Shelley B. Brundage

Real Enough: Using Virtual Public Speaking Environments to Evoke Feelings and Behaviors Targeted in Stuttering Assessment and Treatment

PURPOSE Virtual reality environments (VREs) are computer-generated, 3-dimensional worlds that allow users to experience situations similar to those encountered in the real world. The purpose of this study was to investigate VREs for potential use in assessing and treating persons who stutter (PWS) by determining the extent to which PWSs affective, behavioral, and cognitive measures in a VRE correlate with those same measures in a similar live environment. METHOD Ten PWS delivered speeches-first to a live audience and, on another day, to 2 virtual audiences (neutral and challenging audiences). Participants completed standard tests of communication apprehension and confidence prior to each condition, and frequency of stuttering was measured during each speech. RESULTS Correlational analyses revealed significant, positive correlations between virtual and live conditions for affective and cognitive measures as well as for frequency of stuttering. CONCLUSIONS These findings suggest that virtual public speaking environments engender affective, behavioral, and cognitive reactions in PWS that correspond to those experienced in the real world. Therefore, the authentic, safe, and controlled environments provided by VREs may be useful for stuttering assessment and treatment.

Rates of Typical Disfluency in the Conversational Speech of 30-Month-Old Spanish–English Simultaneous Bilinguals

Purpose The aim of this study was to investigate the typical disfluency rates at 30 months old in a large group of simultaneous bilingual children and also investigate the relationships between disfluency rates and linguistic complexity (mean length of utterance in words [MLU-W]), vocabulary diversity (VocD), and speaking rate (utterances per unit time). Method Fifty-three typically developing children who had been exposed to Spanish and English from birth participated in this descriptive study. The average percent input at home was 46% in English and 54% in Spanish. Outside the home, the children averaged 9 hr of exposure per week in each language. Spontaneous speech samples in both languages were obtained during play sessions between the children and a parent. Results Nonparametric tests revealed a significant difference in typical disfluency rates across languages, with more children being disfluent in English and with a larger range of disfluency rates in English. The effect size for this difference was small. The children had significantly higher MLU-W in English; there were no differences in VocD or speaking rate between the 2 languages. Typical disfluency rate in Spanish was not significantly correlated with MLU-W, VocD, or speaking rate. Typical disfluency rates in English were correlated with MLU-W and VocD, but not with speaking rate. Conclusion This article described the typical disfluency rates of a large group of simultaneous Spanish-English bilingual children at 30 months of age. The typical disfluency rates reported here are lower than those reported in the literature for monolingual children of similar ages. Clinical implications of these findings are addressed.

Fear of negative evaluation, trait anxiety, and judgment bias in adults who stutter

Purpose Persons who stutter (PWS) and those with social anxiety disorder may exhibit fear of negative evaluation (FNE) and anxiety in social situations. However, the information processing biases that perpetuate these characteristics have had limited investigation. This study investigated judgment bias in social situations. Method Participants included 50 adults who stutter and 45 age- and gender-matched fluent persons who do not stutter (PWNS), who made up the control group. Participants completed the Interpretation and Judgmental Questionnaire (Voncken, Bögels, & deVries, 2003), and threat scores were calculated. Results There were no significant differences between PWS and PWNS in social threat or nonsocial threat scores. When the PWS group was divided on the basis of FNE and compared with PWNS participants without heightened anxiety (n = 35), the PWS with high FNE had significantly higher total social threat scores than the PWS with low FNE. The three groups did not differ in threat ratings for ambiguous or profoundly negative social situations. Conclusions Judgment bias in PWS is mediated by the magnitude of FNE present; not all PWS exhibit judgment bias for social situations. Treatment implications include the need for psychosocial support addressing the negative impacts on quality of life and restrictions on social engagement that stuttering may cause in some individuals.

Developing and Using Big Data Archives to Quantify Disfluency and Stuttering in Bilingual Children.

Worldwide, bilingualism is the rule rather than the exception, and yet we have surprisingly little research data on the fluency development of bilingual children, and even less information on their potential risk for stuttering. Many variables influence a bilingual childs language, speech, and fluency development (e.g., amount of exposure to each language); controlling these variables in research studies necessitates large numbers of bilingual participants. The frequency and types of typical disfluencies in the speech of young children are also varied. In addition, stuttering is also variable in its presentation, and when we assess bilingual children for the presence of stuttering we are adding yet another layer of complexity. This article reviews research on typical disfluencies in monolingual and bilingual speakers, and how this information might be useful clinically. We provide examples from our laboratory to illustrate how computerized language analysis (CLAN) can be used over time to track the behaviors of research participants. We also present data on the identification of stuttering in bilingual children. We discuss challenges to studying bilingual speakers and how big data initiatives such as TalkBank address these challenges to increase our understanding of bilingual fluency development.

Systems Thinking and Systems-Based Practice Across the Health Professions: An Inquiry Into Definitions, Teaching Practices, and Assessment

ABSTRACT Phenomenon: Systems thinking is the cornerstone of systems-based practice (SBP) and a core competency in medicine and health sciences. Literature regarding how to teach or apply systems thinking in practice is limited. This study aimed to understand how educators in medicine, physical therapy, physician assistant, nursing, and speech-language pathology education programs teach and assess systems thinking and SBP. Approach: Twenty-six educators from seven different degree programs across the five professions were interviewed and program descriptions and relevant course syllabi were reviewed. Qualitative analysis was iterative and incorporated inductive and deductive methods as well as a constant comparison of units of data to identify patterns and themes. Findings: Six themes were identified: 1) participants described systems thinking as ranging across four major levels of healthcare (i.e., patient, care team, organization, and external environment); 2) participants associated systems thinking with a wide range of activities across the curriculum including quality improvement, Inter-professional education (IPE), error mitigation, and advocacy; 3) the need for healthcare professionals to understand systems thinking was primarily externally driven; 4) participants perceived that learning systems thinking occurred mainly informally and experientially rather than through formal didactic instruction; 5) participants characterized systems thinking content as interspersed across the curriculum and described a variety of strategies for teaching and assessing it; 6) participants indicated a structured framework and inter-professional approach may enhance teaching and assessment of systems thinking. Insights: Systems thinking means different things to different health professionals. Teaching and assessing systems thinking across the health professions will require further training and practice. Tools, techniques, taxonomies and expertise outside of healthcare may be used to enhance the teaching, assessment, and application of systems thinking and SBP to clinical practice; however, these would need to be adapted and refined for use in healthcare.

Utility of virtual reality environments to examine physiological reactivity and subjective distress in adults who stutter

PURPOSE Virtual reality environments (VREs) allow for immersion in speaking environments that mimic real-life interactions while maintaining researcher control. VREs have been used successfully to engender arousal in other disorders. The purpose of this study was to investigate the utility of virtual reality environments to examine physiological reactivity and subjective ratings of distress in persons who stutter (PWS). METHOD Subjective and objective measures of arousal were collected from 10PWS during four-minute speeches to a virtual audience and to a virtual empty room. RESULTS Stuttering frequency and physiological measures (skin conductance level and heart rate) did not differ across speaking conditions, but subjective ratings of distress were significantly higher in the virtual audience condition compared to the virtual empty room. CONCLUSION VREs have utility in elevating subjective ratings of distress in PWS. VREs have the potential to be useful tools for practicing treatment targets in a safe, controlled, and systematic manner.