Articles

You’ve tried that, now try this! Reflections on the re-emergence of feedback devices Issue 27, Spring 2007
By, Monica Bray, formerly Leeds Metropolitan University


Van Riper (1973) commented that ‘it is truly unfortunate that stuttering can be temporarily ameliorated by so many different kinds of treatment, since the sporadic success seems to generate a host of blind enthusiasts who make vast claims that eventually are disproved’.
In his book, he has a whole chapter on Servotherapy in which he explores the use of feedback devices and the possible reasons why they seem to produce fluency. Masking and Delayed Auditory Feedback (DAF) received a great deal of attention in the 1960s but no adequate explanation as to why and how they work was found.
Suggestions included: distraction and suggestion; changing the nature of the speech process; and overcoming a faulty internal auditory monitoring system.
Van Riper discusses his use of DAF in the clinic as a way of exploring options in fluency and showing that stuttering is modifiable.
He concluded his chapter by saying that ‘the use of delayed auditory feedback as a clinical tool holds some promise’.
So, what are we to make of this new rush to Delayed and/or Frequency Altered Feedback (DAF and FAF)?
Thirty years since the original flurry of interest we are really no closer to understanding why or how it works.
The current focus seems to be on the similarity between delayed feedback and choral speaking – the idea that we somehow respond to the ‘second voice in our heads’ as if it is another speaker and speak along with this other and thus are fluent.
Not a new idea – in 1898 Liebman developed unison speaking as part of his therapy (cited in Van Riper, 1973:79).
Of course, we don’t know why people who stutter speak fluently in chorus! Van Riper suggests rhythm and timing, distraction, lack of propositionality of the speech; and/or masking.
Kalinowski and Saltuklaroglu (2006) assume that stuttering is a ‘neural block’ which can be circumvented via a choral signal and this works because perception and production of speech are linked via the ‘mirror neurones’.
This is, at present, supposition and unproved so is as good an explanation as distraction.
The truth is, we don’t know why choral speaking works – though we know it does work.
Because we cannot carry a little person around to speak with us whenever we need, the idea that we can emulate choral speaking by delayed feedback is a pleasing one.
However, in choral speaking the other speaker leads the person who stutters whereas in DAF or FAF the ‘other voice’ follows the person who stutters.
This means that blocks and struggle cannot be overcome through this approach and the stuttering individual needs to be listening to his/her other self intently.
It is interesting to read in the most recent Speaking Out (Spring 2007) that Heidi King’s trip to New York for her SpeechEasy device was a catalyst for opening up previously taboo discussions of her stammer with others, rather than a miracle cure.
It is also important to note that she continues to work with her speech and language therapist to enable her to “tune back into the device when I start to slip” (p14).
So the ease and immediacy of fluency achieved through choral speaking is not replicated with feedback devices. Modern technology has allowed for the development of small (the SpeechEasy is an in-the-ear device) and sophisticated mechanisms that can present a range of delays and frequencies to the ear in an attempt to increase fluency.
Currently the VoiceAmp is being marketed in this country and a number of clinicians are trying it out with clients.
I’m sure we will get some feedback through signal from these trials.
I must say that trying it myself helped me realise how uncomfortable it is to listen to a drawled and/or squeaky sound
it doesn’t even come across as a voice at certain frequencies) in my ear.
The person using it must really be motivated to tolerate the sound.
He or she must not adapt to it too well or the ‘magic’ wears off and the stutter returns!
Will the devices become part of our clinical toolkits?
That will depend on whether our clients find them useful in the long term.
Masking devices fell out of use for all but a small number of people because clients could not tolerate them over time.
So far, the research (see Lincoln, Packman and Onslow (2006) for a review) has not demonstrated universal usefulness – some people respond and some don’t, some positive responses last and others diminish.
Which brings us back to our starting point and Van Riper.
Let us be cautious and watch the second coming of feedback devices with dispassionate interest! M.Bray@leedsmet.ac.uk

References
Kalinowski, J. and Saltuklaroglu, T. (2006) Stuttering. San Diego: Plural Publishing.

King, H. (2006) After nine months SpeechEasy gives birth to new freedom. Speaking Out Spring 2007, 14.

Lincoln, M., Packman, A. and Onslow, M (2006) Altered auditory feedback and the treatment of stuttering: A review. Journal of Fluency Disorders. 31, 71-89.

Van Riper, C (1973) The Treatment of Stuttering. Englewood Cliffs: Prentice Hall.