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From: Vikram
Date: 19 Oct 2004
Time: 22:23:46 -0500
Remote Name: 68.36.15.209
You are right..these studies did report that FAF was not as powerful during monologue as it was during reading. However, we should all realize that these studies reported the use of FAF with no additional alternations whatsoever. As I mentioned before, not every person who stutters experiences the same change in fluency and there are some who do have problems transferring the fluency from reading to other speaking tasks. Nevertheless, there is some change in fluency that aids in building a treatment plan that is geared towards using the alteration in feedback to further his/her fluent speech in a more natural and effortless manner. This protocol requires the use of some highlighting strategies that have been long used in traditional forms of therapy (I prefer prolongations). These occasional prolongations trigger a more dramatic change in fluency when combined with AAF then when used in isolation. We intend to test and collect data to exemplify this clinical observation in the near future. Please refer to the following abstracts as they add to our current discussion. Kalinowski J, Guntupalli VK, Stuart A, Saltuklaroglu T. (2004). Self-reported efficacy of an ear-level prosthetic device that delivers altered auditory feedback for the management of stuttering. Int J Rehabil Res., 27,167-70. Numerous past efficacy studies in stuttering treatment have typically failed to assess generalization of therapeutic gains across speaking environments over time. The purpose of this study was to use a self-report format to gain insight into the improvements of clients who purchased an all in-the-ear device that provides altered auditory feedback to manage stuttering symptoms across everyday speaking situations. A total of 105 participants (age 7-81 years) returned completed questionnaires that examined seven parameters of stuttering behavior before acquiring the prosthetic device and after using the device with minimal clinical intervention for an average of 6 months. Across each parameter, participants rated a significant (P<0.001) improvement of approximately two units on seven-point scales after beginning to use the prosthetic device. In addition, the device received high overall satisfaction ratings, with a median score of 2.0 on the seven-point scale. Self-report is a 'must' for examining clinical efficacy in a disorder such as stuttering, which is so amenable to 'clinic room fluency' yet highly resistant to long-term amelioration. The data suggest that this device is helping to provide its users with functional, effective and efficient management of stuttering without the need for extended clinical follow-up. Stuart A, Kalinowski J, Rastatter M, Saltuklaroglu T, Dayalu V. 2004Investigations 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. Int J Lang Commun Disord., 39, 93-113. 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 naïve 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. Vikram