Health and human services for persons who stutter and education of logopedists in East-European countries.

UNLABELLED: The International Association of Logopedics and Phoniatrics (IALP) assessed the therapy status of fluency disorders, service opportunities, and education of logopedists (speech-language pathologists) with a mail survey in Eastern Europe. Information was collected on the following aspects: incidence, prevalence, availability of information, non-therapeutic support for persons who stutter (PWS), providers of diagnostics and therapy, cooperating professionals, therapy approaches, forms, goals, financing, early detection and prevention, training of professionals, specialization in stuttering therapy, needs for improving the situation of PWS, and problems which hinder better care. Stuttering therapy for children is available in many countries and is frequently provided by the educational system. Therapy for adults is provided best by the health services but is not satisfactorily available everywhere. Modern therapeutic approaches coexist with obsolete ones. Lack of resources, awareness, entitlement, and assessment of therapy effectiveness are pervasive problems. EDUCATIONAL OBJECTIVES: Readers will be able to describe and evaluate: (1) the therapy status of fluency disorders and service opportunities in various East-European countries; (2) the training of logopedists (speech-language pathologists); (3) specialization in stuttering therapy; and (4) the organizational services for PWS within the health and human service systems.

A cross-cultural, long-term outcome evaluation of the ISTAR Comprehensive Stuttering Program across Dutch and Canadian adults who stutter.

UNLABELLED: There is a need to evaluate the effectiveness of stuttering treatment programs delivered in domestic and international contexts and to determine if treatment delivered internationally is culturally sensitive. Evaluation of the effectiveness of the ISTAR Comprehensive Stuttering Program (CSP) within and across client groups from the Netherlands and Canada revealed generally positive results. At 2 years post-treatment both groups were maintaining statistically significant reductions in stuttering frequency and improvements in attitudes, confidence, and perceptions as measured by the Revised Communication Attitude Inventory (S24), Perceptions of Stuttering Inventory (PSI), and the approach scale of the Self-Efficacy Scaling by Adult Stutterers (SESAS). Data pooled across the groups on these measures gave evidence of a global treatment effect with standardized effect sizes ranging from typical to larger than typical in the behavioural sciences. Only two differences between the groups emerged: differences in speech rate and perception of self. Given that these groups represent two distinct cultures, differences were discussed in terms of whether they could be due to cultural, methodological, or other variables. Overall, results suggest that, the CSP appears to be similarly effective in both cultures and thus, sufficiently sensitive to the culture of Dutch adults who stutter. EDUCATIONAL OBJECTIVES: The reader will be able to (a) describe a methodology that can be used in a clinical setting to evaluate the long-term effectiveness of stuttering treatment with adults, (b) describe some of the challenges in developing a model of clinically meaningful outcome, (c) explain the rationale for the need for cross-cultural investigations of treatment outcome, and (d) summarize speech and self-report results of the cross-cultural evaluation of an integrated stuttering treatment program.

The relationship between pre-treatment clinical profile and treatment outcome in an integrated stuttering program.

UNLABELLED: A procedure for subtyping individuals who stutter and its relationship to treatment outcome is explored. Twenty-five adult participants of the Comprehensive Stuttering Program (CSP) were classified according to: (1) stuttering severity and (2) severity of negative emotions and cognitions associated with their speech problem. Speech characteristics (percentage of stuttered syllables, distorted speech score, and the number of correctly produced syllables on a diadochokinesis task) and emotional/cognitive states (emotional reaction, speech satisfaction, and attitudes toward speaking) were assessed before and after treatment, and at a 1- and 2-year follow-up. The results showed that: (a) there was no relationship between stuttering severity and the severity of negative emotions and cognitions, (b) the severe stuttering group had the largest treatment gains but also the highest level of regression, and (c) at post-treatment and both follow-up assessments the differences on measures of emotions between the mild and severe emotional group had disappeared, chiefly due to a large decrease in the latter group's negative emotions and cognitions. Our findings show that, based on treatment gains, specific subgroups can be identified, each requiring different treatment approaches. This underlines the necessity of developing a better understanding of how various dimensions of stuttering relate to treatment outcome. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe why stuttering severity and negative emotions and cognitions that are related to stuttering should be investigated separately and (2) describe how treatment outcome relates to subtypes of persons who stutter.

Gestural overlap in consonant clusters: effects on the fluent speech of stuttering and non-stuttering subjects.

UNLABELLED: This study was designed to investigate if persons who stutter differ from persons who do not stutter in the coproduction of different types of consonant clusters, as measured in the number of dysfluencies and incorrect speech productions, in speech reaction times and in word durations. Based on the Gestural Phonology Model of Browman and Goldstein, two types of consonant clusters were formed: homorganic and heterorganic clusters, both intra-syllabic (CVCC) and inter-syllabic (CVC#CVC). Overall, the results indicated that homorganic clusters elicited more incorrect speech productions and longer reaction times than the heterorganic clusters, but there was no difference between the homorganic and the heterorganic clusters in the word duration data. Persons who stutter showed a higher percentage dysfluencies and a higher percentage incorrect speech productions than PWNS but there were no main group effects in reaction times and word durations. However, there was a significant three-way interaction effect between group, cluster type and cluster place: homorganic clusters elicited longer reaction times than heterorganic clusters, but only in the inter-syllabic condition and only for persons who stutter. These results suggest that the production of two consonants with the same place of articulation across a syllable boundary puts higher demands on motor planning and/or initiation than producing the same cluster at the end of a syllable, in particular for PWS. The findings are discussed in light of current theories on speech motor control in stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to describe: (1) the effect of gestural overlap between consonant clusters on speech reaction time and word duration of people who do and do not stutter and be able to (2) identify the literature in the field of gestural overlap between consonant clusters.

Use of a perceptual evaluation instrument to assess the effects of infant orthopedics on the speech of toddlers with cleft lip and palate.

OBJECTIVE: To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales. DESIGN: In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age. PARTICIPANTS: Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status. METHOD: Five trained listeners assessed the children's speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their total impression of speech on EAI scales. RESULTS: The reliability and consistency of 11 of the rating scales was good. The intelligibility rating scale was the single speech characteristic that distinguished the IO group from the non-IO group; the IO group was judged to be superior. The cleft groups differed from the noncleft group on 9 of the 11 scales. CONCLUSIONS: Evaluation of speech by means of the present newly developed perceptual rating instrument showed that the IO group obtained significantly higher ratings for intelligibility than the non-IO group. The groups did not differ regarding any of the other speech aspects.

Language skills of young children with unilateral cleft lip and palate following infant orthopedics: a randomized clinical trial.

OBJECTIVE: To investigate the effects of infant orthopedics (IO) on the language skills of children with complete unilateral cleft lip and palate (UCLP). DESIGN: In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed up longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group); the other group did not receive this treatment (non-IO group). At the ages of 2, 2(1/2), 3, and 6 years, language development was evaluated in 12 children (six IO and six non-IO). Receptive language skills were assessed using the Reynell test. Expressive language skills of the toddlers were evaluated by calculating mean length of utterance (MLU) and mean length of longest utterances (MLLU); in the 6-year-olds, the expressive language skills were measured using standardized Dutch language tests. PATIENTS: The participants had complete UCLP without soft tissue bands or other malformations. RESULTS: IO did not affect the receptive language skills. However, the expressive language measures MLU and MLLU were influenced by IO. At age 2(1/2) and 3 years, the IO group produced longer utterances than the non-IO group. In the follow-up, the difference in expressive language between the two groups was no longer significant. CONCLUSIONS: Children treated with IO during their first year of life produced longer sentences than non-IO children at the ages of 2(1/2) and 3 years. At 6 years of age, both groups presented similar expressive language skills. Hence, IO treatment did not have long-lasting effects on language development.

Phonological development of toddlers with unilateral cleft lip and palate who were treated with and without infant orthopedics: a randomized clinical trial.

OBJECTIVE: To investigate the phonological development of toddlers from 2 to 3 years of age with complete unilateral cleft lip and palate (UCLP) treated during the first year of life with and without infant orthopedics (IO). DESIGN: In a randomized clinical trial (Dutchcleft), two groups of children were followed up: one treated with IO (IO group) and another that did not receive IO (non-IO group). Phonological skills were analyzed at 2, 2.5, and 3 years of age using a system for assessing phonological development of Dutch children (Fonologische Analyse van het Nederlands: FAN). The analysis included number of acquired consonants, order of phonological development, use of phonological processes, and occurrence of nasal escape. PATIENTS: Criteria for inclusion were complete UCLP, no soft tissue bands, no other malformations, parents fluent in Dutch, birth weight of a minimum of 2500 g, and gestation time of a minimum of 38 weeks. INTERVENTIONS: IO treatment based on a modified Zurich approach was started within 2 weeks after birth and used until soft palate closure at 12 months of age. Children in the non-IO group visited the clinic for an extra check-up at 6 weeks as well as before and after lip repair and soft palate closure. All other interventions were the same across groups. RESULTS: Phonological development of most 2.5-year-old IO children was normal or delayed. Most children in the non-IO group followed an abnormal developmental pattern. At age 3, the children in the IO group had acquired more initial consonants. There were no group differences in the use of phonological processes or the occurrence of nasal escape. CONCLUSIONS: Children treated with IO during their first year of life followed a more normal path of phonological development between 2 and 3 years of age.