Self-assessment is arguably one of the most important aspects of fluency therapy.  A person’s ability to independently assess their own fluency is critical to be able to know if stuttering therapy techniques are working, to know what to focus on, to get an accurate picture on how fluent they are, and to develop acceptance of their level of fluency.  We began this topic in this post on fluency self-assessment and are expanding on the topic here to cover how to improve self-assessment by incorporating it into a fluency home program. 

The truth is, if we relegate self-assessment to a single session or a short informal stuttering rating scale, we are missing out on a ton of impactful therapy because:

Self Assessment is a Goal Unto Itself.

On the other hand, when we extend the topic of self-assessment across several sessions AND what the client is taking home with them, we get huge benefits, liven up our therapy, and take a break from stuttering therapy techniques.

6 Benefits of Focusing on Self-Assessment of Fluency

• Self-assessment is a valid goal.  Giving a person a way to objectively assess themselves is as valid as giving them the ability to modify or shape a disfluent episode.
• Self-assessment can reassure a person that they may not be as disfluent as they think they are or that they are more comfortable with their level of fluency than they thought.  A new and growing body of research positions fluency acceptance at the center of fluency intervention leading to dramatic results.
• Self-assessment breathes life into fluency therapy.  If you have been working on fluency shaping techniques or stuttering modification for a while, shifting over to self-assessment activities can reinvigorate a client and give both you and her a fresh perspective.
• Self-assessment can let a person know where to improve. We can’t simply say a student Is or is not fluent.  Which situation?  When?  How much?
• Extended self-assessment gets to the heart of the matter.   It is nearly impossible to sum up the effects of something as broad-reaching as fluency in a single session or using a single rating scale.  A fluency home program gives a person time to reflect on fluency throughout daily routines and see where and how to make a change (if it is needed at all!).
• Self-assessment connects therapy sessions to real life.  This is where a fluency home program comes in.  If we send home some homework and begin the next session with the results, we get an insider’s view into when and how fluency takes shape in real life. 

In this post we cut to the chase and share fluency activities that are ready-to-go for you to send home with your fluency clients.

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8 Fluency Home Program Activities to Improve Self-Assessment

In the activities that follow,  I wrote the exact text that I share so that you can modify it for your specific clients.  Your fluency home program is dependent on you personalizing it and tying it back to your sessions so that therapy isn’t, as one adult described why he stopped going to therapy, as “a waste of time.”  Not all activities apply to all clients of course so see this as a menu!

Activity 1: Identifying words that cause difficulty 

List 10 or more words that cause difficulty.  Send these via email and I will respond with strategies to make the words easier. 

As a review, your specific difficulties have shown a pattern of starting with words that are “voiced.”  I.e. that start with sounds that involve the vocal folds vibrating.  We will look for ways to start with un-voiced sounds:  hRoger instead of ah-Roger.

1	6
2	7
3	8
4	9
5	10

Activity 2: We are all dysfluent to some degree

Observe someone else in a social or work situation and make note of any repetition of words.  There are two purposes to this activity.  First, to increase your ability to identify stuttering episodes and describe them based on type.  Secondly, it is important to understand that all of us repeat ourselves at a certain level and it can be very eye-opening to see others repeat themselves and know that you are not alone.

  Stuttering-like Disfluencies Data

Stuttering-like Disfluencies	Examples	Observation of Others
Single Syllable Repetition	(e.g. “tea,tea,teacher”)
Whole Word Repetition	(e.g. “I was-was there.”)
Audible Sound Prolongation	(e.g. “Mmmmore please.”)
Inaudible Sound Prolongation	(e.g. “(M—) More please.”)
Blocks	No ability to begin a word or statement.

Non-stuttering Disfluencies Data

Non Stuttering-like Disfluencies	Examples	Observation of Others
Phrase Repetitions	(e.g. “I was- I was there.”)
Interjections	(e.g. “I will um, be late.”)
Revisions	(e.g. “He was, They were driving.”)

Activity 3: Minimal Pairs

The mouth and body are very efficient when they create the sounds of our language.  What this means is that the same movements of the mouth can be used for different sounds because one sound uses the vocal folds (voiced) and one does not (unvoiced). 

This information is specific to you and important because many of the words that you struggle with begin with voiced sounds.  By adding an unvoiced sound or a little bit of air before the word we can relax into it. For example, you had difficulty with “bat” but not with “pat.”  If I say “At the zoo I saw the pat” it does not sound too different from “At the zoo I saw the bat” because 1) of the context (Zoo) and 2) “the” is voiced (vibrates) and that rubs off on “pat” in “the pat.”

Write V = voiced or U=unvoiced next to the following sounds

Hint: put your hand on your throat and say the sound alone, without vowels

B	P	G	S
T	D	V	K
F	H	R	L
SH	CH	Y	N
M

Identify the Minimal Pairs

Put your hand on your throat and say the following sounds.  Your throat should not vibrate.  What sound is produced if you say the same sound but turn on your voice?  This is the sister-sound or minimal pair.  This can be tricky so just give it your best shot!

P

T

K

S  (English only)

F  (English and non-Mexican Spanish only)

CH  (English only)

Activity 4: Reading in front of others

Reading fluently is a relative strength for most people and something that you can rely on as a tool if a situation is very stressful.  We do not know if reading in front of other people is difficult so we need to test it.  Create an opportunity to read in front of others.  We talked about reading quotes as part of a presentation.  Begin here and record yourself.  A free program for your computer is Audacity or you can use your phone. You can just turn it on in the background while you are speaking.  If you find this to be super easy, try a paragraph. 

Activity 5: Which Fluency Shaping Technique Resonates with you?

After covering fluency shaping techniques during a session.

We all have ways to help us be more fluent in stressful situations.  You identified that your strategies include: singing words, switching words, putting letters in front of words, and pointing.  Review the list below.  These are techniques that others find successful. However, it is highly personal and different techniques resonate with different people.  Which fluency shaping techniques resonate with you?

Fluency Shaping Techniques	Definition
Easy Onset	Begin speech slower with less tightness and slighter softer speech.
Stretching	Slightly stretch the beginning sound to ease speech.
Light Contacts	“Touch” the articulators together lightly and softly.
Pausing and Chunking	Grouping words together and adding pauses in places where natural breaks occur.
Cancellation	After stuttering, wait a few seconds and produce the word again in an easier manner.
Pullout	Catch yourself in the moment of stuttering and ease yourself out of it.
Preparatory set	Anticipate what will be stuttered and begin the first sound of the word slowly, smoothly, and easily.
Bouncing	Repeating a word or sound in an easy way to decrease tension and become comfortable.
Full Breath Target	Inhale through the mouth in a relaxed manner.
Gentle Onset Target	Full Breath target then exaggerate the initiation of the sound/words.

Activity 6:  Telephone Fluency Home Program Activities

Unfortunately, the phone does not allow us to point, use facial expressions, or gestures.  Fluency shaping techniques can be very useful for phone conversations.

Choose ONE technique from the list above.  You will make a phone call and practice this technique.  Not more than one.  Remember that shaping techniques are things we practice in safe environments and put in our tool box to pull out at a later time to use.  I would suggest you practice while on the phone with someone you know and had already planned to call.

Start by calling me!

Then, the person you call doesn’t have to know you are practicing anything, and the call does not have to be long.  You can even call a store and ask if they carry a certain product and how much it costs.

This week I will practice the following technique on the phone:_____________________

I will remember to do this by:  (putting a stickie on my phone in the morning…)_____________________

Activity 7:  Presentation Fluency Home Program Activities

Fluency is only one part of a great presentation.  Something that I want you to know is that most people are very disfluent when they have to present.  We repeat words, say ums and ohs.  Yes, we want to be more fluent.  But there are MANY ways you can create an engaging presentation with your slides, gestures, jokes, videos, music, and overall, the story you tell. 

If you want to be better at speaking in front of others, you are not alone.  Start learning about how to improve your speaking.

Watch The Secret Structure of Great Talks – Nancy Duarte

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Activity 8:  Presentation Bonus Activities

Bonus Activity 1:  Watch Steven Jobs debut of the iPhone

After watching Nancy Duarte’s Ted Talk.  Watch:

Steve Jobs Introducing The iPhone at Mac World 2007

Bonus Activity 2:  Watch Martin Luther King’s “I have a dream”

After watching Nancy Duarte’s Ted Talk.  Watch:

Martin Luther King, Jr. I Have a Dream Speech

We spend a lot of time in speech pathology talking about carryover of abilities to the classroom or other environments.  We also get fancy sometimes and talk about “abilities that generalize.”  By taking the reigns and making that carryover the focus of your intervention, we have a lot greater chance of actually getting there. 

A good fluency home program = carryover

More Reading:

How to Obtain Powerful Fluency Rating Scale Information

As speech-language pathologists, we perform fluency assessments far less frequently than we do assessments of language or articulation. In this presentation, I’ll share some of the tasks I include in my fluency assessment, tips for analysis and goal settings, and a cool tool I created to speed up your analysis.