Addressing the Psychosocial Needs of Individuals with Communication Disorders: The Integration of Animal-Assisted Therapy within Counseling.

Individuals with speech, language, and communication disorders often present with psychosocial concerns that span the physiological, intrapersonal, and interpersonal domains of functioning. Despite this fact, the provision of counseling service by speech-language pathologist (SLP) that directly addresses clients' psychosocial needs is sparse. Research shows the primary counseling strategy used by therapists is psychoeducation, failing to effectively address the psychosocial concerns. Integrating complementary approaches to traditional counseling in SLP can enhance both the quality of therapeutic intervention and client outcomes. The purpose of this article is to demonstrate the potential of animal-assisted therapy (AAT) as an adjunctive or complementary approach for counseling within SLP. A review of literature demonstrates a need for improved counseling service provision within SLP treatment, as well as the benefits of integrating AAT. A framework for how AAT intentions and techniques fit within SLP Scope of Practice counseling activities is presented, along with case examples to demonstrate how AAT can be integrated within SLP treatment. It is concluded that the integration of AAT as a complementary approach to traditional SLP counseling can enhance both the frequency of counseling services provided and clients' psychosocial outcomes.

Normative data on audiovisual speech integration using sentence recognition and capacity measures.

OBJECTIVE: The ability to use visual speech cues and integrate them with auditory information is important, especially in noisy environments and for hearing-impaired (HI) listeners. Providing data on measures of integration skills that encompass accuracy and processing speed will benefit researchers and clinicians. DESIGN: The study consisted of two experiments: First, accuracy scores were obtained using City University of New York (CUNY) sentences, and capacity measures that assessed reaction-time distributions were obtained from a monosyllabic word recognition task. STUDY SAMPLE: We report data on two measures of integration obtained from a sample comprised of 86 young and middle-age adult listeners: RESULTS: To summarize our results, capacity showed a positive correlation with accuracy measures of audiovisual benefit obtained from sentence recognition. More relevant, factor analysis indicated that a single-factor model captured audiovisual speech integration better than models containing more factors. Capacity exhibited strong loadings on the factor, while the accuracy-based measures from sentence recognition exhibited weaker loadings. CONCLUSIONS: Results suggest that a listener's integration skills may be assessed optimally using a measure that incorporates both processing speed and accuracy.

Assessing variability in audiovisual speech integration skills using capacity and accuracy measures.

OBJECTIVE: While most normal-hearing listeners rely on the auditory modality to obtain speech information, research has demonstrated the importance that non-auditory modalities have on language recognition during face-to-face communication. The efficient utilization of the visual modality becomes increasingly important in difficult listening conditions, and especially for older and hearing-impaired listeners with sensory or cognitive decline. First, this report will quantify audiovisual integration skills using a recently developed capacity measure that incorporates speed and accuracy. Second, to investigate sensory factors contributing to integration ability, high and low-frequency hearing thresholds will be correlated with capacity, as well as gain measures from sentence recognition. DESIGN: Integration scores were obtained from a within-subjects design using an open-set sentence speech recognition experiment and a closed set speeded-word classification experiment, designed to examine integration (i.e. capacity). STUDY SAMPLE: A sample of 44 adult listeners without a self-reported history of hearing-loss was recruited. RESULTS: RESULTS demonstrated a significant relationship between measures of audiovisual integration and hearing thresholds. CONCLUSIONS: Our data indicated that a listener's ability to integrate auditory and visual speech information in the domains of speed and accuracy is associated with auditory sensory capabilities and possibly other sensory and cognitive factors.

Stuttering inhibition via altered auditory feedback during scripted telephone conversations.

BACKGROUND: Overt stuttering is inhibited by approximately 80% when people who stutter read aloud as they hear an altered form of their speech feedback to them. However, levels of stuttering inhibition vary from 60% to 100% depending on speaking situation and signal presentation. For example, binaural presentations of delayed auditory feedback (DAF) and frequency-altered feedback (FAF) have been shown to reduce stuttering by approximately 57% during scripted telephone conversations. AIMS: To examine stuttering frequency under monaural auditory feedback with one combination of DAF with FAF (COMBO-2) and two combinations of DAF with FAF (COMBO-4) during scripted telephone conversations. METHODS & PROCEDURES: Nine adult participants who stutter called 15 local businesses during scripted telephone conversations; each condition consisted of five randomized telephone calls. Conditions consisted of (1) baseline (i.e. non-altered feedback), (2) COMBO-2 (i.e. 50-ms delay with a half octave spectral shift up), and (3) COMBO-4 (i.e. 200-ms delay and a half octave spectral shift down in addition to the COMBO-2). Participants wore a supra-aural headset with a dynamic condenser microphone while holding a receiver to their contralateral ear when making telephone calls. OUTCOMES & RESULTS: Stuttering was significantly reduced during both altered auditory feedback (AAF) conditions by approximately 65%. Furthermore, a greater reduction in stuttering was revealed during the COMBO with four effects (74%) as compared with the COMBO with two effects (63%). CONCLUSIONS & IMPLICATIONS: Results from the current study support prior research reporting decreased stuttering under AAF during scripted telephone conversations. Findings that stuttering was significantly reduced to a greater extent under the COMBO with four effects condition suggest that second signals reduce stuttering along a continuum. Additionally, findings support prior research results of decreased stuttering frequency under AAF during hierarchically difficult speaking situations. Clinical application of these findings may be that people who stutter can use specific software or smartphone applications that produce second speech signals to inhibit stuttering frequency effectively during telephone conversations.

Lower nonword syllable sequence repetition accuracy in adults who stutter is related to differences in audio-motor oscillations.

OBJECTIVE: The goal of this study was to use independent component analysis (ICA) of high-density electroencephalography (EEG) to investigate whether differences in audio-motor neural oscillations are related to nonword syllable repetition accuracy in a group of adults who stutter compared to typically fluent speakers. METHODS: EEG was recorded using 128 channels from 23 typically fluent speakers and 23 adults who stutter matched for age, sex, and handedness. EEG was recorded during delayed, 2 and 4 bilabial nonword syllable repetition conditions. Scalp-topography, dipole source estimates, and power spectral density (PSD) were computed for each independent component (IC) and used to cluster similar ICs across participants. Event-related spectral perturbations (ERSPs) were computed for each IC cluster to examine changes over time in the repetition conditions and to examine how dynamic changes in ERSPs are related to syllable repetition accuracy. RESULTS: Findings indicated significantly lower accuracy on a measure of percentage correct trials in the AWS group and for a normalized measure of syllable load performance across conditions. Analysis of ERSPs revealed significantly lower alpha/beta ERD in left and right µ ICs and in left and right posterior temporal lobe α ICs in AWS compared to TFS (CC p < 0.05). Pearson correlations with %CT for frequency across time showed strong relationships with accuracy (FWE<0.05) during maintenance in the TFS group and during execution in the AWS group. CONCLUSIONS: Findings implicate lower alpha/beta ERD (8-30 Hz) during syllable encoding over posterior temporal ICs and execution in left temporal/sensorimotor components. Strong correlations with accuracy and interindividual differences in ∼6-8 Hz ERSPs during execution implicate differences in motor and auditory-sensory monitoring during syllable sequence execution in AWS.

Healing From Home: Examination of an Online Mindfulness-Based Tinnitus Stress Reduction Course During the 2020 COVID Pandemic.

PURPOSE: The purpose of this study was to assess the effectiveness of an Internet delivered Mindfulness Based Tinnitus Stress Reduction (i-MBTSR) program during the COVID-19 pandemic. Tinnitus, often a chronic condition, is experienced by 15% of the population. For those with severe, bothersome tinnitus, quality of life is reduced and the treatment options are limited. We evaluated an approach intended to decrease tinnitus-related distress. METHOD: This study examined the data collected for an online i-MBTSR course using a retrospective design. The intervention included an 8-week self-paced i-MBTSR course, including didactic information about mindfulness and tinnitus, as well as meditation practices. Outcome measures included the Tinnitus Functional Index (TFI) and Perceived Stress Scale (PSS), which were measured at four time periods. These time points included pretreatment, midtreatment at 3 weeks, immediately posttreatment, and at 6-month follow-up. RESULTS: Forty-three participants completed the intervention. The mean preintervention tinnitus severity rating was 59.96 ("severe tinnitus") as measured by the TFI. Mean TFI scores dropped to 44.16 (p < .001) at midtreatment and to 34.23 (p = .001) at posttreatment. Repeated-measures analysis of variance and multivariate analysis of variance tests were conducted to determine changes in the two scales at the four time periods. There were significant differences in perceived stress and tinnitus self-function found in all measures and submeasures between the pre-, mid-, and posttreatment time points with the exception of the TFI Auditory subtest. These gains remained significant for those who completed the 6-month follow-up. CONCLUSIONS: The i-MBTSR course appears to be a viable and effective treatment modality. A shorter 3-week course may be effective. Case-control studies to more systematically investigate the effectiveness of i-MBTSR for tinnitus are required.

Development of a probability discounting task of communication for adults who stutter.

Previous research indicates speaking may be emotionally and socially risky for adults who stutter (AWS) due to psychological distress induced by others following a dysfluency. This may impact communication-related decision-making; however, no measure had been developed to objectively quantify this variable. The present study aimed to develop and validate the Probability Discounting for Communication (PDC) task, a behavioral measure of risk taking that characterizes decreasing subjective value of hypothetical communication engagement as the probability of stuttering and listener reaction change. AWS (n = 67) and adults who do not stutter (AWNS; n = 93) were recruited from an online listserv and MTurk. Across a series of trials, participants completed the PDC by using a visual analog scale to indicate their subjective value of communication as probabilities of stuttering (1%-99%) and magnitudes of negative listener reaction risk (10%, 50%, 90%) were manipulated. They also completed measures of stuttering, communication, and demographics. Results revealed communication was discounted hyperbolically across increasing dysfluency odds. AWS showed more systematic discounting patterns compared to AWNS suggesting AWS may be more sensitive to communication due to experiences with stuttering. A magnitude effect was found with both AWS and AWNS discounting communication more steeply with increasing negative listener reaction risk. Significant associations were observed between discounting, stuttering, and communication measures among AWS, which indicates that sensitivity to risk in the context of stuttering and social reaction may influence communication engagement. Overall, the PDC functions as a measure to assess underlying decision-making patterns related to communication among AWS, which may inform treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stuttering inhibition via visual feedback at normal and fast speech rates.

BACKGROUND: Immediate and drastic reductions in stuttering are found when speech is produced in conjunction with a variety of second signals (for example, auditory choral speech and its permutations, and delayed auditory feedback). Initially, researchers suggested a decreased speech rate as a plausible explanation for the reduction in stuttering as people who stutter produced speech under second signals. However, this explanation was refuted by research findings that demonstrated reductions in stuttering at both normal and fast speech rates under second signals. Recent studies have also demonstrated significant reductions in stuttering from second signals delivered via the visual modality. However, the question as to whether stuttering can be substantially reduced at normal and fast speech rates under visual speech feedback conditions has yet to be answered. AIMS: The current study investigated stuttering frequency reduction at normal and fast speech rates across different visual speech feedback conditions relative to a no-visual feedback condition. METHODS & PROCEDURES: Ten adults who stutter recited memorized tokens of eight to 13 syllables under five visual speech feedback conditions at both normal and fast speech rates. Visual speech feedback conditions consisted of participants viewing the lower portion of their face (that is, lips, jaw, and base of the nose) on a monitor as they produced the aforementioned utterances. Conditions consisted of (1) no-visual feedback condition, (2) 0 ms (simultaneous visual speech feedback), (2) a 50-ms delay, (3) a 200-ms delay, and (4) a 400-ms delay. OUTCOMES & RESULTS: A significant main effect of visual speech feedback on stuttering frequency was found (p= 0.001) with no significant main effect of speech rate or the interaction between speech rate and visual speech feedback. Relative to the no-visual feedback condition, the feedback conditions produced reductions in stuttering ranging from 27% (0 ms) to 62% (400 ms). Post-hoc comparisons revealed that all of the delay conditions differed significantly from the simultaneous feedback (p= 0.017) and the no-visual feedback conditions (p= 0.0002) while no significant differences between delay conditions (that is, 50, 200, and 400 ms) were observed. CONCLUSIONS & IMPLICATIONS: The current findings demonstrate the capabilities of visual speech feedback signals to reduce stuttering frequency that is independent of the speaker's rate of speech. Possible strategies are suggested to transfer these findings into naturalistic and clinical settings, though further research is warranted.

The perceived impact of fluency on personalities of adults who stutter: implicit evidence of self-stigma.

PURPOSE: The NEO-FFI is an extensively used instrument that has been used to identify personality differences between those who stutter and matched controls or group norms. The goal of this study was to use the NEO-FFI to implicitly capture and quantify self-stigma related to personality in persons who stutter (PWS). METHODS: Thirty PWS completed the NEO-FFI twice; once as themselves and once while mentalizing (using theory of mind) to respond as though they did not stutter and had never stuttered, thus comparing their true personality to their perceived personality if they were fluent speakers. Compared to their true personalities, PWS perceived their fluent counterparts to be significantly less neurotic and more extroverted. RESULTS: The differences observed are somewhat analogous, though considerably larger in magnitude than personality differences that have previously been reported when comparing PWS to fluent controls or norms. Differences were interpreted to be due to "contrast effects" influencing the comparison. That is, PWS cognitively separated themselves from their fluent counterparts, seeing their true selves in a negative light compared to their fluent counterparts. This "us" vs. "them" separation is considered evidence of self-stigma related to personality in PWS. CONCLUSIONS: The finding that the perceived differences were in the domains of Neuroticism and Extraversion is consistent with prevailing stereotypes about PWS and exemplifies how public stigma can become internalized. Clinical implications are discussed with respect to how similar theory of mind/social comparison exercises can be used in cognitive behavioral therapy to help identify and restructure negative thoughts and beliefs about stuttering.

Stuttered and fluent speakers' heart rate and skin conductance in response to fluent and stuttered speech.

BACKGROUND: Previous studies have found simultaneous increases in skin conductance response and decreases in heart rate when normally fluent speakers watched and listened to stuttered speech compared with fluent speech, suggesting that stuttering induces arousal and emotional unpleasantness in listeners. However, physiological responses of persons who stutter observing stuttering and fluent speech has not been measured. Research suggests that the mechanism responsible for listeners' reactions is the mirror neuron system. The mirror neuron system activates when perceiving and producing goal-directed actions and forms the link between action perception and action production. AIMS: To compare physiological responses elicited via fluent and stuttered speech in fluent and persons who stutter groups. METHODS & PROCEDURES: Participants included 15 adult persons who stutter (mean age = 29.7 years) and 21 normally fluent controls (mean age = 23.7 years). Participants watched and listened to six speech samples read by three persons who stutter speakers and three fluent speakers, while their skin conductance response and heart rate were recorded simultaneously. Participants' responses to each speech sample were defined as changes in mean heart rate and mean skin conductance response between 15 s before and 15 s during stimuli presentation. OUTCOMES & RESULTS: Both groups showed similar patterns of response: skin conductance response was significantly increased and heart rate was significantly decreased in response to stuttered versus fluent speech. Similar to previous findings, the highest skin conductance response measures were induced by the first presentation of stuttered speech, with the response attenuating on subsequent presentations, while the heart rate was stable over time. CONCLUSIONS & IMPLICATIONS: Results confirmed past research that showed arousal and emotional unpleasantness when observing stuttering. Clinically, these results acknowledge the arousal and emotional discomfort in fluent speakers and persons who stutter. The physiological responses to stuttering and the underlying emotional aspects should be discussed in the therapeutic milieu with notions about coping strategies.

The Application of EEG Mu Rhythm Measures to Neurophysiological Research in Stuttering.

Deficits in basal ganglia-based inhibitory and timing circuits along with sensorimotor internal modeling mechanisms are thought to underlie stuttering. However, much remains to be learned regarding the precise manner how these deficits contribute to disrupting both speech and cognitive functions in those who stutter. Herein, we examine the suitability of electroencephalographic (EEG) mu rhythms for addressing these deficits. We review some previous findings of mu rhythm activity differentiating stuttering from non-stuttering individuals and present some new preliminary findings capturing stuttering-related deficits in working memory. Mu rhythms are characterized by spectral peaks in alpha (8-13 Hz) and beta (14-25 Hz) frequency bands (mu-alpha and mu-beta). They emanate from premotor/motor regions and are influenced by basal ganglia and sensorimotor function. More specifically, alpha peaks (mu-alpha) are sensitive to basal ganglia-based inhibitory signals and sensory-to-motor feedback. Beta peaks (mu-beta) are sensitive to changes in timing and capture motor-to-sensory (i.e., forward model) projections. Observing simultaneous changes in mu-alpha and mu-beta across the time-course of specific events provides a rich window for observing neurophysiological deficits associated with stuttering in both speech and cognitive tasks and can provide a better understanding of the functional relationship between these stuttering symptoms. We review how independent component analysis (ICA) can extract mu rhythms from raw EEG signals in speech production tasks, such that changes in alpha and beta power are mapped to myogenic activity from articulators. We review findings from speech production and auditory discrimination tasks demonstrating that mu-alpha and mu-beta are highly sensitive to capturing sensorimotor and basal ganglia deficits associated with stuttering with high temporal precision. Novel findings from a non-word repetition (working memory) task are also included. They show reduced mu-alpha suppression in a stuttering group compared to a typically fluent group. Finally, we review current limitations and directions for future research.

Success in changing stuttering attitudes: A retrospective analysis of 29 intervention studies.

BACKGROUND: Against the backdrop of hundreds of studies documenting negative stereotypes and stigma held by the public regarding people who stutter, a substantial number of investigations have attempted to improve public attitudes and measure their results with a standard instrument, the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S). Although the majority of interventions have been moderately to quite successful, a substantial minority have been unsuccessful. PURPOSE: This study sought to determine what properties of interventions and demographic variables were predictive of least to most successful interventions. Preliminary to that, however, it required the division of samples into clearly differentiated categories of success. METHOD: Twenty-nine different study samples containing 934 participants were categorized into four levels of success of interventions according to pre versus post POSHA-S summary mean ratings. Intervention properties and demographic characteristics and for each success category were analyzed for their predictive potential of successful attitude improvement. RESULTS: Interventions characterized by high interest or involvement, meaningful material, and content that respondents found to be relevant, but not excessive, tended to be associated with more successful interventions. In contrast, demographic variables were weak predictors of intervention success. CONCLUSION: The authors hypothesize that maximally effective interventions reflect optimal matches between participant characteristics and intervention features, although the critical variables in each are not yet apparent.

Phonological working memory in developmental stuttering: Potential insights from the neurobiology of language and cognition.

The current review examines how neurobiological models of language and cognition could shed light on the role of phonological working memory (PWM) in developmental stuttering (DS). Toward that aim, we review Baddeley's influential multicomponent model of PWM and evidence for load-dependent differences between children and adults who stutter and typically fluent speakers in nonword repetition and dual-task paradigms. We suggest that, while nonword repetition and dual-task findings implicate processes related to PWM, it is unclear from behavioral studies alone what mechanisms are involved. To address how PWM could be related to speech output in DS, a third section reviews neurobiological models of language proposing that PWM is an emergent property of cyclic sensory and motor buffers in the dorsal stream critical for speech production. We propose that anomalous sensorimotor timing could potentially interrupt both fluent speech in DS and the emergent properties of PWM. To further address the role of attention and executive function in PWM and DS, we also review neurobiological models proposing that prefrontal cortex (PFC) and basal ganglia (BG) function to facilitate working memory under distracting conditions and neuroimaging evidence implicating the PFC and BG in stuttering. Finally, we argue that cognitive-behavioral differences in nonword repetition and dual-tasks are consistent with the involvement of neurocognitive networks related to executive function and sensorimotor integration in PWM. We suggest progress in understanding the relationship between stuttering and PWM may be accomplished using high-temporal resolution electromagnetic experimental approaches.

Hearing impairment and audiovisual speech integration ability: a case study report.

Research in audiovisual speech perception has demonstrated that sensory factors such as auditory and visual acuity are associated with a listener's ability to extract and combine auditory and visual speech cues. This case study report examined audiovisual integration using a newly developed measure of capacity in a sample of hearing-impaired listeners. Capacity assessments are unique because they examine the contribution of reaction-time (RT) as well as accuracy to determine the extent to which a listener efficiently combines auditory and visual speech cues relative to independent race model predictions. Multisensory speech integration ability was examined in two experiments: an open-set sentence recognition and a closed set speeded-word recognition study that measured capacity. Most germane to our approach, capacity illustrated speed-accuracy tradeoffs that may be predicted by audiometric configuration. Results revealed that some listeners benefit from increased accuracy, but fail to benefit in terms of speed on audiovisual relative to unisensory trials. Conversely, other listeners may not benefit in the accuracy domain but instead show an audiovisual processing time benefit.