The effectiveness of SpeechEasy during situations of daily living

doi:10.1016/j.jfludis.2008.02.001

Journal of Fluency Disorders

Volume 33, Issue 2, June 2008, Pages 99-119

https://doi.org/10.1016/j.jfludis.2008.02.001 Get rights and content

Abstract

A multiple single-subject design was used to examine the effects of SpeechEasy on stuttering frequency in the laboratory and in longitudinal samples of speech produced in situations of daily living (SDL). Seven adults who stutter participated, all of whom had exhibited at least 30% reduction in stuttering frequency while using SpeechEasy during previous laboratory assessments. For each participant, speech samples recorded in the laboratory and SDL during device use were compared to samples obtained in those settings without the device. In SDL, stuttering frequencies were recorded weekly for 9–16 weeks during face-to-face and phone conversations. Participants also provided data regarding device tolerance and perceived benefits. Laboratory assessments were conducted at the beginning and the end of the longitudinal data collection in SDL. All seven participants exhibited reduced stuttering in self-formulated speech in the Device compared to No-device condition during the first laboratory assessment. In the second laboratory assessment, four participants exhibited less stuttering and three exhibited more stuttering with the device than without. In SDL, five of seven participants exhibited some instances of reduced stuttering when wearing the device and three of these exhibited relatively stable amounts of stuttering reduction during long-term use. Five participants reported positive changes in speaking-related attitudes and perceptions of stuttering. Further investigation into the short- and long-term effectiveness of SpeechEasy in SDL is warranted.

Educational objectives: The reader will be able to summarize: (1) issues pertinent to evaluating treatment benefits of wearable fluency aids and evaluate (2) the effect of SpeechEasy on stuttering frequency and the perceived benefits of device use in situations of daily living, as assessed weekly over the course of 9–16 weeks of wear, for seven adults who stutter.

Section snippets

Participants

Seven people who stutter participated in the study. Five had participated in a previous study on the efficacy of the SpeechEasy device (Armson et al., 2006) and two were referred by a local practicing speech-language pathologist. The five participants recruited from the previous study included those four who had exhibited the strongest and most unambiguous treatment effects for self-formulated speech and who had noticed a benefit (Participants 2, 3, 5, and 10 in Armson et al., 2006) as well as

Results

Participants varied with respect to average hours of daily use, ranging from 2 h for Participant 3 to 15 h for Participant 2. Participants 6 and 7 also reported large amounts of daily wearing time at 5.2 and 11.6 h of use, respectively. The remaining participants did not record hours of use in their logbooks, although they verbally reported during weekly phone conversations with the first author that they wore the device on a daily basis. Notations in participants’ daily logs revealed that they

Discussion

This study serves as a preliminary investigation into the effectiveness of SpeechEasy. Results are discussed in terms of the effect of SpeechEasy in the laboratory and in SDL when used in various speaking tasks as well as the wearers’ subjective impressions pertaining to effectiveness, tolerance, and overall impact on quality of life.

Conclusions

Overall, this study reveals that all seven participants exhibited less stuttering with the device than without in laboratory assessments at the beginning of the study. However, two participants in the reading task and three of seven participants in the monologue task exhibited more stuttering with the device than without in the second laboratory assessment at the end of the study. Five of the seven participants reported that the device provided ameliorative effects during SDL. Three of these

Acknowledgements

The authors wish to thank Micro-DSP for supplying, on loan, the seven ITC SpeechEasy devices used in this study. We also thank Unitron Canada for providing device-shelling services.
CONTINUING EDUCATION
The effectiveness of SpeechEasy during situations of daily living
QUESTIONS

1.
In reviewing the results of AAF studies as applied to the treatment of stuttering, Lincoln et al. (2006) concluded that:
- a.
  strong available evidence demonstrates that AAF reduces stuttering in conversational speech tasks
- b.
  strong

Jennifer J. O’Donnell is a graduate of Dalhousie University's Master of Science program in speech-language pathology where she developed a special interest in stuttering treatment. She currently works as a speech-language pathologist and department manager at the Chaleur Regional Hospital in Bathurst, New Brunswick.

References (23)

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J. Kalinowski

Self-reported efficacy of an all in-the-ear-canal prosthetic device to inhibit stuttering during one hundred hours of university teaching

Disability and Rehabilitation

(2003)

Cited by (28)

White matter correlates of sensorimotor synchronization in persistent developmental stuttering
2022, Journal of Communication Disorders
Citation Excerpt :
In the DIVA model of speech production, connections between the IFG and STG (i.e., the arcuate fasciculus) are embedded in the feedback control system that conveys auditory signals when listening to one's own speech (Tourville & Guenther, 2011). Moreover, manipulations that affect auditory feedback during speech production induce temporary fluency in people who stutter (Lincoln, Packman, & Onslow, 2006; Macleod, Kalinowski, Stuart, & Armson, 1995; O'Donnell, Armson, & Kiefte, 2008). Hence, altered connectivity in the arcuate fasciculus of AWS strengthens the view that stuttering may involve aberrant reliance on auditory feedback (Max et al., 2004).
Individuals with persistent developmental stuttering display deficits in aligning motor actions to external cues (i.e., sensorimotor synchronization). Diffusion imaging studies point to stuttering-associated differences in dorsal, not ventral, white matter pathways, and in the cerebellar peduncles. Here, we studied microstructural white matter differences between adults who stutter (AWS) and fluent speakers using two complementary approaches to: (a) assess previously reported group differences in white matter diffusivity, and (b) evaluate the relationship between white matter diffusivity and sensorimotor synchronization in each group.
Participants completed a sensorimotor synchronization task and a diffusion MRI scan. We identified the cerebellar peduncles and major dorsal- and ventral-stream language pathways in each individual and assessed correlations between sensorimotor synchronization and diffusion measures along the tracts.
The results demonstrated group differences in dorsal, not ventral, language tracts, in alignment with prior reports. Specifically, AWS had significantly lower fractional anisotropy (FA) in the left arcuate fasciculus, and significantly higher mean diffusivity (MD) in the bilateral frontal aslant tract compared to fluent speakers, while no significant group difference was detected in the inferior fronto-occipital fasciculus. We also found significant group differences in both FA and MD of the left middle cerebellar peduncle. Comparing patterns of association with sensorimotor synchronization revealed a novel double dissociation: MD within the left inferior cerebellar peduncle was significantly correlated with mean asynchrony in AWS but not in fluent speakers, while FA within the left arcuate fasciculus was significantly correlated with mean asynchrony in fluent speakers, but not in AWS.
Our results support the view that stuttering involves altered connectivity in dorsal tracts and that AWS may rely more heavily on cerebellar tracts to process timing information. Evaluating microstructural associations with sensitive behavioral measures provides a powerful tool for discovering additional functional differences in the underlying connectivity in AWS.
Impact of auditory feedback alterations in individuals with stuttering
2021, Brazilian Journal of Otorhinolaryngology
Electrophysiological evidence has reinforced the hypothesis that stuttering is associated with a deficit in modulation of the cortical auditory system during speech planning, contributing to an inefficient auditory feedback monitoring and, consequently, resulting in disfluencies.
To verify the impact of auditory feedback modifications on the spontaneous speech of individuals with stuttering.
Sixteen individuals, of both genders, aged 8–17 years and 11 months, with a diagnosis of persistent neurodevelopmental stuttering, were divided into two groups: Moderate Stuttering Group and Severe Stuttering Group. The testing procedures consisted of three stages: collection of identification data, audiological assessment and fluency evaluation of spontaneous speech in four auditory feedback conditions (non-altered, delayed, masked and amplified). The speech sample obtained in the non-altered feedback was considered the control; the others were considered as modified listening conditions.
Regarding the stuttering-like disfluencies, a statistically significant difference was observed in the intragroup analysis of the Moderate Stuttering Group between non-altered and masked auditory feedback (p = 0.042), as well as between non-altered and amplified (p = 0.042). There was a statistically significant difference in the Severe Stuttering Group for all auditory feedback modifications in relation to the non-altered (delayed p = 0.012, masked p = 0.025 and amplified p = 0.042). There was also a reduction in flows of syllables and words-per-minute in the Moderate Stuttering Group for the delayed auditory feedback, as compared to non-altered (p = 0.017 and p = 0.025, respectively).
The effect of delayed auditory feedback was favorable for the Severe Stuttering Group, promoting speech fluency. The conditions of masked and amplified auditory feedback resulted in speech benefits in both groups, decreasing the number of stuttering-like disfluencies. The speech rate was not impaired by any listening condition analyzed.
The effect of SpeechEasy<sup>®</sup> on attitudes, emotions and coping behaviors. Outcomes of short time usage
2016, Revista de Logopedia, Foniatria y Audiologia
Citation Excerpt :
One may assume, however, that like in previous studies that investigated the effect of altered feedback therapy on attitudes, emotions, and coping behaviors, wear time varied from individual to individual. In the four participants who recorded hours of daily use in the study by O’Donnell et al. (2008) an average wear time of 2 h, 5.2 h, 11.6 h and 15 h, respectively was noted and in the participants of the study by Pollard et al. (2009) average wear time ranged from 1.1 to 10.4 h/day. In conclusion, the present study confirmed that use of the SpeechEasy® can reduce dysfluency in people who stutter and suggests that after short time use some people who stutter may to some extent show an amelioration of the negative attitudes, emotions and coping behaviors that usually accompany the stuttering.
This study investigated the effect of SpeechEasy^® on attitudes, emotions and coping behaviors after a short period of usage. Nine individuals who stutter were fitted with the SpeechEasy^® and used the device for at least 4 h/day during a period of less than 2 months. Before and after this period spontaneous speech samples were collected and attitudes, emotions and coping behaviors were assessed by means of the Behavior Assessment Battery (Brutten & Vanryckeghem, 2003b) and the adult form of the Communication Attitude Test (Vanryckeghem & Brutten, 2011). Results indicate that after a short time using the SpeechEasy^® some people who stutter may to some extent show an amelioration of the negative attitudes, emotions and coping behaviors that usually accompany the stuttering. However, self-reported changes in attitudes, emotions and coping behaviors do not necessarily reflect objective fluency scores and there seems to be considerable individual variation in reaction the SpeechEasy^®.
El presente estudio investiga el efecto del SpeechEasy^® en la actitud, las emociones y las estrategias de afrontamiento después de un breve periodo de uso. Se colocó un SpeechEasy^® a nueve individuos tartamudos, que lo utilizaron durante un mínimo de cuatro horas diarias a lo largo de un periodo inferior a dos meses. Antes y después de este periodo se tomaron muestras de habla y se evaluaron la actitud, las emociones y las estrategias de afrontamiento por medio del Behavior Assessment Battery (Brutten y Vanryckeghem, 2003b) y del formulario para adultos de Communication Attitude Test (Vanryckeghem y Brutten, 2011). Los resultados indican que poco tiempo después de usar el SpeechEasy^® algunas personas que tartamudean podrían mostrar una cierta mejora de las actitudes, emociones y estrategias de afrontamiento negativas que suelen acompañar el tartamudeo. No obstante, la autoevaluación de los cambios en estos aspectos no necesariamente reflejan una puntación de fluidez objetiva y parece existir una variación individual considerable respecto al SpeechEasy^®.
The SpeechEasy device in stuttering and nonstuttering adults: Fluency effects while speaking and reading
2013, Brain and Language
Citation Excerpt :
The effects were more pronounced during reading than during conversational speech consistent with those reported in the laboratory setting (Armson & Stuart, 1998; Armson et al., 2006; Ingham, Moglia, Frank, Ingham, & Cordes, 1997). Ear effects and sex-linked factors were not controlled nor evaluated as potential confounds in any of these studies, and different device settings were not compared within subjects (O’Donnell et al., 2008; Pollard et al., 2009). Some investigators have speculated that the SpeechEasy device is not therapeutically useful (Pollard et al., 2009), and there continues to be vigorous debate about its efficacy and effectiveness (Saltuklaroglu, Kalinowski, & Stuart, 2010).
The SpeechEasy is an electronic device designed to alleviate stuttering by manipulating auditory feedback via time delays and frequency shifts. Device settings (control, default, custom), ear-placement (left, right), speaking task, and cognitive variables were examined in people who stutter (PWS) (n = 14) compared to controls (n = 10). Among the PWS there was a significantly greater reduction in stuttering (compared to baseline) with custom device settings compared to the non-altered feedback (control) condition. Stuttering was reduced the most during reading, followed by narrative and conversation. For the conversation task, stuttering was reduced more when the device was worn in the left ear. Those individuals with a more severe stuttering rate at baseline had a greater benefit from the use of the device compared to individuals with less severe stuttering. Our results support the view that overt stuttering is associated with defective speech-language monitoring that can be influenced by manipulating auditory feedback.
Long-term effectiveness of the SpeechEasy fluency-enhancement device
2012, Journal of Fluency Disorders
Citation Excerpt :
They discovered that during the monolog task, all seven of their participants exhibited less stuttering without the device in the later assessment as compared to their initial assessment, while in the telephone conversation task, five of seven exhibited a decrease in stuttering frequency over time with one other showing an increase and one showing virtually no change. The initial and latter measurements in the O’Donnell et al. (2008) study were taken over a much shorter period of time (up to 16 weeks) than that of this current study, so the current study may suggest that this finding holds true over a much longer period of time. Van Borsel, Reunes, and Van den Bergh (2003) also noted a carry-over effect of delayed auditory feedback (one of the components of the SpeechEasy device), noting that three months after beginning use of DAF, a stuttering decrease was maintained for many of the PWS while not wearing the DAF device.
The SpeechEasy has been found to be an effective device for reduction of stuttering frequency for many people who stutter (PWS); published studies typically have compared stuttering reduction at initial fitting of the device to results achieved up to one year later. This study examines long-term effectiveness by examining whether effects of the SpeechEasy were maintained for longer periods, from 13 to 59 months. Results indicated no significant change for seven device users from post-fitting to the time of the study (t = −.074, p = .943); however, findings varied greatly on a case-by-case basis. Most notably, when stuttering frequency for eleven users and former users, prior to device fitting, was compared to current stuttering frequency while not wearing the device, the change over time was found to be statistically significant (t = 2.851, p = .017), suggesting a carry-over effect of the device. There was no significant difference in stuttering frequency when users were wearing versus not wearing the device currently (t = 1.949, p = 0.92). Examinations of these results, as well as direction for future research, are described herein.
Educational objectives: The reader will be able to: (a) identify and briefly describe two types of altered auditory feedback which the SpeechEasy incorporates in order to help reduce stuttering; (b) describe the carry-over effect found in this study, suggest effectiveness associated with the device over a longer period of time than previously reported, as well as its implications, and (c) list factors that might be assessed in future research involving this device in order to more narrowly determine which prospective users are most likely to benefit from employing the SpeechEasy.
Immediate effects of AAF devices on the characteristics of stuttering: A clinical analysis
2012, Journal of Fluency Disorders
The present study investigated the immediate effects of altered auditory feedback (AAF) and one Inactive Condition (AAF parameters set to 0) on clinical attributes of stuttering during scripted and spontaneous speech. Two commercially available, portable AAF devices were used to create the combined delayed auditory feedback (DAF) and frequency altered feedback (FAF) effects. Thirty adults, who stutter, aged 18–68 years (M = 36.5; SD = 15.2), participated in this investigation. Each subject produced four sets of 5-min of oral reading, three sets of 5-min monologs as well as 10-min dialogs. These speech samples were analyzed to detect changes in descriptive features of stuttering (frequency, duration, speech/articulatory rate, core behaviors) across the various speech samples and within two SSI-4 (Riley, 2009) based severity ratings. A statistically significant difference was found in the frequency of stuttered syllables (%SS) during both Active Device conditions (p = .000) for all speech samples. The most sizable reductions in %SS occurred within scripted speech. In the analysis of stuttering type, it was found that blocks were reduced significantly (Device A: p = .017; Device B: p = .049). To evaluate the impact on severe and mild stuttering, participants were grouped into two SSI-4 based categories; mild and moderate–severe. During the Inactive Condition those participants within the moderate–severe group (p = .024) showed a statistically significant reduction in overall disfluencies. This result indicates, that active AAF parameters alone may not be the sole cause of a fluency-enhancement when using a technical speech aid.
Educational objectives: The reader will learn and be able to describe: (1) currently available scientific evidence on the use of altered auditory feedback (AAF) during scripted and spontaneous speech, (2) which characteristics of stuttering are impacted by an AAF device (frequency, duration, core behaviors, speech & articulatory rate, stuttering severity), (3) the effects of an Inactive Condition on people who stutter (PWS) falling into two severity groups, and (4) how the examined participants perceived the use of AAF devices.

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Joy Armson, professor and director at Dalhousie University's School of Human Communication Disorders, has over 30 years of clinical experience in stuttering. Her research interests include processes and conditions of fluency enhancement and the relationship between perceptions/attitudes and stuttering.

Michael Kiefte is an associate professor at Dalhousie University's School of Human Communication Disorders. His research interests include auditory feedback in speech production, speech perception, and experimental phonetics.

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The effectiveness of SpeechEasy during situations of daily living

Abstract

Section snippets

Participants

Results

Discussion

Conclusions

Acknowledgements

Journal of Fluency Disorders

Journal of Fluency Disorders

Just noticeable and objectionable group delays in digital hearing aids

Journal of the American Academy of Audiology

Stuttering therapy: The relation between changes in symptom level and attitudes

Journal of Speech and Hearing Disorders

Principles of exposure measurement in epidemiology

A coefficient of agreement for nominal scales

Educational and Psychological Measurement

The minimum detectable delay in speech and music

International Conference on Acoustics, Speech, and Signal Processing

Statistical methods for rates and proportions

Outcomes measurement: Definitions, dimensions, and perspectives

SpeechEasy: A true fluency device

Self-reported efficacy of an all in-the-ear-canal prosthetic device to inhibit stuttering during one hundred hours of university teaching

Disability and Rehabilitation