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Acquired Neurogenic Stuttering

Major type of disfluency


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)