Surgery – Speech correction/therapy
Reexamination Certificate
1995-05-02
2001-05-15
Lacyk, John P. (Department: 3736)
Surgery
Speech correction/therapy
C704S271000
Reexamination Certificate
active
06231500
ABSTRACT:
BACKGROUND OF THE INVENTION
There are many theories as to the origin, nature, and best treatment of stuttering. Many speech pathologists believe that the root of stuttering is an inability to control the laryngeal muscles.
Speech sounds can be differentiated between voiceless sounds, such as /p/ and /t/, which are produced by the lips, tongue and jaw (the articulation muscles) altering the exhalation of air, and voiced sounds, such as /b/ and /d/, which are similar but also involve vibration of the larynx. This vibration is called phonation.
The larynx vibrates faster than the brain can control muscles—about 125-250 Hz. Phonation is caused by the vocal folds catching in air flowing past them. To phonate, the vocal folds must be neither too relaxed (allowing air to flow past without catching), nor too tense (blocking exhalation).
Most words contain both voiced and voiceless sounds, so a normal speaker will start and stop phonation many times per second. Persons who stutter have poor laryngeal control, usually tensing their vocal folds too tightly. Unable to move from a voiceless sound to a voiced sound, the person will repeat or prolong the voiceless sound (“c-c-c-c-cat”), or add an unrelated voiced sound to start phonation, (“ah, cat”), or not make any sound—a silent block. The person may try to push through the blocked larnyx by tensing neck or facial muscles.
The larynx is one of the first muscles people tense when experiencing fear or anxiety. Thus stuttering is often associated with fear and anxiety.
The most widely-practiced stuttering therapy is fluency-shaping therapy. A speech pathologist trains a person who stutters to:
Breathe with his diaphragm, which relaxes respiration muscles, and produces the gentle, steady airflow necessary for phonation.
Gently increase vocal volume, and so laryngeal vibration, at the beginning of each phrase (gentle onset).
Continue phonation through the end of the phrase, without stopping (continuousphonation), by keeping the vocal folds relaxed and air flowing.
Speak slower, with prolonged vowel sounds, to enable continuous phonation (all vowels are voiced).
Reduce articulatory pressure, by relaxing the lips, tongue, and jaw, and de-emphasizing voiceless consonants (produced by these articulation muscles) which interrupt phonation.
Fluency-shaping therapy begins by teaching these speech motor skills in the clinical environment. The speech pathologist models the behavior, and provides verbal feedback as the person learns to perform the motor skill.
At first, the target speech behaviors are exagerated, producing abnormally slow, monotonous, but relaxed and fluent speech. As the person develops speech motor control, he increases rate and prosody until his speech sounds normal.
When the person's speech is fluent and sounds normal in the clinical environment, he works with the speech pathologist the transfer these speech motor skills to his everyday life.
Fluency-shaping stuttering therapy is effective for about 70-75% of adults who stutter (and more effective for children who stutter), according to recent research
1
.
1
Boberg, E., Kullyn D., “Long-Term Results of an Intensive Treatment Program for Adults and Adolescents Who Stutter,”
Journal of Speech and Hearing Research;
October 1994, 37(5)
There are two broad reasons for the failure of fluency-shaping stuttering therapy:
1) the person never develops the target speech motor skills in the clinical environment;
2) the person never transfers the target speech motor skills to his everyday life.
A variety of electronic devices are available to aid both of these goals. Electronic devices can also reduce the fear and anxiety associated with stuttering.
These electronic devices can be divided into three main classes:
1) Devices which enable immediate fluency, without training or mental effort.
2) Motoric audition devices, which alter speech muscle activities by altering vocal perception.
3) Biofeedback devices, which develop awareness and control of speech motor skills.
Immediate Fluency Devices
Several types of auditory feedback reduce stuttering immediately, without training or mental effort.
Researchers have hypothesized that these devices correct an undiscovered defect in the auditory systems of persons who stutter.
2
2
WoIf, A. A., Wolf, E. G. (1959). “Feedback processes in the theory of certain speech disorders.”
Speech Pathology and Therapy,
2, 48-55; Mysak, E. D. (1960). “Servo-theory and stuttering.”
Journal of Speech and Hearing Disorders,
25, 188-195; Yates, A. J. (1963). “Recent empirical and theoretical approaches to the experimental manipulation of speech in normal subjects and in stammerers.”
Behaviour Research and Therapy,
1, 95-119; Butler, B. R., Stanley, P. E., (1966). “The stuttering problem considered from an automatic control point of view.”
Folia Phoniatricia,
18, 33-44; Webster, R. L. & Lubker, B. B. (1968). “Interrelationships among fluency producing variables in stuttered speech.”
Journal of Speech and Hearing Research,
11, 754-766.
Alternatively, a normal auditory function, while not causing stuttering, may impede overcoming stuttering. This is the stapedius muscle reflex of the middle ear. This muscle attenuates vocal perception 5-15 dB.
3
This impairment in hearing your voice impairs changing how you talk.
3
Shlomo Sillman,
The Acoustic Reflex
(1984). San Diego: Academic Press.
Improved vocal awareness improves vocal control. All of the following devices improve aspects of vocal awareness and control:
1) Delayed auditory feedback (DAF) in the 25-75 ms range delays your voice (in your headphones) just long enough to overcome the stapedius muscle reflex, but is not so long that your voice is perceived as an echo. The device reduces stuttering 75-85%.
4
2) Frequency-altered auditory feedback (FAF) alters the pitch of your voice (in your headphones), typically ½ octave. The device reduces stuttering 75-85%.
5
3) Laryngeal auditory feedback (LAF) provides the sound of your larynx to your ears without the sounds added by your nasal and oral (tongue and lips) cavities. This can be accomplished in several ways. The Fluency Master (U.S. Pat. No. 4,784,115) tapes a microphone to your neck, and then amplifies your voice in a hearing-aid type amplifier. The device reduces stuttering in 30-80% of users.
6
The Edinburgh Masker (U.S. Pat. No. 3,566,858 and U.S. Pat. No. 3,773,032) electronically remove the sounds added by your nasal and oral cavities, providing only a sound similar to your laryngeal vibration. This device reduces or eliminates stuttering in about 90% of users.
7
4
Kalinowski, J., Armson, J., Stuart, A., Gracco, V., Roland-Mieszkowski, M. “Effects of alterations in auditory feedback and speech rate on stuttering frequency.” Language and Speech, 1993, 36, 1-16.
5
Ibid.
6
The device reduces stuttering immediately in 30% of users. An additional 50% benefit after 4 hours of therapy. Webster, R., Stigora, W. “Technology and Fluency-Building With Various Patient Populations.” Presented at American Speech-Language Hearing Association annual convention, November, 1991. The Fluency Master is made by GN Danavox, 5600 Rowland Road, Suite 250, Minnetonka, Minn. 55343.
7
Dewar, Dewar, Austin, Brash. “Long Term Use of An Automatically Triggered Auditory Feedback Masking Device in the Treatment of Stammering.”
British Journal of Disorders of Communication
, Vol. 14, No. 3: The device “was found to be effective in abolishing or greatly reducing stammering in 89% of 195 cases. The effectiveness of the portable device has continued in the majority of users during periods of observation of up to three year. In a follow-up study of 67 subjects with six months or more experience of the Masker . . . 67% stated that, as a result of using the device, their unaided speech fluency had improved.” Herbert Goldberg of the Foundation for Fluency (Skokie, Ill.) writes privately: “I am in contact with over 500 people who use or have used the [Edinburgh] Masker. In most cases the end result is the person uses the device less and less as time passes due
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