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Maximizing Fluency: Advice From an SLP
By Cliff Goldman, CCC-SLP
For most people when the SpeechEasy is inserted into the ear canal of a person who stutters there is a dramatic increase in fluency. The delayed auditory feedback and frequency altered feedback (second signal) emulates choral speech or speaking in unison, a condition which inhibits stuttering. But for most users of the device this is not enough. Typically the client needs to do something to activate or further enhance this inhibition of stuttering depending upon the speaking situation.
The "ah" method and extending the duration of vowels are described in the Care & Maintenance Manual in the Tips and Hints panel. This voice activation, if you will, is to be produced before a stuttered word or at the beginning of a speech act to get the voice turned on or to keep it on. Thus, the person who stutters can facilitate fluency or mitigate the severity of the block before it is uttered.
Board Recognized Fluency Specialist SLP Kay Monkhouse's priming techniques of using voice projection and elocution techniques she presented at ASHA's Special Interest Division 4 Fluency Conference this last July is helpful and augments these techniques.
As a user of the device and with a history of severe stuttering, I have found interesting developments in my own speech pattern since wearing the device for just over three years now. My fluency soared and maintained for two years and then I noticed a gradual decline in fluency.
It recently occurred to me what was going on. After two years of using the SpeechEasy, I began to see myself as a normally fluent person. Speaking was indeed easy! It was a joy to be able to say what I was thinking as I was thinking it without the arduous work of monitoring speech fluency targets. When I would stutter I didn't pay much attention.
However, in time, as more disfluencies crept in, I believe I began using my device as a way to avoid stuttering rather than as a way to enhance fluency. A very astute member of my Toastmasters club pointed out I was 'outpacing' myself. The 'ah' method had become a kind of vocal fry constriction of the vocal folds; my articulatory rate was increasing, and I was racing to get the words out instead of listening to the choral effect that the device was creating.
At this fall's Oregon Speech and Hearing Association's Convention, Susan Hamilton, Board Recognized Fluency Specialist from U. of Washington, presented intervention strategies for children who stutter. She showed video tape of a 12-year-old client combining the fluency shaping target of gentle onset with the stuttering modification technique of pull out and bounce to enhance fluency. This combination is helpful, as it provided the opportunity for the 12-year-old client to monitor his speech continuously. In addition, I had fitted the client with a SpeechEasy which, in doing so, enabled him to get out of the house and back into public school; He had been home schooled because attending regular school was too painful for him because of his stuttering.
I was heartened by how Hamilton integrated therapies and recognized the value the SpeechEasy provided him. It dawned on me at that time that I, too, needed to do some integration of therapy myself.
I am now going for a few days without wearing the device. This forces me to be with the stuttering, stutter openly, use pull out techniques, gentle onset to shift my monitoring back to the kinesthetic, proprioceptive channels. Then when I use the SpeechEasy, a more natural sounding fluency emerges. I am more able to 'stay with' the facilitating techniques and use them as they were intended, to enhance fluency, rather than escape from stuttering.
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