English-only treatment of bilingual speakers who stutter: Generalization of treatment effects from English to Mandarin.

PURPOSE: Speech language pathologists often do not speak the dominant language of their clients and so the language of treatment is an important consideration. This research investigated whether stuttering treatment delivered in English resulted in reductions in stuttering in English and Mandarin bilingual Singaporean speakers. METHOD: Participants were 19 English-Mandarin bilinguals who stuttered. They received a speech re-structuring intensive program (IP) delivered in English only. Three 10-minute conversations in English and Mandarin, sampled at pre-treatment, immediately post IP, 4 weeks post IP and 12 weeks post IP, were analysed by two English-Mandarin bilingual clinicians for percentage of syllables stuttered (%SS). RESULT: After English-only treatment, stuttering reductions were found to generalize to Mandarin. Stuttering reductions were significantly higher in English compared to Mandarin at 4 weeks post-IP, but there was no significant difference in the stuttering reductions between languages at the end of IP and at 12 weeks post-IP. Mean %SS scores for English and Mandarin were comparable with the outcome data reported for a similar intensive speech-restructuring program for monolingual English-speaking adults. CONCLUSION: The results of this study show that stuttering reductions can be achieved in two languages following treatment in one language only. Future research in this area is proposed.

Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review.

BACKGROUND: Complementary medicine and alternative approaches to chronic and intractable health conditions are increasingly being used, and require critical evaluation. OBJECTIVE: The aim of this review was to systematically evaluate available evidence for the effectiveness and safety of instruction in the Alexander Technique in health-related conditions. METHODS: PUBMED, EMBASE, PSYCHINFO, ISI Web-of-Knowledge, AMED, CINHAL-plus, Cochrane library and Evidence-based Medicine Reviews were searched to July 2011. Inclusion criteria were prospective studies evaluating Alexander Technique instruction (individual lessons or group delivery) as an intervention for any medical indication/health-related condition. Studies were categorised and data extracted on study population, randomisation method, nature of intervention and control, practitioner characteristics, validity and reliability of outcome measures, completeness of follow-up and statistical analyses. RESULTS: Of 271 publications identified, 18 were selected: three randomised, controlled trials (RCTs), two controlled non-randomised studies, eight non-controlled studies, four qualitative analyses and one health economic analysis. One well-designed, well-conducted RCT demonstrated that, compared with usual GP care, Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. The results were broadly supported by a smaller, earlier RCT in chronic back pain. The third RCT, a small, well-designed, well-conducted study in individuals with Parkinson's disease, showed a sustained increased ability to carry out everyday activities following Alexander lessons, compared with usual care. The 15 non-RCT studies are also reviewed. CONCLUSIONS: Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson's-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering, but there is insufficient evidence to support recommendations in these areas.

Stuttering after right cerebellar infarction: a case study.

UNLABELLED: We report a male patient with neurogenic stuttering after cerebellar infarction. He had suffered from frontal and thalamus damage and he had exhibited aphasia, but his speech had been fluent until onset of the cerebellar infarction. Results of analysis of speech samples included the following: (1) the patient showed very frequent syllable repetition and part-word repetition. (2) The stuttering occurrence rate at the second test was much higher than at the first test. (3) Almost all stuttering occurred on initial word sounds; stuttering on the medial and final word was less frequent. (4) Adaptation effect was absent. (5) Secondary behaviors such as closing of the eyes and grimacing were observed. The internal model related to cerebellar functions can be modified using feedback-error information. Results suggest that internal model dysfunction caused this patient's stuttering. EDUCATIONAL OBJECTIVES: After reading this text, the reader will be able to: (1) provide characteristics of neurogenic stuttering after the cerebellum infarction; (2) discuss the relationship between neurogenic stuttering and functions of the cerebellum.

Self-reported efficacy of an ear-level prosthetic device that delivers altered auditory feedback for the management of stuttering.

Numerous past efficacy studies in stuttering treatment have typically failed to assess generalization of therapeutic gains across speaking environments over time. The purpose of this study was to use a self-report format to gain insight into the improvements of clients who purchased an all in-the-ear device that provides altered auditory feedback to manage stuttering symptoms across everyday speaking situations. A total of 105 participants (age 7-81 years) returned completed questionnaires that examined seven parameters of stuttering behavior before acquiring the prosthetic device and after using the device with minimal clinical intervention for an average of 6 months. Across each parameter, participants rated a significant (P<0.001) improvement of approximately two units on seven-point scales after beginning to use the prosthetic device. In addition, the device received high overall satisfaction ratings, with a median score of 2.0 on the seven-point scale. Self-report is a 'must' for examining clinical efficacy in a disorder such as stuttering, which is so amenable to 'clinic room fluency' yet highly resistant to long-term amelioration. The data suggest that this device is helping to provide its users with functional, effective and efficient management of stuttering without the need for extended clinical follow-up.

Utility of electromyographic biological feedback in chronic stuttering: a clinical study with follow-up.

A systematic case study is presented in which eight chronic adult stutterers underwent an electromyographic (EMG) biological feedback training program designed to reduce masseter muscle tension in an effort to improve fluency. All subjects mastered the program within 10 30-min. sessions. Measures of muscle tension and fluency indicated improvement at the end of treatment that were maintained at 3- to 6-mo. follow-up.