About the authors:
Stuttering  is a most common speech disorder prevalent in 1% of the U.S. population. It has no cure and clinical evidence has shown that speech therapy by a fluency specialist speech-language pathologist (SLP) is the only method that results in long term improvement . The SLP assesses the speech disorder of the person who stutters (PWS) and develops a treatment plan using techniques from the two predominant therapy approaches, (1) fluency-shaping, and (2) stuttering modification . SLPs try several common therapy techniques to get an idea which techniques show potential for improvement, focusing on these techniques first while teaching and trying other techniques until a small set of techniques are identified to pull from in any speaking situation. The bulk of therapy focuses on learning the techniques and practicing them in increasingly difficult and lengthy contexts. It is important to make sure that the practice sessions eventually take place outside of the therapy room. SLPs are handicapped by not having a way to deliver treatment outside of a clinic because PWS need to implement techniques during their real-life conversation [4,5] and not just in the clinic. Clinical therapy has shown to result in as high as 84% relapse because of inability of PWS to integrate changes outside of the clinic [6,7]. Additionally, a large majority of the PWS population does not have access to SLP guided therapy because of the cost and the logistics of seeing the SLP on a weekly basis. Hence a solution that can provide PWS the ability to maintain and improve using accepted therapy approaches is highly desired by SLPs and PWSs. To address this need, we are developing the “Take along Clinical Therapy (TACT)” technology using biologically plausible speech processing algorithms [8-11]. This technology provides biofeedback by analyzing the speech signal to create a solution that a non-clinician like a PWS can use outside of a clinic to achieve their therapy goals. TACT is designed to be adjunct to stuttering therapy. Therapeutic requirements are configurable according to the user and particular therapy approach of the SLP. PWS use the therapy-packs provided to improve compliance with transfer tasks and decrease relapse.
The development is on-going and we are looking for feedback from those in the field, on:
1) What can be added to help improve outcomes?
2) How can the tool assist with the success of the therapy, and how you can use it with your clinical therapy practice?
TACT can assist with clinical therapy, intensive therapy or tele-practice as follows:
1. PWS have difficulty mapping changes made in clinical settings into real world contexts: TACT records PWS audio and provides the measures in real-time of, gentle-onsets, speech loudness, speaking rate, and amount of phonation. Knowing the real-time state of their speech pattern allows the PWS to adhere to the therapy guidelines set by their SLP during real-life conversation.
2. SLPs cannot deliver therapy using real-life data addressing emotional and social aspects: TACT records PWS audio and a subjective questionnaire for the SLP and PWS to review. Fusing therapy sessions with real world data helps SLP provide a mechanism for improvement treatment.
3. PWS are unable to regularly practice their therapy techniques: TACT provides therapy-packs driven by speech measurements to allow a PWS to practice therapy techniques at their convenience. Therapy packs are included for the following techniques: Gentle/Easy onsets, Continuous phonation, Speaking rate, Pullout, Cancellation, Chunking, Stretching, Preparatory sets, Stretched syllables, and Even rate. The drills include words and sentences in increasingly difficult and length. Also includes a drill for free-speech.
4. Multidimensional assessment: Stuttering is best understood from a multidimensional perspective . Such a perspective embraces the importance of individual variability and unique differences among PWS  and the causes for their stuttering. TACT facilitates this multidimensional assessment and treatment approach to a PWS. The affective component includes thoughts, emotions, and attitudes, is captured through subjective questionnaires and different therapy packs that are in development. Negative feelings, attitudes and emotional reactions to stuttering  are managed through positive reinforcement feedback. The linguistic component relating to the PWSs language skills and the motor component associated with factors such as the frequency, type, duration, severity of stuttering, secondary coping behaviors and overall speech motor control, are managed by using appropriate practice material. The social component involving communicative competence in a variety of speaking situations, is managed through live monitoring.
Data from 2 users were sent to us, covering a period of 3 months. This consisted of 14 recordings with 57 minutes of audio, that were evaluated by Dr. Dale Williams (CCC-SLP) based on evidence-based approach to clinical practice [15,16]. The amount of negative emotions went down, amount of secondary behaviors went down, and use of techniques learned went up via the use of TACT. Another important outcome of the pilot study was the user feedback on the usability and functionality of TACT. Analysis of the stuttered audio collected through the pilot trial, showed that particular words with specific phonetic structures were stuttered more than often. Using this phonetic information of the problematic words, we were able to select words with similar phonetic structure in the therapy packs. By enabling delivery of speech therapy outside of a clinic, TACT addresses a critical barrier to progress in the field. TACT allows PWS to manage fluency themselves or work more effectively with an SLP, giving it the potential to improve concepts, methods, treatments, services, and preventative interventions in stuttering.
PROTOTYPE DEVELOPMENT ON SMARTPHONE: MyLynel AND SLPMxS APPLICATION FOR DELIVERY OF CLINICAL THERAPY
We successfully developed the MyLynel [17,18] and SLPMxS [19,20] prototype applications to help administer therapy for stuttering disorders. MyLynel makes your iPhone/iPod/iPAD/Android an on-the-go device that records and analyzes speech practically anywhere. SLPMxS allows Speech Language Therapists to conduct screenings and manage client therapy in their clinics. A brochure below provides an overview of TACT for: automated Biofeedback, live monitoring to assist with transfer of skills, practice therapy techniques, collect MyLynel fuel minutes, set reminders and share on medals on Facebook.
Click image to enlarge.
The table below summaries the landscape of available options for therapy.
|Intensive therapy||Good interaction with fellow clients and SLPs during the two week session. Fosters learning of techniques during a fixed two week period.||Treatment setting removed from familiar environment of clients, no mechanism for therapy care after, costly, cannot be tailored to individual needs, does not treat based on clients performance in real-life.|
|Clinic based therapy||Good interaction with SLPs, continued care available, treatment tailored to individual needs, SLP works with client personally to teach various therapy techniques.||Treatment setting removed from familiar environment of client, does not treat based on real-life data, SLP specific and hampers treatment if client moves or client is not able to find the right SLP, costly, requires client regularly visiting SLPs clinic.|
|Tele-therapy||Similar benefits to clinic based therapy with the advantage of providing therapy remotely.||Does not treat based on real-life data, manual analysis from SLP required.|
|Self-therapy||Self-paced, client does not have to travel regularly to meet with SLP.||No interaction with SLPs, not able to determine if techniques are practiced correctly or which therapy to follow.|
|PC programs, Smartphone app||Self-paced and capability to practice fluency techniques, capability to experiment with AAF technologies||No interaction with SLP, delivery of speech therapy not available, no automated measurements, different therapy treatments not available|
|AventuSoft’s TACT||A multidimensional speech therapy platform, SLP guided, portable, self-paced with capability to practice all the different therapy techniques, speech measurements for automated feedback, monitoring in real-life conversation, delivers clinically proven therapy approaches. Can work adjunct with intensive therapy, clinical therapy or tele-therapy.||No physical interaction with SLP or less often than in clinical therapy.|
SUMMARY- USING TACT ADJUNCT WITH YOUR THERAPY
1) Comprehensive therapy: TACT enables the practicing common fluency shaping and stuttering modification techniques via practice of speech-drills at home and facilitates transfer to real-life conversations.
2) BioFeedback: Speech signal processing technology provides automated real-time feedback to assist in learning and employing the learned techniques.
3) Multidimensional approach to assessment and treatment using (CALMS) model: Cognitive component: attitudes and information about stuttering. Affective component: positive reinforcement feedback to accommodate for negative feelings, attitudes and emotional reactions. Linguistic component: appropriate practice material relating to the persons language skills. Motor component: specific speech drills to provide practice of words, sentence and free speech speaking situations. Social component: live monitoring to facilitate communicative competence in a variety of speaking situations.
4) Therapy packs for 10 speech therapy techniques: gentle onsets, continuous phonation, speaking rate, pullouts, cancellations, chunking, stretching, preparatory sets, stretched syllables, and even-rate.
5) Therapy customization: to handle different levels of therapy.
6) LIVE: Record your audio in any real-life conversations up to 5 minutes with these features: Real-time bio-feedback display of gentle-onsets and speech loudness. Use of learned techniques in real-life conversations and save for offline analysis. Tracking of secondary behaviors that occur through a questionnaire.
7) Evaluate live: Evaluate the live session recordings with these features: Visually marking and tracking dysfluencies. TACT technology analyzes recording for speaking rate (syllables/min) and continuous phonation (%Phonation).
8) Monitor performance: Receive summary emails from clients. Track fuel with number of minutes spent in practice. Track compliance with number of medals earned.
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 MyLynel iOS, Available from: https://itunes.apple.com/us/app/mylynel/id540959300?mt=8
 MyLynel android, Available from:
 SLPMxS iOS, Available from:
 SLPMxS android, Available from:
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