The Cooke Book Approach

Individualizing Therapeutic Procedures for People who Stutter

MSHA Conference - March 23, 2013

Presented by: Paul Cooke, Ph.D.Michigan State University

Contacts: email - cooke@msu.edu phone: 517-353-8788

Learning Outcomes

• Identify therapy principles and strategies

• Identify 2 examples from each principle/strategy

• Identify the decision making process to individualize therapy for people who stutter

• Work through several examples of this process

Unofficial Learning Outcome

Identify aspects from this presentation that are useful for other clients on your caseload

Underlying Principles

• Clients are people with particular conditions• Various factors contribute to those conditions• Variability of current and previous behaviors• Holistic approach (NOT one size fits all)• Each client is a clinical research subject of 1• Many techniques, narrow them down to fit

the needs of the client

Goals for Therapy

• Client moves to the next communication level• Increase probability of improving communication

in meaningful speaking situations• Increase probability of client becoming their own clinician• Increase client’s control of speaking situations• Decrease the adverse influence of the condition

Keys to Clients Moving Toward Those Goals

• Clinician-Client relationship built on trust: empathy self-congruence unconditional positive regard

• Empowerment• Motivation• Therapy Format• Therapy Principles • Decisions to individualize therapy program

Fundamental Concepts

• Every stuttering episode – excessive energy

• Speech is a complex motor skill

• Client can only implement 1-2 concepts

Therapeutic Categories

• Environmental Changes• Fluency Shaping• Stuttering Modification• Stress Management• Transfer and Maintenance• Attitude Adjustments

Environmental Changes

• Improve communication skills• Use child-directed speech• Be a parent• Emphasize client’s strengths• Forward looking, not past blame/regrets• Encourage communication• Balanced reactions to difficulties• Make talking fun• Transition times

Fluency Shaping Techniques

• Smooth vs. Bumpy Speech• Diaphragmatic Breathing/Shorter Breath Group• Stretched/Prolong Speech• Easy Onset• Continuous Voicing• Light Contact• Passive Airflow• Exaggerated Movement• Mouth the words/Add Voicing• Focus on Word Endings/Say all Syllables• Electronic Devices

Stuttering Modification Techniques

• Reduce Secondary Behaviors• Reduce Muscular Tension: Pull Out/Bounce• Control Stuttering • Preparatory Sets• Reduce Avoiding Behaviors

Stress Management Strategies

• Stress Reduction Before Speaking• Stress Reduction During Speaking• Feeling Rushed/Pressured – Use the Flam• Dealing with non-changeable information• Dealing with the telephone• Dealing with oral presentations• Time Management Strategies

Transfer and Maintenance

• 1-2 key concepts at a time• Get off to a good start• Start small• Start big• Integration of practice into everyday activities• Next level as a communicator: SMART goals• Using Tactile, Visual, and Auditory Prompts• Improving Pragmatics Skills

Attitude Adjustments

• Paradigm Shift: changing a hub to a spoke • Acceptance• Assist others• Teasing/bullying• Positive self-talk• Locus of control• Proactive communicator• Journaling/Drawing/Converse with pets

Individualizing Therapy Plans

• My examples

• Youtube examples

• Audience examples

Summary and Conclusions

Review Learning Outcomes & Unofficial Learning Outcome

• Identify therapy principles and strategies

• Identify 2 examples from each principle/strategy

• Identify the decision making process to individualize therapy for PWS

• Work through several examples of this process

• Identify aspects from this presentation that are useful for other clients on your caseload