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Speech therapy - Experiences/thoughts

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Speech therapy - Experiences/thoughts

Postby mewq » Wed Oct 30, 2013 5:04 pm

Hi,

It would be cool to get some insight from other stutterers as to what has and hasn't helped therapy-wise, and why so (theories)? I understand that a lot of people don't have the money or time for therapy sessions, so this could work as a helpful thread for people who want to know what kind of therapy is given, and possibly determine which therapy methods might be more or less helpful.

I'll try to keep personal opinions excluded from the actual therapy methods in my post, so that it's easier to scroll through if you're uninterested - I'll add a bold title for the therapy technique.

// Personal Intro //

I've started speech therapy recently - I'm going to be 22 next month, so I'm already an adult and usually these things are considered "unfixable" at this point (not always true, though). This is the 4th speech pathologist I'm working with, after having fixed stuttering for 3-4 years at a younger age, then relapsing. I have a block type stutter, and have been using avoidance (synonyms, different sentence structures, filler words) to cope with it - increasingly so lately, as I now work in a manager position at a large game company.

I can't honestly say that I remember much from the past three times, but the first two attempts didn't really help at all - I was very young and unmotivated at a young age regarding speech, as I didn't consider it a problem until I was a bit older.


With the latest therapy, here's a summary after evaluation+two sessions:

// The Evaluation Phase of the Therapy //

During evaluation, the pathologist said that she thinks stuttering is caused by the mouth, tongue, etc. articulators not staying in continuous movement - we didn't really start practising at that point, but I spent the next two weeks testing out light articulatory contacts, and to an extent it helped - sometimes even to nearly complete fluency in certain low stress situations. The fluency was however impossible to maintain during time pressure and "higher stress" situations.

// Therapy Technique //

At the first 'actual' therapy session, I was instructed to practise leading out loud with the following technique:

-Inhale
-Start speaking by prolonging the first syllable(s), slower than usual, and softening them
-Tie together words to make it continuous (this actually sounds normal)
-Exhale excess air
-Repeat

Notes:

-You should never run out of breath. When you feel like you are about to, exhale any excess air and inhale, or simply just inhale if you're confident that it's enough
-According to the speech pathologist, 2 minutes of practice each day would get a person forward in their progress. This includes a "warm-up" of 60-80 syllables per minute, followed by and increasable 'syllable per minute' rate for one minute depending on your current progress
-Practising can be either done by reading or by speaking to people (e.g. family, friends, significant other)
-The syllable rates mentioned above are probably not realistic for English. Using a syllable calculator with the initial 60 syllable text, the result was actually 50 syllables if counted 'the English way' - pay attention to this if you're going to try this technique out, as starting too fast will make using and automating this technique significantly harder

As a caution, the pathologist said that 190 syllables per minute is the normal reading speed in my language, and that 60 syllables per minute is the normal starting speed. This will be gradually increased, and as it slowly becomes more automatic, the breathing breaks and prolongations become shorter, the excess air exhalation can be (at least mostly) left out and the initial softening will be seemingly dropped at some point (although, as it's automatic at that point, it's still in place, but not audible and you don't have to think about it).

The slow starting speed is essential because of how muscle memory works. If you've ever played any instrument, you've probably noticed that starting slow makes playing a lot easier and will build the correct motor patterns in your brain. Then you can gradually increase the speed and the rhythm, finger patterns and finger angles (string instruments) remain even in very fast speeds.

For anyone who wants to try this, here's a helpful link for counting syllables is English:
http://www.wordcalc.com/index.php

// Personal Experience and Thoughts Regarding the Therapy //

Having had the evaluation and two actual sessions with two weeks between each, the evaluation didn't seem too promising nor interesting. I was initially told that I would probably never be able to be completely fluent, as I'm already an adult.

Two weeks afterwards we started with the method mentioned above, using the typical 60 syllables per minute speed for the first one minute read. This seemed simple enough, so we increased the speed to 80, then 120. After remaining fluent for each of the three syllable per minute rates, she told me I'd be able to get up to 160 in the two weeks before the next session - at this point she was confident that my stuttering could be made "completely controllable in desired situations" over time. (If you're interested of similar 'promises' or 'progress', you could always try to read out loud to a family member and increase the speed after each in which you maintain fluency)

Again, two weeks afterwards I had my second therapy session after evaluation. During this session, I was asked to read out, using the technique, in both my native language as well as English. My reading speed while 100% maintaining the technique was 286 syllables per minute in my native language (compared to 290 without technique (excluding blocks)). This was mainly due to me having read and practised in English (mostly), where syllables are counted differently. In English, (somewhat) the same speed remained, as did fluency. I noted that this was already a low stress situation, so fluency could be maintained easier, especially while reading. At this point, the speech pathologist said that she is "SURE" that I can achieve a level (over time) where I can maintain fluency in any desired situation.

Following the first post-evaluation therapy and one week of practice, I had a phone conversation that lasted for over an hour, in which I had less than 10 stutters - all very mild compared to the usual longer blocks I have. I did not use avoidance more than perhaps for 1% of the words. After every block, I exhaled all air quickly, took a quick deep breath with (diaphragmatic breathing) and started again slowly and softly, and didn't stutter. This conversation was with my mother, whom I usually stutter with the most (especially while on the phone).

The previous result was followed one week later by a 1.5 hour online voice chat with my brother while playing video games. During the conversation, I had 2-4 minor blocks that sounded more like very slight singular repetitions. I had one 'real' block that I automatically reacted to by substituting the word for another.

I've been using the technique continuously in every speaking situation (work, talking to family, etc.), which has helped make it easier to use over a few week's time. I've also practised 2-15 minutes a day reading out in English.

So far the technique has already helped me to an extent - I can talk fairly/completely fluently in some situations - sometimes even in front of a few friends and 3-4 strangers (e.g. coffee breaks at work). The longer I speak, though, the less I pay attention to it, so it becomes harder to maintain. This is where the automation part comes in, I suppose, but for now it's best for me to just remind myself constantly that I need to keep the technique up.

// Personal Suggestions For Anyone Trying This Technique //

-At first, exaggerate every element of the technique while practising alone. This will help make it 'closer to intended' in more stressful situations
-Use the technique continuously and as slow as required (for fluency) when talking to relatives and close friends. It's good to tell them that you're working on your speech disfluency and that you might speak slower and sound "weirder" (according to people, I don't, though) - they can also give you input on whether you sound weird or not (and via this, reassurance). This is an easier start for you, as it will be in a less stressful situation where you can test if the technique works. It will also make dropping the avoidance techniques easier during those conversations
-Push aside negative speech-related feelings: It's quite normal to think of every word, situation and future situation: "I'll stutter in that word". This is not helpful. It's difficult to change this view, but regardless, try to avoid thinking negatively about speech too much - it will help reduce anticipatory stress, that often increases stuttering frequency and severity
-Let yourself feel negative emotions, but don't link them with speech: It's normal for everyone to have negative feelings, but people who stutter (myself included) often tie them together with their disfluencies. As in the above step, this increases anticipatory stress. Let yourself feel those feelings, but identify what's causing them, rather than linking them to stuttering, or letting them affect your speech and use of technique
-Practice in every speaking situation: When you talk to other people, you can monitor whether you stutter or not, so you can determine whether or not this works for you. If it does work, you can determine what speed was too high and how much 'prolongation' and 'softening' you need to use at that point. This way you also transfer the technique to actual speaking situations

// Last Words //

I truly hope that this post gives some insight for people dealing with stuttering, having found no way out. I'm still in the process of increasing fluency myself, and felt like it would be nice to share my experiences with other people with the same issue. You can always reach me via PM if you're in need of additional information or mental support.
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Re: Speech therapy - Experiences/thoughts

Postby bipolarbirdie » Mon Nov 18, 2013 11:17 am

Hello!
I worked alongside some speech therapists in a fluency clinic some years ago. Your post is great, and very detailed. It was pretty much what the therapists I worked with were doing. It made me realise how difficult it is for stutterers.

The most important thing I learned was that the act of stuttering itself is primarily a neuromotor issue and that therapy is based on assembling the speech motor plan correctly. There are other schools of thought which are psychodynamic in nature, but this neuromotor idea seems to be more useful for remediation. Work on the speech and then the confidence will take care of itself.

The unfortunate part is that once you are past about four or five years old the time for behavioural intervention is over and you are a stutterer for life. That does not mean that you can't be fluent, as you said, but you need to keep maintaining it. The hard news is that there's no magic bullet to cure the stuttering. The good news is that advancements are being made all the time.

The clients from the clinic I was at used to get together weekly for maintenance, and the group was monitored by the speech therapists.

Mainly I just wanted to congratulate you on doing the therapy and on your commitment to fluency.
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Re: Speech therapy - Experiences/thoughts

Postby RamaHay » Sat Dec 16, 2017 5:12 pm

Wow
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Re: Speech therapy - Experiences/thoughts

Postby Brounally » Tue Dec 26, 2017 3:33 pm

Hey there, stay strong! It's very important to have a support whenever you are struggling and going through hell! So please know that there is always people that care. As for me, i know what you're talking about. Going through dialectical behavior therapy right now...
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