm

Arnold has advocated systematic rhythmical exercises

which consist of recognizing and repeating simple thenprogressively more complicated structures.

Accentuation

Exaggerated accentuation consist of placing anexaggerated stress on every accentuated syllable, Brad-ford used simple verses as a material for this exerciseand recited in unison with the patient, she had thepatient tap on the accented syllables. This exercise has

the advantage that it is less artificial and more natural.



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Reading

The clutterers in attentiveness to his own speech as well as to otherslead to large gaps in his vocabulary. All reading exercises probablycontribute to increasing that vocabulary. Attentive reading tends tocorrect the spoken sentences.

The attempt to recognize the correct spelling and accentuation oflesser known words in the dictionary is helpful and should becomecommon practice, reading should be done aloud, slowly and wellaccentuated and thus contributing also to the regulation of verbaldelivery in general.


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Reciting poems

Repetition of stories

Rehearsals

Attent ion span and concentrat ion


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Attent ion span and concentrat ion

Counting backward

It requires some amount of concentration, unlike counting forwardwhich is an automatic procedure.

Somewhat more concentration is required in regressive counting.

To make the exercise difficult we can combine 2 numbers. Thisexercise is very demanding, both concentration and of attention span.

It should be understood that these exercises in counting backwards areonly a sample what can be done to improve the inconsistentperformance of the clutterer.

T t t f t bl


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Treatment of concurrent problems

Dyslalia

While treating dyslalia the patient must pay close

attention to his articulation and hence and his delivery is

slowed

Voice problems

In case of cluttering and co existing voice problems the

cluttering should be treated first.

Tachylalia


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Tachylalia

Chewing helps in reducing the rate of speech and also in treatingspeech and voice difficulties due to pathological concentration oncertain details of phonation, when efforts to concentrate on thedetails of speech have overshot their mark, the chewing methodconstitute a strong corrective in relaxing the patients speech.

The patient is best introduced to the chewing method in the followingmanner: After explaining to him that we can exhale soundlessly (aswe do normally) and also with vocalization we ask to exhale bothways in a relaxed and natural manner. Next we ask the patient to

imagine that he has some thing such as apple in his mouth and tochew it and is again asked to exhale sonorously(with sound as insigning) to chew slowly, we ask him to speak, read or singprogressively complicated material, always keeping chewing inmind.

Metacommunication therapy


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Metacommunication therapy

2 of the weakest links in the communication chain forsevere clutterers are poor language formulation skillsand poor self monitoring of the speech and languageoutput.

Metacommunication therapy can establish a solidworking relationship between clinician and client.

Part of the clinicians agenda is to persuade the client,

through metacommunication therapy and the need forthe therapy.

Increasing clients awareness


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Increasing client s awareness

Counselling and attitude change

Relaxation and mental imagery

Positive self talk and affirmation exercises

Maintain daily routine

Pharmacotherapy


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Pharmacotherapy

Symptoms of cluttering can also be pharmacologically influenced, in thefirst place by means of narcoleptics (chlorpromazine, chlorprotixen,thirodiazine).

This effect is described especially to the inhibition of reticular formation,

which increase the activity and accelerate the motoric and thinkingdynamics, some times even to the point of pathological events .

Cluttering in patients who started clinical treatments and in whom anincreased speech rate and psychomotoric unrest where found isimmediately treated with narcoleptics.

Also this treatment is combined with medium long effect barbiturates.

THANK YOU


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THANK YOU

THEORETICAL PERSPECTIVES IN CLUTTERING, FAST RATE OF SPEECH.pdf / KUNNAMPALLIL GEJO JOHN

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