Apparative speaking aid

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Speech aids are technical devices that are used in the treatment and research of stuttering . Due to their immediate effectiveness and reduction of symptoms , they can make many everyday situations easier for those affected and contribute to increasing self-esteem . However, the effect diminishes again after the devices are switched off and the patient falls back into his original way of speaking. Therefore, a supplementary training for the use of the device within a speech therapy therapy is recommended in order to stabilize the effect of a relative normalization of speech and to adopt it in everyday life.

The effects and mechanisms of speech aids and their influence on stuttering also play an essential role in further research into it.

Theories on how it works

There are various theories that deal with the way in which speech aids work, although none of these hypotheses has yet been able to adequately explain the reduction in stuttering. In the following, several of the existing theories on the mode of operation of speech aids are briefly outlined.

Oliver Bloodstein and Nan Bernstein Ratner (2008) attribute the symptom-reducing effect to the so-called masquerade effect . They assume that the symptoms of stuttering are reduced if they speak in a way that appears strange to them.

Bloodstein (1949) also found that stuttering is reduced when the communicative responsibility for the stutterer decreases, as is the case with so-called simultaneous or choral speaking , i.e. speaking together with other people.

The distraction hypothesis by Barber (1940) states that smoother Talk is achieved by the deflection of the stutterer of the speech production.

According to the theory of an auditory malfunction (Stromsta, 1957; Webster and Lubke (1968)), stuttering is based on a sensory defect in the auditory canal. It is assumed that there is an exceptionally strong involvement of auditory feedback when speaking. A modification of the auditory feedback, which is achieved by means of certain speech aids, enables this defect to be eliminated.

Furthermore, there is the theory of the change in speech patterns , which is pursued by Wingate (1976) and Perkins (1979) and assumes motor dyscoordination as the cause of stuttering. In particular, the reduction in speaking speed brought about by the use of speech aids in combination with the vowel stretching leads to a reduction in stuttering.

Methods

metronome

When speaking metrically, the speech pattern is changed in such a way that the syllables, following the beat of a metronome, are spoken in a steady rhythm and with approximately the same emphasis. This can lead to a drastic reduction in speaking speed and stuttering symptoms. However, many stutterers perceive speaking metrically as strange and more noticeable than their own stuttering, which makes it difficult to transfer it into everyday life.

The beat can be given by acoustic, tactile or visual stimuli. Various types of devices are used for this purpose, such as:

A standard table metronome can also be used for stuttering therapy
  • a standard table metronome.
  • a haptometronome that puts tactile stimuli on the fingertip. It was specially developed for the treatment of stuttering and can be worn inconspicuously.
  • an electronic mini metronome, such as B. the "Pacemaster electronic metronome", which the patient wears like a hearing aid behind the ear.

The effect of metrical speaking can be explained on the one hand by the distraction hypothesis: the attention focus of the stuttering person is directed away from the speech control to the given metronome bars. On the other hand, the segmentation of speech and the reduction of the speech speed facilitate neuromotor coordination.

When using metric speaking in speech therapy, it should be noted that, depending on the severity of the disorder, an optimal metronome speed must be found for the respective patient. The aim of the therapy sessions that follow is to adjust the patient's way of speaking to normal speech in terms of speed and intonation. It is particularly important to vary the number of syllables spoken per metronome beat and to incorporate appropriate breathing pauses.

Masking

The term masking stands for the deactivation of the auditory feedback systems through artificial masking. This is achieved through the presentation of so-called "white noise" via headphones. When speaking under masking, the Lombard effect sets in . This means that the volume and pitch increase, while the pace of speech is slowed down. The stutter-reducing effect of masking can be explained by the theory of auditory malfunction.

Fiedler and Standop assume that the effectiveness lies in resorting to the kinesthetic-proprioceptive feedback. In studies carried out by Shane in 1955 and by Cherry and Sayers in 1956, masking was used to achieve almost symptom-free speech. According to Maraist and Hutton (1957), the stutter-reducing effect is also present when the auditory feedback is not completely switched off due to the low noise level, but increases with increasing volume.

The Edinburgh Masker

Based on the observations that the stuttering symptoms mostly reappear after switching off the "white noise", portable masking devices were developed. However, since these are mostly relatively large devices that are worn on a belt, for example, and connected to headphones, they are not accepted by many stutterers despite the advantages they offer. Furthermore, there is a health problem, since the "white noise" is usually generated at high volume levels and the hearing is exposed to excessive stress as a result. A very well-known portable masking device is the "Edinburgh masker". This device is characterized by the fact that it remains inactive during pauses in speech and automatically switches on when the wearer begins to speak.

Delayed auditory feedback

In the case of delayed auditory feedback, or VAR for short (English: "delayed auditory feedback", DAF for short), the speaker's own verbal utterances are reported back to the speaker via headphones with a delay. In the case of linguistically inconspicuous people, the use of VAR leads to the so-called Lee effect: there are repetitions and lengthening of sounds and syllables, and there is also an increase in the speaking volume. This is known as an "artificial stutter". In the case of stuttering, however, this can lead to a significant reduction in symptoms. Often there is an extremely stretched speech with reduced prosody called the "VAR voice".

In several studies carried out by Naylor (1952) and Lotzmann (1961), among others, it was found that the improvements achieved by VAR are greater the more pronounced the stuttering symptoms are and that there is an increase in people who stutter only slightly the lack of fluency comes. There is currently no unanimous opinion about the cause of the stutter-reducing effect of the VAR. Van Riper, for example, follows the theory that delayed auditory feedback, like masking, is a measure that forces the use of kinesthetic-proprioceptive feedback by interrupting the auditory control process.

Starkweather, on the other hand, attributes the effectiveness of the VAR to the fact that the delayed feedback causes a reduction in the speed of speech, which enables the stuttering person to plan his utterances better.

Thus the use of speech aids with delayed auditory feedback in speech therapy can support the learning of a slow and drawn-out way of speaking.

Wearable devices are developed by the American companies Casa Futura Technologies and Janus Development Group ("SpeechEasy").

Frequency shifted auditory feedback

Frequency-shifted auditory feedback (FAF for short) consists of shifting the frequency spectrum of the spoken word so that the speaker hears himself speaking higher or lower. An influence on speech-motor parameters, as it is shown for example under VAR, cannot be observed.

The mode of action of the frequency-shifted auditory feedback can be explained by two effects. On the one hand, the alienation of one's own speech leads to the masquerade effect already described. On the other hand, the effect of simultaneous speaking is of great importance, since it can achieve a good reduction in stuttering. Some users report that speaking under FAF makes them feel like someone is talking to them.

The research results on the effectiveness of the FAF vary widely. In a study by Natke (2000), for example, no general symptom-reducing effect when reading was found. In contrast, those published by Howell et al. (1987) and Kalinowski et al. (1998) conducted studies. After reviewing the available test results, Lincoln et al. (2006) put together that, in individual cases, considerable improvements and a reduction in fluidity of 40–85% can be achieved in adults. Howell et al. (1999) found that the reduction in stuttering was much lower in children.

Portable devices were also designed for frequency-shifted auditory feedback. Furthermore, devices are offered which combine the frequency-shifted with the delayed auditory feedback. This simultaneous use of DAF and FAF is known as "altered auditory feedback" (AAF). In recent years numerous apps for smartphones have been developed that implement DAF / FAF as software and are much cheaper than special devices, see web links .

Biofeedback

With biofeedback, body functions are reported back to the stuttering person, which enables him to gain greater control over them. An increase in muscle tone and an abnormal breathing pattern are common during stuttering. The patient should consciously counteract this process with the help of biofeedback, which should reduce the symptoms.

Electromyography (EMG) biofeedback is usually used for this. The activity of the muscles in the jaw or larynx is recorded with the help of surface electrodes and reported back by acoustic or visual signals. In this way, the patient should recognize the behavior through which he can achieve the desired relaxation.

Two by Legewie et al. and Guitar in 1975 demonstrated a significant symptom-reducing effect of EMG biofeedback. Wearable devices were developed, but not at the initiative of Legewie et al.

The integration of biofeedback in stuttering therapy is particularly useful in the context of fluency shaping approaches with the aim of better control of breathing and the use of voices.

literature

  • Anke Alpermann, Ulrich Natke: stuttering. Findings, theories, treatment methods. Hans Huber, Bern 2010, ISBN 978-3-456-84891-4 .
  • Peter Fiedler, Renate Standop: stuttering. Etiology, diagnosis, treatment. 4th edition. Psychologie Verlags Union, Weinheim 1994, ISBN 978-3-621-27225-4 .
  • Bert Küppers: Speech aid for stutterers. (2001) Internet source : patent-de.com . Retrieved November 7, 2011
  • Richard Ham: Techniques in Stuttering Therapy. 1st edition. Demosthenes Verlag der Bundesvereinigung Stotterer-Selbsthilfe eV, Cologne 2000, ISBN 3-921897-35-1 .
  • Linda House: What is known and unknown about altered auditory feedback as a treatment for stuttering? The British Stammering Association. (2005) Internet source : stammering.org . Retrieved November 7, 2011
  • Evren M. Candogan: STOTTER symptoms, causes and therapy. GRIN Verlag, Munich 2005, ISBN 978-3-638-37936-6 .
  • Katja Bitsch: Childhood stuttering. The Kassel stuttering therapy evaluation of a computer-aided biofeedback method. Philosophical Faculty III of the Julius Maximilians University of Würzburg. (2007) Internet source : kasseler-stottertherapie.de (PDF; 2.1 MB). Retrieved November 7, 2011
  • Ingham, RJ, Kilgo, M., Ingham, JC, Moglia, R., Belknap, H., & Sanchez, T .: Evaluation of a stuttering treatment based on reduction of short phonation intervals. In: Journal of Speech, Language, and Hearing Research , 44, 1229-1244. Internet source: [1] (PDF; 1.4 MB). Retrieved December 20, 2014

Web links

Individual evidence

  1. ↑ cf. Alpermann, Natke (2010) p. 41
  2. ↑ cf. Alpermann, Natke (2010) p. 30
  3. ↑ O. Bloodstein, Nan Bernstein Ratner, A handbook on stuttering , 6th edition, 2008, Thomson-Delmar.
  4. ↑ cf. Alpermann, Natke (2010) p. 29f
  5. ↑ cf. Alpermann, Natke (2010) p. 32
  6. ↑ cf. Alpermann, Natke (2010) p. 79
  7. ↑ a b c cf. Alpermann, Natke (2010) p. 33
  8. ↑ cf. Fiedler, Standop (1994) p. 141
  9. ↑ cf. Alpermann, Natke (2010) p. 141
  10. ↑ cf. Alpermann, Natke (2010) p. 144
  11. ↑ cf. Alpermann, Natke (2010) pp. 142f
  12. ↑ a b c cf. Alpermann, Natke (2010) p. 34
  13. ↑ a b cf. Fiedler, Standop (1994) p. 119
  14. ↑ a b cf. Fiedler, Standop (1994) p. 120
  15. ↑ cf. Küppers (2001)
  16. ↑ cf. Alpermann, Natke (2010) p. 35
  17. ↑ a b cf. Fiedler, Standop (1994) p. 145
  18. ↑ cf. Ham (2000) p. 141
  19. ↑ cf. Ham (2000) pp. 137f
  20. ↑ cf. Ham (2000) p. 133
  21. ↑ cf. Alpermann, Natke (2010) p. 37
  22. ↑ cf. Ham (2000) p. 136
  23. ↑ See Fiedler, Standop (1994) pp. 145f
  24. ↑ cf. Alpermann, Natke (2010) p. 36
  25. ↑ cf. Alpermann, Natke (2010) p. 38f
  26. ↑ a b c d e cf. Alpermann, Natke (2010) p. 40
  27. ↑ cf. Alpermann, Natke (2010) p. 39
  28. ↑ cf. House (2005)
  29. ↑ cf. Alpermann, Natke (2010) p. 24f
  30. ↑ cf. Candogan (2005)
  31. ↑ cf. Fiedler, Standop (1994) p. 160
  32. ↑ cf. Alpermann, Natke (2010) p. 95