I was one of the first persons to acquire an Edinburgh Masker back in the mid 1970's. A colleague of mine mentioned that it had been featured on a BBC television programme about scientific inventions and, the following day, I travelled to Scotland to take part in a suitability trial.
For those of you who are not familiar with the device, let me explain that it comprised a control box (attached to a belt and worn under my shirt in the small of my back); a throat microphone (affixed beneath my Adam's Apple by means of an adhesive disc); two small amplifiers; several lengths of wires and transparent tubing, the latter connected to ear moulds concealed in each ear.
I subsequently wore ithe Ediburgh Masker for the next 20 years - 10/14 hours daily. When I was at home, I would strategically place it near to the telephone and hastily fit it before answering. Very often, my wife would take the call while I was in the throes of fitting the ear moulds and throat microphone etc.
It became my mechanical crutch for two decades - I felt that I could not do without it. I wore it at work (I was a police officer) and in social situations. I guess I was the world's first bionic policeman;-)
Had I not worn it, I could never have performed my duties in the manner I did. My oral courtroom struggles had earlier banished me to a mundane office role when a supervisor described me as "an embarrassment to all". Within a couple of years of acquiring the Masker, I persuaded them to allow me to return to operational duties.
When I first began wearing the device, another senior officer made a disparaging remark. I insubordinately asked him if he would be able to survive without his thick horn-rimmed spectacles. He became strangely silent;-)
In the early stages, it had quite a dramatic effect upon my speech. I felt so much more capable. However, the fact that I was wearing such a device did not magically eliminate the limiting and engrained beliefs that I had accumulated throughout my lifetime. I still doubted that I could do the things that I had always avoided - the fear was still present.
Although I was never fluent, in common with Marty Jezer, the Masker appeared to give me greater confidence to enter into challenging situations. Without the buzzing sound, I felt naked and vulnerable. Whilst wearing it - I felt I could cope, albeit that I was never wholly fluent.
When the device was active, I modified the way in which I spoke, purposely prolonging sounds in order to keep the throat microphone activated. My wife always knew when I was wearing it - I spoke differently.
As I previously indicated, the Masker gave me greater confidence to enter speaking situations. Consequently, my fear of those situations decreased. They became less threatening. It allowed me to expand my comfort zones and accept my involvement in those situations as a part of my self-image. Hitherto, I viewed myself within much-limited parameters.
When I was away from work on annual leave, I would invariably not wear the apparatus, although it always travelled with me. I needed to escape the buzzing noise that blurted into my ears every time I spoke. In addition, my ears required ventilation, as I suffered many infections as a result of wearing the ear moulds.
However, when I recommenced wearing the Masker, it would take me a considerable time (maybe a day) to re-adjust to the speaking manner that provided the maximum benefit. It was as though I need to re-educate my system.
I became so reliant upon the device and feared that it might become unserviceable. When the pressure was really on - it invariably let me down. What I mean is that it appeared to become less effective. On one occasion, a wire became detached while I was speaking to an audience. Without the masking sound - I reverted to my old stuttering behaviour.
With hindsight (I stopped wearing the device several years ago), the greatest benefit was that it allowed me to venture into speaking situations that I would, otherwise, have avoided. Consequently, my stuttering hexagon had become positive in various areas. Despite the many setbacks that I experienced (whilst wearing it), I now realise that it had helped me set up a system that would later support greater fluency and self-expression.
I have no doubt that, without the support of the Edinburgh Masker for two decades, I would not be in the favourable position I find myself today. It was one piece of my life jigsaw. When the final piece arrived during recent years, everything fell into place.
As many of you know I routinely wear an Edinburgh Masker. I've done so for about 13 years. I've tested 60-80% disfluent, was disfluent even in clinical situations, had tension-filled and physically tiring blocks, love to talk, and so felt to be in a desperate situation.
The Masker didn't cure me! What it did was lessen the tension of my blocks, minimize them, create more calm in my brain, and allow me to use some of the techniques that I've learned but could never use in any real world situation. I've never been tested, but I would estimate that with the Masker I stutter in the 5-20% range, but my blocks are not jaw-busters and I can generally move forward.
I found the Masker works best when I pay attention (am aware of) my speech -- when I am in comfort zone (mind is calm) am speaking slower than my usual rate, and do voluntary stuttering. Many of the ideas we speak about here help maximize the effectiveness of the Masker. I would say, also, that it's confidence, being unafraid to talk -- and to stutter -- that are most important. When I'm confident, hence calm, the techniques come easy.
I would say that over-all the Masker makes me a mild rather than a severe stutterer -- using it I'm in the same ballpark as mild stutters in terms of working with my speech. When my stress is very high, the Masker doesn't work well. But I'm learning to control my speaking stress -- simply by challenging myself to expand my comfort zone so once fearful situations are no longer fearful.
The downside of the Masker is that the white noise is occasionally harsh and annoying. It reduces my hearing (though this may also be a result of age and too many nights spent in jazz clubs in my youth). It's also a problem when it's hot and I sweat. The throat mike that picks up the vibrations in my vocal cords and sets off the white noise in my ears doesn't stick to my throat when I sweat. On the other hand, I don't find wearing it awkward, as some do. It's pretty hidden behind longish hair.
When people notice it, I educate them. One friend almost passed out when he saw my throat mike. He thought it was stuck into (actually it's taped) to my adams apple.
Recently, I've been experimenting with CasaFutura's DAF machines, one that attaches to my telepone, and a portable one which I'm using for public speaking. The set up is pretty much like the Masker in terms of comfort and convenience. The delayed auditory feedback sound is much less harsh than the masking sound of the Masker. Thomas David Kehoe who manufactures these devices, claims that the Masker creates a tension in one's voice that the DAF doesn't -- and I think he is right.
I've tried using the DAF in conversation and it's difficult because the mic picks up all background noise so you hear everybody speaking with delayed auditory feedback, but it works well when I am the only person speaking. Again, it's not a cure, but a fluency aid. The DAF, because it's not as harsh as the Masker, is more pleasant to use. I think I am more in control of my speech when I use it as it slows me down (with the Masker I have to slow myself down) and enables me to be more calm and use voluntary stuttering.
I've been using it for about 6 months now, mostly at Toastmasters -- with mixed results. The degree that I am calm at the podium determines how fluent I'll be when I speak.
The first night at the NSP the excitement and the noise of everyone talking overwhelmed my Masker and my speech fell apart. It was not anxiety that was affecting me, but excitement. I wanted to talk to everyone and was not able to handle the level of intensity. When people say that their speech is under stress they usually mean it as a result of fear, anxiety. I feel it often as a result of excitement. I love to talk. And my exitement overwhelms my motoric abilities. I was looking forward to the Toastmaster workshop as a means of getting focused on calmness and thus gaining control over my speech.
At the Toastmaster session, using the DAF rather than the Masker, I really took command of the podium. It was the first time I ever felt so in control (by which I mean, calm, confident, unhurried, in control of my presentation). I fiddled with the mic, commented on it, began with some very strong voluntary stutters and felt great as I opened my presentation. That good start boosted my confidence and kept me calm for the duration. It was the best public speaking I've ever done.
But the DAF, like the Masker, is only as good as the speaker. The next day I emceed the NSP Writers Read workshop, using the DAF. Because of my own disorganization as the organizer of the workshop I never took command of the podium. As emcee I rushed into my introductions and never quite felt the confidence that I had at Toastmasters. I was OK, but not as good as the Toastmaster experience, which proved to me that preparation is all important -- those first few minutes up on the podium set the pace for the whole presentation.
I also did a lot of talking at Woody and Janet's Birch Tree workshop. I had the Edinburgh Masker on and was, I think, almost totally fluent. That is because I was in a zone of total comfort. Perhaps it was being among friends, perhaps it was the placement of the stars, but I was able, with very little mental effort, to talk slow and bounce.
Conclusion: I find these devices really useful. A lot of people I know have tried them and found them unwieldy. With me the gain I get so outweighs the discomfort that I don't mind the discomfort. For others the discomfort will outweigh the gain so they don't want to use them.
Both the Masker and the DAF work only to the degree that I am working on my speech. When I'm consciously working for better speech (a calming of my mind) they are more effective.
I used to have a philosophic problem about them. How much of my improved speech is me, how much is it a result of the electronic device? I now think this is a stupid question. People with hearing aids don't denigrate themselves because it's the aid that enhances their hearing. If you need a crutch to function better in the world, use one -- and don't worry about it.
Realistically, the devices don't stop my stuttering; what they do do is make it possible for me to more effectively cope with my stuttering. I still stutter; in conversation, even with strangers, it rarely bothers me; indeed, more and more I've stopped thinking of myself as a stutterer. I just speak -- and if I'm disfluent so what. I find people listen to me and that is what counts.
Public speaking is still a challenge. There are situations that still scare me. But I will no longer run from them. And the experience I have with relatively easy public situations (easy now but impossible a few years ago) will prepare me for the tougher challenges.
Date: Sat, 11 Jul 1998 10:28:10 -0400
From: Marty Jezer - mjez@SOVER.NET
Re: long term effects of electronic devices.
The Masker has not helped me in any long-term way. When I take it off I become, I beocome, once again, a severe stutterer. At that degree of disfluency, it's very difficult to use my techniques with any degree of effectiveness. Which raises an interesting question: With a device I can use techniques. Without them I can't. Same person, same techniques. What's different is the starting point. Without the Masker, my struggle is too great for the techniques to be useful. With the boost from the Masker, I can use them successfully. To me, this backs up Gene Cooper's notion of chronic preseverative syndrome. Some of us have such serious deficits that ordinary therapy is not the answer. I wish academics would do a serious study on electronic devices.
As for Casa Futura's DAF machine, it's too early, in my case, to determine its long-term effect. (And I don't use it everyday conversation). But David Kehoe is a real advocate of using it in combination with therapy and his telephone DAF unit has biofeedback components that are useful in therapy situations.
Back to the Masker again: Herb G says the Masker helped make him fluent. When I first met him he had the Masker on but used it only in specific situations. Now I notice that he doesn't even have it on. Jock C., I believe, also claimed improvement with the Masker -- though I've not seen or heard him speak in ten years. In both instances, the Masker helped get them over their fear of speech. Both became good public speakers. It may be that rthe experience of public speaking got them over their fear of speaking, gave the confidence and a good attitude and this, more or as much as the Masker brought the fluency.
In my experience, doing it -- that is accepting challenges and getting over the fear of speech -- has really improved my fluency -- with the devices on.
The people that I have tried the DAF device with found it unacceptably cumbersome to wear and far less effective than the therapy skills I taught them. So for me, the device had the effect of motivating them to work on therapy, a side benefit I had not anticipated.
Date: Sat, 11 Jul 1998 12:56:58 +0000
From: Bruce Carlson - email@example.com
I've got one of the Casa Futura desktop phone models and I've never really used it effectively because of the headset microphone. It seems that, unless I have the mic precisely positioned, people on the other end have difficulty hearing me.
Naturally, when people start saying "What? What? I can't hear you!" and become impatient, it raises my stress level and destroys any effect of the device.
Has anyone else had this problem and how have you dealt with it? I have tried finding the proper position for the headset mic but have found that effort unreliable. What seems to be the exact same place is not and a 1/4" seems to make a dramatic difference.
I have an ER MK-80 headset. Can anyone suggest a better one?
Date: Fri, 10 Jul 1998 23:10:04 -0700
From: Lynda Voigt - mikeandlynda@SEANET.COM
I have one of Casa Futura's portable DAF devices. I have taken it with me for several formal talks I have given, but never used it at one. It made me feel better to have it in my pocket in case my speech really fell apart ( my security blanket). I did use it once when I was in a committee meeting. Everyone was in a hurry to finish up and catch planes back home. I had a lot of trouble with my speech during my first report, and the tension to hurry was very bothersome. So when my turn came again to give my report, I put the DAF on, told people what I was doing, and proceeded to breeze through my review (with fairly slow speech, but faster than my stuttered speech with so many blocks). It was quite a relief under the circumstances. I have also used it twice during conference calls -- that is pretty stressful, also, because people cannot tell if I'm finished speaking or not since there are no visual cues. The only difficulty I have with my speech when using the DAF is when I block on my first word -- then there is no sound to delay. The DAF is too distracting for me to use in my everyday conversations, and I'm pretty comfortable about stuttering most of the time now, anyway.
Date: Tue, 16 Jun 1998 12:31:22 -0400
From: Marty Jezer - mjez@SOVER.NET
Subject: The Edinburgh Masker/DAF devices
Michael has covered the basic ground with regard to the Edinburgh Masker and the DAF units that David Kehoe sells.
I've been using the Masker for about ten years. I usually put it on in the morning and keep it on. Recently I've been trying the DAF units for public speaking and the telephone.
They are not magical cure-alls. Stress (which for me is excitement about speaking as much as it is about anxiety) still has a huge effect. The closer to my comfort zone (more relaxed and "in charge" I feel) the better they work. Both are more effective when I speak slow and use voluntary stuttering. (The DAF has the advantage of making you speak slow).
I wish there was some reliable data about the effect of the machines. In conversation, they pretty much about eradicate my stuttering problem (though not my stuttering). That is, I do not fear speech and have enough fluency to communicate effectively. (Without the devices, this is not so -- and my normal fluency is so shakey that it is a real struggle even using techniques).
The self-therapy I am doing involves increasing my comfort zone in more and more and higher stress situations. When I feel comfortable the fluency comes-- and the Masker or DAF make a huge difference.
But never enough to make me 100% fluent. It's all relative, however - and the perception of one's own stuttering is so subjective. In many everyday conversations I no longer think of myself as having a stuttering problem. Yet, objectively my stuttering is obvious. I just don't care. It's only in public speaking -- and some telephone situations -- that I perceive my stuttering to be a problem.
Both the Masker and the DAF are somewhat annoying to wear -- especially in hot, humid weather. The DAF sound is more pleasant than the white noise of the Masker. It's a question of whether the gain in fluency is worth the discomfort -- and that's an individual judgement.
There's a philosophic question involved. Is it the device that gives me fluency -- or is it me? I worried about that for a long time and came to the conclusion, I don't care. It's true, I'm less fluent without a device. My child, when she was young, chose me as her bedtime reader. But I could only perform that bedtime chore with the Masker. Without it it was too difficult. With it, it was a fulfillment of a dream I never thought I could reach.
So call it a crutch. A hearing aide is a crutch, as is a wheelchair, as is a cane, a walker and an actual crutch. All kinds of people need and use crutches. Why can't we who stutter? It's an individual choice.
Herb G, a wonderful person who many on this list know, created the non-profit Foundation for Fluency to distribute the Masker at cost. He's no longer doing it; you have to order it direct from:
Jetcom (UK) LTD
5 West Street
Tavistock, DEVON, UK
Tel: 01 822 617 611
Fax 01 822 616 619
The person to write to is named John Goatcher.
The DAF units are available from Thomas David Kehoe. The address is:
PO Box 7551
Boulder CO 80306-7551
Tel 303 417-9752
Fax 303 413 0853
Date: Sun, 12 Jul 1998 00:32:31 -0400
From: Lucy Reed - blreed@BELLATLANTIC.NET
Subject: Re: electronic devices/my icebreaker
On electronic devices: I recently met two people who have been very happy wearing a device known as The Fluency Master. I don't know much about it, but from what these folks have told me, it's neither DAF, FAF, nor a masker. They both claim their fluency increases tremendously while wearing this device, especially when combined with the use of fluency techniques.
Date: Sun, 12 Jul 1998 10:07:18 -0400
From: MJ Reis mjreis@TACONIC.NET
Subject: Re: fluency master
Two years ago I tried the Fluency Master. I went down to Pennsylvania and sat through a two or three hour introductory meeting with one other stutterer and two or three clinicians. The other stutterer was helped much by the Fluency master. I had the highest hopes, because this is a small, hearing-aid size device worn behind one ear -- that's it. A small mike picks up vibrations from a bone behind the ear and makes a very subtle noise that is supposed to be not masking, but counteracting to the faulty ear-vocal connection that is thought to bring on stuttering. I used to know it all in detail but have forgotten it. Anyway, the thing costs about $1500. and you have a two weeek trial period after you buy it. I had to return mine because it simply did nothing at all for me. The literature says that maybe 75% of people are helped to some degree. As far as I could figure out, no one really knows why it works.
Date: Sun, 12 Jul 1998 21:30:17 -0400 (EDT)
From: Bernie Weiner - Berniewin@AOL.COM
Subject: Re: fluency master
My own experience with a fluency master was not a satisfying one either. About five years ago when I decided to once again try some speech therapy, the first thing the therapist did was slap this fluency master on me. Besides being too vain to wear the damn thing, I found that it worked sporadically when wearing it, but once I took it off, my stuttering pattern returned. Psychologically, I knew that I was still a PWS and no matter what device I wore , I would still stutter. Besides, the vibration from the fluency master drove me nuts. It is much more satisfying to just try to stutter easier and not go for that perfect fluency thing.
Date: Sun, 12 Jul 1998 22:48:48 -0400
From: MJ Reis - mjreis@TACONIC.NET
Subject: Re: fluency master
Though the Fluency Master did nothing for me, I have to say that at my little training session for the thing there was a speech pathologist sitting in who was, according to him, a stutterer, and he had one of these things on and was totally fluent. He said it worked for him immediately when he first put it on, and it was an amazing change. Of course, as we keep saying, stuttering is different for everyone -- I don't know what the severity of his stuttering was to begin with. But it seemed to immediately help the other PWS who was there with me, too.
Date: Tue, 14 Jul 1998 07:56:47 -0700
From: Thomas David Kehoe - kehoe@NETCOM.COM
Subject: Re: electronic devices/my icebreaker
Re. Edinburgh Masker vs. Pocket Fluency System: The Edinburgh Masker provides white noise (random noise) masking auditory feedback (MAF). The Pocket Fluency System provides delayed auditory feedback (DAF), which delays your voice to your ears a fraction of a second, and sine wave masking auditory feedback (MAF). This synthesizes a sound like your vocal fold vibrations, which is more effective and more pleasant than white noise masking auditory feedback. As everyone seems to agree, DAF is better than MAF, except for "silent blocks." As Lynda Voigt wrote, DAF is useless if you "can't get started." Both the Edinburgh Masker and the Pocket Fluency System have an MAF manual button. If you have a silent block, you just push the button, your brain is fooled into thinking that your vocal folds are vibrating, and off you go.
Marty Jezer wrote:
> I've tried using the DAF in conversation and it's difficult because
> the mike picks up all background noise so you hear everybody speaking
There are three or four microphones available for the Pocket Fluency System:
- The lapel mike rejects background noise up to 80 dB, which is fine for public speaking, but not acceptable for wearing all day.
- The throat mike rejects background noise up to 95 dB, which should work everywhere except rock concerts.
- The headset with the noise-canceling throat mike rejects background noise up to 105 dB, which should work everywhere except loud rock concerts.
- I can get Stanton throat mikes, which are used by NASA and the Air Force. These are large and conspicuous, but enable you to talk while launching a space shuttle.
I don't know which microphone Marty has been using. I would be surprised if his throat microphone picked up background noise, unless he had the gain adjusted wrong or something.
> Both the Masker and the DAF work only to the degree that I am working
> on my speech.
I get calls from stutterers looking for an instant, 100%, effortless cure. They do not want to see a speech therapist for training. They do not want to use therapy techniques (such as a relaxed, slower speaking rate). Some have never had stuttering therapy.
Studies show that altered auditory feedback devices reduce stuttering on average 70-80%, without training, mental effort, or abnormal-sounding or slowed speech. These devices can only approach 100% elimination of stuttering when used in conjunction with speech therapy.
For example, one young man said that most of the time he can talk fast and fluently, but sometimes he gets into hard blocks. He was from India and talked very fast and tensely. He bought a Desktop Fluency System (his job required mostly talking on the telephone, and the DFS plugs into telephones), and adjusted it for the fastest speaking rate. He returned it, complaining that he still got into hard blocks. He said that his fluent speech was fine -- why should he change his fluent speech? He wanted a machine that would get rid of the hard blocks, without changing his fluent speech. I couldn't convince him that he got into hard blocks because his fluent speech was too fast and tense.
Another example: a Ph.D. speech pathologist at a major university bought the top-of-the-line $1500 Desktop Fluency System with EMG biofeedback. Three months later he returned it, complaining that he still stuttered. He said that he'd used the DAF, adjusted for a medium-fast speaking rate, on one 5-10 minute telephone call each day. He was fluent when using the DAF, but his speech the rest of the day hadn't changed. He hadn't tried using the slower DAF settings, or the FAF, the gentle onset monitor, the respiration/vocal fold biofeedback, or the EMG biofeedback. He hadn't looked at the device's 96-page therapy manual.
Woody wrote: > Has anyone tried the FAF device? The research suggests that it should > be considerably better than DAF in that it does not distort your > speech the way DAF does.
Frequency-shifted auditory feedback (FAF) alters the pitch at which you hear your voice. Like DAF, FAF reduces stuttering on average 70-80% without affecting your speaking rate. But DAF is more versatile. DAF can be adjusted to a longer delay to slow your speech, enable use of fluency shaping techniques, and almost 100% eliminate even severe stuttering.
Studies have shown that combining DAF and FAF boosts the effectiveness to 75-85%. The Desktop Fluency System has both. I left FAF out of the Pocket Fluency System to keep the device small and inexpensive.
A few things Woody wrote need to be corrected:
> I am not aware of any long-term effects from any of these devices.
> They work while you are wearing them, but that's it.
There have been several studies showing the long-term benefits of electronic devices.
One study found DAF therapy to be effective with school-age stutterers, in less than 20 hours of therapy. The children continued to be fluent 14 months later. Ryan, Bruce and Barbara Van Kirk Ryan. "Programmed Stuttering Treatment for Children: Comparison of Two Establishment Programs Through Transfer, Maintenance, and Follow-Up," Journal of Speech and Hearing Research, 38:1, February 1995.
Another study found similar results with adults. Ryan, B.P., Van Kirk, B. "The Establishment, Transfer and Maintenance of Fluent Speech in 50 Stutterers Using Delayed Auditory Feedback and Operant Procedures." Journal of Speech and Hearing Disorders, 39:1, February, 1974.
An Australian study compared three types of stuttering therapy with 98 junior high school-age children. The first group did regular stuttering therapy with speech pathologists in a speech clinic. The second group never saw the speech pathologists, but their parents were trained to administer the therapy at home. The third group came into the speech clinic, but didn't see the speech pathologists. They sat down in front of a computerized EMG biofeedback system (my Desktop Fluency System has similar technology). All therapies were effective in the short-term. But a year later, 48% of the children treated by speech pathologists were fluent, 63% of the children treated by their parents were fluent, and 71% of the children treated by the computers were fluent! Craig, A., et al. "A Controlled Clinical Trial for Stuttering in Persons Aged 9 to 14 Years" Journal of Speech and Hearing Research, 39:4, 808-826, August 1996.
CAFET has an unpublished study of its device, showing that 92% of its clients are fluent 2 years after finishing the program. This 8% failure rate is 3-4 times better than the best non-instrumented therapy programs.
Herb G wrote to me that:
"I am in contact with over 500 people who use or have used the Masker. In most cases the end result is the person uses the device less and less as time passes due to less need for it...[a person who does not experience carryover fluency] is exceptional."
Specifically with Casa Futura Technologies devices, 45 of my customers returned a survey, and 85% said they were experiencing carryover fluency.
All in all, there is overwhelming support for the long-term carryover effect of electronic devices, especially when used in conjunction with stuttering therapy.
Woody also wrote:
> In some cases too, the effect of the device wears off so that it
> doesn't work even when you are wearing it.
I've never seen a study supporting that view. My customers have reported the "good days, bad days" phenomenon when using their devices. In other words, some days they use the device for a short period in the morning, and their speech is fluent the rest of the day, with no real effort. Other days they stutter more, even when using the device. I believe this reflects dopamine levels in the brain varying due to diet and other factors.
I warn my customers not to adjust their devices to increase their speaking rate. For example, a Korean engineer bought a Desktop Fluency System, and adjusted it for maximum speed. He called me the next day. "This is great! I can talk as fast as my Korean relatives, and I'm completely fluent!" He was talking at least 50% faster than normal speakers. I persuaded him to adjust the controls to a slower speaking rate.
I think that if you use a device to talk faster or more tensely, your stuttering may return when using the device, and your stuttering may get worse when you take off the device. None of my customers have reported this, but I've heard of one or two people experiencing that with the Edinburgh Masker. If you listen to people use the Edinburgh Masker, and then use DAF, with the Edinburgh Masker their voices are higher in pitch and you can hear increased tension in their speech-production muscles. Then they put on DAF, and their muscles relax. This suggests that the Edinburgh Masker is less effective in developing relaxed, fluent speech.
> The people that I have tried the DAF device with found it unacceptably
> cumbersome to wear
Woody had his clients try wearing one of my anti-stuttering telephones. The anti-stuttering telephones are portable and can be used for face-to- face conversations, they really can't be worn. The Pocket Fluency System is designed to be worn.
> the device had the effect of motivating them to
> work on therapy, a side benefit I had not anticipated.
I see electronic devices, and also drugs, as the starting point for stuttering therapy. You take a pill or put on headphones and you talk with improved fluency. But you don't talk 100% fluently, and you don't want to wear the device all the time, or the pills have side effects. Now you are motivated to do stuttering therapy and reduce your dependence on the device or drug.
Marty Jezer added:
> At that degree of disfluency, it's very difficult to use my techniques
> with any degree of effectiveness. Which raises an interesting
> question: With a device I can use techniques. Without them I can't.
> Same person, same techniques. What's different is the starting point.
> Without the Masker, my struggle is to great for the techniques to be
> useful. With the boost from the Masker, I can use them successfully.
Speech pathologists have the mistaken view that if they can get a stutterer fluent in the speech clinic, their job is done. I'd be 100% fluent in speech clinics, and lose control of my speech in real world conversations. But when I built myself a DAF device, it boosted my vocal control, so I could use the fluency shaping techniques. Over the last six years, fluent speech has become more or less automatic for me, so I don't need the devices any more.
As I've said over and over, the devices alone don't cure anyone, and speech therapy alone didn't work for me, but combining the devices with therapy techniques worked.
> As for Casa Futura's DAF machine, it's too early, in my case, to
> determine its long-term effect. (And I don't use it everyday
I advocate using the Pocket Fluency System for one hour per day. Use it for the most difficult conversations of the day, then take it off and try to continue to talk fluently. One study found that 1 hour of practice per day resulted in better long-term results than 2 hours per day or 4 hours per day.
> But David Kehoe is a real advocate of using it in combination with
> therapy and his telephone DAF unit has biofeedback components that are
> useful in therapy situations.
Marty calls it a "telephone DAF", I call it the Desktop Fluency System. Yes, it can be used as an anti-stuttering telephone. But it also has a gentle onset monitor and it monitors your respiration and vocal fold tension. Most sales are to speech clinics, but it can also be used for home practice, or for using therapy techniques on telephone calls.
Speech pathologists give stutterers homework assignments, but you can't do homework without a computer or person listening to you. During stuttering, your brain's central auditory processing shuts down, and you lose awareness of what you are doing. You need someone or something to tell you when your speech is on-target, and when you miss targets. The Desktop Fluency System also has some really tough exercises that you'd never be able to do on your own, such as talking 100% fluently with no upper chest tension and relaxed vocal folds, with no auditory feedback.
> I've got one of the Casa Futura desktop phone models and I've never
> really used it effectively because of the headset microphone. It seems
> that, unless I have the mic precisely positioned, people on the other
> end have difficulty hearing me.
Turn up the "Telephone Transmit" volume control. If your telephone needs even more volume, there's a second, trimmer volume control inside the case that gives even more volume. The devices are factory-set for AT&T Model 700 telephones (the industry standard telephone), but other telephones may need different settings.
> Has anyone ever heard about or used a device called Continuous
> Phonation Device?
If you mean the Sustained Phonation Unit, it competes with the Pocket Fluency System. They're having a sale now, underpricing me by about $100. You can call them at (800) 758-8255. Buy both, return the one you don't like, and tell us which is better.
> Two years ago I tried the Fluency Master.
> Anyway, the thing costs about $1500.
The last I heard, the price was about $2350, plus travel to one of the speech clinics that sells it. The device only works with the therapy training, and only a handful of speech clinics in the U.S. can do the training.
> I had to return mine because it simply did nothing at all for me.
There is only one published study of the Fluency Master. The device reduced stuttering on average 14%. After 10-12 hours of fluency shaping therapy, stuttering was reduced on average 38%. There was no control group to see if the therapy was effective without the device.
Date: Tue, 14 Jul 1998 12:23:06 -0400
From: Woody Starkweather - V5002E@VM.TEMPLE.EDU
Subject: Re: electronic devices/my icebreaker
A few things Thomas David Kehoe wrote need to be corrected:
> A few things Woody wrote need to be corrected:
> > I am not aware of any long-term effects from any of these devices.
> > They work while you are wearing them, but that's it.
> There have been several studies showing the long-term benefits of
> electronic devices.
> One study found DAF therapy to be effective with school-age stutterers,
> in less than 20 hours of therapy. The children continued to be fluent
> 14 months later. Ryan, Bruce and Barbara Van Kirk Ryan. "Programmed
> Stuttering Treatment for Children: Comparison of Two Establishment
> Programs Through Transfer, Maintenance, and Follow-Up," Journal of
> Speech and Hearing Research, 38:1, February 1995.
This article demonstrates the effectiveness of therapy. DAF was used only to initiate fluency. The article absolutely does NOT demonstrate long term effectiveness of DAF. My Kehoe dissembles.
> Another study found similar results with adults. Ryan, B.P., Van Kirk,
> B. "The Establishment, Transfer and Maintenance of Fluent Speech in 50
> Stutterers Using Delayed Auditory Feedback and Operant Procedures."
> Journal of Speech and Hearing Disorders, 39:1, February, 1974.
> An Australian study compared three types of stuttering therapy with 98
> junior high school-age children. The first group did regular stuttering
> therapy with speech pathologists in a speech clinic. The second group
> never saw the speech pathologists, but their parents were trained to
> administer the therapy at home. The third group came into the speech
> clinic, but didn't see the speech pathologists. They sat down in front
> of a computerized EMG biofeedback system (my Desktop Fluency System has
> similar technology).
Note that the device used in Ashley Craig's research is absolutely NOT DAF.
>All therapies were effective in the short-term.
> But a year later, 48% of the children treated by speech pathologists
> were fluent, 63% of the children treated by their parents were fluent,
> and 71% of the children treated by the computers were fluent! Craig,
> A., et al. RA Controlled Clinical Trial for Stuttering in Persons Aged 9
> to 14 YearsS Journal of Speech and Hearing Research, 39:4, 808-826,
> August 1996.
Again Mr Kehoe distorts the truth to sell his products. I repeat that there is NO research which demonstrates any long term effect of wearing a DAF device. Furthermore, the use of DAF in the Ryan studies was simply a way to initiate fluency. It could have been done by many other means. Initiating fluency is the simplest thing in the world to do in therapy. It does not require a device.
> So, regarding Woody's comment that his clients found electronic devices
>to be far less effective than the therapy skills I taught them
> either Woody teaches better therapy skills than the Australians, or his
> therapy equipment is worse, or he hasn't done long-term follow-ups.
I believe that the therapy skills I teach last far longer than those taught in the Australian programs and do not require constant monitoring as the Australian methods do. I spent a week in Australia teaching and observing. The Australian methods are similar to fluency shaping. They require constant vigilance and constant monitoring. There are as yet only a few individual stories, no hard evidence at all, that people are ever able to gain permanent change without constant vigilance and monitoring from these programs.
The kind of therapy that I and most other speech pathologists do does not require constant monitoring. We teach skills that a person can use in everyday life. Some backsliding is possible, of course, but I have never had a client "crash" the way graduates of these smooth speech programs do.
> CAFET has an unpublished study of its device, showing that 92% of its
> clients are fluent 2 years after finishing the program. This 8% failure
> rate is 3-4 times better than the best non-instrumented therapy
The CAFET system is not a DAF system. It is an instrument that assists in teaching fluency-shaping targets.
> Herb G. wrote to me that:
> "I am in contact with over 500 people who use or have used the Masker.
> In most cases the end result is the person uses the device less and less
> as time passes due to less need for it...[a person who does not
> experience carryover fluency] is exceptional."
I believe this is probably a true statement. I don't think Herb is capable of making an untrue statement. But the people who use the masker are typically older people who have not been successful at therapy. The masker provides a kind of relief, and in many cases the relief reduces anxiety which in turn reduces stuttering. I don't know why the DAF device shouldn't do the same thing, but I haven't seen any evidence yet that it does. Perhaps it is the distortion of speech that DAF produces that makes it not last. DAF slows rate, stretches vowels way out of proportion, introduces some repetition at the ends of syllables, and can alter the pitch and quality of the voice. People talking on DAF sound very, very strange. In fact, in many undergraduate courses, professors let the students speak under DAF so that they can experience the embarassment of talking in an odd way, somewhat like stuttering!
I don't advocate it. I have tried it with my patients, and it just doesn't do very much for them except, as I said, it can motivate them to put more effort into therapy, which clearly works better.
> Specifically with Casa Futura Technologies devices, 45 of my customers
> returned a survey, and 85% said they were experiencing carryover
And we all know how unbiased surveys on products given by the manufacturers are!
> All in all, there is overwhelming support for the long-term carryover
> effect of electronic devices, especially when used in conjunction with
> stuttering therapy.
Absolute rubbish. I hope my exposure of Mr. Kehoe's distortions of the truth put an end to this false idea.
> Woody also wrote:
> > In some cases too, the effect of the device wears off so that it
> > doesn't work even when you are wearing it.
> I've never seen a study supporting that view. My customers have
> reported the "good days, bad days" phenomenon when using their devices.
> In other words, some days they use the device for a short period in the
> morning, and their speech is fluent the rest of the day, with no real
> effort. Other days they stutter more, even when using the device. I
> believe this reflects dopamine levels in the brain varying due to diet
> and other factors.
I don't know of a study either, but most of my clients who used DAF found it less and less effective as they used it more and more. The effectiveness of the masker, on the other hand, does not seem to wear off.
> I warn my customers not to adjust their devices to increase their
> speaking rate. For example, a Korean engineer bought a Desktop Fluency
> System, and adjusted it for maximum speed. He called me the next day.
> "This is great! I can talk as fast as my Korean relatives, and I'm
> completely fluent!" He was talking at least 50% faster than normal
> speakers. I persuaded him to adjust the controls to a slower speaking
In other words, if you can accept the distortion of speech that DAF produces you can be fluent, but as soon as you try to speak normally the effect disappears.
>If you listen to people use the Edinburgh Masker, and
> then use DAF, with the Edinburgh Masker their voices are higher in pitch
> and you can hear increased tension in their speech-production muscles.
> Then they put on DAF, and their muscles relax. This suggests that the
> Edinburgh Masker is less effective in developing relaxed, fluent speech.
This is also incorrect. The masker will naturally increase the loudness of your voice, and with that a small pitch rise could be observed also, but the pitch change that occurs with DAF is well known and considerably more extensive.
> > The people that I have tried the DAF device with found it unacceptably
>>cumbersome to wear
> Woody had his clients try wearing one of my anti-stuttering telephones.
>The anti-stuttering telephones are portable and can be used for face-to-
> face conversations, they really can't be worn. The Pocket Fluency
> System is designed to be worn.
Not so. I had my clients wearing the wearable system when they reported that they were too cumbersome. They found them so cumbersome in fact that they stopped wearing them altogether. They did not try to wear the telephones. Woody
Date: Tue, 21 Jul 1998 12:01:37 -0400
From: Marty Jezer - mjez@SOVER.NET
Subject: electronic devices/Masker and Kehoe's portable DAF device
Let me belated enter Woody and Thomas David Kehoe's discussion on electronic devices.
>The people that I have tried the DAF device with found it unacceptably
>cumbersome to wear and far less effective than the therapy skills I
This qustion about comfort: I remember another speech therapist making fun of people who wear the Masker and going to great lengths about how uncomfortable it was. This was before I had a Masker (before I had ever seen one) and I took his criticisms of it to heart and for a long time resisted getting one.
But the comfort of the Masker, like the DAF device, is a judgement that only the user can make. It is uncomfortable in the sense that any "unnatural aid" one uses, incluing hearing aides, wheelchairs, pills with side-effects, etc. are unnatural and therefore uncomfortable. What counts -- and all that counts -- is the advantage they give. If the gain exceeds the pain, people will wear them; if the pain (discomfort) exceeds the gain, they won't use them. This is a valuable real-life test. No one's going to use these devices as a cop-out or if the gain is ambiguous. If speech comes easier with them, people will wear them. The question of comfort/discomfort is for the user or potential user to make.
The Masker reduces my stuttering and changes the nature of my blocks, from jaw busters to soft ones that allow me to move forward. It takes most if not all the tension away from my jaw. I still seem to have some in my lips but not the kind that makes speech exhausting.
Evidence: I would question all evidence regarding efficacy that is based on self-reporting. Self reports are useful in therapy. The therapist, who knows the client, can interpret the client's reports. As research data, however, self-reportng is useless. Clients have a stake in thinking therapy (or devices) successful. They've invested time, money, their ego in the therapy or the device. Self-reporting is biased heavily towards exaggerated optimism. The exaggerations are both conscious and un-conscious and have a lot to do with denial, expectation, a complexity of subjective reactions.
Have any psychological studies been done on the subjectivity of self-reporting? I don't understand how "social science" allows self-reporting to be used as part of efficacy data.
So when David says that his customers reported that his DAF devices have had a long-term effect on speech improvement, I take it with a grain of salt. I'm not arguing that the devices don't have a long-term effect. I am saying that self-reporting does not provide the evidence to make any conclusive statement on the issue.
I trust Herb's statement with regard to the Masker, and I believe the DAF device would have a similar impact on lowering speech-related stress and thus improving fluency over-time on some people. The Masker has not helped my speech overall. When I don't have it on I'm back to the condition I was at Hollins when I bombed out at a speech rate faster than 1/2 second per syllable. Nor is the Masker an automatic fluency aide. Stress can undermine it's effect. I make the Masker work well by learning to be calm and using the few stuttering modification techniqes that I've found work for me.
BUT WE ALL STUTTER DIFFERENTLY. What doesn't have an impact on me, might have an impact on someone else. When it comes to stuttering, it's really difficult to make bold and conclusive efficacy statements on anything!!!
With regard to the DAF, I've found it a remarkable aide for public speaking. More pleasant (less harsh) than the Masker. I have used it in conversation with a throat mike as David suggests, but not enough to come to any real conclusion.
>People talking on DAF sound very, very strange. In fact, in many
>undergraduate courses, professors let the students speak under DAF so
>that they can experience the embarassment of talking in an odd way,
>somewhat like >stuttering!
I don't understand this statement with regard to Kehoe's DAF device. I use it at a very slow setting (A 210 ms delay). I've heard the tape I made at the NSP Toastmaster workshop where I gave my icebreaker. Even at that setting, I thought my speech rate was a little fast. But --and this is a subjective self-report -- I was well within the range of normal speech. Also, I've worked enough with the DAF and MASKER to put inflectuion in my voice, and sound spontaneous. The people who heard me speak in that workshop can vouch for it. I use it at Toastmaster's always. My fluency sometimes falls down a little, but not my ability to hold the audience, to sound enthusiastic or spontaneous. The idea that the DAF makes people sound weird has no basis in fact -- at least in what my listeners tell me.
Yes, in a clinical setting with the DAF on a very slow delay, a student, using it one time, will sound weird. But with practice, a serious user can learn to sound like a normal speaker (whatever that is).
We need serious research on these devices. Research conducted not in the clinic or on the basis of self-reports but in real world usage. This research has never been done (I wouldn't begin to know how to design such a study) but it ought to be done.
Until it is done, the only thing we can say is that there is no evidence that electronic devices work or don't work in the long-term except on the basis of the anecdotal reports of the users (who are not dependably objective).
I've worn the Masker about a dozen years and have experimented with the DAF for about six months, In my opinion, these devices can be a real boon to the severe stutterer or to the moderate stutterer who is having trouble in high stress situations as, for example, the telephone and public speaking.
And the more the user knows about speech therapy (of whatever kind), the more effective the devices are going to be.
Date: Tue, 21 Jul 1998 15:06:00 -0400
From: Woody Starkweather - V5002E@VM.TEMPLE.EDU
From Marty's comments it sounds as though I may have been misunderstood, or I overstated, which I have been known to do.
I am not at all against the use of devices. They have a real place, just as Marty said, with more severe stutterers who have found therapy wanting. I know how much Marty has been helped by the masker.
There HAS been some research in this area. It indicates the frequency altered feedback is superior to delayed auditory feedback in that the FAF does not distort speech as DAF does. Maybe, as Marty says, a person can learn to "beat the machine" and speak more normally with DAF, but FAF does not distort at all, as I understand it.
The masker distorts a little too by increasing the speaker's volume and slowing his or her speech rate, but these are rather benign distortions. The DAF slows speech, raises pitch, elongates vowels, and causes the speaker to repeat sounds at the ends of syllables. That's what the research shows. With practice, I suppose a person could learn not to let the DAF have this effect, but why bother when FAF is just as effective in promoting fluency and doesn't distort at all.
As for the cumbersomeness of wearing a device, it is just as Marty said -- one man's cumbersome is another man's godsend. My clients have found it too cumbersome.
From: IN%"firstname.lastname@example.org" "Thomas David Kehoe"
NEW STUTTERING THERAPY DEVICE
Kay Elemetrics recently introduced the "Facilitator," a portable delayed auditory feedback (DAF) speech therapy device. The Facilitator costs $950, is 6.5" x 3.75" x 1.5", and weighs 13 oz. Features include white noise masking auditory feedback (MAF), a digital tape recorder, and a metronome. The device includes a lapel microphone and headphones.
PRICE CHANGES IN STUTTERING THERAPY EQUIPMENT
Speech Therapy Systems has reduced the price of the Dr. Fluency computerized stuttering treatment program to $495. Dr. Fluency is based on the Precision Fluency Shaping Program. More info at http://www.dfluency.com or (888) DFLUENC.
EZ Speech reduced the price of its wearable DAF Sustained Phonation Unit to $400. More info at http://www.ezspeech.com or (800) 758-8255.
Casa Futura Technologies increased the price of its wearable Pocket Fluency System to $495. The price of the 3-piece accessories kit (lapel microphone, throat microphone, and earphones) has increased to $250. More info at http://www.casafuturatech.com or (888) FLUENCY.
Date: Thu, 23 Jul 1998 20:50:22 -0700
From: Thomas David Kehoe - kehoe@NETCOM.COM
Subject: Re: devices
> There HAS been some research in this area. It indicates the frequency
> altered feedback is superior to delayed auditory feedback in that the
> FAF does not distort speech as DAF does.
Please provide the references to this research you allude to. Three studies found that 50ms DAF reduced stuttering 60-80% at normal and fast speaking rates, without sounding abnormal, and without training or mental effort, and found DAF and FAF to be equally effective:
Kalinowski, Armson, Stuart, Graco, and Roland-Mieskowski. "Effects of alterations in auditory feedback and speech rate on stuttering frequency," Language and Speech, 1993, 36, 1-16.
Kalinowski, J., Sark, S., Stuart, A., Armson, J. "Stuttering amelioration at various auditory feedback delays and speech rates." Unpublished, 1995, Dalhousie University, Halifax.
Zimmerman, S., Kalinowski, J., Stuart, A., Rastatter, M. "Effect of altered auditory feedback on people who stutter during scripted telephone conversations." Journal of Speech, Language, and Hearing Research, Vol. 40, 1130-1134, October 1997.
> The masker distorts a little too by increasing the speaker's volume
> and slowing his or her speech rate, but these are rather benign
Nope, MAF increases volume, but doesn't affect vowel duration.
> The DAF slows speech, raises pitch, elongates vowels, and
> causes the speaker to repeat sounds at the ends of syllables.
> That's what the research shows.
195ms DAF increases vowel duration. Again, please provide references to your supposed research. The following study is the best I've seen on the subject:
Stager, S., Denman, D., Ludlow, C. "Modifications in aerodynamic variables by persons who stutter under fluency-evoking conditions." Journal of Speech, Language, and Hearing Research, Volume 40, 832-847, August 1997.
This study (of 10 stutterers) found that speaking with a metronome 100% eliminated stuttering in all 10 subjects, 195ms DAF reduced stuttering 85%, and 90dB white noise masking reduced stuttering 55%. Aerodynamic measurements revealed that volume, air pressure and air flow increased with white noise masking; stayed relatively constant with DAF; and decreased with the metronome. Vowel duration increased with DAF and the metronome; but was constant with white noise masking. This suggests that fluency is increased when air pressure, air flow, and volume are reduced and vowel duration is increased.
The effectiveness of these physiological changes is why the Desktop Fluency System combines biofeedback monitors of air pressure (indirect) and volume (direct) with DAF for increasing vowel duration.
Date: Fri, 24 Jul 1998 09:07:15 -0400
From: Marty Jezer - mjez@SOVER.NET
Subject: Re: devices
I've great respect for the folks at NIH (C. Ludlow and S. Stager who I know personally) but was their study made under clinical conditions or out in the world? If done in the clinic the study may have some value as base data -- but the only way to test the efficacy of electronic devices is when the user is making a speech, on the phone, having a conversation, i.e., using the devices as he or she would use them in everyday life.
My nitpicking here isn't just about studies on electronic devices. So much of what passes for research data regarding stuttering was done in clinical situations that don't reflect the speaking experiences of the people being tested.
I understand it's difficult and expensive to conduct studies "in the world." But I don't think clinical studies have much relevance on their own.
To bolster this point: Stuttering is unique precisely because it's so situational. Most disorders exist in all situations -- people have them to a particular degree whether or not they are at home, in a clinic, in a store, giving a speech. This is not true for PWS.
I know the folks at NIH are aware of this (as are Woody and David) and in the studies I did with them they tried to recreate different situations within the clinic.
But I do think the studies cited in this discussion ought to be take with a grain of salt.
Personal note - Woody Starkweather
August 3, 1998
I just read the Armson and Stuart article, and it indicates that FAF doesn't have much of an effect on spontaneous speech, only reading aloud. So my tendency to endorse FAF has diminished considerably, even though it distorts speech less than DAF. If it doesn't work for spontaneous speech, what point is there in using it? DAF seems to have more of a fluency-enhancing effect, but it does distort speech, the device is pretty cumbersome, and of course, the effect disappears as soon as you take the device off.
gleaned from a post to email@example.com, October 17, 2001
My name is Greg Snyder---I'm a ph.d. student (expecting completion spring/summer 2002), and a person who stutters.
As a person who stutters, I can say that the Fluency Master certainly didn't work for me, or three others I know. Further, the science behind the Fluency Master (e.g., the air-bone-gap) has been thoroughly discounted. The theory was that people who stutter don't hear their own voices properly via bone conduction...thus hearing your voice exogenously via air conduction induced fluency. well, that's just plain wrong. The fluency master may only be slightly effective for _some_ people because of the noise introduced into the signal, as well as a minimal delay.
If you're looking for a prosthetic, you may want to consider the edinburough masker, something by CasaFutura, of the in-the-ear-fluency-device (AAF hearing aide) via East Carolina University.
email me personally if you have any questions.
Greg (elocutionary dot com, Greg@elocutionary.com>
added August 3, 1998
last updated November 28, 2003