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
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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
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Environmental Changes
Fluency Shaping
Stuttering Modification
Stress Management
Transfer and Maintenance
Attitude Adjustments
Environmental Changes
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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
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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
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Reduce Secondary Behaviors
Reduce Muscular Tension: Pull Out/Bounce
Control Stuttering
Preparatory Sets
Reduce Avoiding Behaviors
Stress Management Strategies
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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
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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
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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