Transcript Stuttering Inhibited: A Fluency Aid

The SpeechEasyDevice:
Augmentative Communication for
Stuttering
Presentation by
Tim Saltuklaroglu, M.S.
East Carolina University
March 27, 2003
Our view of stuttering
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Stuttering is central neurophysiological
disorder that manifests during speech.
The overt manifestations of stuttering
(repetitions, prolongations, silent speech
blocks) are symptoms of this central
pathology.
Stuttering is a extremely debilitating
disorder that can impede every aspect of
life.
How is stuttering usually
treated?
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By attempting to retrain the speech
producing subsystems:
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Laryngeal.
Respiratory.
Articulatory.
How Is stuttering usually
treated?
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‘Speech Retraining’ involves the imposition
of novel speech patterns that are
supposedly incompatible with stuttering.
Some results of therapy
(Blood et al., 1994)
Age
18
19
19
20
20
20
20
20
21
24
36
Years of
Therapy
8
4
9
8
5
2
2
8
7
13
11
Current Severity
Moderate
Mild
Moderate
Severe
Severe
Mild
Mild
Moderate
Severe
Severe
Moderate
There’s room for improvement…
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Therapy can help many people but may
still not produce the highest level of
fluency possible.
Relapse rates need to be decreased for
therapy to be considered efficient and
effective.
Efficiency and effectiveness in
the treatment of stuttering
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Efficiency:
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Does the treatment act in a timely manner
with as little effort as possible expended?
Effectiveness:
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Does the treatment provide the relief that it
promises?
Our mission
To ‘centrally’ inhibit stuttering and
induce immediate and natural
sounding fluent speech in those
stutter.
Choral speech
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Considered to be the best known
stuttering inhibitor.
Often inducing 90-100% fluency in almost
everyone who stutters.
What does choral speech do?
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Inhibits stuttering at a more central level –
closer to the source of the pathology.
Under choral conditions, brain imaging
studies have shown ‘normalization’ of
abnormal brain activations seen in PWS.
Delayed Auditory Feedback
(DAF)
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Perceiving your own speech with a
temporal delay (similar to an echo).
Delays as low as 25 ms have been found
to induce fluent speech.
Frequency Altered Feedback
(FAF)
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Altering the perceived pitch of a persons
own speech, but the person is not
required to change his/her speech
patterns.
Frequency Altered Feedback
(FAF)
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Pitch can be raised or lowered relative to
the fundamental frequency:
 Mickey
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Mouse (chipmunk) or Darth Vader.
Is also a powerful emulator of choral
speech.
How well do DAF and FAF
work?
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Immediate reduction in stuttering by 7085% across a variety of situations.
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Reading.
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Monologue.
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Scripted telephone calls.
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Speaking in front of audience.
The problem
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Large bulky devices.
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Lack of portability.
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Conspicuous in nature.
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Not functional.
The solution
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SpeechEasy introduced in April 2001.
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DAF: up to 250 ms in 10 ms increments.
FAF: up to 2000 Hz up or down in 500 Hz
increments.
Frequency shaping and noise attenuation.
In-the-canal model.
Completely-in-the-canal model.
ITE/ITC
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This model fits in the
ear canal with only a
small portion visible.
Very inconspicuous
A great combination
of small size and
robust effects.
External volume
control.
CIC
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The smallest model.
The whole device sits
in the ear canal with
nothing showing.
Provides all the effects
of the other models.
Volume is internally
controlled.
How is the SpeechEasy™
programmed?
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PC compatible software.
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Control Box:
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Allows all parameters to be programmed.
Interfaces with computer via serial / USB
cable.
SpeechEasy™ cables
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ITC / BTE cable
Left CIC cable
Right CIC cable
An adjunct or alternative to
therapy…
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Prosthetic devices are incorporated into
the treatments of many disabilities.
The use of a fluency enhancing device
may help people who stutter produce
fluent speech that is more:
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Stable
Natural sounding
Automatic
What about the long-term?
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Client satisfaction levels will tell.
Questionnaire data can be very useful.
Efficacy studies cannot tell the whole story
as they only consider the countable
aspects of stuttering in environments that
are usually controlled.
However, they are necessary for
documentation and accountability.
Mean % stuttered syllables
Long Term Efficacy Study:
4 month
data
reading.
30
20
10
0
without SE
with SE
Initial visit
without SE
with SE
After 4-months
Long Term Efficacy Study:
4 month data - conversation.
Fluency enhancing effects of the
SpeechEasy protocol
Average decrease in Stuttering Frequency
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Reading (immediate) Conversation (immediate) Reading (after 4 months) Conversation (after 4 months) -
88%
85%
86%
69%
Long Term Efficacy Study:
4 month data - naturalness.