Adolescents and Adults

Auditory processing and the role of DAF

 

Assistive Devices

For hundreds of years, practitioners have offered stutterers an incredible array of devices to help them speak more fluently.These devices have included ivory forks placed under the tongue, auditory feedback-delaying devices inserted in the ear, respiration-monitoring belts snugged around the chest, and masking noise generators triggered by sensors wrapped around the throat (Van Riper, 1982). Some have been used alone, and others have been used as an adjunct to therapy. Many have helped stutterers who have not been able to find relief through traditional therapy, but too often, false hopes for a miracle cure have been raised. Merson (2003) presented a brief overview of devices such as the Edinburgh Masker, the Fluency Master, the Case Futura delayed auditory feedback (DAF), and the Speech Easy. He reported that he only uses such devices with clients who seem to not be helped by other therapy procedures alone, using these devices only as an adjunct to more traditional stuttering modification and fluen cy-shaping therapy tech­ niques. Of the 10 patients who have used the Fluency Master (masking triggered by phonation) for 12 to 24 months, five reported that their stuttering was 100 percent reduced, two reported a 50 percent reduction, one stopped using it, and two more could not be contacted. Of the 37 patients who had used the SpeechEasy for three to five months, 55 per­ cent reported that its effectiveness was retained, 53 percent reported less frequent stuttering, 52 percent reported less tense stuttering, and 28 percent r,epo r ted that their speech was more fluent without the Speech Easy. These data are not objective measures of fluency but are the subjective reports of clients who were surveyed and may be unreliable.

Another “soft” source of information about the use of assistive devices is a survey conducted by the Stuttering Foundation (Fraser, 2004; Trautman, 2003). The Foundation contacted 800 adults who had requested inform ation about electronic devices from its website. Ju s t over 100 indi vidu­ als returned the survey, and of these, only 22 had actually bought a device. Most of those who didn’t buy a device cited high costs and the absence of evidence of long-term benefit. Of those who bought devices, 12 bought a SpeechEasy, six bought a Casa Futura DAF, three bought a Fluency Master, and one bought an unspecified device. Initial reports sug­ gested that 14 of the 22 purchasers were happy with their devices. A later follow-up survey to learn how they felt after having used their device for a year was able to reach eight of these 14 individuals. Of those eight ind ividuals, thre e were still happy with their device, three were not happy, and two repor ted mixed reactions . So me of those who were no longer happy with their devices reported that it didn’t work when their stutters were those that stop phonation; others reported that their device didn’t work well in noisy enviro nm ent s.

Ramig reported (personal communication, March 8, 2005) that he and his private practice colleagues have evalu­ ated over 60 stuttering patients over a two-year period, fit­ ting over 40 of them with a SpeechEasy device. Only a few of those patients were able to receive supplemen tal traditional therapy.He indicates that the device helped one-third of the clients significan tly, one-third were helped margin ally, and one – third were not helped at all. For some of his clients, it is the only effective treatment they have experienced. Ramig further notes that for the device to be useful for most clients, the clients must be able to initiate appropriate voicing during their stuttering blocks, and they must pay attention to the auditory feedback from the devic,e. He emphasizes that he only dispenses the device for adults, teens, and children over 11 years old, believing that younger children can be helped by other therapeutic approaches. His reluctance to fit very young children stems primarily from the thought that their auditory cortex is not yet fully developed and the fact that the effect of prolonged exposure to DAF and frequency altered pitch is unknown at this time.

Ramig, Ellis, and Polllard (2010) have written a comprehensive chapter on the SpeechEasy, including video clips of clients using it and talking about their experiences with it. It is a thorough account of his and other’s experiences using the SpeechEasy with clients.