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SpeechEasy's Clinical Principles
Following are clinical principles which will provide added insight in relation to SpeechEasy fluency devices and their significance to those who stutter.
First Principle
Most SLPs know when a person who stutters (PWS) reads out loud with someone else, they almost always sound fluent. This is known as the "Choral Reading Effect." Hearing oneself speak with a delay (DAF) and in a different pitch (FAF), which SpeechEasy creates, simulates the Choral Reading Effect by creating the illusion that someone is speaking along with the person wearing the device. For years, the fluency resulting from DAF was thought to be an artifact of slow speech produced by high levels of DAF. However, recent findings indicate fluency can be achieved even at low levels of DAF and that fluency is maintained even when PWS are asked to speak or read at a fast rate. SpeechEasy, therefore, is designed to use DAF to emulate the Choral Reading Effect, rather than to slow the client's rate of speech, resulting in more "natural-sounding" fluency.
Second Principle
Another principle important to the SpeechEasy approach has been referred to as the Dual Inhibition Hypothesis. Simply stated, introducing AAF passively inhibits stuttering while applying therapy techniques actively inhibits stuttering. Using SpeechEasy on the most appropriate AAF setting passively maximizes fluency. However, active use of speech therapy techniques will maximize the client's overall level and maintenance of fluency. The SLP's ongoing role with the SpeechEasy client will involve instructing, monitoring, and supporting the client in the use of these techniques.
Third Principle
SpeechEasy is not a cure for stuttering. No cure exists for stuttering. SpeechEasy can produce dramatic results but does not perfect the client's speech or completely eliminate stuttering. Nonetheless, the relative degree of improvement it can deliver is sufficiently rewarding to encourage and reinforce daily use.
Fourth Principle
There are many factors of stuttering that are largely "internal" and, as such, a degree of sensitivity needs to be given to the range of emotions and expectations that a client may bring to the therapy session. The clinician should foster an expectation that is optimistic, yet realistic. It is often useful for SLPs to have their client focus on their improvement relative to their speech prior to using SpeechEasy. Relative changes are meaningful, whether they focus on the amount of stuttering, the duration, or the physical tension and struggle associated with the moment of stuttering. Relative changes are also meaningful when they occur in the more covert aspects of the stuttering problem.
Fifth Principle
Many PWS experience positive changes in covert behaviors that are less tangible and less amenable to measurement. Pure behaviorists don't give much credence to this aspect of stuttering, but it is important to appreciate reports from individuals who feel more relaxed, less anxious and less fearful while wearing their SpeechEasy device. There are individuals who stutter primarily in a covert manner and have been identified as exhibiting "interiorized stuttering." Improvement in areas such as anticipation, fear, anxiety and word substitutions are relevant considerations in assessing improvement for these individuals.
Remember, even those who experience a dramatic surge in fluency with SpeechEasy may still have strong, lingering feelings of anxiety. This is a natural process. Time is required for most individuals to realize and internalize that they are actually becoming predominantly fluent speakers, and for their expectations to change accordingly.
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