Effect of speech therapy on stuttering A twoyear followup study in three therapy programs

1
Effect of speech therapy on stutteringA
two-year follow-up study in three therapy
programs

• Wendy J. Huinck
• Herman F.M. Peters
• University Medical Center Nijmegen,
• Dept. of Otorhinolaryngology, the Netherlands
• 5TH WORLD CONGRESS ON FLUENCY DISORDERS
• 25 28th July, 2006, Dublin, Ireland

2
Effect of speech therapy on stutteringA
two-year follow-up study in three therapy
programsresearch group

• University Medical Center Nijmegen, Dept. of
  otorhinolaryngology, The Netherlands
• Drs. Wendy Huinck
• Drs. Esther Wouters
• Dr. Herman Peters
• Institute for Stuttering Treatment and Research,
  University of Alberta, Edmonton
• Marilyn Langevin
• University of professional Education Nijmegen,
  school for logopeadics
• Drs. Ruud Bökkerink
• Graduate Department of Speech-Language
  Pathology,University of Toronto, Canada
• Dr. Pascal van Lieshout
• University of Nijmegen, Nijmegen Institute for
  Cognition Research and Information Technology
  (NICI), The Netherlands
• Prof. Dr. Wouter Hulstijn

3
Therapy programs

• Fluency shaping group therapy
• - CSP (The Comprehensive Stuttering Program)
• integrated group therapy
• training of fluency skills and
  cognitive-behavioral strategies
• 3 week residential program
• Stuttering modifying group therapy
• - DM (Doetinchemse Methode)
• integrated group therapy
• emphasis on cognitive and emotional aspects
  of stuttering
• 5 clusters of 5 consecutive days in a ½
  year period
• Individualized Stuttering therapy
• - VSN (Vereniging Stottercentra Nederland)
• van Riper based individual therapy
• client-based intervention focusing on
  speech motor, emotional, and cognitive
  factors

4
Therapy duration therapy content
5
Participants/clinicians
6
measurements

• pre therapy
• post therapy
• Follow up 1 (one year after therapy)
• Follow up 2 (two years after therapy)

7
Drop outs
8
measurements

• Speech behavior
• Fluency measurements (SS, SPM, self-evaluation)
• Speech quality measurement (perceptual ratings)
• Emotions and cognitions
• Self-report stuttering inventories
• Speech motor control
• Nijmegen Speech Motor Test (NSMT)

9
Speech behavior

• Video and audio recordings of
• Interview
• Reading task
• Monologue
• Telephone call
• Trained counters
• Interrater reliability gt .90
• Intra- and interrater reliability scored speech
  samples
• .95 - .99

10
Results Stuttered Syllables (SS)
CSP N25 DM N15 VSN N13
11
Self evaluation of speech
12
Speech qualityPerceptual rating
instrument(Franken, Boves, Peters Webster,
1995)

• scales
• low pitch ------- high pitch
• slow ------- quick
• slovenly ------- polished
• flat ------- expressive
• shrill ------- deep
• soft ------- loud
• monotonous ------- melodious
• tense ------- relaxed
• weak accentuation ------- strong
  accentuation
• unpleasant ------- pleasant
• slurred ------- precise
• fluent ------- halting
• weak ------- powerful
• unnatural ------- natural

13
Perceptual judgement experiment

• Subjects (speakers)
• 13 CSP mean age 32 (range 17-59)
• 13 DM mean age 21.3 (range 17-32)
• 13 VSN mean age 27.6 (range 18-49)
• Speech samples
• 3 x 13 x 4 156 samples
• Judges
• 42 untrained female listeners
• mean age 20,2 (range 17-26)

14
Perceptual judgment experiment
IALP 2004
15
Results Articulation Quality Factor
IALP 2004
16
Results on Voice dynamics Factor
IALP 2004
17
Results Speech Power
IALP 2004
18
Conclusions perceptual judgment experiment
CSP Articulation quality improved post treatment
(on both short and long term) DM Voice dynamics
increased post therapy (on both short and long
term) Speech Power increased post therapy (on
both short and long term) VSN Voice dynamics
increased post therapy (on both short and long
term) Speech Power increased on the long term
IALP 2004
19
Feelings and emotions

• Self report stuttering inventories
• Speech Situation Checklist Brutten, 1973
• S24 Erickson, 1969 Andrews Cutler 1974
• Stuttering Severity scale (SS scale) Lanyon,
  1967
• Perceptions of Stuttering Inventory (PSI)
  Woolf, 1967
• Achievement Motivation Test (AMT) Hermans, 1968
• Inventory Interpersonal Situations (IIS)
• van Dam-Baggen Kraaimaat, 1987

IALP 2004
20
Self report stuttering inventories
Components
IALP 2004
21
Lanyons Stuttering Severity Scale (Ss scale)
IALP 2004
22
Ericksons S24 (Andrews Cutlers, 1974)
IALP 2004
23
Speech Motor Control

• The Nijmegen Speech Motor Test (NSMT)
• Simultaneous recordings in the respiratory,
• phonatory and articulatory domain.
• Experimental manipulation of variables in
  different
• speech tasks
• (e.g. word length, articulation complexity,
  diadochokinesis,
• accent, word meaning).

IALP 2004
24
Diadochokinesis
Repetition of /pu/ 5 seconds /tuku/ 7
seconds /putuku/ 9 seconds Score number
correct produced syllables
IALP 2004
25
Diadochokinesis
IALP 2004
26
Conclusions

• Fluency
• Dramatic improved fluency but also substantial
  regression
• on long term in CSP
• Only subtle differences between programs on the
  long
• term
• Improved speech satisfaction in all three
  programs
• Speech quality
• No loss of speech quality in terms of
  articulation quality
• and voice dynamics in CSP (in contrast to
  former studies)
• Substantial improved speech quality in
  stuttering
• modification program (DM)

IALP 2004
27
Conclusions (continued)

• Emotions and cognitions
• Substantial improved self-reports in all three
  programs
• (Less anxiety, improved fluency, improved
  self-concepts)
• Speech motor control (diadochokinesis)
• Higher repetition rate post treatment
  improved speech
• motor capacity

IALP 2004