Perspectives of Indian Speech Language Pathologists on Applications of Motor Learning Principles in Stuttering Intervention: Cross Sectional Survey

Self-report of self-disclosure statements for stuttering

Background:Considering the importance of psychological interventions for adults who stutter (AWS), the present study compared the effectiveness of Cognitive Behavioral Group Therapy (CBGT) and Mindfulness and Acceptance Group Therapy (MAGT), in combination with Speech Therapy (ST) in AWS.Materials and Methods:A randomized clinical trial was conducted with 36 AWS in Tehran and Alborz provinces in Iran from September-2019 to September-2020. Participants were assigned to CBGT + ST and MAGT + ST groups. Outcomes variables, the fear of negative evaluation scale (FNE) and the social avoidance and distress scale (SAD), were measured at four stages: (1) pretest, (2) after MAGT/CBGT, (3) after ST, and (4) at 6-month follow-up.Results:The results of repetitive measure-analysis on variance showed that CBGT + ST and MAGT + ST were significantly effective (P = 0.001 and P = 0.003) on SAD. The same analysis showed that CBGT + ST was significantly effective (P = 0.001) on FNE. The results of Analysis of Covariance showed that there was no significant difference between CBGT + ST and MAGT + ST on SAD but CBGT + ST was more effective than MAGT + ST at stage 3 (P < 0.05) on FNE.Conclusion:Data indicated that CBGT + ST and MAGT + ST were both effective for SAD of AWS. Regarding FNE, unlike MAGT + ST, CBGT was effective either alone or in combination with ST for AWS. Further studies are needed to confirm the results of this study.

How reliable and useful are social media videos about stuttering? A comprehensive evaluation of content and credibility.

Purpose: Worldwide, there is an abundance of different treatment strategies, mechanisms, and constituents for individuals who stutter. This study explored what adults who stutter (AWS) think about the nature of stuttering treatment and its components and whether they feel stigmatized. Method: A survey containing nine statements about components of stuttering treatment and one question related to stigmatization was sent to AWS around the world. In total, 213 respondents were included in the study, spread out over North America, South America, Asia, Europe, and Australia/Oceania. Finally, three open-ended questions explored their opinion about important treatment aspects, the qualities of a speech-language pathologist (SLP), and what an ideal treatment looks like. Results: The nine statements referring to stuttering treatment were all seen as key components by more than half of the respondents. Nearly 80% found it very or extremely important that an SLP helps them with stuttering-related anxiety and thoughts, feeling more comfortable in different speaking situations, introducing them to speech strategies, and providing assistance in accepting themselves as a speaker. Three of these four statements were found more important by men than women. Especially respondents from North America and Europe found that (self) acceptance is important. About 50% think they are stigmatized. Conclusions: The survey unveiled that AWS particularly found treatment components focusing on speech and underlying thoughts important. However, it is also clear that AWS' individual opinions vary relative to what they think are important treatment components. Translating these findings to daily practice entails that SLPs should be trained in different treatment programs or approaches to meet the individual needs of each AWS. One size does not fit all. It seems crucial that researchers who conduct clinical trials for stuttering treatments employ more than stuttering reduction as an outcome measure.

This study explores speech motor planning in adults who stutter (AWS) and adults who do not stutter (ANS) by applying machine learning algorithms to electroencephalographic (EEG) signals. In this study, we developed a technique to holistically examine neural activity differences in speaking and silent reading conditions across the entire cortical surface. This approach allows us to test the hypothesis that AWS will exhibit lower separability of the speech motor planning condition. We used the silent reading condition as a control condition to isolate speech motor planning activity. We classified EEG signals from AWS and ANS individuals into speaking and silent reading categories using kernel support vector machines. We used relative complexities of the learned classifiers to compare speech motor planning discernibility for both classes. AWS group classifiers require a more complex decision boundary to separate speech motor planning and silent reading classes. These findings indicate that the EEG signals associated with speech motor planning are less discernible in AWS, which may result from altered neuronal dynamics in AWS. Our results support the hypothesis that AWS exhibit lower inherent separability of the silent reading and speech motor planning conditions. Further investigation may identify and compare the features leveraged for speech motor classification in AWS and ANS. These observations may have clinical value for developing novel speech therapies or assistive devices for AWS.

Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists

Principles of motor learning in treatment for apraxia of speech

This study describes a practical model for improving the quality of Speech-Language Pathology (SLP) education on a clinical setting in a Bulgarian University. During this study, adults who stutter (AWS) received intensive treatment (IT) to increase fluent speech. The intensive treatment was delivered by students trained in the SLP Master's degree program "Logopedics Management in Fluency and Voice Disorders". The La Trobe University intensive program of prolonged speech was implemented. SLP students were trained and delivered the IT for AWS, under supervision in all stages. The treatment followed a clinical modeling pattern. The primary outcomes were measured according to (i) percent of syllables stuttered (%SS) within and outside the stuttering research center of the university; (ii) self-reported inventory scores; and (iii) speech naturalness score evaluations from pre-treatment, immediately following treatment, 11 months post-treatment, and 18 months after the intensive treatment using stutter-free speech samples. The outcomes were reported for the overall IT program delivered by the SLP Master students. The treatment delivered by students can ensure objective speech outcomes. The evidence-based practice model allowed students to develop and master specific clinical skills in establishing fluent speech by applying a prolonged speech technique. During the IT experience, students began to incorporate elements of evidence-based practice (EBP), clinical expertise, and consider values held by AWS. After four outcome-sessions, the AWS developed self-consciousness about the quality of their prolonged speech during controlled fluent patterns. The participants produced objective speech fluency data and statistically significant differences before and immediately after the IT regarding %SS and overall speech naturalness.

BACKGROUND: Despite acknowledgement by various stakeholders that therapeutic alliance (TA) is an essential component of stuttering intervention, a comprehensive understanding of this concept is lacking in the field of speech and language therapy. There continues to be a significant gap in our knowledge regarding what adults who stutter (AWS) perceive to be the qualities and activities required by both themselves and the speech and language therapist (SLT) to facilitate an effective TA. Collection of such knowledge will support the establishment and maintenance of positive TA in clinical contexts and enhance treatment outcomes for those who stutter. OBJECTIVE: To explore the perspectives of AWS on the meaning of TA and the variables that influence its establishment and maintenance. METHODS: Semi-structured interviews were completed with eight AWS. The interview questions centred on three key topics: the conceptualisation of TA through the perspective of AWS; the activities and personal qualities of the SLT that influence TA; and the activities and personal qualities of the AWS that influence TA. RESULTS: Reflexive thematic analysis identified two overarching themes: ‘Recognising stuttering in a biopsychosocial context in order to enhance therapeutic alliance’ and ‘Person-related variables influencing therapeutic alliance’. In addition, five subthemes were identified which further illuminated each overarching theme. CONCLUSIONS: Findings of this study highlight the benefit of collecting patient-based evidence to support our understanding of TA. Results demonstrate the complexity of TA in stuttering intervention, and the impact that person-related variables have on its quality.

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Aphasia therapy works!

BackgroundGoal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person‐centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations.AimsA first step in developing theory and practical interventions is to explore first‐hand experiences of SLTs and clients about day‐to‐day goal‐setting practice. This study was guided by the following research question: What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services?Methods & ProceduresThe qualitative study was carried out in the setting of routine speech–language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video‐reflexive ethnography, using video footage of goal‐setting conversations to facilitate semi‐structured, reflexive interviews. Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client–SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs.Outcomes & ResultsData analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes.Conclusions & ImplicationsSLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal‐setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved.WHAT THIS PAPER ADDSWhat is already known on the subjectSLTs want to set meaningful goals together with their patients but lack theory and resources to effectively shape the goal‐setting process. Few studies have directly reported on the perspectives and needs of SLTs and patients regarding goal setting. Patients generally perceive goal setting as a vague activity in which they minimally participate. SLTs want to involve patients in the goal‐setting process and describe the potential benefits, but they also want to report barriers on the systemic and professional competence level.What this paper adds to the existing knowledgeSLTs and patients perceive shared goal setting as a multifaceted process, rather than a one‐off conversation. This process holds potential vulnerabilities for SLTs and patients alike, and the themes in this study propose potentially helpful ingredients to mediate this vulnerability and shape the goal‐setting process.What are the potential or clinical implications of this work?To take the first steps towards effective shared goal setting, SLTs should embrace the element of discovery in goal setting and apply their expert knowledge in supporting communication. To develop practical interventions for SLTs, shared goal setting needs to be further conceptualized and embedded in policy and clinical guidelines.

Qualitative analysis of bibliotherapy as a tool for adults who stutter and graduate students

Sir, Research studies show that speech therapy treatment for stuttering is available in early childhood,[1] but stuttering in adults is much less responsive to speech therapy.[2] Behavioral speech programs involving speech restructuring are the strongest evidence-based stuttering treatments for adults who stutter (AWS).[3] Hence, cognitive behavior therapy (CBT) has been used in the present case to examine the efficacy in the reduction of anxiety, reduction of avoidance behavior, reduction of frequency of stuttering, and increasing the social interaction, increasing self-esteem, increasing the positive thoughts and attitudes about verbal communication. Index patient Mr. NN was a 24-year-old postgraduate student, belonging to middle socioeconomic family and the younger of two brothers with normal birth and developmental history. He came with the chief complaints of dysfluent speech and difficulty to speak with authority persons and strangers for the last 5 years which have increased in the last 8 months. Dysfluent speech significantly impacted his personal and social life. The onset was insidious, and course of the disorder was progressive. He had poor self-esteem and negative automatic thoughts (NATs) that "I will stutter and I am inferior" as well as autonomic arousal such as sweating and palpitation during communication and interaction with teachers and strangers. Premorbid personality was well adjusted. No significant family and treatment history were reported by him. The patient was diagnosed as a case of stuttering (ICD-10 DCR, F98.5)[4] and was not having any concurrent diagnosis of psychiatric and medical illness or previous exposure to the cognitive behavioral intervention. The pre- and post-intervention assessments were done using Perceptions of Stuttering Inventory (PSI), Stuttering Severity Instrument (SSI), Modified Erickson Scale of Communication Attitudes (MESCA), Rosenberg Self-Esteem Scale (RSES), and Beck Anxiety Inventory (BAI). The CBT program consisted of 25 sessions and each session lasted for 45–50 min duration. CBT components included trust building, psychoeducation, deep breathing, relaxation techniques, cognitive restructuring, problem-solving, and prolongation technique. The prolongation is the speech production style used to facilitate fluency, where the person prolongs segments in spoken utterances. The client was asked to self-monitor and/or control the situations, where he stutters, and maintain a diary for the same. The cognitive-behavioral model of stuttering of Mr. NN is shown in Figure 1.Figure 1: The cognitive-behavioral model of stuttering: Mr. NNThe significant improvement was observed on both pre- and post-intervention scores on the following scales such as PSI (reduced from 42 to 19, 54.76%), SSI (reduced from 22 to 10, 54.54%), MESCA (reduced from 21 to 09, 57.14%), RSES (increased from 19 to 31, 63.15%), and BAI (reduced from 25 to 09, 64%). The severity level came down after implementing structured and need-based 25 sessions of CBT program. This clinically significant improvement was maintained at 1-year follow-up. The improvement criteria analysis was carried out calculating clinically significant changes (>50%) based on pre- and post-intervention scores. This case report highlights that the CBT program plays a vital role in managing NATs pertaining to stuttering, improve communication attitude, and boost self-confidence and self-esteem to face the social situation. The finding of this study is consistent with other studies, which also reported significant improvement in AWS.[5] In another study, it was noted that CBT treatment was associated with significant and sustained improvements in psychological functioning but did not improve fluency.[6] To conclude, CBT is effective in reducing anxiety and developing positive attitude, self-esteem, problem-solving skills, and communication competence in AWS. In the coming years, it would be interesting to compare different treatment modalities and the use of a combination of CBT and mindfulness techniques for the optimum benefit for the AWS. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Few previous randomized trials investigated whether additional therapies could improve the efficacy of the standard combined-approach (stuttering modification and fluency shaping) treatment in adults who stutter (AWS). To evaluate in a randomized controlled clinical trial whether the addition of a psychomotor therapy over a standard combined-approach treatment could improve the efficacy of treatment in young AWS. A total of 47 young AWS (mean age = 24 years, 79% males) with at least moderate stuttering (evaluated by the stuttering severity instrument-3, SSI-3 ≥ 21 points) were randomized to either a standard combined-approach treatment (24 AWS, control group, 16 sessions of 40 min over 8 weeks) or to standard treatment plus the psychomotor therapy (23 AWS, intervention group, adding 20 min of psychomotor training after each session). Stuttering improvement was assessed by reductions in SSI-3 scores, examined using Wilcoxon tests. The primary outcome was the difference in SSI-3 reductions between the control and intervention groups, evaluated by Mann-Whitney tests. Control and psychomotor intervention groups were well-balanced in most baseline characteristics, including stuttering severity (mean SSI-3 score = 32.6 points). After treatment both groups significantly reduced SSI-3 (mean absolute reduction = 10.1 points, 95% confidence interval (CI) = 8.5-11.7 points, p < 0.001), without any significant difference between the two groups (mean difference = 1.0 point, 95% CI = -2.2 to -4.2 points, p = 0.39). Also, there were no significant differences between the groups in relative percentage reductions, or in the proportion of individuals who reached a > 30% reduction or a post-treatment SSI-3 < 20 points. There were also no significant differences in separate SSI-3 components (frequency and duration of stuttering events and physical concomitants). This randomized controlled trial did not demonstrate any benefit of adding a psychomotor therapy over a standard combined-approach treatment in young AWS. ReBEC, identifier number RBR-6YY755. What is already known on the subject Two types of strategies to treat stuttering have been most widely used: stuttering management and fluency shaping. Although there is no consensus in the literature about the best strategy to treat stuttering, in general, comprehensive (combined) approaches seem to provide the best results. Furthermore, the development of psychomotor factors can help the individual to perform more efficient linguistic operations, thus favouring the development of its own communication and potentially improving stuttering. What this paper adds to the existing knowledge This randomized controlled trial did not demonstrate any benefit of adding a psychomotor therapy over a standard combined-approach treatment in young AWS. In addition to these results, this paper reinforces that the traditional speech-language treatment is highly effective in improving stuttering severity. What are the potential or actual clinical implications of this work? A psychomotor therapy did not improve the efficacy of the traditional combined-approach stuttering treatment in AWS, and it shall not be used. Otherwise, it reinforces the efficacy of the standard speech-language treatment even in AWS with a long-standing history of stuttering, which supports the effective approaches in clinical practice of speech-language pathologists worldwide.