ALS is a neurodegenerative disease that affects nerve cells in the brain and spinal cord that control voluntary skeletal muscle. The muscle weakness that results from ALS is relentlessly progressive and rehabilitative attempts to strengthen affected muscles usually fail. When managing swallowing and communication disorders in individuals with ALS, the goals are to maximize function and safety through the use of compensatory strategies, energy conservation, and patient and caregiver education and counseling. This paper will review the current methods of assessment and treatment used with this population in the outpatient setting.

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Self-disclosure is a commonly used therapeutic technique with people who stutter to facilitate self-acceptance and reduce the effects that the stigmatizing views and stereotypes held by the public can have on their communicative interactions. Although there are data on the benefits of self-disclosure from the perspective of the listener, there are no data on the value of self-disclosure form the perspective of the person who stutters. The purpose of this study was to investigate the benefit of self-disclosure from the perspective of the person who stutters in a conversational interaction using a Map task with a normally fluent speaker. The cognitive-affective variables under investigation were self-perception of stuttering severity, comfort, cognitive effort, anxiety, and benefit in a disclosed and non-disclosed condition. The speech variables under consideration in the disclosed and non-disclosed conditions were total syllables, percent syllables stuttered, and total word count. In order to measure level of stigma, the Self-Stigma of Stuttering Scale (4S) (Boyle, 2012) was used. Participants were 25 adults (18-73 years of age) recruited from the La Salle University Speech-Language-Hearing Clinics, National Stuttering Association support groups in Philadelphia and New Jersey, and through social media. The results of the investigation revealed that the participants were equivocal about the benefit of self-disclosure, and that there were non-significant differences for the cognitive-affective variables across conditions. Some positive effects on the speech variables were noted in the non-disclosed state only. All participants demonstrated overall self-stigma based on their 4S scores, but stigma was not acting as a moderating variable for the cognitiveaffective or speech variables. It was concluded that from the perspective of the person who stutters, neither self-disclosure nor overall level of self-stigma are playing a decisive role during the communicative interaction with a normally fluent speaker. The implications of these findings are discussed. vi

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Purpose The author presents a descriptive sociological framework for the communicative interaction between an adult who stutters (AWS) and other communication partners. The author shows that the communicative interaction between an AWS and another interactant is a sociological object that can be evaluated by both parties in real-time, and is impacted by settings, participants, identity, stigmatization, and the type of talk. These elements are consistent with Hymes' SPEAKING model, which was developed to describe speech communication in a social context and can lay the foundation for the development of an ethnography of stuttering. The clinical applications and implications of a sociological framework are discussed and future directions for research are suggested. Method This work is a refinement and enhancement of Mancinelli (2018) and Mancinelli (2019) and the research associated with that work. This is a tutorial with a clinical focus designed to introduce the readership to a sociological perspective on communicative interactions in AWS. Conclusions Stuttering is an emergent phenomenon embedded within a social interaction, necessitating a deeper understanding of the processes at work during those interactions. A sociological framework can provide a more comprehensive description of the communicative interactions as well as the sociocommunicative lives of people who stutter. The information obtained can inform the formulation of realistic, functional goals based on the daily life of the client. Implications for the development of an ethnography of stuttering are discussed.