Means of Managing a Speech Dysfluency - Coursework Example

A Critical Review of Delayed Auditory Feedback A Means of Managing a Speech Dysfluency – Table of Contents I. Introduction …………………………………………………………….3 II. General Facts About Stuttering ……………………………………….. 3 III. Theories About the Causes of Stuttering ……………………………… 4 IV. How Delayed Auditory Feedback (DAF) Works ……………………… 5 IV. Effectiveness of Delayed Auditory Feedback Devices ………………… 6 V. Comparison of Delayed Auditory Feedback with Children and Adults .. 7 VI. Long Term Effects of the Using DAF Devices ………………………… 7 VII. Advantages of Using DAF Devices ……………………………………. 8 VIII. Conclusion ……………………………………………………………... 9 References …………………………………………………………………… 10 - 14 Introduction Stuttering occurrences in preschool children is more than the adult stutterers. Almost 2.5% preschool children have signs of stuttering. Today, one out of 40 preschool children stutter. On the other hand, the incidence of children that stutters at some point in their childhood life is around 5% or 1 out of 20 children. (Proctor et al., 2002) As the child grows, there is a higher rate of improving the level of stuttering by seeking the advice of a speech pathologist. In adults, around 1% are stutterers. Based on a recent study, around 0.73% or one out of 135 adults stutter. (Craig et al., 2002) Approximately 80% adult stutterers are men. Only 20% are women. (Yairi, 2005) The goal of DAF therapy is to increase the length and complexity of utterance with the use of the device. As soon as there is a sign of improvement in the patient’s stuttering of speech, the patient will then be advice to limit the need for speech therapy sessions. In line with this study, the general facts about stuttering, how Delayed Auditory Feedback (DAF) works, the effectiveness of DAF devices, long-term effects of the using DAF devices, and the advantages of using DAF devices will be discussed thoroughly. General Facts About Stuttering Stuttering is a speech fluency disorder that is normally characterized by prolonged frequent repetitions, and pauses that could interfere with the normal flow of speech. When a stutterer speaks, his/her speech is usually broken down by repetition of words (th-th-that way), prolongations (llllike this), or abnormal stoppage (no sound) of sounds and syllables. Unusual facial and body movements could also be associated with the person’s effort to speak. Speech fluency disorder is sometimes related to speaking at a fast rate, searching for the right words, etc. It has been observed that most people who stutter are mostly men with IQ’s between 10 to 14 points higher than the average people. (Cardinal Hill, 2006) Theories About the Causes of Stuttering Several theories with regards to the causes of stuttering have been developed in the past. Some people view stuttering as a syndrome of neurological disturbances even though there are times that stuttering can be triggered by our emotions or by an emotional and/or situational events. (Braun et al., 1997) For this reason, stuttering can be related to both neurological and physiological by nature. Other people view it as a learned behavior wherein a child is in the middle of learning and developing his/her speech. In rare cases, stuttering has been suspected to have a connection with psychological problems. These theories have never been scientifically proven. In the past, stuttering has been widely related to genetic factors. (Cummings et al., 1996) However, the degree to which stuttering is related to genetic factors, environmental factors, or both still remains to be unknown. Due to failure to gather some clear inheritance patterns on stuttering, genetic factors cannot be included as the real cause of stuttering. In line with genetic factors, a recent study has been published with regards to specific genes that cause speech disorder. According to Tony Monaco, identification of a specific gene known as ‘chromosome 7’ also known as ‘Speech 1’ is vital to maintain a proper speech production. (Drayna, 2007) Early intervention on stuttering is necessary in order to correct and/or minimize the occurrences of stuttering. Stuttering has no cure up to now but it can be diagnosed and treated by a Speech Language Pathologist. (Cardinal Hill, 2006) Among the common assistive or anti stuttering devices used includes the Delayed Auditory Feedback (DAF), Frequency-shifted Auditory Feedback (FAF)i, and Masking Auditory Feedback (MAF)ii. How Delayed Auditory Feedback (DAF) Works Delayed Auditory Feedback (DAF) is a speech therapy device used to treat stuttering in speech. This device contains both a speaker and headphones that can be used to support and enable the user to speak as fluently as possible. It enables the user to speak into the DAF machine while the headphones delay the sound to the user’s listening ear. Using DAF allows the user to hear his/her own voice with a slight delay that is quite similar to an echo. This device could help people that stutter in speech to become more fluent by enabling an individual to hear his/her own voice with a pitch and a slight delay in time. For many years, DAF is one of the widely and commonly used speech treatment device to treat stuttering speech. (Van Riper, 1970) The old DAF devices are normally used within the clinical area because of the huge and bulky size of the machine including the apparatus that goes along with the machine can be very impractical to be used in other places. It aims to delay the user’s voice when they hear their own voice through the headset. Normally, the delay is about a fraction of a second. Due to the continuous improvement in the technology, a custom made portable fluency enhancing devices are now available in the market. (SpeechEasy, 2007) Anti-stuttering DAF devices changes the way stutterer hears his/her own voice. This way, stutterers are more conscious in correcting and paying more attention in the fluency of their speech. The positive effects of using the auditory feedback devices is related to the central auditory processing disorder that has been observed in the brain scan of an adult stutterer. When the DAF has been delayed between 25 to 75 milliseconds or about one over twentieth of a second, the stutterer will receive an effect of at least 70% improvement. (Casa Futura, 2007) The effect of the delayed auditory feedback can be produced when the user is speaking in chorus with another person. The same is true when a person hears his own voice. This kind of effects can be produced with the use of electronic devices such as DAF. Effectiveness of DAF Devices No single treatment can be effective for all stutterers. It only means that there are many possible causes of stuttering. For this reason, combining several stuttering treatments and use of anti-stuttering devices could be more effective than relying with the use of only one treatment. Based on a study that was conducted in the past, Delayed Auditory Feedback (DAF) could work faster when it is used together with FAF. (Stuart et al., 2006) The study requires the participants to use both devices for seven hours each day wherein their fluency on speech was measured after four to twelve months. (Reunes and Van den Bergh, 2003) Between 70 to 80% reduction was seen on the participants’ stuttering of speech at a normal speaking rate in the absence of trainings and/or therapy. This positive effect has been maintained for almost twelve months without losing its effect on the stutterers. The only problem without wearing the anti-stuttering devices is that the improvement either remained as it is or it could wear off over time. For this reason, continuous use of these electronic devices is also advisable. Several studies that were conducted using the DAF device, when combined with undergoing a fluency shaping therapy, also prove to give excellent result. (Radford et al., 2005) Comparison of Delayed Auditory Feedback with Children and Adults According to MacKay (1968), Walters (1968), and Timmons and Bourdreau (1978), the developmental trend using the DAF device shows that younger children receive more effects than the adults. It means that as each individual ages, the auditory feedback becomes slower. This is possible because as a person grows older, there is a bigger tendency for the individual to memorize the speech therapy program. Therefore, the use of the DAF devices on older people becomes less effective. A more recent study was conducted with five-year old, eight year old children, and adult speakers that were assigned to perform sentence repetition task under: 0-delay, 250, 375, and 625 milliseconds (msec) of amplified delayed auditory feedback. (Siegel, G. et al., 1980) Specifically, the effect of the use of DAF devices on sound pressure does not depend on the user’s age, rate of speech, or even the specific delay intervals. Based on the result, the same pattern was seen on the tests. The adults show the least effect of the DAF on syllable rate. When the sentence duration or the lengthening of sentences during a delay condition and the syllable rate were tested, youngest children were seen to respond more to DAF as compared with the older children and the adults. On the other hand, younger children have minimal effect when they are instructed to speak. When instructed to speak faster, the participants were seen to speak more syllables per second. This time, more effects were visible on the adults than on children. Therefore, children sometimes show less effect with the use of the delayed auditory feedback. Long Term Effects of the Using DAF Devices A study was conducted wherein nine adult stutterers were asked to use the DAF devices lasting for thirty minutes per day in a span of three months without a speech therapy. (Van Borsel J. et al., 2003) The thirty minutes allocation per day is composed of three activities: reading aloud; conversation with a family member, and a telephone call for ten minutes each. The devices the participants used have binaural or two ears headsets that are set at around 100 milliseconds (msec) delay. The participants’ record has an average of 37% stutter on words three months before the use of DAF devices. After using the DAF device for some time, a 10% improvement was seen in their stuttering. Three months later, as much as 17% improvement was detected on the stuttered words of the participants when not using the DAF device; and 13% stuttered words when the participants are wearing the DAF devices. Another study was conducted with an eleven-year old boy who receives at least fourteen hours of structured therapy with school DAF combined with mediated learning. (Radford et al., 2005) After some time, his stuttering improves by 9% dysfluency to 4.8% dysfluecy each time he speaks without the DAF device. A total of 47% improvement was evident on the boy. In order to determine the effectiveness of using the DAF device, the boy was given another fourteen hours of treatment. The result shows that the boy’s stuttering was reduced to 4.1% dysfluency. Two other studies using a combined speech therapy with a DAF device were separately done in the past. The first study was conducted with a group of adults (Ryan and Van Kirk, 1974) and the second one involves a group of children. (Ryan and Van Kirk, 1995) Both studies using a combined DAF device and stuttering therapy have shown the success rate of enabling the patients to speak more fluently with less than 2% stuttering. Advantages of Using the Delayed Auditory Feedback Devices Many times, teenage of school children that are stutterers get embarrassed because some people around them would normally make fun out of their stuttering. In the case of adult stutterers, they tend to avoid being in a crowd or joining their co-workers and even their own spouse or family members. For this reason, the social life of some stutterers is being affected severely. Most of them prefer to be isolated from other people. With the use of the Delayed Auditory Feedback portable devices, people that severely stutterers are given the opportunity to learn more on how to communicate smoothly and fluently in public. This device could increase their self-confidence and self-esteem to speak up in front of a large crowd of viewers and live a normal life. The use of DAF device enables the stutterers to let go of their fear in talking or avoid certain words or sounds that they find it hard to pronounce. With the use of this device, the stutterers’ frustration for not being able to speak fluently could be over come in due time. Conclusion Delayed Auditory Feedback (DAF) electronic devices are used to treat stutterers. Studies have shown that stutterers could gradually improve their speech dysfluency with an early use of DAF device with or without combining with a speech therapy. There is no cure for stuttering but it can be treated by going through a fluency shaping therapy (Boberg and Kully, 1994), stuttering modification therapy (Blomgren et al., 2005), anti-stuttering medications (Maguire et al., 1997; Jancin, 2002) and anti-stuttering devices. One of the most proven effective way of treating stuttering is through the use of the DAF device combined with other forms of speech therapy and anti-stuttering devices particularly the Frequency-shifted Auditory Feedback (FAF). *** End *** References: 1 Blomgren, M. et al. (2005) ‘Intensive Stuttering Modification Therapy: A Multidimensional Assessment of Treatment Outcomes’ Journal of Speech and Hearing Research. June 2005. 48: 509 – 523. 2 Braun, A.R. et al. (1997) ‘Atypical Lateralization of Hemispheral Activity in Developing Stuttering: An H2150 Positron Emission Tomography Study’ in Hulstijn, W., Peters, H.F.M., and Van Lieshout, P.H.H.M. ‘Speech Production: Motor Control, Brain Research and Fluency Disorder’ Amsterdam: Elsevier, 1997. 3 Boberg, E. and Kully, D. (1994) ‘Long-term Results of an Intensive Treatment Program for Adults and Adolescents Who Stutter’ Journal of Speech and Hearing Research. 37, 1050 – 1059. 4 Cardinal Hill (2006) ‘Stuttering Effects 3 Million Americans’ The Courier-Journal. August 2006. Retrieved: May 29, 2007 < http://www.courier-journal.com/marketplace/ > 5 Casa Futura (2007) ‘Delayed Auditory Feedback’ Casa Futura Technologies: Electronic Speech Therapy Devices for Stuttering and Parkinson’s. Retrieved: May 29, 2007 < http://www.casafuturatech.com/ > 6 Craig, A. et al. (2002) ‘Epidemiology of Stuttering in the Communication Across the Entire Life Span’ Journal of Speech Language Hearing Research. 45: 1097 – 1105. 7 Cummings et al. (1996) ‘Polygenic Inheritance of Tourette Syndrome, Stuttering, Attention Deficit Hyperactivity, Conduct, and Oppositional Defiant Disorder’ American Journal of Medical Genetics. 67: 264 – 288. 8 Drayna, D. (2007) ‘Recent Developments Highlight Genetic Causes in Speech Disorders’ National Institute on Deafness and other Communication Disorders, National Institutes of Health. Last Updated: May 25, 2007. in The Stuttering Foundation Website. Retrieved: May 29, 2007 < http://www.stutteringhelp.org/ > 9 Jancin, B. (2002) ‘Olanzapine for Developmental Stuttering’ Clinical Psychiatry News. July 2002. Vol. 30, Issue 7, p. 8. 10 MacKay, D.G. (1968) ‘Metamorphosis of Critical Interval: Age-linked Changes in the Delay in Auditory Feedback that Produces Maximal Disruption of Speech’ J. Acoust. Soc. Am., 43, 811 – 821. in Siegel, G. et al. (1980) ‘Delayed Auditory Feedback with Children’ Journal of Speech and Hearing Research. American Speech-Language-Hearing Association. pp. 802 – 813. 11 Maguire, G. et al. (n.d.) ‘Effects of Risperidone in the Treatment of Stuttering’ in Hulstijn, W. et al. (1997) ‘Speech Production: Motor Control, Brain Research and Fluency Disorders’ Amsterdam: Elsevier 1997. 12 Proctor, A. et al. (2002) ‘Early Childhood Stuttering: African Americans and Euopean Americans’ ASHA Leader. 4:15, p. 102 13 Radford N., Tanguma J., Gonzales M., Nericcio M.A., Newman D. (2005) ‘A Case Study Mediated Learning, Delayed Auditory Feedback, and Motor Repatterning to Reduce Stuttering’ Perceptual and Motor Skills. 2005, 101, 63 – 71. 14 Reunes, J. and Van den Bergh, N. (2003) ‘Delayed Auditory Feedback in the Treatment of Stuttering: Clients as Consumers’ International Journal of Language and Communication Disorders, 2003. Vol. 38, No. 2, 119 – 129. 15 Ryan B.P., Van Kirk B., (1974) ‘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. 16 Ryan B. and Van Kirk Ryan B. (1995) ‘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. 17 Siegel, G. et al. (1980) ‘Delayed Auditory Feedback with Children’ Journal of Speech and Hearing Research. American Speech-Language-Hearing Association. pp. 802 – 813. 18 Timmons and Bourdreau (1978) ‘Delayed Auditory Feedback and the Speech of Stuttering and Non-stuttering Children’ Percep. Mot. Skills, 46, 551 – 555. in Siegel, G. et al. (1980) ‘Delayed Auditory Feedback with Children’ Journal of Speech and Hearing Research. American Speech-Language-Hearing Association. pp. 802 – 813. 19 Radford, N. et al., (2005) ‘A Case Study of Mediated Learning, Delayed Auditory Feedback, and Motor Repatterning to Reduce Stuttering’ Perceptual and Motor Skills. 2005, 101, 63 – 71. 20 SpeechEasy (2007) ‘What is SpeechEasy Fluency Enhancing Device?’ Retrieved: May 29, 2007 < http://www.speecheasy.com/ > 21 Stuart, A. et al. (2006) ‘Investigations of the Impact of Altered Auditory Feedback in-the-ear Devices on the Speech of the People who Stutter: One-year follow-up’ Disability and Rehabilitation, 2006. 1 – 9. 22 Van Borsel J., Reunes G., and Van den Bergh N. (2003) ‘Delayed Auditory Feedback in the Treatment of Stuttering: Clients as Consumers’ International Journal of Language and Communication Disorders, 2003, 38:2, 119 – 129. 23 Van Riper, (1970) ‘A One Week Stuttering Therapy Program’ WMU Journal of Speech Therapy. Vol. 7, 1970, pp. 1 – 2. 24 Walters, J.E. (1968) ‘A Theoretical and Developmental Investigation of Delayed Speech Feedback’ Genet. Psychol. Mongr., 78, 3 – 54. in Siegel, G. et al. (1980) ‘Delayed Auditory Feedback with Children’ Journal of Speech and Hearing Research. American Speech-Language-Hearing Association. pp. 802 – 813. 25 Yairi, E. (2005) ‘On the Gender Factor in Stuttering’ Stuttering Foundation of America Newsletter, Fall 2005. p. 5. Read More