The SpeechEasyThe SpeechEasyDevice: Device: Augmentative Communication for Augmentative Communication for

StutteringStuttering

Presentation by Presentation by

Tim Saltuklaroglu, M.S.Tim Saltuklaroglu, M.S.

East Carolina UniversityEast Carolina University

March 27, 2003March 27, 2003

Our view of stutteringOur view of stuttering

Stuttering is central Stuttering is central neurophysiological disorder that neurophysiological disorder that manifests during speech.manifests during speech.

The overt manifestations of The overt manifestations of stuttering (repetitions, prolongations, stuttering (repetitions, prolongations, silent speech blocks) are symptoms silent speech blocks) are symptoms of this central pathology.of this central pathology.

Stuttering is a extremely debilitating Stuttering is a extremely debilitating disorder that can impede every disorder that can impede every aspect of life.aspect of life.

How is stuttering usually How is stuttering usually treated?treated?

By attempting to retrain the speech By attempting to retrain the speech producing subsystems:producing subsystems:

Laryngeal.Laryngeal. Respiratory.Respiratory. Articulatory.Articulatory.

How Is stuttering usually How Is stuttering usually treated?treated?

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

Some results of therapy Some results of therapy (Blood et al., 1994)(Blood et al., 1994)

Age Years of Therapy

Current Severity

18 8 Moderate 19 4 Mild 19 9 Moderate 20 8 Severe 20 5 Severe 20 2 Mild 20 2 Mild 20 8 Moderate 21 7 Severe 24 13 Severe 36 11 Moderate

There’s room for improvement…There’s room for improvement…

Therapy can help many people but Therapy can help many people but may still not produce the highest may still not produce the highest level of fluency possible.level of fluency possible.

Relapse rates need to be decreased Relapse rates need to be decreased for therapy to be considered efficient for therapy to be considered efficient and effective.and effective.

Efficiency and effectiveness in Efficiency and effectiveness in the treatment of stutteringthe treatment of stuttering

Efficiency:Efficiency: Does the treatment act in a timely Does the treatment act in a timely

manner with as little effort as possible manner with as little effort as possible expended?expended?

Effectiveness:Effectiveness: Does the treatment provide the relief Does the treatment provide the relief

that it promises?that it promises?

Our missionOur mission

To ‘centrally’ inhibit stuttering and induce immediate and natural

sounding fluent speech in those stutter.

Choral speechChoral speech

Considered to be the best known Considered to be the best known stuttering inhibitor.stuttering inhibitor.

Often inducing 90-100% fluency in Often inducing 90-100% fluency in almost everyone who stutters.almost everyone who stutters.

What does choral speech do?What does choral speech do?

Inhibits stuttering at a more central Inhibits stuttering at a more central level – closer to the source of the level – closer to the source of the pathology.pathology.

Under choral conditions, brain imaging Under choral conditions, brain imaging studies have shown ‘normalization’ of studies have shown ‘normalization’ of abnormal brain activations seen in abnormal brain activations seen in PWS. PWS.

Delayed Auditory Feedback Delayed Auditory Feedback (DAF)(DAF)

Perceiving your own speech with a Perceiving your own speech with a temporal delay (similar to an echo).temporal delay (similar to an echo).

Delays as low as 25 ms have been Delays as low as 25 ms have been found to induce fluent speech.found to induce fluent speech.

Frequency Altered Feedback Frequency Altered Feedback (FAF)(FAF)

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

Frequency Altered Feedback Frequency Altered Feedback (FAF)(FAF)

Pitch can be raised or lowered relative Pitch can be raised or lowered relative to the fundamental frequency:to the fundamental frequency:

Mickey Mouse (chipmunk) or Darth Mickey Mouse (chipmunk) or Darth Vader.Vader.

Is also a powerful emulator of choral Is also a powerful emulator of choral speech.speech.

How well do DAF and FAF How well do DAF and FAF work?work?

Immediate reduction in stuttering by Immediate reduction in stuttering by

70-85% across a variety of situations.70-85% across a variety of situations.

Reading.Reading.

Monologue.Monologue.

Scripted telephone calls.Scripted telephone calls.

Speaking in front of audience.Speaking in front of audience.

The problemThe problem

Large bulky devices.Large bulky devices.

Lack of portability.Lack of portability.

Conspicuous in nature.Conspicuous in nature.

Not functional.Not functional.

The solutionThe solution

SpeechEasySpeechEasy introduced in April introduced in April 2001.2001. DAF: up to 250 ms in 10 ms increments.DAF: up to 250 ms in 10 ms increments. FAF: up to 2000 Hz up or down in 500 Hz FAF: up to 2000 Hz up or down in 500 Hz

increments.increments. Frequency shaping and noise Frequency shaping and noise

attenuation.attenuation. In-the-canal model.In-the-canal model. Completely-in-the-canal model.Completely-in-the-canal model.

ITE/ITCITE/ITC

This model fits in the This model fits in the ear canal with only a ear canal with only a small portion visible. small portion visible.

Very inconspicuousVery inconspicuous A great combination A great combination

of small size and of small size and robust effects. robust effects.

External volume External volume control.control.

CICCIC

The smallest model. The smallest model. The whole device sits The whole device sits

in the ear canal with in the ear canal with nothing showing.nothing showing.

Provides all the Provides all the effects of the other effects of the other models.models.

Volume is internally Volume is internally controlled.controlled.

How is the SpeechEasy™ How is the SpeechEasy™ programmed?programmed?

PC compatible software.PC compatible software. Allows all parameters to be programmed.Allows all parameters to be programmed.

Control Box:Control Box: Interfaces with computer via serial / USB Interfaces with computer via serial / USB

cable.cable.

SpeechEasy™ cablesSpeechEasy™ cables ITC / BTE cableITC / BTE cable Left CIC cableLeft CIC cable Right CIC cableRight CIC cable

An adjunct or alternative to An adjunct or alternative to therapy…therapy…

Prosthetic devices are incorporated Prosthetic devices are incorporated into the treatments of many into the treatments of many disabilities.disabilities.

The use of a fluency enhancing The use of a fluency enhancing device may help people who stutter device may help people who stutter produce fluent speech that is more:produce fluent speech that is more: StableStable Natural soundingNatural sounding AutomaticAutomatic

What about the long-term?What about the long-term?

Client satisfaction levels will tell.Client satisfaction levels will tell. Questionnaire data can be very useful.Questionnaire data can be very useful. Efficacy studies cannot tell the whole Efficacy studies cannot tell the whole

story as they only consider the story as they only consider the countable aspects of stuttering in countable aspects of stuttering in environments that are usually environments that are usually controlled.controlled.

However, they are necessary for However, they are necessary for documentation and accountability. documentation and accountability.

Long Term Efficacy Study:Long Term Efficacy Study:4 month data - reading.4 month data - reading.

without SE with SE without SE with SE

Initial visit After 4-months

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Long Term Efficacy Study:Long Term Efficacy Study:4 month data - conversation.4 month data - conversation.

Fluency enhancing effects of Fluency enhancing effects of the SpeechEasy protocolthe SpeechEasy protocol

Average decrease in Stuttering Average decrease in Stuttering FrequencyFrequency

Reading (immediate) - 88%Reading (immediate) - 88% Conversation (immediate) - 85%Conversation (immediate) - 85% Reading (after 4 months) - 86%Reading (after 4 months) - 86% Conversation (after 4 months) - 69%Conversation (after 4 months) - 69%

Long Term Efficacy Study:Long Term Efficacy Study:4 month data - naturalness.4 month data - naturalness.