Electronic fluency device
Instrumental speech aids are technical devices that are used in the treatment and research of stuttering. Through their direct effect and reduction of symptoms they can facilitate affected many everyday situations and contribute to the increase of self-esteem. The effect can, however, after switching off the device again, and the patient returns to its original speech. Therefore, additional training is use of the instrument within a speech therapy recommended to stabilize the effect of a relative normalization and language to take over into everyday life.
Modes of action and mechanisms of apparatus speech aids stuttering play an essential role in its further exploration.
Theories of action
There are various theories that deal with the effect of apparatus speech aids, which so far none of these hypotheses can explain the stuttering reduction sufficient. In the following, several of the existing theories on the mode of operation of apparatus speech aids are briefly outlined.
Oliver and Nan Bernstein Ratner Blood Stone (2008) attribute the symptomreduzierende effect on the masquerades effect as above. They assume that the symptoms reduced stuttering when they speak in a way that seems foreign to them.
Also presented Blood Stone (1949 ) found that the stuttering reduced when the communicative responsibility for the stutterer decreases as the so-called simultaneous or choral speaking, that is the common talk with other people that is the case.
The distraction hypothesis of Barber (1940 ) states that smoother speaking through the deflection of the stutterer is achieved by the speech production.
According to the theory of auditory dysfunction ( Stromsta, 1957; Webster and Lubke (1968 ) ) the stuttering is based on a sensory defect in the auditory canal. It is of an exceptionally strong involvement of the auditory feedback from speaking. A modification of auditory feedback, which is achieved by certain apparatus speech aids, enables a repeal of this defect.
There is also the theory of change of opening patterns Wingate (1976) and Perkins (1979) is followed, and a motor takes Dyskoordination as the cause of stuttering. Particularly that caused by the use of apparatus speech aids reduction of speech rate in combination with the vocal strain therefore leads to a reduction of stuttering.
Methods
Metronome
When metric Speak the speech pattern is changed so as to be that the syllables, the beat of a metronome following spoken in a regular rhythm, and with approximately the same emphasis. This can cause a drastic reduction of speech rate and stuttering symptoms. Many stutterers perceive the metric Talk but as strange and striking than their own stuttering, making it difficult to transfer into everyday life.
The clock can be set by auditory, tactile or visual stimuli. These various devices are used, such as:
- A commercially available table metronome.
- A Haptometronom, sets the tactile stimuli on the fingertip. It was developed specifically for the treatment of stuttering and can be worn discreetly.
- An electronic micro metronome, as for example, " Pace Master electronic metronomes ", which the patient wears like a hearing aid behind the ear.
The effect of crosstalk metric can be the one with the distraction hypothesis to explain: The focus of attention of the stutterer is guided by the voice control off on the given metronome beats. Secondly, the neuromotor coordination is facilitated by the segmentation of speech and the reduction of speech rate.
When using the metric speech in the speech therapy is important to note that initially optimal for the patient metronome speed must be found depending on the severity of the disorder. The aim of the subsequent therapy sessions is to align the speech of the patient to a normal pace and intonation in speech. It is particularly important to vary the number of spoken syllables per metronome beat and install Sense- breathers.
Masking
The term masking is the elimination of auditory feedback systems by artificial masking. This is achieved by the provision of so-called " white noise" through headphones. While speaking at masking the Lombard effect begins. This means that volume and pitch increase, whereas the speech rate is slowed down. The stotterreduzierende effect of masking can be explained by the theory of auditory dysfunction.
Fiedler and Standop assume that the effectiveness lies in accessing the kinesthetic - proprioceptive feedback. In studies that were conducted in 1955 by Shane and 1956 by Cherry and Sayers, a nearly symptom- free speech could be achieved by using the masking. The stotterreduzierende effect is loud Maraist and Hutton ( 1957) also present when the auditory feedback is not completely turned off because of the low noise level, but decreases with increasing volume too.
Based on the observations that the stuttering symptoms usually occurs again after switching off the " white noise " masking portable devices have been developed. As most, however, are relatively large structures that are worn on your belt, for example, and are connected with headphones, they are not accepted by many stutterers, despite the advantages offered. Furthermore, there is a health issue, as the "white noise" is usually generated at high volume and the hearing is thereby subjected to excessive loads. A well-known portable masking device is the "Edinburgh Masker ". This device is characterized in that it remains inactive in pauses and turns on automatically when the vehicle starts to speak.
Delayed auditory feedback
In delayed auditory feedback, short VAR (english: "delayed auditory feedback", briefly DAF), the speaker 's own utterances are delayed reported back through headphones. In linguistically inconspicuous persons the use of VAR to the so-called Lee - effect results: It occurred repetitions and expansions of sounds and syllables, furthermore, there is an increase in voice level. This is known as "artificial stutter ". In stutterers, however, can be effected by a significant reduction in symptoms. Frequently creates an extremely drawl with reduced prosody, which is referred to as "VAR - voice".
In several studies, among other things, of Naylor (1952) and Lotzmann (1961 ) were conducted, it was found that the improvements achieved by VAR are greater, the more pronounced the stuttering symptoms and that it in only slightly stutterer sometimes to an increase the Sprechunflüssigkeiten comes. A unified opinion about the cause of stuttering -reducing effect of the VAR is not current. Van Riper, for example, follows the theory that the delayed auditory feedback as well as the masking is a measure which encourages the use of kinesthetic - proprioceptive feedback by the auditory control process is interrupted.
Starkweather turn leads the effectiveness of the VAR to the fact that a reduction in the rate of speech is caused by the delayed feedback that allows the stutterer to plan his comments better.
Thus, the use of apparatus speech aids with delayed auditory feedback in speech therapy can reinforce learning and a slow drawl.
Portable devices are developed by the American company Casa Futura Technologies and Janus Development Group ( " Speech Easy" ).
Frequency -shifted auditory feedback
Frequency -shifted auditory feedback (English: "frequency -shifted auditory feedback", short FAF) is the shift of the frequency spectrum of speech, so that the speaker sounds speak higher or lower. An influence on speech motor parameter as shown for example by VAR, it can not be observed.
The effect of the frequency-shifted auditory feedback can be explained by two effects. One hand, the alienation of one's own speech to the already described masquerades effect. On the other hand, the effect of simultaneous speech is of great importance since it a good stutter reduction can be achieved. Some users report that speaking under FAF to make them feel as if another person were speaking with them.
The test results on the effectiveness of FAF fall out very differently. Thus, no general symptom -reducing effect in reading was demonstrated in a study of Natke ( 2000). Positive results provide contrast, Howell et al. ( 1987) and Kalinowski et al. (1998) conducted studies. After a review of the existing research results summarized Lincoln et al. (2006) together, that in each case a significant improvement and a reduction of about 40-85 % in adults disfluencies can be achieved. Howell et al. (1999) found that in children who stutter reduction is much smaller.
Also for the frequency-shifted auditory feedback portable devices were constructed. Furthermore, devices are available that combine the frequency-shifted with the delayed auditory feedback. This simultaneous use of DAF and FAF is referred to as " altered auditory feedback" (AAF ).
Biofeedback
When biofeedback the stutterer's body functions are confirmed, thereby allowing him to gain greater control over this. During the stuttering usually occur due to an increase in muscle tone and abnormal breathing patterns. This operation, the patient should counteract aware with the help of biofeedback, whereby a reduction of symptoms is to be achieved.
Usually, the electromyography ( EMG) biofeedback is to be applied. The activity of the muscles in the jaw or throat area is derived by means of surface electrodes and confirmed by acoustic or visual signals. The patient is seen in this way, by which behavior he can reach the desired relaxation.
Two of Legewie et al. Guitar and in 1975 conducted studies reported a significant symptom- reducing effect of EMG biofeedback after. Portable devices have been developed, but not at the initiative of Legewie et al.
The integration of biofeedback in the stuttering therapy is particularly useful in the context of Fluency shaping approaches with the aim of better control of breathing and vocal use.