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STUTTERING

What It Is and How to Manage it

STU
TTE
NR
G
I

Is not a psychological disorder.


It is a NEUROLOGICAL DISORDER
with psychological consequences.

HISTORY OF CAUSALITY
CONFUSION
Psychological reaction to stress? (Blamed mothers)
Changed left-handedness (What about R-handed stutterers?)
Male fetus incompatibility with mother (Male childbearing?)
Imitating stuttering siblings (What about non-imitators)
Divorce / tumultuous home life (Normal home /fluent siblings?)
Talks faster than thinks (Thought always precedes speech)
Dropped on head as infant (Neurological possibility)

STUTTERING RISK FACTORS


RISK FACTORS

ELEVATING RISKS

Family history of stuttering

Parent, sibling, other family


member who still stutters

Age at onset

After 3 years

Duration since onset

6-12 months or longer

Gender

Male

Speech production concerns

Speech sound errors or


difficulty being understood

Language skills concerns

Advanced, delayed or
disordered

IF APPLIES TO CHILD

STRANGE FACTS ABOUT


STUTTERING
Approximately 1% of the worlds population stutters
Stutterers dont stutter when singing.
Stutterers dont stutter when speaking on inhalation.
Stutterers dont stutter when speaking in unison with others.
Stutterers dont stutter when hearing white noise over earphones.
Stutterers dont stutter at ends of words.
Stutterers are generally in the upper range of intelligence

STRANGE FACTS ABOUT


STUTTERING (cont.)
Most stuttering begins between ages 2 to 5 years
Three times as many males stutter than females
More stutterers are ambidextrous than non-stuterers
Stuttering has a genetic (paternal) predisposition
90% of stuttering twins are identical
Some laryngectomy patients begin to stutter after losing their voices
Stuttering has been observed and studied in birds

STUTTERING BIRDS STUDY


by

David B. Rosenfield, M.D.


Director, Speech and Language Center
The Methodist Hospital Neurological Institute
Professor, Weill Medical College of Cornell University
Houston, Texas

STUTTERING BIRDS

ZEBRA FINCH BIRDSONG &


HUMAN SPEECH COMPARISON
Birdsong

Human Speech

Occurs early in life (Same ratio to life span)


Dependent on auditory feedback

Dependent on specialized brain areas

Spectrally complex (array of sounds)


Temporally complex (complex in musical time)

Hierarchically controlled

Modal (notes, syllables, phrases, phonemes,


words, sentences, paragraphs)

Zebra Finch Normal Song

Repeater Song

BIRD THERAPY
Spontaneous repeater (stuttering) birds
were placed with two populations of Zebra Finches:
1. Birds with normal song
2. Other repeater birds

WHICH BIRDS STOPPED REPEATING?


Birds that stopped repetitions when raised by:
Normal birds:

95%

Other spontaneous repeater birds:

38%

HYPOTHESIS:
Spontaneous repeaters can improve with tutoring
(Stuttering therapy is usually effective)

IN UTERO PREDISPOSITION
TO STUTTERING?
Some researchers suggest that a predisposition to stutter may
be present at birth.
During the course of speech acquisition, structures supporting
speech production may develop differently in children who
stutter compared to children who speak fluently.
In addition, the development of these structures and the
connectivity among them may differ in children who recover
from stuttering compared to those who continue to stutter into
adulthood.

STUTTERING IS NEUROLOGICAL
Stuttering occurs when vocal folds stop moving
Limbic system responds to fear and stress, sends message to
shut down breathing mechanism, closes vocal folds
Closed vocal folds stop breath, begin to spasm until person
gasping for air and has to breathe.
Facial and body tension are reactions to interruptions in
breathing.
Psychological aspect is negative response to stuttering.

STUTTERING EVALUATION
WHAT DO WE NEED TO KNOW?
History, family, onset, previous therapy, what works/doesnt, feared words
Current stuttering look and sound (frequency, duration of blocks, facial &
body tension/movement, talking vs. reading, speech sample
Their perception of & response to stuttering in many settings
Goals for fluency
Commitment to daily practice and acceptance of fluent speech

FLUENCY THERAPY OPTIONS


TRADITIONAL THERAPY STRATEGIES
Cognitive-behavioral therapy (empowers person for lasting changes)
Breath management (opens vocal folds and keeps them moving)
Becoming aware of bodys fear signals, pausing to use strategies
Eliminating negative self-talk
Practicing strategies daily in all speaking situations
Setting calendar goals with practice activities to meet them

FLUENCY THERAPY OPTIONS


SpeechEasy FLUENCY PROGRAM
A treatment for stuttering that merges technology with techniques.
An interactive, team approach to stuttering management.
Another option for your clients who stutter.

SpeechEasy: An
Option for Those
Who Stutter

SpeechEasy IS NOT
A cure
A one size fits all approach
A stand alone treatment option
For everyone

HOW DOES SpeechEasy WORK?


Delayed Auditory Feedback (DAF)
Delays what the speaker hears by a few milliseconds (ms)
DAF provides an echo effect for the user
Frequency Altered Feedback (FAF)
Alters the pitch perception of the users voice
Can be raised or lowered in 500Hz increments

HOW DOES SpeechEasy WORK?


When a client is using the device, they hear their voice slightly
delayed and at a new pitch.
The brain perceives these changes as a different person
talking along with the client.
Both the DAF and FAF can be altered to achieve the best
results.

THE TECHNOLOGY

Looks similar to a hearing aid


4 different models:
Comfort Fit, Completely in the Canal, In
the Canal and Behind the Ear

SpeechEasy Devices:

Are custom fit


Are powered by hearing aid batteries
Are worn in one ear
Are computer-programmed by provider
Require minimal care and maintenance

THE SpeechEasy WORKBOOK


The SpeechEasy workbook is a
supplemental guide that helps
walk clients through the
SpeechEasy learning curve.
The workbook was created to
support our SLPs and your clients
efforts to create and maintain
fluency while using a SpeechEasy
device.

WHAT IS THE COST?


The cost of the device ranges from $2500 to $4500, depending
on which shell style is most appropriate.
The 4-hour SpeechEasy evaluation fee of $300 is charged
separately.
Evaluation fee includes three free follow-up therapy sessions.
Audiological fees may also be a factor for In-the-Ear models
.

SpeechEasy PAYMENT OPTIONS


SpeechEasy Lease Plan
SpeechEasy Financing Plan (+ 0% interest plan)
Flexible Spending Accounts
Check or Credit Card
Vocational Rehabilitation
Veteran's Administration
Civic Groups and Others

SpeechEasy WARRANTIES
60 day trial period
Every client has 60 days from the day they pick up their
custom device to try it in the real world. If, for whatever
reason, they decide to return the device, they receive a 90%
refund on the cost of the device.
1 year manufacturers warranty
Each SpeechEasy is covered by a one year manufacturer
warranty against mechanical defects. This does not cover
loss, theft, accident or negligence.

WHO IS APPROPRIATE FOR A


SpeechEasy?
As with any program, no matter what the age of the client,
many factors play a part in how much benefit can be gained.
The only way to know whether SpeechEasy is appropriate is
for the client to be evaluated by a providing SLP.

QUESTIONS?

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