1. The SpeechEasy  Device: Augmentative Communication for Stuttering Presentation by Tim Saltuklaroglu, M.S. East Carolina University March 27, 2003

2. Our view of stuttering Stuttering is central neurophysiological disorder that manifests during speech. Stuttering is central neurophysiological disorder that manifests during speech. The overt manifestations of stuttering (repetitions, prolongations, silent speech blocks) are symptoms of this central pathology. The overt manifestations of stuttering (repetitions, prolongations, silent speech blocks) are symptoms of this central pathology. Stuttering is a extremely debilitating disorder that can impede every aspect of life. Stuttering is a extremely debilitating disorder that can impede every aspect of life.

3. How is stuttering usually treated? By attempting to retrain the speech producing subsystems: By attempting to retrain the speech producing subsystems: Laryngeal. Laryngeal. Respiratory. Respiratory. Articulatory. Articulatory.

4. How Is stuttering usually treated? ‘Speech Retraining’ involves the imposition of novel speech patterns that are supposedly incompatible with stuttering. ‘Speech Retraining’ involves the imposition of novel speech patterns that are supposedly incompatible with stuttering.

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

6. There’s room for improvement… Therapy can help many people but may still not produce the highest level of fluency possible. Therapy can help many people but may still not produce the highest level of fluency possible. Relapse rates need to be decreased for therapy to be considered efficient and effective. Relapse rates need to be decreased for therapy to be considered efficient and effective.

7. Efficiency and effectiveness in the treatment of stuttering Efficiency: Efficiency: Does the treatment act in a timely manner with as little effort as possible expended? Does the treatment act in a timely manner with as little effort as possible expended? Effectiveness: Effectiveness: Does the treatment provide the relief that it promises? Does the treatment provide the relief that it promises?

8. Our mission To ‘centrally’ inhibit stuttering and induce immediate and natural sounding fluent speech in those stutter.

9. Choral speech Considered to be the best known stuttering inhibitor. Considered to be the best known stuttering inhibitor. Often inducing 90-100% fluency in almost everyone who stutters. Often inducing 90-100% fluency in almost everyone who stutters.

10. What does choral speech do? Inhibits stuttering at a more central level – closer to the source of the pathology. Inhibits stuttering at a more central level – closer to the source of the pathology. Under choral conditions, brain imaging studies have shown ‘normalization’ of abnormal brain activations seen in PWS. Under choral conditions, brain imaging studies have shown ‘normalization’ of abnormal brain activations seen in PWS.

11. Delayed Auditory Feedback (DAF) Perceiving your own speech with a temporal delay (similar to an echo). Perceiving your own speech with a temporal delay (similar to an echo). Delays as low as 25 ms have been found to induce fluent speech. Delays as low as 25 ms have been found to induce fluent speech.

12. Frequency Altered Feedback (FAF) Altering the perceived pitch of a persons own speech, but the person is not required to change his/her speech patterns. Altering the perceived pitch of a persons own speech, but the person is not required to change his/her speech patterns.

13. Frequency Altered Feedback (FAF) Pitch can be raised or lowered relative to the fundamental frequency: Pitch can be raised or lowered relative to the fundamental frequency: Mickey Mouse (chipmunk) or Darth Vader. Mickey Mouse (chipmunk) or Darth Vader. Is also a powerful emulator of choral speech. Is also a powerful emulator of choral speech.

14. How well do DAF and FAF work? Immediate reduction in stuttering by 70- 85% across a variety of situations. Immediate reduction in stuttering by 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.

15. The problem Large bulky devices. Large bulky devices. Lack of portability. Lack of portability. Conspicuous in nature. Conspicuous in nature. Not functional. Not functional.

16. The solution SpeechEasy  introduced in April 2001. SpeechEasy  introduced in April 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 increments. FAF: up to 2000 Hz up or down in 500 Hz increments. Frequency shaping and noise attenuation. Frequency shaping and noise attenuation. In-the-canal model. In-the-canal model. Completely-in-the-canal model. Completely-in-the-canal model.

17. ITE/ITC This model fits in the ear canal with only a small portion visible. Very inconspicuous A great combination of small size and robust effects. External volume control.

18. CIC The smallest model. The whole device sits in the ear canal with nothing showing. Provides all the effects of the other models. Volume is internally controlled.

19. How is the SpeechEasy™ 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 cable. Interfaces with computer via serial / USB cable. SpeechEasy™ cables SpeechEasy™ cables ITC / BTE cable ITC / BTE cable Left CIC cable Left CIC cable Right CIC cable Right CIC cable

20. An adjunct or alternative to therapy… Prosthetic devices are incorporated into the treatments of many disabilities. Prosthetic devices are incorporated into the treatments of many disabilities. The use of a fluency enhancing device may help people who stutter produce fluent speech that is more: The use of a fluency enhancing device may help people who stutter produce fluent speech that is more: Stable Stable Natural sounding Natural sounding Automatic Automatic

21. 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 story as they only consider the countable aspects of stuttering in environments that are usually controlled. Efficacy studies cannot tell the whole story as they only consider the countable aspects of stuttering in environments that are usually controlled. However, they are necessary for documentation and accountability. However, they are necessary for documentation and accountability.

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

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

24. Fluency enhancing effects of the SpeechEasy protocol Average decrease in Stuttering Frequency 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%

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