Welcome

From: Joe Kalinowski
Date: 9/27/99
Time: 7:22:14 AM
Remote Name: 150.216.147.209

Comments

Welcome to the Second International Online Conference on Stuttering. I hope to hear from many of you an look forward
to participating in this relatively new conference modality. 

I remember not too long ago (around 1981) mailing a letter to the late Charles Van Riper and waiting for months to hear
form the "guru from atop the mount". That is how I perceived him when I was much younger than I am today--definitely
not how I think he saw himself. Any ways, the Internet provides us with instant communication with many of the best
minds in the field of stuttering today. People who care passionately about those who stutter and finding answers to their
communicative problems. I wish I had access to such people when I was a younger person ---seeking tidbits of
information. Now thanks to the Internet--- we all have instant access to lots of information. Like all Darwinian
proposition --only the strongest ideas shall survive. 

Be well my friends.. 

Re: Welcome

From: Jerry Johnson
Date: 10/20/99
Time: 3:10:41 PM
Remote Name: 205.188.200.58

Comments

Joe: I have another idea to try out, one that I have just begun to investigate. I had a buddy audiologist ask a hearing aid
company to purposely distort the sound of two behind the ear hearing aids. The distortion is about 30%, not enough to
block out hearing speech, but enuf to distort the speech of the PWS. I wish you could do something similar because, with
very limited trials with one adult and one 5th grader, you might achieve desirable results. I only have descriptive reports
and I would be interested in other reports too. I can't tell you much more, but I thought you might be interested in this
idea.

Post-therapy Speech

From: Rebecca M. Hubbling
Date: 10/5/99
Time: 3:47:25 PM
Remote Name: 134.29.30.64

Comments

I am a graduate student from Minnesota State University, Mankato. Thank you for your article, you have a very
interesting research topic. In your article, when you discussed post-therapy speech, you stated it seemed "unnatural." I
was wondering who (in your study) judged the speech to be "unnatural"? Is it the person who stutters or the listening
audience? If it is the listener who perceives it as "unnatural," have you researched different types of listening audiences
(such as: the general population, different ages, different sexes, professionals in Speech-Language Pathology, and other
people who stutter)? I am curious if all listening audiences would perceive post-therapy speech in the same way.

Re: Post-therapy Speech

From: Joe Kalinowski
Date: 10/5/99
Time: 7:39:23 PM
Remote Name: 134.29.30.79

Comments

Good questions... 

We had 32 graduate students in speech-language pathology rate the audio samples on two separate occasions---about 10
days apart. We had very good interjudge and intrajudge reliability. That means-- people were consistent with their
judgments over time (the same person's judgment at two different times were similar) and between each of the judges
(comparing the 32 judges to each other). With this high reliability (and the past publications of other researchers with the
same tool) we were pretty confident of our findings. 

Naturalness values are underlined. 1= High Natural, 9= Highly Unnatural ... The numbers in parenthesis are the percent
of stuttered syllable. Pre-therapy Post-therapy 

Mild 2.10 (1.5%) 5.81 (0%) Mild 2.25 (2.3%) 5.14 (0.8%) Mild 3.45 (6.5%) 2.83 (1.2%) Mild 1.97 (1.4%) 2.45
(0.5%) Mild 2.92 (1.8%) 5.86 (0%) Severe 8.33 (25.9%) 8.33 (3.0%) Severe 6.97 (10.1%) 8.36 (1.3% Severe 6.27
(8.2%) 7.77 (1.8%) Severe 6.67 (10.3%) 7.30 (0%) Severe 5.75 (17.0%) 7.83 (0.9%) 

If you look at the Table we had in the study. You will see the lower the naturalness the higher the rating value. That
means the value (1) stands for speech which is natural and the value (9) stands for speech which is highly unnatural.
Post-therapy these people were highly unnatural. 

We did further pilot data that we never published examining the general public's perceptions of these and other samples.
And the results were quite similar. We are also looking at speech pathologists with experience and a further examination
of the general public's perceptions of naturalness after therapy. 
Re: Post-therapy Speech--Better Table on The Web

From: Joe Kalinowski
Date: 10/6/99
Time: 8:50:39 AM
Remote Name: 150.216.147.209

Comments



I made a table which is clearer and more informative on our server. Please go to the URL address above. 

(Tough to format tables on the Post It Form--Judy and I spent some time on this..) 

The table shows a decreases in stuttering--sometimes dramatic ones--yet a dramatic increase in unnaturalness, especially
for the severe PWS. 

AAF

From: Kelly R. Birken
Date: 10/5/99
Time: 3:52:50 PM
Remote Name: 134.29.30.64

Comments

I am a graduate student at Minnesota State University, Mankato. I found your article to be very interesting, thanks for the
research update! I am unfamiliar with altered auditory feedback (AAF). Could you please explain how it is used as a
"second speech signal?" Also, how is it used outside of the therapy setting? Thank-you for the research update and your
time, it is greatly appreciated. 

Re: What is AAF?  Where is our hearing aid?

From: Joe Kalinowski
Date: 10/5/99
Time: 6:26:13 PM
Remote Name: 150.216.147.209

Comments

What is AAF? 

Altered auditor y feedback (AAF) is simply an alteration of the auditory feedback modality --typically via air conduction,
but it could be done via bone conduction . The signal can be delayed (DAF), frequency altered (FAF), or a vast number of
permutations (e.g., reverberation, echo, flange). 

Like choral speech and shadow speech these "second speech signals" appear to cause fluency in most people- at least for a
period of time. Possibly through entrainment or by providing more appropriate sensory information. We really don't
know. Everything is a guess at this point in time. 

What makes people fluent? 

We really don't know why anything makes people fluent in stuttering research. That is because we don't know what
causes stuttering to begin with..----- Many of us have notions and beliefs--but nobody, and I repeat--- nobody knows the
causal agent of stuttering. Thus we surely can't tell you why certain conditions make people fluent--we see the behavioral
phenomena of increased fluency under AAF or motoric targets and we speculate, hypothesize, postulate, theorize,
sermonize, pontificate on our beliefs, intuitions, assumptions and lots of associated phenomena. 

Where do we want to go? 

Bottom line: For the near future we want to make a cheap hearing aid which produces DAF and is inconspicuous enough
for the PWS to wear without bringing attention to himself or herself 

Does the effect persist?

From: Lynne Shields
Date: 10/6/99
Time: 8:49:54 AM
Remote Name: 199.217.229.54

Comments

Joe, 

I am interested in knowing whether you have been able to run any trials to look at the effect of AAF over the long term. If
a PWS wears an AAF device for a lengthy period, does he/she continue to show the same effect, more natural-sounding
speech? I am aware that some who use masking or DAF devices report that the effect begins to weaken with prolonged
use. I do think that more effective devices have good potential to assist PWS, and I am glad to see that your research
continues this effort. 

Regards, 

Lynne 

Re: Does the fluency of therapy persist or diminish with time?

From: Joe Kalinowski
Date: 10/6/99
Time: 11:40:13 AM
Remote Name: 150.216.147.209

Comments

Great question!!! 

We need to examine if persons who stutter will adapt or move towards a homeostatic state after long-term use of AAF .
Or do we need to make a variable system in therapy like variable resistance on a treadmill or an exercise bike (which I
need to speech more time on and talk less about!!). 

Any ways, I also think PWS adapt to motoric strategies (e.g., slow rate, gentle onsets), but have judged a lack of
performance by stuttering. When in fact, PWS "may" be using the "SAME AMOUNT OF TECHNIQUE'" BUT IT NO
LONGER WORKS. 

We can only talk about adaptation in therapeutic agents where we know the amount of INPUT into the system. [We never
know the input in motor strategies--we only know the output).] 

For example, L-dopa in Parkinson's patients wears off over time, Prozac in depression wears off for some people,
arterial plaque returns after heart bypass surgery--sometimes they find it within a few weeks, and, of course, we adapt to
simple exercise on a treadmill or exercise bike. 

We all build up a tolerance to exercise after a period of time and have to increase the effort and duration to receive the
same effect. Why would motoric strategies in therapy be different? Why would sensory input alterations be different? Our
eyeglass prescription changes, our medications for hypertension change, our hearing aid fittings change, --we adapt to in
a healthy state and a disordered state -- that is why prevention is so important.. an ounce of prevention is worth a pound
of cure…. 

Post-therapy speech

From: Jonathan Bashor
Date: 10/12/99
Time: 3:05:32 PM
Remote Name: 207.174.156.61

Comments

A speech therapy client cannot worry about the "natural" sound of his speech. That may improve over time. A graduate of
a fluency-shaping program will probably sound good right after the course, but may readily relapse in a few months.
Whereas a client in a program that requires a longer time frame may start out sounding very "unnatural" but steadily
improve. Maybe "naturalness" is in the ear of the listener. Liked your paper. Thanks ! 

Re: Strength comes from a caring, truthful and honest relationship of
likely outcomes.

From: Joe Kalinowski
Date: 10/13/99
Time: 9:58:39 AM
Remote Name: 150.216.147.209

Comments

I like your comments! 

It is my opinion, that persons who stutter have to evaluate the "cost-benefit ratio" of all therapeutic strategies (e.g., rate
control, gentle onsets DAF, desensitization). 

In both the short-term and the long -term, how much does this therapeutic strategy cost me ??? 

Each of us has to ask ourselves (as clinicians and/or PWS): 

Is this set of compensatory strategies more conspicuous, more unnatural, more emotionally taxing than stuttering itself? 

And what is the likely evolution of these strategies (naturalness, adaptation, maintenance)? 

As a clinician and a PWS, I have to as be honest as possible --as to the "costs" and the "probable outcomes of therapy". 

I feel it is my ethical duty to do so. I am not a salesperson selling the best case scenario. 

My physician is as honest as possible about what might happen with other pathologies I have and I respect and feel
comforted by his "truthful and accurate depiction of outcomes. (Although at times this information makes me frightened,
afraid and angry at what may occur…but such is life and such is stuttering). My strength comes from a caring, truthful
and honest relationship of likely outcomes. 

My call is one for a reexamination of what fluency is and what it is not. 

Plus as you point out-- a realistic, truthful-as-possible, communication of "likely" outcomes of therapy. 

Not best -case-scenarios, but what happens and how often does it happen ,and what do and don't you as a clinician
know. 

I think clinicians and clients are tired of best -case-scenarios. 

What I think we need to say is that "stuttering therapy is not great-- or even sometimes that good" . But it often provides
speech which is better and less taxing communicatively than the untreated speech. 

We, as a specialty, have sometimes fallen into the weight-loss clinic syndrome. This time around it will be better--the
weight will stay off. We need to be much more ethical and more cautious. 

Some questions raised by your paper

From: Gunars K. Neiders
Date: 10/17/99
Time: 4:16:20 PM
Remote Name: 206.63.35.52

Comments

Joe, 

I found your paper very fascinating. Your interesting observations raise some questions in my mind. Nothing that needs
urgently be answered by you, but if you do have thoughts on them, I would be more than delighted to hear them. 

Could the study of spontaneous recovery yield an insight in the nature of "cure" for stuttering? 

Is more damage or good done by constructing competing paradigms of stuttering with internal variables that cannot
presently be directly measurable or even detectable? [I start with the fact that "The work of Thomas Kuhn put in doubt the
view that science is progressive and cumulative in the increase of its empirical content. For Kuhn, theories are not
superseded by their successors because of an accumulation of evidence against them, or because they are either
non-verified or refuted, but because they are less good in comparison to the theories that supersede them at choosing new
problems and at setting criteria for solving outstanding scientific problems." p 146 . Salmon, Earman et al (1992)
"Introduction to the Philosophy of Science". Hackett Publishing Company: Indianapolis/Cambridge.] Another reference
is Maxwell, G. (1998) "The ontological status of theoretical entities, in Klemke, E., Hollinger D. et al Introductory
Readings in the Philosophy of Science (3rd edition). Prometheus Books: Amherst, N.Y. 

Have not the theoretists of stuttering come up lacking with respect to inventing more appropriate models, just because
such models would have to include internal variables or states that cannot be verified with present day instruments and
measuring systems? Are we lacking a Noam Chomsky who in 1959 "in a review of Skinner's Verbal Behavior, pointed
out that the operant conditioning model was insufficient to explain a human's ability to produce novel sentences in natural
language." (ibid. pp352-353) …"The general problem is that instead of ending up with a neat one-to-one correspondence
between a specifiable stimulus, and identifiable behavior and a clear reinforcing contingency, we have many-many
correspondences. This means that laws describing behavior in a one-one mapping of physical simulus conditions onto a
specific behavioral response (the paradigm for a psychophysical law) do not exist." Isn't this why some of our best
fluency shaping techniques have failed to yield lasting effects? 

Aren't many of our measurements in the research of stuttering therapy "theory-laden"? (That is, all the data that we have
gathered may have to be re-evaluated since it may be tainted and in the worst case useless because of the way we have
gathered the data.) Curd & Cover, (1998, Philosophy of Science. Norton & Co: New York & London.) on page 1309
define Theory-Ladenness - "According to some philosophers of science (such as Paul Feyerabend, T. S. Kuhn, and N.R.
Hanson), observations are theory laden. What exactly this means is controversial, and whether it is true and what it
implies has been hotly debated. One fairly uncontroversial reading of the theory-ladenness thesis is that observation
reports, if they are to be evidentially relevant to a theory, must be expressed in the vocabulary of that theory rather than in
some theory-neutral observation language. Some philosophers have inferred from this that because observation is theory
laden it cannot be appealed to as a neutral ground on which to judge among competing theories. Less tendentiously, it is
sometimes claimed, under the rubric of the theory-ladenness-of-observation thesis, that observation and experiment alone
cannot rationally compel scientists to accept and reject theories. 

I have some more questions, but this may not be the proper forum for this discussion. However, when I observed
elsewhere in this conference comments' your intimate knowledge of Kuhn, I became really curious what your responses
would be. 

My final question, and maybe the easiest to answer is: "Are we in what Kuhn calls the pre-paradigm state in the research
on stuttering?" 

Re: We are wondering in the desert like Moses, but it has been much
longer than 40 years …

From: Joe Kalinowski
Date: 10/18/99
Time: 6:38:52 AM
Remote Name: 150.216.147.209

Comments

We are wondering in the desert like Moses, but it has been much longer than 40 years …
--------------------------------------------------- 

My colleague, Andy Stuart, introduced me to Kuhn back in 1991 at Dalhousie University in Canada. (I can't believe any
doctoral program would fail to use Kuhn's work and that of Popper's as a prerequisite for doing any science , but I think
many do--and thus the illusion of simple accretion of knowledge and seamless transition from paradigm to paradigm is
passed to yet another generation of young scholars.). 

Kuhn's notions are one of our guiding lights. Andy is more into Karl Popper and the questions of testability and
demarcation that you elude to in your comments. We have a lot of fun teaching a doctoral seminar which examines the
works of Kuhn, Popper, Alan Gross (the Rhetoric of Science), Casti (Paradigms Lost)..and others…we love it. We
suspect the doc students learn to love -- or at least they put up a "good front" . 

 [Our Kuhn Site]  [Our Popper Site] 

___________________________________________________ Any ways, back to stuttering… 

It is my opinion that we are in a pre-paradigmatic state as espoused by Kuhn. Lots of ideas out there with none being
generally accepted. During phases in the last century, we have had slight emergencies that looked like we were moving
beyond the pre-paradigmatic state but we have always receded into the chaos of "everything is a viable explanation" --that
we are in today. 

We have moved back and forth between psychopathology, behaviorism, speech motor dynamics, gestalt, cerebral
dominance, etc.. Our therapies include: hypnosis, acupuncture, 12-steps to fluency, Alexander technique, auditory
feedback, psychotherapy, behavioral therapy, gentle onsets, air flow, diaphragmatic breathing , desensitization,
acceptance, letting go, carrying on.. 

This is no exaggeration--look at this ISAD2--these notions are all here and more.. And they all belong, because of our
inability to "embrace empiricism" (see Stuart, 1999). 

Yes, we are wondering in the desert like Moses!!!!!! 

We have made some progress in that we now pronounce that stuttering lies in the CNS--which is real neat because I have
never met someone without a brain who stutters. (Sorry for the sarcasm!) 

Oh yeah, spontaneous recovery-- I don't know. It seems too nebulous to define, operationalize, and test. But I may be
wrong--very wrong! 

The notion that things are not simple one to one mapping is given before we have picked "all the low hanging fruit".
(Most of our research groups' work focuses on picking the low hanging fruit which should have been picked decades
ago-- in our field's enthusiasm to find an answer -- we moved to fast to the top of the tree and it is barren) . 

In other words, we haven’t done the simple things --yet we have moved onto the "system is too complicated" syndrome.
That makes every answer viable-yet none powerful and compelling. 

Re: Sounds more like a scienticfic revolution...

From: Andrew Stuart
Date: 10/18/99
Time: 8:13:15 AM
Remote Name: 150.216.147.118

Comments

In my opinion, the field of stuttering is not in a pre-paradigmatic state. The absence of a paradigm is characterized by fact
gathering of a "random activity" nature. Although my colleague Joe Kalinowski would characterize research in the field
today as random activity he has pointed out that the field has passed from such "notions" of psychopathology, cerebral
dominance, behaviorism, speech motor dynamics, gestalt, etc. to describe stuttering. I suggest that each has represented a
change from one paradigm to another. 

My interpretation is purely Kuhnian in nature. It lies in the observation of how Kuhn sees scientific activity. In the early
stages of a scientific field's development there may be an absence of a paradigm or a candidate for some paradigm and
consequently all facts may be viewed as equally relevant. As such, different individuals investigating the same
phenomenon may have divergent interpretations or descriptions of the phenomenon. It may be debatable that stuttering
research meets that description today. 

My point is, however, that when paradigms are in place science becomes a "mopping up" operation in the sense that there
is an attempt to fit observations into the defined and relatively fixed box that the reigning paradigm dictates. In my opinion
this has been the state of stuttering research following the genesis of the "speech motor dynamics" theory in the 1970s.
Support for necessity of "slowed speech" for fluency was found empirically (e.g., Perkins, Bell, Johnson, & Stocks,
1979), therapeutically (see e.g., Van Riper, 1973), and with the fact that changes in speech production were observed
among other conditions of fluency enhancement (e.g., Andrews, Howie, Dozsa, & Guitar, 1982). 

Our notion has been that a slow rate of speech is not solely responsible for the fluency-enhancement effects of altered
auditory feedback. This has created an anomaly in the field of stuttering (Stuart, A., & Kalinowski, J., 1996. Fluent
speech, fast articulatory rate, and delayed auditory feedback: Creating a crisis for a scientific revolution? Perceptual and
Motor Skills, 82, 211-218). 

An anomaly leads to a crisis that questions the effectiveness of the existing paradigm. It can, according to Kuhn, close in
one of three manners: (a) Normal science solves the problem and the existing paradigm stands; (b) the problem resists a
solution given the limits of the present state of the field and, as such, is set aside for the future when better problem
solving tools are developed; or (c) a new candidate for a paradigm arises and with it a conflict for its acceptance. 

I view the field in a state of crisis and not in a pre-paradigmatic state because the activity of research over the past 25 years
has not been random but paradigm driven. It may be a mess now because a crisis or crises has generated a scientific
revolution for which a better paradigm has yet emerged. 

For Joe Kalinowski and Andy Stuart: More questions

From: Gunars K. Neiders
Date: 10/18/99
Time: 1:26:34 PM
Remote Name: 12.13.226.15

Comments

Joe Kalinowski and Andy Stuart, 

Thank you both for responding to my questions so quickly and providing the marvelous websites and the good
references. In an ideal world I would read or reread everything (Kuhn and Popper were among my favorite philosophers
of science), before I proceeded to ask other questions. However, Judy is closing down this site for new questions by the
end of the week, and I feel like an undergrad at the local watering hole who discovers that others have studied the
questions that long have plagued me and can't wait to find out what others think. 

Perhaps a better forum for this discussion would be the SID4 listserver and when I get home I will check if both of you
are logged on to it. Then I could leisurely ask you the questions as I proceed to study. And you could pick and choose
which topics you want to contribute to. In any case I would like to get your e-mail addresses. Mine is
neiders@halcyon.com. 

You mentioned that the serious scholars agree that stuttering "resides" in the CNS. Albert Ellis fifty years ago simplified
the Central Nervous System to the layman's concept of four life processes: cognition, affect, perception (both sensory
and cognitive), and the signals that command our motion. What are the current models? Has anybody made a computer
simulation of the CNS? 

[A footnote: I assume that Courtney Stromsta's hypothesis that the stuttering population has different bone conductivity
than non-stuttering population did not yield any evidence. Am I right?] 

Have either of you read much of Noam Chomsky and his hypothesis about learning a language and have you considered
that there may be a flaw in that mechanism for the people who stutter. This may lead to the hypothesis that "Second
Speech Signal" as a more complex interaction than merely being a distraction as Bloodstein asserts. This could be
something akin to sympathetic vibration in physics, where the strings in piano, for example, vibrate "in sympathy" for the
frequency of the sound in room. 

Is there a good survey paper of all the existing models of etiology of stuttering? Something that tries to cast all the current
models in a common language, i.e. graphical system design using boxes to signify various elements and feedback and
feedforward signals identified by arrows? 

I like to think of etiology as two processes: 1) how the stuttering started (etiology) and 2) what propagates the stuttering
now (propagation mechanism). Knowing how stuttering got started is important in helping us prevent the onset of
stuttering and knowing what propagates it would help us to either cure or manage stuttering. Do you think that this model
is a worthwhile one? I believe it is because this reduces the complexity of the problem. (Caesar said, "Divide and
conquer!" J) 

This will do for the conference, I hope we can meet on SID4 listserver or you are gracious enough to send me your e-mail
addresses. 

Gunars 

A Visual Only "Second Speech Signal" is Just as Powerful as A
Sound Transmitted Second Speech Signal!!

From: Joe Kalinowski
Date: 10/24/99
Time: 9:47:52 AM
Remote Name: 150.216.147.209

Comments

The long debate between Motor theorists (e.g., Liberman & Mattingly, 1985), direct realists (e.g., Fowler, 1982), and
auditory theorists (Kluender,, 1986) have peaked our interests in a non-auditory speech signal which might generate
fluency- A VISUAL GESTURE OF SPEECH WITHOUT SOUND. According to Motor theorists "speech is special",
thus it could be supposed that a visual representation of choral speech (i.e., visual choral speech without sound) might
generate fluency enhancement as well or almost as well as auditory choral speech. Our research group has determined that
visual gestures of speech induce fluency in persons who stutters without the attendant auditory speech signal. 

Therefore sound is really not important in fluency enhancement via the second speech signal!!!! Mind blowing, eh!1 We
think so --- 

Stromsta appears to have been wrong, but there is no doubt the man had genius. 

We are at exciting times in the area of stuttering research and therapy. Scary --but real exciting.---- LOTS OF "LOW
HANGING FRUIT" OUT THERE TO BE HAD BY ALL. 

Great Conference!!! Thanks for letting me participate

From: Joe Kalinowski
Date: 10/24/99
Time: 9:55:17 AM
Remote Name: 150.216.147.209

Comments

GREAT CONFERENCE. I LIKED THIS CONFERENCE MORE THAN ALL I'VE BEEN TO SINCE 1982,
BECAUSE I DIDIN'T HAVE TO WORRY ABOUT MY STUTTERING, COULD ASK SMART PEOPLE NEAT
THINGS, AND I DIDN'T WORRY "IF MY HAIR WAS COMBED"!!! 

My e-mail is : kalinowskij@mail.ecu.edu Dr. Stuart is at : stuarta@mail.ecu.edu