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SLP Profile: Dr. Gary Cohen
Dr. Gary Cohen is a Speech/Language Pathologist who has been in private practice in Milwaukee, Wisconsin since 1983. He completed his Master Degree in Speech Pathology and Audiology at the University of Pittsburgh. He completed his Doctoral Degree at the University of Memphis, and was the first doctoral student to cross register for courses at the University of Tennessee Medical and Dental Schools. He has a special interest in fluency disorders and supervised the fluency disorders cases while at the University of Memphis Speech and Hearing Clinic. Dr. Cohen has taught Fluency Disorders Courses at the University of Wisconsin-Milwaukee and Marquette University. He is the Wisconsin provider for the SpeechEasy device for fluency disorders.
Dr. Cohen sounds relaxed. It's a Friday afternoon toward the end of the summer, and even though he has upcoming appointments scheduled all weekend, the calm in his voice sounds like he is about to start a long, relaxing vacation. It's that peacefulness that tells you right away: this is someone who loves what he does.
Dr. Cohen has been working as a Speech-Language Pathologist (SLP) for several decades, and has just about heard and seen it all - every challenge, every victory -- when it comes to dealing with fluency.
As he starts sharing some of his stories about fluency and SpeechEasy, his enthusiasm emerges, and it becomes clear that fitting the SpeechEasy device has given him the opportunity to see lives change ... dramatically.
Let's Talk starts by discussing with him what challenges he sees in helping people create more fluency:
"In my 35 years of practicing speech pathology, there seem to be different subgroups of stutterers," he explains. "And these different subgroups require different considerations and combinations of approaches. There are individuals who have organically-based dysfluencies -- who seemingly have a predisposition to stutter; individuals who clearly are influenced by environment or functionally related facts; and those who may have a combination of both organic and functional factors.
"There are some individuals we can help to change their speech on a dime; some combine with medications and they change on a dime, and some have great difficulty making any change. For example, one client of mine, a patient who had stuttered for many years and was primarily an internalized stutterer, was a student who went to the University of Wisconsin, Milwaukee (UWM). He went to a speech clinic close to his home and was told he didn't stutter, because the person evaluating him didn't hear any stuttering. This clinician missed one of the most important issues in fluency disorders: that of the individual's internal feelings. The clinician didn't listen to what this individual was saying."
Dr. Cohen said the student came to him, and right away he identified him as an intrinsic stutterer.
"An intrinsic stutterer is someone whose stuttering behavior occurs primarily inside the individual. For example, in the student's case, he would put himself in situations where he would be forced to speak, thereby attempting to outwardly demonstrate the dysfluencies and would then have to change his dysfluent speech. In this line of thinking, he studied to become a teacher - a situation requiring him to be a public speaker every day. This, he felt, might resolve the 'confidence' factor. After that didn't work because of his stutter, and instead went into the military and became a radio operator -- again believing he could force himself to change his speech. And when that didn't work, he became a telephone customer service representative for a large national corporation. During this time and with the initiation of Speech Therapy, he made remarkable progress. He became so confident in his increased fluent speech that he would volunteer recommendations for departmental change to his supervisor. His wife wondered if we had 'created a monster!"
"An Organic stutterer is one who clearly demonstrates an organic basis for their stutter. This may also include individuals who do not respond well to traditional fluency therapy, which implies an organic basis to the stuttering. I have seen individuals who fit this description who responded well to use of the SpeechEasy," explains Dr. Cohen.
"Then there's the Functional Stutterer, where stuttering appears to be a learned behavior. We frequently see this in stutterers who are 'labeled' at a young age - usually between the ages of 2 and 6." Dr. Cohen explains, however, that this does not explain all of why children stutter during this period.
"Many children go through a childhood phase, as they are becoming more verbal and verbally competent, where stuttering is considered normal," said Dr. Cohen. "This is called normal developmental dysfluency, and it's the period of greatest speech language formulation and growth, especially for 2- and 3-year-olds. The child's speech gets labeled by mom, dad, a sibling, an aunt, an uncle, or significant other, such as a neighbor. The labeling then creates anxiety that perpetuates the speech problem."
Dr. Cohen gives an example of a highly unusual situation in which someone with great emotional stress will suddenly start to stutter, and will then retain that stutter.
"Here's an example of functional stuttering in an older individual. I saw a teenager who was a junior in high school. She had never stuttered before. But during the period of high anxiety just before taking her ACT test, she started stuttering and it became engrained. I saw her for four months, and during that time she became completely fluent and has remained so," he explains.
"There are some normal dysfluencies that we all have, but this teenager didn't integrate normal dysfluencies as part of her normal speech. We started by making sure she could differentiate normal from abnormal dysfluencies. For example, a normal non-reactive hesitation is a normal dysfluency. But because people who stutter are monitoring themselves so closely and critically, there is a tightening that causes the pressure to be increased."
It becomes a vicious cycle.
"Then they label the normal behavior as an abnormality and it becomes integrated as such. They add more pressure to try and get through this, and it becomes more tension-filled. Thus, abnormal dysfluency can be simply a normal dysfluency that the speaker is trying to push through, which only makes it worse. So I tell them when you feel that pressure, ease off and reduce the pressure and gently onset the word. That's what many clinicians do in therapy, which is called 'easy onset.' Most of us will teach this technique to reduce the likelihood of the pressure-filled dysfluency.
"There are also people who seem to combine organic and functional features-- they have a genetic propensity which is only brought out in certain environments. However, all abnormal dysfluencies involve an increase in pressure - if you feel it, stop, let the moment pass (an average of 1/4 a second) and then easy onset your speech again. If you do it and are successful once, twice, three times, maybe you'll be more likely to do it again. That's why I preach 'The more fluent you are, the more fluent you expect to be.'
"That's why I think the SpeechEasy is so awesome, because it helps individuals along the way to be fluent, so their successful experiences can lead to other experiences that are successful."
Dr. Cohen is very optimistic about Janus' plan to launch the financing and leasing program in early 2007, especially for those young adults with little or no disposable income.
"The financing and leasing program will be a boom for the kid who is 19-years-old and in college. He has his whole life ahead of him! And his parents know that - and it is very important to create a positive image as he gets out of school. And it's important that they can finance it, especially at that age."
Cohen says Janus has been very proactive in making the device available at affordable prices. However, often the parents of a 19-year-old are in the middle of financing college and many times it involves other children in the household as well. Cohen feels the SpeechEasy device is significant for kids at that age because of the many life-defining decisions that we make during that period.
"Research in fluency disorders indicates the disorder tends to decline in middle-aged and in mature individuals. The suspicion is that as we mature, we are more established in our life patterns. Vocations have been decided and we've become resolved -- including with dysfluent speech patterns, which need not be the case.
"A lot of people with fluency disorders opt out of jobs that involve significant amounts of speech responsibility. Even if they're intelligent enough and desire to go to medical school, they just opt out. This is a very sad situation and one which, no doubt, will cause the individual to have sadness throughout their lifetime because of unfulfilled hopes and dreams.
"Also, in middle age, you've already gone through many of the primary challenges in life. You have a tendency to know about yourself and where you are in this world. And you have gone through the process of marriage, putting kids through school - there's not as much pressure, and there's more disposable income."
Cohen says there are also the strivers, those who are Type A personalities who continually strive to achieve more, no matter what age they are.
"For example, I have a 72-year-old man whom I've been working with. He's very accomplished in public and private life; he's had four private sessions with the pope, was the harbor master for several harbors in large cities - and now he's in the phase of his life where he donates much of his money -- a great philanthropist. He's very well known, is a graduate of one of the military academies, has achieved many wonderful things and yet he's an extremely humble man.
"He was asked by his military academy to accept an award as a distinguished Alumnus -- but he initially refused because of his stutter! He didn't want to give the speech! When asked again to accept the award, he reconsidered. He is now working with me so that he can confidently give that speech. He receives many awards because of his philanthropy, and right now he just gets up to the podium and just says 'Thank you very much,' and retires to his chair, even though he wishes he could say more.
"This gentleman gets flabbergasted, he's an internal stutterer - he becomes so overwhelmed when he approaches the podium that he just goes blank. As soon as you talk with him you know he's well educated and bright. His stutter doesn't occur when he's with friends. His stutter only occurs when he's in a new situation with new people or formal speaking situations.
"An extremely important issue to focus on - either in the intrinsic or extrinsic stutterer - is the anticipation or expectation in someone that they are going to stutter. In many situations, it's a learned response - a stimulus response ... ..'I've stuttered in this situation before, so I know I'll do it again.'
"But if the SpeechEasy device is successful for you, then it will be successful in eliminating aspects of your stuttering pattern. It's your speech without the stuttering aspects, true fluency, which is enhanced by the device."
Dr. Cohen is doing work as a part of the UWM Continuing Education program regarding fluency disorders and treatment. The two-day meeting features some of the leading clinicians and researchers in the field, who will examine and share their views of what they think are the causes of stuttering and what they use as treatment. The program is open to anyone, including graduates in the program at UWM, as well as SLPs in the field, family members or others interested in this communication difficulty. For more information on this or any other fluency issues, feel free to contact Dr. Cohen directly at 262.241.7500, or Lprchn13@aol.com.
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