SpeechEasy publicaties

Fluency Disorders Stuttering

The treatment of stuttering and the SpeechEasy fluency device are the subjects of the following abstracts of 7 selected published articles.

Fluency Development Abstract Article 1:

Investigations of the impact of altered auditory feedback in-the-ear devices on the speech of people who stutter: initial fitting and 4-month follow-up.

Stuart A, Kalinowski J, Rastatter M, Saltuklaroglu T, Dayalu V.

Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC 27858-4353, USA

BACKGROUND: Self-contained ear-level devices delivering altered auditory feedback (AAF) for the application with those who stutter have only been recently developed.

AIMS: The paper examines the first therapeutic application of self-contained ear-level devices in three experiments. The effect of the device on the proportion of stuttered syllables and speech naturalness was investigated following initial fitting and at 4 months post-fitting. METHODS & PROCEDURES: Three experiments were undertaken: In Experiment 1, the effect of a self-contained in-the-ear device delivering AAF was investigated with those who stutter during reading and monologue. Two adolescents and five adults who stuttered read and produced monologue with and without a device fit monaurally. The device provided a frequency shift of +500 Hz in combination with a delayed auditory feedback of 60 ms. Custom-made ITC and CIC devices were fabricated for four adults and four youths in Experiment 2. The effect of group (i.e. youth versus adult), time (i.e. initial fitting versus 4-month follow-up), speech task (i.e. reading versus monologue), and device (i.e. present versus absent) on stuttering rate was examined. In Experiment 3, 15 naive listeners rated the speech naturalness of speech produced by the participants in Experiment 2. Speech samples from six conditions were rated: reading and monologue without the device at the initial visit, reading and monologue with the device at the initial visit, and reading and monologue with the device at 4 months. OUTCOMES & RESULTS: In Experiment 1, the proportion of stuttered syllables was significantly (p=0.011) reduced by approximately 90% during reading and 67% during monologue with the device relative to no device. Only a significant main effect of device (p=0.0028) was found in Experiment 2. That is, stuttering rate was significantly reduced with the device in place regardless of speech task or group and remained so 4 months later. In Experiment 3, speech samples generated while wearing the device were judged to be more natural sounding than those without the device (p<0.0001) for reading and monologue with both adults and youths. There was no significant difference between the mean naturalness ratings of speech samples generated during the initial fitting with the device relative to that at 4 months with the device (p>0.05) in all cases except with the youths while engaged in monologue. For that condition, raters judged the speech produced at the initial fitting as more natural. CONCLUSIONS: These findings support the notion that a self-contained in-the-ear device delivering AAF assists those who stutter. With the device in place, stuttering is reduced and speech produced is judged to be more natural than with out the device.

Fluency Development Abstract Article 2:

Investigations of the impact of altered auditory feedback in-the-ear devices on the speech of people who stutter: one-year follow-up.

Stuart A, Kalinowski J, Saltuklaroglu T, Guntupalli V

Stuttering Research Laboratory, Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, USA.

PURPOSE: This study examined objective and subjective measures of the effect of a self-contained ear-level device delivering altered auditory feedback (AAF) for those who stutter 12 months following initial fitting with and without the device. METHOD: Nine individuals with developmental stuttering participated. In Experiment 1, the proportion of stuttering was examined during reading and monologue. A self-report inventory inquiring about behaviour related to struggle, avoidance and expectancy associated with stuttering was examined in Experiment 2. In Experiment 3, naive listeners rated the speech naturalness of speech produced by the participants during reading and monologue. RESULTS: The proportions of stuttering events were significantly ( p < 0.05) reduced at initial fitting and remained so 12 months post follow-up. After using the device for 12 months, self-reported perception of struggle, avoidance and expectancy were significantly (p < 0.05) reduced relative to pre-fitting. Naive listeners rated the speech samples produced by those who stutter while wearing the device significantly more natural sounding than those produced without the device for both reading and monologue (p < 0.0001). CONCLUSIONS: These findings support the notion that a device delivering AAF is a viable therapeutic alternative in the treatment of stuttering.

Fluency Development Abstract Article 3:

A common element in the immediate inducement of effortless, natural-sounding, fluent speech in people who stutter: 'the second speech signal.'

Kalinowski J, Dayalu V

Stuttering Research Laboratory, East Carolina University, Greenville, NC 27858, USA.

Recent attempts to find a common element in the inducement of fluent speech have focused on Wingate's notion that fluency can be induced via an altered manner of speaking by placing an emphasis on phonation. The problem with this notion of fluency enhancement is that it appears to be too expansive a scheme of fluency. The schemata allows for any forward flowing speech or speech-like act to be considered fluent despite the increased cognitive mediation, the extra effort involved in implementing the procedure, the unnaturalness of the resultant end product, and a lack of stability over time. It is proposed that the only significant characteristics of 'true fluency' are that it is indistinguishable from the typical fluent speech of people who do not stutter, and that it is effortless in nature. This is achieved via the use of a second speech signal which is not cognitive in nature, is operationally delineated, and is easy to manipulate. Copyright 2002 Harcourt Publishers Ltd.

Fluency Development Abstract Article 4:

The road to efficient and effective stuttering management: information for physicians.

Kalinowski J, Saltuklaroglu T

School of Allied Health, East Carolina University, Greenville, NC 27858, USA.

Physicians are often the first point of contact when children's speech begins to be disrupted by stuttering behaviors such as sound repetitions and prolongations. For this reason, we feel it is important that they are accurately informed with regards to the nature of stuttering and the available treatment options before making referrals to speech-language pathologists. Stuttering is by definition, an involuntary disorder and remains that way throughout life. Its cause is still unknown and the only true form of remission appears to be the natural, spontaneous recovery that occurs in up to 80% of those children afflicted. No therapeutic course has seemed to change this figure and the prevalence of stuttering in the general population has remained stable, suggesting that speech therapy has never 'cured' stuttering. Therefore, we suggest that therapeutic intervention for stuttering should be best directed towards 'efficient' and 'effective' symptom reduction. Until recently, intervention options for children and adults who stutter have generally been limited consist of countless hours of speech retraining (teaching people 'how to talk again'), while attempting to bring the disorder under voluntary control. The common end-results of these procedures include unnatural speech patterns that are difficult to maintain in all situations and highly prone to relapse, thus, reinforcing the notion that stuttering is highly resistant to treatment. However, miniaturized digital technology now allows those who stutter to take advantage of auditory effects that 'inhibit' stuttering. 'Choral speech' or speaking in unison has long been known to make those who stutter immediately fluent without compromising speech naturalness. All in-the-ear devices can emulate choral speech effects by altering auditory feedback. Therapeutic protocols using these devices can be quickly and efficiently implemented. Furthermore, they are showing high levels of long-term effectiveness with regards to reducing stuttering frequency and maintaining speech naturalness.

Fluency Development Abstract Article 5:

Reduction of stuttering: the dual inhibition hypothesis.

Saltuklaroglu T, Dayalu V, Kalinowski J

Stuttering Research Laboratory, East Carolina University, Greenville, NC 27858, USA.

Treatment for stuttering attempts to reduce or eliminate the observable core markers of the disorder, specifically repetitions and prolongation. In this hypothesis, it is proposed that stuttering may be inhibited by two distinct yet related procedures: active inhibition and passive inhibition. Active inhibition is brought about when the person who stutters makes volitional changes to his or her speaking pattern, such as when employing behavioral modification techniques. Passive inhibition automatically inhibits the involuntary stuttering block and can be induced from an external source, such as altered auditory feedback, or by the use of sufficient active inhibition. It is suggested that passively inhibiting stuttering results in speech that is more automatic, natural sounding, and truly fluent speech than the speech that is derived primarily from active inhibition. Evidence of passive inhibition resulting from active inhibition can be seen when people who stutter exhibit uncontrolled fluency following behavioral therapy. Copyright 2002 Harcourt Publishers Ltd.

Fluency Development Abstract Article 6:

The effect of SpeechEasy on stuttering frequency in laboratory conditions.

Armson J, Kiefte M, Mason J, De Croos D

School of Human Communication Disorders, Dalhousie University, 5599 Fenwick Street, Halifax, NS, Canada B3H 1R2.

The effect of SpeechEasy on stuttering frequency during speech produced in a laboratory setting was examined. Thirteen adults who stutter participated. Stuttering frequencies in two baseline conditions were compared to stuttering frequencies with the device fitted according to the manufacturer's protocol. The fitting protocol includes instructions for deliberate use of vowel prolongation. Relative to the initial baseline condition, stuttering was reduced by 74%, 36%, and 49% for reading, monologue, and conversation, respectively. In comparison, stuttering was reduced by 42%, 30%, and 36%, respectively with the device in place, but before participants were instructed to deliberately prolong vowels. Examination of individual response profiles revealed that although stuttering reduced in the device compared to the baseline conditions during at least one of three speech tasks for most participants, degree and pattern of benefit varied greatly across participants. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) discuss recent research in altered auditory feedback that led to the development of SpeechEasy, (2) analyze and describe issues related to evaluating the treatment benefits of fluency aids, and (3) summarize the range of outcomes that were observed with SpeechEasy in this study.

Fluency Development Abstract Article 7:

Int J Lang Commun Disord. 2003 Apr-Jun;38(2):119-29. Links
Delayed auditory feedback in the treatment of stuttering: clients as consumers.

Van Borsel J, Reunes G, Van den Bergh N.

Ghent University Hospital, Ghent, Belgium. john.vanborsel@rug.ac.be

PURPOSE: To investigate the effect of repeated exposure to delayed auditory feedback (DAF) during a 3-month period outside a clinical environment and with only minimal clinical guidance on speech fluency in people who stutter. METHOD: A pretest-post-test design was used with repeated exposure to DAF during 3 months as the independent variable. Nine stuttering individuals aged between 18 and 45 years served as subjects. Videotaped samples from different speech tasks were collected before and after 3 months' exposure to DAF, each time under two conditions: first during non-altered feedback (NAF) and subsequently during DAF. RESULTS: Before the repeated exposure to DAF, the percentage of stuttered words was significantly higher during NAF than during DAF. After 3 months' exposure to DAF, the percentage of stuttered words during NAF had dropped to a non-significant level in comparison with the DAF condition. Comparison of the percentage of stuttered words during NAF before and after repeated exposure to DAF showed significantly less stuttering after the repeated exposure to DAF. The percentage of stuttered words during DAF was generally somewhat higher, but not significantly so, after the 3 months' repeated exposure to DAF than before the exposure to DAF. CONCLUSIONS: Results confirm that DAF is an effective means of reducing stuttering even when employed as the only treatment approach outside a therapeutic environment. They also suggest that DAF continues to promote fluency when used over a longer period, but also that length of exposure and fluency enhancement are probably not in a linear relationship.