WEBVTT Kind: captions; language: en-us NOTE Treffsikkerhet: 80% (H?Y) 00:00:01.400 --> 00:00:09.900 and now we talked about how the ICF can be a framework for assessing a disorder but I was also 00:00:09.900 --> 00:00:19.200 thinking about and discussing other aspects of the ICF can can be used and then NOTE Treffsikkerhet: 91% (H?Y) 00:00:19.200 --> 00:00:22.750 when it comes to defining a disorder NOTE Treffsikkerhet: 84% (H?Y) 00:00:22.750 --> 00:00:30.800 I find it very interesting how different Frameworks and mindsets can affect what how you actually 00:00:30.800 --> 00:00:44.700 define disorders and start stuttering is defined by WHO in this quote here and it says 00:00:44.700 --> 00:00:51.800 developmental speech fluency disorder is characterized by persistent and frequent or pervasive 00:00:51.800 --> 00:00:53.000 disruption NOTE Treffsikkerhet: 91% (H?Y) 00:00:53.000 --> 00:01:00.700 the rhythmic flow of speech that arises during the developmental period and is outside the 00:01:00.700 --> 00:01:08.900 limits of normal variation expected for age and level of intellectual functioning and results in 00:01:08.900 --> 00:01:17.500 reduced intelligibility and significantly affects communication, can involve repetitions of sounds 00:01:17.500 --> 00:01:22.950 syllables or words prolongations, word breaks, blockage of NOTE Treffsikkerhet: 75% (MEDIUM) 00:01:22.950 --> 00:01:33.600 production, excessive use of rejections, and rapid short bursts of speech NOTE Treffsikkerhet: 91% (H?Y) 00:01:33.700 --> 00:01:38.800 so this is that this definition that NOTE Treffsikkerhet: 91% (H?Y) 00:01:39.700 --> 00:01:49.200 that focuses on what's above the surface if you remember the iceberg so what we can hear what the 00:01:49.200 --> 00:01:58.300 listener hears when he or she is talking to a person who stutters but actually what we know is that 00:01:58.400 --> 00:02:06.600 at least in the older population of people who stutter there's people you have hidden stuttering NOTE Treffsikkerhet: 87% (H?Y) 00:02:06.600 --> 00:02:16.600 so they're able to hide their stuttering by always changing the words that they use for instance if 00:02:16.600 --> 00:02:19.300 they know that I'm going to stutter NOTE Treffsikkerhet: 86% (H?Y) 00:02:19.300 --> 00:02:25.800 where do you come from I come from Drammen but I know that these difficult for me so then I say 00:02:25.800 --> 00:02:36.000 Konnerud, because in this case it is easier to say without suffering we actually know that people are able 00:02:36.000 --> 00:02:48.550 to hide their stuttering and using this definition, it's problematic because you wouldn't that 00:02:48.550 --> 00:02:49.800 person wouldn't NOTE Treffsikkerhet: 84% (H?Y) 00:02:49.800 --> 00:03:00.400 fall within that definition and you and then you wouldn't actually think that the diagnosis 00:03:00.400 --> 00:03:08.900 was the correct one for that person but he or she is actually stuttering they're just NOTE Treffsikkerhet: 84% (H?Y) 00:03:08.900 --> 00:03:20.600 so good at avoiding the stuttering but they're all the time doing actions and relating to their 00:03:20.600 --> 00:03:35.500 stuttering in all they do so that's specifically for stuttering that it's problematic to to use the 00:03:35.500 --> 00:03:38.850 definition that and it might be NOTE Treffsikkerhet: 91% (H?Y) 00:03:38.850 --> 00:03:46.200 something similar for other disorders as well but use the definition that actually is describing 00:03:46.200 --> 00:03:55.700 the behavior but doesn't include all of the behavior because might not be observable that a person 00:03:55.700 --> 00:03:59.100 is able to avoid the stuttering moments NOTE Treffsikkerhet: 85% (H?Y) 00:04:01.200 --> 00:04:11.600 but here we don't get to know anything about how the person himself or herself experiences this 00:04:11.600 --> 00:04:23.900 stuttering then you have another definition which is quite different this is definition proposed by 00:04:23.900 --> 00:04:31.950 David Shapiro and he says that stuttering or refers to individualized and involuntary interruptions NOTE Treffsikkerhet: 91% (H?Y) 00:04:31.950 --> 00:04:40.700 forward flow of speech and learned reactions there to interacting with and generating associated 00:04:40.700 --> 00:04:48.900 thoughts and feelings about one's speech, oneself as a communicator and the communicative world in 00:04:48.900 --> 00:04:51.700 which one one leaves NOTE Treffsikkerhet: 85% (H?Y) 00:04:52.200 --> 00:05:06.600 and here you see that the reactions to the stuttering is included you can see that he has thing to 00:05:06.600 --> 00:05:21.650 it that perceptions related to communication ability and also perceptions and feelings related to 00:05:21.650 --> 00:05:22.950 the community NOTE Treffsikkerhet: 91% (H?Y) 00:05:22.950 --> 00:05:34.900 world one lives in and that might for instance involved thoughts related to being able to speak in 00:05:34.900 --> 00:05:43.600 class this definition refers to the speech behavior that we see among people who stutter but it also 00:05:43.600 --> 00:05:46.700 includes much much more NOTE Treffsikkerhet: 88% (H?Y) 00:05:46.700 --> 00:06:03.200 and if we think about the ICF not only stuttering is moments of speech and disruptions but if we 00:06:03.200 --> 00:06:11.700 have their ICF model in front of us thinking about how activity is limited NOTE Treffsikkerhet: 70% (MEDIUM) 00:06:11.900 --> 00:06:24.100 participation in life events and also how environmental factors and personal factors affect the 00:06:24.100 --> 00:06:32.600 functioning of the individual we can see that this this definition here it entails so much more and 00:06:32.600 --> 00:06:40.150 has a much more holistic view I'm stuttering similarly to the ICF model NOTE Treffsikkerhet: 91% (H?Y) 00:06:40.150 --> 00:06:54.300 and how it captures that more how that person himself or herself is experiencing the disorder and 00:06:54.300 --> 00:06:59.600 not only the frequency and the severity of suffering ones NOTE Treffsikkerhet: 78% (H?Y) 00:07:01.200 --> 00:07:11.900 the ICF also aims to be a framework that can be used scientifically as a scientific foundation for 00:07:11.900 --> 00:07:15.100 assessing treatment effects for instance NOTE Treffsikkerhet: 90% (H?Y) 00:07:15.100 --> 00:07:23.200 and looking at this stuttering literature I've been a part of a review that has been done and published 00:07:23.200 --> 00:07:35.200 recently and what we found that was that in large randomized trials meaning that half the group of the 00:07:35.200 --> 00:07:41.200 children are randomized to control group and half of the children are randomized to a treatment 00:07:41.200 --> 00:07:45.800 group or they are randomized to treatment a and treatment B NOTE Treffsikkerhet: 91% (H?Y) 00:07:46.400 --> 00:07:56.600 we can see that when these researchers measure the effect of the intervention how has the 00:07:56.600 --> 00:08:05.000 intervention improved the child's stuttering NOTE Treffsikkerhet: 79% (H?Y) 00:08:05.000 --> 00:08:12.700 but you could also think about not only the stuttering but the child's functioning in general we can 00:08:12.700 --> 00:08:21.100 see that it's the stuttering that is in focus for these interventions so what we found that was that 00:08:21.100 --> 00:08:33.950 these for RCTs they they all reported on speech outcomes that is and most of them included 00:08:33.950 --> 00:08:35.650 frequency of suffering so NOTE Treffsikkerhet: 89% (H?Y) 00:08:35.650 --> 00:08:41.000 many percentage syllables do your stutter on NOTE Treffsikkerhet: 78% (H?Y) 00:08:41.700 --> 00:08:54.300 so going for instance from 7% of syllables stutter to maybe 1% syllable stuttered and we could see 00:08:54.300 --> 00:09:02.400 that treatment have an effect on frequency but none of the studies reported on the children's 00:09:02.400 --> 00:09:07.000 communication attitudes what they're thinking about their speech NOTE Treffsikkerhet: 86% (H?Y) 00:09:07.000 --> 00:09:17.100 their feelings their how their social life was affected by the stuttering before and after the 00:09:17.100 --> 00:09:26.400 intervention so all of the studies only focused on how frequently stuttering moment spread NOTE Treffsikkerhet: 82% (H?Y) 00:09:26.400 --> 00:09:35.600 and you could imagine that a child being successfully treated with suffering intervention may be 00:09:35.600 --> 00:09:42.700 going down to a one point five percent syllables stuttered some of these children may be highly 00:09:42.700 --> 00:09:50.250 affected by the suffering even though it's much less frequent because they they know that there's 00:09:50.250 --> 00:09:56.000 there stuttering they don't know when they start drinking is coming they might be anxious related to 00:09:56.000 --> 00:09:56.650 that NOTE Treffsikkerhet: 83% (H?Y) 00:09:56.650 --> 00:10:04.900 and they might experience comments in this moment when they're stuttering and then could we conclude 00:10:04.900 --> 00:10:12.100 that the treatment was successful even though frequency went down NOTE Treffsikkerhet: 80% (H?Y) 00:10:13.200 --> 00:10:21.900 so that is one of the things that we're pointing to in this review is that for at least for young 00:10:21.900 --> 00:10:34.600 children who stutter other outcome measures should be included that is not only related to frequency 00:10:34.600 --> 00:10:37.150 or severity of this degree NOTE Treffsikkerhet: 83% (H?Y) 00:10:37.150 --> 00:10:47.400 and then the ICF model which could indicate what is needed to be included for instance how much 00:10:47.400 --> 00:10:55.800 difficulties and there's the children have in communication situations and how does the stuttering 00:10:55.800 --> 00:10:57.200 effect NOTE Treffsikkerhet: 89% (H?Y) 00:10:57.200 --> 00:11:06.700 the child's relationships for instance the child's participation in kindergarten, child's role when 00:11:06.700 --> 00:11:09.650 he or she is playing for instance NOTE Treffsikkerhet: 71% (MEDIUM) 00:11:09.650 --> 00:11:19.400 all of these would indicate and also is also valuable of course to see how these environmental 00:11:19.400 --> 00:11:32.900 factors are influencing but they're often this or many of these programs targets the child's speech 00:11:32.900 --> 00:11:39.150 but some of them also target the environment actually then would be very helpful to us NOTE Treffsikkerhet: 75% (MEDIUM) 00:11:39.150 --> 00:11:49.200 access barriers in the environment for instance our grown-ups around the stuttering child are they 00:11:49.200 --> 00:11:59.200 talking too fast are they interacting the child for instance or facilitators do they give the child 00:11:59.200 --> 00:12:07.300 lots of time maybe have I can't play these things that we assume backed positively affect the NOTE Treffsikkerhet: 90% (H?Y) 00:12:08.200 --> 00:12:17.600 yeah and then the ICF can also be used as a framework for setting goals and treatment for instance 00:12:17.600 --> 00:12:26.400 course we need to be certain that the person if we're using this clinically but the person gets 00:12:26.400 --> 00:12:35.500 knowledge about and the ICF and wants to cooperate and consent to using that but if you're 00:12:35.500 --> 00:12:37.150 explaining the purpose with NOTE Treffsikkerhet: 79% (H?Y) 00:12:37.150 --> 00:12:41.750 but why you want to use this framework NOTE Treffsikkerhet: 75% (MEDIUM) 00:12:41.750 --> 00:12:53.700 maybe get a holistic view of how this disorder affects the person's functioning and then you would 00:12:53.700 --> 00:13:03.100 be able to map out where is the person experiencing the most difficulties where is the person most 00:13:03.100 --> 00:13:11.450 restricted or what kind of barriers do the personal experience in in these or her environment NOTE Treffsikkerhet: 58% (MEDIUM) 00:13:11.450 --> 00:13:12.800 points NOTE Treffsikkerhet: 91% (H?Y) 00:13:13.500 --> 00:13:21.500 and the ICF can also be used as a framework for understanding needs and initiating change to serve 00:13:21.500 --> 00:13:30.800 at a societal level for instance you could use the ICF to discuss whether criteria for eligibility 00:13:30.800 --> 00:13:39.200 for social security benefits are they evidence based for instance to discuss whether guaranteeing 00:13:39.200 --> 00:13:42.849 rights improve functioning at the societal level NOTE Treffsikkerhet: 91% (H?Y) 00:13:42.849 --> 00:13:52.700 and for instance what the needs of persons with varying levels of disability and impairments activity 00:13:52.700 --> 00:14:01.050 limitation and participation restriction what are the needs of these and different groups NOTE Treffsikkerhet: 85% (H?Y) 00:14:01.050 --> 00:14:07.650 and how can society be made more accessible for all people NOTE Treffsikkerhet: 91% (H?Y) 00:14:07.650 --> 00:14:16.250 thank you so much for listening to me please reach out if you have any questions related to this 00:14:16.250 --> 00:14:17.900 lecture NOTE Treffsikkerhet: 85% (H?Y) 00:14:18.200 --> 00:14:21.300 good evening bye