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From: Luc De Nil
Date: 10 Oct 2007
Time: 21:03:10 -0500
Remote Name: 24.197.196.252
You are absolutely right! the main concern of all clinicians is how to provide the best possible treatment. This can be especially challenging in neurogenic stuttering as patients often present with many complicating problems. One approach, of course, is to understand the cause and development of neurogenic stuttering better. If the disorder remains a bit of a mystery, it will be difficult if not impossible to find effective treatments. That is, of course, spoken as a researcher. From clinical experience, I find that the patient often will tell you herself (or himself) what the best approach will be. For some patients, their stuttering may not be all that critical given the fact that they have problems just simply expressing themselves as a result of aphasia, dyarthria or other cognitive problems. In that case, I would say forget the stuttering for now and focus on the other problems. However, for some patients, their stuttering becomes the focus of their attention even though they may have other problems that we as clinicians consider more pressing. In that case, I find that you have to engage the patient in finding an appropriate balance between working on the stuttering and the other cognitive or communication problems. When working on stuttering, I would always start with traditional fluency treatment (typically a combination of fluency shaping and working on perceptions, identification of stuttering, and attitudes). For some this works really well, for others it does not seem to do the trick in treatment and other options need to be explored. What those other options are is still very much trial and error at the moment. They may include fluency enhancing devices (e.g., DAF), medication, AAC approaches (e.g., pacing boards), etc.