The SpeechEasy?Device: Augmentative Communication for Stuttering

1
The SpeechEasy?Device Augmentative Communication
for Stuttering

• Presentation by
• Tim Saltuklaroglu, M.S.
• East Carolina University
• March 27, 2003

2
Our view of stuttering

• Stuttering is central neurophysiological disorder
  that manifests during speech.
• The overt manifestations of stuttering
  (repetitions, prolongations, silent speech
  blocks) are symptoms of this central pathology.
• Stuttering is a extremely debilitating disorder
  that can impede every aspect of life.

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How is stuttering usually treated?

• By attempting to retrain the speech producing
  subsystems
• Laryngeal.
• Respiratory.
• Articulatory.

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How Is stuttering usually treated?

• Speech Retraining involves the imposition of
  novel speech patterns that are supposedly
  incompatible with stuttering.

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Some results of therapy (Blood et al., 1994)
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Theres room for improvement

• Therapy can help many people but may still not
  produce the highest level of fluency possible.
• Relapse rates need to be decreased for therapy to
  be considered efficient and effective.

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Efficiency and effectiveness in the treatment of
stuttering

• Efficiency
• Does the treatment act in a timely manner with as
  little effort as possible expended?
• Effectiveness
• Does the treatment provide the relief that it
  promises?

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Our mission

• To centrally inhibit stuttering and induce
  immediate and natural sounding fluent speech in
  those stutter.

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Choral speech

• Considered to be the best known stuttering
  inhibitor.
• Often inducing 90-100 fluency in almost everyone
  who stutters.

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What does choral speech do?

• Inhibits stuttering at a more central level
  closer to the source of the pathology.
• Under choral conditions, brain imaging studies
  have shown normalization of abnormal brain
  activations seen in PWS.

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Delayed Auditory Feedback (DAF)

• Perceiving your own speech with a temporal delay
  (similar to an echo).
• Delays as low as 25 ms have been found to induce
  fluent speech.

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Frequency Altered Feedback (FAF)

• Altering the perceived pitch of a persons own
  speech, but the person is not required to change
  his/her speech patterns.

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Frequency Altered Feedback (FAF)

• Pitch can be raised or lowered relative to the
  fundamental frequency
• Mickey Mouse (chipmunk) or Darth Vader.
• Is also a powerful emulator of choral speech.

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How well do DAF and FAF work?

• Immediate reduction in stuttering by 70-85
  across a variety of situations.
• Reading.
• Monologue.
• Scripted telephone calls.
• Speaking in front of audience.

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The problem

• Large bulky devices.
• Lack of portability.
• Conspicuous in nature.
• Not functional.

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The solution

• SpeechEasy? introduced in April 2001.
• DAF up to 250 ms in 10 ms increments.
• FAF up to 2000 Hz up or down in 500 Hz
  increments.
• Frequency shaping and noise attenuation.
• In-the-canal model.
• Completely-in-the-canal model.

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ITE/ITC

• This model fits in the ear canal with only a
  small portion visible.
• Very inconspicuous
• A great combination of small size and robust
  effects.
• External volume control.

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CIC

• The smallest model.
• The whole device sits in the ear canal with
  nothing showing.
• Provides all the effects of the other models.
• Volume is internally controlled.

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How is the SpeechEasy programmed?

• PC compatible software.
• Allows all parameters to be programmed.
• Control Box
• Interfaces with computer via serial / USB cable.
• SpeechEasy cables
• ITC / BTE cable
• Left CIC cable
• Right CIC cable

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An adjunct or alternative to therapy

• Prosthetic devices are incorporated into the
  treatments of many disabilities.
• The use of a fluency enhancing device may help
  people who stutter produce fluent speech that is
  more
• Stable
• Natural sounding
• Automatic

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What about the long-term?

• Client satisfaction levels will tell.
• Questionnaire data can be very useful.
• Efficacy studies cannot tell the whole story as
  they only consider the countable aspects of
  stuttering in environments that are usually
  controlled.
• However, they are necessary for documentation and
  accountability.

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Long Term Efficacy Study4 month data - reading.
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Long Term Efficacy Study4 month data -
conversation.
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Fluency enhancing effects of the SpeechEasy
protocol

• Average decrease in Stuttering Frequency
• Reading (immediate) - 88
• Conversation (immediate) - 85
• Reading (after 4 months) - 86
• Conversation (after 4 months) - 69

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Long Term Efficacy Study4 month data -
naturalness.