راهکارهای درمانی خاص در درمان لکنت زبان کلینیک تخصصی لکنت کرج شهرک خاتم الانبیا- ورودی شهرک
be collected on the extent of each moment of stuttering; for example, the length of blocks, number of repetitions. (We return to this last issue in the section on fluency counts below.)
Syllables or words?
As far as the total count is concerned, a fundamental decision as to whether to work with words or syllables needs to be made. Inter-rater reliability in counting both words and syllables can be high (Ingham & Packman, 1999) when practised, although inter-clinic reliability can be a significant problem, as we will come to see. There is now an increasing trend toward using syllable counts which many clinicians and researchers believe to be more accurate.
For example, syllable counts compensate for the possibility of artificial differ-ences in speech rate arising between speakers who use more multisyllabic words, and whose rate might appear slower simply because these take longer to produce than monosyllabic words. It also allows for the possibility of stuttering more than once on the same word. Once the clinician has made this decision, the next concerns what is chosen to be counted as stuttered.
Stuttering vs normal disfluency
This is a crucial but difficult area. In undertaking any analysis of the motoric disruptions seen in stuttering, clinicians need to distinguish what Yairi (1997) terms “stuttering-like disfluencies” (SLDs) from normal disfluencies (NDs). It is not always possible to categorically define certain disfluencies as either SLDs or NDs, but we know that certain types of disfluencies are more char¬acteristic of stuttering than others. Normal disfluencies tend to be character¬ized by pauses, interjections and revisions (Yairi, 1997) while part-word and monosyllabic word repetitions when repeated once are common amongst 2- to 4-year-old children, and even multiple repetitions if shown infrequently need not be cause for concern. However, more consistent multiple repetitions are considered SLDs, and place the child at risk of stuttering, particularly if repetitions lack even rhythm and are at an