Fluency Shaping
Fluency Shaping is a treatment approach from stuttering therapy. The topmost principle is to learn a new way of speaking that is incompatible with stuttering or significantly reduces speech inconsistencies. In the optimal case, the way of speaking should be adopted into spontaneous speech ; if this is not possible, the goal is to learn a controlled fluency in speaking. This can be achieved, for example, through soft voice inserts or prolonged speaking. Fluency Shaping programs start directly with the stuttering person's speech and dispense with the treatment of motor characteristics (e.g. muscular movements and cramps) or psychological reactions (fear of words, avoidance behavior), as it is assumed that any accompanying symptoms will disappear through learning a fluent way of speaking. Fluency Shaping is a behavioral therapy program.
Soft voice insert
The soft use of voices is a central element in fluency shaping therapy and is based on the difficulties that every stutterer knows of producing different sounds at the beginning of a word or syllable. The basis of the soft use of voices is to speak utterances without hurry, tension or pressure and thus avoid stuttering symptoms. The voice is used softly, gently and gradually. This can be done, for example, through light consonant contact, widening the airways, relaxation with simultaneous coordination of breathing, continuous phonation and articulation, stretching, speed reduction and breath control.
Prolonged speaking (stretching)
The prolongation (stretching) of a sound, a syllable or a word is used to maintain a continuous phonation of the vocal folds , so that as far as possible no stuttering symptoms can occur. Either all sounds or only the vowels are prolonged. This results in a slowed-down manner of speaking with clear pauses for breathing. During an exhalation phase, the words can be combined while speaking. This way of speaking is noticeable at first, but enables the stuttering person to speak more fluently in a controlled manner.
Fluency Shaping Therapies
The basic principle of fluency shaping techniques is relatively simple, but requires a lot of practice, which is why intensive therapy programs lasting several weeks are usually offered in this area. Examples include the Lidcombe program (cf. e.g. Onslow & Packman 2003, Lattermann 2003; Huber & Onslow 2001), Precision Fluency Shaping Program (cf. Webster 1974, 1980), Comprehensive Stuttering Program (Boberg & Kully 1985 ; Jehle & Boberg 1987), Smooth Speech (Neilson & Andrews 1993), Camperdown Program (O'Brian, Cream, Onslow & Packman, 2001) and the Kassel stuttering therapy (Euler & Wolff von Gudenberg 2000). Fluency shaping approaches often use technical devices such as DAF devices or biofeedback programs to practice prolonged speaking and to control the soft use of voices.
Biofeedback method
Biofeedback devices are used to map physiological functions and to gain greater control over bodily functions through visual feedback. On the one hand, the stutterer can learn to arbitrarily influence the normal course of speech with such methods, and on the other hand, fluency-shaping speech styles can be acquired and consolidated. A tuning curve shown gives feedback on soft voice inserts and continuous phonation. Drops the voice (phonation), interrupts the vocal curve; soft vocal inserts are measured using the volume level. Training with such computer programs should complement the follow-up care of the therapy in the form of refresher courses.
Development of fluency shaping therapy
In the beginning, the goal is to drastically reduce the speed of speech - to 0.5 syllables per second, for example. This is done either by prolonging all sounds or just the vowels. It is important to produce a soft voice entry with every initial sound. In addition, emphasis is placed on clear breathing pauses and on connecting the individual words during phonation. With plosive sounds (k, g, t, d, p, b), light articulatory contacts are observed. The product of these specifications can sound very noticeable and monotonous at first, but when used correctly, significantly fewer or no more stuttering events occur. In the course of the therapy, the speed of speech is increased again and a natural prosody is worked on until it almost equals the speed of a normal speaker, but only as far as there is no stuttering.
The use of audio and video recordings is advantageous in giving the patient clear feedback regarding his or her speech and the changes in speech. Transfer exercises within the therapy are also part of the fluency shaping programs as so-called in vivo exercises and should be continued at home in the long term. The learned manner of speaking should be used as constantly as possible at the beginning. In the course of the therapy, a more natural sounding speech pattern is worked towards. However, the clients must be taught to increase the level of application of the technology accordingly when stuttering events occur again and to return to the controlled speech technique they have learned. The frequency of relapses in the absence of consistent use of speech technology is also a known and frequent problem with these procedures, which is why structured follow-up care over 1–2 years is integrated into many of the programs.
Disadvantages of fluency shaping programs
Pure fluency shaping approaches are often viewed critically, as speaking is changed globally. In addition to the stuttered parts of speaking, parts are also changed that would actually be fluid. Due to the soft inserts, stretches and the overall slowdown, speaking continues to sound "abnormal" and noticeable. Another common point of attack of fluency shaping methods is that cognitive aspects of stuttering play too little role in therapy. Primarily the audible symptoms of stuttering are dealt with, fear of speaking or avoidance behavior are excluded on the grounds that these would evaporate if more fluent speech was achieved.
Individual evidence
- ↑ Ochsenkühn, C., Frauer, C. & Thiel, M. (2015) Stuttering in Children and Adolescents.
- ↑ Sandrieser, P. & Schneider, P. (2015). Childhood stuttering
- ↑ a b c d e Natke, U. (2010). Stutter. Findings, theories, treatment methods.
- ↑ a b Ham, R. (2000). Techniques in stuttering therapy.
- ↑ Böhme, G. (2003). Speech, speech, voice and swallowing disorders.
- ^ Ward, D. (2006) Stuttering and Cluttering. Frameworks for understanding and treatment.