Marie-Christine Franken

Quality of Life in adults who stutter

Although persistent developmental stuttering is known to affect daily living, just how great the impact is remains unclear. Furthermore, little is known about the underlying mechanisms which lead to a diminished quality of life (QoL). The primary objective of this study is to explore to what extent QoL is impaired in adults who stutter (AWS). In addition, this study aims to identify determinants of QoL in AWS by testing relationships between stuttering severity, coping, functioning and QoL and by testing for differences in variable scores between two AWS subgroups: receiving therapy versus not receiving therapy. A total of 91 AWS filled in several questionnaires to assess their stuttering severity, daily functioning, coping style and QoL. The QoL instruments used were the Health Utility Index 3 (HUI3) and the EuroQoL EQ-5D and EQ-VAS. The results indicated that moderate to severe stuttering has a negative impact on overall quality of life; HUI3 derived QoL values varied from .91 (for mild stuttering) to .73 (for severe stuttering). The domains of functioning that were predominantly affected were the individuals speech, emotion, cognition and pain as measured by the HUI3 and daily activities and anxiety/depression as measured by the EQ-5D. AWS in the therapy group rated their stuttering as more severe and recorded more problems on the HUI3 speech domain than AWS in the non-therapy group. The EQ-VAS was the only instrument that showed a significant difference in overall QoL between groups. Finally, it was found that the relationship between stuttering severity and QoL was influenced by the individuals coping style (emotion-oriented and task-oriented). These findings highlight the need for further research into stuttering in relation to QoL, and for a broader perspective on the diagnosis and treatment of stuttering, which would take into consideration quality of life and its determinants.

Perceptual evaluation of the speech before and after fluency shaping stuttering therapy

Abstract An often-cited criterion for assessing the effect of a stuttering therapy is the ability of the stutterers to produce normally fluent speech. Many modern stuttering therapies use special techniques that may produce stutter-free speech that does not sound completely normal. The present study investigates this problem in the framework of the Dutch adaptation of the Precision Fluency Shaping Program. Pre-, post-, and 1 2 -year follow-up therapy speech samples of 32 severe stutterers who were treated in a four-week intensive therapy are compared with comparable samples of 20 nonstutterers. For that aim the samples were rated on 14 bipolar scales by groups of about 20 listeners. The results show that the speech of the stutterers in all three conditions differs significantly from the speech of the nonstutterers. The pretherapy speech takes an extreme position on a Distorted Speech dimension, due to the large proportion of disfluencies. The posttherapy speech has extremely low scores on a Dynamics/Prosody dimension, a`1 while the follow-up therapy speech differs from the normal speech on both dimensions, but now the distances are smaller. These results are discussed in relation to the severity of the stuttering problem in the group of treated stutterers. Finally, implications for future research on therapy evaluation are discussed.

Perceptual and Acoustic Evaluation of Stuttering Therapy

Formal evaluations of the results of speech therapies are not carried out very often. Stuttering therapies form no exception to this rule. In general, such evaluations can have two goals, viz. to assess the results of a therapy for a given (group of) subject(s) after a certain amount of treatment time, or the identification of weaknesses in the therapy program. The lack of formal evaluations of speech therapies is at least in part due to the fact that few treatment techniques have been sufficiently refined so that a standardized form of treatment can be evaluated and a systematic feedback from evaluation to therapy becomes possible. Yet, there is a real and increasing need for formalized evaluations of speech therapies, if only to reduce the economic and emotional costs of ineffective therapies.

Diagnostiek bij stotterende kinderen

De exacte oorzaak van stotteren is nog steeds onbekend (Janssen, 1994) en bij de diagnostiek van stotterende kinderen ontbreekt een gouden standaard (Curlee & Yairi, 1997). Maar de laatste jaren is er veel onderzoek gedaan naar ontwikkelingsstotteren, waardoor de klinische evaluatie van stotteren beduidend verbeterd is (Yaruss e.a., 1998; Ambrose & Yairi, 1999). Het is een fabeltje dat ‘alle kinderen wel een poosje stotteren’. Naar schatting stottert slechts ongeveer 5% van de kinderen een poosje, lichte gevallen meegeteld (Andrews & Harris, 1964; Yairi & Ambrose, 1999); een kleine 1% blijft stotteren.

Comparison of percentage of syllables stuttered with parent-reported severity ratings as a primary outcome measure in clinical trials of early stuttering treatment

PurposenThis report investigates whether parent-reported stuttering severity ratings (SRs) provide similar estimates of effect size as percentage of syllables stuttered (%SS) for randomized trials of early stuttering treatment with preschool children.nnnMethodnData sets from 3 randomized controlled trials of an early stuttering intervention were selected for analyses. Analyses included median changes and 95% confidence intervals per treatment group, Bland-Altman plots, analysis of covariance, and Spearman rho correlations.nnnResultsnBoth SRs and %SS showed large effect sizes from pretreatment to follow-up, although correlations between the 2 measures were moderate at best. Absolute agreement between the 2 measures improved as percentage reduction of stuttering frequency and severity increased, probably due to innate measurement limitations for participants with low baseline severity. Analysis of covariance for the 3 trials showed consistent results.nnnConclusionnThere is no statistical reason to favor %SS over parent-reported stuttering SRs as primary outcomes for clinical trials of early stuttering treatment. However, there are logistical reasons to favor parent-reported stuttering SRs. We conclude that parent-reported rating of the childs typical stuttering severity for the week or month prior to each assessment is a justifiable alternative to %SS as a primary outcome measure in clinical trials of early stuttering treatment.