Personalized speech therapy framework for clinical therapy outside of a clinic

About the authors:

kaleKaustubh  Kale, is the founder and CEO of Aventusoft LLC. He is an innovator with 4  patents and expertise in Human-psychoacoustics, audiology and speech-disorders. With focus in developing disruptive technologies that help enhance the
efficiency and function of people through advanced biologically inspired speech  processing. He is currently completing his Ph.D. at the University of Florida,  Gainesville in Computational NeuroEngineering.
williamsDale F. Williams, Ph.D., CCC-SLP, BRS-FD is a Professor of Communication Sciences and Disorders and Director of the Fluency Clinic at Florida Atlantic University. His publications include the book Stuttering Recovery: Personal and Empirical Perspectives (Psychology Press). Dr. Williams has coordinated the Boca Raton chapter of the NSA since 1996.

Stuttering [1] 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 [2]. 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 [3]. 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.

AUDIENCE FEEDBACK

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?

OVERVIEW

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 [12]. Such a perspective embraces the importance of individual variability and unique differences among PWS [13] 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 [14] 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.

RESULTS

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.

mylynel

EXISTING TECHNOLOGIES

The table below summaries the landscape of available options for therapy.

Technologies

Strengths

Limitations

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.

REFERENCES

[1] Riper C. and Erickson R. (1996). Speech Correction – An Introduction to Speech Pathology and Audiology, 9th Edition. USA: A Simon & Schuster Company, Needham Heights.

[2] NSA Study reference. Available from: http://www.nsastutter.org/stutteringInformation/NSA_Survey_Results.html

[3] Ingham, J. C. (1993). Current status of stuttering and behavior modification. I. Recent trends in the application of behavior modification in children and adults. J. of Fluency Dis., 18, 27–55.

[4] Langevin M, Kully D (2003). Evidence-based treatment of stuttering: III. Evidence-based practice in a clinical setting. Journal of Fluency Disorders, Vol 28, Number 3, pp. 219-236.

[5] Coleman C, Yaruss J, Hammer D (2007). Clinical Research Involving Preschoolers Who Stutter: Real-World Applications of Evidence-Based Practice. Language, Speech, and Hearing Services in Schools Vol.38, pp 286-289.

[6] Andrews, G., and Cutler, J. (1974). Stuttering therapy: The relation between changes in symptom level and attitudes. Journal of Speech and hearing Disorders, 39, 312-319.

[7] Woolf, G. (1967). The assessment of stuttering as a struggle, avoidance, and expectancy. British Journal of Disordered Communication, 2, 158-171.

[8] Skowronski, Mark D., Harris, John G. (2003). Improving the Filter Bank of a Classic Speech Feature Extraction Algorithm, IEEE Intl Symposium on Circuits and Systems, Bangkok, Thailand, vol IV, pp 281-284.

[9] Kompe, Ralf (1997). ”Prosody in Speech Understanding Systems”. LNAI 1307, Springer.

[10] Vicsi, K., Szaszák, G. (2006). Automatic Segmentation for Continuous Speech on Word Level Based Suprasegmental Features. International Journal of Speech Technology.

[11] Howell, P. and S. Sackin, (1995). “Automatic recognition of repetitions and prolongations in stuttered speech,” in Proceedings of the First World Congress on Fluency Disorders,pp. 372-374.

[12] E. Charles Healey , A Multidimensional Approach to Assessment and Treatment of Stuttering in School-Age Children Who Stutter, Communication Disorders, Vol. 31, pp. 40-48.

[13] Starkweather, C.W. (1999). The effectiveness of stuttering therapy: An issue for science? In N.B. Ratner and E. C. Healey (Eds.), Stuttering research and practice: Bridging the gap. Mahwah, NJ: Lawernce Erlbaum.

[14] Van Riper, C. (1982). The nature of stuttering (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.

[15] Onslow, M., et.al. (1996). Speech outcomes of a prolonged-speech treatment for stuttering. Journal of Speech and Hearing Research, 39, 734–749.

[16] St. Louis, K.,Westbrook, J. (1987). The effectiveness of treatment for stuttering. In Progress in the treatment of fluency disorders (pp. 235–257).

[17] MyLynel iOS, Available from: https://itunes.apple.com/us/app/mylynel/id540959300?mt=8

[18] MyLynel android, Available from:
https://play.google.com/store/apps/details?id=com.aventusoft.mylynel&hl=en

[19] SLPMxS iOS, Available from:
https://itunes.apple.com/us/app/slpmxs/id542552354?mt=8

[20] SLPMxS android, Available from:
https://play.google.com/store/apps/details?id=com.aventusoft.slp&hl=en

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Comments

Personalized speech therapy framework for clinical therapy outside of a clinic — 28 Comments

  1. We are very excited to share our work on this international platform. Our goal is to provide each and every SLP with a truly personalizable stuttering speech therapy application for their clients. Enabling SLPs to successfully deliver therapy outside of their clinics. MyLynel is a first step towards such a goal. The global collaborative environment provided by ISAD is invaluable and we are eager for your comments, feedback and discussion on:
    1) How can it be used in your therapy practice?
    2) Can it help improve the success of therapy?

    Thanks,
    +Kaustubh

    • I know you have mentioned that TACT is an ideal supplemental therapy tool, would you recommend using TACT as a primary speech therapy technique? I am thinking about people that may have hectic schedules and are constantly traveling, that can not find time to visit a speech/language pathologist on a regular basis.

  2. I wonder how the PWS (who is not in a clinical setting) will know when to try new techniques? Also, how will they know if they are improving in their disfluent behaviors? Finally, how does the “TACT” address secondary behaviors?

    • Thanks for the questions. Models are provided for some of the techniques. The others are self-monitored by the client. Because of this, they must be mastered in a clinical setting first, then practiced outside therapy. Fluency in conversation can be monitored by the SLP or client (again, if and when the client is able to do so). Secondary behaviors are self-rated. Electronic devices as a whole work better as adjuncts to (as opposed to replacements for) therapy. As such, the system is designed to be guided by the therapist.

      • Thank you for the reply. I agree with your statement that as a whole electronic devices work better as adjuncts to therapy. Evidence and research has taught us that the clinician plays a central role in therapy for clients that stutter. I think that a device could supplement the clients “recovery,” but I don’t think that it could replace it.

  3. Your overall idea of TACT is very intriguing! As a current graduate student, seeking my master’s degree in Communication Sciences and Disorders, I am becoming more knowledgeable about providing therapeutic services to PWS. As of right now, I am working with a third grader at a local public school. One of his goals is to identify/monitor stuttering behaviors and to use fluency control techniques. In therapy, the child has very minimum disfluencies. I have talked with my supervisor about creating scenarios outside of the therapy room to see how he monitors his speech and to view his overall awareness of stuttering events. If TACT was available, it would be neat to see the results not only in communication situations within the school environment but outside the school as well. My question to you is: What ages do you think will benefit the most with this program? Thinking about data/documentation, is there a way that clinicians or clients could print out results?

    • That you understand the importance of addressing transfer early tells me you’re going to be a good therapist. The pilot data for TACT was taken only from adults, so we don’t know how user-friendly it is for school-aged clients (plus most are not allowed to bring phones to school). Still, with parent cooperation, there’s no reason why the client couldn’t use the system to practice speech techniques and even to monitor conversation in different settings. When my daughters were in 3rd grade, they knew their way around my cell phone better than I did, so I really doubt there are technical aspects that would preclude its use. As for printing data, I will let the engineer (Kaustubh) answer that.

      • I really appreciate your response! I feel that not only is it important for success in the therapy room but also in real-life situations as well. I look forward to keeping up with the development of this program.

        Thanks again,
        Danielle

      • Yes, there is a way. It provides a facility to email the summary results which can then be printed as required.

  4. Interesting. As a life long stutterer, covert-to-overt, I have heard many other people who stutter lament the fact that carry-over is extremely difficult. When in therapy would the SLP and the person who stutters decide this might be a good option?
    If the person who stutters was not successful with this, how might the SLP address the feelings of failure the individual might have?
    Thanks for sharing the concept.
    Pam

    • Hi Pam. Good questions (no surprise there). You are correct—carry-over is the most difficult part of therapy. Also the most frustrating, for clients & SLPs alike. In fact, that was one of the motivations behind this idea. I feel that it is important to start transferring skills to different environments as soon as possible. Thus, the therapy packs can be put to use on day 1. As you know, therapy also includes identification of feared and difficult words/situations; thus, the Live portion of TACT can also be helpful from the start. Counseling is also a big part of fluency therapy, which can help with feelings of failure (and, more importantly, moving past them and being willing to try something else).

      • Thanks for the response Dale. Do you think student SLPs get enough training on the counseling piece? Do you have any worries that this tech adjunct could sway (collaterally) new clinicians away from understanding the importance of counseling?
        Pam

        • In general, no, I don’t believe students get enough training in counseling. And you make a good point re technology potentially swaying the focus away from counseling and toward data that’s more easily quantifiable. Aventusoft is reaching out to fluency specialists to put together a guide for how best to use the system. A good point to stress is that information on avoidance and negative attitudes toward speech need not only be accumulated but also properly addressed in therapy.

  5. Thank you for this paper, this is a very well researched paper and I learned a lot from it, Thank you! I enjoyed reading about TACT and other technologies that can be used with an iPad, and other smart phones, but I agree with earlier comments about the importance of using both the technology that is out there and the help of professionals such as Speech Language Pathologists in order to get better results for people who stutter. I think that it is pivotal to look at the client as a person first, in order to better help them. I have read comments from other people who stutter that don’t necessarily like this new technology because it makes them sound “too robotic”.
    Thank you for sharing your paper,
    Maria Leon-Luciano

  6. Hi Maria. You’re probably referring to auditory feedback devices, which are designed to increase fluency and often result in more relaxed-sounding speech with less intonation. Those devices are made to reduce or eliminate stuttering upon wearing. TACT is intended as an aid to the learning of therapeutic skills. Thank you for raising the question, as I am glad to have the opportunity to clarify this point.

  7. As a graduate student studying Communication Disorders, TACT is definitely an interesting therapy tool because it puts the client in control of practicing and transferring the skills they learned in speech therapy to real-life situations. I know that my school-aged clients that I am working with many times do not complete their carryover assignments or practice at home so it would be interesting to see how children would react to TACT and if they would use it at home or school. How much feedback have you received from parents of PWS who would like to try this product? Also this is a great tool for PWS who are not able to go to a speech-language pathologist due to cost or location, my question is how will the PWS be able to know if they are following the therapy packs appropriately and using the therapy techniques effectively? Is there a follow up program for clients who use TACT?

  8. Personally, I have received no feedback from parents. Of course, they would be more likely to contact Aventusoft, but it is also true that most have not heard of TACT as yet. Because the system is designed to be used with ongoing therapy, the SLP can hopefully monitor performances on packs & conversational assignments as he or she would with any other treatment format. In addition, they can be recorded & sent to the SLP. Thanks for your interest & input.

  9. I’m relieved to see that you view this as a supplement to therapy with an SLP and not a replacement. I can see its value for generalization outside the clinical setting but think it would pale in its abilities without the human element at the core. I was wondering, in the development of your algorithms, reinforcement and feedback, how did you go about testing the effectiveness of your program? What kind of sample size and demographics where involved?

    • Thanks for the questions. We are pursuing feedback from SLPs and users alike. It’s not really efficacy data (as this is not a therapy program as much as it is a way to help SLPs deliver their preferred therapy methods). Rather, we are trying to make the MyLynel as usable as possible, e.g. will PWS practice techniques? Does MyLynel provide an easy way for SLPs of measure transfer during real-conversation? etc. The bottom line, however, is that the system can only be as good as the SLP guiding it.

  10. I’m skeptical of the value of MyLynel. It analyzes recorded speech samples. That’s not biofeedback, as the article claims. Biofeedback is real-time analysis to increase the subject’s awareness and control of a physiological process, such as vocal fold activity. Software to analyze recorded speech samples has been available for decades yet I’ve never heard of this being done in stuttering therapy. If I record myself stuttering, then use software to analyze the recording, what good does that do? Showing me what I did wrong a minute ago isn’t going to help me as much as showing what I’m doing wrong (or right) as I speak. Your references don’t list any published studies of MyLynel, or any studies showing that analysis of recorded speech samples has an effect on stuttering.

    A variety of biofeedback devices have been used in stuttering therapy:

    – Electromyography (EMG) displays the level of muscle activity or tension. EMG is used to train stutterers to speak with relaxed vocal folds, lips, jaw, tongue, etc. and has been proven effective in many studies, including one in which fluency shaping therapy with EMG was compared to fluency shaping therapy without EMG, with the result that therapy with EMG was nearly twice as effective.

    – CAFET displayed respiration and vocal volume, training the stutterer to coordinate respiration and phonation.

    – Modifying Phonation Interval (MPI) analyzes the duration of phonated intervals, that is, the time your vocal folds are vibrating to produce vowels and voiced consonants, delineated by pauses and voiceless consonants. The stutterer practices speaking without the too-short phonated intervals that precede stuttering. The result is fluent speech at a normal speaking rate. A published study of MPI therapy found that 2-3 hours per day for 2-3 weeks resulted in “near zero” stuttering for all subjects on telephone calls to local businesses (a stressful speaking situation). This fluency was maintained for a year afterwards. The SLPs trained the subjects to use the software and then the subjects used it on their own without the SLPs. (Ingham, 2001)

    MyLynel, in contrast, analyzes speaking rate, %phonation, and displays vocal volume graphically. If your goal is to slow down you’d be better off using delayed auditory feedback (DAF) as you speak, not having an app telling you later what your speaking rate was.

    %phonation might be useful if your goal is to do continuous phonation (gondinuavonayshun?). But it’s better to look at the duration of phonated intervals.

    A real-time (biofeedback) graphical display of your vocal volume is used, I believe, at Hollins, but I can’t picture how looking at a graphical display of a recorded speech sample will do much.

    Additionally, I’m skeptical that MyLynel could be used in a noisy environment such as a restaurant. And in some situations stutterers want a device that can be worn discretely. Let’s say you have a job interview. The interviewer asks you a question. You answer while speaking into your iPhone. Then you stop and click buttons on your iPhone to analyze your answer. The interviewer waits for you to finish using MyLynel and then asks the next question. I doubt you’d get the job!

    I agree that technology helps stutterers to do therapy outside of the speech clinic, when their SLPs aren’t present, and especially in stressful speaking situations such as job interviews. I believe that my MPiStutter app (http://www.casafuturatech.com/mpistutter/) is more effective than MyLynel. MPiStutter supports MPI stuttering therapy, rejects background noise, and can be worn inconspicuously with auditory feedback. It displays the duration of your phonated intervals in real time in the main window, the last ten minutes of your speech in the secondary window, and your cumulative speech for the day in a third window. MPiStutter is ideal for SLPs to use in school with children, and then their parents can do therapy at home with their child. Adult stutterers can do MPI therapy in a speech clinic and then use MPiStutter on their own outside the speech clinic.

    Can you tell us more about the grants you received from the National Science Foundation (NSF), National Library of Medicine, and Department of Education to develop MyLynel and SLPMxS? How much were the grants for? Where can I see a copy of the grants?

    Also, the first sentence of your paper claims that “Stuttering is a most common speech disorder.” Articulation disorders are more common. Stuttering is one of the less common speech disorders.

    The second sentence of your paper claims that “speech therapy by a fluency specialist speech-language pathologist (SLP) is the only method that results in long term improvement.” This is not true. Several people have told me that the book “Self-Therapy for the Stutterer,” by Malcolm Fraser, helped them. Additionally, a study of the Casa Futura Technologies School DAF (http://www.casafuturatech.com/school-daf/) found that 30 minutes of use for three months resulted in 55% carryover fluency, without therapy from a SLP. (Van Borsel, 2003)

    References

    Ingham, R., Kilgo, M., Ingham, J., Moglia, R., Belknap, H., & Sanchez, T. (2001). Evaluation of a stuttering treatment based on reduction of short phonation intervals.

    Van Borsel, J., Reunes, G., and Van den Bergh, N. (2003). “Delayed auditory feedback in the treatment of stuttering: clients as consumers,” International Journal of Language and Communication Disorders, 2003, Vol. 38, No. 2, 119-129.

    • I hardly know where to start with this one. Let’s see…TACT does provide biofeedback and we make no claim that conversation is its equivalent. That you can’t see the value of recording everyday speech indicates little, other than you are not an SLP. The rest of your post seems to be predominantly copied and pasted from your marketing literature as a way of sneaking in some free advertising for your company. Hardly an objective analysis.

  11. Interesting article and innovative idea. You discussed using TACT in conjunction with a speech-language pathologist. I would like to know how you intend to ensure or encourage users to still consult with a qualified SLP? Is TACT designed only for adults or do you perceive teens or even children being able to use this application?
    Teresa Young
    ISU SLP graduate student

    • Hi Theresa. You make a good point. We really can’t force users to consult an SLP, any more than SLPs can keep strangers from trying their published techniques without guidance (though we can strongly recommend). Re younger users, I have asked adolescent clients to download the app. In those cases, I knew they liked playing around with iPhones and/or seemed less than completely motivated to complete traditional home program sheets. Thanks for your interest.

  12. As a graduate SLP student currently learning about PWS, I have a few questions about the use of a program such as TACT. It is known that when demands exceed capacities for the PWS, their speech becomes less fluent. Having to take out a mobile device and record the conversations occurring daily in order to understand and monitor stuttered speech seems as though it would be an added component of stress/another demand on the individual. Can the program record from a pocket or earbuds, or does the individual have to hold the device to achieve a good recording?

    Also, it was stated that “negative feelings, attitudes and emotional reactions to stuttering are managed through positive reinforcement feedback.” What is the positive feedback that is given through TACT? I ask because it has been said in another paper written for this conference that only producing positive feedback when the individual does not stutter can cause them to become more introverted. It is the ethical responsibility of the SLP working with the PWS to refer the individual to a psychologist if the negative feelings, attitudes and emotions are strong towards stuttering. Will this device suggest counseling to the client is these feelings are strong?

    Thank you for your time!
    Amanda Doran
    Graduate SLP Student
    Kean University, Union, NJ

    • Interesting questions, Amanda. The system is designed to record the user’s speech via a standard headset or with the iPhone alone, whichever is most comfortable for the client. I’m not sure that this creates additional demand for fluent speech. And even if it does, the client is in therapy, so capacity should be increasing as well. I would argue that, because stuttering therapy requires clients to expand their comfort zones, anything a therapist can do to help the client attempt techniques in new situations is a good thing. The positive feedback you refer to is for affective and cognitive components of stuttering; the paper you cite refers to behavioral components. Working with all of these components is within the SLP’s scope of practice, though I suppose if the emotions were strong enough that the SLP was uncomfortable addressing them, a referral or consultation would be appropriate. Finally, the device doesn’t suggest anything. Referrals are still solely up to the SLP who is guiding the therapy.

  13. I thank everyone for reading and/or leaving comments. I will be out of the office tomorrow, so I will wish everyone a happy ISAD a day early.

  14. Thank you very much for sharing this technique with us through this conference. I have had one course in fluency disorders in the past and currently enrolled in another one. I learn new information every day, but I have seen a trend in that the generalization of therapy can be quite difficult for the speech-language-pathologist (SLP). I know in the clinic settings I have been in, some SLPs take their clients on a ‘field trip’ during their weekly sessions. This would consist of them walking down to a store or restaurant. The client would be able to practice what they had been working on in therapy in the real work with the support of the SLP. This also took place in an undergraduate clinic setting, which when applying this thought to the real world I think it would be hard to do this with every client that might stutter. TACT seems to bring a happy-medium into therapy intervention for PWS. They still get face to face time with a clinician but also have the feedback and therapy packs for when they are outside the clinic. One thing I am a bit confused on is how the TACT actually gives real feedback to the clients when they are outside of clinic-or am I misunderstanding this concept?
    Thank you again for sharing this!