A clinical training model for students: intensive treatment of stuttering using prolonged speech

Georgieva, Dobrinka; Stoilova, Rositsa

doi:10.1590/2317-1782/20182017259

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • CoDAS 30 (5) • 2018 • https://doi.org/10.1590/2317-1782/20182017259 copy

A clinical training model for students: intensive treatment of stuttering using prolonged speech

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

This study describes a practical model for improving the quality of Speech-Language Pathology (SLP) education on a clinical setting in a Bulgarian University. During this study, adults who stutter (AWS) received intensive treatment (IT) to increase fluent speech. The intensive treatment was delivered by students trained in the SLP Master’s degree program “Logopedics Management in Fluency and Voice Disorders”.

Methods

The La Trobe University intensive program of prolonged speech was implemented. SLP students were trained and delivered the IT for AWS, under supervision in all stages. The treatment followed a clinical modeling pattern.

Results

The primary outcomes were measured according to (i) percent of syllables stuttered (%SS) within and outside the stuttering research center of the university; (ii) self-reported inventory scores; and (iii) speech naturalness score evaluations from pre-treatment, immediately following treatment, 11 months post-treatment, and 18 months after the intensive treatment using stutter-free speech samples. The outcomes were reported for the overall IT program delivered by the SLP Master students.

Conclusion

The treatment delivered by students can ensure objective speech outcomes. The evidence-based practice model allowed students to develop and master specific clinical skills in establishing fluent speech by applying a prolonged speech technique. During the IT experience, students began to incorporate elements of evidence-based practice (EBP), clinical expertise, and consider values held by AWS. After four outcome-sessions, the AWS developed self-consciousness about the quality of their prolonged speech during controlled fluent patterns. The participants produced objective speech fluency data and statistically significant differences before and immediately after the IT regarding %SS and overall speech naturalness.

Keywords
Student Training; Stuttering; Adult; Intensive Treatment; Prolonged Speech

	Instatement stage	Transfer stage	Maintenance stage
Total duration of the program: 54 hours, 8 weeks	3 days, 8 hours each day	4^th and 5^th day, 8 hours each day	7 follow-up sessions, conducted across 7 weeks, 2 hours each week
Stages description	a. Prolonged speech b. Emphasize speech naturalness c. Gentle onsets d. Sliding in e. Elongating vowels f. Linking words together	a. Hierarchy of speaking situations constructed by client prior to treatment b. Situations are different for each AWS (five to sixteen steps in these hierarchies)	a. The patients discuss setting tasks they would like to practice between each session. The goal is to use their strategies all the time. b. Self-management strategies taught: self-monitoring and self-evaluation c. Parents and friends involved
Forms of treatment	Intensive and spaced; Individual and group treatment	Intensive and spaced; Individual and group treatment	Individual (2h) and group opportunities (2h). It could be different and is tailored to the patient’s needs.

Measure	Situations	1week pre-treatment	1 day pre-treatment	Immediately after the IT	11 months after the IT	18 months after the IT
Mean %SS (SD)	Monologue-clinic	11.9 (1.38)	12.4 (1.33)	2.6 (0.5)	1.5 (0.1)	2.6 (0.1)
	Conversation-clinic	10.8 (1.37)	11.4 (1.4)	2.5 (0.9)	1.5 (0.1)	2.5 (0.1)
	Telephone-home	9.8 (1.19)	10.3 (1.22)	1.4 (0.69)	1.4 (0.1)	2.5 (0.1)
	Conversation-home	7.3 (1.21)	8.1 (1.22)	0.9 (0.72)	1.4 (0.1)	2.5 (0.1)
Mean NAT	Monologue		6 (1.044)	1.58 (0.51)	2.1 (0.71)	2.2 (0.45)

Participant Self-Reported Inventory item	Present study n = 12	Cocomazzo et al.⁽²⁴24 Cocomazzo N, Block S, Carey B, O’ Brian S, Onslow M, Packman A, et al. Camperdown program for adults who stutter: a student training clinic phase I trial. Int J Lang Commun Disord. 2012;47(4):365-72. http://dx.doi.org/10.1111/j.1460-6984.2012.00150.x. PMid:22788223. http://dx.doi.org/10.1111/j.1460-6984.2... ⁾ n = 12	Block et al. et al.⁽²⁰20 Block S, Onslow M, Packman A, Gray B, Dacakis G. Treatment of chronic stuttering: outcomes from a student training clinic. Int J Lang Commun Disord. 2005;40(4):455-66. http://dx.doi.org/10.1080/03093640500088161. PMid:16195200. http://dx.doi.org/10.1080/0309364050008... ⁾ n = 34	O’Brian et al.⁽²³23 O’Brian S, Onslow M, Cream A, Packman A. The Camperdown program: outcomes of a new prolonged-speech treatment model. J Speech Lang Hear Res. 2003;46(4):933-46. http://dx.doi.org/10.1044/1092-4388(2003/073). PMid:12959471. http://dx.doi.org/10.1044/1092-4388(200... ⁾ n = 16
1. How would you rate your speech on an average day now? 1= 'no stuttering', 9='extremely severe stuttering'	1.5	3.1	3.2	2.8
2. How would you have rated your speech on an average day before beginning this treatment? 1= 'no stuttering', 9='extremely severe stuttering'	5.7	4.6	6.5	5.5
3. How satisfied are you with your present level of fluency? 1='extremely satisfied', 9='totally dissatisfied'	1.1	3.3	3.6	3.4
4. How satisfied were you with your level of fluency before beginning this treatment? 1='extremely satisfied', 9='totally dissatisfied'	6.3	5.5	7.4	7.6
5. How much of the time do you now have control over your stuttering outside the clinic? 1='none of the time', 9='all of the time'	6.3	5.9	6.4	6.2
6. How much of the time did you have control over your stuttering outside the clinic before beginning this treatment? 1='none of the time', 9='all of the time'	2.8	4.6	3.1	3.0
7. How difficult did you find learning Prolonged Speech in the clinic? 1='very easy', 9='extremely difficult'	3.6	2.4	2.8	3.2
8. How easy is it to use Prolonged Speech outside the clinic? 1='very easy', 9='extremely difficult'	3.3	3.4	4.2	4.7
9. How comfortable are you using Prolonged Speech in social situations outside the clinic? 1='very comfortable', 9='extremely uncomfortable'	3.9	2.9	4.1	4.4
10. How much do you have to think about controlling your stuttering? 1='none of the time', 9='all of the time'	5.9	6.0	6.2	6.3
11. How would you rate the sound of your speech on an average day now? 1='very natural speech', 9='extremely unnatural speech'	2.5	2.9	2.9	2.7
12. What is the most unnatural sounding speech you are prepared to use when talking with a friend? 1='very natural speech', 9='extremely unnatural speech'	4.5	4.3	4.5	3.2
13. What is the most unnatural sounding speech you are prepared to use in a situation where it is very important for you to control your stuttering (for example, a job interview)? 1='very natural speech', 9='extremely unnatural speech'	4.8	3.1	4.3	3.2
14.Do you prefer stuttering over using an unnatural speech pattern? 1='none of the time', 9='all of the time'	1.6	2.6	2.6	2.6
15. Is this level usually adequate to control your stuttering?	Yes= 9/12 (75%)	Yes= 5/8 (63%)	Yes= 21/34 (62%)	Yes= 9/13 (69%)
16. How satisfied were you working with clinician students during the treatment? 1='extremely satisfied', 9='totally dissatisfied'	1.1	3.1	-	-
17. How comfortable were you working with clinician students during the treatment? 1='extremely comfortable', 9='totally uncomfortable'	1.3	3.3	-	-
18. How satisfied were you with the amount of student supervision? 1='extremely satisfied', 9='totally dissatisfied'	1.3	2.5	-	-

Sociedade Brasileira de Fonoaudiologia Al. Jaú, 684, 7º andar, 01420-002 São Paulo - SP Brasil, Tel./Fax 55 11 - 3873-4211 - São Paulo - SP - Brazil
E-mail: revista@codas.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Conflict of interests: nothing to declare.