Efficacy of the Modifying Phonation Intervals (MPI) Stuttering Treatment Program With Adults Who Stutter.

Purpose: This study compared a new adult stuttering treatment program (Modifying Phonation Intervals, or MPI) with the standard of care for reducing stuttered speech in adults (prolonged speech).

Method: Twenty-seven adults who stutter were assigned to either MPI or prolonged speech treatment, both of which used similar infrastructures. Speech and related variables were assessed in 3 within-clinic and 3 beyond-clinic speaking situations for participants who successfully completed all treatment phases.

Regional brain activity change predicts responsiveness to treatment for stuttering in adults.

Developmental stuttering is known to be associated with aberrant brain activity, but there is no evidence that this knowledge has benefited stuttering treatment. This study investigated whether brain activity could predict progress during stuttering treatment for 21 dextral adults who stutter (AWS). They received one of two treatment programs that included periodic H2(15)O PET scanning (during oral reading, monologue, and eyes-closed rest conditions).

A welfare economic approach to measure outcomes in stuttering: comparing willingness to pay and quality adjusted life years.

Purpose: The purpose of this study was to compare two welfare outcome measures, willingness to pay (WTP) and quality adjusted life years (QALYs) gained, to measure outcomes in stuttering.

Method: Seventy-eight adult participants (74 nonstuttering and 4 persons with stuttering) completed one face-to-face structured interview regarding how much they would be willing to pay to alleviate severe stuttering in three interventions of varying impact. These data were compared with QALYs gained as calculated from time trade off (TTO) and standard gamble (SG) data.

Assessment of respondent acceptability for preference measures in stuttering.

Purpose: To assess the feasibility of using one or more of four standard economic preference measures to assess health-related quality of life in stuttering, by assessing respondents' views of the acceptability of those measures.

Method And Results: A graphic positioning scale approach was used with 80 adults to assess four variables previously defined as reflecting the construct of respondent acceptability (difficulty of decision making, clarity of text, reasonableness for decision making, and comfort in decision making) for four types of preference measurement approaches (rating scale, standard gamble, time trade-off, and willingness to pay). A multivariate repeated measures analysis of variance (p<.

Brain activity in adults who stutter: similarities across speaking tasks and correlations with stuttering frequency and speaking rate.

Many differences in brain activity have been reported between persons who stutter (PWS) and typically fluent controls during oral reading tasks. An earlier meta-analysis of imaging studies identified stutter-related regions, but recent studies report less agreement with those regions. A PET study on adult dextral PWS (n=18) and matched fluent controls (CONT, n=12) is reported that used both oral reading and monologue tasks.

Integrating functional measures with treatment: a tactic for enhancing personally significant change in the treatment of adults and adolescents who stutter.

Purpose: It is proposed that stuttering treatment, particularly for adults and adolescents who stutter, may benefit from more inventive and extensive use of functional measurement-measures that are also treatment agents. Such measures can be tailored to produce more personally significant and evidence-based treatment benefits. They may be especially useful when employed in conjunction with partial self-management and performance-contingent procedures.

Phonation interval modification and speech performance quality during fluency-inducing conditions by adults who stutter.

Purpose: To relate changes in four variables previously defined as characteristic of normally fluent speech to changes in phonatory behavior during oral reading by persons who stutter (PWS) and normally fluent controls under multiple fluency-inducing (FI) conditions.

Method: Twelve PWS and 12 controls each completed 4 ABA experiments. During A phases, participants read normally.

Systematic studies of modified vocalization: speech production changes during a variation of metronomic speech in persons who do and do not stutter.

Unlabelled: The most common way to induce fluency using rhythm requires persons who stutter to speak one syllable or one word to each beat of a metronome, but stuttering can also be eliminated when the stimulus is of a particular duration (e.g., 1 second [s]).

Statistical, practical, clinical, and personal significance: definitions and applications in speech-language pathology.

Purpose: To discuss constructs and methods related to assessing the magnitude and the meaning of clinical outcomes, with a focus on applications in speech-language pathology.

Method: Professionals in medicine, allied health, psychology, education, and many other fields have long been concerned with issues referred to variously as practical significance, clinical significance, social validity, patient satisfaction, treatment effectiveness, or the meaningfulness or importance of beyond-clinic or real-world treatment outcomes. Existing literature addressing these issues from multiple disciplines was reviewed and synthesized.

Systematic studies of modified vocalization: effects of speech rate and instatement style during metronome stimulation.

Purpose: This study introduces a series of systematic investigations intended to clarify the parameters of the fluency-inducing conditions (FICs) in stuttering.

Method: Participants included 11 adults, aged 20-63 years, with typical speech-production skills. A repeated measures design was used to examine the relationships between several speech production variables (vowel duration, voice onset time, fundamental frequency, intraoral pressure, pressure rise time, transglottal airflow, and phonated intervals) and speech rate and instatement style during metronome-entrained rhythmic speech.

Measurement of speech effort during fluency-inducing conditions in adults who do and do not stutter.

Purpose: To investigate the effects of 4 fluency-inducing (FI) conditions on self-rated speech effort and other variables in adults who stutter and in normally fluent controls.

Method: Twelve adults with persistent stuttering and 12 adults who had never stuttered each completed 4 ABA-format experiments. During A phases, participants read aloud normally.

Measurement of phonated intervals during four fluency-inducing conditions.

Purpose: Previous investigations of persons who stutter have demonstrated changes in vocalization variables during fluency-inducing conditions (FICs). A series of studies has also shown that a reduction in short intervals of phonation, those from 30 to 200 ms, is associated with decreased stuttering. The purpose of this study, therefore, was to test the hypothesis that the distribution of phonated intervals (PIs) should change during 4 of the most well-known FICs.

Identification of children's stuttered and nonstuttered speech by highly experienced judges: binary judgments and comparisons with disfluency-types definitions.

Purpose: The purposes of this study were (a) to determine whether highly experienced clinicians and researchers agreed with each other in judging the presence or absence of stuttering in the speech of children who stutter and (b) to determine how those binary stuttered/nonstuttered judgments related to categorizations of the same speech based on disfluency-types descriptions of stuttering.

Method: Eleven highly experienced judges made binary judgments of the presence or absence of stuttering for 600 audiovisually recorded 5-s speech samples from twenty 2- to 8-year-old children who stuttered. These judgments were compared with each other and with disfluency-types judgments in multiple interval-by-interval assessments and by using multiple definitions of agreement.

Patient-reported outcomes in stuttering treatment: conceptual framework.

Evaluation of: Yaruss JS, Quesal RW. Overall Assessment of the Speaker's Experience of Stuttering (OASES): documenting multiple outcomes in stuttering treatment. J.

Psychometric evaluation of condition-specific instruments used to assess health-related quality of life, attitudes, and related constructs in stuttering.

Purpose: This study assessed the psychometric properties of instruments used to measure constructs similar to stuttering-specific health-related quality of life. In the stuttering literature, most such instruments were originally intended to measure speakers' attitudes about, or reactions to, their stuttering.

Method: Seventeen instruments were identified through a comprehensive literature search.

Stuttering treatment research 1970-2005: II. Systematic review incorporating trial quality assessment of pharmacological approaches.

Purpose: To complete a systematic review, incorporating trial quality assessment, of published research about pharmacological treatments for stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence.

Method: Multiple readers reviewed 31 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations.

Stuttering treatment research 1970-2005: I. Systematic review incorporating trial quality assessment of behavioral, cognitive, and related approaches.

Purpose: To complete a systematic review, with trial quality assessment, of published research about behavioral, cognitive, and related treatments for developmental stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence about stuttering treatment for preschoolers, school-age children, adolescents, and adults.

Method: Multiple readers reviewed 162 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations.

Comparing judgments of stuttering made by students, clinicians, and highly experienced judges.

Purpose: The purpose of this study was to compare judgments of stuttering made by students and clinicians with previously available judgments made by highly experienced judges in stuttering.

Method: On two occasions, 41 university students and 31 speech-language pathologists judged the presence or absence of stuttering in each of 216 audiovisually recorded 5-s intervals of the speech of adults who stutter. Intrajudge and interjudge agreement were calculated, and comparisons were made to judgments previously made about the same recordings by 10 highly experienced judges of stuttering.

The Stuttering Treatment Research Evaluation and Assessment Tool (STREAT): evaluating treatment research as part of evidence-based practice.

Purpose: This article presents, and explains the issues behind, the Stuttering Treatment Research Evaluation and Assessment Tool (STREAT), an instrument created to assist clinicians, researchers, students, and other readers in the process of critically appraising reports of stuttering treatment research.

Method: The STREAT was developed by combining and reorganizing previously published recommendations about the design and conduct of stuttering treatment research.

Conclusions: If evidence-based practice is to be widely adopted as the basis for stuttering assessment and treatment, procedures must be developed and distributed that will allow students, clinicians, and other readers without specialized knowledge of research design to critically appraise treatment research reports.

Using preference-based measures to assess quality of life in stuttering.

Purpose: The purpose of this study was to determine whether standard pharmaco-economic preference methods can be used to assess perceived quality of life in stuttering.

Method: Seventy-five nonstuttering adults completed a standardized face-to-face interview that included a rating scale, standard gamble, and time trade-off preference measures for 4 health states (your health and mild, moderate, and severe stuttering) in the context of 2 anchor states (perfect health and death).

Results: Results showed mean utility values between .

Science and pseudoscience in communication disorders: criteria and applications.

Purpose: The purpose of this tutorial is to describe 10 criteria that may help clinicians distinguish between scientific and pseudoscientific treatment claims. The criteria are illustrated, first for considering whether to use a newly developed treatment and second for attempting to understand arguments about controversial treatments.

Method: Pseudoscience refers to claims that appear to be based on the scientific method but are not.

"Roadblocks" revisited: neural change, stuttering treatment, and recovery from stuttering.

Unlabelled: In light of emerging findings concerning untreated recovery and neural plasticity, this paper re-examines the viability of an NIH conference recommendation [Cooper, J. A. (1990).

Evidence-based treatment of stuttering: V. The art of clinical practice and the future of clinical research.

Unlabelled: This epilogue summarizes and expands on some of the many points raised in Parts I through IV, emphasizing that evidence-based practice is not in conflict with the "art" of clinical practice but may actually be synonymous. An evidence-based practice framework is also used to suggest some future directions for clinical research in stuttering.

Educational Objectives: The reader will learn about and be able to (1) describe the similarities between evidence-based practice and the art of clinical practice, (2) explain how evidence-based practice provides a structure for future stuttering research, and (3) evaluate the importance of an evidence-based approach to stuttering treatment.

Speech modification approaches to stuttering treatment in schools.

The treatment procedures referred to here as "speech modification" are those that use a known fluency-inducing condition and that have as an explicit goal teaching the client to speak in a manner that will not include stuttering. This paper briefly reviews four subcategories of speech modification approaches for children in the schools: variations on prolonged speech, extended length of utterance approaches, response-contingent approaches, and mixed approaches. Special challenges to be faced by clinicians who would like to use speech modification procedures in the schools are also addressed.