Aim

The aim of this stuttering therapy approach is to replace stuttered speech with fluent speech. This is achieved by teaching the person who stutters to use a new speech pattern. The approach is thought to be particularly useful when overt features (e.g. facial tics; blushing) are more significant than any co-occurring covert features (e.g. attempts to hide/mask the dysfluency) (RCSLT, 2005).

Prolonged speech

Typically, speech therapists use variations of Goldiamond’s (1965) original prolonged speech technique. Stuttering is, therefore, modified by deliberately prolonging speech. This is typically achieved through the following modifications.

Slowed speech

To begin with, prolonged speech will sound unnatural, as the client is encouraged to begin speaking extremely slowly, at around only 40-60 syllables per minute (spm). This is gradually quickened over the following weeks, aiming for a speed of about 120-150 spm. This is the typical rate of speech of most adult speakers who are considered to be fluent.

Easy phrase initiation

A rationale underpinning the prolonged speech technique is that stuttering may be considered to be a sensory-motor processing deficit (RCSLT, 2005). This can manifest as difficulties processing sensations from touch, muscles and joints that affect the quality of movements: in this case, of the vocal tract (Ayres, 2005). Consequently, it is advantageous to reduce any unnecessary muscle tensions in the vocal tract. Any excess tension in the internal laryngeal musculature of the vocal folds will prevent them moving together easily, smoothly and without effort. As a result, it may be difficult to initiate phonation, leading to struggling behaviors as the person attempts to activate vocal fold vibration.

The client is, therefore, encouraged not to ‘punch’ or force out the first sound of a phrase. This so-called easy onset can be assisted by aspirating speech sounds at the beginning of phrases, i.e. accompanying them with slight puff of air. This can also be achieved by preceding the relevant speech sound with the consonant /h/. For example, in the phrase any other people, a short duration /h/ sound can be added before the initial vowel to give hhh-any other people. The reason this helps is because during the production of a /h/ sound the vocal folds are nearly fully abducted (open) and this, therefore, reduces any hard attack as the vocal folds come together more gently.

Soft contacts

The client is encouraged to ensure that all speech sounds are produced gently and without excess muscle tension. However, plosive consonants (such as /b/, /d/ and /g/) are more likely to have a hard, ‘punchy’ quality if produced with too much effort. Rather like easy phrase initiation (see above) the client can be encouraged to “blow the sounds away gently,” accompanying them with a slight puff of air if needs be. For example, the /b/ in the word bin would be softened so that the word sounds more like the word pin, and the /d/ in din would be softened so that the word sounds quite similar to the word tin. Using soft contacts makes all so-called hard consonants sound gentler and more relaxed.

Breath-stream management

The client is encouraged to divide their speech up into manageable sizes that they can speak on one breath. There should be sufficient breath to speak each short phrase. There should be no straining or gasping for breath. The client should be reminded about the importance of monitoring their breath support for speaking. In addition, they should monitor their chest and upper shoulder tension, and keep the neck and jaw as relaxed as possible.

Deliberate flow between words

The client should be encouraged to run each word of a short phrase into the next one. This will create a continuous stream of words. This promotes the concept of an easy, flowing, smooth production of continuous speech. It reduces the possibility of hesitating or halting between words.

Monotone (in the early stages)

Variations in the pitch of the voice (i.e. how high or low the note produced by the vibration of the vocal folds appears to be) are achieved by movements of cartilages within the larynx that increase tension along the length of the vocal folds. On the principle that we wish to reduce as much tension as possible whilst practicing the prolonged speech technique, I generally ask clients to speak using a monotone – at least in the early stages of practice. From about 40-100 spm I encourage a rather flat, expressionless monotone. For speeds above this, I typically encourage more ‘coloring’ in the voice and ask the client to simply allow their pitch to vary naturally. In fact, in most cases, I have found that the pitch contour takes care of itself as the client gains facility in using prolonged speech at the higher rates of speech.

Stuttering cure

Does prolonged speech cure stuttering or indeed stop stuttering completely? Well, the evidence is mixed. There are studies that suggest that prolonged speech techniques do contribute to reducing stuttering (e.g. Packman, Onslow and van Doorn (1994); Onslow, Costa, Andrews, Harrison and Packman (1996)) and that the gains can be maintained over time (Howie, Tanner, and Andrews (1981)).

However, there are investigations suggesting that fluency shaping therapies are “relapse prone, and they produce speech that sounds unnatural to the listener and feels unnatural to the speaker” (Onslow, Menzies and Packman, 2001:116).

Many clients remain vulnerable to dysfluency throughout their life. Arguably, their stuttering is never cured but, rather, they learn to manage their dysfluent speech at different times in their life. Consequently, it is likely that they will require several treatment episodes – and a number of treatment approaches may be necessary.

References

Ayres, A. (2005) Sensory Integration and the Child: Understanding Hidden Sensory Challenges Los Angeles: WPS.

Goldiamond I (1965) ‘Stuttering and fluency as manipulable operant response classes’ in Krasner, L. and Ullman, L. (eds) Research in Behavior Modification New York: Holt, Rinehart and Winston.

Howie, P.M., Tanner, S. and Andrews, G. (1981) ‘Short and long-term outcome in an intensive treatment program for adult stammerers’ Journal of Speech and Hearing Disorders 46, 104–9.

Onslow, M., Costa, L., Andrews, C., Harrison, E. and Packman (1996) ‘Speech outcomes of a prolonged-speech treatment for stuttering’ Journal of Speech and Hearing Research 39, 734-749.

Onslow, M., Menzies, R.G. and Packman, A. (2001) ‘An operant intervention for early stuttering: the development of the Lidcombe Program’ Behavior Modification 25, 1, 116-139.

Packman, A., Onslow, M. and van Doorn, J. (1994) ‘Prolonged speech and modification of stuttering: perceptual, acoustic, and electroglottographic data’ Journal of Speech and Hearing Research 37, 724-737.

RCSLT (2005) Clinical Guidelines (Royal College of Speech and Language Therapists) Bicester: Speechmark Publishing Ltd.