Professional Documents
Culture Documents
SPHY304 2021 Lecture 2 Slides 3pp
SPHY304 2021 Lecture 2 Slides 3pp
SPHY304 2021 Lecture 2 Slides 3pp
SPHY304: Fluency
Disorders Across
the Lifespan
Week 2
Using evidence-based practice to guide
assessment
Measuring stuttering and its impact
Early Intervention: when do I treat? Dr Michelle Donaghy
Michelle Donaghy
1
22/07/2021
Michelle Donaghy
Michelle Donaghy
External evidence:
Scientific Rigour,
Research
NB: There is an E4BP – 4th consideration is clinical expertise ‘Are you trained to carry out this Tx?’☺
Michelle Donaghy
2
22/07/2021
Michelle Donaghy
Michelle Donaghy
Stuttering:
ICF and E3BP
Let's use the External evidence to guide our
questions about.....
Internal evidence....
• What is the impairment? (body functions and
structures)
• How does this impact on activity? (limitations)
Patient preference ...
• How does this impact on the
PWS’ participation?
• Do your goals also impact on the
child’s activity and participation?
• How will you measure/assess progress in
all areas?
Michelle Donaghy
3
22/07/2021
Michelle Donaghy
10
Michelle Donaghy
11
Michelle Donaghy
12
4
22/07/2021
Michelle Donaghy
13
Michelle Donaghy
14
15
5
22/07/2021
Michelle Donaghy
16
Stuttering,
ICF, and E3BP
Internal evidence....
• What is the impairment? (body functions
and structures)
• How does this impact on activity?
(limitations)
Patient preference ...
• How does this impact on the
PWS’ participation?
• Do your goals also impact on the
child’s activity and participation?
• How will you measure/assess progress in
all areas?
Michelle Donaghy
17
Michelle Donaghy
18
6
22/07/2021
Michelle Donaghy
19
Michelle Donaghy
20
2. Measurement:
Severity, Frequency, Impact
Michelle Donaghy
21
7
22/07/2021
Michelle Donaghy
22
Parent SR
Chart
Lidcombe
Program
Michelle Donaghy
23
Michelle Donaghy
24
8
22/07/2021
Michelle Donaghy
25
Michelle Donaghy
26
Measurement in Practice
• Check with parent what they would normally rate
their child’s stuttering from 0-9 (as in SRs)
• Observe types of stutters
• Take SR in initial conversation (& %SS for >300
syllables – optional)
• Take a baseline SR/SEV at the beginning of
every clinic visit
Michelle Donaghy
27
9
22/07/2021
Measurement in Practice
• Obtain beyond clinic recordings (optional but
handy!)
• Take a baseline SR/SEV at the beginning of
every visit
• Discuss baseline SR/SEV with parent/PWS
GOAL: Take a baseline SR/SEV at the beginning of every visit
Take a baseline SR/SEV at the beginning of every visit
Take a baseline SR/SEV at the beginning of every visit
Michelle Donaghy
28
Michelle Donaghy
29
Michelle Donaghy
30
10
22/07/2021
Michelle Donaghy
31
Michelle Donaghy
32
Michelle Donaghy
33
11
22/07/2021
SR Practice
• Hurdle Task
• SRs and Identify Types of Stutters (MCQ)
Practice with a Friend…
Google ‘Stuttering’ ‘Stammering’
(or ‘Stottern’ [German]; ‘Bégaiement’ [French])
• Identify stutters and rate with a friend or group
Michelle Donaghy
34
Michelle Donaghy
35
Michelle Donaghy
36
12
22/07/2021
Michelle Donaghy
37
%SS ACTIVITY!!
Count Syllables:
Ask a family member/housemate what they had for
breakfast.
Take a count of the number of syllables they
produced.
Did you notice any normal disfluencies?
- Interjections
- Repetitions
- Hesitations
Michelle Donaghy
38
Michelle Donaghy
39
13
22/07/2021
PROS continued
• Easy for clients to understand (but not to use!)
• Can compare differences between contexts
• Inter-rater reliability for experienced judges
• Inter-rater reliability increases if intra-rater reliability
is good (Cordes, 1994)
Michelle Donaghy
40
Michelle Donaghy
41
Michelle Donaghy
42
14
22/07/2021
Michelle Donaghy
43
Michelle Donaghy
44
Michelle Donaghy
45
15
22/07/2021
Michelle Donaghy
46
Michelle Donaghy
47
Other Measures
• %WS & WPM - percentage of words
stuttered/words per minute
• SMST – Stutters per Minute of Speaking Time
The future...neurophysiologocial measures?
(Cordes, 2004)
Michelle Donaghy
48
16
22/07/2021
Other Considerations……
• Making a judgement:
✓Unambiguous stuttering (when in doubt, leave it out!!)
✓Avoidance strategies by the PWS/CWS?
Michelle Donaghy
49
Michelle Donaghy
50
Michelle Donaghy
51
17
22/07/2021
Michelle Donaghy
52
Michelle Donaghy
53
Michelle Donaghy
54
18
22/07/2021
55
CONS
• Cost (manual and test forms)
• Time to complete (100 items)
• Measurement of stuttering severity/frequency
still required
https://hrcc.cas.msu.edu/throwback-thursdays/overall-
stuttering.pdf
https://www.stutteringtherapyresources.com/pages/oases
Michelle Donaghy
56
Canadian Occupational
Performance Measure (COPM)
• An Occupational Therapy tool.
• 'Occupation performance problem' being...
What someone wants to do, or is expected to do
but can't do, doesn't do or isn't satisfied with the way
they do
Assess by semi structured interview to determine:
• Defining the problem
• Client evaluation of performance (1-10)
• Client satifaction of performance (1-10)
Michelle Donaghy
57
19
22/07/2021
Michelle Donaghy
58
Canadian Occupational
Performance Measure (COPM)
CONs:
• While used in Speech Pathology, it has not been
tested in SP
• Useful as a measure of progress in functioning and
participation, does not measure severity of
stuttering in all contexts
Michelle Donaghy
59
Michelle Donaghy
60
20
22/07/2021
Reporting – Descriptors
Mild – Moderate - Severe
QUESTION:
Parent: How impaired is my child?
Michelle Donaghy
61
Reporting – Descriptors
Mild – Moderate - Severe
ANSWER:
- Consider severity (SR/SEV) and take into account
frequency if a reliable count (%SS) and you have
noted the context
- How much would a naïve listener would notice
the stutter?
- How much is the stutter affecting communication?
Michelle Donaghy
62
Reporting – Descriptors
Mild – Moderate - Severe
Onslow (2021)
SR0 = No stuttering
SR1 = extremely mild
SR2-3 = mild
SR4-5 = moderate
SR6-7 = severe
SR8-9 = extremely severe
Michelle Donaghy
63
21
22/07/2021
Reporting – Descriptors
Mild – Moderate - Severe
Guitar (2014)
Michelle Donaghy
64
4a.
Treat or
Monitor?
When should we start
treatment?
Michelle Donaghy
65
• Family Hx of stuttering
• Developmental History
• Communication History
• Consider speech and language skills - assess more
formally if concerned
• How close is the child to school age?
Michelle Donaghy
66
22
22/07/2021
Michelle Donaghy
67
Michelle Donaghy
68
Other Considerations
Observe the child’s behaviour:
• Are they very chatty?
• Are they reticent to initiate conversation?
Barriers to treatment:
• Financial
• Time
• Ability to attend the clinic
Michelle Donaghy
69
23
22/07/2021
What next?
• Be prepared for Case Studies in your Skills
Class….and….
Duh duh DUHHHHHH….
PEER
SIMULATION
But first…do the Week 2 Quiz
Michelle Donaghy
70
Michelle Donaghy
71
Some Bizarre
examples of Non-EBP in Stuttering
• Pebbles (Demosthenes)
• Burning coal helped Moses (The Talmud)
• Changes in diet, reduced lovemaking - in men
only; and purging (Hyronymus Mercurialis)
• Drink water from a snail shell all your life
(Cameroon)
72 Michelle Donaghy
72
24
22/07/2021
Michelle Donaghy
73
NHMRC, (2009)
Michelle Donaghy
74
Michelle Donaghy
75
25
22/07/2021
Mandatory Reading:
The Lidcombe Program Guide
Michelle Donaghy
76
26