Altered Auditory Feedback

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Altered Auditory Feedback

• Some Perspectives..

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What is Altered Auditory Feedback (AAF)?

• A definition
• AAF is a collective term for conditions that
  involve electronically altering the speech signal
  so speakers perceive their voice differently from
  normal (Lincoln, Packman and Onslow 2006)

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Types of AAF

• Masking
• Edinburgh masker 1970s
• Interest waned in the 1980s problems with
  continuous usage, and discovery that DAF and FAF
  were more effective

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Types of AAF

• Delayed Auditory Feedback DAF
• Delay of conductive voice signal by typically
  50-100 ms. Speakers experience this as a delay in
  hearing what they have just said.
• Historically used as a method for inducing
  prolonged speech (Goldiamond 1965)
• Only in the 1990s was DAF alone considered as a
  treatment for stuttered speech.

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Types of AAF

• Frequency Altered Feedback FAF
• Shifting the frequency of the speakers voice up
  or down, typically between a ¼ to 1 octave.
  Speakers hear their voice at a higher or lower
  pitch than usual.

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General effects of Altered Auditory Feedback (DAF
and FAF)

• DAF and FAF both shown to reduce stuttering in
  reading tasks in lab conditions by 40-85
• An estimated 10 show no reduction under these
  conditions
• Children ( 9-11) showed a smaller reduction than
  adults under these conditions (10as opposed to
  65 reduction). Howell et al 1999

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General effects continued..

• Reduced speech rate is not essential for
  stuttering reduction to occur under AAF
  conditions (though a smaller reduction occurred
  in faster speech rates)
• Listeners rated enhanced speech naturalness as
  opposed to no AAF (Stuart and Kalinowski 2004)

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Conditions under which AAF has been researched

• Manipulation of delay 50 ms best for most
  (Kalinowski et al 1996). But individual
  differences
• Manipulation of Frequency shift ¼ octave may be
  best for most (Stuart et al 1996). But individual
  differences
• Monaural v binaural delivery. Binaural may be
  more effective (Kalinowski and Rastatter
  1997).Left v right ear, no significant differences

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Speaking Tasks

• Oral reading and monologue have been extensively
  researched. Oral reading has the best results
• Conversation- as yet no real experimental
  evidence about day today use outside the clinic.
• Telephone ( scripted calls, from a clinic),
  though authors say there was spontaneous
  conversation too. Significant reduction in
  stuttering( Zimmerman et al 1997)

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Speaking tasks..

• Audience size (reading aloud). Argued audience
  size will provoke anxiety. Approx 75 reduction
  in stuttering regardless of audience size (2,4,15
  people). Armson et al 1997

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AAF as a treatment

• Very little reported to date
• Van Borsel et al (2003)
• Looked at DAF (Casa Futura School DAF)
• Sampled speech before and after 3 months of daily
  use
• Assessed on reading, picture description and
  conversation (in the clinic only)

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Findings..

• At initial assessment immediate reduction in
  stuttering noted across all speech tasks
• More stuttering noted in conversation as compared
  to oral reading and picture description
• The reduction noted on first assessment was
  maintained after 3 months, with, again,
  conversation showing less reduction in stuttering
• Some carry over effects of DAF noted as NAF tasks
  were significantly more stutter free after 3
  months
• No speech naturalness data reported

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Stuart et al (2004)

• Used SpeechEasy device (FAF and DAF) with 4
  adults and four youths
• 4 month follow up period
• Significant reduction in stuttering in both
  assessments (within clinic)
• No carry over effects noted
• Speech naturalness judged higher using the device
  (except in the youths in monologue tasks)

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What is successful treatment?

• Is it reduction in SS, such as these studies
  have been examining?
• OR
• are there other parameters we should be looking
  at?
• E.g. reduction in avoidance
• E.g. reduction in struggle
• E.g. being more open about stuttering
• E.g. enjoying more speech related challenges

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• Heidi takes over here

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Some final comments..

• We need good assessment procedures
• We need to know more about using the device
  outside of clinic conditions in particular
  conversational speech, telephone use etc
• We need to think about where we stand as regards
  children using these devices
• We need to think about whether AAF should be used
  with other treatment strategies e.g. prolonged
  speech

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• But most importantly we need to know what our
  clients think of the devices and
• what they are wanting from treatment

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Referencesin order of presentation

• Lincoln M., Packman A., Onslow M. (2006) Altered
  auditory feedback and the treatment of
  stuttering a review. Journal of Fluency
  Disorders 3 , 71-89Goldiamond, I. (1965).
  Stuttering and fluency as manipulatable operant
  response classes. In L. Krasner L.
  Ullman(Eds.), Research in behaviour
  modification. New York Holt, Rinehart and
  Winston.Howell, P., Sackin, S., Williams, R.
  (1999). Differential effects of frequency-shifted
  feedback between child and adultstutterers.
  Journal of Fluency Disorders, 24,
  127136.Stuart, A.,Kalinowski, J. (2004). The
  perception of speech naturalness of
  post-therapeutic and altered auditory
  feedbackspeech of adults with mild and severe
  stuttering. Folia Phoniatrica et Logopaedica, 56,
  347357.

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References

• Kalinowski, J., Stuart, A., Sark, S., Armson,
  J. (1996). Stuttering amelioration at various
  auditory feedback delays and
• speech rates. European Journal of Disorders of
  Communication, 31, 259269.
• Stuart, A., Kalinowski, J., Armson, J.,
  Stenstrom, R., Jones, K. (1996). Fluency effect
  of frequency alterations of
• plus/minus one-half and one-quarter octave shifts
  in auditory feedback of people who stutter.
  Journal of Speech and
• Hearing Research, 39, 396401.
• Stuart, A., Kalinowski, J., Rastatter,M. P.
  (1997). Effect of monaural and binaural altered
  auditory feedback on stuttering
• Zimmerman, S., Kalinowski, J., Stuart, A.,
  Rastatter, M. (1997). Effect of altered auditory
  feedback on people who
• stutter during scripted telephone conversations.
  Journal of Speech, Language and Hearing Research,
  40, 11301134.

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References

• Armson, J., Foote, S., Witt, C., Kalinowski, J.,
  Stuart, A. (1997). Effect of frequency altered
  feedback and audience
• size on stuttering. European Journal of Disorders
  of Communication, 32, 359366.
• Van Borsel, J., Reunes, G., Van den Bergh, N.
  (2003). Delayed auditory feedback in the
  treatment of stuttering Clients
• as consumers. International Journal of Language
  and Communication Disorders, 38, 119129.
• Stuart, A., Kalinowski, J., Rastatter, M.,
  Saltuklaroglu, T., Dayalu, V. (2004).
  Investigations of the impact of altered
• auditory feedback in-the-ear devices on the
  speech of people who stutter Initial fitting and
  4-month follow-up.
• International Journal of Language and
  Communication Disorders, 39, 93119