Intensive speech-language pathology therapy with adults who stutter: preliminary study

Miranda, Amanda Caroline Pereira da Silva; Ninno, Camila Queiroz de Moraes Silveira Di; Britto, Denise Brandão de Oliveira e

doi:10.1590/2317-1782/20232021159pt

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Brief Communication • CoDAS 35 (3) • 2023 • https://doi.org/10.1590/2317-1782/20232021159en linkcopy

Intensive speech-language pathology therapy with adults who stutter: preliminary study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To compare the results of fluency and self-perception of the impact of stuttering on the lives of adults who stutter, before and after undergoing intensive speech-language pathology therapy.

Methods This is a descriptive and longitudinal study with data collection before and after intensive therapy in four patients who stutter. The intensive care program consisted of thirty one-hour sessions held in five individual sessions a week. Speech samples collected before and after therapy were analyzed by two fluency experts. Descriptive data analysis was performed through the frequency distribution of categorical variables and analysis of measures of central tendency and dispersion of continuous variables. The verification of agreement between the evaluations carried out by the two judges was performed using the intraclass correlation coefficient (ICC). Correlation analysis was also performed using Spearman's rank correlation coefficient between the variables in the speech sample and the OASES-A scores.

Results There was a reduction of the percentage of stuttering disfluencies, increasing the flow of words per minute of the participants. The descriptive analysis of the OASES-A showed a decrease in the degree of impact of stuttering on the participants' lives in all parts of the questionnaire.

Conclusion There was an improvement in all variables analyzed after intensive care, including an improvement in speech fluency and a reduction in the impact of stuttering on the participants' lives, which suggests the relevance of the intensive speech therapy proposal for stuttering.

Keywords:
Speech Therapy; Language; Language Disorders; Childhood-Onset Fluency Disorder; Stuttering

Sessions	Objectives	Strategies
1	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
		● Definition of Stuttering;
		● Actions that affect stuttering positively or negatively;
	● To learn how to make smooth and continuous articulatory contact point (Fluency Modeling)	● Conceptualization of Difficult Speech and Easy Speech;
		● Characteristics of negative speech and practice (100% tension, 50% tension, and smoothed) with a ball: picture naming
2	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works	● Breathing exercises;
	● To simplify stuttering and get up-to-date scientific information	● Orofacial motricity exercises;
	● To perceive different ways of producing speech (Awareness)	● Dynamics: Speech Machine;
		● Dynamics: Machine failing
		● Myths and Truths about Stuttering
	● To learn how to make and use smooth and continuous articulatory contact point (Fluency Modeling)	● Characteristics of negative speech and practice (100%, 50%, and smoothed) with a ball:
		o Picture naming;
		● Reading word lists looking in the mirror and looking at the therapist.
3	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works	● Breathing exercises;
	● To perceive different ways of producing speech (Awareness)	● Orofacial motricity exercises;
		● Dynamics: Crazy Speech;
	● To learn how to make and use smooth and continuous articulatory contact point (Fluency Modeling)	● Characteristics of negative speech and practice (100%, 50%, and smoothed) with a ball:
		o Own name;
		o Other names, other naming and brainstorming.
4	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works	● Breathing exercises;
	● To simplify stuttering and get up-to-date scientific information (Awareness)	● Orofacial motricity exercises;
		● Myths and Truths about Stuttering;
	● To know and reduce negative emotions (Desensitization)	● Dynamics: Stuttering Iceberg
	● To learn how to make and use smooth and continuous articulatory contact point (Fluency Modeling)	● Characteristics of negative speech and practice (100%, 50%, and smoothed) with a ball:
		● Other names, other naming and brainstorming.
5	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works	● Breathing exercises;
	● To perceive tension points (Awareness)	● Orofacial motricity exercises;
		● Perception of speech tension points;
	● To learn how to make and use smooth and continuous articulatory contact point (Fluency Modeling)	● Perception of Easy Speech / Normal Speech / Difficult Speech;
		● Characteristics of negative speech and practice (smoothed) with a spring:
		● Repetition of sentences.
6	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To know and reduce negative emotions (Desensitization)	● Good and bad thoughts related to stuttering;
	● To learn and use smooth and continuous articulatory contact point (Fluency Modeling)	● Characteristics of negative speech and practice (smoothed) with a spring:
		o Repetition of sentences;
		o Reading sentences looking in the mirror and looking at the therapist.
7	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To know and reduce negative emotions (Desensitization)	● Role-playing everyday situations;
	● To learn and use smooth and continuous articulatory contact point (Fluency Modeling)	● Characteristics of negative speech and practice (smoothed) with a spring:
		o Reading sentences looking in the mirror and looking at the therapist;
		o Complete ready-made sentences with figures from the deck;
		o Create spontaneous sentences with figures from the deck.
		o Connected speech training with line.
8	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To learn and use smooth and continuous articulatory contact point (Fluency Modeling)	● Characteristics of negative speech and practice (smoothed) with a spring:
		o Complete ready-made sentences with figures from the deck;
		o Create spontaneous sentences with figures from the deck.
		o Role-playing conversations with the line.
9	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To learn and use smooth and continuous articulatory contact point (Fluency Modeling)	● Communicative Skills Training: Waiting Time (2”), Communicative Turn and Eye Contact:
	● To develop skills that promote good communication, promoting self-confidence and security, integrating them with smoothing (Communicative Skills)	o Picture naming;
		o Reading word lists looking in the mirror and looking at the therapist.
10	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To learn and use smooth and continuous articulatory contact point (Fluency Modeling)	● Communicative Skills Training: Waiting Time (2”), Communicative Turn and Eye Contact:
	● To develop skills that promote good communication, promoting self-confidence and security, integrating them with smoothing (Communicative Skills)	o Own name;
		o Other names, other naming and brainstorming;
		o Repetition of sentences looking in the mirror and looking at the therapist.
11	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech and stuttering works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To accept the presence of stuttering and learn to use strategies to change it (Stuttering Modification)	● Volunteer Stuttering Training:
		o Picture naming;
		o Own name;
		o Formulation of sentences.
12	● To facilitate voice production	● Body relaxation;
	● To understand how fluent speech works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To learn and use smooth and continuous articulatory contact point (Fluency Modeling)	● Communicative Skills Training: Waiting Time (2”), Communicative Turn and Eye Contact:
	● To develop skills that promote good communication, promoting self-confidence and security, integrating them with smoothing (Communicative Skills)	o Other names, other naming and brainstorming;
		o Repetition of sentences looking in the mirror and looking at the therapist;
		o Description of the characteristics, parts and functions of objects.
	● To accept the presence of stuttering and learn to use strategies to change it (Stuttering Modification)	● Volunteer Stuttering Training:
		● Picture naming;
13	● To facilitate voice production	● Mouth relaxation;
	● To understand how fluent speech works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To accept the presence of stuttering and learn to use strategies to change it (Stuttering Modification)	● Volunteer Stuttering:
		o Picture naming;
		o Own name;
		o Formulation of sentences;
		o Repetition of sentences looking in the mirror and looking at the therapist.
14	● To facilitate voice production	● Mouth relaxation;
	● To understand how fluent speech works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To accept the presence of stuttering and learn to use strategies to change it (Stuttering Modification)	● Cancellation and Skipping
		o Picture naming;
		o Own name;
		o Reading word lists looking in the mirror and looking at the therapist.
15 16, 17,18 and 19	● To facilitate voice production	● Mouth relaxation;
	● To understand how fluent speech works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To use stuttering modification techniques associated with skills that promote good communication, integrating them with smoothing (Fluency Modeling, Stuttering Modification and Communicative Skills)	● Waiting Time Training (2”), Communicative Turn, Eye Contact and Cancellation and Skipping Techniques:
		o Picture naming;
		o Own name;
		o Reading word lists looking in the mirror and looking at the therapist.
		o Formulation of sentences.
20, 21 and 22	● To facilitate voice production	● Mouth relaxation;
	● To understand how fluent speech works (Awareness)	● Breathing exercises;
		● Orofacial motricity exercises;
	● To use stuttering modification techniques associated with skills that promote good communication, integrating them with smoothing (Fluency Modeling, Stuttering Modification and Communicative Skills)	● Communication Skills Training and Cancellation and Skipping Techniques;
	● Knowing and reducing negative emotions (Desensitization)	● Role-playing everyday situations;
23	● To facilitate voice production	● Breathing Control;
	● To maintain and use the strategies and fluency patterns obtained in previous sessions	● Speech Training:
		o Reduction in the number of breaks per minute;
		● Perceiving the fluency;
		● Dealing with speech:
		o Aspects to remember;
		o Speech diary;
		o Warning the listener.
24	● To facilitate voice production	● Breathing Control;
	● To maintain and use the strategies and fluency patterns obtained in previous sessions	● Speech Training:
		o Reduction in the number of breaks per minute;
		● Perceiving the fluency;
		● Controlling negative thoughts:
		o Bob and Ken story;
		o How to avoid negative thoughts;
		o Change Table.
25	● To maintain and use the strategies and fluency patterns obtained in previous sessions	● Speech Training:
		o Reduction in the number of stuttering episodes per 5 minutes;
		o Speech pause.
		● Keeping the fluency:
		o What helps maintain fluency;
		o How to deal with speech before, during and after stuttering.
		● Managing negative stress:
		o Keeping a calm attitude;
		o Looking after the environment;
		o Taking care of comfort;
		o Taking care of the health.
26	● To maintain and use the strategies and fluency patterns obtained in previous sessions	● Speech Training:
		o Reduction in the number of stuttering episodes per 5 minutes;
		o Speech pause.
		● Facing the phone training in therapy:
		o Phone call simulation.
27	● To maintain and use the strategies and fluency patterns obtained in previous sessions	● Speech Training:
		o Reduction in the number of stuttering episodes in the conversation;
		o Speech rate control.
		● Facing the phone:
		o Phone call to acquaintances.
28	● To maintain and use the strategies and fluency patterns obtained in previous sessions	● Speech Training:
		o Reduction in the number of stuttering episodes in the conversation;
		o Speech rate control.
		● How to control tension;
		o Alone
		o While standing in a public place;
		o While sitting in public places.
		● Facing the phone:
		o Phone call to acquaintances;
		o Phone call to strangers.
29	● To maintain and use the strategies and fluency patterns obtained in previous sessions	● Simulation of tension control:
		o Alone
		o While standing in a public place;
		o While sitting in public places.
		● Conversation about preventing relapses in speech control;
		● Facing the phone:
		o Phone call to acquaintances;
		o Phone call to strangers.
30	● To collect data for evaluation after intensive care	● Speech Sample Collection;
		● OASES-A questionnaire application;
		● Final guidance;
		● Analysis of speech samples of the patient pre- and post-therapy:
		● Self-assessment.

Variables	Pre-Therapy PAPF	Post-Therapy PAPF	Pre-Therapy OASES	Post-Therapy OASES
Participant #1
Percentage of speech discontinuity	95.5%	39.4%	Grade 4	Grade 3
Percentage of stuttering disfluencies	70.0%	23.1%	Moderate to Severe	Moderate
Speech rate (words per minute)	14.6	37.4
Speech rate (syllables per minute)	23.9	66.3
Participant #2
Percentage of speech discontinuity	11.2%	2.3%	Grade 3	Grade 2
Percentage of stuttering disfluencies	3.1%	0.9%	Moderate	Mild to moderate
Speech rate (words per minute)	147	113.0
Speech rate (syllables per minute)	304	215.0
Participant #3
Percentage of speech discontinuity	36.6%	23.0%	Grade 3	Grade 2
Percentage of stuttering disfluencies	27.6%	18.0%	Moderate	Mild to moderate
Speech rate (words per minute)	30.1	40.2
Speech rate (syllables per minute)	57.5	77.9
Participant #4
Percentage of speech discontinuity	29.3%	2.3%	Grade 4	Grade 3
Percentage of stuttering disfluencies	22.7%	0.4%	Moderate to Severe	Moderate
Speech rate (words per minute)	48.7	138.7
Speech rate (syllables per minute)	91.0	267.0

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[1] Source: Prepared by the authors based on strategies from PFPF(⁸) and Fluency Workshop(⁹)