Search

Background: Numerous studies have demonstrated the benefit of devices delivering altered auditory feedback (AAF) as a therapeutic alternative for those who stutter., Aims: The effectiveness of a device delivering AAF (SpeechEasy®) was compared with behavioural techniques in the treatment of stuttering in a randomized clinical trial., Methods & Procedures: Two groups of adults who stutter participated: group 1 consisted of 10 men and one woman aged 21-42 years (mean = 30.0). Group 2 consisted of six men and one woman aged 20-50 years (mean = 35.6). Participants in group 1 were fit with a SpeechEasy® device and were not given any additional training (i.e., supplementary fluency enhancing techniques). Participants used the device daily for 6 months. Participants in group 2 received treatment in the form of a 12-week fluency promotion protocol with techniques based on both fluency shaping and stuttering modification., Outcomes & Results: There were no statistically significant differences (p > .05) between groups in participants' stuttered syllables following treatment. That is, both therapeutic protocols achieved approximately 40% reduction in number of stuttered syllables from baseline measures, with no significant relapse after 3 or 6 months post-treatment., Conclusions & Implications: The results suggest that the SpeechEasy® device can be a viable option for the treatment of stuttering., (© 2016 Royal College of Speech and Language Therapists.)

General vulnerability to stuttering is the broad awareness of stuttering and the ever-present, experiential sense of a person who stutters (PWS). It is defined by stuttering in all its forms and the awareness of its presence, both in moments of stuttering and moments of perceivably fluent speech. Under the heading of general vulnerability to stuttering is specific vulnerability to stuttering, which includes the actual events of stuttering (i.e., overt symptoms, covert symptoms, subperceptual stuttering, and anticipation of stuttering). The differentiation between the two is that specific vulnerability requires a specific moment of stuttering where general vulnerability does not., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Extreme prolongations, which can be generated via extreme delayed auditory feedback (DAF) (e.g., 250-500 ms) or mediated cognitively with timing applications (e.g., analog stopwatch) at 2 s per syllable, have long been behavioral techniques used to inhibit stuttering. Some therapies have used this rate solely to establish initial fluency, while others use extremely slowed speech to establish fluency and add other strategic techniques such as easy onsets and diaphragmatic breathing. Extreme prolongations generate effective, efficient, and immediate forward flowing fluent speech, removing the signature behaviors of discrete stuttering (i.e., syllable repetitions and audible and inaudible postural fixations). Prolonged use of extreme prolongations establishes carry-over fluency, which is spontaneous, effortless speech absent of most, if not all, overt and covert manifestations of stuttering. The creation of this immediate fluency and the immense potential of extreme prolongations to generate long periods of carry-over fluency have been overlooked by researchers and clinicians alike. Clinicians depart from these longer prolongation durations as they attempt to achieve the same fluent results at a near normal rate of speech. Clinicians assume they are re-teaching fluency and slow rates will give rise to more normal rates with less control, but without carry-over fluency, controls and cognitive mediation are always needed for the inherently unstable speech systems of persons who stutter to experience fluent speech. The assumption being that the speech system is untenable without some level of cognitive and motoric monitoring that is always necessary. The goal is omnipresent "near normal rate sounding fluency" with continuous mediation via cognitive and motoric processes. This pursuit of "normal sounding fluency" continues despite ever-present relapse. Relapse has become so common that acceptance of stuttering is the new therapy modality because relapse has come to be understood as somewhat inevitable. Researchers and clinicians fail to recognize that immediate amelioration of stuttering and its attendant carry-over fluency are signs of a different pathway to fluency. In this path, clinicians focus on extreme prolongations and the extent of their carry-over. While fluency is automatically generated under these extreme prolongations, the realization is that communication at this rate in routine speaking tasks is not feasible. The perceived solution is a systematic reduction in the duration of these prolongations, which attempts to approximate "normal speech." Typically, the reintroduction of speech at a normalized rate precipitates a laborious style that is undesirable to the person who stutters (PWS) and is discontinued, once departed from the comforts of the clinical setting. The inevitable typically occurs; the well-intentioned therapist instructs the PWS to focus on the techniques while speaking at a rate that is nearest normal speech, but the overlooked extreme prolongations are unlikely to ever be revisited. The foundation of this hypothesis is that the departure from fluency generators (e.g. extreme prolongations) is the cause of regression to the stuttering set point. In turn, we postulate that the continued use of extreme prolongations, as a solitary practice method, will establish and nurture different neural pathways that will create a modality of fluent speech, able to be experienced without cognitive or motoric mediation. This would therefore result in fewer occurrences of stuttering due to a phenomenon called carry-over fluency. Thus, we hypothesize that the use of extreme prolongations fosters neural pathways for fluent speech, which will result in carry-over fluency that does not require mediation by the speaker., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Overt stuttering is inhibited by approximately 80% when people who stutter read aloud as they hear an altered form of their speech feedback to them. However, levels of stuttering inhibition vary from 60% to 100% depending on speaking situation and signal presentation. For example, binaural presentations of delayed auditory feedback (DAF) and frequency-altered feedback (FAF) have been shown to reduce stuttering by approximately 57% during scripted telephone conversations., Aims: To examine stuttering frequency under monaural auditory feedback with one combination of DAF with FAF (COMBO-2) and two combinations of DAF with FAF (COMBO-4) during scripted telephone conversations., Methods & Procedures: Nine adult participants who stutter called 15 local businesses during scripted telephone conversations; each condition consisted of five randomized telephone calls. Conditions consisted of (1) baseline (i.e. non-altered feedback), (2) COMBO-2 (i.e. 50-ms delay with a half octave spectral shift up), and (3) COMBO-4 (i.e. 200-ms delay and a half octave spectral shift down in addition to the COMBO-2). Participants wore a supra-aural headset with a dynamic condenser microphone while holding a receiver to their contralateral ear when making telephone calls., Outcomes & Results: Stuttering was significantly reduced during both altered auditory feedback (AAF) conditions by approximately 65%. Furthermore, a greater reduction in stuttering was revealed during the COMBO with four effects (74%) as compared with the COMBO with two effects (63%)., Conclusions & Implications: Results from the current study support prior research reporting decreased stuttering under AAF during scripted telephone conversations. Findings that stuttering was significantly reduced to a greater extent under the COMBO with four effects condition suggest that second signals reduce stuttering along a continuum. Additionally, findings support prior research results of decreased stuttering frequency under AAF during hierarchically difficult speaking situations. Clinical application of these findings may be that people who stutter can use specific software or smartphone applications that produce second speech signals to inhibit stuttering frequency effectively during telephone conversations., (© 2013 Royal College of Speech and Language Therapists.)

Background: Fluent speakers and people who stutter manifest alterations in autonomic and emotional responses as they view stuttered relative to fluent speech samples. These reactions are indicative of an aroused autonomic state and are hypothesized to be triggered by the abrupt breakdown in fluency exemplified in stuttered speech. Furthermore, these reactions are assumed to be the basis for the stereotypes held by different communicative partners towards people who stutter., Aims: To examine the autonomic and emotional reactions of graduate student clinicians in speech-language pathology as they viewed fluent and severe stuttered speech samples., Methods & Procedures: Twenty-one female graduate student clinicians in speech-language pathology participated in this study. Each participant viewed four 30-s video samples (two fluent and two stuttered speech samples) while their autonomic responses (skin conductance response (SCR) and heart rate (HR)) were concurrently captured. Furthermore, emotional responses to stuttered and fluent speech samples were captured using the self-assessment manikin (SAM) and a rating scale with nine bipolar adjectives reflecting one's feelings., Outcomes & Results: An increase in SCR and deceleration in HR was observed as graduate clinicians viewed stuttered speech samples versus fluent speech samples and the differences were statistically significant. In addition, results from the self-rating scales showed that participants had negative feelings (e.g., emotionally aroused, unpleasant, embarrassed, uncomfortable, etc.) while viewing stuttered speech., Conclusions & Implications: Findings suggest that graduate student clinicians in speech-language pathology demonstrated altered autonomic and emotional responses similar to those manifested by fluent and stuttered speakers as they viewed stuttered speech samples. Collectively, these findings support the contention that the inherent nature of stuttered speech triggers a visceral reaction in a listener, irrespective of their background and knowledge about the disorder., (© 2012 Royal College of Speech and Language Therapists.)

Background: It is frequently observed that listeners demonstrate gaze aversion to stuttering. This response may have profound social/communicative implications for both fluent and stuttering individuals. However, there is a lack of empirical examination of listeners' eye gaze responses to stuttering, and it is unclear whether cultural background plays a role in regulating listeners' eye gaze response to stuttering., Aim: To examine listeners' eye gaze responses to stuttering speech relative to fluent speech in three cultural groups., Methods & Procedures: Eighteen African-American, 18 European-American and 18 Chinese adults were audiovisually presented with three stuttering and three fluent speech samples, when an eye-tracking device simultaneously recorded their gaze behaviours. The targets of listeners' eye gaze included four regions of interest (ROIs) on the speaker's face: eyes, nose, mouth and outside (i.e., everything else). Listeners' per cent of gaze time, gaze fixation count and average duration of gaze fixation were analysed with repeated-measures ANOVAs regarding each ROI as functions of the speaker's fluency status and listeners' cultural background., Outcomes & Results: When observing stuttering speech, listeners tended to reduce gaze fixation duration on the speaker's eyes and increase their gaze time on the mouth. However, different from the two American groups, the Chinese group reduced their gaze time on the speaker's mouth. In addition, the Chinese participants' gaze behaviours were more focused on the ROI of outside, whereas the two American groups showed a similar focus on the ROIs of eyes and mouth., Conclusions & Implications: All groups of listeners responded to stuttering with gaze aversions mainly contributed to by a reduction in gaze fixation duration rather than gaze fixation number. This pattern of gaze aversion suggests that stuttering oppresses listeners with an emotional and/or cognitive overload. Attention shift and compensation strategies for speech signal degradation may also account for listeners' gaze responses to stuttering. Cultural differences in eye gaze responses to stuttering were observed mainly between Chinese and American listeners., (© 2012 Royal College of Speech and Language Therapists.)

This study examined relationships between anticipatory autonomic arousal and stuttering in four reading tasks. 13 adult persons who stutter (PWS) reported their 'feared' (expected to elicit more stuttering) sounds. They read phrases initiated by feared (F) and neutral (N) phonemes. Both stimuli sets were read solo (S) and with choral accompaniment (C), creating FS, FC, NS, and NC conditions. Skin conductance (SC) and heart rate (HR) measures were made during a 9s window that followed stimulus presentation and preceded speaking. Only SC measures produced significant differences across conditions. Choral conditions produced decreases in SC measures and stuttered trials. Feared conditions produced increases in SC but not stuttering. HR measures were variable, undifferentiated by condition, but produced a gradually increasing triphasic response pattern. No differences in anticipatory SC or HR measures were found in stuttered versus fluent trial comparisons. However, the NC condition, which eliminated stuttering, produced significantly lower SC measures than the fluent utterances in the other conditions (FS, FC, NS). Furthermore, SC measures from the fluent and stuttered trials were similar in these three conditions. These findings suggest that anticipatory autonomic arousal is better differentiated by the possibility of stuttering than by a fluent/stuttered speech outcome. Trials that produced anticipatory SC responses showed greater final HR deceleration, suggesting autonomic coactivation, a response pattern that is associated with aversive stimuli and herein, likely indicative of speech-related state anxiety. However, these physiological markers of anxiety appear to be neither necessary nor sufficient to induce observable stuttering., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The inhibitory effects of continuously presented audio signals (/a/, /s/, 1,000 Hz pure-tone) on stuttering were examined. Eleven adults who stutter participated. Participants read four 300-syllable passages (i.e. in the presence and absence of the audio signals). All of the audio signals induced a significant reduction in stuttering frequency relative to the control condition (P = 0.005). A significantly greater reduction in stuttering occurred in the /a/ condition (P < 0.05), while there was no significant difference between the /s/ and 1,000 Hz pure-tone conditions (P > 0.05). These findings are consistent with the notion that the percept of a second signal as speech or non-speech can respectively augment or attenuate the potency for reducing stuttering frequency.

Perceptions of benefits of speech therapy, success of therapy across clinical settings, reasons for returning to therapy, client-clinician relationships, and clinicians' competency were assessed in 57 participants (47 men, 10 women; M age = 34 yr.) trying a new therapy. A majority of respondents had cumulatively five or more years in therapy and at least two stuttering therapies. Respondents rated university or hospital settings as more successful than services in public schools. 70% of the respondents noted difficulty communicating basic needs; they blamed themselves for inability to maintain posttherapeutic gains while perceiving their clinicians to be competent and attentive--although 47% of the respondents had minimal to no contact with their therapist after therapy.

The aim of the study was to evaluate the role of steady-state and dynamic visual gestures of vowels in stuttering inhibition. Eight adults who stuttered recited sentences from memory while watching video presentations of the following visual speech gestures: (a) a steady-state /u/, (b) dynamic production of /a-i-u/, (c) steady-state /u/ with an accompanying audible 1 kHz pure tone, and (d) dynamic production of /a-i-u/ with an accompanying audible 1 kHz pure tone. A 1 kHz pure tone and a no-external signal condition served as control conditions. Results revealed a significant main effect of auditory condition on stuttering frequency. Relative to the no-external signal condition, the combined visual plus pure tone conditions resulted in a statistically significant reduction in stuttering frequency. In addition, a significant difference in stuttering frequency was also observed when the visual plus pure tone conditions were compared to the visual only conditions. However, no significant differences were observed between the no-external signal condition and visual only conditions, or the no-external signal condition and pure tone condition. These findings are in contrast to previous findings demonstrated by similar vowel gestures presented via the auditory modality that resulted in high levels of stuttering inhibition. The differential role of sensory modalities in speech perception and production as well as their individual capacities to transfer gestural information for the purposes of stuttering inhibition is discussed., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Immediate and drastic reductions in stuttering are found when speech is produced in conjunction with a variety of second signals (for example, auditory choral speech and its permutations, and delayed auditory feedback). Initially, researchers suggested a decreased speech rate as a plausible explanation for the reduction in stuttering as people who stutter produced speech under second signals. However, this explanation was refuted by research findings that demonstrated reductions in stuttering at both normal and fast speech rates under second signals. Recent studies have also demonstrated significant reductions in stuttering from second signals delivered via the visual modality. However, the question as to whether stuttering can be substantially reduced at normal and fast speech rates under visual speech feedback conditions has yet to be answered., Aims: The current study investigated stuttering frequency reduction at normal and fast speech rates across different visual speech feedback conditions relative to a no-visual feedback condition., Methods & Procedures: Ten adults who stutter recited memorized tokens of eight to 13 syllables under five visual speech feedback conditions at both normal and fast speech rates. Visual speech feedback conditions consisted of participants viewing the lower portion of their face (that is, lips, jaw, and base of the nose) on a monitor as they produced the aforementioned utterances. Conditions consisted of (1) no-visual feedback condition, (2) 0 ms (simultaneous visual speech feedback), (2) a 50-ms delay, (3) a 200-ms delay, and (4) a 400-ms delay., Outcomes & Results: A significant main effect of visual speech feedback on stuttering frequency was found (p= 0.001) with no significant main effect of speech rate or the interaction between speech rate and visual speech feedback. Relative to the no-visual feedback condition, the feedback conditions produced reductions in stuttering ranging from 27% (0 ms) to 62% (400 ms). Post-hoc comparisons revealed that all of the delay conditions differed significantly from the simultaneous feedback (p= 0.017) and the no-visual feedback conditions (p= 0.0002) while no significant differences between delay conditions (that is, 50, 200, and 400 ms) were observed., Conclusions & Implications: The current findings demonstrate the capabilities of visual speech feedback signals to reduce stuttering frequency that is independent of the speaker's rate of speech. Possible strategies are suggested to transfer these findings into naturalistic and clinical settings, though further research is warranted., (© 2011 Royal College of Speech & Language Therapists.)

In contrast to most therapeutic protocols for stuttering that induce fluency while producing speech targets, we investigated the possibility of inducing "carry-over" fluency prior to normal speech production. Ten adults who stutter read 7-12 syllable phrases after actively producing (via shadowing) or passively listening to: (a) repeating syllables, matched to the initial syllable of the target utterance; (b) repeating syllables, not matched to the initial syllable of the target; (c) nonrepeating syllables; and (d) fricative /noise-like acoustic signals. Relative to baseline, all active syllabic conditions produced approximately 70% inhibition (reduction) of stuttering in the ensuing target utterances, which is attributed to carry-over from fluent shadowing. The most robust passive inhibition (56%) resulted from listening to matched repeating syllables. These findings further sustain that a perception-production link in speech, possibly resulting from mirror neuron activity, can facilitate the inhibition of stuttering. However, in this study we further demonstrate gestural and temporal flexibility of this mechanism, showing that this inhibitory strategy may be enacted prior to producing speech targets. We discuss possible clinical implications and draw comparisons between core stuttering behaviors (i.e., repetitions and prolongations) and behavioral therapeutic strategies (e.g., slowed speech, preparatory sets) used to inhibit or eliminate stuttering.

Background: Previous studies have found simultaneous increases in skin conductance response and decreases in heart rate when normally fluent speakers watched and listened to stuttered speech compared with fluent speech, suggesting that stuttering induces arousal and emotional unpleasantness in listeners. However, physiological responses of persons who stutter observing stuttering and fluent speech has not been measured. Research suggests that the mechanism responsible for listeners' reactions is the mirror neuron system. The mirror neuron system activates when perceiving and producing goal-directed actions and forms the link between action perception and action production., Aims: To compare physiological responses elicited via fluent and stuttered speech in fluent and persons who stutter groups., Methods & Procedures: Participants included 15 adult persons who stutter (mean age = 29.7 years) and 21 normally fluent controls (mean age = 23.7 years). Participants watched and listened to six speech samples read by three persons who stutter speakers and three fluent speakers, while their skin conductance response and heart rate were recorded simultaneously. Participants' responses to each speech sample were defined as changes in mean heart rate and mean skin conductance response between 15 s before and 15 s during stimuli presentation., Outcomes & Results: Both groups showed similar patterns of response: skin conductance response was significantly increased and heart rate was significantly decreased in response to stuttered versus fluent speech. Similar to previous findings, the highest skin conductance response measures were induced by the first presentation of stuttered speech, with the response attenuating on subsequent presentations, while the heart rate was stable over time., Conclusions & Implications: Results confirmed past research that showed arousal and emotional unpleasantness when observing stuttering. Clinically, these results acknowledge the arousal and emotional discomfort in fluent speakers and persons who stutter. The physiological responses to stuttering and the underlying emotional aspects should be discussed in the therapeutic milieu with notions about coping strategies.

Background: People who stutter are often acutely aware that their speech disruptions, halted communication, and aberrant struggle behaviours evoke reactions in communication partners. Considering that eye gaze behaviours have emotional, cognitive, and pragmatic overtones for communicative interactions and that previous studies have indicated increased physiological arousal in listeners in response to stuttering, it was hypothesized that stuttered speech incurs increased gaze aversion relative to fluent speech. The possible importance in uncovering these visible reactions to stuttering is that they may contribute to the social penalty associated with stuttering., Aims: To compare the eye gaze responses of college students while observing and listening to fluent and severely stuttered speech samples produced by the same adult male who stutters., Methods & Procedures: Twelve normally fluent adult college students watched and listened to three 20-second audio-video clips of the face of an adult male stuttering and three 20-second clips of the same male producing fluent speech. Their pupillary movements were recorded with an eye-tracking device and mapped to specific regions of interest (that is, the eyes, the nose and the mouth of the speaker)., Outcomes & Results: Participants spent 39% more time fixating on the speaker's eyes while witnessing fluent speech compared with stuttered speech. In contrast, participants averted their direct eye gaze more often and spent 45% more time fixating on the speaker's nose when witnessing stuttered speech compared with fluent speech. These relative time differences occurred as a function of the number of fixations in each area of interest. Thus, participants averted their gaze from the eyes of the speaker more frequently during the stuttered stimuli than the fluent stimuli., Conclusions & Implications: This laboratory study provides pilot data suggesting that gaze aversion is a salient response to the breakdown in communication that occurs during stuttering. This response may occur as a result of emotional, cognitive, and pragmatic factors in communication partners. Regardless of the factors contributing to the response, its primary importance may be that gaze aversion is a visible communication partner signal informing the person stuttering that something is amiss in the interaction and hence, may contribute to inducing negative emotions in the persons stuttering, via engagement of the mirror neuron system. We suggest that witnessing and interpreting communication partner responses to stuttering may play a role when a person who stutters engages in future interactions, perhaps contributing to the development of covert strategies to hide stuttering., (2010 Royal College of Speech & Language Therapists.)

Background: Stuttering is prone to strike during speech initiation more so than at any other point in an utterance. The use of auditory feedback (AAF) has been found to produce robust decreases in the stuttering frequency by creating an electronic rendition of choral speech (i.e., speaking in unison). However, AAF requires users to self-initiate speech before it can go into effect and, therefore, it might not be as helpful as true choral speech during speech initiation., Aims: To examine how AAF and choral speech differentially enhance fluency during speech initiation and in subsequent portions of utterances., Methods & Procedures: Ten participants who stuttered read passages without altered feedback (NAF), under four AAF conditions and under a true choral speech condition. Each condition was blocked into ten 10 s trials separated by 5 s intervals so each trial required 'cold' speech initiation. In the first analysis, comparisons of stuttering frequencies were made across conditions. A second, finer grain analysis involved examining stuttering frequencies on the initial syllable, the subsequent four syllables produced and the five syllables produced immediately after the midpoint of each trial., Outcomes & Results: On average, AAF reduced stuttering by approximately 68% relative to the NAF condition. Stuttering frequencies on the initial syllables were considerably higher than on the other syllables analysed (0.45 and 0.34 for NAF and AAF conditions, respectively). After the first syllable was produced, stuttering frequencies dropped precipitously and remained stable. However, this drop in stuttering frequency was significantly greater (approximately 84%) in the AAF conditions than in the NAF condition (approximately 66%) with frequencies on the last nine syllables analysed averaging 0.15 and 0.05 for NAF and AAF conditions, respectively. In the true choral speech condition, stuttering was virtually (approximately 98%) eliminated across all utterances and all syllable positions., Conclusions & Implications: Altered auditory feedback effectively inhibits stuttering immediately after speech has been initiated. However, unlike a true choral signal, which is exogenously initiated and offers the most complete fluency enhancement, AAF requires speech to be initiated by the user and 'fed back' before it can directly inhibit stuttering. It is suggested that AAF can be a viable clinical option for those who stutter and should often be used in combination with therapeutic techniques, particularly those that aid speech initiation. The substantially higher rate of stuttering occurring on initiation supports a hypothesis that overt stuttering events help 'release' and 'inhibit' central stuttering blocks. This perspective is examined in the context of internal models and mirror neurons.

Purpose: This study assessed the impact of stuttering via a questionnaire in which fluent individuals were asked to assume the mindset of persons who stutter (PWS) in various life aspects, including vocation, romance, daily activities, friends/social life, family and general lifestyle. The perceived impact of stuttering through the mind's eyes of nonstutterers is supposed to reflect respondents' abilities to impart 'theory of mind' in addressing social penalties related to stuttering., Method: Ninety-one university students answered a questionnaire containing 56 statements on a 7-point Likert scale. Forty-four participants (mean age = 20.4, SD = 4.4) were randomly selected to assume a stuttering identity and 47 respondents (mean age = 20.5, SD = 3.1) to assume their normally fluent identity., Results: Significant differences between groups were found in more than two thirds of items regarding employment, romance, and daily activities, and in fewer than half of items regarding family, friend/social life, and general life style (p <0.001)., Conclusions: The social penalties associated with stuttering appear to be apparent to fluent individuals, especially in areas of vocation, romance, and daily activities, suggesting that nonstuttering individuals, when assuming the role of PWS, are capable of at least temporarily feeling the negative impact of stuttering., (Copyright 2008 S. Karger AG, Basel.)

Purpose: The effect of frequency altered feedback (FAF) on stuttering type (i.e., prolongation, repetition, or silent block) and stuttering duration (i.e., average duration of stuttering event and total stuttering time) was examined., Method: Retrospective analyses of previously collected data from 12 adult persons who stutter who participated in an ABA time-series design while reading orally was undertaken. It was hypothesized that stuttering duration would decrease and there would be a differential reduction in the type of stuttering during FAF, concurrent with previously confirmed reduction of stuttering episodes. A total of 2,971 stuttered syllables were analyzed., Results: The total stuttering duration (s/min) was significantly reduced by approximately 50% irrespective of stuttering type (p = .0014). Although significant differences in the average duration(s) of the 3 stuttering types (p = .0064) existed, FAF significantly reduced each type of stuttering by approximately 20% (p = .0055). There was no differential effect on the reduction of proportion of stuttering type during FAF (p = .36)., Conclusions: FAF positively affects the speech of persons who stutter by reducing the proportion of stuttered events with a concomitant decrease in duration of residual stuttering and total stuttering time during oral reading.

Background: People who stutter produce speech that is characterized by intermittent, involuntary part-word repetitions and prolongations. In addition to these signature acoustic manifestations, those who stutter often display repetitive and fixated behaviours outside the speech producing mechanism (e.g. in the head, arm, fingers, nares, etc.). Previous research has examined the attitudes and perceptions of those who stutter and people who frequently interact with them (e.g. relatives, parents, employers). Results have shown an unequivocal, powerful and robust negative stereotype despite a lack of defined differences in personality structure between people who stutter and normally fluent individuals. However, physiological investigations of listener responses during moments of stuttering are limited. There is a need for data that simultaneously examine physiological responses (e.g. heart rate and galvanic skin conductance) and subjective behavioural responses to stuttering. The pairing of these objective and subjective data may provide information that casts light on the genesis of negative stereotypes associated with stuttering, the development of compensatory mechanisms in those who stutter, and the true impact of stuttering on senders and receivers alike., Aims: To compare the emotional and physiological responses of fluent speakers while listening and observing fluent and severe stuttered speech samples., Methods & Procedures: Twenty adult participants (mean age = 24.15 years, standard deviation = 3.40) observed speech samples of two fluent speakers and two speakers who stutter reading aloud. Participants' skin conductance and heart rate changes were measured as physiological responses to stuttered or fluent speech samples. Participants' subjective responses on arousal (excited-calm) and valence (happy-unhappy) dimensions were assessed via the Self-Assessment Manikin (SAM) rating scale with an additional questionnaire comprised of a set of nine bipolar adjectives., Outcomes & Results: Results showed significantly increased skin conductance and lower mean heart rate during the presentation of stuttered speech relative to the presentation of fluent speech samples (p<0.05). Listeners also self-rated themselves as being more aroused, unhappy, nervous, uncomfortable, sad, tensed, unpleasant, avoiding, embarrassed, and annoyed while viewing stuttered speech relative to the fluent speech., Conclusions: These data support the notion that stutter-filled speech can elicit physiological and emotional responses in listeners. Clinicians who treat stuttering should be aware that listeners show involuntary physiological responses to moderate-severe stuttering that probably remain salient over time and contribute to the evolution of negative stereotypes of people who stutter. With this in mind, it is hoped that clinicians can work with people who stutter to develop appropriate coping strategies. The role of amygdala and mirror neural mechanism in physiological and subjective responses to stuttering is discussed.

The present study examined the psychophysiological responses of fluent listeners to stuttered speech. Specifically, skin conductance and heart rate changes were measured from adults who do not stutter while watching one-minute video speech samples of persons stutter read aloud. Fifteen adult participants observed three stuttered and three fluent speech samples, presented in random order with a two-minute interstimulus intervals. Results revealed that observing stuttered speech evoked a significant increase in skin conductance and a significant deceleration in heart rate relative to watching fluent speech samples. These findings suggest that listeners are physiologically aroused by stuttering and appear to maintain feelings of unpleasantness to stuttered speech. Further, deceleration in heart rate during stuttered samples also suggest that listeners may be paying more attention to the stuttered speech samples as compared to the fluent speech samples. We speculate that aberrant and anomalous stuttering behaviors probably simulate the mirror neuronal mechanism eliciting the emotional arousal associated within them. Such physiological arousal may provide the emotional genesis to the listener's negative stereotypical perceptions towards people who stutter.

Sensory signals containing speech or gestural (articulatory) information (e.g., choral speech) have repeatedly been found to be highly effective inhibitors of stuttering. Sine wave analogs of speech consist of a trio of changing pure tones representative of formant frequencies. They are otherwise devoid of traditional speech cues, yet have proven to evoke consistent linguistic percepts in listeners. Thus, we investigated the potency of sinusoidal speech for inhibiting stuttering. Ten adults who stutter read while listening to (a) forward-flowing natural speech; (b) forward-flowing sinusoid analogs of natural speech; (c) reversed natural speech; (d) reversed sinusoid analogs of natural speech; and (e) a continuous 1000 Hz pure tone. The levels of stuttering inhibition achieved using the sinusoidal stimuli were potent and not significantly different from those achieved using natural speech (approximately 50% in forward conditions and approximately 25% in the reversed conditions), suggesting that the patterns of undulating pure tones are sufficient to endow sinusoidal sentences with 'quasi-gestural' qualities. These data highlight the sensitivity of a specialized 'phonetic module' for extracting gestural information from sensory stimuli. Stuttering inhibition is thought to occur when perceived gestural information facilitates fluent productions via the engagement of mirror neurons (e.g., in Broca's area), which appear to play a crucial role in our ability to perceive and produce speech.

Purpose: This study examined objective and subjective measures of the effect of a self-contained ear-level device delivering altered auditory feedback (AAF) for those who stutter 12 months following initial fitting with and without the device., Method: Nine individuals with developmental stuttering participated. In Experiment 1, the proportion of stuttering was examined during reading and monologue. A self-report inventory inquiring about behaviour related to struggle, avoidance and expectancy associated with stuttering was examined in Experiment 2. In Experiment 3, naïve listeners rated the speech naturalness of speech produced by the participants during reading and monologue., Results: The proportions of stuttering events were significantly ( p < 0.05) reduced at initial fitting and remained so 12 months post follow-up. After using the device for 12 months, self-reported perception of struggle, avoidance and expectancy were significantly (p < 0.05) reduced relative to pre-fitting. Naïve listeners rated the speech samples produced by those who stutter while wearing the device significantly more natural sounding than those produced without the device for both reading and monologue (p < 0.0001)., Conclusions: These findings support the notion that a device delivering AAF is a viable therapeutic alternative in the treatment of stuttering.

Background: Bloodstein reviewed hundreds of studies that investigated the efficacy of therapeutic protocols for ameliorating the stuttering syndrome. Surprisingly, almost all were effective in significantly reducing overtly perceptible behaviours such as repetitions and prolongations of speech sounds. These results seem highly improbable considering that many of the treatment methods were diametrically opposed in their principles and implementation procedures (e.g. psychoanalysis, drug therapy, behaviourism, cognitive behavioural therapy and auditory feedback devices with rate control, etc.). In addition, time and more ecologically valid methods such as self-report measures demonstrate that overt measures of success are tenuous, their ameliorative effects tend to diminish drastically over time and show poor generalizability. Further, the real conundrum in stuttering therapy is the failure to acknowledge stuttering as a complete syndrome of continuous compensatory behaviours., Aims: To highlight how self-report measures serve as a primary tool to understand the syndrome-like nature of stuttering and to test the efficacy of the therapy outside the confines of the clinic and the needs of the people who stutter., Methods & Procedures/outcomes & Results: In the past, therapeutic efficacy has typically been measured by the reduction in overtly observable and countable events of stuttering such as repetitions and prolongations. However, recent neuroimaging data and our research suggest that the stuttering syndrome is more than the mere presence of peripheral speech disruptions. Stuttering is a central, experiential sense of 'loss of control' that manifests itself across a continuum of compensatory behaviours from the central nervous system outwards to the speech periphery. In other words, aberrant neural activity, as well as covert stuttering behaviours, subperceptual stuttering forms and overt speech disruptions are all effects or compensations for the central involuntary 'neural block'. Hence, by counting only perceptible portions of the disorder, efficacy measures 'fail to capture' the experiential sense of 'loss of control' and the covert compensatory behaviours of the disorder (i.e. avoidances of words or situations, substitutions, circumlocutions, subperceptual stuttering forms, etc.). Furthermore, unnatural sounding speech, decreased ease of speech production, elevated levels of clinic room fluency and poor reliability in counting stuttering behaviours confound the overt measures in the clinic milieu. Therefore, while overt measures remain important, used in isolation, they cannot provide a 'true metric' of efficacy., Conclusions: Any efficient and effective means of evaluating intervention methods over the long-term should include a form of self-report as a primary tool as it best accesses the experiential sense of 'loss of control' and other covert behaviours. Overt measures should be used to supplement or complement the self-report data.

The recovery of 'gestural' speech information via the engagement of mirror neurons has been suggested to be the key agent in stuttering inhibition during the presentation of exogenous second speech signals. Based on this hypothesis, we expect the amount of stuttering inhibition to depend on the ease of recovery of exogenous speech gestures. To examine this possibility, linguistically non-congruent second speech signals were temporally compressed and expanded in two experiments. In Experiment 1, 12 participants who stutter read passages aloud at normal and fast speech rates while listening to second speech signals that were 0, 40, 80% compressed, and 40 and 80% expanded. Except for the 80% compressed speech signal, all other stimuli induced significant stuttering inhibition relative to the control condition. The 80% compressed speech signal was the first exogenously presented speech signal that failed to significantly reduce stuttering frequency by 60--70% that has been the case in our research over the years. It was hypothesized that at a compression ratio of 80%, exogenous speech signals generated too many gestures per unit time to allow for adequate gestural recovery via mirror neurons. However, considering that 80% compressed signal was also highly unintelligible, a second experiment was conducted to further examine whether the effects of temporal compression on stuttering inhibition are mediated by speech intelligibility. In Experiment 2, 10 participants who stutter read passages at a normal rate while listening to linguistically non-congruent second speech signals that were compressed by 0, 20, 40, 60, and 80%. Results revealed that 0 and 20% compressed speech signals induced approximately 52% stuttering inhibition. In contrast, compression ratios of 40% and beyond induced only 27% stuttering inhibition although 40 and 60% compressed signals were perceptually intelligible. Our findings suggest that recovery of gestural information is affected by temporal compression before intelligibility starts to decrease.

Background: Similar positive results (e.g. immediate decreases in stuttering frequency and a 60-80% recovery rate from stuttering) have been reported for numerous therapeutic protocols for treating childhood stuttering, many of which have been diametrically opposite in their orientations and implementations. For example, Johnson advocated indirect treatments that simply advocated refraining from drawing any negative attention to childhood disfluencies as persistent and chronic stuttering was thought to progress via negative parental reactions to normal disfluencies. In contrast, direct interventionists sought immediately to eliminate stuttered speech patterns by training 'corrected' speech models that usually involved some form of prolonged speech. However, reports from speech and language therapists around North Carolina, USA, suggest much lower recovery rates in the children they treat (i.e. 13.9% over a median therapeutic period of 3 years, which to the present authors is an indicator of therapeutic inefficiency and ineffectiveness)., Aims: The discrepancy between these recovery rates calls for a re-examination of the efficacy of stuttering therapy for children, especially in light of recent statements from some therapies suggesting that therapy might be curative in nature., Main Contribution: Spontaneous and complete recovery (removing all overt and covert markers of the pathology) occurs in 60-80% of all children who display incipient stuttering behaviours. As such, it appears that many claims of therapeutic success in children who stutter are confounded by the possibility of spontaneous recovery during the testing and intervention period. Simply put, it is impossible to discriminate between recovery that would occur naturally over time, and what may have been simply accelerated via therapy. Based on stable prevalence rates and the data in the present paper, it is suggested that therapy does little to boost recovery rates from incipient stuttering. Therapy can provide 'inhibitory' symptomatic relief with varying degrees of success with respect to decreasing stuttering severity and the need for continued therapy. However, it must be made clear that curing stuttering is not a likely outcome of therapy, although successful management can decrease the severity of the problem. It is argued that all forms of stuttering inhibition, including those at work during spontaneous recovery, are all mediated by the degree of mirror neuron engagement in the brain., Conclusions: It is proposed that in children who stutter, the best source of relief from stuttering is in the effective and efficient engagement of mirror neurons via methods that best replicate choral speech. In order to induce natural sounding, fluent speech, it is suggested that one uses primarily derivations of choral speech such as altered auditory feedback. Motoric techniques might also be used synergistically to provide supplementary sources of mirror neuron engagement.

Background: Speech and language therapists treating children who stutter appear to be assigned a difficult task. Natural spontaneous remission accounts for approximately 60-80% of all children recovering from stuttering. Despite our best efforts, no protocol has ever shown its effectiveness separate from natural recovery rates (i.e. 60-80%). Although speech and language therapists have used a vast array of therapeutic protocols, the incidence and prevalence of childhood stuttering appears to have remained unchanged. Therefore, although in possession of multiple treatment tools, speech and language therapists might be ill-equipped to treat stuttering children effectively and efficiently to the point of recovery., Aim: To assess speech and language therapists' self-reported perceptions of their success in helping children 'completely recover from stuttering' (i.e. no longer exhibiting any overt or covert stuttering symptoms or using therapeutic strategies to modify speech and no longer being viewed by themselves or anyone else as a 'stutterer')., Methods & Procedures: A questionnaire was sent to 290 speech and language therapists providing stuttering therapy to children attending school in North Carolina, USA, in a system similar to what can be found in many other US states. It addressed therapeutic efficacy in the management of stuttering: the numbers of stuttering children treated and those perceived to be recovered, the therapeutic methods, the time spent in practice, therapy durations and schedules., Outcomes & Results: Usable questionnaires were returned by 101 respondents who reported treating a total of 2036 children who stutter. They reported using a full array of techniques known to reduce stuttering. The median reported recovery rate among respondents was 13.9%. Twenty-eight respondents reported no recoveries whatsoever, and 81 reported five recoveries or fewer. The median time spent on a caseload was 3 years. In addition, longer practising therapists reported significantly higher recover rates than those with less time practising., Conclusions: Remission from stuttering in children being treated in the schools of North Carolina appears to be the exception rather than the rule. The reported recovery rates suggest that not much is being done therapeutically to help children recover from stuttering. The chance of recovery decreases with age, and speech therapy for children who stutter appears to do little to improve their odds of recovery. Speech and language therapists treating these children either do not possess the tools or the tools do not yet exist to change 'nature's recovery agendum' and put children who stutter on the path towards natural sounding, fluent and spontaneous in all situations. As such, the provision of therapy, in North Carolina at least, does not yet allow for stuttering children to shed the label of 'stutterer', in their own eyes and in the eyes of all others for the rest of their lives. In light of these data, the authors suggest re-examining the tools, policies and procedures used in the treatment of stuttering children.

Previous research has suggested that word meaning can influence the loci and frequency of stuttering moments. Based on this proposition, it was hypothesized that people who stutter will exhibit a larger proportion of stuttering moments on meaningful words when compared to nonmeaningful or nonsense words. In order to test this hypothesis, stuttering frequency was examined among 9 English-speaking adults who stutter as they read a total of 126 words that were either meaningful or nonmeaningful in nature. The results indicated that approximately 117% more stuttering moments were recorded on nonmeaningful words when compared to meaningful words and this difference was statistically significant (p=0.01). These findings challenge the notion that word meaning can be considered as a reliable predictor of stuttering frequency., (Copyright (c) 2005 S. Karger AG, Basel.)

This study investigated use of choral reading with filtered components of speech and whispered speech on the frequency of stuttering. Three passages read by a normal adult male were lowpass filtered with kneepoint frequencies at 100 Hz (approximate glottal source), 500 Hz (source and first formant), and 1 kHz (source and the first two formants). Along with a whispered passage, a normal passage, and a control condition, these stimuli were used in a repeated-measures design with 12 adult stutterers as they read passages while listening to one of the stimuli. Frequencies of stuttering in each condition were analyzed. The choral speech, the 500-Hz, the 1-kHz, and the whispered speech conditions all decreased the frequency of stuttering while the 100-Hz stimuli did not. It is suggested that articulatory events, chiefly the encoded speech output from the vocal tract, create effective cues and may induce fluent speech in people who stutter.

The effect of therapy and altered auditory feedback (AAF) on the perception of speech naturalness of people who stutter was examined. Thirty-five naive young adult listeners rated speech samples from fluent speakers and individuals who stutter. Samples came from normal adults who spoke Standard American English; adults with mild or severe stuttering who spoke under conditions of non-altered feedback (NAF), delayed auditory feedback (DAF), and frequency-altered feedback (FAF); and adults with mild or severe stuttering prior to and following successful completion of a Precision Fluency Shaping Program. Speech produced under AAF was rated as significantly more natural sounding than speech from the same individuals under NAF (p < 0.0001). Speech produced during FAF was judged to be more natural sounding than that produced during DAF for those with mild (p = 0.003) and severe (p < 0.0001) stuttering. Mild stuttered speech was judged to have more natural-sounding speech than severe stuttered speech during AAF (p < 0.0001). Speech from individuals following therapy was rated significantly less natural sounding than that from individuals during AAF for both mild and severe stuttering (p < 0.0001). The speech of individuals prior to therapy was rated significantly more natural than their speech produced after therapy (p < 0.0001). Speech from normal fluent speakers was rated as significantly more natural sounding than all samples produced from the individuals who stutter (p < 0.0001). These findings support the contention that AAF benefits those who stutter through a reduction of stuttering with a gain in perceived speech naturalness.

Instead of being the core stuttering 'problem', syllabic repetitions may be a biological mechanism, or 'solution', to the central involuntary stuttering block. Simply put, stuttering is an endogenous transitory state of 'shadowed speech', a choral speech derivative that allows for a neural release of the central block. To investigate this possibility, 14 adults who stutter read while listening to forward fluent speech, reversed fluent speech, forward stuttered speech, and reversed stuttered speech. All conditions induced significant degrees of stuttering inhibition when compared to a control condition. However, the reversed fluent condition was less powerful than the other three conditions ( approximately 42% vs. approximately 65%) for inhibiting stuttering. Stuttering inhibition appears to proceed by 'gestural recovery', made possible by the presence of an exogenous or 'second' set of speech gestures and engagement of mirror neurons. When reversed fluent speech was used, violations in normal gesture-time relationships (i.e., normal speech entropy) resulted in gestural configurations that apparently were inadequately recovered, and therefore, were not as conducive to high levels of stuttering inhibition. In contrast, high levels of encoding found in the simple syllabic structures of stuttered speech allowed its forward and reversed forms to be equally effective for gestural recovery and stuttering inhibition. The reversal of repeated syllables did not appear to significantly degrade the natural gesture-time relationships (i.e., they were perceptually recognizable). Thus, exogenous speech gestures that displayed near normal gestural relationships allowed for easy recovery and fluent productions via mirror systems, suggesting a more choral-like nature. The importance of syllabic repetitions is highlighted: both their perceived (exogenous) and produced (endogenous) forms appear to be fundamental, surface acoustic manifestations for central stuttering inhibition via the engagement of mirror neurons.

Numerous past efficacy studies in stuttering treatment have typically failed to assess generalization of therapeutic gains across speaking environments over time. The purpose of this study was to use a self-report format to gain insight into the improvements of clients who purchased an all in-the-ear device that provides altered auditory feedback to manage stuttering symptoms across everyday speaking situations. A total of 105 participants (age 7-81 years) returned completed questionnaires that examined seven parameters of stuttering behavior before acquiring the prosthetic device and after using the device with minimal clinical intervention for an average of 6 months. Across each parameter, participants rated a significant (P<0.001) improvement of approximately two units on seven-point scales after beginning to use the prosthetic device. In addition, the device received high overall satisfaction ratings, with a median score of 2.0 on the seven-point scale. Self-report is a 'must' for examining clinical efficacy in a disorder such as stuttering, which is so amenable to 'clinic room fluency' yet highly resistant to long-term amelioration. The data suggest that this device is helping to provide its users with functional, effective and efficient management of stuttering without the need for extended clinical follow-up.

Physicians are often the first point of contact when children's speech begins to be disrupted by stuttering behaviors such as sound repetitions and prolongations. For this reason, we feel it is important that they are accurately informed with regards to the nature of stuttering and the available treatment options before making referrals to speech-language pathologists. Stuttering is by definition, an involuntary disorder and remains that way throughout life. Its cause is still unknown and the only true form of remission appears to be the natural, spontaneous recovery that occurs in up to 80% of those children afflicted. No therapeutic course has seemed to change this figure and the prevalence of stuttering in the general population has remained stable, suggesting that speech therapy has never 'cured' stuttering. Therefore, we suggest that therapeutic intervention for stuttering should be best directed towards 'efficient' and 'effective' symptom reduction. Until recently, intervention options for children and adults who stutter have generally been limited consist of countless hours of speech retraining (teaching people 'how to talk again'), while attempting to bring the disorder under voluntary control. The common end-results of these procedures include unnatural speech patterns that are difficult to maintain in all situations and highly prone to relapse, thus, reinforcing the notion that stuttering is highly resistant to treatment. However, miniaturized digital technology now allows those who stutter to take advantage of auditory effects that 'inhibit' stuttering. 'Choral speech' or speaking in unison has long been known to make those who stutter immediately fluent without compromising speech naturalness. All in-the-ear devices can emulate choral speech effects by altering auditory feedback. Therapeutic protocols using these devices can be quickly and efficiently implemented. Furthermore, they are showing high levels of long-term effectiveness with regards to reducing stuttering frequency and maintaining speech naturalness.

This study examined fluency enhancement in people who stutter via the concomitant presentation of silently mouthed visual speech. Ten adults who stutter recited memorized text while watching another speaker silently mouth linguistically equivalent and linguistically different material. Relative to a control condition, in which no concomitant stimulus was provided, stuttering was reduced by 71% in the linguistically equivalent condition versus only 35% in the linguistically different condition. Despite being an 'incomplete' second speech signal, visual speech possesses the capacity to immediately and substantially enhance fluency when it is linguistically equivalent to the intended utterance. It is suggested that fluency enhancement via concomitantly presented external speech is achieved through the extraction of relevant speech gestures from the external speech signal that compliment the intended production, thereby compensating for possible internal inconsistencies in the matching of speech codes in people who stutter. As visual speech perception relies on fewer redundant cues to demarcate the intended gestures, when used as an external stuttering inhibitor, higher degrees of linguistic equivalence seem to be necessary for optimal stuttering inhibition.

Stuttering can be effectively inhibited via exogenous sensory signals (e.g., speaking in unison or using altered auditory feedback) or by using endogenous motoric strategies (e.g., singing or therapeutically implementing long vowel prolongations to reduce speech rates). We propose that these channels, which superficially appear to be diametrically opposite, centrally converge in the engagement of mirror neurons for fluent gestural productions. Sensory changes incurred via exogenous speech signals allow for direct engagement of mirror systems, while endogenous motor strategies appear to require significant departures from normal speech production (e.g., highly unnatural or droned speech) to engage mirror systems. Thus, paradoxically, stuttering is prone to resurface during attempts to impose naturalness upon therapeutic speech.

In accord with a proposed innate link between speech perception and production (e.g., motor theory), this study provides compelling evidence for the inhibition of stuttering events in people who stutter prior to the initiation of the intended speech act, via both the perception and the production of speech gestures. Stuttering frequency during reading was reduced in 10 adults who stutter by approximately 40% in three of four experimental conditions: (1) following passive audiovisual presentation (i.e., viewing and hearing) of another person producing pseudostuttering (stutter-like syllabic repetitions) and following active shadowing of both (2) pseudostuttered and (3) fluent speech. Stuttering was not inhibited during reading following passive audiovisual presentation of fluent speech. Syllabic repetitions can inhibit stuttering both when produced and when perceived, and we suggest that these elementary stuttering forms may serve as compensatory speech gestures for releasing involuntary stuttering blocks by engaging mirror neuronal systems that are predisposed for fluent gestural imitation.

Background: Self-contained ear-level devices delivering altered auditory feedback (AAF) for the application with those who stutter have only been recently developed., Aims: The paper examines the first therapeutic application of self-contained ear-level devices in three experiments. The effect of the device on the proportion of stuttered syllables and speech naturalness was investigated following initial fitting and at 4 months post-fitting., Methods & Procedures: Three experiments were undertaken: In Experiment 1, the effect of a self-contained in-the-ear device delivering AAF was investigated with those who stutter during reading and monologue. Two adolescents and five adults who stuttered read and produced monologue with and without a device fit monaurally. The device provided a frequency shift of +500 Hz in combination with a delayed auditory feedback of 60 ms. Custom-made ITC and CIC devices were fabricated for four adults and four youths in Experiment 2. The effect of group (i.e. youth versus adult), time (i.e. initial fitting versus 4-month follow-up), speech task (i.e. reading versus monologue), and device (i.e. present versus absent) on stuttering rate was examined. In Experiment 3, 15 naïve listeners rated the speech naturalness of speech produced by the participants in Experiment 2. Speech samples from six conditions were rated: reading and monologue without the device at the initial visit, reading and monologue with the device at the initial visit, and reading and monologue with the device at 4 months., Outcomes & Results: In Experiment 1, the proportion of stuttered syllables was significantly (p=0.011) reduced by approximately 90% during reading and 67% during monologue with the device relative to no device. Only a significant main effect of device (p=0.0028) was found in Experiment 2. That is, stuttering rate was significantly reduced with the device in place regardless of speech task or group and remained so 4 months later. In Experiment 3, speech samples generated while wearing the device were judged to be more natural sounding than those without the device (p<0.0001) for reading and monologue with both adults and youths. There was no significant difference between the mean naturalness ratings of speech samples generated during the initial fitting with the device relative to that at 4 months with the device (p>0.05) in all cases except with the youths while engaged in monologue. For that condition, raters judged the speech produced at the initial fitting as more natural., Conclusions: These findings support the notion that a self-contained in-the-ear device delivering AAF assists those who stutter. With the device in place, stuttering is reduced and speech produced is judged to be more natural than with out the device.

We explored a possible temporal window for central stuttering inhibition via exogenously presented speech signals. Thirteen adults who stutter were asked to read while listening to a continuous vowel /a/, or a repeating 1 s vowel /a/ followed by 1, 3 and 5 s silences. In all conditions, stuttering was significantly reduced. However, the continuous and 1 s repeating conditions showed the greatest reduction in stuttering relative to all other conditions. Furthermore, these conditions did not differ significantly from each other, suggesting a temporal window of at least 1 s for stuttering inhibition induced by a 1 s stimulus. We propose that exogenous speech signals provide an additional speech source that engages mirror neurons for 'on-line' stuttering inhibition during continous speech. Employing dual speech sources results in 'on-line' stuttering inhibition and continuous speech flow. In contrast, endogenous (single source) inhibitory techniques require speech flow to be interrupted and go 'off-line' to derive the mirror neuronal.

'Choral' speech or speaking in unison is an undeniable phenomenon that immediately induces fluent and natural sounding speech in almost all people who stutter, regardless of linguistic content, situation or audience size. We propose that the choral speech effect is a form direct imitation, a primitive and innate human capacity that is possibly mediated at the neuronal level by 'mirror neurons'. Mirror systems link observations and actions are considered by many to be a neuronal substrate for gestural language acquisition, as well as forming the basis for many learned behaviors, thus possibly playing a vital role in ensuring survival during infancy. The engagement of these systems allows gestural sequences, including speech, to be fluently replicated. Choral speech and its permutations use the capacity for fluent imitation in people who stutter via a 'loose' gestural matching system in which gestures in the external signal possessing cues found in the intended utterance can serve as stuttering inhibitors. We suggest implementing these innate gestural mirrors to provide immediate and effective amelioration for stuttering.

Purpose: This survey investigated the effect of 'pseudostuttering' experiences on self-perceptions of 29 female, graduate students enrolled in a graduate seminar in stuttering while in a programme of study to become professional speech language pathologists., Method: Perceptions of self prior to, and immediately after, participation in five scripted telephone calls that contained pseudostuttering were measured via a 25-item semantic differential scale., Results: Participants perceived themselves as significantly more (p < 0.002) withdrawn, tense, avoiding, afraid, introverted, nervous, self-conscious, anxious, quiet, inflexible, fearful, shy, careless, hesitant, uncooperative, dull, passive, unpleasant, insecure, unfriendly, guarded, and reticent after their pseudostuttering telephone call experiences., Conclusions: Findings suggests that the pseudostuttering experiences have an impact on self-perceptions and that the experience of 'adopting the disability of a person who stutters' may provide insight as to the social and emotional impact of communicative failure. It is suggested that pseudostuttering exercises may be a valuable teaching tool for the graduate students, especially for those who do not stutter.

'Choral speech', 'unison speech', or 'imitation speech' has long been known to immediately induce reflexive, spontaneous, and natural sounding fluency, even the most severe cases of stuttering. Unlike typical post-therapeutic speech, a hallmark characteristic of choral speech is the sense of 'invulnerability' to stuttering, regardless of phonetic context, situational environment, or audience size. We suggest that choral speech immediately inhibits stuttering by engaging mirror systems of neurons, innate primitive neuronal substrates that dominate the initial phases of language development due to their predisposition to reflexively imitate gestural action sequences in a fluent manner. Since mirror systems are primordial in nature, they take precedence over the much later developing stuttering pathology. We suggest that stuttering may best be ameliorated by reengaging mirror neurons via choral speech or one of its derivatives (using digital signal processing technology) to provide gestural mirrors, that are nature's way of immediately overriding the central stuttering block., (Copyright 2003 Elsevier Science Ltd.)

The design and operating characteristics of the first self-contained in-the-ear device to deliver altered auditory feedback is described for applications with those who stutter. The device incorporates a microdigital signal processor core that reproduces the high fidelity of unaided listening and auditory self-monitoring while at the same time delivering altered auditory feedback. Delayed auditory feedback and frequency-altered feedback signals in combination or isolation can be generated to the user in a cosmetically appealing custom in-the-canal and completely-in-the-canal design. Programming of the device is achieved through a personal computer, interface, and fitting software. Researchers and clinicians interested in evaluating persons who stutter outside laboratory settings in a natural environment and persons who stutter looking for an alternative or adjunct to traditional therapy options are ideal candidates for this technology. In both instances an inconspicuous ear level alternative to traditional body worn devices with external microphones and earphones is offered.

This manuscript outlines the lifelong battle with severe stuttering and describes a new modality of effective amelioration of the disorder from the standpoint of a university professor and researcher in the field of stuttering. Childhood reactions to stuttering are discussed, along with the educational and vocational impact of stuttering. Ongoing therapy was received throughout the formative years and into adulthood, emphasizing reduced rates of speech. The use of Delayed Auditory Feedback (DAF) was found to induce fluent speech, but was considered only as a tool for decreasing the speech rate to achieve fluency. When fluency under DAF was discovered to be possible at faster speech rates, the possibility that the use of DAF and other forms of altered auditory feedback could themselves have an inhibitory effect on stuttering, without concomitant rate reduction was investigated. An In-The-Canal (ITC) fluency-enhancing device was used that provided DAF and Frequency Altered Feedback (FAF) to produce more fluent speech. After 10 months of use, the author was relatively free from stuttering. Speech was natural sounding, relatively spontaneous and unlaboured with an absence of fear. However, further testing (that is currently underway at various centres) is necessary before generalizations can be made.

Issue: The state of stuttering therapy continues to be of great concern in the field of speech-language pathology. Despite decades of research and clinical practical, stuttering is still treated by ineffective and inefficient means., Proposal: Our research group suggests that therapy failures stem from the use behavioural approaches; procedures that have resulted in only temporary and unnatural alleviation from the symptomatology by masking the disorder. These procedures 'denature' the disorder and induce pseudofluency rather than true fluency. It is proposed that in order to truly provide relief to those who stutter, professionals need to view both the overt and covert components of the disorder from the standpoint of attaining true fluency. Only then can the true syndrome-like nature of stuttering be addressed. In order to achieve true fluency the use of stuttering inhibitors must be incorporated such as choral speech and its permutations to derive natural sounding, stable and effortless speech in those who stutter., Conclusion: By doing so, the goal is to not only derive stable and natural-sounding speech, but also to help remove such factors as the expectancy, anticipation and the fear of stuttering that generally continue to shackle most people who stutter following behavioural therapy.

This study investigated stuttering frequency as a function of grammatical word type (i.e., content and function). Ten adults who stutter participated. Participants recited aloud a list of 126 words consisting of an equal number of content and function words, which were presented individually and visually via a laptop computer. Each word belonged to a single grammatical category. Further, words were matched for initial sound and approximate number of syllables. The results indicated that adults who stutter exhibited significantly greater stuttering frequency on content words when presented in isolation (p = 0.018). It was conjectured that the responsible factor contributing to differences in stuttering frequency in adults who stutter resides in word frequency disparities between the two classes of words categories. That is, because the function words are limited in number and are used frequently, repeated use on the part of adults who stutter may lead to a generalized adaptation effect for function words and hence reduced stuttering frequency (as compared with content words).

Craig discussed fluency outcomes following stuttering therapy that involved retraining the speech system, on the assumption that the speech end product is truly fluent. As previously outlined by Dayalu and Kalinowski, we strongly disagree with the notion that behavioral paradigms can ever result in automatic, long lasting natural sounding fluent speech. Fluent speech is within the grasp of one who stutters as seen in the effects of choral speech and derivatives such as delayed auditory feedback.

The majority of therapy programs for people who stutter are aimed at modifying the entire speech output by using techniques that reduce the overt signature events. Use of these techniques for extended time periods are thought to induce true fluency that is automatic, natural, and effortless. It is proposed that the present form of therapeutic intervention induces pseudofluency rather than true fluency. Pseudofluency is the speech posrtherapy of persons who stutter, free of the discrete signature events of stuttering, but replaced by cognitively mediated gestures that are embedded as continuous prolongation or masked stuttering events throughout the speech act. This may account for the high rate of relapse and the problems associated with the maintenance, stability, and naturalness of speech after stuttering therapy.

Treatment for stuttering attempts to reduce or eliminate the observable core markers of the disorder, specifically repetitions and prolongation. In this hypothesis, it is proposed that stuttering may be inhibited by two distinct yet related procedures: active inhibition and passive inhibition. Active inhibition is brought about when the person who stutters makes volitional changes to his or her speaking pattern, such as when employing behavioral modification techniques. Passive inhibition automatically inhibits the involuntary stuttering block and can be induced from an external source, such as altered auditory feedback, or by the use of sufficient active inhibition. It is suggested that passively inhibiting stuttering results in speech that is more automatic, natural sounding, and truly fluent speech than the speech that is derived primarily from active inhibition. Evidence of passive inhibition resulting from active inhibition can be seen when people who stutter exhibit uncontrolled fluency following behavioral therapy., (Copyright 2002 Harcourt Publishers Ltd.)