This is a sudden or gradual development of stuttering as result of neurologic injury. Typically first identified post-puberty Although the prevalence is low, its not uncommon for clinicians to see this. More often reported in males than females. Onset varies from sudden and immediate, to gradual after months. Similar to developmental stuttering in that it causes communication problem. Understanding this type of stuttering has potential to inform developmental stuttering. Ultimately, a fluency disorder with some common characteristics but many individual differences Etiology plays important role. Assessment and intervention may be trial & error with support coming from case reports with similarities to your patient. Acquired neurogenic stuttering etiologies 1) CVA 2) Degenerative disease 3) Head trauma
Canter's (1971) subtypes of acquired
neurogenic stuttering speech characteristics 1) Dysarthric 2) Apraxic 3) Dysnomic Canter's (1971) criteria for differential diagnosis of acquired neurogenic stuttering from other types of disfluencies 1) Repetitions & prolongations on final consonants (e.g, make-k-k-k) 2) Stuttering occurring mostly on /r/, /l/, and /h/ 3) Not systematically related to grammatical structure/ function 4) Disfluencies inversely related to propositionality 5) Absence of adaptation effect 6) Absence of marked anxiety 7) Absence of secondary behaviors Helms-Estabrooks (1993) criteria for differential diagnosis of acquired neurogenic stuttering from psychogenic stuttering 1) Disfluencies occur on function and content words with equal frequency 2) Speaker annoyed but not anxious 3) Repetitions, prolongations, blocks do not occur only on initial syllables 4) Secondary symptoms are not associated with moments of stuttering 5) No adaptation effect 6) Stuttering consistent across speech tasks. Secondary behaviors and acquired neurogenic stuttering
There are inconsistent in literature re: acquired
neurogenic stuttering Many careful clinical cases comment on lack of these Some hint at relationship between severity and these Attitudes and emotions There is little systematic research on psychological effects of acquired neurogenic stuttering and this Canter and Helms-Estabrooks both suggested that the acquired neurogenic stutterer might be annoyed, but these components may be lacking Few reports of reactions, particularly head trauma Using speech attitude test with 12 neurogenic stutterers, Jokel & De Nil report similar scores to developmental stutterers, suggesting specific reactions to speech situations, without overtly observed reactions of these Assessment of acquired neurogenic stuttering Frequency and type of disfluencies across various settings and speaking conditions Propositional speech compared to automatic Influence of fluency enhancing techniques Other speech, lang, cog, sensorimotor abilities
Treatment types of acquired neurogenic
stuttering 1) Behavioral fluency tx-case studies report change 2) Delayed auditory feedback - effective in reducing stuttering in specific condition, but no generalization and return to pre-tx levels over time 3) Drug tx - case reports of positive effects using anti- convulsants, pain med, anti-anxiety 4) Surgical intervention- (study: 4 patients with adult-onset stuttering used stimulation of thalamus; resulted in elimination of stutter in 2, significant reduction in 2)