Fluency Shaping Research Articles

Solution-Focused Brief Therapy for Stuttering in the Public Schools: Children Solve Their Own Stuttering Problems in This Case Study.

This clinical focus article follows the case studies of three school-age children who stutter in solution-focused brief therapy (SFBT), highlighting treatment features and demonstrating positive outcomes. Empowerment and self-agency are emphasized as desired characteristics. Children searched within themselves and acted to influence therapy results. Techniques such as self-disclosure and fluency shaping were incorporated into this approach. In a public school district, participants with moderate-to-severe stuttering used the Clinical Use of Self-Reports to measure their perceived stuttering severity across various contexts and audiences. The speech-language pathologist (SLP) provided verbal feedback/contingencies including personalized questions, supportive statements, and positive gestures/comments. The students identified a stuttering problem, implemented the suggested techniques in clinic and in their natural environments, and shared pertinent feedback during the following therapy sessions. Participants solved stuttering problems and took charge of their own treatment. After 5 weeks of SFBT, the 18-year-old demonstrated sufficient problem-solving skills to agree to be discharged from the program. The remaining two students exhibited growth toward their individualized goals. They showed curiosity about their own stuttering situations and applied innovative strategies, in the outside world, that had been practiced and formulated in their therapy sessions. The participants engaged in conversations with the SLP, teachers, peers, and family members. They documented conversations, reflections, performance scales, and personal goals in their journals. During therapy sessions, the children clarified real-life goals and tried out techniques for managing their stuttering difficulties. In addition, they completed the Clinical Use of Self-Reports to assess their communication values, successes, and challenges. https://doi.org/10.23641/asha.23706363.

Concealing Stuttering at School: "When You Can't Fix It…the Only Alternative Is to Hide It".

The purpose of this study was to explore experiences with concealing stuttering in children and young people who stutter based on recollections from adults. In addition, we explored how school-based speech therapists can be helpful or unhelpful to children who are concealing stuttering from the perspective of adults who stutter. Thirty adults who stutter, who previously or currently conceal stuttering, participated in semistructured interviews exploring their early experiences with hiding stuttering. Purposeful and random sampling was used to diversify experiences and opinions. Reflexive thematic analysis was used to develop themes and subthemes to describe participants' experiences. All participants in the study reported beginning to conceal stuttering at 18 years of age or younger, with more than two thirds sharing that they began in elementary school. Participants reported that exposure to implicit and explicit ableist messaging about stuttering and traumatic social experiences at school contributed to their inclination to hide disfluencies. Many participants described concealment as a strategy for protecting themselves from stigma. Several participants condemned fluency shaping, calling it harmful and likening it to teaching concealment. Participants believed that speech therapists could be helpful by promoting safe and supportive school environments and by being responsive to the social and emotional challenges that can accompany speaking differently and navigating stigma at school. Some children who stutter may attempt to protect themselves from stigma by concealing their disfluencies, but doing so can feel isolating and confusing. Speech therapists can play an important role in making the school environment safer and more supportive for children who stutter.

EFFECTS OF PROLONGATION OF SPEECH AND SYLLABLE TIME SPEECH ON REDUCTION OF SEVERITY OF STUTTERING IN STUTTERING PATIENTS

Background: Stuttering is an organic process utterance condition. This utterance condition is broken by prolongation of sounds and repetitions of part words and phrases. Speech constitution strategies facilitate the client to use a new way of oral communication in stutters. Objective: to determine the effects of prolongation of speech and syllable time speech on reduction of severity of stuttering in stuttering patients. Methods This Randomized clinical trial study design was conducted in National Institute of Rehabilitation Medicine Islamabad. A total of n=30 participants of both gender having developmental stuttering with age between 20-30 years were included in the study through purposive sampling. The n=30 participants were randomly divided in to Group A received prolonged speech protocol (PSP) and Group B received syllable time speech protocol. The data was collected using the Scale of rating severity of stuttering (SRSS) at baseline, after 6th weeks and after 12th weeks of training. The data was analyzed through SPSS-21. Results The mean age of the study participants was 22±2.05 years. The median number of sibling was 4(2), birth order 2.5(2) and age of onset was 4(1) years. With-in group analysis showed that the group received prolong speech protocol {F=25.24(2), p<0.001} and syllable time speech protocol {F=29.52(2), p<0.001}, both were significantly improved from the baseline to the end of 12th week of intervention as well as at each level of assessment. While comparing the groups, there was significantly large mean difference (MD) of SRSS in group received syllable time speech protocol (2.53±.83 ver 1.73±.59, p=0.005, Cohen’s d=0.72) as compared to group received prolong speech protocol. Conclusion It is concluded that Syllable time speech was effective in reducing severity of stuttering and improving fluency in stutterers. . Key words: Stuttering, stammering, fluency shaping therapy, speech therapy.

THE COMPARISON OF EASY ONSET AND PANTOMIMING TREATMENT ON BLOCKING IN STAMMERING

Background: Stammering is a speech fluency disorder categorized by repetitions, prolongations and blocks that interrupt the normal flow and forward movement of speech. The Fluency shaping techniques including Easy Onset and Pantomiming treatment are commonly used techniques for the management of stuttering. Objective: To compare the effectiveness of Pantomiming and easy onset method for the treatment of blocks in stammering in school aged children. Material & Method: A randomized control trial (NCT04813588) was conducted in hospitals of Rawalpindi and Islamabad. The Convenient sampling technique was used for data collection from National Institute of Rehabilitation Medicine (NIRM). The sample size was n=16, randomly divided in Easy onset (n=8) and Pantomiming (n=8) through lottery method. The schools going children and adolescent between 6-18 years of both genders with mild to moderate stammering with blocking symptoms were included. The severity of stuttering was assessed with real time analysis of speech fluency. The data was analysed at the baseline and after three months of intervention. The non-parametric tests were applied for within and between group analyses. Results: The mean age of the participants was 10.38±5.290 years. A total n=11 were males and n=5 were females. When compared both groups, there was no significant difference between Easy onset and Pantomiming technique {MR=9 vs MR=8, U=28, p=0.535} in the management of stuttering after three months of intervention. Conclusion: The easy onset and pantomiming techniques are equally effective in improving the blocking in stuttering. Keywords: Blocks, easy onset, fluency shaping, pantomiming, speech therapy, stammering, stuttering

EFFICACY OF DIGITAL MANIPULATION OF THYROID CARTILAGE, FLUENCY SHAPING THERAPY AND COMBINATION OF BOTH IN TREATMENT OF STUTTERING SEVERITY: A RANDOMIZED CLINICAL TRIAL

Background: The stuttering is manifested by disruption in normal speech flow and fluency that also disturbs social and emotional wellbeing. There is immediate need of rehabilitation for the improvement of fluency and reduce the severity of stuttering.Objective:To compare the digital manipulation of thyroid cartilage (DMTC), fluency shaping therapy (FST) and combination of DMTC and FST for improving severity in stuttering patients. Material and Method: A randomized clinical trial was conducted at National Institute of Rehabilitation Medicine. The patients were enrolled through non-probability, convenient sampling technique. The participants were randomly allocated into three equal groups (n=10): DMTC group, FST group and combination of both. The Scale of Rating Severity of Stuttering (SRSS) was used to assess the severity level at baseline, 2ndweek, 4thweek, 8thweek and 12thweek of intervention.Results: The mean age of DMTC, FST and combination group was, 22.25 ±3.33 years, 21.65±3.36 and 21.35±3.76 years respectively. Friedman with post hoc test revealed significant improvement (p<0.05) in all groups but combination group had showed better outcome than single DMTC and FST intervention. A Kruskal-Wallis H test showed that there was no significant difference (p≥0.05) among DMTC, FST and Combination group from baseline to 8thweeks of training, but significant difference {X2(2) =5.897, p<0.014} was observed after 12thweek of training among the groups. The post hoc test showed that the combination group was more significantly improved as compared to DMTC group {MR=9.10 ver. MR=17.71, p=0.012} but not significant difference between difference between combination and FST group (p=0.317) as well as DMTC and FST group (p=0.619) regarding severity of stuttering. Conclusion: It is concluded that combination of digital manipulation of thyroid cartilage and fluency shaping therapy were more beneficial for improving fluency in stuttering patients. Key words:Digital manipulationtherapy,fluency shaping therapy, stammering, stuttering.

Lexipontix Program: Facilitating Change toward "Best Hopes" of the School-Age Child Who Stutters and the Family.

Lexipontix is a structured therapy program for school-age children who stutter. It is based on theoretical principles and clinical practices of cognitive behavioral therapy, parent-child interaction therapy, solution-focused brief therapy, fluency shaping, and stuttering modification. A case example of a school-age child who stutters and his family who participated in the Lexipontix program is illustrated to highlight the theoretical principles, structure, content, and clinical tools of the assessment and therapy process of the program. The Lexipontix program addresses the stuttering experience of the child and family in a holistic way. The child and family are assisted in facilitating changes in all components of the International Classification of Functioning, Disability, and Health model (i.e., body function, personal factors, activity and participation, environmental factors), which help them move toward their "best hopes" (i.e., personally meaningful change) from therapy. The role of the clinician in facilitating change is also considered. Therapy outcomes for the specific case example are presented and discussed in relation to data from a retrospective chart review. The mechanisms underlying the effectiveness of the program are explored and discussed.

Fluency shaping increases integration of the command-to-execution and the auditory-to-motor pathways in persistent developmental stuttering

Fluency-shaping enhances the speech fluency of persons who stutter, yet underlying conditions and neuroplasticity-related mechanisms are largely unknown. While speech production-related brain activity in stuttering is well studied, it is unclear whether therapy repairs networks of altered sensorimotor integration, imprecise neural timing and sequencing, faulty error monitoring, or insufficient speech planning. Here, we tested the impact of one-year fluency-shaping therapy on resting-state fMRI connectivity within sets of brain regions subserving these speech functions. We analyzed resting-state data of 22 patients who participated in a fluency-shaping program, 18 patients not participating in therapy, and 28 fluent control participants, measured one year apart. Improved fluency was accompanied by an increased connectivity within the sensorimotor integration network. Specifically, two connections were strengthened; the left inferior frontal gyrus showed increased connectivity with the precentral gyrus at the representation of the left laryngeal motor cortex, and the left inferior frontal gyrus showed increased connectivity with the right superior temporal gyrus. Thus, therapy-associated neural remediation was based on a strengthened integration of the command-to-execution pathway together with an increased auditory-to-motor coupling. Since we investigated task-free brain activity, we assume that our findings are not biased to network activity involved in compensation but represent long-term focal neuroplasticity effects.

Stuttering Disorder Therapy Using Aristotle’s Rhetoric Method In The King’s Speech Movie

Stuttering is a speech disorder that can be caused by many aspects such trauma, incident, and illness because there is no one born with this kind of speech disorder. The researcher in this study is focused on how Fluency Shaping Therapy and Stuttering Modification Therapy were used by Lionel, can reduce Bertie’s stuttering utterance. In addition, this study is using descriptive qualitative method to analyze and describe the data. Moreover, the data in this study is in the form of dialogues between Bertie and Lionel that were collected from The King’s Speech movie using analysis document. Then, the collected data is analyzed by data condensation, data analysis, and conclusion. The result shows that these two stuttering treatments (stuttering modification and fluency shaping which part of motor learning study) can be effective therapies because each of them has procedures that can support each other. In conclusion, stuttering is not an illness that human born along with but can be caused by many things and this speech disorder cannot be cured but can be reduced and modified using two methods, stuttering modification and fluency shaping therapy. Both of them can be combined together with Aristotle’s Rhetoric as a method to teach public speaking especially those who are having problems with stuttering.

Two cortical representations of voice control are differentially involved in speech fluency.

Recent studies have identified two distinct cortical representations of voice control in humans, the ventral and the dorsal laryngeal motor cortex. Strikingly, while persistent developmental stuttering has been linked to a white-matter deficit in the ventral laryngeal motor cortex, intensive fluency-shaping intervention modulated the functional connectivity of the dorsal laryngeal motor cortical network. Currently, it is unknown whether the underlying structural network organization of these two laryngeal representations is distinct or differently shaped by stuttering intervention. Using probabilistic diffusion tractography in 22 individuals who stutter and participated in a fluency shaping intervention, in 18 individuals who stutter and did not participate in the intervention and in 28 control participants, we here compare structural networks of the dorsal laryngeal motor cortex and the ventral laryngeal motor cortex and test intervention-related white-matter changes. We show (i) that all participants have weaker ventral laryngeal motor cortex connections compared to the dorsal laryngeal motor cortex network, regardless of speech fluency, (ii) connections of the ventral laryngeal motor cortex were stronger in fluent speakers, (iii) the connectivity profile of the ventral laryngeal motor cortex predicted stuttering severity (iv) but the ventral laryngeal motor cortex network is resistant to a fluency shaping intervention. Our findings substantiate a weaker structural organization of the ventral laryngeal motor cortical network in developmental stuttering and imply that assisted recovery supports neural compensation rather than normalization. Moreover, the resulting dissociation provides evidence for functionally segregated roles of the ventral laryngeal motor cortical and dorsal laryngeal motor cortical networks.

Speech restructuring group treatment for 6-to-9-year-old children who stutter: A therapeutic trial

For children who stutter (CWS), there is good evidence of the benefits of treatment for pre-school age, but an evidence gap for elementary school age. Here we report on the effectiveness of a fluency shaping treatment for 6- to 9-year-old children. The main treatment component is the reinforcement of soft voice onsets. An intensive in-patient group treatment phase lasts 6 days, followed by a 6-month maintenance phase with 3 in-patient weekend group refresher courses. Child and a parent participate together in various treatment activities. In this controlled intervention study (waitlist control, intention-to-treat design) assessments were performed before treatment (T1), 4 weeks after the intensive phase (T2), at the end of the maintenance phase (T3), and 1 year later (T4). Participants were 119 children (108 boys, 11 girls, age 5.5‑10.4 years). Control conditions included a subgroup with delayed treatment (N=25) as well as the assessment of complexity of utterances, inter-rater reliability, and speech naturalness. From before treatment to 1-year follow-up, percent stuttered syllables and OASES-S (Overall Assessment of the Speaker’s Experience with Stuttering - School-age) scores decreased with large effect size. Speech naturalness improved during this period but did not reach the level of non-stuttering children. Complexity of utterances increased during the intensive phase, but only temporarily. Twenty children (16.8 %, including dropouts) showed no demonstrable treatment benefit. Fluency shaping treatment can be effectively applied to young school children. It is assumed that parental support, group therapy, intensive treatment, and regular exercises at home are essential.

Surface Electrical Stimulation for Persistent Stuttering and Concomitant Orofacial Disorders: A Multiple Case Study.

This multiple case study analysis describes the immediate effects on speech fluency of transcutaneous electrical nerve stimulation (TENS) applied to participants with persistent stuttering and concomitant orofacial disorders. Study participants were 14 adolescents and adults who stuttered and had jaw clenching bruxism or mouth breathing. Participants experienced low-frequency TENS applied at mild motor level for 20 minutes with electrodes placed at the lower third of the face (Area A), submandibular region (Area B), posterior neck (Area C), or shoulder girdle (Area D), with speech fluency assessed immediately before and after each stimulation.For participants with stuttering and bruxism, AB stimulation reduced the median frequency of syllables stuttered by 27% and reduced the median duration of the three highest stuttering moments by 29%. In addition, for participants with stuttering and mouth breathing, CD stimulation reduced the median duration of the three highest stuttering moments by 28% and increased their median speech rate by 113%. As a single session of TENS may help participants with stuttering and concomitant orofacial disorders better use fluency shaping techniques, the therapeutic potential of TENS for treating stuttering should be further investigated.

Fluency Strategies of Spanish–English Bilinguals Who Stutter: A Thematic Analysis

Purpose Stuttering is multifaceted in that the frequency and types of behaviors vary across speakers, contexts, and languages. Similarly, bilingualism varies in language history, levels of proficiency, and languages spoken. The variations in bilingualism make it difficult to investigate and result in knowledge gaps about the bilingual stuttering experience. The purpose of this exploratory, qualitative study is to identify and examine fluency-inducing strategies used by Spanish–English bilingual adults who stutter. Method Twenty Spanish–English bilingual adults who stutter, ages 18–61 years, answered open-ended questions about their stuttering and language history via an online survey. Thematic analysis procedures were used to explore participants' narrative responses to 2 survey items regarding fluency-inducing strategies. Result Three major themes emerged from participants' responses regarding self-reported strategies: (a) clinical techniques, (b) focused breathing, and (c) idiosyncratic practices. Participants reported using clinical techniques classified as fluency shaping, stuttering modification, or both approaches. Focused breathing was used as both an anticipatory and a recovery strategy. Idiosyncratic practices included physiological changes, listener-focused strategies, emotional regulation, and switching words. When asked specifically about use of code-switching for the 2nd question, half of the participants stated that they do switch languages to induce fluency. Conclusion Clinical implications include the need for individualized client education, a thorough assessment of avoidance and escape behaviors, and customized treatment programs for bilinguals who stutter.

Speech fluency disorders in childhood and adolescence

Persistent speech fluency disorders, mostly stuttering and less frequently cluttering, occur in approximately 1% of children and adolescents. They considerably impair the social participation and quality of life of those affected. The German interdisciplinary evidence-based S3 guidelines provide information about the pathogenesis, diagnostics and treatment of speech fluency disorders and contain asystematic review on the efficacy of stuttering treatment. For preschool children the Lidcombe therapy shows the best evidence of efficacy. Strong evidence also exists for an indirect approach. For adolescents and recently for children aged 6‑12 years old there is ahigh level of evidence for speech restructuring methods, such as fluency shaping. There is weak evidence for stuttering modification procedures and for combined speech restructuring and stuttering modification approaches. Negative evidence exists for the eclectic, unspecified stuttering therapies, breathing regulation, and hypnosis, which are frequently applied in Germany. An early start of treatment is decisive.

Clinical trial of the D.E.L.P.H.I.N. speech treatment for children and adolescents who stutter

Purpose: The present trial investigated the D.E.L.P.H.I.N. (Deblockierungsimpuls, Entspannung, Logopädie, Phonetik, Hör-Wahrnehmungstraining, Intensität, nasaler Schwingungsakzent) speech treatment for children and adolescents who stutter, an approach using fluency shaping with an intensive time schedule and group sessions.Methods: Participants were 42 male and 14 female persons who stuttered with a median age of 13.0 years. Participants and their parents completed the strength and difficulties questionnaire at the beginning of the therapy and 1 year later. Participants completed the Speech Questionnaire, an instrument to measure the impact of stuttering, twice before and twice after completing the therapy. The stuttering rate and mean length of the three longest stuttering events were studied four times in videos of interviews, reading texts and three telephone calls. Outcomes are reported for the 56 children and young adults who stuttered and who completed D.E.L.P.H.I.N. The main analysis was performed using linear mixed models.Results: Quality of life as measured in the Strength and Difficulties Questionnaire (SDQ) – filled in by the participants/their parents – increased significantly from before the start of the therapy to 1 year after completion of the therapy. The subjective rating of the impact of stuttering also improved significantly. The stuttering rate and mean length of the longest stuttering event decreased significantly for all three modes from pre-treatment to 12 months post-treatment.Conclusions: After D.E.L.P.H.I.N., a significant improvement of the relevant endpoints quality of life, impact of stuttering, and severity of stuttering is observed.

Incorporating a Mindfulness Meditation Exercise Into a Stuttering Treatment Program

A mindfulness meditation exercise was incorporated into a stuttering treatment program for an adult male who stutters. Speech disfluencies were analyzed before and after mindfulness meditation and implementation of fluency shaping techniques. Findings suggested that including a mindfulness meditation exercise into a treatment program may be helpful for people who stutter.

The Pathogenesis, Assessment and Treatment of Speech Fluency Disorders.

Approximately 1% of children and adolescents, 0.2% of women, and 0.8% of men suffer from stuttering, and lesser numbers from cluttering. Persistent speech fluency disorders often cause lifelong problems in communication and social participation. In an interdisciplinary, evidence and consensus based clinical practice guideline, the current understanding of the nature, identification, diagnosis, and treatment of stuttering and cluttering was summarized. A systematic review of the literature was carried out to assess the efficacy and effectiveness of treatments for stuttering. Evidence is lacking on the etiology, pathogenesis, evaluation, and treatment of cluttering. In view of the fact that common (developmental, idiopathic) stuttering is associated with structural and functional changes of the brain, the guideline recommends that it should be called "originary neurogenic non-syndromic stuttering." Heritability estimates for this disorder range from 70% to over 80%. For preschool children, the Lidcombe therapy has the best evidence of efficacy (Cohen's d = 0.72-1.00). There is also strong evidence for an indirect treatment approach. For children aged 6 to 12, there is no solid evidence for the efficacy of any treatment. For adolescents and adults, there is good evidence with high effect sizes (Cohen's d = 0.75-1.63) for speech restructuring methods such as fluency shaping; weak evidence with intermediate effect sizes for stuttering modification (Cohen's d = 0.56-0.65); and weak evidence for combined speech restructuring and stuttering modification. The evidence does not support the efficacy of pharmacotherapy, rhythmic speaking, or breathing regulation as the sole or main form of treatment, or that of hypnosis or eclectic, unspecified stuttering therapies. Stuttering is often treated in Germany with therapies for which there is inadequate evidence, and the initiation of treatment is often unnecessarily delayed. The guideline presents treatment methods whose efficacy is supported by the current evidence.

Speaking-related changes in cortical functional connectivity associated with assisted and spontaneous recovery from developmental stuttering

We previously reported speaking-related activity changes associated with assisted recovery induced by a fluency shaping therapy program and unassisted recovery from developmental stuttering (Kell et al., Brain 2009). While assisted recovery re-lateralized activity to the left hemisphere, unassisted recovery was specifically associated with the activation of the left BA 47/12 in the lateral orbitofrontal cortex. These findings suggested plastic changes in speaking-related functional connectivity between left hemispheric speech network nodes.We reanalyzed these data involving 13 stuttering men before and after fluency shaping, 13 men who recovered spontaneously from their stuttering, and 13 male control participants, and examined functional connectivity during overt vs. covert reading by means of psychophysiological interactions computed across left cortical regions involved in articulation control.Persistent stuttering was associated with reduced auditory-motor coupling and enhanced integration of somatosensory feedback between the supramarginal gyrus and the prefrontal cortex. Assisted recovery reduced this hyper-connectivity and increased functional connectivity between the articulatory motor cortex and the auditory feedback processing anterior superior temporal gyrus. In spontaneous recovery, both auditory-motor coupling and integration of somatosensory feedback were normalized. In addition, activity in the left orbitofrontal cortex and superior cerebellum appeared uncoupled from the rest of the speech production network.These data suggest that therapy and spontaneous recovery normalizes the left hemispheric speaking-related activity via an improvement of auditory-motor mapping. By contrast, long-lasting unassisted recovery from stuttering is additionally supported by a functional isolation of the superior cerebellum from the rest of the speech production network, through the pivotal left BA 47/12.

Efficacy of the Arabic Modified Fluency Shaping Program in the treatment of stuttering

Abstract The goal of fluency-shaping approaches is not to modify stuttering but rather to completely replace it with fluent speech. This is achieved by applying a range of fluency-controlling techniques, usually implemented within a slow-speech framework, which fundamentally changes the way that respiration, phonation, and articulation are coordinated for speech. The present study aimed at evaluating the efficacy of the Arabic Modified Fluency Shaping Program as a valuable treatment approach for Egyptian stutterers. The study design was a prospective longitudinal experimental controlled one. The present work was carried out on 100 stutterers of both sexes in the age range of 8–20 years. The participants were divided into two groups: the study group and the control group. A multidimensional assessment protocol was used for all participants. It included elementary diagnostic procedures (personal interview, visual perceptual assessment, and auditory perceptual assessment), clinical diagnostic aids (Stuttering Severity Instrument for Children and Adults-Arabic version, speech rate, psychometric evaluation, and assessment of feelings and attitudes using speech performance self-reported questionnaire), and additional instrumental measures (spectrographic assessment and Visi Pitch). Therapy program: Participants in the study group were trained using the Arabic Modified Fluency Shaping Program. The study group achieved better outcome with the therapeutic program regardless of the age of the patient at the time of therapy. There was marked reduction in mean total score of Stuttering Severity Instrument for Children and Adults-Arabic version in the study group and was 1.48, 1.66, and 2.12, respectively, during post-therapy, first follow-up, and second follow-up evaluations compared with 25.36 during the pretherapy evaluation. As regards spectral analysis, there were higher post-therapeutic values for voice onset time, vowel duration, syllable duration, and shorter sentence duration. As regards Visi Pitch, there were lower post-therapeutic values for percent voiced and percent pause and a higher value for the percent unvoiced, which denotes improvement. The results of speech performance self-reported questionnaire showed an increase in patient’s satisfaction with speech and trust in their abilities as a speaker; there was also a decrease in avoidance of speaking situations and speaking on the phone after therapy. The results of this study indicated the efficacy of the Arabic Modified Fluency Shaping Program in rehabilitation of stuttering. The presented program provides participants with strategies that significantly improve their speech behavior and their attitudes toward speech.

Randomized clinical trial: the use of SpeechEasy® in stuttering treatment.

Numerous studies have demonstrated the benefit of devices delivering altered auditory feedback (AAF) as a therapeutic alternative for those who stutter. The effectiveness of a device delivering AAF (SpeechEasy®) was compared with behavioural techniques in the treatment of stuttering in a randomized clinical trial. Two groups of adults who stutter participated: group 1 consisted of 10 men and one woman aged 21-42 years (mean = 30.0). Group 2 consisted of six men and one woman aged 20-50 years (mean = 35.6). Participants in group 1 were fit with a SpeechEasy® device and were not given any additional training (i.e., supplementary fluency enhancing techniques). Participants used the device daily for 6 months. Participants in group 2 received treatment in the form of a 12-week fluency promotion protocol with techniques based on both fluency shaping and stuttering modification. There were no statistically significant differences (p > .05) between groups in participants' stuttered syllables following treatment. That is, both therapeutic protocols achieved approximately 40% reduction in number of stuttered syllables from baseline measures, with no significant relapse after 3 or 6 months post-treatment. The results suggest that the SpeechEasy® device can be a viable option for the treatment of stuttering.

A Report on the Development and Clinical Application of Lexipontix, a New Therapy Programme for School age CWS

The development of ‘Lexipontix’, a structured therapy programme for children who stutter (CWS)8 to 12 years, is presented. ‘Lexipontix’ is based on principles and clinical practices of Cognitive Behavioural Therapy, Parent-Child Interaction Therapy, Solution Focused Brief Therapy, Fluency Shaping and Stuttering Modification Therapy. Therapy aims at ‘Communication Restructuring’ and is based on a metaphor and a theme. It develops as a rolegame between a ‘Superhero’ (the child), an ‘Alliance’ (the family) and a naughty mouse called ‘Lexipontix’. Two case examples are presented. Formal and informal assessment results are discussed in relation to the structure and the content of the programme.