Speech Therapy Program Clinical Guidelines
Working with SpeechEasy Clients
In providing therapy to the SpeechEasy client, please keep one major point in mind: Any training involving SpeechEasy should focus on optimizing the generation and maintenance of the choral signal. What this statement means to you as the SLP is that a SpeechEasy therapy program involving the use of a SpeechEasy fluency device should be used in conjunction with speech therapy techniques that target maintaining the choral speech effect. Your client may have trouble initiating speech or may block on certain sounds. When the flow of speech is disrupted and there is no vocalization being created by the client, the SpeechEasy cannot be as effective. The speaker must initiate voice for the SpeechEasy to create and utilize a choral signal. With that in mind, you as the SLP may want to emphasize techniques that will facilitate voicing for these clients. Speech therapy program guidelines for the natural hierarchy of a speech therapy program for those who stutter should be as follows:Warm Up Exercises - Use any / all of the following: sustain the syllable /ah/ for 10 seconds, count to 10 several times, recite the months of the year or the days of the week. The warm up exercises are important because they give clients the opportunity to "prime the system" to listen to the SpeechEasy closely. It may be helpful if you complete some of these exercises along with your client. This step gives you an opportunity to ensure the device is functioning properly.
Reading Tasks - You may want to use standard reading passages or ask clients to bring in materials that interest them. Try to have appropriate reading material for young clients or those who may be low-level readers.
Easy Question and Answer Tasks - Ask your client simple questions that do not require deep thinking to answer. Ask questions like: "What is your address?" or "What is your phone number?" By asking rote memory types of questions, your client can focus on the signal rather than developing an answer.
Conversation - This step is usually the most difficult because it is spontaneous and free-flowing. During this step, be sure to interrupt your clients if / when they stutter in order to demonstrate or cue a fluency technique that may be used in specific situations. Discuss how the technique improves fluency and whether your client is able to use and comfortable with using the technique in conversation.
This speech therapy program hierarchy will allow you to proceed in incremental steps to help ensure that your client can become more successful using SpeechEasy. The amount of time you spend on each area will depend on how well your client is able to adapt to using the SpeechEasy and how easily they can produce voicing. You may have to adjust the order of the hierarchy if you find that certain areas require more practice. The client may sound fluent at most levels with the exception of conversation. If this is the case, you may choose to spend more time at the reading level so that they have a chance to practice techniques with a less demanding task.
Some techniques you may use in your treatment protocol include: easy vocal onsets, inserting a starter, inserting a filler, prolonging small words throughout the reading and / or conversation, constant voicing, and holding harder sounds.
Reminder: Any techniques you use should assist your client to initiate and sustain voicing.
Easy Vocal Onsets - If your client has a very difficult time initiating and is exhibiting struggle behaviors, an easy vocal onset may work. Teach them how to produce an easy vocal onset and try to replace the difficult (often blocked) initiation with the easy onset. This keeps the client from struggling to get a sound produced and helps them ease into the start of the conversation. The SpeechEasy develop can then help to facilitate constant voicing so that the client's starting and stopping becomes less of an issue.
Inserting a Starter - The use of a starter is another technique you can employ. Try using a prolonged /uh/ or a prolonged /m/ at the beginning of the sentence to help get voicing initiated. When the SpeechEasy is able to pick up on the starter, it will use that to help emulate choral speech and the user may be able to continue with their thought more easily. For example, if your client is saying "Can you get the phone?" and they block on the initial sound, ask them to repeat the phrase in the following manner: "Mmmmm, can you get the phone?"
Inserting a Filler - If your client has difficulty throughout the reading or conversation, a filler may be helpful. For example, if your client blocks on plosives and the words “the dog†come up in conversation, instruct your client to repeat the phrase like "the uhhhh dog" and determine if that prolonged sound is helpful.
Prolonging Small Words - Highlighting small words throughout the reading and / or conversation enhances the choral speech signal the SpeechEasy is producing. For example, if your client is saying "I want that book" and has difficulty producing "book", ask them to repeat the sentence in the following manner: "I want thaaaaat book". This can be achieved with words like: the, I, and, in, on, a, and etc.
Constant Voicing - Use your voice to demonstrate the concept of constant voicing. Usually the person who stutters has greatest difficulty with the starting and stopping of speech. Demonstrate to them that when you are talking, your words tend to run together to create one long word. It is unnatural to say each word while pausing between them, as the starting and stopping can be difficult. If your client can grasp the concept of running their words together to create a constant voice, he or she may have greater capability to optimize and maintain the choral speech signal.
Holding Harder Sounds - If your client is blocking on voiced continuant sounds, ask them to hold that sound. For example, if your client says, "M-m-m-m-my name is Sam" (repeating the blocked /m/) have him or her repeat that sentence in the following manner: "Mmmmy name is Sam" (holding out the /m/).
In addition to the aforementioned techniques, it is possible to incorporate many other traditional therapy techniques along with the SpeechEasy device. Just remember that, fundamentally, SpeechEasy is designed to expedite, enhance, and simplify the therapeutic process. Therefore, in some respects, it can be redundant and / or counterproductive to have your client use all that they have ever learned in therapy once they begin wearing the SpeechEasy. However, the use of a limited number of selected fluency targets while wearing SpeechEasy has been found useful in many cases. Your client’s history of therapy may reveal one or two fluency targets that have been particularly helpful to them but were previously inaccessible. While wearing SpeechEasy, your client may find these speech targets much more useful because they are applied in the context of altered auditory feedback. Furthermore, after your client completes the clinical protocol herein described and has had an opportunity to use the SpeechEasy device for a while, you might suspect that they would benefit from a specific fluency-enhancing target or two, based on the nature of any residual stuttering you observe. Feel free to introduce those targets you consider compatible with the physical symptoms you observe during residual moments of stuttering.
The amount of time and schedule of treatment devoted to speech therapy program follow-up with a SpeechEasy client will depend on many factors. At the outset, it is important to identify the goals your client wants to achieve. While most individuals are satisfied with the relative improvement they have noted in their speech, others may want to focus on a particularly difficult sound, a specific type of dysfluency, or simply explore their overall potential for maximum fluency. In all cases, be sure that the client’s expectations, while optimistic, are grounded in reasonable and realistic terms. The SpeechEasy cannot perfect speech, but it can make a significant and often dramatic improvement in a short period of time. Speech therapy program guidelines for the amount of follow-up therapy necessary to achieve goals need to be flexible. Generally, a person can be expected to make progress meeting with the clinician once a week for approximately 45 minutes. After three to five weeks most clients can be expected to continue progressing on an every other week schedule, assuming they are continuing to apply their techniques independently between appointments. Depending on progress, it is reasonable to gradually reduce the frequency of visits to every third or fourth week, and to eventually discharge the client from therapy. However, some individuals may feel the need to maintain a monthly therapy schedule for three to six months or even longer in order to keep their fluency at maximum levels. In any case, clients needing help between appointments or after being discharged from treatment should always feel free to contact you as their primary SLP.
In summary, your client should arrive in your office with a functional SpeechEasy device and experiencing increased fluency due to the passive inhibition of stuttering created by the feedback. The altered auditory feedback delivered by SpeechEasy should be producing more fluency than what had previously been observed in your client without the device. This relative enhancement in fluency can be maximized by your direct intervention. Your ongoing role is to ensure the SpeechEasy device is functioning properly, take speech samples before and while your client is wearing SpeechEasy, and to instruct your client as to the use of active therapy techniques. Your continued intervention will assist your client in maximizing fluency relative to stuttering levels existent before using the SpeechEasy.
Finally, the material herein, along with the website, should prepare you to provide professional and competent ongoing care to the SpeechEasy client. However, as with any enterprise involving a clinical and technical interface, it is not possible to cover every question or eventuality. In special circumstances where you face an issue not covered in this training module, you may call 1-866-551-9042 for guidance from a technical assistant.
